A therapist trained in the Douglas Braun-Harvey OCSB (out-of-control sexual behavior) treatment program can be an effective help for someone dealing with compulsive sexual behavior.
What is CBSD?
Compulsive Sexual Behavior Disorder (CSBD), oftentimes termed as hypersexuality or sexual impulsivity, is demarcated by enduring and intensifying sequences of sexual behaviors that culminate in noteworthy distress and obstructions in diverse facets of an individual’s existence. OCSB (out-of-control-sexual behavior) presents an alternative non-addiction lens to this intricate predicament.
Compulsive Sexual Behavior Disorder isn’t merely an embodiment of a heightened sexual appetite or indulging in copious sexual endeavors. It’s interwoven with a forfeiture of reign over one’s sexual actions, frequently spawning unfavorable ramifications in personal alliances, vocation, and other daily routines. Afflicted souls may be swamped with profound fixations on sexual musings, fantasies, and impulses, which may incite them to partake in perilous and excessive sexual acts.
Some common manifestations of CSBD include excessive consumption of pornography, compulsive masturbation, engaging in multiple affairs or casual sexual encounters, and seeking out sexual experiences in inappropriate or high-risk situations. These behaviors often lead to feelings of guilt, shame, and regret, yet the individual continues to engage in them despite these negative emotional consequences.
It is essential to recognize that CSBD is not a moral failing or a lack of willpower. It is a complex mental health disorder with biological, psychological, and social factors contributing to its development and maintenance. The exact cause of CSBD is not fully understood, but it is believed to involve a combination of genetic predisposition, neurobiological factors, and environmental influences, such as early-life experiences and exposure to trauma.
Diagnosing CSBD can be challenging, as it requires a thorough assessment of the individual’s sexual behaviors, thoughts, and emotions, as well as ruling out other potential causes for their symptoms, such as substance use disorders or other mental health conditions. Treatment for CSBD typically involves a combination of individual psychotherapy, group therapy, and self-help strategies aimed at helping the individual regain control over their sexual behaviors and develop healthier coping mechanisms for managing their thoughts and urges. When a CSBD client who is in a relationship seeks treatment, it is best for both the CSBD client, the betrayed partner, and the marriage to each have their own counseling and treatment plan.
As a therapist specializing in sex addiction and Compulsive Sexual Behavior Disorder (CSBD), I have developed the Karuna Healing approach to focus on the deep healing required for long-lasting recovery. This approach incorporates my personal experience with the best practices in the industry, including psychoeducation around trauma, brain science, neuroplasticity, mindfulness-based therapies, Internal Family Systems (IFS), attachment repair, and psychoeducation in sex addiction models.
Centrally, healing trauma holds the linchpin to enduring triumph in sex addiction recovery. Trauma, imprinted within our neural and corporeal matrices, acts as a catalyst, driving individuals towards sexual deviations. Traditional Cognitive Behavioral Therapy (CBT) can be successful in making short-term change, but it is difficult to translate that to permanent change. Our therapy aims at trauma recovery through methods such as mindfulness, self-compassion, IFS, and attachment repair, which help build new neural pathways that heal trauma.
Mindfulness is the most important piece of our approach and the building block of all other components. It increases the “window of tolerance,” allowing individuals to better manage triggers and change their automated responses. Acceptance and Commitment Therapy (ACT) is the only approach to sex addiction with proven clinical results, focusing on building skills to acknowledge and sit with distress rather than exploring the reasons behind the addiction.
IFS therapy is especially effective for clients who have internal conflict or compartmentalization issues. By isolating and working with each part of an individual, we can help them understand and manage their different desires and motivations, leading to a more cohesive and healthier mindset.
Attachment repair is crucial for individuals with insecure attachment, which often results from trauma and can cause problems with emotion regulation, impulsivity, and stability in relationships. By teaching clients to reparent themselves using methods such as the Ideal Parent Figure Protocol, we can help them heal their attachment insecurity and overcome the effects of trauma.
In addition to these therapeutic approaches, we also provide psychoeducation in sex addiction models, such as the Carnes CSAT model and the Douglas Braun-Harvey OCSB model. We focus on helping clients work out their moral conflicts over their sexual behavior and establish healthy sexual expression that avoids addictive or dependent elements.
For clients in relationships, we emphasize the importance of partner empathy and relationship skills. Developing empathy for a partner’s pain and improving communication and conflict management skills can significantly improve recovery prospects. By understanding boundaries, bolstering attachment security, and avoiding relationship sabotage, clients can better manage their triggers and maintain healthier relationships.
OCSB Treatment Plan
As a therapist specializing in sex addiction and Compulsive Sexual Behavior Disorder (CSBD), I believe that an alternative and/or adjunct to the Sex Addiction model is needed. The Out of Control Sexual Behavior (OCSB) model, developed by Douglas Braun-Harvey and Michael Vigorito, offers a more holistic and strength-based approach when assessing and treating compulsive sexual behavior.
The OCSB model considers compulsive sexual urges, thoughts, and behaviors as a sexual health problem rather than a mental illness. It focuses on the presence of internal conflicts and self-discrepancies when deciding to provide OCSB assessment and treatment. The OCSB Clinical Pathway is used as a map for therapists to help clients achieve sexual health, employing a set of principles to guide ethical decision-making for both clients and therapists.
The treatment phases of the OCSB Clinical Pathway begins with the Unique Client Picture phase, where the therapist explores and better understands the client’s strengths and weaknesses related to sexual health. Factors of vulnerability, self-regulation, and sexual and erotic conflicts are investigated, creating a unique client picture that guides the therapeutic process and informs which therapeutic interventions are needed. Working with untreated trauma/abuse, untreated mental health issues, unresolved relationship issues, and problematic behaviors are critical in this phase.
The OCSB model provides an opportunity to identify and engage underlying causes of compulsive sexual behavior. By not making an enemy of their compulsive sexual behavior, clients may find more space to work with it, be curious about it, and attempt to understand it. Additionally, by moving the focus away from refrainment and towards healthy sexual behavior, clients have an opportunity to experience sex as nourishing and pleasurable.
However, the financial cost for individual and/or group therapy might make this approach less accessible compared to Twelve Step groups. Also, the pervasiveness of the Sex Addiction model may make it difficult for individuals to find clinicians who work with the OCSB model.
I incorporate aspects of the sex addiction model and the OCSB model when I treat CSBD.
Rob Terry is a therapist for clients in Utah and coach for clients outside of Utah and across the globe. He specializes in sex addiction recovery for individuals and couples. He integrates the CSAT, OCSB, and Minwalla models for individual recovery and Gottman Method, RLT, and ERCEM for couples recovery. He is betrayal trauma informed. His therapy modalities are IFS, ACT, CBT, EMDR, and Attachment Theory.