Safe Harbor Christian Counseling. Sexual Addiction Treatment Workshop. September 23, 2011

Transcription

1 Safe Harbor Christian Counseling Sexual Addiction Treatment Workshop September 23, 2011

2 Mission To provide the Christian based, clinically sound counseling for individuals, couples and families, that helps clients grow emotionally, relationally, mentally, and spiritually, thereby increasing the well being of our community.

3 Sexual Addiction Defined Compulsive and repetitive behavior Escalating both in frequency and in client s disregard for negative consequences. The client experiences this behavior as something they can not stop. Can be a pathological relationship with a mood altering substance or behavior.

4 Definition - Easy Takes you further than you want to go. Keeps you longer than you want to stay. Costs you more than you want to pay.

5 Carnes Levels of Sexual Addiction - Level 1 Masturbation Compulsive Relationships Pornography Prostitution Anonymous Sex Phone Sex Sexting

6 Carnes Levels of Sexual Addiction - Level 2 Exhibitionism. Voyeurism. Indecent phone calls. Indecent liberties.

7 Carnes Levels of Sexual Addiction - Level 3 Child molestation. Incest. Rape. Authority/Power Rape.

8 Sexual Addiction Cycle

9 God s View Assessment & Treatment of Sexual Addiction, The Geneva Series, DVD series with Mark Lasser.

10 Women Sex Addicts Sexual Recovery Institute Defines: (SRI) Elements of sex addiction in women are the same as in any addiction: Compulsion Continuation despite adverse consequences Preoccupation or obsession

11 Women Sex Addicts 1. Compulsion: Changing relationships to control Swearing off Breaking promises to self and others Switching to caretaking, workaholism, romance novels, eating; any ism

12 Women Sex Addicts 2. Continue behavior in the face of negative consequences: Unplanned pregnancies Terror or shame Decreased productivity work/home/school Depression Food or substance disorders

13 Women Sex Addicts 3. Obsessive thinking in planning or obtaining sex: Neglecting career, family, relationship

14 Women Sex Addicts Some examples of sexually addictive behavior patterns: Excessive flirting Personal grooming Provocative clothing

15 Women Sex Addicts Idea of being love addicted VS Sex Addict

16 Women Sex Addicts Female Presentations of Sexual Addiction Ferree s Umbrella Term Confusion about nature of sex addiction

17 Women Sex Addicts 8 Presentations: Relationship or love addiction Romance addict Fantasy addict Pornography or cybersex addict

18 Women Sex Addicts 8 Presentations continued: Masturbation Exhibitionism Addict who sells or trades sex Partnering with another addict

19 Women Sex Addicts Sex addiction as an intimacy disorder?

20 Messages about being female Cultural Religious

21 Shame in Sexual Addiction

22 Shame Reduction Shame is what drives the addiction: Shame I am bad, unworthy It is who I am Guilt I have done bad things It is what I do

23 Shame Reduction Your relationship with client 70% Education, understanding and support Telling their story (all of it) 12 step work Confession & forgiveness

24 Shame Reduction con t Facing feelings Identify lies and exchange them for the Truth

25 Shame Reduction Shame and guilt differentiating for the trauma survivor

26 Shame Reduction Defenses against shame: Rage Contempt Striving for power Striving for perfection Transferring blame Internal withdrawl

27 Brain & Body Autonomic Nervous System Parasympathetic rest and digest Sympathetic fight or flight ED and Porn - Norman Doidge

28 Diagnosis Is it SA?

29 Is there a need? 300,000,000 (300 hundred million): adult population in the United States 6% - 8% of population: estimated to be sexually 17,000,000 37,000,000 (17 37 million): estimated number of adults in the United States with sexual addictions. Sources: Carnes, 2001; Cooper, Delmonico & Burg, 2000 in Hagedorn 2010

30 Is Sexual Addiction really an Addiction? Sexual Addiction is not included as a distinct mental disorder in DSM-IV- TR. Sexual Addiction may be diagnosed under: Anxiety Disorders: + Obsessive-Compulsive Disorder (300.3) Impulse-Control Disorders Not Elsewhere Classified: + Impulse Control Disorder (312.30) Sexual and Gender Identity Disorders: + Sexual Disorder NOS ( 302.9) Comorbidity clinicians need to assess for other disorders.

31 CRITERIA FOR CLINICAL CONSIDERATION Client reports sexual behaviors/activities that manifest as: Compulsive. Chronic. Consequential. Cultivated. Comorbidity.

32 COMPULSION An uncontrollable or irresistible impulse to perform an act, often repetitively; a repetitive or ritualistic behavior that a person performs to reduce anxiety.

33 CHRONIC Lasting for a long period of time or marked by frequent recurrence. Despite periods of abstinence from the behavior, it reoccurs patterns may be regular or irregular.

34 CONSEQUENTIAL Negative consequences follow the behavior or would follow the behavior if discovered Loss of partner. Severe relational problems with spouse/partner. Family stress and conflicts. Unplanned pregnancies. Exposure to sexually transmitted diseases, including HIV. Loss of job and loss of future employment in career field. Legal repercussions, including incarceration. Financial hardship. Alienation from God, self, and others. Public exposure & publicity, loss of community standing, Personal, marital, & family humiliation & shame.

35 CONSEQUENTIAL Sample Questions: Has your sexual behavior ever caused problems for you in your family? Are you in crisis over sexual matters? Have you used magazines, videos, or online pornography even when there was considerable risk of being caught by family members who would be upset by your behavior?

36 CULTIVATED Ritualistic thinking and/or behaviors that feed and escalate the addictive behavior(s). As tolerance increases, the current level of sexual activity is no longer satisfying; the thrill is not as great. Consequently, behaviors pursued become more intense, more frequent, and/or more risky. In Carnes model, the behavior can move up to the next level. Three or more behaviors within a level can be combined to create a new sexual high, e.g., fantasy, prostitution, & anonymous sex.

37 COMORBIDITY The presence of co-existing and/or additional disorders with respect to the presenting condition. Other disorders that may co-exist: Anxiety Disorders. Mood Disorders. Substance-Related Disorders. Attention-Deficit and Disruptive Behavior Disorders. Personality Disorders. Adjustment Disorders. Attachment Disorders.

38 ASSESSMENT TECHNIQUE THE CLIPBOARD TECHNIQUE Hold a clipboard on which an assessment instrument is attached. Say to the client, I need to ask you some questions. Then READ the questions clearly and at a measured pace not too quickly or slowly, without hesitation, with confidence, without making excuses or apologies.

39 ASSESSMENT TECHNIQUE Con t Clinical Key: Think & act like a doctor/scientist. Clients will answer the most private and personal questions if the questions are scripted. Clients will not second-guess your motives in asking questions about their sexual practices. A skilled clinician will be alert to clients hesitations, responses that seem untrue, attempts to minimize behaviors, areas of struggle, etc. Probing questions can be asked, such as could you elaborate on your response? Is there something else that I need to know?

40 Treatment Keys

41 Extinguishing unwanted behavior Offer strong suggestions Cutting off avenues that make provision for acting out Filters i.e. SafeEyes Hot spots & People Accountability: Money, time, phone, Verbal agreement or Signed agreement Education & Empathy

42 Managing Temptation Measureable goals PMIL James 1 and second look Bouncing eyes Use commonsense Understand your human

43 Healthy Sexuality Relapse and Prevention Rebuilding your marriage Single life Accountability Less Shame, Boundaries, Self control Know your triggers: HALT

44 Repairing damaged relationships Repentance/Remorse Reconciliation/Restitution Regeneration/Resurrection

45 Anger Worth Needs Conviction Source: Carter, L. & Minirth, F. (1998). The anger workbook. Nashville, TN: Thomas Nelson Publishers.

46 Family of Origin 80-85% - history of sexual abuse 72-75% - history of physical abuse % history of emotional abuse

47 Family of Origin Family systems Interview for addictive/abusive behaviors in family of origin; Assess family structure: Organized/chaotic, disconnected/enmeshed stable/unstable household healthy/unhealthy boundaries

48 Sexual History Important for breaking through shame, denial, justification, rationalization and minimization

49 Sexual History Important for understanding triggers, false core beliefs, healing from trauma, and family of origin influences

50 Sexual History Breaking the silence

51 Discipline and Accountability For a Lifetime (a lifestyle for a lifetime) One Day at a Time Sobriety (contingent on the maintenance of spiritual condition)

52 Discipline and Accountability Accountability Partner/Partner s Accountability Team 12-Step Recovery

53 Discipline and Accountability 12-Step Recovery Love Addicts Anonymous (LAA) Sexaholics Anonymous (SA) Sexual Addicts Anonymous (SAA) Sexual Compulsives Anonymous (SCA)

54 Discipline and Accountability 12-Step Recovery Sex and Love Addicts Anonymous (SLAA) Sexual Recovery Anonymous (SRA) Celebrate Recovery (CR) Renewal from Sexual Addiction (RSA)/RSA-W, R-CoSA

55 Spiritual Application IF client seeking, help them develop a spiritual life with God, self and others

56 Spiritual Application Sin? Need to understand client s belief s, value s, denomination, etc. Remember God s plan (Lasser)

57 Q & A