Co-morbidity Challenges that Impact Sexuality with Attachment-Informed Focus (4.5 CE Hours)

Description

This course provides an in-depth exploration of how comorbidity, attachment dynamics, and sexuality intersect within clinical practice. Using an attachment-informed lens, learners examine the complexity that clients bring into the therapy room—biological, psychological, relational, cultural, and systemic. The course introduces a multi-layered mental mapping system (Lines, Circles, Wheels, and the Spider Web) designed to support therapists in organizing and making sense of intricate client presentations. Through case-based learning, participants deepen their understanding of diagnostic intersections, the cyclical nature of attachment and sexual experiences, and the practical application of the 4-D Wheel and the Wheel of Consent in sex therapy. Emphasis is placed on cultivating the therapist’s own secure presence, clinical attunement, and capacity to contain and navigate complexity with clarity, compassion, and confidence.

Learning Objectives

At the conclusion of this workshop, participants will be able to:

1. Identify and analyze comorbid diagnostic, medical, relational, and cultural factors that influence sexual functioning within an attachment-informed framework.
2. Describe the core components of the Lines–Circles–Wheels mental mapping system and apply each layer to case conceptualization in complex client presentations.
3. Explain the cyclical nature of attachment and sexuality—including the Cycle of Attachment, Cycle of Sex, and natural life cycles—and evaluate how these cycles inform therapeutic intervention.
4. Apply principles from the 4-D Wheel and the Wheel of Consent to help clients clarify boundaries, identify personal desires, and engage in healthy relational exchanges.
5. Assess how insecure attachment styles intersect with comorbid conditions such as anxiety, chronic illness, pelvic pain, trauma, neurodivergence, and desire discrepancies.
6. Demonstrate the ability to use therapeutic containment, mirroring, attunement, and consistent availability to support client healing while maintaining the therapist’s own secure attachment style.

Activity Schedule

Hour 1 — Foundations of Attachment-Informed Sex Therapy & Comorbidity

1. Introduction to Complexity in Sex Therapy

1. The primary question
2. Biological, psychological, relational, and cultural contributors to complexity
3. Therapist presence, containment, and foundational attachment stance

2. Comorbidity: The “Lines”

1. Demographic & Diagnostic Lines
2. Understanding comorbidity vs. complexity
3. Mapping timelines, family systems, and developmental markers
4. Common intersecting diagnoses in sex therapy 
5. Case study application

Hour 2 — Cycles, Context, and Attachment

3. The “Circles”: Clients in Context

• The Boundary Target model (concentric circles of relational access)
• Natural cycles: seasons, menstrual cycles, rhythms of growth and rest

4. The Cycle of Attachment

• Core attachment needs of connection & autonomy as the foundation for relational health
• Movement Toward, Togetherness, Movement Away, Autonomy
• How insecure attachment alters the cycle
• Links between attachment patterns and sexual functioning
• Case study application

5. The Cycles of Sex

• Cycles of Sex: Cycle of Arousal, Penetration cycle & Sexual Relational Cycle 
• How cycles of sex intersect with attachment patterns
• Case study application

Hour 3 — The Wheels: Models for Organizing Complexity

6. The Medicine Wheel

• Origins and symbolism
• Why indigenous frameworks matter in modern clinical mapping
• Interconnectedness and multidimensionality in sexuality

7. Gina Ogden’s 4-D Wheel

• Physical, Mental, Emotional, Spiritual dimensions
• Shadow sides and blocks in each quadrant
• Centering practices and integrating the four aspects
• Case-based application to client narratives
• Case study application

8. The Wheel of Consent (Betty Martin)

• “Who is it for?” and “Who is doing the action?”
• The 4 Quadrants: Serve, Take, Allow, Accept
• Consent shadows and relational mis-attunements
• Using role clarity to support sexual healing and boundary-setting
• Case study application

Hour 4 — Integrating the Model & Case Applications

9. The Spider Web as the Integrating Mental Map

• Bringing Lines, Circles, and Wheels together
• Directiveness vs. non-directiveness
• Creating clinical containment in complexity

11. Therapist Identity & Secure Centering

• Therapist self-awareness and attachment
• Building the map for a client
• Building the map for the therapist

Speaker Bio

Jessica Szymas is a Grand Rapids–based Licensed Mental Health Counselor and AASECT Certified Sex Therapist with over a decade of experience supporting individuals, couples, and groups. She earned her MA in Counseling Psychology from The Seattle School of Theology and Psychology and founded her private practice in 2012, specializing in sexual and relational concerns such as desire discrepancy, pain during sex, sexual shame, gender identity, and trauma. Her work integrates psychology, sexuality, and spirituality to create a warm, non-judgmental space for healing and growth. As a clinician and educator, Jessica emphasizes experiential learning and relational presence, translating complex ideas into accessible, meaningful experiences.

Class originally recorded: 12/21/2025

Social workers completing this course receive 4.5 clinical continuing education credits.