Out-of-Control Sexual Behavior

Treatment for Out-of-Control Sexual Behavior (OCSB) is based on the idea that although some sexual behaviors (porn, cybersex, infidelity, commercial sex) can feel out-of-control, that doesn’t mean that they are out-of-control. Central to the way that I work is the belief that people can regain control over destructive sexual behaviors (through stopping or moderating) without having to submit to the ‘sex addiction’ paradigm. In my extensive experience working with individuals struggling with out-of-control sexual behavior, understanding the problem from the client’s perspective and developing a customized treatment plan is by far the most effective approach. Here are some typical components of my work:


It’s helpful to target the particular dimensions of the problem you're struggling with. Bill Herring has a useful theory-neutral framework that categorizes problematic sexual behavior along these five dimensions: ongoing commitment violations, conflict between values and behavior, diminished control, negative consequences and a lack of sexual responsibility. Discussion on which dimension(s) the problem falls and an in-depth understanding of your personal experience, helps me customize my interventions. Getting into the specific details, while it may feel uncomfortable, is an important part of the healing process. 

It’s also important to assess improvement. A tool that I use to chart progress is the Sexual Symptoms and Assessment Scale (SSAS). This is like getting your blood pressure taken each time you visit the doctor. Each week I have clients fill out this 10-question scale that measures the severity of urges, thoughts, behaviors, feelings and consequences over the prior seven days. We track this each week not only to monitor your progress, but to help develop your self-observing skills—a critical skill clients must develop in order to make different choices in the heat of the moment. 

Sexual Health Plan

The sexual health plan is a living document that clarifies sexual boundaries, encourages reflection and serves as a motivational tool for change. Clients are asked to fill out three columns: sexual behaviors that they are 100 percent clear they want to change, behaviors they are still ambivalent about, and a vision of the kind of sexual life they want, including key activities that will support that vision. In order to develop self-acceptance and reduce the harmful effects of toxic shame, clients are asked to let me know in the session when they’ve crossed their sexual boundaries. This document is not meant to be used as a weapon, but rather a gentle tool to increase self-awareness, make adjustments to their approach, and achieve their vision of sexual health.

Sexual History

An exercise that I like to assign clients is a sexual history. A sexual history is a 2-3 page narrative of important sexual events that occurred from a client’s earliest memories until the present day. This exercise serves several important functions. First, it helps us understand the context in which compulsive sexual behaviors may have developed. What was going on with the client at the time? What was happening in the family? In what way was the behavior a way to cope with stressors? The answers to these questions helps us make sense of how the behaviors started in the first place. Second, writing a sexual history and then telling that story to another person helps reduce the shame associated with the behaviors. Shame reduction is a vital part of treatment because a toxic level of shame often drives compulsive sexual behaviors. Third, there is something about writing about our experiences that makes them more real and undeniable. It forces clients to reckon with the reality, consequences and history of their behavior in way that can be quite transformational.

Self-Destructive Cycles

The more clients knows about their unique self-destructive cycles, the better positioned they are to interrupt the cycles. Paula Hall has identified six phases in self-destructive cycles: the dormant phase, the trigger(s), preparation, acting out, regret, and reconstitution. The dormant phase is when the problematic behavior is in remission, but the underlying issues and needs have yet to be resolved. Triggers include an external event, an opportunity or a difficult emotion that spur people to turn to problematic sexual behavior. The preparation phase involves a “setting up” that needs to take place, which could include something as simple as turning on a laptop to something more complex like planning an affair. Acting out is the sexual act itself. Regret includes the painful emotions that follow the sexual act such as guilt, shame, depression and anxiety. The reconstitution phase is when people make a promise to themselves or others to never do it again and try to put their lives back together again. Being able to distinguish these phases from each other and do the work necessary in each of them helps prepare clients break these self-destructive cycles.