Sexual Relapse

Implications for Counselors

Often, many clients will commit in front of counselors to practice safer sex, only to lose their resolve in a sexual setting, while some clients will make promises to counselors that they never intend to keep. Other clients tell counselors they have no intention of permanently restricting their sexual practices.

For all of these clients, risk reduction guidelines have limited use. Counseling for these individuals and for others who have relapsed into unsafe activities, may require an examination of the client's background and other psychosocial factors. For instance, a troubled client may consider precautions for safer sex to be a low priority. And an individual with a low sense of worth may believe risk to be acceptable.

Because many individuals who vow to practice safer sex lose their resolve when under the influence of alcohol or other drugs, acknowledgment and help with a substance abuse problem may be needed. This may include a careful assessment of drug and alcohol use, current and historic, and in some cases referral to an alcohol substance abuse program, or to a self-help, 12-step or similar intervention.

Some alcohol and drug users who relapse may not understand the connection that drug and alcohol use has to relapse, and these individuals may not understand the relevance of referrals to them. For these clients, it is important to explain that being under the influence of alcohol or other drugs does have an effect on their resolve to practice safer sex, and they should try to understand their relationship.

Other individuals may lose their resolve to give up unsafe sex because of a lack of self-esteem, which makes them unable to assert their desires for safer sex to a partner. For these individuals, acknowledging this difficulty may be a part of the counseling session.

It may be useful to offer specific teaching skills to help clients anticipate and successfully deal with the temptation to relapse, and to negotiate safer sex with partners. This may be done by discussing a client's level of confidence and ability to assert feelings and intentions to a partner. In addition, counselors might engage clients in a role play involving partner negotiation.

Learning about a client's behaviors and background can be useful in some cases to determine if that person is more likely to relapse. For instance, individuals who are more likely to relapse tend to engage in unprotected receptive anal intercourse more frequently than others and they generally have a greater number of overall sexual partners. Because men in relationships may have different reasons for relapse from men who are single, counselors need to know about an individual's current and past relationships.

Peer support is important in maintaining behavior change and combating the multiplying effect of relapse. Many individuals perceive that their peers are not practicing safer sex and they feel pressured to conform to what is being practiced.

Because a trend toward relapse can have a multiplying effect within a community, clients may need reinforcement to help them maintain safer sexual behavior and assert their desires for safer sex to partners.

Antibody test counselors can reiterate the importance of safer sex and provide positive support for those practicing safer sex. And counselors can encourage clients to enter support groups to maintain their resolve to practice safer sex. Peer-led support in a relaxed group may be the most useful way to acknowledge concerns about relapse, and may lead to a reduction in the tendency to relapse.

Counselors must remember that knowledge of risk does not necessarily lead to a decrease in risk behaviors. Most gay men in large cities who are practicing unsafe sex are well-informed about the dangers of their activities. Knowledge is important in making an individual aware of risks, but prevention of relapse involves a more comprehensive study of the reasons a person practices unsafe sex and the specific factors that motivate behavior change for the individual.

Counselors also need to be aware that individuals who receive a positive test result are vulnerable to relapse, and that individuals may return to unsafe sex regardless of their test result. Clients may not even realize that they are susceptible to relapse at this time. It may be helpful for some clients to be aware of this tendency so that they can better anticipate some of the feelings or impulses that may arise after receiving a negative or a positive test result, and prepare to deal with them constructively.