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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 […]

Couples: Making Space for Connection

One of my specialties is working with couples who are struggling to rekindle their sexual desire for each other. It’s a frequent enough occurrence in my practice, that I’ve been interviewed in a number of media outlets about it, including the Huffington Post. As I indicated in that article, the loss of desire in a long-term committed relationship is not uncommon and is often related to a number of factors that go way beyond the simple idea of attraction. Often there may be complex emotions that have come between the partners over the course of time, corroding the foundation of closeness much like water creates cracks and rifts in bedrock over time.

I’ve explored different facets of overcoming emotional issues and resentment with couples in other areas of my blog both here and here and here. In this particular post, I want to focus on a different, yet essential aspect of getting couples back on track– carving out the space for each other. First, though, I want to take a step back and make some general observations about my experience with successful treatment outcomes in couples therapy. I’ll then come back and tie this back into my original point, since I think both are interconnected.

Usually when I work with a couple, I am very active and give homework that is relevant to the particular situation. It’s not that I am passive or don’t give homework to my individual clients, it’s just that the level of conflict or tension that a couple brings into the room almost requires a more prescriptive and assertive stance on the part of the […]

Sexuality and Creativity

I’ve gotten a lot of positive feedback from my earlier post about aliveness and flow, and it got me thinking more about the kinds of attributes required to get to such elevated levels of experience and connection. Obviously, as I pointed out in that article, we need to feel spontaneous and flexible enough to try new things, to be experimental, and to do so requires us to discard unnecessary dogma that may keep us feeling stuck and rigid. And what it all comes down to at the core is that all of these traits are simply different facets of a larger concept– creativity.

I think the subject of creativity and sexuality is an extremely relevant topic, especially in this day and age, since so much of current-day sexological concepts and research around sexual orientation and identity center around ideas of essentialism (meaning, our essential self that we are innately born with). On the other hand, most academic writing on gender is more social constructionist in nature (meaning that what we learn from society influences behavior), which makes for a very uneasy tension between these two schools of thought.  (I’ll probably start a series in this blog on the science of sexology, which will address these core concepts and more). But I digress. My point by bringing up the concept of essentialism is simply to point out, that while we are certainly born with certain pre-determined characteristics, much of sexual behavior is actually much more fluid than we may realize. And I believe much of that fluidity may stem from a concerted merging of our sexuality with our ability to tap into our innate […]

What Role Does Sociology Play in Psychotherapy?

As a sexologist, my approach to my work is multi-disciplinary. In other words, I cull from numerous fields, including psychology, human reproductive biology, anthropology, as well as sociology to inform my world view and the way I approach my clients. These days, as part of my writing and research activities, I find myself drawn much more to the sociological side of things, rather than the psychological. There are various reasons for this that I think are important to clarify, not only because it may help prospective or existing clients to better understand how I think, but also to contrast what in essence are very different ways of viewing and understanding human behavior. And when it comes down to it, my overarching point in this article is that any psychotherapist’s training is inadequate without a thorough grounding in sociological theories and principles.

Let’s begin. Sociology is the study of social behavior. Psychology is the study of the individual mind and resulting individual behavior. There is some overlap, for example with social psychology. But the main difference being that sociology focuses on the external forces within society that influence behavior, while psychology’s intent is to keep its focus within the individual. So, sociologists might take a look at how group dynamics shape human interactions, while social psychologists would be more interested in understanding how the individual relates to and processes these groups. This is just a brief and superficial explanation, and I’m sure some PhD student somewhere will want to argue some of the finer points stated here, but my purpose here is just to provide a rough outline of how […]

An End to Conversion Therapy?

President Obama made news this week when he made a statement, posted on the whitehouse.gov website, calling for the end of conversion therapies aimed at gay and trans* youth. Numerous news sites reported that, in making the statement, he had been moved by the December suicide of a 17-year old trans* youth named Leelah Alcorn, who had been subjected to conversion efforts by religious therapists. A petition to ban conversion therapy, begun in her honor, has already received over 120,000 signatures.

Those are some of the bare facts, but as is usually the case, by the time someone high up like the president gets around to an issue, it’s already been building steam for a while. States such as California and New Jersey, as well as Washington DC have already banned conversion therapy aimed at youth, and I believe this is just the beginning of further state legislation. In making these decisions, the courts have pointed to the complete lack of empirical, scientific evidence for the efficacy of these so-called therapies as well as the catastrophic potential harm that they can cause.

In my mind, therapies such as conversion therapy and it’s close cousin, reparative therapy are nothing more than formalized ways of exploiting shame, under the cloak of professionalism and authority. They reach out to potential clients (victims?) by appealing to their pain points of shame that is based around their sexuality and then proceed to intensify the shame by trying to eradicate the sexual thoughts, fantasies or behaviors. So what you have here is an individual who is already scarred by shame, and then retraumatized over and […]

Generalized Anxiety and Sexuality

One of the most common issues I see in my practice is the negative effect of anxiety on sexual performance and satisfaction. I’ve written about performance anxiety before, particularly in the context of social anxiety, but in this particular post I want to focus more on a different kind of anxiety– generalized anxiety.  The first thing to understand about anxiety is that it comes in many different forms and flavors. Social anxiety, panic disorders, hypochondria, and obsessive-compulsive disorder (OCD) are all classified as different types of anxieties. The most common anxiety, as it relates to sexual functioning is generalized anxiety.

Now, based on the name alone, most people probably don’t place enough importance to an anxiety that is considered to be generalized in nature. After all, everyone has experienced some sort of “generalized anxiety” before, right? I mean, the commute to work, the looming deadlines, the financial obligations can all make someone feel very, very anxious. So, it’s not really a big psychological problem, right? Not true at all.

At the core, folks with generalized anxiety experience a prevailing, sometimes even debilitating worry that something really bad is going to go wrong, that things are about to fall apart any moment. Often they feel that the anxiety alone is what keeps things glued together. If they stopped worrying, all hell would break loose. Often times this worrying is focused on things that, if they did fall apart, then all hell would indeed literally break loose. These things include pivotal life arenas such as finances, health, and relationships.

The main reason that sexuality often becomes the focus of generalized anxiety is […]

Demisexual? Sapiosexual? What’s in a Name?

Another article making it’s way through the online and especially Twitterverse is this one entitled Young, Attractive, and Totally Not Into Having Sex http://www.wired.com/2015/02/demisexuality/?utm_source=digg&utm_medium=email . The article chronicles the way that some college co-eds self-identify sexually. One considers himself a “heteroromantic demisexual.” What the heck is a “demisexual?” Good question. According to the article, “most people who describe themselves as demisexual say they only rarely feel desire, and only in the context of a close relationship.” Conversely, “gray-­asexuals (or gray-aces)” are different in that they “roam the gray area between absolute asexuality and a more typical level of interest.”

Demisexuals, gray-aces, according to these students, it mainly depends on the day. “So although labels are a big part of it, demisexuals and gray-aces don’t get too caught up in the lingo. They tend to be pretty comfortable with the idea they might change. A few months after that Friday at the outreach center, Genevieve realized she is more of an asexual than a gray-ace, and Sean now isn’t sure if he’s demi or ace. “Every single asexual I’ve met embraces fluidity—I might be gray or asexual or demisexual,” says Claudia, a 24-year-old student from Las Vegas. “Us aces are like: whatevs.””

Got those terms down? Well, that’s not it. There’s more. A colleague of mine asks– “a patient told me he’s seen over 120 girls on Tinder who define themselves as “sapiosexual. Any thoughts or experience with this?” According to Urban Dictionary (of course the most reliable source on these things– joke), http://www.urbandictionary.com/define.php?term=sapiosexual , a sapiosexual is “one who finds intelligence the most sexually attractive feature.” Apparently, sapiosexuality is […]

BDSM or Abuse?

Recently a new article by sex columnist Dan Savage trigged a lot of discussion and debate online, and I thought that the subject matter was important enough to also add another piece of commentary to the already crowded field. Basically, Savage answers a concerned mother whose 15 yr old son has been “watching sadistic porn- and ONLY sadistic porn- for a couple of years” and that “he thinks about this porn all the time-all day, every day- and fantasizes about doing sadistic things to the girls he dates.”

Savage then checks in with a bunch of experts including Canadian sex researcher Dr. James Cantor, who suggests that the woman’s son is a budding kinkster and any concerns that he could be the next Ted Bundy should be put to rest. Some other folks add their opinion, including a professional dominatrix who brings up the importance of “ethical sadism.”

I’ll leave the description of the column at that for the moment, and merely suggest that anyone who is interested in reading more go directly to the column here: http://www.thestranger.com/seattle/SavageLove?oid=21679058 .  I think it’s well worth the read.

So what should we make of this mother’s concerns about her son’s use of violent porn? First, let me get some basics out of the way. As I’ve written in this blog before, there is absolutely no evidence that violent porn leads to acts of sexual violence. In fact, in the aggregate those countries that have legalized porn use have experienced an inversely correlated drop in sex crimes.  Second, fantasies involving themes of seemingly sexual violence are not uncommon as I’ve written about here and here. […]

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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. http://www.marketwatch.com/story/how-the-future-of-virtual-reality-depends-on-porn-2015-07-15?

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: http://nytlive.nytimes.com/womenintheworld/2015/07/10/why-did-bill-cosby-want-to-have-sex-with-comatose-women/

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. http://www.mensfitness.com/women/dating-advice/5-reasons-you-shouldnt-have-sex-her/slide/2

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: http://www.huffingtonpost.com/2014/11/03/common-sex-problems-experts_n_5978560.html?1415023230

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