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Breath and Good Sex

Rhiannon No Comments

There is such a strong connection between breath and good sex.  I’ve written about it before in previous blogs and if you are a client or want to be a client, you’ll know that we work a lot on deep breathing and meditation.

At the 2017 American Association for the Society of Sexuality Educators, Counselors, and Therapists (AASECT) Conference, Charlie Glickman (2017)  presented on somatic work with clients.  He stated the following statement:

“The key to really good sex is not technique: it’s breath movement and sound”.

Anyone who practices yoga or meditation will know about deep, rhythmic breathing.  And breath is a fundamental foundational exercise in the practices of tantra and orgasmic meditation. It’s an easy way to bring mindfulness, awareness, and connection to oneself and a partner.  Here is a GIF demonstrating a basic deep breathing technique.  Try it and follow along:

via GIPHY

I know what you might be thinking?  Good sex is so much more COMPLICATED than the breath- that breath and good sex might be connected but it isn’t that strong of a relationship.  I’ll challenge y0ur thinking on that by offering you a couple exercises to try with your partner next time you express yourself sexually.

 Deep Breathing Exercise (Solo or within a Relationship)

Sit or lay comfortably, either alone prior to a solo sexual session or prior to a partner(s) session.  Do deep, rhythmic breathing, or what this video calls “belly breathing”.  We suggest for 3-5 minutes and if you have a difficult time with it, do a guided breathing exercise (easily found on podcast app or this other video below.

Tantric Breathing: Breathing in Unison

Sit across from your partner comfortably so you can look into your partners eyes, some partners like to sit crossed legged, knee to knee, and some need more support from pillows and chairs.  Be comfortable- you will do this exercise for five minutes so I suggest you setting a timer.  Sit across from your partner and gaze into their eyes.  For five minutes, I want you to match each others breath while gazing into each others eyes.  Generally, one person will need to breath deeper than the others, because our lung capacity is different.  Try to breath deep together, increasing air flow and connectivity.  For more information, see my blog on Tantra Sexuality: Weaving Spirit and Sex

Tantric Breathing: Alternating Breath

Like the exercise above, but alternate breath: when one of you inhales, the other exhales. Do this for five minutes.

 

If you’d like to learn more about how to have Good Sex, listen to my podcast love.sex.ATX and the episodes dedicated to Good Sex at (love.sex.atx).

breath photo

Do-It-Yourself Dating: Part 1- Pre-Dating

Rhiannon No Comments

Do-It-Yourself Dating: Part 1- Pre-Dating

One of my favorite areas to counsel people is in the area of dating.  It is such a meaningful and exciting time for people, yet very rarely do I think people go into dating with thought, knowledge, and intention.  Dating is one of the MOST important processes in our lives, no matter what the outcome, and yet many people seem to go into dating willy nilly as if it is supposed to just be something we KNOW how to do and as if it NEVER changes over time (and we all know how it DOES change over time).

I always advise my clients to go into dating intentionally and prepared to encounter a variety of issues that will come up before and during the dating process.  And it is important to note, that dating IS a process.  It isn’t a destination but rather a journey.

In this first blog, I’m going to talk about the tasks that I advise my clients to do PRIOR to beginning dating (it will be helpful for anyone in the dating process too, but this is what I might discuss with someone who hasn’t yet dated and is thinking about dating).

Do Your Research

It’s a big ocean out there, and there truly ARE plenty of fish in the sea.  I’m pretty sure none of us would go deep sea diving without the proper training, equipment, experience etc.  While dating is much less dangerous than deep sea diving (most likely you won’t DIE dating) I’d argue that it is way more complicated.  So why would we venture off into the deep sea of dating without knowledge, training, education, and all the other stuff we need to know in order to figure out how to be successful in dating????

So in this step (the pre-dating step- as mentioned above, even if you are already in a dating relationship, these recommendations are still good to follow because they will only HELP you and your relationships), I encourage my clients to do the house cleaning they need to do as well as fill-in-the-blanks that they are missing with the training and education they lack in order to come to the table as complete as they can be.

So a few suggestions:

  1. If you have been meaning to take care of something for a while: manage a bad habit/addiction, accept your body, get your health in check, sell an old car, invest to therapy, sell a property, divorce/break up with someone, improve a sexual issue you have etc. etc., do that BEFORE you start dating.  You want to be the best version of yourself when you are out and about dating, not a work in progress, because you will be more likely to attract a work in progress if you ARE a work in progress.
  2. If you are angry, hold resentments, and/or have some old emotional baggage around exes, your parents, a middle school teacher who was an asshole, or have trauma that you haven’t processed, invest in therapy and work that out, or at least get started.  Dating and being in a relationship requires you to be present and available, and if you are tied up into past haunts and hurts, you might not be able to be there for your partner.  Don’t know a good therapist or don’t have one in your area? That’s where I come in (if you are looking for a dating coach and relationship therapist in Maine, Massachusetts, New Hampshire, New York, and Texas). Feel free to contact me at the information below.
  3. Educate yourself.  The best way I can tell you to do that is go to a relationship therapist or dating coach AND read the following books (just think, if your car wasn’t getting you where you wanted to go, you wouldn’t just read a book and it would magically be fixed- you need a professional mechanic to help you fix it so you can get where you want to go!).  The science of dating, partner selection, attachment, and everything in the world of relationships has changed over the years.  Here’s what I recommend for reading:

Start with Modern Romance by Aziz Ansari and Eric Klinenberg

A comedian and sociologist team up to talk about dating, why it sucks and why it rocks, and the historical and scientific perspective on dating, relationships, and romance.  My suggestion is to get the audio book, cause Aziz (Parks and Recreation, Master of None) reads it himself and he is FUNNY.  Most of these books are available in Audiobook, so don’t worry non-readers.

Next in my pre-dating/dating reading list is Wired for Dating by Stan Tatkin

Dr. Tatkin is a marriage and family therapist who uses the science of attachment to construct a pretty digestible theory on partner selection and modern dating.  For example, he talks about introducing your dates to your friends and family EARLY, so if there are any concerns or red flags that you can catch them well before you get attached to the person (the popular romance competition/strategy shows like the Bachelor and the Bachelorette make this mistake, which makes for great TV, because the last episode is usually when the contestant brings his/her choices home to the parents.  WAY TOO LATE, according to Tatkin’s work, because the attachment is already there).

Some of my clients LOVE Wired for Dating.   For those that don’t, I recommend Attached by Amir Levine and Rachel Heller

This book is GREAT on the science of adult attachment- why we attach and don’t attach to people, and how we can attach better and more productive to partners with different attachment styles.  Usually my clients either like Wired for Dating OR Attached (the science minded like Attached, the relationship minded like Wired).  If you are motivated, read both 🙂

My next recommendation comes with a word of caution.  The author of this book IS religious (Christian), misogynistic, and pretty heterosexist.  BUT, the work is so good I have to overlook these sometime major flaws, especially since his ideas and his theory is so simple, even the most emotionally shut off people really, really, really do connect with his five simple love languages.  The book I like for people dating is Five Love Languages: Singles Edition by Gary Chapman although he has several other versions

He also writes a mens version, but any version will do- the premise is the same and is SO helpful to so many people, and especially I find that men really get what he writes about.  It’s simple, easy to understand, and can really teach you a lot about ALL your relationships (kids, friends, pets, neighbors, co-workers, etc.).

Next on my list is taking dating to a deeper level with, Deeper Dating by Ken Page.

I love how this book suggests you read it and do the exercises with a learning buddy.  Like many of these books- they are person growth programs because ultimately, dating is about personal growth.  Learning about yourself is the number one outcome of dating, despite us thinking the opposite.  And trust me, no one has to or should do it alone- friends, dating coaches, matchmakers, therapists, family- you need help.  So make sure you ask for it.

Referencing above with Chapman’s work, I didn’t mean to imply that spirituality in dating wasn’t important in my above recommendations, in fact, it is one of THE most important things in relationships and dating.  Having a strong SPIRITUAL (not necessarily religious) connection to a power greater than oneself is an essential component of deeply pleasure sensuality and sexuality (see my blog on Spirituality and Sexuality and Tantra Sexuality).  I like this book if the Buddha dated: A Handbook for Finding Love on a Spiritual Path by Charlotte Kasl.



So once you complete those, if you want more information on partner selection and relationships, I like the (now classic) Getting the Love You Want by Harville Hendrix

Hendrix and his wife write this book on their popular Imago Therapy theory and have helped millions of couples communicate and connect.  Even if you aren’t in a couple, this book is great at figuring out who to pick, how to communicate, and making it work.

My suggestion is treat these books like a self-study.  Do the exercises, keep a journal, analyze and think, write and read, discuss it with a therapist, coach, group, and friend.  A lot of these exercises I recommend to my clients without them ever picking up a book, so you’d be surprised how much you can accomplish just from what we call in the biz bibliotherapy.  You get out of it what you put into it.

Okay, now that you are armed with all the knowledge in the world, you’ll be a total expert right?  Not really, but at least you’ll feel like, on some level, you know what is up!

What is your GOAL of dating? 

The first thing I ask my clients is “What do you want out of dating?”  There are a lot reasons why people date and it is important to know why you are dating so you can target what you are looking for.   Popular reasons people date are as follows:

  1.  To meet people and/or make friends
  2. To practice dating
  3. To have fun
  4. To hook up/be sexual/have sex
  5. To get over an ex*
  6. To find a partner
  7. To get a free meal*
  8. To occupy time
  9. To learn about yourself
  10.  Other reasons??? (Are there other reasons people date- I’m sure, but I think these cover the most common reasons)

You’ll notice I starred two of the items.  I did that because these two reasons (“To get over an ex” and “To get a free meal”) I find particularly abhorrent.  I know, the “rebound” might not be the WORST thing in the world, but dating is hard, and a lot of people are dating to find a partner and I feel its important that if you are going to embark on the process of dating that you are as close to the BEST VERSION OF YOURSELF as possible.  It’s a common belief that often times we attract people who are at the place emotionally that we are at (if on a scale from 1-10 you feel a 4 about yourself, you are likely to attract another 4- do you want a 4?).  If you are going through a break up, this is the time to heal,

and to mend, and to grow, not a time to get caught up in a new relationship that you may not be prepared to emotionally adapt to and handle the challenges.  There isn’t a set time that has to elapse before you can start dating after a break up, but you should have processed the loss of the previous relationship and feel really good about yourself by the time you get back out there and dating.

The second star was about a “free meal”.  I hear and see this a lot in the dating world.  And it is 9.9/10 being said by women.  And it is straight up exploitative.  In our culture, we often explain that “chivalry is dead”, but part of what is killing it is entitled beliefs like the fact that it is acceptable to go out on a date with someone just for the fact that you are hungry and don’t want to pay for your own food.  Men, who are expected to pay, can get resentful really fast if they feel like they are being used for a free meal, and that resentment is a horrible feeling amongst everyone.  Don’t get me wrong, as a woman, I love when a man pays.  It reminds me of my grandfather and how he used to take me out to dinner and make a big production of paying for an expensive meal and made sure I knew I was worth it.  Men paying for me is directly tied to my own self-worth (whether that is a good thing or not, I don’t know).  And I don’t take that for granted.  I am honored to have someone spend their time AND money on me, even if it is just a coffee.  Exploiting someones’ time and money is rude and I don’t approve!

So now that you have read all the books and done all the exercises (I particularly like Tatkin’s Ideal Partner Exercise and an exercise I call Red/Yellow/Green), figured out what your goal of dating is, then you should figure out how you are going to accomplish said goal.  For example, if your goal of dating is to hook up, your strategy might be different than if your goal is to meet a lifelong partner.

That’ll be Part II of the blog… so you’ll just have to stay tuned!  And in the meantime, if you need help, feel free to contact me at the contact information below.  You don’t have to do this alone!

STD Testing and Screening Available in Austin, TX

Rhiannon No Comments

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!

 

Online Sex Therapy in New Hampshire

Rhiannon No Comments

SexTherapy-Online, a private sex therapy practice that predominantly provides sex therapy and sex addiction therapy services online, got its inspiration by providing online sex therapy in New Hampshire about five years ago.

It all began when I returned to my home state, after some health concerns, to be closer to family.  I left my home of seven years in New York and moved myself, my animals, and my practice back to New Hampshire, where I was raised (interestingly enough, while I had lived in New Hampshire for the majority of my life, I was actually born in Vermont since my family originally was from the Keene, NH area, which is right near the border of New Hampshire, Vermont, and Massachusetts.

When I left New York, I opened my practice in a beautiful history building in the heart of downtown rural, sleepy Newmarket.

I loved that office and had a successful practice until my move to Austin, TX in 2014. I served clients in the Seacoast Area and since I am licensed in Maine and Massachusetts, I served clients on the North Shore of Massachusetts and Southern Maine.  The exposed brick created an impressive and healing ambience and was beloved by clients.

Six months after I moved from New York to my office in New Hampshire, I did a follow up call with my clients in New York that I had referred to my colleagues when I moved away.  I still had my license in New York and called them to see if everything was okay.  They clients wanted to continue seeing me and asked if we could start meeting online.  I had never worked online and it was 2011 and a online therapy, tele-therapy, and distanced based therapy was just a developing field so I took a leap to provide services to my previous clients and started seeing a couple clients over Skype and over the phone.

And that is how SexTherapy-Online was born!

But let’s go back to the beginning, after being born in Vermont, I lived in my first house in Winchester, NH with my Mom, Dad, and brother.  Shortly after, my parents bought the house my great-great grandfather built in the mid-1800’s and we moved into that home in Keene, NH.  Here is a photo of the home in the late 1800’s with my ancestors on the little front lawn.   My family still owns the home and it has been converted into a quaint apartment building with several units.

We moved to another home in Keene and most of my family lived in the Keene, Marlborough, Dublin, and Swanzey area.  My grandparents and an Aunt also lived in the Concord and Bow area.  When I was in second grade, I moved to Walpole, NH and went to Walpole School and then Fall Mountain Regional High School.  I graduated from Exeter High School in Exeter, NH and lived in Exeter for my final year before leaving the state for college (see my previous posts on online sex therapy in Massachusetts).

I was an active member of my local 4-H and showed in Dairy and Horse 4-H at the Cheshire County Fair and New Hampshire State 4-H Horse Shows.  My main hobby as a kid and teenager was my horse, Yomen, who I still show and own today.

While I have lived and loved other places and most family members have long left the state, New Hampshire still is considered where I grew up and I hold it dear in my heart.  I periodically return to visit with the remaining family and to have an annual canoe trip with friends.

If you live in New Hampshire and are seeking online sex therapy, feel free to give me a call or contact me on the form below.

Online Sex Addiction Therapy Group for Men Beginning

Rhiannon No Comments

Online Sex Addiction Therapy Group for Men Beginning May 2, 2016

An online sex addiction therapy group is beginning for men on May 2, 2016.  Establishing a culture of support and reducing isolation are essential tasks in early and long-standing recovery for sexual compulsivity, sex addiction, problematic sexual behavior, and/or unhealthy sexual behavior.  While 12-step groups offer a wonderful way of working with folks that struggle with the same things that others may be struggling with, not everyone is comfortable with the 12-step model, comfortable with going to a 12-step meeting, available during times when meetings meet, or have access at all to 12-step meetings.  And some people would like a more therapeutic approach to their group work as part of their therapy and recovery.  This group can be in addition to 12-step work or instead of.

Accessibility and Scope
An online sex addiction therapy group may be exactly what is needed, and due to demand and lack of resources for group work in the underserved areas of the states I work in (Maine, Massachusetts, New Hampshire, New York, and Texas), I’ve decided to offer an online sex addiction therapy group for men beginning May 2, 2016.  Please email me for me details.

While I am generally limiting my scope to clients residing in the states that I am licensed in (ME, MA, NH, NY, and TX), some states offer exceptions/exemptions on working with a therapist who is licensed in another jurisdiction.  If you are from another state and would like your client or you to join our group therapy group, a call will need to be placed to the Board of Mental Health Practice, Licensing Board for Marriage and Family Therapists, or other licensing body to see if one can work in this group.

Format
The group will be an hour long and will draw from a variety of therapeutic modalities including psychoeducational, cognitive-behavioral, skills development, support, and interpersonal process group therapy.  I am eclectic in my work with clients who are struggling with sexual behavior and draw from all work that is good and effective, including Patrick Carnes work.  My work not only addresses problematic sexual behavior, but healthy sexual behavior with oneself and partner(s).

 

Please feel free to contact me with more questions or for more information.

 

Sex Coaching, Sex Counseling, Sex Therapy

Rhiannon No Comments

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.

“Female Viagara” Treatment for Low Sexual Desire: Win or loss for Female Sexual Health

Rhiannon No Comments

A lot of press has been given to the FDA Approval of flibanserin or Addyi, marketed as the “Female Viagara” by the media in the last few months and I wanted to briefly weigh in on my thoughts about this pharmaceutical.

First, flibanserin really isn’t the “female viagara” as Viagara for men works with the arousal system of a male (helping a client to keep and maintain an erection).  Flibanserin actually has been promoted to address female sexual desire, not arousal, so the nickname isn’t really suited.  Although I wouldn’t recommend promoting this, if we wanted to come up with a more accurate nickname for flibanserin, “pharmaceutical foreplay” might be more appropriate… (please don’t publish that or quote me on that!)

Second, there has been a lot of concern about the negative side effects and possible harmful side effects of this medication.  I’m not going to really take a stance on that because every medication ever invented has negative side effects and when a physician makes the decision to prescribe a medication to their patient, they do so hopefully knowing and hopefully being fully aware of the side effects and have made the decision to prescribe this drug, because they believe that the BENEFIT outweighs the RISK to the patient.  All drugs have side effects, some positive, but many negative or harmful.  What I will say, is that doctors are NOTORIOUS for not going over the side effects of medications (or not being aware of the side effects) so this is something I am going to be firm on.  Don’t rely on your doctors to go over this with you- be your own advocate and research the side effects and know what you are taking.  Track those side effects over a period of time and be aware of what you can and can not tolerate.  Track the positive benefits as well- you don’t want to be taking a drug that doesn’t work or does more harm than good.  And clinicians, take the time to go over the side effects with your clients as well.  It might save everyone a lot of time and effort around treatment if everyone is informed.

Third, my main issue with flibanserin is the same issue I have for all pharmaceuticals prescribed that aim to address a sexual issue: if the mechanism of change is not targeted at the reason for the problem, the drug will likely not be effective.  Taking a pill, that is supposed to fix your issue, and then when it doesn’t, can just REINFORCE the problem.  A failed attempt at solution can often just be more fuel to the fire of the problem.

I’ll demonstrate:

I guest lectured at St. Edwards University in Austin, TX in a graduate-level counseling and marriage and family therapy course and we were discussing the diagnosis, assessment, and treatment planning for sexual dysfunctions.  I asked the class to pick a sexual issue that a client might present with for therapy.  The class chose one of the most common sexual dysfunctions: low sexual desire in females.  The next activity I had them do is to come up with all the reasons why a woman might have low sexual desire or low libido.  Here is the list they came up with (in no particular order):
Depression
Anxiety
Low Sexual Self Confidence
Religious Concerns
Cultural Concerns
Medication Side Effects
Communication Issues in the Relationship
Communication Issues about Sex
Sexual Orientation Issues
Gender Identity Issues
Body Image Issues
Stress
Not Enough Time
The Sex Isn’t Good
Lack of Creativity or Novelty in Sex
Pain or Discomfort
Illness
Post-Traumatic Stress Disorder
Lack of Pleasure In Sex (no orgasm)
Dysfunctional Meaning of Sex
Fertility/Hormone Issues
Feeling Pressured to Have Sex
Lack of Foreplay

These are all causes of low libido or low sexual desire or female hypoactive sexual desire disorder (as according to the DSM-V).  Flibanserin doesn’t say that they treat ANY OF THE ABOVE ISSUES, so then, readers, can you see how this drug might not be that effective if it DOESN’T TREAT THE ROOT CAUSE OR CAUSES OF THE ACTUAL LOW DESIRE!  So, I am sure you can understand that if depression is one of the main contributing factors to low desire, and a woman takes flibanserin to increase desire, it might not work.  And if it doesn’t work, how do you think that “failure” of that specific intervention might contribute the main contributing factor of depression.  It would likely increase it!

Fourth, and final, thing I would like to say about this drug.  I am a firm believer of having a lot of different tools in your toolbox for your issues.  And I am also a believer that you can never have enough tools- in life and in your “real” toolbox!  So I support flibanserin as a tool in our toolboxes to treat low desire.  However, just as you wouldn’t use a screwdriver to hammer in a nail, you wouldn’t use flibanserin to resolve low desire if that isn’t the tool you need.  How do you decide which tool you need?  That is a great question to answer in collaboration with a qualified and certified sex therapist.

I am choosing intentionally not to mention anything about the “equality” of having a drug for women that addresses sexual functioning.  The makers of flibanserin started a “Even the Score” Campaign in efforts to rally support around the FDA-approval and subsequent manufacturing and sale of the drug.  The idea was that it is only “fair” and “equal” if women have a drug to address sexual functioning just like the men (amongst other ideas).  The only thing I will say about that is that as soon as you start keeping score with something, everyone has already lost.  There are no winners.

If you are struggling with low desire, low libido, hypoactive sexual desire disorder, whether male or female, I can help.

 

Is it cheating or sex addiction?

Rhiannon No Comments

Is it cheating or sex addiction? I get this question a lot, often from spouses who have been betrayed and are trying to understand their partner’s behaviors. It’s a complex question, with an even more complex answer. The diagnosis of a sex addiction is controversial both in the field of sex therapy and mental health therapy, as well as in pop culture and mainstream opinion. There’s no doubt in my mind that sex addiction exists, and sometimes I find it interesting that people are so adamant about insisting that it does not exist. Sometimes I wonder if those who insist that it doesn’t exist have ever struggled with sex and love addiction or have ever worked with clients that have struggled with sex and love addiction. It isn’t my style to debate controversial issues on my blog or  in public forums, so I’m just going to present my views on this topic based on my experience, training, and knowledge.

Cheating
As complex as this question is, so are the two types of behaviors that we are discussing. “Cheating” can be defined in a million different ways  and is often highly individualized and based on what the individuals and the couple constructs as the boundaries of their relationships.  These boundaries can be affected by many socio-cultural factors such as culture, ethnicity, geography, religion, age, generation, time period, gender, sexual orientation, social group, and on and on.

For the purpose of this article I will just simply define cheating as having relationships, either sexual, emotional, or both, outside a committed relationship where monogamy and exclusivity is either implied or explicitly expected. This is important because often times people will insist that it wasn’t “cheating”, because they were on a break, or they were just starting to date. But if exclusivity was implied at any point during the time in question, either verbally, nonverbally, physically, or non-physically, then it likely could still be considered cheating.  Another question I always ask is “Did it feel like cheating?” Even if something falls in the gray area of cheating or not, if it feels like cheating, it likely should be treated like cheating.

Another important thing to note is that different relationships define “cheating” differently. It would be important to determine what the relationship considers cheating before assigning someone the label as a “cheater”. For example, does the relationship consider watching pornography cheating? Does the relationship consider going to an adult film store and watching a private movie cheating? Does the relationship consider going to a strip club cheating? What about sensual massages (happy endings)?  Prostitutes?

While in most relationships cheating is often defined as being sexual with other people, there’s a lot of gray area in defining what cheating is and is not.

Sex Addiction
There are many definitions of what a “sex addiction” is and generally the definitions involve some problematic sexual behaviors with an inability/unwillingness to stop despite consequences.  While people commonly use the term “sex addiction”, I usually like to allow my clients to define for themselves when we discuss the issues.  I often use “compulsive sexual behavior”, “problematic sexual behavior”, “unhealthy sexual behavior”, etc. as ways to describe behaviors that my clients present with.  Not all problematic sexual behavior falls into the definition of addiction, but the treatment is often similar.   However I’m not afraid to call a spade a spade and if it walks like a duck, looks like a duck, and quacks like a duck, then sometimes I will just tell the client it is a duck.

What I don’t encourage is having other people make that diagnosis for the client.  Often times another therapist, a spouse, a partner, family, and friends will assign the client a diagnosis in efforts to understand the behavior. A diagnosis should be a collaborative decision, between a qualified professional who has experience diagnosis and working with clients with sex and love addiction and the client and, if appropriate, the partner.  The goal of a diagnosis or label is to help the client gain awareness and understanding and eventually healing from the issues they are struggling with.  I often cringe at the word “diagnosis” as I sometimes feel that diagnosing or labeling a client is sometimes counterproductive, but many times offering a label or diagnosis can get the client started on a path to recovery through resources, meetings, groups, and other things that have an immense therapeutic value.

Diagnoses or labels should not be used for the purpose of understanding someone’s behavior, to make excuses for that person, or blame that person or something beside that persons for what is happening.   I sometimes see partners of those who had cheated or who have a sex addiction looking for a label as a way to understand their partner’s behaviors. For example, it is not uncommon for a partner to want to label their partner as a cheater rather than a sex addict because the label of a sex addict seems so much more negative or severe than a cheater. On the other hand, some partners want the diagnosis of a sex addiction because it’s easier to understand it as a disease rather than a choice.    A diagnosis and/or label of sex addiction or cheating should be one that is collaboratively made between a client and their therapist and can  involve the partner as long as it is appropriate to include the partner in this process.  A time when including the partner in the diagnosis would be contraindicated is when the partner attempts to skew the diagnosis for their own understanding or if the partner is more concerned about their needs for a certain diagnosis than for the needs of the client who is attempting to receive treatment for their behavior.  This is a fine and delicate line and should not be addressed without the consultation of a qualified professional who specializes in infidelity, affairs, cheating, and sex addiction.

Denial and Compartmentalizing
Denial and compartmentalizing are back-up dancers to the leads of sex addiction and cheating.  Without denial or compartmentalizing behaviors, neither cheating or sex addiction would be able to exist in the context of problematic sexual behavior.  Very rarely do I see cheating and sex addiction without some form of denial and compartmentalizing of behavior.  While denial is defined as not facing a fact because it is too uncomfortable to accept, compartmentalizing is an unconscious (or conscious) psychological defense mechanism used to avoid the discomfort of anxiety and discomfort caused by conflicting values, behaviors, thoughts, and actions.  Both run rampant in these situations and are often part of the first stage of treatment for sex addiction and cheating.

Is it cheating or sex addiction? No Internet resources would truly be able to point you in a  definitive answer. You should consult with a qualified sex therapist for sex addiction therapist before trying to self diagnose. I’d be happy to help you with this. Please feel free to call or email me for more information or to set up an appointment.  I can be reached at rhiannon[at]sextherapy-online.com or 603.770.5099 or 512.765-4741.  Or you can fill out the form below and I will contact you!