Working with insurance companies requires that I make a diagnosis and provide them with access to audit your file (which includes session notes), which often means a breech in confidentiality. While I celebrate sexuality, I also understand that many, if not most, of my clients value strict confidentiality above all else when working through relationship and sexuality issues. Because being reimbursed by insurance companies as a provider often compromises aspects of what I believe creates a safe, and trusting client-therapist relationship, this process does not feel right to me, especially given the kind of work I do.
I believe it is important for an individual suffering from compulsive sexual behavior and those supporting them, to hold the social views of sexuality with open-mindedness and non-judgement. There may be aspects of an individual's sexual behavior that they feel needs attention and want to change, but there is a beautiful richness in the spectrum of sexual expression that social views and morals needlessly limit and restrict. Perhaps the conversation needs to shift to better understanding principles of sexual health, promoting sexual education, and empowering individuals to cultivate and express their sexuality by engaging in sexual behavior that is meaningful and nourishing to them rather than judge and impose subjective beliefs of sexuality and sex.
What the Out of Control Sexual Behavior model allows for in the Individual and Group Psychotherapy phase, and what the Sex Addiction model fails to address, is healing focused on identifying and attending to the underlying causes of compulsive sexual behavior. I have experienced how addressing the trauma rather than only attacking the related compulsive sexual behavior or related symptoms can be a more effective approach.
I believe two of the greatest strengths of the Out of Control Sexual Behavior model are that it addresses potential underlying causes of compulsive sexual behavior, and that it is focused on organizing around and encouraging the individual’s unique expression of sexual health through wanted sexual behavior–which the Sex Addiction model fails to do.
I believe the greatest limitations of the Sex Addiction model are: it pathologizes sexuality and sexual behaviors based on subjective values and moral judgments; it does not address potential underlying causes of the sexual behavior; and it is focused on refrainment from unwanted sexual behavior rather than organizing around and encouraging the individual’s unique expression of sexual health through wanted sexual behavior.
A difficulty for me as a sex therapist is how to communicate my approach to working with compulsive sexual behavior that does not alienate those who identify with the Sex Addiction model, while still providing an alternative to those for whom the Sex Addiction model does not resonate. As a result, I believe more education and outreach is needed in order for our society to better understand, relate to, and support those struggling with Out of Control Sexual Behavior–an endeavor to which I am glad to add my voice.
I believe it is imperative that we move away from methods that focus on sexual dysfunction and pathologizing behavior when working with compulsive sexual behavior, and towards those that focus on cultivating sexual health and engaging the underlying causes of unwanted sexual behaviors. As a result, this article discusses the importance and impact of language in this work.