Monday, March 24, 2008

Concurrent Issues with Sexual Compulsivity

When someone receives treatment for any compulsive behavior, it is common for other problematic behaviors to occur. In my work, I've helped people get their chemical use behaviors under control, only to see their sexual behaviors escalate. Once we've identified and provided interventions on the sexual behavior, a new problem such as spending, or gambling, or anger, or eating concerns arise. The problem is that treatment needs to address the entire acting out dynamic versus simply stopping negative behaviors. It is this recognition that shapes the next sections of the workbook.

Depending on your current place in life, there might be other issues that need to be addressed. This process is sometimes referred to as “triage” where an honest review of the issues occurs. The process includes prioritizing these issues, and developing treatment plans to address the most important issues first. Only you, in consultation with your support network, can prioritize the issues. It may not be wise to address the sexual compulsivity behaviors at this time if other issues are more important. At the same time, if the sexual behavior contributes to the concerns, then it may be even MORE important to address the sexual behavior.

In the list below are the issues to be addressed in the remainder of the workbook. I've tried to be complete, but I have no doubt the list is not exhaustive. If something is relevant in your life, please add it to the list. You might want to review your sex history and your sexual time line and determine to what degree some of these events are present in your time line. As you read through the list, score each topic area on a four point scale where:

1) Not a concern - (i.e., never abused as an adult or growing up.)
2) Minimal concern - (i.e., only feel anxious at certain times, I don't think it is connected to my behaviors at this time.)
3) Major concern - (i.e., my relationship is in danger of ending because of my behaviors.)
4) Emergency concern -(i.e., I'm so depressed, I wish I would die.)

If there is anything that is a "4," please seek immediate help. If you find that you are in a depressive episode, for example, you might rank it a 3. But, if you are having suicidal thoughts or feelings, the concern is an emergency and immediate intervention is necessary. Any concerns with a score of four require support and services before you address the other issues.

Once you have scored the topic areas, go back and rank the areas that are of most importance. This is simply a process of sorting out the 4, 3, 2, and 1s in an order that makes sense with you. This becomes a tentative plan about which topics should be addressed first in your treatment process.

  • Emotional Expression
  • Anger Expression
  • Communication Skills
  • Assertiveness
  • Boundaries
  • Shame
  • Masturbation
  • Fantasies
  • Intimacy
  • Touch
  • Body Image
  • Sexual Competency
  • Positive Sexuality
  • Sexual Satisfaction/Dissatisfaction
  • Safer Sex issues
  • Sexual Functioning
  • Sexual Identity
  • Chemical Dependency
  • Depression
  • Grief
  • Anxiety
  • History of Physical and/or Sexual Abuse
  • Gambling
  • Spending
  • Working
  • Eating Disorders

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