Out of Control Sexual Behavior: An Alternative Approach to the Twelve Step-based Model of Working with Sex Addiction

In a previous article, The Sex Addiction Model: Why an Adjunct/Alternative is Needed, I discussed why I believe an alternative and/or adjunct to the Sex Addiction model is needed, and how there are those in the field of psychology, including myself, wanting a more holistic approach. For example, as a result of his findings on the limitations of the Sex Addiction model, Klein (2003) believes that a clinical model is needed that: considers subjectivity, is clinically sophisticated with differential diagnosis, is based on personal agency and responsibility, and includes cross-cultural insight (p. 78).  Both Cannon (2015) and Ley (2012) call for a strength-based approach that identifies and considers underlying potential causes of the compulsive sexual behavior. Perhaps, the Out of Control Sexual Behavior model is one such approach.

Development and Overview Out of Control Sexual Behavior Therapy

Douglas Braun-Harvey and Michael Vigorito will publish “Treating Out of Control Sexual Behavior” in the fall of 2015. This will be their first book defining and treating Out of Control Sexual Behavior. In the meantime, Braun-Harvey has presented their findings to professional associations and facilitated trainings for mental health professionals working with this population. In addition, other professionals–particularly members of the American Association of Sexuality Educators Counselors and Therapists (AASECT) such as Dr. Neil Cannon–have been advocating for a more holistic and strength-based approach when assessing and treating Out of Control Sexual Behavior.

Assessment and Symptoms in Out of Control Sexual Behavior Therapy

Braun-Harvey (2014) considers Out of Control Sexual Behavior (OCSB) to be “a sexual health problem in which an individual’s consensual sexual urges, thoughts, and behaviors feel out of control [to them]” (p. 10), as opposed to as a mental illness (as in the Sex Addiction model). According to Braun-Harvey, Out of Control Sexual Behavior is a self-discrepant model similar to Motivational Interviewing (personal communication, February 10, 2015). As a result, it is the “focus on the presence of internal conflicts and self-discrepancies when deciding to provide OCSB assessment and treatment” (Braun-Harvey, 2014, p. 11). Although there is a clinical interview and a number of measures as part of the therapist’s assessment plan, ultimately it is the client (as opposed to a program) who identifies wanting to do one thing while doing another and experiencing a feeling of being out of control as a result (Braun-Harvey, 2014, p. 24).

Treatment in Out of Control Sexual Behavior Therapy

Braun-Harvey (2014) uses the OCSB Clinical Pathway as a map for therapists to help clients achieve sexual health (p. 30).  Braun-Harvey (2014) employs “a set of principles to guide the ethical decision-making, both for people making sexual decisions and therapists providing treatment for problematic or out of control sexual behavior” (p. 16). Those principles are: (1) consent, (2) non-exploitation, (3) protection against Human Immunodeficiency Virus (HIV), Sexually Transmitted Infection (STI), and unwanted or planned pregnancy, (4) honesty, (5) shared values, and (6) mutual pleasure (Braun-Harvey, 2014, p.19).

After an initial screening and assessment, the treatment phases of the OCSB Clinical Pathway begins with the first phase, Unique Client Picture (Braun-Harvey, 2014, p. 56). This phase is concerned with exploring and better understanding strengths and weaknesses related to sexual health. The therapist investigates factors of vulnerability (e.g., physical safety, physical health, mental health, and substance abuse), client’s ability to self-regulate (or not), and any sexual and erotic conflicts, the sum of which creates a unique client picture that guides the therapeutic process and informs which therapeutic interventions are needed (Braun-Harvey, 2014, p. 58). It is in this phase that working with untreated trauma/abuse, untreated mental health issues, unresolved relationship issues, and problematic behaviors are critical (Cannon, 2015, p. 19), as “more often than not, OCSB is a symptom of something that has nothing to do with sex” (Cannon, 2015, p. 12). It is from this work and an understanding of sexual health that empowers the client to create their Sexual Health Plan, which group and individual therapy then serve to support. Finally, the Rescreen and Evaluate phase helps assess if the treatment is complete or requires continuing and/or concurrent services (Braun-Harvey, 2014, p. 58).

Strengths and Limitations of Out of Control Sexual Behavior Therapy

Strengths of this model that I observe are that for some, the Out of Control Sexual Behavior model provides an opportunity to identify and engage underlying causes of compulsive sexual behavior. By not making an enemy of their compulsive sexual behavior, subjects may find that there is more space in which to work with it; to be curious about it, to attempt to understand it. In addition, by moving the focus away from refrainment and towards healthy sexual behavior (however they define it, and by not shaming unconventional turn-ons), there is an opportunity for them to experience sex as nourishing and pleasurable; as an aspect of themselves that contributes to living a richer life.

However, the financial cost for individual and/or group therapy might make this approach less accessible compared to Twelve Step groups (which are low-cost/donation-based). In addition, because the Sex Addiction model is so pervasive and more well known, there may be individuals who are not aware of this approach and may have difficulty finding clinicians who work with this model–and few clinicians do (although I am one).

Concluding Thoughts on Out of Control Sexual Behavior Therapy

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. It has been my personal experience, where the greatest change occurred not when I attempted to refrain from or disown the part of me that was ensnared in compulsive sexual behavior. Rather, it occurred after engaging my history of childhood sexual abuse and learning to cultivate a healthy relationship to my sexuality while engaging in sexual behaviors that are nourishing to me.

Braun-Harvey, D. (2014). Treating out of control sexual behavior [Presentation by Dr. Douglas Braun-Harvey on September 19-20, 2014 in San Francisco, CA].
Cannon, N. (2015). A strength based approach to treating out of control sexual behavior (ocsb) [Presentation by Dr. Neil Cannon on February 6, 2015 at the Buehler Institute].
Klein, M. (2003) Sex addiction: A dangerous clinical concept. SIECUS Report, Vol. 31, No. 5, 77-80.
Ley, D. J. (2012). The myth of sex addiction [Kindle Edition]. Plymouth, United Kingdom: Rowman and Littlefield Publishers.