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A Different Perspective on Out of Control Sexual Behavior

A Different Perspective on Out of Control Sexual Behavior

I have just come back from Chicago, where I presented my latest research at the Society for Sex Therapy and Research (SSTAR) Annual Conference. In the next few posts, I will point out a few key ideas that I took away from some of the other presentations, which were uniformly excellent. In particular, and that which is the subject of this particular article, I am going to focus on what I consider to be the groundbreaking work of clinicians Doug Braun-Harvey and Michael Vigorito and their approach to “out of control sexual behavior” or (OCSB). OCSB? What is that? Well, you may recognize this concept as “sex addiction,” which in my view is a problematic term that I’ve critiqued both here and here. So, the first thing to understand about these two guys is that they are working with the same sets of behaviors as sex addiction counselors, but without the addiction lens. Why is this so significant? Let’s take a look.

One of the most salient concepts from their talk is the central importance of therapist self-awareness. In other words, especially in the field of sexuality, it is very easy for any clinician to get carried away with one’s own prejudices and biases, which of course will inevitably interfere with treatment, often likely even causing great harm. This kind of bias may lead to a “premature evaluation”, in which a pre-established label (such as sex addict) is automatically assumed and foisted onto the client, stigmatizing him (and it’s often a “him”) for life. Braun-Harvey and Vigorito urge us to never assume etiology, instead approaching each client as […]

By Michael Aaron|April 20th, 2016|Couples Therapy, Sex Addiction, Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|0 Comments

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What the Buddha Had to Say About Love (and What That Means for Sexuality)

What the Buddha Had to Say About Love (and What That Means for Sexuality)

In a previous article, I brought up a broad overview of Buddhist psychology and its implications for understanding sexuality. In this article, I want to expand on that a little bit more and talk about some more specific ideas that the Buddha taught. Specifically, I’ll be drilling down to focus on four key concepts (what the Buddha called the “four qualities of love”) which lay at the heart of the Buddha’s teachings, and that also hold specific implications to modern sexuality.

Let’s begin. The first quality is called metta- translated as loving kindness. And by this we mean actions, not just thoughts and feelings. The thought that comes to my mind about acting towards others in a manner of loving kindness, specifically when it comes to sexuality, is the importance of consent. Indeed, as I’ve written about before, what often separates sexual “deviance” from just simply kinky non-normative sexuality is consent, or lack thereof. This is a very trick and thorny issue because consent is often quite complex. Unfortunately, in most relationships, the issue of consent is never adequately addressed or discussed in matters of sex, or otherwise. Great sex, however, requires the trust that comes from a direct discussion of defining what is consensual and what is not. Terrible sex, on the other hand, often involves no discussion, no negotiation, and just either carrying one’s desires in secrecy or acting out on them non-consensually.
Next is karuna- translated as compassion. And not just compassion for others, but also compassion for oneself. As I’ve written about here and here, self-compassion is one of the hardest lessons to learn when it […]

By Michael Aaron|February 10th, 2016|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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An Ode to Hedonism

An Ode to Hedonism

An ode to hedonism? What?!? That might seem like an unusual posting coming from a therapist, particularly in a field which usually pathologizes behavior we might consider to be too extreme. Too commonly, when we think of the word “hedonism,” we conjure up images more akin to a similar, yet different word, “debauchery,” symbolic of sexual, alcoholic, or drug excess. In other words, being out of control, unbalanced, and again, just too extreme. But when you look at the dictionary definition for hedonism, the first thing that comes up is simply, “the pursuit of pleasure,” and with no further commentary on how unbalanced or extreme that pleasure is experienced.

It is this more pure definition of hedonism, as simply meaning “pleasure” that I would now like to focus on, because far often than not, unhappiness, depression, anxiety, and sexual difficulties are more correlated with too little pleasure, rather than too much. For, far too often, when we are stuck on a negative cycle, we lose all perspective and only notice the negative. The things that trouble us, that worry us, that cause us pain and anxiety. And that negative cycle continues unabated in part precisely because we lose sight of the other areas of life that bring us pleasure.

Look at it this way. Imagine a magnet, it has two poles, one negative, the other positive. That negative pole symbolizes all the things that cause us pain. These are the things we seek to avoid. The positive pole on the other hand symbolizes all that which provides us pleasure, these are the things that we strive […]

By Michael Aaron|January 24th, 2016|Sex and Culture, Sex Therapy, Sexuality and Psychology|0 Comments

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Sexuality and Radical Self-Acceptance

Sexuality and Radical Self-Acceptance

In an earlier post, I discussed the importance of self-compassion, and as I progress further in my work, I become more and more certain that it is the cultivation of compassion, rather than the absence of painful emotions and anxiety, that is the hallmark of mental health. I want to expand a bit more on that here, as one integral aspect of compassion towards oneself is self-acceptance. In fact, I’m describing a self-acceptance so complete and pervasive that I call it a radical self-acceptance. What do I mean by this, and what does this have to do with sexuality?

In brief, let me first state before diving deeper, that our culture, at least when it comes to sexuality (and I would extend it further than that) is a shame-based culture. I have much more to say about that in my upcoming book (be sure to subscribe below to the blog or in the sidebar to the newsletter to stay updated on its release), but for now, I don’t think it’s a stretch to say that a country has a sexually shame-based culture when same sex marriage was only nationally legalized a few months ago and people still have their children taken away in custody proceedings due to the nature of their sexuality. My colleague, Joe Kort, has written about the institutional trauma of growing up gay in this country; I would also add that there is an institutional trauma of growing up anything beyond normative and “vanilla.”

Unfortunately, the mental health field, while providing support and relief for millions of people, has also carried within its […]

By Michael Aaron|December 2nd, 2015|Sex Addiction, Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|1 Comment

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Undoing the Effects of Sexual Trauma

Undoing the Effects of Sexual Trauma

Perhaps no form of personal trauma is as painful and nefarious in its impact as sexual trauma. I have written extensively on this topic before, and my research in the area of impact of childhood sexual trauma on adult sexuality has won an award and been published in a peer reviewed academic journal. For those interested, you can read the journal article here- Pathways.

In my work with adult survivors of sexual trauma, I invariably encounter a cluster of difficulties that must be worked through. Specifically, the trauma is often internalized, which means that the affected individual may often place blame on themselves or make generalized assumptions about their own sexuality or identity. A boy, for example who has been assaulted may question his own orientation, wondering what made him vulnerable to attack. Of course, orientation never has anything to do with it, as violent hands-on sexual offenses are an indicator of sociopathy, which is marked by a lack of empathy and remorse. Or the survivor may often develop a phobia of sex, and a negative body image to boot.

It’s this phobia, this specific fear response that I want to focus in on in this article. After working with countless trauma survivors, I have found that at the root of their sexual difficulties, which may run the gamut from performance difficulties to pain syndromes to the inability to experience pleasure, is that an automatic fear response has become associated with their natural sexual response. In other words, fear and arousal become co-mingled. And as a result, one of our most important tasks is to create some separation […]

By Michael Aaron|November 18th, 2015|Sex Therapy, Sexuality and Psychology|0 Comments

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Gray Areas in Sexuality: When Is a Fetish “Too Extreme?”

Gray Areas in Sexuality: When Is a Fetish “Too Extreme?”

I was inspired to write this article following my interview on Vice.com about “Cash Slaves.” This documentary examines the edgy, underground world of Financial Domination, or “Findom.” Basically what this entails is an authority-based relationship where one individual experiences pleasure, and perhaps arousal, by being financially dominated (ie controlled, used, possibly exploited) by another. I would categorize this under “psychological edge-play” because it does touch upon some thorny, gray areas. For example, what if someone desired to be drained to the point of bankruptcy, what do we make of that? Is it ever healthy to be financially dominated in this way? These are all indeed tough questions and lead to an even bigger question– is a sexual fetish or desire ever too extreme or unhealthy? This video examines all of these questions, and then some, and pins the question of what it means to have this kind of a fetish up against the backdrop of living in an age of extreme capitalism. Brilliantly produced, directed, and edited, you can check out the video below, and after you watch it continue reading for my additional commentary.

When I agreed to participate in this documentary, I told the producers that I wanted to make sure that it did not portray any kind of non-normative sexual template in a pathological light. Along those lines, I made a point out of clearing up some misconceptions. Most of the individuals who participate in this do so in a controlled manner and have money to burn. Second, there are certainly a bevy of individuals wanting to jump into the findom game […]

By Michael Aaron|October 25th, 2015|Sex Therapy, Sexual Minorities, Sexuality and Psychology|0 Comments

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Three Types of Couples’ Communication

Three Types of Couples’ Communication

When I work with couples in distress, I often first need to put out some fires and get the couple out of crises before we can make any steps forward. If they are having sexual problems but have also built up so much resentment that they are fighting like cats and dogs, we can’t even begin to get to the sex stuff until we address the overall relational dynamic. I’ve written about this before in this article about why sex therapists must also be good couples therapists.

What I want to address in this piece are some of the mechanisms of how we can get a couple out of dire conflict and into a place where we can get some real work done. This requires achieving a safe space for both individuals, a sanctuary if you will. And it’s not small feat as we are in effect trying to transform a battlefield into a sanctuary. Wow, even writing that, it feels so daunting, like it would take something miraculous to pull off. But it doesn’t require miracles, but simply a process in which both partners are equally committed to putting aside attachments to who is right and wrong and putting in the necessary work to communicate more collaboratively.

There, that’s the magic word– collaboration. Which is so difficult for folks to pull off when they feel flooded and go into fight or flight response. Let’s talk more about collaboration and the fight of flight response when it comes to the way that couples communicate. I am indebted to the work of Dan Wile, and his writings on collaborative […]

By Michael Aaron|October 7th, 2015|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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The Three Types of Fear

The Three Types of Fear

Some of the most common issues I work with are sexual performance difficulties and sexual fears and anxiety. In this particular post, I want to open up the discussion a bit more to include a broader review of the types of fears that I most commonly encounter in my practice. For simplicity’s sake, I will break it down into the 3 most common types of fears that I see my clients struggling with. These are, in no particular order, the fear of failing, fear of the unknown, and fear of emotions. These are all quite ubiquitous, but can create devastating effects, and so I would like to briefly touch upon each one in turn. And although they are uniquely different, they also have much in common.

Let’s start with fear of failing first. This fear is so common, there is a word to describe it– atychiphobia. In the older heyday of psychoanalysis, a common way of seeing clients who were struggling to make progress was that they were just simply resistant. This viewpoint assumes a kind of oppositional stance, with the client somehow working or fighting against the therapist to make change or progress. Rather than trying to push up against this so-called “resistance,” I take what I call a “pro-symptom” approach, which basically means that I want to try to understand what are the benefits of holding onto these problems or symptoms, rather than discarding them at once. This goes back to the harm reduction model that I advocate and have written about in the past; rather than try to push someone into something they are not ready yet […]

By Michael Aaron|September 30th, 2015|Sex Therapy, Sexuality and Psychology|0 Comments

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Self-Compassion and Sexuality

Self-Compassion and Sexuality

As I continue working on my upcoming book, I find myself naturally shifting my focus a bit more away from larger sociological constructs (although there is still plenty of that) and more towards the essential work that I do with my clients on a day-to-day basis. As I’ve written about before (here and here and here), one of the main missions of my work is to help individuals rid themselves of unnecessary internal shame, and sexuality is one of those areas that folks may often may feel the most shamed about.

And the further I go in my work, the more I become certain that self-compassion is one of the key ingredients that allows us to resolve that shame. Indeed, if I were to now be asked what is the most important takeaway that I can provide anyone through psychotherapy, I would answer that it would be the tools to cultivate self-compassion. When it really comes to it, I believe that self-compassion is one of the quintessential hallmarks of mental health.

So what is self-compassion and how do we cultivate it? First, I think it’s important to point out that it’s something that’s poorly understand. If I ask a client, for example, if they are able to experience self-compassion for themselves, they will invariably draw a blank look and state that of course they have self-compassion, or something to that effect. And this may be a client who struggles mightily with self-criticism, depression, anxiety, or any other internal conflict that would create distress.

I’ll say, let’s imagine that there is a distressed child standing on the corner of 5th Ave and […]

By Michael Aaron|September 16th, 2015|Sex Therapy, Sexuality and Psychology|0 Comments

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Why All Sex Therapists Must be Skilled Couples Therapists

Why All Sex Therapists Must be Skilled Couples Therapists

A recent discussion on one of my professional list servs highlighted a common misconception that many in the public have about sex therapists. Specifically, it seems there is the idea circulating that sex therapists are only trained in helping individuals with sexual problems. This online professional discussion seemed to resonate with many, as it dragged on for several days and involved numerous contributors.

Suffice it to say, it got me thinking about my own experiences answering prospective clients’ questions, and it is indeed true that I am often asked whether, in addiction to sexual difficulties, I can also help people with other issues such as depression and anxiety (note to self: add this to the FAQ section). I answer that, as a certified sex therapist, I am first and foremost a licensed psychotherapist, so my foundational training is in general psychotherapy. Before sex therapy, I worked in hospitals and outpatient mental health clinics, just like any other mental health professional. Indeed, there is no separate track for sex therapy; if you want to become a sex therapist, you have to become a psychotherapist first (and then add a ton more specialized training after that).

The most common question I get however is whether I can provide couple’s therapy as well, or if not, should the individual hire a couple’s therapist in addition. This answer is complex because sometimes I get referrals from couple’s therapists when there is a particular sexual difficulty that they feel is out of their comfort zone, but suffice it say, a sex therapist generally must absolutely be skilled at couple’s therapy as well. Why? The short simple […]

By Michael Aaron|July 27th, 2015|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments