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Sex Therapy—What Is It and Who Needs It? – Part 1

I’m often asked about my work as a sex therapist. I’m surprised at how few people have any sense of what a sexologist does. While I can’t speak for all my fellow therapists, I can tell you a bit about my own practice.

Most of the work I do is Cognitive Behavioral Therapy (CBT): short-term, goal-directed and personally liberating (I don’t believe this kind of therapy should become a lifestyle). Basically, I suggest that people with sexual issues change the behaviors that contribute to their problems as a surefire way to solve them. I try to give my clients all the tools they need to successfully work things out on their own once the therapeutic intervention is over. This approach doesn’t fit everyone; however, 99.9 percent of the people I work with respond positively.

I encourage my clients to give themselves permission to investigate their sexuality. This in turn assists them in taking charge of making themselves feel better and/or perform better. And as soon as they do, they almost immediately have a greater sense of wellbeing. Like they say, nothing breeds success like success.

Once we identify an area of concern, my client and I create a plan of action for them to implement. I believe the more an individual is part of their own healing process, the more productive that process will be.

Sadly, I find that fewer and fewer people are willing to give their sexual issues the attention they deserve. Rather than investing the time and energy to get to the bottom of their issues, many opt instead for the quick fix—the “Give me a pill for that” mentality. They’re often unwilling to make the necessary lifestyle changes to actually solve their problems. For example, I encounter people who are eating themselves to death, or abusing alcohol or drugs. Of course they have the accompanying sexual response issues—erection problems for men and arousal concerns for women. They may desperately want to resolve these issues, but without committing to any change in behavior—i.e.: “I want my erection back, but I won’t stop drinking”—such interventions almost always ends in disappointment.

Sexual dysfunction of one sort or another is the issue I see most recurrently in my practice, although the reason why a client reaches out varies. Sometimes an individual’s tolerance level peaks, and they finally decide to do something about an issue that may have been smoldering for years. Sometimes it’s a partner who brings in their proverbially “broken” partner, telling me to “fix him/her.”

Couples often seek sex therapy together, as sexual problems tend to be more obvious within relationships. However, by the time the couple comes for therapy, the issues have most likely been plaguing them for some time. The relationship often comes close to ending before the couple agrees to address the problem. For example: Say a guy brings his wife in because she’s “frigid,” whatever that may entail. They’ve been married for X-number of years, and he’s finally had it. She, on the other hand, doesn’t want to be in therapy, because she doesn’t really think there’s anything wrong with her. She just doesn’t want to have sex anymore, and she doesn’t want to discuss it. Period.

This is a difficult way to start therapy. Resentments are high and frustrations rage. If the couple does continue, we usually discover that there’s also something desperately wrong with the husband. Inevitably, we ascertain that he’s an ineffectual lover—and his inability to pleasure his wife is the root of her “problem.” It’s often painfully clear that he knows little (if anything) about his wife’s sexual needs or desires. Meanwhile, the wife has never had permission to know her body, so she’s unable to help or direct him. As you can imagine in a case like this, there’s a load of remedial sex education that must come before anything else is resolved.

Couples also seek therapy when one spouse has cheated on the other. The “cheat-ee” declares, in no uncertain terms, that this therapy is the last-ditch effort before “the end of the road.” Often in such cases, it’s too late for a successful intervention, because each partner is so angry and shamed that the chance of turning the situation around is slim. Sometimes the best we can do is end the relationship with as little acrimony as possible.

In difficult couple counseling situations like this, my first effort is to get the couple to disarm. There will be no sex therapy—and God knows there is a need for sex therapy—until there is some semblance of peace between partners. If we don’t establish at least a small bank of goodwill, our efforts are doomed.

We’ll pick this up next week at this time.

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The Heartbreak of Male Performance Anxiety

I get a dozen or so messages a month on this topic. I’ve written about it in numerous postings and spoken about it in several podcasts, but still the email comes.

One of the real bugaboos for anyone, regardless of gender, is living up to our own expectations of sexual performance. So many things can get in the way, literally and figuratively, of fully enjoying ourselves and/or pleasuring our partners.

The arousal stage of our sexual response cycle is particularly vulnerable to a disruption. And when there’s trouble there, there’s no hiding it. A limp dick or a dry pussy can put the kibosh on all festivities that we may have hoped would follow.

However, performance anxiety can strike any of us, regardless of age, and at just about any point in our sexual response cycle. This is a particularly galling when it seems to come out of the blue. And regaining our composure can be more far more difficult than we imagine.

Today we will be focusing on male performance anxiety.  I’ll address female performance anxiety at a later date.

Here’s Bob, he’s 26:
Doc, this has never happened before. But I couldn’t get it up tonight, and this chick was H.O.T. Now I’m not gay at all, but I haven’t had sex in about 3 years because I was locked up…so I masturbated pretty regularly, about 3 or 4 times a week. But I can’t figure out why I was soft… the only thing I can think of is I ate clams tonight and I’ve never had them before. Could it be that or should I get checked out?

It weren’t the clams, darlin’! And I don’t think you need to get “checked out” either…at least not right away. If you could back away from the situation a bit and stop freaking out, I think you’d discover the source of your problem all on your own.

Here’s the thing—while you were out of commission there in the slammer, you relied, as you say, on jerking off. Okay, cool. We all do what we gotta do. Now the first time you try to score after your release…you go soft. This tells me you have a mild case of performance anxiety. We all get that from time to time.

There’s probably nothing wrong with you or your johnson. You just got the jitters first time you tried to get you some after being away, that’s all.

The anticipation of boning this H.O.T. chick—fueled by some predictable self-consciousness; what with just getting out of the big house and all—pulled the plug on your wood. No surprise there, right?

What I don’t want to see happen is for you to replay the incident over and over in your mind’s eye til that’s all you can think about. If you do, this proverbial molehill will become a mountain. You’ll then bring all this anxiety to your next encounter, setting yourself up for even more disappointment. You can see how this shit can snowball? If you interpret every less than satisfying encounter as a failure, your fears will become self-fulfilling. You’ll begin to avoid partnered sex and you’ll develop a full-blown sexual dysfunction. And your self-esteem will take a nosedive, too.

If you’re preoccupied with your performance, it’s less likely that you’ll be fully present during sex with a partner. This pretty much fucks up your sexual responsiveness and any hope for spontaneity. Why not just relax into the whole sex thing and not try to prove your manhood with your pecker?

Then there’s Steve with a slightly different take on this meddlesome problem:

My partner and I have been together for just over 3 years now in a monogamous relationship. I am the top and he the bottom. Our problem is not premature ejaculation on his part, but his inability to have an orgasm at all. No matter what I try and even if he masturbates, sometimes it is impossible to get him to cum. Is this a medical issue? Have you ever heard of this?

Delayed ejaculation is the difficulty one has ejaculating even with a firm erection and sufficient sexual arousal and stimulation. This problem is not uncommon. For most men, delayed ejaculation occurs during partnered sex more frequently than while masturbating. In fact, 85% of men with delayed ejaculation can usually cum by jacking off. However, in partnered sex, the guy may be unable to ejaculate at all, or only after prolonged partnered stimulation. This problem can be very frustrating and cause distress for both partners involved, as you already know.

What causes delayed ejaculation? Well, it could be a number of things. It could be something as simple as performance anxiety, or inadequate stimulation, or there could be neurological damage.

I don’t want to be too reductionist here, but most of us experts believe that the majority of instances of delayed ejaculation aren’t physical in nature, but rather are the product of psychological concerns. Simply put, there’s a difference between the psychosexual response we have when we are alone and the one we experience with a partner. There’s probably nothing wrong with your partner’s unit. It’s all in his head…or his mind, to be more exact. If I had to guess, I’d say he’s got a real bad case of performance anxiety.

When I see this sort of thing in my private practice, I always begin the therapeutic intervention by calling a moratorium on fucking of any kind. This immediately takes the pressure off the couple. From there we begin to rebuild the partnered psychosexual response one step at a time. We begin with sensate focus training (Sensate Focus is a series of specific exercises for couples that encourage each partner to take turns paying increased attention to their own sensations. More about these helpful exercises in the weeks to come.), stress reduction and relaxation exercises. These applications are designed to reduce performance pressure and instead focus on pleasure. The idea is to get them to stay in the moment; absorb the pleasure present without worrying about what is “supposed” to happen.

Finally we address as frankly and openly as possible any fears or anxieties that they may have—as individuals or as a couple. I have the greatest confidence in this method; it succeeds over 90% of the time.

Ok, let’s recap shall we?

Overcoming sexual performance anxiety is dependent on five simple things.

  • First, a guy needs to be attuned to his sexual response cycle — arousal, plateau, orgasmic and resolution phases. He should know what kind of stimulation he needs at each phase to fully enjoy himself and satisfy his partner.
  • Second, the more worried a guy is about a performance issue, the more likely that problem will present itself. A bad experience in the past can often set the stage for its recurrence.
  • Third, don’t be afraid to talk this over with your partner. Withdrawing from your partner or shying away from sex altogether will only increase the likelihood that the problem will persist.
  • Forth, be proactive! Fearing the loss of your sexual prowess or feeling sorry for yourself is counterproductive. Confront the challenge head on. Employ sensate focus training stress reduction techniques and relaxation exercises to help you push past this temporarily impasse and regain your self-confidence.
  • Fifth, free yourself from the mindset that your dick is the center of the universe. Your manhood or your capacity to be a great lover does not reside in your genitals. Expand your sexual repertoire. Remember, pleasure centers abound in your body as well as your partner’s.

Good luck!

SEX WISDOM With Celeste Hirschman and Danielle Harel — Podcast #307 — 11/02/11


Hello sex fans! Welcome back.

I got a totally kick ass show in store for you today, my friends. I’m so stoked to welcome not one, but two very special guests to this SEX WISDOM program. Celeste Hirschman and Danielle Harel are fellow sexologists, acclaimed authors, innovative therapists and all-round fabulous people. I am so proud to share a microphone with these remarkable women.

Celeste and Danielle developed their own very unique approach to sex therapy. They are indeed among the movers and shakers in the field of human sexuality who are making news and helping us take a fresh look at our sexual selves.

Celeste, Danielle and I discuss:

Celeste and Danielle invite you to visit them on their site HERE! Look for their amazing blog HERE! Find them on Facebook HERE and Twitter HERE!

(Click on the book cover below to buy their book.)

BE THERE OR BE SQUARE!

Check out The Lick-A-Dee-Split Connection. That’s Dr Dick’s toll free podcast voicemail HOTLINE. Don’t worry people; no one will personally answer the phone. Your message goes directly to voicemail.

Got a question or a comment? Wanna rant or rave? Or maybe you’d just like to talk dirty for a minute or two. Why not get it off your chest! Give Dr Dick a call at (866) 422-5680.

DON’T BE SHY, LET IT FLY!

Look for my podcasts on iTunes. You’ll find me in the podcast section, obviously, or just search for Dr Dick Sex Advice. And don’t forget to subscribe. I wouldn’t want you to miss even one episode.

Today’s podcast is bought to you by: Hot Plus Size Lingerie.
Plus Size Lingerie

Almost Heaven

Hey sex fans,

I know; let’s make this Friday a Product Review Friday!

Ya’ll have probably noticed that everyone on the Dr Dick Review Crew has taken a break from reviewing. The truth of the matter is we all seemed to hit our saturation point at once. I guess we all experienced a little burn out.

I know, some of you must be thinking, gee, I should have such a problem; burning out on sex toys. Let me tell ya; no one who has actually had to honestly review sex toys would make that comment. Because, despite the fun aspects of reviewing them the review process itself can, and often is, grueling.

So just about the time we were about to throw in the towel, we were approached by a new partner in our review effort, the good people who are responsible for The Romance Series videos.

As you know, we’ve reviewed educational videos in the past; so it wasn’t much of a leap to include these excellent enrichment videos.

To explain what I’m talking about we have Dr Dick Review Crew member Jada to tell you all about the DVD she viewed.

Almost Heaven  ——  $29.95

Jada
My husband is a porn aficionado. He’s been watching porn since he was a teenager. Frankly, I can’t see how he can stomach the mind-numbing sameness of it all. For the most part, every thing I’ve tried to watch with him has been a disappointment.

Don’t get me wrong; I love sex. I love stories about sex; I have a fantastic erotica library. I love depictions of sex; I thoroughly enjoy Dr Dick’s The Erotic Mind podcasts and their accompanying slideshows of the artwork of his guest. But, for the most part, I do not like porn. I want to like porn; it’s just that I rarely see anything I can like.

I’ll admit it; I need a bit of a story line to get into the sex. I want the characters to be believable and I want the women in the movies to be more than one dimensional sex dolls. I don’t know, is that too much to ask for?

When Dr Dick asked me if I would consider reviewing one of The Romance Series titles, I hesitated. I wanted to do it, because it would be something my husband and I could do together, but I didn’t want to waste my time or his. I finally agreed and I stopped my Dr Dick’s and picked up Almost Heaven.

I was pleasantly surprised to find the DVD housed in a very tasteful, yet erotic package. The DVD comes in a traditional plastic package, but this is sheathed in a cardboard carton that give is a much warmer presentation. The promotional imagery on the box is suggestive, but not overt. It’s obvious that this presentation is geared to a female audience.

When I got home I tantalizing waved the package in my husband’s face. I said, “Look what I scored.” His eyes rolled up in his head and dismissed my find with a wave of his hand. I was crestfallen. He didn’t mean to be mean; he just thinks porn for women means toning down the sex till it’s soft-core pabulum.

I asked him to put aside his prejudice and watch it with me. He said he would.

Our date night arrived, we got comfortable in bed and I slipped the Almost Heaven DVD in the player. I hoped for the best.

Almost immediately my husband commented on the production values. The audio track was clear and balanced, and he didn’t notice any background noise. Apparently this is a big bugaboo for pornophiles, like my husband. I was just happy that a bunch of fake boobs weren’t jumping out at me from the screen.

It was easy for me to slip into the storyline. A pretty young woman, Angie, is told that she died the night before and is able to take only one memory with her into the afterlife. She chooses to remember her husband, Jake. But what memory of Jake should she choose? Another couple, Sara and Michael, helps Angie make the right choice. It’s a sweet concept. In fact, it was like watching a mainstream movie, but getting to see all the sex, which would only implied in a Hollywood version.

There are four scenes in the movie. The music, lighting and camerawork are all topnotch. Each scene is a sexual vignette featuring a different couple, but all the scenes follow the story arc. And ya know what I liked most? Condoms were used throughout. Kudos to The Romance Series people for being considerate to their performers and respectful to their audience. Thank you!

I was totally impressed with how the sex was presented. Despite the romantic overlay, this is a full-on sex movie, mind you — oral, cowgirl, spooning, doggie, missionary, all very tastefully presented. The chemistry between the couples is palpable, there is lots of kissing and the sex is hot. I couldn’t have asked for more. And I caught my husband adjusting his boner under the covers more than once.

My husband said Almost Heaven is not a porn movie for women, whatever that is; but it’s a really great porn movie for couples.  High praise coming from him.

If you’re looking for a bit of romance and plot with your sex, this title is bound to please. It was just the thing to get our motors running for the sex we had after the movie. It was the perfect date night!
Full Review HERE!

Enjoy

LORDY, LORDY, LORDY!

Hey Dick!
As you know, I am an escort. My business is doing very well. In fact, so well I need to ask if you know of any meds, besides Viagra, that I can take that will help me maintain an erection over a longer period of time?
Can I be frank? Here’s the deal, let’s say I have I have two one-hour clients during the day. Then a regular of mine calls and wants an all-nighter. That’s not a problem other than the fact that this particular client wants to get fucked hard. I mean real hard, for hours at a time. He’s an insatiable power bottom.
I want to be able to ride his ass, like the bitch he is. Hell, I’m even attracted to him. I just can’t stay hard enough to fuck him like he likes (especially after having had the two clients before him that same day). Sometimes I have difficulty getting it up for him, and wind up finger-fucking him till my hand is sore. I do not want to lose this client. And shifting days is not the solution. Because when he wants it he wants it and I have to produce. That’s what I do, I sell “muscle.” I have a reputation for giving the best hard driving, dominating and controlling sex around.
Again, is there a medication I can take to maintain the erection?
— Works Hard

Dear WH,

Your life reads like a cheap porn movie script. Lordy, the good doctor nearly got the vapors simply reading through your very explicit missive. (As you can see, I had to edit out some of the more gory details so I could protect your identity in this public forum.) Of course, as you suggest, it never hurts to advertise. You’re so bad!

I thoroughly understand the pressures you and other sex workers face. It’s not as glamorous a life as it is often portrayed, huh? Ok, so you’re beautiful, men idolize you and crave your attention. You’re getting loads of sex, putting all those “bitches” in their place, and crying all the way to the bank to boot. It’s a tough job, but someone’s got to do it. But then again, there are all those sniggling performance issues that even a he-man like you must contend with.

The trouble lies in the fact that you are a workaholic. And that’s never good, regardless of the work one does. Sex work, like any other work, will burn you out if you’re not careful. If you don’t learn to pace yourself, darlin’, you’ll fizzle. (How’s that for an appropriate euphemism?) And from what you tell me, this is already beginning to happen. Keep it up (no pun intended), and you won’t be the first causality in this line of work, nor will you be the last. But If you ask me, and I happen to know a little something about sex work myself, the object here is to grow old (or older in your case) in your chosen profession.

I’m tellin’ ya, WH, if the erectile burnout don’t get ya the psychological torment will. I’ll bet you’re terrified the word will get out that Mr. Big-Beautiful-29-year-old-Stud-Power-Fucker can’t get it up. That would be real bad for business. And you know how those johns can gossip. Bitches! They don’t know that you’re servicing men at a rate that would make a superhero blush. All they see is limp willie and that spells trouble right there in River City.

It’s not surprising that you are having erection concerns given the number of clients you are seeing in one day. I mean, girlfriend, when do you find time to eat? You don’t need a new med, you need a vacation. If Viagra and a good cock ring don’t do the trick, then, in my humble opinion, your body is telling you to slow the fuck down.

And here’s another tip; research is beginning to show that prolonged and persistent use of Viagra can have some very unpleasant side effects. Those who overuse this potent cardiovascular drug, particularly young men who use it recreationally, may be in for some very unpleasant surprises down the road. So, I have one simple suggestion, WH, have a care about your sexual wellbeing and treat your dick gently. Despite the pounding you can inflict with it, it is a very delicate mechanism.

Good Luck

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