Wednesday, October 31, 2007

Partners of individuals struggling with sexual compulsivity

As a new blog, it is important to recognize a gift when something occurs. Today, I received such a gift via a phone call from a woman who is the partner of a person with sexual compulsivity. (The gift is that her struggle became today’s topic. As a resource, my goal is to respond to particular needs. Feel free to suggest topics and review the list of upcoming topics.) “Jill” (not her real name) is struggling with a partner in denial about his behavior. She is frustrated, angry and confused about what to do. In our conversation, my assessment is that she came across as assertive in her search for information on how she can cope with his behavior. To a degree, she knows what she wants and needs to do. Her goal is find information in her journey to facilitate the process and avoid obstacles. Unfortunately, she couldn’t find much information.

After completing a search, I agree with Jill that there is very little information. A few books exist, but not much is written about it from a scholarly point of view. One author that I found (Tripodi) affirms that little information exists. Tripodi’s experience is a good place to start understanding the experience of the individual whose partner is caught in the compulsive cycle. I summarize her findings here.

Tripodi highlights that it is typical to experience feelings of despair, hopelessness, confusion anger and sadness. The powerlessness that comes with not knowing what to do and how to get your partner to stop the behaviors is to be expected. Various forms of denial may occur. These forms may be blaming yourself, turning the other cheek, buying into the partner’s commitment to change by “giving him one more chance.” Eventually, the denial strategies fail, and the individual is faced with responding to the partner’s behavior. In some cases, the individual isn’t in denial; rather, he or she simply doesn’t know until some type of disclosure occurs by the partner that there is a pattern of compulsive behavior. I do disagree with Tripodi’s statement that the underlying theme in “all cases” (yes, her word, page 5) is the lack of a developed self leads to the individual undermining and second guessing themselves. In my opinion, this is the same as blaming the rape victim for being raped. In many, if not most cases, this theme might be present; in other cases it is absent particularly when the individual is unaware of the compulsive behavior and disclosure occurs unexpectedly. One such example is when the individual received a positive result for an HIV/STD test which requires a follow-up with the partner who then discloses a history and pattern of compulsive behavior.

While much of the blog will focus on treatment for the individual with sexual compulsivity, this entry is to address treatment issues for the partner. The following issues need to be addressed in your support network. Many times, they will need to be addressed more than once as future disclosures occur or choices made in response to the behaviors. I like Tripodi’s paradigm of early, middle and final phases of treatment. They parallel the stages of treatment that I use. I provide a summary of the issues to be addressed in treatment for the spouse.
  1. Need for support. This can be through professional help, peer network (groups), family and spiritual. Feelings of shock, confusion, anger, hurt, sadness, depression and grief are but a few of the emotions that an individual will face.
  2. Need for information. The phone call from Jill reflects this need. She was seeking information on where to get support, who and what she needs to do to take care of herself, etc. What she and later I discovered, is there isn’t a lot of information available. Increasing familiarity with the language is also part of this goal. Those in the 12-step movement and therapists often use a jargon for short hand communication. Learning what these terms mean is important.
  3. Medical Health. When a partner has multiple sexual contacts, the individual is at increased risk for HIV/STIs. Tripodi recommends that the individual seek medical attention to assess any possible problems. It is my recommendation that you be completely open and honest about the purpose of the visit with your health care provider. Some providers will assume that since you are in a relationship, you’re not at risk. You will need to be explicit and say “I found out my partner has multiple sex partners and I’m worried about being infected with a sexually transmitted illness (STI).”
  4. Safety for Family. Sexual compulsivity is not the same as pedophilia. However, as Tripodi states, family members may have access to pornography. Setting boundaries to maintain safety of others is important.
  5. Triage. Identify what needs to be done today, and what can be done in one month, three months, or 1 year. Unfortunately, no guidelines are availabe. Tripodi identified how individuals may be pressured to leave the relationship. If possible, I recommend that you wait a period of time (the length of which, you decide) where you focus on the immediate concerns. This suggestion, however, is mute if your safety is at immediate risk.
  6. Focus on the self. As you move away from crisis/shock, it is important to stay focused on your emotional and physical health. As you cope with the partner’s compulsive behavior, you need to identify what you need to do for your self-care. This includes addressing the shadow aspects of your personality. It also includes clarifying what you need and want in a relationship and an honest assessment of where the current relationship is going. Some relationships can be saved, some should end. This is a chance for you to clarify your boundaries and develop the skills to enforce those boundaries.
  7. Life Purpose. Near the end of the treatment, it is important for you to step back and review where/how/what you want in life. This may mean developing the skills for new employment, coping with divorce, or reestablishing intimacy with your partner. Each goal will require different interventions.

The seven areas are great places to start. I’ve included additional references below to also help you in your journey. Good luck to Jill and to others in a similar spot.


Academic Resources:

Tripodi, C. (2006) Long Term Treatment of Partners of Sex Addicts: A Multi-Phase Approach. Sexual Addiction & Compulsivity, 13, 269-288.

Book Resources:

Schneider, J. (2005) Back From Betrayal, Third Edition, Chapin

Mellody, P., Wells-Miller, A., Miller, J. Keith (2003) Facing Co Dependency. HarperOne

Mellody, P., Wells-Miller, A., Miller, J. Keith (2003) Facing Love Addiction. HarperOne

Web Resources

Sex Addicts Recovery Resources

Support Groups

Co-Sex Addicts Anonymous (COSA)

Tuesday, October 30, 2007

Sexual Compulsivity Treatment Approach

The approach I use in treating sexual compulsivity is to blend aspects of cognitive-behavioral psychology, humanistic psychology, and positive psychology. What this means in non-technical terms is that I attempt to help you increase your awareness of your thoughts and behaviors, within a supportive environment to help you create a better life for yourself. In light of this integrated treatment approach, I have developed a number of assignments based on clinical experience and education which are designed to address issues or topics relevant to sexual compulsivity.

Generally, the assignments have the following goals:
By understanding your “acting out cycle” by knowing your primary high risk situations, feeling triggers and thinking errors you can reduce the raw number of compulsive behaviors. The assignments are designed to explain the concepts and apply them to your treatment process. In addition to eliminating the unhealthy behaviors, the assignments will also address related topics that may be relevant to your sexually compulsive patterns.

2) Helping you develop healthy sexual behaviors.

Eliminating unhealthy behaviors simply creates a void. To maintain long term health, the void needs to be replaced by healthy sexuality. This assignments will help you understand yourself better (self-knowledge), provide for a breadth of information that facilitates healthy sexually choices, facilitate your journey to define appropriate sexual behaviors, and review any possible barriers that get in the way of living a life you love. As such, this goal is to address issues beyond simple sexual behavior.

Structure of the assignments

The assignments are structured into three stages. Within each stag are exercises designed to help increase your ability to cope with sexual compulsivity. The assignments attempt to provide clear-cut tasks to help the individual address sexual compulsivity. Some of the topics are more important and should be completed by all individuals. These have been marked as “primary” exercises. As you move through the assignments, some may not apply to you. The process is designed to be adapted to your particular needs: complete only those assignments that are necessary for you. And I encourage you to review each assignment and not simply dismiss the topic. I’ve learned that many people can learn more about themselves when they ask “how does his topic apply” versus “does this topic apply.” As a note of caution, you may experience personal distress while working on the assignments. This is typical in any personal growth process. It is strongly recommended that you have a support system to facilitate your work. This support can include a therapist, sponsor, or self-help group.

The structure of the process takes the individual through the following three stages:

Problem Identification

During this stage, you will have opportunities to examine your sexual behaviors and assess the level of compulsiveness. You will complete a number of assignments examining your sexual history, and your acting out cycle. Based on your findings, you will be able to identify the major topics that will need to be addressed in your journey toward improved sexual health.

Primary Treatment

Once you have identified the major issues during stage 1, the second stage of treatment helps you begin the work on the issues by providing assignments and resources for the most frequently identified issues. Not every issue you identified may be included; you may need to address additional issues. And, in reviewing the topics, you may identify additional concerns that contributed to your acting out cycle. Not all of the issues will apply but it is recommended give serious consideration to each topic.

Prevention Planning

The third stage of treatment attempts to stabilize the growth and movement toward sexual health that occurs in stage two. Stage thee attempts to help you reach out to others for support, encouragement and accountability. You are also encouraged to consider how you would live a life you love and the impact of sexual health in personal self-fulfillment. The goal is to develop plans to move in that direction.

The Importance and Limits of Confidentiality and Risk of Disclosure

Trust is a major component of counseling. In my opinion, trust builds safety and safety can lead to tremendous therapeutic change. This trust is facilitated by knowing that any information you share will not be passed onto other people. In any therapeutic relationship, confidentiality is the privilege the client has that limits what a professional can disclose any of the information about the client to others. Depending on where you live, however, any professional you work with has limits to this privilege. Most often these limits are designed to facilitate safety in the broad sense of the term. Most often the limits to confidentiality require the professional to report any suspected abuse to a child or vulnerable adult; significant and real potential harm to yourself (statements such as I’m going to kill myself); significant and real potential harm to another person (I’m going to kill that person); or when a court order requires the release of information.

As you complete the assignments, it is important to be open and honest about your past and present behaviors. While it is important for disclosure to occur, it is important for disclosure to occur in a prudent manner. Be careful when making disclosures of sexual behavior. Seriously consider if your disclosure of information would trigger a mandatory report as required by the state and local laws in your residence. There may be a risk of legal consequences if some of your sexual behaviors include illegal behaviors. One way this can be done is to be specific about behaviors, but do not provide any identifiable information. For example, you might want to say “Sexual partner #1” versus giving specific identifiable information. We will address the issue of disclosure to partners in a particular assignment. My bias is that disclosure should occur; the question is when and how which is not the focus at this point. It is worth repeating, the goal is to be as honest to yourself and your therapist/treatment team as possible.

Sunday, October 28, 2007

Welcome to the Sexual Health Institute

Welcome to the new blog for the Sexual Health Institute. You can check out the Sexual Health Institute at

In starting this blog, I think it is important to explain why the time is right. There are three primary goals I would like to achieve

A) To promote sexual health
B) To provide a resource for Sexual Addiction/Compulsivity
C) To provide on-line support for individuals struggling with Sexual Health Issues.

My plan is to highlight recent research and clinical findings. In addition, various activities or worksheets will periodically be made available. I'd encourage you to add your responses to the material or to the activities. The goal is to provide you a chance to share your struggles and to listen to the struggles of others in a safe environment.

The blog is NOT a replacement for therapy. No theraputic relationship is envisioned. You may use any material for personal use only. If you use the material, it is recommended that you work with a 12-step group, professional or other treatment protocol as well.

Please feel free to contact me if you have questions, or post a response as well