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Sexual Health in Recovery: Professional Counseling Skills Douglas Braun-Harvey, MFT, CST, CGP http://www.theharveyinstitute.com
World Health Organization Health Dimensions Spiritual Mental Physical Sexual 3
What is Sexual Health? 5
What is a sexual health conversation? 6
Sexual Health Inventory: A sexual health conversation with yourself Sexual Health Inventory
Parameters of sexual health conversations? 8
9
Knowing One's Own Relationship with Sexual Health
Components of a Sexual health conversation? 11
Sexual Health Language 12
Language Word Find 13 The Harvey Institute 2013
Sexual Functioning
The ability to achieve sexual desire, arousal and orgasm Sexual Functioning
Sexual Response
A sequence of physical and emotional changes that occur as a person becomes sexually aroused and participates in sexually stimulating activities Sexual Response
Sexual Behavior
The way in which one participates in or engages in a sex act with oneself or another Sexual Behavior
Sexual Activities
Individual acts engaged in, including, but not limited to, fantasy, embracing, caressing, masturbation, kissing, oral-genital stimulation, oral-anal stimulation, anal intercourse, and vaginal intercourse Sexual Activities
Sexual Pleasure
Positively valued feelings induced by sexual stimuli Sexual Pleasure
Orgasm
A peak of sexual pleasure characterized by a general euphoric sensation and physical or emotional release. Orgasm
Sexual Self-Esteem
Positive regard for and confidence in the capacity to experience one s sexuality in a satisfying and enjoyable way. Sexual Self-Esteem
Where do sexual health conversations happen? 28
29 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
30 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
31 Braun-Harvey, D. (2010). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
32 Braun-Harvey, D. (2010). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
33 Train the Trainers
My first consensual sexual intercourse I was drinking or high 34
35 Train the Trainers
I had sex with someone I was not attracted to when I was drunk or high 36
37 Train the Trainers
I have done sexual activities when drunk or high that I would not do when sober 38
SteppingStone Client Retention: 1999-2002 39
What is Sex/Drug-Linked Addiction?
Sex/Drug-Linked Pattern of Addiction Drug and/or Alcohol Dependent Behavior Sexual Activity
Resulting in the need for specific sexual health based client relapse prevention skills and interventions
What is Sex/Drug-Linked Relapse Prevention?
Assessment: Level of Sex/Drug-Link Triage: Relapse Prevention Plan Treatment: Sexual Health in recovery What is Sex/Drug-Linked Relapse Prevention?
Stepping Stone 2002-2006 Sex/Drug-linked relapse Risk Assessment survey What psychological/attitudinal/ behavioral/emotional variables are correlated with high sex/drug linked addiction? 45
Sex/drug-linked relapse? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 46
Client Retention Data? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 47
Sexual Health Attitudes? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 48
Sexual Health Behaviors? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 49
Mental Disorders? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 50
Sexual Sensation Seeking? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 51
Condom Use? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 52
Safer Sex Boundaries? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 53
Out of Control Sexual Behavior? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 54
Motivation for Change? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 55
Self-Efficacy? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 56
Shame? What psychological-attitudinal-behavioralemotional variables are correlated with sex/drug linked addiction? 57
High Sex/Drug Linked Clients > (Double) Levels of Shame 59
Sex/drug-linked shame most salient risk factor? 60
Three months later: High Sex/Drug- Linked Clients = Shame Low Sex/Drug Linked Clients. 61
Shame measure correlated with improvement in client retention and increased self-efficacy for completing treatment. 62
Sexual Health in Drug and Alcohol Treatment is a shame-reduction intervention providing sex/drug-linked relapse prevention tools 63
Status of Clients at Stepping Stone Residential Treatment Center 64 (N = 213) updated to Oct 2006.
Hypothesis 65
Providing a sex positive treatment environment combined with a sexual health psycho-educational curriculum Decreases sex/drug linked shame which contributes to improving self efficacy Resulting in a treatment ready client population. 66
67 Braun-Harvey, D. (2010). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
Initial Screening Process Self-Report (Braun-Harvey,2011) 68
Initial Screening Process Self-Report (Braun-Harvey,2011) 69 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
70 No Wrong Door Integrative Screener, Center for Community Collaboration, Baltimore MD. (2014)
I Worry. That sex is not as satisfying sober and is more satisfying when I am high My drug and alcohol use is linked to my sexual relationships and/or sexual pleasure. 71
I Worry. That I can not imagine sex without being high. Some aspect of my sexual behavior may make it difficult to complete this treatment program. 72
Seven Sexual Health Services (Braun-Harvey,2011) 73
Seven Sexual Health Services 1. Pregnancy 2. HIV/AIDS 3. STI s 4. Sexual Dysfunction 5. Medication Side Effects 6. Non-consensual Sex 7. Out of Control Sexual Behavior 74 (Braun-Harvey,2011)
Identify Sexual Health in Recovery Relapse Risk Prevention Plan Additional Sexual Health Services Pregnancy HIV/ AIDS Sexually Transmitted Infections Sexual Dysfunction Psychiatric Medication Side Effects Nonconsensual Sex Out of Control Sexual Behavior (Braun-Harvey,2011)
Establish Sex/Drug-Linked Relapse Prevention Goals (Sexual Health in Recovery, 2010, Chapter 2) 76
Core Four Concepts Sex/ Drug-Linked Sexual Health Sexual Attitudes and Values Sexual Past Sexual Health Sex/ Drug- Linked Relapse Risk Motivations for Sex Sexual Development Sexual Functioning Sexual Decisions Talking About Sexual Health Non- Consensual Sex Sexual Boundaries Dating and Sexual Relationships Spirituality and Sexuality Out of Control Sexual Behavior Relationship with my Body (Braun-Harvey,2011)
What goes through the mind of counselors doing sexual health relapse prevention work? 78 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
What kind of judgements must be suspended? 79 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
What does a counseling sessions look like when sexuality is being affirmed as central to being human? 80 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
Basic Sex-Confident Counselor Skills 81 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Sexual Knowledge 82 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Level of Counselor Comfort with Sexual Material 83 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Counselor Readiness 84 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Counseling Skills for Beginning Sexual Health in Recovery 85 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Disrupting Drug and Alcohol Counselor Sexual Health Conversation Avoidant Patterns with Client 86 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Practice Anxiety Management in Client Sessions 87 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Disrupting Drug and Alcohol Counselor Sexual Health Conversation Avoidant Patterns with Client 88 Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company
Therapist sex avoidant verbal and non-verbal behaviors The Six S's: 1. Silence 2. Silliness 3. Shame 4. Shyness 5. Suppression 6. Superstition 89 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
Therapist Anxiety Management Skills Step back from ones own feelings, values, ideas, stereotypes and sex phobic reactions and engage in sexual health communication motivated to reduce and prevent sex/ drug-linked relapse. 1. Verbal inquiries 2. Affective reactions 3. Clinical judgments 90 Braun-Harvey, D. (2011). Sexual Health in Recovery: A Professional Counselor's Manual. Springer Publishing Company.
Andrews, Methodological and Definitional Issues in Shame Research. In: Shame: Interpersonal Behavior, Psychopathology, and Culture, Edited by Gilbert, P. & Andrews, B. New York, Oxford University Press 1998 Braun-Harvey, D. (2009). Sexual Health in Drug and Alcohol Treatment: group facilitator s guide. Springer Publishing Company, New York, N.Y. Center for Substance Abuse Treatment (CSAT). (2006). National Summit on Recovery: Conference Report (DHHS Publication No. [SMA} 06-xxxx. Rockville, MD: Substance Abuse and Mental Health Services Administration Coleman, E. (2007). Creating a Sexually Healthier World Through Effective Public Policy. International Journal of Sexual Health Vol. 19(3) pp. 5-24. Bibliography 91
Harder, D. W., & Lewis, S. J. (1986). The assessment of shame and guilt. In J. N. Butcher & C. D. Spielberger (Eds.), Advances in personality assessment (Vol. 6, pp. 89-114). Hillsdale, New Jersey: Lawrence Earlbaum. Harder, D. W., Rockart, L., & Cutler, L. (1993). Additional Validity Evidence for the Harder Personal Feelings Questionnaire-2 (PFQ2): A Measure of Shame and Guilt Proneness. Journal of Clinical Psychology, 49(3), 345-348. MESTON,C. & Buss, D. (2007). Why humans have sex. Archives of sexual behavior, 36, 477-507. U.S. Department of Health and Human Services, Office of the Surgeon General (2001) The surgeon general s call to action to promote sexual health and responsible sexual behavior. Downloaded June 17, 2009 at http://www.surgeongeneral.gov/library/sexualhealth/call.htm Bibliography 92