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Sexually “Deviant” Fantasies: A Concept Without Credibility

Sexually “Deviant” Fantasies: A Concept Without Credibility

As a member of numerous sexuality organizations, I’m often involved in a variety of conversations, both online and in-person, with colleagues in my field. The truth is, even amongst professionals, the field of sexology is still dominated by regional biases, rather than dispassionate science. For example, a sex therapist in New York City, where I practice, is probably going to hold a more tolerant view of a broad spectrum of sexual practices than a sex therapist in more conservative regions. I suppose this is something that would be obvious to most readers, but unfortunately, this lack of uniformity is a black mark on the field of sexology. Case in point, a cardiologist in New York is likely to have the same level of knowledge and theoretical background as a cardiologist in Biloxi, Mississippi. An opthalmologist in Seattle will probably agree on mostly everything with an opthalmologist in Tulsa, Oklahoma. That’s because these are medical practices ruled by scientific study. And sexology is a scientific discipline as well. But it is poorly funded, so there’s still a lot we don’t know about sexual practices from a scientific standpoint. As a result, sexology (and sex therapy) is still dominated by local mores, community standards, and personal prejudice.

As a case in point, I will briefly discuss an online conversation in one of the organizations I belong to. I don’t want to reveal anything too personal about anyone involved in the conversation, so I will just touch upon the main themes that I think are extremely important because they touch upon a major issue– the current state of the field of sexology […]

By Michael Aaron|October 13th, 2014|Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|1 Comment

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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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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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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

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What Does It Mean to Be “Sex Positive?”

What Does It Mean to Be “Sex Positive?”

Anyone surfing the net looking for sexual information will have probably encountered the term “sex-positive.” Individuals seeking therapists for sexual difficulties will also have inevitably read a therapist profile or bio which indicated that the clinician identified as sex positive. But what does this term mean, especially coming from a therapist?

I will offer a quote from sexologist Carol Queen to get the discussion going–
“Sex-positive, a term that’s coming into cultural awareness, isn’t a dippy love-child celebration of orgone – it’s a simple yet radical affirmation that we each grow our own passions on a different medium, that instead of having two or three or even half a dozen sexual orientations, we should be thinking in terms of millions. “Sex-positive” respects each of our unique sexual profiles, even as we acknowledge that some of us have been damaged by a culture that tries to eradicate sexual difference and possibility.
It’s the cultural philosophy that understands sexuality as a potentially positive force in one’s life, and it can, of course, be contrasted with sex-negativity, which sees sex as problematic, disruptive, dangerous. Sex-positivity allows for and in fact celebrates sexual diversity, differing desires and relationships structures, and individual choices based on consent.”
In my mind, being sex positive at its core means that one’s default position is that sex is natural, generally healthy in all its variations, and can be utilized positively in the service of personal growth and creativity. Now, that of course does not mean that sex can’t be used destructively, just that pathology is never the underlying assumption. For a distinction between the two, click here. (Cliffs Notes version– according to […]

By Michael Aaron|July 3rd, 2014|Sex and Culture, Sexuality and Psychology|0 Comments

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Book Review: The Sober Truth and What It Means About Sex Addiction

Book Review: The Sober Truth and What It Means About Sex Addiction

I recently finished reading a fascinating book, The Sober Truth, by Lance Dodes, which focuses a critical look at the treatment of addictions, particularly inpatient rehab centers and 12-step groups. I’m sure this book will prove to be very controversial, especially in addiction circles, as its main premise is there is no evidence that 12-step groups, or inpatient rehabs (which are mostly modeled on the 12-steps) are more effective than no treatment at all in helping folks to overcome their addictions. In all, research shows that only 5% of those who regularly attend a 12-step fellowship are able to abstain fully from alcohol or drugs in the long-term, which is about the same percentage of those who quit on their own.

As a sexologist, my expertise is not in addictionology, but where my practice does intersect the addiction field is in the area of sex addiction and sexual compulsivity. There is currently tremendous debate whether out-of-control sexuality is really an addiction or a compulsion. For more on this, check out this article which covers recent research in this area. Interestingly, in The Sober Truth, Dodes states that all addictions, yes ALL addictions, and this includes all manner of drug addictions and alcoholism are really compulsions, not addictions. To illustrate his point, Dodes differentiates between physical addictions, where the human body has built up a tolerance and would go into withdrawal if the substance is removed, and the psychological or emotional aspect of the addiction, which looks very similar to a compulsion. Dodes states that it is quite possible to develop a physical addiction without emotional dependence, as well as emotional dependence without physical addiction. […]

By Michael Aaron|June 22nd, 2014|Sex Addiction, Sexuality and Psychology|0 Comments

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Narcissism and Sexuality

Narcissism and Sexuality

Note: The following article is meant to examine the ways in which powerful negative emotions can combine to form certain personality traits and how that can impact sexuality. It is not meant to pathologize or demonize anyone who struggles with any of these difficulties, but merely to illustrate how problematic emotions can create chronic relational and sexual disturbances. As a therapist, I always take a strengths-based approach, and focus on how the individual can resolve their difficult emotions, rather than what is wrong with them.

Previously, I wrote about borderline personality disorder and sexuality. In this post, I will focus on narcissism. In many ways, narcissism is the jigsaw puzzle piece that is the perfect fit for the borderline. There are many reasons for this. The narcissist is often self-preoccupied and unavailable, which does not set off the borderline’s abandonment fears because the relationship feels like it will never get close enough for the borderline to truly be hurt. While the borderline tends to be more anxious/ambivalent in her attachment style, the narcissist is more avoidant, and it is this avoidancy that feels safe to the borderline. For more on attachment styles take a look here.

As in the case of borderline, there are nine distinct criteria in the DSM for narcissistic personality disorder (NPD), including grandiosity, exploitativeness, envy, and lack of empathy towards others. Again, rather than focus on diagnostic criteria, I’m going to take a look at the core emotions that the narcissist struggles with. While the borderline is consumed with fear of abandonment, the narcissist is primarily motivated by a strong sense of internal […]

By Michael Aaron|June 2nd, 2014|Sex Therapy, Sexuality and Psychology|6 Comments