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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

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Couples Therapy: What is Differentiation?

Couples Therapy: What is Differentiation?

I have often thought, and now have come to firmly believe, that couples therapy is one of the most powerful ways to get people unstuck, not only as a couple, but also as individuals. The reasons for this are multi-dimensional, but in short have everything to do with the concept of “differentiation.” What is differentiation? To my knowledge, this is a concept first introduced by family therapist Murray Bowen to describe the level of individuality present within a family system. The more differentiated a family system, the more the people in that family can advocate for themselves and treat each other like separate individuals who have their own wishes and desires rather than as objects that need to be controlled and molded in order for the family system to survive.

I don’t work with entire family systems (children, grandparents, extended relatives, etc) but the same certainly holds true in couples systems. When a couple is poorly differentiated, neither partner can tolerate signs of individuality or advances towards personal autonomy in the other person. Instead the couple remains stuck in symbiosis, a system marked by unhealthy merger (these couples are the ones who may often be labeled as co-dependent), and may use a variety of methods to try to keep this balance intact. These methods may include various forms of manipulation (guilt-tripping, coercion, passive-aggressiveness) to manage the threat that is experienced by the other partner pushing towards more differentiation.

I want to emphasize that by differentiation, I don’t mean that the partner who is trying to differentiate is going out and doing things on his or her […]

By Michael Aaron|June 28th, 2015|Couples Therapy, Sex Therapy|3 Comments

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Couples: Making Space for Connection

Couples: Making Space for Connection

One of my specialties is working with couples who are struggling to rekindle their sexual desire for each other. It’s a frequent enough occurrence in my practice, that I’ve been interviewed in a number of media outlets about it, including the Huffington Post. As I indicated in that article, the loss of desire in a long-term committed relationship is not uncommon and is often related to a number of factors that go way beyond the simple idea of attraction. Often there may be complex emotions that have come between the partners over the course of time, corroding the foundation of closeness much like water creates cracks and rifts in bedrock over time.

I’ve explored different facets of overcoming emotional issues and resentment with couples in other areas of my blog both here and here and here. In this particular post, I want to focus on a different, yet essential aspect of getting couples back on track– carving out the space for each other. First, though, I want to take a step back and make some general observations about my experience with successful treatment outcomes in couples therapy. I’ll then come back and tie this back into my original point, since I think both are interconnected.

Usually when I work with a couple, I am very active and give homework that is relevant to the particular situation. It’s not that I am passive or don’t give homework to my individual clients, it’s just that the level of conflict or tension that a couple brings into the room almost requires a more prescriptive and assertive stance on the part of the […]

By Michael Aaron|June 7th, 2015|Couples Therapy, Sex Therapy|0 Comments

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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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Is it Possible to Eradicate a Fetish?

Is it Possible to Eradicate a Fetish?

In a recent post, I wrote about how the field of sexology is uneven in its application and rife with regional and individual biases, largely due to general sex phobia and a subsequent lack of empirical research within the field. Recently, a debate on the mailing list of one of the sexological organizations to which I belong touched again upon discrepancies within the field. The discussion in question concerned whether or not it is possible to eradicate a fetish. Most respondents were in agreement that, like a sexual orientation, eradicating a sexual fetish is not only not possible, but particularly in fetishes that cause no harm, even unethical.

One clinician, however, stated not only that eradicating a fetish is possible, but then went on to describe exactly how (he/she believes) it is done. The methodology described was so disturbing, however, that I felt it necessary to challenge the ideas presented and to present both his/her perspective as well as my response here on my blog as a cautionary tale to individuals who may have questions regarding their own sexuality so that the know what to avoid in therapy. I have eliminated any details that could reveal the identify of the other clinician.

Below is what the clinician wrote in support of fetish eradication. I am highlighting and italicizing the most objectionable aspects:
I don’t see a fetish as similar to sexual orientation – it is something that does reflect “something wrong”, and in my own experience, DOES respond to therapy! One issue is that sexual fetishes – paraphilias – typically involve sexual activity with something that does not provide the […]

By Michael Aaron|December 8th, 2014|Sex and Culture, Sex Therapy, Sexual Minorities, Sexuality and Psychology|2 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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Sexuality and Unresolved Grief

Sexuality and Unresolved Grief

In previous posts, I addressed the relationship between sexual difficulties and such powerful negative emotions as guilt, shame, and rage. I briefly addressed the emotion of grief in this article, but I also wanted to take the opportunity to expand on the ways in which grief affects sexual functioning, particularly because it is such a prevalent experience for so many people.

When we experience grief, inevitably we are dealing with some kind of a loss. Grief is the emotional response to loss. Typically, we may think of the loss of a loved one, but loss doesn’t just have to be about the death of a person– it could be about the death of an idea, a hope, a dream, an identity, and so on. In many ways, grief is a normative process in human development. We’ve all had to (or will have to) grieve the loss of childhood dreams and opportunities; we have to accept that we will never be an astronaut or professional ball player. And we also have to grieve the natural effects of the aging process– we cannot stay young and keep our looks and health forever. So grief is an inevitable experience for all of us in one way or another. We cannot escape it. But there is also a large gap between this kind of normative grief and the unresolved, perhaps pathological, grief that causes long-term difficulties.

When grief becomes unresolved it is typically because an individual is stricken with grief but does not allow him or herself to fully experience it. Essentially, the person is afraid to experience the grief, and develops something resembling […]

By Michael Aaron|October 22nd, 2014|Sex Therapy, Sexuality and Psychology|1 Comment

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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