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!


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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.

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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.

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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.