Comprehensive Notes on Sexual Behavior Analysis (SBA) in ABA Practice

Presenter background and session context

• Speaker has over nineteen years of experience in sexuality work.
• Roles and affiliations: bylaws chair at the American Association of Sexuality Educators, Counselors, and Therapists (ASEC); mentor offering free career guidance and work-life balance; PhD educational requirements in clinical sexology completed.
• Land acknowledgment: acknowledges that the land where the talk occurs was forcefully taken from Hawaiian people and calls for honoring those affected under colonial rule.
• Session designation and CEU information: presentation is worth
  • $1.5$ BACB learning CEUs.
• Audience engagement note: question about awareness of SBA at the conference; majority raised hands.
• Logistics note: presenter is dry mouth and asks for patience; there will be two resources provided; emphasis that attendance or completion does not make someone a sexologist.
• Four objectives for the afternoon:
  • 1) Operationally define SBA in terms of scope of subfield.
  • 2) Discriminate between SBA and sex therapy while noting overlap.
  • 3) Introduce Safe Circle Coalition (SCC) and its goals in Missouri: a volunteer collaborative of adult-serving agencies aiming to cultivate sexuality best practices and reduce inappropriate sexual behavior towards staff; ensure access to dating/relationships and sex when appropriate.
  • 4) Introduce the Sexual Behavior Analysis Competency Self-Assessment tool to gauge competency and identify needs for improvement.
• Resource note: attendees will walk away with two new resources and a reminder that acquiring resources does not confer expertise.

Session objectives and resources (core definitions and scope)

• Objective 1: Operationally define SBA in terms of the scope of the subfield.
  • In the ABA framework, determine whether a behavior analytic approach applies by meeting the criteria of Get It, The Assumptions of Science (GITACAB) and the core assumptions of science.
  • Common misperception: items like ACT, social skills training, etc., are not considered ABA by some, but the presenter argues they are ABA if behavior-analytic methodologies are used and the criteria and assumptions are met.
  • Other subfields listed (examples):
  • Analysis of animal behavior; forensic behavior analysis; behavioral gerontology; behavioral wellness and life coaching (certification exists); clinical behavior analysis (ACT-focused); behavioral sports, fitness and nutrition; organizational behavior management; sexual behavior analysis.
  • Emphasis: SBAs are ABA applications targeting sexual, sociosexual, or sexual-appearing behaviors. Example humor about mislabeling behaviors (itching vs. sexual behavior) to illustrate the importance of not misclassifying behavior.
  • Mention of evolving literature and sources: Java (journal), behavior analysis and practice literature, practitioner foci, conference dissemination, minimum competency standards, and evidence-based technologies with substantial single-case design literature.
  • White paper on SBA coauthored with Shane Spiker; growing SBA literature.
• Objective 2: Discriminate SBA from sex therapy; note overlap.
  • Distinction between SBA and sex therapy; sexual counseling is a separate track with distinct scope and ethics.
  • Introduction to the Safe Circle Coalition (SCC) in Missouri as a collaboration across adult-serving agencies to implement best practices in sexuality, with emphasis on consent, access to dating/relationships, and safety.
  • Tools used in SBA practice include functional assessment interviews (FAI), FAST, QABF, TalkSCR (capacity to consent), TalkSC (original), supports questionnaire, and SCAT-3 (Sexual Knowledge and Attitudes Test Revised; addressing digital behavior and inclusive language such as nonbinary identities).
  • Baseline probes for SBA programs used when standardized assessments aren’t suitable for a given population; use of AAQ-2 (Acceptance and Action Questionnaire—Revised) for ACT-based interventions; modification of FAI for relevance when assessing history, medical checks, and values.
  • Emphasis on consent and assent; clients are not required to attend sessions; flexibility to accommodate client needs; data collection includes in-session measures (Statements of Willingness, Statements of Resistance), and IOH checks (interview-observation-history checks) for couples, with attention to social validity.
  • Use of MPFI (Multidimensional Psychological Flexibility Inventory) and AAQ-2 in ACT-based assessments, with caution that these measures are not designed for behavior-analytic service billing and may be taken home for completion.
  • Additional measures used in practice: SAMs (Stereotypes About Male Sexuality), EI/QI (Excitation and Inhibition inventories); data from these measures guide understanding of self-punishment and external punishment.
• Resource and credentialing note: introduction of CVS, CBS, and related certifications to clarify scope and professional standards (see further sections).

Safe Circle Coalition (SCC) and practical implications

• SCC described as a volunteer collaborative in Missouri joining heads or representatives from different adult-serving agencies.
• Goals:
  • Address and cultivate best practices in sexuality within agencies.
  • Ensure staff do not engage in inappropriate sexual behavior with clients; expand access to dating/relationships and sex for clients when appropriate and safe.
• Implementation approach:
  • Focus on environmental arrangements and tangible behaviors of individuals and their surroundings.
  • Emphasize consent, ascent, and ethical practice across agencies.
• Practical outcomes:
  • Promote safety for staff and clients; reduce risk of abuse; provide structured avenues for sexual education and enhancement within ethical bounds.

Assessment tools and data collection in SBA practice

• Functional Assessment tools:
  • FAI (Functional Assessment Interview)
  • FAST (Functional Assessment Screening Tool)
  • QABF (Question-Answering Behavior Function?)
• Consent and capacity tools:
  • TalkSCR (capacity to consent assessment) – developed with two behavior analysts; TalkSC original includes supports questionnaire.
• Knowledge and attitudes measures:
  • SCAT-R (Sexual Knowledge and Attitudes Test Revised); upcoming SCAT-3 addressing digital behavior and language inclusivity (nonbinary).
  • AAQ-2 (Acceptance and Action Questionnaire - Revised) for ACT-based interventions.
• Baseline and post-training measures:
  • Baseline probes for SBA programs when standardized tools aren’t suitable; post-intervention data collection using the same or adapted measures.
• Coupled and interpersonal measures:
  • IOH checks (In-Order of Habituation checks) for couples to capture frequency of sexual activity and communicate operational definitions of sex; helps reveal relationship dynamics and potential issues with rigid definitions.
  • In-session measures: transcriptions coded for willingness vs. resistance; analysis of punishment vs. reinforcement dynamics within sessions.
• Data handling and economics:
  • MPFI and AAQ-2 are ACT-based; not designed for behavior-analytic billing; time spent may be unpaid or not billed; materials sent home for completion.
• Other behavioral inventories used:
  • SAMs (Stereotypes About Male Sexuality); EI and QI inventories for measuring excitation/inhibition tendencies and self-punishment tendencies.
• Data visualization and feedback:
  • Graphs are used to show clients their progress; can be motivating and clarifying for clients who may misperceive their own progress.

Ethical boundaries, safety, and professional practice in SBA

• Core ethical premise: avoid “hand-over-hand” stimulation for sexual activities; only allowed in limited hygiene-related scenarios with caution and barriers; emphasis on client dignity, safety, and consent.
• Trauma and mental health considerations:
  • If trauma is present or suspected, refer to trauma-informed psychotherapy in conjunction with SBA work; never attempt to be the sole trauma healer.
• Distinction between mind-focused exploration and behavior-focused analysis:
  • Behavior analysts focus on function, observable/environmental determinants, and use data to adjust interventions; avoid deep psychoanalytic unpacking of mental states or root causes.
• Get A Cat: the assumptions of science in BA practice to stay within scope:
  • Detemrinism, empiricism, selectionism, parsimony, pragmatism, philosophical doubt.
  • Avoid ungrounded mind-reading or unpacking; do not diagnose dysfunction.
• Collaboration with other professionals:
  • When appropriate, seek consultation or refer out to sex therapists or trauma-informed specialists; maintain clear scope boundaries.
• Language and communication:
  • Use respectful, non-judgmental language; be prepared for graphic terms; establish guidelines for patient safety and comfort; allow breaks as needed.
• Client autonomy and consent:
  • Emphasize consent and assent; clients are free to leave; ensure they feel welcomed to do so without judgment.

Distinctions among SBA, sex therapy, and sexuality counseling

• What is psychotherapy here?
  • According to APA, psychotherapy is a psychological service provided by a professional that uses forms of communication to assess, diagnose, and treat dysfunctional emotional reactions, thinking, and behavior. This can involve verbal prompts and discussions about internal states.
• Core distinctions:
  • SBA (Sexual Behavior Analysis): An ABA-based application focused on function, environment, and observable behavior related to sexual and sociosexual behaviors; data-driven; does not diagnose dysfunction or unpack mental states; aims for behavior change and safety within ethical guidelines.
  • Sex Therapy: A psychotherapy-focused approach addressing dysfunction, trauma, and underlying psychosexual issues; may involve exploring internal states, origins, and long-term therapeutic work; may use dream therapy and other psychotherapeutic modalities (some of which the presenter personally questioned or rejected).
  • Sexual Counseling (Counselor model): A distinct credential within sexuality fields (PLICIT model) focused on providing information and guided practices rather than psychotherapy. It is not psychotherapy; offers permission, limited information, specific suggestions, and, in some interpretations, intensive therapy as the domain of sex therapists.
• PLICIT model (used by sexuality counselors):
  • Permission: ongoing consent and acknowledgment of client authority.
  • Limited Information: share only what is needed for goals; not turning every client into a sex educator.
  • Specific Suggestions: concrete exercises and prompts for behavior change.
  • Intensive Therapy: reserved for sex therapists; advanced clinical treatment.
• Certification and scope:
  • ASEC credentials for sexuality counselors (CSCs) and certified sexuality counselors (CSCs) include CE hours, client-facing practice, supervision, and a comprehensive exam; the CVSC (Certified Behavioral Sexologist for common concerns in couples) is another pathway; the presenter also created a CBS (Certified Behavioral Sexologist) program and a Level 2 CVSC path.
  • The presenter emphasizes that the CSC title is widely recognized and that the CVS program provides a clear alignment with ABA-based counseling skills within sexuality scope.
• Practical takeaway: if a population has intellectual disability, dual diagnosis, autism with support needs, a behavioral sexologist or certified behavioral sexologist is an appropriate professional; sex therapists may handle issues like unresolved trauma, dream exploration, psychedelics, tantra; SBA handles functionality, safety, and education around sexuality in a behavior-analytic framework.

Certification pathways and examples of practice (ASEC, CVS, CBS, CVSC)

• Certified Sexuality Counselor (CSC) pathway by ASEC:
  • 90 hours of ASEC CE training; 20 hours sexuality counseling skills; 14 hours in-person training (sexual attitudes reassessment); 100 client-facing hours of sexuality counseling delivery; 30 group or individual supervision sessions; supervision by someone who may not fully understand the scope but must oversee the practice.
  • ASEC provides free ongoing mentorship to members; the presenter notes personal experiences with supervision and the importance of scope alignment in practicum.
• Certified Behavioral Sexologist (CBS) and Certified Behavioral Sexologist for Common Concerns in Couples (CVSC):
  • Level 1: 60 hours of online training; Level 2: 90 hours (total 150 hours); both require client-facing SBA delivery; Level 2 requires more supervision and a higher number of hours.
  • 10 group supervisions (Level 1) and 15 group supervisions (Level 2); 3 individual supervisions (Level 1) and 13 (Level 2). All supervision observations; a comprehensive exam with small quizzes; cohort-based retreats.
  • The CBS/CVSC credentials align sexuality counseling skills with behavior-analytic practice; the program emphasizes data collection, ethical practice, and transparent demonstration of competency.
• Practical note: the presenter emphasizes the importance of supervision, data-driven practice, and showing evidence of skills rather than relying on self-reporting.

Practical applications and client populations

• Populations addressed in SBA practice:
  • Individuals with intellectual disability, dual diagnoses, autism spectrum disorder (with support needs), and neurodivergent populations.
  • Couples where one or both partners have disabilities or special needs; relationships in general (reduction of punitive dynamics, increasing reinforcement and positive interactions).
  • LGBTQIA+ individuals and identities; sex education and support for coming-out processes and safe expression.
  • Solo sexual behaviors (e.g., solo sex and masturbation) and education around safer, pleasurable practices.
• Practice settings:
  • The presenter’s private practice ( Empowered Center for Sexuality ) emphasizes pro bono and sliding-scale services; faced challenges with insurance coverage for clients with Down syndrome or cerebral palsy; decided to offer alternative funding methods such as fundraisers (sexy bingo, sexy jeopardy, drag competition with task analyses) to support client balances.
  • Emphasis on environmental manipulation and tangible behavioral goals; training for staff and caregivers to support clients in safe and empowering ways.
• Notable safe and risky practices:
  • Clear stance against coercive or punitive approaches; emphasis on consent, assent, and support for autonomy.
  • Avoidance of trauma-based, untested dream therapies; emphasis on evidence-based, observable-behavior change.
  • Use of public displays and sexual education in a controlled, ethical, and safety-focused manner; if in doubt, seek consultation.

Historical and ethical case examples in the field (highlights and lessons)

• Conversion therapy and ethical concerns in ABA history:
  • Barlow & Argos (1973) attempted conversion therapy to increase heterosexual arousal in gay men; reports that participants later reported reduced homosexual behavior—but the study was conducted under coercive conditions (gay men forced to participate when homosexuality was illegal) and used a plethysmograph ring to measure arousal, which creates data concerns and ethical issues.
  • Cantor (1978) examined pre-orgasmic reconditioning and post-orgasmic deconditioning; involved heterosexual arousal conditioning with images; reported an 18.3% increase in arousal via plethysmograph, highlighting ethical concerns about coercion and heteronormativity.
  • Wreckers and LeVos (1974) – Behavioral treatment of deviant sexual behaviors in a male child; LeVos later developed the Feminine Boy Project; this line of work is cited as modern conversion therapy; the project reinforced masculine behaviors and excluded feminine ones, with later tragic outcomes including the suicide of the subject (Andrew Murphy) in 2003; researchers note this as an unethical and harmful application of behavior analysis.
  • Myers (1995) – Elimination of battering of women by men; focus on identifying antecedents and observable abusive behaviors; use of behavior-analytic approach to define and address abusive dynamics in relationships.
• Safer and more constructive interventions:
  • Bowman & Davis (2009) – Teaching women with intellectual disabilities to identify and report inappropriate staff-to-resident interactions; used video and in-person modeling; baseline 20–38% correct responding; training achieved 100% accurate responding in the study; emphasizes safety and empowerment for individuals with disabilities.
  • Poch, Brower, Swearingen (1981) – Teaching young children to resist grooming and avoid being lured; modeling, behavioral role-play, and social reinforcement; resulted in 100% of children reporting to a trusted adult when approached with grooming attempts.
  • Hanan & Flanky (1990) – Condom promotion via visual prompts in Alaska during the AIDS epidemic; used an ABAB design by placing a sign and condom bowl by a doorway; observed 248 condoms taken across multiple weekends; demonstrates the efficacy of visual prompts and simple behavioral interventions in public health contexts; note: causality about actual condom use remains uncertain.
  • Cicero (publication on shaping masturbation in persons with developmental disabilities) – solo sexual behavior can be shaped with reinforcement and task-analysis-based approaches; cautions against hand-over-hand assistance; highlights social validity and safety considerations in sexual education for adults with ID.
  • Richmond et al. (1984) – Menstrual care training for women using task analysis and token economy; demonstration of acquisition and maintenance of menstrual-care skills; enabled women to self-manage menstrual care with less invasive involvement from staff.
• Practical implications from historical examples:
  • The field must actively avoid coercive, punitive, or conversion-type approaches and prioritize consent, safety, and observable outcomes.
  • There is a need to separate evidence-based practice from ethical pitfalls in history and to emphasize trauma-informed care and respect for autonomy.

Pre- and post-session considerations, trauma, and safety

• Trauma-informed approach and collaborative care:
  • If trauma exposure or recovery needs arise, connect clients with trauma-informed psychotherapy alongside SBA work.
• Ethical boundaries around clinical imagination and explanations:
  • When faced with unfamiliar terms or beliefs (e.g., Therian communities), the responder uses inquiry and research rather than making assumptions; “I don’t know, but I care, so I’ll find out.”
• Cultural and faith considerations:
  • Acknowledge varied faith systems and potential conflicts; maintain respect while keeping behavior analytic focus on function and safety.
• Practice boundaries and responsibilities:
  • Do not attempt to be a client’s personal psychotherapist; focus on functional analysis and tangible behavior changes; avoid diagnosing dysfunction; rely on referrals for deeper psychodynamic work if needed.

Differences in clinical pathways and when to call specialists

• When SBA is appropriate vs. when sex therapy is required:
  • If the client has intellectual disability, dual diagnosis, autism with support needs, or requires SBA for sexual or sociosexual behaviors, a behavior analyst or certified behavioral sexologist may be most appropriate.
  • For unresolved trauma, dream exploration, psychedelic-assisted work, or tantric methods, sex therapists are better equipped.
• Practical decision-making: collaborative care and referrals
  • The presenter emphasizes the importance of consulting with sex therapists when necessary and referring out for psychotherapy when trauma or deep psychodynamic work is required.

Self-reflection, growth, and professional development in SBA practice

• The presenter encourages humility and ongoing learning: it is okay not to know something and to seek out help or consultation.
• The maxim: “I don’t know, but I care, so I’ll find out” is presented as a guiding principle for ethical practice.
• Emphasizes evidence-based practice, ongoing measurement and data use, and a commitment to avoiding misinformation.

Resources, ongoing education, and community networks

• SCC Best Practices Assessment (free tool): designed for any agency; helps determine whether best practices in sexuality education and counseling are in place; provides glossary, links to resources, and actionable steps to improve.
  • Covers domains such as access to sexuality information, consent training, access to relationships, budgeting for adult items, DEI, LGBTQIA+ affirming care, staff training, policies, and continued growth.
• Sexual Behavior Analysis Competency Self-Assessment (Costigan): free tool for behavior analysts to assess alignment with ethics code; includes areas such as sexual development, anatomy; LGBTQIA+ rights and issues; intimacy and sexual functioning; safety; and referral resources.
• Accessibility and dissemination:
  • The speaker maintains a presence on Facebook (Sexual Behavior Analysis group) and ABAI’s Sexual Behavior Research and Practice SIG; these forums provide consultants and networking for professionals in SBA.
• Funding and access considerations:
  • Insurance coverage challenges for certain disability groups; practice includes pro bono work and sliding-scale slots; fundraising events to support client balances (e.g., sexy bingo, sexy jeopardy, drag competitions with task analyses).

Personal notes and closing reflections

• The speaker identifies as autistic and describes moving and sensory strategies (e.g., being bouncy and moving during presentations); emphasizes authenticity and self-care in professional roles.
• Final messages:
  • Acknowledges the importance of community, mutual respect, and the ongoing development of the SBA subfield.
  • Expresses gratitude toward the audience and the conference community; ends with thanks and mahalo.

Quick takeaways for exam prep

• SBA is ABA-based and focuses on function, environment, and observable behavior related to sexual behaviors.
• Differentiate SBA from sex therapy (psychotherapy) and sexuality counseling (non-psychotherapy, guidance and coaching under PLICIT framework).
• Key tools and measures in SBA practice include FAI, FAST, QABF, TalkSCR, TalkSC, SCAT-R, AAQ-2, MPFI, SAMs, EI/QI; use baseline probes when standardized tools aren’t suitable.
• Ethical boundaries include avoiding hand-over-hand sexual stimulation, trauma-informed collaboration, refusal to diagnose dysfunction, and reliance on Get A Cat principles (determinism, empiricism, selectionism, parsimony, pragmatism, philosophical doubt).
• Historical case studies illustrate ethical pitfalls (conversion therapy examples) and emphasize the evolution toward safe, consent-based, evidence-driven practice.
• Resources like the SCC Best Practices Assessment and the SBA Self-Assessment help practitioners align with best practices and ethics.
• Certification pathways (CSC, CBS, CVSC) provide structured avenues for sexology-related competencies within ABA-derived practice; supervision and data-driven demonstration of skill are central.
• Practical considerations include funding challenges, community outreach, and the importance of multidisciplinary collaboration to serve diverse populations.

End of notes