Tuesday, January 12, 2010

Dating and Sexual Health Recovery

As a person starts to address sexually compulsive behaviors, they sooner or later start the process of moving toward meeting others including dating and eventually courtship. The suggestions below aren’t the “how-to-date” suggestions. For those tips, I refer you to other resources (Dating for Dummies). Instead, I want to focus on the bigger question of how does dating fit into your recovery process. The 8 questions are designed to help frame the desire to date as progress, and a tool for your ongoing recovery. While perfection isn’t required (or possible), addressing these concerns will increase your chance of positive experiences.

1. Clarify if you are ready to date. Dating requires that you have a sense of self, and that you are comfortable in your overall progress. Dating requires assertive communication. It requires that you’ve defined your basic boundaries including level of disclosure, when disclosure will occur, and a multitude of desires and wants. Examining past dating experiences and addressing triggers that led to relapses is important. Talking with your support network and addressing their feedback is also important.
2. Clarify your boundaries about what behaviors would be acceptable. Set up explicit boundaries about the type of sexual behavior that can/won’t occur. This needs to be clarified before you start dating.
3. Identify your goals. Be honest with yourself and your support network about what you are looking for in your desire to start dating. Are you looking for friendship? sex? relationship? children? None of these is better than any other; but the key is to be honest. Develop the skills to effectively communicate these goals with your potential partners. Communicate and get feedback from your support network.
4. Clarify the types of “date” you want. Sometimes starting small is a better plan. You might go on a “coffee-date” on a Saturday morning. You might do a lunch-date. Instead of calling it a date, describe it as a social chat or a meet-and-great. Taking the word “date” off the table, and focusing on the social interaction can reduce stress and anxiety. Scheduling it during the day, or mornings (versus Friday evening) can create clarity regarding your goals.
5. Identify activities that you want to do. In identifying your activities, use it to start conversations about what your potential dating partner likes to do. Think outside the box. Review the suggestions on intimacy to consider alternatives to the classic date. You might go to church, go to a museum, go to lecture, etc. Consider volunteering to channel the energy, but also focus outside of yourself.
6. Create safety plans. Before you go, make sure you schedule an out. If you’re going for coffee-date, set up an out at 1 pm by saying I have a meeting with a friend at 1. And, set up a meeting with a person from your support network for 1 pm to talk about the experience.
7. Remember dating for what dating is. It’s a chance to meet and interact with others. You’re not making a lifetime commitment to the person on a single date. By addressing the expectations and assumptions you bring to the conversation, you can maintain your focus.
8. Address known concerns before hand. For example, if you’re an introvert develop topics you feel comfortable sharing and asking about. Make sure you are asking questions versus letting the other person set the agenda. If you’re the classic extrovert, make sure you listen as well.

Monday, January 11, 2010

Topic 12: Behavioral Analysis

--I apologize...the formatting didn't transfer from the table. Please feel to contact me via email for a copy of the document.

Clients often report they don’t know why they did what they did. And to a large degree, I believe them. I often challenge my clients to tell me the steps necessary to drive a car. As they do, I playfully trip them up by asking questions about this or that. What they come to realize is that driving a car is a remarkably complex task that calls for multiple thought processes and requires you need to pay attention to details. In psychology, this term is called “automaticity:” the ability to complete complex behaviors without active cognitive thinking –like a habit. Much of the ritual in Internet sexual compulsivity is automatic. People fall into a trance, and simply don’t know why they are doing what they are doing. A helpful tool in identifying thinking errors, feeling triggers and high-risk situations is the completion of a behavioral analysis. This is a step-by-step examination of what happens in an acting-out experience. The goal is to help you identify additional relevant issues, so you should examine all details, no matter how small you think they are. The behavioral analysis is a way to slow down and uncover the contributing factors. In the process of completing the analysis, you will identify a number of places to intervene and interrupt the cycle.
• You will learn to recognize and then contradict thinking errors. Challenging negative thinking through corrected thoughts or using affirmations (if you are familiar with the 12-step tradition) is a start.
• You will be able to address your feelings. Identifying ways you can connect with others in a healthy way, for example, allows you to help address feelings of loneliness. If your sadness and depression are significant and long lasting, medications or therapy might be helpful.
• High-risk situations are recognizable. Too much free time can make you vulnerable to a high-risk situation. Finding ways to engage in healthy fun is another way to intervene on the cycle.
In each of the behavioral analyses, I talk about an escalating pattern of behaviors that sets the stage for the next trip through the cycle. When working with clients, I call these trips “micro-cycles,” because you may experience multiple trips through the cycle within a given time period. The example below highlights multiple ways you may have failed to cope with the setups throughout a given time period. The key then is to identify ways you can interrupt any and all of the various parts of the cycle.
• Using the template below, complete a behavioral analysis of an acting-out encounter. What feelings triggers (see page XX) thinking errors (see page xx) or high-risk situations (see page xx) did you identify? Update the current lists, as appropriate.
To complete the analysis, it may be helpful to work backwards. Start with the acting-out incident. Answer the question “What happened?” Then ask, “What happened right before that” and so on. Stay focused on what happened while you work backward. Don’t give up to early, but you can always add more if you remember parts of the cycle. It’s like tracing the last domino’s fall back to the first domino. Once you have a good start at what happened, complete the other columns by adding the corresponding thinking errors/thoughts, feeling triggers and high-risk settings. Try to fill each column, but if you can’t you can always come back to it. At the end of the process, summarize the behavioral analysis. Every item in the analysis becomes a place to develop an intervention plan.
---Start Here---
What happened?
Include Payoffs or Consequences Thoughts
What was I thinking?
What reason did I use?
What was I feeling? High-risk Situation
When, where, who, what?
I hooked up with someone I did it again. Shame.
Hopelessness. Isolation. Avoid my support network.
Late night
No support
I drove over to their place He/she is attractive. Sex will be great.
Why do I keep doing this? Excited, happy, numb, distracted. Going to other peoples house.
Not establishing boundaries.
No support network
Keeping secrets
I was chatting online Maybe I can connect with someone.
My partner is already asleep, no one will know.
My partner isn’t available Lonely, excited, aroused Cruising.
Online late
Online in “bad” places
I start looking at porn. No one will know
It’s only pictures
I earned it after how bad today was. Justified, entitled,
Bored No supervision online.
Porn sites
I was checking my email I have to see what else needs to be done on the project. Lonely, tired, sad. Working too late
Using work to give me an excuse to use the internet
I was heading to bed Can’t talk to anyone.
I’m alone.
No one cares Sad, depressed, lonely, tired. Isolation.
I had a fight I can’t do anything right.
My partner doesn’t understand.
It’s my fault Fear, sadness, shame, guilt. Seeing someone angry.
Lack of assertive skills
I missed dinner My partner doesn’t care; he/she didn’t’ wait for me. Hungry Not eating well
Not keeping a schedule
Life not in balance
I come home late I had to get this project done.
Maybe my boss won’t be mad at me if I’m done.
It’s not a big deal. Stress
Fear Working late
Not keeping a schedule
Trying to please others.
I had a project to complete at work. Oh no. I’m in trouble.
I should know better.
I have to do it myself.
No one will help.
It has to be done today.
I’m going to get fired. Worried, anxious.
Stress Made a mistake.
Not talking with others.
Not being honest.
Not asking for help.
Lots of conflict at work. Better be careful or my boss will turn on me.
I’d better not screw up. Worried/fearful that someone is angry.
Shame/Fear Someone is angry
Consequences at work.
My boss yelled at me. I did it again
I’m in trouble
I can’t do anything right.
I told myself I wouldn’t do that again. Tired.
Shame/Guilt Conflict
Doing things I said I wouldn’t
I came in late because I overslept Frustrated that I didn’t sleep well.
I did it again Tired. Hooking up the night before (complete and/or continue the analysis)
Summary of the analysis Catastrophizing.
I can’t make a mistake.
I’m in trouble.
I can’t tell anyone.
I’m going to get fired.
I’m alone. Lonely.
Stress. Not sleeping well.
Making a mistake.
Being online.
Working from home.
Working late.
Chatting online.
Looking at porn.

Sunday, January 10, 2010

Topic 11: Payoffs—Why go-online for sex?

Interrupting the acting-out cycle requires awareness of the payoffs for online sexual behavior. This is essentially answering the question, “Why go online?” While the reasons for engaging in online sex may vary, it is important for you to uncover some of the reasons and payoffs that are important to you. It is our opinion that ALL behavior is goal focused. Your online behavior is seeking some type of payoff.
While we believe the payoffs are always present, our level of awareness of these payoffs varies. Some payoffs are direct: “I find someone to hook-up with and have sex.” Some of these payoffs may be “hopes” that something will happen: “If an attractive person says yes, I’ll be OK.” In some circumstances, the reasons for online sexual behavior may highlight clinical issues (depression), or patterns of the acting out cycle that you need to address. This is a much more difficult task than you may think. To put this in perspective, a recent journal article identified 237 reasons a person has sex separated into 13 factors. As you review your online sexual behavior, consider the following:
• Physical reasons for sex:
o Stress Reduction. “I am at work, and this gives me a distraction.”
o Pleasure. “Sex is fun.” “Having an orgasm is fun.”
o Physical Desirability. “I want that person.” “That person wants me.”
o Experience Seeking. “I’m bored and don’t have anything to do.” “I can do something online that I wouldn’t do in person.”
• Goal attainment for sex:
o Resources. “I will get money/drugs.”
o Social Status. “My reputation will get better.” “No body will know.”
o Revenge. “I will make that other person mad.”
o Utilitarian. “I will get a raise/promotion.”
• Emotional reasons for online sexual behavior:
o Love and Commitment. “I love you.” “I’m scared of my partner.”
o Expression of Feelings. “I’m sorry.” “I’m mad at my partner”
• Insecurity reasons for sex:
o Self-Esteem Boost. “Someone wants me, I feel better.”
o Duty/Pressure. “My partner won’t do what I want.”
o Mate Guarding. “I can’t have sex with my partner, so I’ll go online instead of. . . .”
Levels of Payoff
We think about three different types of payoffs: Primary, Secondary, and Indirect. Primary payoffs roughly (but not always) parallel biological or immediate emotional needs. These are often the focus of the behavior. Consider the following examples.
It’s been a long, hard day at work. I think I earned a break. I go online for stress release. While online, I start chatting with someone who wants to hook-up. I have great sex, feel great and get even more of a sense of relief from the stress. But I also feel shameful and guilty which reinforces why I need to work so hard to get a sense of affirmation thereby causing the stress.
Additional examples of primary payoffs include:
• Great Sex.
• Sense of connection/Intimacy
• I can find things online that I can’t find in person.
• Stress Reduction.
Secondary payoffs are pleasant outcomes of the behavior. While they aren’t the first goal, the outcome also is a pleasant payoff.
I realize I may be attracted to someone of the same-gender (gay/bi/lesbian). I’m scared of meeting people, or others finding out so I go online. This way I avoid the reaction of others; a preferable outcome versus my parents/partner finding out.
I’m horny, and my partner doesn’t want sex. I go online to look at sexually explicit material. While surfing, I go to a chat room and start to look at the pictures of other people and start chatting/video cam.
In some stereotypes, women are not seen as “sexual beings.” A woman might go online for a sexual encounter, but they also don’t have to cope with the reactions of others.
Examples of secondary payoffs might be:
• Sense of Affirmation.
• Addresses boredom with something to do.
• I get to be someone I’m not in real life.
• No one will find out.
• Not alone for an evening.
Indirect payoffs are very subtle and complex to identify. They may or may not be present all the time. Sometimes the negative consequence is actually what we are seeking. I find that some people will actually sabotage their goals out of a fear of success. These individuals might have a high level of shame, such that the only sense of any accomplishment comes through getting in the way of their own goals.
Examples might include.
• Reaffirms the negative feelings I have about myself.
• I can justify how I work to make up for the negative feelings.
Notice that what is a payoff depends on the person. While some of the payoffs may appear similar across individuals, each person has their own unique pattern of payoffs. Review your sexual timeline and history and times where you acted-out. Examine which reasons for sexual behavior may be relevant. As you reflect on the reasons, examine the thoughts and assumptions that are present. If, for example, a reason for sexual behavior is to increase self-esteem, examine what are the thoughts and feelings associated with the low esteem. Finding healthy ways to get these needs met will be done by stage 3 of the workbook.
• Review your timeline. Identify the payoffs for your most recent acting-out encounter. Pay attention to both the primary and secondary payoffs and the indirect payoffs. Pick another acting-out encounter and repeat. Review with your support network.
• Analyze the timeline for the possible payoffs listed above.
• Share these with your support network. Do they agree? Disagree? Why?
• Which payoffs do they suggest might be present?
• What are your initial plans to help you get these payoffs in healthy ways?
• Return to the list and update as necessary.
Summary of Your Current Payoffs for Sexual Behavior
My plans for coping:

My plans for coping:

My plans for coping:

Wednesday, January 6, 2010

Abuse, Sexual Health and Recovery

Recent discussions have keenly reminded me of the tremendous affects of abuse on sexual behavior, mental health, and chemical dependency recovery. I refer the reader to other entries in the blog regarding extended conversations about types of abuse. Here I simply want to acknowledge the big three: sexual, physical and emotional. While these are helpful labels, they are far from black and white. I also think of abuse in terms of overt (recognizable) and covert (hidden). The experience of sexual abuse has so much shame associated with it that we never talk about it. The Hollywood version of abuse hides the experiences of innuendo, harassment and manipulation. People often recognize when they are physically hit, but clients also recognize the concept of “the look” or the statement “wait until your father gets” home. Both experiences introduce the experience of unease, of fear, to outright terror suggesting linkages to abuse. The experience of emotional manipulation belies the difficulty in defining emotional abuse.

I encourage my clients to think about the following indictors. If you know you’ve been abused, I ask you to think about which symptoms are present. If you don’t know you’ve been abused, I ask clients to consider which symptoms are often present. What types of experiences trigger the symptoms? If there are patterns to the experience, I encourage the individual to look further into the issue.

Some consequences/indicators that trigger further work include:

• Displays agitation or anger, uncontrollable behaviors, tantrums.
• Displays anxious behaviors (nail biting, teeth grinding, rocking, etc.).
• Often belittles self (“I’m bad, naughty, evil, etc.”).
• Resists authority or desperately tries to please because they fear repercussions.
• Exhibits excessive guilt.
• Shows fear of a particular person or place.
• Thoughts involve themes of sexual acts, torture, bondage, humiliation and/or abuse.
• Hurts others sexually or physically.
• A child mimicking adult sexual behavior (such as intercourse, French kissing, etc.)
• A child having age-inappropriate sexual knowledge.
• Increased chemical use.
• Increased sexual behavior.
• Individual has lots of fears.
• Shows inappropriate emotions or no emotions at all.
• Fearful others hate them, are angry, want to hurt them, punish them or kill them.
• Fearful someone is “after them” or going to hurt them; wary of strangers.
• Has low self-esteem.
• Struggles with forming or maintaining friendships.
• Engages in self-destructive behaviors; intentionally inflicts harm on self.
• Appears to be “in a fog.”
• Experiences excessive mood swings.
• Suicidal thoughts, statements or gestures

Recovery from abuse is a bit of a process. I highlight the broad themes here.

1) Find Safety. If you are in immediate or ongoing danger, you’ll need to be in a safe place. There are treatment programs, and/or shelters available for this area. Look for Domestic Abuse or Sexual Violence programs in your local area.
2) I encourage you to find a therapist/professional help. My experience is that this can be a significant process for many clients. For clients who have severe experiences, the treatment process is rather entailed.
3) Once stable, tell your story. And then tell your story again and again. Group support/therapy is helpful. The decrease in shame, fear and isolation that occurs through group can be powerful. Understanding that “I’m not alone” and “Someone understands” is a powerful source of hope. I often have clients complete an “abuse history” describe the life history of abuse. Lest that scare you, remember the next step.
4) Take it slow. This is a long process. Sharing your story once is only the start. Moving forward sometimes requires 3 steps forward, 2 back. I start the assignment on the abuse history by focusing on 4 events: “Describe 4 (or whatever number) events.” Or, simply acknowledging “I’ve been abused” is the first step.
5) Identify triggers. Once you know your history, understand what triggers flashbacks and struggles in your current daily functioning. You’ll need to develop plans to address the triggers.
6) Move forward. What do you want your life to look like? This is hardest place to get to in therapy. The level of fear and lack of hope will need to be resolved prior to this place.
7) Put a plan in place. Follow the plan. Developing healthy intimacy and health sexual expression is in of itself difficult. My last two posts describe this process.
8) Journal, Journal, Journal. Journaling is both for the therapy process, as well as reminders of your progress. When frustrated, recognizing where you’ve been, what you’ve come through, and where you’re going is helpful. Some clients “beat” themselves up because they can’t talk to everyone at a party because they are uncomfortable. A journal can highlight how simply getting to an event is amazing progress. Journaling doesn’t have to mean writing; given technology this can include video recordings, or art or other forms of expression.