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.

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