Addendum To My Recent "PSB Framework Applied to Group Therapy" Workshop

I am writing this note for anyone who attended my August 4, 2023 workshop “Not Just for Sex Addicts: Applying the Problematic Sexual Behavior (PSB) Framework to Group Therapy”.  This was my first attempt to teach clinicians how to run a therapy group using the PSB Framework and I came away somewhat dissatisfied with how I presented the material.   I wrote the following to fill in an important gap that I didnt realize was missing until after I reflected on the workshop.

While much of the information was cogent and concise I now realize that I simply did not adequately address one central characteristic that distinguishes a PSB group from a typical therapy group for sex addicts.  Even though I've facilitated over two thousand groups using this framework I am only just now recognizing and appreciating that one of the most essential attributes of a PSB group was so ‘close’ to me that I couldn't sufficiently distinguish it as separate from my own skills as a group therapist.  I only gained this fundamental insight after delivering my presentation, and I believe it's important enough to make this "addendum" available to everyone who attended.  (Even if you didn't attend the workshop, read this article or watch this 11-minute video if you want to quickly get up to speed to make sense of the following.)

A Quick Note Amending My Stance on Facilitator Gender of Men's PSB Groups

But before getting to all that I want to offer a mea culpa for the way I spoke about male versus female therapists running men’s groups.  I regret the degree of male bias I displayed, especially since I know several highly respected female colleagues who have very successfully run long-term men’s groups.  For this reason I want to amend my position to affirm that I fully respect and support any qualified therapist to run a PSB group.  While either choice brings unique benefits and deserves careful consideration, the most important factor for a successful PSB group facilitator resides with each individual's unique skills and qualities.

 My "PSB And Group Therapy" Workshop Dilemma

One of my challenges in preparing for this workshop was that I needed to accomplish two sequential goals: (1) to introduce the PSB Framework to those unfamiliar with it, and then (2) to apply this framework to group therapy.  In order to accomplish this twin goal I devoted the first half of the workshop to a condensed overview of the framework itself, but in retrospect I can now see that the second half covered little more than “how Bill runs his groups”.  While this information may have been useful to some, others likely found it of minimal value and only sketchily connected to the earlier material.  The result was that my presentation came across more like two unrelated workshops that were spliced together than a single unified whole.  I've subsequently realized that the missing element was my need to recognize and introduce an important, unique and perhaps even elegant PSB group attribute that effectively weaves together the two portions of my workshop into a thematically unified and fully realized presentation. 

The First Unique PSB Group Trait: Membership Diversity

A major goal of this addendum is to more fully address the fundamental question: “what special qualities distinguish a PSB group?"   My workshop answer was devoted primarily to its diversity of membershp.  It's certainly true that expanding membership criteria beyond the necessity for diminished self-control creates a unique configuration of addicts and non-addicts who share a common sexual health goal that in itself provides ongoing benefits to all the members.  Since the workshop already covered many of these benefits I won't repeat them here.

The Second Unique Trait of a PSB Group: Language Choices 

A second distinguishing trait of PSB is its reliance on descriptions rather than labels.

An optimal PSB group uses the five problematic sexual behavior categories as its primary “language”.  As an example, PSB groups tend to avoid predominately 12-step phrases such as ‘acting out’, ‘sobriety’, and even ‘relapse’.  While these words and the concepts they represent certainly have a place in a PSB group, they do not occupy a privileged position.  These same actions can be just as easily described in terms of commitment violations, values conflicts, diminished self-control, negative consequences and insufficient responsibility to others.  For this reason, PSB group members are more likely to articulate their behavior in relation to their core values, their commitment integrity, their self-control and their level of responsibility to others

A vital role of a PSB group facilitator is to find ways to ‘bridge’ all of the various group conversations to the five PSB categories.  This happens by using these five categories as metaphorical anchors, guideposts or guardrails that support each member’s unique sexual health vision.  While the specifics may vary all PSB group members desire and work toward the ability to maintain control of their sexual behavior so that they live fully within their commitments in a way that is consistent with their strong personal values while protecting the health and well-being of others How you help members accomplish this goal will vary based on your unique personal and professional characteristics as well as the life stage and overall “strength” of the group, among many other characteristics. 

An effective PSB group facilitator observes and explores member behavior and interactions through the lens of these five categories.  With just a little practice you’ll find effective ways to create narrative bridges connecting these categories to the unique characteristics of each member.  Since the PSB framework provides a common foundational language that aligns all the diverse models, theories and methods that exist now or may develop in the future, a PSB group has the unique ability to encompass many different member viewpoints into a shared group perspective.

It's now time to introduce the final fundamental characteristic, which I didn't recognize clearly enough to discuss during my workshop but which is truly the "special sauce" of a PSB group. 

The Third Unique PSB Group Trait:  Five Conversational Domains

The distinguishing quality of a PSB group, beyond its expanded membership range, resides in the nature of the "conversational domains" the framework helps to develop and expand.  Almost every significant PSB group conversation in some way engages one or more of the five central categories of problematic sexual behavior (commitment violations, values conflicts, diminished control, negative consequences and lack of social responsibility).

Since this framework is built around descriptive conversational categories rather than labels, they inevitably inhabit any meaningful group conversation.  Even when not readily apparent in whatever topic the group is addressing, these categories often reside just under the surface of almost any significant PSB group discussion, accessible for an alert faciilator to always notice and, as warranted, to highlight and invite for discussion.

Utilizing each of the framework's five descriptive categories (or their combinations) as broad conversational topics reveals an almost limitless number of possibilities that are available to the facilitator depending on the group member(s), the overall group dynamics and many other factors.  The ultimate result is that a PSB group offers its members ongoing and highly relevant opportunities to examine, explore, question and even challenge their relationship with each of these five fundamental categories of sexual health

Detailed Examination of the Five PSB Group Conversational Domains

Below are just a few illustrations of how each of the five PSB categories ‘shows up’ in group conversations.  These and many more examples will demonstrate how these conversational domains saturate and unify many group interactions in ways that are consistently relevant to each member’s sexual health journey.  (The facilitator generally does not need to directly point out which of these five categories is being addressed at any particular moment, only to remain aware that a well-balanced PSB group will devote an appropriate amount of time unpacking all of them on an ongoing basis.)  

PSB Conversational Domain #1: Commitment Violations

Since it is likely that almost all PSB group members will have engaged in multiple commitment violations (usually prompted by discovery), it follows that this category will manifest in many PSB group topics.  For instance, PSB group members must manage many complex, painful and lengthy consequences resulting from the discovery or disclosure of their commitment violations.  PSB group members support each other through every difficult stage required to come to terms with the full consequences of their commitment violations.  Such common group tasks can include helping members prepare for a formal disclosure (with and without polygraph) as well as the entire impact and restitution letter process that can be so critical for relational healing.  Just on this one basis it is evident that a major goal of a PSB group is to focus on the causes, consequences and cures for commitment violations.

In order to consistently maintain their commitments, members need the skills necessary to resolve inevitable relationship conflicts in a healthy manner that avoids further commitment violations.  Since people who engage in repeated commitment violations often lack a robust ability to consistently demonstrate intimacy and empathy skills, PSB group conversations that help members address and improve these skills will always be important – and they will always be available.  Members who use the PSB group to practice managing emotionally difficult interactions in a healthy manner are developing valuable skills that will help them to honor their commitments and therefore maintain rather than violate their integrity due to a lack of alternative coping mechanisms.

PSB Conversational Domain #2: Values Conflicts

A PSB group also provides a venue to explore the role of personal values in the life of each member, especially as they conflict with sexual behavior.  Topics related to this category can include the process of articulating, clarifying, developing and demonstrating a set of strongly held personal core values.  Rather than avoid them, members grapple with conflicting values they discover within themselves.  Recognizing and resolving the reality of values conflicts is one of many byproducts of personal maturation PSB groups help members develop. 

The category of values conflicts will inevitably weave throughout a PSB group in the form of thematic conversations that the facilitator can prime, monitor and/or reinforce across the life of the group.  Members can use the group to gain insight into how they were able to live with a strong set of personal values most of the time, only to shift into sexual binges of hedonistic lust.  These and other discussions allow members to gain valuable skill in preventing, recognizing and responding to values lapses.  (As an example of categorical overlap, the relationship between values lapses and diminished self-control is important enough to lead some members to ask themselves, as one member put it, “am I really an addict or just an asshole?”)

As members gain some distance to look at their past behavior with a sense of incredulity and shame they learn to fully and consciously experience the conflict between the values they profess to hold on the one hand and their history of problematic sexual behavior on the other.  A healthy PSB group reinforces and supports members through this emotionally difficult self-assessment of values deficits.

A PSB group is an excellent venue to help members formally articulate their professed values and discuss the battles they have fought or fled in the face of moral adversity.  This category shines brightly whenever group members demonstrate their willingness, courage and fortitude to become “men of integrity” who stay true to their core principles in all situations.

Whenever PSB group members report a temporary obsessive temptation to act in a manner that is outside of their stated values you will find that a rich group discussion is readily available to help resolve such challenges so that they hold fast to their stated values in the face of these momentary urges.

It’s worth noting that a strong PSB group helps members to clarify and refine their overall personal values well beyond those that directly affect their sexual behavior.  No stone of character escapes investigation in a well-functioning PSB group.

PSB Conversational Domain #3: Diminished Control

The problematic sexual behavior category of diminished self-control will naturally populate many PSB group discussions at very regular intervals and lead to rich conversations about self-discipline, accountability, the value of mutual assistance, the revelation and resolution of underlying trauma and many other important topics central to the development of a strong capacity for directed agency. Any time a member struggles to maintain consistent sexual self-control the avenues you choose to take as facilitator are wide open for informed group interactions.  These obviously can include examination of triggers, preventable and nonpreventable risk factors and the methods for effectively coping with them, forensic examination of lapses and many other permutations of this ample conversational domain. 

A common and effective way to assist ongoing sexual self-control (as well as an all-around healthy lifestyle) is by maintaining regular contact with peers on similar personal journeys who can offer vital emotional support both on a regular basis and during times of crisis.  This is one reason I encourage PSB group members to not just maintain but deepen their relationships with each other outside of the actual group meetings. It’s a sure bet that fostering these affiliation bonds helps at-risk members weather times when self-control is challenged.

Since diminished self-control is the central defining characteristic of sex addiction, many aspects of this category will likely be very ably addressed by PSB group members who self-identity as sex addicts, especially those in 12-step recovery. These PSB group members possess a knowledge, perspective and skill set that will benefit their non-addicted group peers.  Such members will import into the group many helpful concepts and “best practices” for developing and maintaining adequate sexual self-control.  The diverse membership criteria for PSB groups also provides the fundamental structure to transform the stigma of sex addiction into a source of stature by providing the self-identified sex addicts an inclusive haven that replaces isolation with social engagement on a basis of shared equality with the non-addicted group emmbers. 

Since early traumatic life experiences, especially those that were sexualized, are associated with an increased likelihood of diminished sexual self-control in adults, trauma recovery work is well-served within the safe and strong circle of a PSB group as its members access, express and heal early attachment injuries and other damaging effects of childhood trauma.

PSB Conversational Domain #4: Negative Consequences

Long after their problematic behavior has stopped most PSB group members will be dealing with the lingering negative consequences of their behavior, both those they experience for themselves as well as those they have inflicted on other people, primarily due to their protracted commitment violations.  Since it is inevitable that every PSB group member has experienced negative consequences, this category will percolate through numerous PSB group conversations. 

A common example involves members who have created deep estrangements from immediate and extended family members who have been traumatized by their behavior.  These consequences can last for years if not decades or an entire lifetime.  PSB group members help each other both process their grief and remorse while remaining accountable for both the damage they have caused and for the willingness to do the long and arduous work of creating restitution and rehabilitation for these deeply wounded relationships with family members and others.  PSB group members help each other manage these lengthy sequences of healing that are required to address the damage created by their commitment violations, values conflicts, diminished self-control and lack of responsibility to others.

Of course, PSB group members often experience many other negative consequences that they will bring into group conversation, including job loss, legal and financial consequences, reputational damage and so forth.  Negative consequences can descend on one member or the entire group at any time, such as when a member announces a divorce, lawsuit or criminal charge.  I’ve had two group members leave to serve prison terms for child pornography possession and this sobering reality serves to remind every member of the seriousness of their behavior.  Sometimes the sense that “there but for the grace of God go I” reverberates across the group, either quietly or openly expressed.

PSB Conversational Domain #5: Lack of Social Responsibility

The final category of problematic sexual behavior, lack of responsibility to others, weaves through the life of a PSB group in many different iterations.  As with the other four categories, an adept PSB group leader will find ongoing opportunities to highlight this conversational domain.

As an example, I’ve had a couple of instances where a group member fathered a child outside of a committed relationship.  Since this topic simultaneously engages the categories of commitment violations, values conflicts, (potentially) diminished control and (obviously) negative consequences, a PSB group leader is in a position to weave, emphasize or pend any of these conversational domains.  In this instance the negative outcome serves to highlight the impact caused by a lack of responsibility to others by not taking proper steps to protect against an unwanted pregnancy.

Another common way this category emerges is in conversations about pornography.   It’s important for members to accept the probability that many of the people they were viewing sexually were neither recorded with full consent nor sufficiently protected from negative health outcomes and/or exploitation. 

By keeping in mind that the category of social responsibility itself encompasses three components (full consent, full protection and absence of exploitation) alert PSB group facilitators will be able to notice rich conversational possibilities worthy of exploration.

Closing Thoughts and Invitation

I could (and probably will) continue to include other examples of the seemingly limtless group conversations orbiting around these five categories.  You can be sure that one or more of these five categories will show up in or near any substantive PSB group discussionYour goal is not necessarily to overtly name these categories as they occur, only to remain aware that these are the central constructs you’re working with in whatever type of PSB group that you devise.

PSB group members obviously often face challenges that simultaneously engage more than one category.  It is common for a group member to have engaged in behavior that spans the categories of commitment violations, diminished control, values conflicts, negative consequences and lack of responsibility.  Your opportunity as group facilitator is to help craft these conversational domains in a manner that provides the most insight, support and progress for every group member.

Men who are charged with the arduous task of growing emotionally while repairing the harm they have caused to others because of their sexual behavior need certain skills that a PSB group is exquisitely designed to instill.  Again, these concepts can apply to whatever group process and format works best to fit your clinical needs, even if it looks much different than the way I do it.  While I appreciate attribution the framework itself is more important than who created it.  This is my professional "life work" and since I want these ideas to survive me my goal is to continue expanding awareness of the Problematic Sexual Behavior Framework in order to spark innovative and ever-expanding methods for assisting people who currently remain outside our assistance models.

I hope that this addendum to my August 4th workshop brings cohesion to its two halves to demonstrate the value of applying the PSB Framework to group therapy.  I doubt I could have articulated these ideas with this degree of clarity had the workshop not bothered me.  I appreciate everyone who attended (or independently took the time to read this) because it means you have an interest in this topic. I believe that with this addendum I've finally succeeded in providing you the full measure of the workshop you deserve. 

Please don't hesitate to reach out to chat about any part of my original presentation, this addendum, the PSB Framework in general -- or for any other reason!  I appreciate your time reading this.

Bill Herring, LCSW, CSAT

678 773-3083 cell

August 19, 2023