This New York Magazine (published 1/31/17) is an important contribution to the conversation about how to treat sexual compulsions, especially about the fact that shaming people is counterproductive. While that may seem obvious, a lot of providers haven't caught up to the research:
Marty Klein's article on how facts should shape public policy especially about sexuality is worth reading. I spend a lot of time in my practice undoing the damage done by ignorancee about human sexuality:
The sounds of the fife and drum pulled me away from what I was doing like the insistent memory it was - one that keeps saying "don't forget where you came from". So, like I first did years ago, I left to follow the sounds of my ancestors.
Long ago, a kindly neighbor, (perhaps sensing my dilemma) took me to see my first St. Patricks Day Parade. I was a quirky 5 year old who sensed, but couldn't know the closet my parents were trapped in. All I knew was that something was off at home, that I adored art, music and dance, and that no one around me looked or acted like me. So I was beside myself to see people whose skin and hair looked like mine. I nearly jumped out of my skin at the sight red haired men wearing skirts and making music.
Days ago, just like years ago, a marshall at a bandstand said to the crowd: "We need to know our history so it can be told correctly." Years ago when I wanted to know where I came from, I would learn that "in this house we don't discuss those things". The day my mother slapped me for asking where the red hair came from was the day my I resolved to keep asking questions, despite the consequences. Why don't I look like anyone else in the family? What's wrong with dying the slipcovers purple? Why shouldn't men wear skirts?
I would go on to make friends with people who like me, who were not easily categorized: artists, odd balls, queers, trans and other mixed-race kids. It would take years to discover the family secrets, years to put what l discovered to good use.
An accident took me from a career in the arts one in psychotherapy, a career I was reluctant to enter, not for lack of a desire to help, but from a deep discomfort with the privilege it conferred. I cringed at the mainstream cliches of psychotherapy, unable to accept that being gay or kinky were diagnosable conditions requiring treatment. Once I entered the field, without ever asking for it to happen, kinky, quirky, queer, trans bi and other not easily categorized clients found me. Some of my colleagues judged me harshly for my support of sexual minorities.
I found solace and legitimacy in research. Deeply uncomfortable with popular image of the psychotherapist as a distant, judgmental expert and still obsessed with finding my ancestors, I found them in Family Therapy, a discipline separate and distinct from mainstream psychotherapy, its roots in biology and systems theory. Within the lineage of Family Therapy I found Solution Focused Brief Therapy, a way of working that matched who I am and how I think, characterized by curiosity, respect for clients and an unshakeable faith in their ability to discern what works for them. I was relieved to learn that Solution Focused therapists asked useful questions like:
- What really helps clients?
- What do they want?
- What does it look like?
- What differences would it make in their lives if it happened?
Using these question meant I didn't need to be an expert in anything but asking questions. Work got easier. My own history started to make sense, and can be told correctly.
I absolutely love a parade.
It has been a week. I've been watching the the reports from France and remembering.
Out to dinner, one of my companions, surveying the menu asks "what is gateau?” Cake, I say without hesitation. Some one else asks are you French? Partly, I say, also without hesitation. I explain that I grew up listening to it, and try to stop there. It’s complicated and I don’t always want to explain how I developed an ear for language listening to my partly white, partly black, french-speaking English teacher father, who sometimes spoke proper French, sometimes a partly-French partly-German version spoken in Alsace-Lorraine.
I remember one day teaching, during a first day of class introduction exercise a young woman introduced herself saying she was nervous to be speaking in class, because she is French. Another young woman jumped up to admonish her “What kind of French girl are you, saying you are nervous? You have to be strong and show people what we are all about!" They became fast friends and represented their culture well all semester.
Watching the people of France surge back to cafes and restaurants as an act of defiance, I remember some of my father's defiance. I remember how he refused to compromise his integrity to get ahead. I remember his admonitions: always do your best, don't settle for mediocrity, but also manage to...enjoy the moment. I remember going with my father to small, good restaurants for fresh crab, or clams, to a good play or an exhibit that wasn't well known. I remember how a raised eyebrow from him conveyed that certain popular books, music or films I was eagerly consuming were somehow not all they could be. I learned not to make a statement I couldn't back up, not to accept a theory that couldn't be explained in plain language, not take things at face value. I learned to be skeptical and discerning, without losing any of my enthusiasm.
I learned growing up in a household with one biracial parent and one bisexual one that few things are as they seem, and that people who are not easily categorized must be careful who they reveal their identities to. I remember the first time client called me in tears to ask if I could work with her without judging her sexual practices. I remember wondering what was wrong with my (then new) profession that she had to ask such a question.
Today as I eagerly consume research to understand what really helps clients, I must remain skeptical that some theory is all it claims to be. There is too much at stake. I can't forget how my parents, friends and clients have suffered defying easy categorization. There are many ways to be defiant. Mine is to not accept things at face value, to always do my best and to...enjoy the moment. I am partly French after all.
It’s championship season, and I have been thinking and reading about athletic performance. I have long been fascinated by the concept of the champion. I just finished the book The Art of Mental Training by DC Gonzalez and want to share some of what’s in it.
Champion athletes know that after enough physical skill training, their best performances come from having the correct mental attitude, which includes working with disappointment and failure. A champion performer in any field is one who has learned to control their mental attitude, knows what they are feeling (good and bad) but does not give in to negativity.
Any event you engage in will have it’s own event-energy that will mix with what is already going on in your head. The more consistently you exercise effective self-belief, positive internal self-talk, focus, and create a proper mental climate, the better you will be equipped to handle whatever event energy comes at you. An ideal mental climate means understanding how your mental state effects your performance, and being able to shift into mental states that help you perform effectively.
Effective mental states help you achieve control by creating an expectation you will succeed. This means understanding and taking the necessary steps to succeed, focusing on the things that need to be done more than the end result. Doing this creates optimism and positive mental energy, energizes you to take action. This is not wishful thinking, it turning information into action, to create a mental edge.
In order to work with unwanted emotions like nervousness, anger, or fear, anyone wishing to become a champion needs a mixture of knowledge, tools and techniques they can draw on instantly.
When things seem stressful:
Remain task-focused, interrupt any negative self talk and images as soon as they arrive. Shut them down at once, replacing them with positive self talk, showing your brain exactly how you will achieve what you want. This should include recovering from any setbacks. This earned self belief is real, as it comes from you concentrating on developing your own competence.
When you experience a disappointment:
Don’t brush it aside. Allow yourself to feel the emotions run through your body in real time, so they won’t keep coming back at you later. Your emotions will surface and subside like waves, so let them run their course, then let them go. Learn something from what happened. As you get more proficient at surfing your emotions like this, you will develop the facility to recognize what you need to do to work with disappointments and losses.
When you experience anger:
Recognize you don’t need to act on it, and often you shouldn’t. Use the energy it give you to focus on positive actions.
What distinguishes average players (in any realm) from champions is that champions have trained themselves to do execute these skills as a reflex. To create a mental edge, you must also consistently practice mental skills and pre-event routines to tap your full potential so the are available when you need them.
World soccer champion Pele had a pre-game routine that helped him redefine the sport of soccer.
Pele’s pre game routine:
- Arrive an hour early and relax in a quiet place where you will not be disturbed. Close and cover your eyes.
- Find an internal place you can go to rehearse, visualize, and prepare to perform by playing and watching your own mental highlight tapes of past (and future) successes.
- Watch a film in your mind’s eye of your past successes and happy times, vividly recalling the sensations, emotions and most important, the love of your endeavor.
- Allow yourself to experience a flood of positive emotions, enthusiasm, and engagement.
- Connect with love you feel for your goal, the physical sensations and positive emotions associated with developing competence, and succeeding at something you love.
- See yourself overcoming any adversity by visualizing the specific steps you took to manage your anxiety, recover from mistakes, remain focused and in control.
- Then, visualize what you are about to do well, practicing specific moves and actions again and again, feeling the sensations that go with them, allowing yourself to physically and emotionally experience your own hard won competence.
- If you do not yet feel competent, visualize yourself taking steps to get there.
Here is a more detailed routine you can use to train yourself to keep doing what you need to do.
The big 3: Breathe, Relax and Imagine
- Draw the air in through your nose, taking it in slowly and deeply to the bottom of your lungs while expanding your diaphragm to make room for it.
- Hold the air for a moment.
- Then slowly let allow it out of your lungs by drawing your diaphragm in, with you mouth slightly open and your tongue on the roof of your mouth, resting just behind your front teeth.
- Just observe your body while doing this, and, if thoughts come to you, let them go and focus on your breathing. The thoughts will subside as you continue to let them go.
- The more you focus on your breath and body, the more quiet your mind will become.
With practice, you can focus on your breathing without effort, even in the midst of other activities. With practice, you can achieve mental control at any moment in time. Once you build this habit, it will be available to you for as long as you continue practicing it.
Your practice of deep breathing will allow you to enter deep relaxation whenever you choose.
- Move to a quiet place where you won’t be disturbed or distracted.
- Be sure you can maintain a comfortable state (no tight clothing, temperature not too hot or cold) before proceeding.
- Lie down your back with your feet apart and your hands slightly away from your body.
- Fix your eyes on point above you on the ceiling.
- Staying as still as you can, remembering how you learned to relaxing breaths, take 3 long, slow, deep breaths, inhaling each through your nose, holding it briefly before you exhale it through your slightly open mouth.
- As you gently let go of each of the 3 breaths, allow your eyelids to slowly close.
- For the next 10 breaths, imagine your eyelids getting heavier and heavier as your relaxation deepens.
- Mentally repeat the word “deeper” to yourself each time you exhale, letting letting any thoughts and tensions that may arise dissolve with the breath as it leaves your body.
- Allow your self to go deeper into relaxation with each exhalation.
- Should your mind drift, gently bring your attention back to your breath.
- Continue breathing and repeating “deeper” slowly to yourself until you have finished these 10 deepening breaths.
- Next, focus your attention on relaxing the muscles of every part of your body.
- Start with you toes, and begin slowly moving up your body, as total relaxation takes over.
- Focus on relaxing each muscle in your body from your toes, to your calves, thighs, abs, chests, back, arms, shoulders, neck, face, head and scalp.
- As you visualize each muscle relaxing, allow yourself to feel a deep wave of relaxation flowing deeply into all your muscles, though your entire body. Allow yourself to go deeper into relaxation with each breath you take.
- Don’t try to rush or force anything, just allow your muscles to become loose, and yourself to relax naturally as you drop into total relaxation.
Deep breathing and relaxation, when used in conjunction with mental imagery (see the Pele Principle, above), allows your wise inner or subconscious mind to help you get what you want. Show your mind through images and feelings what you seek to accomplish. As you feed you mind these movies of success, it will set out to help you accomplish your goals by keeping you motivated and focused.
- As you allow yourself drift in a the state of deep relaxation for around twenty minutes, imagine watching a movie in which you are the main character.
- See yourself immersed in doing the work, taking the steps that will result in your achieving your goals. See yourself practicing what you need to learn to get there, making adjustments and improving your skills. Focus in detail on the process you must take to achieve outcome, not the outcome itself.
- Accept this image of yourself working towards your goals diligently, with focus and enthusiasm, as the truth. Show your deeper mind the images and feelings associated with what you want to achieve.
After 20 minutes of this success conditioning, you can slowly bring yourself back to full awareness by letting your eyelids open, inhaling, and stretching. Then, imagine a staircase with 5 steps going up. See yourself slowly walking up each of the 5 steps; at each step becoming more awake, alert and refreshed. At the top step, imagine yourself ready to go on with your day.
I have long been fascinated by self help books and articles, looking for ideas that anyone can implement. These ideas from blogger Tynan, author of the book Superhuman by Habit, are are so simple they are they profound. I want to share how some of them apply to relationships.
Your life gets screwed up worse by bad habits than having bad things happen to you.
A single piece of cake won’t make you fat. Habitual overeating will. One drink doesn’t create an alcoholic, a lifetime of drinking does. A single missed payment doesn’t ruin someone’s credit but a lifetime of not paying bills will, just like a lifetime of regular saving actually works. Fighting the same fight over and over with your partner absolutely doesn’t work. Same for blaming others for your problems or trying to get them to change, things many of my clients struggle with when they first come in.
You are what you do.
Not what you aspire to. You actually change your identity when you develop good habits.
If you want to run a marathon, you do it by getting out there and running, not talking about it or buying gear. If you want to run, run. That’s how you become a runner. If you want to write, write. Not once, but daily. Till it becomes a habit, till it’s just what you do. It’s that simple.
A few good habits put your decision-making process on autopilot.
When you have good habits, things go well for you more often, and you know what to do, from experience. When you develop good work habits, your career becomes rewarding. When you develop good relationship habits, you no longer waste time having the same fight over and over. Good habits are easier to maintain as time passes: as you succeed, you have more energy to keep doing what works.
Life is easier when you take responsibility
When you make the effort to do the right thing, you become free from wasting time focusing on others, wanting them to do what you want them to, trying to get them to change. When you do you, things go right more of the time. There are no guarantees you will always get what you want, but when you focus on what you can do, not what others aren’t doing for you, your path becomes clear.
Don’t avoid effort
If you are learning something and it’s hard, go towards it. Your effort will be rewarded as you learn master this and future challenges. You spend as much energy avoiding a task (which only makes you feel bad) as mastering it (which makes you feel great). The person who is afraid of water wastes a lifetime avoiding the water. The person who breaks it down and learns to swim gains more than the ability to swim, they gain the ability to learn.
Reward the effort, not the outcome
Outcomes are not in your direct conrol, but your process is. When you have a process that works for you, it is always available. When school children are rewarded for grades, they don’t how to learn to think, or study. So, focus on process and learn to solve problems. When you develop a good process, you don’t need an elaborate reward because having the process is it’s own reward. I’ve worked with couples who stubbornly swore they would only change once their partner did: only get married if the other person promised to have a child with them, stop fighting, make more money, you name it. For hose who get paralyzed looking for a guaranteed outcome they can’t get, the real loss comes from refusing to work on themselves.
Start now, and just keep going.
A huge predictor of success is how soon people start a project after deciding on it. Those who start soon after deciding to do something do better at it than those who put it off. I’ve seen people complain that things only go well…by chance, when conditions are right, etc. Conditions are rarely right enough. I’ve seen people walk away from any number of workable relationships in search for the perfect partner, and I’ve seen arranged marriages work brilliantly.
Learn from your mistakes.
Mistakes feel bad, especially when there are consequences. Still, those who choose learn from failed relationships more often than not go on to build healthy ones. So, if you fail, do not stop! Failure is an opportunity to learn. Those who stumble learning a new skill often get better at it than those who get it right the first time, because they train themselves to make needed adjustments. Learning from your mistakes will take you from pass/fail to a world of options.
Don’t give up
If you give up, your brain will figure out you don’t have go do tough things. So, figure out what your error was and how to correct it. When you get clear how well you are doing and how to do better, you build a self sustaining process that keeps working and can be applied to all challenges: “ a universal framework for training yourself”. Ok, now, get going.
I wanted to share a New York Times Modern Love column "To Fall in Love With Anyone, Do This” by Mandy Lin Catron that describes practices that can be called solution focused.
Catron describes how she and her (now) partner, already somewhat interested in each other, got much closer and eventually fell in love, using some of these instructions:
- "alternate sharing something you consider a positive characteristic of your partner, a total of 5 things"
- “tell your partner what you like about them; be very honest this time saying things you might not say to someone you’ve just met”.
They took turns asking each other questions from an original study by Dr. Arthur Aron, which describes "a practical methodology for creating closeness" in which pre-selected pairs of college students carry out a series self-disclosing and relationship-building tasks of gradually increasing intensity (small steps).
The study describes how practices that could be considered solution focused were used to create closeness in a short (45 minute) time frame. The instructions begin: "We believe that the best way for you to get close to your partner is for you to share with them and for them to share with you.” and goes on to discuss how closeness produced in the studies "seems similar in many important ways to the felt closeness in naturally occurring relationships that develop over time", defining closeness as “including other in the self”, an interconnectedness of self and other, a process in which people feel “validated, understood and cared for”.
Catron describes how, by focusing on each other without distractions, asking questions designed to gradually increase their level of vulnerability, giving compliments, and then staring into each other’s eyes, these two people found they “ didn’t notice we had entered intimate territory until we were already there”.
She concludes that:
- "It’s astounding, really, to hear what someone admires in you. I don’t know why we don’t go around thoughtfully complimenting one another all the time".
- "what I like about this study is how it assumes that love is an action. It assumes that what matters to my partner matters to me"
- "it’s possible — simple, even — to generate trust and intimacy, the feelings love needs to thrive."
- "Love didn’t happen to us. We’re in love because we each made the choice to be."
Some of the solution focused practices used in the study that are clear to me:
- small steps lead to big changes
- ask detailed questions
- notice what is best in a person
- pay compliments
- behavior change leads to emotional change.
the research it was based on based on:
I am a big fan the concept of small slivers of change, which means the right dose of the right intervention at the right frequency, and I mean often. Often enough, strong enough, manageable enough for change to become reality. We could be talking about dieting, exercise, or any behavior change someone expects to improve their life.
A 12/31/14 article in the Well column in the New York Times about the "super short workout” and other fitness trends reported that small short bouts of intense activity (often called brief high intensity interval training) are more effective than longer, more sustained workouts.
In a series of recent studies on brief workouts, both mice and humans having brief, intense repeated exertion experienced “more potent changes" than those doing less intense workouts. It’s like resting between sets of lifting weights. The studies showed changes at a cellular level that lead to larger healthy muscles. An explanation for it the effectiveness of brief intense workouts was that for physical exercise to be effective, "sometimes you have to get out of your body's comfort zone".
As with working out, for psychotherapy to be effective, you need to have a different experience and feel it in your body. You need to recognize the experience as a different state of being, and take it again (repeatedly), so you know it’s not just a fluke, something people mistake improvements for.
A term use to I explain this phenomenon to couples I work with is the vacation effect. A struggling couple returns from vacation feeling reinvigorated and optimistic that things between them have changed, only to find the good feelings they had on vacation quickly fade, leaving them confused and discouraged a mere few days back into their normal routine.They want things to stay as they were on vacation
You can keep good things going. With careful questioning, you can discover what actually worked about being on vacation. It could be that you used your electronic devices less, had more privacy, or paid more attention to each other. Theses discoveries are different for everyone, and it’s best to take time to really look at what actually turned things around for you. Sometimes it’s not what you think. Sometimes it’s easier than you think.One couple discovered that preparing meals together lead to their talking more, which lead to them having sex again.
Careful questioning revealed which elements of the vacation could practically be put into into daily life,in small, frequent, intense doses, or intervals (back to that workout). It’s so worthwhile to have daily routines that work for you, so you’re not just waiting for another vacation for things to be good again.
New habits may seem hard to form but are actually easy, once you understand how they work. Recognize a new behavior, one that works for you. See what works about it. Remember how it feels. Do it again. Take it in. Repeat till it becomes your new normal. When you have small sliver of a good habit inserted in to your everyday life, your perceptions change along with the your habits. And things keep getting better.
When a client comes to me with this complaint, it is usually for one of these reasons:
- most of their recent sexual activity has been with porn, and now that they are with a new partner, they are having trouble connecting to that person
- their partner thinks they want too much sex, want the wrong kind of sex, or that they watch too much porn
- their partner caught them practicing non-consensual non monogamy
- another therapist thinks they are a sex addict
- they are uncomfortable with or feel stigmatized by their desires.
Because I practice solution focused brief therapy, a way of working that looks at how clients will recognize a successful outcome for therapy, I don’t need to label a person to help them, and I don’t need to give them advice. I do need listen very attentively, and ask a series of carefully crafted questions to elicit precise descriptions of what things will be like they begin to improve, how they will know they are on the right track. Listening carefully for these clues inevitably leads to helpful conclusions. These are questions that will lead to improvement, descriptions of when things were better, and to pick up clues in what they say.
While as a certified sex therapist I have must subject matter expertise, it is equally important for me to have expertise in relating to clients in a way that actually helps them. I have heard so many stories about experts who didn’t listen to clients, gave advice that didn’t apply to them, or talked down to them. It is only once I have truly understood how a client measures success that I can accurately point them to resources.
There is a a growing body of evidence (http://www.solutionfocused.net/research.html) to support the idea that asking someone solution focused questions is much more likely to help clients than telling them what to do. When this way of relating is backed up with knowledge of sexual and psychological health, my client and I have truly built a solution that works for them.