Today’s guest Jessica Levith, is a Licensed marriage therapist from California and is here to talk about the “Out of Control Sexual Behavior Model” which is a view of compulsive, out-of-control sexual behavior. A treatment model is developed around this, and Jessica extends it to cisgendered women with challenging and problematic sexual behaviors. She provides treatment for people who think they exhibit out-of-control behavior. The episode also discusses sexual health and its influence on our sexuality.
Define – Out of Control Sexual Behavior (OCSB)
Jessica defines Out Control Sexual Behavior as the client’s perception of their sexual behaviors, feelings, and urges being out of their control. What makes OCSB different from the Sex Addiction Model is that OCSB is a sexual health-focused treatment where people establish their vision of sexual health without giving up a part of their sexuality. Jessica mentions a history of conflation of non-consensual sexual behaviors in the OCSB model. She debunks a theory in the Sex Addiction Model that it is believed that when a person’s sex addiction goes untreated they fall more towards non-consensual behaviors. However, in OCSB when a patient presents a sign of non-consensual sexual behaviors, they have to be ruled out as they’re more suitable for specialized treatment from a therapist whose practice deals with non-consensual behaviors.
In OCSB model treatment, they are on the lookout for patients with a genuine interest in changing how they view their sexuality. This treatment is not for those who may be simply motivated to escape the shame of exposure to their family or partner by labeling their behavior as a disease. This aligns with the perception in the OCSB model where sexual addiction is viewed as a behavioral problem that can be regulated in all parts of life. In contrast to that, the Sex Addiction Model views sexual addiction as a disease that allows the patient to step back from their responsibilities of change.
How to broaden what people see as out-of-control sexual behavior.
To broaden the view of what one would consider being an out-of-control sexual behavior, they have to process the cause behind their belief. To explain where some of these beliefs originate from, Jessica explains how women have been socially imprinted through history on how we should look, feel and act. She gives a historical context of parallels of women’s behavior being dictated in religion, art, and even science and the instance where the change started. Through Doug’s book and his model, Jessica points out the concept being based on Human Behavioral Theory which prompts for change and adaptability especially in women.
Steps in the clinical journey of OCSB model treatment?
Initial screening is the first step in the process of OCSB Model treatment where clients are screened to rule out non-consensual sex, for internal motivation, presence of any acute issue that could disrupt the treatment like being a physical threat to self or others, substance use, and abuse, mental health issues or physical health issues. In the next step, an assessment is done with a series of courses such as Adverse Child Experience (ACE), Sexual Symptom Assessment Scale (SSAS), Sexual Inhibition Scale (SIS), Sexual Excitation Scale (SES), and semi-structured assessment. During the process, the therapist learns a lot about the client as a person. In the end, the therapist helps the client to use sexual health terms instead of pathology terms, which means, they stop viewing it as a disease. Then the therapist and the client together make a sexual health plan by using this information.
Sexual health in OCSB is upheld by six principles – consensual sexual activity, non-exploitative, honesty, shared values, protection from STIs and STDs and unwanted pregnancies, mutual pleasure, and solo pleasure. When you live within these six principles, with the help of your therapist you can come up with a sexual health plan. The sexual health plan has 3 columns. The first column is boundaries which are the behaviors when crossed resemble in breaking your agreements. The middle column is ambivalence and high-risk behaviors. It means being honest and recognizing the competing motivations within yourself. The last column is sexual health is “the ideals, goals, and aspirations for how you want to be sexually and in life”.
What drove you to apply this specifically to women?
After being on the side of the medical models and then reading Doug’s book, Jessica noticed how everything was geared towards cis-gendered white men. However later she realized that most of the work in Doug’s book can be translated for clinical work with women. To gain a deeper understanding, Jessica dived into the historical and current context of the source of “implicit and explicit expectations and messages projected onto women and internalized by them”.
She discovered three ways of how women were impacted by socio-cultural value systems. First, through historic and systemic power over women’s rights and the means to control birth by pregnancy prevention and termination, through the Comstock act, making women’s access to birth control is dependent upon where she lives, her access to health insurance, her socio-economic standing, and financial status. Secondly, controlling women’s view of sexual functioning, appearance, and pleasure, and thirdly, sexual and social value.
Intersectionality is discussed in context with the power of sexual and social values. It’s how we identify in the world in terms of class, race, age, gender, sexual orientation, and more influence our social and sexual standing and values. Jessica adopted it because of its influence on women’s sexual self-concept which influences their attachment.
How does it show up clinically?
Understanding the historical context of the impact on women’s perception of sexuality, pleasure, and appearance helps the process of the treatment in understanding their perception of sexual health and what they perceive as out of control sexual behaviors. Jessica gives an example of a client who comes in with what she thinks is a problem of “porn addiction”. In these situations, to understand if this is a problem for the client or whether it’s stemming from a partner, Jessica asks questions to find out. These ideas of out-of-control sexual behaviors in women are internalized because women are not taught to be sexual in their vision. It is highly influenced by the media especially in children. Jessica also points out a flip side of the internet where feminist and ethical porn is being debated, where people of disability, people of all sizes and cultures are being represented accurately. This is what brings a shift in the internalization in women.
Integration of said historical markers into the assessment
OCSB focuses on three clinical areas of self-regulation, attachment regulation, and sexual neurotic conflict which are impacted by the historical markings researched by Jessica. With this knowledge, Jessica says, you can help bring awareness to slow it down.
Jessica leaves us with a parting message to avoid making assumptions of someone’s desires and to be in the moment with your partner or with yourself to connect and understand who you are at the core.
Jessica Levith, an Oakland CA Certified Licensed Marriage and Family Therapist, LMFT specializes in treating Problematic Sexual Behavior, Infidelity, Unhealthy Attachments, Sexual Health support, Emotional Dependency, early attachment trauma, and recovery from trauma.
She has a Sex Therapy Certificate from the California Institute of Integral Studies, training in Out of Control Sexual Behaviors from both The Society For The Advancement Of Sexual Health and The Harvey Institute, and specialized training in supporting partners of those with Out of Control Sexual Behaviors.
Resources and links:
Jessica’s research article: Translating the Out of Control Sexual Behavior Treatment Model for Work with Cisgender Women
Doug’s book: https://www.theharveyinstitute.com/publications/books
Training video – https://jessazimmerman.mykajabi.com/video-choice
Sex Health Quiz – https://www.sexhealthquiz.com
The Course – https://www.intimacywitheasemethod.com
The Book – https://www.sexwithoutstress.com
Podcast Website – https://www.intimacywithease.com
Access the Free webinar: How to help your partner want more sex without making them feel pressured or obligated: https://intimacywithease.com/free-webinar