Friday, November 30, 2007

A program of integrity versus a rigorous program.

A recent phone call prompted this post. The end result of the conversation was feedback that my program wasn’t “rigorous enough.” When I asked how things might be different, the individual wasn’t able to answer. When I reflect on the question and my response, I came to a clarifying insight. I affirm that my approach to treatment is not “rigorous.” Rather, my treatment approach emphasizes integrity.

Let’s expand on the two terms, rigorous and integrity. Merriam -Webster defines rigorous as: “1): harsh inflexibility in opinion, temper, or judgment: severity (2): the quality of being unyielding or inflexible: strictness (3): severity of life: austerity b: an act or instance of strictness, severity, or cruelty.” Explicit in this definition are the concepts of cruelty, inflexibility, and emphasis on rules and procedures.

Applying this definition to a treatment program, it is easy to imagine how many people desire the clinician to be in charge. I can’t tell you how many times that I’ve been asked “Tell me what to do.” “Is this OK?” or “what should be my bottom line behavior?” As a clinician I will provide feedback and suggestions, but I impose very few behavioral restrictions. When I do, the restrictions are usually around legal, ethical or health consequences. I might say “Remember Sen. Larry Craig? Engaging in public sex like you just described probably isn’t helpful.” Or, “Using the work computer to look at porn will get you fired.” And as a final example, “Unsafe sex puts you at risk.” To fall into the trap of “rigorous treatment,” in my opinion, sets up the therapist as the external control which is bound to fail. In motivational psychology, a long term consequence of external control is a decrease in compliance to the external limits. Slowly, resentment builds as the individual “fights” with the external limits. Eventually a total break might occur where the client’s resistance causes a rupture in the therapeutic relationship. One of my critiques of the “sexual addiction” approach is the risk of imposing an external code to create sobriety through rigorous compliance. This code is usually reflects narrow Christian values. Simply complete a web search and you’ll find many therapists treating sexual addiction using a 12-step approach with a Christian evangelical approach. In the long run, it is my opinion that this treatment approach will fail.

Instead, I emphasize integrity in my treatment approach. Merriam-Webster defines integrity at “1: firm adherence to a code of especially moral or artistic values: incorruptibility; 2: an unimpaired condition: soundness; 3: the quality or state of being complete or undivided.” Implicit in this definition are the ideas of wholeness, completeness, and unity. The approach also implies an internal local of control. Research in motivational psychology has repeatedly demonstrated that individual’s will create profound possibilities when internally motivated. When a person is internally motivated, they will do things not thought possible; they will run marathons for example because they want to make a difference in the world. Think for a moment of someone who has inspired you; their source of motivation was probably internally focused. My treatment approach is designed to help the individual create integrity in their life. The goal is to help identify behaviors, attitudes and goals that lead to wholeness, completeness and unity. This approach, however, is more work and intensive than simply following a list of rules. It also requires some trial and error which results in reassessment of the internal purpose. Following this approach, a client who has created an internal moral code of sexual health will be happier, more effective and ultimately “whole.” This is what I create in my treatment approach.

Furthermore, my commitment is to provide my services with integrity. My internal purpose evokes from me a level of interest in your progress that goes beyond the therapeutic hour. I try to help you develop a parallel internal purpose as defined by you. My role is to be a coach, advisor, teacher, and supporter. And it requires direct honest feedback which may sometimes feel harsh. But, paradoxically, you’ll be amazed at how often I’m “thanked” for being honest with my clients. In the end, my treatment approach requires from you a transformation versus a compliance with a set of rules. And in this transformation, unlimited possibilities are possible.


Merriam-Webster Dictionary retrieved from

Visual Thesaurus retrieved from

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