Summary of a framework for understanding categories of chronically problematic sexual behavior

I recently published an article in the journal Sexual Addiction & Compulsivity titled "A Framework for Categorizing Chronically Problematic Sexual Behavior".  These ideas also comprise the core foundation of an online training course called the "Advanced Training in Problematic Sexual Behavior " (ATPSB), offered exclusively by the Society for the Advancement of Sexual Health.  (This training will come online in February 2018 and I will provide a link when it is available.)  You can catch a podcast video of me discussing these ideas by  watching the video here or listen to it anytime by downloading the audio podcast here

For now I want to offer a short introduction about this way of thinking about problematic sexual behavior patterns, and how it relates to the more narrow concept of "sex addiction".

I'm not one of those odd therapists who doubts the reality of what has come to be known as sex addiction.  (After all, I AM a "Certified Sex Addiction Therapist" in Atlanta).  However, many people experience negative outcomes as a result of their sexual behavior patterns without necessarily being "out of control" in a classically addictive or compulsive manner.  Unfortunately, in order to receive help many people will take on the "sex addict" label when that may not actually be the most precise term to use.  The reason for this over-categorization is that "sex addiction" is just about the ONLY term available that is part of a comprehensive set of theories to guide the assessment and assistance process.

However, the problem with having a label already in mind when assessing someone's sexual behavior is that this makes it easier to see things through this lens from the very beginning of the assessment process.  This risks placing people into pre-determined categories without sufficiently considering other alternatives.  This tendency is called "confirmation bias", and Mark Twain expressed it humorously with his observation that a kid with a hammer thinks everything looks like a nail.  (I'm not calling qualified therapists 'kids' as much as this entire field of expertise.)

The approach I have developed steers away from labels as much as possible.  The framework I find valuable involves assessing five categories to determine whether a pattern of sexual behavior can be considered to be problematic. These five categories are sexual behavior patterns that regularly:

  • Conflict with a person’s commitments, and/or
  • Conflict with a person’s values, and/or
  • Conflict with a person’s self-control,  and/or
  • Result in negative consequences, and/or
  • Lack fundamental sexual responsibility (everybody consents, everybody is protected, nobody is exploited)

These five categories each yield a question to explore when assessing for any problematic components of a person’s ongoing sexual behavior:

  • Commitments—are you keeping your promises?
  • Values—are you OK with what you are doing?
  • Control—are you in control of yourself?
  • Consequences—is everything OK?
  • Responsibility—are you protecting others?

Note that this framework does not evaluate the type or frequency of any sexual behavior as indicating a problem apart from how it shows up in the above five categories. What a person does and how often they do it is not in itself relevant to this framework.  It is also worth noting that several of these categories can be reduced or eliminated by changing either sexual or nonsexual aspects of a person’s life to bring them into alignment.  (As an example, a person repeatedly engaging in sexual behavior that violates a relationship commitment can either change the behavior or change the commitment.)  This means that not all sexual problems require sexual solutions.  

There are another couple of important notes to include in this brief description.  First, this is not a diagnostic classification system, which is basically an attempt to place a label on a set of symptoms.  Instead, this is a way of organizing information in a manner that is common-sense and straightforward.  Determining if a set of behaviors is problematic is not the same as claiming it is pathologic (i.e. an illness).  Problematic aspects related to a person's sexual behavior are often more accurately seen as a lack of fit between the sexual and nonsexual components of a person's life. It's also important to emphasize that this framework is based on patterns of behavior, not single incidents. Finally, this framework is consistent with universally established principles of sexual health (which deserves a whole page unto itself).

I find that this framework helps many people feel less defensive when discussing their sexual behavior without getting too caught up in the labels we use to describe them.  It's a major reason that in my therapy groups for problematic sexual behavior some people identify as being sexually addicted and others don't (even when their behavior often looks very similar) yet everyone benefits from the collective experience.

I believe that this framework can serve to support the development of more assistance models to help people who are suffering from some problematic aspect(s) of their sexual behavior.  This framework doesn't intend to compete with, amend or replace any existing models (such as sex addiction).  Instead, it is a theory-neutral foundation for extending assistance to more people who want to achieve greater sexual and relational health.

So that's it in a nutshell.  I would like to keep talking about this is open forums for people to participate in, so if anybody reading this has ideas for podcasts please let me know.

Bill, 02-02-2018

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Bill Herring, LCSW, CSAT is a psychotherapist and relationship counselor in Atlanta.