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.