Michael Aaron, Author at Dr Michael Aaron

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Why Sex is Just the Tip of the Iceberg

Why Sex is Just the Tip of the Iceberg

When people ask me what is sex therapy, my answer often comes as a surprise– sex therapy is simply regular talk therapy, which also includes a frank discussion of sexual issues and/or difficulties. In other words, the skills necessary to be a good sex therapist cannot be separated from the skills of more general psychotherapy. And there is a specific reason for this– more often than not, the sex is just the tip of the iceberg.

Let me explain. An individual may come in to my office, complaining of a sexual difficulty, let’s say inability to enjoy sex, for example, but as we start working together it becomes apparent that this individual’s entire body is numb because he has shut himself off from ever having to feel intense, painful emotions again. So, in this instance, a deeper emotional issue has now begun to affect the individual’s sexual functioning, but the core issue isn’t the sex, it’s these nagging underlying painful emotions. The sex is merely the fire under someone’s butt to get him or her into the office, but the sexual issue will not and cannot be resolved unless the individual is willing to take a committed look at the deeper underlying issues.

This is just an example, and yes, sometimes sexual difficulties can be resolved without any of this deeper work. Often, because we live in a culture that is so confused about sex, just providing accurate sex education to dispel toxic and inaccurate beliefs is enough to send someone in the right direction. Or some behavioral interventions are sufficient when we are working with more […]

By Michael Aaron|October 6th, 2014|Sex Therapy, Sexuality and Psychology|0 Comments

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Some Additional Thoughts on Anger: The Three-Headed Monster

Some Additional Thoughts on Anger: The Three-Headed Monster

In numerous previous posts, I have gone into extensive length in discussing anger. For most of us, anger is such an uncomfortable emotion, that we have found elegant solutions to manage it, tolerate it, and push it away from our awareness. Unfortunately these defensive maneuvers, although at one time may have worked, often create more pain and suffering than benefit for us. Let’s take a look at the three most common strategies that people typically have found to manage anger along with the negative consequences that result from these strategies.

The first and most common strategy is called deflection. This is the typical “kick the dog” when you’re angry strategy. In other words, this is when we focus our anger on someone else, rather than the actual source of the anger, because this other entity is either more vulnerable in some way or just plainly a more easy target. So, for example, if a boss or supervisor has enraged the individual, it is far easier to take out the anger at home with one’s family, which is usually a captive audience, rather than deal with direct conflict at work, which may have unknown and terrifying consequences. When we are angry at someone and we have no idea why, it may be helpful to take a look at deflection as a potential culprit.

Second is projection. If it is too uncomfortable for us to tolerate the anger, we may project it unto another person, which means that instead of being aware of our anger, we instead believe that someone is angry at us. In essence, the end result of […]

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

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Sexuality and Self Destructive Behavior

Sexuality and Self Destructive Behavior

I’ve written many times before about all of the wonderfully positive aspects of sexuality, but I cannot examine the totality of sexual experience without acknowledging that some individuals can and do use sexuality for destructive purposes. Often as clinicians, we will see these destructive acts in the form of self-destruction– risky sexual behaviors in which the individual can end up badly hurt, dead, or in jail. Often these destructive behaviors are compulsively performed in the face of, and even due to the threat, of these dangers. In other words, the danger itself is what makes the behavior so arousing. I don’t think it’s enough though to simply understand that self-destruction is arousing. That makes it seem like any other kind of fetish or sexual proclivity. Rather, I think the other salient point to understand about this behavior, is that the individual believes that they are worthy of self-destruction. In other words, the individual may be aroused by destruction (or the “death drive” as Freud called it), but for him to continue seeking self-destruction, he must believe that this is what he deserves. So, fundamentally, if we are to try and change this individual’s self-destructive behavior, we must seek to change his relationship to himself.

Destructive behaviors of any kind, whether they are sexual or not, usually if not always involve underlying aggression. And as I’ve discussed in numerous other posts, aggression is fueled by anger and rage. So, destruction of any kind is fueled by anger, which is a simple enough observation. But it becomes an important consideration to keep in mind when understanding destructive […]

By Michael Aaron|September 19th, 2014|Sex Addiction, Sex Therapy, Sexuality and Psychology|3 Comments

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Is Couples Therapy Right For You?

Is Couples Therapy Right For You?

Deciding to see a couple’s therapist is never easy. It can bring up many painful and scary questions. For example, is going to see a therapist an admission that both I and my relationship are failures? What if couples therapy doesn’t work, will that mean the end of my relationship? And what if it does work, will that too push my relationship to the brink? Will I discover things that I am not ready to deal with? These are all normal and typical questions that folks may find themselves dealing with when pondering whether or not they should seek out the services of a couples therapist.

So, let’s talk about what someone can expect in couples therapy, when couples therapy makes sense, and when it can prove to be less than effective.

First, I think that any good couples therapist will help the couple to realize and understand dynamics within the relationship that can be undermining it. A couples therapist can act as a neutral facilitator to help couples overcome disagreements and impasses, embark on life transitions, and make important relationship decisions. Here are some specific instances where couples therapy can do a whole lot of good for a couple:

Resolving ineffective communication strategies
Resolving differences in expectations of and attitudes about the relationship
Resolving discrepancies in sexual desire and/or sexual interests
Deciding whether to make important life decisions, including whether or not to stay in the relationship
Overcoming infidelity and deceit

The common denominator in these situations is that a couple is so lost in the weeds, that they cannot step outside of the conflict or disagreement to see the bigger picture. This is why it can […]

By Michael Aaron|September 8th, 2014|Couples Therapy|0 Comments

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Mindfulness and Sexuality

Mindfulness and Sexuality

One of the most important topics that I address with clients is the subject of mindfulness. To understand the importance of mindfulness, particularly when it comes to sexuality, let’s first take a look at what it is and what it isn’t. Many people confuse mindfulness with some sort of meditation practice, such as Zen or Vipassana. While it is true that meditation builds and fosters mindfulness, one can practice mindfulness without engaging in any of the meditative traditions. So what is mindfulness? It is defined as “the intentional, accepting and non-judgmental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment.” This can occur within a meditative practice, or just throughout the day, as one observes oneself while at work, sitting on the train, eating, or engaging in interactions with others. The most important aspect of this kind of self-observation is acceptance and non-judgmentalness. I’ll say this once more, because it bears repeating. Acceptance. Non-judgmentalness.

What does this have to do with sexuality? Everything. Often when we find ourselves struggling with some aspect of our sexuality, what is actually going on is that we are fighting ourselves. What I mean is that sexual performance, sexual desire, sexual arousal, and so on, come naturally. We don’t have to think about it. It just happens. But when we are experiencing sexual difficulties, we may be pressing too hard, putting undue pressure and stress on results, tensing our pelvis and surrounding muscles, or just fighting off the natural emotions that arise. In other words, we are going against the current, and not allowing ourselves the experience […]

By Michael Aaron|August 23rd, 2014|Sex Addiction, Sex Therapy, Sexuality and Psychology|2 Comments

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Why Thoughts, Feelings, and Fantasies Differ From Behavior

Why Thoughts, Feelings, and Fantasies Differ From Behavior

One of the biggest sources of confusion and alarm for clients is when they find themselves struggling with various sexual thoughts, feelings, or fantasies that feel foreign to them or add odds with their values. This is a significant source of distress for many individuals, and one that arises from a lack of understanding of how the human mind works. As a result, folks with these concerns may find themselves feeling out of control, fearful of their own desires, and self-identifying themselves as sex addicts. The good news is that sexual thoughts, feelings, and fantasies, now matter how outlandish, are often normal byproducts of the human mind, and rarely, if ever lead to acting out on them.

In my work with my clients, I often find that defusing some of the stigma around these internal sexual preoccupations helps to lighten the weight and pressure surrounding them. Often the biggest source of distress is not the fantasy itself, but the meaning that the individual ascribes to it. For more on the meaning of sexual fantasies, take a look here. Things may tend to feel more out of control if they seem monumental with importance, infused with pressure, and viewed as dangerous or pathological. For example, someone with chest pain may easily feel overwhelmed and out of control, fearing the worst case outcome of a heart attack, but will feel significant relief and sense of self-agency if he or she learns that the pain is merely heartburn. This is how our human mind works. When we fear and dread the worst, we are much more likely to […]

By Michael Aaron|August 17th, 2014|Sex Therapy, Sexuality and Psychology|0 Comments

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Male Sexuality, Aggression and Porn

Male Sexuality, Aggression and Porn

I recently received a very interesting question from a writer for Women’s Health Magazine. She asked:
A new British study that found young adults describing a culture where men are pushing for anal sex from their female partners, even though they expect them not to enjoy it much. I was wondering why this behavior might be common, and how to better communicate with your partner about anal sex and how to deal if your partner is making you feel pressured.
My response:

Young men are pushing for anal sex because that is what they see in porn. They may not care if the woman enjoys it for similar reasons in that most porn is male-centric, often centering around themes of power and aggression.
If women feel pressured, they need to set clear boundaries and be able to communicate that their needs are an essential aspect of the experience. Young men often learn about sex through porn so their views about sex can be skewed.

I think this exchange is important enough to unpack because on the surface it appears that I am criticizing porn, but I think that my answer is far more nuanced and touches upon several very important issues. First, it is true that porn does not provide a realistic portrayal of the experience of sex. But porn is not education. It is entertainment. Just like action movies do not show realistic portrayals of the FBI, CIA or Secret Service. Porn is not supposed to be enlightening. It’s supposed to get people off, and that’s about it. If young people are learning how to have sex from porn, […]

By Michael Aaron|August 8th, 2014|Sex and Culture, Sexuality and Psychology|0 Comments

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What is Social Justice and How Does It Apply to Sex Therapy?

What is Social Justice and How Does It Apply to Sex Therapy?

As I discussed in my previous post about an upcoming TV show, social justice is an important part of my mission and my work as a sex therapist. So what does social justice mean, and how exactly do I apply it in my sex therapy practice? First, let’s take a look at a definition of what social justice is. I found a good quote from Matthew Robinson, a Poli Sci professor, that pretty much sums up my own views on this issue:
Social justice is defined as “… promoting a just society by challenging injustice and valuing diversity.” It exists when “all people share a common humanity and therefore have a right to equitable treatment, support for their human rights, and a fair allocation of community resources.” In conditions of social justice, people are “not be discriminated against, nor their welfare and well-being constrained or prejudiced on the basis of gender, sexuality, religion, political affiliations, age, race, belief, disability, location, social class, socioeconomic circumstances, or other characteristic of background or group membership”
The key elements of this that resonate for me in my practice are: a) challenging injustice, b) valuing diversity, c) welfare nor well-being constrained or prejudiced based on gender, sexuality, etc…. As a practicing psychotherapist, I am sometimes concerned that social justice is not always appropriately observed in consulting rooms and I often speak out about this in my writings and lectures. Often, social injustice is perpetrated unwittingly through unnecessary pathologizing of non-normative, yet non-pathological manners of sexual expression and behaviors. I believe the good folks who do this mean well, they just don’t have enough […]

By Michael Aaron|July 28th, 2014|Sex and Culture, Sexual Minorities|0 Comments

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Some Thoughts about TV Show Casting for Kinky Couples

Some Thoughts about TV Show Casting for Kinky Couples

I was recently contacted by a TV producer seeking kinky couples for a tv show set to premier next spring.

The email read:
We’re currently working with a major cable network on a television project that’s dedicated to highlighting the wildest, craziest and most unusual sexual fetishes out there and meeting the couples (or singles!) who believe that adding a little – or a lot – of spice in the bedroom is the best way to keep their sex lives fun and fresh! We’re looking for everyday couples (or singles) who have fully embraced a unique sexual fetish and have no intention of slowing down. If you’re ready to share your fetish with the world in the hopes of removing the stigma that often accompanies them, we want to hear from you!
I spoke with the producer over the phone to feel her out. First, she wanted to know if I could refer any of my clients, and I point blank turned that down because, as a matter of policy, I never involve my clients in media inquiries. Then she wanted to know if I could put out some feelers in the kink community to see if anyone would be interested in participating. She seemed to have her heart in the right place, explaining that they wanted to put kink in a positive light, and show how sexual experimentation can be (and is) used by couples to enhance relationships. But in the end, after conferring with other colleagues, I decided to pass on getting involved.

On one hand, I think this project, if done properly, could represent a […]

By Michael Aaron|July 21st, 2014|Sex and Culture, Sexual Minorities, Sexuality and Psychology|0 Comments

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Sexual Inhibition and Guilt

Sexual Inhibition and Guilt

In previous articles, I discussed the connection between sexuality and emotions, particularly anger and shame. In this post, I want to focus more on the emotion of guilt. In my mind, one of the first things to understand about guilt is that it is very closely connected to anger. In fact, I believe that guilt is the flip side of anger. To illustrate this idea, let’s take a look at what someone may say to another person if he or she is provoked to anger. For example, someone who has become angered may state, “You messed up,” to the other individual. Now what may someone say to himself if he feels guilty about something he has done? How about, “I messed up.”

Anger– “You messed up.” Guilt– “I messed up.”

Just replace the “you” with “I” and anger becomes guilt. My point here is that what we call guilt is really anger directed at oneself. When we feel guilty, we are angry at ourselves.

The other crucial aspect of guilt is that it always entails punishment. Someone who is found guilty in a court of law is going to be handed down a punishment by the judge. In this way, criminals have been judged to be guilty by society and are deemed to be worthy of appropriate punishment. Sometimes the punishment may merely be a fine if the guilt is moderate. Other times, punishment entails a prison sentence for guilt that is more severe. And of course, the death penalty is the ultimate punishment for ultimate guilt.

Finally, guilt is always subjective. One jury may convict an individual for […]

By Michael Aaron|July 11th, 2014|Sex Therapy, Sexuality and Psychology|0 Comments