Q: What do you mean by integrative counseling?
A: Rather than treating a part of the client (e.g. mental health), integrated counseling reflects the current trend in healthcare toward treating the whole cliet. Integrative counseling also contains both a theoretical and practical meaning. Theoretically, treating the whole client is the foundation of Mr. Vigorito's clinical approach. Mr. Vigorito views health as the linkage of differentiated systems (integration) of the embodied mind*. Counseling (aka psychotherapy) is a process to help clients honor these different systems while promoting connection, all toward creating a harmony within the client and the client's relationships. From a practical standpoint, integrated counseling involves understanding the client's unique clinical picture (the interplay between and within internal and external systems), developing a comprehensive and, at times, interdisciplinary treatment plan and coordinating care among all healthcare providers.
*The definition of health by Dr. Daniel Siegel, UCLA School of Medicine.
Q: What is out of control sexual behavior (OCSB)?
A: Out of control sexual behavior (OCSB) is a non-diagnostic term used to describe men and women who experience significant difficulties regulating their sexual thoughts, behavior, or urges despite repeated harmful consequences. Harmful consequences may include problems with relationships, occupation, finances, physical and mental health, and drug and alcohol recovery.
Other terms include sexual compulsive behavior, sex addiction and hypersexual behavior. Currently, scientific consensus has not crystalized around one diagnosis or etiological understanding of this problem. However, research does identify an array of interrelated factors that contribute to sexual behavior dysregulation requiring an comprehensive approach for maintaining sexual health.
Through extensive study and treatment experience, Mr. Vigorito co-developed an assessment and treatment protocol in collaboration with Doug Braun-Harvey at the Sexual Dependency Institute. OCSB is defined as a sexual health problem in which an individual's consensual sexual urges, thoughts or behaviors feel out of control.
Q: Who does Mr. Vigorito treat for OCSB?
A: Heterosexual, gay and bisexual men in the DC Metro Area.
Q: Does Mr. Vigorito only treat clients with sexual HEalth Problems?
A: No. Mr. Vigorito provides individual and couple counseling for people concerned with a variety of issues that interfere with life satisfaction. Mr. Vigorito has assisted clients concerned about depression, anxiety and mood disorders, chemical dependency, relationship problems, coming out issues, grief and loss, and sexual dissatisfaction.
Q: How do I know when my sexual behavior is out of control?
A: One basic measure is to ask yourself if you have had limited success stopping the specific sexual behavior that concerns you. Often times, "out of control" describes the feeling people experience with their sexual urges, thoughts and behaviors. If this describe you, you might benefit from discussing your concerns with a sexual health professional.
Q: Are there symptoms I should look for?
A: For many men, their sexual urges, thoughts or behaviors are in direct conflict with their sexual health, their sexual values, or generates problems in various life areas. Symptoms may include:
- Repeated, distressing and intrusive sexual thoughts, fantasies and urges
- Repetitive harmful, embarrassing or humiliating consequences from sexual behavior
- Harboring significant secrets or double life from spouse/partner, family or employer
- Preoccupied thoughts of sex or planning next sexual activity
- Continued sexual behavior despite recurrent negative consequences
- Sexually transmitted infections and unwanted pregnancies (or risk thereof)
- Negative consequences such as problems with relationships, occupation, finances, physical and mental health, and drug and alcohol recovery
Additionally, the assessment process is designed to prevent prematurely labeling thoughts, urges or behaviors as OCSB. For example, sometimes fundamental sexual values conflict between you and your spouse/partner, with your faith or religion, or within yourself. A values conflict is not a symptom of OCSB. Sometimes people are distressed that an aspect of their sexual interest is unconventional. An unconventional turn-on is not an OCSB symptom.
To avoid mislabeling your behavior as OCSB, sexually compulsive or sex addiction, a comprehensive clinical assessment is recommended.
Q: What if I think my sexual behavior is problematic or out of control?
A: For people concerned about their sexual health, Mr. Vigorito recommends scheduling a 50-minute consultation.
People rarely have opportunities to discuss sexual behavior concerns in a safe, respectful and informed environment. At the initial meeting, you have the opportunity to discuss your concerns in a relaxed, confidential setting and ask the questions you want to know to feel confident in your decision. There is no commitment to schedule additional appointments and there will be no charge if we decide to not work together.
Q: How do men with problematic or out of control sexual behavior achieve sexual health?
A: The first step is identifying what is motivating you to change your sexual behavior. Research suggests that change is most effective when it comes from you. Therefore, the consultation always includes questions about what distresses you about your sexual experiences (i.e. your motivation for change) and your vision of sexual health (i.e. your treatment goals)?
Mr. Vigorito clarifies your motivation and goals, evaluates the various factors that contribute to OCSB, and provides recommendations to address your sexual health obstacles. During the consultation, Mr. Vigorito reviews a set of screening criteria that are common sexual health disruptors. If any of those disruptors are present, improvements in those health domains will likely benefit your sexual health and help you regain sexual behavior control.
After the screening criteria are evaluated, a comprehensive sexual health assessment may be recommended. The assessment is designed to help you understand the individual factors leading to OCSB and to develop targeted treatment interventions to address those factors.
Treatment recommendations will address the contributing factors in any of these three areas:
- Strategies to improve your ability to regulate emotional states and sexual urges
- Strategies to change relationship behavior patterns and improve empathy capacity
- Strategies to improve your erotic literacy and integrate your eroticism into your identity and relationships.
Recommendations vary depending on your unique clinical picture. Improvements in these areas can occur through individual and group psychotherapy as well as auxilary services.
At the conclusion of an OCSB assessment, you create a Sexual Health Plan (SHP). Much of therapy focuses on helping you maintain your SHP boundaries and deconstructing the events surrounding your boundary crossings.
Q: What are my treatment options for OCSB?
A: Your options could include:
- Individual therapy
- Group therapy
- Treatment coordination with other treatment providers
- Couples consultation for treatment recommendations and summary
- Referrals to auxilary services include, but are not limited to couple therapy, psychiatric or medical consultations and mindfulness practices
Q: Does Mr. Vigorito also work with people dissatisfied with their sexual functioning?
A: Yes, Mr. Vigorito also works with men dissatisfied with their sexual functioning, including dissatisfaction with sexual pleasure, achieving and sustaining erections and orgasm control. An assessment is recommended to help determine if the contributing factors of your sexual dissatisfaction are biologically or psychologically rooted. Referrals to a sexual medicine provider may be necessary to identify and treat biogenic sexual dysfunction.
Q: Does Mr. Vigorito only treat people concerned about sexual behavior or functioning?
A: No. Mr. Vigorito provides individual counseling for people concerned about depression and anxiety, relationship problems, grief and loss, work and career issues, stress management, addiction and recovery, living with HIV/AIDS and coming out issues. Mr. Vigorito provides psychotherapy for same and opposite-sex couples concerned about intimacy and sexual dissatisfaction, communication problems and conflict resolution.
Q: Does Mr. Vigorito take health insurance?
A: Mr. Vigorito is not an in-network provider with any health insurance company. Mr. Vigorito will submit claims to your insurance electronically so you can receive reimbursement for services based on your out-of-network benefits.
Q: What if I have a question not listed here or would like to schedule an appointment?
A: To schedule a consultation appointment for counseling or request a training, please call (202) 417-7171 or email Mr. Vigorito.