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1. Utilize diagnostic interviewing and a trauma timeline to uncover the roots of the problematic sexual behavior.
2. Assess for signs and symptoms of the problematic sexual behavior to inform treatment planning.
3. Analyze the etiological role of childhood trauma in relation to problematic sexual behavior.
4. Determine whether to first address maladaptive sexual behavior or the underlying trauma.
5. Create a treatment plan based on both the stage of client’s addiction and his/her history of abuse and neglect.
6. Differentiate between early, mid-stage, and long-term treatment modalities and objectives.

Foundations of Maladaptive Sexual Behavior

• Demographics and prevalence
• Excessive pornography use, massage parlors, escorts, affairs
• Sexual addiction, hypersexuality, and out of control sexual behavior
• Sexual acting out as a dissociative quest
• Why sex isn’t the issue and stopping the behavior isn’t enough

Assessment and Diagnosis

• 5 must-ask questions to uncover problematic sexual behavior
• Signs, symptoms, patterns and stages
• ”If you see one, think three”
• No DSM-5® diagnosis: What’s the next best thing?
• Differential diagnosis: Could it be bipolar disorder?
• The intersection of trauma and sexual acting-out

TRAUMA-INFORMED TREATMENT STRATEGIES

Pre-Treatment and Early Treatment

• Stopping and staying stopped: Using the trauma-informed addiction paradigm
• Diagnostic Interview: Gently piercing through the client’s shame shields
  • 20 questions that circumvent denial
  • Assess motivation for treatment: Under duress because of discovery or “sick of being sick and tired”?
  • Early countertransferential issues
  • Which comes first: Behavioral remediation or trauma treatment
  • Psychoeducation: Development of alternate coping skills
  • Stage One Planned Dissociation: Are you “just an addict”?
  • Ego States: The healthy adult and the acting-out self (the Addict)
  • Group therapy and adjunctive resources

Mid-Stage Treatment

• Sexual history questionnaire
• Sexual behavior profile
• Stage Two Planned Dissociation: Introducing the inner children to the healthy adult
• Trauma Timeline:
  • Experiential therapy
  • Gestalt Therapy Techniques: Empty chairwork, guided fantasy, anger and fear releases
  • EMDR
  • Psychodrama, art therapy, breath and bodywork, anxiety tolerance, etc.
  • The intersection between trauma and problematic sexual behavior:
    • Unmet needs
    • A misguided search for intimacy
    • A defense against powerlessness
    • Sexual harassment and violated boundaries
    • Learning to dissociate rather than to cope
  • Starting Relational Recovery
    • Engaging partners and families
      • Acknowledging partner trauma
      • My work, their work, our work
      • The 5 stages of processing partner betrayal
    • Client accountability for harmful behavior
      • Disclosure
      • Transparency contract

Long-Term Treatment

• Ongoing treatment goals:
  • The Recovery Continuum (see attachment)
    • A transformative recovery
    • Moving from fear to flexibility
    • From trauma to trust
    • From power to pleasure
    • From expulsion to expression
    • From romanticization to relatedness

Clinical Considerations

• How comfortable are you talking about sex?
• Countertransference issues
• When and where to refer to higher level of care
• Multicultural factors – race/ethnicity, LGBTQIA, and more

Chris Samuels, Ph.D., a clinical psychologist who has specialized in the treatment of problematic sexual behavior for more than 25 years. A pioneer in the field of sexual addiction, Dr. Samuels began her work in 1989 with Patrick Carnes, clinician and author of landmark books on sexual addiction, including Out of the Shadows (1983) and Don’t Call it Love (1991). In 1992, Dr. Samuels founded and serves as the executive director of The Sexual Addiction Treatment and Training Institute (SATTI), the foremost treatment facility in the New York metropolitan area. Known for a compassionate and nonjudgmental approach to treatment, SATTI clinicians offer evaluation and treatment for individuals, groups, and families who are struggling with sexual addiction and related problematic sexual behavior. In addition, SATTI offers training and supervision for mental health professionals as well as a range of consultation services to business, mental health organizations, religious institutions, and the media concerning sexual addiction, sexual harassment, and other problematic sexual behavior. For more information about Dr. Samuels and SATTI, please visit: www.thesattigroup.com and www.sexualaddictionintensive.com.

Speaker Disclosures:

Financial: Chris Samuels is the executive director of The Sexual Addiction Treatment and Training Institute (SATTI). She receives a speaking honorarium from PESI, Inc.

Non-financial: Chris Samuels has no relevant non-financial relationship to disclose.

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CE Information Coming Soon
Continuing education credit information is coming soon for this non-interactive self-study package.

CEs may be available for select professions, as listed in the target audience. Hours will be dependent on the actual recording time. Please check with your state licensing board or organization for specific requirements.

There may be an additional fee for CE certificates. Please contact our Customer Service at 1-800-844-8260 for more details.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

• Psychologists
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