Teaching Couples to Empathize

Posted by admin on May 09, 2012
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Empathy forms the cornerstone for a successful therapeutic relationship.  While we may find empathy difficult to establish or even define, it is vital for building trust and engendering communication.

When working with couples, empathy is complicated because the therapist must, in addition to conveying empathy to each individual, teach each member in the couple to empathize with each other.  Within this triad, the danger of rupture is real, and the work, perilous.

In couples’ therapy I begin by framing the issues as they’ve been presented.  I make it clear that such problems will be considered on a 50/50 basis.  That this is imperative is obvious – I’m not going to take sides or make one person the sole cause of a problem.  When a member of the couple feels that responsibility for a particular action (or non-action) resides with the other, I remain rigorous in holding to the premise that responsibility is shared equally.  I never treat an issue as though it were one person’s fault even when pressured by a member of the couple to do so.  I have found that this egalitarian approach is eventually accepted by the couple and contributes greatly to the balance of the work.

Virtually all problems with couples result from misunderstanding and a lack of communication.  Once I’ve taught the couple to behave in an empathic way, issues long cemented shut through repetition are revealed such that the couple can view the problem from a different perspective.

Sex and money are the most problematic and intractable issues in most relationships because those issues are really about much more than just sex and money.  Couples generally have assumptions that issues like sex and money will be complimentary and problems suggest dysfunction in the relationship.  But in fact conflicts in relationships are natural when two people merge their lives, each of the couple bringing into the relationship the entirety of his or her histories.

I often work with couples who have a substantial sexual problem, mostly when sex has ceased to be an expression of intimacy.  This is probably the most difficult area to facilitate change and growth.  

I worked once with a couple who had a total breakdown of physical intimacy, each blaming the other for   the dysfunction.  The man in the relationship had closed down and was not capable of physically or emotionally initiating or following through with physical intimacy.  His early sexual trauma was reactivated when he shared it with his girlfriend.  The woman blamed her boyfriend for not being attracted to her anymore (their early sexual relationship was very good) and angrily accused him of distorting his history.  This created a serious rupture of trust that caused the man to shut down.  I helped each of the couple talk about their pain – she of being rejected, he of not being trusted and cared for.  This reframing helped them feel empathy for the other.  The couple did not stay together but they were able to part with understanding and compassion.

Such understanding, compassion, and honesty are necessary for establishing empathy and replace defensiveness with loving communication.  The role of the therapist is to model empathic behavior and help each in the couple accept and appreciate their differences as well as similarities, furthering an emotional maturity in which a healthy relationship thrives.

Sensuality, Sex, & Relationships

Posted by admin on March 18, 2012
COUPLES, SEX / No Comments

Couples are often at a loss when inevitably infatuation runs its course and the topography of sexual desire shifts.  As a relationship matures, the initial lust abates and familiarity and predictability become the norm.  Couples who seek counseling to reaffirm their sexual relationship often expect their sex lives to be as they were at the beginning.  While that early phase cannot be revived, sex can function in a mature relationship to deepen a couple’s connection in profound and exciting ways.  Embracing this shift often requires considerable work and experimentation.

Many factors contribute to loss of lust in a relationship.  As couples become more familiar, they take each other for granted.  Mystery and fantasy give way to compromise and predictability.  Sex becomes routine and just another chore along with work, children, and bills.  As sex becomes something to check off a list, it loses priority, becomes less frequent and can slip completely out of a relationship.  I have worked with many couples who enter treatment because perfunctory or nonexistent sex is causing a major rupture in their relationship.

Many couples seek treatment in an effort to have the early magic reaffirmed; if it is not, they fear their relationship is dysfunctional and may even break-up.  In such cases I first get the couple to bring sensuality into their relationship without any pressure to perform.  Most couples think of intercourse as necessary for sexual intimacy, but through experimentation without the expectation of intercourse and orgasm, couples can learn to experiment with each other in new sensual ways.  I help couples establish sensuality in their relationship that isn’t necessarily tied to sex.  This helps couples develop a renewed awareness of each other’s bodies, redeveloping what had been lost by neglect.

Often, without the pressure to perform, touch becomes more sensitive.  The boundaries between sensuality and sex become blurred and couples learn to put less importance on the hard line distinctions between the sex act and what feels erotic.  I suggest that couples be playful when exploring sensuality to help move the focus away from the pressure to perform.  I then suggest a gradual physical exploration, slowly moving the couple towards a more genital experimentation.  This process helps the couple find, develop, and renew their physical intimacy without pressure and expectation.

With work and commitment couples can develop a new, exciting, open and fluid sex life that is an expression of their emotional intimacy.  This new mature physical intimacy is deeper because it is an expression of the bond between the partners rather than an expression of lust toward the unknown.

 

When Lust Changes

Posted by admin on February 01, 2012
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We often suffer from a misunderstanding of how our romantic relationships mature. Many of us fail to realize that, in a relationship, our feelings of lust naturally change and usually decrease.  This runs as a counter current to a society obsessed with sexual images and infatuation.   Madison Avenue and Hollywood, with their stories of romantic bliss, contribute to this misuderstanding by manipulating how couples view sex within relationships.

Sexual desire plays a major role in a budding relationship.  Infatuation is in full bloom and is driven by fantasy, need, and mystery.  For months or years lust remains strong.  It draws two people together such that they continue to learn about one another.  Often, however, reality butts up against fantasy and replaces feelings of excitement with those of disappointment.

When a relationship goes through a phase of diminished lust, many assume that something is wrong when, in fact, the relationship has entered a new more mature stage.  This maturity can deepen both love and sexual excitement but it will look very different than infatuation.  If both partners expect their lust to be as it was in the beginning, they may grow apart instead of deepening their physical and emotional bond.

I have worked with many couples whose bond has ruptured because of sexual dysfunction.  Because change in lust is interpreted as dysfunction, couple want to either get that lust back, look outside the relationship for satisfaction, or terminate the relationship.  If enough time passes without sex, thoughts of reviving it again seem insurmountable.  As a non-sexual relationship becomes the norm, sexual thoughts about the other partner can often feel incestuous.  By working on sensitization, empathy, experimentation, and risk, sex can often be rekindled, and what was once infatuation will be replaced by a deeper and more profound physical bond.

Our society, through media and advertising, teaches us to expect physical intimacy to be universally magical, spontaneous, and exciting.  Instead, intimacy is as complicated as life.  The couple needs to work on their sexual intimacy and establish a different but deeper physical satisfaction.

 

Men, Sex, and Society

Posted by admin on January 23, 2012
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Generally, men and women relate to sex differently. Men tend to think of sex in external ways, women in internal ways.  This difference leads men and women to approach sex in a manner that can lead to misunderstanding and conflict.

Because men tend to think of sex in physical terms, initial attraction is based on physical appearance. Men’s lust is aroused visually; emotional intimacy and connection are not the primary motivations.  In fact, because visual arousal is so immediate and two-dimensional for men, most pornography is made for and by men.  An addition consequence is that men are far more likely to become addicted to porn and sex than are women.

As discussed in my last post “Gay Men, Sexual Addiction, & Society”, the lack of socialization for gay children and adolescents contributes greatly to how gay men learn to relate to each other.  In addition to society’s role in the development of gay male sexuality, gay men, like heterosexual men, are first motivated by sexual arousal in their search for romantic partners.  Because both partners are men, sex plays a different role in homosexual mating than it does for heterosexuals.

There are many theories about what contributes to the male’s sexual habits.  As we’ve seen before, socialization is one factor that plays a significant role in sexual development.  It is more difficult to assess how much gender informs male sexuality.  Clearly, when coupling involves two men, sexual expression is going to be different than between men and women.

Society has judged harshly the sexual habits of gay men and has relied on prejudice and stereotyping to make unfair comparisons to the mating habits of heterosexuals.  Comparing heterosexual and homosexual sex disregards the impact of gender and ignores the fact that two gay men are both males.  Many heterosexual men claim that their sexual behavior would be similar to that of  gay men if women themselves responded sexually like they did.  But women’s sexuality is different such that this isn’t an option.  Here we can see the impact that gender plays on how men experience and act on arousal.  While gay sex is greatly influenced by societal factors, the simple fact that both partners are male also contributes to the way gay men function sexually.

Because the mating of gay men involves partners that are both male, they’re going to approach sex differently than mating between men and women.  Understanding the role gender plays in sexuality will enable society to empathize rather than criticize gay male sexual habits.

 

 

Gay Men, Sexual Addiction, & Society

Posted by admin on January 16, 2012
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It is commonly held that gay men have greater problems with sexual addiction than their heterosexual counterparts.  This may be because of a broad misunderstanding of the origins and nature of gay men’s sex lives.

The societal influences on gay men’s sexual expression cannot be overstated. Because of society’s deep-rooted prejudice against homosexuality and the overwhelming predominance of the heterosexual culture, adolescents are expected to conform to the heterosexual norm.  Positive gay images and role models – in advertising, media, education, and social outlets – are near non-existent.  In forty years, homosexuality has come from a subject only mentioned in hushed tones to a publicly debated issue with gay rights at the forefront.  Yet, the typical young person sees no positive reinforcement for being gay.  (Although some of what I am describing may also pertain to lesbian, bisexual, and transgender people, in this post I will restrict my observations to gay men.)

While adolescence presents obvious challenges – hormones are exploding and sexuality is blossoming – there is pervasive support and guidance for heterosexual young people.  Madison Avenue is awash in images of boy meets girl.  Schools institutionalize social opportunities for children and adolescents to meet each other and interact.  There are proms and dances and discussions of mating and dating.  Questions are asked with the opposite sex in mind that always assume heterosexuality:

“Do you have a boyfriend / girlfriend?”

“I have a nice girl / boy for you to meet.”

“What do you think of him / her?” 

“Do you want to get married someday?”

When parents try to discuss sexuality with their children – an already fraught subject – homosexuality is rarely mentioned.  Elaborate sets of boundaries, rules, and curfews govern the adolescent without regard to the possibility that the adolescent may be gay.  How does this heterosexual-centric culture affect the child who is gay or questioning his sexuality?

Given peer pressure, parental discomfort, a puritan social culture and a lack of modeling at home, at school and in the society at large, the gay boy learns to keep his blossoming sexuality hidden at all costs.  There are no outlets for gay adolescents to explore relationships and learn about intimacy through dating, social events, and talking among friends.  Because there exist no avenues to normalize gay sexual development, gay adolescents learn to experience lust and sex as the sole outlets for their sexual expression.

This absence of social outlets for gay boys restricts the possibility of connecting to the object of their romantic desire except through sex.  The whole process of socialization and integration of sexuality becomes truncated such that sex becomes the only initial way for many gay adolescents to explore their sexuality.  Initial encounters are based on sex first since there are so few avenues to connect in other ways.  If the adolescent is lucky, he may go on to develop a romantic relationship, but only after the initial sexual encounter.  As the adolescent becomes a young adult, this behavior becomes a template used to meet prospective partners.  Sex first becomes the norm for developing romantic relationships.

Failure to understand society’s role in gay adolescent development leads to the common interpretation of gay men’s sexuality as sexual addiction.  This misconception leads to the erroneous assumption that gay men suffer from sexual dysfunction because of their sexual orientation.  This misjudgment absolves society of the responsibility of guiding gay adolescents during the maturation of their sexuality.

We can only hope that in the future society will recognize its responsibility for guiding young people through their sexual development regardless of where they fall on the sexual spectrum.

 

 

Interviewed on Porn Addiction – 12/22/2011

Posted by admin on January 05, 2012
SEXUAL ADDICTION / No Comments

 

Porn Addiction Television Interview on “Sex @ 11 with Rebecca”

 

 

Pornography Addiction

Posted by admin on December 20, 2011
SEXUAL ADDICTION / 2 Comments

In addition to our society becoming more sexualized, the internet has greatly contributed to the availability of pornography.  Both these factors have led to a dramatic increase in pornography addiction.  Online pornography is so pervasive that porn sites often appear on computers unsolicited.

In itself, looking at pornography only becomes dysfunctional and addictive when one is compelled to seek it out and then, once the search has begun, is unable to stop.  Long unsatisfying hours may go by unnoticed as frustration builds and more time is lost.  The object of porn addiction is not necessarily sex itself but rather images of sexual perfection, a perfection that becomes increasingly unattainable as the search progresses.  Even with orgasm, the obsessive hunt may continue with satisfaction elusive.

The negative consequences of pornography addiction are insidious and harm one’s capacity for intimacy – particularly when the addiction is played out while the addict is in an intimate relationship.  Since pornography deals in fantasy, sexual relationships with real people become dissatisfying.  Compulsive pornography viewing desensitizes one’s lust and desire for the sexual partners in one’s life and, hence, leads to the need for more pornography to satisfy sexual desire.

Pornography addiction, much like sex addiction, ruptures one’s intimate relationships.  In addition to negatively affecting the sexual desire for one’s partner, the addiction alienates the partner and causes painful feelings of rejection, insecurity, and jealousy.  Relationships break down and recriminations abound.

It is vital when dealing with porn addiction to understand that the addiction is not about the partner or about sex.  Rather it is a way for the addict to self-medicate unwanted feelings of intolerable pain.  While porn addiction is often considered a weakness, the addictive behavior is an uncontrollable disease.  A pornography addict needs to avoid even a casual look as this can initiate the addictive behavior.

It is also of primary importance not to demonize pornography or the compulsion to look at it, but rather to recognize that the addiction is beyond the person’s control.  Outside support – from the partner, recovery groups, and counseling – is the key to dealing with addictive behavior.  Given the difficulty for the partner to understand and not personalize pornography addiction, patience and understanding, for both the addict and the partner, are necessary to support the hard work that recovery will entail.  Since addiction results in deception, secrecy and shame, an enormous amount of support is vital to help the person deal honestly with his or her compulsive behavior.

 

 

 

 

 

Interviewed on Sexual Addiction – 12/8/2011

Posted by admin on December 15, 2011
SEXUAL ADDICTION / No Comments

 

Sex Addiction Television Interview on “Sex @ 11 with Rebecca”

 

 

Treating Sexual Addiction

Posted by admin on December 10, 2011
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Sexual addiction is not defined by how frequently a person has sex or what kind of sex one prefers, but rather is when one has a compulsive/obsessive relationship to sex that leads to habitually acting out repeated behavior.

Sex addiction is particularly hard to treat because, unlike addictions which are typically treated in a way that encourages abstinence, not all sex is unhealthy or is to be discouraged.  Unless one is asexual and has no interest in sex, completely abstaining from sex is not possible.  Therefore, with sexual addiction, the goal of treatment is not to refrain from sex but to treat the compulsive behavior that feeds the addiction.

How does one know if a person who wants to have frequent sex simply has a high sex drive or if there is a problem with addiction?  Because our society uses a moralistic barometer to define behavior, it’s essential to separate behavior that may be negatively judged by moral standards from that which is genuinely unhealthy and destructive.

Because there is a tendency to judge and blame those with addiction problems, I am careful not to think of addiction based only on the behavior itself.  When I suspect addictive behavior, I start by asking simple questions that allow me to distinguish addiction from non-destructive behavior.

Does the behavior negatively affect one’s functioning, e.g. one’s job/career, health,
family, etc?

Does the behavior negatively affect one’s relationships, involving deception, guilt, secrecy and shame?

Can a person stop the behavior if he/she wants to?

What would the person feel if the behavior was taken away?

These questions establish whether the behavior is an addiction and, if so, to what degree the behavior is self-destructive.

Harder to treat than other addictions, sexual addiction has become more pervasive because of both the availability of internet sites devoted to the seeking of sex and pornography and the increased sexualization of our culture.  While in the past, it was harder to satisfy sexual addiction, today one can feed compulsive behavior without ever leaving home with the click of a mouse on the computer.  Sexual addiction has increased dramatically in segments of the population where it had previously been rare, e.g. women, adolescents and senior citizens. This has created a significant problem and made it difficult for many people to establish healthy intimate sexual relationships.

The Therapist Stance as Self-Disclosure

Posted by admin on December 04, 2011
SELF-DISCLOSURE / 2 Comments

As an analyst, I wrestle with myself about what stance will be most effective and helpful for my patients.  Being psychoanalytically trained, I was taught that the “blank screen” was a most effective approach.  After exploring and working in this way, I have abandoned the concept of the blank screen as ineffective and unrealistic.

While the theory behind the “blank screen” has merit and can be useful at times, psychotherapy is a two person psychology.  The “blank screen,” while theoretically tempting, is, in fact, illusory.  Inevitably, therapists and the people they treat affect each other in a multitude of ways, both verbal and non-verbal, that cannot be controlled by self-imposing an artificial neutrality.  As much as we may try to remain “blank,” patients pick up things about us, by transference, projection, deduction and/or exposure.

In the psychotherapeutic setting, we are often confronted with dilemmas about the most effective way to respond and meet the needs of our patients.  We continually make decisions about how best to offer empathy to our patients, including when to keep silent.  When listening to patients, how much do we self-disclose what we are thinking and feeling?  When do we keep thoughts and feelings hidden?

While to some analysts unorthodox, I offer my patients those aspects of myself that contribute to a holding environment.  For example, when a fearful and anxious patient chastises him/herself for not being “normal,” I may point out that such feelings or thoughts are common.  On rare occasions when I think that a personal example may ease a patient’s self-judgment, I’ll offer a personal detail that helps my patient feel less isolated.  One patient talked about how together and organized I am and how she suffers so in comparison.  I told her that this self-organization took a lot of time, work, and learning.  She was both grateful and hopeful.  My self-disclosure left her with the feeling that she too could accomplish positive change.

While such self-disclosure is uncommon, I have used it to offer hope to a despairing patient.  There are times as analysts when we can use ourselves as examples and hence ground patients and quiet their self-recriminations.  I once had a patient in his mid 30′s who talked at length about his lack of career achievement and focus.  He felt it was too late to have a satisfying career and furthermore he didn’t even know what he wanted to do.  He used his own expectations and the expectations of society to reinforce his feelings of worthlessness.  I told him that I had changed careers mid-life and went on to establish myself in another profession by going back to school for 12 years, an experience which at first was daunting but to which I had adjusted and succeeded.  My self-disclosure gave him hope and helped him work through the blocks he created by his self-recrimination and found motivation to explore what he might want to accomplish.

Non-verbal self-disclosure of our feelings can help convey empathy and caring.  If I am moved to cry by what I am hearing from my patient, do I hold back and hide my tears or gently let them be known?  Often when I tear up or cry, patients feel that I am empathizing with them and feel psychically held.  I am careful to let them know that it’s okay for me to cry when I am sad and I make sure they know I do not need to be taken care of.  Both my tears and my reassurance that I can still take care of them relieves patients and allows them to go deep into their sadness.

It is of the utmost importance that patients experience me as a human being with thoughts and feelings.  At times, self-disclosure can help create a warm and empathic relationship and provides a safe environment vital to the work.  It’s vital to let patients work though negative transference and rupture.  But to allow that to happen, careful self-disclosure can facilitate the safe holding environment necessary for the patient to freely express all that he/she is thinking and feeling.

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