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Three Types of Couples’ Communication

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 […]

By Michael Aaron|October 7th, 2015|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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The Three Types of Fear

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 […]

By Michael Aaron|September 30th, 2015|Sex Therapy, Sexuality and Psychology|0 Comments

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Self-Compassion and Sexuality

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 […]

By Michael Aaron|September 16th, 2015|Sex Therapy, Sexuality and Psychology|0 Comments

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Why All Sex Therapists Must be Skilled Couples Therapists

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 […]

By Michael Aaron|July 27th, 2015|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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Overcoming Sexual Shame

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 […]

By Michael Aaron|July 13th, 2015|Sex Addiction, Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|1 Comment

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Couples Therapy: What is Differentiation?

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 […]

By Michael Aaron|June 28th, 2015|Couples Therapy, Sex Therapy|3 Comments

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Couples: Making Space for Connection

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 […]

By Michael Aaron|June 7th, 2015|Couples Therapy, Sex Therapy|0 Comments

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What is Harm Reduction?

What is Harm Reduction?

Last post I discussed some ideas around self exploration and peak experiences that strongly resonate with me. In this post, I’m going to address another issue which is just as equally important to me– harm reduction. What is harm reduction and what application does it have for sexuality in general and sex therapy in particular?
First, let me say that my introduction to the field of sex therapy was in harm reduction, so all of my work is firmly rooted through this lens. Initially I volunteered and then worked in several harm reduction facilities in the city conducting outreach to homeless intravenous (IV) drug users, street prostitutes, and transgendered individuals. For example, I would go into Tomkins Square Park in the village and trade clean needles for old, dirty ones. I always wore an ID badge to make sure I wasn’t arrested. I would go into known prostitution areas and hand out fresh condoms to mitigate the chances of them contacting STDs. If they were ready for help, I’d bring them back to the facility and connect them with a benefits counselor who would assist them with getting sober and finding housing and any other necessities they needed.
According to psychologist Andrew Tatarsky at the Center for Optimal Living, harm reduction is “a philosophy and set of interventions that seek to reduce harmful consequences of substance use and other risky behaviors without requiring abstinence.” Without requiring abstinence? What is that about? I think an important point here, and one that many harm reduction theorists and practitioners would argue, is that abstinence doesn’t work for everyone. Or […]

By Michael Aaron|February 9th, 2015|Sex Addiction, Sex and Culture, Sex Therapy, Sexuality and Psychology|0 Comments

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Another Word on Loss of Sexual Desire

Another Word on Loss of Sexual Desire

Recently, I was interviewed in a Huffington Post article about the most common sexual issues that sex therapists see in their office. To see more on this article, you can click here. Anyway, since the interview response that they posted was a bit abridged, I wanted to spend a little more time exploring this difficulty since it is so prevalent.

When I work with individuals struggling with low libido, I first want to understand the context in which they are having this experience. For example, I would want to know answers to the following questions. What is the relationship status of the person– are they single, dating, in a committed relationship? If in a committed relationship, for how long? When did this problem begin? I would also want to rule out medical issues, so I will refer the individual to a physician for blood work to determine levels of testosterone and other hormones. Sometimes testosterone is a major player, but more often not. In my experience, with individuals low libido tends to be more emotional, rather than physical in nature, while with couples it is more often than not it stems from relational problems. For more info on the relational aspects of low libido difficulties within couples, you can check out my article “Three Main Reasons Behind Loss of Sexual Desire in Couples”, which was picked up and syndicated by numerous other websites.

As I indicated in my response to the HuffPost journalist, relational issues include stuff like resentment (which is basically a euphemism for anger) and lack of trust, along with other elements I didn’t mention such as inequitable power […]

By Michael Aaron|November 25th, 2014|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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New Documentary about Mind/Body Connection

New Documentary about Mind/Body Connection

I don’t often endorse projects that come to my attention, but I feel so strongly about the subject matter of this upcoming documentary film, that I felt a strong desire to share it on my site with my readers. The film, All the Rage sheds light on one of the pioneers of mind/body medicine, Dr. John Sarno. Dr. Sarno, who worked for many years in the rehabilitation center of NYU Medical Hospital treating individuals who had various structural and back injuries due to vehicular collisions, slips and falls, and various other accidents. At some point, he started noticing very interesting phenomena– some people who injured their back would get well rather quickly, while others never moved on past their back pain. In addition the severity of the pain had no correlation to the severity of the injury. And finally, there was absolutely no connection whatsoever between back pain and structural abnormalities discovered through x-ray imaging and MRIs. In other words, individuals with severe back pain would have nothing show up on an x-ray, while those with no pain at all would show multiple ruptured disks, and so on.

Dr. Sarno began to realize that most, if not all, of the chronic back pain that he was treating was not caused by structural abnormalities, but by other factors. Specifically, he noted that most of the chronic pain sufferers he treated shared many similar psychological commonalities. For example, they were more likely to be Type-A people, you know the type who are very perfectionistic and successful, but also very hard on themselves. He started realizing that perhaps the […]

By Michael Aaron|November 18th, 2014|Sex Therapy, Sexuality and Psychology|0 Comments