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Why Thoughts, Feelings, and Fantasies Differ From Behavior

One of the biggest sources of confusion and alarm for clients is when they find themselves struggling with various sexual thoughts, feelings, or fantasies that feel foreign to them or add odds with their values. This is a significant source of distress for many individuals, and one that arises from a lack of understanding of how the human mind works. As a result, folks with these concerns may find themselves feeling out of control, fearful of their own desires, and self-identifying themselves as sex addicts. The good news is that sexual thoughts, feelings, and fantasies, now matter how outlandish, are often normal byproducts of the human mind, and rarely, if ever lead to acting out on them.

In my work with my clients, I often find that defusing some of the stigma around these internal sexual preoccupations helps to lighten the weight and pressure surrounding them. Often the biggest source of distress is not the fantasy itself, but the meaning that the individual ascribes to it. For more on the meaning of sexual fantasies, take a look here. Things may tend to feel more out of control if they seem monumental with importance, infused with pressure, and viewed as dangerous or pathological. For example, someone with chest pain may easily feel overwhelmed and out of control, fearing the worst case outcome of a heart attack, but will feel significant relief and sense of self-agency if he or she learns that the pain is merely heartburn. This is how our human mind works. When we fear and dread the worst, we are much more likely to […]

Male Sexuality, Aggression and Porn

I recently received a very interesting question from a writer for Women’s Health Magazine. She asked:  
A new British study that found young adults describing a culture where men are pushing for anal sex from their female partners, even though they expect them not to enjoy it much. I was wondering why this behavior might be common, and how to better communicate with your partner about anal sex and how to deal if your partner is making you feel pressured.
My response:

Young men are pushing for anal sex because that is what they see in porn. They may not care if the woman enjoys it for similar reasons in that most porn is male-centric, often centering around themes of power and aggression.
If women feel pressured, they need to set clear boundaries and be able to communicate that their needs are an essential aspect of the experience.  Young men often learn about sex through porn so their views about sex can be skewed.

I think this exchange is important enough to unpack because on the surface it appears that I am criticizing porn, but I think that my answer is far more nuanced and touches upon several very important issues. First, it is true that porn does not provide a realistic portrayal of the experience of sex. But porn is not education. It is entertainment. Just like action movies do not show realistic portrayals of the FBI, CIA or Secret Service. Porn is not supposed to be enlightening. It’s supposed to get people off, and that’s about it. If young people are learning how to have sex from porn, […]

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    What is Social Justice and How Does It Apply to Sex Therapy?

What is Social Justice and How Does It Apply to Sex Therapy?

As I discussed in my previous post about an upcoming TV show, social justice is an important part of my mission and my work as a sex therapist. So what does social justice mean, and how exactly do I apply it in my sex therapy practice? First, let’s take a look at a definition of what social justice is. I found a good quote from Matthew Robinson, a Poli Sci professor, that pretty much sums up my own views on this issue:
Social justice is defined as “… promoting a just society by challenging injustice and valuing diversity.” It exists when “all people share a common humanity and therefore have a right to equitable treatment, support for their human rights, and a fair allocation of community resources.” In conditions of social justice, people are “not be discriminated against, nor their welfare and well-being constrained or prejudiced on the basis of gender, sexuality, religion, political affiliations, age, race, belief, disability, location, social class, socioeconomic circumstances, or other characteristic of background or group membership” 
The key elements of this that resonate for me in my practice are: a) challenging injustice, b) valuing diversity, c) welfare nor well-being constrained or prejudiced based on gender, sexuality, etc…. As a practicing psychotherapist, I am sometimes concerned that social justice is not always appropriately observed in consulting rooms and I often speak out about this in my writings and lectures. Often, social injustice is perpetrated unwittingly through unnecessary pathologizing of non-normative, yet non-pathological manners of sexual expression and behaviors.  I believe the good folks who do this mean well, they just don’t have enough […]

Some Thoughts about TV Show Casting for Kinky Couples

I was recently contacted by a TV producer seeking kinky couples for a tv show set to premier  next spring.

The email read:
We’re currently working with a major cable network on a television project that’s dedicated to highlighting the wildest, craziest and most unusual sexual fetishes out there and meeting the couples (or singles!) who believe that adding a little – or a lot – of spice in the bedroom is the best way to keep their sex lives fun and fresh! We’re looking for everyday couples (or singles) who have fully embraced a unique sexual fetish and have no intention of slowing down. If you’re ready to share your fetish with the world in the hopes of removing the stigma that often accompanies them, we want to hear from you!
I spoke with the producer over the phone to feel her out. First, she wanted to know if I could refer any of my clients, and I point blank turned that down because, as a matter of policy, I never involve my clients in media inquiries. Then she wanted to know if I could put out some feelers in the kink community to see if anyone would be interested in participating. She seemed to have her heart in the right place, explaining that they wanted to put kink in a positive light, and show how sexual experimentation can be (and is) used by couples to enhance relationships. But in the end, after conferring with other colleagues, I decided to pass on getting involved.

On one hand, I think this project, if done properly, could represent a […]

Sexual Inhibition and Guilt

In previous articles, I discussed the connection between sexuality and emotions, particularly anger and shame. In this post, I want to focus more on the emotion of guilt. In my mind, one of the first things to understand about guilt is that it is very closely connected to anger. In fact, I believe that guilt is the flip side of anger. To illustrate this idea, let’s take a look at what someone may say to another person if he or she is provoked to anger. For example, someone who has become angered may state, “You messed up,” to the other individual. Now what may someone say to himself if he feels guilty about something he has done? How about, “I messed up.”

Anger– “You messed up.” Guilt– “I messed up.”

Just replace the “you” with “I” and anger becomes guilt. My point here is that what we call guilt is really anger directed at oneself. When we feel guilty, we are angry at ourselves.

The other crucial aspect of guilt is that it always entails punishment. Someone who is found guilty in a court of law is going to be handed down a punishment by the judge. In this way, criminals have been judged to be guilty by society and are deemed to be worthy of appropriate punishment. Sometimes the punishment may merely be a fine if the guilt is moderate. Other times, punishment entails a prison sentence for guilt that is more severe. And of course, the death penalty is the ultimate punishment for ultimate guilt.

Finally, guilt is always subjective. One jury may convict an individual for […]

What Does It Mean to Be “Sex Positive?”

Anyone surfing the net looking for sexual information will have probably encountered the term “sex-positive.” Individuals seeking therapists for sexual difficulties will also have inevitably read a therapist profile or bio which indicated that the clinician identified as sex positive. But what does this term mean, especially coming from a therapist?

I will offer a quote from sexologist Carol Queen to get the discussion going–
“Sex-positive, a term that’s coming into cultural awareness, isn’t a dippy love-child celebration of orgone – it’s a simple yet radical affirmation that we each grow our own passions on a different medium, that instead of having two or three or even half a dozen sexual orientations, we should be thinking in terms of millions. “Sex-positive” respects each of our unique sexual profiles, even as we acknowledge that some of us have been damaged by a culture that tries to eradicate sexual difference and possibility.
It’s the cultural philosophy that understands sexuality as a potentially positive force in one’s life, and it can, of course, be contrasted with sex-negativity, which sees sex as problematic, disruptive, dangerous. Sex-positivity allows for and in fact celebrates sexual diversity, differing desires and relationships structures, and individual choices based on consent.”
In my mind, being sex positive at its core means that one’s default position is that sex is natural, generally healthy in all its variations, and can be utilized positively in the service of personal growth and creativity. Now, that of course does not mean that sex can’t be used destructively, just that pathology is never the underlying assumption. For a distinction between the two, click here. (Cliffs Notes version– according to […]

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    Book Review: The Sober Truth and What It Means About Sex Addiction

Book Review: The Sober Truth and What It Means About Sex Addiction

I recently finished reading a fascinating book, The Sober Truth, by Lance Dodes, which focuses a critical look at the treatment of addictions, particularly inpatient rehab centers and 12-step groups. I’m sure this book will prove to be very controversial, especially in addiction circles, as its main premise is there is no evidence that 12-step groups, or inpatient rehabs (which are mostly modeled on the 12-steps) are more effective than no treatment at all in helping folks to overcome their addictions. In all, research shows that only 5% of those who regularly attend a 12-step fellowship are able to abstain fully from alcohol or drugs in the long-term, which is about the same percentage of those who quit on their own.

As a sexologist, my expertise is not in addictionology, but where my practice does intersect the addiction field is in the area of sex addiction and sexual compulsivity.  There is currently tremendous debate whether out-of-control sexuality is really an addiction or a compulsion. For more on this, check out this article which covers recent research in this area. Interestingly, in The Sober Truth, Dodes states that all addictions, yes ALL addictions, and this includes all manner of drug addictions and alcoholism are really compulsions, not addictions.  To illustrate his point, Dodes differentiates between physical addictions, where the human body has built up a tolerance and would go into withdrawal if the substance is removed, and the psychological or emotional aspect of the addiction, which looks very similar to a compulsion. Dodes states that it is quite possible to develop a physical addiction without emotional dependence, as well as emotional dependence without physical addiction. […]

Marat/Sade: Some Thoughts on Social Change and Sexuality

Over this past weekend, I was fortunate enough to see a new, more futuristic adaptation of the classic play Marat/Sade performed at the Players Theater in Greenwich Village. As I was watching, I was struck by the realization that many of the ideas as well as the main theme of the piece had much to do with my work as a sex therapist. And so I would like to put some of my thoughts down as a post on my blog, both as a means to clarify them and delve deeper in further exploration.

Marat/Sade originally premiered in West Berlin in 1964 and eventually won the Tony Award in 1966 for Best Play. It is set in the historical Charenton Asylum during the reign of Napoleon, and centers on a play staged within the asylum by the Marquis de Sade and using the asylum inmates as actors. The Marquis de Sade (from whom we have the term “sadism”) was held in the asylum after his arrest for the anonymous publication of Justine and other pornographic tracts. In real life, the director of the hospital did allow de Sade to stage plays within the asylum, often to a public audience. The particular play-within-a-play performed as Marat/Sade focuses on the life and assassination of Jean-Paul Marat, a radical journalist who goaded on the French Revolution, and was eventually assassinated by a member of a rival faction. As the play unfolds, the Marquis pops in now and then to add his commentary to the proceedings.

The central idea of the play is the juxtaposition and contrast between the philosophies of Marat and de Sade. […]

Boundaries: The Most Important Part of a Relationship

Inevitably, when I work with couples that have long-standing problems in their relationship, I come across a litany of boundary issues strewn along the way starting from the very beginnings of the relationship. For more on why the beginnings of relationships are absolutely crucial, please click here. In this particular article, I want to focus on the very specific but essential topic of boundaries. Typically when people think of boundaries, they are actually thinking of cut-offs, or situations in which such a firm wall is put up that it literally cuts off all further communication or connection. For example, “Don’t call me after 9pm,” is a cutoff; the idea being that there will be absolutely no further phone contact after 9pm. Or “I’m so mad at you that I never want to speak to you again.” Again, I think it’s clear that statement is more of a cutoff than an example of appropriate boundary setting.

So what exactly are boundaries then? The way I see it, boundaries are guidelines that people put in place to allow them to enjoy their lives and relationships better. In this sense then, boundaries are built on internal values. So for example, if someone values his or her free time, then they will set boundaries on how many hours they are willing to work. If an individual values their time (and therefore promptness), they will place a boundary on people showing up on time to meetings and appointments. Again, boundaries are based on values. If we are not clear on our values, we will have absolutely no boundaries. If we don’t place […]

Narcissism and Sexuality

Note: The following article is meant to examine the ways in which powerful negative emotions can combine to form certain personality traits and how that can impact sexuality. It is not meant to pathologize or demonize anyone who struggles with any of these difficulties, but merely to illustrate how problematic emotions can create chronic relational and sexual disturbances. As a therapist, I always take a strengths-based approach, and focus on how the individual can resolve their difficult emotions, rather than what is wrong with them.

Previously, I wrote about borderline personality disorder and sexuality. In this post, I will focus on narcissism. In many ways, narcissism is the jigsaw puzzle piece that is the perfect fit for the borderline. There are many reasons for this. The narcissist is often self-preoccupied and unavailable, which does not set off the borderline’s abandonment fears because the relationship feels like it will never get close enough for the borderline to truly be hurt. While the borderline tends to be more anxious/ambivalent in her attachment style, the narcissist is more avoidant, and it is this avoidancy that feels safe to the borderline. For more on attachment styles take a look here.

As in the case of borderline, there are nine distinct criteria in the DSM for narcissistic personality disorder (NPD), including grandiosity, exploitativeness, envy, and lack of empathy towards others. Again, rather than focus on diagnostic criteria, I’m going to take a look at the core emotions that the narcissist struggles with. While the borderline is consumed with fear of abandonment, the narcissist is primarily motivated by a strong sense of internal […]

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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="http://www.drmichaelaaronnyc.com/wp-content/uploads/2014/01/Episode-7-Relationships-Are-Something-You-Do-Not-Something-You-Have.mp3"][/audio]