SEXUAL DEVELOPMENT THEORY An alternative approach to sexual dysfunction

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


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


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

SIT & SPA Model

SIT: Sexual Interdependence TheorySPA: Sexual Progression Approach

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)

SEXUAL INTERDEPENDENCE THEORY

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


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

Sexual Development Stages

INTERDEPENDENCE


Trust vs. Mistrust



Sexual MistrustSexual

Mistrust

Sexual(Con)Fusi

on

Sexual(Con)Fusi

on

Sexual IdentitySexual Identity

Sexual IntegritySexual

Integrity


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




Mistrust

Sexual(Con)Fusi

on

Sexual(Con)Fusi

on


INTERDEPENDENCE


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




Mistrust

Sexual(Con)Fusi

on

Sexual(Con)Fusi

on


INTERDEPENDENCE


Integrity


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




Mistrust

Sexual(Con)Fusi

on

Sexual(Con)Fusi

on


INTERDEPENDENCE


Integrity


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




Mistrust

Sexual(Con)Fusi

on

Sexual(Con)Fusi

on


INTERDEPENDENCE


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.

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SEXUAL DEVELOPMENT THEORY An alternative approach to sexual dysfunction