Saturday, November 22, 2008

Topic 4: Immediate Short-Term Prevention Plan

Occasionally, I receive feedback from colleagues that leads to a new topic. A friend suggested that he has worked with clients who need an immediate behavior plan to help them radically interrupt the acting out cycle. Of course, I responded. While it was implicit in the workbook, the conversation lead to a new topic. For those who have the workbook, consider this assignment topic 3.5.

Topic 4: Immediate Short-Term Prevention Plan
Often what brings a person to therapy is the fact that there are immediate behaviors that are interfering in one’s life. These behaviors need to be stopped right away before any additional consequences (legal, emotional, relational) occur. This assignment is to help you clarify what your immediate problem behaviors and develop immediate plans. (By the end of the workbook, you will develop long-term sexual healthy behavior plans.)

To begin with, answer the following questions:
1) Review what brought you into treatment. What are the problematic behaviors?
2) Review the sexual timeline. What are the behaviors that are of immediate concern?
3) Think forward into the future, what current behaviors do you want to stop?

Your assignment is to identify which behaviors you want to stop and to develop the short-term plan to help you meet you goals. For this assignment, these are the most important behaviors that need to stop now. In medical triage, you treat the most important issues first. When someone is bleeding for example, you don’t worry about a temperature until after the bleeding has stopped. Now, think about the plan for the next week, 30 days, or even 90 days. This plan is short term and is meant to help you build on short-term successes. I’ve included some examples of interventions that might be helpful.

1) I will not go online to internet sex sites.
2) I will not go to public sex sites
3) I will not have sex outside my relationship.
4) I will not have sex for the next week (or the next 30 days).
5) I will not masturbate to unhealthy fantasies for the next week.
6) What do I need to put in place to help me succeed

There is a high probability that you might fail. Interrupting and stopping the cycle is difficult. If it was as easy as saying “I’m not going to do this anymore” you would have already stopped! The key is to keep trying and address the issues why you fail. If and when you fail, completing a behavioral analysis (discussed at the end of stage 1)is important. You will be able to use what you learn from the process to uncover your unique components to the acting out cycle (which is addressed next) and help you strengthen your plans.

Tuesday, November 18, 2008

What Is Sexual Wellness?

I started my next workbook. As before, I will incorporate parts of the topics in this blog. The first blog from the new workbook is on Sexual Wellness.

Believe it or not, sexual wellness is not defined within the field of psychology. A literature review of both psychology and medicine literature databases identified three articles. A brief review of the internet also finds few resources. One website, highlights 10 different types of wellness but fails to include sexual wellness in this list., for example, highlights dildos, condoms and lubricants. A few websites offer services toward sexual wellness. Ohio State University (, for example, highlights many aspects of helping the student move toward developing skills integrating behaviors and values. The term as defined on their webpage elicits the idea of sexual health as defined in this workbook. The dictionary defines wellness as the quality of being in good health especially as an actively sought goal.

Given the lack of an existing definition, the definition of sexual wellness we are establishing for this workbook is that sexual wellness is the movement toward sexual health. All of the issues, concerns, and barriers within the concept of sexual health are integrated into this definition. Sexual Wellness is the active participation of the individual in his or her life by addressing the numerous issues within sexual health. This requires active participation and movement. The purpose of this workbook is to help expand specific topics from the literature to help you move toward improved sexual health. The process is what we define as sexual wellness.

Monday, November 17, 2008

Getting you and your partner off.

o increase your sexual satisfaction, it is important to address the six most common types of sexual performance problems.

Impotence problems reflect struggles with achieving and maintaining an erection.

Ejaculation problems
Sometimes a guy gets off too quickly or not able to get off at all. Ejaculation is when come is present and is not the same as an orgasm. They are often linked, so confusion is possible.

Orgasm problems
Some people aren't able to orgasm. An orgasm is the body response that is “involuntary” to sexual arousal. It is equivalent to the “sneezing” response of the body --it is going to happen no matter what.

Anal pain
Some people have too much pain when getting penetrated.

Low Sexual Desire
Sexual desire changes over time, both in terms of frequency and targets of sexual pleasure.

Sexual Aversion
An avoidance of sexuality or sexual behavior.

Obstacles To Blast Off

Medical care
You've heard it before but it still holds true. The first place of intervention is to get a complete medical check-up and address any medical issues. The causes of sexual dysfunction are varied and require tailored treatment plans. Medical issues could be age, high blood pressure, side effects of medications, etc. If there is a medical condition, no amount of talk therapy will help.

Many partners don't know how to stimulate their partners. Your job is to ask your partner what he likes just as it is your job to share with your partner what you like. Each of us has body parts more arousing for us. On the topic of masturbation and lasting longer, I highlighted the importance of getting to know your body and sharing this with your partner. Great sex requires talking with each other about what you like as well as what you don't like

Sometimes life events such as stress, lack of sleep, job changes impair your ability to function. In these cases, healthy coping with the events will help you on the sexual functioning level.

Mental Health
Anxiety, depression, self-esteem, performance anxiety, and fear of disapproval are examples of mental health concerns that may impair getting off.

Keeping a realistic expectation is important. Older guys typically have a longer time between the ability to have an erection and the intensity of ejaculation changes (usually for the worse) than younger guys. If we compare ourselves to the young porn stars all the time, we're bound to have difficulties.

It's just the wrong time?
This is a catch all category. Take a look at what might be getting in the way. If you're going for a quickie, the rush and pace of the setting can curb your libido. And 'newsflash' guys; if you've been drinking expect things to take longer to happen, if they happen at all.

What You Can Do

1. Get a medical check-up. As the commercials go, make sure you're healthy enough for sex.
2. Learn about your body. What do you like or don't like. Share this with your partner and ask him about what he likes and doesn't like.
3. Address external circumstances in your life such as stress, exhaustion etc.
4. Address mental health issues related to functioning. A conversation with a professional may help.
5. Be realistic in light of age, circumstances, or setting.
6. Take your time. Improved sexual functioning is a process of practice, taking your time and learning what works and doesn't work. With a partner, using various touch techniques can decrease anxiety and address internal messages. Shame due to poor body image can be addressed through mutual affirmation with a partner which can take time. Addressing anal pain requires time to loosen the muscles allowing a guy to be penetrated.
7. Focus on other forms of sexual pleasure other than exclusive attention to the erection or orgasm.

Tuesday, November 4, 2008

Drugs, Sex and Thinking Errors.

In the last week, I’ve been working with a number of clients struggling with integrating the power of thought and the primary thinking error. An example of a primary thinking error might be “I can’t do that.” In recognizing this thinking error, you might see when either you or another person responds to limits in their life when they believe others say “You can’t do that.”

In one scenario, a client will sometimes project as coming from others the message that he or she can’t do something. One example is a client who knows that he is gay. This person might project as coming from others the thought that “I can’t be gay.” Later, they may project that “I can’t do this or that because I will be rejected” which they use as justification for many types of behaviors. To cope with these perceived external limitations, a client will use alcohol and/or drugs as a way to cope with being gay in response to the perceived limitations. Next while under the influence, these external restrictions lose their controlling influence leading to out of control sexual behaviors. (In a similar way, it is possible to map the opposite direction --sexual behavior leading to chemical use.) As a consequence of the sexual behavior and chemical use, the client experiences feelings of shame and guilt. In one example, I saw a client use the relapse on sex and drugs as proof that “they couldn’t do” anything right. In a way, they set themselves up to repeat the cycle using a version of a primary thinking error “I can’t be sober”

In reviewing the power of thought and the idea of the primary thinking error, it might be helpful to review the post I wrote in July. I’ve cleaned up the language since the first draft. In this post, the concepts of the primary thinking error and core thought are the same.