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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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Sex EDGE-U-cation With Toni Newman — Podcast #301 — 09/28/11


Hello sex fans! Welcome back.

I’m delighted to welcome back Toni Newman, the author of the groundbreaking: I Rise – The Transformation of Toni Newman, as my guest, for Part 2 of this special twofer show. As you recall from last week, Toni is here as part of both the SEX WISDOM series and the Sex EDGE-U-cation series. Her signature no-hold-bared style of addressing the issues of sex, sexuality and gender is as refreshing as it is often startling.

But wait, you didn’t miss Part 1 of our chat, did you? Well not to worry if ya did, because you can find it and all my podcasts in the Podcast Archive right here on my site. All ya gotta do is use the search function in the header; type in Podcast #299 and Voilà! But don’t forget the #sign when you do your search.

Toni and I discuss:

  • The lack of positive role models for transgender people of color;
  • The personal price of authenticity;
  • Finally being comfortable in her own skin;
  • Sex, sexuality and gender;
  • The fluidity of sexual attraction;
  • The hypocrisy of some of her former johns;
  • The role of prostitution in society;
  • Knowledge is power and education is the key to survival;
  • Being a sex educator;
  • The future — completing law school and a screenplay.

Toni invites you to visit her on her site HERE! She’s on Facebook HERE! And enjoy her twitter feed HERE!

(Click on the book art below to buy Toni’s 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.
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More SEX WISDOM With Jo Langford — Podcast #284 — 06/08/11

Hello sex fans! Welcome back.

I have the pleasure of welcoming back my friend, the marvelous Jo Langford. He is a therapist, educator, author and parent and he’s here for another helping of his spot-on teen and parental oriented SEX WISDOM.

I got so much positive feedback about last week’s show from ya’ll. And I totally agree with everything you said. Creating a healthier, more informed and sex-positive culture for young people, which is Jo’s mission, should also be our highest priority.

But wait, you didn’t miss Part 1 of this show, did you? Well not to worry if ya did, because you can find it and all my podcasts in the Podcast Archive right here on my site. All ya gotta do is use the search function in the header; type in Podcast #282 and PRESTO! But don’t forget the #sign when you do your search.

Jo and I discuss:

  • The parents’ role in sex education;
  • Tips for the sex-squeamish parent;
  • The sex-positive online resources for teens and their parents;
  • A parents need to keep themselves educated;
  • Kids and the meaning of sex;
  • Making parent/kid sex education non-seductive;
  • Contraception and safer sex;
  • Helping young people deal with the internet porn they are likely to see;
  • The legal and social aspects of sexting;
  • His inspirations.

Jo invites you to visit him on his site HERE! And be sure to follow him on Twitter HERE!

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 all my podcasts on iTunes. You’ll find me in the podcast section, obviously. 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: DR DICK’S — HOW TO VIDEO LIBRARY.

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Healing Sexual Trauma through Sensate Focus

One of the most difficult things for me to deal with as a therapist is the aftermath of sexual trauma. And I know that the trouble I have with this is only a tiny fraction of the difficulty my client has as he or she faces his/her past. I share with you a correspondence I’ve had with a 36-year-old man from Boston named Trent.

Dr. Dick,
When I was 10 years my parish priest molested me. It went on for over a year. Mostly, I’ve been able to put this behind me. I’ve been married over a year to this really great gal. She’s been very understanding and supportive, and we love each other very much. A couple of weeks ago when we were having sex, my wife started to massage my bottom. This was the first time someone touched me there since I was 10. At first it felt good, but then I remembered how I felt when I was a kid and freaked out. I started to cry. My poor wife was devastated at the thought of triggering this painful memory. I told her it wasn’t her fault, but we haven’t had sex since. I’m worried, but I don’t know what to do.

Working through a sexual trauma, like the one Trent experienced as a kid, is difficult. But it is essential for regaining a healthy sense of the sexual self. I told Trent—and this applies to any anyone else who has had regrettable early sexual experiences in their past—that I strongly suggested that he and his wife engage a sex-positive therapist to help them get back on track.

Many people have dealt with some kind of sexually related trauma in their lives.  However, some trauma is more severe than others. Emotional scar tissue and painful memories may linger, but you can learn to insulate yourself from the disruptive effects of the past in the present. Thanks to the indomitable human spirit, most of us live through our difficulties and go on to develop healthy, integrated sex lives.

Sensate focus is a process that helps individuals move through painful sexual memories and heal the rift between the affected parts of the body and the pleasure they can produce. I thought this technique would be of particular value for Trent because of something he’d said: “At first it felt good, but then I remembered how I felt when I was a kid and freaked out.” This tells me that he was able to enjoy the sensations before the association with the molestation kicked in and ruined everything. Sensate focus offers a way to short-circuit this disruptive connection and rewire it for pleasure instead of pain.

What follows are structured therapeutic touching exercises for couples. They are not a prelude to sex. You need to be clear on that. Your genitals will be involved. There will be pleasure and arousal, for sure. But the object of this process is to desensitize the trigger (in Trent’s case, his butt), then re-sensitize it for pleasure. These exercises take about an hour one day a week over the course of a month. If you embark on this course, make sure that you dedicate that kind of time commitment. Please, don’t short-change yourselves; this is an investment in your sexual health and wellbeing.

You and your partner will take turns being the one touched and the one doing the touching. Both of you will have 30 minutes to touch and 30 minutes to be touched: 15 minutes lying on your front; 15 minutes on your back.

Week 1—Breaking the Ice
Structured touching will be unfamiliar to you at first. I want you to use this first session to connect with each other in a sensual and playful way. I want each of you to explore every inch of your partner’s body from head to toe, first the back of the body then the front. This first week, however, avoid one another’s genitals.

This isn’t massage, where touch is directed toward pleasuring your partner. Sensate focus exercises are about gleaning information. Focus on how it feels to touch different parts of your partner’s body in a non-seductive way. Be aware of the different textures contours and temperatures. Use different pressures—heavy and light; different strokes—long and short. Use fingertips, palms, the back of your hands and forearms.

When you’ve finished the first 30 minutes, swap places. This will work best if the one being touched relinquishes control as much as possible. Keep verbal communication at a minimum. Once the hour is over, thank one another for the experience and get on with the rest of your day. Don’t try to process things right then and there, just sit with the sensations. Or better still; write your feelings in a journal that you might want to share later.

Week 2—Making Things More Interesting
Building on what you learned in the first week; this time, kick it up a notch by expanding the structured touching to include anal and genital areas. These are sexually charged zones, but the touch must remain non-seductive. Begin the exercise with some full-body touching before moving on to the new areas. Again, the emphasis is on obtaining information and awareness of physical sensations.

This is where things got a bit challenging for Trent. When his wife touched his butt, I told him I wanted him to want stay in the moment and focus on who was touching him and why. Trent’s wife was not touching him in a sexual manner; she was gathering information.

Staying in the present helps take the edge off. If anxiety builds, deep breathing can help you to relax. Your partner will probably be very nervous too, so breathing together can be helpful.

A guided touch technique can also be useful. Place one of your hands on top of your partner’s and guide it over your trigger area. Try using more or less pressure as you see fit. Remember your trigger spot is just like every other part of your body. Even though an early trauma has sensitized this area to be off bounds, sensate focus exercises will re-sensitize and reintegrate it with the rest of your body. You’ll have to trust me on this.

Week 3—Mutual Touching
This week, we move on to mutual touching. However, it must remain structured and non-seductive, both in the giving and receiving. Mutual touch will provide a more natural form of physical interaction than the previous weeks. You’ll also be shifting attention from how it feels to touch to being aware of how your partner is receiving your touch. Keep verbal communication to a minimum. Let your body tell your partner how you are enjoying the touch. If you must talk, assign a number code to the touch you are receiving: 5 being, ho-hum, 1 being Yowsa!

Remember, no matter how sexually aroused you become, this is not a prelude to sex. If you need to release your sexual tension, feel free to masturbate afterward. No partnered sex during the exercises. Okay?

Week 4—Bringin’ It Home
This last week of exercises continues the mutual touching, with a focus on overcoming any final reservations you have about your trigger zone and the pleasure you derive from it. More of your partner’s touch should focus on that area. For Trent, I advised that his wife include a nice lotion or personal lube for this investigation. (Touching with a wet hand is different from touching with a dry hand.) While concentrating on his butt with one hand, I suggested she fondle his genitals with the other. By playing with the energy around Trent’s sphincter, his wife was able to redirect it and help him reconnect his ass to the rest of his body.

Try receiving your wire’s touch in different positions. Being proactive will facilitate the healing. While she is touching your trigger area, move your butt toward her to meet the caress. You’ll immediately see how being in control will help you move beyond any remaining anxiety. You are not just being passive recipient anymore; you are actively involved with inviting the pleasure. If there are still reservations, take it slow until they too, melt away.

Once he’d freed up his ass for pleasure, I told Trent be sure to incorporate butt play into his future lovemaking repertoire, but I also reminded him to take as much time as he needed to resolve the issue. There is no quick fix. I assured him, though, with diligence and care, sensate focus would remove the fear and shame of the molestation, and replace it with a sense of wholeness, joy and pleasure.

Good luck

A Particular Sexual Predilection

No podcast today, but there is this…

Name: Adam
Gender:
Age: 34
Location: UK
I have been attracted to male children for years. Having been arrested for viewing child porn I realize that I need to pursue a celibate lifestyle. I realize that celibacy is a demanding lifestyle. What advice would you offer me?

You present a particularly touchy issue for our culture, Adam. But before I respond, I’d like to help you with some of your vocabulary. You say you need to pursue a celibate lifestyle. I think you mean to say you need to pursue a sexually abstinent lifestyle. The two concepts — celibacy and sexual abstinence — mean different things. Unfortunately, way too many people use these terms interchangeably, which is not a good thing. It only serves to muddy the waters further.

Celibacy has a very specific meaning. Let me whip out my trusty, handy dandy Funk & Wagnalls dictionary. Celibacy: the state of being unmarried. Some people infer, especially those of a strict religious bent, that celibacy also connotes sexual abstinence. Ya see, religious people are of the mind that there is no legitimate sexual expression outside the confines of heterosexual marriage. Legitimate or not, unmarried people have always been and will always be sexual, so making that unfortunate connection between celibacy and abstinence ill advised and erroneous.

The only thing we ought to be able to say for sure when someone identifies himself/herself as celibate is that he/she is not married. To assume a celibate person, even one who has taken a vow of celibacy, is sexually abstinent is quite a dangerous stretch indeed. Need I point out the very unfortunate sex abuse scandals that continue to plague the Roman Catholic Church?

In the same way, if someone identifies him/herself as sexually abstinent, the only thing we ought to be able to say for sure is that he/she is not engaging in any type of sexual expression. It would be false to assume that a sexually abstinent person is not married, because there are a lot of married people who are indeed sexually abstinent.

In your case, Adam, I believe you are telling me that you are both unmarried (celibate), and because of your particular sexual predilection — young boys — you must also be sexually abstinent. If I’ve got this right…and it is very important that I not misinterpret your words…then I think there are options you may not have considered.

I firmly believe that we learn our sexuality. All we eroticize, in your case boys, is learned behavior. You once learned to eroticize boys; you can now learn to eroticize a more appropriate group of people. This isn’t a particularly easy thing to accomplish, but it’s not impossible either.

Anytime any one of us discovers that the object of our desires is someone inappropriate, we need to adjust our eroticism immediately. This is the better part of being a sexually responsible person. Pedophilia is just one such inappropriate eroticism. A father for his daughter, a mother for her son, a boss for a subordinate, a man for his neighbor’s wife, a teacher for her student, a counselor for his/her client, a congressman for his page…are you getting the picture? I hope so. And the list goes on and on.

I believe learning to readjust one’s eroticism to a more appropriate outlet is a much better option than trying to live a sexually abstinent lifestyle. The reason I believe this is that having a more appropriate outlet will at least give you an outlet for your pent up sexuality. If you have no outlet, or limit yourself to masturbation, you will only intensify your longings and further fixate on the inappropriate object of your current desires.

Like anyone trying to wean him/herself off a bad habit, the task ahead of you Adam, will be challenging. It will also be enriching and life-affirming. I hasten to add that you ought not try to do this on your own. Work with a sex-positive therapist on this.

You’re a relatively young man with many years ahead of you. These years can be filled with happy, healthy and appropriate sexual expression. I encourage you to make it happen.

Good luck

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