SEXUAL DEVELOPMENT THEORY An alternative approach to sexual dysfunction.
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Transcript of SEXUAL DEVELOPMENT THEORY An alternative approach to sexual dysfunction.
Agenda Traditional Sexual Therapy Traditional vs Alternative Approach Developmental Theory Sexual Interdependence Theory Sexual Progression Approach
Predominant sexual therapy is limited Sequence of intervention is fixed, rigid Narrowly focused on addiction Lacks theoretical underpinning
Why an alternative approach?
More inclusive: Addresses broader range of clientele/conditions
Open to new research Treatment flexibility Builds upon an established theory
Origins of Modern Sexual Theory & Intervention
12 Step Carnes 30-steps Adapted, task-based treatment models
Origins of Modern Sexual Theory & Intervention
12 Step Reliance on ‘higher power’ Begins with abstinence Treatment is the only Theory Shame reinforced by identifying as ‘addict’ High attrition Aged; Limited adaptation to modern
intervention
Origins of Modern Sexual Theory & Intervention
Carnes 30-step It’s compatible, but too compatible with 12-
step Lots of tools, but based on strict sequence and
task completion Good at psycho-education (rational brain) Under-emphasizes affect processing
(emotional brain)
An alternative model should… Easy to grasp – easy to apply Account for limitations of the predominant
approach Built upon established theory Offer actionable therapy & resources Open framework: incorporates new research &
findings Inclusive: applies to more people, broader
conditions Effective, lower attrition
Introducing SIT
Sexual Interdependence Theory Adapted from Developmental Theory Based on the developmental models of:
Erik Erikson Abraham Maslow Jean Piaget Lawrence Kohlberg
Tenets of Developmental Theory
People seek self-actualization People progress in a predictable sequence Progression involves discreet developmental
stages Staged progression of sexual development
mirrors human development Sexual development stages (theory) informs
stage-specific intervention (treatment)
Attachment & Individuation Widely held approach to early social development Now commonly extended to adult development Theory helps us address drivers of sexual behavior SPA (Treatment) is based on progression between
states of attachment & individuation The goal is achieve balance (sexual
interdependence)
Eriksonian Crises Erikson offered first life-span developmental
model Human development is based on response to
life-crises Response to life-crises precipitates attachment
or individuation (Robert Kegan) For SIT, response to life-crises has high
correlation to sexual behavior
INTERDEPENDENCE
SEXUAL INTERDEPENDENCE THEORY
Trust vs. Mistrust
Role Confusion vs. Identity
Ego Integrity vs. Despair
Sexual Development Stages Progression between Attachment &
Individuation is defined by specific stages Each stage exhibits expressive and
repressive sexual behavior Different stages carry unique treatment
implications
INTERDEPENDENCE
SEXUAL INTERDEPENDENCE THEORY
Trust vs. Mistrust
Role Confusion vs. Identity
Ego Integrity vs. Despair
Sexual MistrustSexual
Mistrust
Sexual(Con)Fusi
on
Sexual(Con)Fusi
on
Sexual IdentitySexual Identity
Sexual IntegritySexual
Integrity
Sexual Development Stages
Description:•We don’t trust others in sexual relationships•We assume malice from potential partners
Expressive Behavior:•Master of the Universe – seek to control•Reenact sexual trauma
Repressive Behavior:•‘Primitive’ Sexual Anorexia – safety/survival•Avoidance of re-traumatization
Sexual Mistrust: “Julie”
Trust vs. Mistrust
Role Confusion vs. Identity
Ego Integrity vs. Despair
Sexual MistrustSexual
Mistrust
Sexual(Con)Fusi
on
Sexual(Con)Fusi
on
Sexual IdentitySexual Identity
INTERDEPENDENCE
Sexual IntegritySexual
Integrity
Sexual Development StagesDefinition•Fusion: Our views on sexuality are rigid (even if ineffective)•Confusion: We are confused by what we believe vs. what we experience (cognitive dissonance)
Expressive Behavior:•Experimentation•Strict behavioral compliance to beliefs (regardless of impact)
Repressive Behavior:•Passive Aggression •Information gathering•Sexual Anorexia (white-knuckle)
Sexual (Con)Fusion: “Andrew”
Trust vs. Mistrust
Role Confusion vs. Identity
Ego Integrity vs. Despair
Sexual MistrustSexual
Mistrust
Sexual(Con)Fusi
on
Sexual(Con)Fusi
on
Sexual IdentitySexual Identity
INTERDEPENDENCE
Sexual IntegritySexual
Integrity
Sexual Development Stages
Definition•We are comfortable with our values on sex, but we behave contrary to our values
Expressive Behavior:•Wimpy Masturbators •Values based expression
Repressive Behavior:•Values-based abstinence•Distrust of partners who have proven un-trustworthy
Sexual Identity: “Maria”
Trust vs. Mistrust
Role Confusion vs. Identity
Ego Integrity vs. Despair
Sexual MistrustSexual
Mistrust
Sexual(Con)Fusi
on
Sexual(Con)Fusi
on
Sexual IdentitySexual Identity
INTERDEPENDENCE
Sexual IntegritySexual
Integrity
Sexual Development Stages
Interdependence•We are balanced between attachment and individuation
Healthy Attachment:•We seek connection and intimacy•Service orientation & open to feedback
Healthy Individuation:•Hold and adhere to healthy values and boundaries on sex•Not susceptible to sexual manipulation from others
Sexual Identity: “Paul”
Trust vs. Mistrust
Role Confusion vs. Identity
Ego Integrity vs. Despair
Sexual MistrustSexual
Mistrust
Sexual(Con)Fusi
on
Sexual(Con)Fusi
on
Sexual IdentitySexual Identity
INTERDEPENDENCE
Sexual IntegritySexual
Integrity
Introducing SPASexual Progression Approach
Aligned to SIT Allows for more accurate, stage-oriented
assessment Stage specific treatment Allows for individualized beyond just tasks (task
vs. processing) Flexible enough to incorporate new research Eschews counterproductive stigma of ‘addict’ and
‘relapse’ in favor of ‘progression’ and ‘integrity’
Compare & Contrast
SIT/SPA Model
• Flexibility: custom treatment for unique individuals, condition
• Internalized Values and Aligned Behavior is the objective – abstinence is a bi-product
• Abstinence as final achievement or pursuit – relapse is informative and part of ‘progress’
SIT/SPA Model
• Flexibility: custom treatment for unique individuals, condition
• Internalized Values and Aligned Behavior is the objective – abstinence is a bi-product
• Abstinence as final achievement or pursuit – relapse is informative and part of ‘progress’
Common Sex Therapy
• Rigidity: Mandatory steps (12 or 30) regardless of individual, condition
• Abstinence is the first ‘step’ – relapse is failure or regression
Common Sex Therapy
• Rigidity: Mandatory steps (12 or 30) regardless of individual, condition
• Abstinence is the first ‘step’ – relapse is failure or regression
SPA: General Techniques Identify the benefits associated with
their current stage. Exploration of benefits must be authentic
and reflect empathic expression. Anything less will be correctly interpreted
as insincere and may result in an attachment rupture.
SPA: General Techniques (cont.) Identify limitations or “what’s missing”
from the stage. Theory gives clinician window into stage
limitations. Gentle application of socratic method can
also help client to see and accept these limitations.
SPA: General Techniques (cont.) Build a bridge from client’s current sexual
development stage and the subsequent stage. All stages, except Sexual Integrity, have their
limitations. Clinicians may confidently explain how (a) the
next stage fills limitations of current stage while (b) taking into account benefits of the current stage.
SPA: Specific Techniques Sexual Mistrust Sexual (Con)Fusion
Exposure Response Prevention (e.g. EMDR) Mistrust is frequently rooted in trauma, neglect, or some
other form of interpersonal and/or sexual disturbance. Talk therapy provides adequate healing with only 15% of
clients. Treatments that incorporate desensitization or, better
yet, disturbance reprocessing pave the way for stage advancement.
SPA: Specific Techniques Sexual (Con)Fusion Sexual Identity (ACT)
Values development (e.g. Acceptance & Commitment Therapy) Identity represents healthy and internalized
values. Treatment is most effective that emphasizes value
development before behavioral change. Mandatory behavioral change, , often lead to shame,
attrition and/or recidivism.
SPA: Specific Techniques Sexual Identity Sexual Integrity
Mindfulness (e.g. Acceptance & Commitment Therapy) “Reject and replace,” so fundamental to traditional approaches,
is not sufficiently effective and can make matters worse. Once one wants to change (i.e. reaches Sexual Identity,) the
only remaining question is: “Can you co-exist with temptation?” Mindfulness techniques, such as meditation, are more effective
than traditional approaches without their associated drawbacks.