The introduction is shared to let you know what is in the workbook. No surprises, just a commitment to provide you the tools to help you say “I’m Living a Life I Love.”

Introduction to the Workbook

A Typical Day in the Office

Many people are struggling to live a life they love. Consider the following telephone conversations.

Me: Hello, this is Weston. How may I help you?

Client: Hi. I need to set up an appointment for therapy.

Me: OK. Can you tell me a bit to see if I’m a right fit?

Client: I keep having sex with a lot of people. I don’t seem to be able to stop.

Or, Client: Yeah. My probation officer told me I had to see you because I was arrested.

Or,Client: My partner is threatening to break up because I’m on the Internet too much.

Or, Client: I went home with a sexual partner last night, and I think I was raped. I don’t know for sure. I can’t remember everything.

Or, Client: I’m too nervous to have any type of sexual contact.

Or, Client: Can you help me find help for my partner? I just found out he’s been having sex with other people. I don’t know what to do.

And one more. Client: Yeah, I just found out I’m HIV positive. I’ve been drinking, drugging, and having lots of sex.

My heart breaks when I have these conversations. In the realm of sexuality, feelings of pain and hopelessness abound. In my opinion, however, it is a courageous act to pick up a book on sexuality. Starting this workbook is movement toward healing. This workbook is committed to helping you move forward and address the issues related to problematic sexual behaviors. In the end, my goal is you will have the freedom to say, “I’m living a life I love.” Shall we begin?

What Is in a Name?

When it comes to this particular field of treating problematic sexual behavior, coming up with a blanket definition and universal term is a challenge, mainly because in the past we’ve attached to this behavior various terms that have been widely misused or overused. These terms include “sexual compulsivity,” “sexual compulsion,” “sexual addiction,” “sexual impulsivity,” “sexual obsession,” “sexual anorexia,” “out-of-control sexual behavior,” “sexaholism” and, finally, but certainly not the most obscure, “love addiction.” As a field, we have a range of accepted opinions. Generally, I prefer the term sexual compulsivity because of my choice to use a behavioral treatment approach.

Defining Sexual Compulsivity

In providing the following definition, my goal is to create a definition that works in the majority of circumstances and to provide a resource for individuals struggling with sexual problems.

The definition of sexual compulsivity I use has two components: subjective and objective.

Subjective – Realization that a Problem Exists
On some level you recognize your sexual behavior is a problem. Sexual compulsivity includes many sexual behaviors or thoughts that violate your personal values and boundaries. These behaviors often lead to feelings of guilt, shame, and self-recrimination. In psychology, we call this “egodystonic:” “I know I did something I didn’t want to do.” The vast majority of people seeking help realize they need help. The key to treatment, however, requires additional information as to why, what, who, when and where the problem lies. This is the focus of the workbook.

Objective – External Notification of a Problem
You may not have realized there is a problem, but 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 consequences (such as money spent on sexual partners) 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, but it’s useful when the level of denial regarding the individual’s internal awareness is so great they fail to recognize the impact of the behavior.

What part of your behavior is compulsive is hard to detail. Often your answer might be, “It depends.” The answer will depend on the presence of consequences, your values and your relationship agreements with others (e.g., your marriage/partnership). The basic premise of my approach is that you define healthy and unhealthy behaviors in dialogue with others. At the same time, there are behaviors that automatically raise questions. For example, research suggests that spending 11 or more hours a week viewing Internet pornography is one warning sign of Internet sexual compulsivity. This number, however, does not answer the question with any sense of finality. As you go through the workbook, you may find the same behavior may or may not be compulsive, depending on the day, your mood and other circumstances.

Just to clarify, sexual compulsivity is not the same as sexual promiscuity. Sexual compulsivity can occur in the absence of sexual behavior; examples include obsessive thoughts or fear of sex (sometimes referred to as “sexual anorexia” or “sexual avoidance”). Sexual compulsivity is also not the same as pedophilia (defined as an attraction to children). While these problems may sometimes overlap, the issues are separate therapeutic concerns.

Creating Sexual Health

Integrated into the treatment philosophy is an explicit goal of helping you clarify your healthy sexual behaviors. In order to achieve this goal, it is important to understand what sexual health is. I prefer the World Health Organization’s 2002 definition that defines sexual health as:

a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.

The definition is complex and represents nearly 35 years of study and development. Creating sexual health is more a process than a response to a yes or no question. My goal is to help you develop and improve your sexual health throughout your work.

The Ten Components of the Sexual Health Model

To help you move toward sexual health, the topics in this workbook are based on a theoretical model of sexual health that consists of 10 components, which I briefly summarize here. You will address these topics by completing assignments in each area.

Talking About Sex
This is a cornerstone of the Sexual Health Model that includes talking about one’s own sexual values, preferences, attractions, history and behaviors.

Culture, Values and Stereotypes
In order to understand a sense of sexual self, individuals must examine the impact their particular cultural heritage has on their sexual identities, attitudes and behaviors.

Sexual Anatomy and Functioning
One needs a basic understanding, knowledge and acceptance of sexual anatomy, sexual response and sexual functioning. Sexual health includes freedom from sexual dysfunction and other sexual problems.

Sexual Health Care and Safer Sex
This covers a broad perspective encompassing knowing one’s body, administering regular self-exams and responding to physical changes with appropriate medical intervention. Examination of one’s safer sex behaviors is critical.

Challenges and Barriers to Sexual Health
Some of the major challenges include sexual abuse, substance abuse and compulsive sexual behavior. Other challenges might include sex work, harassment and discrimination.

Body Image
This requires challenging the notion of one narrow standard of beauty and encouraging self-acceptance. In order to achieve sexual health one needs to develop a realistic and positive body image.

Masturbation, Fantasy and Sexually Explicit Material
Both masturbation and fantasy can be a healthy expression of sexuality. It is important for individuals to clarify their values on these subjects. Too often, shame is linked with masturbation and fantasy because of the historical myths associated with sin, illness and immaturity.

Positive Sexuality
All human beings need to explore their sexuality in order to develop and nurture who they are within a positive and self-affirming environment. Positive sexuality includes appropriate experimentation, sensuality, sexual boundaries and sexual competence developed through the ability to give and receive sexual pleasure.

Intimacy and Relationships
Taking many forms, intimacy is a universal need that people receive through relationships. Sexual health requires knowing what intimacy needs are important for the individual, and finding appropriate ways to meet these needs.

Spirituality, Values and Sexual Health
There is consistency between one’s ethical, spiritual and moral beliefs, and one’s sexual behaviors. This spirituality may include identification with a formal religion but doesn’t necessarily have to. However, one’s beliefs always address moral and ethical concerns and deeper values in order to integrate a person’s sexual and spiritual selves.

Treatment Approach

In treating sexual compulsivity, I use a blend of cognitive-behavioral psychology, humanistic psychology and positive psychology. What this means in non-technical terms is, I attempt to help you increase awareness of your thoughts and behaviors within a supportive environment, in order to help you create a better life for yourself.

As in any treatment program, understanding what the end goals are will help you achieve them. In this case, we are looking to achieve two goals.

Reduce your Immediate Short-term Unhealthy/Compulsive Behaviors
My first goal is to help you understand your “acting-out cycle” by identifying your primary high-risk situations, feeling triggers and thinking errors. Through this process, you can reduce the raw number of compulsive behaviors. The topics will explain the concepts and help you apply them to your experience. In addition to eliminating the unhealthy behaviors, the assignments will address related risk factors that may be relevant to your sexually compulsive patterns.

Develop Healthy Sexual Behaviors.
Eliminating unhealthy behaviors simply creates a void. To maintain long-term health, you’ll need to practice healthy sexual behaviors in order to fill this void. These assignments will help you understand yourself better, provide extensive information that encourages healthy sexual choices, facilitate your journey to define appropriate sexual behaviors, and help you review any possible barriers that get in the way of living a life you love.

Structure of the Assignments

As you see, the tone of this workbook is conversational in nature. I wrote it as if you and I were sitting together during a counseling session, discussing the topics. Within each topic are clear-cut tasks designed to help increase your ability to cope with sexual compulsivity. Space is provided to answer the questions as you move through the workbook. As you go through the assignments, you may find that some do not apply to you. Please adapt the process to your particular needs. In other words, feel free to complete only those assignments that are necessary for you. However, I encourage you to review each assignment and not simply dismiss the topic. You can learn more when you ask yourself, “How does this topic apply to me?” than when you simply ask, “Does this topic apply to me?” If the topic fits, you will need to follow-up as necessary. Each topic could be a workbook in its own right. Admittedly, the material in each topic is an introduction to the issue.

As a note of caution, you may experience various levels of personal distress while working on the assignments, such as embarrassment, shame or guilt. This is typical in any personal growth process. It is recommended you have a support system to help smooth the progress of your work. This support can include a therapist, sponsor or self-help group.

To achieve the workbook goals, the structure of the process will take you through the following three stages:

Problem Identification
During this stage, you will have opportunities to examine your sexual behaviors and assess the level of compulsiveness. You will complete a number of assignments examining your sexual history and your acting-out cycle. Based on your findings, you will identify the major topics to address in your journey toward improved sexual health.

Primary Treatment
Once you identify the acting-out cycle in stage 1, the second stage of treatment helps you begin the work on the major topics within this cycle. You’ll do this by completing assignments and resources for the most frequently identified topics. Not every topic you identified may be included, so you may need to address them with your support network. Moreover, in reviewing the topics in this workbook, you may identify additional topics that contribute to your acting-out cycle.

Groundwork for Completing Treatment
The third stage of treatment attempts to stabilize the growth and movement toward sexual health you began in stage two. Here you will continue to reach out to others, obtain support and encouragement, and increase accountability. You will also be encouraged to think about living a life you love and the impact of sexual health in helping you create personal fulfillment. This involves clarifying your personal definition of sexual health.

Keeping the End in Mind

When you start a marathon race, your focus is not on the first mile. Rather it is on completing the entire race and planning how you will survive all 26 miles. In the same way, it is important to have the end of therapy in mind. I not so jokingly start out an early therapy session with a new client by telling that that my goal is to work myself out of a job. I ask them to think about what it would look like to be done with treatment. Honestly, people often do not have an answer, which is OK at this point of treatment. The question, nevertheless, frames the therapeutic relationship as time limited, goal focused and conscious of the client’s goal. Although the formal therapy might be complete, the life process has only begun.

In my vision of when you have reached your therapeutic finish line, you will have accomplished the following tasks:

Complete Stage-3 Assignments

You will be able to recognize and complete all aspects of the stage-3 assignments.

Identify and Avoid the Acting-Out Cycle
The continuing-care plan is composed of plans addressing the most important thinking errors, feeling triggers and high-risk situations.

Replace Negative Behaviors with Positive Ones
In the beginning you might ask yourself, “What are sexually healthy behaviors?” “How can I get my sexual needs met and still respect my values and boundaries?” “What are the issues I need to address in order to support healthy sexuality?” In the end, you’ll be able to identify and prevent negative behaviors and replace them with positive ones.

Develop a Support Network
This is the part of the plan that is the most difficult for many clients and can result in the most avoidant behaviors. I want you to identify three to five people who can serve as your primary support network. You will choose people who can listen without judgment, support you as needed and confront you when necessary. Often clients have so much shame that they can’t or won’t share anything regarding their history with others. It takes a lot of trust to reach out to these people. For me, you will share your plan with the individuals in your support network.

If for whatever reason you find you can’t complete any part of the plan, it’s important to examine why. Many times the reasons are the source of additional therapeutic issues. As you begin to examine your sex history, review the cycle and work through additional topics, think about what it would look like to complete treatment.

A Program of Integrity

It is easy to imagine how many people desire their clinician to be in charge. I cannot tell you how many times I’ve heard, “Tell me what to do,” “Is this OK?” or “What should be my bottom-line behavior?” As a clinician, I provide feedback and suggestions, but I impose very few behavioral restrictions. When I do, the restrictions are usually around legal, ethical or health consequences. I might say, “Engaging in public sex like you just described probably isn’t helpful,” or, “Using the work computer to look at porn will get you fired,” or “Unsafe sex puts you at risk.”

This workbook will not tell you what do, or have you follow a predetermined pattern of required rules. To fall into the trap of telling you right from wrong sets up the therapist as the external control. In motivational psychology, a long-term consequence of external control is a decrease in compliance to the external limits. Slowly, resentment builds as the individual “fights” with those external limits. Eventually a total break may occur where the client’s resistance causes a rupture in the therapeutic relationship.

Rather, my treatment approach emphasizes integrity. The approach implies an internal source of control. Research in motivational psychology has repeatedly demonstrated that individuals will create profound changes and new possibilities when internally motivated; they will, for example, run marathons because they want to make a difference in the world. Think for a moment about someone who inspires you; this person’s source of motivation is probably internally focused.

My treatment approach helps you create integrity in your life. The goal is to help identify behaviors, attitudes and goals that lead to wholeness, completeness and unity. This approach, however, requires more work than simply following a list of rules. It also requires some trial and error that results in a reassessment of how you want to live your life. Following this approach, you can create an internal moral code of sexual health. You’ll be happier, more effective and ultimately “whole.” In the end, my treatment approach requires from you a transformation rather than a compliance with a set of rules. In this transformation, unlimited possibilities are achievable, including living a life you love.

Additional Resources

Not everyone likes to read. I placed a number of short lectures explaining the topics on my website www.livingalifeIlovebooks.com. The goal is to provide additional venues where you can learn this material. While in draft form, I posted much of the material at http://sexualhealthinstitute.blogspot.com. Too often people are isolated and have no place to engage in these conversations. Please review the blog for new material. You are encouraged to suggest ideas, ask questions and participate in any way you feel comfortable. For everyone’s safety, all posts are moderated and anonymous, unless you give explicit permission to use your name.

There are additional online resources that may be of help. I recommend the Society for Advancement of Sexual Health (www.sash.net), which is just one resource where you can find a mental health professional to help facilitate your growth process. A good therapist is someone who respects your personal integrity, appropriately challenges your thoughts and behaviors, and guides you through the therapeutic process.

The Importance and Limits of Confidentiality and Risk of Disclosure

Trust is a major component of counseling. Trust builds a sense of safety that leads to tremendous therapeutic change. Knowing others will not be told any information you share only strengthens that trust. In any therapeutic relationship, confidentiality limits what a professional can disclose to others. You are the one who “holds” this privilege. Depending on where you live, however, there are limits to this privilege. Often the limits facilitate safety in the broad sense of the term, such as requiring the professional to report any suspected abuse of a child or vulnerable adult; significant and real potential harm to yourself (e.g., if you make statements such as “I’m going to kill myself.”); significant and real potential harm to another person (e.g., if you makes statements such as “I’m going to kill that person.”); or when a court order requires the release of information.

As you complete the assignments, it is important to be open and honest about your past and present behaviors. While it is important for disclosure to occur, it is important for disclosure to occur in a prudent manner. Be careful when making disclosures of sexual behavior. Seriously consider whether your disclosure could trigger a mandatory report as required by the state and local laws in your residence. There may be a risk of legal consequences if some of your sexual behaviors include illegal behaviors. One way to ensure privacy and confidentiality is to be specific about behaviors, but not provide any identifiable information. For example, you might want to say “Sexual partner #1” instead of giving the person’s full name. It is worth repeating that the goal is to be as honest to yourself and your therapist/support network as possible, while ensuring your own safety