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.

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

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?

Photo by Quasic

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!

Being nearly 10 years in practice, over the last decade, I have been able to identify some common barriers to good sex within relationships.  Here is a brief blog on some common barriers I have found.  If you have some of these barriers, it’s important to do the work to remove them or help limit the effects that these barriers have on your sex life.

Trauma
Unresolved and/or complex trauma is a huge barrier to good sex.  It’s also a barrier to general happiness and satisfaction in life and can be one of the main sources of anxiety, depression, and other mental health concerns.  And any type of trauma (even if it is not sexual) can impact your sex life.

Grief and Loss
I see grief and loss as one of the main causes of sexual functioning concerns and sexual disatisfaction in a persons life.  Whether active or unresolved, grief and loss appears to directly affect the sexual functioning system and it would be worth the time to resolve and do work around this.

Photo by dryhead

Fear
Fear of anything, nothing, and/or everything can create a barriers to good sex.  We live in a fear based society and fear is instilled inside of us from a very early age.  Fear greatly affects our ability to feel safe with ourselves and partners and in the world and can be huge barriers to good sex.

Lack of Knowledge
Most people don’t feel super knowledgeable about sex and a lack of knowledge about sex can be a barrier of good sex.  I encourage my clients to be “students of sex”, lifelong learners, recognizing that there is no ceiling on how much one can learn about sex.  I will never stop learning about sex, and I sometimes feel like there is so much to learn about sex I will never learn it all, and this is MY profession!  Sex is an never-ending journey- an EXCITING never-ending journey.  Buckle up and enjoy the ride!

Lack of Experience
Experience doesn’t mean competence, but our culture often values more experience as being more competent.  Lack of experience can often create a barrier to good sex, but it doesn’t have to.  As mentioned above, we are lifelong students of sex.  Since we have our whole lives to learn about sex, experience is all relative and quantity is not more important than quality.

Low Sexual Self Confidence
Self-esteem and self-confidence is a huge contributor to whether sex is good or not, and if you have low sexual self confidence and low sexual self-esteem, it can be a great barrier to good sex.

Body Image Issues
I generally believe that you have to feel pretty good about your body in order to want to share it with someone else.  If someone doesn’t feel good about their body, they often don’t feel like sharing it with others.  Body image issues can be huge barriers to good sex.

Closed Mindedness
The most common way I see closed mindness coming up is when people think that they know what sex is supposed to be like, or what their partner is supposed to be like or like.  It’s this closed mindedness to the individuality and nuances of sexuality that prevents good sex from happening.

Perfectionism
Human beings and SEX is imperfect.  Having a perfectionistic attitude toward life and sex is a HUGE barrier to good sex.

Marijuana and Sex: My General Thoughts on Therapeutic Cannabis for Sexual Functioning

This November, Maine and Massachusetts, two of the states that I provide online sex therapy to their residents, pass laws legalizing recreational marijuana for consumers over the age of 21 (making the laws similar to alcohol consumption).

Photo by “Caveman Chuck” Coker

I have long had many thoughts about the therapeutic use of marijuana/cannabis/THC for certain sexual functions in certain people but haven’t really had the science or empirical proof to back up anecdotal reports.  But as we start to move into a new era around the use of marijuana, I just want to make a general statement that marijuana is worth researching on its negative and POSITIVE effects for some sexual functioning concerns.  That’s right, positive.

That isn’t a general statement that I want everyone to think to just use marijuana for sex.  That isn’t what I am saying at all, because some usage can actually harm sexual functioning.  But for certain sexual functions, it has been reported that therapeutic cannabis actually do a lot of good.  But there are a lot of factors, like type of marijuana, dosage, routes of transmission, etc. and sometimes the costs are not worth the benefits.

I particularly like some of the sex specific products that are being developed, such as lube with THC infused in it, so the route of transmission is vaginally or anally.  And for certain issues (like desire, performance anxiety, and pre-orgasmia in women) it has been reported that marijuana has really helped in improving the negative symptoms of these issues.

Photo by “Caveman Chuck” Coker

But like with anything that could be harmful or helpful, or a little bit of both, I like to talk to my clients about staying within the boundaries and balance of what is legal, moral, and ethical and when the benefits outweigh the risks.  We discuss manageable use, just as we would discuss if we were to use any substance for sexual functioning.

Want to talk about this more?  Email me at the contact information below and we can set up an appointment.

“FOOD IS MEDICINE” says Dr. Michael Lara, a physician in private practice from San Francisco in his seminar on “The Pharmacy in Your Kitchen: An Overview of Medical and Medicinal Food”.

“Let food by thy medicine and medicine be thy food” – Hippocrates

The content in this blog is based on information gathered from the above titled seminar that took place on Thursday February 18, 2016.  Most of the information presented in this blog was acquired from the presentation and accompanying materials.  If you have any questions about what is written here, please feel free to contact me directly or connect with Dr.Michael Lara through Facebook: www.Facebook.com/BrainMD and his website: www.drmikelara.com.

Please be sure to check with a qualified health professional before implementing any medical or medicinal food protocol.  Food is medicine and also has a potential to harm.  It’s important to include your health care provider(s) in the conversation to keep you safe and maximize benefit.  

87% of Americans believe that certain foods have health benefits that go beyond basic nutrition.  But most doctors and physicians don’t think of medical foods when discussing health concerns and treatment options with their patients.  I signed up for the seminar to see what the options are out there for my clients when dealing with sexual concerns as well as other health conditions, like depression, insomnia, and chronic pain.

Photo by Michael Stern

What is a medical food?
The FDA defines Medical Food as “A food which is formulated to be consumed or administered enterally through the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”

Medical foods aren’t regular foods, but rather the dietary products formulated for the management of diseases for which specific nutritional requirements have been established.  They aren’t drugs or dietary supplements and are monitored separately by the FDA. All efficacy claims for medical foods must be based on recognized scientific principles and clinical data and medical foods may be used only under medical supervision (but may or may not require a prescription).

Medical foods are different than supplements and drugs, and are regulated by the FDA.

The purpose of this blog is to discuss the use of medical and medicinal foods in relation to sexual functioning as well as other conditions that my clients present with.

Medical Foods and Mechanisms of Actions

Medical foods affect three mechanism of actions: neurotransmitters, inflammation, and nutrient metabolism.  While much of the research presented deal with conditions related to diseases such as Alzheimers, osteoarthritis, and insulin resistance, medical foods also address sleep issues, depression, pain, inflammation, chronic pain, neuropathy, and metabolic issues.

The mechanism of action that I found very interesting and relevant was medical foods that alter neurotransmitter levels.  One of the biggest challenges I have as a sex therapist is working with clients who have various mental health concerns such as anxiety and depression who take psychopharmaceuticals to address the anxiety and depression.  They often present with sexual issues related to the anxiety and depression AND/OR the side effects related to taking psychopharmaceuticals to treat the anxiety of depression.  We sometimes feel very stuck when trying to address the sexual issues while at the same time effectively managing the anxiety, depression, or other health concern.

Medical Foods and Depression

Medical foods that affect neurotransmitters can offer options to address depression without the side effects to sexual functioning.

Deplin (L-Methylfolate) is a medical food for patients with treatment-resistant depression.  While Deplin may require a prescription, L-Methylfolate can be purchased over the counter.  L-Methylfolate improves depression and reduces markers of inflammation.  And even more interesting is that there are tests that can be done (and more and more mainstream doctors are having patients have these tests) that can tell you whether you are deficient in some of these areas.   Dr. Lara recommends the company 23 and Me for genetic testing to see if you have deficiencies in areas that could benefit from targeted treatment based on the results.  .

Dr. Lara presented extensively on curcumin (found in spice tumeric and mustard) which can have anti-depressant effects via MAO Inhibition as well as other positive benefits.

Medical Foods and Sleep Issues

MANY of my clients struggle with sleep issues, and medical foods might provide an alternative to sleep medications that might have unpleasant side effects, be highly addictive, quickly increase tolerance, and diminish the quality of your general sleep.  A medical food that may work on sleep issues through acting on neurotransmitters is Gabadone.

Medical Foods and Sexual Functioning 

While I wish Dr. Lara spent more time discussing the benefits of medical foods for sexual functioning (even if just periphery, like, how a medical food can reduce inflammation, possibly inflammation in the genital region due to issues that cause sexual pain, or how medical foods can affect the neuropathy of sexual organs), he did spend some time talking about the benefits of Cocoa and Maca.

Cocoa is derived from the trees and considered the”drink of the gods” and is  rich in anti-oxidants.  Dr. Lara made it clear that he wasn’t talking about Milk Chocolate (and a groan ensued from the crowd) but dark, unsweetened 70%+ cacao.  Optimal dose is 10 grams a day.

Maca is a plant that grows in central Peru in the high plateaus of the Andes mountains. It has been  harvested as a vegetable crop in Peru for at least 3000 years. Maca is a close relative of the radish. Maca has been linked to helping with low desire, sexual dysfunction, erectile dysfunction, hormonal issues, symptoms of menopause, and menstrual problems.   To be clear, Maca is not a medicinal food, but when combined with cocoa, it can have medicinal affects.  Maca Cocoa a libido-enhancing antioxidant drink.  It also can reduce the effects of menopause without affecting the hormones and has been reported to increase the subjective feelings of well-being.  

Natural Food Sources

While there are several products that can provide some of the medicinal foods to you, it has been stated that the best way to get some of these medicinal foods is through actual FOODS!  A great resource to see how much a food has of what you are looking for is the USDA National Nutrient Database for Standard Reference (http://ndb.nal.usda.gov/),  The website is a great way to find natural sources of nutrients mentioned above in your food.

Working With Practitioners That Can Help You 

Dr. Lara stated that most doctors don’t prescribe or recommend medical food because they don’t know about them.  If you are interested in learning more about medical food, especially medical food for sexual functioning, you will want to seek out one of the following providers who are trained and educated on using medical foods for sexual functioning (or just general use): Naturopaths, Osteopaths, and Functional Medicine Doctors are all trained and educated in working with supplements and medical foods.  You can find information on these practitioners at the following websites:

Institute for Functional Medicine: https://www.functionalmedicine.org
American Association of Naturopathic Practitioners: http://www.naturopathic.org
American Osteopathic Association: https://www.osteopathic.org/

Overall, the presentation was well-done and informative, although there wasn’t a whole lot of information presented about sexual functioning.  But very valuable information that is relevant to my work is how there are a multitude of options around medical food and insomnia and depression, which are often confounding conditions that affect my clients.  Medical foods may offer options to many clients with a variety of medical issues that could be effective in treating their condition while reducing or eliminating the sexual side effects of the issues themselves (one of the hallmark symptoms of depression is low sexual desire) and psychopharmaceuticals and other drugs.  While there really isn’t a lot of data on the efficacy of medical food for sexual functioning, its a growing area that has a lot of fascinating implications.   Definitely worth asking your healthcare provider about.

There are so many words that people type into search engines when they are looking for some extra help in their sex lives (sex coaching, sex counseling, sex therapy), and sometimes when I am looking through my website data, I am surprised at what people search for, and how many different spellings of sex therapy people can create (sex therpy, sex thrapy, sexthreapy, sex theropy, sex terapy, sex thearapy, sex thearpy, sex therepy, and on and on).  People search for services like sex counseling, sex coaching, sex therapy, sex advice, and sex education and search for a professional like a sex counselor, sex therapist, sex educator, and sex coach.

I also get a lot of questions what the difference is between a sexual therapist, a sexual counselor, and a sexual coach. Then some of the questions go even further on if I am a surrogate partner therapist or provide any hands-on instruction/sex services.  To be clear, I am not a surrogate partner or a sex worker.  Most people realize they have made the wrong call pretty quick but if they stay on the line long enough, they usually realize that they could use my services!

As a Licensed Marriage and Family Therapist and Certified Sex Therapist, I often get asked if I do sex coaching and what the difference between sex coaching, sex counseling and sex therapy are.  These are important questions because it will matter how you proceed in seeking out the services you are looking for and what professionals you work with.  I will start by addressing what I do.

I am a Licensed Marriage and Family Therapist in the states of Maine, Massachusetts, New York, New Hampshire, and Texas, and an American Association for Sexuality Educators, Counselors, and Therapists (AASECT) Certified Sex Therapist, I provide sex counseling and sex therapy to individuals and relationships.

Sex Counseling vs. Sex Therapy
While counseling and therapy are used interchangeably in the mental health world, in the sexual health world, the certifying body for sexual therapy, sexual counseling, and sexual education, the American Association for Sexuality Educators, Counselors, and Therapists (AASECT) delineates a sex therapist from a sex counselor.

“AASECT Certified Sex Therapists are licensed mental health professionals, trained to provide in-depth psychotherapy, who have specialized in treating clients with sexual issues and concerns. In the absence of available licensure, they are certified, registered, or clinical members of a national psychotherapy organization. Sex therapists work with simple sexual concerns also, but in addition, where appropriate, are prepared to provide comprehensive and intensive psychotherapy over an extended period of time in more complex cases.

AASECT Certified Sexuality Counselors represent a variety of professions, ranging from medicine to the clergy. Examples of sexuality counselors are Planned Parenthood counselors, nurses and other health professionals, school counselors, and clinical pastoral care and counseling providers. Counselors assist the client to realistically resolve concerns through the introduction of problem solving techniques of communication as well as providing accurate information and relevant suggestions of specific exercises and techniques in sexual expression. Sexuality counseling is generally short term and client centered, focusing on the immediate concern or problem.”  www.AASECT.org

A sex therapist does sex counseling and sex therapy.  A sex counselor is more limited in their scope.  For more information on the scope of an AASECT Certified Sexuality Counselor and Therapist, click here.

So when you are searching for general counseling or general therapy, you would essential be searching for the same thing, but when it is sex specific, you may be looking at something different.  An interesting point, however, is that the word counseling is often more searched on the internet than therapy, which can also provide some insight that more people refer to”counseling” than “therapy” (and might make the language even a little bit more confusing around what direction to take), but as an AASECT Certified Sex Therapist, I provide sex counseling AND sex therapy.

It can be a little confusing when discussing the different professions practicing sex therapy.  There are social workers, mental health counselors, pastoral counselors, art therapists, psychologists, etc.  Psychology Today, a great online directory for mental health therapists, has a wonderful link to the differences between the professions here.

It is important that anyone seeking out sexual therapy or sexual counseling is an educated consumer and knows the credentials of their therapist or counselor.  Don’t be afraid to ask your counselor for their credentials, what fields they specialize in, and their training and expertise.  You wouldn’t go to a orthopedic surgeon for a skin rash, so don’t go to a sex therapist that isn’t trained in your presenting problem (but keep in mind, what you define your presenting problem may not actually be the problem at all).

And there is something to be said about this fact: that there are some excellent sex therapists and sex counselors out there that are not “certified”.  However, there are way MORE therapists out there that say they “do” sex therapy or sex counseling, but don’t have the adequate training, knowledge, and experience to work with your sexual issues.  As mentioned above, be an educated consumer and do your homework about the qualifications, experience, knowledge, and training of your sex therapist or sex counselor.

What is sex coaching?
Sex coaching gets a little more complicated as there isn’t a lot of regulation around what the term “sex coach” is.  A dear colleague of mine feels very passionate about sex coaching and her, along with her competent team of experts, have created a training program for Sex Coaches.  Since there isn’t a lot of regulation around sex coaches, although last time that I checked with her, she was trying to get AASECT to recognize coaches as a certification level, it may be hard to determine who is actually a qualified sex coach and who isn’t.

I am a sex therapist but do sex coaching.  Sex coaching is about providing educational and instructional methods for sex and intimacy.  However, since I am also a sex therapist and counselor, I will always operate with that ethical code in mind regardless of the service I offer.  That means that where some sex coaches who aren’t regulated by a licensing or certification board may engage in some interventions or recommendations, I would not if it violates my code of ethics or my professional boundaries.  Coaching often aims to stay in the here and now and the future, and doesn’t specifically focus on any past or current traumas or intensive work.  In general, I find that most people benefit at first from counseling and therapy and once issues that are contributing to/creating the sexual issues are addressed, if their sexual issue remains, then a coaching approach may be the next step.  That transition can be easily made with my clients and it isn’t necessary to delineate the approach within the work since even if we are working with coaching techniques, my professional identity and integrity is always as a sex therapist.

I believe the word “coaching” attracts people because it implies that they will just be told what needs to be done and as long as they follow it their lives will be better.  Sexual therapy or sexual counseling seems like hard work or very “deep” so people are attracted to coaching because it is more about behavioral change.  As a therapist and counselor, I caution those that look to sex coaching and not to sex therapy or sex counseling.  A good sex therapist will help construct new solutions with their clients, not direct or provide advice based on their own experiences to a client.  A good sex therapist will leave their own experiences at the door (unless therapeutically relevant) and understand that their clients experiences are independent of their own.  Also, sometimes a course of sex therapy or sex counseling can greatly improve the situation or completely resolve the situation, whereas coaching may not have because it did not attend to the causal/maintenance factors that required therapy.

While I am not trying to fault coaching, after all, help comes in many different forms and if it works for you, then keep doing it.  I am just trying to caution those clients who seek out sex coaching when they really need sex counseling or sex therapy.

If you feel like you are unsure of which route to take, contact me at the information below  to talk more to a sex therapist about your goals and which route would be best for you.

All clients that come through my practice first start with a comprehensive sexual assessment.  Within that sexual assessment, I analyze all your current medications, as many of them unknowingly have negative sexual side effects.  Even if it doesn’t say so on the literature, many medications can have a negative affect on your sexual functioning.

It is important that if you are experiencing some sexual issues, that you take a look at the medication that you are taking to see if there are sexual side effects.   Often, clients will come to their first session with a list of medications, many or all of which have some reported sexual side effect, and have no idea that they are currently taking things that can inhibit their sexual functioning.

I call it “swimming upstream” (no sexual pun intended!) when you try to resolve a sexual issue when you don’t realistically look at the health and medical issues a client might have, and this includes medication.  For some one with erectile issues or early ejaculation who is on medication that has erectile issues as a side effect, all the sex therapy in the world isn’t going to be able to overcome that medicine-induced side effect.

Common culprits are blood pressure medications and almost all of the psychopharmaceuticals that treat anxiety and depression (which is interesting because many folks have no idea that their anti-depressant could be the main reason behind their ability not to have an orgasm, get an erection, etc.).

What can you do?  Read the information provided with your prescription and do a little web searching to see what others have to say about it.  If you find that your medication has a sexual side effect, make an appointment with your doctor and see if there are alternatives to the medication with lesser or no sexual side effects.  You may have other options with other medication or other treatment options that don’t have any negative affect on your sexual functioning.

Once you are done with that, schedule an appointment with SexTherapy-Online 🙂