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).