Monday, January 28, 2008

High Risk Situations

High Risk Situations.

The final component to review in the first box of the acting out cycle is a high risk situation. Of all the therapy work in treating sexual compulsivity, this is the easiest component to identify, the easiest component to create prevention plans, and the least successful at reducing sexual compulsivity. Don’t get me wrong; it is very important, but between thoughts/thinking errors, feeling triggers, and high risk situations, clarifying and reducing high risk situations simply require structural interventions that can easily be circumvented if the other issues aren’t addressed.

First, let’s define a high-risk situation. It is the setting in which an acting out behavior occurs. Assume you take a snap shot of the behavior. In that snap shot, you have the setting that can easily be described. Based on the following snapshots, you can start to see how easy it is to identify a high risk situation.

I was home alone.

I was surfing the internet for work.

I was taking a walk in the park.

I was chatting with friends at the bar.

I drove by the __________ (fill in the blank, it could be bar, strip club, book store, park, etc).

I had a fight with my partner.

I was fired.

I was just got a raise/made a big sale.

I stopped at the gas station and they had magazines.

I saw the inserts in the newspaper.

I saw something on TV.

Snap shots simply describe the setting. As you picture your behavior, simply describe what is going on in the environment. The classic questions of Who, What, Where, When, and How are the tools for identifying high risk situations.

What where you doing right before?

What was going on?

Where were you?

Who was with you?

What time is it?

When did it happen?

How did it happen?

Second, developing a prevention plan is simply a matter of developing a structural intervention; a structural intervention is something that gets in the way or removes the high risk situation. So, for example, if you’re surfing the internet, you can identify an intervention such as an internet blocker, or an internet tracker, or have someone watching over you, or don’t have your house connected to the internet. These are all interventions to reduce the possibility of accessing pornography online. These types of interventions are simple to identify and are a matter of brainstorming ideas. In my opinion this is a necessary but not sufficient intervention in treating sexual compulsivity.

The difficulty lies in the fact that the interventions can be easily circumvented. Take the online pornography use. Even if you put all of those interventions in place, it is possible to use the cell phone to access pornography. You might have access to the internet at work. Thus, all the tools at your home become ineffective and require additional structural interventions. Or, with the amount of explicit material in our culture some people struggle with underwear or swim suit magazines as a high risk situation. Thus all of the internet interventions fail to address the reality of access to explicit media.

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