While the terms “pedophile” and “child molester” are often used interchangeably, they do not mean the same thing. A pedophile is a person who is attracted to children, but not all people with pedophilia molest children. Many individuals who are attracted to children never act on their attraction, and some seek help in order to keep from harming children.

Pedophilia is considered by some to be one of the most difficult social problems to understand. The 5th edition of the Diagnostic and Statistical Manual classifies pedophilia as a paraphilia, distinguishing it from pedophilic disorder: It is diagnosable as a mental health condition when it causes distress to the affected individual or to someone who is unwilling or unable to consent. Thus, according to this classification, having an attraction to children and not acting on it does not indicate a mental condition.

New research shows that pedophilic disorder may be neurological in nature, lending further support to the position that an attraction to children is not a choice. Some may find this difficult to accept, as those who do act on their desires and molest children have the potential to cause serious and lasting harm to many children. They may repeat their crime over and over until stopped by the criminal justice system. Many people may believe that, once caught, people who molest children deserve to spend the rest of their lives in prison, but the reality is that many of these individuals will eventually be released.

Upon release from prison, offenders are often required to enter rehabilitation programs, which are meant to redirect pedophilic urges and help a person refrain from harming children. These programs are often viewed with skepticism, as many believe that a person who molests children cannot be rehabilitated and that pedophilic urges will always lead to the sexual abuse of a child. However, there are several perspectives on the issue.

The Difference Between Pedophilia and Child Molestation

Psychological perspectives on child molestation vary greatly, but experts agree that most people who molest children fall into one of four categories:

1. Children or teenagers under the age of 16 who are sexually curious and may experiment with younger children.
2. Adults who have a brain condition, intellectual disability, or other mental health issue.
3. Individuals who have an antisocial personality and may use children sexually but have no particular sexual desire for children.
4. Individuals who are older than 16 and experience ongoing sexual desire for children. Sexual desire for children, or pedophilia, can be identified and treated or controlled with therapy and medication.

Ninety-five percent of all known instances of child molestation are committed by people with pedophilia. Other individuals may molest children for the above reasons, out of sexual frustration, or in order to maintain power or exert control.

Though nearly all those who molest children have pedophilia, many people with pedophilia will never molest a child, and some work to eliminate their attraction to children through various forms of treatment and therapy.

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Non-Offenders

Dan Savage, who frequently writes on the topic of human sexuality, has published several accounts of people who, despite their attraction to young children, avoid being alone around children and are able refrain from committing acts of molestation. It is generally acknowledged that it may take a significant amount of self-control to avoid offending and that pedophiliac inclinations typically mean a person with pedophilia will find it difficult to have a healthy sexual relationship.

In several European countries, Savage points out, people experiencing a sexual attraction to children are often able to seek treatment confidentially. In the United States, however, an individual who discloses pedophilic tendencies may be arrested, as therapists and physicians are required by law to report anyone who poses a threat to children. This law, in addition to the stigma surrounding pedophilia and the limited number of resources available to those seeking help in the U.S., is likely to discourage non-offenders from seeking professional help, help that may enable them to continue to keep from offending.

Free and confidential prevention and treatment programs–such as Germany’s Prevention Project Dunkelfeld–may help those who are attracted to children refrain from acting on their desires. Some European countries do have lower child molestation rates than the United States, and this fact may be connected to the availability of treatment.

Many people who are attracted to children are horrified and frightened by their preferences and attempt to do everything they can to keep from harming a child. They may wish to attend therapy, explore ways to curb their desires, or take medication. Making treatment available and accessible to individuals before they offend may reduce instances of child molestation.

Chemical Castration

Chemical castration is one method that may keep child molesters from reoffending. Many states in the U.S. offer voluntary chemical castration in exchange for earlier release. Some states, such as California, mandate castration for offenders with multiple convictions as a condition of release. The treatment has been shown to greatly reduce sexual desire in men who are attracted to children and to lower rates of recidivism.

Those who have not yet harmed a child and who are committed to avoiding doing so may find relief from their desires through chemical castration. In some cases, an antidepressant, which may have the effect of further limiting one’s sex drive, is also prescribed.

Sexual desire cannot be completely eliminated by castration, a fact that leads many individuals to question the efficacy of the treatment and the risk of releasing offenders who may still experience some sexual desire for children. Another objection stems from the fact that the person undergoing treatment must be relied on to take their medication regularly. However, chemical castration has been shown to be effective for many individuals and thus is likely to protect many children who would potentially be victims of sexual abuse.

Group Therapy

Many therapists use group therapy as a type of treatment for people with pedophilic tendencies. Groups can provide a safe environment to discuss inappropriate and harmful urges, and the support of a group of individuals facing similar challenges may give some people the strength to avoid offending or reoffending.

However, when someone is involuntarily enrolled into group therapy and has no particular desire to stop offending, a support group can become a different environment. Other members may, knowingly or unknowingly, support a high-risk offender’s further attempts at molestation. But because mandated group therapy may be of benefit to some convicted offenders or those who are at risk for offending, group leaders may not wish to withhold a potentially helpful treatment from anyone. They may, however, choose to carefully screen participants prior to program entry and during treatment.

Aversion Therapy

Aversion therapy pairs an unpleasant stimulus such as an electric shock, pinch, or flick along with a pleasant stimulus. Sex offenders may use aversion therapy to attempt to eliminate their attractions to children. While this therapy can be effective, it often poses ethical problems, as therapists cannot shock their patients. It can also be difficult to maintain consistency with this type of treatment. Further, when aversion therapy does work, it is unlikely to do more than eliminate the attraction to children. It likely will not help people develop an attraction to age-appropriate adults if they do not already experience such an attraction.

Fake Porn

Psychologists have still not reached an agreement about whether pedophilia is a sexual orientation or a mental illness. Those who believe it is a sexual orientation may advocate the use of fake porn, depicting animated or CGI children, as a way for those with pedophilic tendencies to achieve sexual release. Some therapists have reported that this method has been successfully used to reduce an individual’s desire to molest a child.

However, other therapists point to studies demonstrating the effect pornography can have on sexual desire and express concern that such pornography may actually create or increase a desire to sexually abuse children. Many also question the ethics of making such pornography, even when it does not involve actual children.

References:

1. Early Diagnosis and Effective Treatment. (n.d.). Retrieved from http://www.childmolestationprevention.org/pages/focus_on_the_cause.html
2. Goode, S. D. (2010). Understanding and addressing adult sexual attraction to children: A study
   of paedophiles in contemporary society. New York, NY: Routledge.
3. Jenkins, P. (2004). Moral panic changing concepts of the child molester in modern
   America. New Haven, CT: Yale Univ Press.
4. Kaplan, M. (2014, October 5). Pedophilia: A Disorder, Not a Crime. Retrieved from http://www.nytimes.com/2014/10/06/opinion/pedophilia-a-disorder-not-a-crime.html?_r=0
5. Kincaid, J. R. (1998). Erotic innocence: The culture of child molesting. Durham, NC: Duke
   University Press.
6. Nanos, J. (2014, March 1). Can Chemical Castration Help Pedophiles Tame the Beast Within? Retrieved from http://www.bostonmagazine.com/news/article/2014/02/25/chemical-castration
7. Schwartz, C. (2011, December 7). What Science Reveals about Pedophilia. Retrieved from http://www.thedailybeast.com/articles/2011/12/06/what-science-reveals-about-pedophilia.html
8. Seto, M. C. (2008). Pedophilia and sexual offending against children: Theory, assessment, and
   intervention. Washington, DC: American Psychological Association.

If you haven’t read the novel yet, you might be 50 shades of curious about why Fifty Shades of Grey is the most-talked-about tale in print currently.

A quick search will reveal that the romance between the main characters, Mr. Grey and Miss Steele, revolves around bondage, discipline, dominance, submission, sadism, and masochism (BDSM). In fact, Christian Grey appears to really only get satisfaction from sex when it involves inflicting pain or dominance over his partner, which, following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) used by mental health professionals to make diagnoses, could be considered a mental disorder called sexual sadism.

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The DSM IV-TR states that “sexual sadism involves acts (real, not simulated) in which the individual derives sexual excitement from the psychological or physical suffering (including humiliation) of the victim.” In order to officially be diagnosed with sexual sadism, individuals must meet the following criteria:

1)    “Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.”
2)    “The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.”

In the first novel of the series, Christian Grey appears to engage in sexual sadism only with consenting participants (like Anastasia Steele, the main female character), but he openly admits to being abused (including sexual abuse) as a child and teenager and appears to be at least somewhat distressed by the fact that it’s difficult for him to have a “normal” relationship. He even explains to the character Anastasia Steele at one point that this is just the way he is, almost with sorrow. And although he does have “normal” or “vanilla” sex with Anastasia, he makes it obvious that he prefers sex that involves pain and pleasure at the same time, always with him dominating.

Anastasia also admits to herself that there is something unusual about Christian and his sexual preferences, but she lets her desire for him take over, and she hopes that she can make him want a “normal” relationship with her. She herself has issues with low self-esteem and confidence, which is perhaps why she is so drawn to the seemingly overly confident Christian. Both characters appear to function as well as the average person in their fictional world, but both have issues that could potentially need to be addressed by a professional if they lived in the real world.

So it appears that one of the main characters of Fifty Shades of Grey may have a diagnosable disorder related to sexuality, or at least has abnormal sexual preferences and a traumatic past that hasn’t been resolved yet. He has major difficulties maintaining any lasting romantic relationship, and yet the relationship between Christian and Anastasia seems to have been received in a somewhat positive light, considering the large following of readers.

The Experts Weigh In
Several mental health experts have offered their insight into the unusual relationship found in Fifty Shades of Grey (and the two other novels in the series). Reef Karim, a board-certified psychiatrist, the founder and medical director of the Control Center for Addictions, and author of Why Does He Do That? Why Does She Do That? and host of the new show Broken Minds on the Discovery channel, said that the novel is definitely making people think about normal and abnormal sexuality and possibly changing some people’s minds.

He said in an e-mail that the main question people are wondering is, “What is normal and abnormal sexual behavior, and when is aberrant sexual experimentation and behavior considered a mental health diagnosis?” “The really interesting part of psychiatric diagnoses is that many are based on a behavioral spectrum where the interruption of an individual’s social, relational, occupational, and functional life is a key factor in making the diagnosis,” Karim said. “This book has become a literary piece of pop culture that is challenging many to review their thoughts on normative and ‘out of the box’ sexual behaviors.”

He said that there could be concerns about a link between sadomasochism (S&M) and childhood abuse as well, since that is mentioned in the novel. “There is definitely a connection, but many people with no psychiatric or psychological history report enjoying BDSM primarily as a novel and alternative way to connect with each other,” Karim said.

Despite (or because of) the unusual relationship involving pain and pleasure (and emotional issues), many women appear to be captivated by the novels. Karim suggests this is because women enjoy having sexual fantasies, but that doesn’t necessarily mean they want the type of relationship found in the novel to become more than a fantasy. If anything, women might be more prone to sexually experiment during or after reading the novels.

However, he doesn’t think the novel is capable of completely changing sexual norms, so sexual sadism and sexual masochism will most likely still be considered mental disorders according to the DSM in the future. “I believe the novel opens up the conversation of BDSM, kink and sexual norms, but it’s much more in the curiosity range than actually changing research-driven professional medicine,” Karim said. “Expecting an increase in sex shop purchases is different than changing a clinical manual.”

Karim explains further why the novel is so appealing to women (and men), even with the dysfunctional (and sometimes even depressing) personalities of the characters. “In regards to sexual research, many women fantasize about submission, and many men fantasize about dominance,” he said. “Even though men and women are more equal than ever in regards to occupation and finances, we are still very different sexes, and definitive gender and role-based fantasies do exist,” he added. “Many people in our society have hidden (or not so hidden) fantasies involving kink, S&M, or altered sexual behavior. 50 Shades of Grey has opened up the conversation of previously hidden sexual desires and fantasies of many women.”

He said the novel could help couples become more creative in their sex lives, but going to any extremes is generally not beneficial. “The introduction of BDSM can add to a couple’s sexual tool box, but occasionally it can get out of control,” Karim said. “When extreme behavior leaves the bedroom or involves extremes in the bedroom, it can negatively impact the relationship. I’ve treated couples who use BDSM as a novel, fun experience in a healthy and intimate way, and I’ve treated other couples or individuals who became obsessed with the act or re-created a previous abuse history with a lot of painful markings.”

Overall, the BDSM series is encouraging men and women to discuss sexuality more openly with each other. “The book mentions childhood abuse and difficulties with self-esteem that contribute to the psychological make-up of these characters, but it has also found a way to tap into the S&M lifestyle curiosity shared by many men and women,” Karim said. “It may actually normalize the behavior, when done in moderation, as not something strange but perhaps just another form of sexual expression. Life isn’t always black and white; sometimes it’s fun to live with a little grey.”

Kari Tabag, a licensed clinical social worker, works with adolescents and college-age men and women and has read the series. She said the novel has passages that hint at mental health issues like posttraumatic stress, codependency, BDSM, and alcoholism.

Although she agrees that the novel can improve people’s sex lives through fantasy, role play, and experimentation, the sexual expectations people might have after reading the series might be set too high, leading to disappointment. Also, she emphasizes that the actual relationship depicted in the series is very unhealthy in many ways. “Christian and Anastasia’s relationship is not a healthy one. They are codependent and are too enmeshed with each other,” Tabag said. “A lot of women are codependent and are what I call ‘daddy hungry.’ This novel depicts two people who have abandonment along with trust issues.”
There are even more unhealthy aspects of the fictional relationship, according to Tabag:

• When Anastasia finds out that Christian only dates women with brown hair, it is a dead giveaway of his childhood abuse and abandonment. In fact, Anastasia refers to him as her “boy,” which is not healthy.
• Anastasia repeatedly feels that she is not worthy of Christian and vice versa.
• Christian is obsessed with Anastasia and even follows her to another state when she visits with her mother.
• They both are looking for someone to take care of rather than focusing on healing themselves. A healthier relationship involves two people who have their own separate, independent personas, making them well-established, well-rounded, self-reliant individuals.
• Christian wants Anastasia to give in to him and give up all control, and he lavishes her with gifts as a reward.

Although the relationship in the novel is not healthy, BDSM is not necessarily as terrible as it’s made out to be. Tabag suggests our society is not necessarily mature when it comes to accepting and understanding sexual preferences outside of ‘man on top.’”

Viewpoint From a Submissive
Kasi Alexander, the author of several books and short stories about alternative lifestyles, such as Becoming Sage and Saving Sunni, has herself been involved in the lifestyles of polyamory, BDSM, and power exchange. She currently identifies herself as a “slave,” and the partner in her polyamorous relationship is the “master”; she could also be referred to as a submissive. She said in an email that the relationship between Christian and Anastasia is not necessarily a model of the typical BDSM or power exchange relationship. The characters themselves are also not typical. For example, Christian Grey was abused as a child and became involved in BDSM at 15, and he now avoids “vanilla” sex and relationships.

“Very few people in the lifestyle immerse themselves so deeply that they have no desire for a relationship outside the parameters of power exchange,” Alexander said. “The ones who do are using the lifestyle to mask other personality defects, not the other way around. Accepting your dominant or submissive tendencies does not kill the desire for intimacy, closeness, or connection.” Also, the character of Anastasia Steele is low in self-esteem, self-worth, and confidence, which is not usual for submissives, Alexander said.

“Many people assume that submissives give up all responsibility for themselves, are doormats that cannot stand up for themselves, and so are taken advantage of by predatory dominants,” Alexander said. “That couldn’t be further from the truth. Submissives are stereotypically extremely strong, capable people. Many of them crave submission as a way to temporarily escape the huge responsibilities they take on in their “vanilla” lives.”

Alexander adds that the BDSM lifestyle can even be considered therapeutic in different ways. “In my own relationship, we have used our power exchange to work on my self-image and body issues, increase my self-confidence, and achieve many goals, including writing and publishing three books (so far),” she said. “Other kinky people that we know use sensation play as therapy or catharsis to work through feelings of inadequacy, childhood abuse issues, and various kinds of mental health issues.”

The BDSM element of 50 Shades of Grey just takes the typical romance/erotic novel a little further. “Women have a genetic inclination toward alpha males, so we love our fictional heroes to be large, powerful, and a little scary—someone who has the ability to hurt us but doesn’t,” Alexander said. “And almost all BDSM play is based on the intensification of physical experiences. So the fantasy of the physical ‘danger’ (intensity of experience) goes along with the mental domination of having a strong alpha male taking over your life. It’s erotic, even if it’s not what we want in our actual day-to-day lives.”

She said BDSM and power exchange have the potential to make relationships more sexually fulfilling, but just like in any relationships, it’s a matter of communicating wants and desires. And just like in other bad relationships, abuse and manipulation can happen, but that is a matter of individual personalities and relationships, not a characteristic of BDSM as a whole. She said it’s important to make a distinction between mental conditions and different sexual preferences and alternative lifestyles. “The most important aspect of the mental disorder consideration is the difference between true sadism and kinky sadism,” Alexander said. “A vast majority of ‘sadists’ in the BDSM community derive no pleasure from inflicting pain unless the recipient is enjoying the experience, whereas a true sadist is not concerned with the benefit of the other person.”

She believes that people will eventually become more accepting of these types of lifestyles and realize that they can be beneficial to people who can learn how to make them work.

“More education is needed to show people that polyamory is not cheating, BDSM is not abuse, and power exchange is not manipulation,” Alexander said. “The important thing to keep in mind is the benefit for the people involved. BDSM and power exchange can be done badly and for the wrong reasons, but they can also be used for personal, professional, and spiritual growth and for the enhancement of relationships.”

Related articles:
What Do Your Sexual Fantasies Mean?
The Good and Bad Sides of Porn
Exploring Alternative Lifestyles in Your Relationship

Whether or not we believe we should talk about sex with our therapist in treatment may have something to do with what we believe therapy is for or what the expected outcome is.

Are you going to therapy for a relationship issue? For a mental disorder such as depression or anxiety? To overcome trauma? Or because you are having a difficult time adjusting to a new situation? Therapy is useful for a multitude of issues, and no, sex may not be the most significant thing affected by a particular issue, but it definitely doesn’t hurt for the therapist to ask about it, to allow for the conversation to include some open, honest discussion not just about sex but also about sexuality, to at least let the client know it is okay to bring up the topic of sex in the therapist’s office.

Pervasive in our society is the inability to talk about sex, awkwardness, and embarrassment, which in turn leave us often bereft of the coping skills required to handle sexual issues in our relationship as they come up. When we avoid talking about sex with our partners, it can lead us down the path of avoiding talking about lots of other things as well. We all know that open, honest communication is key in successful relationships, so the absence of conversation and inability to talk about sex with our partners can be like a ripple effect in the breakdown of communication in a relationship.  And when we go to therapy and our therapist also doesn’t feel comfortable talking about sex, the therapist in turn perpetuates what society has taught us—that sex is too taboo to talk about. This may be okay for some, but not for all. Some people want a more comprehensive experience.  Some people want more than just a quick fix for their problems. Some people want to address the problems at their root. Some people want real change and real growth.

In treating relationships, sex must be addressed. Sex is not always everything, but in relationships it is definitely something. Most therapists treat some aspect of relationships. Even when an individual comes in for treatment for depression, anxiety, trauma, a new life situation, etc., if the person in therapy is involved in a relationship, or is dating, or even if they are single and celibate, a few questions encouraging open, honest communication about any concerns he/she has about sex can make all the difference in the world. Therapy should be a nonjudgmental safe haven where an individual can work stuff out, ask questions, and find answers. An avoidant therapist who is uncomfortable talking about sex sends a subtle message that can perpetuate feelings of shame, guilt, or embarrassment about sex, which in the end thwarts growth. Therapy should promote growth, not thwart it.  In couples therapy, it is absolutely pertinent to ask about sex.

Feelings about our sexuality and our bodies are core in our lives. Many people walk around feeling bad about their desires or fantasies. Shame and guilt about sex are extremely common, and people have very little awareness of this. If a self-loathing, self-hating, guilt-ridden client comes to therapy, is it not best to address where the feelings come from? A client may not be that aware of the root of the problems. It is important for the therapist to open the door for exploration and discussion.

Therapists do not even have to be especially knowledgeable about sex. In fact, therapists rarely know anything about what the client has experienced, in terms of sex or any other aspects of the person’s life. Therapists are trained to ask questions in order to understand the client’s experience. The client is the expert on his or her experience. A therapist’s job is to ask questions and provide a nonjudgmental environment to foster the client’s growth.  In looking at it from this model, therapists do not need to be well-versed in something to be open about it.

Therapy is a holistic health treatment that is helpful in guiding people to lead happier, healthier, genuine, and more honest lives all the way around. In therapy we attempt to break down the road blocks that prevent us from moving forward on our life journey, whether it be in our relationships at work or with our friends, family, or partner. Many psychological issues have a physical manifestation. It is important to remember that a sexual issue may be a representation of something bigger, stemming from depression, anxiety, or a relationship problem. We cannot treat problems in a vacuum. Mind and body are connected. When you leave sex out of treatment, the client’s journey remains incomplete.

Related articles:
Sex Talk
The Importance of Addressing Sexual Issues in General Therapy
The Elephant in the Room: Why We Need Full Disclosure in Sex Therapy

In therapy, many issues are covered, but sex may still be an uncomfortable topic for many clients and even therapists to talk about. Yet many people have sexual issues that need to be resolved in order for life to be the most fulfilling that it can be.

In general therapy, there may be an uncomfortable attitude in regard to clients and therapists talking about sex, an uncertainty of what constitutes sexual issues (considering there is a wide range of acceptable sexual behaviors, experiences, and attitudes in the modern world), and possibly a lack of guidelines for how to address sexual issues that may be occurring in client relationships.

Some experts have offered opinions and guidelines that general therapists might find useful in addressing sexual issues in therapy.

Sara Rosenquist, a board-certified clinical health psychologist who also specializes in sexual and reproductive health issues, said in an email that her clients tend to seek her out specifically for sexual issues, but she realizes this is not the case for many general therapists. “A whole lot of marital therapists are uncomfortable talking about sex, so they don’t ask or they don’t create the kind of climate in their sessions that would give patients the idea that they can talk about anything or bring up sexual issues,” Rosenquist said.

She said that she has certain ways that she approaches sexual issues with clients. “When I’m doing marital therapy with a contentious couple, I may ask outright about their sex life, or they might bring it up,” Rosenquist said. “But I don’t go fishing … I operate under the assumption that I am to work on the goals the patient brings to me with the material the patient brings to me.”

She said for certain mental health issues, it can be likely that the clients also have sexual issues to address. “If a patient is on antidepressants, there is about a 67 percent chance that they have sexual side effects, such as inability to orgasm, which is very frustrating and causes people to avoid sex to avoid the frustration,” Rosenquist said. “If one partner is depressed, there is a 50 percent probability that the other one is, too, and a high probability that the relationship is affected, particularly the sexual relationship.”

She thinks it is best to bring up the topic of sexuality with clients so they feel comfortable talking about it. “My advice to therapists would be to make it a practice to ask directly about sexual concerns and sexual side effects, thereby giving a clear message that you can talk about this in here,” Rosenquist said. “Most general therapists would avoid learning about ‘unusual’ sexual experiences because they are frankly not equipped to deal with it and they don’t want to lose the patient.”

She said that therapists also need to think about what their limits are in regard to treating sexual issues. “It is frustrating to me when the therapist sends them to me ‘just for the sex part’ instead of allowing me to treat the whole couple,” Rosenquist said. “Ethically we are supposed to know the limits of our competence, but in real life people are reluctant to refer out, and most feel that if they have sex, they’re competent to treat sexual concerns. And most couple therapists feel that if you treat the couple communication issues, the sex will fix itself. I find that often the opposite is true—that the sex difficulties are an important lightning rod, and if you treat that the communications improve.”

Along with therapists realizing their competencies in addressing and treating sexual issues, it’s important for them to avoid misdiagnosing or making assumptions with clients who have sexual issues. For example, just because a woman has multiple sex partners or has sex more often than other women, therapists should not jump to conclusions that she has sex addiction.

“A lot of general therapists lump ‘unusual sexual practices’ together as ‘sex addiction,’” Rosenquist said. “Doing so is not helpful. For one thing, ‘sex addiction’ is not in the DSM—but a variety of sexual practices/appetites behave as if addictive. Many variant arousal patterns and even some high needs for sexual contact/release interferes with genuine intimacy because the person is usually ‘scratching an itch’ (using sex to calm anxiety or satisfy a compulsion) and the sex becomes not so personal. Whenever sex becomes about scratching an itch for one person, it will kill desire in the other, and this, in turn, damages the relationship.”

Barbara Gross, a licensed master social worker and a sexual counselor for the Medical Center for Female Sexuality, said in an email that there are four basic categories of female sexual dysfunction that therapists can be aware of: desire, arousal, orgasm, and pain.

Here are her explanations of each category:

Desire: “We define desire as the ‘wanting aspect.’ Many women come to the Center and report that they are concerned that they have no interest in being sexual. It may be that they once had desire but now they don’t, or it is possible that they never really had much interest in being sexual. We often see low desire in women in their 40s, although it may also present in younger women.”

Arousal: “We explain arousal as the body’s ability to become lubricated and to experience heightened sensitivity or tingling in the genital area. Generally when a woman gets turned on, her vagina becomes wet and amenable to further sexual contact. If lubrication is not happening, a woman would be described as having hypoarousal. If a woman is in a constant state of arousal, she would probably be diagnosed with persistent genital arousal disorder.”

Orgasm: “An orgasm is a natural release of sexual tension through a series of muscle contractions that produces a pleasurable sensation. There are two types of anorgasmia, primary and secondary. Primary means that the individual has never had an orgasm. Secondary means that they were once able to have them but the individual is unable to have them now.”

Pain: “Women with vaginal pain generally have one of two types of sexual dysfunction. Vaginismus is the inability to have vaginal penetration. Vulvodynia is generally pain on the outer part of the vagina. Women most often describe it as a burning pain, though it is sometimes experienced as itching or general discomfort.”

There is a whole section in the Diagnostic and Statistical Manual of Mental Disorders (DSM) on sexual and gender identity disorders for therapists to refer to as well, and different associations are devoted to sexuality research, information, and careers, like the American Association of Sexuality Educators, Counselors and Therapists and the Society for the Scientific Study of Sexuality. These are all possible resources for therapists in regard to sexual issues.

Gross thinks there needs to be work on guidelines in general for therapists on addressing and detecting sexual issues. “I don’t think there are good guidelines for detecting and addressing sexual issues,” she said. “Many women suffer for years without being properly diagnosed or treated. For low desire they are often told to relax, take baths, and drink wine. These suggestions are ludicrous and result in further frustration and hopelessness.”

There are treatment options available for low desire, arousal and orgasm difficulties, and painful intercourse, she added. All of these sexual issues can be caused by different factors, so she said a comprehensive assessment is needed to look at psychosocial and physiological factors.

“In regards to pain, intercourse simply should not be painful. That is the basic guideline,” Gross said. “If you are having pain during intercourse you should seek help. Women often feel it is something that will resolve itself. We generally do not find that to be true. Both vaginismus and vulvodynia are treatable. If you have difficulty inserting a tampon, getting a pelvic exam or find penetration to be difficult or painful, seek help.”

She said certain myths need to be dispelled as well, including these most common ones she has dealt with:

Myth Number One: Women can have orgasms from intercourse. “Seventy percent of women CAN NOT have orgasms from intercourse. This is a fact. There have been countless scholarly articles about it and books published that attest to this fact, and yet I see women each day who feel they should be capable of doing it. They shouldn’t, and women and their partners should spend more time on clitoral stimulation, which consistently works to provide women with orgasm. And, everyone, men and women, should let go of the notion that women have orgasms from intercourse. Some do but most do not.”

Myth Number Two: Oral contraceptive pills have no negative side effects. “For millions of women, the pill is a great form of contraception. For women who are susceptible to sexual dysfunction, the pill can wreak havoc on your body. It can destroy your libido, deprive your vaginal tissue of necessary hormones for vaginal health, which in turn can cause pain. And it can reduce sensitivity in your clitoris. I believe this information should be shared with women when the pill is prescribed, and most often it is not.”

Myth Number Three: Sex is easy. “Good sex is a process of exploration both with yourself and with a partner. Like learning to read, good sex takes time, and you have to [learn] the basics first. You have to start with knowing your body and what feels good, and then you have to explore what feels good with each partner you have. It is not like it is in the movies. It is not a seamless scene without starts and stops and embarrassing moments. However, if you take the time, learn about yourself and who you are with, it is obviously one of the best parts of life.”

What are certain guidelines or information that you think would be useful for general therapists to have or know in order to address sexual issues in clients?

Related articles:
Dealing with Sex and Relationships in Recovery
Depressed by Disappearing Libido?
Sex and Anti-depressants

After 5 years of sobriety, in 1985, I began to notice a pattern in my sexual relationships: Even if I really liked someone, I couldn’t go more than 3 months before my attraction to them fizzled. I would then find some reason to end the relationship, although I never really understood why, and it made me feel bad. Thankfully, while I was leading a weekend retreat on Spirituality in Recovery, one participant pressed for bringing the subject of sex into the process.

Although I was unprepared, it gave me the opportunity to address the issue, and I shared my struggles with the group. When I asked if anyone else identified with the issue, all hands went up. I immediately felt a sense of relief, having previously thought I was uniquely flawed. And then I felt angry that no one had told me about this before, which launched my enthusiasm to shift the primary focus of my work. I began to create healing techniques for underlying trauma and sexual challenges.

The sexual-spiritual split, a deep psychic schism within almost everyone, prohibits loving relationships from forming and enduring. The chasm between sex and love, caused by generational, cultural, religious, and early programming, planted seeds in our unconscious that makes merging with another virtually impossible without the specific healing that new perspectives and experiences can offer.

In the previous article (Part One), I describe the subtle powers of Source Energy, our innate intelligence, to direct us forward. I have chosen sexual healing as the next pathway for expanding our access to Source Energy, although there is no particular linear course. Sexual energy, primal and fundamental to our nature, fully awakens our sensorial nature that always knows our best next step in life. A shift in perspective in our relationship toward the life force in sex can expand our Source Energy.

Like most of us who grew up in the Western world, I internalized sex and all references to it as shunned experiences to keep secret. Many of us received discordant messages in our formative years: love, family, and good deeds provide a happy, acceptable life. Conversely, anything having to do with sex, or even our bodies, was cloaked in a wall of shame and secrecy. While experiences vary, our collective consciousness suffers from this split, locking us out of our own rich, informative, multidimensional sensuality.

There are five key elements to dissolving the sexual/spiritual split:

Shifting Concepts: S.E.X.

Our erotic energy pathways have suffered trauma and distortion. To heal those wounds by utilizing expansive Source Energy, we must gently put our old concepts about sex aside. Most of us never developed a healthy, conscious context for having erotic pleasure. We clumsily fall into sex, gradually shaping ideas about it from what we have observed, and from our own, perhaps awkward, experiences.

When barriers dissolve, we are more likely to have more of what could be called “sacred” or “transcendent sex” and an openness to meaning and purpose for all types of lovemaking, including with ourselves. In paying attention to old sexual identities, we can rediscover, or in some cases reinvent, a new meaning of sex. Our willingness to detach from outdated conditioned thinking is the foundation for transforming sexuality to the sacred.

To help us step out of the cultural box, my partner and I created the abbreviation, S.E.X., for Soul Energy eXchange. It suggests we can choose to enlighten our sexual experiences by focusing on energy that comes from our souls, not just our bodies, and thereby designing a new outlook on pleasure. For those who are willing, it does take a bit of work. It’s rare that I’ve met anyone with an ongoing rich and fulfilling sexual life who did not have to go back in their history to create new contexts for their erotic experiences. But the payoff is huge.

S.E.X. Primary Energies

There are four primary forces in Erotic Ritual’s Soul Energy eXchange (S.E.X.): love, pleasure, lingam, and yoni, which are Hindu Sanskrit terms for penis and vagina. Though lingam energy is typically male identified as drive, pursuance, initiation, and aggression, it’s an energy shared in both genders. Yoni energy, feminine, receptive, creative, and artistic, is also found in both sexes. Love is an energy transmitted from the heart. It can be felt through hands of a lover or from a father or mother to a child. It is gender-neutral. Love means losing ourselves in the beloved. Pleasure takes many forms, but erotic pleasure can be defined as stimulation of the pleasure centers of the brain through visual and tactile stimulation. While some have a low threshold for erotic pleasure, others may find everything erotically pleasurable.

The kind of love we are exploring is the love that moves us to listen and intuit what our lover wants, to care about the other person’s needs. It is best to have the constant energy of love as the foundation for everything in life. The energy of love can be triggered by the energy of pleasure, but it is at its greatest when love is present first.

We have all experienced limiting conditioning in the expression of our lingam and/or yoni energies. Most of us experienced some sort of trauma that blocks our love and pleasure energies as well. Unlocking trauma and toxicity of shame and melting frozen erotic energies are pathways to the sacred. Judgment- free experimentation, using all four of these soulful forces, leads us on a path to the divine, to earth energy, and to a greater connection with the universe.

Perhaps more than in other rituals, through Erotic Ritual we learn that we are all expressions of a much larger source of communal energy. It melts barriers and we feel less isolated. Notice when you are having an erotic experience there is always giving and receiving of energy. Sometimes it’s reciprocated or sometimes one is consistently giving or receiving, and either is fine. Allow yourself to be really present in any prolonged erotic exchange and you will find yourself in a circle of energy. (The yoni expression fully experiences the lingam expression, and vice versa.)

Sexual Concerns

The very private issues that people have shared with me about sex have ranged from not feeling that they are desirable, to experiencing a sexual apathy, erectile and/or orgasmic dysfunction, or feeling detached from a loving partner. Sometimes it’s an obsession with body parts that they just don’t like or think something is wrong with.

Many people carry much the same type of burden, sometimes silently. The principles of Source Energy can have a very beneficial impact in renegotiating and resolving these hardships. With the right resources, including therapy in some cases, the barriers to erotic fulfillment will dissolve, creating possibilities for a blissful engagement with one’s self and with another.

When the sex in a monogamous relationship is unsatisfying, a substantial foundation is at risk. If the condition lingers, with sex becoming almost nonexistent, then the relationship is compromised. Often couples aren’t equipped with the tools to communicate sensitive issues. Their avoidance, sometimes lasting years, continues the downward spiral. Addressing these problems with the assistance of Source Energy can enhance those very skills.

Happily, mine is a loving, growing, and sexually fulfilling relationship, lasting many years. All of our efforts have paid off. Creating sacred time and using it for shame-free sex while opening our hearts, along with taking responsibility and respecting ourselves, have all been key. Sexual loving intensifies consciousness and pure love. In that vast, nurturing ocean there is no ego, nothing to defend, only a sense of just being and connection.

Communication in these sensitive areas can at first feel like hard work. With practice, it eventually becomes quite natural. When my partner and I explored having a committed relationship those many years ago, my primary request was that our sexual relations be the first priority in our union. Even in a number of long-term relationships I’d been in there was the sex-spirit split, along with undeveloped communication skills, causing sex and sensuality to wither. They were left with a sense of deadness in a potentially thriving relationship.

Instead, having made the commitment, we began a life of focalized conscious S.E.X. Expansiveness and sexual gratification became a planned, sacrosanct part of our time together. While it might seem to defy spontaneity, let me suggest that there is a significant payoff. Respecting existing realities—being tired, stressed, too busy, or distracted—doesn’t mean spontaneity is stifled. Rather, without earnest communication of our needs and desires, or without planning, we cannot build rich, enduring erotic lives.

Sexuality, Higher Consciousness, and Fantasy

Although it could feel clumsy, it is crucial to learn to express what we need and desire, as well as what we fantasize about. I like to call it reclaiming adolescent awkwardness, to allow people to go where it might be difficult, in order to heal the sexual-spiritual split, a requirement in forming intimate relationships that are authentic.

In sexual counseling, many are curious about where their fantasies come from, often feeling shame for having them. I tell my clients good fantasies are like rainbows, mysterious and beautiful, sometimes fleeting, and they are to be respected. Their origins may vary from abuses early in life to Freudian, or they may relate to recollections of pleasure from our past. Sometimes they mysteriously come from no conscious recollection whatsoever. Focalizing Source Energy filters the shame out of our fantasies and allow us to fall more deeply in love with ourselves. Self-love is essential to grow in sacred sexuality. Having fantasies doesn’t mean we’re bad or that something is wrong with us, as we don’t have to act on them. Only shame is Godless. Removing the shame from our fantasies transforms them, and that contributes to keeping a long-term relationship sexually alive.

Natural Resistance to S.E.X.

With all our knowledge we still encounter resistance to a loving fusion of our sexual and spiritual energies. The delicate nature of exploring repressed sexual history is likely to trigger that very resistance. When we appreciate the essence of our resistance to removing shame, our fantasies can be an entryway to joyous energetic harmony, where we can experience full-body orgasm along with deeply felt spirituality. Full-body orgasm refers to a burst of the four energies in S.E.X. that can take over every dimension of our physical and subtle energy being. When this happens, we can experience expansiveness and sometimes formlessness that is sublime. It is a full-body encounter that is uniquely restorative when we feel depleted and deeply relaxing when we are tense.

If we can consent to the reality that energy and its many vibrations and frequencies make up our physical reality, we can learn new skills to heal, with an efficient pathway to our inner wisdom. When we energetically experience resolution in our bodies from sexual barriers, we land in the divine center of Source Energy. As we tap into it, the more it begins to lovingly lead our lives.

Related articles:
Part I: Source Energy Optimizes Life – Finding Source Energy
What Do Your Sexual Fantasies Mean?
Fanning the Spark of Sexual Passion

Hypnotism can be a useful and versatile tool for addressing sexual concerns, including several types of sexual problems (such as non-medically caused erectile dysfunction and low desire) and negative body image, shame, and sexual inhibitions. Hypnotism can help discover and correct inner obstacles to sexual health and pleasure. As a skill set, hypnotism is used in a complementary way by many types of helping professionals. Hypnotism also provides the foundation for a growing group of professional practitioners variously known as consulting hypnotists and hypnotherapists.

I spent a good portion of 2011 working on a doctoral project related to this topic. The literature search was extensive, fascinating, and deeply frustrating. Part of my frustration had to do with the strange history and frequently tarnished reputation of hypnotism, which has created a number of public and professional myths and misconceptions. Another complication had to do with the diversity of practitioners who use hypnosis to address sexual problems; licensed therapists (and sex therapists in particular), clinical sexologists and sex coaches, professional hypnotists and hypnotherapists, and a wide variety of erotic hypnotists (professional and amateur) have all found human sexuality to be fertile and often lucrative terrain. This meant that my literature search ranged from peer-reviewed articles in journals, to popular “how to” erotic hypnosis books, and everything in between. While I labored on my project, I found myself thinking that one lifetime would not suffice to understand it all. The history and use of hypnotism for sexual concerns is that broad, that deep.

What does stand out is the efficacy and promise of hypnosis in this area. This is supported by numerous peer-reviewed articles, as well as books by authors and practitioners such as Dr. Daniel Aroaz, who has became a tremendous guiding light to me.

Another thing that stands out is the almost universal lack of training in the specialty I’ve come to call “sexological hypnosis” – the application of hypnotism to sexual and gender concerns. My concept of sexological hypnotism is based on the triple-pronged idea that:

• (1) more therapists, counselors, and other licensed professionals should be trained in sexology (a multi-disciplinary study of human sexuality, which includes but is not limited to clinical considerations)
• (2) more therapists, counselors, other licensed professionals, and sexologists should be trained in hypnotism
• (3) more consulting hypnotists and hypnotherapists should be trained in sexology, human sexuality, and gender studies – particularly those who want to offer hypnosis for sexual problems.

However, there are no comprehensive programs which specifically address the application of hypnotism to sexual and gender concerns. The one hypnotism school I found which includes sexuality courses in its curriculum was founded by a man (now deceased) who believed that most women don’t have an orgasm – they have a “climax” – and that “ethnic sexuals” are distinctly different than non-ethnic sexuals (whatever that means!). In other words, discredited ideas and inaccurate information is likely still a part of this school’s curriculum, as the books are still published and sold without revision. (Incidentally, none of these books cite even a morsel of research or contain a bibliography or list of sources – however dated!) Hypnotists trained in this school get something worse than no sexuality education at all – they are sold an old “clunker” when they rightfully deserve a Ferrari. Clients may suffer as a result.

Up-to-date, comprehensive training in human sexuality is crucial because people whose understanding of human sexuality is limited to their own experience (or a few books or workshops or outdated programs) may have a skewed perspective on the bigger picture of adult, consensual diversity. Such practitioners may pathologize or misinterpret any behavior or expression that seems out of the ordinary to them. This is a disservice to clients who seek assistance with sexual or gender concerns. Issues of erotic or gender authenticity – so crucial to sexual health and well being – may not be acknowledged, let alone addressed, respected, and supported.

I would like to see more real training and expertise in this area. In my doctoral project, I designed a 150-hour certificate course capable of delivering the triple-pronged training that I wish already existed. In 2012, I hope to teach the entire program, in addition to the partial courses I now offer online through Creative Sexuality and Sex Coach U. As a dual practitioner, I’ve experienced the value of combining clinical sexology with hypnosis and believe that my clients are generally well-served as a result.

Related Articles:
What Do Your Sexual Fantasies Mean?
An Introduction to Clinical Sexology
An Introduction to Holistic Psychotherapy

In many ways, it would appear that breaking up is similar to falling in love. I know what you are thinking, and you are right – it’s not quite the same thing. However, in terms of the physiological effects that it has on your mind, psyche, and body, it would appear to have quite a significant effect as it can potentially turn your world upside down.

Breakups can throw our worlds into a chaos, similar to falling in love, I would suggest. Dr. Helen Fisher wrote a book called Why We Love, and in her book, she discussed the chemical changes that actually take place in the human brain and body when one ‘falls in love,’ which she surmised was similar to being on cocaine. In the early stages of, what she describes as lust and romantic love, the brain goes through a series of changes, which can be best described as exciting, but chaotic. The third stage is the attachment phase, or long-term love, which is basically biology’s way of allowing couples to raise children together; not as chaotic, and not as exciting, but with deep trust and love. In breakups, we experience a similar chaos, though perhaps not quite as exciting, and sometimes perhaps downright tumultuous. Now, most of us hope that we won’t have to get to this stage of “breaking up,” but sometimes it’s actually bound to happen and is in fact a blessing, perhaps in disguise, as it will undoubtedly force us to grow and heal. Like ripping a band-aid off, breakups do allow for new cell growth, if given the proper time and patience.

Breakups are not only a chaotic time, but are also a vulnerable time for most. The early stages of breakup periods, if not dealt with consciously, with allowance for grieving, and sadness, can lead to a slew of other problems. Many people turn to other sources for solace in the early stages of a breakup: alcohol, drugs, food, one-night stands, dating, and sex, to name a few. Some people do this, but not all. Some people turn inwards, decide to eat healthy, exercise, spend some quality time alone, and balance it with friends, work and family. Others may jump head first into some other relationship, without a break from their current life, and start over anew. The point is that jumping head first into something new, whether it be a new relationship, or even just work, or random one-night stands, though they may feel good in the moment, during this time of new vulnerability can lead to bigger and greater problems down the road.

Let’s talk about sex for just a brief moment. After a long-term relationship, some people may find that their sexual drives are at an all time high. People respond to this increase in arousal in several different ways. Finding another long-term partner to focus your affections on is one way, and finding a series of anonymous or one-night stand hook-ups might be yet another way. Either way may be fine for you; however, it is very important to take care, as jumping head first into either of these options could halt the healing process, and in many cases adds on a whole other series or problems to the fold. Sex addiction is amongst those possibilities. Addictions often develop as a result of anxieties which require soothing. Acting out sexually could, in the moment, alleviate one’s anxiety, but in the long run can turn into an escape from dealing with one’s problems in the present, which could eventually turn into an addiction.

The main thing to remember during a breakup is what to not do. Avoid jumping into something new right away, and avoid patterns that alleviate pain, temporarily. Do allow yourself to sit and feel the pain, as difficult as that may seem. Allow yourself to be alone, to sit alone. Give yourself time to think, breathe and exist in your own pain. Pain and suffering are a part of life. Avoiding the inevitable strips us of growth, as it doesn’t allow us to utilize our own coping skills, which in the end are akin to survival. Develop those survival skills now, not later. In addition, allowing our own healing to occur now can prevent a slew of maladies later on. Sometimes a breakup can seem like the end of the world, and it’s hard to hear these words, but trust me when I say time heals all wounds.

Related Articles:
Phases of Healing
3 Things You Can Do in Overcoming Sex Addiction
Why Does Mr. Wrong Feel Like Mr. Right?

In my neck of the woods the majority of therapists see mainly women (probably about 80% of their clients). Not so for me – more than half my clients are male, and when I work with a couple it is more often the men who initiate conjoint therapy. I think this is because many guys tend to become very uptight about their penis, what Paul Joannides (author of The Guide to Getting It On) calls “deadwood – the bummer in your pants”. Many of the men I work with are concerned about their system crashing when their pants are off!

I’m not comfortable diagnosing erection problems as “erectile dysfunction.” I hate labeling, and the “dys” implies failure and the overwhelming shame that goes along with it. I never click on the links that come with the numerous ads in my spam folder offering “your instant cure for impotence” (why are they sending these to ME?). Viagra can make a huge difference but masks the issues that cause the tissues to stay soft.

It’s not just men over 50 who have erection problems. They happen to men of all ages, from teens on up. Often erectile challenges crop up quite early in a sexual relationship when folks are just beginning to find their sexual rhythms together. Many guys are nervous that their performance is not up to par – they may require a few weeks or even months to find their groove. Especially when the couple moves from dating to mating in domesticity!

So gals, remember that expecting a guy to get it up straight away could be a big mistake – especially if you truly feel that he’s the man for you.

It can make for a big opportunity to look beyond sexual performance to deep bonding with each another. The danger is not the lack of an erection, but what each of you makes of it. When a woman needs her partner’s erection to validate that she’s desirable, a short term problem can quickly become long term.

Recently a 23 year old client described a typical scenario with his fiancée, with whom he has a long distance relationship. “So it’s Friday evening and we’re coming home from a romantic dinner. She says, ‘Wanna have sex when we get home?’ and I panic! I feel like all the blood is draining from my body. It’s this deep seated fear that I won’t be able to get an erection 30 minutes from now and it becomes self-fulfilling and self-defeating. How do I get control over my own body?”

He was extremely surprised when I suggested that trying to “get control” was precisely the problem. Viagra did indeed help with his attempts to stave off what he called “hydraulic failure.” But the blue pills were only part of the picture for this couple. In this kind of situation I usually sit down with both people separately as well as seeing them together. I call this my three-legged stool approach. When you eliminate one leg the stool often topples.

His fiancée had been blaming herself, “He obviously doesn’t find me attractive any more. I’ve gained some weight…” etc. Once I helped her to realize that his erection problems had nothing to do with her, it turned out that she wasn’t nearly as attached to a hard penis as he had imagined.

Viagra produced the requisite hard-ons but was no help at all when this couple couldn’t laugh together or let go of their attachment to having things go a certain way between the sheets. They needed to learn more about intimacy. Many couples require some help deepening their intimacy, and therapy can provide the tools.

Joannides again: “When it comes to making love, relationship issues trump d*** issues.”

I’m struck by the fact that people with addiction issues, when confronted with the destructive effects of their behaviors, often find it harder to stop. This is especially true, in my clinical experience, when it comes to compulsive sexual behavior, aka sex addiction. Why is that?

Therapy clients who struggle with drinking or substance abuse tend on the whole to accept – eventually, and with my ongoing support – that they do have a problem with drinking or using, and that these behaviors are an obstacle to happier living. Once “the cat is out of the bag”, they usually attempt to reduce or quit using, over time, or else quit therapy altogether.

Those struggling with compulsive sexual behaviors, however, may remain ambivalent for years, while remaining in therapy –  aware of their dependence on these behaviors and the destructive effects of same, while wrestling with whether or not they want to stop. It’s a matter of two steps forward, two steps back, over and over again, with no change in sight.

Additionally, it is often reported to me that there appear to be more people in Alcoholics Anonymous with long-term sobriety compared to those in Sex Addicts Anonymous or Sex and Love Addicts Anonymous or other 12-step programs for healthier sexuality. Those with long-term sexual sobriety – or “abstinence” – tend to be fewer in number. Again – how come?

I know there is a lot of controversy in the mental health field about whether sexual compulsivity is truly an “addiction.” It is not my intent here to address that complex question. Suffice it to say that the suffering of those who can’t stop, in the face of heartbreaking damage and loss, is staggering to behold. If one of the key criteria for an addiction is an inability to stop in spite of negative consequences, then compulsive sexual behavior more than qualifies as an addiction.

So, if one assumes we are in fact dealing with two actual addictions, we are still left with the aforementioned disparity between drug/alcohol vs. sexual sobriety. Is it because one can live without drugs or alcohol, but cannot “remove” sexuality from one’s being? We are, organically speaking, sexual creatures, and the goal of treating sexual addiction is not to remove one’s sexuality but to create healthier, more intimate and less self-destructive behaviors.

I suspect that, because we are dealing with sex after all, the issue goes even deeper. Sexual desires and fantasies often emanate from the very core and are difficult to interpret. Heterosexual men with compulsive sexual issues, for instance, may desire sex with other men while staying married to a woman; some pursue sex with transvestite prostitutes, in ways that put themselves at legal and medical risk. I know of high-functioning women who are compelled to conduct serial affairs, virtual or real, with men whose only apparent goal is to sexually “use” them in sadistic or degrading ways. These are people who have little to gain, it would seem, and everything to lose.

Another complication is that sexuality is a relational activity. It always implies another person, either real or fantasized. One can use heroin or drink alone, as many do. But it always “takes two to tango”, even if one of those people is a fantasy or “virtual” person. Even when one uses online pornography, for instance, another person is “present”, at least onscreen.

Close readings of sexual fantasies and compulsive behaviors can be revealing of one’s buried self-concepts and unexpressed needs; an S&M fantasy may represent a way of coping with an overbearing or shame-inducing caregiver, by sexualizing the pain and staying in control of the fantasy/scenario (even if one is the “M”). Those struggling with scenarios of dominance over others may be trying to compensate for intolerably low self-worth, an attempt to control chaotic emotions leftover from a traumatic upbringing.

My experience with straight men who compulsively watch porn often reveals a desire for a woman who can offer everything but demand nothing, and disappear when the encounter is over, before she decides he’s “too much” for her, or “gross,” or perverted, etc.  It’s a sort of mini-relationship, easily controlled by someone who usually has a desire for and deep fear of intimacy, who gets his needs met quickly and then signs off.

It’s almost as if these fantasies provide a window into the psyche, revealing unmet needs.   Like the need to feel in control, to express repressed desires, to sexualize (i.e. numb or self-medicate) hurtful or shameful feelings or other emotions that are unconscious or too difficult to articulate.

These are feelings and needs that cannot be expressed in their actual relationships – usually because they are perceived as “disgusting” or “too much” for their partner.  Of course, their partner very often has her own “stuff” and tends to be closed off, angry, controlling, etc.  It’s an extremely painful dynamic that I see with many of my male clients – straight and gay – who struggle with sexual compulsivity.

Why would a man, or anyone really, seek an “emotionally unavailable” partner? Because we tend to gravitate toward the familiar, even if what is familiar is dissatisfying or even abusive.

Very often the person chooses an emotionally closed off, or overly aggressive (or withdrawn) partner because, in reality, the alternative is too scary. It may sound strange, but what’s even scarier than not finding love – especially in cases of a traumatized upbringing, which includes just about everyone I work with – is actually finding it! Why is that? Because love can be lost or taken away, leaving the person abandoned and traumatized (again) – even more painful than being mistreated or ignored. In the latter case, at least you know someone is there.

Thus the person suffering from core interpersonal trauma – the result of a faulty caregiver, another human being – who ends up sexualizing their needs via the behaviors described above, hovers between a desperate yearning for and deep aversion to intimate connection. The sort of “mini-relationship” described above is often a substitute. It satisfies…for a while. One connects, finds relief via sex and affection (what’s actually virtual feels real at the moment) – then detaches before becoming too invested or emotionally “at risk” for abandonment.

That emotional risk, believe it or not, is usually more frightening than the prospect of the legal or health risks that accompany these behaviors. Abuse and emotional distance is familiar, even if painful, while the possibility of genuine love is new and terrifying.

Thus the compulsive behaviors are a temporary solution to the very real and shameful problem of a confusing inability to connect with others.  I say “shameful” because very often the feeling is something like, “I’m an idiot because I don’t know how to stop.  Why do I do such disgusting things.  What a piece of garbage I truly am.”  (Even if the person is outwardly successful, wealthy, etc.  As they say in recovery, it’s always an inside job.)

One of my clients once said in my office, with a smile on his face, “I have no love in my life.  I’d only ruin it if I did”.  This was a successful, married attorney with a compulsion to see prostitutes.

It took me a few moments to realize the smile was an awkward attempt to conceal shame, not any sort of bemusement. That smile was one of the saddest things I’ve ever seen.

What I want to stress here is the pain that needs soothing is, in part, not the result of an unrequited hunger for love, nor a fear of finding it, but rather an impossible non-reconciliation between the two.

Here are two opposing, powerful forces at work, with radically different agendas – one to connect, the other to protect.  Without help, this internal conflict results in unmanageable emotional turmoil and frustration. The cycle never ends, until the person says “enough,” and seeks help.

I’ll talk next time about how therapy can, when effective, provide a slow but steady path towards healthier intimacy and a chance to escape the suffocating shame and loneliness that so many of my clients describe as a slow-moving poison — leading them to behaviors they so desperately want to stop, but can’t.

Related Articles:
Super-sizing Sex
The Good and Bad Sides of Porn
Three Ways to Avoid Sex Addiction Relapse

Perhaps youʼve come across one of the many articles or videos with titles like, “In Love with the Eiffel Tower”, or a recent National Geographic Taboo program called “Forbidden Love?” The topic is Objectum Sexuality (OS), a rare sexual orientation which includes affectionate, romantic, and sometimes erotic attraction and relationships with objects. The beloved objects can range from transport to landmarks, from sporting equipment to fisheye buttons.

Such stories may make us shake our heads and mutter, “How can this be?” Are these people delusional, or worse – dangerous? How seriously should we take these stories, and the people who are featured in them?

In April 2009, my interest in autism and Aspergerʼs Syndrome (AS) sexuality led me to contact OS-Internationale, an organization of people who have relationships with objects. I had read on their website that a number of the organizationʼs members reported diagnoses of AS, or showed significant autism traits (while other members simply identified as animists). After some correspondence with Erika Eiffel, one of the most influential and well-known OS activists, I volunteered to do a sexological survey of the membership, so that they could have data to offer other interested professionals, as well as journalists.

I didnʼt know it at the time, but the accumulated information kindly provided by the 21 English-speaking members of OS-Internationale granted me a perspective unique among sexologists and mental health professionals. I suddenly became “the” expert in Objectum Sexuality – though obviously OS people are themselves the true experts on what it is like to live and love in this manner.

The most startling finding, from my perspective, is how natural object relationships feel to those who have this orientation. Most of the people I surveyed rejected the idea of human-to-human romance, and many have never had a desire to experience it. Only two people reported having a sexual human relationship in addition to object loves.

Other findings: A history of sexual trauma does not seem to cause OS – only a couple of respondents reported abuse. And aside from Aspergerʼs Syndrome and autism diagnoses, one case of Tourettes, and two cases of PTSD – object lovers are a fairly balanced bunch. Though some respondents mentioned feeling anxiety and depression due to social ostracism, all but one person said they were happy with their orientation toward object relationships.

And itʼs not because object relationships are simple, either. These relationships include jealousy, breakups, and the heartbreak of unrequited love (especially when the object is an inaccessible public landmark or large piece of public transportation) as well as blissful love. Some people who love objects are monogamous, and others are not.

And when two or more people love the same public object, this too requires a complex negotiation within the human community. You can read more about this research in “Love Among the Objectum Sexuals” in the Electronic Journal of Human Sexuality (vol. 13).

At first I saw autism as containing the most likely explanation for Objectum Sexuality – but this didnʼt account for the people who were adamant that they were not autistic! I knew there had to be some other explanation, or collection of explanations, to account for the feelings of “this is whatʼs natural for me!” held by so many OS people.

Then I happened across an article about object personification synesthesia and realized that if a person senses a pleasing personality in, say, a teapot – it is logical that a person may develop warm feelings for that object, and warm feelings may grow even warmer over time. Humans, being what they are, are capable of eroticizing nearly anything.

Interestingly, synesthesia is also known to be more prevalent among people with autism.

Voila! Object personification synesthesia emerged for me as an area of exploration! About a year later I followed up the first OS survey with a second, shorter one. Many respondents did report various synesthesia-like experiences, including sensing personalities in objects. I am convinced that this area merits more research. My modest (self-funded) efforts can only offer an intriguing glimpse into this mystery of love and brain function. A clever group of well-funded researchers could do so much more.

In the meantime, people who identify as OS have the same needs as the rest of us, and share much in common with other sexual and gender minorities. They need acceptance and understanding from informed helping professionals. They need help dealing with social discrimination, grieving, and all the usual developmental challenges we face in life. OS people ask for the same right to live and love as human-loving humans do, and for access to help as they need it.

OS people, and their lovers, may seem improbable to many of us. But it is my belief that they are not part of a circus side-show, far down the midway, but that they too are in the big tent of trying to make sense of it all. Their erotic and emotional preferences may be rare, but they are real.

As a sexologist, I see the need for professional training in understanding OS, and will begin to offer online classes on this topic next week. While you may never have an OS client yourself, I guarantee that making the effort to understand this group will pay off in expanding your concepts of love and  intimacy.

So, is it love? Or is it object personification synesthesia? My answer is: it’s most likely both.

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In couples and sex therapy, one of the common themes that come up is that of acceptance. I strongly encourage people to accept their partner, and accept each other. I believe that acceptance is at the core of a successful intimate relationship. I discourage long lists of expectations and/or changes that people often bring into their relationships, which may be ideals of who their partner should or should not be, perhaps based on how a previous partner may have been or how the perfect partner should be. These ‘ideals’ or ‘shoulds’ can be quite detrimental not just to the relationship as a whole, but affect other areas of the relationship along the way, such as a couple’s sex life. Ideals and ‘shoulds’ can sound like judgments and criticisms, and there is just no room for hostility in the bedroom (well, in most cases). So limiting our lists to two very specific items is something I recommend; simply accept the rest. Acceptance conveys the message that we love our partner just the way he/she is, and that quite possibly we even admire them, look up to them, and still love and/or are in love with the same person when we met, and who we fell in love with. If we find we cannot accept our partner much of the time, and that we get angry too much, then taking a look at ourselves is the next step.

But there is another side of acceptance I want to talk about. There is a detrimental aspect of acceptance, and that is when it allows for things like abuse, manipulation, and control to take over the relationship. Being too accepting of all things, especially when they risk harming someone, is where learning to draw the line becomes important. Having boundaries is key, and knowing what one’s boundaries are is a good place to start. Some examples of behaviors that should be at least questioned and looked at include drug and alcohol use and abuse, violence of any kind (this includes physical abuse), sexual abuse towards anyone, including spouse, pets, and children in particular. Yes, there are some things we should not blindly accept. Accepting these often become like shoving things under the rug — a giant pink elephant in the room that everyone knows is there, but no one acknowledges or talks about. This is also sometimes known as denial (a concept that Sigmund Freud suggested was one of our coping mechanisms). Denying that there is a problem may often lead to trying to cover up the problem or fix the problem by accepting our partners behavior. I call this covering-up behavior enabling.

Enabling is simply trying to smooth things over, to keep things in peace and harmony, to keep the relationship together and intact, and while enablers definitely have their personal roots and reasons, enabling may have severe and detrimental costs. In the case of violence, physical abuse, and drug or alcohol abuse, the worst case scenario is death, but along the way there are many other costs. The enabling individual (or, enabler) may have to work harder and harder to make up for the addict or abuser’s behaviors to keep the relationship and family running smoothly. There may be financial hardships. There may be accidents or legal battles, and there may be a lot of physical or emotional suffering. Establishing boundaries for what is acceptable and unacceptable behavior is absolutely key. No, we cannot accept everything, for we risk becoming an enabler. The person who accepts too much must also take a look at him/herself.

Below is a link to some questions from TellingItLikeItIs.Net for you to ask yourself, to help you determine if you might be enabling some sort of otherwise unacceptable behavior. If you answer yes, I strongly suggest making some changes, determining and developing your boundaries and seeking out the help of a mental health professional.

Identifying Early Warning Signs of Enabling Behavior

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Lesbian, gay and bisexual (LGB) clients may form better alliances with therapists who have similar sexual orientations, according to a new study. This new study done by researchers at the Graduate School of Education at Fordham University examined gay and bisexual men in therapy who had therapists of the same sexual orientation. Trends found in the research may be applicable to the LGB community at large. Thomas I. Stracuzzi, lead author of the study, said that when LGB clients share the same sexual orientation with their therapists, they may achieve better treatment outcomes because the alliance developed between the client and therapist begins with identification and trust. Stracuzzi said, “From this perspective, LGB counselors may be more likely than their heterosexual colleagues to have the knowledge and attitudes associated with successful clinical work with LGB clients and the possibility that LGB clients may fare best with counselors who are LGB or are perceived to be LGB.” Additionally, some experts believe that cultural diversity, including universal-diverse orientation (UDO), self-reported or perceived, provides a common platform from which a LGB client and their therapist can develop a strong alliance. “For some LGB clients, it can be especially meaningful to work with a counselor who also is LGB,” said Stracuzzi. He added, “However, counselor disclosure may inhibit client exploration of issues related to sexual identity due to clients’ assumptions about how their counselor’s sexual orientation might influence the counselor’s understanding of and reactions to the client. For example, a gay male client may mistakenly assume that his gay male counselor understands aspects of his experience due to their shared sexual identity.”

Stracuzzi and his colleagues interviewed 83 male LGB clients. Of the therapists who worked with the men, some told their clients their sexual orientation, while others did not. The researchers discovered that the clients whose therapists revealed their orientation experienced a smooth, strong, working alliance. But the clients who assumed the sexual orientation of their therapists did not form strong alliances. The team added, “However, findings do suggest that LGB-affirming counselors should be aware that clients do not always accurately perceive their counselor’s orientation and that perceived similarity—whether accurate or not—may negatively affect the therapeutic process.”

Reference:
Stracuzzi, Thomas I., Jonathan J. Mohr, and Jairo N. Fuertes. “Gay and Bisexual Male Clients’ Perceptions of Counseling: The Role of Perceived Sexual Orientation Similarity and Counselor Universal-diverse Orientation.” Journal of Counseling Psychology 58.3 (2011): 299-309. Print.