SEXUAL DEVELOPMENT THEORY
An alternative approach to sexual dysfunction
Agenda
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Traditional Sexual Therapy
Traditional vs Alternative Approach
Developmental Theory
Sexual Interdependence Theory
Sexual Progression Approach
Predominant sexual therapy is limited
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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
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12 Step
Carnes 30-steps
Adapted, task-based treatment models
Origins of Modern Sexual Theory & Intervention
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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
Origins of Modern Sexual Theory & Intervention
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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…
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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 Theory
SPA: 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 stagespecific 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
INDIVIDUATION
ATTACHMENT
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
SEXUAL INTERDEPENDENCE THEORY
Ego Integrity vs. Despair
Role Confusion vs. Identity
Trust vs. Mistrust
INDIVIDUATION
ATTACHMENT
INTERDEPENDENCE
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
Sexual Integrity
Sexual Identity
Sexual (Con)Fusion
Sexual Mistrust
SEXUAL INTERDEPENDENCE THEORY
Sexual
Integrity
Ego Integrity vs. Despair
Role Confusion vs. Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs. Mistrust
Sexual
Mistrust
INDIVIDUATION
ATTACHMENT
INTERDEPENDENCE
Sexual Development Stages
Description:
Sexual Integrity
•
•
Sexual Identity
Expressive Behavior:
Sexual (Con)Fusion
Sexual Mistrust
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We don’t trust others in sexual relationships
We assume malice from potential partners
Master of the Universe – seek to control
Reenact sexual trauma
Repressive Behavior:
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‘Primitive’ Sexual Anorexia – safety/survival
Avoidance of re-traumatization
Sexual Mistrust: “Julie”
Sexual
Integrity
Ego Integrity vs. Despair
Role Confusion vs. Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs. Mistrust
Sexual
Mistrust
INDIVIDUATION
ATTACHMENT
INTERDEPENDENCE
Sexual Development Stages
Definition
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Sexual Integrity
Sexual Identity
Sexual (Con)Fusion
Sexual Mistrust
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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:
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Experimentation
Strict behavioral compliance to beliefs (regardless
of impact)
Repressive Behavior:
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Passive Aggression
Information gathering
Sexual Anorexia (white-knuckle)
Sexual (Con)Fusion: “Andrew”
Sexual
Integrity
Ego Integrity vs. Despair
Role Confusion vs. Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs. Mistrust
Sexual
Mistrust
INDIVIDUATION
ATTACHMENT
INTERDEPENDENCE
Sexual Development Stages
Definition
•
Sexual Integrity
Sexual Identity
We are comfortable with our values on sex, but we
behave contrary to our values
Expressive Behavior:
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Wimpy Masturbators
Values based expression
Sexual (Con)Fusion
Repressive Behavior:
Sexual Mistrust
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Values-based abstinence
Distrust of partners who have proven un-trustworthy
Sexual Identity: “Maria”
Sexual
Integrity
Ego Integrity vs. Despair
Role Confusion vs. Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs. Mistrust
Sexual
Mistrust
INDIVIDUATION
ATTACHMENT
INTERDEPENDENCE
Sexual Development Stages
Interdependence
•
Sexual Integrity
Sexual Identity
We are balanced between attachment and
individuation
Healthy Attachment:
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We seek connection and intimacy
Service orientation & open to feedback
Sexual (Con)Fusion
Healthy Individuation:
Sexual Mistrust
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Hold and adhere to healthy values and boundaries
on sex
Not susceptible to sexual manipulation from others
Sexual Identity: “Paul”
Sexual
Integrity
Ego Integrity vs. Despair
Role Confusion vs. Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs. Mistrust
Sexual
Mistrust
INDIVIDUATION
ATTACHMENT
INTERDEPENDENCE
Introducing SPA
Sexual 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’
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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’
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
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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.)
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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.)
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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
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Sexual Mistrust  Sexual (Con)Fusion
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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.
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SPA: Specific Techniques
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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.
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Mandatory behavioral change, , often lead to shame, attrition
and/or recidivism.
SPA: Specific Techniques
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Sexual Identity  Sexual Integrity
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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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