The Maltz Hierarchy of Sexual Interaction

​© 1995 Wendy Maltz, LCSW, LMFC, CST
(all rights reserved)

“Only one who, tragically, has never experienced love would question whether sex can be fulfilling when love is absent. Physically satisfying, perhaps, but never fulfilling. It can never reach the depths of what we are as human beings, and what we are capable of becoming [emphasis added]. To climb the heights, sex education is not enough. We need to learn how to love.”(1)
–Joseph and Lois Bird, Sexual Loving

couple1Sexual energy is a powerful force in our society. Like water, it can be channeled for constructive, noble purposes, or left untamed to wreak potential damage and destruction. If we hope to direct sexual energy in a positive way, towards a safer society in which people have more fulfilling interpersonal experiences, we need to construct a goal-oriented paradigm that provides guidelines for evaluating sexual behavior within the context of relationships.

In my twenty years of work as a sex therapist and researcher, I have encountered thousands of people suffering from sexual problems caused by negative sexual experiences, such as, sexual addiction, sexual abuse, sexually transmitted disease, and unwanted pregnancy. These negative sexual experiences have become more prevalent in our society and are tragic consequences of mis-channeled sexual energy.(2)
It can be difficult for people who have been exposed to negative sex to conceptualize sex as potentially positive and healthy. Traditional sexuality models which focus simply on the need for consent between two adults, or on how to improve sexual pleasure, ignore the complex circumstances, distinguishing factors, and serious consequences of contemporary sexual interactions. Lacking a different way to conceptualize sex, recovering sex addicts and others may jeopardize their healing because they fail to aspire to sex that is more than a commodity or a performance.

I have developed a new model to assist in sex education, sexual addictions recovery and therapy. The Maltz Hierarchy of Sexual Interaction is an attempt to offer both men and women, regardless of sexual orientation, a progressive framework for understanding and evaluating sexual behavior. Because it describes conditions for optimum sexual interaction, it can help individuals grow and evolve as sexual beings, channeling their sexual energy toward more deeply fulfilling interpersonal experiences.

In other fields, such as psychology, we have seen the benefits of looking at human behavior according to such models. Maslow’s model for the hierarchy of human needs,(3) for example, sets out a continuum along which one can progress from a foundation of safety and trust toward self-actualization. Erikson’s model for the stages of human development is helpful as a tool to help us understand universal truths about growth and maturity.(4)

Why have we lacked a similar model for understanding human sexuality? Our cultural attitudes have been in the way. Until very recently in human history, information about sexuality was obscured by a moralistic, puritanical veil.(5) Prevailing social mores taught for generations that normal, healthy human sexuality was, at best, a taboo subject, and, at worst, a source of guilt and shame. The body was seen as the receptacle of sin, and sexual feelings were seen as intrinsically bad and dangerous.

During the generations when patriarchal thinking dominated our culture, women were defined as the property of men. A woman’s sexual behavior, whether or not she was virginal before marriage and faithful once married, determined her worth in society. Sexual repression became a way men insured dominance over women. It was commonly assumed that women had few sexual desires or needs of their own. Another social mindset limited men’s sexual behavior. Men were supposed to be in control, in charge, of sexual relating. Non-aggressive, “intimate” sexual expressions were condemned as effeminate. And only certain sexual practices–typically, those leading to procreation–were defined as acceptable. Hence, the once-common teachings that masturbation could lead to insanity, or that anal sex or homosexual sex were “perverse” or “unnatural.”

According to the most rigid religious teachings, sex has been defined as only for procreation, not for pleasure. These attitudes have persisted, even though we know that humans have an awakened sexual interest well past their child bearing years. Unlike other animals, humans experience sexual desire throughout the year, not only during a mating season. Our sexuality is linked with our intrinsic human desire for love, for connection, for community.(6)

Although the notion of romantic love dates back for centuries, due to religious doctrines and cultural attitudes, it was not until the sexual revolution of the 1960s that we begin to throw off those trappings of guilt, and embrace our sexuality as something to discuss, to enjoy, to celebrate.

Perhaps, now, three decades after the sexual revolution, we have reached a time when we understand enough about sexuality, we understand enough about the possible repercussions of sexuality, and we understand enough about human growth that we can benefit from a new model for sexual relating — a model that offers guidance, without leading us back to moralistic myopia or sexual repression. This would not have been possible 25 or 100 years ago. But given what we have learned about sexuality in recent decades, and given our increasingly egalitarian society, perhaps we are ready to move forward.

The Maltz Hierarchy of Sexual Interaction model is predicated on the notion that certain conditions shape the nature of sexual interaction — whether it is experienced as healthy or hurtful. This way of evaluating sex according to conditions has become popular in the fields of sexual abuse,(7,8) sexual addiction,(9) and sex education.(10) Conditions such as consent, equality, respect, trust and safety lead to healthy interactions, while conditions of dishonesty, disregard for physical safety, domination, objectification and shame lead to negative interactions.

Within this model, we don’t automatically judge specific sexual behaviors. Instead, we look at the context in which any behavior takes place. In a certain context, for example, spanking might be seen as lighthearted and playful, a way to enhance arousal. In another context, the same behavior could be humiliating, painful or degrading. Similarly, marital intercourse in one context could be experienced as intensely passionate, while in another, as spousal rape.

For this model, we look at both the context and the consequences of any sexual behavior. Sexual energy can unite a couple in a dance of tenderness and passion, heightening their self-awareness and strengthening their self-esteem and commitment to one another. Or, if used in a violent act like rape or humiliation, sexual energy can shatter trust and destroy one’s sense of self-worth and safety.

comparison-chart-positive-negativeAccording to the Maltz Hierarchy, sexual energy is channeled along one of two routes: the path to disintegration and disconnection, or the path to integration and connectedness (see Figure 1). The positive qualities build and intensify as one travels upward and the negative qualities build and intensify as one travels downward in the model. To help explain the hierarchy, I encourage individuals to visualize sexual energy as “ground zero,” like the lobby level of a hotel. Here, sexual energy enters our lives as a benign natural force. Neither good nor bad, this energy is a continuous influx of our drives and hormones.
We each have a choice to make, in how we direct this energy. The path to disintegration, the underground levels in the hotel, leads to negative repercussions (-1: Impersonal Interaction; -2: Abusive Interaction; and -3: Violent Interaction). The path to connectedness, leading eventually to authentic intimacy, is all positive and “above ground” (+1: Role Fulfillment; +2: Making Love; +3: Authentic Sexual Intimacy). By designing the model this way, with two divergent paths, it illustrates that positive relating is distinctly separate from negative behavior (see Figure 2). Which way will we take the elevator from the lobby? On which level will we exit? We can choose how we channel our sexual energy.

hierarchy-sexual-interactionLevel -1: Impersonal Interaction — This first level of destructive sex involves a lack of responsiveness to one’s own, or one’s partner’s personal experience and safety. This is the realm in which partners operate out of ignorance, denial, callousness, and self-centeredness. Level -1 is commonly seen in situations such as engaging in unprotected sex, sex under the influence of drugs or alcohol, dishonest circumstances, legal forms of compulsive or addiction-driven sex, and sex which is endured though upsetting or painful. Regret and sexual shame are generated. Partners are depersonalized and sexually objectified. The sexual interaction ends up being at someone’s expense.
In Level -1 one or both partners may act dangerously. A woman client evaluated a sexual interaction she experienced as -1 because she had unprotected sex with a stranger she met in a bar. While both she and her partner consented, the manner in which she approached the sex put herself and possibly her partner at risk of emotional and physical harm. A male client rated the extra-marital affair with his secretary as -1 because of the possible future harm that could come to him (if his secretary accused him of sexual harassment), and to his wife (when she learned of the affair), and to his secretary (if she fell in love with him).(11)

At Level -1 sexual partners are more misused and misunderstood, than intentionally abused. Because the sexual behaviors in Level -1 are legal, sex addicts may rationalize a lot of sexual acting out at this level as harmless. Individuals may find themselves stuck in this level due a wholesale adoption of societal myths, such as: Sex is uncontrollable; People are objects; Sex is a way to get love; Females should be sexually subservient to males; and, Men must adhere to rigid standards of sexual performance.

Level -1 interaction is automatically “chosen” when couples fail to insure on-going mutual consent or fail to use protection against sexually transmitted disease and unwanted pregnancy. Without mutual respect and responsibility, sex can become an act of reckless endangering with unpleasant, sometimes serious, negative consequences.

Level -2: Abusive Interaction — At this level, sexual relating is an act of conscious domination and exploitation. One person acts to control the other person through psychological pressure or manipulation. Level -2 is commonly seen in situations of non-violent acquaintance rape, spousal rape, and incest, but can include situations of public or private humiliation. The victim, trapped in a submissive role, is seen as an object, with no options to change or control what is happening. The dominant perpetrator tricks or degrades the other person, damaging the other’s self-esteem and trust in the process.

In Level -2, perpetrators often act from a position of feeling entitled to sexual contact. They frequently suffer from distorted thinking, which attempts to rationalize or deny the personal harm they cause the victim. One female client’s father coerced her into sex with him during a time when she was a teenager and her mother required hospitalization. He told her that sex was her duty as the next oldest female in the family.(12)

In Level -2, communication is colored by lies, put-downs, shaming, threats, manipulation and coercion. Victims may feel paralyzed to effect change in the sexual interaction due to their innocence and fear. Because of the exploitation and coercion involved, Level -2 sexual behavior is often against the law.

Level -3: Violent Interaction — This is the lowest, most disintegrated and disconnected level. Here, the perpetrator incorporates abusive traits from the previous level, and also strives to have absolute control over the victim. Sexual energy is purposefully employed to express rage and hostility. Sexual pleasure is rigidly defined, perverse and often ritualized. The perpetrator may operate in a preprogrammed, almost mechanical way, strongly dissociating from his or her own body. Sex organs are weapons and targets. In this level, we find warped thinking, to the extent of serious psychological disturbance and pathology. In the extreme, this is the zone inhabited by serial killers and cult abusers who sexually torture their victims for sadistic pleasure. In such cases, the perpetrator carries control to the extreme of deciding whether the victim may live or die.
These underground levels become progressively constricted. As one travels downward, the interpersonal options decrease and the negative consequences intensify. Eventually, sexual experience is merely a sideline to an act of murder.

Due to the progressive, escalating nature of sexual addiction, sex addicts can slide lower on the hierarchy, as they seek the excitement of more risky and shame-filled sexual behaviors.(13)

At lower levels, sex is not a journey that two people willingly take together, but an upsetting or traumatic ordeal imposed on one person by another. The person in the submissive role may have his or her self-image and sense of sexuality seriously damaged by the sexual experience. A person who is treated as an object may begin to see himself or herself in this way. Especially if a victim is young or lacks other life experiences for reference, these negative encounters can become primary experiences. Tragically, as a result, victims may view sex as bad and themselves as dirty or disgusting. Future sexual relationships may be wrought with fear, suspicion, and sexual shame.

People who experience negative sex may require years of therapy to overcome the emotional, sexual, legal, social, and spiritual repercussions that follow. The damage incurred on these lower levels is not limited to the couple, but resonates into the lives of family members and others in the larger community.

Now that we have looked at the worst ways sexual energy can be channeled, let’s go back to the imaginary lobby and, looking upward, consider the positive expressions of sex in human relationships. Keep in mind that these “upper floors” are built on conditions of mutual choice, caring, respect and safety.

Level +1: Role Fulfillment –This is the first level on the path to connectedness, leading to enhanced self-esteem, integration and positive intimate bonding. At this first level, sexual energy is channeled in terms of social customs, typically based on well-defined gender roles. Society provides a template for such behavior, defining how partners should meet, how sexual relating is initiated and who does what to whom within the relationship. In heterosexual relationships, the male is assertive, the initiator. The female is passive. Sexual repertoire is limited, and, because the relationship is built on shared assumptions, there may be little communication.

Level +1 is often the setting for new relationships, courtship, and for couples who follow strict religious doctrines or particular cultural prescriptions. Thus a wife may agree to sex to please her husband even when she isn’t feeling particularly interested. Her husband doesn’t force her and she doesn’t feel coerced. By participating, she gains some positive sense of herself as one who fulfills what she considers to be her wifely duty. A sense of fairness exists because the wife perceives her husband as having duties that he must honor as well. Obviously, Level +1 would not be the level of choice for feminists. They might see this sexual scenario as destined to slide downward into Level -1 and Level -2.

Still, partners can enjoy a sense of safety and satisfaction within this level of relating. They know what’s expected of them, and they know which acts are acceptable and which are taboo. There is mutual respect, physical safety and commitment to a relationship. These aspects are generally positive, enhancing self-esteem. For a recovering sex addict, establishing the conditions of respect, safety and caring essential for this level, can be a major accomplishment. If we think of sex as a journey, these partners would be boarding a tour bus, with a scheduled route and destination. The predictability of their choice offers security, helping them avoid anxiety and chaos if their travels should take them to unfamiliar territory.

However, positive role fulfillment is ultimately limiting. Sex can become boring and relied on mainly for drive reduction. There’s little creativity. Partners can easily get stuck in their roles, lacking opportunities to talk about or experiment with other ways of channeling their sexual energy. Thus, a man who is naturally passive forces himself to be the initiator. A woman who would be better as the initiator remains passive. They don’t communicate about intimacy, or risk breaking free of their roles. Staying in Level +1 leaves couples with few options for enhancing sexual pleasure and deepening emotional intimacy.

Level +2: Making Love — In this level of relating, the partners focus on creating mutual pleasure. They break out of prescribed roles, giving one another permission to experiment, to express individuality and creativity through intimacy. Partners share a view that sex is special, worth learning more about and enhancing. They are willing to talk about sex, to try out different positions and stimulation techniques. They may plan special times for intimacy. The sexual fulfillment needs of both partners are taken into consideration in sexual interaction.

At this level, sex becomes a celebration of the body — recreation mixed with personal caring and sensual sharing. Through experimentation and exploring, partners learn to recognize different levels of experience that are possible in sexual pleasure. Recovering sex addicts learn they can express and receive caring through very passionate erotic touch. For inspiration, guidance or reference, couples may consult such books as The New Joy of Sex (14) or Dr. Ruth’s Guide for Married Lovers.(15) This is the sex of steamy Hollywood love stories, romance novels, and soft porn. This is what many of us in the last thirty years have been led to believe is the ultimate in sexual relating.

Although they have broken free from stereotypical roles, partners on Level +2 may feel another, more subtle, pressure: to be “good lovers.” They may feel they have to be able to perform, to be sexual gymnasts. They may see orgasm — even mutual or multiple orgasms — as a goal they are expected to reach. If they see sex as a journey, they might envision a scenic care ride, stopping at delightful resorts and gourmet restaurants enroute. They can plan their own trip, focus on pleasure, and take time on the way to their destination.
At this level, partners reveal more of themselves and are thus able to feel more intimately connected. The shared sexual enjoyment can create a pleasure bond which increases feelings of mutual caring and specialness.

Level +3: Authentic Sexual Intimacy — This is a natural outgrowth of Levels +1 and +2, emerging from the established qualities of respect, safety, communication, mutual commitment, sensual pleasure, and love. It is the roof garden level on the top of our imaginary hotel. Authentic relating may be a momentary peak experience, or overlay a whole lovemaking experience. When it happens, there is a shared sense of a deep connection, a reverence toward the body and toward one another. During lovemaking, while enjoying sensual pleasure, partners have a consciousness of really expressing love for the other person.

When sex becomes an act of conscious loving, it can open up new dimensions in the relationship.(16) Partners may feel a spiritual connection or sense of ecstasy as their two selves merge, but are not lost in one another. Through this merging, each gains a greater sense of his or her own wholeness. While they cannot plan for these transitory moments of ecstasy and communion, partners who glimpse this level of relating draw on tools they have learned together. They feel secure and safe in the relationship. They communicate easily, knowing they are able to stop and talk at any time. They are aware of the full range of sensual activities and pleasures. They share a sense of freedom, knowing they can go where they want, together.
But rather than using sex to get to a specific place, couples recognize that the moment they are sharing on this deeper level is their destination. Emotional honesty and intimacy are more important to the total experience than how long sex lasts or whether either of them climaxes. When they are authentically in the moment with one another, they have arrived.

For the recovering sex addict, achieving this level of sexual intimacy represents a release from old psychological attachments to sex. Being real and feeling close are more important than engaging in a particular sexual activity. The power of sex has been transcended.

If sex is seen as a journey at Level +3 the options for travel are limitless. How and where a couple travels is less important than just being together with whatever they are experiencing. They open to sensual pleasures and feelings of the heart, and let the sexual energy fuel them on a magic carpet ride.

Although this model for viewing sexual relating is a hierarchy with authentic sexual relating as the pinnacle, it is also a fluid construction. Partners are never locked into only one way of relating, nor are two partners necessarily experiencing a relationship on the same level. Some examples: A couple may be making love when one partner tightly holds down the other’s wrist. The other partner may communicate discomfort and ask to be released. If that does not occur, their relationship would, at that moment, shift down the hierarchy to violent sexual relating. Similarly, partners who have always stayed within prescribed roles may one day decide to experiment or talk about trying new ways of relating. Their relationship thus moves up the hierarchy, with pleasure as a new focus.

The levels in the hierarchy are not rigidly distinct. They may merge into one another, like colors in a rainbow. A moment of high arousal in making love may suddenly awaken a sense of deep honoring and shared intimacy with one’s partner. Thus, a particular sexual encounter may include a combination of various attributes from different levels.

When I show this model to couples in my practice and we discuss the different ways they can channel sexual energy, they gain an awareness of the different interpersonal skills necessary at different levels of relating. For example, the nature and content of communication becomes more personal as one moves up the positive levels of the hierarchy. A recovering sex addict may need to develop skills for self-awareness and disclosure, before being able to achieve the degree of honest communication required for Level +3.
The hierarchy also provides couples in therapy with a model to help them understand where they are now, and where they may be evolving within their relationship. As couples begin to sense that they can enhance their relationship — by learning how to move up the hierarchy — they often experience a feeling of pride. They realize that they are progressive as a couple, and that they can progress further as they experience the pleasures of relating more authentically.

For survivors of sexual abuse, this model can help them to understand the negative repercussions of the abuse and the possibility for other, more positive kinds of sexual relating. They see graphically that sexual energy can be channeled in an entirely different direction than what they experienced during abuse. They see, for example, that arousal can occur in a context that is not tinged with shame, fear or pain. They see the possibility for sexual intimacy to be nurturing, beautiful, and life-affirming.

For victims of abuse and their partners, sexual recovery requires a level of communication and emotional honesty which goes beyond the standard in our society. Someone who has never been abused may never have developed some of these skills nor ever have expected to master them to enjoy a satisfying sex life. If, for example, a husband has been operating in a role-based model of relating he may assume that his role is to be kind to his wife, and that hers is to have sex with him whenever he initiates it. Because of cultural messages, he may assume that is how she shows her love for him. But if the woman is a survivor of abuse, she may have flashbacks triggered by his demands for sex.(17)

In recovery work a therapist may ask the husband to be patient, to listen, to respect his wife’s need for comfort and safety, to develop a deeper sensitivity to her needs. This may involve communication skills he has never learned. But when he sees the hierarchy model, he may finally understand why he needs to develop such skills to help his wife relate with him sexually. The attributes he acquires higher up on the hierarchy clearly distinguish him from an offender. He also learns that the changes he makes will enable him to advance in his own sexual enjoyment and satisfaction.

In addition to its application as a tool in therapy, sexual addiction, and sexual abuse recovery work, this model can be useful in sex education. It helps people realize that the nature of our sexual behavior has to do with the choices we make. To make healthy choices and have positive experiences, we need to recognize interpersonal dynamics as much as learn safe sex practices and pleasuring skills. Similarly, since it emphasizes the differences between abusive and healthy sex, this model can also be used in rape prevention and sex offender treatment.

Another benefit of this model is that it is not based on heterosexuality. It respects different sexual orientations. Because the focus is on the interpersonal context rather than on specific behaviors, this model has universal applications for any two persons in a relationship.

Far from encouraging sexual repression, this model strives to increase our capacity for a higher level of sexual interaction. It complements recent trends in therapy that promote equality, fairness, mutual respect and deeper intimacy in relationships. The hierarchy can inspire couples to create long-lasting, more satisfying sexual lives together.

If authentic sexual relating were to be embraced as a broader social goal, imagine the benefits to our communities. Our media might offer tangible images of authentic intimacy, rather than the current focus on exploitive sex. If the skills required for authentic relating were the norm, we would reduce the likelihood that sexual energy would get channeled in destructive, violent, abusive ways. Similarly, the increased honesty in communication and respect for the body would decrease the spread of sexually transmitted diseases. All of these are sex-positive benefits, rather than a lapse into the repression of a more puritanical era.

If sex is truly like water, it is both life-sustaining and a source of tremendous energy. As a society, we are willing to plan for the quality and uses of our water. If we allow sexual energy to go undirected, we are opening the floodgates to sexual abuse and harm. We can only benefit by channeling this natural energy to positive, life-affirming purposes.



1. Bird J, Bird L: Sexual Loving. Garden City, Doubleday, 1976.
2. Thirty Years. SIECUS Report 22(4), 1994.
3. Maslow A: Toward a Psychology of Being. Princeton, Van Nostrand, 1968.
4. Erikson E: Childhood and Society. New York, Norton, 1963.
5. D’Emilio J, Freedman E: Intimate Matters. New York, Harper & Row, 1988.
6. Richards D: The Moral Criticism of Law. Encino, Dickenson, 1977.
7. Maltz W, Holman B: Incest and Sexuality. Lexington, Lexington Books, 1987.
8. Maltz W: The Sexual Healing Journey. New York, HarperCollins, 1991.
9. Carnes, P: Don’t Call It Love. New York, Bantum, 1991.
10. Reiss, I: Sexual Pluralism: Resolving America’s Sexual Crisis.SIECUS Report, 1992.
11. Author’s clinical files, 1994.
12. Ibid.
13. Carnes, P: Out of the Shadows. Minneapolis, CompCare, 1983.
14. Comfort A: The New Joy of Sex.. New York, Crown, 1991.
15. Westheimer R: Dr. Ruth’s Guide for Married Lovers. New York, Warner, 1986.
16. Gramunt M: Sacred Sex. Yoga Journal, May/June: 58-140, 1994.
17. Maltz W: Identifying and Treating the Sexual Repercussions of Incest. J Sex & Marital Therapy, 14(2): 142-170, 1988.

Note: “The Maltz Hierarchy of Sexual Interaction” by Wendy Maltz, MSW, was first printed in Sexual Addiction & Compulsivity, Volume 2, Number 1, 1995. Special thanks goes to Dr. Patrick Carnes, Ph.D., editor of the journal for special permission to reprint the article on