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What do I cover in “Out of Control Sexual Behaviour: A Cognitive Analytic Therapy informed relational approach to assessment, formulation, and intervention.”

Posted: 01/04/2019

This workshop takes place in London on Monday 29th April.  Book at:


And there is another in London on Monday 10th June.  Book at:


Cognitive Analytic Therapy as a relational model of therapy can be applied to aid the understanding of human sexuality and patterns of sexual behaviour that are restricting or harmful. A relational approach to formulating these difficulties invites us to understand how the behaviour fits with our clients emotional and relational world.  We all have characteristic patterns of relating to ourselves and others:  these can be rich clues for formulating the relational drivers of patterns that repeat in your client’s lives. Is your client’s relationship with themselves an affirming or a belittling one?  Are they for the most part critically demanding of themselves in a way that leaves them feeling overwhelmed by the pressure to be perfect whilst feeling that nothing they do is good enough?  It is not hard to see how such a deeply ingrained relationship with self could give rise to difficult states of mind that push someone towards sex and drugs in order to provide a powerful albeit temporary escape or respite from self-attacking or self-pressuring patterns of thinking.

CAT offers us many useful ways of understating how so much of our suffering arises from our view of the self, and the ways others treated us for better or for worse, become internalised as ways we see ourselves.  Paradoxically, the better people’s lives get, the more pressure they can feel to present a good self, so the more they suffer when their self-image is damaged. We can alleviate much of our suffering by temporarily forgetting about ourselves or getting lost.  We can forget about our self in many ways, and sex and drugs are just one.

I would like to suggest that in order to help clients we need to hold in mind the nature of escape.  It is not about a desire to self-destruct.  Apart from the potential to pathologise, this idea misses the central purpose of escape – to limit or stop the patterns of thinking about self that give rise to difficult feelings about self- such as I am a failure, I am unlovable etc.  We need to help clients identify and change relational patterns that give rise to these feelings and assist them develop more helpful relationships with themselves and others, and thereby reduce the need to escape.  In other words, out of control sexual behaviour can represent an attempt to find a solution to some form of vulnerability and to ease the “burden of self “, and the perceived risks of vulnerability, such as the vulnerability of living up to expectations, to be approved of by others, or to be loved and accepted.  As someone once put it:

It’s easy to take off your clothes and have sex.  People do it all the time.  But opening up your soul to someone, letting them into your spirit, thoughts, fears, future, hopes, dreams…that is being naked”.  

To learn more about using CAT’s relational understandings to help support people struggling with “Chemsex” and other sexual activities which have come to feel out of control, join Robert Watson at the second run of this workshop on Monday 29th April in London. Read more and book at:


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