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 to do, I would like to explore what are some incremental changes we can make without necessarily de-stabilizing things too rapidly for the client.

Anyway I often come across the fear of failing as a root cause of the kind of “stuckness” that folks can sometimes feel mired in. In this rut, people typically experience a sense of ambivalence– a part of them once to get going and put things in motion, while another part just feels it cannot move forward. It is this second part, the paralyzed part towards which I want to address my interventions. Again, rather than seeing this part as resistant, I view it as a part that is trapped in fear, and as is often the case, it is the fear of failure. So, when someone just cannot get the wheels in motion to start a new project, transition to a new career, or embark on some interesting idea, there is invariably a fear of failure that is underlying the ambivalence and feeling of being “stuck.” This type of fear often comes up as performance anxiety. The fear of public speaking, the fear of test-taking, and yes, the fear of not being able to perform sexually often belies a more powerful fear of trying and failing. And the shame that potentially comes from that failure. So the fear of failure is often tied into fears of feeling shame.

Which leads to the second type of fear– the fear of emotions. As I’ve written about numerous times, a common root cause of diffuse anxiety that we cannot explain often lies in trying to suppress uncomfortable emotions, such as shame, grief, and anger. It is this suppression of emotions that may cause the symptomotology of anxiety. Here’s a good way of understanding this: Let’s say you are driving down the highway and somebody suddenly cuts you off and it just feels so annoying. What might you do? You might honk your horn, yell, make some comments. I’m not saying you should do these things, but these are things that you may conceivably do and you probably won’t feel any anxiety about doing so. But what if you were at work and your supervisor just gave you a bad performance review that you felt was unfair and now you have to sit in a prolonged business meeting with this supervisor and a bunch of other people? What you really want to do is tell your boss how angry you are, but you can’t allow yourself to do it because there are repercussions– your job is on the line, you might not get that promotion, etc. So what might you do? You might feel uncomfortable and grit your teeth, clench your fists and tap your feet, trying to suppress your angry feelings. What does look like? Yes, that’s right– anxiety.

Anxiety doesn’t just have to be about negative feelings, it could be about positive feelings too. Folks who have had a lot of trauma may not trust in positive feelings because they’ve had the rug pulled out from under them one too many times, so they may start to feel anxious when they realize they feel fine. It may feel like “waiting for the other shoe to drop” and these are the situations where the individual may self-sabotage in order to get the anxiety out of the way. This kind of chronic anxiety about emotions may play out with difficulties in interpersonal relationships and achieving the feeling of intimacy and closeness with a lover or partner. Sometimes out of control behavior or performance issues are (unintentional) means of regulating levels of closeness.

Which finally leads us to the last fear, the fear of the unknown. Making any kind of personal changes exposes us to an element of the unknown, even if the change is for the best. What would it be like to be so vulnerable with another person? Well, we may be rejected or abandoned eventually, we just don’t know what to expect. It is the fear of the unknown. This may also contribute to the aforementioned feeling of “stuckness.” A part of the individual may want to to change, but that subjects the person to the unknown. They think, “Who will I be once this metamorphosis is complete?” and it is a very scary thought.

I think I’ve gone long enough and I could probably write at least several more articles on this topic. For now, I will end by summing up the major point. Often when it comes to sexual and relational issues, and more specifically a feeling of being “stuck,” somewhere lurking is one or more of the three main types of fears that I have outlined above. By understanding the dynamics behind that feeling of anxiety, ambivalence and paralysis, we can start to take some steps to make progress in spite of the fears that haunt us.