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Generalized Anxiety and Sexuality

Generalized Anxiety and Sexuality

One of the most common issues I see in my practice is the negative effect of anxiety on sexual performance and satisfaction. I’ve written about performance anxiety before, particularly in the context of social anxiety, but in this particular post I want to focus more on a different kind of anxiety– generalized anxiety. The first thing to understand about anxiety is that it comes in many different forms and flavors. Social anxiety, panic disorders, hypochondria, and obsessive-compulsive disorder (OCD) are all classified as different types of anxieties. The most common anxiety, as it relates to sexual functioning is generalized anxiety.

Now, based on the name alone, most people probably don’t place enough importance to an anxiety that is considered to be generalized in nature. After all, everyone has experienced some sort of “generalized anxiety” before, right? I mean, the commute to work, the looming deadlines, the financial obligations can all make someone feel very, very anxious. So, it’s not really a big psychological problem, right? Not true at all.

At the core, folks with generalized anxiety experience a prevailing, sometimes even debilitating worry that something really bad is going to go wrong, that things are about to fall apart any moment. Often they feel that the anxiety alone is what keeps things glued together. If they stopped worrying, all hell would break loose. Often times this worrying is focused on things that, if they did fall apart, then all hell would indeed literally break loose. These things include pivotal life arenas such as finances, health, and relationships.

The main reason that sexuality often becomes the focus of generalized anxiety is […]

By Michael Aaron|March 20th, 2015|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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BDSM or Abuse?

BDSM or Abuse?

Recently a new article by sex columnist Dan Savage trigged a lot of discussion and debate online, and I thought that the subject matter was important enough to also add another piece of commentary to the already crowded field. Basically, Savage answers a concerned mother whose 15 yr old son has been “watching sadistic porn- and ONLY sadistic porn- for a couple of years” and that “he thinks about this porn all the time-all day, every day- and fantasizes about doing sadistic things to the girls he dates.”

Savage then checks in with a bunch of experts including Canadian sex researcher Dr. James Cantor, who suggests that the woman’s son is a budding kinkster and any concerns that he could be the next Ted Bundy should be put to rest. Some other folks add their opinion, including a professional dominatrix who brings up the importance of “ethical sadism.”

I’ll leave the description of the column at that for the moment, and merely suggest that anyone who is interested in reading more go directly to the column here: http://www.thestranger.com/seattle/SavageLove?oid=21679058 . I think it’s well worth the read.

So what should we make of this mother’s concerns about her son’s use of violent porn? First, let me get some basics out of the way. As I’ve written in this blog before, there is absolutely no evidence that violent porn leads to acts of sexual violence. In fact, in the aggregate those countries that have legalized porn use have experienced an inversely correlated drop in sex crimes. Second, fantasies involving themes of seemingly sexual violence are not uncommon as I’ve written about here and here. […]

By Michael Aaron|February 23rd, 2015|Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|1 Comment

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More on Working with Fetishes: Important Considerations

More on Working with Fetishes: Important Considerations

My earlier post about whether it is possible to eradicate fetishes appears to have struck a nerve, as I have heard from folks all over the world with their comments, questions, and requests for further information. I want to thank everyone for writing in– everyone’s communications have been very thoughtful and respectful, and it is really heartening to be able to reach so many in constructive dialogue.

As I read over the article however, I realize that, while pointing out what I believe to be inappropriate and unethical treatment, I do not go into any detail about what I do believe to be appropriate treatment protocols when someone is seeking help with a fetish. So, to address that gap, I’m going to go into some treatment protocols here in this particular post. It’s a lengthy and very broad topic, so I think this may very well turn into a series of postings, but I’ll see how it goes. For this article though, I’m just going to focus on initial steps (edit: as you’ll see, I found that laying down some groundwork of important initial considerations took up a lot of writing, so in this post, I am focusing on the groundwork, and I’ll talk about specific interventions in subsequent posts).

First, in the interest of disclosure, let me put it out there that I hold a sex-positive perspective. For more on what this means, you can take a look at my article about sex positivity here. Basically, I start out with the assumption that sexual behavior is neither inherently negative nor pathological unless shown to be otherwise. In other words, the meaning […]

By Michael Aaron|January 8th, 2015|Couples Therapy, Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|0 Comments

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Another Word on Loss of Sexual Desire

Another Word on Loss of Sexual Desire

Recently, I was interviewed in a Huffington Post article about the most common sexual issues that sex therapists see in their office. To see more on this article, you can click here. Anyway, since the interview response that they posted was a bit abridged, I wanted to spend a little more time exploring this difficulty since it is so prevalent.

When I work with individuals struggling with low libido, I first want to understand the context in which they are having this experience. For example, I would want to know answers to the following questions. What is the relationship status of the person– are they single, dating, in a committed relationship? If in a committed relationship, for how long? When did this problem begin? I would also want to rule out medical issues, so I will refer the individual to a physician for blood work to determine levels of testosterone and other hormones. Sometimes testosterone is a major player, but more often not. In my experience, with individuals low libido tends to be more emotional, rather than physical in nature, while with couples it is more often than not it stems from relational problems. For more info on the relational aspects of low libido difficulties within couples, you can check out my article “Three Main Reasons Behind Loss of Sexual Desire in Couples”, which was picked up and syndicated by numerous other websites.

As I indicated in my response to the HuffPost journalist, relational issues include stuff like resentment (which is basically a euphemism for anger) and lack of trust, along with other elements I didn’t mention such as inequitable power […]

By Michael Aaron|November 25th, 2014|Couples Therapy, 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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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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Boundaries: The Most Important Part of a Relationship

Boundaries: The Most Important Part of a Relationship

Inevitably, when I work with couples that have long-standing problems in their relationship, I come across a litany of boundary issues strewn along the way starting from the very beginnings of the relationship. For more on why the beginnings of relationships are absolutely crucial, please click here. In this particular article, I want to focus on the very specific but essential topic of boundaries. Typically when people think of boundaries, they are actually thinking of cut-offs, or situations in which such a firm wall is put up that it literally cuts off all further communication or connection. For example, “Don’t call me after 9pm,” is a cutoff; the idea being that there will be absolutely no further phone contact after 9pm. Or “I’m so mad at you that I never want to speak to you again.” Again, I think it’s clear that statement is more of a cutoff than an example of appropriate boundary setting.

So what exactly are boundaries then? The way I see it, boundaries are guidelines that people put in place to allow them to enjoy their lives and relationships better. In this sense then, boundaries are built on internal values. So for example, if someone values his or her free time, then they will set boundaries on how many hours they are willing to work. If an individual values their time (and therefore promptness), they will place a boundary on people showing up on time to meetings and appointments. Again, boundaries are based on values. If we are not clear on our values, we will have absolutely no boundaries. If we don’t place […]

By Michael Aaron|June 9th, 2014|Couples Therapy|0 Comments

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Couples: To Deepen Feelings– Show, Not Tell

Couples: To Deepen Feelings– Show, Not Tell

This is an older article I wrote a number of years ago. I thought it would an appropriate piece to resurrect for Valentine’s Day, especially in light of its message to show your sweetie through actions how much you care… Enjoy.

This piece of advice for couples falls solidly in the “Actions Speak Louder than Words” category.

When I work with couples, I often need to remind everyone that human relationships are based on feelings. Yes, we may have initially been attracted to someone based on looks, charm, confidence, or other attributes, but what keeps us connected to that person is how they make us feel. And those feelings are shaped based on the way that we are treated. Actions. When it comes to feelings, words often prove to be empty and hollow.

Sure it feels good to have someone say something flattering, but it won’t be sustained if that person’s actions are incongruent with their words. For example, if someone praises us for our intelligence but then acts in a condescending manner, those words are not only meaningless, but make the person seem untrustworthy. If someone praises our looks but then ignores us on a date, that person seems to be nothing but a fraud and liar.

So, with that in mind, I often tell my couples if you want to make the other person feel good, you have to “Show, not Tell.” Let’s take a look at how this can be applied immediately within the relationship. If one partner is feeling neglected or low on the other person’s list of priorities, instead of telling the hurt […]

By Michael Aaron|February 14th, 2014|Couples Therapy|0 Comments

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When Resentment Takes Hold of a Relationship

When Resentment Takes Hold of a Relationship

Often when I see troubled relationships, there really is no one true source of the problem. In other words, there isn’t one central issue that is undermining the relationship, but rather years and years of multiple troubles piled one on top of another. Trying to get at the root of the issue becomes almost untenable as mistrust, poor communication, and most importantly RESENTMENT cloud the picture and interfere with peeling away all those years of negative layers. Above and beyond all else, many couples’ most dire root problem is the resentment that they have built up for each other. This resentment prevents proper communication, undermines trust, prevents clarity and creates an environment of rage and despair. Whenever I hear that a couple is on-again/off-again, or has a “love/hate” relationship or “love each other, but can’t live together” or any other ridiculous cliche that is being bandied about, I can already state with a high degree of certitude that resentment is eating away at the relationship.

But where does this resentment come from? How is it created? And what can be done about it?

Resentment forms when one or both parties feel that their needs or expectations are not being met. For example, if one partner feels that they are always doing what the other person wants to do, then they will start to feel resentful if this issue is not addressed (see the previous article about Power Imbalances). Likewise, lack of sex, lack of intimacy, lack of sharing, and lack of understanding, perceived or real are all reasons for the formation of resentment. The key reasons […]

By Michael Aaron|February 10th, 2014|Couples Therapy|0 Comments