As more and more states in the US decriminalize, medicalize, and legalize marijuana and THC related products, cannabis and sex comes up a lot with my clients. A few months back (2021), I virtually attended the 2021 AASECT Annual Conference and was very impressed by the panel presentation featuring Chelsea Cebara (www.chelseacebara.com) and Jordan Tischler, MD (www.inhalemd.com). I took some notes to write this blog to help my clients and others understand how cannabis can be utilized therapeutically for sexual concerns.

To start, I want to be clear, I am not a cannabis or marijuana expert and do not have the adequate training or experience in cannabis and sex to make any formal recommendations or for you to read this blog and say that I an expert. Just merely reporting a small amount of information that I absorbed from this presentation or my own research.

What Does Cannabis Help With Related to Sex

Cannabis and Pain

Canabanoids are anti-inflammatory and anti-spasmodic and can help with inflammation or spasmodic pain which can contribute to sexual pain and orgasmic functioning. There is over 60-70 years of data on the use of THC and cannabis for the treatment of pain. The sexual issues that cannabis can treat around pain include:

• The pain and spasmodic pain related symptoms of endomietroisis
• Symptoms related to menopause such as hot flashes, insomnia, depression/anxiety, decreased libido, sexual pain
• Vaginismus/Dyspareunia (sexual pain in females)
• Neuropathy (which can cause sexual pain and sexual disorders)

Cannabis and Mental Health Issues related to Sexual Issues

There is a lot of evidence that having a mental health issue is a contributing factor to having sexual issues, with anxiety and depression being the most common that I see with clients. Cannabis has been shown to help with the following mental health issues (which I find in sex therapy being often comorbid with sexual issues in my clients):

• Anxiety (a huge contributing factor in sexual issues)
• Depression
• Insomnia (if sleep is disturbed, usually sex is as well)
• Post-Traumatic Stress Disorder

Cannabis and Sexual Issues

• Helps with delayed orgasm
• Increases libido and arousal
• Remarkably helpful in increasing orgasm frequency and intensity of all groups
• Increase vasodilation which can lead to increased arousal and vaginal lubrication which is a passive process from that peripheral vasodilation
• Sexual Pain- cannabis can shift the perspectives of pain
• It can address the things that are hitting the breaks so the gas can emerge (see Nagoski’s work on Sexual Accelerator and Brake Systems)
• Increase vulnerability,
• Enhanced embodiment,
• Enhanced being in the moment and mindfulness

What Evidence Exists for Cannabis and Sexual Functioning

I can’t even begin to say that I’m an expert on this but I’ll offer a few references to some recent studies (last five years) on cannabis and sex. After reviewing these and more studies, it does appear that cannabis has more positive effects on women and sexuality than men (in fact, the research and anecdotal reports seem to align that cannabis actually can contribute greatly to increased sexual functioning issues in men, however, I think for certain issues I have seen it be helpful such as increase sensation, decrease anxiety, hep with pain or neuropathy).

A 2017 study says those that use marijuana have more frequent sex.

A 2017 study concluded that the majority of female marijuana users who used marijuana before sex reported a better overall sexual experience, an increase in sex drive, a more pleasurable orgasm and a decrease in pain.

A 2019 study says that marijuana improves satisfaction with orgasm in women.

A 2019 study reported that many participants in the study found that cannabis helped them relax, heightened their sensitivity to touch, and increased intensity of feelings, thus enhancing their sexual experience, while others found that cannabis interfered by making them sleepy and less focused or had no effect on their sexual experience. 

A 2019 study suggests that erectile dysfunction is twice as high in cannabis users compared to controls.

A 2020 study concluded that increased frequency of marijuana is associated with improved sexual functioning in women.

How Should One Consume Cannabis for Sexual Healing

The real key to this in finding a way to consume cannabis to minimize the intoxication (high) while maximizing the benefit of the THC says Tischler (2021). If there is really no intoxication/high its unlikely that it is going to work so the goal in treating someone with cannabis is finding a minimum effective dose. Maximize benefit, minimize that side effect (intoxication). Additionally, intoxicated sex comes with risks, requires planning, and a huge focus on consent.

According to Dr. Tischler (2021) inhaled cannibus is particularly good with sexuality and partners and he recommends vaporizers, suppositories, capsules, and THC lube. Topicals are mostly recommended for sexual issues because they can be localized. Best practices for consumption are topical, ingested, and vaporized. THC “pens” or cartridges are not recommended and Tischler recommends “straight up flower” for vaporization. Combusting the flower (smoking, joints, bowls, bongs, blunts, etc.) is not recommended due to the fact that the heat can actually damage the THC content and that transmission into the body can be very harmful.

Tischler (2021) recommends THC content to be between 15-20%. If you start using the 30% pure THC, Tischler says, that is pharmaceutical grade, its not a very effective medicine and is often a dysphoric experience. He suggests 15-25 mg of THC for the average person and dosing is very important.

A note about CBD, according to Tischler (2021), CBD is at best supportive but hasn’t been really shown much significant impact on sexual systems. Tischler also warnes about some potential interactors so doing your research and consulting with a qualified health professional is recommended.

You’ll see I recommend you consulting with a qualified healthcare provider before experimenting with any of this. There are potential complications related to cannabis use such as Cannabinoid hyperemesis syndrome (CHS). CHS is a condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana. Marijuana has several active substances. These include THC and related chemicals.

Recommended Products

There are some products that are specifically designed for sexual and intimacy and include:

Foria THC (only available in some states, cannot ship cross state lines)

Velvet Swing (only available in Washington and Oregon): This is the only THC lube that is barrier compatible. Everything else out there is going to be oil-based and not compatible with barriers (condoms, dental dams, etc.)

Best Practices around Cannabis and Sex

Tischler and Cebara (2021) shared some best practices when trying out integrating cannabis into your solo and partner sexuality. Here are some highlights:

• Consult with a qualified health professional before trying any substances.
• When trying something new, start with just yourself and then masturbate. If you have a positive or neutral experience a few tries, invite in a trusted partner.
• Open up and be present to the possibilities. Try things without expectation or judgment.
• Focus on what feels good: PLEASURE IS THE MEASURE. There is no “shoulds”.
• Journal after the experience to reflect on it and keep track of what works for you.

All this being said, it is important that you work with a qualified health provider and a sex therapist to discuss cannabis as an option for the treatment of sexual issues or symptoms associated with sexual dysfunction. It is important that you don’t DIY your own therapy and sex therapy without thoughtful intention, especially when substances and sex are involved. If you would like to work with me on this, please feel free to reach out!

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Many people have reported how kink and BDSM have helped them work through traumatic situations in their past however, there wasn’t much research/data around how kink and BDSM could help someone work through past traumatic events in their life. I recently completed a course from TASHRA (The Alternative Sexual Health Research Alliance) entitled Kink & Healing: Two Approaches with Julie Lehman, LMFT and Andrew Pari, LCSW, CCTP. I love this organization as it really is doing some interesting things around alternative sexualities and therapy and any training they put on or put out is thorough and research-based. This training talked about how kink and BDSM scenes are being used for healing within participants. It is clear that kink is NOT therapy, but it IS therapeutic, and preliminary research is being conducted to explore ways that kink can have therapeutic benefit for those that are experiencing post-traumatic stress disorder, anxiety, depression, and other mental health concerns. Personally being in the kink would for the past 13 years I can say that kink and BDSM has immensely helped me with trauma, anxiety, and spiritual growth so I know first hand how beneficial it can be. This training offered significant insight to who is consciously using kink to address trauma, how much, the similarities between therapeutic interventions and models of therapy and kink scene/play, and a model of how clients can consciously use kink to work through their own trauma.

People Are Doing This! But Who, How Much, and for what Issues?

Dr. Richard Sprott presented some very preliminary answers to two questions around using kink scenes to address past traumas. At the time of presenting he shared that these numbers were just informational and expected to change with more respondents.

Have you have ever consciously used a kink scene to address past trauma?
33% Yes (83)
55% No (139)
13% Not sure (32)

How many scenes have you done that intentionally addressed past trauma?
4+ scenes: 28% (28)
1-3 scenes: 38% (37)
1 scene: 10% (10)
Not Sure: 23% (23)

The nature of the original traumatic experience was overwhelming sexual, such as sexual assault, abuse, childhood sexual abuse, and rape. Additional traumatic experiences were related to partner abuse, shame, and consent.

While it is always a fine line for therapists who work with kinksters advising them to use strong caution when working with mental health themes such as trauma in the context of kink, what we are understanding is that people are doing this and finding a lot of benefit from it. So it is good that efforts are being made to understand it.

Here is an interview with Licensed Clinical Social Worker and Certified Sex Therapist Samantha Manewitz did on “Can Kink Help Transform Trauma?” and the parallels between kink-scening and trauma work.

A Proposed Model for Constructing these Scenes

The biggest take away I took from the training was a proposed model, called the Somatic Mastery of Sexual Trauma Model, that Andrew Pari, LCSW, CCTP presented on. I italicized proposed because this isn’t a currently accepted or validated model for trauma, but I found it a nice framework on how conscious kink and therapy could intersect to address traumatic experiences. The model looks like this:

I love the collaborative nature of this model where the therapist can do much of the work with the client and help them create spaces to prepare for re-enactment, role play, aftercare, etc. as well as offer so much clinical treatment around the trauma. The Somatic Mastery of Sexual Trauma Model is a therapeutic blend of Prolonged Exposure Therapy, Attachment Theory, Dramatherapy, and Trauma Release Exercise.

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If you are interested in working with a sex therapist to work through trauma with kink and BDSM, please reach out below!

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What is sexual grief? According to Edy Nathan (2023), sexual grief is a natural response to an unnatural sexually traumatic event or experience which can occur over the span of one’s life.

I recently took a webinar from Edy, who was talking about her book-in-the-works, Healing Sexual Grief and wanting to share her thoughts on sexual grief and how to heal from it.

Nathan says we don’t talk about sexual grief, and that we really didn’t have an accurate label for this experience that is felt by many, and spoken by none. Sexual grief is about the primal part of you that has a sexual self, a sexual birthright, and when that sexual self is harmed, traumatized, neglected, hurt, it results in
– self-loathing
-disgust
-shame
-hiding
– GRIEF

What’s left in the shattered soul is a lost sense of self.

Sexual grief can play “hide-and-seek”, or lay dormant and resurface throughout ones life. I describe grief and trauma as something that never quite goes away, even if you do the work, but it comes back around and around throughout your life. Each time it emerges, powerfully, triggered, activated, raw, its time to focus a new strategy on managing it.

Sexual grief can look like a lot of things, but I’ll share a few examples that I have come across in my work that I think does a good job of explaining what sexual grief actually is.

Sexual grief resulting from an interrupted sexual development. This results in the loss of sexual innocence, ones sexual “purity”, disrupts their entire sexual sense of self and beyond. Grief relates to what happened, what could have been, who the person could have been, sexually and beyond, had the incident(s) not occurred, the responses of others, and the loss of a life that was supposed to happen except for the traumatic event.

Sexual grief because of sexual dysfunction, injury, pain, medication side effects, just not being the sexual person that you thought you would be. Letting go of sexual myths, ideals, and expectations that cause grief around that. Not having sex or pleasure in the way that “everyone else does”. Feeling different or othered because of what is perceived as an abnormal difference in sexual functioning.

Sexual grief because of you are living a sexual life you didn’t expect to be living. Perhaps you are married and expected a blissful lifetime of sexual freedom and pleasure, but instead you or your partners expectations aren’t met. Sexual grief because of orientation issues, including asexuality. Sexual grief because decisions that you made lead to low sexual desire, drive, or pleasure.

Nathan describes sexual grief as a “hostage taker”. Edy presents six “hostage negotiation strategies” to tackle sexual grief. If you want to learn more about sexual grief and how to negotiate with the hostage of sexual grief, Edy Nathan has a 5 Part Video Series on YouTube on Sexual Grief. You can find the first part here: https://www.youtube.com/watch?v=udd50DhH9mc

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If you would like to tackle sexual grief and start living a more healing and whole sexual life, please reach out using the form below or email admin@sextherapy-online.com

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Sex toys, vibrators, sexual health aids, dildos, lube etc. are often recommended in sex therapy for pleasure enhancement, sexual functioning concerns, and sexual pain and dysfunction. Recently, I took a course with Dr. Caleb Jacobson on the Clinical Uses for Sexual Health Aids (February 5, 2023) and wanted to write a post on commonly use of sex toys and sexual health aids in sex therapy.

These are just some of the commonly used and recommended sexual health aids out there. While I have personal and professional experience with some of them, I do not have experience with all of them so please do not take this blog as a specific recommendation for any of these sex aids.

Additionally, it is important that you work with a qualified sex therapist and/or pelvic floor physical therapist if you are trying to solve any sexual functioning concerns or dysfunction as generally a DIY approach to sexual functioning concerns is usually not recommended and can actually make an existing problem worse.

Common Sexual Health Aids

1. Lube
   • Water-based- ie: ID Glide
     Pros: Can be used with sex toys/condoms and pretty body safe
     Cons: can get sticky or dry out easier (Pro Tip: reactivate with water… keep a spray bottle near the bed and refresh your water-based lube with a little water)
   • Silicone-based- UberLube
   • Hybrid- Sliquid Silk
     Pros: You don’t have to apply it as often, smooth in application, doesn’t leave a sticky feeling while using it, Can use it with condoms
     Cons: Can stain sheets/clothes, cannot use silicone lubricant on silicone sex toys (can be used on medical grade silicone)
   • Oil-based- coconut oil based Coconu
     Pros: natural and can be gentle on the body
     Cons: not compatible with condoms, if you use these with a latex condom, condom may break
2. Women/Vulval/Vagina Sex Toy Categories
   • External Toys- stimulates external anatomy
     • Womanizer
     • Magic Wand
   • Internal Toys- created to simulate penetration or intercourse
     • NJoy Pure Wand
   • External/Internal Toys- combines internal and external stimulation
     • Womanizer
3. Male/Penis/Testical/Prostate Sex Toy Categories
   • Masturbators- simulates intercourse
     • Arcwave Ion
     • Fleshlight
     • Kiirroo Keon
     • Tenga Flip Orb
     • Tenga Egg
   • Testicle Stimulators- provides stimulation to scrotum
     • Balldo
4. Anal Toys– B Vibe
   • Plugs
   • Beads
   • Dildos/Vibrators
   • Dilators
5. Trans Toys
   • Buck Angel- Buckoff
   • Non-Anatomic
     • Starsi
     • Tenga Egg
6. Couples Toys
   • We-Vibe Chorus
   • Eva by Dame
   • We-Vibe Pivot

Sexual Health Aids for Sexual Issues

Female/Vulval/Vagina Owner Sexual Issues

1. For clients with female/vulval/vagina orgasmic disorder, pre-orgasmia, difficulty orgasming
   • Womanizer
   • Magic Wand
   • The Lioness
2. For clients with female/vulva/vagina desire issues, less interest in sexual desire
   • Dipsea Audio Erotic Stories
   • Mysteryvibe Legato
   • JO Clitoral Gels
3. For clients with female/vulval/vagina pain and Genito-Pelvic Pain Disorders
   • Dilators
   • Pinpoint Vibration- Mysteryvibe Crescendo
   • The Lioness

Male/Penis Owner Sexual Issues

1. Erectile issues
   • Penile pump
   • Mysteryvibe Tenuto
   • Penile rings- Firmtek Penile Ring
2. Delayed/inhibited ejaculation
   • Arcwave Pow
3. Early Ejaculation/Premature Ejaculation
   • Promescent
   • Myhixel

Boost Kegel Exerciser for Men

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These are just a few suggestions for sexual health aid and sex toys used in sex therapy. If you are interested in working with me and learning more, please don’t hesistate to contact us.

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Coronavirus is SCARY.  There is a lot of misinformation out there and the information that is out there is constantly changing.   One thing is certain and that all information sources agree: staying home is safer than being out and about in public and reduces your chances of contracting/spreading germs, illness, and the coronavirus.  

So if you are lucky enough to have a job that allows/wants you to stay home during this time of uncertainty, why not take advantage of the flexibility that working from home has to offer and invest in yourself, your relationship, and/or your future by getting around to that “to do” item of going to online sex therapy?  Most people talk about wishing they had time to work on their relationship, and cite busy and stressful work schedules and differing schedules as a factor that prevents them from doing so, but online sex therapy is perfect for this period of time that is uncertain and where it is safer to stay home than be out and about. 

I am writing this post kind-of tongue in cheek (although I am totally available for telehealth sessions- register as a client and see my availability by going to https://rhiannon.clientsecure.me/) and am not trying to capitalize on a unpredictable, dangerous, and deadly situation.  But there is some truth to making the most of your time at home when you and your partner(s) are available to do some work on the relationship or just yourself.  And tight quarters and long hours together can have mixed results, so why not get a little extra help from yours truly.  

Even though I’m kind of kidding with my title,  while I have your attention, here are some helpful articles/media that I have found have given me some information that I found helpful and reasonable.  In a time of misinformation, it’s important that we are careful on consuming media, making sure it is accurate and reasonable.  If you feel like information is sensationalized, check your source, and always cross check with the CDC website.   (I don’t know how relevant these links are now, since the situation is constantly changing, so consume with caution)

Here is a really normal guy, who got coronavirus, and felt like junk but describes the virus: 

I love John Oliver explaining the basics, he does it engaging and doesn’t feel to fear mongering or too dismissive: 

As John Oliver explains- we need to find ACCURATE information about the disease in order to make the best decisions for ourselves.  Here are some things me and my family are doing to prepare for really the unknown, since it isn’t clear how this is all going to pan out (tolerating uncertainty is a real skill- if you lack the ability to tolerate uncertainty, working with a therapist that specializes in cognitive-behavioral therapy is really helpful). 

1. I discuss with my partner on a regular basis the current events that are going on.  
2. I limit my consumption of media to 1-5 pieces of information a day and stay away from media that is intentionally sensationalistic or fear-mongering. 
3. I check in with my partner about what I’m feeling and come up with a plan to address the unknown. 
4. We have a plan for our child if/when daycares close- we’ve connected with grandma’s (one local, one out of state) if/when we need them and have all come together and decided how we would handle needing to keep him home.  Is childcare stressing you out?  How Working Parents Can Prepare for Coronavirus Quarantine 
5. We stocked up on some essentials- mostly dried toddler milk and some of the kiddos favorite food.   We have committed to keeping our gas tanks full and making sure we don’t run out of too many things in case we do have to quarantine.   This article talks about what you need and what you don’t. 
6. We have used our teledoc quite a bit during cold/flu season, and feel comfortable using that if we were to get sick. 
7. We have a local pharmacy that delivers if needed.  
8. We’ve talked about how we would help our neighbors, friends, and people who rely on us for income to keep their lives as continuous as possible.  We come from a place of privilege and recognize that not everyone is in as good of a situation as we are. 
9. I’ve discussed with my clients about their preparedness for the unknown and encouraged them to meet online if there is concern about them being sick.  I’ve committed to doing the same. 
10. We’ve reviewed handwashing and handsanitizing in our household, and commit to sanitizing things more frequently.  

While the situation is continuously changing- what do you and your family need to help weather this storm?  The best thing to do is talk with your friends and family and come up with a plan and answer these questions?

1. How can I limit my interaction with the public?  Is working from home an option?  Is delivery an option?  
2. How can I help those that might be less fortunate than me who might be in a different socio-economic place than me?  Do my neighbors have food and medicine?  How can I help my friends, family, neighbors, and those in need?  Are there kiddos that rely on food at daycare and school that might be hungry?  
3. What resources do I have access to that can help me in a time of crisis?  
4. What resources do I need that can help me in a time of crisis?

I’m here for y’all- at a distance if you are sick.  Take care of yourselves and your loved ones and if you are in Maine, Massachusetts, New Hampshire, New York, or Texas, lets take advantage of this time together to get started on some work.  Nothing like a health crisis to make us focus on our (mental) health. 

 

 

An area of interest of mine that I’d like to write a little about is a model of couples work called discernment counseling.  Discernment counseling is a short term counseling model that aims to help couples who might be on the brink of ending their relationship gain clarity and confidence about the decisions they make in regards to the future of their relationship.  Discernment counseling was based on a model of counseling initially introduced by Betty Carter at a conference in the 1980’s and then revamped and revived by Bill Doherty (2017) after working with a family law judge who was noticing that many couples were in the process of divorcing that seemed ambivalent or unsure that divorce was the right choice for them.  It seemed like some couples get on the divorce train and don’t feel like they can get off it once the train starts moving.

Discernment counseling aims to help couples on the brink of ending their relationship gain clarity and confidence in the next steps of their relationship.  I first became interested in helping couples make decisions about their relationships when I obtained an Advanced Certificate in Divorce Mediation from Hofstra University in 2007.  While we weren’t trained specifically in discernment counseling (it wasn’t really a “thing” back then), we were trained in the therapists role in a divorce mediation process.  Essentially, as a Licensed Marriage and Family Therapist on a divorce mediation team, my role would be to assist the couples in making the best decisions for their relationship, children, family, etc. as they moved through the divorce process.  While the attorneys on the team advocated for the law and in the best interest of the client(s), my presence would lend the attention to the relational factors that needed to be considered in order for the clients to feel empowered in their divorce process and in order for the clients to make the decisions they needed to make that were in the best interest of their families.

I often find couples proceed with divorce because “that’s what you do” when something goes wrong in the relationship (betrayal, cheating, domestic violence, sex addiction, etc.) and aren’t really aware or encouraged to look at all the options that might be out there for them: couples therapy, discernment therapy, planned separation, and/or just taking some time, taking a deep breath, and putting decision making on hold until everyone is in a better place.

Discernment Counseling and Sex Therapy

You might be wondering how a SEX THERAPIST gets involved with helping couples decide what the appropriate path is for their relationship when facing discernment concerns.  Well, often times, my clients come see me for sex therapy but the situation has gotten so dire, usually around sex AND other issues, that there is a leaning out partner (someone who is thinking they might not want the relationship/marriage any more).  While I begin most couple and relationship work with the intention of working on the couple/relationship, some times for a variety of circumstances, the relationship moves into a place where couples therapy doesn’t have a chance of being successful unless the mixed agenda couple (one partner leaning in/one partner leaning out) has a clear path to work on their relationship.  Sometimes a sexual issue is enough to push a couple into a place of discernment- “do I stay or do I go?”.  Often times it is a sexual issue that got the couple into the room, but other issues that contribute to the overall general concerns, are in need of a discernment process.

Do any of these situations sound like you or your situation?

• If we don’t fix our sex life, I don’t think I can go on in this relationship/marriage.
• I don’t want to get divorced or break up but I’m getting to a point in our relationship that I think that is what has to be done in order for me to have a sexually satisfying relationship.
• My partner has said that divorce is inevitable if we don’t get more on the same page sexually.
• My partner had an affair and is thinking about divorce.  I want to work on the marriage, my partner doesn’t think it can be saved.  I’d do anything to save this marriage.
• We’ve both been sexually unhappy for a while.  We’ve tried different things swinging, non-monogamy, etc. but I just want to be sexually satisfied in my primary relationship.  I’m thinking about ending things so I can start over with someone else.
• Our sex life has never been okay and I think that divorce is the only answer for me getting a happy sex life.

Provided there is a leaning in (read more for definitions) partner in each of these scenarios, discernment counseling could be a good option for couples in this situation.

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Discernment is a valuable process for many couples and relationships, because working with a relationship where one partner is leaning out and one partner is leaning in a couples therapy doesn’t always prove to be successful. Unless we have a commitment to work on the marriage and work in therapy, results from couples therapy aren’t often successful.

Here I’ll go over the basics of discernment counseling.  I often go over these points in the first phone call to each partner(s) in efforts to orient each partner to what it is that we are going to be doing in the discernment process.

Goal of Discernment Counseling:

The goal of discernment is to help couples arrive at greater clarity and confidence in their decision making about the future of their marriage based on a deeper understanding of the problems in the marriage and each person’s contribution to them.

• Greater clarity and confidence in their decision making about divorcing.
• Better equipped to understand their prospects for reconciliation.

Discernment Counseling focuses on getting the clients solidly on one of three paths:

Path 1: Status Quo Path- Marriage goes on as it is.

Path 2: Separation or Divorce Path- Proceed with Separation/Divorce

Path 3: Possible Reconciliation Path- Both partners agree to a 6-month all-out effort to make the marriage healthy without divorce on the table, to see if they can get the relationship to commit.   A PROVISIONAL commitment.

Discernment Counseling

• Is not therapy, we don’t problem solve but if problems come up, we can note them as problems that need to be addressed if Path 3 (Intensive Therapy) is chosen.
• The goal is to help you decided whether to try to solve your problems or choose a different path.
• No change should be expected in the relationship during the discernment process as this isn’t therapy.
• We are going to ASSESS the situation, not TREAT the situation. You won’t get assignments as couples, but may get separate assignments based on where you stand.
• The point of discernment counseling is to prevent half-hearted couples therapy attempts and failures in couples work.

Who is Discernment Counseling Good For:

When one is leaning in, and one is leaning out (mixed agenda couples)

Leaning In Partner- partner who is leaning towards maintaining the relationship and reconciliation and are motivated to fix the relationship

Leaning Out Partner– partner who is leaning towards ending the relationship or wants out, but has not made any final decision

Mixed Agenda Couple– when one partner is leaning out and the other leaning in

When is Discernment Counseling Not Recommended:

• When both partners are leaning out.
• When divorce is 100% inevitable and everyone is out the door.
• When you just want a safe place to announce to your partner that you want a divorce
• When someone(s) not sure if I want to stay in this marriage, but they are SURE they want to work on it and give it a try and they aren’t a mixed agenda couple. They want to roll up their sleeves and try couples therapy.

What it looks like:

Length of treatment: 1-5 sessions, no need to commit to all sessions, we will only commit to one session at at time

Session Time: Generally each session is 100 minutes, with one-to-one conversations, and conjoined conversations

 

Does this sound like something that would be helpful to you or your clients?  If so, please feel free to reach out using the form below!

 

 

 

A new technique I am happy to begin to introduce and to integrate into some clients’ sex therapy treatment plan is EMDR (Eye Movement Desensitization and Reprocessing) Therapy.  My landing on EMDR has been a curious one- as a client myself I have had some experience with EMDR, but never with EMDR and sex therapy and I’ve also had many clients have successful experiences with EMDR therapy to work with trauma and intrusive thoughts and memories.

But recently, I had a wonderful opportunity to start my own EMDR Training through the first weekend of EMDR Basic Training on June 29-July 1, 2018 in Austin, TX.  My entire EMDR training will be two, 20-hour training weekends plus 10 additional hours of small group and one-on-one consultation and training sessions for a total of 50-hours of training in the EMDR Basic Training.  My second weekend will be in October, 2018 in Austin, TX so by January, 2019, I will have completed the EMDR Basic Training.  Until then, I will be following the practice guidelines in between training and will only begin integrating some EMDR with clients who I have an established relationship who meet the qualifications to begin the work with me.

My intention is ultimately to integrate EMDR with sex therapy clients and to specifically to start working with victims of sexual assault in Austin, TX.  A unique training and volunteer opportunity presented itself recently that I applied for and out of hundreds of applications, I was one of 57 therapists, social workers, and counselors selected to participate in a program that aims to assist survivors of sexual assault in Austin TX.  Through a partnership with Austin Police Department, Victim Services Division and the Austin/Travis County Sexual Assault Response and Resource Team (SARRT), an innovative program was funded that will provide complete EMDR training to therapists in the private and not-for-profit sectors in Travis County in order to provide free therapy for survivors of sexual assault in the City of Austin and Travis County.

If you aren’t from Austin, TX or Texas and/or don’t know what has been happening with rape kits from sexual assault survivors, in the short of it, we had a huge and unacceptable backlog of rape kits that had not been processed, with over 2,200-3,000 kits waiting to be tested dated as far back to the 1990’s just in Austin alone, with nearly 10,000-20,000 kits backlogged in other counties and the state as a whole.  I won’t get into WHY this was happening (it’s complicated and involves a lot of factors, not just negligence and long wait times and lab contracts, but victim cooperation and a variety of other issues), but it is totally unacceptable (you can find out more information online from various news sources about this).  As of April 10, 2018, all kits from Austin’s backlogs are in process or have been sent out, but now what?  It was becoming painfully clear that these survivors needed services as their kits came back and their cases began the long and arduous journey of being considered and processed.  APD Victim Services and SARRT realized that these survivors need services with trained trauma professionals, and got funding to train local professionals to provide evidence-based trauma treatment.  Each trained professional is required to provide at least 50 pro-bono sessions to survivors of sexual assault in the three years after training.  Through this program, over 3,000 pro-bono sessions will be provided to the survivors of sexual assault in the Austin and Travis County area.

I am very proud to be selected for this program, help victims of sexual assault in my community, and to develop my skills to begin integrating EMDR and sex therapy.  Specifically, my goal in helping my clients and survivors of sexual assault is to not only address the trauma but specifically work with sexual functioning concerns and post-assault/trauma sexuality.  Because I am a sex therapist, I am a more specialized therapist than many of the therapists, social workers, and counselors in the training in that my training is sex, sexuality, relationships, and gender specific.  I have a more specified knowledge of treatment of sexual issues related to sexual trauma and assault as well as relational and gender issues.  I am greatly looking forward to not only providing quality sex therapy services to existing clients but also welcome survivors of sexual assault into my practice and integrate EMDR and sex therapy.

So I wanted to take a little time to inform my clients, new and existing, a little bit about what EMDR is, what it treats, why we think it works, and what its about.  This is by no means an extensive explanation, and there is so much research out there on EMDR that you can find a ton of other information about it in books, articles, webinars, etc.

To get started, here is a video from Bessel van der Kolk, a leading theorist, therapist and author of a pivotal work on trauma and the body entitled The Body Keeps the Score: Mind, Brain, and Body in the Transformation of Trauma. 

 

Here is a popular short video that explains a little bit about what to expect with EMDR and how it is believed to work:

 

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) Therapy is an evidence-based therapy model that has been empirically proven and validated with more research conducted and published on the treatment of trauma than any other therapy model.  This model works and has been PROVEN to work.  That is pretty cool!  EMDR is a distinct, comprehensive treatment approach and includes 8 phases of treatment:

1.  History Taking and Treatment Planning
2. Preparation
3. Assessment (Setting Up Target)
4. Desensitization (Reprocessing of Memory)
5. Installation (of Positive Cognition)
6. Body Scan
7. Closure
8. Re-Evaluation

It is important to note that EMDR Therapy has these 8 phases of treatment, most which do not involve any eye movement/reprocessing.  Often times, clients will be eager to get to the eye movement interventions but sometimes Steps 1-3 take quite a bit of time to get to.  It’s important to understand that EMDR is a treatment and therapeutic program, not just a one and done technique.

What does EMDR treat?

• Post-Traumatic Stress Disorder (PTSD)
• Complex Post-Traumatic Stress Disorder (C-PTSD)
• Disorders of Extreme Stress (DESNOS)
• Depression
• Dissociative Disorders
• Phobias
• Complicated Grief
• Addictions
• Anxiety Disorders
• Performance anxiety or enhancement
• Treatment of Children
• Couples Therapy
• Chronic Illness and Somatic Disorders
• Eating Disorders

What SEXUAL ISSUES does EMDR help with/treat?

• PTSD and C-PTSD from sexual trauma/abuse/assault
• Depression and anxiety
• Sexual anxiety
• Dissociation during sex
• Fear of Sex
• Aversion to sex, sexual aversion
• Grief and loss related to and unrelated to but affecting sexual functioning
• Sexual addiction, sexual compulsivity, problematic sexual behavior
• Sexual performance anxiety
• Couples and relationship sexual therapy
• Chronic sexual pain and chronic sexual illness
• Chronic illness that has sexual effects
• Somatic processing issues around sexual functioning
• And many others!

How does EMDR work?

This question can be answered in many different ways, from simple answers to complex answers.  Here is a sample explanation of EMDR that might give you some insight to how it works:

“Often when something traumatic happens, it seems to get locked in the nervous system with the original picture, sounds, thoughts, feelings, and so on.  Since the experience is locked there, it continues to be triggered whenever a reminder comes up.  It can the basis for a lot of discomfort and sometimes a lot of negative emotions, such as fear and helplessness that we can’t seem to control.  These are really the emotions connected with the old experience that are being triggered.  The eye movements we use in EMDR seem to unlock the nervous system and allow your brain to process the experience.  That may be what is happening in REM, or dream, sleep: The eye movements may be involved in processing the unconscious material.  The important thing to remember is that it is your own brain that will be the healing and that you are the one in control”

– Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures.  New York: The Guilford Press. pg. 123-124.

That may seem like a vague answer, but there are a lot of theories on how and why EMDR works and I don’t want to spend a ton of time explaining why (if you want to know, I suggest doing a little more research) but it gives you an idea of a few of the theories on WHY and HOW EMDR works.

So what is EMDR all about?

EMDR Therapy is a treatment program and therapeutic model that aims to help you change your relationship, neurologically, emotionally, cognitively, and physiologically with memories, trauma, disturbing cognitions, or disturbing emotions.  In using EMDR and sex therapy, I hope to use it as a therapy in and of itself with my clients, existing and new, as well as an adjunct model with clients that may have other complicated therapeutic needs but a component of the work would be appropriately addressed by EMDR.  Like I mentioned above, many clients believe that we will get right into eye movements if we are doing EMDR, but in fact, EMDR is a treatment protocol that is a lot more than just eye movements and takes time and multiple sessions to assess, prepare, and conduct.

What EMDR can do though, is incredible- it can unlock and allow you to reprocess cognitions, emotions, and sensations that you may have previously felt that there was nothing you can do about.  Trauma is everywhere, but you don’t have to suffer or struggle with trauma- you can heal and reprocess your experience of trauma.

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern.” – Elisabeth Kubler-Ross

If you aren’t located in Austin, TX and want to find an EMDR professional, the EMDR International Association (EMDRIA) is a great place to start:  FIND AN EMDR THERAPIST

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If you are in a dangerous situation or need help now: please call 911.

You can also call the National Sexual Assault Telephone Hotline: 1-800.656.HOPE (4673)

You can also call the Austin, TX Crisis Helpline: 512-472-HELP(4357)

If you are in Austin, TX (and beyond) and have been a survivor of sexual assault or trauma, here are some resources for you.

Austin, TX Victim Services Resources

The SAFE Alliance

If you are interested in FREE therapy in Austin, TX and are a survivor of sexual assault, the following organizations offer free therapy to survivors of sexual assault:

YWCA Greater Austin

SAFE Place Counseling 

• SAFE Place offers a mens survivor support group as well as individual and relationship counseling.

If you are interested in working with me, please fill out this form below and I’ll contact you within 24-48 hours to see I can be most helpful!

 

There are two common issues I see in my sex therapy practice: sex and anxiety issues and sex and attachment issues.  Generally all clients that I see come to me with one or both of these issues, and often times they are the core and fundamental route of other sexual and relationship issues that I see in my work.

I recently attended a training presented by David S. Elliot, PhD on “Healing Adult Attachment: The Three Pillars of Integrative Treatment”.  He is one of the authors of Attachment Disturbances in Adults: Treatment for Comprehensive Repair which details in depth a lot of the concepts presented here around attachment issues in adults.   A lot of this blog comes from the information in his book as well as the presentation and information along the way of being at sex therapist for over 10 years.   I will specifically attend to the issue of how I am seeing SEX and attachment present itself in my therapy practice.  Attachment concerns aren’t a DIY fix- it requires a skilled and trained therapist to take clients to a depth of repair that needs care, nurturance and support.  This book is a big one, thick and cerebral, and something that presents as an invaluable amount of information and resources for the type of therapy that I do.

What is adult attachment?

Watch this brief video on modern adult attachment to learn more about adult attachment.

Attachment affects everything that we do.  Attachment insecurities underlie a lot of mental health problems.  If we treat the attachment issue, we can treat the underlying issue for a lot of mental health issues.

Characteristics of Adult Attachment Patterns

Here are a list based on Elliot’s (2018) presentation handouts of the four main types of attachment styles.  Read through the description and see where you fall.

Jealousy can be so painful and fiery and dealing with jealousy can be even harder than experiencing it.  And jealousy is SO prevalent.  At the recent 50th Annual 2017 American Association for Sexuality Educators, Counselors, and Therapists (AASECT) in Las Vegas, NV, there was a presentation entitled “Coping with Jealousy: Tools for Individuals and Relationships” presented by Erica Marchand, PhD and it was SO popular it had to be held in the main ballroom and had nearly 500 people attend.  And it was just a break out session!  There seemed to be more people than the keynote and plenary sessions!

Why was this presentation so popular?  Because jealousy is one of the most intense and powerful and common emotions in intimate relationships.  And we’ve all felt it, and we are all afraid of it.

Most of this information was reference from the presentation by Dr. Erica Marchand and is credited to her presentation.

So what is jealousy?

Jealousy is an emotional state aroused by a perceived thereat to a valued relationship or position, involving feelings of hurt, anger, anxiety and/or betrayal, which often motivates behavior aimed at countering the threat. Jealousy is different from envy, where jealousy is a fear of losing what you have, while envy is desiring what someone else has.

Theories of Jealousy
There are a variety of theories psychologically on why jealousy occurs and why it occurs is important because it informs us as clinicians on how to treat it.  In the therapy room at SexTherapy- Online, we approach jealousy from an integrated model of all these perspectives.

From a psychodynamic and attachment perspective, jealousy is caused by painful childhood experiences, such as loss of love, loss of parent, or threat thereof and poor attachment with primary caregivers.

From a systems perspective, jealousy arises from relationship dynamics and serves a purpose in the relationship.

From a cognitive-behavioral perspective, jealousy is a learned response that can be unlearned and people can be retrained.  From a social perspective, jealousy is shaped and defined by culture and social norms.

From an evolutionary perspective, jealousy functions to guard against losing mate and/or associated resources.

Gender Differences
Men experience more jealousy in response to sexual aspects of infidelity, while women experience more jealousy about emotional aspects of infidelity.  Sometimes this is credited to evolutionary psychological factors, but its a little more complicated than that.  When working with clients, Marchand says that the evolutionary explanation washes over a lot of other relevant information and factors.  Sexual and emotional infidelity are overlapping concepts and research on gender differences and infidelity has not been replicated consistently. Jealousy and infidelity overlap a lot, but in this blog, we are really just talking about jealousy, and not aspects of infidelity.

Jealousy has been been reported at higher levers among people who have experienced infidelity, people who have been unfaithful, and person(s) with less power/status in the relationship.

Same Sex Relationships
In same sex relationships, Marchand says there is not a lot of research out there but a few items to note: gay men in monogamous relationships experience more jealousy than in non-monogamous relationships and that intimate partner violence in same sex couples is more prevalent if jealousy is present.

Consequences of Jealousy

There are significant outcomes and consequences of jealousy.  In individuals, when one or both partners are jealous, individuals experience lower self-esteem, anxiety, anger, betrayal, and hurt. Attempting to address jealousy often threatens the relationship and the person can be prone to seeking reassurance, provoking conflict, exerting control, and investing more time and energy into the relationship in efforts to increase their value in the relationship.

If that doesn’t sound EXHAUSTING, I don’t know what does!

In relationships, jealousy can often lead to hostile, aggressive or abusive behavior.  Jealousy can also mask as a perception of love, caring, and investment in the relationship (this is the argument that if one didn’t love someone, they wouldn’t be jealous).  When jealousy occurs, the partner’s reassurance as a response to jealousy is associated with greater relationship stability (I don’t see this happening ALL that often, but it does occur!)

So if you are struggling with jealousy, and need help getting out of its clutches, I can help.  Feel free to contact me at the form below or check out the Schedule An Appointment page for more information.

But here are some of the things we would be working on.  If jealousy is bothering you as an individual, we would focus on the following:

• Accepting /tolerating distress
• Increase self-esteem and perception of value
• Increase self-awareness about beliefs and experiences that are contributing to jealousy
• Increase ability to self-soothe
• Create response flexibility

I also see couples, poly-relationships, and Non-Monogamous relationships which can particularly prone to jealousy.  If you came to therapy for your relationship(s) and coping with jealousy, we’d be working on:

• Developing a critical awareness of relationship patterns
• Changing relationship dynamics
• Improving and Adjusting Communication
• Reconciliation and healing

Some questions you can get started with for homework on helping you better understand your jealousy:

For the Individual
How do you respond to jealousy?
What are your feelings, thoughts, beliefs?
What did you learn from past experiences?
– About other people and relationships?
– About acceptable or desirable responses to jealous feelings?
What do you fear losing
What do you gut-level want to do?  What do you frontal lobe level want to do?
How can you treat yourself like a valuable person?
Make a list of qualities that make you valuable.
List five affirmations a day of your value and worth.
Make a list of ways to be kind/nice/awesome to yourself
Imagine if…
What do you need to do to take care of yourself?

For the Relationship
Communication
– Create space for talking about jealousy
– Take responsibility for own feelings/validate others feelings
Make an inventory of partners relationship experiences and expectations
List how to build trust/express affection/reassurance
– Things your partner can do or say to reassure you when you feel afraid, anxious, jealous (do it for self and other person)

If there is infidelity, you will want to focus on rebuilding relationship security, ethos, self-esteem
– Create space to talk about emotions related to affair- including jealousy
– Complete above lists
– Set new boundaries/agreements
– Hurt partner rebuilding
– Atone/Atune/Attach

[The majority of this blogs content was taken from “Coping with Jealousy: Tools for Individuals and Relationships” presented by Erica Marchand, PhD at the 50th Annual 2017 AASECT Conference in Las Vegas, NV]

Still need help with dealing with jealousy, give me a call.  You don’ have to suffer alone!

What a better way to start off the year than to commit to regular STD Testing and Screening!

Recently, I recorded a podcast episode (www.lovesexatx.com) on sexually transmitted diseases and infections.  When the topic was posed by my team, I initially thought “Who is going to want to listen to an hour long podcast about STDs?”  I mean, I could talk about sexual health and STDs all day long (and many days, I talk about them a lot!) but who wants to tune in and listen to us talk about the risks and dangers of sex?

That’s when my producer stopped me and said something along the lines of “I’m not proud of it, but there were many times I abandoned any concern about my sexual safety for pleasure.  If we can just help 10 people practice safer sex, than it would be a success.”

I was speechless: he was SO right.  I guess working in the field of sex sometimes disconnects me to the average persons experience of sex, and safer sex is one of my most FAVORITE topics to talk about, so I probably take for granted how much I talk about it, and maybe how little people talk about it in their regular lives.

Since the podcast is based in Austin, TX, I wanted to make sure that listeners were provided with helpful resources of where they can get STD testing.  Some of these resources can be generalized to all of the areas I work (and beyond), but many are local and aim to provide services to people in the Austin, TX area.

The FIRST thing I will say about getting STD tested is knowing what you are getting tested for.  People will often say “I’ve been tested. I’m clean” (imposing the inherent shame that we feel about our sexual health, as if having a sexually transmitted disease means you are DIRTY).  Fun fact: More than half of all people will have STD/STI at some point in their life (American Sexual Health Association, 2016).  That means having an STD/STI is really common, so common that it seems unnecessary how much secrecy and shame we have out there about having had or currently having a sexually transmitted disease or sexually transmitted infection.  But that’s sex in this country right- riddled with secrecy and shame, often disguised as “privacy” and “modesty”, but let’s be honest- sex in many families is seen as something you don’t talk about and you don’t feel good about- hence the secrecy and shame part.

So back to WHAT you are getting tesedt for- when someone say “I’ve been tested”, they are usually referring to ONLY four diseases they have been screened for:

1. HIV (shows up as HIV AB/AG Combo or HIV 1 + 2 AB + AG or some variation): Desired result Non-reactive or Negative
2. Syphilis (shows up as RPR on your lab tests): Desired result: non-reactive or negative
3. Gonorrhea and Chlamydia, Desired Result: negative

What that doesn’t include is HPV (genital warts and can cause cervical cancer and oral cancer), Herpes, Hepatitis B & C, Trichomoniasis, or any other skin diseases that can be transmitted through blood, semen, saliva, vaginal fluids, or skin to skin contact.

The other thing, is you actually have to ASK to be tested.  And you need to be specific on what you want to have tested.  According to the American Sexual Health Association (2016), in a national survey of US physicians, fewer than one-third routinely screened patients for STDs/STIs.  That means that this is something YOU need to make a priority.  I know, it isn’t right, for something that carries so much weight, shame, and heartache, why don’t our physicians take a more proactive approach in helping us navigate sexually transmitted infections and diseases?  THAT is a great question, and a WHOLE other topic for another blog!

So know that you know what I recommend you getting tested for, here are some places in Austin, TX that will do it for a low-cost or free.

1.  First, if you have health insurance, MOST, if not all, of the above mentioned tests will be covered.  But you have to ask and you HAVE to be insistent.  In all the years I’ve been a sex therapist and have been getting regularly screened 1-2 times per year, I STILL have to insist to “regular” doctors why I need the tests I need.  Even if some years I am “low risk”, I have to explain to the doctor that my sexual health is a priority and the sexual health of my partner is also a priority.  Because of that, I need to have tests for the following:
   1. HIV
   2. Syphilis
   3. Gonorrhea
   4. Chlamydia
   5. Trichomoniasis
   6. Herpes I and II
   7. Hepatitis B and C
   8. HPV
   9. If symptomatic, yeast culture as well – CHERRY ON TOP!
      Most of these are blood tests (HIV can be a finger prick, which I don’t like).  A couple are a culture from my vagina or in men, their urethra.  I usually get fought by the practitioner (insane, I know) on 1 or 2, generally hepatitis and HPV.  HPV is a REALLY dangerous and common virus, and it isn’t always uniform on testing for it.  Women usually have it done through a pap test- for men, there isn’t an “approved” way of testing/screening unless there is a wart or lesion present.  An anal Pap test is available for those who frequently have anal sex.
2. Go to a low-cost or free clinic. Generally, my experience has been that these places are WAY more receptive at testing you for whatever you want and many accept your insurance and if you have crummy insurance or none at all, they are often very reasonably priced or FREE!  It’s often easy to get free HIV testing, whereas other tests usually aren’t free.  World Aids Day in December 1 every year is often a pretty easy day to get a free HIV test too, so you could make it an annual thing.  If you go to college or university, you can also take advantages of some of their free and low-cost STD/STI screening programs because each year, one in four teens contracts an STD/STI, one in two sexually active persons will contract an STD/STI by age 25 and about half of all new STDs/STIs in 2000 occurred among youth ages 15 to 24 (ASHA,2016).Here is where I would go (taken from the Austintx.gov website):

Austin/Travis County Health and Human Services Department

HIV Prevention & Outreach Program

15 Waller Street (and various other locations)
Austin, TX 78702
512.972.5580
FREE HIV testing
See the Mobile Outreach Van testing schedule.

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RBJ Sexually Transmitted Disease (STD) Clinic

Austin/Travis County Health and Human Services Department
15 Waller Street
Austin, TX 78702
512.972.5430
Low-cost STD/HIV Testing

Other Testing Locations

AIDS Services of Austin

7215 Cameron Rd # A
Austin, TX 78752
512.458.2437
Call for dates & times

MHMR CARE Program (Community AIDS Resources & Education)

5015 S. IH35, Suite 200-D
Austin, TX 78744
512.804.3650
FREE, confidential HIV and Hepatitis C testing
Monday and Wednesday mornings, 8:30 a.m. – 12:00 p.m.
First-come, First-served basis
Rapid test results

Planned Parenthood Downtown Clinic

1823 E 7th Street
512.477.5846
Austin, TX 78702
Rapid testing is available.
$0 – $60

Planned Parenthood North Austin Clinic

9041 Research #250
512.331.1288
Rapid testing is available.
$0 – $60

Kind Clinic

1101 W 40th St. #102
Austin, TX 78756

Any Lab Test Now

Offer a variety of tests at several Austin area locations
1.800.384.4567

LabCorp

Call 1.800.809.9252 for testing locations and cost.

STDcheck.com

Fast, private, and affordable STD testing at 10 locations in and around Austin

STD Labs

A professional STD testing service offering fast, private, and affordable STD testing.

And if you are in the Austin area, or Texas, or Maine, Massachusetts, New York or New Hampshire and are looking for some help in dealing with sexually transmitted infections, please fill out the information below and I will be happy to contact you to set up an appointment.

Sex isn’t scary, it just needs to be enjoyed responsibly!