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In this post, I interview Bill Herring, a clinical social worker with a private psychotherapy practice in Atlanta. In addition to providing general psychotherapy services, Bill is a specialist in treating noncriminal problematic sexual behaviors. He’s a former board member for The Society for the Advancement of Sexual Health. He also serves on the editorial board for The Journal of Sexual Addiction and Compulsivity. He has a chapter in a recently-published book on the history of sex addiction field. Finally, he’s been instrumental in the development of a training program for mental health professionals on chronically problematic sexual behavior, which is rolling out in February 2018.

Elevating Sex Addiction Treatment: An Interview with Bill Herrin

Bill: Thanks, Craig. I’m glad to be here. I appreciate you inviting me.

Craig: Yeah. No, man. This is so great. I’m so honored. Not only is Bill all those wonderful things that I said. He’s also a friend, guys. Bill and I go way back. We actually lectured together at The Society for the Advancement of Sexual Health. We talked about media and how sex addiction has been treated in the media. That’s where our relationship started. So glad to have you, man. You recently came up with a framework for categorizing chronically problematic sexual behavior. Tell me about where did that grow? Where did that come from?

Bill: Sure. This is a topic that’s been a passion of mine for quite a while, Craig. I’ll give you a little development about how that progressed for me. Again, for years I’ve worked with people whose sexual behavior has taken them outside their commitments and their value systems or outside of their self-control, outside of sexual responsibility, just really, as you know, engaging in a set of behavior patterns that can cause just tremendous amount of devastation for them and the people who care about them. So, one I have noticed and tried to work around for years is that people can have all these different aspects of their behavior that’s problematic, but if they don’t have loss of control, then they really have difficulty accessing a lot of the services for sex addiction because obviously sex addiction relates to addiction, which relates to pure self-control. I have come to the conclusion over the years, in talking to a lot of people, that not everybody who engages in behaviors that look very similar are necessarily diminished in terms of their self-control.

I mean, some people just do what they do because they do what they do, and they get into a tremendous amount of trouble with that and then when they’re finally ready to get help the question will almost always come down to the fact of are you in control of your behavior? Are you doing this volitionally or are you doing this because something has seized your decision-making ability? Of course, many people will say, “I’m not in control. I’ve tried to correct this. I’ve tried to deal with this on my own, and I can’t do it.” Classic powerlessness and unmanageability. I think that there are some people who have done almost the same things and when you really bare down to them, what they’re describing, and really what they’re demonstrating, wasn’t so much of a lack of control. It was, I was going to say poor control, but even that’s not the word. It’s poor decision making.

So, what do you do with those folks? You say, well, here’s this whole treatment methodology for addiction, compulsion, all the different variants of that, but what do you do with somebody who doesn’t necessarily register very strongly on the addictive or compulsive measures? What I have found is so often people would then wind up sort of saying that they don’t have control so that they could get into the services, so they could go to 12-Step meetings, so they could, which, by the way, I’m sure you agree, I don’t think you have to be an addict to get benefit from 12-Step meetings. I think anybody who lives life could benefit from those principles. Regardless, my struggle for years has been how to not push people into the addiction category just because there’s no other place to put them. That is the first thread that started my whole thinking, and this is really years ago.

Craig: Yeah. Keep going. I love it. Because you’ve been not just part of, but a leader in the evolution of the thinking around this. You’re what I call an elevator. You’re elevating the dialogue. You’re elevating the conversation in a way that’s really helping people. So, guys, we’re getting an inside view really how this has progressed because you’re seeing a movement in many places away even from the language of addiction; problematic sexual behavior, compulsive sexual behavior and that represents an evolution of our thinking. So, keep going. Thread number two.

Bill: It led me to this second one by coming into this organization that I’ve been a part of for years, SASH, where we met, the Society for the Advancement of Sexual Health. When this organization was first founded back in the late 1980’s it was the National Council on Sexual Addiction. Very clearly this was an organization that was put together to deal specifically with that framing of the problem. Within just a few short years it became evident that there were different ways of looking at the same problem that are pretty similar, but not always similar.

The first example of that is compulsion. What is the similarity and differences between an addiction and compulsion. In many people they can be practically synonymous, but to people who really bare down into this there are some slight differences between what you would call an addiction or a compulsion or even something that might be impulsive. So, the organization, National Council on Sexual Addiction, wanted to be more inclusive, so they added the name, this is before I came on board, the National Council on Sexual Addiction and Compulsivity. It started to be a mouthful, but appreciated the opportunity to try to be more inclusive. You know, it’s like the old joke about don’t let the camel get its nose in the tent because as soon as it does a little bit the whole camel’s going to come in.

Once that one name change was put into place it became evident there’s other ways of looking at the issue as well that are not necessarily about addiction or compulsion. Maybe it is an impulse disorder for some folks. Maybe this concept of hypersexuality has been sort of bandied about and how that fits in with some of these other categories and so forth and how it doesn’t. The organization couldn’t just keep putting more names to it, because after awhile they can’t all fit on a business card.

In 2004, the National Council on Sexual Addiction and Compulsivity had what I considered to be a watershed moment and realized that the goal was going to forever be illusive if we try to just find a name that’s going to capture the problem. As we get more advanced we realize in many situations there’s not just a problem. There’s many problems.

And, we do a disservice if we try to pack everybody into one way of looking at something. My concern has often been that if you don’t give people many choices you’re giving them more opportunities to fail.

Because not everything’s going to be one size fits all. So, the challenge for the field has been how to bring all these different visions and voices together toward the common goal, and that’s where the organization flipped from trying to find the problem to looking at the goal, which is sexual health.

So, this is how the Society for the Advancement of Sexual Health sort of came into being. I think that’s a great change. The difficulty had been, for many people, that phrase sexual health was just kind of two words. You know, it sounds good, but it was hard for many people to really lock into what that means. It’s like life, liberty and the pursuit of happiness. That sounds great for everybody, but it can mean something different to many different people.

Craig: Especially when you’re trying to diagnose and treat. These labels and these terms matter. What is the goal? I talk so much about we as men and my clients and the people listening to this podcast that’s got to be the destination. You’ve got to move towards sexual health, and how you define it is unique to you. What’s good for the goose isn’t good for the gander, but that destination is so critical. But, from a clinical perspective what does it mean?

Bill: Well, and that’s where it really becomes interesting, at least to me, when you’re talking about everybody can have their sexual health vision. What works for one person may not work for another and yet at the same time if everybody had a unique sexual health vision, like how are we going to have 300 million sexual health visions in our country?

Seven billion sexual health visions worldwide. There has to be some commonalities between them that we can say no matter what else you can say about the ways that you express yourself sexually, there has to be some parameters that we can look at as being consistent with universal notions of sexual health.

But, as a profession I think in some ways we’re playing catchup and that’s part of what my work has been trying to do is to really, as you say, sort of uplift the conversation and provide some different ways of really bringing a lot of professionals together and I say all that to say, this is another major thread that has come together in my thinking, as I believe you know there are a lot of disagreements among sexuality therapists, sex therapists.

Craig: It’s like politics, Bill, isn’t it? You’ve got your right, you’ve got your left and they’re not talking to each other, and in some cases, you’ve seen it’s demonizing each other. I’ve always kind of not been in the middle, but I’ve had close contacts, as have you, on both sides and you see good people trying to do good things, but really, really convinced that their way is the way, and here come guys along like you who say, “Hey, what can we learn from each other?” Which is why I love you.

Bill: Oh, thank you. I think you made a very apt parallel with politics, just how much it seems to be human nature to polarize and to really reduce problems down to a thumbs-up or thumbs-down, so you get into these really, in my mind, ridiculous reductionist arguments about is sex addiction real or not real. It’s such a nuanced topic that doesn’t yield itself over, in my mind, to very simplistic answers.

Having said that, yes, it’s real. Of course, it’s real. You know, the people, when I hear colleagues who really seem to be unwilling to look at any validity to addiction models or compulsion models or really any model that can say it’s possible for a person’s sexual behavior to take them away from the way that they want to live their life. There are still some holdouts who I don’t think they were ever going to change. I’ve come to respect and empathize with why. I think a lot of sex therapists, just for the nature of the field, came into the field in order to help people to have more satisfying, more expansive sex, but in both the cases the word more is in there. The sex therapy profession was initially founded on helping people get past their hyposexuality, people who had insufficient libido or couldn’t find a way to express themselves sexually. So, lots of sex therapy techniques have historically been about widening the ability for people to feel comfortable about themselves sexually.

Since that’s where they came from it makes sense that another field that comes up and says, “You know, there are limits to sexual freedoms. There are limits and consequences to what we do sexually.” That could seem to some people who are what I call guardians at the gates of sexual freedom, they will look at that and see a wolf in sheep’s clothing.

They will say it’s some puritanical, sex-negative movement that wants to have people just fit into very narrow bandwidth. The argument then dumbs down to people sort of talking past each other. Because of that, and this is to your point earlier, there’s not a lot of talking with each other across the different fields and professions and the different disciplines. There’s an incredible amount of knowledge, strong knowledge base, across all of these different levels of professionals, but we haven’t been talking to each other for a long time in a constructive way.

I think, in part, we have to look back, and I’m talking about people in the sex addiction field, to acknowledge that one of the reasons for that is that our primary initial formulation for “the problem” took a very specific theoretical orientation, which is not just addiction, but this sort of classic addiction that was dragged and dropped from AA and all the different 12-Step movements. So, it very much has had its stamp of 12-Step in the normative paradigm of what does addiction mean, which has worked great for some people, not great for other people and in really lousy ways for others. But, we have come into the world of sexuality professionals, and we’re talking about a theory. At times, in our mind, we’re talking about some thing very much more fundamental than a theory. We’re talking about a fact. Presenting it in the language of a theory, and not everybody that we speak with is going to agree that’s the bottom floor of where to start with.

All of that led to my efforts, really over a number of years now, to try to somewhat change the conversation or at least present a new ability for people to talk with each other that avoids some of these schisms and these buzzwords. As I talked with sex therapists, many of whom looked really suspiciously at the sex addiction model when we were talking about, okay, what do you call this thing? You can’t pretend like there’s not a problem just by saying you don’t like the wording of it. A number of years ago the phrase problematic sexual behavior started to pop up a little bit that I was hearing more. Sex therapists used the phrase, and I even encouraged it. Everybody was kind of agreeing, yeah, this may be a theory-neutral way of talking about what we’re trying to talk about. Now, there’s obviously some issues with the phrase problematic sexual behavior. One is that it’s so generic.

It seems like it just means nothing, you know. Here’s a problem. Is that what you mean by problematic sexual behavior? No. It doesn’t just mean any sexual problem. It’s one reason why I have started to put the word chronically in front of problematic sexual behavior, so you’ll hear me say chronically problematic sexual behavior. Just that puts in this idea that this is an ongoing pattern. We’re not just talking about a few single incidences of problems. We’re not talking about just whether the sex wasn’t good, and that’s a problem. We’re talking about an ongoing pattern of behavior that has problematic aspects. So, then the question becomes, well, what are these problematic aspects?

So, this is how the framework comes to be that you referenced and wanted me to come talk about that. In my research and trying to think this through and consulting with other folks, over time it became apparent to me that most all sexual behavior patterns that we could consider to be problematic boil down to one of five different categories.

Craig: I just want to say I love the categories, and I’m so excited for you folks who are listening, and pay attention to see what category you might fall into because each category, as Bill’s going to explain to us, presents a whole set of questions that can help you dig deeper and understand versus saying, I have sex addiction. I have problematic, I have compulsive. I mean, we could all pick 100 words and they could all fit, but the question for the patient is, okay, what do I do about it? Where do I go with this information? You’re going to help us. Keep going and explain to me those five, because I think it’s a really, really neat way that you laid it out.

Bill: Sure thing. Thank you, Craig, for that, and for actually reading my stuff, because I can tell that you actually read it, so thank you.

Craig: Listen. I like to be prepared, man, because I see already me using this framework to help my guys. Many of my men didn’t connect with the disease-based model for a variety of different reasons, even though there are attributes of it that are helpful and may not have connected with that model and put it together. I’ve got this Mindful Habit System over here, but the way you’ve broken this down is really, really going to help people. Let’ talk about those five categories.

Bill: Absolutely, and then like you say, we can talk about some of the benefits and how to use this in your day-to-day work. Some of them seem pretty obvious if you stop back and think about it. What makes a pattern of sexual behavior problematic? Let’s start with first and foremost any behavior that’s consistently violating your commitments has to be considered problematic.

Craig: Yeah. You’ve made a promise here and you’re not keeping it there.

Bill: That’s it. You make a promise. You make a series of promises and you’re not keeping them, however much you’re going to look at it, that’s problematic. Obviously, the kinds of commitment violations that people can have are maybe they don’t go to work that day or people, as they get more isolated may break social connections, social commitments. People may not be where they’re supposed to be. Those are all commitment violations. Far and away, the most destructive commitment violation is that which happens to a primary partner.

If a person in a relationship with a partner… By the way, let me also say with a partner or partners part of what I have learned to be very sensitive to, especially during the last few years, is the vast range of ways that people can express themselves sexually and that includes not everybody’s monogamous.

So, in some ways when I say, somebody’s breaking a violation with a partner, that will always suggest, well, there’s just one person. I would ask you to please assume that if I use a phrase like partner that could just as easily apply to people who may be in some sort of polyamorous relationship. It doesn’t matter how you’re connected with somebody. It matters what promises you’ve made to that person.

And if you’re violating those promises, especially over and over again, just by it’s very nature, that’s a prime category of what I would call chronically problematic sexual behavior. The second one after commitment violations is what I would call values conflicts.

Craig: I’d just like pause. Like that value conflict, Bill, you see it all the time, and so some of these men, I’m just remembering a LDS client that I worked with that masturbated a few times and watched porn a few times, I’m talking a handful, and in no model, could it be considered chronic or could it be considered addiction, but the universe of therapy where this man goes it was instantly labeled a sex addiction. Of course, that model wasn’t helping him. These occasional slips were exactly these value conflicts. So, yeah, good, so important to make that distinction, and we’ve seen all over how a person’s religious beliefs impact their attitude towards sexuality in such a significant way.

Bill: Well this is, in some ways, a tricky topic, and you pointed out several of the dilemmas around looking at consistent values conflicts as an example of problematic sexual behavior. The primary one being that a values conflict is going to be inherently subjective. If my behavior is conflicting with my values nobody can tell me that it does or doesn’t other than me. It’s my values.

The dilemma I had with this category was trying to bridge the chasm between the idea that, how do I want to put it, people, certainly we all have a right to have our own autonomous values and, at the same time, some people can be raised with values that maybe you and I and someone else can look at and say, well, that value is a repressive value. Somebody who would say that, oh, I don’t know, it’s sinful to play cards. I’m using a silly stereotyped example that doesn’t have anything to do with sex. Most people would look at that and say, there’s nothing inherently wrong with playing cards, but for a person growing up within that it doesn’t matter what everybody says. It matters what works for that person.

When we’re talking about sexual behavior this is the topic where sexual shame can come in I almost want to say masquerading as a value, but the value is very much covered in what could be sexual shame, and maybe somebody from a very traditionally sexually conservative environment in which same-sex behavior, as a classic example, would be inherently sinful, and that person finds themselves engaging in same-sex desire, involved with somebody that way, may have tremendous guilt and values conflicts because of it where even though you and I, somewhat more “enlightened,” may step back and say, well, maybe this person’s values are so restrictive that that’s part of the problem there. That got me to think, on these first two topics, commitment violations and values conflicts, either one of these as examples of problematic sexual behavior, can be changed by altering either the sexual behavior or the non-sexual behavior.

In other words, let’s go back to commitment. The person can stop their behavior that’s breaking the commitment or they can stop the commitment. Values conflicts. The person who’s experiencing a conflict between their behavior and their values, they can either change or modify their behavior or at least conceivably they can change and modify their values. I think what we find in therapy at times is, in talking with people, helping them to unpack some of their dilemmas in that regard, people may be able to start to have shifts in the way that they value themselves, their behavior, many things.

Craig: Masturbation feels like the big fat one here, right Bill? I mean it’s masturbation is a sin, you know, Christianity, Judaism, Islam and in different degrees. In some sects, masturbation is tolerated. Other places it’s a sin. The man may kind of realize that, well, it’s not that bad but the masturbation gets wrapped up with the porn, so there’s a snowball that keeps building and getting worse and worse for the person. Instead of cultivating a healthy relationship with masturbation and separating those two, they’re all wrapped up in causing significant conflict in someone’s life. I can see how something like this, and I like, too, how it’s subjective because it’s got the framework and it goes back to the client. Is it a commitment violation? Is it a value conflict, and that can only come from them versus you projecting yours onto theirs which, of course, isn’t something that we would ever do. Or we try not to.

Bill: Except we do it all the time.

Craig: Yeah, exactly.

Bill: Again, I’ll go back to, let’s talk about sex addiction as the primary sort of ground floor initial way that so many people in our profession were trained and it’s the way so many people who struggle with their sexual behavior, it’s the language that they use, the diction, so I have great respect for that. At the same time, one of my challenges for people who are sex addiction therapists is to be careful not to engage in subtle forms of what’s called confirmation bias, which is if you’re looking for it you’ll see it. Mark Twain’s humorous saying that to a boy with a hammer everything looks like a nail. To somebody who helps somebody and they’ve got a good, strong theory, everything may look like it fits into that theory.

Coming in with questions like, using the framework of addiction can tend to make that category, and I’m going to come right to that in a minute, because that’s the third category, can make that a category almost more important than all of the others. My model tries to level out all five of these categories; the two we’ve talked about and the three we’re about to, so that each of them is an independent characteristic, an independent criterion sufficient unto itself for a person to be able to say, this aspect of my behavior is problematic, come help me without having to get into labels.

What you find a lot. I really try to avoid labels in favor of descriptions. Again, back to the phrase, problematic sexual behavior, as a label you have to sit there and explain what it means. As a description, this is exactly what it is. Somebody’s breaking their valuation, somebody’s having consistent values conflict. How is that not problematic for that person.

So, that’s the description that can lead to all kinds of different theories based upon language that is sort of value neutral. The idea that a sexual problem doesn’t necessarily need a sexual solution is value neutral. It says the person can change their sexual behavior. They can change their commitment or their values. Whatever is reducing the spread between those two is reducing or even eliminating the problematic aspect of that behavior. Whether a person changes themselves sexually or doesn’t, they can get better in the help that they’re looking for. Having said that, let me move on to the other three.

We spent a while talking about the first two. Primarily because of this idea that the sexual or the nonsexual aspect of their life can change to reduce the problematic nature. We’ve established commitment violations and values conflicts. The third is diminished self-control. This is the sex addiction model. This is the compulsive model. This is any time that a person can say or demonstrate behavior that indicates they’re not in full sufficient control of themselves.

And whatever else you can say is problematic. In some ways that’s a very simple category. It’s simple in that we’re accustomed to looking at diminished control as what I would call the gatekeeper symptom. Again, for lots of our codified methodologies you have to be able to turn the key to get into them and diminished control has been that key. 

That’s the entryway. I’m trying to provide five different keys that people can come in and say, I’ve got this combination. I need help. My hope is that in the future this will generate more models and theories that can be based on these different combinations of these five categories.

Let me move onto the fourth and the fifth one.

I talked about values conflicts being subjective and part of what you’ll find in these five categories is some are objective, you know a commitment violation. You’re either cheating or you’re not. Let me back that up.

Values conflicts will be a little more subjective. Diminished control can be both. The fourth category, and I debated a little while for putting this one in, consistent negative consequences. Even if somebody’s behavior is not incompatible with their commitments and even if they’re okay with it and even if it doesn’t represent diminished control, they’re consistently having negative consequences. You’ve got to look at that as a problematic category. No matter what else you can say, unintended pregnancies, sexually-transmitted infections, arrest for pornography and so forth, those are problems however we look at it even if it’s not outside of a person’s values or even if they’re not breaking any commitments and even if they’re not out of control.

My debate with myself for quite a while was that this is the category that seemed almost a little arbitrary, that if two people can engage in the same behavior and one person had negative consequences and the other didn’t, does that mean that this person has problematic sexual behavior and that person doesn’t. I went back and forth with that because I thought, that’s kind of capricious. Then I fell back and said, you know what? Problem is as problem does.

If a person is consistently having negative outcomes, whatever else you can say about their behavior, something has to be different. So, consistent negative outcome.

Craig: One comment on that, Bill. Getting arrested for prostitution. You may be sex-positive. You may be open about this with your partner or whatever hypothetical we can think of, and at the end of the day you’re engaging in behavior that could get you arrested.

Bill: You could lose your job.

Craig: You could lose your job, and reputational harm, depending upon where you are on the newsworthy food chain. I’ve had clients call me with the cameras outside the door of their office because it’s a slow news cycle. From a risk management perspective, having clarity on what those consequences are, is critical. You’re right. I am seeing how each one is a swim lane and there could be multiple in play, but each goes down a path of different inquiry and self-awareness and ultimately addressing the problems and then fixing them. Good. Keep going.

Bill: Yeah. Very good. I’m going to borrow some of that language. That was good. I wanted to take some notes. That was a nice summary, Craig. I appreciate that.

The fifth category is one that, again, I had some internal debate about for quite a while. When I say it, it will show why. The fifth category of sexual behavior patterns that can be considered problematic would involve behavior that violates protective responsibility for other folks. I would call this just basic sexually responsibility. Now, this became tricky. Part of why I went back and forth with this is that the word responsible and responsibility can carry historically a real moral tone to it, especially if you flip it around. What is the opposite of responsible? Irresponsible. It’s hard not to use that word without a really judgmental tone to it, as in you violated an ethical standard. You shouldn’t do that. That’s irresponsible of you, which is absolutely an interpretation that somebody could have, but the need to establish sexual protective responsibility extends past a moral judgement to it, to introducing what is more of a public health perspective.

I’ll stop here to say that so much of what we do in a profession can be put under mental health if you just want to call it some general term. We want people to live more satisfying lives, to be more in touch with themselves, to live more fulfilled, to be happier. All these are sort of internal benefits. Of course, the people around them get benefits too.

That’s the mental health piece of it. A public health approach is not necessarily how one individual can “get better.” It’s how an entire public gets better. How do we help the collective health? What I learned about the concept of sexual health and finally

I can start to roll that concept into this discussion here, is that sexual health can really be seen as a combination of mental health and public health, that both of those are valuable and necessary, but we have, understandably, sort of privileged the mental health part of it and now we’re back to life, liberty and the pursuit of happiness, which is wonderful. There’s nothing in there that counterbalances that to say, are there limits to this. So, just under the surface of sexual health theory, for a number of years, really started at about the beginning of this century in the literature, the phrase responsible sexual behavior started being used just a little bit.

The former surgeon general, David Satcher, really promoted this term a lot at the beginning of the century. It wasn’t really picked up on much by the sexuality fields, and I think for the very reason that I said, that it was looked at a bit as some way of blocking somebody’s behavior because the person that’s looking at it feels that it’s not right. So, that just seems very…subjective.

Actually, what I’ve come to appreciate is that there are some objective markers for sexual responsibility that extend past any cultural setting that a person may live their life in to really cover the entire world and in no cases would these markers be looked at as appropriate. I’ve seen lots of different numbers that say these are all the categories, and I was able to boil them down to basically just three. I like having fewer lists rather than more lists because they’re easier to remember.

I put forward this notion that sexual responsibility has composed itself of just three basic elements:

1) Everybody consents – that’s not just between two people, two or more people who are being sexually involved, but anybody else whose opinion matters. You can’t have two people consent to have an affair when a spouse doesn’t consent. Everybody with a stake has to.

2) Everybody has to be protected from unwanted physical consequences. This is wearing a condom. This is not engaging in behavior that’s likely to result in unintended pregnancies, STDIs, all of that. Everybody has to be protected.

3) Nobody is exploited for another person’s sexual benefit.

Simply, everybody consents. Everybody’s protected. Nobody is exploited.

If you’re meeting those three criteria, I would consider that you are engaging in responsible sexual behavior no matter what else you’re doing because that piece is the piece about responsibility.

Now, that doesn’t mean that you’re not violating commitments or having the values conflicts or any of those other categories. Again, like all of them, this is a standalone category, but one that sort of brings in the idea that all rights need a counterbalance with responsibilities and for sexual health to really be real, for sexual health to be legitimate in any society, the sexual rights of everybody need to be upheld so that I’m not living in a sexually responsible manner if I’m taking your sexual rights away from you by not getting your consent or by not protecting you or by exploiting you for my gains. That is, in and of itself, problematic.

Now, remember earlier we talked about some of these standards are subjective. Like, I feel like I’m violating a value. This is one that I would call a principled standard. This framework that I’ve put together and offer is a combination of subjective, objective and principled categories. I think looking at sexual responsibility has some objective measurements to it, but fundamentally this is a principle that we all need to live by. So, I wanted to go ahead and bring that into this formulation because otherwise people can do whatever they want to do, and if someone else is hurt by it, hey, as long as I’m honoring my commitments and my values are okay I’m scot free. No. We have responsibility to treat others. That’s the five categories. I’ll go over five questions in a minute that I think can be useful in accessing each of these, but you may have some comments.

Craig: Well, I’m so enamored by the concept of consent. For example, even from, take the client who’s oogling and objectifying, sexualizing his neighbor and it’s been fascinating to see them, look at that, wait, I don’t have consent to do that even though some of these other categories, the boxes wouldn’t be checked. I really like how it has this like global bigger component to it; consent, safety and exploitation; three areas where the pornography industry has been heavily criticized.

Even though the stars sign a sheet, in some cases they aren’t consenting. Acts are being engaged in that weren’t agreed to. That’s prolific in the industry. Protected from unwanted physical consequences: Clearly that’s not happening as a matter of industry standards around condom use and then the exploitation. How many instances have you heard of young women and men being exploited by a power dynamic. I’m fascinated with all the different places this can apply to. I just thought of the porn industry by way of example.

Let’s jump into the questions, Bill, and once you’ve gone through that and identified where you might fit in, then there’s these questions.

Bill: The questions, to me, are really, I would almost look at them as just conversational opportunities. My colleague, Doug Braun-Harvey, talks about the importance of having sexual health conversations with clients. I would consider this consistent with that idea of an opportunity to begin to have a conversation about how that person’s sexual health vision, what that is for them and how their behavior is lining up with it. Again, just looking at them as conversational questions, for commitment violations, simply asking, are you keeping your promises? Are you having any struggle with keeping your violating promises? I mean, that’s just the entryway question that can lead into all kinds of discussion about commitments, violations. What’s an overt violation? What’s a covert one? What’s people wanting to know about that people don’t know about? What’s the difference between whether it’s an explicit commitment or an implied one? To assess, to help people start to have conversations around values conflicts, I think just some variation of, are you okay with what you’re doing?

Craig: And do you feel good about it? Do you like it? Are you okay with it? I love it.

Bill: Right. Are you confused with it? Do you have questions? Do you wonder? Does sometimes it feel okay? Did you used to be okay and now you aren’t? Did you used to not and now you do? How does that shift happen? There are all sorts of different ways you can start to drill down into that particular person’s relationship with that topic. For diminished self-control, just basically kind of asking that as a question. Do you feel in control of yourself? Do you feel that you’re making the decisions? Do you feel like they’re starting to make you?

There are 100 questions that can lead into conversations with that. For negative consequences, I just like to say, how’s everything going? Is everything going okay? Not this, this, this, this. Those are negative consequences.

Craig: Any chance you could be arrested by anything that you’re doing?

Bill: Yeah. Exactly. Either what has happened, is happening now, could happen.

For the fifth question about the protective nature of sexual responsibility. When you are engaging sexually are you protecting everyone? In some ways people may have to ask, what is protection mean? I’ve seen some of these formulations of these are what we have to protect people from or help people to have. I have seen the idea that since everybody has a right to experience sexual pleasure that doesn’t mean that everybody has a responsibility to be able to give sexual pleasure to somebody else.

I say that a person could hold all five of these categories, have no problem with that. You could say that they’re not engaging in problematic sexual behavior, their behavior is consistent with the sexual health vision, however that is. That doesn’t mean that the sex is going to be good or that they’re going to attract a partner or keep a partner or know what to do. Any more than if you have good physical health that doesn’t mean that you know how to play tennis. That doesn’t mean that you can run a marathon. It just means that you don’t have these barriers, and once those barriers are removed, then it’s whatever you do with that. In this issue about what are some other sexual responsibility safeguards, I’ve seen some other authors put out I saw honesty as one, that we have a responsibility to be honest to other folks.

I actually chose not to include that in my little three categories in everybody consents, everybody’s protected, nobody’s exploited, because I imagined a situation in which two people may hook up. They have some kind of sexual encounter. Neither one of them is giving their real names because it doesn’t matter to them, etc., and that’s not honest, but neither many times would that be considered inherently problematic, in the same category as somebody being exploited. Once dishonesty lifts up to that level that people are getting exploited, then that behavior is already captured in the exploitation category. It doesn’t have to be, well, you always have to be honest.

Do what you’re going to do. You can’t exploit that other person. Having all these conversations about how are you protecting yourself and other folks goes along with those other four questions to then, I think, resolve in a fairly nuanced and very individualized understanding of what are the different threads of what could be considered problematic in a person’s sexual behavior. In none of this have we ever used a label.

Craig: Yeah. No labels.

Bill: This is not a diagnostic classification system. I’m not trying to put something out here that’s going to compete with sex addiction or anything else because those are theories and this, when I keep using the word framework, means that these are what I would consider the building blocks of how you’re going to build any structure of service for someone else. You’re going to build a building you’ve got to have good material, foundational material, so these are the bricks.

All kinds of theories can be created from this model without having to use any sort of labels. You also notice that this does not say that any particular behavior is okay or not okay except to how it affects those five categories that we’ve talked about. I think this is really crucial because what I have seen a lot in previous assessment tools often have some specific behavior listed.

This formulation we’re talking about here has nothing to do with what anybody does, how often they do it, how frequently, what kind, except to the point that it violates one of those categories. Let me bring it home as to why this is really helpful for me, Craig, in my clinical practice. Like you started off, I see clients throughout the week with these very kinds of issues, and I have come to really value group therapy, especially for men. I don’t have to tell you. We’re so isolated. There’s so little ability to really connect with other men, to go deep. We have all these myths and misconceptions, what I consider a little boy’s version of what a grownup is supposed to be like and then we become adults and wonder why we’re not satisfied. There’s almost no way to talk about sexual ideas and all of that.

Bringing groups together helps so much and the more groups I form, the more people come into them and then nobody wants to leave. Group practice is becoming a large part of what I do here. In every one of my groups I have a mixture of people who identify themselves as sex addicts and people who don’t identify as sex addicts. If you lined up and looked at their behavior, in many ways there is a lot of overlap between their behavior.

There may be just a few distinctions, but in many ways people who self-identify as sexually addicted or people who don’t, it doesn’t matter as long as people can then drop down and get past those labels and say, are you keeping your promises? Are you okay with what you’re doing? Are you in control of yourself? How is everything going? Are you protecting other folks? They come up with answers that are conflicted in all of those areas. They have a right to, I don’t think even a possibility, I would consider they have a right to be able to receive help at the same level as somebody else who would live under a label and would say not just, this is what my struggle is, but I have this; therefore, I am this, and wear that label, as you know.

In my groups, as people are talking for an hour with each other, you would have no ability to pick out, that’s the person who says they’re a sex addict and that’s the person who doesn’t because their behavior is going to look very, very difficult. Because of this, it removes barriers. It really brings people together and they can all learn from each other and leave the labels outside the door. I find that reduces resistance tremendously, because I don’t have to do a lot of work in helping somebody to decide if they’re sexually addicted if that’s not how they’re going to be able to see themselves. All I have to do is help them to see how they’re conflicting with one of these five categories and then they will identify themselves the kind of work they need to do. So, that’s the framework in a pretty long nutshell. There’s lots of other conversations we could have about it, but I’m sure we’re getting close to our time here. I don’t know if you want to hear.

Craig: I do. I just want to say to folks out there who are listening, this is, as Bill said, a framework, and it gives you an opportunity to go through these categories and then ask the follow-up questions to really begin to understand yourself better because this is a way to create that sexual health mission statement and define who it is you want to be.

The debate I hear so often, as you do, which is why you’ve done this, and we’re so blessed to have it, “Well, am I an addict? I’m not an addict. Let me take the quiz. Oh, no, this website says I am. Let me go on another website and take the quiz, and this website says I’m not, and I’m fighting with my wife about it.” It’s like, are you healthy? Are you happy? This just really, really is going to empower people to take it deeper, Bill. I just want to thank you so much, but before we go, if people want to get in touch with you, how do they do that? Are you able to practice with folks or is it just your state only? I want to make sure that if people can reach you, they can, but subject to the rules.

Bill: Thank you, and as you know, that’s an ongoing development about being able to offer services across states. Let me answer it a couple different ways: 1) I’m easily locatable. I’m easy to be reached as long as you can remember the name Bill Herring. Go to It’s going to be my website. My email is simply Basically, you remember me, you can get to me. My practice, understanding, is here in Georgia, to be able to provide ongoing counseling services to people outside of the state. I no longer do that because of some of the still unsettled…

Craig: A little murky in some states, still blurry.

Bill: Here’s the deal. I have no problem if somebody contacted me and wanted to do a little work with me by phone or online, enough to really serve as a consultant, for me to help triage, maybe help a person to get a little cleaner understanding as to what they need to be able to deal with and primarily to help folks find resources local to them that may be useful. I have no problem being the person who can sort of be that, almost like emergency room receiving facility for somebody whose life is falling apart. Absolutely, give me a call. Absolutely contact me. I’ll help in what way I can primarily to get you to a place that you can then do the rest of your work. For short-term work, assessment, consulting and coaching, I can do that, just not the longer-term psychotherapy or counseling.

Craig: Right. Bill, I want to thank you so much for being here. All of our sexual health, everyone listening is elevated because of this conversation. You’ve been elevating this conversation since we first met. That’s why I said to myself, I’ve got to partner with the really smart guy. I mean, I’m a life coach. My life had fallen apart a year before, and I said, that guy’s going places, so I want to present with him and you’ve been elevating the dialogue ever since. I want to thank you for that. We’re healthier because of it. Look forward to having you back. Thank you so much for joining us, Bill.

Bill: Thank you, Craig. It’s a pleasure, and I appreciate the work you do as well.


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