Monthly Archives: September 2022

Working with perpetrators of child sexual abuse

By Lisa R. Rhodes September 16, 2022

Perpetrators of child sexual abuse are a clientele that some counselors may find challenging to treat. According to the Department of Justice Office of Justice Programs, the term “sex offender” refers to a person who is convicted of a sex offense, which is defined as “a criminal offense that has an element involving a sexual act or sexual contact with another” as well as one that is an offense against a minor.

As of April, 767,023 people were listed in the sex offender registries in the United States, according to SafeHome.org. This number, however, may not reflect the total number of people who have sexually abused children. The Rape, Abuse and Incest National Network (RAINN) reports that the majority of sexual assaults are never reported to law enforcement.

Courtney T. Evans, a licensed clinical mental health counselor with a private practice, Purpose in Grace Counseling, in Eden, North Carolina, says mental health treatment, specifically sex offender therapy, is a recommended form of counseling to reduce recidivism rates among perpetrators of sexual assault.

“While traditional therapy seeks to reduce feelings of anxiety and inadequacy, sex offender therapy seeks to confront the offender with thinking errors, promoting accountability and acceptance for actions,” notes Evans, a member of the American Counseling Association who specializes in treating people with trauma-related disorders, specifically children who have been sexually abused. “Sex offenders are given tools in counseling, but just like someone who attends Alcoholics Anonymous meetings long term, sexual offenders should engage in lifelong support.”

Risk factors

Community safety is the first goal of sex offender therapy, says Pablo Serna, a licensed professional counselor and independent contractor at Henger Enterprises, a therapeutic practice specializing in sexual offender risk assessment and evaluation and sex offender programming in Wisconsin.

Serna has counseled adult male sex offenders, including those who have abused children, for eight years. Most of his clients are mandated by the court to undergo sexual offense treatment or their probation officer may refer them to the practice where he works.

Serna treats perpetrators using group therapy, and he says group members can range from those who fully admit to an offense to those who admit they’ve done something wrong but are not willing to accept full responsibility for their actions.

“As a facilitator, I will introduce concepts in a general way prior to moving to [the topic of] offenses so members will grasp the idea before applying it to their offense,” Serna explains.

If a group member is reluctant to participate, Serna says he applies ideas from motivational interviewing. For example, he may empathize with the member about how group therapy can be uncomfortable or how the member does not want to be in the group. “I will admit I cannot make him participate and ultimately, he has the choice to participate,” Serna says. “Yet I point out discrepancies like ‘If you want your probation agent off your back, is not participating [going] to help with that?’”

The end goal for clients, Serna says, is to “prevent further victimizations by demonstrating an understanding of their [clients’] thinking and the risk factors that contributed to their offense and [having them] assist in developing interventions.”

Serna and his colleagues use a sex offender treatment curriculum that was developed by Joseph Henger, the president and clinical director of Henger Enterprises. The curriculum involves the perpetrator understanding the cycle of sexual abuse and relapse prevention to help them develop positive lifestyle changes. The curriculum’s main focus is to diminish deviant arousal and overcome pro-offending beliefs and behaviors, Serna says.

Serna and his colleagues also use Static 99R, an actuarial risk assessment tool developed by Karl Hanson and David Thorton. The Static 99R has 10 risk factors for assessing people who have been convicted of a sexual offense. The score of the risk factors characterizes a person’s relative recidivism as below average, average, above average and well above average.

The risk factors are divided into three categories: static, dynamic and acute. The static category refers to risk factors that do not change; the dynamic category notes personality traits or learning deficits that can change with an outside intervention, such as counseling; and the acute category refers to factors that are temporary or that can easily change because of the person’s environment or relationship with others.

According to Serna, static risk factors can include a person’s age, their prior criminal record, their gender and the relationship of the perpetrator to the victim. Dynamic risk factors are ones that can change over time, such as whether the person has any positive life influences, displays impulsivity, has problem solving skills, has an increased sex drive or any deviant sexual interests (such as voyeurism or exhibitionism) or if the person has cooperated with the probation, parole or correctional authorities involved in the assessment and management of their sexual offending behavior.

Dynamic factors, Serna says, can shed light on the person’s motivations to commit a sexual offense. He’s noticed that several of his clients who have perpetrated a childhood sexual offense have a few risk factors in common: a deviant sexual interest or attraction to children, an emotional connection to children or a hypersexual nature.

Clients often tell Serna that they feel they don’t fit in with their peers and that they feel more comfortable doing things that children do, such as playing video games. And a deviant sexual interest in children, he says, is often what allows perpetrators of sexual abuse to give themselves permission to cross social boundaries in order to have sexual contact with someone they know is a minor.

For others, a hypersexual nature plays a part in their motivations. “Some people are pretty indiscriminate” when it comes to sex, Serna notes. They want to have sex with whomever says yes or whomever is available. These clients define themselves by their sexual acts, he says, because it gives their ego a boost and helps them to feel better about themselves.

Although the assessment tool does not consider if the person was sexually abused in childhood or if it is even a risk factor for their behavior, Serna has found that the client’s own childhood sexual abuse can play a role. He has worked with clients who have abused children and tried to justify their actions by saying, “I was abused as a child. I learned to live with it, so I figured my victim would” or “The person is too young; they won’t remember it.”

Serna says other examples of distorted thinking include:

“She’s attracted to me; she’s older than her age.”
“I needed my sexual needs met. The person was there at the time.”
“I’m not going to take the time to find out how old this person is.”
“If a girl is able to have her period, she’s good for sex.”

Serna establishes some ground rules with his clients, including having mutual respect, not using objectified language (e.g., sexist or racist slurs), displaying respectful behavior (e.g., not falling asleep during group sessions), respecting the privacy of other group members and completing assigned therapeutic work.

Taking responsibility

Evans, an assistant professor of counseling at Liberty University, says the current treatment for perpetrators of sexual abuse focuses on the management of the offender. “Most programs are victim-centered approaches,” she explains. “The goal of counseling sex offenders is to prevent recidivism, while different acts and regulations pave the way for enhancing public safety and protecting victims through supervision, re-entry, registration and community notification.”

Evans says that sexual deviance (e.g., sexual interests for children over adults, abnormal preoccupation with sex) among people who sexually abuse children is often associated with an increased likelihood of sexual reoffending. “Child sexual offending may be part of a broader pattern of criminal behavior, underpinned by antisocial, impulsive and aggressive tendencies and a lack of empathy,” she notes. “This is why sexual offender counseling focuses on building empathy and taking responsibility.”

A cognitive behavioral technique that Serna uses in counseling is covert conditioning, a therapeutic approach created by John Morin and Jill Levenson. In their book Road to Freedom: A Comprehensive Competency-Based Workbook for Sexual Offenders in Treatment, Morin and Levenson note that covert conditioning helps perpetrators of sexual abuse control their arousal by linking “deviant sexual thoughts with images (pictures in your mind) of some of the terrible consequences of sex offending.”

Serna often asks clients to write a script about the distorted thinking or triggers that might occur before they decide to engage in a risky situation. Then, they write a second script that includes the negative consequences they will experience if they move forward with their desires.

The purpose of this exercise, Serna says, is for clients to attach the triggers for their behavior in risky situations to a realistic consequence, such as being incarcerated or dealing with feelings of shame or embarrassment.

When clients review the scripts repeatedly in group therapy, the recognition of their unhealthy thought patterns and the negative consequences “becomes automatic,” Serna notes. The scripts also include a part that allows clients to create a way to escape risky situations or distorted thinking patterns so they can apply and reinforce interventions with alternative thinking and behaviors, he adds.

People who sexually abuse children need to be aware of triggers, Serna stresses, but it is even more important for them to understand the problematic thinking and choices of their behavior and identify appropriate interventions.

“If they stick with me, they’re going to have a level of responsibility,” he says.

The importance of self-care

Although sexual offense therapy is an important tool in helping to reduce crimes of a sexual nature, it can also take a toll on the counselors themselves. In fact, research has found that mental health professionals who treat perpetrators of sexual assault often need psychological support themselves.

In an article on counseling sex offenders and self-care, which was published in Cogent Social Services in 2019, Evans, along with Courtney Ward, explored the impact of burnout and secondary/vicarious trauma on counselors who work with people who commit sexual abuse, and they found that mental health professionals who do this kind of work often “have a high rate of burnout and stress.”

Thus, “understanding self-care factors that influence well-being is essential,” Evans says.

In the study, Evans and Ward acknowledged that this kind of work can be difficult for some counselors because they are required “to engage in traumatic material in graphic detail while maintaining an empathic relationship with the client.” In addition, they noted that “perpetrators/offenders of sexual abuse are [often] in denial or demonstrate little or no remorse for their abusive behavior, which may exacerbate the impact on the counselor.”

Evans says the detrimental effects on counselors who work with this population can include changes in their self-perception, changes in their thoughts about other people and their environment, problems in personal and romantic relationships, changes in their sexual performance, and depression.

“Personal factors can make a counselor more prone to countertransference,” Evans adds. For example, a counselor who works with this clientele could become more protective of their own children because of the material they deal with in session. If this happens, Evans recommends clinicians seek supervision and feedback on ways to distance their own lives from their clients’ lives, which can also help counselors become more sensitive to the ways countertransference can occur.

Serna says he has managed to remain largely unaffected by the content of his therapeutic sessions with clients who have sexually abused others. He currently leads about 14 to 15 two-hour group therapy sessions per week with clients who have sexually abused children, enticed children, have downloaded/distributed materials online in which children are sexually exploited or have sexually abused adults. Some group members have also abused adults.

Yurta/Shutterstock.com

“If it came to that point [being emotionally affected], then I would know that I can’t do this anymore,” he admits.

Serna says he remains objective and requires clients to reflect on their distorted thinking and feelings because they impact their own lives — not his. “It’s up to the offender to evaluate their own thoughts, rather than me making a judgment about it,” he explains.

With a career that spans 15 to 20 years in the field, Serna has counseled a diverse clientele from the chronically mentally ill to families and adolescents. And he says these experiences have helped him to recognize his own biases and the necessity to lean on his training to maintain a professional distance from difficult clients.

“I’ve learned how to take a step back and be objective,” he says. “I feel like, as a therapist, my role is to be objective. So, when I hear these things, the only way to help them [clients] is to be objective.”

Serna says he maintains boundaries with his clients by not disclosing any personal information, such as his relationship status or if he has children. And he practices self-care by running three miles a day, playing piano and guitar, drawing and taking art classes in his spare time.

“I think keeping these boundaries permits me to separate my personal and professional life,” Serna explains. “When I am frustrated at work, I know it’s a professional issue and will look [to] the resources I have.”

Serna says if he ever gets emotional because he’s feeling frustrated, he’s trained himself to say, “OK, Pablo, this is becoming your issue now.”

Evans suggests that counselors who want to work with this population be “self-reflective regarding signs and symptoms of burnout and engage in self-care activities for prevention and alleviation.” Some self-care strategies include meditation, mindfulness, journaling and personal counseling — anything that promotes emotional well-being.

Overcoming barriers

Most of Evans’ students have not expressed an interest in treating perpetrators of child sexual abuse, largely due to preconceived notions that most people who commit sexual abuse are predators and highly resistant to treatment, she says. Personal morals and beliefs may also prevent students from choosing to work with this population, Evans adds.

But for counselors who are interested in working with this clientele, Evans recommends they seek training and certifications (such as the National Association of Forensic Counselors’ Certified Sex Offender Treatment Specialists and the Certified Juvenile Sex Offender Treatment Specialists certificates) so they can better help this population. It is also important for counselor educators to prepare students to work with difficult clients, particularly those who abuse children, Evans says.

“I think that most counselors have so much empathy for children, as we all should, and this influences feelings and thoughts related to harm to children,” she says. “This is a positive attribute in counseling, [but] it also greatly impacts services to sexual offenders.”

Perpetrators of sexual assault are often victims of sexual offenses themselves, Evans continues, so she advises counselors to take preventative action by “working with those who have experienced trauma and doing trauma screenings and, if warranted, assessments on each client.” Evans says understanding the client’s lifestyle and private logic is essential in understanding their current behavior and preventing future maladaptive behavior.

“I hope that counselor education can instill [an] understanding of sexual abuse, … not only for the victims [but also for] the motives and proper treatment for offenders,” she says. “This is … the best way to treat the problem [and] to work preventatively.”

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Preventing veteran suicide

By Justina Wong September 9, 2022

In February, Russia invaded Ukraine and started a war that is still going on today. When President Zelensky asked foreign fighters to join Ukraine’s resistance against Russia, many American veterans answered the call. Although it’s a devastating war that has taken many innocent lives, it has given some veterans, especially those who are still struggling with the aftermath of the U.S. military’s withdrawal from Afghanistan, a renewed sense of purpose.

Having a sense of purpose and belonging and working toward a common goal can help veterans who are struggling with suicidal thoughts or ideations. According to the Centers for Disease Control and Prevention, in 2019 an average of 17.2 veterans died by suicide daily, and from 2001 to 2019, the suicide rate among veterans increased by almost 36%. In certain battalions, there have been more deaths from suicide than those killed in action during the wars in Iraq and Afghanistan.

With September being Suicide Prevention Awareness Month, it is important to remember that suicide affects the military and veteran communities year-round.

What to know about veterans and suicide

Suicide in the veteran community is different from suicide in the civilian community. Veterans have a higher suicide rate compared to civilians, and in my personal experience working with different nonprofit veteran organizations and being friends with veterans, I noticed that veteran suicides can sometimes be more impulsive than civilian suicides.

Photo by Sgt. Agustín Montañez/defense.gov

I also noticed that one of the biggest triggers for veteran suicides are other veteran suicides/deaths. In talking with veterans, I learned that some are more likely to think about and follow through with taking their own life when they hear about a close friend who died by suicide or died from a variety of reasons.

In my attempt to destigmatize suicide among veterans, I encourage all the veterans I speak with to be transparent and honest about their experiences. I have heard some harrowing stories.

One veteran told me about how his team leader in Iraq attempted to end his own life in front of his family members, and when he survived, he crawled into his bedroom and died in a second, fatal suicide attempt. The veteran who shared this with me could not fathom why the family did nothing to stop him, and he felt hopeless and helpless.

Another veteran told me about how a happy battalion reunion with his fellow veterans ended in tragedy when one of his friends who had been struggling with survivor’s guilt for many years died by suicide. After the reunion was over and they all went home, three more of his fellow veterans killed themselves and another died in a car accident. He said he felt hopeless because it didn’t seem as if anyone or anything could help stop veteran suicides.

The two most common statements I hear from veterans about suicide in the veteran community are that it never ends and that it’s not about if but when it will happen to them. Stories and statements such as these happen too often among veterans, but it doesn’t have to be that way.

Screening for triggers

One of the biggest lessons I learned through my nonprofit work with veterans is that clinicians need to understand what triggers veterans to attempt to take their own life and how to continuously screen for these triggers.

Potential triggers could include the following:

Being reminded of a similar place through smell, sound or sight
Having a history of mental health illness
Losing fellow veterans to suicides or other deaths such as drowning, car accidents or fires
Experiencing the death of family members who were pillars of support
Ending a romantic relationship through breakup, separation or divorce
Feeling hopeless, helpless and like nothing will ever take their pain away
Continuously seeking and being denied help
Facing financial, food or housing insecurities
Being exposed to continuous world tragedies such as pandemics, natural disasters and school shootings
Being in toxic environments where they are emotionally, mentally, physically or sexually abused

Veterans are special people because they signed up to do a job that most people are unwilling to do. Every human being has a breaking point, and it’s up to counselors to ensure that veterans don’t reach their breaking point or to help veterans navigate their lives if they do reach that point.

Nontraditional ways to help veterans

When veterans leave the military community, they often lose their sense of purpose. As I mentioned previously, some veterans found their sense of purpose again by helping Ukrainian refugees or helping train Ukraine’s military to fight Russia.

In my CT Online article “Addressing the Afghanistan humanitarian crisis,” published earlier this year, I referenced Ben (a pseudonym), a former Marine and a personal friend of mine. He worked as a military contractor for 15 years until the United States withdrew from Afghanistan, a withdrawal that caused Ben to struggle with moral injury.

When Russia invaded Ukraine, Ben decided to end his military contracting career to join a group of veterans who served in special operations units prior to leaving the military. Together they deployed to Poland and Ukraine to train individuals in Ukraine’s military and help evacuate Ukrainians who had difficulty leaving.

This new mission gave Ben a renewed sense of purpose, and his feelings of anger, hopelessness and worthlessness over the United States withdrawal from Afghanistan subsided. He also had the opportunity to go into Ukraine at the beginning of the invasion to help evacuate Ukrainians who had physical disabilities. He told me about how he and another veteran helped carry an older woman who was in a wheelchair to safety across the border to Poland. The woman’s son had died recently, and she was the sole caretaker for his four children, all of whom were under the age of 15.

Although carrying an older woman across the border may seem like a small act, her gratitude toward Ben ignited his passion for continued selfless service. It reminded him that he can still utilize what he learned in the military to help people. It was the moment that Ben realized he wasn’t hopeless or worthless. He had skills and a purpose. He went from helping Ukrainians evacuate to training Ukrainian women in hand-to-hand combat and combat triaging. I heard a great sense of pride in his voice as he described these events to me.

Ben’s decision to deal with his anger, hopelessness, worthlessness and suicidal thoughts by helping evacuate and train Ukrainians might not be a traditional form of therapy, but it worked for him just as much as traditional forms of therapy work with civilians.

Counseling veterans often requires a certain level of creativity, especially if traditional therapy is not working. Here are some nontraditional forms of therapy that may help veterans:

Engaging in activities that utilize a veteran’s military occupational specialty
Using adventure/outdoor forms of therapy, such as hiking, cycling, hunting, fishing, whitewater rafting, skiing, snowboarding or surfing
Volunteering with organizations that are built and led by veterans (e.g., Team Rubicon, The Mission Continues, Team RWB, Operation White Stork)
Attending unit/battalion reunions on a regular basis
Using cinematherapy
Incorporating creative arts, including drawing, painting, sculpting, glassblowing, coloring, music and writing
Utilizing an organized battle buddy system
Doing good deeds for others
Attending veteran retreats that are specifically built for veterans struggling with suicidal ideation
Engaging in religious or spiritual activities and rituals

Counselors must take action

The veteran population has always been a population that is underserved. During my fieldwork internship, I worked with veterans who waited months to get appointments with mental health professionals at their local Veteran Affairs clinics. Even veterans who expressed experiencing suicidal ideations were denied services and forced to wait. Most veterans will give up after being denied many times. Some veterans will assess their situation and decide that it is not as severe as other veterans’ problems and will not seek help so that their fellow veterans are serviced first.

As counselors, we must do better. As a community and world, we are better than this. It is up to counselors to uphold veterans’ human rights and advocate for them. This population will always be underserved unless we as a community of mental health professionals come together to serve those who have served us.

Counselors must take action. Veterans deserve to know that they are not alone.

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Related reading, from the Counseling Today archives:

“Suicide prevention strategies with the military-affiliated population”

“Advice for counselors who want to work with military clients”

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Justina Wong

Justina Wong is a second-year new professional currently earning hours toward licensure at a group private practice in California. She serves on the Military and Government Counseling Association’s board of directors and has worked with veterans in the nonprofit community for over 10 years. Justina is also a member of the American Counseling Association’s Human Rights Committee.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Rewriting the client’s narrative through colors

By Jetaun Bailey, Heather Hodge, Beverly Andes, Bryan Gere and CharMayne Jackson September 8, 2022

In our work as counselors and educators, we find that others are increasingly receptive to conversations about color preferences and interpretations during our interactions. It is as if talking about colors creates an entryway for open dialogue, mutual respect and connectivity and encourages all who are present to express authentic and insightful thoughts and opinions. Moreover, we have noticed that there is a connective alliance between these conversations and the continued, open discussions about understanding personality and issues related to mental health.

This process begins by asking a simple question: “What color or colors do you feel reflect your personality?” The individual or participants almost always pause, smile and then say, “Good question.” This practice of starting the discussion with a nonintrusive question creates a calm, safe space for everyone to become curious and explorative and engage in meaningful dialogue before delving deep into a topic about their mental health concerns.

And the answers to this seemingly simple question can be rather complex. The numerous color mixtures and hues we see — and the myriad ways in which we view colors — invokes meaning in our lives. Regardless of cultural background, influential sport teams, seasons of the year or clothing trends, colors have a way of speaking to the individual as well as the collective.

The power of colors

After witnessing the power of color in a staff training, Bryan Gere and I (Jetaun Bailey) first wrote about the psychology of colors in the 2018 Counseling Today online exclusive, “Identifying colors to create a rainbow of cohesion in the workplace for helping professionals.” Since then, we have incorporated colors into our teaching and counseling activities, including classroom discussions, group presentations and individual client sessions, as a unique way to get to know the student or client in a nonintrusive yet welcoming manner.

Recently, the authors of this article used color psychology to help the participants in a process group rewrite their own narratives by using their favorite color. We asked the participants to reconsider their past experiences through the lens of this color. The goal of this exercise was to help them discover what was preventing them from acting as their true selves in the present and to help them learn to move ahead effectively into the future. According to a 2019 article by Benjamin Hardy in Psychology Today, rewriting one’s present and future narratives requires an investigation of one’s past. A person’s outlook on their past narrative affects their present and future narratives, and in turn, their new outlook on the present and future also changes the significance they place on their past experiences.

During this group presentation, one person described her favorite color as pink. After stating this, she seemed uncomfortable and almost apologetic for her answer. And she downplayed her color by saying, “It is a color that symbolizes weakness.” When we asked her to elaborate on why she felt uncomfortable sharing that this was her favorite color, we learned that she also considered herself “weak.”

This discovery led to a deeper conversation on how she defined weakness and its relationship to the color pink. She said that pink is a “girly” color and is associated with being kind and pleasant and not speaking up for oneself. She then told us that she had been unable to advocate for herself and had remained in a broken marriage for years. She had allowed herself to be dominated during her marriage, and as a result, she had low self-esteem. By processing with the other group members, this participant began to understand not only the negative cultural and societal norms associated with the color pink (e.g., frail, timid, overly emotional disposition) but also positive traits such as compassion. This discussion and reframing allowed her to look at pink in a new way, and then she used this new perspective to reframe her thoughts about herself. What she once mistook as a representation of her personal weaknesses, she now realized represented her internal strength of compassion. Thus, her story was rewritten.

Although this color activity was part of a one-session process group, it can be modified and used in regular group therapy as well as in individual sessions. Counselors can also use this activity as a training tool for various organizations. Within a work environment, for example, the color activity would allow employees to learn more about themselves and others within the organization. This insight can be revealed in a nonintrusive fashion that others may not be aware of. I (Jetaun Bailey) once used this activity in a training with a group of university faculty members. One of the faculty members identified with the color gray and associated it with neutrality. She went on to explain how her family life was chaotic, and she found solace in remaining as neutral as possible, which is a trait she had carried over into her work life. This trait led several of her co-workers in the group to express how they had noticed she had perfected the skill of remaining neutral, and although this trait is often considered a positive quality, it sometimes meant she would avoid addressing situations to remain neutral. Asking a nonintrusive question about color allowed the faculty to gain a greater understanding about their co-worker.

Steps for implementing the color activity

The group activity of rewriting one’s narrative through colors involves four sequential steps. During these steps, participants analyze their past using their favorite color, and in doing so, they are able to determine what prevents them from being their authentic self. In turn, this helps them to function more productively in the present and move forward into their future.

Step 1: Connect colors to the client’s personality. Counselors can ask questions to help clients connect the color(s) with what it means about their personality. They can start by asking, “What color or colors do you feel reflect your personality?” While each participant answers the question, counselors should notice their body language or any spoken or unspoken explanations about the color(s), such as the previous example about the participant who closely identified with the color pink. Clinicians can then ask a gentle yet appropriate question about what they observed while the participant was identifying their favorite color. Some participants are forthcoming. For example, a Chinese American who participated in our process group easily connected the color red, which is symbolic in both Chinese and American cultures, to her own struggle with identity. She explained that she had been embracing and respecting one culture while feeling embarrassed by the other.

Step 2: Investigate negative associations with the colors. Counselors should ask group members to identify one or two negative associations with the color(s) they chose and how it relates to past experiences in their lives. In addition, clinicians can ask the other participants in the group to share the negative connotations they may have heard about the color(s). This allows every participant to stay in a neutral zone so that no one feels attacked personally, and it also offers a broader understanding of the various meanings ascribed to colors on the part of different individuals, cultures and ethnicities. As noted by Iris Bakker and colleagues in their 2015 article published in Color Research and Application, a person’s gender, age, education and personality (e.g., being technical, emotional or a team player) affect their color preferences.

Step 3: Investigate the negative associations with specific colors as potential barriers to personal growth. Next counselors can ask clients to consider how the negative connotations associated with the color could be connected to negative feelings they have about themselves as well as how it might have hindered their growth in the past. It can be helpful during this step to self-disclose. Experts say that in small doses, self-disclosure can be a very effective technique. And when used judiciously, particularly in a group environment, it can help build trust, promote empathy and improve therapeutic relationships.

To break the ice during a group session on one occasion, I (Jetaun Bailey) disclosed that red, my identified color, is associated with aggression and impulsivity and that I am a risk-taker. I noted that I often get into trouble because of my impulsivity and risk-taking nature, and that my association with risk-taking being an ill-advised trait, which I learned from my experiences as a youth, often caused me to remain silent around others. Group processing teaches people how to voice their difficulties, and I believe my self-disclosure in this case increased the bond between the group members and myself.

Self-disclosing also works well with clients who appear to be introverted. The participant who identified with the color pink in the previously mentioned example was somewhat apprehensive about sharing this color, which could imply that she may have introverted tendencies. But with the counselor’s and group’s own disclosure and encouragement, she began to express herself more freely.

Step 4: Help the client reframe the narrative. After exploring the negative connotations associated with the colors, counselors can ask each group member to think about positive qualities associated with the same color. For example, they could ask, “Now that you are aware of the negativity linked with the color(s) with which each of you have identified, how might you look at that negativity differently?” This technique, which is a form of cognitive restructuring, helps the participants reframe what they find to be negative and reflect a more positive view of the color.

Clinicians could also have the client replace the negative word associated with the color with its antonym. It may be helpful to provide an example such as how sadness, which is often associated with the color blue, can be reframed by thinking of words that mean the opposite such as hopeful and optimistic. Counselors can then ask each participant to use that antonym or positive word to reconsider how they view their professional or personal lives now as well as how they hope to view it in the future.

The person who identified with pink, for example, used the word “compassion” to reframe how she viewed herself and her marriage experience. This allowed her to see her strength amid the seeming dysfunction of her marriage, build self-awareness and help her understand that her strength lies in her compassion. In turn, the participant indicated that she would use this strength of compassion to regulate her emotions during difficult moments by using soothing, kind and supportive words or messages rather than self-criticism. She noted that decreasing self-criticism would improve her self-esteem as well as her relationships and communication skills with others.

During this step, counselors can use a variety of techniques and modalities in addition to the cognitive behavior therapy technique of reframing. In fact, this step is an excellent time to use the “miracle question” technique from solution-focused therapy. For example, the counselor could say, “The rainbow symbolizes many things in Western society and art such as a sign of hope and better days to come. If that were the case, what miracle would your specific color bring you and why? How would that miracle alter the negative connotations associated with your chosen color(s)?” This approach achieves the solution-focused goal of helping clients rewrite their narratives, which makes it a good substitute for the cognitive behavior therapy technique of reframing.

A mindful approach

This creative approach to rewriting one’s narrative offers inspiration and excitement because it can trigger a child-like curiosity and exploration and disarm tension and the expectation of a stereotypical psychoanalysis. The simple question of “what color(s) best reflects your personality” invites clients to express feeling, emotion and vision, which helps clients break down and deconstruct information into smaller, more manageable categories. Thus, counselors can easily incorporate the mindfulness method throughout this group process.

This question also causes many people to pause and reflect before answering, as though they are engaged entirely in their own mental imagery. The reliance on mental imagery is similar to guided therapeutic imagery, a relaxation technique closely associated with mindfulness. Asking what colors reflect their personality rather than simply asking what their favorite color is requires participants to use an inner sense or senses to elicit sensations associated with the color(s) and consider which color is most closely linked to their personality.

The participants in our process group transitioned into a state of peace and tranquility the instant the question was posed, coinciding with the mindfulness approach of being fully present. In expressing their colors, they contributed to a sense of belonging created by the shared warmth, friendliness and evident understanding of the issue. The participants continued to work with this prompt in the present moment, completely involved in their own and each other’s experiences of the way their colors were manifesting.

Throughout the four steps of this approach, the counselor holds space for mindful listening. They must listen deeply and ask open-ended questions to allow everyone to express their authenticity through their colors, while gaining clarity and knowledge. And they also need to pay attention to verbal and nonverbal communication, especially to each individual’s breathing and physiological expressions. Clinicians should document clients’ comments and suppress clients’ negative self-talk.

Effective mindful listening eventually creates an atmosphere of collective communication, resulting in each participant rewriting their narrative from self-reflection and collective sharing by way of mindful listening. The participant who identified with pink provides a great example of this. She communicated through both verbal and nonverbal expressions that the color pink caused her some uncomfortable feelings, and the other participants were able to help her see the beauty in her color and connect it to her own compassion. The participant was then able to self-reflect and reshape her narrative.

Because each group member brings their own cultural understanding of colors as well as their own color norms and practices with them, the group also gains a comprehensive richness that infuses components of cultural awareness in this activity of rewriting their narratives through colors. Each participant demonstrates cultural understanding by attentively listening to each other’s relationship with a color(s) and indicating how the connections are similar and different from their own. This cultural awareness creates a collective cohesive and appreciation for one another. As a result of this collective communication, a shared sense of culture emerges; the shared experience of discussing their own colors helps them form a community while still embracing each other’s individual identities and unique cultures.

Conclusion

Choosing one’s identifying color and the accurate attributes it holds, as well as the feelings and emotions associated with the thoughts, becomes rich material to work with in the therapeutic setting. Having clients consider the basic question — “Which color(s) do you feel reflect your personality?” — prompts a diverse range of responses and often results in enlightenment. It’s as if sharing colors has some magical or unexplainable way of shifting the discourse or topic in the group’s or individual’s favor. We are often oblivious of the way colors influence our moods, sensations and perceptions. Rewriting our narratives by looking at our interactions with colors from a cultural, personal and biological perspective can teach us something about ourselves, of which we are often unaware.

Africa Studio/Shutterstock.com

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Jetaun Bailey holds a doctorate in professional counseling and supervision and is a licensed professional counselor with supervision status. She is also a college professor and a certified school counselor. Contact her at BaileyJetaun@hotmail.com.

Heather Hodge is a graduate student in the mindfulness-based transpersonal counseling program at Naropa University. Contact her at heather.hodge@naropa.edu.

Beverly Andes is a graduate student in the mindfulness-based transpersonal counseling program at Naropa University. Contact her at beverly.andes@naropa.edu.

Bryan Gere holds a doctorate in rehabilitation counseling and is an associate professor in the Department of Rehabilitation at the University of Maryland Eastern Shore. He is also a certified rehabilitation counselor. Contact him at bryangere23@gmail.com.

CharMayne Jackson is a registered mental health counselor intern in Florida and holds a master’s in counseling psychology with a concentration in clinical psychology and a bachelor’s in psychology. Contact her at charmayne.jack@gmail.com.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The shame of sexual addiction

By Scott Stolarick September 6, 2022

Editor’s Note: This article uses terminology commonly used in the addiction and criminology fields.

Josh is six months sober. He is finally feeling the confidence to branch out and insert himself in a social situation and test the waters. At dinner with some acquaintances, Josh orders a soda much to the surprise of the others. Without much hesitation, Josh discloses that he is an alcoholic and quit drinking. He shares a sobriety coin with the group and receives unbridled support and praise for his courageous journey.

Like Josh, Derek is also six months sober. He is at a social gathering and his friends decide to watch a rather risqué television show that everyone is talking about. Because he is among friends, Derek takes a risk and discloses that he is a sex addict and is not supposed to watch those types of shows because of potential triggers and the risk of relapse. You could hear a pin drop in the room. This reaction caused Derek to regret coming forward with this disclosure, and he awkwardly excuses himself.

These two different reactions to addiction illustrate that not all recovery is created equal. Unfortunately, most laypeople do not know what sexual addiction is much less how to deal with it if it affects them or others they know. Although sexual addiction has received some high-profile exposure with movies such as Don Jon and celebrities Tiger Woods and David Duchovny revealing that they are addicted to sex, the issue still remains foreign to most.

What is sexual addiction?

In his book Out of the Shadows: Understanding Sexual Addiction, Patrick Carnes, an expert on sex addiction and treatment, defines sexual addiction as “any sexually related compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one’s work environment.” This behavior can manifest in a variety of ways, including the overuse of pornography, promiscuity, infidelity, paid sexual encounters and a high frequency of sex (even within a committed relationship).

There are several stereotypes that often come to mind when people hear the term “sex addict.” Sometimes the term is used synonymously with sex offender, and although the two terms can certainly coexist, they can also be mutually exclusive. Many people think a sex addict is that creepy-looking person they tend to avoid, the person who is unsuccessful in pursuit of relationships, the social outcast, the person without means and resources, or the person with the corny pickup lines in bars. And although all of these descriptions could be part of a sex addict’s profile, focusing on stereotypes is an antiquated and closed-minded way of thinking, especially when it comes to understanding sexual addiction.

I treated sex offenders on an outpatient basis for 26 years. If I learned one thing, it was the fact that these individuals came in all shapes, sizes, colors, genders and socioeconomic backgrounds. Often, it was the unassuming person, ostensibly the harmless law-abiding type, who was committing the most heinous crimes. A sex addict can be your “happily married” neighbor, your pastor, a doctor, a lawyer, a man or a woman. Sexual and gender orientation are also not factors that determine sex addiction. In other words, this issue does not discriminate, and neither should we in our attempts to understand and/or treat it.

Twelve-step programs emphasize the need to completely abstain from the identified problematic behaviors, but this philosophy is not as straightforward as it sounds when it comes to sexual behavior. Instead of educating people about healthier sexuality, some recovery movements emphasize complete abstinence of sexual behavior, outside of marriage and committed relationships, which results in extreme pressure and self-imposed guilt and shame. Carnes coined the term “sexual anorexia” to describe the shame-based and unhealthy avoidance of sexual behavior. People often avoid even discussing sex and sexual problems, but this same approach should not be used when clinically treating problems in sexual behavior.

I have mistakenly referred past sex addict clients to support groups in which they were shamed for having sexual thoughts and masturbating. This triggered relapse behavior and a general clinical regression.

While sexual addiction does parallel other forms of addictive behavior, it is also quite different. All people have a libido. Granted this exists to varying degrees, but it is there, and as humans we possess it. Sexual behavior and reproduction rituals also exists in various levels of the animal kingdom. Creatures that can reproduce asexually such as worms also elect to mate with other worms as another reproductive option. Therefore, when approaching the problem of sexual addiction, I believe it is our duty to conceptualize it knowing that sexual desire is a common denominator (at various levels) among both humans and animals. The fact that sexuality is a core part of the human experience explains why categorically it is different from other types of addiction such as alcohol and substance use, gambling, and shopping. Sure, there is a strong argument for genetic predisposition, but not all people are genetically predisposed to addiction. Sexual addiction is not a cookie-cutter issue, so I feel it cannot be dealt with via thought extinction, complete behavioral abstinence and a pathologizing mindset. Later in this article, I discuss some treatment approaches that encompass both the similarities and differences of other addictions.

The mental health profession still struggles with accepting and working to develop agreed-upon diagnostic criteria for sexual addiction. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not acknowledge sexual addiction, but it is hoped that the next version of the DSM will acknowledge the congruence between behavioral and chemical addiction and include sexual addiction as a legitimate diagnosis. In 2014, the American Society of Addiction Medicine, however, recognized sexual addiction as a legitimate addictive disorder. This lack of congruency around sexual addiction demonstrates the barriers that counselors and the public often face when trying to conceptualize sexual addiction.

What are the signs?

Looking at the behavioral manifestation and realizing how the behavior shows up is one important aspect when determining if someone is struggling with a sexual addiction. Understanding what drives the behavior is also crucial. Having said that, I am not professing to have a recipe for recognizing someone with a sexual addiction, but there are telltale signs. Common personality traits seen in sex addicts are obsessive thoughts, impulsivity, shame, depression, maladaptive coping methods for perceived losses of control, poor communication skills, high risk tolerance for sexual behavior and a hyperactive focus on sex. Any one or combination of these traits is often seen in cases of active sexual addiction.

fizkes/Shutterstock.com

Sexual addiction is considered a process or behavioral addiction. Process addictions, which also include excessive shopping and gambling, are marked by a strong desire to engage in behaviors despite the potentially negative consequences. Thus, the elevated mood associated with addictions, albeit temporary, is often viewed as the elixir for troubling life circumstances and unwelcomed thoughts. The addict is vigorously chasing this elevated mood, but the behavior of engaging in the addiction is often followed by intense feelings of guilt and shame. In my work with sex offenders, I often used the term “transitory guilt,” which is a short-lived guilt that is very intense in nature and not manageable to carry around in one’s mind, to describe the offensive cycle of behavior. A myriad of thinking errors or cognitive distortions are used to decrease and eventually eliminate the guilt, thus putting the offender in a position to reoffend. This process is similar to what sex addicts experience, but it is even more accelerated because the actual guilt and shame process decreases in duration throughout the life of the addictive behaviors.

I’m sure many readers are already aware that sexual addiction has a serious impact. I can say without hesitation that it has the potential to be a relationship and life wrecker, and it often does just that. For the addict, sexual addiction can result in relational, legal and financial consequences. It can also cause someone to experience shame, low self-worth, depression and anxiety.

Sexual satiation perpetuates the addictive process by propelling it into deeper and more deviant places. A pornography addict, for example, might “upgrade” to impersonal sexual encounters, and then impersonal sexual encounters may lead to illegal sexual acts, such as voyeurism and exhibitionism. The addict’s objective is to continually seek gratification when the usual sources have lost their luster, so to speak. And pornography use can also complicate one’s ability to become aroused. The degrading and other unrealistic themes depicted in pornography create highly distorted expectations of what should occur within the context of real-life sexual relationships, thus rendering the addict incapable of arousal in those situations. This can also lead to men experiencing pornography-induced erectile dysfunction because the sexual outlets that are supposed to be acceptable and appropriate no longer elicit arousal.

Someone’s sexual addiction can also affect their loved ones, friends and work. The partner of a sex addict, for example, may feel disregarded, betrayed, devalued, replaced, insufficient and so on. If the additive behavior manifests in the workplace, the employer may have to terminate the person because the addictive behavior is affecting their work productivity.

The internet, dating apps and virtual reality have ushered in a new world of opportunities for the sex addict. The saying “a kid in a candy store” has never been more applicable as it pertains to the anonymity, accessibility, variety and cost-free options that technology provides. Not only does television media inundate viewers with a “sex sells” approach to advertising, but the internet provides a wide array of sexual options at one’s fingertips. These factors certainly present added layers in the creation of a solid and effective recovery/treatment plan.

What does treatment look like?

I personally believe that a clinician treating someone with a sexual addiction should have some level of clinical experience in this area. Counselors should not venture into this arena because they think it is interesting or they want to learn along with the client. This could be significantly more harmful than helpful and could lead the client and all those associated with the client down the wrong path. At the very least, a background in addictions or forensic psychology should be a qualification. Counselors can also receive training and specialized certifications in sexual addictions, such as the certified sex addiction therapist program at the International Institute for Trauma and Addiction Professionals, which was founded by Carnes. The bottom line is that if you have zero experience working with this population, you should refer accordingly and seek training if you want to work in this area.

Providing clinical treatment for sex addicts involves first conducting a thorough assessment of the identified circumstances. You must also gather an extensive social history with relevant collateral contacts. Remember, the addict’s point of view is not the only one; family members, friends and other treating professionals may have relevant data to offer. Examining the addict’s personal motivation for change, patterns of acting out, trauma history and other addictive manifestations are other crucial areas of exploration. And for those in relationships, it may be necessary to refer the significant other for services to address their trauma.

Here are some other core clinical strategies counselors can use when working with sex addicts:

Establish the artful balance between engagement and accountability.
Set clear boundaries within the clinical arena. If an addict learns they can manipulate you, they will.
Ask clients to use accountability software on their electronic devices. Obviously, this is not foolproof, but it offers some external control.
Develop allies within the addict’s life system to aid in supporting the treatment plan.
Refer to a psychiatrist for a medication assessment to address anxiety and depression. Psychiatric medications can also act as a helpful libido suppressant while the client develops new skills.
Work with clients to establish definitions of healthy sexual behavior and fantasy.
Help clients develop adequate social skills training.
Integrate bibliotherapy and appropriate support groups as needed.
Be empathetic.

Collaboration within care is important with this population. Make no mistake about it: Treating a sex addict in a vacuum is not clinically recommended. As clinicians, we have to embrace our inner case manager to keep up with the demands of this work.

And remember, we play an important role in helping clients who are struggling with sexual addiction. With counseling, they can learn that sex is not a bad thing and that they can experience it in a healthy way.

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Scott Stolarick is a licensed clinical professional counselor who has been practicing in the state of Illinois for 30 years. He is an experienced administrator and clinical supervisor as well as a seasoned clinician. Scott has management and leadership certifications from the University of Notre Dame and Cornell University. Scott is currently a program director for Arbor Counseling Center in Gurnee, Illinois.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling Today recognized with four awards

The Counseling Today staff won a total of four awards in APEX 2022, the 34th annual awards program recognizing excellence in publishing.

Editor-in-chief Lindsey Phillips received a Grand Award in the COVID-19 media category for her March 2021 feature “How COVID-19 is affecting our fears, phobias and anxieties.” Of the 1,213 entries, only 100 Grand Awards total were presented across 14 major categories.

Senior writer Bethany Bray earned Awards of Excellence in two separate writing categories: one in feature writing for her February 2021 feature “Gone but not missed: When grief is complex” and another in health and medical writing for her August 2021 cover story “Crisis counseling: A blend of safety and compassion.”

The September 2021 issue of Counseling Today was recognized with an Award of Excellence in the category of best magazine, journal and tabloid issue over 32 pages. Among the articles featured in that issue was a cover story on suicidality in children and adolescents.

Counseling Today has been published by the American Counseling Association since 1958. CT staff have received 62 awards for writing, design and website excellence over the past 17 years.