Saturday, December 11, 2010

Others as a reflection of your desires

The inside functions like a projector; others become screens and you start seeing films on others which are really your own tapes. OSHO

What we like and dislike in others reflects our inner core. This is a classic psychological principle that also applies to sexuality. That to which we are drawn reflects an inner craving that we must address. That to which we are rejecting also reflects an inner craving that we must address. As posted in earlier blogs, much of the way many individuals cope with sexuality is through repression resulting in a passive suicide. Take the opportunity to discover about what you crave by becoming mindful of your reactions to others. Your strongest reactions reflect a deeper truth. An open, honest and fearless examination of those reactions might create profound transformation and possibility.

The book I'm using a source.

Sunday, December 5, 2010

Cybersex Unplugged

Click the title to follow the link!

Yeah....It's "done" ---almost! Today I submitted the first full draft of Cybersex Unplugged to the editor! What remains is the final editing, and updating in response to editorial comments. However, the content is complete. The goal is to have the book published by the end of the year. Our goal was 6/30/10, and we only missed it by 6 months. I always underestimate the time necessary to complete these tasks.

Friday, December 3, 2010

Transforming Sexuality

Positive Sexuality

Anger is beautiful; sex is beautiful
But beautiful things can go ugly.
That depends on you.
If you condemn them, they become ugly,
If you transform them, they become divine.
Anger transformed becomes compassion
The same energy that moves into sex becomes love.


One of the most difficult aspects of transforming sexuality is the struggle to address the shame of sexuality. Our society has so many sex negative messages that it impairs many an individual’s journey toward sexual health. To transform your sexuality, become aware of the negative messages. Challenge these negative messages. Affirm your sexuality. Celebrate and Share your sexuality. Then you transform a burden into a gift.

The book I've been reading/using. You can download a kindle program for any platform.

Thursday, November 18, 2010

Your plan for sexual health in an electronic world

The last assignment of the up and coming workbook, Cybersex Unplugged is finished. All that remains is the editing. Coming soon!

Our final assignment is also about integration. Given the continuing care plan, it is also important to assess the specific internet behaviors that contribute to acting out situations, or otherwise cross personal boundaries. There are many variations of this assignment that follows. One way to complete this assignment is to create three circles where you address the following:
1) Inner Circle are Acceptable behaviors
These behaviors are any internet behaviors that are healthy in your world. The difficulty is that many individuals want us to tell them the answers to this question, but the key is that you have to define these. Others might provide feedback and suggestions, but in the end you MUST clarify and determine what are acceptable behaviors in YOUR world.
2) Middle Circle are Cautious behaviors
These behaviors often have a “depends” linked to them. Sometimes the same behavior at work is acceptable, but at home is unacceptable (or vice versa). Anything you can’t clarify as healthy/unhealthy, needs to go here. You might be able to use the “depends” to gain further insight into risk factors in your life. As appropriate, clarify the depends component of these behaviors as much as possible. One example was a client who could surf the internet at home until 9 pm. At 9 pm, he started to tired and moved into the trance often associated with compulsive online behaviors. Surfing the internet until 9 was cautious, because he had to make sure his plans were in place to prevent ongoing surfing after 9 pm.
3) Outer Circles are Unacceptable behaviors.
These are behaviors that you have determined are unhealthy in any and all cases. For some people, any explicit sexual online behavior at work is unhealthy. Surfing for porn or engaging in sexual chat conversations may fit here. Certain types of websites might fit here. The key is that YOU must agree to any behaviors that are defined as unacceptable.
Behaviors to consider include the following. It is also important to link these behaviors to any qualifiers.
• What devices can you use to access the internet (think computers, smart phones, iPads, etc.).
• How frequently can you use the internet? Can you use it for sexual content? Where can you access the internet (work, home, friends, relatives)?
• Who is with you, as appropriate?
• What types of websites are acceptable? Think typical web sites such as banks, but also a typical hookup site?
• What types of online sexual activity could be explored online,(e.g., certain ethnicities, feet, animals, diapers…)?
• Identify if engaging in sexually charged chat, online relationships, virtual sex, exhibitionism or voyeurism online?
• What email accounts can you use?
• Using the internet to arrange real-time hook ups.
• Posting online erotic or sexual pictures/videos of yourself or others (including via webcam).
• Masturbating to online sexual materials or activities?
• Have you ever used a sex toy that connects to your computer while online?
• What other sexual activities have you engaged while online that would be important to review?

Wednesday, November 17, 2010

ADHD and Internet Behavior

A number of studies have reported an association between internet compulsivity and attention deficit/hyperactivity disorder (ADHD). Unfortunately, this type of research focuses on relationship between two things versus whether or not one causes the other. It is difficult to truly understand what is going on in relational research. To use a metaphor, it’s like saying ice cream sales and crime rates are related (they are). Both are high at the same time, and both are low at the same. While they are related, people will sometimes try to say one causes the other. For example, a person might propose, “People are stealing money to buy ice cream.” Another response might be, “Eating ice cream leads to crime.” Neither is accurate, and often another explanation might be better. In this case, both ice cream sales and crime rates increase in warmer weather. More people are out when it is 85 degrees (and hence may be robbed), and also more people are willing to eat ice cream when it is 85 degrees versus when it is 30 degrees.

Most often ADHD is first recognized as a child or adolescent. Recently, more and more adults are being diagnosed with ADHD. The diagnosis isn’t without controversy. It isn’t clear if the diagnosis is the current “trendy” diagnosis or if it is a true problem with adults. Having an ADHD diagnosis is also open to misuse, particularly with providing an excuse for the behavior, “I go online because I have ADHD.” Without a doubt, the relationship between internet use and ADHD is present, but complex. The key in our work is to acknowledge the relationship, and provide a basic level of information for you to follow-up with your primary physician. In some cases, treating ADHD might reduce an individual’s problems with the internet.

To help you determine if you need follow-up, please review the following symptoms. If you see five or six of them as descriptive of you, please seek out and obtain the necessary support for further follow-up.

Symptoms of ADHD

Does not give close attention to details
Makes careless mistakes in work, or other activities.
Often has trouble keeping attention on tasks.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions
Fails to finish duties in the workplace
Often has trouble organizing activities.
Doesn't want to do things that take a lot of mental effort.
Often loses things
Is often easily distracted.
Is often forgetful in daily activities.
Often fidgets with hands or feet or squirms in seat when sitting still is expected.
Often gets up from seat when remaining in seat is expected.
Often feel very restless.
Often has trouble doing leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively.
Often blurts out answers before questions have been finished.
Often has trouble waiting one's turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games).

Tuesday, November 16, 2010

Projection, Transference and Sexuality

The inside functions like a projector;
Others become screens
And you start seeing films on others
Which are really your own tapes.

Over the past few weeks, a book I’ve been reading has been a source of reflection for a series of quick blog entries on sexual health. This blog continues this process.

I experience being a target of significant emotional reaction from folks, --either aversion or awe—when they discovery my area of work in sexual health. I’ve been in the field long enough to know it’s not about me, but rather a reflection of the inner workings of the individual (And usually I don’t take it personal, but heck, I’m human.). I’m amazed at how frequently an individual’s reaction reflects their reaction to sexuality. Those who have a strong negative reaction are often projecting the negative feelings of sexuality. The same is true for positive reactions.

In my work, I place a strong emphasis on increasing awareness of your reactions. Anyone who evokes a strong reaction is your teacher. Your reaction is yours. Figure it out. In the realm of fantasy, the entire fantasy is a projection of your inner being. Learn from it. In your dreams, you discover how you want to live in the moment. Start now!

OSHO (1999) Emotions: Freedom from Anger, Jealousy and Fear. OSHO International: New York.

The Kindle version is no longer free (updated 11/16). You can download a version to read kindle books on your computer desktop for free.

Sunday, November 14, 2010

What would your genitals say?

To increase your self-awareness, it is important to be aware of the unspoken messages that are part of your inner story. One assignment is to write a response to the question, “What would your genitals say?” The impact of Internet sexual compulsivity can include a distortion of body image and genital image. I find these two topics are some of the biggest issues in a person’s recovery process. This assignment primary addresses both body image (and your image of your genitals) as well as shame associated with sexuality.

The assignment:

Write 1-2 pages about what your genitals would say if they could talk. Include any thoughts and feelings about the size, look and/or feel of your genitals, where they’ve been, and what has occurred with them. Include things you like and dislike. Describe any possible sources of the thoughts, as appropriate.

Letting go to become...

When I let go of what I am, I become what I might be.
Lao Tzu

Building a life you love requires transformation. Often, however, fear, insecurity, and hopelessness leads to paralysis in a person's movement toward sexual health. In the realm of sexuality, there is often external pressure to conform. When you let go of the expectations that you place on yourself, you move toward the possibility of becoming something more. In my opinion, you start living a life you love.

Saturday, November 13, 2010

Your Truth and Sexual Health

Truth liberates – but it must be your own.

The last few entries on sexual health (including authenticity and repression) highlight the importance of understanding YOUR truth regarding sexual health. The process of clarifying your values, and the behaviors consistent with those values is YOUR truth. Identifying the thoughts, feelings and high-risk situations that impair your life is a process of discovering YOUR truth. One of the major assignments in the workbook is the personal definition of sexual health. The focus of the assignment is to help your discern YOUR truth regarding sexuality. My experience suggests a client is much more successful with sexual health when it reflects YOUR truth.

OSHO (1999) Emotions: Freedom from Anger, Jealousy and Fear. OSHO International: New York.

This is currently available as a free kindle ebook on Amazon. (The kindle version is no longer free, updated 11/16)

Friday, November 12, 2010

Masturbation, Internet and Sexual Health

One of the major concerns in assessing the internet is the linkage between sexual media and masturbation. Often partners will have different opinions in addressing masturbation. In some opinions, masturbation is a healthy outlet within a relationship and should be incorporated into an individual’s relationship with him or her self as well as his or her partner. Masturbation can be a way to discover what you like sexually, as well as what parts of you body are most arousing or sensitive. In this example, masturbation can lead to a heightened awareness of self that can be shared with your partner. In other opinions, masturbation is a form of settling when the primary partner isn’t available. One example is a guideline within a relationship where you ask the partner if he/she is available for sexual behavior contact before you masturbate. If the partner says, “no” masturbation is allowed. Still other opinions view masturbation as a sin.
The key to the following questions is to clarify your opinions, beliefs and values about masturbation. Consider how the internet has impacted these values. Think about the role of masturbation in your definition of sexual health.

• Under what circumstances are masturbatory behaviors unhealthy for you?
• Under what circumstances are masturbatory behaviors healthy for you?
• What are my current values toward masturbation and fantasy?
• What are my current appropriate masturbation behaviors? (Where, when, how often?)
• What are my guidelines about disclosing my masturbation behaviors to my partner?
• What are my guidelines about disclosing my fantasies to my partner?
• What are my partner’s reaction to these guidelines?

Tuesday, November 9, 2010

Body Image, Partners Support and Sexual Health

One component of sexual health is body image. One critique of sexually explicit material is that it sets unrealistic expectations for men and women regarding body image as well as genital image. Without a doubt, mainstream American culture worships the perfect body and sets unrealistic expectations for both men and women.

Researchers continue to examine contributing factors to struggles regarding body image. Research suggests that a person’s self-image is linked to the partner’s response. As one could guess, individual who struggle with body image issues have a better response to treatment progress with the support of a primary romantic partner. Individuals who receive this support have less stress and anxiety. Negative reactions from partners led to increased struggles with body image.

There are three implications that I think are important. First, for individuals who struggle with body image issues, the key is to gain support from the primary partner. Second, if the partner isn’t supportive, I think it is important to address the negative impact of the partner’s behavior. As you could guess, hearing “Your fat.” isn’t going to help individuals address body image. Third, as one could guess, partners are also pummeled by the same cultural messages. Partners may need training and education as well as feedback regarding providing the necessary support.

Much of this appears to be common sense. Explicit positive and negative messages about a person’s body can easily be recognized for the. The difficulty, however, lies is recognizing implicit, hidden, or subtle positive and/or negative messages. For individuals struggling with sexual health concerns, assessing the messages is important.

Weller, J & Dziegielewski S. (2004) The Relationship Between Romantic Partner Support Styles and Body Image Disturbance Journal of Human Behavior in the Social Environment, 10(2) DOI: 10.1300/J137v10n02_04

Monday, November 8, 2010

Gratitude to my clients

I have a remarkable privilege of working in the realm of sexual health. The participants in a 6-week workshop on addressing chemical health recovery and sexual health again reminded me of this privilege. As one person stated, this is the last issue I need to address. I’m continually impressed with the client’s commitment toward “getting this stuff” for their long-term recovery.

As the saying goes, insanity is doing the same thing over and over expecting different outcomes. I’m happy these guys are doing something different in the realm of sexual health.

Sunday, November 7, 2010

Sexual repression as suicide

Repression is to live a life that you were not meant to live. Repression is to do things you never wanted to do. Repression is to be fellow that you are not, repression is a way to destroy yourself. Repression is suicide – very slow of course, but a very certain slow poisoning. OSHO

Another quote from a book I’ve been reading.

The last line of the quote struck me. “Repression is suicide – very slow of course, but a very certain slow poisoning.” This is no truer in the realm of sexuality. I can not remember how many times I’ve worked with people who are experiencing a slow death because of the repression of their sexual energy. I can’t help but think of my work in chemical dependency as a way to avoid the pain of this slow death. The shame, fear, hurt, and guilt are the consequences of this repression.

What would it look like if you ended your own repression regarding your sexuality? How might life be different? How might you be different? How would your relationships be different?

I believe that one of the best interventions is to simply affirm the possibility of the individual to be who he or she is. I don’t give permission; rather the individual has within him or her own being the inherent permission to the core in all areas. Given my focus, this includes being alive in the realm of sexuality. It is stepping beyond the repression to affirm you wants, needs, and desires. Sometimes this will be easy; often it will be a bit of work.

OSHO (1999) Emotions: Freedom from Anger, Jealousy and Fear. OSHO International: New York.

This is currently available as a free kindle ebook on Amazon. (The kindle version is no longer free, updated 11/16).

What is sexual health?

“You simply remain authentic: you don’t know what is good and what is bad, you don’t know what is positive and what is negative. You are simply authentic. This authenticity will allow you to have a glimpse of the real.” OSHO

What is sexual health?

There are an abundance of formal definitions of sexual health. And still, what is sexual health? The quote reflects the key to sexual health in my opinion. It is simply authenticity. It is neither good, nor bad, simply authentic. And it is YOUR authenticity, not what you think others think should be authentic to you. Yes, that reads awkwardly, but the key is to focus on your authenticity. Clients will often worry about what family, friends, partners, and others think is important that they loose their voice.

Authenticity is more than simply doing what you want when it comes to sexuality; it is engaging in behaviors that express the core of who you are. The key for me is the core; your heart of hearts. From that core, sexual health is authentic.

OSHO (1999) Emotions: Freedom from Anger, Jealousy and Fear. OSHO International: New York.

This is currently available as a free kindle ebook on Amazon. (The kindle version is no longer free, updated 11/16)

Wednesday, November 3, 2010

Sex, Shame, Fear, Recovery, Hope, Life

I was keenly reminded how difficult it is to talk about sexual health issues in general and sexual compulsivity in particular. For many individuals, the first steps toward discussing sexual issues are shaped by shame, embarrassment, fear and guilt. I can not stress enough how NORMAL these feelings are when opening up a new area of growth. While it is easy to say, I also know how many of these thoughts and feelings are irrational, based in cultural messages that “sex is bad,” and a general aversion to addressing sexuality.

Even though these reactions are normal, I’m also aware how important it is to start the process of talking about your sexual health concerns. My experience suggests that sexuality is at the core of many of the most important aspects of our life. For many people in recovery, sexuality is the last issue to be addressed. At the same time, it is often the last issue counselors want to (and in some causes are trained) to address.

In almost every situation when someone starts the process of addressing sexuality, the reaction eventually has been positive. The energy “protecting” the shame is released allowing the energy to be directed toward life giving actions. New possibilities are created allowing the individual to life a new life.

What do you need to start the process?

Sunday, October 31, 2010

Sex and Ice Cream

Sometimes it is easier to explore sexual health issues through a use of a metaphor. A metaphor I like regarding sexual expression is ice cream.

Who doesn’t like ice cream, one of god’s primary gifts to humanity! Imagine, if you will, sitting down with a serving of vanilla ice cream. Think of the creamy feeling, and the taste of vanilla as you eat the first spoonful. Even the frozen Vanilla Yogurts are good. The soft-serve ice creams are great when you want something in a hurry. Some of the premium brands have done a great job making vanilla ice cream almost a spiritual experience! The extra cream makes the texture extra smooth. Using real vanilla, perhaps with pieces of vanilla beans creates an amazing experience.

Because vanilla ice cream is so good, and so many people like it, I have decided to impose a new rule. Vanilla ice cream in all its variation is the ONLY form of ice cream that is good/holy/sacred. Only vanilla ice cream can be created, served, and sold. I have declared this, so it is so.

Absurd, isn’t it!

But that is what we’ve done with sexual expression. Individuals in power eloquently describe why a particular form of sexual expression is good/holy/sacred. Then they impose on everyone else this value.

Absurd, isn’t it!

Sexual health requires you to make a choice about what is good/holy/sacred in your life. Yes, you might like “vanilla” but “vanilla” is far from the only flavor of sexual expression. What do you like? Choose.

Monday, October 25, 2010

Bi Cities

My interview on Bi Cities about sexuality, chemical dependency, and sexual health.



Wednesday, October 20, 2010

Disclosure in the therapy process

How to talk about therapy without talking about therapy.

In other discussions, I emphasized the importance of full disclosure. I recognize the importance, however, of full disclosure occurring in a meaningful way usually near the end of the therapy process. It is also important for some type of ongoing disclosure to occur along the way that fosters healing and trust in the relationship. Below are a few ideas on how to talk about the therapy process without getting bogged down in the details of the history. Eventually the history will be shared.

1) Both individuals in the relationship have to agree to this process. I typically meet with the client and partner near the beginning of therapy to talk the process through, and clarify the guidelines.

2) Clients are encouraged to talk about their internal process, without necessarily disclosing the content. This is where the client can share feeling statements from therapy. As an example, “I realized I fell sad which is a trigger in my acting out cycle…”

3) Clients are encouraged to talk about the “lessons learned” from therapy. For example, “Today’s topic was on intimacy, and I realize I need to develop my skills in emotional intimacy.”

4) Clients are encouraged to develop assertive communication skills to express needs, desires and requests. All behavior is goal focused, including sexual compulsivity. Identifying healthy ways to get needs meet reduces the future risk of acting out.

My experience is when the client learns how to engage in these smaller disclosures, the relationship experiences healing. Occasional intermediate sessions with the partner can foster this process. It is this healing that allows the full disclosure to occur. Yes, couples therapy will still be necessary but much of that work is helped by the ongoing disclosure.

Saturday, October 9, 2010

The New Book is available on Amazaon

The book I published in August is now available on

Back from the Abyss/Taping for BiCities

August was a bit of a vacation, while Sept was a lot of traveling for work. I'm now a bit more settled to start blogging. The most recent activity was taping a show for BiCities talking about Chem Dep, Sexual Compulsivity, and Internet Sexual Compulsivity. To be aired in Minneapolis on Channel 6 on Nov 9 and 23 at 7:30. Check the link for other times and cities

Monday, August 2, 2010

Discovering Your Life --My New Book is Available

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

Discovering Your Life: Your Book of Lists

Why Can't I Figure Out What I Want in My Life?

Are you struggling with a vague notion that things are wrong in your life, but you can't figure out what? Are you unhappy, but you can't figure out why? Are you flailing around trying to figure out what steps to take, where to start, what questions to ask, whom to talk to?

This handy little workbook will give you a fresh way of looking at your life, ultimately leading you to a life you will love! In a series of fun, stimulating questions, a psychologist helps you identify the hidden obstacles preventing YOUR true happiness, allowing you to discover the REAL YOU and identify what YOU truly want in life.

You can easily adapt this book for couples and group therapy. How much do you know about your partner? How much can you share with your partner. Learn how to share what is important in your life.

Thursday, July 1, 2010

Introduction to Cybersex Unplugged

We're getting close! Yes, progress is being made. An updated rough draft of the introduction to the new CYBERSEX UNPLUGGED. See LIVINGALIFEILOVEBOOKS.COM

Does anyone track what I’m doing online? We all wonder who knows what we do online. How do I hide what I’m doing from my partner? OMG, did she see what I was doing? I hope the person on the other side is as hot as they say they are. I get so tired of the online games. I’m only online because I can’t have sex with my partner. Boy that chat was great; is that cheating? I’d like to have sex with that person in the video. Is that pic legal?

We’ve all heard the stories of people getting caught doing online sexual stuff. Someone was fired, a relationship ended, a fight ensued, or someone was arrested. Perhaps one of the stories people talk about is you? Perhaps your just the next person they’ll talk about if you don’t stop what your doing.

This workbook resulted from conversations with individuals who struggle with their online sexual behavior. The consensus from these individuals and their therapists was a current workbook addressing the common issues for cybersex compulsivity was needed.

This book builds on our experience to focus on the nuances of Internet sexual compulsivity. We break down the complex elements into what we think are basic issues to addressed. We also highlight what we think are issues unique to cybersex including topics such as: psychology of the Internet, cybersex user categories, and understanding, assessing, and managing your Internet use. These topics highlight the nuances of cybersex. Sadly, not much research has been done in this area. Very little is truly known. Still, the three of us represent over 50 years of clinical and research work. Much of what we do write is based on our clinical experiences, research on related topics that we find are helpful in addressing cybersex, and in all honesty a bit of a “guess.” We hope you find this workbook useful as you strive to find sexual health in an electronic world.

This workbook focuses on cybersex; as such it is limited to cybersex. We believe cybersex is a subset of a larger field of sexual compulsivity. This workbook is not meant to address the larger topic of classic sexual compulsivity that is broad, with a variety of factors and addressed in the first book by Dr. Edwards (Living a Life I Love).

Sunday, June 20, 2010

What is positive sexuality

Defining positive sexuality requires understanding sexuality in a brand new way. In this approach, sexuality is a normal, vital, and positive aspect of your life. Too many people suffer pain when they think about sexuality. Give yourself permission to be a sexual being. Rather than repressed, hidden or shamed, positive sexuality celebrates your sexual energy and being. Yes, this includes sexual behavior but it includes much more.

Your task in this section is to challenge most, if not all of the messages you have heard about sexuality. This doesn’t mean you have to discard the beliefs. Instead, understand both the letter and spirit of the messages. Sexual Health is a journey. Today’s thoughts are for today. What you like today is for today. What you want is for today.

The key to this section is discovery. When you watch a child in a playground, they meander through all of the play areas. They might stop at the swings, or the merry go around. Next the may check out the slide, and perhaps build something in the sand. When they like something, the child stays in the area. So to is the role of discovery in the realm of sexuality. Check out what you like or don’t like. Enjoy the positive experiences, and let go of the unpleasant experiences.

Balance is important in the journey. You can change your mind on this journey. I place good/bad sexual experiences on a different continuum then the continuum of healthy/unhealthy. You can have a sexual encounter that feels good but is unhealthy (think meth/sex), and a bad experience that is healthy (think too tired to function, but emotional intimacy).
Enjoy your journey in sexual health. My hope is that you have great experiences along the way. Sometimes the only way we know what is sweet is because we can compare it to what is sour.

Saturday, June 19, 2010

Disclosure of Sexual Compulsivity to Partners

Over the last year, I've been updating the previous workbook for a new workbook to be released this summer. Here is one of the last articles that have been rewritten. Check out the website LIVINGALIFEILOVEBOOKS.COM for more information about CYBERSEX UNPLUGGEG

We recommend sharing this section with your partner sooner than later.

When a person is addressing sexual compulsive behavior, one person it impacts is the partner. For a partner, a variety of issues need to be addressed, including emotional, physical and sexual issues. It is our recommendation that the partner obtain therapy/support for himself or herself. Through individual therapy, we recommend each partner clarify his or her commitment to the future of the relationship before disclosure occurs. Coping with a partner’s disclosure has a parallel process for the partner. Treatment issues include getting information, including “understanding” the language of people in the field. Therapists and those involved in the 12-step movement often use a jargon for shorthand communication. Learning the meaning of these terms is important. As you move away from crisis/shock, it is important to stay focused on your emotional and physical health. Incidentally, family members may have access to pornography because of another member’s behavior. Addressing basic safety issues and setting boundaries to maintain safety of others is important. As you cope with your partner’s compulsive behavior, you need to identify how you will take care of yourself. It is important to identify what you need to do today, what you can do in the next month, next three months, or the next year. Partners typically may have feelings of despair, hopelessness, confusion, and anger. Additional feelings of shock, depression and grief may be present. Sometimes the individual blames himself/herself, either due to ignoring signs or simply not knowing. Part of the healing process is to gain support from professionals, peer networks (groups) and family or spiritual support.

When an individual has multiple sexual contacts, the partner is also at increased risk for HIV/STIs. It is my recommendation that you be completely open and honest about the purpose of the visit with your healthcare provider. Some providers will assume that since you are in a relationship, you are not at risk. You will need to be explicit and say, “I found out my partner has multiple sex partners and I’m worried about being infected with a sexually transmitted infection.” A partnership will need to determine safer-sex guidelines in light of the risky behaviors.

Once both individuals address their respective issues, couples therapy can facilitate the healing of the relationship. Relationship issues can include addressing blaming statements by the partner. Often there is a sense of powerlessness that comes with not knowing what to do and how to get your partner to stop the behaviors. Treatment for the individual and the partner includes clarifying what you both need and want in a relationship and assessing honestly where the current relationship is going. This is a chance for you to clarify your boundaries and develop the skills to protect those boundaries. Some partners may feel pressured by their support network to leave the relationship. Unfortunately, no guidelines are available for the decision you and your partner may need to address. Some relationships can continue while others should end. In some cases, this is an appropriate response. If you know you are not going to stay in the relationship, disclosure is not necessary. If you know you want to stay in the relationship, disclosure can occur. I will not work with couples who use the process of disclosure as ammunition against each other. In my approach, disclosure is about repairing, reconciling and taking full responsibility in order to foster an ongoing relationship.
One issue rarely addressed is the disclosure of your history to any future partners. The timing and level of detail in regard to your future disclosures are important to consider. Again, I have the bias of full disclosure. You wouldn’t necessarily avoid disclosure of a chemical addiction or health issue, and I see the issue of sexual history as similar. I also recommend working with a couple’s therapist to help you and your partner through the process.

What do you share?

After discovering that his partner was engaging in sexual behavior outside of the relationship, a client commented that coping with identity theft was easier than coping with the loss of his image of the relationship. He reported that he felt like a part of his identity was ripped away. I think the metaphor is accurate. One of the biggest issues in addressing sexual health is the question of disclosure to the partner. Not everyone agrees, but my bias is toward full disclosure or at least giving the partner the right to set how much disclosure he or she would like. I do not recommend that disclosure happen outside a couple’s therapy process. Again, we recommend sharing this with the partner sooner than later. Your treatment process is designed to help you respond to the needs of your partner as identified in this section.

• These questions are for your partner to answer.
• Who is your primary support network? What is your plan to reach out for support when disclosure is complete?
• What work have you done to address your treatment issues triggered by the partner’s acting out behavior?
• What are your feelings and thoughts about disclosure?
• Are you committed to staying in the relationship? If not, we do not recommend disclosure. If you are ambivalent, why do you want disclosure at this time? What work do you need to complete in order to strengthen your commitment to the relationship before disclosure?
• What is your goal of disclosure?
• How much detail do you want to receive? Consider the following:
o Your partner completed a sex history and timeline? Review the questions. Which of these questions would you like answered? The sex history is very detailed (about 4 pages) and includes questions addressing frequency, intensity, consequences (legal, medical, financial), duration, location, types of behaviors, number of partners, online behaviors, etc.
o Your partner completed a timeline? Would you like to see this timeline? At what time in your partner’s history do you want him to start (Since dating? Last disclosure? Lifetime?)
o Often there are additional acting out behaviors, would you like to know about these compulsive/addictive behaviors?
o Is there any information you DON’T want disclosed to you?
o Your partner has identified a continuing care plan addressing the major high-risk situations, thinking errors, and feeling triggers related to his/her acting out behaviors. Would you like your partner to share this plan?
• Are you prepared to respond to your partner with your own disclosures? Why or why not?

Monday, June 7, 2010

Life, Liberty and the Pursuit of Sexual Health

I argue that all of our life is built on sexuality. Simply look and it is possible to see connections to sexuality that may have been unrecognized. A great deal of the advertising is built on sexuality. “If I buy this thing, I will get the right partner, perfect job, or woo the person of my dream.” The funniest jokes are often based on sexual innuendo. The biggest social issues of the time are related to sexuality. Many of our fears about the future are based on the question of whether or not I will find someone to love. Some of the biggest fears we have are about trusting our partner. Our biggest pains often connect to relationship failures. For some people, our biggest joys are children.

All of these examples highlight how important sexuality is in our life. But almost no-where do we have any discussion about sexuality that fosters growth and understanding. Much of our discussion on sexual health is unspoken, or if spoken it is fear based. What would it look like to take a moment to expand the discussion and uncover all the messages we hear about sexuality? What would it look like if we sat down and discussed our sexual beliefs? What would it look like if I identified what is healthy in my life and actually took the responsibility to assertively get my needs met?

Friday, May 28, 2010

The language of relationships

Much of couples therapy focuses on communication skills. A metaphor I use in working in couples therapy is based on language. Undoing the assumption that we all speak the same language is often the first place of intervention. Consider the following examples. English is the predominant language in the United States. “We all speak English” is the assumption. Yet, within the United States, words are used differently and take on special meaning as a result. Travel across the world, and different English speaking countries have different words for the same concept. For example, in the US, we use the word trunk for where we put luggage in a car on a car-trip, while in England they use the word boot. England uses the term lift to talk about elevators. Another example is the significant difference between Latin America Spanish and Castilian Spanish in Spain. Even Arabic has multiple dialects. While there are major commonalities between the dialects, important differences remain that are barriers to communication. Learning to understand and translate these differences can be helpful but difficult.

Applying the metaphor to relationships, it is important to remember that we all have different dialects of communication in relationships. These dialects are informed and shaped by the multiple cultures we belong to (age, race/ethnicity, religion, gender, etc), our family of origin, and our life history. Often there is enough commonality to be able to communicate with a partner. In my work, the majority of relationship problems are about communication problems that show up in the guise of unmet expectations and assumptions, hidden wants and needs, past hurts and pains, and hoped for joys and goals.

A classic example is around fighting. In some families, conflict is forbidden. A partner learns that anger cannot be expressed. Another partner may come from a family where conflict is resolved quickly and respectfully. When two partners come together, the dialect of conflict is an obstacle to be resolved. The resolution is often as simple as teaching each other the respective dialects. We can apply the metaphor to smaller things. The dialect around the level of cleanliness in the house comes to mind. The application of the dialect can be applied to very difficult areas, such as sexual expression, needs and values.

The difficulty in this process is much of our dialect regarding relationships is automatic and habitual. We assume everyone has the same language, mannerisms, assumptions, and expectations in a relationship that is often the source of the relationships problems. Teaching each other your individual dialects, and learning to translate your partner’s dialect is a necessary skill toward powerful and strong relationships.

Monday, May 24, 2010

The power and experience of Sexual Health

A mentor (who I greatly respect) and I have a running debate between the need to learn about sexual health and the need to experience sexual health. While we might argue the nuances, I think we agree that both are important. Much of my work in the writing/blog is about providing basic education regarding sexual health. Recent feedback from a client is that I use too many big words. Rather than interpret her words as an attack, I am impressed with HOW MUCH she wants to get this stuff. Her words brought into clarity the need to help people experience sexual health as much as it is important to educate people about sexual health. Here are some thoughts on how to move forward in your experience of sexual health.

1) I’ve said it before, and it is worth repeating. Give yourself permission to be a sexual being. Sexuality is a normal, vital, and positive aspect of your life. Too many people suffer pain when they think about sexuality.

2) Ask, “Say’s who?” One of the earliest questions a child learns is “why.” Plenty of stories are available where eventually an exhausted parents says, “Because, and eat your carrots!” The question applies to the realm of sexuality. Challenge most, if not all, of the messages you have heard about sexuality. This doesn’t mean you have to discard the beliefs. Instead, understand both the letter and spirit of the messages. The ultimate goal of monogamy isn’t about control as taught in many religions, but rather about a profound love.

3) Sexual Health is a journey. Today’s thoughts are for today. What you like today is for today. What you want is for today. Too often we loose sight of today, and “catastrophize” every sexual experience. We attempt to project into the future today's experience, and often that projection is full of assumptions resulting in a failure of living in the moment. As the 12-step saying goes, "One day at a time."

4) Balance is important in the journey. Too often we look ONLY for perfection, and if perfection is not possible, the experience is BAD, SINFUL, and UNHEALTHY. I place good/bad sexual experiences on a different continuum then the continuum of healthy/unhealthy. You can have a sexual encounter that feels good but is unhealthy (think meth/sex), and a bad experience that is healthy (think too tired to function, but emotional intimacy).

5) Experiment. When you watch a child in a playground, they meander through all of the play areas. They might stop at the swings, or the merry go around. Next the may check out the slide, and perhaps build something in the sand. When they like something, the child stays in the area. If a bully or something is unpleasant, the child moves on. So to is it important to experiment in the realm of sexuality. Check out what you like or don’t like. Enjoy the positive experiences, and let go of the unpleasant experiences.

Enjoy your journey in sexual health. My hope is that you have great experiences along the way. Sometimes the only way we know what is sweet is because we can compare it to what is sour.

Questions? Comments? Feel free to post or email.

Wednesday, May 19, 2010

The Pain of Sexuality

I am keenly reminded of the pain many people experience in the realm of sexuality. This pain is from a variety of sources including the typical sources of abuse, shame, and guilt. But, the sources of pain can include social, familial, cultural or religious messages. A major concern is when the external messages become internalized and the individual replicates and reinforces the painful messages in a tighter and tighter circle within him or her self. Once this pattern begins, the pain takes on a life of its own, leading to feelings of hopelessness, desperation and profound isolation. For me, this is perhaps the saddest part of the pain.

The process of healing this pain is beyond the scope of a simple blog entry. The short summary is the process requires much work, and support. My clinical work, and blog writing is about helping people in the healing process. To highlight three starting points, I would encourage you to:

1) Give yourself permission to be a sexual being. Sexuality is a normal, vital, and positive aspect of your life. Having an experience of sexual health is remarkably liberating and affirming.

2) Reach out for support. Using your support network best facilitates the process. The network can include friends, family or professionals such as your therapist, spiritual guide, or other providers.

3) Feel the pain. You cannot avoid the pain; this only intensifies the pain. Paradoxically, the only way to resolve the pain is to go through the pain. A recent encounter involved working with someone in the healing process. At one point, the release of the pain resulted in surprisingly intense sobbing session. The level of wailing can best be described by imagining a 4-year-old toddler who wails after his/her finger has been accidentally slammed in a car door. Witnessing this from a normally stoic grown adult highlights the profound pain.

There is a saying in the workout/gym/weightlifting community: No pain, no gain. Not so surprisingly, this platitude applies to healing the pain of sexuality. When this process is complete, you can experience peace and acceptance. And, you have the potential for great love.

Thursday, May 6, 2010

I need help with my luggage. Another scandal

In the last few days, another scandal broke regarding homosexuality and the Christian right. In short, George Rekers, a Baptist minister who provided testimony against gays, served on the Board of NARTH (National Association of Rehabilitation and Treatment of Homosexuality), and on the board of a predecessor to Focus on the Family was seen with a sex worker who advertised on RENTBOY.COM. The unfolding discussion can easily be Googled on the net.

The focus of my blog is on three parts.

First I feel anger and frustration at the ongoing hypocrisy of members in the Christian Right. A long laundry list is found here. Sadly, the frustration is often expressed through the comment “here’s another one.”

Second, I do have compassion for Dr. Rekers. Here is a man who has denied a major part of his identity for all of his life, only to have the issue exposed in a scandal. Dr. Rekers' behavior can easily be understood as a form of psychological defense: reaction formation --attack the parts of my life that I hate. His stance against homosexuality over his lifetime takes on a new understanding in light of the scandal. It is easy to see how his avoidance grows over time.

Third, I want to use Dr. Rekers’ experience to highlight the need for personal sexual health in the treatment of sexual compulsivity. (While I don't label Dr. Reker's behavior as sexually compulsivity, I do want to acknowledge how this defense is sometimes present in individuals who do struggle with sexual compulsivity.) A component of sexual health is to be able to talk about all aspects of your sexuality. The conversation doesn’t need to occur in the national press, but I stress the importance of talking about sexuality with your support network. Needless to say, sexual health implies the congruence between your identity and behavior. Please review the recent conversations on integrity. In promoting sexual health, my hope is that you can find that congruence. If it isn’t there, please seek help and support.

I found the euphemism on Andrew Sullivan’s Blog “The Daily Dish.”

Wednesday, May 5, 2010

The power of story

When we think about who we are, we essentially come up with a story. When you string enough of the stories together, you develop a sense of self. Some of our stories have a profound role in shaping our identity; other stories have a minimal impact. Sometimes there is a story we deny, avoid or otherwise minimize. Sometimes we simply forget our stories. In a few cases, we’ve never thought about a particular story line. When prompted, however, thinking about the story can lead to profound change.

I encourage you to think of all of the stories about yourself and others. One place to look at is phrase that comes after because. “I do that because….. I’m that way because…… This is important because….. “ These are the stories that shape your life.

As you will find, some of the stories may be helpful or unhelpful. Some stories may suggest topics to review with your support network or therapist. A few of the stories may be a source of profound joy or emotional pain. As you understand the stories, there is no right or wrong story. What is important is that this is your story.

Believe it or not, it is possible to change the story. This is a process of growth and development. Taking a new perspective on a story can lead to new insights. Gaining additional information changes the content of the story. Feedback from peers can facilitate a reframe of the story. This process of change requires us to know and understand the stories in our life.

Friday, April 30, 2010

The Reverse-Golden-Rule

We’ve all heard about the Golden-Rule: Treat other people as you would like to be treated. Pretty straight forward and most people get it.

Have you ever heard of the “Reverse Golden-Rule?” It simply states: Treat yourself the way you would treat others.

Many times in recovery, clients treat themselves so poorly that I’m bothered by the way they treat themselves. These individuals emotionally berate themselves, sometimes even expressing the self-hate and shame out loud. Statements such as “I’m so stupid, I’m a F***-up, and I deserve SH**” are not uncommon. When I hear this, I simply ask, “Would you treat others the way you treat yourself? Almost always, the response is No. Hence the Reverse-Golden-Rule: Treat yourself the way you would treat others. For individuals early in recovery, this is the only way to learn self-care, self-respect, and self-love. It isn’t the end of treatment, but it’s a start.

Be Gentle with yourself!


Have a question or topic of interest? Please email or post.

Finding a relationship therapist

A few weeks ago I highlighted a few strategies for finding a sex therapist. When looking for a relationship therapist, a few adjustments to the strategies are important.

1) What is your Goal?
Before you start, to the best of your ability clarify your goal. While it might be hard to acknowledge, if you know you don’t want to stay in the relationship, be honest and up front for the sanity of everyone.

2) Provide a time commitment.
Many times the individuals in the relationship will start therapy during a rocky period. If either one of the individuals is unsure about the future of the relationship, I ask for a time commitment from both of them to discern and work on the relationship.

3) Finding Referrals
Ask your friends and current therapist for referrals for individual therapy. Not everyone has training in relationship therapy. Questions such as "Who did you see?" or "Who do you recommend?" are helpful.

4) Who is the client?
Remember that the RELATIONSHIP is the client, not the individuals. Most individual therapists will NOT do relationship therapy when working with one person of the relationship. There are appropriate exceptions, so this is not an absolute rule. Check with the therapist.

5) Put everything on the table.
During the intake session, put everything on the table. Whether it is sexual issues, insecurity, jealousy, communication, respect, or whatever, put it on the table. In my work, my 2nd and 3rd session are individual meetings with each individual of the relationship to provide an opportunity to put additional issues on the table that may be too difficult in the first session.

6) Share the secrets.
This is a bit different than #5 simply because there might be things you don’t think are related. If you engage in alternative sexual behaviors, or had a sexual contact outside the relationship, say so. In some cases, external family pressure or fertility issues might be a secret.

7) Be realistic.
I use a juggling metaphor in relationship therapy. When starting relationships therapy, there are three balls to juggle: Person A, Person B, and the Relationship. This means it is more difficult than individual therapy to create change in the relationship.

Thursday, April 29, 2010

A sex-positive approach to healing sexual compulsivity

I work with many individuals whose view of sexuality is amazingly negative. For any number of reasons ranging from abuse, “-isms,” fear, trauma, cultural and/or religious messages, many of my clients have a very negative view of sexuality in general and their sexuality in particular. Many individuals tell their personal story about how they need chemicals to shut of these negative messages. Others use chemicals to medicate their shame. Due to the “bad” aspect of sex, clients aren’t able to link intimacy and sexual behavior. In other words, why would I share sex with someone I love?

The approach I take in treating sexual health/sexual compulsivity is sex positive. A review of the literature leads to a smattering of definitions. Here are a number of characteristics I consider sex positive.

1) Sexuality is an essential and vital part of your life, and needs to be integrated with your personhood.
2) Sexuality is a life-enhancing part of your life, creating energy, happiness, and celebration. Even if a sexual encounter isn’t great sex, it can still enhance your life.
3) Sexuality is integrated into your primary relationships. This doesn’t mean you engage in sexual behavior with everyone, but each is supported in all aspects of sexuality (i.e., support, talking about sex, relationships, needs, intimacy, etc).
4) Sexuality and sexual expression is remarkably individual. What is healthy for a person depends on the individual. A one-size-fits-all approach doesn’t work.
5) The negative experiences and messages about sexuality have been addressed and resolved as appropriate.

Wednesday, April 28, 2010

Sexual Health and what I SHOULD

One of the more difficult aspects in moving toward sexual health is clarifying YOUR personal definition of sexual health. This journey builds on yesterday’s discussion on integrity. What do you really want in your life? Today’s nuance highlights how many times we are told what we SHOULD want. Listen to the language in statements by others, the frequency of “You SHOULD…..” is amazing. All of our marketing is based on “You SHOULD.” Much of our sexuality discussion is based on “You SHOULD,” or often, “You SHOULDN'T.”

In this blog, I will not go into an extended conversation about the sources of you should (i.e., review culture and sexuality). Instead, I invite you to increase your awareness of all the ways you are told, “you should,” or “shouldn’t” or more importantly, when you say, “I should” or “I shouldn’t.” There is a significant pressure toward conformity in sexuality. In reality, anything is possible. Sexual health requires that you choose. I choose to live my life this way; I choose to engage in or not engage in these behaviors. It is your responsibility to assertively confront the pressure toward conformity. What you choose is truly your choice.

Monday, April 26, 2010

Integrity and Sexual Health

Integrity (Merriam-Webster): The quality or state of being complete or undivided.

One of my major goals in fostering sexual health is to help individuals move toward integrity in the realm of sexuality. A number of important characteristics are identifiable by a person living in integrity.

1) HONESTY. You speak what you mean and you mean what you speak. In other words, if you relapse or act out, you're honest about what happened. Everyone who needs to know, knows. In terms of your sex history/timeline, everything is on the table.

2) COMPELTE. When something happens, you are completely thorough about what occurred. You actively volunteer all information versus playing a cat and mouse game about not disclosing information. Remember, your support network is on YOUR side; it isn’t a game of gothca!

3) ASSERTIVE. Ultimately, integrity requires you to speak your opinion and beliefs. If your partner, support network, group or even your therapist wants you to do something, but you don’t want to, the key is to say so and be assertive in your communication. As you finish your personal definition of sexual health, it reflects YOUR needs, wants and desires communicated to your support network.

4) BALANCE. On a philosophical level, I believe integrity reflects balance. If something feels out of wack, say so. When you ride a bicycle, for example, you know when you are in balance. The same is true for integrity. You know when you are in balance in the realm of sexuality.

5) COMMITMENT. The classic saying, “When you fall off a horse, get back on.” applies to this characteristic. Are you willing to continue doing the work when a problem occurs?

6) ENDURANCE. The going will be tough; it will require energy to keep going when you feel like giving up. When in conflict, a desire to run away is normal but endurance requires us to stay in the conversation even when anxious or fearful.

Have a question? Or an opinion? Please email or post to

Saturday, April 24, 2010

Unsafe Sex and HIV Disclosure: Should I disclose?

>A recent request for questions resulted in someone asking what I think is one of the MOST difficult questions in sexuality/HIV prevention. “Should I disclose HIV status when I’m having unsafe sex?”

My short answer is “yes.”

My long answer is also “yes,” but probably not for the reason one would think.

Before I go into my response, I highlight the level of fear, AIDS phobia, inaccurate knowledge, and generally rude behaviors by many negative individuals toward positive individuals. The level of discrimination by negatives toward positives is sad and disappointing given that we are 25+ years into the epidemic. I also highlight all the reasons the CDC, and other prevention workers would say yes: we all have a responsibility toward stopping the epidemic.

But, in my opinion, the reason a person should disclose his or her HIV status is the expression of the individual’s own mental health. I think it is incredibly brave and courageous when an individual stands up and says, “This is me.” When an individual discloses their HIV status, I think it represents a level of self-knowledge, self-acceptance, and overall inner strength where he or she also says, “This is me, if you don’t like it, deal with it.” I recognize this level of self-knowledge and self-acceptance is a bit utopian, but then again that’s what we psychologists move toward: helping an individual claim a level of pride and integrity in all aspects of his or her life. If you’re not at that point, I think it can be a goal. Finding someone (or many someones) who will walk with you in that journey is important.

Have a question? Or an opinion, please email or post to


Web: TheBody.Com

Monday, April 19, 2010

Finding a sex therapist

Recent events reminded me how difficulty it is to find a clinician with skills in the area of sexuality. I thought it might be helpful to highlight a few strategies to find a clinician who specializes in sexuality. I forget the difficulty many clients have in talking about sexuality. I’ve been in the field for 16 years at this point; sometimes it feels like all I do is talk about sex. (Is it possible to talk about sex too much?) Client’s will often say, “I’ve never told a previous therapist about this…..” and then go into an story regarding their life, sexual history, acting out, or assault.

1) Advocate for yourself. Check out a number of websites, including SASH.NET and AASECT.ORG. (For example, between the two websites, about 15 clinicians are listed in the Minneapolis/St. Paul area.). Call your insurance company for referrals to see clinicians experience working in sexual matters.

2) Call. Most clinicians will take a 10-15 minute phone call to see if an initial interview should be set. Be direct and open in the phone call. This is not the time to beat around the bush. Use the time efficiently. Put your issue out there. I’m struggling with Internet porn. I’ve been sexually assaulted. Do you work with clients in this area? What is a summary of your treatment approach? Do you have any resources available on the web?

3) Ask for referrals. If the clinician responds no, ask him/her for referrals. Repeat the process until you have 1-3 clinicians who you might want to meet.

4) Set-up a meeting. Some clinicians will have free 1/2 hr sessions, others don’t. The intake interview is as much for you as it is for the clinician. Feel free to ask questions to the clinician as well. How busy are you? What is your training/experience in this area? How many clients have you worked with on this topic? The more forthright you will be, the more likely you will find a clinician who can help in your recovery.

Remember, the therapist is there for you, not you for the therapist.

Thursday, April 15, 2010

Sin is doing something wrong; Hell is staying in something wrong.

As individuals move forward in recovery, I hear enough stories of being not being able to stay clean. In psychological terms, we might describe this as failure and make reference to the stopping the acting out cycle as we move forward. In 12-step language we might describe this as relapse, and highlight the powerless needed to stop the addiction. In spiritual language, we might recognize this as sin and the need to seek forgiveness. Each of the different frameworks helps us understand the same behavior through a different lens.

Using the spiritual framework, my personal definition of hell builds on the concept of sin. If sin is doing something wrong, hell is staying in something wrong. I encounter individuals who after a relapse, enter into shame spirals, emotionally abuse themselves, and forever put themselves in negative place. For many of these individuals, they punish themselves much more than I or anyone else could ever punish them. And in my mind, the individuals are in a self-imposed hell distinguished as helplessness, frustration, and hopelessness.

When I met an individual in this self-imposed hell, I encourage them toward self-forgiveness. I ask them to if they would treat others they way they are treating themselves (a reverse Golden Rule). And I encourage them to “be gentle with yourself.” Recovery from drugs and stopping the sexual acting out cycle requires accountability that is respectful and leads toward forgiveness and healing versus shame, fear, and the ongoing experience of a personal hell.

Friday, April 9, 2010

Integrity in the recovery proces. Meaning what you say and saying what you mean

A few weeks ago (March 13) I talked about the role of discernment. Discernment is the process of deciding, choosing, and uncovering for yourself what is at your core and your personal truth. As part of the discernment process, integrity is essential. A quick definition of integrity is meaning what you say and saying what you mean. And for most people in the depths of addiction and compulsivity, all integrity has been lost. Trust of you by another person is built on your integrity. Early in the process, integrity is absent. Two recent examples in my practice highlight the importance of integrity.

A client who I hadn’t seen for many years let me know he celebrated 9-months free from meth use. In offering congratulations, I asked how was he able to stay sober. His response was “I discovered I wasn’t being honest about stopping. Yeah, I told you I wanted to stop, but I was still glamorizing the drug and sex.”

Another client talked about a recent use of pornography. He said “I’m not able to stop viewing porn. Oh, by the way, my wife thinks pornography is a problem, but I don’t. “

Both examples highlight the role and difficulty of integrity. Only when you’re transparent about who and what is important in your life, can you build integrity. It is imperative that you be radically honest in the process. Tell everything to your support network. If you engaged in a behavior, say so. Minimizing is a failure of integrity and feeds the acting out cycle. Sharing every interior/secret thought helps uncover the multiple rationales behind your behavior. Saying you want “A” because your partner wants “A” is a failure of integrity. Being honest about what you want, for example, reduces resentment.

Building integrity requires recognizing the disconnect between what you say and what you do, and then completing the steps toward honesty. It requires work, and conflict may ensue. There are ways to recognize the level of integrity in your life. Think about the following:

1) When someone asks, “How are you today?” do you respond with a bland response or with integrity? “It’s a good day” or “It’s a bad day.”

2) When you engage in a conversation about where to eat, for example, do you put your opinion out there, or simply “go along?”

3) When you struggle with a goal, are you sure that it is YOUR goal. Are you ready to put the work toward reaching the goal? For example, do you really want to loose the 15 lbs, or are you simply bowing to the pressures of culture saying you should when you really don’t want to do what is necessary regarding diet and exercise.

4) When your partner says, “stop that” do you agree with his/her request, or do you go along with the request to avoid conflict? For example, I agree to no porn. Or, I agree to engage in sex today.

Wednesday, April 7, 2010

Recovery and balance

“The quest stands upon the edge of a knife. Stray but a little and it will fail. But hope remains, if friends stay true.” Tolkien, Fellowship of the Ring.

The quest for sexual health, for recovery, for life is a journey requiring balance. And yet, balance is the aspect that is missing the most. Until balance is discovered, recovery is at risk. It doesn’t take much to push the individual off the edge resulting in damage, hurt, and pain both for the individual and his/her network.

Individuals in early recovery struggle with the concept of balance. Regardless of the type of compulsivity/addiction, an individual losses balance in their life. Like a spinning top, an addict’s life is spinning more and more out of control until it crashes. When the addict picks up the banner of recovery, he or she may start the recovery with the same fervor of the addiction. Instead of 90 in 90, they go to 90 in 90 volunteering as trusted servant, 8 sponsors and by day 90 have 3 sponsees. There is a move from multiple sexual acting out to absolute abstinence that denies the sexuality of the individual. This spinning top of “recovery” continues until a relapse occurs because of the lack of balance.

Three strategies for developing balance are:

1) Develop a plan.
As you start the recovery process, with your treatment team and support network it is important to develop a recovery plan. In that plan you need to define what recovery will look like for the next 90-180 days. Components of the plan include arrangements addressing living, treatment, relationship, and aftercare aspects of recovery. Obviously a higher level of structure and insight into the plan are important.

2) Follow the plan.
Once you have the plan, FOLLOW the plan. If you and your team develop a plan that you don’t like, say so at the beginning. If you agree to the plan, follow it. This sounds obvious, but I’ve seen plenty of plans that are not followed leading to a relapse.

3) Follow the plan.
What, he just said that. Too often, people will change the plan because they don’t like it. I encourage people in early recovery to stick to the plan unless there is imminent danger. Yes, it may be work, uncomfortable, or disliked. But sticking to the plan is about addressing the factors leading to the relapse. Making quick changes is a warning sign. Changes that are reactive are a concern. Changes that are reflective are possible when discussed. When changes are necessary, the changes need to be reviewed with your support network and treatment team.

Monday, April 5, 2010

What does a relapse in sexual addiction mean?

In the field of sexual compulsivity treatment, addressing the reality of a relapse is important. It is highy probably that you will experience some type of relapse around your high-risk situations, feeling triggers or thinking errors: you will move into a realm of acting out behaviors somewhere in your process. Why? Most likely because you’re HUMAN! Being human acknowledges that perfection is not possible. Here are a few suggestions to help you address a sexual health relapse.

1) In the process of moving toward sexual health, to assume that you will never make a mistake sets you up for the cycle of shame and guilt that is probably a big part of your cycle at this point. Now, this doesn’t mean being human is permission to relapse (nice thinking error), but it does provide a starting point toward self-forgiveness.

2) It is remarkably easy to relapse. Depending on the circumstances, the ease by which a relapse occurs is shockingly easy. If sexually explicit material is a form of relapse, simply walking in a mall could lead to a relapse (Seriously, have you seen the display windows!). Recognizing the ease by which triggers occur helps frame a plan for ongoing sexual health.

3) Relapse can help you learn. By examining the relapse, you can uncover new factors associated with your acting out cycle as well as set up plans to address these factors. In many cases, the relapse can help prioritize treatment issues.

4) The degree of relapse is a sign of progress. Often what happens is that the intensity of acting out decreases. Rather than hooking up with someone via a website, the behavior this time might be limited to viewing sexually explicit material. While still something to be addressed, this is progress in my book. (For a more formal discussion, search out the term harm-reduction). (As with #1 above, you can’t use this to justifying acting out.)

5) Telling on yourself when a small or large relapse occurs is a reflection of the treatment progress. By using your support network, you demonstrate the ongoing skills to move toward health. The amount of disclosure to your primary network is a measure of your progress. Your ability to learn from the relapse is also a measure of your progress.

Saturday, March 27, 2010

Life Coaching and Sexual Health

The number of stories I hear about sex in casual conversations boggles the mind. Many times in response to the question “What do you do?” I hear a personal story about sexuality. I could tell stories about where I’ve heard stories –the gym, coffee shop, walking the dogs, parties, meetings, etc. This highlights the need many people have to understand, embrace, and discover their sexuality and sexual health.

Often, however, the only venue to seek professional support is through the use of a “problem” model where the individual seeks help because bad things are happening.

What would it look like to develop a health based, holistically integrative approach to sexuality? What would it look like if the conversation starts from a place of health versus starting from a problem? In my experience, the more enjoyable conversations occur when a person is experiencing a transformation in their life regarding sexuality.

Over the recent years, there has been the development of a “Life Coaching” movement. What is a Life Coach? Take a sports star, they still have their coaches to help them further improve their skills. Similarly, life coaching is based on your experience, to help you integrate your values and goals and foster empowerment. A life coach is someone who walks along in your journey. The focus is on integration, positive sexuality, and health (instead of the more traditional illness based model).

There is a great need for the integration of life coaching and sexuality. Not all life coaches have the skills in sexuality. I encourage you to seek someone who is skilled in both coaching/counseling and sexuality. The goal will be to help you integrate your life and values to the ultimate goal where you say “I’m living a life I love.”

Thursday, March 25, 2010

Neither Gay Nor Bi: Understanding men who have sex with men (MSM)

I finished my second power point for a second presentation tomorrow at the University of Minnesota "Beyond the Boxes" Conference. If you would like a copy of the pdf handout, please contact

The first power point on Internet Sexual Compulsivity is also available.

Sexual Compulsvity and Internet Sexual Compulsivity

I finished my power point for a presentation tomorrow at the University of Minnesota "Beyond the Boxes" Conference. If you would like a copy of the pdf handout, please contact

Wednesday, March 24, 2010

The Power of Parallel Process

Picture a railroad track. When you look at one rail, it’s pretty easy to guess where the second rail goes. Even if you see the railroad tracks disappear into the horizon, you have a pretty good guess that if you find one rail of the tracks, you’ll find the other rail of track nearby.

Often, individuals early in the recovery process express fear and anxiety about the way things will end up. In psychology, we talk about parallel process to help people understand what is going to happen. In the realm of sexual compulsivity, I use parallel process to help clients grasp where they are going when they start the therapy process. It provides a tool to understand and shape the direction of therapy.

As an example, someone in chemical dependency recovery understands the process of recovery. A client will experience shame and guilt when they first realize they have a chemical use problem. The shame and guilt leads to isolation and increased problems. Once they start telling the stories of their chemical use, the shame and fear starts to easy and the recovery process gains momentum. Connections are made to individuals with similar struggles. Eventually recovery and a sense of hope are born allowing for a sense of being fully alive to develop.

In the same way, dealing with sexual compulsivity follows a parallel process. In the beginning, feelings of shame and guilt about sexuality lead to isolation. In a similar manner, recovery occurs through sharing your story and reaching out for support. Hope is born in the relationships and connections with others. Following the process of recovery in chemical dependency can give us a direction of recovery in sexual compulsivity.

Many parallels exist; the key is to find something in your life that will help you understand the direction in your recovery process in the area of sexual compulsivity.

Monday, March 22, 2010

Levels of Understanding and Knowledge in Recovery

In moving through treatment for sexual compulsivity, it is important to understand a development process in the level of knowledge that occurs for a client. Consider the following five different levels of understanding.

1) Ignorance is not bliss
Clients may say, “I don’t know why I do this. I don’t know how to stop. What’s going on? What’s a feeling?” In this stage, we have to work with clients who struggle with the question of whether or not they have a problem. How many times have we heard “I don’t have a problem with my behavior; others have a problem with my behavior.“ The major task at this point is lack of information, or in some cases denial.

2) Recognition
Clients start to be aware that something unhealthy is occurring. The level of confusion and minimal awareness is a trademark at this point. When others point out a thinking error, or feeling or whatever, the client can recognize the concepts, but may not have been able to figure it out on their own. With help, the client is able to grasp what others are talking about. The major task at this point is learning and teaching.

3) Recall
Here the client is able to accurately talk about the information, and even proactively offer insights about his/her behavior. Awareness such as “I was feeling sad, mad, and/or glad.” Or, “I was stuck in unhealthy thinking errors.“ In my opinion, when a client gets to this point, therapy becomes “fun” since the client is doing more of the work. The major tasks at this point are support and education to fill in the blanks.

4) Integration
In this stage, the client is able to do the majority of the work. Clients will understand the components of the cycle, and grasp connections between the material and their other issues. Daily insights are occurring. The major task is coaching and occasional direction.

5) Creation
This stage is the art of therapy. Clients are making connections between the material, recovery, and other aspects of their lives. Recovery moves away from a process or task to a profound change in the way clients live their lives. Transformational insights are occurring. The task of the therapist at this point is to stay the hell out of the way. Too often we impose our framework when in fact the client is creating their framework for healthy living.

Saturday, March 20, 2010

When should I get into a relationship?

I was asked a question about the right time to get in a relationship for someone who struggles with sexual compulsivity. Obviously the only answer I can give is depends. I do have some benchmarks that I want a client to consider: if you answer “no,” or “maybe” to any of the benchmarks below, I don’t think you’re ready. Ultimately it is up to the you, the client, to consider when it is the right time to get into a relationship.

Benchmarks to consider:

1) Are you aware of your acting out cycle? This requires you to understand the components of the acting out cycle, different ways you act out, and the underlying factors associated with the acting out cycle. If you don’t understand the words in this benchmark, I don’t think you’re ready to be in a relationship. (An example as a HINT: You’re aware of the thinking errors and subsequent feelings of shame that result from a history of sexual abuse and how they contribute to your chemical use and/or sexual acting out.)

2) You’ve addressed the major issues contributing to the acting out cycles in #1. My workbook has a list of 22 major issues that often need to be addressed. These are listed elsewhere in the blog or at the website for the workbook. (See table of contents). While I don’t think these issues have to be completely resolved, I do recommend that you have a basic understanding of how they impact your life.

3) Do you have prevention plans to address the topics in #1? Each feeling, thinking error and high-risk situation needs a basic prevention plan.

4) Are you open to a conversation about your history with your potential partner? If you’re not willing to share your history with him/her, you risk setting up the trap of secrecy and the subsequent trust issues. Repeatedly I’ve shared that my bias is full disclosure. Timing and support (usually in couples therapy) is important at this point.

5) Are you aware of your sexual interests, relationship needs, intimacy goals, and able to communicate these to your partner? Is this sharing mutual?

6) Are you talking about all of these benchmarks with your support network and your potential partner?

While these may seem easy benchmarks to read, I know that the underlying work is substantial. Perfection isn’t required, but in the end understanding the substance of these benchmarks will help you strengthen the relationship.

Saturday, March 13, 2010

Why does a person stop at a stop sign? The role of discovery in sexual health.

One of my favorite exercises is to ask a client: Why does a person stop at a stop sign? After a moment of confusion often based on the thought “what is the purpose of that stupid question” the client will usually respond with a nice answer that is sometimes punctuated with an attitude (and for drama, a nice roll of the eyes) of “that is so obvious.” My enjoyment is to follow-up with “Why ELSE might a person stop at a stop sign?” And the exercise continues until the person exhausts all of the answers; usually this is about 2-3 responses. Then I ask them to think of a funny reason, a silly reason, a stupid reason, an absurd reason etc. In one group setting, the group eventually identified 41 reasons why a person might stop at the stop sign. My point had been made. Until you think outside the box, your options are limited.

So often in the realm of sexuality, we assume we know the answer to the question. We’ve been taught, told, indoctrinated, forced, or otherwise encouraged to “know” the right answer that we haven’t thought about what is our response to the question “what is sexual health for me. The movement toward sexual health is a process of discovery and thinking outside the box. Your purpose in this process is to ask, “Why do I think this?” What else may be an answer, response, thought, issue, concern associated with the topic? This process is about unfolding, uncovering, and discovery. A great concept from my experience is the concept of discernment. Discernment is the exercise of discovering, uncovering, and revealing the truth within you (for those with a religious faith, this truth within is believed to be the Spirit acting in your life.).

I want to provide three simple examples where the concept of discernment helps us understand the movement toward sexual health.

In my opinion, staying in or leaving a relationship is a process of discernment. It is uncovering, revealing and discovering the health of the relationship. It requires an honest evaluation of your contribution to the state of the relationship, and assessment whether you are capable or willing to help build, repair or develop the relationship. It requires assessing whether the relationship can be transformed or declaring it should end.

What does it mean to live as a LGBT individual is my second example. There are many cultural factors (religious, family, community) that affect this process. In the end, the individual is charged with discovering what it means for him/her to live as an LGBT individual. I’ve seen it all. From an individual who knew at age 12 they were LGBT and appeared to have little difficulty in the process of living as an LGBT individual to a 70-year-old man coming out and choosing to stay with his wife of many decades.

My third example is to link discernment to sexual behavior. Ultimately it is up to you to determine what behaviors are sexually healthy. In other words, what behaviors help me grow as an individual, foster respect in my life and the life of my partner and the health of my community? As you see in the previous blogs, it is a process to discovery the behaviors that reflect and protect the values you use to shape your life.

Two notes of caution.

Discernment is a process. While the first response to what is healthy may “seem” like the “correct” response, sometimes discovering your personal truth needs time. Many times we edit or limit our thoughts, beliefs and desires. Uncovering sexual health requires you to challenge the thoughts, beliefs and values you assume to be true. Sexual health is about integration resulting from many trials and errors, experimentation, successes and trip-ups. And sexual health is about continuing the process when all seems dark.

Discernment is about responsibility. It requires you to step-up and say, “This is important to me. This is what I believe.” Too often, people avoid this responsibility for any number of fears including fear of judgment, or disapproval. Paradoxically, when you step-up and take responsibility for your journey, freedom is possible. It is also communal in sharing your choices with others. Should you say, “Yes this is me!” but fail to talk with your primary support network, I would say that you are avoiding the responsibility of your choice.

Tuesday, March 9, 2010

Relationship parallels for sexual health

My last two posts focused on sexual functioning issues, and unlinking sexual behavior and drug use. The feedback from clients has been positive. A colleague adapted the material to also talk about relationship development. I'm pleased to add Dr. Shannon Garrity as a guest author for this post.

Relationship parallels for sexual health
Shannon Garrity, Psy.D, LP

You have admitted you want a relationship, which is an important first step. As you progress in finding your *perfect* partner, consider the process it took to even admit or realize you want a relationship. We have mastered the art of skipping over the tough, ambiguous parts of life – now we are learning to navigate the unknown, vulnerable, exhilarating process of life. Consider the guide below as you put yourself out into the dating world (a relational parallel for de-linking sex and drugs):

1. Looking. Physical attraction or that “something” about the other person is often what first sparks interest, but to what else are you attracted? How important is it that your partner demonstrates values consistent with yours? Do you want someone with whom you can laugh? Is intellectual stimulation important to you? What about openness? Is it important to have a partner who is friendly, polite, compassionate, and/or sincere? Consider other general characteristics that you wish to have in a partner. It may also be helpful to consider to what extent do you demonstrate these?

If you need to, set rules for yourself. Some rules may be: no naked times until at least 3 months have passed, no overnight dates until at least 2-3 months, no sex until you really know (and still like) the person. Also consider your non-negotiables: he/she must be gay/bi/etc. and un-partnered and out, he/she must have xyz length of sobriety and/or not use, he/she must demonstrate general levels of respect, social decorum, etc. What have you struggled with in the past and what are you intent on changing?

2. Chatting/Flirting. In the early stages of dating or getting to know someone, you are doing just that – getting to know a person. You are getting to know him and how you are or how you feel when you are with him. Does he/she interest you? Does he/she laugh with you (or do your jokes fall on seemingly deaf ears or does he make fun of people rather than use humor in a non destructive way)? When you are in the chatting stage, you are at the beginning stages of getting to know someone. Generally, topics of conversation involve current events, pop culture, likes and dislikes, general relationship histories or life lessons; consider the idea of playing and having fun. This is the “hanging out” period. Face to face contact is probably once per week and maybe a chat or two during the week. Notice and heed to what is comfortable for you. Try dating – remember you are dating and getting to know the person, you aren’t married yet ☺

3. Spending more time together. As you get to know each other, you increase the frequency and time you spend together. If things are going well, this is when you usually might start thinking: will we want dogs or cats, does he want kids, or where will the honeymoon be? Resist judging the fantasies as good or bad, or trying to “figure out” if he likes you as much. Just note that they are fantasies and reconnect with the moment and stage of the relationship. If you were dating others when you met, you are likely both still dating other people; but you may begin to notice that you are particularly fond of this one.

4. Emotional touching. When you begin to notice you are really happy when he/she texts or calls or you feel noticeably excited to see him, you have progressed to the “emotional touching” phase. You likely exchange confessions of “I like you,” “you’re cool,” etc. You begin to experiment with the idea of progressing to a true, “I’m interested in you” dating relationship. Questions of “where is this going” or questions of a celestial nature are answered in the interaction itself. If you are wondering how he/she feels about you, consider his actions: does he seem happy to see you, do you talk, is the interaction balanced? Trusting yourself is key and takes practice. Notice the state of your anxiety level – this may be when you typically would have either bolted or started really worrying about whether “he/she likes you” or started covertly criticizing him/her. Pause, regroup and stay focused on yourself (yes, attend to the interaction, but remember it is not just about him/her – if he/she doesn’t call you back for 5 days, fine – this is about you practicing being grounded and authentic). Check in with yourself, how do you feel with him/her? Do you feel good and energized? Do you feel uncharacteristically dominate or uncharacteristically submissive or uncharacteristically somewhere in the middle? Periodically ask yourself these questions.

5. Emotional Petting. Ok, so you really like each other. You really like him/her. Notice the stirrings you feel. Remember to take care of yourself during this time. Keep working, keep spending time with your other friends and family. Yes, feel excited about your new guy/gal, but continue to attend to yourself. As you continue to get to know the relationship, ask yourself if you would be proud to introduce him/her to your friends and family? Have you met his/her friends and family? If you have done this already, how did it go? If you haven’t done this and have wanted to, consider what is happening (e.g., are you nervous or noticing “red flags”)? Do you feel comfortable having a conversation about this?

6. Full heart touching. As the relationship progresses, you will feel more of a connection. You will share more of your histories, etc. Be mindful when sharing your story. You are not “hiding” parts of yourself or your past. This is not about shame or keeping secrets; rather, you are learning about, setting, and experiencing your emotional and psychological boundaries. Do not assert more vulnerability than you are willing to lose. For example, if you feel a rush to disclose something or anxious to inquire about his/her response to more details of your history, notice what happens (your internal dialogue) or what you are thinking about before you take the plunge (this is not to say, “don’t do it,” just have a sense of your goals or hopes in doing it).

Be equally mindful when hearing his/her story. Is he/she going too fast for you? What is he/she “pulling from” or touching in you? For example, does he/she talk in detail about how much he/se has been hurt and you feel the need to take care of him, or does he/she assert anger about someone to the point where you start to feel nervous? Does he/she “push” you or ask you questions you are not ready to answer? Does he/she respect your boundaries when you set them? Notice what is happening within yourself: is it feeling too close? Are you changing yourself in some way? How can you correct this?

7. True Vulnerability. You have decided it is the two of you and things are going well. You know the other person as a separate being. You get who he/she is, quirks and all; and he/she gets you, quirks and all. The intimacy progresses to different levels, you feel like you have a close friend/partner with the other person. You are your best self.

8. Mutual Expression. You can talk with each other about everything: values, spirituality, family, work, friends, sex, likes and dislikes, open or not open relationship and related expectations. Although the connectedness and openness is there, you are still psychologically and emotionally autonomous. You have your bad days still but you know your partner is not responsible for not anticipating your every need. You still take care of yourself but you have a supportive partner.

9. No more fantasy land. Believe it or not, part of healthy relationships includes conflict at times. This is not about “I want Thai and he wants Burger King,” this is a fight where you might hurt each others feelings, say things you shouldn’t, etc. When you take time to look at the conflict notice how you experience it: do you feel victimized, do you feel he was “totally” in the wrong, are you thinking of ending it? What is happening in your world? Consider how the fight emerged, what happened? What was it about? Did it involve others? Were you starting to feel anxious and restless? Did you “pick” the fight? Did he /she“pick” the fight? Was there a need that hadn’t been met or stated? Consider the content of the fight and the process of the fight. You have been disappointed and have disappointed. You are both totally human. How will the relationship tolerate this?

10. Break-through (first kiss and make up). How did you resolve the conflict? Resolution takes time – re-attuning with your partner is something of a process, depending on the nature, intensity and frequency of the conflict. Do you feel good about how the resolution occurred? Did you both consider each others’ feelings and person? Did you just feel blamed? Were you really blamed or was that a voice and were you able to discuss that with your partner? Did you feel you both worked at it and met in the middle?

Often, a conflict of sorts brings couples closer, provided the conflict is “fair.” In working through the conflict, you both describe only your own positions (no one is the victim and no one is the abuser). This means you are grounded in your own experience. If you have a guess as to the other person’s reality, then ask, but you cannot read the other person’s mind – he is doing what makes sense to him and you are doing what makes sense to you. What can you learn from the conflict? For example, if one person was starting to feel resentful about something, where was the point for assertiveness? At the same time, where was the other person and did he know? Now repeat steps 1-10 multiple times.

11. Transformation. You have the house in the Hamptons and a pet tiger (now keep repeating steps 1-11 in no particular order…and remember to keep playing and having fun).