SEXUAL DEVELOPMENT AND
DYSFUNCTION:
THE SEXUAL INTERDEPENDENCE
AND SEXUAL PROGRESSION
MODEL
An alternative approach to treating sexual dysfunction – Brett Copeland,
PsyD & Andrea Rabie, B.A.
Agenda
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Define Root Cause for Sex Addiction
Traditional Sexual Therapy
Traditional vs. Alternative Approach
Sexual Interdependence Theory (SIT)
Sexual Progression Approach (SPA)
Root of Sex Addiction
◻Hedonism
⬜Biological instinct common to all
members of the animal kingdom
that compels us to:
■ Pursue pleasure
■ Avoid pain
Two Types of Sex Addiction
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Traditional Addiction (20% of population)
Primary drive: pursuing pleasure
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Regardless of how well life is going, the pleasure
response associated with the drug of choice is so
intense that one is consistently vulnerable to
relapse, i.e. intense temptation to “use” is present
even in the absence of other sources of pain
Two Types of Sex Addiction
◻ Pain-based Addiction (80% of population)
◻ Primary drive: pursue pleasure as an outlet
from pain
⬜ Persons in this category can go years with no
excessive/problematic behavior but it
becomes dysfunctional when life stressors,
crises, etc. mount to levels perceived as
intolerable
Predominant Sexual Therapy is Limited
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Sequence of intervention is fixed, rigid
⬜ Lacks theoretical underpinning
⬜ Narrowly focused on addiction
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This is important because, at least for 80% of people,
the addiction is not the primary cause but is an effect
of hedonistic imbalance
Interventions that merely treat the effect may simply
be giving cough drops to someone suffering from an
impaired immune system
Why an alternative approach?
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More inclusive: Addresses broader range of
clientele/conditions
⬜ Open to new research
⬜ Treatment flexibility
⬜ Builds upon an established theory
⬜ Treats the cause (hedonistic imbalance) and the
effect (addiction)
An alternative model should…
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Be easy to grasp – easy to apply
Account for limitations of the predominant approach
Build upon established theory
Offer effective corresponding therapy & resources
Be an open framework: incorporates new research
Be inclusive: applies to more people, broader
conditions, not just “addiction”
◻ Be effective, lower attrition
SIT & SPA Model
SIT: Sexual Interdependence Theory
SPA: Sexual Progression Approach
Introducing SIT
Sexual Interdependence Theory
⬜ Adapted from established Developmental Theory
⬜ Incorporates Attachment & Individuation (hedonism)
⬜ Integrates Erikson’s main three developmental crises
⬜ Sexual progression defined by different stages
⬜ These may exhibit either expressive or repressive
sexual behavior
⬜ Different stages carry unique treatment implications
Sexual Development Stages
SEXUAL INTERDEPENDENCE THEORY
INTERDEPENDENCE
Sexual
Integrity
Ego Integrity vs.
Despair
Role Confusion vs.
Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs.
Mistrust
Sexual
Mistrust
Introducing SPA
Sexual Progression Approach
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Aligned to SIT
Allows for more accurate, stage-oriented assessment
Stage-specific treatment
Treats cause and effect
Flexible enough to incorporate new research
Eschews counterproductive stigma of ‘addict’ and
‘relapse’ in favor of ‘progression’ and ‘integrity’
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.)
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Identify limitations or “what’s missing” from the
stage
Use client’s pain to identify/address what’s
missing
⬜ Theory gives clinician window into stage
limitations
⬜ Gentle application of Socratic method can also
help client to see and accept these limitations
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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 tactfully explain how (a) the next stage fills
limitations of current stage while (b) taking into account
benefits of the current stage
⬜ Don’t engage in verbal “tug-of-war” but allow their life
experience to support your conclusions
Sexual Development Stages
Description:
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We don’t trust others in sexual relationships
We assume malice from potential partners
Expressive Behavior:
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Master of the Universe – seek to control often
through objectification
Reenact sexual trauma
Repressive Behavior:
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‘Primitive’ Sexual Anorexia – safety/survival
Avoidance of re-traumatization
Sexual Mistrust: “Julie”
INTERDEPENDENCE
Sexual
Integrity
Ego Integrity vs.
Despair
Role Confusion vs.
Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs.
Mistrust
Sexual
Mistrust
SPA: Specific Techniques
◻ Sexual Mistrust → Sexual (Con)Fusion
⬜ Problem: Unable to experience the emotional
vulnerability that preludes effective
interpersonal attachment
⬜ Goal: Reprocess attachment barriers
SPA: Specific Techniques
◻Sexual Mistrust → Sexual (Con)Fusion
⬜ Interventions:
◻ Person-Centered Techniques → Therapeutic rapport
helps them realize you have their best interest at heart and
serves as model for other relationships they hope to create or
improve
◻ Resource enhancement → Associated emotional
regulation serves as precursor for effective exposure-based
interventions
◻ Exposure-Response Prevention → Reprocesses
disturbance history so that fulfilling attachment is possible
Sexual Development Stages
Definition:
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Fusion: Our views on sexuality are rigid (even if
ineffective)
Confusion: Confusion between our beliefs vs. our
experiences (cognitive dissonance)
Expressive Behavior:
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Strict behavioral compliance to beliefs (regardless
of impact)
Victim of manipulation
Experimentation
Repressive Behavior:
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Passive Aggression
Sexual Anorexia: culturally-driven (white-knuckle)
Information gathering
Sexual (Con)Fusion: “Dallin” & “Maria”
INTERDEPENDENCE
Sexual
Integrity
Ego Integrity vs.
Despair
Role Confusion vs.
Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs.
Mistrust
Sexual
Mistrust
SPA: Specific Techniques
◻ Sexual Fusion → Sexual Confusion
⬜ Problem: Rigid sexual beliefs prevent sexual fulfillment
⬜ Goal: Illuminate unworkability of black/white beliefs & behaviors
■ Objective: No change or Abstinence vs. Values-based Sexual
Behavior
■ Impact: None or Devastating vs. Shame Reduction/Impact viewed
on a Continuum
■ Recovery Timeline: Immediate or Lifelong/Never vs. Whenever
achieve Sexual Integrity
■ Recovery Initiatives: Analysis or Avoidance vs.
Awareness/Acceptance
SPA: Specific Techniques
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Sexual Fusion → Sexual Confusion
⬜ Interventions:
■ General Techniques → Use objective
experience (rather than verbal coercion) to convey
unworkability of beliefs and/or behaviors
■ Acceptance & Commitment Therapy → Use
“creative hopelessness” to expose limitations of rigid
sexual beliefs
SPA: Specific Techniques
◻ Sexual Confusion → Sexual Identity
⬜ Problem: Lack of sexual values leads to emotionallydriven sexual behavior
⬜ Goal: Establish internalized, workable values
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Internalized: Conviction that is independent of outside
influences
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Workable: Yields benefit that does not harm self or
others
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Value areas: General, couple, intimacy, sexuality
SPA: Specific Techniques
◻Sexual Confusion → Sexual Identity
⬜ Interventions:
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Values development (e.g. Acceptance &
Commitment Therapy)
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Values Assessment
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Introspection, e.g. prior experience,
others’ experiences, prayer, spiritual retreat
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Use evidence derived from
experimentation (others or your own) as your
teacher
Sexual Development Stages
Definition:
● We have internalized and workable
sexual values but behave contrary to
those values
Expressive Behavior:
● Wimpy Masturbators: where willpower
breaks down
Repressive Behavior:
● Distrust of partners who have proven
untrustworthy (Sexual Integrity?)
Sexual Identity: “Li”
INTERDEPENDENCE
Sexual
Integrity
Ego Integrity vs.
Despair
Role Confusion vs.
Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs.
Mistrust
Sexual
Mistrust
SPA: Specific Techniques
◻ Sexual Identity → Sexual Integrity
⬜ Problem: Unable/unwilling to co-exist with
sexual temptations
⬜ Goal: Reprocess triggers and apply mindfulness
to what remains
SPA: Specific Techniques
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Sexual Identity → Sexual Integrity
⬜ Interventions:
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Awareness: Primary goal is not “why” but “what”
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Process triggers: Use EMDR protocol to defuse addiction
triggers
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Acceptance: Apply mindfulness (e.g. meditation) to see
triggers for what they are rather than what they say they are
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Values-based living: Teach adherence to internalized,
workable values
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Timely tools and outlets: filters, letter to self, sponsorship,
values sheet
Sexual Development Stages
Interdependence:
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We are balanced between attachment and
individuation
Healthy Attachment:
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We seek connection and intimacy
Service orientation & open to feedback
Healthy Individuation:
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Hold and adhere to healthy values and
boundaries on sex
Not susceptible to sexual manipulation from
others (Note: this may take the form of
values-based abstinence)
Sexual Identity: “Paul”
INTERDEPENDENCE
Sexual
Integrity
Ego Integrity vs.
Despair
Role Confusion vs.
Identity
Sexual
(Con)Fusion
Sexual
Identity
Trust vs.
Mistrust
Sexual
Mistrust
Compare & Contrast
SIT/SPA Model
• Flexibility: custom treatment for
unique individuals, conditions
• Develops internalized, workable
values
• Treats cause and effect
• 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
• Adopts steps or tasks regardless
of alignment with personal values
• Treats effect without fully
addressing the cause
• Abstinence is the first ‘step’ –
relapse is failure or regression
Specific Techniques: Relapse
Don’t
• View relapse as failure or
“starting over again”
• Ignore hedonistic imbalance by
simply addressing symptoms
Do
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Reprocess addiction triggers
View relapse as information
Monitor emotional bank account
Compare behavior to values
Gauge “willingness”
Strengthen coping strategies
SIT/SPA Training
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Practitioners interested in effectively
employing the SIT/SPA may do the following:
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Learn the SIT/SPA
⬜ Develop exposure-based approach (EMDR)
⬜ Learn mindfulness-based treatment (ACT, DBT)
⬜ Implement daily mindfulness practice (meditation,
yoga, tai chi, prayer?)