Sunday, March 23, 2008

Prevention Planning-Always have the end in mind.

It is important to have the end of therapy in mind. I often state in one of my first sessions with a client that my goal is to work myself out of a job. And I ask them to think about what it would look like to be done with treatment. And, honestly, people often don't have an answer. The question, nevertheless, frames the theraputic relationship as time limited, goal focused, and honors the client's overarching goal.

In the area of sexual compulsivity, I ask them to to develop a prevention plan for sexual compulsivity. This plan has three primary components. It truly shapes the content of therapy. And, it is not as easy to complete the plan as the title suggests. I will review each component.

A) Preventing the Acting out Cycle. In previous posts, I have reviewed the acting out cycle. The prevention plan is comprised of 5 of each of the important components of the cycle (thinking errors, feeling triggers and high risk situations). As treatment progresses, the client will identify many of these. I stress developing plans for each of the primary 5 issues in each area. So, if under the feelings, depression is identified as a feeling trigger, I ask the client to identify 3 plans to cope with depression. In the case of depression, the three plans could include: Taking medications, talking with my support network, and managing my physical health through diet and exercise. Thus, by the end of the treatment, the prevention plan will have up to 45 interventions that could be used. (Some interventions, may overlap. For example, if depression and anxiety are both present, taking medications may be appropriate for each).

B) The second part of the plan is to identify sexual healthy behaviors. In preventing the negative behaviors, we have to replace them with positive behaviors. In what manner will I get my sexual needs met that respects my values and boundaries? What are the issues that need to be addressed to support healthy sexuality? The difficult part for many clients is that they want me to tell them what to do; the work is for them to develop their plan.

C) Developing of a support network. This is the part of the plan that is the most difficult and results in the most avoidant behaviors by the clients. I want them to identify 3-5 people with whom they can use as a primary support network. This would be a person who can listen without judgment, support as needed, and confront when necessary. Often clients have so much shame, that they can't share anything regarding their history. It takes a lot of trust to reach out to these people. For me, a client will share his/her prevention plan with the individuals in the support network.

Taken together, these are the measures I use for when a client is done. If any part of the plan is not completed, it is imperative to examine why. Many time the issues why are the source of additional theraputic issues. When these are resolved, this phase of treatment is complete.

So, as you review the cycle, and work through additional topics, reflect on what it would look like for you to be done. These are tasks to be addressed in your process.


No comments:

Post a Comment