Q: “I can’t stop masturbating! It’s out of control! It’s ruining my life! What can I do?!”
A: I would like to invite you to please close your eyes, take a few breaths… inhale deeply and exhale completely… and as you do, please imagine your life beyond the simple absence of your problematic sexual behavior… Imagine that not only the behavior itself and its negative consequences have disappeared but that you have integrated your personal values into your overall sexual experience… What do you see? To realize this vision for your sexual health, what might you need to give up?
Sexual behaviors (e.g., excessive pornography use, excessive masturbation, casual sexual encounters with strangers, soliciting sex workers or frequenting "massage parlors") that are experienced as out of control may cause high level of distress and can negatively affect your daily functioning. Some problematic sexual behaviors may involve consensual and commonly enjoyable sexual experiences (e.g., masturbation, viewing pornography) that over time have become disruptive and often harmful to you and/or your partners and relationships.
Common approaches to assessment and treatment of such behaviors tend to be pathologizing, marginalizing, and condemning in nature. Conversely, Out-of-Control Sexual Behavior (OCSB) Treatment Model, developed by Douglas Braun-Harvey and Michael A. Vigorito, is a framework within which problematic sexual behavior is seen as a sexual health concern rather than a mental health disorder or a sign of moral degeneration. The OCSB Treatment Model is collaborative (i.e., both the client and the therapist cooperate in the process to bring on the desired change), integrative (i.e., combining multiple frameworks for the understanding of multiple factors contributing to the development of complex behavioral problems) and focuses on realizing the client’s personal vision for their sexual health as the desired treatment outcome rather than imposing a one-size-fits-all idea. The goal of the treatment is to align your sexual behavior with your unique vision and the sexual health principles such as consent, non-exploitation, protection from HIV, STIs and unintended pregnancy, honesty, shared values and mutual pleasure.
Additionally, in order to better understand problematic sexual behavior, OCSB Treatment Model utilizes the Dual-Process model which conceptualized human behavior as a product of the interaction between two systems in our mind: the deliberative system and affective system responding to internal (e.g., thoughts, feelings, urges) or external (i.e., situation, environment) cues. The deliberative system influences our behavior by assessing options and consequences while the affective system involves emotions, drives and motivational states. Motivations of these two systems compete at times which accounts for the tension in problematic sexual behavior: wanting to do one thing (e.g., remain faithful, save money, avoid legal/criminal consequences, etc) and doing another (e.g., seek pleasure, relieve tension, etc)
For example, a person may desire to live up to their personal and professional commitments (e.,g, "I want to be a trustworthy partner in my relationship, a good friend and a reliable employee") and yet they continue to spend hours viewing pornography on the internet, which impairs their functioning in many areas of his life (e.g., "I keep secrets from my partner. I do't keep commitments to my friends. I spend the company resources viewing porn instead of working). Thus, on one hand, their deliberative system is influencing their conscious intention to adhere to self-imposed rules, values and boundaries, to honor their personal and professional obligations, and, avoid negative consequences of excessive porn use. On the other hand, other motivations (e.g., stress, anger, feelings of helplessness, worry, sexual tension) arising from their affective system, steer their behavior in another, seemingly contrary, direction. Feeling out of control describes the difficulties resolving these competing motivations.
OCSB Treatment Model facilitates recognizing and reconciling these competing motivations by adjusting the degree of influence of one’s affective and deliberative systems. The new behavior resulting from this improved balance fits better within the sexual health principles. Integrating dual-process model and the sexual health framework provide a compassionate and effective treatment alternative to examine one's sexual problems and promote their sexual health.