Wednesday, December 30, 2009

Unlinking Sex and Drugs

Yesterday I posted a strategy for addressing sexual health issues. Today, I wanted to highlight the strategy can be useful for unlinking sex and drugs.

It is important to be aware how the linkage between sex and drug shows up. For some people, they need a drug to help them with sex. A number of people might use alcohol or pot, or other “downer” to help them address the anxiety they feel around sex. To help move toward sexual behavior, they ingest the drug to calm down.

For others, particularly meth users, the power they feel as a result of the drug creates such (false) feelings of self-esteem that they go overboard in the realm of sexual behavior. Meth as a sex drug has been documented elsewhere; what hasn’t been talked about is struggle with unlinking sex and drugs. I’ve worked with enough people who struggle and describe stories where months and years after their last use, any sexual behavior triggers euphoric recall on drugs. Many of their fantasies include drug use. When masturbating, the only way they “get-off” is by including chemical use in their thoughts. This is a major issue regarding recovery and sexual health

In all the examples above, the desire is to unlink the relationship between sex and drugs. In many ways, the strategy highlighted yesterday (SEE BLOG, 12/29/09) is the same strategy. I provide a few nuances here to clarify the process.

1) Start slow as well. Review the process as described.
2) When you move through the process, it is important to “tell on yourself” when you experience the linkage of sex and drugs. This will not be a quick process, but it is a matter of talking through the experiences as they occur. With your support system, be as descriptive, thorough, and honest as possible. The goal is to put everything on the table. In the process, you might discover something you need to address in your overall recovery.
3) As you move through the various stages, when you experience the linkage I would encourage you to take a break. For example, perhaps when you are making out with someone, and you experience the linkage of sex and drugs, it would be helpful to stop for a while. The experience may seem frustrating, and it probably will be. The key is to talk it through, including talking how you are experiencing the linkage. This also includes talking with your partner BEFORE the process as well. As I mentioned yesterday, couples therapy and support group for both you and your partner may be necessary.

Tuesday, December 29, 2009

Sexual Functioning and Development of Sexual Skills

When asked to define healthy sexual expression, many individuals first respond with the idea of sexual intercourse. They envision a typical explicit movie and assume that he/she needs to have sex “like them.” For many individuals, this is unrealistic.

A number of sexual functioning problems exist (See the topic on Sexual Functioning). In addition, many individuals struggle with sexual shame that they simply shut down any sexual energy. Individuals who struggle with sexual anorexia/sexual avoidance may believe they lack a level of competence in the skills to engage in sexual behavior. For individuals who struggle with sexual anxiety, the necessary skills evoke such anxiety that his/her performance results in unpleasurable experiences creating a cycle that leads to additional anxiety. Individuals who are sexually compulsive will sometimes focus on one type of sexual experience at the expense of all other types of sexual intimacy. In these examples, one goal of sexual health is the development of the knowledge, comfort, and skills to engage in a variety of forms of sexual expression.

Sexual Health requires self-knowledge, and the awareness to assertively communicate what you want. I’ve heard stories from individuals about how they were looking for one type of sexual intimacy, but didn’t know how to ask for it, or how to maintain the boundary if they knew what they were looking for. Many times, the individual and the partner don’t feel comfortable talking about the different types of sexual intimacy.

Below is a list of different types of sexual intimacy. They are listed, in my opinion, on increasing levels of intensity. Other clinicians may have a different order. While we may have different orders, it is generally believed that clients need to develop the skills at each level, moving toward increasingly complex skills. I use the metaphor of math skills. You start with addition and subtraction, moving to multiplication and division before learning about algebra and calculus. Only then would you teach statistics. My goal with this post is to highlight some basic skills and help you eventually move toward increasingly complex forms of sexual expression.

Instructions for the process:
Start with each step. Make sure you absolutely comfortable before you move to the next step. This process can be time consuming (think months). Some steps may be easier than others. It is important to develop and maintain open communication with your partner and his/her willingness to participate; this may require couples therapy. Obviously if you are struggling with this process, quickies or one-time encounters will interfere with this process. The key is to move slowly. When you feel anxiety or uncomfortable, say so, slow down and stop, if necessary. Comfort at each level is necessary before moving to the next step. After each experience, reflecting and talking about the experience is necessary. The debriefing can give you insight about what was easy, difficult, liked, disliked and whether or not you think you are ready to move toward the next step. If something is too uncomfortable or too anxiety producing, you may have to stay at that step for a while, or even move to an earlier step.

1) Looking
Often the first place to start is an awareness to whom you are attracted. What kind of person do you find attractive? What characteristics do you like? And the characteristics you don’t like. Focus beyond just the physical. If you can, think about why you answered the questions the way you did. Share your responses with your support system. Provide them with examples. Recognizing your attractions leads to the next step.

2) Flirting
Once you start to recognize your attractions, the next step is disclosure with the person to whom you are attracted. Often this is where people get stopped. This step requires addressing fears of rejection. In some cases, rather than dealing with rejection, people either shut down their attractions or settle for someone else.

3) Spending time together
Learning how to spend time together is the next step. Sometimes this may be simply going out to coffee or dinner, or a more formal type of date. Review the (future) topic on dating. Many of these activities can be integrated into this section.

4) Touching
Learning healthy, safe and respectful touch is a next step. This can involve simply holding hands, perhaps dancing or even light kissing. Being able to express what you like and don’t like is a part of this process. At this part of the development, the assumption is that you are “clothes on.” Future steps will introduce the experience of clothes off. At this point, the goal is to simply be comfortable with touch.

5) Kissing and Touching
At this step, you move toward increased physical touch. It is assumed that the clothes are still on, and that the touch focuses on areas other then genitalia and breasts. You might focus on touching parts of the face, hands, head, etc. Once you feel comfortable with types of touch in this area, moving toward touching breasts and genitalia over the clothes is the next step. As with all other steps, it is important to be aware of what you like/dislike and what feels comfortable/uncomfortable. Ongoing communication with your partner and support system is also assumed.

6) Nurturing and Full Body Touch.
In this stage, you still have your clothes on, but the level of touch has increased to the point where multiple parts of the body are touching. You may also be sitting next to each other on a couch, etc, or lying next to each other. This level of touch is sometimes described as “spooning” or laying front to back. As with the previous two steps, starting with touching non-genital parts of the body, moving toward eventual touching the genitals/breasts over the clothes.

7) Nudity
Moving up scale, the next level is being next to each other naked. This may have to start slowly, for example, simply being in undergarments before being naked. Again, starting off touching parts of the body other then breasts and genitalia is important. Once the touch is comfortable, move toward touching your partner’s genitalia as well as being comfortable with your partner’s touch is the next step.

8) Masturbation and Mutual Masturbation
Continuing up the scale of intensity, masturbating yourself in front of your partner and watching your partner masturbate is the next step. Many individuals struggle with shame, guilt, and embarrassment around masturbation. Reviewing the topic on masturbation may be helpful to help you increase self-awareness on this issue. Mutual masturbation (you masturbating your partner and your partner masturbating you) is the next step. At this point, orgasm isn’t the goal, simply being comfortable with the level of touch and sexual intimacy is the key. Perhaps when you are comfortable with the touch, orgasm through masturbation can be introduced at this level. Orgasm may be also be introduced at the later stages as well.

9) Fantasy
I believe fantasies are extremely powerful. I place them this far up the scale because I think they give others a views to the inner most part of the person. It takes a lot of trust to share your fantasy with your partner. This is where reviewing the topic on fantasy as well as your fantasies with your therapist may be helpful before sharing your fantasy with your partner.

10) Penetration
The next step is developing comfort with sexual intercourse. The first step at this point is feeling comfortable with penetration. Understanding what you like/dislike, and what feels comfortable/uncomfortable is the key. Learning strategies and positions for penetration are required as well. Some people struggle with penetration due to pain, shame, or fear. As with all stages, ongoing reflection and conversation in this step is important with your support system and your partner.

11) Orgasm
Clinicians disagree whether orgasm is required in the final stage. I place it at the end because many individuals do see it as the goal and they struggle with experiencing an orgasm. And, obviously, orgasm feels great. Orgasm isn’t always required or needed. It is included, however, because my goal is to help you develop the skills, comfort, and self-awareness to experience orgasm. At this step, all of what you learned in the previous steps is used to facilitate success at this step. It is difficult to provide universal instructions, so working with your support system and your partner is very important.

1) Review your sex timeline. What parts of the above process do you need to address?
2) What do you need to discuss with your partner?
3) Develop a plan to build your sexual experience and skills.

Sunday, December 13, 2009

Attitude of Gratitude: Sexual Health Mentors

A brief self-disclosure on a blog that is usually focused on clinical issues. I had a fortunate privilege to share brunch with one of my mentors, Eli Coleman. I take away two thoughts as I reflect on the experience.

First, everything I bring to the conversation is built on the shoulders of others. It is not possible for me to move the conversation on sexual health forward without the mentorship, support and encouragement from others. For those who don't know, Eli Coleman is the Director of the Program in Human Sexuality at the University of Minnesota. He was my adviser for my PHD, and wrote a generous preface to my book. He, along with others, has been part of my journey in this realm since 1993. In the 16 years, I remain inspired and encouraged.

Second, I'm aware of the isolation that occurs in this field. The cultural bias against talking about sexuality is powerful, even for myself. Answering the question "What do you do for a living?" leads to a reaction of hesitancy and anxiety (aka fear) by those asking the question. (I have a new appreciation of the difficult clients experience when I push for disclosure.) The implication of this "new" revelation affirms the need for all of us to talk about sexuality. I affirm my need to reach out and talk with peers for support, encouragement and affirmation.


Wednesday, December 9, 2009

Tiger Woods and Sexual Compulsivity

In all of the recent news on Tiger Woods, very little conversation has occurred beyond the titillating sexual behaviors, number of sexual partners, and the eventual impact on his marketing career. I would hope that somewhere in the conversation, the media would start to address questions of sexual compulsivity. Like many of the recent sexual scandals, we focus on the sensationalism without focusing on the emotional toll on those involved and the struggle many individuals have in the area of sexuality. (Just to note, not knowing the details, I will refrain in assessing Tiger Woods the person.)

This story is only one in a series of many stories to come. Who is next is irrelevant; the key for me is to help others get the services they need. Whenever something like this occurs, I hope people can use the story as a way to reach out for support, help and resources. There are many resources available including SASH.NET, and AASECT.ORG. Reach out and find some resources. Help your self, or help others get the help they need.

Living a Life I Love, workbook availability

I'm happy to announce that Living a Life I Love is now available on an expanded distribution network. You can now purchase the book via orders from any bookstore! This is a change that occurred today, but may take a few weeks to percolate through the paper/electronic distribution networks. Stop by your local bookseller today!

Sunday, December 6, 2009

Living a Life I Love: 6-week workshop

As part of my new job, I'm posting information on a 6-week workshop addressing sexual compulsivity. The goal is to help participants toward getting what they want in their relationships.

Start the New Year addressing sexual health issues in your recovery. Join a discussion group designed to help you address sexual health concerns. The goal of this workshop is to help you get the type of relationships you want. This workshop is for individuals who have questions about sexual addiction/compulsivity, or avoidance of sexual behavior (sexual anorexia). For many in recovery, sexual health concerns are the last topics to be addressed. The topics reviewed are:

Jan 6, Week 1: Acting out cycle/Safety Plans
Jan 13, Week 2: Sex Timeline/Behavioral Analysis
Jan 20, Week 3: Understanding your Timeline
Jan 27, Week 4: Co-factors of Sexual Compulsivity
Feb 3, Week 5: Prevention Planning
Feb 10, Week 6: Creating a Personal Definition of Sexual Health.

Group size is limited to 10 individuals. Space is limited. Cost is $170 for the entire 6-week series and includes the cost of materials, paid at the first session.
Weston Edwards, PhD, LP will facilitate the discussion group. He is the Clinical Director at Prism. He has 16 years experience working in the area of sexuality. For More Information, contact Dr. Weston Edwards, PHD, LP at 612 825 8714

Professional Changes

The next few weeks will see radical changes in my professional career. I'm happy to announce that I will be the Director of Clinical Services at Pride Institute and Prism. I will supervise the Outpatient Adult and Adolescent Intensive Outpatient Chemical Dependency Programs at Pride Institute. I will also supervise the new mental health program at Prism. In this role, I will develop the new program.

Prism is a new program providing mental health services. (Essentially I am moving my current practice to Prism.) Prism will provide specialty services in mental health, substance abuse and sexual health concerns. For many individuals, the problem areas overlap. Both mental health and psychiatric services will be available. Our goal will be to provide one-stop services.

Watch for future updates.

Monday, November 2, 2009

Feeling Triggers and Internet Compulsivity

As promised, slow but steady progress on the next work book is being made. An update of the feeling trigger topic. I apologize for the loss of formatting. (I hope you buy the book instead!)

A major factor in the acting-out cycle is the presence of a feeling trigger. As we’ve said elsewhere, we agree with clients when they say, “I don’t know what I’m feeling” at the beginning of the therapy process. In may circumstances, the words below are simply words without any real understanding by the individual caught in the compulsive cycle. The growth process is about learning to identify the feelings.

Identifying feelings is more difficult than most people realize. To that goal, the process is designed to help you increase your awareness. As you sit down before the computer, ask yourself "What am I feeling." Other strategies include asking, what would others be feeling? Am I feeling this? Or, “What feeling might I guess that I’m having? In both of these situations, end with confirming whether or not this feeling is present. It is important to remember that feelings are based on thoughts and the interpretation of the world around you. You might also ask, “What am I thinking?” and as a result, “How do I feel” given that I’m thinking this. In a future topic, (see Topic XX Behavioral Analysis strategies for identifying feelings will also be reviewed).

Below is a list of feelings that many people have highlighted as contributing to their Internet use. Notice that both positive and negative feelings are associated with the cycle. Keep in mind that feeling confident may lead to feelings of overconfidence, where you then place yourself at risk for an acting-out encounter. Another feeling might be anger or hurt. In some circumstances, some clients have reported they acted-out sexually as a way to get back at their partners. Review the list of feelings as they relate to the acting-out cycle. Which are your major feeling triggers?
Abandoned Despondent Hopeful Protective Vengeful
Accepted Disappointed Hopeless Proud Wary
Afraid Discontent Horrified Provoked Weary
Alone Discouraged Humble Reassured Worried
Amazed Dissatisfied Humiliated Regretful Worthy
Ambivalent Distressed Hurt Rejected Defensive
Angry Drained Indignant Relief Defiant
Annoyed Eager Irritated Relieved Dejected
Anxious Ecstatic Jealous Reluctant Desire
Apathetic Embarrassed Jolly Remorse Despair
Apprehensive Empathy Joyful Resentful Glad
Ashamed Empty Jubilant Resigned Grateful
Awe Encouraged Let down Sad Guarded
Brave Energized Lonely Secure Guilty
Calm Envious Merry Selfish Happy
Careful Exasperated Miserable Self-pity Peaceful
Caring Excited Mortified Shocked Pity
Cautious Exhilarated Murderous Stunned Playful
Cheated Fearful Nervous Surprised Pleased
Cheerful Flighty Numb Thrilled Possessive
Confident Free Overcome Tired Defeated
Courageous Frightened Overjoyed Triumphant Panicked
Cowardly Frustrated Overwhelmed Uneasy Unworthy
• Identify 3-5 feeling triggers you have in your life.
• Review the list of feeling triggers with your support network. Which feeling triggers do they suggest might be consistently present?
• Review and update the following list after reviewing the feeling triggers in this topic. What are your initial plans to help you cope with these feeling triggers?
• Return to the list and update as necessary.

Sunday, November 1, 2009

Small Gifts and the Persistence of Recovery

My office away from my office away from my home is Bruegger's Bagels in Uptown Minnesota on Lake and Humboldt. I'm "well-known" by the staff, who often treat me like "Norm" from the sit-com "Cheers." My Diet Coke is poured and ready by the time I make it to the register! (Thanks Guys!)

While working on a presentation (which I will post on Thursday), a client I haven't seen in nearly two years stopped by out of the blue and said hi. I had heard bad things --bad relapse, bad consequences, and the like. He filled in the missing blanks and acknowledges significant recovery --the longest in a while.

I took away from the conversation two important things.

First, the power of awakening. Whether you use spirituality, 12 steps, religion, or CBT, there is a moment of choice. In that moment, I choose "A" or I choose "B." And these moments are often small (I call them pivot points), but the long-term impact is significant. I heard in his story the moment of choice. I heard in that moment a choice to live. He started to create a new future.

Second, often in my role as a clinician, I never hear about the long-term impact of my work. I am humbled to hear and accept his gratitude for our work together. When clients "disappear" I do find myself concerned; I'm also constrained that I'm not able to follow-up. The update is appreciated. In his update, I'm re-affirmed in my comment to sexual health and the work I choose to do.

Saturday, October 31, 2009

Sexual Health and the Employee Assistance Professional

On October 23rd, I presented in Dallas at the World Conference for the EA Professional. (see The general topic is sexual health and how the EA professional needs a basic awareness of the sexual health model in triaging employees. As always appropriate self-knowledge, awareness of resources, and targeted referrals is a necessary part of the process.

What was "scary" for the presentation was how little sexual health training many of these folks received in their formal degree program. I know our academic programs are full (remember, I teach in a program), but given the importance of sexuality in everyone's lives, I would advocate for additional training. Playfully, the participants at the conference recognize that they are now the "experts." An expert is someone who has more skill or training than those around him/her. Given that definition, a simple workshop will make someone an expert in that they know more than those around them. If that isn't scary, I don't know what else will.

If you would like a copy of the presentation, please contact me back channel. I will forward a copy of the handout which reviews the sexual health model, and provides specific suggestions for the EA professional.

Sunday, October 11, 2009

Topic 8: Power of Though, Thinking Errors and the Psychology of the Internet


Weston Edwards

As I shared, our goal is to post much of the material.

A lot of emphasis in our treatment approach focuses on helping you understand your thinking patterns and, in particular, your “thinking errors.” To do so, we first need to discuss the power of thought. (Insert the following as an endnote: If you want to read additional resources, please read Slowing Down to the Speed of Life by Carlson and Bailey, Flow: The Psychology of Optimal Experience by Csikszentmihalyi, and Blink: The Power of Thinking Without Thinking by Gladwell, and The Power of Now by Tolle.) The basic premise is our entire existence is based on though ranging from the way we examine life events, perception of events in our life, the feelings we have, and the way we interact with others. This chapter explains why we hold this premise.

At one point in the Broadway Musical Wicked, the heroine enters Oz, where the citizens wear green-colored glasses. Over time, the citizens had just forgotten they were wearing green glasses, and simply concluded that everything was in fact green. This was why Oz appeared to be an “Emerald City.” In a similar way, our thinking patterns color our view of life. These patterns are so pervasive that we simply don’t realize they are present. Sometimes the assumptions have a limited impact in our lives; other times, these thinking patterns are so unhealthy they result in painful consequences. In many ways, the cultures we belong to are the lenses we use to look at the world. Our awareness of these lenses has disappeared simply because we see through them versus seeing them. The movement toward sexual health is the process toward understanding the cultural lenses we use to understand the world.

Our cultural views shape both the worldview and the experience of each moment. Within each moment our awareness and knowledge are based on perceptions, and through the almost instantaneous analysis of these perceptions, we arrive at a conclusion (i.e., a “thought”) that guides our feelings, choices and behaviors. This is a bit different from conventional wisdom, which often dictates that feelings come first. Yet, consider the following scenarios.

You parked your car on the street. As you return from the store, you find your car is gone. The awareness is that your car is missing. The feelings result from the conclusions based on various thoughts. Depending on the thought, your feelings might be different. Consider the following:
• You have been reading the newspaper about stolen cars in the neighborhood. The thought that percolates to your awareness is, “My car has been stolen,” and you probably have feelings of anger or of being violated, or both.
• As an alternative, you notice a “No Parking” sign during high traffic/rush hours. You happen to have parked your car just before that time began, and you returned to find you car gone. Your thought might be, “My car has been towed.” Notice, however, your feelings are different based on your thoughts. You might feel anger, embarrassment, frustration or shame because you feel you should have known better.
• Consider a third possibility. You’re talking on a cell phone, as you get to where you thought you parked your car, you realize it is gone. You think, “My car is gone” with thoughts of anger, violation, frustration, etc. Then you notice that six spaces up is your car. Because you were distracted, you went to the wrong space. The corresponding feelings might be embarrassment, relief, and/or humor as you realize how you overreacted.

These three examples help explain how thoughts shape your feelings and subsequent behaviors. Gladwell highlights how much of our thought is actually automatic and can occur in the blink of an eye. Sometimes we simply don’t realize how many different thoughts we have in a particular moment. Not true, you say? Think about how many complicated tasks, thoughts and attention to stimuli occur while you drive a car. Yet, you never think about driving a car. You simply drive. The application in treating internet sexual compulsivity is to help clients realize how ritualized the acting-out process is for many people.

Two strategies we want you to use at this point for increasing the awareness of the power of your thoughts are mindfulness and transference. Both are powerful tools that give us insight into the power of thought.

Mindfulness is the experience of being aware of your current thoughts, feelings, body state and surroundings by paying attention to your reactions, motivations and actions. To increase your ability to be mindful, I encourage you to become aware of your inner conversation. When someone walks into the room, we may say to the person next to us, “She’s attractive.” But our inner conversation is what we have with ourselves when no one is around. Someone might walk into the room, and we say to ourselves, “I want to have sex with her.” Various meditation techniques can also be helpful in increasing your mindfulness. The process of behavioral analysis described later in the stage is a tool of increasing mindfulness by asking you to reflect on your thoughts, feelings and behaviors when you last acted-out (see page Error! Bookmark not defined.).

Transference is any reaction we have to another person. Often the experience of transference occurs so quickly, we don’t realize either that it occurred or the content of the transference. We are CONSTANTLY making assessments and judgments of our environment based on our past experience. It is the past experience applied to the current situation that typifies transference. Most of the time we focus on negative transference, or the negative reactions we have to someone. Positive transference is also helpful to understand. In any reaction, you can learn what you are feeling and thinking and how it relates to your acting-out cycle. The individuals with whom we have the strongest reaction are perhaps the people who can teach us the most. It is your reaction that tells you the most about yourself. Ask yourself the following questions: “Why am I having this reaction? Who does this remind me of? What memory does this person trigger? Why do I like or dislike this person?”
Whatever the response, you can gain insight into your internal thoughts and feelings.

Taken together, mindfulness and transference are two important concepts to help you increase your awareness of your thoughts. Much of what we think occurs so automatically that we see the picture but fail to see the pieces of the puzzle. The acting-out cycle is equivalent to the picture, while the thoughts, feelings and high-risk situations are the individual pieces.

Thinking Errors and the Psychology of the Internet


Thinking Errors

This concept has a variety of different names, depending on the theoretical orientation of the clinician. You might have heard terms such as “psychological defenses,” “cognitive distortions,” or even “stinkin’ thinkin.” All of these labels refer to a pattern of unhealthy thinking. We prefer to call them “thinking errors.” Often, these thinking errors are attempts to minimize pain, justify our behaviors, avoid responsibility, or otherwise help us avoid reality. As you increase your awareness of thinking errors, the variety and number of thinking errors will surprise you. You will be amazed at the presence of these thoughts and how we use them to justify almost all behavior. A great place to start recognizing a thinking error is to look at any thought that comes after the word “because.” I was online “because……, or “ I was downloading pictures because….” While not universal, the vast majority of times we answer the response “because” we are using a thinking error.

In the movie “Shrek,” the character of the Shrek describes Orge’s as having layers, like an onion. Applying the idea, our thoughts often have deeper layers. As we delve deeper into recognizing our thinking, it is possible to gain insight into deeper levels of meaning. Sometimes even a “great reason” hides a thinking error so it’s important to think outside the box and look at the layers of thought. Take, for example, why a person stops at a stop sign. In asking the question, “What is one reason a person stops at a stop sign?” it is possible to identify a number of thoughts that could be thinking errors. A few reasons might be “I don’t want to get a ticket.” I don’t want to get hurt” “It is what I’m taught.” While true, each reflects a possible deeper level that needs to be uncovered. “I don’t want to get in trouble” might reflect layers of guilt/shame. A possible deeper level of using safety as an explanation might also reflect layers of anxiety. For some people, they don’t stop at stop signs, they sort of “roll through them.” This can also reflect a patter of thinking such as “the rules don’t apply to me. As a fun exercise, ask yourself the reason you are stopping at the next stop sign you come across as you drive.

As illustrated in the acting-out cycle (see page Error! Bookmark not defined.), and in the power-of-thought above (see page Error! Bookmark not defined.), our thoughts shape our reality. We act based on these thoughts. Too many times I’ve heard comments such as “I didn’t know what I was thinking” or “I knew I shouldn’t be doing this, so why couldn’t I stop myself?” My response is to affirm that the acting-out cycle is sophisticated; people will act on thoughts they may not fully realize are present. The speed of our thoughts is simply too fast for us to fully understand them before we act. Some of these thoughts might be suppressed and/or repressed. Others may be so automatic we simply don’t recognize their power. An important purpose of therapy is to help you reveal the unhealthy thinking patterns in your life.

Now we’ve included a summary of thinking errors, we must state that in no way is this list exhaustive. The mind is an amazingly creative source of never-ending thinking errors, and these examples represent just the most frequent types. One of our main goals is to help you become aware of the various thinking patterns in your life.

Justification: Making excuses for our behaviors.
“I deserved it.”
“It happened to me and no one cared, so why should I care?”
“I was angry, so my behavior is understandable.”
“It’s what I like, so the other person should like it too.”
“My partner isn’t available, so it’s OK to be online.”
“I’ve been working all day at the computer, I deserve a 5-minute surfing break.”
Repression: Forgetting things that are uncomfortable.
“I didn’t know what I was doing.”
“I have no memory of my behavior.”
“I didn’t think anything bad would happen.”
Displacement/Blaming: Telling ourselves someone or something else is responsible for our actions.
“If she had not done what she did, nothing bad would have happened.”
“He started it.”
“The web page kept popping up on it’s own; I didn’t know how to stop it.”
“I was only downloading adult porn, I didn’t want the child porn.”
“She had a reputation, so she deserved it.”
“He didn’t tell me to stop, so it was his fault.”
“She’s a tease, so it was as much her fault as mine.”
“I had to do what I did because my partner isn’t interested in sex.”
Victimization: Using one’s own history as a justification for behavior.
“I’m the victim in this case.”
“I had no other choice.”
“It happened to me at that age, so my actions should be forgiven.”
“I never get what I want.”
“If this hadn’t been done this to me, I wouldn’t be doing it now.”
“No one was there for me.”
Minimization: Playing down the nature of the discretion or the harm.
“I only did it this one time.”
“No harm, no foul.”
“I was just trying to make her feel better.”
“Things just got out of hand.”
“It wasn’t sex.”
“I’ll only do it one last time.”
“I didn’t actually connect with someone.”
“It was just chatting”
“It’s just pictures; no one was hurt.”
Denial: Refusal to accept external reality because it is too threatening.
“I didn’t know it was against the law.”
“I won’t get caught.”
“No body will know I’m visiting this website.”
“I didn’t think my partner would care.”
Catastrophizing/Exaggerating: Exaggerating the reasons for or the consequences of our actions. Use of the phrases “the worst,” “the best,” etc.
“If I hadn’t done it, something awful would have happened.”
“I did what I did because I had the worst family.”
“It was worth it because it was the best sexual encounter ever.”
“He was the meanest guy.”
Using dramatic gestures and vocalizations such verbal sighs, waving hands.
Over-Generalization: Use of terms such as “everybody,” “never,” “always,” “no one.”
“Everybody else seems to do it.”
“I am never wrong.”
“I know others do it so I figured it would be OK.”
“I’m always blamed.”
Misinterpretation: Deliberately taking the comments or actions of another out of the context.
“I just did what you told me to do.”
“I only did oral sex, so it isn’t real sex.”
“You didn’t say I couldn’t act this way.”
“I didn’t sleep with anyone, it was only ______” (fill in the blank: Internet sex, exhibitionism, voyeurism, pornography or other)
Escaping/ Fantasy: Tendency to retreat into fantasy in order to resolve inner and outer conflicts.
“I hoped it would make me feel better.”
“I didn’t think I would get ______ .” (fill in the blank: arrested, sick, caught, hurt, etc.)
Projection: Shifting one’s unacceptable thoughts, feelings and impulses onto someone else so as to blame or attack that person.
Accusing your partner of unhealthy sexual behavior.
Being antigay when you have sexual feelings for others of the same sex.
Using “you” statements. (“At least I’m not like you.”)
“It’s your fault because your not sexually available to me.”

Primary Thinking Error (to be reworked)
We use many thinking errors over time, but sometimes one constant theme may be present throughout our thinking errors. We label this theme the “primary thinking error.” It is often the foundation of how we make sense of the world. To put it more accurately, it is the thought that we first use to interpret any situation. The less information we have about a situation in real time, the more likely we are to base our assessment on our primary thinking error. As ingrained as this pattern of thinking is in our life, it is very difficult to recognize. Think about the example of wearing glasses: After a while, we forget we have them on. Another example is driving a car. When we drive home, we don’t think about the route we take; we simply drive. But after we move to a different place, we have to make a conscious effort to get home so we don’t automatically drive to the old residence.

Often it is the primary thinking error that drives our behavior. For example, if your primary thinking error is “I don’t fit in,” you might look for ways to use this thought of not fitting in to justify your behaviors. You might go online for a sexual chat because you avoid the risk of being rejected. If you’re in a situation where you do feel rejected, you look at it as further proof of how you don’t fit in. As a result, you constantly worry about not fitting in, and you look for that perfect situation where you don’t have to worry about the possibility of not fitting in. It gets exhausting!

Identifying the Primary Thinking Error
There is no easy way to identify your primary thinking error directly, but we’ve found it helpful to use a variety of different approaches in an effort to pin down what your primary thinking error is. In the beginning, we recommend you simply list the thoughts that come to mind without trying to analyze them too much at this point. Complete the following:
1. Review the examples of Thinking Errors (see page Error! Bookmark not defined.). Which thinking errors, in relation to others, elicit the most intense reaction from you? It might be the ones where you say, “I say this often” or those where you say, “That is NOT me…no way.” If any of the thinking error examples elicit a reaction, think about why the reaction occurred. Think about the deeper layers under any particular thinking error.
2. Look at an incident where you acted-out. As you complete a behavioral analysis (see page Error! Bookmark not defined.), track the thoughts backward. I use the idea of dominos as an example. Think of a thought as a domino. Each domino’s fall is triggered by the fall of the domino before it, and that domino’s fall was triggered by the fall of the domino that preceded it, and the fall of all the dominoes can be traced down the line to the very first domino. In the same way, a thought we have is triggered by a preceding thought, and that thought was triggered by the thought that preceded it, all the way back to the initial thought. If we can trace our thoughts back to one “initial thought,” we could find our primary thinking error.
3. What life events, big or small, trigger the strongest reaction? (It might be helpful to review the concepts on mindfulness and transference, see page Error! Bookmark not defined.). Before you react, identify the internal conversation or thoughts you are having. What is the assumption you have about what happened or what you think the other person or persons involved did or said?
4. Look back over times in your life when things did not go the way you wanted. These could be what you consider “big” things (such as losing a job, being called into the boss’ office) or “small” things (such as plans with a friend falling through). What do you say to yourself to make sense of the situation? What might be your fear in these situations?
5. When you look at the list of thoughts, restate them in a simple way. I encourage my clients to rephrase the thought as a six- or seven-year-old might phrase them.
Some examples of primary thinking errors:
• “It’s my fault.”
• “I can’t do it.”
• “It doesn’t matter.”
• “Why try?”
• “This won’t work.”
• “You can’t make me.”
• “I can do what I want.”
• “I don’t fit in.”
• “Nobody wants me.”
• “I don’t know.”

It is important to emphasize that we are looking for a “thought” and not a feeling. If you identify a feeling in the process, ask yourself “Why do I feel this? What is the thought that creates that feeling?” Too often people will say, “I’m bad” or “I’m not good enough.” My response is to ask, “Why do you feel that?”

These exercises are simply tools to help you pinpoint your primary thinking error. If you can’t pinpoint it at this point, that’s OK. You might be able to identify it later on as you start to look at incidents as they occur in real time.

As difficult as it is to identify the primary thinking error, the reward for identifying and recognizing it is amazing. Consider the reality that you cannot break a bad habit if you do not know you are engaging in a bad habit. In golf, for example, coaches often help you “unlearn” bad habits you picked up along the way. So it is with the primary thinking error. It is a habitual way of thinking. When we recognize our primary thinking error, new opportunities become possible. Part of freedom is the ability to do whatever we want to do, but another part of it is being able to step out of bad patterns and choose the direction in which we want to go. As you recognize how often you use the primary thinking error, you can make a different choice toward something else that is more important.
• Mindfulness is the process of becoming aware of the “here and now.” Start to increase your awareness of your current thoughts.
• If you have any emotional reaction, identify the thoughts associated with the reaction.
• Describe the underlying thought relating to any experience of transference.
• Complete the tasks identified in #1-5 above under the subsection Primary Thinking Error. Summarize any common themes here.

• Start to examine patterns of thinking that appear to be present in your life. Pay attention to how you answer the question “because…” What themes appear to be present at this point?

• Identify 3-5 thinking errors you use in your life.

• Review the list of thinking errors with your support network. Which thinking errors do they suggest might be consistently present?

• What are your initial plans to help you cope with these thinking errors?

• Return to the list and update as necessary.

Summary of Your Current Thinking Errors
My plans for coping:

My plans for coping:

My plans for coping:

Thursday, October 1, 2009

The Unique Focus of Cybersex Unplugged

by Weston Edwards

What’s different about this workbook?

Our collective clinical and research experience in addition to a multitude of requests from other providers highlights the need for a workbook addressing the unique issues of Internet sexual compulsivity. While classic sexual compulsivity is broad, with a variety of factors and addressed in the first book by Dr. Edwards, this book builds on our experience to focus on the nuances of Internet sexual compulsivity. The following topics highlight a few of the factors that will be addressed in the book that may be different from other expressions of compulsivity.

In classic sexual compulsivity, we see people engaging in high-risk behaviors that involve others in some form of public behavior. This might range from public sex, hiring a sex worker, spending money on lap dance, or hooking up with a casual partner. In each of these cases, some type of public activity has occurred. Within the context of Internet sexual compulsivity, there may be situations where the Internet is a venue to these activities. Often, however Internet compulsive behaviors occur in the realm of privacy and fantasy. The download of sexual explicit material can occur in the privacy of one’s home with the illusion that “no one knows.” The wasted time occurring while masturbating to streaming videos highlights the fact that the behavior often occurs in privacy with few public consequences. There are limited direct medical consequences from Internet sexual compulsivity.

Building on these differences, the treatment and intervention for Internet Sexual Compulsivity is also nuanced. While going “cold turkey” from the Internet sounds appealing, our clinical experience suggests that this isn’t as possible as we would like. The amount of legitimate business requiring the Internet has significantly increased. It is almost impossible for a person to “cut-off” the Internet in his or her life as it was 10 -15 years ago. We find many individuals can stop the Internet Access at home, only to be forced to use the Internet at work. Treatment therefore requires some type of Internet Use plan. These best comparison is the example of individuals recovering from an eating disorder who develop a safe-eating plan as part of the recovery process simply because eating is required for survival. The same analogy can be applied to sexual health in general and recovery from Internet sexual compulsivity in particular.

Wednesday, September 30, 2009

Cybersex Unplugged: Finding Sexual Health in an Electronic World

Cybersex Unplugged: Finding Sexual Health in an Electronic World
By Weston Edwards

Living A Life I Love Books

It’s been a few months since the last entry. I’ve been experiencing significant professional changes that I took some time off from the writing. I’m happy to say I’m back. I’m excited to say, “We’re back.” Over the next few months, two additional authors will be joining me in posting to the Sexual Health Institute Blog.

David Delmonico, PhD is an associate professor Duquesne University where he teaches in the School of Education. Elizabeth Griffin, MA is a therapist in private practice. Together the two of them run a consulting company “Internet Behavior” addressing Internet Sexual Compulsivity among many issues. They previously published a workbook on Internet Compulsivity that is since out of print. While we’ve known each other for years, we recently reconnected. The positive synergy resulting from our interactions led to a decision to collaborate on the new workbook. The material will integrate concepts and content from our respective work. While there may be some overlap with our previous work, much of what is in the workbook will be new and tailored to treating Internet Sexual Compulsivity.

The future blogs will reflect some of the “brainstorming” and ”first drafts” in the conversation as we develop and edit the book. As always, our commitment is to make a difference in the world and sharing the information in this venue allows anyone access to the material. Your help and suggestions are welcome. If you see something missing let us know.

Until the next post, be safe.

Wednesday, July 29, 2009

New Era of HIV prevention needed.

HIV prevention has had two previous "eras" of prevention. When HIV/AIDS first broke, the primary message was "don’t get HIV or you’ll die." This era was before the time of effective medication (pre-1996). Once the field discovered some basic medications, the second era of HIV started where prevention attempts had an implicit assumption that we would be able to eradicate the spread of HIV.

However, today we need a third era of HIV prevention and I honestly don’t have the answer on what the new era should look like. We need an approach that affirms the importance of HIV prevention without using fear as the primary motivator. We also need to acknowledge the reality that HIV is no longer considered a deadly illness but is now a chronic illness. Don’t get me wrong; HIV is extremely serious, but, we might be able to learn from other prevention programs, smoking for example, in developing better HIV prevention.

We also need to see risky sexual behaviors as a symptom rather than the problem. Co-occurring problems such as drug and alcohol use, mental health concerns, sexual compulsivity, and poverty are but a few of the related issues that need to be addressed in prevention.

Please don’t start a flame-war by attacking other respondents, but I’d like to hear from you.
How do you think our community should move forward?

Thursday, July 2, 2009

The dilemma of outing "closeted" LGBT

A few of the stories in the recent posts highlighted how individuals were outed to help them in the coming out process: friends and/or family members told other people to "help them along." To someone in the closet regarding his or her sexual orientation, the biggest fear is the exposure of the secret. This is known as "being outed.” Simply the fear of being outed has sent more than a few individuals back into the closet.

The rise of outing people partially occurred in the 1980s in response to the AIDS epidemic, particularly when "closeted" individuals worked against the best interests of the LGBT community.

Much of the current debate, and one which the paparazzi feeds on, is the fascination the general public has with people's sexuality. Adam Lambert is a very recent example of this. Throughout his time on "American Idol" questions about his sexuality were raised not only on individual blogs but also in the mainstream press. The recent Rolling Stones article highlights the culmination of the process where Adam Lambert responds to the ongoing reaction. The dilemma raises the question of whether or not a public person like this has a "right" to privacy.

The biggest reason against outing others is their right to privacy. When a person is outed his or her privacy and freedom to chose the method of coming out is violated. In the first article in this series, I highlighted how the coming out process is a personal process that should reflect the individual’s needs. Outing ruptures this process and can interfere with his or her personal growth.

One of the justifications for outing people, so the argument goes, is because of hypocrisy. For example, in 2006, Ted Haggert was publically outed for same-sex behavior with a sex worker. At the same time, Ted Haggert was the senior pastor at a fundamentalist church that was outspokenly anti-gay and openly hostile to the gay community. The argument is that because of the hypocrisy, he deserved to be outed. Haggert is but one example, and the list could continue.

What are you opinions about outing people? Have you been outed? What was the outcome?

Saturday, June 27, 2009

Are you a counselor or a minister? -My 100th post

A student of mine recently referred to homosexuality as abomination quoting the traditional scriptural references. Given the context, I sternly but respectfully challenged the student to address the cultural bias in his statement. The fact that it occurs in a graduate level course on multiculturalism is a “small problem” (tongue in cheek!). The fact that the program is a Mental Health Counseling program is also a “small problem” (tongue in cheek, again!).

What I would love to say to my students is that they have a choice. You can choose to be a counselor or you can choose to be a minister. If your choice is to be a counselor, you must base your practice on the science of psychology. Being a counselor means that your theology may inform your psychology, but it does not dictate your psychology.

If, in any way, your theology dictates your psychology, you are a minister. Stop the illusion of being a counselor. While I may disagree with your theology, I respect your right to choose a life as a minister. But don’t use the guise of psychology to push your theology. That is malpractice and unethical in my opinion.

The area of human sexuality is where the most damage occurs when theology is confused as psychology. The science of psychology is relatively settled when the issue of abstinence based safer-sex approaches are evaluated. They programs don’t work. In some cases, they create MORE harm.

The question of homosexuality is another area. Despite the research, too many counselors continue to subscribe to the abomination theory of homosexuality; a theory that is simply not supported. You can extend the conversation into areas of masturbation and fantasy.

Are you a counselor or a minister? Choose.

Friday, June 26, 2009

Staying Sober: Tips to stay on the wagon

Dear Dr. Weston I noticed on your bio that you work at Pride Institute so I thought you might have some ideas to help me. I've been in and out of recovery for the last 6 years and just haven't been able to stay clean. I've been sober for about 9 months now, I go to my meetings, but I'm getting way too close to relapsing again. Got any help?

Although your dilemma is bigger than what I can tackle in a simple online article I believe there are two immediate things you can do that may begin to help you.

  • First, you need to identify the "payoffs" of using drugs.
  • Second, identify ways to get these "payoffs" in healthy ways.

Pay attention to the payoffs of your continued using. Counselors do a good job identifying the "consequences" of use. I'm sure you can identify your laundry list of horror stories about what has happened as a result of your use. All behavior is goal focused, including drug use, so I think it is important to focus on the payoffs of using as well. Someone who is using has a belief that a real or perceived payoff will result from the drug use. As you can probably recognize, the payoff is usually temporary.

I think about payoffs on three levels.
The primary level of payoff is the result of the actual drug use. For example, I'm bored and have nothing to do. Getting "high" is something fun to do, at least for a while.

A secondary payoff refers to an outcome that also happens. It might be a helpful consequence of the use. Many meth users experience significant weight loss as an outcome. For individuals struggling with body image, when they start to get sober they struggle with the weight gain.

The third type of payoff is difficult to recognize. It's also important to think strategically. The following example might be helpful. This level of payoff doesn't make sense to those watching on the outside, but on the inside, the payoff is that ongoing use gives the person the illusion that they are in charge of how messed up their life is. "I know drugs are bad, and that's why my life is so messed up." The outcome is that "I'm to blame." What makes this type of thinking so dangerous is the use of the fact that when a person's life is out of control, it is justification for additional drug use.

Finding healthy ways to get the payoffs

Primary Healthy Payoff
Looking first at the primary level payoff, we need to talk about filling your time with healthy friends, sober fun and other personally meaningful activities. You have to develop plans and social networks where you can have healthy fun without using. Additional Healthy Payoffs

If, for example, body weight becomes a problem, developing a healthy body image is also part of the treatment plan. If you are self-sabotaging your recovery because of low self-esteem, it's important to address the belief that you have no control in your life. A person needs to get a sense of an internal source of power. In my opinion, these three payoffs require a lot of work and effort. This is why therapy may be helpful.

If you find that you continually relapse, professional help might be necessary.

The question I'd like to hear about is "What healthy ways have you developed to get your needs met?"

Wednesday, June 24, 2009

Do I have to be out

How does coming out fit into our identity? The question of coming out raises the issue of private and public personas. How much of our life is private and how much is public. This public side of our identity is the stuff we show with most people. Obviously, the private side is the part of our self that we keep "close to our chest."

There are many reasons for not disclosing sexual identity. For some people it's about safety. I've worked with people in the corrections field who suggest that coming out in prison is not a safe place. Then there is the current military policy of "Don't Ask, Don't Tell" which highlights the consequences of coming out. And still today, in some countries, coming out risks a death sentence.

Some people choose not to be out for other reasons such as privacy, financial or familial. Others believe we have arrived at point in history were the need to be out simply doesn't matter anymore. We've made so much progress as a group that we simply don't need to push the issue any further.

On the other hand, there are people who encourage everyone to be out. There is often an implicit assumption that being out is a healthy expression of a LGBT identity. The assumption is you need to "embrace" your sexuality. Being out is a statement that being gay is OK. A major step toward personal growth is the affirmation of all aspects of a person's life.

Then there is the idea that being visibly out is a public statement and as a result helps to encourage public acceptance thus creating a safer environment for those who come out later. The modeling behavior attempts to provide support and encouragement of this aspect. In my opinion, the stories shared over the last few similar articles highlight the benefits of coming out. In those stories others found support and encouragement for their process.

Being out is also a political statement. Since at least the 1950s, individuals have stressed the political aspect of being out as a confrontation to the straight world. Stonewall and the subsequent 30+ years of Pride Celebrations reflect coming out as a political claim. Harvey Milk and the 2008 movie is a recent expression of the political impact of coming out; his witness transformed the political reality of both San Francisco, and eventually the world. Obviously we're not done with the political nature of equality; coming out is a contribution in small and large ways to ongoing political discourse. As a group, the more visible we are, the less they can ignore us.

This post is a start of the conversation. What are your thoughts? Should a person be out and why?

Monday, June 22, 2009

Starting the coming out process

It is sometimes easy to forget that our community is diverse. We are comprised of individuals at different places in the coming out process. The coming out process is a remarkably individual thing and each of us will move through the experience in our own way. It is important to remember that each of us chooses the method of our coming out. For some people, this will be a relatively "easy" process while others will have a significant struggle.

An important tool is breaking through the isolation and shame of sexual orientation by sharing our personal story and listening to the stories of others. The public stories shared on the website as well as some of the emails I received highlight how important this is for many people. I'm moved by the amount of pain, fear, shame and guilt many people still struggle with in their process of coming out. I'm also moved by the courage expressed in the stories that can serve as inspiration to others.

While our stories are unique, it may be helpful for our individual growth by understanding the experiences of others. Hearing what worked or didn't work can be part of our growth and development. I think the responses highlight some of the things that helped. I encourage those who are earlier in the process to learn from you brothers and sisters.

Our coming out process is a repetitive process. Sadly, this means coming out is not a "finished product." When we meet someone new, or start a new job, or talk about what we did last weekend, we come out yet again. In each of the situations, we may go through quicker versions of the process. When I speak publicly, I often come out to the group. Almost every time, I have to go through process of identity comparison/tolerance. For me it occurs by wondering if the will they compare me to the stereotypes. I wonder if they are accepting enough, or will have to justify myself.

Coming out is only one piece of the puzzle. Implicit in the comments are references to many other topics. For any number of reasons, the coming out process is directly related to concerns such as guilt, shame, spirituality, risky-sex, and chemical use. Coming out will necessitate addressing these issues; and addressing these issues will also facilitate coming out.

What is the one thing you wish you knew in your coming out process?

Wednesday, June 17, 2009

Nice plug for my book from Planetout.

Click on the link to see the article on about my book.


Friday, June 12, 2009

Coping with Grief in a Relationship

The responses on my recent articles "Do all gay men cheat?" and "Are you really over your ex?" brought to light a level of hurt and grief many people experience but may not understand. As you looking toward the future and new relationships, it may be helpful to address feelings of grief and loss.

I like using analogies in my work because they can help make things easier to understand. Consider the analogy of the relationship between Luke Skywalker and Darth Vader in the Star War movies Empire Strikes Back and Return of the Jedi as a way to highlight how people cope with grief. (I realize I may be starting to date myself by picking the analogy!)

For a brief reminder, in the series the enemy, Darth Vader, says to Luke those famous words "Luke, I am your father." Luke's response is "NOOOOOOOOO" and rather than surrendering to Darth Vader he falls to what he thinks is his death only to be rescued at the last moment. The pain in Luke's yell and the desperation that leads to the fall highlights the power of denial in grief and loss. When a relationship ends, the loss leads to the emotional fall. Rather than deal with the truth, we may run away and avoid the reality of the loss.

A few scenes later, Luke is talking to Obi Wan Kenobi saying, "Why didn't you tell me?" The tone of his voice is clearly anger. In this case, the anger is not "explosive yelling" but "cold simmering." The "how dare you look" that can send shivers down a person's spine. In my opinion, the cold simmering is a scarier expression of anger than explosive reactions.

In that same scene, Obi Wan responds to some of the questions by saying "from a certain point of view" the good person of your father died when he became the bad guy. He is introducing the concept of bargaining in coping with the grief of relationships.

As you look at your last relationship, from a certain point of view, it may be better to be out of the unhealthy relationship. Sometimes we may want to avoid the unhealthy aspects of the old relationship simply because we don't want to feel the grief. Moving toward health is to recognize that sometimes the end of a relationship might be healthy.

Near the end of the 3rd movie, Return of the Jedi, Leah asks, "What's wrong?" Luke's response is "Ask me later." Sometimes in the grief process, we simply don't want to talk about it. It may be too painful or take too much energy.

Luke also exhibits the final stage of grief, acceptance in the Return of the Jedi. Luke has come to acknowledge Darth Vader as his father. The acceptance doesn't lead to paralysis but instead turns into action to save the good guys from the evil Emperor. Luke's grief has even been transformed into action to save his father. In the same way, once we have addressed the grief, we get to the point where we can live a full life. We are also able to relate to others in a healthy way. And the past relationship isn't necessarily in the way of our next relationship. We may even be ready to reach out to our ex from a place of love and concern.

If you are coping with grief regarding a previous relationship, where do you see yourself? What can you do to move forward? Oh, and may the Force be with you!

The workbook is Live!

I'm pleased to announce that my first book is now available.

Living a Life I Love:™ Healing sexual compulsivity, sexual addiction, sexual avoidance and other sexual concerns is designed to help you create a life you love in the area of sexuality. The workbook will help you understand your "acting out cycle" by identifying your high-risk situations, feeling triggers and thinking errors. The workbook has three stages:
1. Problem identification: During this stage, you examine your sexual behaviors, sexual history and acting out cycle.
2. Primary treatment addresses factors linked with unhealthy sexual behaviors.
3. Creating your future: The third stage will help you reach out for support and encouragement. You'll complete a personal definition of sexual health to help you live a life you love.


Saturday, June 6, 2009

Sexual Health For All/Pursuit of Sexual Happiness

Why start a second workbook.

Shortly after completing the first workbook, I started this edition. The workbook evolves from the request of “I don’t have a problem, but I want to learn more.” I struggle with some of the topics, but I’m not compulsive/addictive/avoidant, simply unhappy in the realm of sexuality. While people used the compulsivity workbook, it wasn’t really the best fit. Thus started this workbook.

More than 100 years ago, Williams James highlighted the concepts of once-born and twice-born people. The once-born rarely considers evil, or even imperfections within the self. Once-born are not naïve. They simply have a perception of their identity that is straightforward and direct. The application of these concepts to the field of sexuality is very helpful. Once-borns never think about sexuality, it’s not any issue. They simply exist as sexual beings and usually have a level of contentment that the second-born never experience. If you have the advantaged of being once-born, congratulations.

Twice-born individuals, however, have the opposite experience. For any number of reasons, twice-borns struggle in life. Life is something to understand and challenge. The inner conflict is an integral part of the difference. As you could guess, the conflict extends to the realm of sexuality.

This workbook is committed to both once-born and twice-born. For the once-born, I hope to provide resources to help you understand the diversity of sexuality, and the richness that can develop in response to discovery.

For the twice-born, I empathize with your journey. I too have journeyed the depths of confusion, despair, frustration and paralysis. I would add, however, that integration and happiness is possible. “Living a life I Love” is possible, just like the once-born. This workbook is designed to provide a breadth of information in your journey. When you find a topic particularly relevant, seek out more information.

Often, when a once-born and twice-born are partnered, the probability of conflict is extremely high. The once-born simply doesn’t understand the difficulties. This understanding isn’t out of ignorance or avoidance, or minimizing. They simply don’t understand. Hopefully reading and working through these topics you will understand your partner. My hope is to help you both develop the wherewithal to provide and facilitate mutual understanding, respect and love.

Thursday, June 4, 2009

Coming Out Gay

One of the more disappointing reactions I saw in the comments left on the "Can Someone Choose To Be Gay?" article is the judgmental attitudes towards those who aren't completely "out". I think we can help our community and ourselves by better understanding that the coming out experience is different for each of us. The ability to label one's self as "gay" varies person to person. Some people "know" from an early age; others "know" at a later time in their life. For some people this process is easy. For others, the coming out process can be very difficult.

One of the first researchers in this area, Vivian Cass writes the model I like best.

Stage 1 - Identity Confusion
The classic phrase at this point is simply "Something's not right, I'm different." Sometimes we simply lack the language to describe how we know something is different. Many people talk about knowing at a young age that they knew. How we respond to this statement separates people who come out quickly or those who take a while. For any number of reasons, some people get stuck and shut down. Others get a sense of what "I'm different means" and they start to put the pieces together.

Stage 2 - Identity Comparison
The question becomes "Is there anyone else like me?" This process is where we might start to understand the label "gay" or "homosexual" by hearing things on TV, seeing others, hearing snippets of conversations, or even getting teased. Others say something that helps us "click" into a new level of understanding. A lot of this stage is about coping with feeling alone or coping because we lack the information. This stage is about getting enough information.

Stage 3 - Identity Tolerance
In this stage, there is a sense of initial self-recognition where we can say "I probably am gay." The internal denial decreases, but I don't interact much with those around because I'm so "different." This is the classic "in the closet stage" where I act straight to create a "mask" and hide part of myself. It is also a stage where a person will react negatively to certain stereotypes saying, "I'm not like them." "Them" are the stereotypes which might be the leather community, the drag community or the "fems." In this stage, the internalized stereotypes have the most negative impact on the individual's coming out process. Getting through this stage is about confronting and challenging the internal messages.

Stage 4 - Identity Acceptance
Finding other gay men and women as friends and role models is important. This was difficult for older generations; in my opinion in-school groups and TV images makes this easier now. Those individuals fortunate enough to have access to support groups and/or social events often experience a sense of self-acceptance. Guys start to ask, "How do I want to live my life as a gay man."

Stages 5 - Identity Pride
In this stage, there is a sense of "this is who I am." The pride of being gay starts to show, and the disclosure to others is a commonplace occurrence. In some people, the pride even becomes militant: 'I'm here, I'm queer, deal with it." There is sometimes a rejection of the "straight" world: "I only want to be with people like me."

Stages 6 - Identity Synthesis
Being gay in this stage is simply part of my life. Individuals move from a "them and us" mentality into an acceptance of the similarities between the heterosexual and homosexual worlds. We are all dealing with life issues that are more similar than different: Is my job secure? How am I happy in the world? What's important to me? How do I find someone I love? And believe it or not, the relationship issues are more similar than different. We are all striving for intimacy.

I want to restate this; it's important to keep in mind that we don't all move through this process at the same speed. The men and women at earlier stages in this process aren't helped by "pushing" them through it faster no matter how well intended you are. They have to take it at their own pace.

What does help is to honestly answer their questions and to not judge them for not fully embracing it. What can help is to share your coming out process. Whether it was a good experience or not others reading them may find themselves in a similar situation and use your example as a means to make it easier for themselves. Hopefully they will share their story with others, which in turn will help to make their journey easier.

What's your story?

BDSM, Abuse and Sexual Identity

I have a question pertaining to BDSM and sexual orientation. I am a straight male who has on some occasions fantasizes about being submissive to a dominate, older man. I don't look at men in a sexual way. I am never attracted sexually to a man be it on the street, gym, in school, or wherever. I am very attracted to women and I currently am in a healthy heterosexual relationship. However, these fantasies are very confusing to me. If I am not gay, or attracted to men, why do I have these fantasies? My father was a strict disciplinarian, where being tied up and spanked naked as a child was the norm if I miss behaved. Could this stem from this? I need help and I thank you for your time.

My response:

This is a very complex question raising a number of issues. I don’t think I can answer your question with any sense of finality. As a starting point, I would have you think about the following three issues.

1) BDSM is separate from sexual orientation. Why do you like BDSM? Part of that answer appears to be the concept of submission, and what can be more submissive than a straight man submitting to another man. I would guess that the act of submission is the turn-on, regardless of the gender of the partner. In the fantasy you highlight the ultimate submission a guy can experience.
2) Not every sex act between two guys means the person is gay. There are many circumstances where a “straight” guy will have sex with another guy. A colleague highlights 20 reasons here: Included in his list are examples that parallel in your fantasy.
3) The question about your abuse history does warrant further review. I don’t think the abuse is why you like BDSM. Rather because of the enjoyment of humiliation, you start to remember past experiences where you were humiliated including the abuse you describe. Given my limited understanding of your history, I highlight that this is speculation at this point. I would encourage you to work with a therapist on this issue.

Wednesday, June 3, 2009

Why do people cheat?

Why do people cheat?

The recent post on “Do all gay men cheat?” resulted in a cross section of great responses. In summarizing the conversation, I highlight three themes from the conversation.

Cheating is not limited to gay men.
The phenomenon of cheating is not limited to gay men as I was reminded in the conversation.

What is cheating depends on the rules of the relationship.
The responses highlight how many individuals successfully negotiated relationship guidelines and expectations.

Monogamy remains a strong expression and desire.
The key for monogamy is an open and honest conversation between partners regarding their interests, desires and hopes in the relationship.

A follow up to the question of “Do gay men cheat” is the question “why do people cheat.” As you might expect, there is no easy answer. The answer parallels why do people have sex. A recent journal article identified 237 reasons why a person may have sex. After analyzing the data, their research identified four groups of reasons of why people have sex.

Physical reasons
The guy is looking for some type of physical payoff. This can include getting off, but it can be about seeking different experiences. Another theme is that the other sexual partner is physically desirable. Finally, there are physical payoffs such as stress reduction or boredom that leads to sexual behavior.

Goal attainment
In some cases, people have sex to obtain a goal. Sexual behavior is a means to an end. This might be around survival sex (I need a place to live.) It can include the “badge of honor” when a person can brag “I had sex with him.” In some cases, it is about getting revenge. Finally, it is about getting resources such as money or drugs.

Emotional reasons
For many people, sexual behavior is about love and commitment. It is the expression of intimacy shared between two individuals. In our society, monogamy emphasizes this reason for having sex. The lack of a satisfying emotional relationship may lead to sexual contact outside the primary relationship. To be fair, in some cases, the emotional connection isn’t limited to monogamous sexual relationships.

Insecurity reasons
The final cluster of reasons people have sex is around insecurity/self-esteem. “I feel so insecure, I will have sex with anyone.” “Or, this hot guy wants me.” “I couldn’t so no.” I may also think that I have to have sex because it is expected. The recent blog on dating myths highlights how expectations play into dating and sexual behavior.

Why do you think people cheat? If you cheated, why do you think you did?

How do I know I'm straight or Sexual Identity Development for all.

Identity is a statement “this is who I am.” In the process of clarifying identity, individuals go through a process of reviewing aspects of their lives sorting through events responding “like-me/not like me.” While this is an oversimplification, identify development is the attempt to both define and understand who we are. Obviously this also occurs in the area of sexuality. Previous blog entries highlight the sexual identity development for LGBT individuals, but there an interactive process that everyone goes through in forming their understanding of their sexual self. The purpose of this entry is to summarize this process and the tasks that everyone addresses in forming sexual identity.

The process consists of five dimensions.
1) Unexplored commitment reflects the fact that many people simply don’t think about the topic of sexuality.
2) Active exploration refers to the process of seeking information regarding sexuality. This dimension addresses the six tasks below. The person actively seeks information via the Internet, therapy, friends, family, society, etc.
3) Diffusion reflects a time of struggle and confusion. “What I thought I know is no longer the case.” This is a time of rejecting social norms about what I should be, and a time of exploration sometimes through trial and error.
4) Deepening and commitment of the identification of the individual’s likes and dislikes and an increased level of comfort with the self. For many people who identify of “straight” this may be occur without the exploration and diffusion dimensions.
5) Synthesis is a process of integration of all aspects of the self. There is an internal congruence between the self, values, behaviors, likes and dislikes. There is also an integration of the sexual identity with all other aspects of the person’s life including gender, racial, religious, and familial.

During the process, all individuals need to address the following 6 tasks.

1) What are my sexual needs?
Sexual needs are defined as a desire, appetite, biological necessity, impulses, interest, and/or libido with respect to sex. How much sex do I want, what are my levels of interest, etc.
2) What are my sexual values?
Sexual values are defined as moral evaluations, judgments, and/or standards about what is appropriate, acceptable, desirable, and innate sexual behavior.
3) What do I like?
I need to know what behaviors I like to engage in relating to or based on sexual attraction, sexual arousal, sexual gratification, or reproduction (e.g., fantasy, holding hands, kissing, masturbation, sexual intercourse).
4) Who do I like?
I need to figure out what are the physical, emotional, intellectual, interpersonal, economic, spiritual, or other attributes of a sexual partner.
5) How do I let others know?
This involves my skills in letting others know I’m interested. This can include verbal or nonverbal communication, and direct and indirect signals (e.g., flirting, eye contact, touching, vocal quality, compliments, suggestive body movements or postures).
6) How do I label myself.?
This is related, but different from “who do I like.” “Who do I like” refers to the attractions, but sexual orientation identity is how I define myself. This is self-defined, whether or not it is shared with others. Examples include heterosexual, straight, bicurious, bi/straight, heteroflexible, pansexual, kink, questioning, bisexual, gay, lesbian, and queer, among others.

For more information see:
Worthington R., Bielstein Savoy, H., Dillon F., & Vernaglia, E. (2002) Heterosexual Identity Development: A Multidimensional Model of Individual and Social Identity The Counseling Psychologist 30; 496 DOI: 10.1177/00100002030004002

Sunday, May 31, 2009


Yes Virginia, there really is bisexuality.*

The recent opinion editorials and responses highlight how much of a flashpoint this topic is in the LGBT community. As fun as it is to banter about, what does the research suggest? In the case of bisexuality, the picture is “Yes, there is bisexuality.”*

Every once in a while the research makes the picture more confusing. The “*” requires us to look at the fine print. The fine print almost always requires a clarification of what we mean by the term “bisexual.” The lack of precision in understanding the term is the source of much of the confusion.

Starting with the granddaddy of psychology, Sigmund Freud defined bisexuality as the ability to get sexual pleasure from a male or female. Strictly speaking, he emphasized genital satisfaction and suggested since all of us can be sexually stimulated by anyone we are all bisexual. Obviously, this view has significant limitations.

The concept of “situational sexuality” applies Freud’s theory. This is behavior where a “straight” guy engages in same-sex behavior. This type of behavior is often present in prisons, same-same sex institutions and other times when the only available partner is the same sex. Other times include when a person is under the influence of chemicals or is engaging in compulsive sexual behavior. Joe Kort, a noted gay author, talks about 12 types of situations where this can occur. You can read more at

In a similar way, a “gay-guy” can engage in genital contact with a woman. Men who consider themselves gay have sex with women for any number of reasons, ranging from wanting children, denial of their orientation, social pressure or various other reasons. This is why researchers emphasize same-sexual behavior versus same-sex identity. Behavior is what I “do” whereas identity is how I see/label myself.

The fact that we perform sexually with anyone raises a problem. Using an analogy, simply because it looks like a duck, walks like a duck, and quacks like a duck doesn’t mean it’s a duck. If it is not a duck, what else could it be?

Many people in the coming out process misuse the term bisexual. It's their way of attempting to minimize their gay identity as they come to terms with a same-sex identity (see “identity tolerance” in the coming out process: This part of the coming out process is where I think the most damage is done to those who have a true bisexual orientation. I wonder if the reaction to the question of bisexuality is a projection of “been there, done that” assuming that anyone who says they are “bi” is “doing that” as well.

Moving away from a view of sexual orientation as an "either/or" idea, the “granddaddy” of sexuality research, Alfred Kinsey developed the “Kinsey” continuum to highlight attraction on a scale of 1-6. Typically “straights” score themselves 1-2 and “gay/lesbians” score themselves 5-6. In the middle are those who are attracted to the both sexes, the “bisexuals.” Kinsey’s research estimates about 4.1% of women and 9.6% of men are bisexual. Another major study (National Health and Social Life Study) estimates 3.3% of women and 5.8% of men identify as bisexual.

Another way to confuse the picture is to think about sexual orientation beyond simply genital expression, and look at many different variables. One researcher uses 7 different variables to define sexual orientation such as genital behavior, attractions, emotional attraction, etc. An extended conversation of the seven variables probably isn’t helpful, but you get the idea that the answer to bisexuality will “depend” on how you ask the question.

So, yes, Virginia there really is bisexuality.* But this is just the start of the conversation. It is important to read the small print.

Additional reading: For those who want to get into the details, a great summary of the research is: Rust, Paula C. Rodríguez (2002) Bisexuality: The state of the union. Annual Review of Sex Research, 13. 180-240.

Saturday, May 23, 2009

Types of Relationships

Culture is very powerful in shaping our view of what is a healthy relationship. Our current culture emphasizes that sexual behavior should occur within a monogamous relationship, and that only monogamous relationships are healthy. How much do you agree with this expectation? In fact, there are a multitude of different types of relationships. Sexual health requires that you clarify the type of relationship you want. This is a controversial opinion where other clinicians may legitimately differ. The primary approach taken in this book is that you have the responsibility to choose the type of life you want to live regarding sexual expression.

As a summary, I highlight three types of sexual relationships:

Celibacy is a choice to not engage in any sexual contact with anyone. How people define celibacy varies. There are opinions saying that any sexual expression including masturbation, fantasy and use of sexually explicit material would be unhealthy. Other opinions focus celibacy as not allowing any genital contact with another person. Some religious traditions impose celibacy as the only form of sexual expression for groups of people (usually LGBT individuals or non-married straight couples). Also, some religious traditions impose celibacy as a discipline in order to for a person to qualify to be a minister in that tradition.

Rightfully understood, however, celibacy is less about telling yourself “you can’t do that” and instead emphasizing something greater in a person’s life. Celibacy allows a greater commitment to the major focus in a person’s life. In this approach, celibacy is believed to facilitate other types of intimate relationships. Many religious traditions have identified celibacy as a “gift of the Spirit” referring to it as a gift from God. In my opinion, a healthy expression of celibacy is possible. It does take a bit of work and self-understanding. And celibacy doesn’t “turn-off” the sexual energy within a person. If you choose this, you must find healthy ways to channel your sexual energy. It is very important for celibacy to be chosen for the right reason. In my experience, I’ve run into many individuals who “choose” celibacy out of fear, a history of abuse, or low self-esteem. If these are the motivating factors for choosing celibacy, it is only a matter of time that any commitment to or vow of celibacy will be broken.

Most of this workbook is built on the assumption of monogamy that is typically defined as sexual contact exclusively between two individuals within some type of committed relationship. Even this definition has different interpretations resulting in confusion and conflict. For some people, monogamy is expanded to prevent any emotional relationships with anyone but the primary partner. Some opinions of monogamy also see any use of sexually explicit material as a violation of the monogamy rule. As expected, in these examples monogamy is less about an expression of love but an expression of fear and attempts to control the partner. There is a decided lack of trust.

Healthy monogamy, in my opinion, is about trust and commitment. It’s working with your partner to put the other first. And paradoxically, in putting the other first, your needs are simultaneously met (partially because the other is putting you first). Monogamy isn’t passive, but requires tremendous amounts of work. The workbook is designed to start the necessary conversations regarding healthy monogamy.

Open Relationships
A final type of relationship discussed here is open relationships (typically defined as a relationship where there exists a primary sexual and emotional partner followed by a secondary partner or partners). Even within this concept there is a variety of definitions and expressions. If you choose an open relationship it is important for you and your primary partner to clarify ground rules and expectations. When, where, with whom and how often are all topics to be addressed. What are the plans for communicating and coping with fear, jealousy and insecurity? What are the safer-sex rules?
If you want an open relationship, examine what unmet needs (if any) exist within your primary relationship. Significant reflection should occur within your support network to clarify the reasons you want an open relationship. In particular, be careful that you are not simply trying to get out of the primary relationship. If the primary relationship is not healthy, it is important to address the issues first. If it should end, do this with integrity instead of forcing a rift that ends the relationship. One requirement is that all partners be open and honest in the conversation. Both partners must agree with a sense of internal integrity with any decision. It might be better to end a relationship than agree to a type of relationship that is inconsistent with your values.
Sexual satisfaction is a major component of overall relationship satisfaction. Research has repeatedly stressed overall health is connected to relationship satisfaction. If you continue to struggle in this area, I strongly recommend seeking additional help from a qualified professional.

Can I choose to be gay?

I have a question I know is sure to be controversial but I have to ask. Based on my experiences as a gay man and from relationships I have been in with men identifying as gay, I have often wondered if it is possible that some people CHOOSE to be gay. I was recently in a relationship with a man who said he was gay but had a previous relationship with a woman. One night while we were dating, he revealed to me that he had been violently raped by his older brother when he was growing up. He said he believed he was always gay and the traumatic event did not make him gay. Nonetheless the story disturbed me and left me questioning the idea that some people may become gay as a result of some kind of childhood trauma. To add to my confusion, the man I was dating called me one day to tell me the woman he was previously dated asked him to come back to her and that he decided he wasn't really gay after all.

This a great question; it’s a the real-life “hot-potato” question that leads to intense conversations and much confusion. The causes of sexual orientation are unknown. Any theories as to why a person might be gay usually don’t work for another person. A great analogy is what causes “left-handedness.” We simply don’t know what causes a person to be left-handed. What we do know about left-handedness is that people are this way from birth, usually have a stable predominant hand, and can use their other hand as well.

This analogy can be helpful in many ways. Just like a kid starts to use his left-hand more often, and sees that he is different, people with a gay orientation recognize something is different. Sexual orientation is stable from an early age. What appears to change is our awareness of our orientation.

For some people who are left-handed, they are trained not to use that hand. So too, many people are taught not to express any same-sex orientation and play it straight.

In some cultures, giving something to another person using your left hand is a cultural insult. There is a lot of pressure to conform to the cultural expectations and use your right hand. In a similar way, gay people have a lot of pressure to “play straight.”

A few people are ambidextrous, meaning they can use both hands with equal dominance. So it is with sexual orientation; there are some people genuinely attracted to people of both genders.

When someone experiences damage to the dominant hand, they can learn to use the other hand to compensate. Given various circumstances, a straight guy can have sex with a guy, and a gay guy can have sex with a woman. This is simply an expression of sexuality; it doesn’t change the initial orientation.

The left-handed community has experienced significant stereotypes over the years. As a result, there is “left-handedness pride” (seriously, there is!). You can see the analogy to gay pride. (link:

All in all, I don’t know what’s up with your friend. It would be unethical for me to even guess. What I would say is that there are many different factors that impact a way a person chooses to express sexuality. This is the key. My orientation is stable, but I choose to engage in a variety of different behaviors.

Integration with the 12-steps

I'm still adding a few ideas now and then in the new workbook (so much for being done!). This was a requested topic. "How do the 12-steps and the workbook overlap."

All of the topics listed here are in the blog...the order is a bit confusing. The page and topic numbers refer to how the new workbook has been reorganized.

One of the more common ways that people address sexual compulsivity is using the 12 steps. I see the workbook and 12-steps as complementary. In fact, I created the first draft of the workbook for a 12-step chemical dependency program where I work as the Director of Program Development. The first task was to develop a Sexual Health Program within a residential and outpatient CD program. The following is how I think the 12 steps overlap with some of the topics in the workbook.

1. We admitted we were powerless over sexuality—that our lives had become unmanageable.
Topic 1: Immediate Short-Term Prevention Plan, page 11.
Topic 3: Sex History, page 15.
Topic 5: The Acting-Out Cycle, page 23.

2. Came to believe that a Power greater than ourselves could restore us to sanity.
Topic 37: Spirituality, Values and Sexual Health, page 144.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
Topic 39: Creating Your Future, page 160.

4. Made a searching and fearless moral inventory of ourselves.
Topic 3: Sex History, page 15.
Stage 2: Primary Treatment: Related Topics, page 57.
Topic 24: Abusive Behaviors Toward Others, page 106.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Topic 2: Talking About Sex, page 13.
Topic 40: Toward a Personal Definition of Sexual Health, Component 1. Talking About Sex, page 165.

6. Were entirely ready to have God remove all these defects of character.
Introduction to the Workbook, page 1.
Defining Sexual Compulsivity, page 2.
Topic 7: Thinking Errors, page 28.
Topic 8: Primary Thinking Error, page 33.
Topic 9: Feeling Triggers, page 36.
Topic 10: High-Risk Situations, page 38.

7. Humbly asked Him to remove our shortcomings.
Defining Sexual Compulsivity, page 2.
Topic 37: Spirituality, Values and Sexual Health, page 144.
Topic 38: Continuing Care Plan, page 150.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.
Topic 3: Sex History, page 15.
Topic 24: Abusive Behaviors Toward Others, page 106.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
Topic 36: Disclosure to Partners, page 140.

10. Continued to take personal inventory and when we were wrong promptly admitted it.
Topic 1: Immediate Short-Term Prevention Plan, page 11.
Topic 13: Logging your Sexual Behaviors and Fantasies, page 48.
Topic 38: Continuing Care Plan, page 150.
Bottom Line Behaviors, page 158.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His Will for us and the power to carry that out.
Topic 6: Power of Thought, page 25.
Review and Repeat, page 174.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to others, and to practice these principles in all our affairs.
Topic 39: Creating Your Future, page 160., page 174.