Working on a Newsletter summary of the Cybersex Workbook.

CYBERSEX AND RECOVERY

The overlap between chemical health recovery, sexual health/sexual compulsivity and cybersex is well documented. Too often, clients and professionals don’t examine the role of the Internet as a relapse trigger for sex and drugs. This brief article provides a basic intro to addressing online behaviors.
What is Cybersex?

The term “cybersex” has become a catchall to describe a variety of computer based sex related behaviors. These behaviors can include accessing online pornography (audio, video, text), engaging in sexual chat with others, creating an avatar to engage in sexual acts or chat, using sex toys designed for the online world, or a combination of all the above. More variations of online behavior are being developed as the Internet changes.


When Does Cybersex Become Compulsivity?
It is important to understand that not everyone who engages in cybersex behavior has a problem with compulsivity. Research indicates about 85% of individuals who engage in cybersex behaviors do so without serious consequences. In thinking about your cybersex behavior and determining whether it is problematic or out of control in your life, there are two components.

Subjective – Realization that a Problem Exists
On some level you recognize your online sexual behavior is a problem. Cybersex compulsivity includes many sexual behaviors or thoughts that violate your personal values and boundaries. “I know I did something I didn’t want to do.” The vast majority of people seeking help realize they need help.

Objective – External Notification of a Problem
Some form of external feedback has presented itself to bring the situation to light. This feedback can come in the form of a legal consequence (such as an arrest), a financial consequence (such as money spent on the Internet, or termination from a job) or damage to a relationship because of the violation of boundaries. For some people, the objective component of sexual compulsivity may not always be present.
The basic premise is that you define healthy and unhealthy behaviors in dialogue with others. It will be most helpful for you to pay attention to whether there is a repetitive and consistent pattern to your behavior, and how the consequences of your behavior may be affecting your life and relationships.

Internet Sex Screening Test
One way to help determine if a behavior is problematic is to take a self administered screening test. The Internet Sex Screening Test has been taken by thousands of individuals and can be used to help gauge how problematic your online sexual behavior may be. This screening test is available at www.internetbehavior.com


Problematic Cybersex Users
Remember 85% of people don’t have a problem with online behaviors. People who exhibit problematic sexual behavior on the Internet tend to fall into one of the three groups:

Discovery Group
People in this group have no previous problem with online sex and no history of problematic offline sexual behavior. However they often begin using sex on the Internet as a recreational user and become completely carried away with online activities.

Predisposed Group
This group is made up of people who have never acted out sexually until they discovered cybersex. They might have fantasized about exposing themselves or had the urge to see a prostitute or go to a strip club. Until they discovered the world of cybersex, however, they were able to manage their fantasies and urges.

Lifelong Sexually Compulsive Group
People in this group have been involved in problematic sexual behavior throughout most of their lives. They might compulsively masturbate, compulsively use pornography, practice voyeurism or exhibitionism, or compulsively frequent strip clubs and prostitutes. For these people, cybersex simply provides a new option for acting out sexually that fits within their already existing patterns of problematic behavior.


A Primary Assignment to cope with Cybersex.
It is important to assess the specific Internet behaviors that contribute to high-risk situations, or relapse. The final assignment from the workbook follows. In this assignment, you create three circles where you address the following:

Outer Circle Are Acceptable Behaviors
These behaviors are any Internet behaviors that are healthy in your world. The key is that you have to define these behaviors. Others might provide feedback and suggestions, but in the end you MUST clarify and determine what are acceptable behaviors in YOUR world.

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. 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 p.m. At 9 p.m., he started to get tired and moved into the trance often associated with compulsive online behaviors. Surfing the Internet until 9 was a cautious behavior, because he had to make sure his plans were in place to prevent surfing after 9 p.m.

Inner 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 at work 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.

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.






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

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.

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.

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.

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.

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 nsimon@pride-institute.com.

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.

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.

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.

Tiger Woods and Sexual Compulsivity

In all of the recent news on Tiger Woods, very little conversation has occurred beyond the titillating sexual behaviors, number of sexual partners, and the eventual impact on his marketing career. I would hope that somewhere in the conversation, the media would start to address questions of sexual compulsivity. Like many of the recent sexual scandals, we focus on the sensationalism without focusing on the emotional toll on those involved and the struggle many individuals have in the area of sexuality. (Just to note, not knowing the details, I will refrain in assessing Tiger Woods the person.)

This story is only one in a series of many stories to come. Who is next is irrelevant; the key for me is to help others get the services they need. Whenever something like this occurs, I hope people can use the story as a way to reach out for support, help and resources. There are many resources available including SASH.NET, and AASECT.ORG. Reach out and find some resources. Help your self, or help others get the help they need.

Living a Life I Love: 6-week workshop

As part of my new job, I'm posting information on a 6-week workshop addressing sexual compulsivity. The goal is to help participants toward getting what they want in their relationships.

Start the New Year addressing sexual health issues in your recovery. Join a discussion group designed to help you address sexual health concerns. The goal of this workshop is to help you get the type of relationships you want. This workshop is for individuals who have questions about sexual addiction/compulsivity, or avoidance of sexual behavior (sexual anorexia). For many in recovery, sexual health concerns are the last topics to be addressed. The topics reviewed are:

Jan 6, Week 1: Acting out cycle/Safety Plans
Jan 13, Week 2: Sex Timeline/Behavioral Analysis
Jan 20, Week 3: Understanding your Timeline
Jan 27, Week 4: Co-factors of Sexual Compulsivity
Feb 3, Week 5: Prevention Planning
Feb 10, Week 6: Creating a Personal Definition of Sexual Health.

Group size is limited to 10 individuals. Space is limited. Cost is $170 for the entire 6-week series and includes the cost of materials, paid at the first session.
Weston Edwards, PhD, LP will facilitate the discussion group. He is the Clinical Director at Prism. He has 16 years experience working in the area of sexuality. For More Information, contact Dr. Weston Edwards, PHD, LP at 612 825 8714

Professional Changes

The next few weeks will see radical changes in my professional career. I'm happy to announce that I will be the Director of Clinical Services at Pride Institute and Prism. I will supervise the Outpatient Adult and Adolescent Intensive Outpatient Chemical Dependency Programs at Pride Institute. I will also supervise the new mental health program at Prism. In this role, I will develop the new program.

Prism is a new program providing mental health services. (Essentially I am moving my current practice to Prism.) Prism will provide specialty services in mental health, substance abuse and sexual health concerns. For many individuals, the problem areas overlap. Both mental health and psychiatric services will be available. Our goal will be to provide one-stop services.

Watch for future updates.

Sexual Health and the Employee Assistance Professional

On October 23rd, I presented in Dallas at the World Conference for the EA Professional. (see http://www.eapassn.org/i4a/pages/index.cfm?pageid=1117) The general topic is sexual health and how the EA professional needs a basic awareness of the sexual health model in triaging employees. As always appropriate self-knowledge, awareness of resources, and targeted referrals is a necessary part of the process.

What was "scary" for the presentation was how little sexual health training many of these folks received in their formal degree program. I know our academic programs are full (remember, I teach in a program), but given the importance of sexuality in everyone's lives, I would advocate for additional training. Playfully, the participants at the conference recognize that they are now the "experts." An expert is someone who has more skill or training than those around him/her. Given that definition, a simple workshop will make someone an expert in that they know more than those around them. If that isn't scary, I don't know what else will.

If you would like a copy of the presentation, please contact me back channel. I will forward a copy of the handout which reviews the sexual health model, and provides specific suggestions for the EA professional.

The workbook is Live!

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

Living a Life I Love:™ Healing sexual compulsivity, sexual addiction, sexual avoidance and other sexual concerns is designed to help you create a life you love in the area of sexuality. The workbook will help you understand your "acting out cycle" by identifying your high-risk situations, feeling triggers and thinking errors. The workbook has three stages:
1. Problem identification: During this stage, you examine your sexual behaviors, sexual history and acting out cycle.
2. Primary treatment addresses factors linked with unhealthy sexual behaviors.
3. Creating your future: The third stage will help you reach out for support and encouragement. You'll complete a personal definition of sexual health to help you live a life you love.

To READ MORE:
www.LivingALifeILoveBooks.com
TO ORDER:
https://www.createspace.com/Customer/EStore.do?id=3382965

Integration with the 12-steps

I'm still adding a few ideas now and then in the new workbook (so much for being done!). This was a requested topic. "How do the 12-steps and the workbook overlap."

All of the topics listed here are in the blog...the order is a bit confusing. The page and topic numbers refer to how the new workbook has been reorganized.

One of the more common ways that people address sexual compulsivity is using the 12 steps. I see the workbook and 12-steps as complementary. In fact, I created the first draft of the workbook for a 12-step chemical dependency program where I work as the Director of Program Development. The first task was to develop a Sexual Health Program within a residential and outpatient CD program. The following is how I think the 12 steps overlap with some of the topics in the workbook.

1. We admitted we were powerless over sexuality—that our lives had become unmanageable.
Topic 1: Immediate Short-Term Prevention Plan, page 11.
Topic 3: Sex History, page 15.
Topic 5: The Acting-Out Cycle, page 23.

2. Came to believe that a Power greater than ourselves could restore us to sanity.
Topic 37: Spirituality, Values and Sexual Health, page 144.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
Topic 39: Creating Your Future, page 160.

4. Made a searching and fearless moral inventory of ourselves.
Topic 3: Sex History, page 15.
Stage 2: Primary Treatment: Related Topics, page 57.
Topic 24: Abusive Behaviors Toward Others, page 106.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
Topic 2: Talking About Sex, page 13.
Topic 40: Toward a Personal Definition of Sexual Health, Component 1. Talking About Sex, page 165.

6. Were entirely ready to have God remove all these defects of character.
Introduction to the Workbook, page 1.
Defining Sexual Compulsivity, page 2.
Topic 7: Thinking Errors, page 28.
Topic 8: Primary Thinking Error, page 33.
Topic 9: Feeling Triggers, page 36.
Topic 10: High-Risk Situations, page 38.

7. Humbly asked Him to remove our shortcomings.
Defining Sexual Compulsivity, page 2.
Topic 37: Spirituality, Values and Sexual Health, page 144.
Topic 38: Continuing Care Plan, page 150.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.
Topic 3: Sex History, page 15.
Topic 24: Abusive Behaviors Toward Others, page 106.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
Topic 36: Disclosure to Partners, page 140.

10. Continued to take personal inventory and when we were wrong promptly admitted it.
Topic 1: Immediate Short-Term Prevention Plan, page 11.
Topic 13: Logging your Sexual Behaviors and Fantasies, page 48.
Topic 38: Continuing Care Plan, page 150.
Bottom Line Behaviors, page 158.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His Will for us and the power to carry that out.
Topic 6: Power of Thought, page 25.
Review and Repeat, page 174.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to others, and to practice these principles in all our affairs.
Topic 39: Creating Your Future, page 160.
SexualHealthInstitute.blogspot.com, page 174.

Healthy Solo-sex

"Can you tell me how to masturbate longer than 10 minutes that includes using a dildo?"

Here are eight ideas to prolong things -- in a good way, that is.

Be the turtle
Jacking off is not a race to see who can finish first, although that can be fun, too. Often, a j/o session is a fill-in behavior to boredom, or simply a spontaneous reaction to feeling horny. Think about when you can "schedule" the time and you'll find your j/o sessions will get more intense and powerful.

Not all dildos are created equal
If you are planning on using a dildo, make sure you have a size realistic for you. Anal play requires a lot of lubrication and time to loosen up, so before you grab the dildo modeled after your favorite well-endowed porn star, you might want to think about starting with something smaller. Dildo novices! This means don't just push in the largest thing you can find. Make sure you follow good dildo care by using a condom (condoms can help keep the dildo clean, make them last longer as well as help with clean up).

You might also want to consider trying a butt plug instead. Given the solo process, your hands might be busy with other things, making it difficult to keep the dildo in your body.

Go for the fantasy
Think about your favorite sexual fantasy. Perhaps writing your fantasy out can help expand the fantasy. Identify who, what, when, where, paying attention to the surroundings, smells, sounds, circumstances and details. By identifying your fantasies, you can integrate them into your solo-sex sessions

Really get to know your body
Part of making a solo j/o session fun is the process of discovering which parts of your body are most arousing. Since there are a number of known erogenous parts of your body, go exploring and pay attention to those that are most erogenous for you. Some guys find their nipples arousing. Others find their legs, balls, or neck arousing. Don't forget the anus and the area between the balls and anus. Play, rub, and otherwise stimulate these areas. Move to massaging and playing with the various parts of your body.

Give him a hand
When you stimulate your penis, pay attention to the various ways you can hold your penis. Different grips lead to different experiences. Discover what you like the most, and try other ways, as opposed to simply doing it the same way every time.

Edged out
The typical guy has a time of increasing arousal, a period of time of erection, and then a point where no matter how hard he tries, he can't stop the orgasm. Edge play is the process of approaching this point and then backing down again.

Two's company
One sign of a healthy relationship is the ability to talk about sex, including fantasy and masturbation. Mutual masturbation, dildo play and many of the ideas above can easily be integrated into your relationship. Talk with your partner about what he likes and incorporate them as well. Healthy sexual relationships can include solo masturbation, mutual masturbation and multiple forms of play.

Review and repeat
This is perhaps a task that is great to practice and repeat. Use different positions, body parts, hand holds or other things, such as fabric, or types of lubricants. Try different fantasies and scenarios. In other words, keep changing things up to keep things lively.

The Importance of Community

Having people in your life to support you in the process of improving your sexual health is important. It is recommended that you have 3-5 people with whom you are transparent. In the process of defining your personal definition of sexual health, it is this group who serves as a counter balance to an individual's desire to do anything you want. Remember that sexual compulsivity has both an internal and external accountability. Developing your support network is a way to increase external accountability.

Four strategies for starting the process of developing a support network include.

1) Start off small. Say "I'm now in therapy. I need someone to support me, but I'm not ready to go into full detail right now."

2) Examine who in your life is already supportive. Expand what you might say to the person that increases your self-disclosure. You might say that I'm working with a therapist in the area of human sexuality.

3) Identify a big name "star" who has "come out" regarding sexual addiction and compulsivity. (David Duchovny is one of the recent stars who disclosed his personal struggles.) This can help you introduce the topic.

4) Without naming the issue, share some of the negative thoughts or feelings that set you up to act out. Share "I'm really stuck on how negative my thoughts are" or, "I struggle with a lot of shame."

These are simple strategies to start the process of disclosure in your recovery process.

Grief

Another issue sometimes connected with the acting out cycle is grief. Various theories have talked about the process of grief. The theory I like best is provided by Kubler-Ross where she identified five stages of grief. Her original research has focused on death of a loved one through terminal cancer. Subsequent researchers have modified or adapted her model, but the common reference in all of those models is a comparison to the original model. The five stages of grief according to Kubler-Ross are denial, bargaining, anger, depression and acceptance.

Three adaptations or expansions of the model that I include are: one, the role of perceived losses and two, the role of small losses, and three the “time focus” of grief. Sometimes feelings of grief result from a loss such as a death of a loved one as originally highlighted by Kubler-Ross. Grief from other losses can have a powerful impact in a person’s life. Feelings of grief may be due to the end of a relationship or friendship. It is important to highlight that grief may be due to the loss of hopes, dreams, and/or fantasies. For example, in the coming out process, depression is sometimes present because of the loss of the expectation that life was supposed to be a certain way and recognizing a same-sex identity brings an end to the expectation. Sometimes, the symbolic meaning of an event, location or person triggers a great experience of loss. Moving from your home results in a recognition of the end of a relationship. These perceived losses can have the same impact as a tangible loss. The feelings associated with the loss of a dream can parallel the loss of a partner. Third, some feelings of grief are anticipatory; in this situation, I might “see” the end of something. This may show up as “This is a bad relationship; I need to get out of it so I have sex with a third person to cause a rupture in the relationship causing it to end.” Another example is getting yourself fired because you don’t like your job.

As you review your acting out cycle, pay attention to how the following stages of grief may have played out. I’ve provided a few examples that are descriptive of how the stage might be expressed.

Denial. In this stage, this is an active thinking process of avoiding grief. For some people, they might start overworking and then use the overwork to justify the acting out behavior. With some clients who discover they are HIV+, their acting out behavior may increase because of the sense that it simply doesn’t matter anymore. Another example might be the loss of a relationship, and engaging in sexual contact because you’re lonely.

Bargaining. In this stage, there is recognition of the grief, but the coping mechanism is toward minimizing the impact of grief. “It’s not a big deal.” Or, starting to date before the grief is resolved. Another way this may be present is selecting a new partner with the thought “He/She is better than no-one.” A final example is “He/She isn’t like the last one!”

Anger: In this stage, the energy of the process of coping with grief is extended outward. Statements such as “All men are like that” may reflect an avoidance of relationships or forms of intimacy. As you could guess, these feelings might lead to isolation resulting in a subsequent acting out cycle.

Depression: Common thoughts in this stage might include “why try” or “it doesn’t matter” or even “It’ll never work out.” One of the difficulties is distinguishing between depression and grief is that depression is part of the grief process. Review the topic on depression. Might any of the symptoms you’re experiencing of depression be related to grief?

Acceptance: By this point, the grief is recognized, integrated and while present, has lost most of the power. In my mind, this means that you can acknowledge the loss, but the loss doesn’t result in a barrier to healthy relationships or daily functioning of the individual. In some cases, the loss may actually facilitate transformation. These are signs of successful adjustment to grief.

One of the critiques of Kubler-Ross’ model is the perception that the process of coping with grief is linear; that you simply go through one stage to the next, followed by stages 3, 4, and 5. My experience suggests that is cyclical; you might see parts of each stage in the moment and depending on the circumstances of the moment, experience the grief differently. The key for me is to recognize whatever the situation, it is acceptable and healthy to be present to your thoughts and feelings. A second critique is the implication that process occurs once and is rather “quick.” The manual used by the mental health field suggests that grief only lasts two months which may be too short. My experience also suggests that in some circumstances grief can exceed a year or more. And you can re-experience grief when certain rituals, anniversaries or memories are triggered.

In addressing grief and the acting out cycle, I will request clients complete the following task: Take a piece of paper, and create three columns. In the first column, list 100 experiences of real, perceived, major and/or minor experiences of loss. While 100 may seem like a lot, my experience is that people can identify more losses than they realize. Usually, this part of the assignment can take days and weeks to complete. Complete this part of the assignment before you move to columns two and three. In the second column, explain why this loss still impacts you today. Why does it have so much power now? In the third column, identify possible thinking errors or plans to address the loss. The example below can be helpful.

Type of Loss
Major loss (death)
Minor loss (plans cancelled)
Real (relationship ended)
Perceived (loss of my idea how the future would look. Explanation.
How does it impact me today?
Why does this loss have so much power? Plans and corrections.
How will you address this loss?
Is the loss based on a thinking error, if so, what is your correction?
My partner left me. I feel alone and hurt
Shame (it’s my fault).
I will never find anyone
Nobody loves me
I will talk about it with my support group and therapist. I will read a book on dating.
I didn’t get the job I’m no good
They don’t like me. I can find another job.
My job doesn’t define me.
I’m gay.

I won’t be able to have children. Everybody judges me.
I will be alone
It is a sin. I could adopt.
There are happy gay people in connected loving relationships.
Not everyone believes it is a sin; in fact some people think it is a blessing.

Male on Male Rape

One of the more difficult issues I struggle with is helping guys cope with their experiences of being raped. The presence of this phenomenon simply isn't talked about in our society. In the gay community, the lack of any dialogue highlights the unspoken tragedy. There are few resources available. One of the first books I read on the material is by Michael Scarce "Male on Male Rape." His book reviews many of the issues including fears, embarrassment, masculinity issues, perceived issues of invulnerability, sexual desires, cultural issues regarding sexual prowess to name but a few of the issues. All of these concerns need to be addressed in recovery. The consequences of male on male rape are significant and parallels many of the experiences of male/female rape. Typical feelings include:


frightened
guilty
powerless
angry
ashamed
depressed
numb
lacking self-confidence

In a previous post, I highlighted the concerns of abuse and sexual violence. In those posts are a few ideas to become aware of as you look at the consequences of abuse and assault. Please review these two posts as part of the process.

One important idea to highlight is that during a sexual encounter if consent is removed, the experience is ASSAULT. You have the right to say no at any point. I strongly encourage you to talk about any sexual assault with your support issue.