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Clinical Guidelines — v2.1

A NON-COHORT, SHAME-REDUCTION, DENIAL-INTERRUPTION, RELATIONAL-RESTORATION MODEL

FOUNDATIONAL TRUTH: WHAT WE'RE ACTUALLY TREATING

Sex addiction is fundamentally an intimacy disorder—fueled by shame and bulwarked by denial systems.

It emerges from:

  • Disordered attachment (never learning secure connection)
  • Developmental trauma (emotional neglect, abuse, abandonment)
  • Negative core cognitions ("I'm not enough," "I'm not safe," "I don't belong")
  • Relational incompetence (never learning how to connect authentically)

This primary wound leads to chronic self-abandonment:

  • Inability to be present with oneself
  • Inability to self-regulate
  • Inability to tolerate vulnerability
  • Inability to receive love or care
  • Fleeing one's own internal experience

Fueled by shame:

  • Deep belief in unworthiness
  • Terror of being truly seen
  • Conviction that authentic self is unlovable
  • Compulsion to hide and perform

Protected by denial systems:

  • Minimization ("It's not that bad")
  • Rationalization ("Everyone does it")
  • Compartmentalization ("This doesn't affect my real life")
  • Intellectualization (understanding without changing)
  • Fantasy and distortion (rewriting reality)
  • Exceptionalism ("I'm different")
  • Victim stance ("This is happening to me")

Which manifests as:

Trauma reenactment, power/control dynamics, dissociative escape, arousal template distortions, neurochemical hijacking, fantasy addiction, objectification, shame cycles, sexual anorexia, risk compulsion, compulsive sexual behaviors, relational avoidance.

The acting out is the symptom.
Self-abandonment is the mechanism.
Shame is the fuel.
Denial is the bulwark.
Intimacy disorder is the root.

THE TRANSFORMATION WE SERVE

Recovery is not stopping the behavior.
Recovery is the restoration of relational capacity—first with self, then with others.

This program guides clients from:

FROM (Addiction) TO (Recovery)
Self-abandonment Self-presence & integrity
Intimacy disorder Relational capacity
Shame-fueled hiding Vulnerability & authenticity
Denial systems Reality contact & honesty
Loneliness & isolation Connectedness & belonging
Compulsive escape Grounded regulation
Object-based soothing Relational regulation
Fantasy & avoidance Embodied presence
Fragmented parts at war Internal integration
Cotton candy fixes Sustainable nourishment

The aim is not sobriety.
The aim is becoming someone capable of staying present with themselves and others—someone who can give and receive love, tolerate discomfort, and live with integrity.

I. HOW THIS PROGRAM ACHIEVES TRANSFORMATION

This program outperforms traditional residential treatment by directly targeting the three-part structure maintaining addiction:

1. COLLAPSE DENIAL SYSTEMS

Denial prevents truth.
Truth enables choice.

Method: Public exposure of distortions in real-time, adapted to client capacity

2. REDUCE SHAME RAPIDLY

Shame is the fuel.
Shared honesty is the extinguisher.

Method: Collective vulnerability through theme work + relational witnessing

3. RESTORE RELATIONAL CAPACITY

Intimacy disorder is the root.
Connection is the cure.

Method: Tools for self-presence + behavioral activation in real life

Core Advantage:

Clients remain "out in the wild" so distortions, shame, and relational failures surface where they actually operate—in daily life, relationships, stress, and temptation. Recovery is trained where it will be lived.

Additional Mechanisms:

  • Translating awareness into lived behavioral change (awareness without action can become intellectual defense)
  • Training regulation under actual stress (not in controlled environments)
  • Integrating (not replacing) ongoing CSAT therapy (coordinated timeline, one narrative arc)
  • Building capacity to tolerate truth progressively (titrated exposure to reality)
  • Developing loving parent capacity (showing up for inner child)

II. CORE MECHANISM OF CHANGE

Understanding What We're Actually Treating

Addiction is maintained by:

  • Intimacy disorder (the root wound)
  • Shame (the fuel keeping the cycle active)
  • Denial systems (the bulwark preventing truth and change)
  • Self-abandonment (the mechanism of escape)

Recovery accelerates when:

  • Denial is exposed publicly (truth becomes available)
  • Shame is reduced relationally (hiding becomes unnecessary)
  • Self-presence is practiced daily (loving parent shows up for inner child)
  • Awareness is integrated through behavior (insight becomes embodied)
  • Connection replaces compulsion (relational regulation replaces object-based soothing)

Everything in this program serves these core mechanisms. Group structure, daily practices, individual work, and coordination with outside therapists all point toward collapsing denial, reducing shame, and restoring relational capacity.

III. TWO TRACKS OF PROGRESS (EXPLICIT & NON-NEGOTIABLE)

Progress occurs on two parallel tracks, both essential to transformation:

1ïžâƒŁ AWARENESS PROGRESS (Developmental)

This includes:

  • Earlier recognition of denial
  • Clearer naming of distortions
  • Increased emotional precision
  • Less minimization and rationalization
  • Greater honesty with self and others
  • Increased tolerance for truth
  • Recognition of parts (inner child, critical parent, teen, loving parent, witness)
  • Understanding of personal triggers and patterns
  • Connection between present behavior and developmental wounds
  • Capacity to sit with discomfort (even briefly)

This is real progress.

It is:

  • Explicitly named
  • Documented
  • Valued
  • Reinforced
  • Never dismissed

Awareness growth is never dismissed.

2ïžâƒŁ BEHAVIORAL INTEGRATION (Recovery Consolidation)

This includes:

  • Using tools while activated
  • Interrupting urges earlier in the sequence
  • Choosing honesty under stress
  • Following through on values despite discomfort
  • Staying present instead of dissociating
  • Reaching out relationally instead of acting out
  • Showing up for self (loving parent to inner child)
  • Tolerating vulnerability
  • Making esteemable choices
  • Practicing daily structure (DSAP, Kitchen Table, EOD, Gratitude 2.0)
  • Repairing ruptures instead of fleeing

This is where awareness becomes embodied.

Core Distinction

Awareness marks growth.
Behavior marks integration.

One without the other is incomplete—not wrong.

The equation:
1 (awareness) + 3 (behavioral action) = 5 (synergistic transformation)

  • Awareness is necessary (1 point)
  • Behavioral integration is three times harder and more powerful (3 points)
  • Together they create something greater than the sum of parts (5 points total)

Awareness alone can increase pain (seeing what's broken without knowing how to fix it).
Behavior without awareness is white-knuckling.
Together they create sustainable change.

IV. THE CORE RULE (v2.1) — DENIAL CONFRONTATION AS CLINICAL ART

Core Clinical Principle: Denial Work is Central

Denial operates in every session, often subtly. Your primary clinical task is staying attuned to it and calling it out appropriately. This doesn't mean every session requires dramatic confrontation—it means you're always tracking distortion and addressing it in ways that match client capacity.

Awareness is honored as developmental progress—never dismissed. AND the client needs to be coached toward behavioral solutions and commitment to these as soon as their system can handle it. Your skill is holding both: honoring the awareness while securing commitment to specific behavioral change in a way that respects capacity and state.

Recovery consolidates when awareness is integrated through behavior. Awareness without action can become intellectual defense.

The art is knowing when, how, what, and with whom to confront. This section will help you develop that discernment.

WHAT "CONFRONTING DENIAL" ACTUALLY MEANS

Denial operates on multiple layers simultaneously:

Layer 1: Surface Distortion (Conscious but defended)

  • "It's not that bad" (minimization)
  • "Everyone does it" (normalization)
  • "I'm different" (exceptionalism)
  • "I'll handle it differently this time" (fantasy)

Layer 2: System Protection (Unconscious defensive structure)

  • Intellectualization (understanding to avoid feeling)
  • Compartmentalization (this doesn't touch my real life)
  • Dissociation (I wasn't really there)
  • Victim stance (this is happening TO me)

Layer 3: Core Shame Defense (Protecting the wounded self)

  • "If I'm really seen, I'll be abandoned"
  • "I can't tolerate what's underneath this"
  • "The truth will destroy me"
  • "I have to perform or I'm worthless"

Layer 4: Trauma Response (Survival mechanism, not resistance)

  • Freeze/shutdown when confronted
  • Hypervigilance to criticism
  • Fight response to truth
  • Fawn/people-pleasing to avoid conflict

As you work with clients over time, you'll become more skilled at:

  • Identifying which layer is active
  • Assessing capacity for truth at this moment
  • Choosing confrontation method accordingly
  • Distinguishing defense from incapacity
  • Knowing when regulation must come before confrontation

CLINICAL DECISION TREE: WHEN & HOW TO CONFRONT

ASSESS FIRST:

1. What is the client's current state?

  • Regulated enough to receive truth?
  • Dysregulated and needing co-regulation first?
  • Defended but reachable?
  • Dissociated/frozen and needing grounding?
  • Shame-spiraling and needing containment?

2. Which part is speaking?

  • Inner child (terrified, needs safety first)
  • Critical parent (attacking self, needs interruption)
  • Teen/addict (defending the behavior, needs loving confrontation)
  • Intellectualizer (bypassing feeling, needs somatic grounding)
  • Performer (trying to please therapist, needs permission to be real)

3. What is the system's tolerance for truth right now?

  • Can handle direct confrontation?
  • Needs exploratory questioning?
  • Requires side-door approach?
  • Benefits from group witnessing?
  • Needs one-on-one safety?

4. What is the therapeutic goal THIS SESSION?

  • Build capacity for truth (regulation practice)
  • Expose specific distortion (denial collapse)
  • Bridge to behavior (activation)
  • Repair rupture (reconnection)
  • Validate developmental progress (awareness honoring)

đŸ”„ PARAMOUNT (but requires ongoing development):
Making every attempt to distinguish incapacity from avoidance is what creates therapeutic bond and helps the client feel truly seen and understood. Use consultation with clinical lead, review client screenings, and discuss with their outside therapist to inform your assessment. This is one of the most important clinical skills you'll develop here.

CONFRONTATION METHODS (MATCHED TO CLIENT STATE)

You'll find your own style within these six methods. Some will feel more natural to you than others. The goal is developing range—knowing you have options and can adapt to what each client needs in each moment.

METHOD 1: DIRECT CONFRONTATION (For defended but stable clients)

"That's bullshit and you know it. What's actually true?"

You'll develop a feel for when direct confrontation lands as loving firmness vs. shaming attack. The difference is in your presence, not just your words. As you work with clients over time, you'll know who can receive this and when.

Consider using when:

  • Client is regulated enough to receive challenge
  • Safety in the relationship has been tested and held
  • Client is using a familiar defense intellectually
  • Directness will cut through faster than exploration

Reconsider or adapt when:

  • Client is fragile or newly disclosing difficult material
  • Trauma response is active (freeze, flight, fight, fawn)
  • Shame spiral is already occurring
  • Trust hasn't been established or was recently ruptured

This method requires good attunement. If you're uncertain, consult in supervision—we'd rather you check in than guess.

METHOD 2: EXPLORATORY CONFRONTATION (For defended but fragile clients)

"I notice you're explaining a lot right now. What are you protecting yourself from feeling?"

Consider using when:

  • Client is intellectualizing
  • Client needs help identifying the defense
  • Client is disconnected from emotional truth
  • Curiosity will serve better than directness

Reconsider or adapt when:

  • Client needs direct naming instead
  • Exploration becomes another bypass
  • Time-sensitivity requires directness

METHOD 3: PARTS-BASED CONFRONTATION (For fragmented/dissociated clients)

"I'm hearing your teenager right now defending the acting out. Can we hear from your inner child? What does he actually need?"

Consider using when:

  • Multiple parts are in conflict
  • Teen/addict part is running the show
  • Inner child needs voice
  • Integration is the goal

Reconsider or adapt when:

  • Client isn't familiar with parts language yet
  • Would create more fragmentation
  • Client needs unified presence first

METHOD 4: SOMATIC CONFRONTATION (For dissociated/intellectualized clients)

"Stop. Come into your body. What's happening in your chest right now?"

Consider using when:

  • Client is living in their head
  • Intellectualization is the primary defense
  • Client needs embodiment to access truth
  • Stories are bypassing feeling

Reconsider or adapt when:

  • Body is unsafe due to trauma history
  • Client needs cognitive framework first
  • Somatic work would destabilize

METHOD 5: RELATIONAL CONFRONTATION (For defended attachment wounds)

"You're performing right now. You're trying to be a good client. I don't need that. I need you real, even if it's messy."

Consider using when:

  • Client is people-pleasing
  • Performing "good recovery"
  • Hiding authentic self
  • Needs permission to be imperfect

Reconsider or adapt when:

  • Would trigger abandonment terror
  • Client isn't ready for that vulnerability
  • Relationship hasn't been tested yet

METHOD 6: SILENT CONFRONTATION (For shame-defended clients)

[Sustained eye contact. Silence. Presence.]

Consider using when:

  • Words create more defense
  • Client needs to feel seen without judgment
  • Silence invites truth
  • Presence is the intervention

Reconsider or adapt when:

  • Silence feels punitive
  • Client needs verbal scaffolding
  • Cultural context makes silence uncomfortable

THE AWARENESS-TO-ACTION BRIDGE (NUANCED)

The question is NOT always: "What did you do differently?"

The question adapts to capacity:

For High-Capacity Clients (Stable, regulated, aware):
"Given that awareness, what did you do differently?"

  • Expects behavioral follow-through
  • Appropriate pressure
  • Integration is accessible

For Medium-Capacity Clients (Aware but struggling):
"What is the next smallest action your system can tolerate?"

  • Honors current limits
  • Builds capacity gradually
  • Doesn't demand what isn't available

For Low-Capacity Clients (Newly aware, fragile):
"You saw it this time. That's the first step. What would support you in staying present with that awareness?"

  • Awareness IS the work right now
  • Premature action demand would create shame
  • Building tolerance for truth comes first

For Trauma-Response Clients (Freeze, flight, fight):
"Your system is protecting you right now. Let's regulate first. Then we'll talk about what's next."

  • Regulation before integration
  • Co-regulation before solo action
  • Safety restores capacity

For Defended/Resistant Clients (Intellectualizing, minimizing):
"I hear you explaining. What are you avoiding doing?"

  • Cuts through the bypass
  • Names the defense as avoidance
  • Firm but not shaming

NO ACTIVATION ≠ FAILURE (BUT IT REQUIRES ASSESSMENT)

When a client has awareness but no behavioral follow-through, assess whether this is:

✅ Unfinished integration (awareness present, capacity building, action coming)

  • Client is working toward it
  • System is digesting truth
  • Regulation practice is happening
  • Next session will build on this

❌ Active avoidance (awareness present, capacity available, choosing comfort)

  • Client is intellectualizing
  • "Understanding" is the hiding place
  • No evidence of discomfort tolerance
  • Pattern of awareness without change

✅ Trauma freeze (awareness overwhelming, nervous system shutdown)

  • Client wants to act but can't
  • Genuine incapacity, not resistance
  • Needs co-regulation and titration
  • Integration follows capacity building

❌ Entitlement/resistance (awareness rejected, defending the addiction)

  • "I don't think I need to change that"
  • "That's not really my issue"
  • Minimization disguised as clarity
  • Needs loving confrontation

✅ Developmental appropriateness (early stage, awareness itself is massive)

  • First time seeing the pattern
  • Overwhelmed by what's being revealed
  • Integration is premature
  • Stabilization comes first

Your assessment informs your response. Document your thinking—it helps track patterns over time and supports our case review discussions.

CLINICIAN COMPETENCIES REQUIRED

To apply this approach with sophistication, you'll develop the ability to:

Read dysregulation in real time

  • Identify fight/flight/freeze/fawn
  • Know when to regulate before confronting

Distinguish parts and their motivations

  • Recognize which part is speaking
  • Engage the part appropriately

Assess shame vs. resistance

  • Shame needs containment
  • Resistance needs confrontation
  • Confusing them causes harm

Titrate truth exposure

  • Too much = retraumatization
  • Too little = collusion with denial
  • Right amount = growth edge

Track capacity over time

  • What was this client capable of last month?
  • Is this stagnation or consolidation?
  • When does support become enabling?

Tolerate your own discomfort

  • Can sit with client's pain without rescuing
  • Can confront without becoming the critical parent
  • Can hold both truth and compassion

These competencies develop with practice, supervision, and honest reflection on what's working and what isn't. Bring your questions and uncertainties to case review—that's where real learning happens.

THIS APPROACH GOVERNS:

  • Group facilitation (reading the room, choosing which denial to name, knowing who can handle what)
  • Individual sessions (adapting confrontation to real-time state)
  • Homework review (distinguishing incapacity from avoidance)
  • Progress evaluation (tracking movement vs. stagnation with nuance)

V. DAILY PRACTICES (BEHAVIORAL SPINE OF THE PROGRAM)

These practices exist to:

  • Interrupt denial before acting out
  • Train self-presence
  • Develop loving parent capacity
  • Create evidence of showing up
  • Build regulation tolerance

đŸ”„ NON-NEGOTIABLE:
These practices are not optional extras. They ARE the behavioral integration. Without them, clients have no tool to reach for when urges hit, no evidence they're showing up, and no way to interrupt the cycle before acting out.

1ïžâƒŁ KITCHEN TABLE — DAILY (5–10 minutes)

Purpose: Parts-based honesty + regulation

Method: Brief written check-in using five parts:

INNER CHILD
What am I feeling? What do I need?

  • Fear, sadness, loneliness, joy, excitement
  • Raw emotion without explanation
  • Needs: safety, presence, connection, play

CRITICAL PARENT
What am I telling myself? How am I shaming myself?

  • "You're pathetic"
  • "You'll never change"
  • "You're going to lose everything"
  • Identifies the attack, doesn't believe it

TEEN / ADDICT
What do I want to do? What's my escape plan?

  • "Fuck it, I'm acting out"
  • "Just one more time"
  • "I deserve this"
  • Names the urge without judgment

LOVING PARENT
What does my inner child actually need? How can I show up?

  • "You're scared. That makes sense."
  • "Let's take three deep breaths together."
  • "You're not alone. I'm here."
  • Offers what's actually needed

WITNESS
What's actually true here?

  • Observes without judgment
  • Names reality
  • Holds perspective
  • "This is hard AND you're doing the work."

When clients use it:

  • Before reaching out for support
  • Before acting out (interrupts the cycle)
  • When dysregulated (regulation tool)
  • Daily check-in (maintenance)
  • After a slip (reality contact)

Counts as behavioral activation when:

  • It interrupts an urge
  • It delays acting out
  • It increases presence under stress
  • It replaces isolation with self-connection
  • It's done BEFORE reaching out (self-responsibility first)

đŸ”„ NON-NEGOTIABLE:
Kitchen Table BEFORE support call.
Teaches self-regulation before co-regulation.

Note: Clients can extend Kitchen Table to include back-and-forth dialogue between parts if that deepens the work. Otherwise, the structure remains as described.

2ïžâƒŁ DSAP (Daily Spiritual Action Plan) — DAILY MORNING (≈5 minutes)

Purpose: One day at a time plan for integrity—the opposite of self-abandonment

A plan for intentional action aligned with core values.

The Hierarchy:

1. SPIRIT / RECOVERY / LOVE (Without which life loses meaning)
What demonstrates this matters to me today?

Examples:

  • Meditation (even 5 minutes)
  • Meeting attendance
  • Sponsor call
  • Prayer practice
  • Recovery reading
  • Gratitude practice

2. SELF-CARE (Tending to mind and body entrusted to us for service)
What keeps my instrument functional?

Examples:

  • Take medication
  • Three balanced meals
  • Hydration (track it)
  • Sleep before 11pm
  • Exercise (appropriate intensity)
  • Hygiene
  • Medical appointments

3. SERVICE (Being of service to family, friends, community)
How do I show up for those I love?

Examples:

  • Quality time with kids (no phone)
  • Connect with partner (ask about their day)
  • Reach out to friend
  • Organize shared space
  • Help without being asked
  • Listen without fixing

4. WORK (Making a living, supporting family, education)
What moves me toward self-sufficiency?

Examples:

  • Client sessions
  • Job applications
  • Study for certification
  • Complete project
  • Professional development
  • Skill building

The Method:

  1. Write 2-3 items per category (reasonable, not stuffed)
  2. Put an asterisk (*) next to the one you dread most = "FIST BUMP"
    • This is the highest-leverage item
    • Changes the entire day when done first
    • Usually the thing you're avoiding
  3. Do the Fist Bump first if possible
    • Builds momentum
    • Reduces anxiety
    • Proves you can do hard things
  4. When life happens: SUBSTITUTE, DON'T STUFF
    • No cramming/adrenalizing
    • No "time-stuffing" to achieve more
    • Realistic adjustment, not self-abandonment
  5. Aim for 70%, not perfection
    • Progress, not perfection
    • Showing up matters more than completing
    • Some structure beats perfect structure

The Evidence:

Creates proof someone is showing up (loving parent for inner child). Stacks of completed DSAPs become evidence against "you're a piece of shit" thoughts. Shows pattern of integrity over time. Physical artifact clients can hold when monkey mind attacks.

3ïžâƒŁ GRATITUDE 2.0 — DAILY (3–5 minutes)

Purpose: Shift perspective; feel actual gratitude (not perform it)

The problem with traditional gratitude lists:
They're intellectual. You write words. You feel nothing. It's performance.

Gratitude 2.0 method:

  1. List 3-4 things you're genuinely grateful for

    • Supportive partner
    • Your health
    • Your kids
    • Transportation
    • Best friend in recovery
    • Home

  2. Choose the one that would hurt most to lose

  3. Close eyes and visualize life WITHOUT it for 2-3 minutes

    • What would mornings be like?
    • What would you have lost?
    • How would you feel?
    • Really go there (it's uncomfortable)

  4. Sit with the loss

    • It may take 90 seconds to actually access it
    • Your brain will resist (too painful)
    • Keep coming back to the image
    • Feel it in your body

  5. Snap back to reality: You still have it

    • Notice the shift
    • Relief
    • Actual gratitude (felt, not thought)
    • Perspective change
    • Value becomes visible

Why it works:

"This is a perception problem." Loss makes value visible. Embodied gratitude (not intellectual listing). Interrupts entitlement. Trains appreciation.

4ïžâƒŁ EOD (End of Day Review) — DAILY EVENING (≈3 minutes)

Purpose: Collapse narrative rewriting; maintain reality contact

The problem:
Addicts rewrite history.
"Today was fine" when it wasn't.
"I'm doing great" when you're struggling.
"That didn't really happen" when it did.

EOD prevents this.

Questions:

  1. What actually happened today?

    • Facts, not interpretation
    • Honesty, not performance

  2. Where did denial show up?

    • Did I minimize something?
    • Did I rationalize?
    • Did I avoid something I said I'd do?

  3. Did I use tools?

    • Kitchen Table?
    • DSAP?
    • Reached out?
    • Regulated myself?

  4. Did I avoid anything?

    • A conversation?
    • A feeling?
    • A commitment?
    • Reality?

  5. Where did I show up? Where did I abandon myself?

    • Both are true most days
    • Name both honestly

Why it works:

  • Prevents moral licensing ("I did great, so I deserve to act out")
  • Interrupts fantasy ("Today was fine") when it wasn't
  • Builds pattern recognition
  • Creates accountability to self
  • Maintains reality contact
  • Prevents tomorrow's denial

VI. WEEKLY HOMEWORK (INSIGHT GENERATION)

FACING THE SHADOW (FTS) WORKBOOK — WEEKLY

Structure:

  • Completed privately
  • Different clients work different chapters (non-cohort model)
  • Written submission required
  • đŸ”„ FIRE-LEVEL REQUIREMENT: Submitted 48 hours before Group A (allows processing time)

Purpose:

  • Extract denial
  • Surface distortion
  • Expose avoidance and shame
  • Generate self-awareness
  • Create material for group processing
  • Identify patterns

Chapters cover:

  • Sexual history
  • Trauma inventory
  • Relationship patterns
  • Acting out cycles
  • Arousal templates
  • Shame sources
  • Attachment wounds
  • Consequences inventory
  • Values clarification
  • Recovery vision

Critical distinction:

FTS generates awareness.
It does NOT, by itself, constitute recovery progress.

  • Writing about your patterns ≠ changing your patterns
  • Understanding your trauma ≠ healing your trauma
  • Identifying your triggers ≠ managing your triggers

Awareness must be followed by behavioral integration.

How FTS is used in treatment:

  • Group A: Processes selected sections for meaning-making and shame reduction
  • Individual sessions: Explores material for pattern recognition
  • Progress tracking: Documents awareness gains

đŸ”„ FIRE-LEVEL REQUIREMENT:
Process FTS work regularly. Always prioritize the 2 clients who haven't had their work processed in the longest time. Clients are paying for processing and meaning-making, not just submitting work into a void.

FTS is the excavation.
Daily practices are the construction.

Both are required.

VII. NON-COHORT GROUP MODEL

This program is not cohort-based.

Traditional cohort model:

  • Everyone starts together
  • Everyone does the same work
  • Everyone moves at the same pace
  • One person's resistance slows the group
  • Artificial timelines

Return 2 Intimacy model:

  • Clients enter at different times
  • Clients work different FTS chapters
  • Clients are at different developmental stages
  • Individual pace honored
  • Real-time application

Clients differ in:

  • Trauma history
  • Stage of recovery
  • Workbook chapters
  • Personal themes
  • Behavioral capacity
  • Denial sophistication
  • Regulation ability

They are unified by one invariant focus:

đŸ”„ DENIAL & COGNITIVE DISTORTION

Every group, every week:

  • One distortion is named by facilitator
  • Everyone must locate themselves inside it
  • No one hides behind "I'm working on different stuff"
  • Shame is reduced through shared exposure
  • Awareness is bridged to action (capacity-appropriate)

This creates:

  • Collective honesty
  • Shared vulnerability
  • Mutual witnessing
  • Shame reduction through exposure
  • Pattern recognition across different content

Example:

Three clients working on different chapters all locate themselves in "minimization" this week:

  • Client A: Minimizing impact on kids
  • Client B: Minimizing financial consequences
  • Client C: Minimizing slip as "not that bad"

Different content.
Same distortion.
Shared exposure collapses shame for all three.

VIII. REQUIRED GROUP COMPONENT (ALL GROUPS)

đŸ”„ DENIAL → AWARENESS → ACTIVATION SEQUENCE

Approximately 15–20 minutes in every group session

This sequence is where shame dies and truth lives. It's the primary mechanism for denial collapse and shame reduction.

STEP 1: DISTORTION NAMED

Facilitator names one active distortion operating in the room this week.

Common distortions:

  • Minimization ("It's not that bad")
  • Rationalization ("Everyone does it," "I had a hard week")
  • Entitlement ("I deserve this after what I've been through")
  • Intellectualization ("I understand why I do it, so I don't need to change")
  • Compartmentalization ("This doesn't affect my marriage/work/real life")
  • Victim stance ("This is happening TO me," "I can't help it")
  • Fantasy ("It'll be different this time," "I can control it")
  • Exceptionalism ("My situation is unique," "The rules don't apply to me")
  • Spiritual bypass ("God will fix this," "I'm praying about it")
  • Comparison ("At least I'm not as bad as ___")

Facilitator chooses based on:

  • What showed up in FTS submissions
  • What's happening in the room right now
  • What the group needs to face
  • What's being collectively avoided

As you gain experience, you'll develop instincts for which distortion will land most powerfully for the group in that moment.

STEP 2: FORCED SELF-LOCATION (Everyone speaks)

Each client completes one sentence out loud:

"This distortion showed up for me this week when _____."

Rules:

  • No story
  • No explanation
  • No fixing
  • No "I don't think I do that"
  • Just the moment of recognition

Examples:

Minimization:
"This distortion showed up for me when I told my wife the slip was 'just looking' and left out that I paid for content."

Rationalization:
"This distortion showed up for me when I said I was too tired for my DSAP but spent two hours gaming."

Victim stance:
"This distortion showed up for me when I blamed my acting out on my wife not being sexually available."

Intellectualization:
"This distortion showed up for me when I explained my triggers to my therapist instead of using my tools."

Purpose:

This is public exposure of denial—the primary shame-reduction mechanism.

When everyone names their denial out loud:

  • Shame loses power (it thrives in hiding, dies in light)
  • Truth becomes collective (not isolating, universally human)
  • Defenses become visible (can't hide in "understanding")
  • Performance ends (everyone is messy, no one is special)

The magic:
Saying it out loud to witnesses who are also saying it.
Shared confession.
Collective honesty.
Mutual vulnerability.

This is why group works when individual doesn't always.

STEP 3: AWARENESS VALIDATION

Facilitator explicitly acknowledges clarity where present.

Examples:

  • "That's a clear naming."
  • "You saw it faster this time than last week."
  • "That's real awareness—you're tracking the pattern now."
  • "Notice how quickly you caught that. That's growth."

Purpose:

  • Honors developmental progress
  • Reinforces that seeing the distortion IS the work
  • Prevents shame about having the distortion
  • Validates movement

This is critical. Clients must know that awareness is progress, not failure.

If they feel ashamed of SEEING the pattern, they'll stop looking.
If they feel celebrated for seeing it, they'll keep looking.

STEP 4: ACTIVATION BRIDGE

Facilitator assesses capacity and asks accordingly:

For high-capacity clients:
"Given that awareness, what did you do differently?"

For medium-capacity clients:
"What is the next smallest action your system can tolerate?"

For low-capacity clients:
"You saw it this time. That's the first step. What would help you stay present with that awareness?"

For trauma-response clients:
"I'm noticing you're frozen right now. Let's regulate first, then we'll talk about what's next."

For defended clients:
"I hear you explaining. What are you avoiding doing?"

Possible responses:

✅ Behavioral activation present:

  • "I used Kitchen Table before calling my sponsor instead of white-knuckling."
  • "I told my wife the truth even though I was terrified she'd leave."
  • "I didn't act out—I just sat with the urge for 10 minutes and it passed."
  • "I reached out to the group instead of isolating."
  • "I admitted to my CSAT that I'd been lying about my slip."

✅ Awareness consolidating (integration coming):

  • "I haven't done anything yet, but I know I need to tell my wife the full truth."
  • "I'm too scared to act, but I'm not denying that I'm scared anymore."
  • "I can see what I need to do. I'm building toward it."

❌ Intellectualization (awareness as avoidance):

  • "I understand why I do this because of my childhood trauma, so I'm working on that in therapy."
  • "I've been thinking a lot about this pattern."
  • "I'm really getting clear on my triggers."

(Facilitator: "That's understanding. What have you done differently?")

❌ Active avoidance:

  • "I don't think I need to do anything about that yet."
  • "That's not really my main issue."

(Facilitator: "That's denial. We just named it. Try again.")

If no activation:

This is unfinished integration, not failure.

Facilitator assesses:

  • Is this incapacity (needs more time/support)?
  • Is this avoidance (needs confrontation)?
  • Is this trauma freeze (needs regulation)?
  • Is this developmental stage (awareness itself is the work right now)?

Response depends on assessment.

The bridge has been built.
The work continues.

IX. GROUP ROLES (CLEARLY SEPARATED)

GROUP A — PROCESS & MEANING

90 minutes weekly

Purpose:

  • Shame reduction through collective vulnerability
  • Distortion collapse through public exposure
  • Meaning-making (connecting past to present)
  • Emotional truth (accessing what's underneath)
  • Relational restoration (learning to be seen)

Structure:

1. Denial → Awareness → Activation Sequence (15-20 min)

  • Facilitator names distortion
  • Everyone self-locates
  • Awareness validated
  • Bridge to behavior offered

2. Selected FTS Processing (30-40 min)

  • Choose high-impact sections from submissions
  • đŸ”„ FIRE-LEVEL: Always prioritize the 2 clients who haven't had work processed in longest time
  • Explore for pattern recognition
  • Connect developmental wounds to current behavior
  • Surface shame for collective witnessing
  • NOT excavation—that's CSAT's job
  • Focus: How does this pattern operate NOW?

3. Regulation Practice (20-30 min)

  • Kitchen Table demonstration
  • Guided meditation (box breathing, loving parent/inner child)
  • Parts work
  • Somatic grounding
  • Tool rehearsal while regulated (so it's accessible when dysregulated)

4. Integration Check (10 min)

  • What are you taking from today?
  • What's your fist bump for the week?
  • What's one small action available to you?

Does NOT include:

  • Tool teaching (that's Group B)
  • Deep trauma processing (that's CSAT therapy)
  • Problem-solving (that's Group B)
  • Reassurance (recovery lives in discomfort, not comfort)

Tone:

  • Confrontational when necessary
  • Compassionate always
  • Focused on truth and presence
  • Willing to sit with pain
  • No rescuing

Facilitator's role:

  • Read the room (who can handle what right now)
  • Choose which denial to name
  • Assess capacity in real-time
  • Regulate when needed
  • Confront when needed
  • Model vulnerability
  • Hold both truth and compassion

GROUP B — INTEGRATION & PRACTICE

90 minutes weekly

Purpose:

  • Behavioral activation
  • Tool implementation
  • Accountability with evidence
  • Skill rehearsal
  • Translation of awareness → behavior

Structure:

1. Daily Practice Verification (20-30 min)

  • DSAP check-in (show screenshots)
  • Kitchen Table usage
  • EOD completion
  • Gratitude 2.0 practice
  • Evidence required, not stories

2. Activation Review (30-40 min)

  • What did you commit to last week?
  • What actually happened?
  • Where did you follow through?
  • Where did you avoid?
  • No shame, just facts

3. Rehearsal of Next Actions (20-30 min)

  • "What will you do when the urge hits?"
  • Role-play difficult conversations
  • Practice tool use under simulated stress
  • Identify obstacles
  • Plan around predictable barriers

4. Weekly Commitment (10 min)

  • One specific behavioral goal
  • Make it measurable
  • Make it small enough to actually do
  • State it out loud to the group

Does NOT include:

  • Emotional processing (that's Group A)
  • Reinterpretation of meaning (that's Group A)
  • Reassurance (that's no one's job)
  • Allowing intellectual bypass

Tone:

  • Direct
  • Structured
  • Evidence-focused
  • No bullshit
  • Compassionate firmness

Facilitator's role:

  • Track follow-through patterns
  • Identify avoidance vs. incapacity
  • Enforce accountability without shame
  • Teach tools (not just discuss them)
  • Demand specificity
  • Challenge vague commitments

WHY TWO GROUPS?

Different functions, both essential:

Group A = Truth extraction + Shame reduction
(Why am I doing this? What's underneath?)

Group B = Behavioral translation
(What am I actually going to do about it?)

Without Group A:
Tools become white-knuckling.
Behavior change is unsustainable.
Shame remains intact.

Without Group B:
Awareness becomes intellectualization.
Insight doesn't translate to life.
Nothing actually changes.

Together:
Awareness is generated and honored.
Behavior is activated and tracked.
Integration happens.

X. INDIVIDUAL SESSIONS

MONTHS 1–2: Two Individual Sessions Per Week

INDIVIDUAL 1 — REGULATION & CAPACITY TRAINING

Focus: Real-time dysregulation work and nervous system capacity building

What happens:

  • Real-time dysregulation work
  • Urges, collapse, shame spirals
  • Live use of tools (not discussion of tools)
  • Nervous system tolerance for truth
  • Building capacity to stay present instead of fleeing
  • Parts work (inner child, loving parent dialogue)
  • Regulation under stress

Answers the question:
"How do I stay present instead of acting out?"

Methods:

1. Guided Meditation

  • Box breathing (4-4-4-4)
  • Loving parent / inner child visualization
  • Hand on navel, hand on heart
  • Extended practice (10-20 minutes)
  • Building regulation muscle

2. Live Kitchen Table During Activation

  • Client is triggered IN session
  • Walk through parts in real-time
  • Experience regulation while dysregulated
  • Learn the tool when it's actually needed

3. Somatic Regulation

  • Body awareness
  • Grounding techniques
  • Breath work
  • Interrupting dissociation

4. Parts Dialogue

  • Inner child speaks
  • Critical parent identified
  • Teen/addict named
  • Loving parent developed
  • Witness perspective accessed

5. Exposure to Discomfort with Support

  • Sitting with shame
  • Tolerating vulnerability
  • Staying present with pain
  • Not rescuing, not fleeing

Facilitator's role:

  • Co-regulate when client can't self-regulate
  • Model presence
  • Hold space for pain without fixing
  • Teach tools experientially (not theoretically)
  • Build nervous system capacity progressively
  • Know when to push, when to hold

INDIVIDUAL 2 — ACCOUNTABILITY & VERIFICATION

Focus: Evidence-based accountability and behavioral tracking

What happens:

  • Review daily practices (evidence required)
  • Track activation attempts
  • Identify avoidance patterns
  • Set next behavioral focus
  • Confront denial in daily execution
  • No stories—just facts

Answers the question:
"Where is the evidence of integration?"

Methods:

1. DSAP Review

  • Show screenshots (proof required)
  • What was the fist bump?
  • Did you do it?
  • If not, why not? (incapacity or avoidance?)

2. Kitchen Table Verification

  • When did you use it this week?
  • Show the writing
  • Did it interrupt an urge?
  • If you didn't use it, what stopped you?

3. EOD Tracking

  • What patterns emerged?
  • Where did denial show up?
  • Where did you avoid reality?

4. Activation Challenge

  • You said you'd do X. Did you?
  • If yes, what was that like?
  • If no, what's the truth about why not?

5. Next Behavioral Assignment

  • Specific
  • Measurable
  • Small enough to actually do
  • Stated out loud

Facilitator's role:

  • Demand evidence, not stories
  • Distinguish incapacity from avoidance
  • Challenge minimization
  • Track patterns over weeks
  • No intellectual bypass allowed
  • Compassionate but relentless

MONTH 3+: One Individual Session Per Week

Focus:

  • Pattern recognition across time
  • Consolidation of gains
  • Increasing autonomy
  • Sustained honesty
  • Preparation for maintenance phase
  • Reducing reliance on external structure

Tone shifts:
From intensive training → autonomy building
From constant co-regulation → self-regulation
From external accountability → internal integrity

Still includes:

  • Denial confrontation (always)
  • Regulation practice (as needed)
  • Capacity assessment (ongoing)
  • Activation bridge (every session)

The structure becomes more flexible based on what each client needs, but the core principles remain.

XI. OUTSIDE CSAT THERAPY (COORDINATED, NOT COMPETING)

CSAT therapy handles:

  • Trauma processing (EMDR, Brainspotting, IFS depth work)
  • Attachment wounds (developmental repair)
  • Sexual history exploration (detailed disclosure work)
  • Developmental roots (childhood excavation)
  • Long-term reprocessing
  • Couples work (if applicable)

This program handles:

  • Regulation in real-time (tools under actual stress)
  • Denial exposure (public confrontation)
  • Behavioral activation (daily practices)
  • Shame reduction (collective vulnerability)
  • Reality contact (EOD, Kitchen Table, DSAP)

Integration (not fragmentation):

One narrative arc, coordinated:

  • CSAT explores WHERE the wound came from
  • R2I trains HOW to regulate now
  • CSAT processes WHAT happened then
  • R2I activates WHAT to do now

Communication structure:

  • đŸ”„ FIRE-LEVEL REQUIREMENT: Coordinate with outside CSAT monthly (minimum)
  • Major disclosures communicated immediately
  • Treatment plans aligned
  • No competing timelines
  • Client knows everyone is talking

What clients are told:
"Your CSAT is doing deep work on your past. We're doing active work on your present. Both matter. Both are required. We're coordinated—you're not playing us against each other."

Red flags (failure to integrate):

  • Client says different things to different providers
  • CSAT doesn't know about slips we know about
  • We don't know about trauma work affecting capacity
  • Client uses one provider to avoid the other
  • Competing narratives about "what recovery looks like"

When integration works:

  • CSAT tells us: "He's processing sexual abuse—capacity will be low this week"
  • We tell CSAT: "He disclosed a new acting-out pattern—might surface in your session"
  • Client experiences unified support, not fragmented care

Maintaining this coordination requires proactive communication. Schedule regular check-ins with CSATs and document all contact.

XII. WHATSAPP (BOUNDARIED SUPPORT)

WhatsApp is:

  • Accountability between sessions
  • Brief honesty ("I'm struggling")
  • Tool usage reporting ("Used Kitchen Table, still activated, what's next?")
  • Relapse-risk signaling ("I'm white-knuckling—need support")
  • Quick check-ins

WhatsApp is NOT:

  • Processing (that's sessions)
  • Reassurance (that's no one's job)
  • Workbook discussion (that's Group A)
  • Crisis management (that's 911 or crisis line)
  • Therapy (that's sessions)

đŸ”„ NON-NEGOTIABLE SEQUENCE:

Kitchen Table FIRST

  • Write it out
  • Identify parts
  • What does inner child need?
  • What would loving parent do?

THEN reach out

  • Share what you discovered
  • Ask for what you need
  • Not "fix me," but "I need support staying present"

Why this order matters:
Teaches self-regulation before co-regulation.
Prevents learned helplessness.
Builds internal resource before external.

Response guidelines:

Respond with:

  • Reflection ("Sounds like your teen is loud right now")
  • Redirection ("Have you done Kitchen Table yet?")
  • Brief tool reminder ("Try box breathing for 5 minutes, then text me back")
  • Validation without rescue ("This is hard. You're doing the work. What's next?")

Do NOT respond with:

  • Long processing
  • Reassurance ("It'll be okay")
  • Problem-solving ("Here's what you should do...")
  • Therapy session via text

Boundary:
If WhatsApp becomes therapy, it gets redirected to session.
"This needs session time. Let's hold this for our call."

XIII. HOW PROGRESS IS DOCUMENTED

đŸ”„ FIRE-LEVEL REQUIREMENT:
Clear notes for each client, no more than 2 sessions without documentation.

Notes explicitly track:

1. AWARENESS GAINS

  • What distortions were named this week?
  • What patterns were recognized?
  • What connections were made (past → present)?
  • How quickly is denial being spotted?
  • Is awareness deepening or staying surface?

2. BEHAVIORAL ATTEMPTS

  • What tools were used?
  • What activation occurred?
  • What commitments were made?
  • What was followed through on?
  • What was avoided?

3. CAPACITY LIMITS

  • What is too much right now?
  • What is the growth edge?
  • When does confrontation become retraumatizing?
  • When does support become enabling?

4. DISTORTION PATTERNS

  • Which defenses are primary?
  • How sophisticated is the denial?
  • Is it loosening or hardening?
  • What layer is operating (surface vs. trauma response)?

5. ACTIVATION CONSISTENCY

  • Is behavior change happening?
  • Is it sustainable?
  • Is it increasing or plateauing?
  • Where is integration solid?
  • Where is it fragile?

6. SPECIFIC CHALLENGES DISCUSSED

Brief notes on what particular issues, relationships, or situations were the focus of clinical attention this session.

PROGRESS LANGUAGE:

Format for documentation:

(a) Awareness on: [specific patterns, distortions, connections recognized]
(b) Behavioral modifications demonstrated on: [specific tools used, actions taken, follow-through evidence]

Examples:

✅ Awareness growth:

  • "Client identified minimization 48 hours earlier than last slip"
  • "Connected people-pleasing to childhood abandonment fear"
  • "Named critical parent voice mid-attack"

✅ Behavioral integration:

  • "Used Kitchen Table before acting out—delayed urge by 3 hours"
  • "Completed DSAP 6/7 days this week (up from 3/7)"
  • "Told wife partial truth—building toward full disclosure"

✅ Capacity building:

  • "Tolerated 15 minutes of discomfort without dissociating (up from 5)"
  • "Stayed in room during confrontation instead of fleeing"
  • "Allowed loving parent voice to speak for first time"

❌ Stagnation:

  • "Awareness present but no activation for 3 weeks"
  • "Understanding childhood wound, using it to avoid current behavior change"
  • "Daily practices sporadic despite no capacity barriers"

EVALUATION FRAMEWORK:

Clients are evaluated on movement, not perfection.

Questions to ask:

  • Is the client moving?
  • Is awareness translating to behavior?
  • Is capacity growing?
  • Is denial loosening?
  • Is shame reducing?
  • Is honesty increasing?

Movement = progress, even if messy.
Stagnation = problem, even if explained.

Documentation serves multiple purposes: clinical continuity, supervision support, liability protection, and pattern recognition over time. Invest the time in clear, specific notes.

XIV. ONE-PARAGRAPH SUMMARY

Clients privately extract truth through Facing the Shadow workbook and daily practices (DSAP, Kitchen Table, EOD, Gratitude 2.0), publicly expose denial through shared theme work in Group A, reduce shame through collective vulnerability and witnessing, train regulation and tool use in individual sessions (nervous system capacity building and accountability/activation), translate awareness into behavior through daily structure and Group B integration work, and consolidate recovery through consistent activation—all while remaining embedded in real life (not residential isolation) and coordinated with their CSAT therapist (one narrative arc). Progress is tracked on two explicit tracks: awareness gains (developmental) and behavioral integration (consolidation), with the understanding that 1 (awareness) + 3 (behavioral action) = 5 (synergistic transformation), guided by the principle that denial must be tracked and addressed appropriately in every session, awareness is honored as real progress, and recovery consolidates only when insight is followed by embodied behavior change.

XV. FINAL PROGRAM DEFINITION

We honor awareness as developmental progress, expose denial through public confrontation (calibrated to client capacity), reduce shame through shared truth and collective vulnerability, restore relational capacity through tools for self-presence, require behavior to change before recovery is considered integrated, and guide clients from self-abandonment and intimacy disorder toward integrity, connectedness, and the capacity to stay present with self and others.

This is relational restoration work.
Not behavior management.
Not trauma excavation alone.
Not intellectual understanding.

The transformation from loneliness to belonging, from compulsion to presence, from shame to authenticity.

WELCOME TO THE TEAM

You're joining a clinical team committed to continuous learning and open dialogue. We've developed these protocols through years of trial, error, and refinement—but we don't have all the answers. When you have questions, suggestions, or concerns, bring them to case review. When something doesn't feel right clinically, consult. When you discover something that works better than what's written here, share it.

Your clinical judgment matters. These guidelines exist to support your work, not replace your thinking. As you develop fluency with this model, you'll find your own voice within it.

đŸ”„ NON-NEGOTIABLES (Fire-Level):

  1. Process FTS work regularly (prioritize 2 clients who've gone longest)
  2. Clear documentation (no more than 2 sessions per client without notes)
  3. Coordinate with outside CSAT monthly (minimum)

PARAMOUNT (but requires development):

  • Distinguish incapacity from avoidance (creates therapeutic bond)
  • Never use shaming language (causes harm)
  • Daily practices are required (they ARE the behavioral integration)
  • Kitchen Table before support call (self-regulation before co-regulation)

Everything else in this document represents what we've learned works. Use it as a framework. Develop your discernment. Consult when uncertain. Document your thinking. And remember: we're here to support your growth as much as our clients' recovery.

Welcome.

End of Clinical Guidelines v2.1