The first Living and Loving Freely Programme Assessment Review Forum was held on 23 April 2016 in Auckland. The day was a great success, and thanks extended to all those who participated and contributed. We will be holding further review forums throughout the country. If you think you might like to attend, let us have your contact details and we’ll keep you updated on developments.
We will be holding further review forums throughout the country. If you think you might like to attend, let us have your contact details and we’ll keep you updated on developments.
STEPS Assessment Review Forum of Problematic Sexuality
Auckland, 23 April 2016
Introductions were made by way of answering 3 questions
field of work/interests, and
what were you hoping to get out of today.
The day began with a warm welcome from David Moore and acknowledgment of the collective wisdom present with a thank you of choosing to be part of this forum. David made it clear from the outset that this assessment model is to be seen as a living document, one that will continue to be shaped by those delivering the program, as it will by those receiving its enquiry.
In reaching this day, David explained that the complete program had been formulated as result of working in the field of sex addiction for over 25+ years primarily within the Christian community. Over those years, he has witnessed the destructive influence SA has had on families, partners and their children when there has been a deterioration of relational trust between primary care givers.
In his experience, the trauma experienced by the partner has led to clients seeking help, not religious doctrine or moral conviction. Though we may attribute a cyclic pattern to SA behaviour, in reality, it more commonly resembles that of a “Pinball”. Moving indiscriminately throughout the life of the client.
STEPS Living and loving freely program, does not fixate to a particular point within the clients experiences. It understands individual experiences are best understood as somewhere on a continuum. Aiding clients to move from intellectualising behaviour to connecting with emotion. When you meet the story of a sex addict, either abuse to self or other will also be found.
It is crucial that partners join a therapeutic group specifically designed for them. These groups serve to help move partners away from increased isolation as is often the outcome particularly within faith based communities. Noted by some forum members was a belief that men have the ability to segment their lives with greater ease than women. This does not constitute absolution to crimes committed or present a natural human defence. This point argues against reified ideas that men are merely “dumb” or “non emotive”, but could offer insight to why there is a perceived lack of empathy toward partners.
Another great point to note when working with those identified as a SA. David explained that in his view, it takes longer for the partner to heal than it does for the client to recover. It takes the client to step forward in owning what has occurred. At no time in the recovery is it the responsibility of the partner to be the gatekeeper, guard, conscience or “strong one”. It is imperative that the partner’s needs are acknowledged, reflected, in the presence of the other.
Questions arising from viewing the assessment model
Unfortunately, time did not permit an answer for all questions. Responses to those covered are listed below.
How young does SA start?
Potentially at birth/Pre natal, being setup by adults (Silently Seduced. Kenneth Adams)
What are the things that can introduce and stimulate SA?
Childhood attachments/family. Accessibility and anonymity of social media. Considering what are the causes or environments that make it more desirable for youth to lead secret lives. Families, parents are important parts of the answer. The use of DBT skills in offering clients mindfulness techniques. More conversations needed within cultures, people group of appropriate boundaries and appropriate behaviour. More focus is needed on the education of peer groups about sex and sexuality.
What can we as a society do to reduce this stimulus?
How can we recognise SA in young people (those not in relationship)?
How prevalent is SA in youth?
What is the effect on tier futures long term and society?
How to modify for same sex or those not in relationship – Singles
Was noted that for men, one of their greatest relationships is with their work. The needs of same sex male relationships are quite different to those of female. Definition of promiscuity cannot be assumed the same across relationship; they vary between people groups, culture, age, and gender. It has been reported that there is increase in “teenage impotence” due to use of pornography.
(Google teenage impotence)
What is appropriate age for program (teenagers)?
Manual for teenagers and children
What if clients reject assessment?
It remains that every client has the ability to reject all recovery interventions but the question is why would he or she. Opportunity to enquire as to why, offer alternative intervention assessments, use of Externalising questions (Narrative), or drawing.
How long would this take to work through?
It is possible to work with clients up to 12 months, minimum 3 months. Clients need to commit to six, 1-hour sessions. Patrick Carnes says of the sex addict; recovery could take up to 5 years of therapy. It is important to define as part of any treatment, a relaxation prevention plan that privileges forgiveness. Recognising that “behaviour” in SA is the drug of choice. Deconstructing an identity template developed through childhood and teenage years takes time!
For the partner, learning to trust, having trust again is dependant on many variables and expectations. It is important to recognise that the affected partner will also have a developed/learnt response to trauma, triggering a fight, flight or fight response leading them to question own identity, needs and attachments.
Description/definition of elements (p10) of Continuum of problem sexuality
Email list to network
How to detect sociopath and with them individually/group
How to assess comorbidity
Policies and protocols to work with those in the criminal system
What does the law require in reporting?
Define “passive Sexual Addiction”
Do you actually recover or develop better coping skills?
How do we make sure the partner is attended to?
DSM-V does not attend to SA (Political interests in keeping out)
Clarity on number system
Which section attends to evaluate attachment style?
Possible forum on Facebook so conversation can continue. SANA, STING
How could MSD, Government support this initiative?
Unfortunately, time did not permit getting to the additional questions. David introduced forum chairperson, John Groom. John gave a brief bio of his work and confessed that despite his best efforts he finds himself continually drawn back into this work.
He invited all to consider that an elephant existed in the room and that elephant is intimacy. Stating intimacy remains largely un-acknowledged or examined in this field of work. It might also be helpful to view this work through the lens of trauma, sensitivity and attachment.
John acknowledged working in this field is challenging for client and clinician. That sometimes we find ourselves working on both sides of a metaphorical fence. On one side, we find a traumatised partner, the other, a partner captured by addictions grip. John considered that wherever you find yourself in working in this field, “working compassionately” could be one way to describe the intent of our work.
Assessments were then handed out where for the next 30 minutes attendees were given the opportunity to note, suggest and critique later in the afternoon sessions.
General discussion in the last session:
Unfortunately, time did not permit an answer for all questions. Responses to those covered are listed below.
There is a need to engage in conversations about what is healthy sexuality because after all we are sexual beings. A reference was made to the use of “Acceptance Commitment Therapy” in working with SA is quite effective when working with individuals and couples.
When strong, authentic sexual relationships prevail, strong families are built.
For this model to succeed, move forward, strong evidential Qualitative research needs to be undertaken. Once this has been accomplished, significant barriers to implementation by professionals, Government agencies might be overcome. Without evidence based research available, it will be almost impossible to attract funding.
Universities have Masters programs; perhaps making this program available to them may give a Masters Student the opportunity to make this their research project.
Sex Therapy NZ was a good resource for therapists looking for resources, research.
It is vitally important that if clinicians choose to work in this field that they are supervised by someone specialised in this field.
(Page 1) There seems to be no reference to Brain development, Neurobiology or acknowledgment of potential trauma, Attachment theory
David explained that he was advised to leave out references to Neuroscience and development as it could over complicate issues for clients. That this was a living document and is not by any means a final draft. It will continue to be shaped.
(Page 49) Was this a reference to the partner or client?
David: It represents a time for the client to enter into the partners shoes. A time for the client to acknowledge what this relationship must be like for their partners.
Perhaps the use of the word “should” needs to be replaced by “could”. Even if it were to be reworded to include “validation”, may be more helpful in aiding the client to see what life must be like for the partner.
Shaming and blaming MUST be avoided at all cost.
(Page 14) Sexual Dysfunction. Clarification of terminology used in the context of SA
David: It is believed that clinicians working in the field of SA will reach a point where there is a need to refer clients to a specialist. Ongoing conversations are required in order for each person to work within their scope of practice so asked the question of all attendees, are we clear on the limits of work. David explained that he does not want to be labelled a Sex Therapist, working with client’s beliefs encapsulating sexual dysfunction.
“Are you attracted to children” is a closed question, is this appropriate?
“Have you committed an offence”, is the wording also appropriate and are there legal definitions that need to be substituted here.
What happens when a disclosure is made? At what point are clinicians required to report? While NZ law does not mandate reporting, there was acknowledgment of some agencies, within the scope of their policies, do require reporting. Further clarification here would be beneficial. “Incest” Why not use the term Sexual Violence against a family member? This would make obvious where power imbalance exists regarding issues of consent within the family system.
The use of Motivational Interviewing (MI) was of great benefit when establishing with clients, a desire to change behaviour.
The “trauma egg” example, also a great tool to help clients reflect on their own stories
Why bring the program together when there is vast amounts of training and resources available around the world but primarily out of the USA?
David: The barrier as he sees it has been the cost of training, either getting to the US for the training or bringing the trainers to NZ. Costs indicated were up to $25k per person. Some training institutions in the US require candidates as a minimum, to have a Masters before they can apply.
In closing, the attendees wished to register appreciation to the structure of the forum in making time available during the forum sessions to engage with each other in the sharing of information, ideas and experiences. Rather than spending all day being “talked at”, this was a forum that privileged the other, providing space for vulnerability to emerge, building authentic relationality.
An expression of heartfelt thanks and gratitude was conveyed from David and John to the attendees after which point the Auckland forum came to close. 80% of you registered a high level of satisfaction in attending this forum, taking with you new sight, more questions not mention initiatives in collegial support.