OUT OF CONTROL SEXUAL BEHAVIOR AS AN ACTION SYMPTOM: EFFECTIVELY WORKING WITH URGES

This presentation will discuss the importance of a biopsychosocial model when working with out-ofcontrol sexual behavior (OCSB), with a focus on how OCSB functions as an action symptom, where action takes the place of thinking and mentalizing one’s inner experience. Because OCSB is an action symptom with often devastating consequences, there is a tendency in the field to overly focus on stopping the behavior while neglecting or underemphasizing the complex biopsychosocial process that the behavior reflects. Viewing a sexual issue or problem through a biopsychosocial lens allows for a complex and fluid framework that views the individual’s struggles as multi-determined and multi-layered. In OCSB, or any addictive or compulsive behavior, the biopsychosocial complexity gets collapsed into an urge for action. We will look at how to work with urges by inviting them into the room, and how to build the client skills needed to successfully tolerate and navigate an urge. Therapists often struggle with action symptoms and join with the patient’s urgency in feeling that an urge is to be avoided and that the primary goal is to quickly stop the destructive behavior; however, an urge can be the axis of change and the portal to understanding the behavior’s meaning and what it is communicating. In my presentation, I will address the importance of the therapeutic relationship in unwrapping the urge, urge surfing, and sitting with the urge using mindfulness techniques to aid in decision making. A biopsychosocial model allows us to help the patient gain a deeper understanding and appreciation of what their behavior is about, with the aim of pausing the action in order to explore, discover and articulate the underlying complexity and develop alternative healthier ways to express and care for what is reflected in the out-of-control sexual behavior.