The Problematic Sexual Behavior (PSB) Framework: An Extended Summary Review

After spending years contemplating how to solve some fundamental challenges I perceived to exist in the overall sex addiction construct (which I absolutely affirm is very useful for many people), I ultimately developed the Problematic Sexual Behavior (PSB) Framework. 

Overview of the Problematic Sexual Behavior (PSB) Framework

The Problematic Sexual Behavior Framework is a universal, simple, portable, descriptive and theory-neutral method for assessing sexual behavior patterns for problematic components in a way that avoids resistance and effectively navigates a clinician through unfamiliar or personally uncomfortable sexual practices.

The PSB Framework assesses sexual behavior patterns across five distinct but oven overlapping categories: (1) commitment violations, (2) values conflicts, (3) diminished self-control, (4) negative consequences, and (5) lack of sexual responsibility.  The PSB Framework asks five questions that get right to the heart of what makes any pattern of sexual behavior problematic:  “Are you keeping your promises?”; “Are you ok with what you’re doing?”; “Are you in control of yourself?”; “Is everything ok?”; and “Are you protecting others?  The PSB Framework uses descriptions rather than labels, is applicable across cultures and values, and is useful in many settings.

Expanding Beyond the Limits of The Sex Addiction Model With the PSB Framework

One feature of the PSB Framework is that it solves the vexing problem of how to extend the kind of specialized assistance provided by sex addiction therapists (or those who practice any other model describing “out-of-control” sexual behavior) so that it becomes available to people who engage in many of the same behaviors as self-identified sex addicts for reasons other than lack of self-control, such as people whose chronic infidelity seems more a function of entitlement than addiction. Since many of the skills such therapists provide are applicable to people suffering from chronic sexual behavior problems for reasons other than diminished self-control, the PSB Framework effectively unlocks such specialized assistance protocols to an expanded range of people who can benefit from the kind of help they provide.

Stated slightly differently, the PSB Framework allows sex addiction therapists to drag-and-drop the immense knowledge base and practice expertise of that professional community so that it is accessible to people who desperately need help but who are either reluctant to identify themselves as sex addicts or do not cleanly or exclusively fit within the sex addiction model.

(As a practical application, I run a half-dozen therapy groups that bring men together in a shared sexual health vision regardless of whether they self-identity as sex addicts.  This has the profoundly positive effect of reducing the sense of "otherness" that self-identified sex addicts often experience while bringing the benefits of the many helpful sex addiction recovery practices to the other members.   It's very rewarding to witness men supporting each other regardless of whether they self-identify as sex addicts.  The framework has truly transformed the way I practice. Many people who engage in behavior such as chronic infidelity may on the surface appear very much to be sex addicts, yet it’s not always clear that they are actually engaging in such behavior because they lack self-control. Sometimes the reality is that such people accept the sex addiction label because they have no other category available to them if they want help, often with the ready encouragement of well-meaning sex addiction therapists who label them as sex addicts almost by default.  The PSB Framework avoids what might in actuality be premature or inaccurate labeling by not requiring it as a basis for a person to receive professional assistance.  I'll be presenting a workshop on how to apply this framework in a group therapy format on August 4, 2023.)

Similarly, the PSB Framework bypasses potential resistance many people have to the sex addiction label, even by those who acknowledge that they are experiencing problems because of their sexual behavior patterns.  Thus, the PSB Framework avoids needless initial resistance to receiving help by eliminating the requirement of a label entirely.

This is as good a place as any to clear up the misperception some people have that sex addiction and problematic sexual behavior are somehow competitive formulations.  They are not.  Rather, sex addiction is one category of problematic sexual behavior.

The Important Difference Between a Framework and a Model

Before moving forward to review some of the essential characteristics and benefits of the PSB Framework, let’s take a moment to discuss what the term “framework” means, including how it differs from a model and the reason why this distinction is important to understand.

In the material world, construction that begins with a solid framework can support many different types of structures that can be built for different purposes.  Frameworks are created by using their elemental components, such as bricks, metal, lumber and nails, which can be combined in many different ways for various purposes.  

In a similar manner, a conceptual framework refers to a set of concepts and relationships that are proposed as the basis for understanding something being considered.  A framework is therefore the essential perspective for considering an issue. The elemental components of the PSB Framework are commitment violations, values conflicts, diminished control, negative consequences and lack of responsibility.  These are capable of being combined in many different forms and degrees based on each unique individual.  Some people may engage all five categories to a greater or lesser extent, others only one.

A framework provides the foundational assumptions that are necessary for the creation of models, which are attempts to describe how the key elements of the framework are potentially interrelated.  Models, in turn, are the basis for formulating and testing theories, which are predictions about the best way to manage the relationships between the framework’s key concepts. Theories are then used to develop methods for achieving these preferred relationships. Finally, sets of methods form methodologies for achieving desired goals in a manner that is consistent with the theories, models and foundational assumptions supported by the framework.

The PSB Framework brings foundational cohesion to multiple models and theories, whether it’s the sex addiction model, the integrity-abuse disorder model or any other model that is now or could be framed in the future.

The PSB Framework: Five Categories, Five Questions

Sex addiction requires one essential key to unlock access to help, diminished control.  This is the only variable that is capable of granting clinical engagement under the sex addiction model.  In contrast, the PSB Framework provides five avenues to professional assistance:

  1. Sexual behavior that repeatedly conflicts with a person’s commitments,
  2. Sexual behavior that repeatedly conflicts with a person’s values,
  3. Sexual behavior that repeatedly conflicts with a person’s self-control,
  4. Sexual behavior that repeatedly results in negative consequences, and
  5. Sexual behavior that repeatedly lacks adequate sexual responsibility.

The shorthand for these five categories can be reduced to five words: commitments, values, consequences, control and responsibility.

As stated above, each category of the PSB Framework requires only one simple question to begin a sexual health conversation:

  1. “Are you keeping your promises?”
  2. “Are you ok with what you are doing?”
  3. “Are you in control of yourself?”
  4. “Is everything ok?”
  5. “Are you protecting others?”

It is easy to see how these questions offer gentle and non-threatening invitations to initiate sexual heath conversations related to commitments, values, control, consequences and responsibility.

It’s important to note that some categories are binary like a light switch that toggles between on and off, while others are assessed along a gradient that ranges from slight to severe.

Please note that the PSB Framework is not a diagnostic classification system.  That means it is not used to create a diagnostic syndrome. This is because what is problematic does not have to be pathologic. We’re not talking about assigning a pathology to a client, but merely stating that their behavior is problematic to them.

The Numerous Benefits of the Problematic Sexual Behavior Framework

There are at least seven benefits that commend the PSB Framework:

The first benefit is that it’s universally applicable. This means that it is capable of navigating widely diverse personal values and sexual practices.  Since the world comprises a rich diversity of normative assumptions related to sexual expression, such variety must be met with a similarly diverse range of sexual health assistance models that are capable of supporting effective methods for motivational engagement that may work well in one cultural setting but not another.  The five fundamental categories of the PSB Framework are designed to be adaptable to anyone on earth, regardless of cultural setting.

Since the PSB framework avoids assessing the types or frequencies of sexual practices, it is very supportive of sex-positive values and practices. This is important because the same behavior can be ok for one person and problematic for another.

Another benefit of the PSB Framework is that it is simple and portable.  For instance, the Sexual Addiction Screen Test (SAST) is comprised of 45 questions, while the PSB Framework only requires five questions.  The PSB Framework is designed to be useful in many different professional and personal settings.  It is a quick and easy way for clinical generalists to assess and refer people for more specialized help when appropriate. Because of its portability, simplicity and utility the PSB Framework has been termed the “Swiss Army knife” of assessment tools.

Yet another benefit of the PSB Framework is that it is outcome neutral.  This means that sexual problems don’t always need sexual solutions. Take, for example, sexual behavior that conflicts with a person’s commitments.  In such cases it is possible to reduce the problematic aspect of that category by changing either the sexual behavior or the commitment.  Similarly, a values conflict can be resolved by either changing the sexual behavior or experiencing a shift in values. Thus, the framework is neutral regarding the direction of change that is optimal for any particular situation, reinforcing the reality that what is healthy for one person may not be for another.

A further benefit of the PSB Framework is that it is descriptive.  The PSB Framework uses descriptions rather than labels in order to reduce confirmation bias. To describe something is to give an account of its relevant characteristics, such as its precise appearance, essential nature or inherent qualities.  The act of applying a label to an object of observation inevitably concretizes it by reducing a complex and nuanced reality into a simple reductionist perspective, which inevitably influences how it will be perceived from that point forward.  Labelers rarely look beyond their labels, and as Kierkegaard wrote, “once you label me you negate me”.  Since perception has such a profound influence on our judgement, the PSB Framework’s use of descriptions rather than labels reduces the risk of clinical confirmation bias that often happens when people representing different perspectives examine the same set of behaviors.

An additonal benefit of the PSB Framework is that it is theory neutral. In other words, the framework supports multiple theories of causation. The PSB Framework does not get involved in what may have caused the problematic sexual behavior which can happen for a variety of reasons.  Perhaps the cause is indeed a form of addiction, but it may alternately be the result of a comorbid condition, a reflective or moral deficit, a culturally privileged power imbalance, a characterological or personality disorder, a form of traumatic reenactment or simply a troubling fetish, among other potential influences.

Finally, the PSB Framework is sexual health informed. I carefully studied the historic evolution of the sexual health construct over the past half century, and I track its development in my workshop.  For this overview I will just say that sexual health is best conceived as a combined function of mental health, physical health, and public health. Sexual health balances sexual rights with sexual responsibilities by balancing emotional well-being with protection from harm, which are the complementary realms of mental health and public health.

The essential public health dimension of problematic sexual behavior involves the degree to which that behavior is responsible. Although it does not seem to be strongly emphasized by some sex therapists (perhaps because of its subtly moralistic tone), responsible sexual behavior is nevertheless a contemporary fundamental sexual health component.

The PSB Framework essentializes sexual responsibility to three core components, which are (1) the need for everybody to consent to what is happening, (2) the requirement that everybody must be protected from unwanted physical consequences, and (3) the assurance that nobody is being exploited by the sexual behavior. This can be abbreviated to the maxim that “everybody must consent, everybody must be protected, and nobody can be exploited’.

Conclusion -- and My Request

To review its essential components, The PSB Framework assesses five dimensions of sexual behavior: commitment violations, values conflicts, diminished control, negative consequences and lack of responsibility.  It asks five questions about a person’s sexual behavior: “Are you keeping your promises?”; “Are you ok with what you’re doing?”; “Are you in control of yourself?”; “Is everything ok?”; and “Are you protecting everyone?” It assesses sexual responsibility along three dimensions:  everybody must consent, everybody must be protected from harm, and nobody can be exploited.

That’s all there is to it!  Some people may be surprised there are not more sexual health guidelines in this assessment tool, but this is not necessary.  Keep in mind that the PSB Framework provides guardrails, not destinations.  In other words, people may hold any manner of sexual health visions for themselves.  They are free to engage in whatever sexual behavior works for them as long as these five central guardrails are maintained.  Another metaphor is that the PSB Framework represents the floor rather than the ceiling of a person’s sexual behavior.

I hope you have found this summary of the PSB Framework to be useful.  If this is the case I will end by asking you to help me expand awareness about it so that its value can reach a wider audience.  One way to do that by inviting others to watch the 11-minute summary video.  I would also love to know about relevant conferences for me to submit workshop proposals.  I’m interested in being a guest on more podcasts than I’ve appeared on so far.  Also, if you belong to an organization that has staff meetings or run consultation groups, please consider inviting me to give a brief presentation.  And, of course, please contact me with any other ideas you may have that I haven’t thought about.

I appreciate the time you just invested to understand the basic components of the PSB Framework.  I’m readily available to respond to any of your comments or questions.

Bill Herring, LCSW, CSAT

May 20, 2023