What do the sex addiction and psychological models have in common?

Both of these models pathologize the client.

There is no consensus or acceptance of the concept of sexual addiction within the field of sex therapy.

How do we deal with popularly accepted diagnoses that do not have scientific support or acceptance within the profession?

A Client Centered Pragmatic Model for the Treatment of Problematic or Out-of-Control Sexual Behavior

Principles of the Pragmatic Model

  • Client centered
  • Psychosexual educational
  • Non-Pathologizing and growth oriented
  • Self-empowering


  • 1-3 Session Assessment Period
    • Extensive sexual history
    • Assessment of the nature and parameters of the problem
    • Psychological and mental status evaluation
    • Systems evaluation
    • Assessment of motivation

Sexual Health Wheel

Psychosexual Education

1. Intimate Communication
2. Culture and Sexual Identity
3. Sexual Functioning
4. Sexual Safety and Health
5. Challenges to Overcome
6. Body Image
7. Masturbation and Fantasy
8. Positive Sexuality over the Lifespan
9. Intimacy and Relationships
10. Spirituality (Religion)

Adapted from: Robinson B.E., Bockting W.O., Simon Rosser B.R., Rugg, D.L., Miner M., and Coleman E. (2002. The Sexual Health Model: Application of a Sexological Approach to HIV Prevention. Health Education Research: Theory and Practice, 17, 43-57.)

Client Centered Collaborative Approach to Develop:

  • Boundaries
  • Limits
  • Mutual Respect in Relationships
  • Honesty and Ethical Behavior
  • Self-Direction and Determination
  • Safety

The Goal is to Put Person in Charge of His/Her Sexuality and Not Have Sexuality Rule the Person

Must Defeat Shame and Guilt

  • Identify Conditions that Promote Self-Mastery
  • Identify Conditions or Triggers of Acting out Behavior

Explore Core Issues

  • Fear of Intimacy
  • Reenactment of Trauma

Normalize and Bring Fetishes under Personal Control

Develop (Write) Personal Standards or Guidelines for Sexual Behavior

  • Non-Perfectionistic
  • Non-Punitive
  • Self-Monitoring and Self-Enforcement

Teach Methods of:

  • Cognitive Restructuring
  • Emotional Self-Regulation
  • Deconstruction of Negative Self
  • Support for Self-Acceptance

Involvement of Significant Other

  • Invite as a needed ally to treatment
  • “You’re not the cause of the problem, but you are essential to achieve the solution.”

Significant Other

  • Allow Venting and Expression of Feelings
  • Must Get to her Wound
  • Self-Esteem, Body Image, Etc.

Restoration of Trust

  • The death of blind trust
  • Conjointly work on the development of evidence-based trust
  • Elimination of secrecy
  • Transparency toward respect for privacy

Psychosexual Educational Therapeutic Support Groups

  • Themed Sessions
  • Group Dynamics
  • Peer Support
  • Emphasizing Health Not Pathology

Common Case Presentation

  • Male client
  • Appears under duress
  • Self-identified “Sex Addict”
  • Dysfunction in at least one domain
  • Must get “fixed” or relationship in jeopardy

Client Centered Pragmatic Treatment Model

  • Must proceed cautiously with respect for the patient’s view of his condition
  • Therapeutic alliance
  • Application of the client centered pragmatic treatment model
  • Incorporation of the significant other
  • Overcoming shame and guilt
  • Harm reduction approach
  • Personal control and empowerment
    -“You’re the boss of your sexuality, your sexuality is not the boss of you.”
  • Identifying protective and risk factors
  • Collaborative approach