My first posts for this blog were a series of articles about sexual values and how they might operate in therapy for sexual issues (see the first in the series here). At that time I was early in the development of steering my practice toward a focus on sexual issues. I knew that I needed to understand my personal sexual values or they could interfere with treatment for clients. I decided that when personal values are difficult to avoid in therapy, it is best to acknowledge the values that you are operating under. To that end I identified how consent, sustainability, generativity, and adaptability are values that I bring as the therapist. I wrote those posts with the intent that the transparency could allow clients to better choose whether my care would be a good fit, and as a check for me. If I can identify where my values are, I hoped, I could better identify when my values conflicted with those of the client and therefore could be more cautious about imposing my values on my clients. I don’t know that there’s anything wrong with this approach, but I believe that I have since then learned a better way to guide clients who want to evaluate or change their sexual behaviors.
Treating Out of Control Sexual Behavior
Two colleagues of mine in the American Association of Sex Educators, Counselors, and Therapists, Douglas Braun-Harvey and Michael Vigorito, describe a treatment model for out-of-control sexual behavior (OCSB) in their book on the topic. The types of presenting issues they are treating are the same as those that may be referred to in the popular culture as sexual addictions (a term I have written about here). However, the term “sex addiciton” has no diagnostic validity. Another colleague, David Ley, in AASECT has written about the problems with “sex addiction” in his book, the The Myth of Sex Addiction.
One core aspect of the OCSB treatment model resolves the challenge that psychologists have in determining what defines unhealthy sexuality without imposing personal values on the client. This is a challenge in the profession because there are limited and problematic actual diagnoses for sexual behavior problems. Braun-Harvey and Vigorito resolve this dilemma by defining healthy sexuality instead of trying to define unhealthy sexuality. To do this, they utilize the World Health Organizations definition of healthy sexuality and glean from it six Sexual Health Principles. I now use those principles extensively in my practice and will share them here with brief descriptions.
Consent refers to the willingness of all participants to engage in the sexual behavior and/or to bear witness to the sexual behavior they are engaging in. When people are engaging in nonconsensual sexual behaviors, another type of treatment (typically from a forensic psychologist).
This refers to the absence of power used to coerce consent. Some methods of exploitation include using power over (like when a boss coerces a subordinate at work into sexual favors), money (for example when someone needs money for survival so they agree to sexual behaviors to get the money), or withholding knowledge (for example, in an affair if the partner knew about the affair, they would no longer consent to the relationship with the cheating partner).
Protection from HIV, STIs, unplanned/unwanted pregnancy
This includes allowing people to make informed decisions about the risks they take when engaging in sexual behavior with you and protecting yourself from risks to your health.
Not everyone wants to know everything but honesty means that everyone is informed about what is important to them. One way that I’ve learned to talk about this principle with my clients is to ask about what the explicit and implicit commitments of the relationship in question are and whether the include informing the person about the behavior in question. Most of the time, my client has a fairly clear response that helps them understand then whether withheld information is more about privacy or more about secrecy.
This includes shared values from the community level to the interpersonal level. So, behavior abiding by shared values is legal and abides by the relationship agreements that have been made between partners. I still have some challenges with the legal aspects of the “shared values” principle as I have described more completely in my entry on (Sexual Values That Didn’t Make The Cut). However, looking at shared values as a lens on whether the client will experience shame or other mental health consequences of their behavior, and therefore whether it will be healthful, this principle is spot on.
This doesn’t always include orgasm but it may. This doesn’t always include simultaneous pleasure but it may. When I’m working with individuals this principle is still relevant because sometimes, challenges arise in a person’s sexuality because they don’t allow themselves pleasure and they don’t acknowledge and accept what does bring them pleasure. When doing relationship therapy I make sure that each person is allowed the freedom to have an individual erotic landscape and to find pleasure in their shared activities.
After several years in practice, my personal sexual values haven’t changed and if you are interested you can read about them starting with this article, Sexual Values: One Therapist’s Provisional Set. I examined those values and wrote about them originally because I thought that being aware of them would help me insulate my clients from my biases. I also thought that broadcasting them it would help potential clients determine whether I’d be a good fit for them. However, now that I have been exposed to Braun-Harvey and Vigorito’s excellent exposition on treating Out-of-Control Sexual Behavior, I can use a more empirically validated set of therapeutic principles for the care for my clients and their sexual health.