Undoing the Effects of Sexual Trauma

Perhaps no form of personal trauma is as painful and nefarious in its impact as sexual trauma. I have written extensively on this topic before, and my research in the area of impact of childhood sexual trauma on adult sexuality has won an award and been published in a peer reviewed academic journal. For those interested, you can read the journal article here- Pathways.

In my work with adult survivors of sexual trauma, I invariably encounter a cluster of difficulties that must be worked through. Specifically, the trauma is often internalized, which means that the affected individual may often place blame on themselves or make generalized assumptions about their own sexuality or identity. A boy, for example who has been assaulted may question his own orientation, wondering what made him vulnerable to attack. Of course, orientation never has anything to do with it, as violent hands-on sexual offenses are an indicator of sociopathy, which is marked by a lack of empathy and remorse. Or the survivor may often develop a phobia of sex, and a negative body image to boot.

It’s this phobia, this specific fear response that I want to focus in on in this article. After working with countless trauma survivors, I have found that at the root of their sexual difficulties, which may run the gamut from performance difficulties to pain syndromes to the inability to experience pleasure, is that an automatic fear response has become associated with their natural sexual response. In other words, fear and arousal become co-mingled. And as a result, one of our most important tasks is to create some separation […]

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    Gray Areas in Sexuality: When Is a Fetish “Too Extreme?”

Gray Areas in Sexuality: When Is a Fetish “Too Extreme?”

I was inspired to write this article following my interview on about “Cash Slaves.” This documentary examines the edgy, underground world of Financial Domination, or “Findom.” Basically what this entails is an authority-based relationship where one individual experiences pleasure, and perhaps arousal, by being financially dominated (ie controlled, used, possibly exploited) by another. I would categorize this under “psychological edge-play” because it does touch upon some thorny, gray areas. For example, what if someone desired to be drained to the point of bankruptcy, what do we make of that? Is it ever healthy to be financially dominated in this way? These are all indeed tough questions and lead to an even bigger question– is a sexual fetish or desire ever too extreme or unhealthy? This video examines all of these questions, and then some, and pins the question of what it means to have this kind of a fetish up against the backdrop of living in an age of extreme capitalism. Brilliantly produced, directed, and edited, you can check out the video below, and after you watch it continue reading for my additional commentary.

When I agreed to participate in this documentary, I told the producers that I wanted to make sure that it did not portray any kind of non-normative sexual template in a pathological light. Along those lines, I made a point out of clearing up some misconceptions. Most of the individuals who participate in this do so in a controlled manner and have money to burn. Second, there are certainly a bevy of individuals wanting to jump into the findom game […]

Three Types of Couples’ Communication

When I work with couples in distress, I often first need to put out some fires and get the couple out of crises before we can make any steps forward. If they are having sexual problems but have also built up so much resentment that they are fighting like cats and dogs, we can’t even begin to get to the sex stuff until we address the overall relational dynamic. I’ve written about this before in this article about why sex therapists must also be good couples therapists.

What I want to address in this piece are some of the mechanisms of how we can get a couple out of dire conflict and into a place where we can get some real work done. This requires achieving a safe space for both individuals, a sanctuary if you will. And it’s not small feat as we are in effect trying to transform a battlefield into a sanctuary. Wow, even writing that, it feels so daunting, like it would take something miraculous to pull off. But it doesn’t require miracles, but simply a process in which both partners are equally committed to putting aside attachments to who is right and wrong and putting in the necessary work to communicate more collaboratively.

There, that’s the magic word– collaboration. Which is so difficult for folks to pull off when they feel flooded and go into fight or flight response. Let’s talk more about collaboration and the fight of flight response when it comes to the way that couples communicate. I am indebted to the work of Dan Wile, and his writings on collaborative […]

The Three Types of Fear

Some of the most common issues I work with are sexual performance difficulties and sexual fears and anxiety. In this particular post, I want to open up the discussion a bit more to include a broader review of the types of fears that I most commonly encounter in my practice. For simplicity’s sake, I will break it down into the 3 most common types of fears that I see my clients struggling with. These are, in no particular order, the fear of failing, fear of the unknown, and fear of emotions. These are all quite ubiquitous, but can create devastating effects, and so I would like to briefly touch upon each one in turn. And although they are uniquely different, they also have much in common.

Let’s start with fear of failing first. This fear is so common, there is a word to describe it– atychiphobia. In the older heyday of psychoanalysis, a common way of seeing clients who were struggling to make progress was that they were just simply resistant. This viewpoint assumes a kind of oppositional stance, with the client somehow working or fighting against the therapist to make change or progress. Rather than trying to push up against this so-called “resistance,” I take what I call a “pro-symptom” approach, which basically means that I want to try to understand what are the benefits of holding onto these problems or symptoms, rather than discarding them at once. This goes back to the harm reduction model that I advocate and have written about in the past; rather than try to push someone into something they are not ready yet […]

Self-Compassion and Sexuality

As I continue working on my upcoming book, I find myself naturally shifting my focus a bit more away from larger sociological constructs (although there is still plenty of that) and more towards the essential work that I do with my clients on a day-to-day basis. As I’ve written about before (here and here and here), one of the main missions of my work is to help individuals rid themselves of unnecessary internal shame, and sexuality is one of those areas that folks may often may feel the most shamed about.

And the further I go in my work, the more I become certain that self-compassion is one of the key ingredients that allows us to resolve that shame. Indeed, if I were to now be asked what is the most important takeaway that I can provide anyone through psychotherapy, I would answer that it would be the tools to cultivate self-compassion. When it really comes to it, I believe that self-compassion is one of the quintessential hallmarks of mental health.

So what is self-compassion and how do we cultivate it? First, I think it’s important to point out that it’s something that’s poorly understand. If I ask a client, for example, if they are able to experience self-compassion for themselves, they will invariably draw a blank look and state that of course they have self-compassion, or something to that effect. And this may be a client who struggles mightily with self-criticism, depression, anxiety, or any other internal conflict that would create distress.

I’ll say, let’s imagine that there is a distressed child standing on the corner of 5th Ave and […]

Book Review– Sex Addiction: A Critical History

On the heels of the controversial Myth of Sex Addiction comes a new just released book entitled Sex Addiction: A Critical History by Reay, Attwood and Gooder. My colleague, Dr. David Ley, a therapist and author of several book including Insatiable Wives and the aforementioned The Myth of Sex Addiction had an extra copy laying about and I said I would be happy to receive it in exchange for an honest review of the book. Putting that piece of full disclosure out of the way, I should also mention that this is a version of a fuller review I have written that will appear in an upcoming issue of the Journal of Sex and Marital Therapy, in which I have a standing outlet for book reviews.  On to the review.

For those unfamiliar with the sex addiction debate, this book is as thorough of an introduction and analysis of the key concepts as one could find anywhere. Even for those like myself, who is up on the latest in sex research, reads all the journals and is keyed in to dialogue with all of the thought leaders, there is still a significant amount of new information to be learned. Typically, when reading a new sexological book, I find myself thoroughly reading the first few chapters and then skimming the rest because either I already know most of what is being presented or the rest of the book simply repeats the ideas from the beginning but in a variety of different ways. Not the case here. The book is strong from beginning to end, and is as much a referendum on our […]

What Do Focus and Awareness Have to Do With Sexuality?

As most readers of this blog know, I have long been trumping the importance of mindfulness in helping to resolve a number of sexual difficulties. For most, it’s not easy to put a mindfulness or meditation practice into effect because there are so many obstacles and distractions that get in the way during the course of our busy lives. In addition, many people give up prematurely because taking out some time throughout the day to put a meditation practice into place feels like hard work, without any concrete results or metrics to be able to point to at the very beginning. Indeed, it takes a while to see specific results and by that time, many people have already moved on. It is well known by meditation teachers that drop out rates (of sticking with it long-term) are quite high.

As a result, I am constantly scouring for more resources that would allow my clients to experience a more seamless introduction to mindfulness. In this article, I’m going to introduce a few basic tools and then I want to explain in a little more detail what the quality of our focus and awareness specifically has to do with sexuality. I have learned that if my clients better understand the how and why, it helps them to dive in with a renewed sense of purpose.

One of the best tools out there is a completely free app called Headspace. It was developed by a former Tibetan monk, Andy Puddicombe, and takes the end user through a guided 10 minute meditation each day. It is both sequential (it builds on the […]

Why All Sex Therapists Must be Skilled Couples Therapists

A recent discussion on one of my professional list servs highlighted a common misconception that many in the public have about sex therapists. Specifically, it seems there is the idea circulating that sex therapists are only trained in helping individuals with sexual problems. This online professional discussion seemed to resonate with many, as it dragged on for several days and involved numerous contributors.

Suffice it to say, it got me thinking about my own experiences answering prospective clients’ questions, and it is indeed true that I am often asked whether, in addiction to sexual difficulties, I can also help people with other issues such as depression and anxiety (note to self: add this to the FAQ section). I answer that, as a certified sex therapist, I am first and foremost a licensed psychotherapist, so my foundational training is in general psychotherapy. Before sex therapy, I worked in hospitals and outpatient mental health clinics, just like any other mental health professional. Indeed, there is no separate track for sex therapy; if you want to become a sex therapist, you have to become a psychotherapist first (and then add a ton more specialized training after that).

The most common question I get however is whether I can provide couple’s therapy as well, or if not, should the individual hire a couple’s therapist in addition. This answer is complex because sometimes I get referrals from couple’s therapists when there is a particular sexual difficulty that they feel is out of their comfort zone, but suffice it say, a sex therapist generally must absolutely be skilled at couple’s therapy as well. Why? The short simple […]

Overcoming Sexual Shame

One of the main topics covered in my upcoming book, due sometime later next year, is the shaming effect that society has on our innate sexual selves and what we can do about it. It’s definitely not an easy subject to tackle because both sexuality and shame are extremely complex and cut right to the core of our identities. Save perhaps for urban millennials, who appear to be more sexually open than any other generation in history; it is the rare individual who has been able to escape the ill effects of the social repression of sexuality completely.

For many folks, shame may feel so pervasive that they don’t even realize how much shame they experience; they don’t have anything to compare it to.  It may only come out after many years of a committed relationship, where sexual boredom and complacency demand creativity and thinking outside the box. For others, shame is so deeply felt that they enter relationships hiding their true sexual desires, fearing that they will be rejected for who they are. Some of them may believe that they are sex addicts and usually have no difficulty finding someone who will treat them from a pathology lens.

The first thing I want to do when I work with a new client is make it clear that there is no shame or judgment in my office. I’ve heard it all and there is nothing that will shock or disgust me. The books on my shelves range in topic from homosexuality to sadomasochism and I don’t hide them, I put them in full view. The implication is that […]

Couples Therapy: What is Differentiation?

I have often thought, and now have come to firmly believe, that couples therapy is one of the most powerful ways to get people unstuck, not only as a couple, but also as individuals. The reasons for this are multi-dimensional, but in short have everything to do with the concept of “differentiation.” What is differentiation? To my knowledge, this is a concept first introduced by family therapist Murray Bowen to describe the level of individuality present within a family system. The more differentiated a family system, the more the people in that family can advocate for themselves and treat each other like separate individuals who have their own wishes and desires rather than as objects that need to be controlled and molded in order for the family system to survive.

I don’t work with entire family systems (children, grandparents, extended relatives, etc) but the same certainly holds true in couples systems. When a couple is poorly differentiated, neither partner can tolerate signs of individuality or advances towards personal autonomy in the other person. Instead the couple remains stuck in symbiosis, a system marked by unhealthy merger (these couples are the ones who may often be labeled as co-dependent), and may use a variety of methods to try to keep this balance intact. These methods may include various forms of manipulation (guilt-tripping, coercion, passive-aggressiveness) to manage the threat that is experienced by the other partner pushing towards more differentiation.

I want to emphasize that by differentiation, I don’t mean that the partner who is trying to differentiate is going out and doing things on his or her […]

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Love&- 5 Things Wives Want Their Husbands to Know about Sex

Love&Love& is a new magazine about relationships and sex. They interviewed me about common things that women may want their guys to improve upon in the bedroom. One of the big ones is touch, as a lot of men are way too rough and don't know how to adjust their touch to what their partner wants. For more on this, and other pointers, check out the article itself below:

Thrillist: 5 “Terrifying” Sexual Disorders You Didn’t Know Existed

thrillistDespite the alarming headline, I was asked by lifestyle website the Thrillist to discuss a bunch of sexual issues that folks out there may encounter, such as Persistent Genital Arousal Disorder (PGAD), sexsomnia and phimosis (when the foreskin does not fully retract and may cause pain). Much of what I said was cut out (as sometimes happens) but I get in a few good points on phimosis at the tail end. Phimosis is an issue I've encountered frequently enough with my male clients, so it's definitely worth a read. Cash Slaves

Vice_Media_Logo_2015I am featured in the newly released Vice documentary, "Cash Slaves." This is a very edgy and provocative look at the underground world of Financial Domination (Findom). As usual, I wanted to provide a fair and balanced portrait of the subject matter and make sure that the material was not pathologized. Findom is regarded by many to be an extreme fetish and definitely touches upon some very gray areas. Take a look at the video below and you can come to your own conclusions!  

Men’s Fitness Magazine Advisory Board

mens-fitnessI have recently been chosen to be on the Advisory Board of Men's Fitness Magazine. As part of that, I will be popping in now and then to answer reader questions. It's possible my role will expand in the future, and there have been discussions to that effect, but for the meantime, I will keep everyone posted when they can pick up an issue to see my responses in print.

Wall St Journal: The Future of Virtual Reality Porn

Wall-Street-Journal-LogoMarket analysts predict that new virtual reality technology will revolutionize the way we experience media, and will specifically boost the porn industry to unprecedented levels. This detailed article covers a lot of ground, addressing both the technology, business and social ramifications of virtual reality porn. I was asked to give my take on the issue and somehow a 20 minute phone conversation was distilled to a brief paragraph at the end of the piece, but nonetheless, it is still a worthwhile read.

NY Times: Women of the World

ny times logoDoes Bill Cosby have a fetish for unconscious women? Who knows? He's not a client and I've never met him, so I cannot say for sure, but this provocative piece in the NY Times tries to get to the bottom of his alleged bizarre behavior. The reporter did a great job dealing with some uncomfortable material,  so be sure to click the link below to see what I had to say on this issue:

Men’s Fitness- July 2015

men's fitnessI was recently asked by a reporter from Men's Fitness magazine to discuss reasons why a heterosexual man might refrain from having sex with a willing woman. The questions were basically soft balls, seemingly aimed at a younger, more inexperienced, male audience, but hey, I managed to drop a few decent pointers, relating to finding out if the woman is in a relationship, and if so, what kind of relationship she is in before diving in. If you want to take a look and poke around more, you can go directly to the article below. You are going to have to click to page 3 to see my quotes, btw.

Huffington Post: Most Common Sex Problems

imgresI was recently interviewed for a piece in the Huffington Post about common sex problems. Entitled "The Most Common Problems People Have in Bed, According to Sex Experts", the article interviews a number of sex therapists about the most common cases they see in their practice. I indicated that lack of sexual desire rated pretty high, and they kind of bunched it up under the the umbrella of "mismatched sexual desires", which when it comes to couples is definitely fair enough. Solid piece all around, and written by a gifted writer who has a number of other interesting articles on the site. Definitely check it out:

Men’s Health- Building the Perfect Sex Machine

Men's HealthI was recently interviewed for a Men's Health article on sex toys designed for men. They wanted to know my take on these "robotic masturbators" (as they called them) and as always, I tried to take a fair and balanced view of things. I pointed out that they could be used as a way to get better acquainted with one's sexuality (as well as get some much needed relief), but an over-reliance on technology may also limit guys from developing the necessary skills that would help them form romantic relationships. At any rate, hurry on over to the article here-- Building the Perfect Sex Machine-- and you can form your own conclusions and decide for yourself.

Upscale Magazine- May 2014 Issue

SwingersGo check out a great, and I mean GREAT, absolutely fascinating article in the May issue of Upscale Magazine, entitled "Secret Lovers," in which I am interviewed regarding the hush hush world of the swinger subculture.  The writer does a really good job of trying to understand the psychology of folks who practice consensual non-monogamy and I think the piece is very even-handed, with some practical tips for couples who are curious about dipping their toes in the lifestyle. I'll leave you with a quote from one of the swingers profiled in the piece, which I think gives a good feel for the tone and depth of the article-- "I love to see her with two guys and two girls at once. I enjoy submissive women, and there is no sexier submission than to watch my wife please me by pleasing others."  If that sounds interesting, then I suggest you head out and grab a copy. It's well worth the read.

Cosmo- April 2014

cosmoI am featured in the Sex Q&A section of Cosmo's April 2014 issue, in which I get asked about BJs, Plan B, sex in hot tubs, and all kinds of other tittilating reader questions. They did a good job of adding all kinds of humor, including a silly picture of tea bags-- need I say more? It's a can't- miss hoot. Go and check it out at news stands now!

Sex For Smart People Podcast

sex for smart peopleI just recently did an interview for a cool podcast called Sex For Smart People. Here is their description of the show: Sex therapist/psychoanalyst Dr. Michael Aaron is our guest of honor this time. Hear his and our perspectives on things like: What to do when you feel less ravenous about sex than your partner feels? Is it really honestly possible to feel coziness/familiarity and also sexiness/mystery/excitement in a long term partnership? How do you begin to talk to your partner about your interest in power play? (Trigger warning, around the half hour mark, we talk explicitly about rape fantasies.) And did you know that *just this past year*, kinky behavior was officially de-pathologized in clinical psychology terms (we think it is about f*****g time)? Plus, Dave is super silly and time)? Plus, Dave is super silly and loopy on NyQuil, and he and Stephanie share their favorite pick-up lines. [audio mp3=""][/audio]