In a recent session, a client was struggling to accept and get on board with her husband’s ideas of what is sexy. According to her, he even went so far as to say he doesn’t find her sexy because she doesn’t look or act like the women he sees in porn and he finds those women sexy. (This is a perfect example of why we shouldn’t tell our partners everything we think and feel.) She then told me how she’s been trying, albeit with a lot of anger and resentment if she’s being honest with herself, to be more like the women her husband sees in porn but as a result of that resentment it’s been a half-hearted attempt and ultimately unfulfilling because that’s just not who she is. She’s come to see me to examine her husband’s ideas about what is sexy, how those impact her and their sexual relationship, and how she’s come to feel very un-sexy over the years. I interrupted her and said, “You don’t think you’re sexy?” She said no earnestly. And I said, “I see a smart and feisty woman who, after decades of conforming to her husband’s ideas about all things sex, is finally giving a shit about her own sexual experience and her own sexual pleasure. And THAT is sexy!”
Because it is. And I’ve learned over the years that most people seem agree with me. I’m referring to how my clients say they want their partner to “want to want to have sex.” That "wanting to want" is an IRL energy, attitude, and enthusiasm that is sexy to most people. More than any nameless digital visual will ever be. And if more people thought about ‘what is sexy’ in this way instead, perhaps they’d find the eroticism, sexual pleasure, and connection with their partner that perhaps they have been longing for.
On my way to work this morning (Valentine's Day 2019), I heard an internationally-known psychologist and expert on relationships be interviewed. In the course of the conversation about marriage and relationships, the interviewer asked “Some people say you need to work on the relationship while others say if you need to work on the relationship then something’s wrong. What is your take on that?” And the expert replied, “Well, I hate to break it to you, but you need to work on your relationship.”
NO NO NO NO NO. My profession’s marketing department has gotten this all wrong.
It drives me bonkers when I hear the phrase “The Relationship.” It’s not THE relationship - something that’s out there, separate from you and your partner, an entity that you manage like your checking account.
But this is, unfortunately, the bill of goods my profession has sold people to expect when they hear an expert on the radio say what they said today. So it's no surprise many clients come into therapy with a laundry list of complaints about their partner (because it's about "The Relationship", not me personally). They want the therapist to fix their partner while they sit passively by, nodding in agreement when the therapist points out their partner’s imperfections. They’re waiting for the “I told you so!” moment. At least that is what I think some people fantasize will happen in therapy. Like a form of destructive validation. Meanwhile, when one partner engages in that behavior, *of course* their partner is going to become defensive and/or counterattack and tell the therapist all the ways their partner is at fault. And we’re off to the races. This is not a productive use of everyone’s time in therapy.
The fact is, it’s YOUR relationship or even better yet it's OUR relationship. Try thinking about it this way instead: “I create this relationship together every day with my partner. This relationship is a part to me, it’s a part of my partner, and it’s a part of our life together. It is ours to own, change, and nurture.”
Because the reality is, you need to work ON YOURSELF, not “The Relationship.” This is what my profession needs you to know. Any relationship, but particularly the intimate one you’re currently in, *will* challenge you and you *will* feel uncomfortable feelings. It’s inevitable. And it’s not your partner’s job to make sure you aren’t challenged and don’t feel uncomfortable feelings. If they believe this (or you lead them to believe this), you will find out down the road all the harm it causes.
So how do you cope with all this? You need to work on understanding your feelings. You need to work on listening non-defensively. You need to give up black and white thinking. You need to work on identifying what you want and need (and what the differences are between these) while learning how to communicate those as requests, not demands or threats, and preparing yourself for disappointment. You need to learn about your anger and how to soothe yourself when you feel it. You need to practice empathy, loving kindness, and patience in those moments when it’s especially hard to do so. You need to remember why you chose your partner in the first place. And the built-in paradox of all this attention to self is that you need to learn it’s not all about you.
These are not things your partner, or your couples therapist, can do. Only you. And I promise that when you take your focus off your partner’s faults and instead focus on how you can grow and stretch yourself, “The Relationship” will improve. Not because of any magic that the therapist spun, but because you took ownership and responsibility for what you are doing and choosing to act differently.
Happy Valentine’s Day.
Last year my friend’s husband died suddenly and like when all young and thriving people pass unexpectedly it was and still is a huge loss for our group. A few months after he died, my friend asked if she could talk to me since, as she said, “You’re a sex therapist and all.” She told me about a specific pain and heartache she feels regarding the death of her husband. They had a monogamous relationship and with his abrupt death she also lost her partnered sex life that same awful day. She told me that sure she misses the sex, but what she is realizing in her grief is that she is also missing the laughing, the cuddling, the caressing, the hugging, the holding each other, the looking into each other’s eyes, the silly moments, the awkward moments, and yes even the disappointing moments. While masturbation scratched an itch, she said with partnered sex she had exactly that: a partner and intimate friend with whom she could share all those things. It was the 'sharing with' that felt particularly special for her, and is something she profoundly misses now. I was, and still am, deeply moved by her experience and her description of her experience. And with her permission, I share it here as a way in to discuss how partnered sex is different than solo sex.
(On a side note, she also said this issue has not been addressed in any of the grief support groups she’s been going to. Yet another time my profession falls short when it comes to sex. And just this morning on my way to my office I heard the radio deejays describe partnered sex as “that special connection you have with someone else.” It seems everyone understands partnered sex is fundamentally different than solo sex.)
As I talked about in my previous blog (see below), I define solo sex as your first and primary sexual relationship and it is a relationship you have for your entire life regardless of your external relationship situation. I also said that solo sex is your internal experience of your sexuality and chosen external expression of that internal experience. For those that also desire a partnered sex life (because there are people that do not and that’s just fine), solo sex is the foundation of partnered sex.
Partnered sex is when you decide to share your solo sexual self with another person or persons and they decide to share theirs with you. So all parties must first consent. While consent is necessary it is not enough. What exactly is everyone consenting to? For how long? In what order? What kind of safer sex method(s) will be practiced? Who decides when it’s over and how? And what will happen after it’s over? When I ask my clients that initial question (“What are you consenting to?”), they usually say “Duh, sex!” But that still is not clear enough because as I’ve learned everyone has a different idea of what sex is (and isn’t).
As you can see from my questions, when we choose to engage in a partnered sexual encounter, there is a lot more that needs to be addressed ethically. How many times in your life did you engage sexually with another person but you didn’t discuss beforehand about what would and would not happen or what you would and would not do? I think everyone. Looking back, what was missing? “Yeah Diane, it’s called communication” is probably what you’re thinking. OK sure. But that word, “communication”, is horribly inadequate to describe what skills are needed in a partnered sex scenario. A better description of what is needed are things like: self-awareness regarding your likes and dislikes, turn ons and turn offs, and hard and soft boundaries; verbally describing these things clearly and assertively — and of course having the courage to say it; knowing how to negotiate when differences occur; resolving your ambivalence if there is any about any aspect; understanding your hopes and expectations for the experience itself, what happens after, and describing these expectations; preparing for the possibility of disappointment (or judgement) and coping well if it happens; and then having the knowledge that, empathy for, patience with your partner(s) has all these things going on too. You don’t need all these skills in solo sex and this is what is precisely different about solo sex vs. partnered sex. And you can see why when partnered sex “is good”, it brings people closer together and they say they feel more connected - they’ve not only shared of themselves and shared something with someone else, but they’ve also revealed something about themselves to another and it was received with respect and (hopefully) tenderness. And you can also see why when partnered sex “is bad”, just why it’s so darn painful: partnered sex offered the promise of intimacy and connection, seeing and being seen, and mutual pleasure but resulted in hurt feelings, disconnection, and perhaps even relationship discord.
Yes, it is a complex process that in my experience most vanilla (as opposed to kinky) people don’t take the time to do…and when they don’t, they end up experiencing all kinds negative consequences. If you know anything about kinky folks, one of the the hallmarks of kink is how and what is discussed and negotiated beforehand. This is a valuable skill many vanilla people need to learn from kinksters.
I’ve had clients tell me that there are times when they are in the mood for and ready to handle all the complexities of partnered sex that I just described and there are times when they are not in the mood and not ready for dealing with the complexities of partnered sex. I think that’s great - that someone has that much self-knowledge to know this about themselves. I hope more people will come to know and understand themselves better in this way.
I often talk with my clients about “solo sex” and “partnered sex.” If you Google “solo sex”, you’ll see that in the majority of the articles where the phrase is used, it’s referring to masturbating by yourself and that seems to be how most of my clients understand the term. OK sure, that’s fine — another phrase for masturbating — but don’t we have enough of those already? Ask any 14 year old adolescent male or Adult Swim viewer how many terms for masturbating he/she/they can think of in 10 seconds and you’ll see what I mean. Instead, I want you to expand your conceptualization of the term “solo sexuality” to include SO MUCH MORE. I think that if you do, your sex life will improve.
So what do *I* mean when I say “solo sex”? Yes, I can be referring to masturbating by yourself. That’s just one aspect of solo sex. But I’m also talking about your internal experience of your sexuality and chosen external expression of that internal experience. This can include your romantic, sensual, erotic, and sexual fantasies; your turn ons, turn offs, and how you relate to them (if you don’t understand what I mean by this just think of the ashamed fetishist); how you experience your sexuality in your body sensually, erotically, and sexually; your relationship to pleasure; how you utilize your mind and body to express this sexuality (so here’s where masturbating comes in but I also mean things like how you dress or dance or when and where you choose to feel sexual feelings and with whom); and heck even things like that pleasurable and fun zing! you get when you see an attractive person on the street or the decision-making involved when you decide to flirt with that cute barista who makes your latte every Friday just the way you like it.
Do you see what I mean now? Solo sexuality needs to encompass all this and more!
Your solo sexuality is your first and primary sexual relationship and it is a relationship you have for your entire life regardless of your external relationship situation. It can and does frequently change over the course of your life as you grow and have new experiences both challenging and successful. Unfortunately for many, their solo sexuality can also cause immense confusion, fear, and shame.
Based on the clients I have seen over the years and speaking in generalizations (something I should probably get a slap on the hand for), it seems that a lot of men regardless of sexual orientation seem to understand my broad concept of solo sexuality. They have already had hundreds (if not thousands or more) of private experiences with themselves and their solo sexuality. One subset of people that seem to need some help with this idea is women. Many of my female clients don’t have a solid understanding of, acceptance of, or pleasure in their solo sexuality. There’s lots of possible causal factors for this: our culture’s fear of a truly sexually empowered and embodied woman; the taboo nature of female pleasure; and how historically female sexuality has been minimized or denied or thought to be there for the purpose of men. Some women feel uneasy about masturbating (see my previous blog entry) or some women feel that they *should* (there’s that word) only experience their sexuality in a partnered setting. In fact, it’s not just some women who have this latter belief. Another subset of people who seem to need help with my idea of solo sexuality are a few religions and 12 step programs that say partnered sex is the only acceptable sex one can have. Ay yi yi.
Besides all the things I’ve mentioned above, another thing I tell my clients who have little understanding, acceptance, or pleasure with their solo sexuality is that their pleasure during partnered sex is dependent upon their understanding of their solo sexuality. How can you tell your partner where or how you like to be touched if you haven’t explored that on your own? In the absence of that knowledge, these clients stressfully default to focusing on their partner’s experience “I’ll just make it about you tonight”. So long as their partner isn’t pathological, at first this can be experienced as my client is giving them a gift and/or being sexually generous. But it’s been my experience that if this behavior happens repeatedly over time it’s inevitable that their partner will want them to become invested in a mutually pleasurable sexual experience. Their partner is asking for a sexual equal. What’s more feminist than that? This means knowing what you like and want sexually in a partnered experience. So once again we’re right back where we started: developing and understanding your solo sexuality. It’s a worthy endeavor to embark upon. And I hope that by reading this, you’ll become more attuned to your solo sexuality and its fascinating nuances and edges. In a future blog post, I’ll discuss more about the differences and similarities between solo sex and partnered sex.
One of the genuinely heartbreaking aspects of my work is how little cisgendered and heterosexual women know about their own bodies. In particular, how little they know about what I call the anatomy of pleasure. Now that being said, most, if not all, of these women have some knowledge about the clitoris. That when I say the phrase “sexual pleasure”, many of them tell me they immediately think of this one organ.
“Yes, the clitoris!” I say with excitement. "Talking about the clitoris a great place to start. Have you found its four legs on your own body with your own hand or a vibrator perhaps?” I ask. Most of these women give me a confused look or a blank stare. Then I often hear one of the following responses:
“The clitoris has legs? What do you mean?”
“I don’t own a vibrator.”
“I have never touched my genitals with my own hand.”
As I’ve said before in this very blog, I am so thankful for my clients’ honesty as it tells me precisely where we need to begin our work.
And so I tell them about the clitoris. How it’s not just the external nub; it has four “legs” inside the body. I can get quite animated and enthusiastic extolling the wonders of the clitoris. Hell, sometimes I even get out a piece of paper and draw a representation of it. (I always wonder what my clients think when they see this side of me.) If you don’t know what I’m talking about, here’s an article that explains more.
A good part of my work involves this kind of education (a.k.a. sex education) as the first step. But as any sex therapist can tell you, that’s often not enough. Putting this information into the context of the client’s own psychology and sexual relationship is the next crucial step.
First, integrating this knowledge into the person. Many women tell me they feel awkward, uncomfortable, and some even say they feel “dirty” or “bad” for touching their genitals with their own hand. I point out they touch their own genitals when bathing, when going the bathroom, dealing with their menstrual cycle, perhaps using certain contraception and safer sex methods, maybe even when changing or adjusting clothes. So we look more closely at why touching her own body for pleasure is taboo to her. Shame always is part of this and usually takes center stage; there’s usually a lot to unpack and reprogram.
Eventually comes the day when she gets a ‘homework assignment’ from me, her sex therapist: go home and touch yourself or buy a vibrator and use it on yourself. Then come back and tell me how it went because learning your own body is so crucial to understanding your own sexual response and enjoying a sexual relationship. And that’s when therapy can really enter a whole new dimension.
Different women have different reactions to this ‘assignment’. Some are so curious and motivated they leave my office and stop at the local sexuality shop on the way home. Some go home and immediately buy a vibrator online. Some make a point to take a private bath that night. Other women, though, are more hesitant or ambivalent. That’s OK, I tell them; that just means we need to work on the shame some more.
(And BTW it’s not just the clitoris that allows a woman to feel sexual pleasure. Other parts of the body are erogenous zones too like breasts, the inner thigh, neck, ears/earlobes, small of the back, buttocks, hands, feet and toes. It’s wonderfully unique from person to person.)
Women and their own pleasure. It’s such a huge topic that every woman needs to grapple with and decide where they want to land with it. The question is, where do you want to be / what’s your goal in terms of your own sexual pleasure? The answer to that question will tell you exactly the work that needs to be done to get there.
I work with many couples during and after the discovery of an affair or other form of betrayal. Let me tell you about one of them.
This couple came to work with me after the wife learned that her husband had had an affair with a work colleague. She was devastated and was openly questioning if she wanted to stay married to him. He was shame-ridden, deeply remorseful and afraid, saying he was willing to do anything to “save the marriage”. We spent the first year or so of their couples therapy working on managing the fallout from the affair, its impact on their relationship and the medical, financial, emotional, relational, sexual, and existential/spiritual consequences. Things mostly stabilized between them and they found a “new normal” in their lives.
Post-crisis, we began to discuss what their relationship was like pre-affair. This is an incredibly important part of the recovery work — I cannot emphasize this enough. They described an all-too-common situation I frequently hear from couples: her center of attention was being the stay-at-home parent to their young children while also managing her mental health; he focused on being the breadwinner and not causing her stress. As is so often the case, sex fell by the wayside. They described their sex drives as him having a higher libido, her a lower libido. He eventually explained how their lack of sex is what led him to have the affair. This resulted in her feeling guilty for not “giving him sex” (BTW, sex is not something you “give” another person but that’s another topic for another time), feeling angry that in his mind his decision to have the affair was about her not having sex with him during that very, very difficult time, and also feeling resentful about the now omnipresent pressure she felt to have sex with him to deter him from having another affair. He repeatedly said that if she would “just have sex with him more often”, he would be a happy guy.
Variations of this is, unfortunately, a narrative many couples create. When someone decides to do X (have an affair, be in a bad mood, start an expensive hobby) because “my partner doesn’t have sex with me.” People often make sex — or the absence of it — the reason they do something in a relationship. This is a false narrative!
When you make it about sex, you’re not making it about other important things, like your feelings about sex. When you make it about sex, it means you’re not being vulnerable with your partner and sharing what role sex plays in your life. When you make it about sex, it’s a sneaky way of shifting responsibility away from your own actions and experience and onto something — or someone — else.
Knowing that making it about sex is a slippery slope into avoidance behaviors I just described (and what would be the relationship implications if they did yikes), I didn’t want this to become their dominant narrative about his affair or their pre-affair sex life. So I asked him:
“What are you thinking and feeling when she doesn’t have sex with you?”
Him: “I’m thinking, I wonder if she still likes me, is she still attracted to me, does she still want to be with me.”
“Aaah” I said. “You have thoughts and feelings of self-doubt and relationship insecurity?”
He said yes.
I continued: “And so the way you know how to deal with those uncomfortable thoughts and feelings is to have sex with your wife. And when you have sex with your wife do those uncomfortable thoughts and feelings go away?”
“Yes,” he said softly, but he was looking me squarely in the eye so we all knew we were getting somewhere. She was quietly observing our exchange, riveted by what she was hearing for the first time.
I continued: “Well then, we need to help you find another way to cope so that you don’t always rely on having sex with your wife to alleviate those painful thoughts and feelings.”
There was a long silence in the room. This was big.
He risked vulnerability to show her his inner life. She saw a side of him that she had never seen before. Because he revealed this important thing about himself to her, he felt closer to her and she felt she understood him better. It was a powerful session, it shifted things between them, and was a moment they continued to reflect upon after it was over.
I hear a common complaint from my clients: “<Sigh> I just don’t have the interest/drive/desire for sex." These clients feel badly about this and wish it was different. Maybe their health isn’t what it was. Or maybe they feel pressured by their partner and that is what is bringing them in. Or maybe they long to have more sexual interest/drive/desire like they used to; nostalgia is a powerful force my clients and I frequently reckon with in my office.
What I also hear from many of these folks is how busy and full their lives are…to the point of regret or even downright dislike. They describe a life not of abundance but of near-constant responsibilities in all areas: demanding jobs, demanding kids, the high cost of living in northern California, aging parents, the wish to engage more in hobbies and socializing, the need to exercise and eat healthy and get adequate sleep, the never-ending cycle of household chores and errands, and some vague notion about pursuing personal fulfillment and happiness (“Is this all there is?”).
What many of these folks end up doing is relating to sex the same way they approach the rest of their pressure-filled lives: using a cost-benefit analysis with time and energy playing major factors in their decision-making. So for example, many people relate to their workday mornings as follows:
“I must be at work at 9am. Therefore I will need to wake up at 6am so I have enough time to walk the dog for 30 minutes, then leave for the gym at 6:30am and workout for 1 hour, then at 7:45am I will get showered and dressed, then at 8:20am I will start commuting to work and it takes me 30 minutes to get there but I will give myself a little bit of a cushion in case there’s traffic.”
Folks also tend to relate to their workday evenings similarly: “I have to leave work to pick up the kids at 4:30pm, then drive home, make dinner by 6pm, make sure the kids do their homework, get them bathed and in bed by 8:30pm, then maybe after that I can do the dishes, maybe a load of laundry, and in bed by 10pm.”
Every task is broken down into discreet chunks of time and prioritized according to any number of values (i.e. necessity, duty, self-care) while also assessing how much time and energy is needed to do that task and how much will be spent. I have heard more than once over the years a client say that when their partner invites them to have sex at night, they say to themselves “But I’m already so tired…how much sleep will I lose if I have sex tonight?” Wow - talk about unsexy sex. No wonder your sexual interest/drive/desire has declined.
Sure, sometimes sex is a box you check off your list of things to do. I don’t deny that reality and sometimes it honestly is a humdrum experience. In long term relationships that is going to happen…and when it’s disappointing and uninspired you need to practice resiliency, not blame your partner, and even move towards them versus away from them. After all, do you expect every dinner to be fantastic? You probably don’t, or I hope you don’t. Some nights you eat a bowl of cereal and move on, knowing that tomorrow and the next day and the next day you have another opportunity at dinner. Sex in a long-term relationship is the same way.
But when you perpetually consider sex a chore to maintain your relationship, it’s now in the same category as brushing your teeth or exercising to maintain your health. You do it because you should. There’s no emotional or relational investment to your partner, the sex itself, or a good outcome. You’re on autopilot. You do it to get it over with. When sex becomes “yet another thing you should do” in your life, you now relate to it differently and it inevitably loses its luster. (Cue that nostalgia. It’s often where people go in this moment.)
When clients describe their sex lives with a mindset that it’s “yet another thing to do”, I hear it and it honestly sounds pretty awful to me too. I feel sad for all involved. I hear one partner often trying to keep hope alive and keeping something afloat, while I hear another partner appreciating the other’s efforts but also feeling some degree of pressure and ultimately playing defense. The first thing I do is I usually encourage everyone to stop doing what they’ve been doing. I sometimes get push back from clients: “But then we’ll never have sex!”, they fear. “Doing that brings you the ho-hum sex you’ve been having, and isn’t that why you’re here in my office, to stop having that kind of sex?”, I say. Yes, they quietly acknowledge.
Creating a good to great sex life is not a emotionally or behaviorally passive experience and the work it takes to get out of these sorts of sexual ruts is proof of that. Your passivity is what in part produced your current humdrum sex life. It’s also not good to great because of your partner or because of mood-altering substances or because of the youthful and firm body you used to have or because years ago your feelings about your partner were mostly positive based on limited experience. Good to great sex is about you having an enthusiasm and openness to a not-yet-determined experience. Imagine that — not playing it out in your mind like a script that’s already been written and everyone knows their parts! This is a better mindset to have. And having the courage to tell your partner what you like and don’t like sexually helps too. But that’s usually step #2 in this process.
More on that later.
Besides doing an assessment based on the presenting problem in my initial appointments with new clients, I’ve begun to assess for how does this person or couple relax. So I ask “What do you do to relax?” And I hear common answers like “Exercise” or “Watch movies or shows” or “Play video games.” I hate to break this to you, but none of those things actually help you RELAX.
Exercise gives you a temporary rush of endorphins (i.e. make you feel good and that probably has a secondary sexual benefit when it comes to your self-esteem and body image) but it can also make you feel fatigued - or as a client recently described it, “spent.” And watching movies and shows or playing video games distracts us, takes our mind off other things, and is a bit like numbing ourselves. When I describe that relaxed is a state of feeling calm (vs. tense), alert (vs. distracted or numb), and awake and energized (vs. tired), many of my clients sheepishly admit “Yeah, I don’t really have that feeling regularly.” Some clients are even courageous enough to confess “I don’t really know what that feeling is.” Boy am I glad my clients are this honest; it tells me precisely where we need to focus our efforts.
I can’t tell you how many people minimize the need for regular and consistent relaxation in their lives. I think part of this is the economic realities of living in expensive northern California; part is the demands of our two-income, two children families and lifestyles; part is how omnipresent technology is in most people’s lives; part is a very American mindset regarding hard work and sacrifice; part is the individual’s psychological and trauma history; part is the existential anxiety we all start to feel at a certain age; and part is the individual’s relationship to and understanding of their own body.
Is it any surprise that those people who struggle to relax also have sexual issues? Absolutely not. The connection between these things is no coincidence. As I like to say, who we are outside the bedroom is exactly who we are inside the bedroom. My clients frequently tell me that when they begin a sexual experience with their partner their minds are elsewhere: on their stressful job, the never-ending household chores (this is where I’m reminded of choreplay as a way to “solve” one partner’s anxious feelings but if you've ever done it you know it doesn't really solve anything), the kids, what other productive thing they could be doing with this time instead, how much precious sleep they expect to lose if they have sex at this late hour, etc. What they hope happens, and I do too, is that at some point during the experience the sex becomes interesting enough or arousing enough or pleasurable enough that they are able to change their focus from those other thoughts to instead what is happening in their here and now and go with it. If they don’t or can't, sexual problems generally occur.
But I want to reverse that. What if you started a sexual encounter already relaxed and with a calm mind and body? What if you got relaxed first and then had sex? This is what people say a glass of wine or music or cannabis or candles helps them do. Problem is, all of those are passive ways of transitioning into sex and experiencing your sexuality. What if you actively took steps to not just set aside the worries of the day but to also get into your body, feel your sexuality, and prepare for partnered sex? What would that take?
Think about it.
One of my biggest frustrations as a mental health professional is that certain ideas and terms, promoted in pop psychology circles and then spread throughout media, get established in the culture as legitimate without widely-accepted scientific knowledge and research. Here’s a perfect example: “codependency” was a popular “diagnosis” in the mental health field several years ago. Many people entered therapy with the presenting problem “I’m codependent”. Treatment programs popped up all over the country, many of them very expensive, claiming they “treat codependency.” Codependent Personality Disorder was even proposed as a diagnosis in the DSM-III, the publication of mental health disorders, in 1987 but thankfully failed to be included due to a lack of scientific evidence.
As the two sayings go, everything old is new again and those who fail to learn from history are doomed to repeat it.
This is and has been happening again with the concepts of “sex addiction” and “porn addiction”. Once again many people, and statistics are showing that it is predominantly men, are entering therapy with the presenting problem “I’m a sex addict” or “I have a porn addiction.” Once again treatment programs have popped up all over the country, many of them very expensive, claiming to “treat sex addiction and porn addiction.” And once again Sex Addiction was proposed as a diagnosis in the DSM-V in 2013, its most recent publishing, but thankfully failed to be included due to a lack of scientific evidence.
I certainly do not expect the general public to understand the controversies and conflicting research surrounding such provocative “diagnoses” of “sex addiction” or “porn addiction”. Yet it is still paramount we, the mental health profession, ask questions like:
- Why are “sex addicts” predominantly men? They also tend to have more conservative and negative
attitudes about sex - why is that?
- What is the influence of mental health issues like depression, anxiety, OCD, or a personality disorder on their sexual functioning and sexual decision-making?
- What are the stressors (marriage, relationships, parenting, money, health, work) in these men’s lives and how are they coping with them?
- What messaging and values (from family, from religion, from culture, from friends, from his spouse) did he internalize about his sexuality? How do those square up with what is actually going on in his sexual self? Does he really believe those messages and values now? What are the consequences if he does and does not follow them?
Many manifestations of so-called “sex addiction” can be summed up with the following statements: “I like X and I shouldn’t like X” or “I do X and I shouldn’t do X.” What a wonderfully succinct description of an inner conflict! This is exactly what psychotherapy is here to help with - better understanding of self. “Why” is a question about motivation and it is a fundamental question in psychotherapy. It is a fundamental question sex addiction treatment providers generally fail to explore with their clients, other than ascribing it to the “diagnosis” of “trauma”. Another reason sex addiction treatment providers give for "sex addiction" is “because it’s addiction”, yet that’s a circular explanation that does nothing to illuminate the inner workings of the individual’s psyche.
So why would a man do X when he feels or believes he shouldn’t do X, you ask? Maybe he feels he shouldn’t do X because it’s illegal and he doesn’t want to get arrested and go to jail. Or because his family-of-origin messaging/religion said so. Or because if his wife found out he’s afraid she will judge him for it and that prospect is painful him. Or maybe because it’s a symptom of his depression but because he’s a man and male depression often presents differently than in women he (and his doctor) failed to recognize it. Or maybe because he’s angry at his spouse and can’t tell her so this is how he has been displacing and sublimating his anger. Or maybe because he hasn’t had sex with his wife in years and doing X is a way to stay monogamous.
These are just some of the reasons I’ve seen in my male clients for doing what they do. They are explanations and not excuses. That being said, explanations matter because when we understand the "why" we can better begin to change what we want to change. Calling yourself (or your husband) a “sex addict” jumps over the “Well, why is that?” question itself and the necessary exploration of the possible answer(s) to that question. As Douglas Braun-Harvey and Michael Vigorito described in their book, “Treating Out-Of-Control Sexual Behavior; Rethinking Sex Addiction”, when someone enters therapy saying “I’m a sex addict” and the therapist accepts this without much of an assessment, this is akin to you telling your doctor “Hey doc, I have cancer” and your doctor responding “When would you like to start chemo and radiation?”
Being a sexual person means accepting the consequences of your sexual choices. Hell, being an adult person means accepting the consequences of your choices. And let’s face it: that’s painfully difficult to do at times. For many it’s even more so when those consequences happen in the sexual arena of their lives and they lack an understanding of their motives. I work with these issues every day and see first-hand the consequences in people’s lives.
Sexuality, and more importantly sexual choices, do not exist in a vacuum and they are not solely driven by biological processes. Sexuality and sexual decision-making exists in a context that includes biological, psychological, and social factors and is constantly taking in and responding to the internal and external stimuli of these factors.
What ultimately matters is that I, as a sex-positive clinician, understand how a person’s relationship to sexual activities and/or pornography can be problematic in their lives and relationships. What also matters is that I hold a humane and judgement-free space for curiosity and respect for my client's lived experience while we explore their underlying motivations. I get that many people do not understand their sexual selves and may even be afraid of examining their sexuality. I am here to help.
Finally, I have no idea how far and wide (or not far and not wide) this blog post will travel. Many others with bigger and better credentials than mine have written about all of this before. Some of those people have received not just troll-y emails and comments for their opinions on this topic but some of them have even received threats of harm to themselves and their families. So not cool, Internet. It is alarming that a difference in opinion can generate such animosity and aggression. Tension can be healthy and has the potential to move us towards a better outcome; it is not inherently a threat. And as a society we need to learn to better tolerate our differences without resorting to attack.
A common issue I see is low or absent sex drive in women who report previously having a high(er) sex drive. These women usually, but not always, have been with the same partner for years. Their emotional reactions to the phenomena run the gamut. Some of these women are distressed by its decline/disappearance while some women are ambivalent while even others are relieved. Remember, sex is never one-size-fits-all and if I’ve taught you anything, dear reader, it’s that there’s always good reasons why she feels the way she does.
So I ask questions and learn about her sexual history. Was there a time when she had a high(er) libido? Was it with her current partner/relationship? When did it start to decline and what was going on in her life? What has she (or they) tried to increase her sex drive? Were those attempts successful? Why or why not? Why is she seeking treatment now for this issue? What are her partner’s thoughts and feelings about (A) her lower libido and (B) her seeking help for it? Are there any drawbacks to having an increased sex drive? And so on.
It’s incredible what these questions uncover. For example, maybe her sex drive changed after the birth of their first child when life, and her priorities, went a new direction and not to mention she felt fatigue like she never had before. Maybe after baby and baby weight she did not like her body and felt deeply insecure and judgmental about being sexual with it. Maybe her sex drive took a nosedive after her alcoholic mother was diagnosed with cancer and their historically tumultuous mother-daughter relationship became even more draining when she began to take care of her mother. Maybe her libido went underground as a result of growing resentments she had towards her partner. Or maybe she’s just plain bored and unsatisfied with the sex she and her partner do have but doesn’t want to tell her partner her truth for fear of hurting their feelings.
We examine these life and relationship issues and their impact on her libido but there’s a powerful detail in all this that gets easily missed. Often what is revealed is that at some point, she decided to sacrifice her right to sexual pleasure. She traded it in for something else she deemed more valuable: sleep, time with the children, advancing at work, completing household chores, or preferred emotional states like not feeling bad about her relationship, not feeling bad about her partner, or not feeling bad about herself. This usually seems like a worthwhile trade-off for a period of time until it doesn’t and the consequences become big…and she finds her way to my office.
Ladies, you must stop doing this! Sexual pleasure is not something to be bartered. When you make your sexual pleasure optional and unimportant you make sex optional and unimportant. You have a right to sexual pleasure so honor it. Pursue it. You have unique anatomy that allows you immense pleasure. Even the World Association of Sexual Health’s Declaration of Sexual Rights has stated we have a right to sexual pleasure. It’s #7 if you’re curious.
I am a licensed Marriage and Family Therapist and AASECT Certified Sex Therapist located in Sonoma county, California.