Kimberly had the opportunity to meet with colleague and friend Mike Giancola, an AASECT certified sex therapist and out of control sexual behavior (OCSB) practitioner located in San Diego, CA, to discuss the relevance and importance of the OCSB model in individuals struggling with out of control sexual behavior and erotic conflicts. The full interview is included below. Check out some highlights!

Mike: What drew you to the OCSB model?

Kim: I originally saw Doug Braun-Harvey’s OCSB model discussed at an AASECT conference many years ago in Minneapolis, MN. The intellectual rigor of the model, the novel, sex-positive approach, and Doug’s integrity as a therapist struck me as something I wanted to know more about.

Mike: What academics did he talk about that aligned with you?

Kim: At that time the dominant model was the sex addiction model and it was 12-step oriented. The Patrick Carnes book, Out of the Shadows, introduced that framework, and seemed like a good start to frame what we see in clinical practice but it didn’t provide an affirming stance on the behaviors. The work seemed to leave the client with a negative experience. I was struck by the literature in Doug’s presentation combined with a compassionate, non-judgmental approach to the behaviors. It was exciting to have someone present something that we hadn’t seen before as clinicians.

Mike: Where did you take that talk from Minneapolis to keep exploring?

Kim: Over the years I weaved the model into my individual work. This slowly evolved into running an OCSB group, and joining our peer consultation group, where I could further my knowledge using the model in conjunction with other therapies and individual sessions and groups.

Mike: Yes, Doug is clear that it’s a clinical model but not a new theoretical orientation for people to learn. The application of this pathway could look different depending on the theoretical orientation practitioner.

Kim: Yes, it took me a while to figure that out. For me, it landed on a theoretical foundation of interpersonal group psychotherapy. The OCSB group’s I run are the classic Irvin Yalom style interpersonal psychotherapy groups with the OCSB model laid over that where the principles of sexual health and the utilization of a sexual health plan for all group members are used. That is what works for me, but I’ve come to appreciate that the model has a lot of flexibility in that different therapists can use different theoretical orientations.

Mike: Are there things about this combination of the interpersonal psychotherapy theoretical approach and the OCSB framework that you are finding rewarding?

Kim: I think what is inspiring to me and my group members is the ability to have sexual health conversations with others who have out of control sexual behavior. Sexual health conversations usually just don’t happen at all, and if they do happen they are usually medical. So you have a group of people who come together to work on problems with their sexual behaviors, whether it's infidelity, problems in their relationship, or distress with what is happening. The model also includes this idea of erotic conflicts—so there is a group of people who are used to being told in their relationship that their sexual behavior or preference is wrong or strange and doesn’t belong in their relationship. I don't accept that, and in the OCSB group people can talk to each other about who they are as a sexual person and what that looks like, and whether  that can be expressed in a way that has a health component for both themselves and the people they are partnered with. 

In the context of an interpersonal psychotherapy group where group members explore their relationships with each other, there is a high degree of emotional vulnerability  about sexual intimacy. I have found that this is usually the first time people have experienced that in their lives. It is magical at times to see people have this shift in going from risky sexual behavior that they have grown detached or comfortable with, to feeling very afraid of having sexual health conversations and over time have that become their preference because they choose sexual health as they experience the rewards. The problematic behavior becomes less desirable. 

Truly, sexual and emotional intimacy is more satisfying than detached, high-risk, and harmful sexual behavior.

Mike: When you say this it reminds me of the principles of sexual health in the OCBS model, including pleasure, consent, honesty, and non-exploitation—the levels of satisfaction that people experience. How do you know as a clinician when you are in a sexual health conversation?

Kim: That’s a great question. As a sex therapist, we do that all day. I don’t think it has to be on any particular topic; I think it includes human sexuality and not necessarily education. But in the OCSB group, we are talking about sexuality that has qualities of health: respect, non-judgement, sexual preferences, boundaries. For example, if someone is using sex workers or masturbating in a manner that is inconsistent with their definition of sexual health, we can talk about what is the case for them. The model is driven by the client applying the principles of sexual health to their preferences and values. What would be part of sexual health for you about that behavior? This is woven into not only sex itself, but how this is communicated to group members, their partners, or other people in their life. Once they can learn to talk about it with each other it can be transferred to others outside in their lives.

Mike: What have you seen shift in group members as a result of being in an OCSB group?

Kim: I think one of the biggest things is the amount of shame, and what that gives away is affirmation and confidence that who I am as a sexual person is okay. If it pleases me and it’s consensual, it’s okay. Over time, with that acceptance grows a confidence, a reduction in anxiety, and honesty in not leading a double life, along with the associated burdens with carrying all that.

The full interview with Mike and Kim is available below.

Group Therapists: Kimberly Keiser

Group Participants: Mixed sexual orientation males over 18 years of age

Group Format: This will be a closed group consisting of 8-10 group members who commit to enrollment for no shorter than six months. New members will be added to the group on a rolling basis as current members transition out. Contact us for more information.

Meeting Time: Wednesdays from 5 pm-6 pm

Cost: $45 per group session

Location: 2101 W 69th St, Suite 103, Sioux Falls, SD 57108