SEXUAL DEVELOPMENT AND DYSFUNCTION: THE SEXUAL INTERDEPENDENCE AND SEXUAL PROGRESSION MODEL

1. SEXUAL DEVELOPMENT AND DYSFUNCTION:THE SEXUAL INTERDEPENDENCE AND SEXUAL PROGRESSION MODEL An alternative approach to treating sexual dysfunction – Brett Copeland, PsyD & Andrea Rabie, B.A.

2. Agenda • Define Root Cause for Sex Addiction • Traditional Sexual Therapy • Traditional vs. Alternative Approach • Sexual Interdependence Theory (SIT) • Sexual Progression Approach (SPA)

3. Root of Sex Addiction • Hedonism • Biological instinct common to all members of the animal kingdom that compels us to: • Pursue pleasure • Avoid pain

4. Two Types of Sex Addiction • Traditional Addiction (20% of population) • Primary drive: pursuing pleasure • Regardless of how well life is going, the pleasure response associated with the drug of choice is so intense that one is consistently vulnerable to relapse, i.e. intense temptation to “use” is present even in the absence of other sources of pain

5. Two Types of Sex Addiction • Pain-based Addiction (80% of population) • Primary drive: pursue pleasure as an outlet from pain • Persons in this category can go years with no excessive/problematic behavior but it becomes dysfunctional when life stressors, crises, etc. mount to levels perceived as intolerable

6. Predominant Sexual Therapy is Limited • Sequence of intervention is fixed, rigid • Lacks theoretical underpinning • Narrowly focused on addiction • This is important because, at least for 80% of people, the addiction is not the primary cause but is an effect of hedonistic imbalance • Interventions that merely treat the effect may simply be giving cough drops to someone suffering from an impaired immune system

7. Why an alternative approach? • More inclusive: Addresses broader range of clientele/conditions • Open to new research • Treatment flexibility • Builds upon an established theory • Treatsthe cause (hedonistic imbalance) and the effect (addiction)

8. An alternative model should… • Be easy to grasp – easy to apply • Account for limitations of the predominant approach • Build upon established theory • Offer effective correspondingtherapy & resources • Be an open framework: incorporates new research • Be inclusive: applies to more people, broader conditions, not just “addiction” • Be effective, lower attrition

9. SIT & SPA Model SIT: Sexual Interdependence Theory SPA: Sexual Progression Approach

10. Introducing SIT Sexual Interdependence Theory • Adapted from established Developmental Theory • Incorporates Attachment & Individuation (hedonism) • Integrates Erikson’s main three developmental crises • Sexual progression defined by different stages • These may exhibit either expressive or repressive sexual behavior • Different stages carry unique treatment implications

11. Sexual Development Stages

12. SEXUAL INTERDEPENDENCE THEORY INTERDEPENDENCE Sexual Integrity Ego Integrity vs. Despair Sexual Identity Role Confusion vs. Identity Sexual (Con)Fusion Trust vs. Mistrust Sexual Mistrust

13. Introducing SPA Sexual Progression Approach • Aligned to SIT • Allows for more accurate, stage-oriented assessment • Stage-specific treatment • Treats cause and effect • Flexible enough to incorporate new research • Eschews counterproductive stigma of ‘addict’ and ‘relapse’ in favor of ‘progression’ and ‘integrity’

14. SPA: General Techniques • Identify the benefits associated with their current stage • Exploration of benefits must be authentic and reflect empathic expression • Anything less will be correctly interpreted as insincere and may result in an attachment rupture

15. SPA: General Techniques (cont.) • Identify limitations or “what’s missing” from the stage • Use client’s pain to identify/address what’s missing • Theory gives clinician window into stage limitations • Gentle application of Socratic method can also help client to see and accept these limitations

16. SPA: General Techniques (cont.) • Build a bridge from client’s current sexual development stage and the subsequent stage • All stages, except Sexual Integrity, have their limitations • Clinicians tactfully explain how (a) the next stage fills limitations of current stage while (b) taking into account benefits of the current stage • Don’t engage in verbal “tug-of-war” but allow their life experience to support your conclusions

17. Sexual Development Stages Description: • We don’t trust others in sexual relationships • We assume malice from potential partners Expressive Behavior: • Master of the Universe – seek to control often through objectification • Reenact sexual trauma Repressive Behavior: • ‘Primitive’ Sexual Anorexia – safety/survival • Avoidance of re-traumatization

18. Sexual Mistrust: “Julie” INTERDEPENDENCE Sexual Integrity Ego Integrity vs. Despair Sexual Identity Role Confusion vs. Identity Sexual (Con)Fusion Trust vs. Mistrust Sexual Mistrust

19. SPA: Specific Techniques • Sexual Mistrust → Sexual (Con)Fusion • Problem:Unableto experience the emotional vulnerability that preludes effective interpersonal attachment • Goal: Reprocess attachment barriers

20. SPA: Specific Techniques • Sexual Mistrust → Sexual (Con)Fusion • Interventions: • Person-Centered Techniques → Therapeutic rapport helps them realize you have their best interest at heart and serves as model for other relationships they hope to create or improve • Resource enhancement → Associated emotional regulation serves as precursor for effective exposure-based interventions • Exposure-Response Prevention → Reprocesses disturbance history so that fulfilling attachment is possible

21. Sexual Development Stages Definition: • Fusion: Our views on sexuality are rigid (even if ineffective) • Confusion: Confusion between our beliefs vs. our experiences (cognitive dissonance) Expressive Behavior: • Strict behavioral compliance to beliefs (regardless of impact) • Victim of manipulation • Experimentation Repressive Behavior: • Passive Aggression • Sexual Anorexia: culturally-driven (white-knuckle) • Information gathering

22. Sexual (Con)Fusion: “Dallin” & “Maria” INTERDEPENDENCE Sexual Integrity Ego Integrity vs. Despair Sexual Identity Role Confusion vs. Identity Sexual (Con)Fusion Trust vs. Mistrust Sexual Mistrust

23. SPA: Specific Techniques • Sexual Fusion → Sexual Confusion • Problem: Rigid sexual beliefs prevent sexual fulfillment • Goal: Illuminate unworkability of black/white beliefs & behaviors • Objective: No change or Abstinence vs. Values-based Sexual Behavior • Impact: None or Devastating vs. Shame Reduction/Impact viewed on a Continuum • Recovery Timeline: Immediate or Lifelong/Never vs. Whenever achieve Sexual Integrity • Recovery Initiatives: Analysis or Avoidance vs. Awareness/Acceptance

24. SPA: Specific Techniques • Sexual Fusion → Sexual Confusion • Interventions: • General Techniques → Use objective experience (rather than verbal coercion) to convey unworkability of beliefs and/or behaviors • Acceptance & Commitment Therapy → Use “creative hopelessness” to expose limitations of rigid sexual beliefs

25. SPA: Specific Techniques • Sexual Confusion → Sexual Identity • Problem: Lack of sexual values leads to emotionally-driven sexual behavior • Goal: Establish internalized, workable values • Internalized: Conviction that is independent of outside influences • Workable: Yields benefit that does not harm self or others • Value areas: General, couple, intimacy, sexuality

26. SPA: Specific Techniques • Sexual Confusion → Sexual Identity • Interventions: • Values development (e.g. Acceptance & Commitment Therapy) • Values Assessment • Introspection, e.g. prior experience, others’ experiences, prayer, spiritual retreat • Use evidence derived from experimentation (others or your own) as your teacher

27. Sexual Development Stages Definition: • We have internalized and workable sexual values but behave contrary to those values Expressive Behavior: • Wimpy Masturbators: where willpower breaks down Repressive Behavior: • Distrust of partners who have proven untrustworthy (Sexual Integrity?)

28. Sexual Identity: “Li” INTERDEPENDENCE Sexual Integrity Ego Integrity vs. Despair Sexual Identity Role Confusion vs. Identity Sexual (Con)Fusion Trust vs. Mistrust Sexual Mistrust

29. SPA: Specific Techniques • Sexual Identity → Sexual Integrity • Problem: Unable/unwilling to co-exist with sexual temptations • Goal: Reprocess triggers and apply mindfulness to what remains

30. SPA: Specific Techniques • Sexual Identity → Sexual Integrity • Interventions: • Awareness: Primary goal is not “why” but “what” • Process triggers: Use EMDR protocol to defuse addiction triggers • Acceptance: Apply mindfulness (e.g. meditation) to see triggers for what they are rather than what they say they are • Values-based living: Teach adherence to internalized, workable values • Timely tools and outlets: filters, letter to self, sponsorship, values sheet

31. Sexual Development Stages Interdependence: • We are balanced between attachment and individuation Healthy Attachment: • We seek connection and intimacy • Service orientation & open to feedback Healthy Individuation: • Hold and adhere to healthy values and boundaries on sex • Not susceptible to sexual manipulation from others (Note: this may take the form of values-based abstinence)

32. Sexual Identity: “Paul” INTERDEPENDENCE Sexual Integrity Ego Integrity vs. Despair Sexual Identity Role Confusion vs. Identity Sexual (Con)Fusion Trust vs. Mistrust Sexual Mistrust

33. Compare & Contrast SIT/SPA Model • Flexibility: custom treatment for unique individuals, conditions • Develops internalized, workable values • Treats cause and effect • Abstinence as final achievement or pursuit – relapse is informative and part of ‘progress’ Common Sex Therapy • Rigidity: Mandatory steps (12 or 30) regardless of individual, condition • Adopts steps or tasks regardless of alignment with personal values • Treats effect without fully addressing the cause • Abstinence is the first ‘step’ – relapse is failure or regression

34. Specific Techniques: Relapse Don’t • View relapse as failure or “starting over again” • Ignore hedonistic imbalance by simply addressing symptoms Do • Reprocess addiction triggers • View relapse as information • Monitor emotional bank account • Compare behavior to values • Gauge “willingness” • Strengthen coping strategies

35. SIT/SPA Training • Practitioners interested in effectively employing the SIT/SPA may do the following: • Learn the SIT/SPA • Develop exposure-based approach (EMDR) • Learn mindfulness-based treatment (ACT, DBT) • Implement daily mindfulness practice (meditation, yoga, tai chi, prayer?)