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

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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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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

Come Out, Come Out Wherever You Are

Just in time for National Coming Out Day, which just so happens to be today, October 11th, we have this from Craig:

Doc,
I’m 19, and I’ve decided that I’m gay. But I don’t know how to tell anyone. I’m afraid that I’ll lose my friends and family. I come from a very religious family, and they’ll never understand. I don’t want to hurt them, but I want to be honest about who I am. Just wondering if you could help me.

Coming out is never easy—or almost never—but having to do so to bigoted people makes things worse. There are many different aspects to the coming out process. It means both owning and valuing who you are, and sharing that information with others. You’ve apparently laid the groundwork by self-identifying as gay. Unfortunately, coming out also means learning to deal with the hostility many people have toward us sexual minorities.

Owning your sexual identity and integrating it into your overall sense of self is the first step in what I believe is a lifelong process. Your sexual preferences are just a small part of who you are. It is indeed an important part, but it’s not necessarily the defining element that some would make it out to be. In this instance, LGBT folks are not all that different from everyone else who is awakening to his/her sexuality. We can take some comfort from the fact that we are not alone. So many other segments of the population are marginalized and discounted because of their race, gender, age, religion, ethnic origin, you name it. Let’s face it, pup, our culture doesn’t do real well with diversity.

And ya know what else? There are a whole lot of us who are marginalized and who are discriminated against, who then turn right around and discriminate against and marginalize others. This just breaks my heart! Hopefully you’ll avoid the temptation to do this yourself.

Being different in our society is a double-edged sword. Obviously, it’s a challenge to the status quo, but it also frees us up to tread a less traveled path. To compensate for the difficulties of being a minority, we get to define ourselves in ways that are unavailable to the dominant culture.

I don’t suppose any of us is ever entirely really free of our own internalized homophobia, any more than other marginalized minorities can rid themselves of their internalized self-doubt. No one can completely escape the prejudices and biases that surround them, but most of us make our way, regardless. That’s why coming out is so important. It empowers us. It increases our self-esteem. Honesty increases personal integrity. And when we stop hiding or denying this important aspect of ourselves, we have greater freedom of self-expression, and we become more available for happy, healthy and honest relationships.

So, how much do you know about LGBT history? Knowing that you belong to a big and vibrant community with a long and illustrious history will enhance your queer identity. You’ll find positive role models in every era of human history, and in every human endeavor—and affirmative role models will help you achieve a positive sense of self. (However, you’re gonna have to do some digging. The dominant culture suppresses queer history, which often leaves those who are just coming out feeling isolated, alone and unsure. Fear of rejection from the dominant culture is greatest for those who don’t know they belong to something bigger and stronger than themselves.)

Knowing your gay history will also give you ammunition to refute those around you who will try to label you as sick or sinful. Loads of LGBT folk have enriched civilization through science, religion, music, politics, art, theater, sports and literature, to name just a few. Long before you and I showed up on the scene they were paving the way for the freedoms and tolerance we currently enjoy in this country.

If you’re not already involved in your local gay community, it’s high time you got hooked up. Practice your coming out skills with other LGBT people. Coming out to those who are most likely to be supportive will make this phase easier. And in doing so, you’ll be creating a natural support system of friends who will be your gay “family.” You will also find helpful resources, including support groups, crisis lines, gay-friendly churches and synagogues, social outlets and political and cultural activities and organizations.

Once you’ve honed your coming out skills with the queer community, you’ll be ready to move on to straight folks. This will probably be a mixed bag. Some won’t give a hoot. Others may have a lot of hoot to give. The best advice I can give you is the same advice I received from my gay elders when I was coming out at about your age: Make your coming out a celebration.

Listen, if you carry your hat in your hand, shuffle your feet and look all dejected when you make your announcement, your audience will have little choice but to receive the information as bad or troubling news. However, if you stand up, look the person in the eye, and tell her or him that you have some wonderful news to share with them, you will be giving them a running start on receiving the information as good news. Besides, a positive presentation will help short-circuit some of the initial shock or confusion they may experience.

Expect that most straight folks—particularly those of a religious bent—will need some time to get used to the idea of you being queer. And as you suggest, it is quite possible that some family members or friends may reject you initially. But it’s not the end of the world, and lots of people, even some religious folks, come around in their own sweet time.

Coming out to others will be a more positive experience if you’re comfortable in your own skin. Hopefully you’re not overly dependent on others for your sense of self—a tall order for someone of your tender age and background. But remember, thousands of people, young and old from every corner of the world, are making their first tentative steps out of the closet right this minute. You are not alone.

How well you do fare may ultimately hinge on controlling, as much as possible, the time and place you come out. If you “out” yourself as opposed to being “outted” by someone else, you’re more likely to succeed. Being able to judge the receptiveness of your audience is also important. The best time for you might not necessarily be the best time for the person you’re about to tell. (F’rinstance, grandpa’s funeral may not be the ideal time to announce to your family that you’re a big fat flamer.)

While some friends and family may have figured you’re queer long before you have, give everyone the time and space he or she needs to work through the news. Be prepared for some negative reactions. (Having some supportive friends available to talk things through afterward, or retreat to, will help.) If you do your best to bring the news in a life affirming way and your audience still rejects you, that’s not your fault; nor does that make them right. You have the right to be who you are. You have the right to be out, proud and open about all the aspects of your life, including your sexuality. Never let people unable to accept that, even if they are family, diminish your self-worth.

Coming out may be difficult, but it’s also very rewarding. Coming out affirms your dignity, as well as underscores the dignity of other queer folk. Finally, never take for granted the freedom and tolerance the dominant culture begrudgingly gives us. It’s only through vigilance and political action that we secure our rightful place in society.

Good luck.

Eating Out at the Y: The Finer Points of Cunnilingus

Many women prefer oral sex to intercourse, because it has the potential to give them exceptional orgasms. And for those of you who need loads of direct clit contact to get off, mouth-to-clit stimulation is one of the easiest, most enjoyable ways to get make that happen. Unfortunately, for many gals, like Carol here, her man’s oral skills simply aren’t up to the task.

I like oral sex, but my new BF doesn’t know what he’s doing down there. He’s really sweet and I like him a lot. Unfortunately, he thinks he this really great lover when actually he sucks…and not in a good way. I know he reads your column, he was the one that turned me on to your site, so could you give him some pointers on how to orally pleasure a woman? He doesn’t listen to me.

Now, despite being a big fat homo, I am regularly quizzed on the art of muff diving. I’m always happy to oblige, but I’m bound to say that everything I know about cunnilingus I’ve learned from my lesbian friends. Instead of me—who has no pussy—pontificating on the joys of orally pleasuring a woman, I turn to my #1 friend of the lesbian persuasion, Joy. Not only does she have her very own pussy, she also knows her way around other pussies as well.

I shared Carol’s letter with her, and asked for her thoughts. I figure, if you wanna learn how to do something right, ya talk to a pro. Simply put, no one sucks cock as good as a queer; no one gobbles clam like a dyke. Enough said! Joy’s first comment was…and I quote, “What’s this chick doin’ with a dude? If she wants good head, she should bed a dyke. Once you go lezzie, you never go back.” Ahhh, Joy is such a joy!

Okay, so giving oral is about the most perfect sexual thing you can do for a woman. It makes her feel special. What woman doesn’t groove on knowin’ her partner finds her finger-lickin’ good? And maybe that’s a good place to start this tutorial. If you don’t like the taste or smell of pussy, give up on the idea that you’ll be a fabulous lover. However, if you want to give this whole muff diving thing a try, but you don’t know if you can handle the flavor or aroma, or if your chick’s unsure about you being down there, thinking she might be unsavory; you could start off by showering or bathing together.

The novice pussy lapper would do well to approach this amazing piece of human anatomy very gently…at first. If the woman you’re eatin’ out wants more vigorous attention, she will ask for it. So relax and enjoy! (Note: If all this licking and sucking isn’t a turn on for you, it won’t be much of a pleasure for your partner, either. So, if your heart’s not in it, you will have to find other ways to please her.)

Don’t make the mistake that Carol’s boyfriend makes. Listen to the feedback you’re getting on the job you’re doing. If you’re not getting any, ask for it. (Just don’t talk with your mouth full.) Once you hit on something that works for your gal, stick with it for a while—unless of course, you’re trying to drive her wild with some tongue teasing.

Joy says that the biggest no-no in pussy divin’ is divin’ in without knowing your way around. Like I always say, ladies, it’s completely up to you to introduce your partner to your particular pussy. Remember: Just because he’s been with other women, don’t make him an expert on your parts. Get it? Got it? GOOD!

Finding just the right position will eliminate the fatigue factor and neck strain. Have her lie across the bed (or the sofa, kitchen table, whatnot shelf) with her ass situated just at the edge. With her legs apart, knees up and her feet resting on the edge of the bed/table/whatever, take a comfortable position on the floor between her legs. Here’s a tip: The more muscle control she has to exert to maintain her position and balance will often lead to a stronger, more pleasurable and intense orgasm, because a thunderous orgasm is all about muscle tension.

Joy insists that a soft tongue and a relaxed jaw work best. And holy cow, she knows of what she speaks. She always starts out licking her pal from vaginal entrance up to her clit. She follows the outer edges of her pussy along both sides. Slowly at first, then more rapidly. Sometimes she’ll even throw in some raspberries. (You know, the vibrating sound you make when you force breath through lightly closed lips.) Joy stands by this technique, don’t cha know! Sounds like so much fun, I kinda’ wish I had me a cunt.

Don’t let your hands be idle when you’re yodeling up the valley. Gently press the two outer vaginal lips together, then run your tongue between the inner and outer labia one side at a time. Try poking your tongue into her vagina. The majority of a woman’s vaginal nerve endings are around the opening and within the first couple of inner inches. Target them with a darting tongue motion. Insert a hardened tongue into her hole. Try moving your tongue in and out, as well as in circles around the inside of her opening.

Spread her outer vaginal lips with your fingers. With your tongue pointed, gently flick your tongue around her clit. Feel free to roam around in there, but keep coming back to her clit, because it is the most sensitive area—just like your dick head, you dickhead! Be careful though: some women find the direct approach too intense. If this is the case with your woman, blow a stream of warm breath over and around the clit. This lighter, breathy touch might do the trick.

Keep your tongue and hands busy flicking and massaging, poking and prodding lapping and kneading. In other words, find out what she likes and how she likes it, and let her have it just that way. Again, be sure to ask for feedback—and then do precisely what she says.

Once your partner is good and hot and juicy wet, Joy suggests you kick things up a notch. Spread her lips, expose her clit and give it a quick little suck. If this hits the spot, you might want to lightly pull back her clitoral hood and repeat the quick sucking motion. Joy assures me that this feels incredible, and it’s just the thing to do if you feel like driving your partner crazy with ecstasy. Now take her exposed clit into your mouth and gently suck on it, simultaneously flicking your tongue over and around it. This combined with fingering her hole will usually produce a stunning orgasm.

Finally, Joy suggests you surprise the little woman by having a sugar-free mint or an ice chip in your mouth while you eat her out. These can create a very intense tingling sensation and will enhance your performance—and her pleasure—immeasurably.

Good luck!

Libido Disparity

No other sexual complaint for couples is more pervasive then that of libido disparity. I’ve heard from hundreds of frustrated and desperate women and men trapped in undersexed relationships. It’s one thing to have the sexual connection drift away by mutual consent. It’s quite another to have one partner unilaterally dissolve the sexual connection leaving the other partner bewildered and disoriented.

Often a partner will refuse to talk about why the sex has taken a nosedive. I understand not knowing what to say when things go south, or not knowing how to say what may be on your mind. But to clam up all together, that’s just unfair.

Sexuality is both a personal expression and a means of bonding with another. Sexual wellbeing in a relationship is more than simply getting off. It means taking responsibility for one’s eroticism as an integral part of relationship. The confusion, unhappiness and anxiety that result when there’s a breakdown of this can spill over and contaminate other areas of the relationship.

When I encounter this predicament in my counseling practice, I always build in some individual time with each partner even though the couple is there for “couples counseling.” I often get a much better sense of what’s causing the problem in these private sessions. It’s easier for the individual to talk to me privately than to be open, honest and forthcoming about his/her feelings with his/her partner sitting right there.

Some people don’t know how to express themselves without hurting the feelings of the other. Or an individual may not know why things are different than they once were. Often there are lifestyle issues at play — family concerns, work concerns, lack of sleep, drugs and alcohol consumption, etc. Sometimes medical and psychological issues are impacting on a person’s libido — weight gain, birth control, other pharmaceutical drugs, diabetes and depression to mention a few. But more frequently than not, the explanation is the partnered sex has become stale, rote and boring.

Whatever the cause of the imbalance, it needs to be addressed as a couple. Once the couple has identified the problem the next step is learning how to talk about it in an effective yet non-threatening way. This can be tricky, to say the least. But it is still so much easier than trying to avoid the issue all together.

When the couple is ready to break open this discussion, I encourage them to use “I” statements instead of “you” statements. I ask them to identify how they feel and own their feelings. “I feel confused. I feel frustrated. I feel that our relationship is in jeopardy.” Avoid statements like; “you make me feel…” Active listening is as important as being honest with one’s feelings.

The couple moves on to identify concrete steps they can take together to address the problem. Making a mutually agreed upon plan of action and sticking to it is essential.

Problems do not go away simply by ignoring them. Disappointments will become resentments and resentments will inevitably lead to acting-out and that will surly fuck things up royally.

Good luck

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