Working with Compulsive Sexual Behaviour
5 April, 2023
The controversy amongst professionals continues about whether problematic sexual behaviours are best conceptualised as an addiction or a compulsion, but in the meantime clients continue to seek help for behaviours they perceive to be ‘out-of-control’.
And however you conceptualise the problem, the treatment approach is the same. Clients need to identify and address the conscious and unconscious causes of the problem, such as anxiety or depression, relationship issues, or adverse childhood experiences and actively engage in positive behaviour change strategies.
This two-pronged approach is essential when working with any kind of compulsive or addictive behaviour. If you only address the underlying issues, the unwanted behaviours will remain and if you only stop the behaviour, the underlying causes will continue to cause emotional pain. The goal of any therapeutic intervention should be to help clients achieve ‘recovery’ not just ‘sobriety’.
A growing number of therapists are undertaking additional training in this specialist field, but not all clients can afford their services. When that’s the case, how can general therapists ensure they’re providing the best possible support? One way is to utilise additional resources, such as self-help books and digi-health apps. This way, the client can use and share their learning and progress alongside the therapeutic work that’s being done with a counsellor.
Most of us already work in this way, to a lesser or greater extent, utilising apps like Headspace for mindfulness, or one of the many journaling apps, or incorporating online worksheets and self-help exercises. For people struggling with sex or porn addiction there’s a new not-for-profit service called Pivotal Recovery that counsellors can incorporate into their work.
The Pivotal Recovery Course is a 60-session, professionally guided course consisting of a daily podcast and a workbook to personalise the learning content. It is suitable for anyone struggling with compulsive sexual behaviours including those with cross addiction, including chemsex, and those who have offended or may be at risk of offending. The course provides a psycho-educational framework for understanding addictive / compulsive behaviours from a bio-psycho-social perspective and is based on 30 years of clinical experience. It is trauma-informed and sex positive and primarily uses CBT, ACT and psychodynamic strategies.
The programme is based on the CHOICE recovery model, which is widely used in other settings to help clients overcome compulsive sexual behaviours. CHOICE is not only an acrostic to help remember the six steps, but it’s also a philosophy that encourages clients to take responsibility for their individual recovery journey. The steps are as follows:
- Challenge faulty core beliefs – especially those that result in shame and have previously sabotaged recovery.
- Have a vision – using the principles of positive psychology, this step helps build motivation for a life without the unwanted behaviours.
- Overcome unwanted behaviours – this step helps clients recognise their personal cycle of addiction and stop it.
- Identify positive sexuality and set sexual boundaries that are culturally sensitive and appropriate to the individual.
- Connect with others – this is about the importance of relationships and healthy attachments.
- Establish confident recovery. With any addiction, stopping is the easy bit; staying stopped is the challenge. Hence this final step is all about life change – understanding trauma, managing uncomfortable emotions such as anxiety and depression, anger, loneliness and low self-esteem, establishing boundaries and building resilience.
For counsellors and therapists who find themselves working with people with sex or porn addiction and are unable to refer them for specialist help, Pivotal Recovery offers an affordable resource to incorporate into therapy. You can find more information about the course at https://PivotalRecovery.org and a full guide for professionals to use when working alongside clients is available by emailing info@PivotalRecovery.org.
Dr Paula Hall, D.Psych, is a BACP Accredited and COSRT Senior Accredited therapist with 30 years experience working with sexual, relationship and addictive problems. She is founder of The Laurel Centre who provide individual and group therapy for people with addiction and support for partners and course director of ISAT who provide accredited diploma-level training to professionals. Most recently she has launched the not-for-profit service, Pivotal Recovery to provide accessible, anonymous and affordable help for those who can’t access traditional therapy.
