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Working with Relationships in Transition

Working with Relationships in Transition

One of the key topics that I cover in my Common Issues in Partners’ Sex Therapy class is how to work with those relationships that are undergoing some sort of a transition. What I mean by a “transition” in this case, especially when it comes to sex therapy, is some new item of information that is introduced into the relationship which also serves to destabilize that relationship.

What are some examples of this kind of destabilizing information? Here are some common ones– one partner introduces a desire for a specific kind of sex (or fetish) that is found to be repulsive or offensive to the other partner; one partner shares a desire to open up the relationship and explore some form on non-monogamy; or, and this was more common in the past, but still happens frequently enough, one partner shares information about his or her orientation or preferred gender that is at odds with the other partner’s prior knowledge or understanding. Regarding the last item, these types of relationships are called “mixed orientation” relationships. In the recent past, with a lessening of homophobia in general society, this kind of disclosing was likely to be of a man opening up to be homosexual. These days, my observation is that, while that still does happen, mixed orientation couples tend to be more of a hetero/bi dynamic. But I digress.

Let’s now talk about some specifics of how I work with relationships that find themselves in transition. The first and most important step (as is the case in any type of psychotherapy) is to create a safe space for both […]

By Michael Aaron|July 27th, 2016|Couples Therapy, Sex Therapy, Sexual Minorities, Sexuality and Psychology|0 Comments

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Common Issues In Partners’ Sex Therapy

Common Issues In Partners’ Sex Therapy

I am teaching a course this summer entitled “Common Issues in Partners’ Sex Therapy,” and as I’m in the midst of creating the outline and curriculum, I thought it appropriate to go through my old catalogue of articles and see what I’ve already written that provides further resources to the material I plan on covering. I’ve divided the class into six sections– 1) General considerations; 2) Communication issues; 3) Infidelity/sexual compulsivity; 4) Desire discrepancy; 5) Relationships in transition; and 6) Alternative relationships. I’ll go through each of these in turn.

Let’s start with “General considerations.” Typically when I work with a relational system, I want to get a sense of where each individual is developmentally. Are these folks in they honeymoon stage? Are they trying to differentiate from one another? Are they in different head spaces (one is trying to assert independence while the other is trying to maintain the status quo)? Are there any personality disorders that are preventing this relationship from moving forward? Here are some articles I’ve written in the past that provide further detail on these subjects:

The Connection Between Attachment and Sexuality
Couples Therapy: What is Differentiation?
Why The Beginning of a Relationship Determines It’s Success
Borderline Personality and Sexuality
Narcissism and Sexuality
Boundaries: The Most Important Part of a Relationship

Moving on now to “Communication issues,” my work as a therapist requires me to dissect the communication difficulties that relationship systems struggle with and then model new, more productive forms of relating. I am informed by numerous thinkers in this area including John Gottman and Daniel Wile and here are some articles that highlight some of these […]

By Michael Aaron|June 28th, 2016|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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Research Shows When It Comes To Sex, It’s Quality Over Quantity

Research Shows When It Comes To Sex, It’s Quality Over Quantity

Moving along with my review of key talks from the most recent Society for Sex Therapy and Research (SSTAR) conference, I will focus this particular article on the fascinating research on peak sexual experiences by Dr. Peggy Kleinplatz, from the University of Ottawa. In my previous review, I summarized the groundbreaking work of Doug Braun-Harvey and Michael Vigorito in creating a competing model to the sex addiction model in treating out of control sexual behaviors.

But before diving in, let’s first take care of some housekeeping. As many of you know, we just wrapped up the 1st Annual AltSex NYC Conference, which I created and co-produced with my colleague, Dulcinea Pitagora. It was a smashing success, in which over 150 attendees participated in a day long conversation around sexuality topics that are rarely discussed anywhere else. We had numerous media in attendance. New York Magazine just posted a nice summation, and additional reviews will be forthcoming in other media outlets. Feel free to continuously check the media page for additional updates.

Also, I am proud to announce that I am now blogging for Psychology Today, with my new blog entitled Standard Deviations. There is no content up there yet, as I am just getting started, and have been busy finishing up other matters, but feel free to subscribe there as well, as I will be posting a few articles to that blog in the next few weeks. I will still be blogging here, but my articles here will be more focused on clinical issues relevant to clients, while my writing for Psychology Today will be more big picture […]

By Michael Aaron|April 29th, 2016|Couples Therapy, Sex Therapy, Sexuality and Psychology|0 Comments

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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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How Fluid is Sexuality?

How Fluid is Sexuality?

How fluid is sexuality? This is a question I often hear both from clients and from my peers. In my upcoming book, I argue that much of sexuality is either inborn, or influenced by innate factors. However, that doesn’t mean sexual expression is fixed or static. After all, as we all have heard, much of human behavior comes down to a mix of “nature” vs “nurture.” Rather, even the fluidity itself I believe is influenced by as many genetic as social factors. Let me explain further.

There is an expression I like to use– you can have ten different people in a room engaging in the same exact behavior, but for ten different reasons. Where we often go awry is making judgments or conclusions based solely on external markers, in this case behaviors. But, as I’ve written about before, when it comes to sexuality, it’s all about intent. And we have no idea what that intent really is comprised of without having a greater understanding of the inner workings of that particular individual’s mind.

Let’s take same-sex behavior as an example. Psychiatrist Fritz Klein created what is called the Klein Sexual Orientation Grid, which divides orientation into seven distinct categories– Attraction, Behavior, Fantasies, Emotional Preference, Social Preference, Lifestyle, and Self-Identification. Those are a lot of categories! In other words, according to Klein, someone, let’s say in this case a man, may have a sexual attraction to a man, but only feel an emotional preference for women. Or that man may find a deep emotional connection with other men, but not find any desire for sexual interaction. […]

By Michael Aaron|March 31st, 2016|Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|0 Comments

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Book Review– The Truth: An Uncomfortable Book About Relationships by Neil Strauss

Book Review– The Truth: An Uncomfortable Book About Relationships by Neil Strauss

This review is a preview of a more formal review which will appear a few months from now in the Journal of Sex and Marital Therapy. I will start by putting this book into context and then I will address the content before going into other aspects of the book, such as structure, quality of writing, etc. The author, Neil Strauss is a Rolling Stone Magazine journalist, and known for co-authoring books by rock stars such as Marilyn Manson, Dave Navarro from Jane’s Addiction, and Motley Crue. These names will all be familiar to those who were into rock music in the late 80s through the 90s. He then came to more prominence by documenting his rise from a journalist nerd who couldn’t “score” even when traveling with rock stars to a guy who learned to “pick up” women in the The Game. The Truth is marketed as a sequel in which this ladies’ man is now trying to learn how to maintain a great relationship now that he can find willing partners to form one. I happened to get my hands on a copy after a social media discussion I had with the author, in which I stated I was willing to provide an honest review in exchange for a copy of the book.

While The Game has received criticism for its portrayal of attitudes towards women within the “seduction community”, as it is called, I found The Truth to have more broad appeal to a variety of different groups. Off the top of my head, the following individuals would probably find at least something of interest within this book: Individuals who are […]

By Michael Aaron|March 11th, 2016|Couples Therapy, Sex Addiction, Sex and Culture, Sex Therapy, 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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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