Douglas Braun-Harvey on Out of Control Sexual Behaviors & Sex Addiction – Smart Sex, Smart Love with Dr. Joe Kort
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Sexual health author, trainer and psychotherapist Douglas Braun-Harvey bridges sexual and mental health. A certified group Therapist, Certified Sex Therapy Supervisor and Certified Sex Therapist, Doug chats to Joe about Out of Control Sexual Behaviors, (OCSB) versus “Sex Addiction” on this week’s Smart Sex, Smart Love podcast. Doug is all about reconsidering the popular notions of addictive sex. His USP is ‘Re-thinking Sex Addiction.’ Doug’s collaborative client/therapist treatment relationship is founded on the principle of men taking responsibility for defining and integrating their personal sexual health vision. So, Joe asks, ‘Do you think “sex addiction” really exists and if not what about his model of OCSB works more effectively?’
Dr. Joe Kort: Welcome to Smart Sex, Smart Love, where talking about sex goes beyond the taboos, and talking about love goes beyond the honeymoon. I’m Dr. Joe Kort. Thanks for tuning in.
Welcome to Smart Sex, Smart Love. I’m Dr. Joe Kort, and today I have the honor and privilege of having Doug Braun-Harvey. Doug Braun-Harvey is a sexual health author, trainer and psychotherapist, and bridges sexual and mental health and facilitates organizational change. In 2013, Doug Braun-Harvey and Al Killen-Harvey co founded the Harvey Institute, an international education, training, consulting and supervision service for improving healthcare through integration of sexual health.
Since 1993 he’s been developing and implementing a sexual health based model treatment approach for men with out of control sexual behavior. His new book Treating Out Of Control Sexual Behavior: Rethinking Sex Addiction, written with coauthor Michael Vigorito, was published in 2015. Mr. Braun-Harvey is licensed marriage and family therapist, certified sex therapy supervisor, and certified sex therapist. He’s adjunct assistant professor in the Center For Human Sexuality Studies at Widener University, and faculty for the University of Michigan certificate program in human sexuality. Welcome Doug Braun-Harvey.
Doug B.: Well thank you Joe for having me. It’s a delight to be asked to be on conversation with you.
Dr. Joe Kort: Same here. I mean, I want people to know you’ve been a good friend, you’ve been a colleague, you’ve been a mentor. Your work is, in my opinion, very, very important about rethinking sex addiction. I thought that I would first just say, I remember my comment to you when I reconnected, because I don’t really know that we, we had sort of a long period where I didn’t talk to you or see you, I didn’t see you around, and then I did. I went to your training and I said, “I really think you’re cleaning up the mess that sex addiction is making in our culture.” That seemed to resonate for you. Do you remember that?
Doug B.: Boy, Joe I remember that moment like it was yesterday, and I really respected it coming from you, somebody who had immersed himself completely in providing the sex addiction treatment method to many, many clients and then having sort of some rethinking on your part and actually coming to our training. When you said that, it actually galvanized my motivation even more that there was the need for alternative models, there was a need for alternative discussion out there, for how do we understand dysregulated sexual behavior, and that particularly the sex addiction model, not being as sexualogically informed as the other models that were out there did create messes because of lack of sexological information. So, I do remember that, and here we are having this conversation all these years.
Dr. Joe Kort: I know. I remember you early on, at the early, early conferences, because you know I’ve been in sex addiction as a certified and therapist for many years, and there’d be you with a whole different model and a whole different thing year after year. You’d come in with your stuff. I’d be like, what’s that guy doing here, he’s not talking about sex addiction. He’s talking about something else, and doesn’t even make sense. I think I went to one of your things and it made sense, but I didn’t want it to make sense. Finally, it was like time when I finally reconnected with you.
Doug B.: Well I think the other thing Joe you’re describing is the kind of process it takes for people to go through when they feel so strongly aligned with a particular way of thinking, and it’s a way of thinking that maybe has helped them change their life in a way that at one time was very meaningful for them. It’s hard to revisit an idea that at one point was for you not only personal, but also a professional way of working and thinking. Those are not easy processes for anybody to go through. So, I respect and applaud you for having some other motivation that sort of drove you to reevaluate this. That’s what our model and our book is really about is helping people rethink this in a way that maybe fits more with a health model than a disease model.
Dr. Joe Kort: That brings us to why did you decide to write the book with Michael Vigorito? What was your goal?
Doug B.: Well, our goal was actually to provide an alternative model for therapists to work from. I found in the sex therapy field and many other mental health professionals were saying they did not agree with the sex addiction model. But then the conversation kind of drifted away because there wasn’t really a specific theory, assessment and treatment method that was an alternative for people to learn, to begin to adapt to their clinical methods, and more importantly, a model that didn’t require fidelity to a specific way of working, or a specific theory or ideology that if you strayed from it, your work would be in doubt. It was really important for us to create a model like that.
Dr. Joe Kort: Can you tell the listeners so they know, what is different about your model? What is it?
Doug B.: Well, I think first of all it’s called out of control sexual behavior rather than sexual addiction. Out of control sexual behavior really is a sexual behavior problem. We can think of things as being disorders or dysfunctions, we can think of things as being problems, and we can think of things as being kind of just general worries. Levine and his text on dealing with sexual issues and mental health professionals really proposes this kind of spectrum, that not all sexual issues really are disorders or dysfunctions, and there’s this area in between of problems where things really are problems. Like affairs, those are real problems. But that doesn’t mean you have a disorder or disease. You may have become infected with a sexually transmitted infection. That doesn’t mean you have a disease, but you do have a problem. You’ve got a bacteria in your body and you need to address that. So, these are real issues. These are real problems that happen.
First of all, out of control sexual behavior is seen as a behavior problem, not a disorder or disease. It’s not a lifelong condition that requires sort of an identity formation, or I am a sexual addict, or I have this disorder sexual addiction, and it has to be monitored and addressed and managed throughout the course of my life. That’s not our perspective. We really see this as a human behavior problem with many reasons why it may be emerging at a certain time in someone’s life, but it doesn’t mean they’ve somehow crossed into a threshold of disease.
The other thing is it’s a sexual health model, which means that we’re really interested in giving men a direction to move forward towards sexual health rather than ameliorating or treating a disorder. Our model really invites men to have to think about their sexual health and who they want to be as a sexual person, and their out of control sexual behavior may be an indication that they haven’t really seriously thought about or been asked to be responsible for really articulating who they want to be as a sexual person.
Dr. Joe Kort: I love that about your model because it puts the agency and the ability to change on the person, not something outside the person that they have to follow some outside norm.
Doug B.: I think it’s really true Joe. I mean this is not a model that says here’s a series of steps or already identified methods of how to change and how to be. It’s really, we just really propose a kind of a pathway, a kind of series of steps they can go through to self-reflect, to look at themselves, who do I want to be as a sexual person, how do I change how I am as a sexual person so it’s aligned with my values and my beliefs and with the fundamental ideas of sexual health. That’s a very different way to think, how do I align myself with ideas of health rather than follow a prescribed way of being sexually.
Dr. Joe Kort: Can you talk about the sexual health principles that you guide men through to sexual health?
Doug B.: I will Joe. These six sexual health principles come from actually World Health Organization definitions of sexual health. The Pan American Health Organization in 2000 convened and had a definition that they described of overall kind of a macro definition of sexual health. Out of that definition I harvested these sort of six principles of sexual health and promoted them in my first two books and then Michael and I really coalesced our OCSB model around these six principles.
The idea is that these six principles, which are consent, sex is always consensual, non-exploitation, which is really about power and the use of power for gaining sex consent, non-exploitation, honesty, shared values, which are really the more subjective aspects of the model in the sense of how honest do I want to be in my sexual interactions, am I meeting my expectations of honesty in my sexual relations, shared values, what are my values around sexual activity and who I’m having sexual with and under what circumstances, and what are the values of the other other people in which I’m involved with sexually, and is there a shared common agreement about the value or meaning of the sexual activity we’re engaged in. Then protection, which is the typical idea of sexual health is protection from unwanted or unplanned pregnancy, protection from sexually transmitted infections and protection from HIV.
The last is pleasure or mutual pleasure. Really our sexual health model, and these principles of sexual health, really describe sort of safety aspects of sexual health balanced with pleasure and the pleasure aspects of sexuality. That’s the basic kind of equation or algorithm for sexual health in all the definitions of sexual health on the planet. How do we balance the safety of sexual activity with the pleasure of sexual activity? That sort of dance, that choreography is always within the experience of human sexual activity.
Our model says how do we align these six principles of sexual health with your vision of sexual health, and that our idea is if your behavior is aligned with consent, non-exploitation, honesty, shared values, protection from HIV, unplanned and unwanted pregnancy, and STIs and pleasure, if your behavior is aligned with those six aspirations sufficiently in your kind of way you want to live your life, you’re not going to be able to have out of control sexual behavior. They’re mutually exclusive endeavors.
Dr. Joe Kort: Which is what I love because the sex addiction model tends to pathologise the behavior and do what you talk about in your book with Michael Vigorito giving people an erotic ectomy. I loved when I heard that word because clients come in and they say, “I don’t want to do this. I don’t want to think this. Just take this out of my head,” as if we can perform an erotic ectomy. Sex addiction treatment tries to do that, but your model does not.
Doug B.: Well, people are very conflicted about the sources of pleasure in their sexual lives. We live in a culture that has lots of judgments about diverse, erotic and sexual pleasure interests, and many times wants to see those erotic interests as pathology, as something sick or perverted. Those kind of severe judgments are so painful for people that actually I find one of the allures and one of the draws of the sex addiction model, because it is a disease or disorder, in some cultural contexts, religious and faith-based context and others, to avoid the rejection and the absolute shunning of one’s attachments in their community or with people that love them. If there erotic interest is seen as a disorder or a disease, their relationship won’t be severed. They won’t be cut off from their community and relationship ties, or even their relationship with God. That disease idea, that your erotic life could be a disease or disorder, is somewhat of a salvation equation for some people who want to stay connected with their faith system.
In some ways that has an appeal for some people, but the OCSB model really says that erotic diversity is a normal and typical part of all human behavior throughout history, and that erotic diversity is not a sign of pathology, there’s just a wide range of things that people feel sexual pleasure from. But people sometimes when they haven’t integrated or haven’t accepted, or maybe they don’t even quite understand what really erotically interests them, they may be pursuing these erotic interests in ways that cause negative consequences, are secretive, are full of shame. In those circumstances, people don’t behave very responsibly, and those consequences of that behavior through an unintegrated erotic turnon might be what somebody calls or feels is their out of control sexual behavior.
We find that when people begin to make friends and really integrate and understand their full erotic diversity, the dysregulation and all the negative consequences of their erotic life begin to subside and move away. All of this can be done without having to make the erotic interest a sickness that should be removed or completely avoided.
Dr. Joe Kort: It’s so hard to listen to you without taking notes. I feel like I’m going to have to listen to this again and write it down because it’s so good. I hope people do listen to it more than once because you’re saying really important things and you’re inviting men to go very deep into themselves around sex, which men do not, are not taught to do. I mean, men have more permission to have all kinds of sex, but they’re not really taught how to understand it and get dimensional about it. You’ve talked about that yourself, right?
Doug B.: Well, you know, I do weekly groups, Joe, with men and out of control sexual behavior. I do groups with men who are heterosexual identified, and men who identify as somewhere same sex attraction, or gay identified. I do have groups that are separate based on those specific sexual attraction and identities. In both of the groups, what I find is the alienation from one’s erotic interest actually aligns well with masculinity scripts. In other words, the more one is invested in their masculine identity, oftentimes the more they can be conflicted with specific erotic interests or desires because those erotic interests and desires may conflict with who they expect themselves to be as a man. So oftentimes men are sitting in groups talking about their erotic interests and at the same time having to deal with the chagrin of exposing a less masculine part of themselves to other men in the group.
These are vulnerable and very tender and dear moments, and it’s really a vital place for men to be able to feel safe, to explore both what’s it like to transcend, transgress masculinity scripts while at the same time moving towards one source of pleasure.
Dr. Joe Kort: Really you’re talking about the stigma men face. It’s like-
Doug B.: Well, yes. It can be stigma from others, but what I find actually more pervasive amongst the men I work with is their internal judgments about not being masculine enough. They may have dealt with a lot of stigma from outside, but the real narrative that I think regulates the behavior and stifles it even more is their fears of their own self rejection for not being masculine enough through their sexual and erotic desires. They really have to sort of go inside and figure out how important is this pleasure, and is it worth facing that judgemental self that keeps them in line as a man.
Dr. Joe Kort: Now I can see some listeners might not understand why we’re only talking about men and not women. Can you talk about your model and why you chose to do it for men?
Doug B.: Well, yeah Joe. I’ve been doing this work with the OCSB since 1993. I began to work specifically actually with gay men. They were being arrested in underground vice operations here in the early 90s in the darkest days of the HIV epidemic and being court ordered to sit with sex offenders in sex offender treatment programs. They might’ve been having anonymous sex in some sort of a public place and arrested by a vice officer, and one of the consequences was having to go to court ordered sex addiction treatment, which was only being provided at that time by a sex offender treatment provider. In order to even feel safe walking from their car, from the treatment center to the parking lot, they had to literally pass as straight men in all of these groups just even have physical safety to attend these groups.
Then I would have men come to my office after these court ordered experiences quite traumatized and quite, this is horrible. So, I began to approach the San Diego court and ask them if my therapy could be an acceptable alternative to the sex offender treatment programs for men arrested under these circumstances. The court went along and said yes, so I began to actually now be able to see these men who were under these vice operation arrests. What I began to see with the men I was seeing was there were some men who did have some aspects of behavior that seemed a bit out of control and they needed some help, and I began to develop my ideas about working with these men. That was, my first group was with gay men.
Then I began to see that there were obviously a need for much more expansive services for heterosexual men, but I made a decision very early on that I would limit my work to working specifically with cisgendered identified men. Primarily because in and of itself was a great deal to learn and I just didn’t have the bandwidth as a therapist in private practice, not an agency, not a large hospital based treatment environment, that I really decided to keep my focus on working with cisgendered men. I advocated for years for other therapists to do the same as I have been doing and they could do that with women. They could get interested. They could go and start providing services and learn about women and their experiences with these behaviors.
There’s now a therapist in the Oakland area, Jess Levith, who has taken it upon herself to create a kind of a salon monthly meetings where she and other therapists around the country are reading through Michael’s and my book chapter by chapter, and going through the content through the lens of cisgendered female identified clients, and how the content might be different from a female perspective. That work is beginning, but it was work that I just chose myself that I couldn’t do. I couldn’t do that as well.
Dr. Joe Kort: Yeah, no, that makes sense. I didn’t know how you got started. I love your line, if you could say it again, about we only talk about male sexuality in certain ways. Do you know what you say about that?
Doug B.: Yes. Right. You know, Joe, this has been more recently that I’ve kind of come to understand. I think men are really pretty much on their own when it comes to places where they can go and talk and address and really be taken seriously about their sexual health and sexual concerns. The reality is now I believe we’re sort of in the situation that men have access to services for informed professionals around their sexual lives if they are a sex offender, if the man has been sexually abused, or if the man labels himself as a sex addict. Then we have the services. Then we’re interested in the sexual lives of men. That’s the ticket for men’s lives to be a sexual, the sexual lives of men to be of interest to others. Other than that, men are really kind of on their own. The unfortunate situation is until men hurt somebody, we’re really not that interested in the sexual lives of men.
Dr. Joe Kort: That’s the line that always blows me away. Until men hurt someone, we’re not interested in the sex lives of men. So true.
Doug B.: Yeah. And men don’t have access to informed spaces that are going to be specifically focused on helping them with their sexual lives. These are very rare, very difficult to come by in our country.
Dr. Joe Kort: One of the things I remember when I came to your training for the first time was you said this, and I actually teach this, and I can quote you of course. You said something like, “What goes on now is what we would call,” and you and Michael Vigorito call it, “premature evaluation on the therapist part. Where they come in and they say, I think I have a sex addiction and my wife concurs.” Then you said, “That’s like going to the doctor and saying I think I have kidney cancer and my wife concurs, and the doctor says well I don’t need to do any more tests, I’m just going to take your kidney out and put you on chemo.” That’s what kind of happens when someone goes for sex addiction treatment. The therapist jumps in, gives them 12 step groups, gives them readings, and doesn’t do differential diagnosis. Is that what you said correctly?
Doug B.: Well, I think it’s a fairly common practice that the, and not just clients will do this, but therapists will do this. A therapist will hear specific sexual acts that a person’s involved in, let’s say they have multiple affairs, or they’re online looking at sexual imagery for a long time, or they’re just not keeping the agreements in their sexual relationships. This is where the premature evaluation comes in, very quickly these behaviors will be summarized in an evaluative way through the label of sex addiction. “Oh, have you ever thought you might have sex addiction? This might be sex addiction,” as if that conclusionary language is the introductory question. That’s really the hallmark of premature evaluation where you describe the problem through the label, which really cuts off a lot of curiosity, a lot of individualized circumstances, a lot of contextual circumstances.
It also moves couples and individuals in the direction of a very specific treatment methodology, the sex addiction treatment model. If that language is in the client’s life for whatever reason, they’re going to move towards a sex addiction treatment professional. Why this is such an important thing to understand is once you move in the direction of seeing a certified sex addiction therapist, you’re moving in the direction of a therapist who might be very highly trained in the model of sex addiction therapy, but may have little to no education at all in human sexuality.
Dr. Joe Kort: Yup. That’s so true. I can say that from my own personal experience. I know a lot about trauma, I know a lot about addiction, but I knew nothing about sex. It wasn’t until I learned about healthy sexuality and sexual health that I started realizing how damaging and misinformed the sex addiction model is, so I’m so glad you said that.
Doug B.: Joe, I’m just going to do a language comment here-
Dr. Joe Kort: Please.
Doug B.: Because you did use the phrase healthy sexuality. For listeners who are sort of interested in language and the influence of language, I don’t use the sequence healthy sexuality in my work because healthy sexuality is a binary phrase. There’s healthy sex and unhealthy sex. The phrase healthy sexuality creates a duality, where you’re on one side of health. Of course, everybody wants to be on the side of health and healthy sex, but that means there’s also unhealthy sex, which just creates that sort of either/or thinking.
That’s why I like the phrase sexual health because sexual health is a series of concepts and principles that isn’t a binary either/or concept. It’s a conceptualization of many factors related to sexual health, and so it gets the thinking out of following a particular prescribed course of action in order to have healthy sex. There are lists out there that people will provide that say here’s healthy sex. They’ll list items, or specific sex acts, or specific ways of being sexual, as if as if once you’re aligned with those particular ways of acting sexually, that means you’re healthy. I think that’s a really important distinction that I invite listeners to think about.
Dr. Joe Kort: I love that you just did this for so many reasons. One is, this is how you work with clients, this is how you work with supervisees, and this is how you work with colleagues. I said something and you very politely said I see it a different way and I say it a different way and here’s why. I want, I really want listeners to hear that and even replay it so you can see how you did that because now that you’ve said that to me I’m informed and I probably will never say healthy sexuality again. Not because of anything more than you’re right, it makes a binary and that it presumes that we even know what healthy sexuality is, and we don’t for everybody.
Doug B.: Yes. Right. And it also creates an authoritarian perspective. Somebody gets to determine what’s healthy and they’re in a position of authority, or they’re in a position of influence and power to say this is healthy and other things or not. Some people like those ways of resolving difficult sexual problems. Just tell me how to be and I’ll try to follow it. Some people that’s appealing, but from my perspective I’m more interested in the responsibility of each person determining for themselves who they want to be as a sexual person. My one parameter is is it aligned within the six principles of sexual health.
Dr. Joe Kort: Which really summarizes your work so well. I so appreciate. Do you want to add anything else for the listeners about you or your work, where they can find you even?
Doug B.: Well, my company that my husband and I founded, The Harvey Institute, you can find me at that website, TheHarveyInstitute.com. I’ll be doing several workshops in the coming remainder of 2019. At the end of September I’ll be doing a two day training in Dublin, Ireland on sexual health conversation skills and then a one day training on out of control sexual behavior. I’ll also be training in Duluth, Georgia, right outside of Atlanta, Georgia in October, on a two day training there as well. We’ll be debuting in the Duluth training a training specifically for partners of people who are dealing with out of control sexual behavior. This is a new training we’re developing, and I’m doing this in conjunction with Kristin Hodson, a sex therapist as well.
Then in November I’ll be doing a two day training in West Palm Beach, Florida. My first day will be specifically on my first two books on sexual health and drug and alcohol treatments and dealing with sexual health issues for people in substance abuse treatment. Then my last day will be, again, my one day training in out of control sexual behavior. Those are ways to access personal trainings if you’re interested in the coming year.
Dr. Joe Kort: Yeah, for sure. The one in November in West Palm Beach is going to be with Modern Sex Therapy Institute, and I’m coming to that one because I want to learn. I’ve never heard you present on your other books and I’m looking forward to it.
Doug B.: Oh! Oh cool Joe. Oh, I’m glad we get to see you. We’re going to see each other I think in other places this year too.
Dr. Joe Kort: Yes.
Doug B.: Yeah. Again, I just thank you so much for the work you’re doing. You are a powerful voice for professionals to take stock in how they think throughout the course of their professional lives. We all start in some places as professionals, but your grace and your transparency and your process I think has been a gift to many, many people. I just want to thank you for that.
Dr. Joe Kort: Thank you. Really just to tell you, thank you for being a steady, on your feet, sort of reasonable, contained wealth of information that was at the conference year after year and nobody really, or I didn’t tap into it. That conference didn’t tap into it. I’m very grateful that I did and very grateful to the work you do. You’ve changed my life.
Doug B.: Thanks Joe, and congratulations on the podcast. I’m glad to be part of the early voices in this platform.
Dr. Joe Kort: Thank you Doug. It was a pleasure speaking with you.
Doug B.: Okay. Take care.
Dr. Joe Kort: All right, take care. Bye bye.
Thanks for listening to this episode of Smart Sex, Smart Love. I’m Dr. Joe Kort, and you can find me on joekort.com. That’s J-O-E-K-O-R-T.com. See you next time.
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