Category Archives: Uncategorized

By Aly Pancer, Mindful Wellness Coach

Happy 2022! We have arrived at a brand new year, with brand new beginnings, goals, hopes, and dreams. We get to begin again. We set New Year’s Resolutions that include better nutrition, better sleep cycles, a regular exercise routine, and the decision to lose weight. We then pick an ideal weight and size, and go on a diet where we learn to restrict food in an effort to become thinner than we are. We tell ourselves we will start our diet on Monday. “In fact, by the end of December, many people have made that promise to themselves 52 times” (Merendes, Gabriel, MD, Mayo Clinic, 2021).

Food. We need it, we crave it, we love it, and sometimes we have a challenging attachment to it. Like the diverse and negative attachments we enact in romantic relationships, our relationship to food itself is a symptom of how we are anxiously, avoidant or securely attached to our self. Many folks try to have three meals per day with a few snacks in between. Often, we are eating a meal or snack while multitasking, such as watching TV, checking Instagram, watching the latest Tik Tok video our friends shared, socializing, working, walking, driving, etc. We take the first bite of what we have chosen to eat, enjoy the taste, and then continue to eat the rest of our food in auto pilot, where we have stopped paying attention to what we are eating. The next thing we know: we are stuffed, feel bloated, and more often than not, we have finished everything on our plate. Then what follows usually are the twin emotions of guilt and shame into a spiral of negative attachment to ourselves and food.

Frequently people blame ourselves for having consumed too much. This can lead to a cycle of feeling depressed, anxious, self-conscious and isolated for overeating. They shame and criticize the way their body looks, which can lead us into developing eating disorders. “While there is no single cause of eating disorders, research indicates that body dissatisfaction is the best-known contributor to the development of anorexia nervosa and bulimia nervosa (Stice, 2002)”. Distorted thoughts encourage people to climb onto the scale too often, or ignore it all together as part of an avoidant attachment to their bodies. An attempt to fit into clothes that are sizes too small in an effort to be the “ideal size” only furthers a magical thinking that leads to unrealistic diet fantasies. Many folks feel helpless if they dare to look at themselves in the mirror perhaps even calling themselves some negative names we believe describe our bodies.

The fantasy continue as people make 2022 New Years’ resolutions by restricting food through diets, fasting, and other unhealthy rules about food in an effort to reach a goal weight which feeds into the multi-billion dollar industry of diets. There have been a slew of recent articles about Noom arguing that the way it markets itself as the ‘un-diet’ is just good marketing.

Consider for a moment changing your relationship with your food by exchanging the words and actions of “MindLESS Eating” to “MindFUL Eating”. What would that look like? How would it feel to abandon many fad diets, where you are being told about how to eat, what to eat, how much to eat, etc by others? How would it feel to be guided by your OWN cravings and satiety cues, from the inside out, using mindfulness techniques for yourself, so that you can organically enjoy your food, moment by moment, bite by bite, and feel a secure attachment to your body and ultimately yourself?

The Mindful Eating skills I teach through coaching are based on the Mindfulness Based Stress Reduction model pioneered by Jon Kabat-Zinn. It invites you to slow down the pace of eating, to awaken all your senses, to focus on every bite you take and ultimately to give yourself permission to stop eating when you notice you are satiated.

I find it exciting to work with mindful eating clients who are eager to establish a wellness journey that focuses on intention and practice rather than fantasy and anxious attachment. One can create a secure relationship to food, and in doing so, be fully present, embodied and able to show up fully in their life.

“So Are You Seeing Anyone?”: Single Folx Experiences of Holiday Family “Diss”-Stress

December 20, 2021

Sari Cooper

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From the end of December through January 1st many people will spend time with their families to celebrate Christmas, for non-religious gatherings, and to welcome in the New Year. Generations of family members will gather at dining tables across the country to share meals and spend time catching up on their lives since last holiday season or, for many, since before the pandemic. For some, these gatherings are something to look forward to, but for others–particularly young couples and single people–they can be stressful. While 95 percent of people believe that spending time with family around the holidays is important, 40 percent admit it is stressful to do so, and 45 percent of Americans say they would rather skip out on celebrations than deal with the stress.

Some couples, like many I see in couples sex therapy, have unresolved psychological and emotional dynamics with their parents, in-laws, siblings, and/or extended family. For these people, celebrations can be experienced more as obligations. Couples with children often describe attending holiday gatherings as a sacrifice they are willing to make so that their children can experience extended family rituals. I advise partners to create non-verbal signals to one another so they can take breaks when triggered by a relative’s comment or leave when their bandwidth for conversation runs out.

My single psychotherapy clients experience the added emotional stress of prying questions, comments, and unsolicited advice from family members about their dating status. I have heard countless stories of crossed boundaries and unwelcome instructions into the private lives of single folks in my private practice and in my recent online talks. The anticipatory dread that uncoupled people experience, both emotionally and physically, is palpable to me as I listen to descriptions of their feeling like a deer in headlights at family gatherings–whether they are in their thirties, forties, or over fifty. The most anticipated question for them is: “So, are you seeing anyone?

Generational differences on coupledom and family life

American family gatherings are likely to hold five different generations this year. Each family member comes from a generation that has been affected by a wide array of experiences (including world events, technological advancements, economic shifts, Coronavirus, and social change) and are in a different stage of life from one another. As can be expected, there are varied generational views on current events, ever-changing social order expectations, as well as on family, dating, and relationships.

For many people in the older generations (the Silent Generation, Boomers, and Generation X), there was only one blueprint for the majority population on adulthood and family life. Between 1950 and 1965, divorce rates dropped, fertility rates rose and the nuclear family thrived. Twenty-six percent of Boomers got married between the age of 18 and 21 compared to only 7 percent of Millennials and 4 percent of Gen Z. Therefore, parents, aunts, uncles, and grandparents at one’s Christmas gathering may expect that a person is lonely or something is awry if they are not partnered, married, and/or talking about having kids. My clients have heard comments like: “You’re such a catch, are you putting yourself out there?” or “Sometimes people need to be more practical and less idealistic when looking for a husband/wife. These young people today are so picky they’ll drive two miles for a perfect latte.”

Another generational difference is that “family” has a more expansive interpretation for Millennials and Gen Zers. People I speak with in therapy sessions and in talks I give frequently use the term “chosen family” when describing with whom they’re planning to share a holiday. In fact, ninety-four percent of respondents in a recent survey reported that they are more likely to feel “belonging” with communities based on shared values, beliefs, and hobbies than with their biological families. These younger generations are much more comfortable with “non-traditional” family arrangements.

Additionally, one in every six Gen Z adults identifies as LGBTQI+, and a poll from January 2020 indicated that 43 percent of Millennials say their ideal relationship is non-monogamous. These surveys illustrate that Millennials and Gen Z are generally not going to follow in the footsteps of their parents and grandparents in terms of child-rearing and family. For some, the question

“So, are you seeing anyone?” is confusing and disorienting to the single person to whom it’s addressed. They may be thinking; I’m not looking for a heterosexual relationship, or I am polyamorous and believe on many partners, or I don’t want to get married or be in a committed relationship. For others, these questions reinforce existing fears–fear that the pool of eligible partners is shrinking, fear that they will be the last single person in their circle, fear of the risks that come with having children later in life, and fear of pity and stigmatization.

Single stigma

Some of that fear of ostracization is well-founded. Researcher Tobias Greitemeyer found that single people are generally viewed as: less extraverted, less agreeable, less conscientious, more neurotic, less physically attractive, less satisfied with their lives, and as having a lower self-esteem than those with a partner. Despite not being well-founded in truth, the idea that single people are less satisfied with their lives is extremely pervasive in the U.S. Dissatisfaction with life without a relationship is at the center of numerous movies, television shows, books, plays, and additional media that we regularly consume.

One recent example is the Broadway show Company–a recently revived 1970s musical with music and lyrics by the late Stephen Sondheim— that focuses on single gal Bobbie (gender swapped from main character Robert in the original production). All of her friends are partnered, engaged, or married. In one song, Bobbie’s friend Harry sings:

Bobbie ought to have a fella

Poor baby, all alone

Nothing much to do except to check her phone

We’re the only closeness she’s really known

Poor baby!

I coach my single clients to remain mindfully grounded around relatives they know will be asking questions or making comments about their relationship status. If they feel they can remain calm, I invite my clients to explain that they are feeling judged and that, despite not being romantic in nature, their friendships are intimate and fulfilling. In fact, while high quality romantic relationships have positive psychological and physical effects, low quality long-term romantic relationships have been found to have significant negative effects on a person’s well-being. In addition to considering if they are willing to take on the emotional labor of educating their relatives, younger single folks should consider how their internalization of the single stigma is affecting their emotional response to those questions. Is it possible to hear the question as just a question, and not a judgement?

For a client who recently had a breakup, holiday gatherings are a potential place of embarrassment as they anticipate intrusive questions about the ex-partner who “got away”. The client is still trying to understand the recent breakup and is hurting. Comments from family members like this one feels like salt being rubbed into his recent emotional wound.

Setting expectations with family members in advance can be a useful strategy. Setting expectations can be done by emailing family members ahead of time saying that you are not ready to discuss the relationship and not bringing it up would be experienced as a loving act. Another way to set expectations is to have an ally in the family who is able to step in and speak up. It may even be useful for the ally to explain that asking someone from a younger generation about their dating life is as uncouth as asking someone from an older generation how much money they make.

Generational differences and the experiences of single people in America mean that conversations around dating and relationships around the holidays can be tense. I encourage readers of all ages to give some thought as to how they can express their love for a relative in another age-group in ways that focus on their accomplishments, what relationships have helped them thrive through the pandemic, and what they are looking forward to in the new year. I especially encourage single readers to express their confidence succinctly by responding to questions like, “So, are you seeing anyone?” with “No, I’m an awesome party of one!”

Is Porn Addiction Really a Disorder? How Shame is Connected to Problematic Porn Use

January 26, 2021

ADeng

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What if the problem with frequent or problematic porn use was not the behavior itself, but how you, your partner, your religion and the culture around you judged it? For the past twenty years since pornography became easily accessible online, there has been a tremendous amount of attention on the potential addictive qualities inherent in porn. There has also been a huge growth in residential treatment facilities who offer sobriety and recovery programs for those that self-identify or whose partners identify them as “porn addicts.”

There have been much discussion in sexuality research and clinical circles on possible new diagnoses and treatment models including: hypersexual disorder, Impulsive/Compulsive Sexual Disorder (ICSD), nonparaphilic compulsive sexual behavior disorder (CSBD) and Out-Of-Control Sexual Behavior (OCSB). As a sex therapist who sees clients who frequently come to treatment in crisis when their out of control sexual behaviors are threatening their marriages, relationships or jobs, I often hear clients self-diagnose as “porn addicts.” I recently began to run Out of Control Sexual Behavior Men’s Group in my practice. While there was not enough research to warrant a formal diagnosis in the most recent revision of the Diagnostic and Statistical Manual (DSM5) in 2013, in 2019 the World Health Organization included the novel diagnosis of CSBD in the 11th revision of the International Classification of Diseases.

Porn Use and Relationship Challenges

In a recent study by Beáta Bőthe et Al. from a large sample (13,778 participants) researching hypersexuality and problematic porn use, the results indicated that both impulsivity and compulsivity were weakly related to problematic pornography use among men and women, respectively. There is however, growing research that tells us that the frequency of porn use may not be the most critical variable associated with a person’s feeling dysregulated or out of control. Self-Perceived Problematic Porn Use (SPPPU) is a term referring to an individual who self-identifies as addicted to porn because they feel they are unable to regulate their porn consumption, and that use interferes with everyday life.

However, within academic research (Grubbs, Lee, et al., 2020; Vaillancourt- Morel et al., 2017) and my clinical practice, people who report problematic pornography use may do so independently of the actual number of times a week they’re using porn or the length of time spent online while watching porn. Thus, there is evidence that quantity or frequency may not be the only determining factor in whether a person reports feeling out of control in their use of porn.

The problematic porn or self-described ‘porn addiction’’ use can be viewed more as a symptom of deeper psychiatric issues and/or relational conflicts the person has with others.

In my clinical experience, which has been primarily with cisgender male clients, a client feels out of control due to the shame he feels when the type of porn he is watching is discovered by a partner and he/she feels disgusted by his erotic interests.

In other situations, a client may feel angry with himself for paying a large amount of money to watch porn secretly. He feels guilty for what his partner and he may look upon as a ‘filthy habit’ that has eaten away at their joint savings. At other times, if a client feels resentful of the sense of powerlessness he feels in his relationship or at work, his use of porn may be an unconscious expression of anger, freedom, revenge and liberation, a powerful antidote to this concoction of emotions that centers erotic and sexual pleasure to silence the feelings he can’t communicate effectively.

Part of the Sex EsteemⓇ model used with clients is to teach them how to identify what he is feeling by using mindfulness techniques to initially locate the emotion in his body. If it’s anxiety, frequently a client will feel tightness in his chest, with shame he may report a nauseous sensation in his stomach. If he has not come to terms with his own rage, he may feel clenching his jaw area. Frequently these clients report masturbating to porn then feeling deep guilt and shame afterwards. What he learns through individual and group therapy is that although he had a moment of reprieve from these intrusive feelings, his conflicts have not been resolved or communicated to the person about or to whom he feels angry, frustrated, ignored or worried.

In a 2021 paper by Joshua B. Grubbs and Shane W. Kraus, the authors state that “although there is evidence that pornography use can be longitudinally predictive of negative relational outcomes, it is not clear whether such links are causal in nature, how prevalent such associations are in practical terms, and whether third variables (e.g., sexual orientation, sexual dissatisfaction, sexual misalignment between partners, religious differences between partners) are potential moderators.” As a couples sex therapist, I hear about longstanding conflicts and misunderstandings that have been swept under the carpet repeatedly for years at times resulting in both partners feeling angry, defensive and frustrated. The porn use may then be a strategy to avoid further conflict with a partner and more of a symptom of a deeper relational conflict.

Porn Use and Internalized Cultural Shame

For clients brought up in highly strict families or communities, sexual activity is rarely discussed among family members and informed sex education may be missing from one’s development. Frequently children and young teens internalize shame and guilt about sex in general including the experience of having sexual fantasies.

Many self-perceived addictions are shame-based. Unlike diagnosed addictions to substances, porn addiction which one prescribes to oneself is, more often than not part of an internal conflict with values learned implicitly and explicitly in one’s family of origin and larger culture as to the:

“Right” way of having sex
“Normal” masturbation frequency
Accepted sexual orientation
Unacceptable fantasies if one identifies as heterosexual
Potential sinful nature of masturbation in general
Derogatory views of a person paying for pornography

Therefore, part of the Sex EsteemⓇ assessment is an in-depth inquiry into the implicit and explicit lessons learned from childhood around sexuality, religious beliefs, cultural norms, familial expectations regarding marriage, erotic taboos and the use of sexually explicit media. I have worked with clients who have had strict Catholic, Muslim, Hindi and Jewish religious upbringings and educations. While they may still practice these religions and believe in a deity, they have not come to terms with how they want to have sexuality in their lives and relationships.

In another study by leading porn researchers Joshua B. Grubbs, Samuel L. Perry, Joshua A. Wilt & Rory C. Reid the authors regard the problematic sexual behaviors a person who self-describe as porn addicts better understood “ as functions of discrepancies—moral incongruence—between pornography-related beliefs and pornography-related behaviors.”

This study puts some finality into the answers as to whether porn addiction is a true addiction. By reframing “porn addiction” as an “an incongruity between morals and behaviors,” the paper showed that the amount of time spent using porn does not predict problems with porn; rather, religiosity seems to be the bigger problem.

New Findings About Religiosity and Porn Addiction

An exciting new 2021 study from the Archives of Sexual Behavior by researchers David C De Jong and Casey Cook found that religiosity–the belief in a deity–had indirect effects on perceived addiction via shame. “…religious primes were associated with higher shame, and in turn, perceived addiction among individuals high on both organizational religiosity…” With regard to pornography addictions, those who self-reported as religious and who were more morally disapproving of porn were more likely to perceive addictions.

Religiosity, then, emphasizes the moral incongruence of porn by forming a system of belief. For those who worship a god, the use of porn depends less on the amount of minutes spent watching porn than the amount of pressure a sense of religiosity imbues on the time spent watching porn. Time is subjective. The misalignment between religious beliefs and pornography use can alter time.

Larger Cultural Myths in the Media

Unfortunately, the self-help industry is able to perpetuate this sense of shame for their

profit. In this way, religiosity and capitalism promote feelings of shame in their own self-interest. These are some things a “porn addiction clinic” may try to shame people into thinking:

“People can become addicted to pornography in much the same way they can become addicted to drugs.”
They often conflate “sex disorder” with “porn addiction.”
“Porn addiction is the result of smartphones, social media and the Internet.”
“There is too much pornographic content in the world.”
Do not thoroughly examine the root causes of the problem.
They encourage a separation between the stresses of daily life and pornographic addiction.
“There is such a thing as excessive porn use.”

The treatment models of Sex EsteemⓇ and the Out of Control Sexual Behavior used in my practice looks at porn use as an expression of all sorts of internal conflicts including moral incongruence, relationship struggles and potential symptoms of some underlying disorders that have never been assessed or diagnosed. For example, a client may have ADHD and plays out in the distraction of porn to avoid doing mundane aspects of their jobs. He may have a debilitating Anxiety Disorder and the porn use is a way of overwhelming feelings of anxiety.

When seeking help for what one might experience as problematic porn use, it is critical to ask a potential therapist what their beliefs are regarding pornography. Many therapists are also impacted by the culture at large and may regard frequency as a sign of compulsivity rather than using a larger biopsychosocial lens to help clients get more focused on what the behaviors mean, if they want to moderate them and giving them tools to do that individually, in a group and/or in couples therapy.

Will a New Year’s Resolution to Have More Sex Lead to More Happiness?

December 18, 2020

ADeng

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Many couples seeking to reinforce their relationships may resolve to have more sex in the new year. However, does more sex really make partners happier? Is this belief held up equally among single, gender-fluid, gay, lesbian, and polyamorous folks?

Whose happiness matters during sex?

The assumption behind the oft-made resolution to have more intimate/erotic times with one’s partner assumes that upping sex will make a relationship stronger and bring about more happiness between two partners. While some studies do show a correlation between partners’ sexual habits and their happiness, the nature of these studies’ participants reveals an intrinsic bias. There is bias about what is a working definition of sex for each partner, who experiences pleasure in couples, and whether by “couple” they mean heterosexual couples. Then, the bias continues: which partner’s opinions on pleasure are more readily available through research studies in general?

A November 2015 study from the Social Psychology and Personality Science titled “Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better” points to the idea that more sex for heterosexual married couples tends to lead to more happiness for both people in the relationship. According to a press release from the Society for Personality and Social Psychology, the subjects “are most representative of married heterosexual couples or those in established relationships.” But does this type of claim take into account the different meanings of happiness for all genders?

In sex therapy, the experience of “happiness” can also have intersectionally different meanings. For a Black woman who may feel less-empowered in her relationship with a Latinx man, happiness may mean that she focuses more on her partner’s pleasure and less on her own, with the thought that this will protect their relationship from a non-consensual hookup or affair. However can she be keyed into her own sexual pleasure within a sexual encounter? For an Indian-American first generation man, penetrative sex in which both he and his wife, who is white & third generation, climax, may have him report feeling “happy” since they both have orgasmed, but may have a meaning that has more to do with his feel masterful and turned on because he’s proven himself “worthy” of her. Whereas his wife senses that he’s not fully present to his own experience and this leaves her feeling like the sex they’re having is more performative. Perhaps she feels like her orgasm is for him and less about what kind of sex she would rather be having.

Sexual Quality over Sexual Quantity

For those in consensually monogamous heterosexual relationships, more sex might be a good resolution; but some studies bring in the variable of affection to see if it changes the happiness quotient. In a March 2017 study published by Personality and Social Psychology Bulletin, researchers asked sixty couples to take notes on their phones about their sexual and non-sexual activities, and when they individually experienced affection.

The study found that sex created feelings of affection not just immediately after the sexual act, but hours later. This suggests that sex can be a means to an affectionate end. A clear takeaway from this study is the idea that sex with affection between sexually-exclusive consensually monogamous couples can be the glue that makes that particular type of relationship stronger.

This may seem like an obvious result. However, what clients report in the therapeutic space is that while some partners want more frequent sexual connection, the quality of the sexual experience helps to make them feel either closer to or more distant from their partner.

In fact, in another study researchers explored the hypothesis that more sex would enhance a couples happiness. They asked one group of heterosexual couples to double the amount of weekly intercourse sessions they normally would have. The findings surprisingly showed that partner did not report feeling happier. I have clinically found through clients’ reports in sex therapy treatment that if partners create more time and relaxation around a sex date they are more likely to feel more intimate. Bringing more intention to their sexual and emotional connection and staying embodied is more likely to be increase pleasure on all body/mind/spirit levels.

Communication and Sex Within the LGBTQ+ Community

There are many assumptions in the aforementioned March 2017 study published by Personality and Social Psychology Bulletin to the finding of sex as a reinforcer for a happy relationship between a committed couple: one needs to examine the meaning of the terms: “committed,” “happiness,” and “couple.” Largely, these terms belong to the world of consensually monogamous, sexually exclusive, heterosexual relationships. One needs to keep in mind that the sixty couples who were subjects were most likely to be married, heterosexual couples, and not representative of some parts of the population who don’t identify with one or all of these variables.

As a sex therapist who works with many types of couples, including LGBTQ+, consensually non-monogamous, kink-identified, in addition to sexually-exclusive heterosexual couples, I have found that the bonding or glue comes when there are two (or more) partners fully present in a sexual experience. When one partner is not fully present or is going through the motions, the experience of bonding may not be mutually enhancing.

When one partner is continually giving pleasure to another partner, they may not experience feeling as bonded. In addition, if one partner feels it is their duty or responsibility to have penetrative sex, it may actually alienate that partner from their own embodied pleasure. This is why I give many mindfulness-based exercises to clients so that they can check in with themselves to see whether they are turning themselves off, avoiding feeling excited or feeling distracted from the sensations and experience. These sexual encounters don’t always result in happier or more bonded couples.

The queer community might have higher rates of orgasm

A 2017 study from Archives of Sexual Behavior published by the NIH found that in heterosexual relationships, heterosexual men were most likely to say they usually-always orgasmed when sexually intimate (95%), while the women they were sleeping with reported the lowest likelihood, at 66%. The queer community had the higher reporting of orgasm, on average: gay men (89%), bisexual men (88%), lesbian women (86%), and bisexual women (66%).

In the clinical setting, LGBTQ+ clients tend to have a wider menu of sexual activities than heterosexually-identified clients. While it is not a requirement that all partners need to orgasm every time they have a sexual encounter, it is important that partners check in with one another on whether they’re satiated. It is part of my Sex Esteem®️ model as a sex therapist and coach to help clients expand their sexual menu to include many erotic and sexual experiences. Orgasms are an important menu item for all genders.

Another step in the Sex Esteem®️ model allows for each partner to communicate the array of options they would be open to explore with a partner, whether they are a longtime sexually exclusive partner, a longtime consensually non-monogamous partner, or a person they are dating or hooking up with.

For those seeking to make a New Year’s resolution for a current romantic relationship, be aware that the resolution to “have more sex” is riddled with preconceptions about happiness, sex, orientation, relationship status and identity. It would do one well to do a deep dive into how you feel about each of these topics’ meanings for yourself personally before diving under the covers with one’s longtime bae or a new partner. This type of inquiry and practice would be what I call a New Year’s Sexolution and would boost your Sex Esteem®️ intelligence.

What’s in a Name? Is Out of Control Sexual Behavior Treatment Really Different from Sex Addiction Recovery Programs?

October 11, 2020

Sari Cooper

Couples Therapy Uncategorized No Comments

What IS so important about the name of a pattern of sexual behavior? A new term called Out of Control Sexual Behavior is closer to the clinical frame I have used to help clients coming in to CLS for help to stop their compulsive sexual encounters. People diagnosed–casually, jokingly, or professionally–as suffering from “sex addiction” might want to think twice about what this term implies and how it in fact will impact their therapeutic treatment, how they feel about themselves and the relationship with partners (if they are in a relationship).

Although most people in the field of sexual addiction cite Patrick Carnes as a the father of the term sex addiction, it was actually a Cornell psychiatrist Dr. Lawrence Hatterer, who defined homosexuality as a pathology, conflating homosexuality/queerness with “addictive hypersexualized living” and “addictive sexual pattern.” The term he wrote about argued that a sexual orientation was an illness. He unfortunately stood by this opnion both before and long after homosexuality was removed as a diagnosis from the Diagnostic and Statistical Manual (DSM).

But Carnes popularized the term sex addiction, putting it on the map in America by creating a list of thoughts, feelings and behaviors that he cited were proof of of a pathological diagnosable disorder. He created the Sex Addiction Screening Test (SAST) that attempts to create a differential assessment of addictive vs. non-addictive behaviors. However, this assessment is still prone to pathologizing certain sexual behaviors deemed alternative, or kinky.

Many of the treatment recommendations in his curriculum and at many of the sex addiction programs or 12-step groups around the country are based on heteronormative expectations in sobriety including only having sex with one’s spouse, no casual sex at all and/or no masturbation with or without porn. There has been a long debate between Certified Sex Addiction Therapist (CSAT) and AASECT Certified Sex Therapists and Counselors. As part of their training, CSAT therapists have historically not received training in established Sexual Disorders in the Diagnostic and Statistical Manual, sexual anatomy, ethics nor education on the diverse practices of sexual health.

These are requirements in the AASECT Certification Training.

I would argue that Carnes regards the sexual behavior itself as the illness. Sex therapists view the sexual behavior as a symptom.

Sex therapists utilize a Sexual health model that understand that even though some people may feel tremendous shame about the erotic interests and sexual behaviors they enact, frequently there is nothing inherently pathological about them. The behavior may feel out of control because it’s against one’s values or it may be tied with an underlying untreated diagnosis. The term and treatment of sex addiction may not thoroughly assess and treat underlying established diagnoses like: Depressive Disorder, Biploar Disorder, Attentional Deficit Hyperactivity Disorder (ADHD), Panic Disorder or PTSD. Many clients who report years of Out of Control Sexual Behavior may have in fact experienced attachment trauma by a loved one who abandoned them, severe neglect or physical or sexual abuse early on.

The organization solely responsible for certifying Sex Therapists in the U.S., American Association of Sexuality Educators, Counselors and Therapists (AASECT), released a statement calling for the retirement of the term “sex addict” referring to it as a treatable illness including this section:

“AASECT:

1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and

2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge.

Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.”

There have now been several suggestions put forth by sex therapists and/or researchers for behaviors that contributes to negative outcomes socially, professionally and relationally. These include:

Compulsive Sexual Behavior (Eli Coleman): “…the experience of sexual urges, sexually arousing fantasies, and sexual behaviors that are recurrent, intense, and a distressful interference in one’s daily functioning”
Hyper-Sexual Behavior (Martin Kafka): “a sexual behavior disorder with an impulsivity component.”
Out-of-Control Sexual Behavior (Doug Braun-Harvey): “a sexual health problem in which an individual’s consensual sexual urges, thoughts, and behaviors feel out of control [to them]” (p. 10, Treating Out of Control Sexual Behavior).

These are all different names that do NOT include the term addiction but instead utilize a model that points to underlying disorders, internalization of shame in the face of not living up to one’s values and the ambivalence around changing. They also point to behavior that is more linked to underlying psychiatric disorders than a process oriented addiction.

I believe two of the greatest strengths of the Out of Control Sexual Behavior model are that it not only addresses potential underlying causes of compulsive sexual behavior, but also that it is focused on organizing around and encouraging the individual’s unique expression of sexual health through wanted sexual behavior–which the Sex Addiction model fails to do.

When a client comes in to our office self-identified as a “sex addict” we look at the whole person, their family of origin, their religious beliefs, how and when the pattern of sexual behavior began, whether they have a history of abuse, whether their symptoms line up with a proven psychiatric disorder and how the secretive nature of their sexual practices play into the beliefs they have about sex, fantasy, consent, monogamy and desire. We ask them to create a sexual health plan that allows for all the disparate parts they’ve been splitting off into secretive sexual behaviors to come together into one person who is supported in their search for personal integrity and potential treatment for underlying issues.

What CLS therapists offer is individual therapy and couples work to help clients who are struggling with sexual behaviors that are negatively impacting their mental health, their job, and or their relationships. We work frequently with clients who are having affairs, hook-ups or encounters with sex workers that feel split off from their own sense of what it right, and hurts their partners or spouses when it’s discovered. On Oct. 20th, I’ll be co-leading a small group-oriented men’s therapy group that creates a safe space for all those in distress to come together and reassess how their sexual habits have gotten out of control and learn new skill to help their behavior align with their own values. Sexual shame thrives in secrecy, and addressing it head-on with others sharing the same difficulties helps to chip away at the shame while allowing a space to consider and create new choices that are supported in a sexual health plan that belongs to you.

I am co-leading the 6-week Men’s Out of Control Sexual Health group with my colleague Shimmy Feintuch LCSW. It is designed for those identifying as male who feel that their sexual behaviors are out of control and that they want to get more information on why they’ve continued these behaviors despite its negative impact. If you feel this group could help you or someone you know please email my intake coordinator for more information: coordinator@centerforloveansex.com

The goals for this group include:

Having each member define what their sexual health goals are
Identifying the internal conflicts they have regarding these goals and their current behaviors
Learning about potential underlying disorders which may have never been diagnosed and treated before that contribute to their behavior like: Depression, Panic Disorder, Obsessive Compulsive Disorder, ADHD, PTSD, Bipolar Disorder and finding sources for treatment
Learning new stress and coping mechanisms including: mindfulness, CBT, Embodied recovery for trauma-induced dissociation
Developing integrated and positive coping in their sexual lives
Relational skills to communicate sexual desires to existing and future partners
Increasing one’s core Sex EsteemⓇ

While the last task force of the DSM (#5) considered the term Hypersexual Disorder, they felt there wasn’t enough solid evidence to prove that this best describes a clinical pattern of behavior. The most recent International Classification of Disorders-#11 did include Compulsive Sexual Behavior Disorder, defining the pattern as repetitive sexual activities that may become an essential focus of a person’s life to the point that they neglect their health and personal care or other interests, activities and responsibilities. Other symptoms may include continued repetitive sexual behavior despite negative consequences or receiving little or no satisfaction from the behavior.”

So while there are many diagnostic names and criteria still being studied by American researchers and clinicians for a pattern of compulsive sexual behaviors, NONE of these terms include the wording or clinical treatment framework of addiction.

Impact of PRIDE, BLM & SCOTUS’ landmark LGBTQ Rights Decision on Sex Therapy Clients

June 15, 2020

Sari Cooper

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It’s PRIDE 2020 and included in the rise of consciousness among so many citizens in the wake of George Floyd’s murder by a white police officer and the current swell of Black Lives Matter protests around the country is another reason to be hopeful. In a huge victory for LGBTQ+ employees, the Supreme Court handed down the Bostock v Clayton County decision to include legislative protection for ALL LGBTQ+ folks in America. The majority decision written by Neil Gorsuch stated:

“In Title VII, Congress outlawed discrimination in the workplace on the basis of race, color, religion, sex, or national origin. Today, we must decide whether an employer can fire someone simply for being homosexual or transgender. The answer is clear. An employer who fires an individual for being homosexual or transgender fires that person for traits or actions it would not have questioned in members of a different sex. Sex plays a necessary and undisguisable role in the decision, exactly what Title VII forbids.”

In the Bostock v. Clayton County case SCOTUS considered Title VII of the Civil Rights Act of 1964, which forbids employment discrimination that occurs “because of [an employee’s] race, color, religion, sex, or national origin.” While the Civil Rights Act didn’t set out to protect people who had same sex attractions and alternative gender identities, the context of equality embedded in this law is what was considered paramount.

As a sex therapist who works with straight and LGBTQ+ clients who struggle daily with shame around their erotic desires and gender identity, this decision provides a long awaited public affirmation that their jobs are legally protected. I have heard many a client articulate why they need to keep their sexual behaviors on the down low, or dress one way at work for fear of appearing too gay, fem, butch or non-binary. As a white therapist who sees Latinx, Black, and Brown clients individually or with their partners, I’m aware that sharing sexual experiences and challenges can be a harder bridge to cross due to racist experiences they have had with the majority of past authority figures along with generational racist trauma genetically inherited through their DNA. I may also add to this load with unconscious statements that a client may feel angry about but won’t reveal to me. The fear a client experiences of being judged, blamed or dismissed by one more white expert is palpable in a session and I try to ensure the racism ‘elephant in the room’ is addressed early on by encouraging clients to let me know if I’ve said or done anything that triggers or angers them. I ask them how they feel I am white and how they came to choose a white therapist.

With this latest Bostock v. Clayton County decision, the Supreme Court justices have cleared a path for the wider protection of the Equality Act which will need to be finalized in the Senate since Congress already passed it last year. According to Kevin Jennings, CEO of Lambda Legal: “We have a long way to go in securing the full and undeniable civil rights of LGBTQ people, especially those in our community who are Black, Indigenous and people of color for whom their sexual orientation or gender identity is only one of many barriers to equal opportunity in this country. But today’s victory is a necessary step forward on the journey toward equal justice for all without caveats or qualifications.”

Most American citizens understand that discrimination is wrong, so the hope is that with the Equality Act, the loopholes and cracks not addressed in this decision will be covered by comprehensive federal protections. The Equality Act updates and expands protections in the workplace not only on the basis of sexual orientation and gender identity, but also on the basis of race, color, sex, national origin and religion in the workplace, the marketplace, and beyond.”

Last June we celebrated the 50th anniversary of The Stonewall Riots begun by gay men, and trans-women who with their protests proclaimed they had had enough and refused to be beaten, arrested and killed sorely because of who they chose to have sex with and how they identified in gender expression. Stonewall marked the beginning of the LGBTQ+ Rights Movement. Today we are in the midst of a new chapter of a multi cultural response to continued violence and discriminatory arrests of BIPOC in every American city despite facing a deadly COVID 19 viral pandemic.

However, just last year alone at least 18 transgender people the majority of whom were people of color, were murdered in the U.S. This SCOTUS decision could be the most hopeful moment in decades to pass a law that protects all LGBTQ+ folks and impacts Black and Brown queer folk at a time when the wounds of racism have been violently torn open once again. When the outside world brings confirmation, validation and freedoms into the therapeutic work my associates and I do with our clients, it is a day to celebrate, even if it is cautiously. I say cautiously because of a case that is coming down the pike to the Supreme Court next fall challenging the rights of religious organizations who feel they should have a broad right to engage in anti-LGBTQ discrimination.

Remember that case brought by a bakery owner in Colorado who refused to bake a wedding cake for a gay couple’s wedding because his religious opposition to same sex marriage? Yep, that one. Well that’s the issue coming up again this fall to the Supreme Court in another case and Gorsuch sided with the religious bakery owners last time. So by all means let’s celebrate but the battle for racial, sexual orientation and gender identity equality is very much a slow work in progress.

Happy Pride 2020 ! BLACK LIVES MATTER

BLM Protests in the streets of NYC — Photo taken by @ELanser Instagram

Why I’m Marching

January 18, 2019

Sari Cooper

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There will be a Women’s March and two Women’s rallies In New York City tomorrow supporting women’s rights. A conflict that ensued after one of the co-founders of the original Women’s March on Washington Tamika Mallory was accused of anti-Semitic views due to her alignment with Nation of Islam leader Louis Farrakhan. There were also accusations of anti-Semitic remarks made by Carmen Perez, another organizer. lastly a third organizer Linda Sarsour has stated her support for Boycott, Divestment and Sanctions (BDS) against Israel’s policies in the occupied Palestinian territories.

There have been so many published articles on the conflict over the past two years between these initial Women’s March activists and co-leaders of the first 2017 Women’s March and the leadership of many community groups supporting Jewish and LGBTQ+ women. This led to a new organization called the Women’s March Alliance to take on the mantle of organizing the 2018 and 2019 marches. Tomorrow Alliance sponsored march will begin on the Upper West Side of NYC. The gathering affiliated with the original organization Women’s March group will be a rally downtown at Foley Square and is led by women of color.

There have also been women with disabilities who claim they were not granted a permit to march who have organized a rally of their own in Grand Central Station tomorrow.

I’m a family therapist who views conflict and repair through a systemic lens. What this means is that a conflict expresses a challenge and a hope for change, whether between a couple, a family or any other system. The whole system needs to change the previous patterns for full healing to take place. It’s not the fault or blame of one person or one group or one side. If there’s going to be real change it will require dialogue, empathy and compromise.

It saddens me that the American tent for the Women’s March, a reckoning the likes of which had never been seen, echoed across the globe now presents as no longer big enough for all of us. The feeling that day on 2017 after Trump’s inauguration when people of all genders took to the streets to protest all the misogynistic, sexist, racist, anti-LGBTQ, anti-Semitic rhetoric that had been spewing throughout Trump’s marching side by side was cataclysmic in its enormous hope that each of us could be a change agent. Each of us could repair the world whether in our small communities, organizing politically or running for office.

When I attended fundraisers this past year to hear women run for local office for the first time in their lives, each one of them said:

“I just thought, I could no longer wait for someone else to change our lives.

I must do this”.

This to me is the sound of hope, change and healing. But it is only THROUGH conflict, engagement and action with those that have different views that longstanding experiences of hurt, hate, disenfranchisement, assault, harassment and harm to one’s body can be both authentically witnessed AND repaired. It would be immature to think that the vast differences in beliefs that women hold regarding Israel’s political policies, Zionism and Palestinian challenges would NOT unleash tremendous energy and anger. As Rebecca Traister reflected about her discussion with co-chair Linda Sarsour in her elegant piece in The Cut recently:

“The painful reflections and calls to responsibility were meant to bring anger to the surface as part of the process of marching together, rather than allowing that anger to fester and separate a group that could, united, wield power.”

But I believe that the tent has to be large enough to hold all women’s courage to address the inequities and injustice in this world for all of us.

This is why I’ll continue to march and rally. With those that come from very different places and those that come from similar spaces.

I’m marching for those who can’t.

I’m marching to protest #metoo assault and harassment.

I’m marching to support women with less/no privilege

I’m marching to support those that need a living wage.

I’m marching for those that are targeted for the color of their skin, their religion, their orientation, their gender.

I’m marching to inspire and be inspired.

I’m marching for healing because this world is fractured.

I’ll end this blog with a quote by Martin Luther King whose legacy we honor this Monday:

“We may have all come on different ships but we’re in the same boat now”

AND A QUESTION TO KEEP YOU THINKING:

Why are you marching?

How to Get/Give Comfort from Your Partner After a Mass Shooting (Post Pittsburgh)

November 2, 2018

Sari Cooper

blog Couples Therapy Sex Therapy Uncategorized No Comments

When Bad Things Happen to Good People, the world seems more fragile

When Robert Bowers, the gunman who ran into The Tree of Life Synagogue in Pittsburgh this past Saturday he murdered 11 innocent people and wounded 6 more. The event also tore into the fabric of the American community’s sense of safety, respect and collective faith in the country.

Each time there’s been a traumatic event in the US whether it’s a terrorist threat (the bomb packages allegedly sent by Cesar Soyac last week), the Las Vegas shooting one year ago at the Harvest Music Festival and the riot allegedly incited by white supremacists RAM members in Charlottesville, Virginia last year, clients come in to sessions and are palpably frightened. They are seeking a place to express their feelings of rage, fear and vulnerability (many of the bomb packages were mailed to locations all around Manhattan). The rabbi of the Tree of Life Synagogue described receiving letters of condolence and support from people all over the world. The media shows communities spontaneously gathering to hold candlelight vigils in cities around the USA. What does a therapist who specializes in sex therapy advise after a traumatic event that shakes a nation like this? How does this even connect with one’s sex life?

Vulnerability and Sex

One of the main challenges for clients in my group practice Center for Love and Sex, is the longing they have for more meaningful sex. This can come in the form of wanting more frequent sex with their partner or spouse. It can also present as the desire to express a long-held fantasy to a partner in order to feel more whole in their sexual expression. It also can be described as the wish to lower one’s anxiety so as to feel more present and freer in partnered sex. For many of these presenting problems, anxiety is a large contributor to the challenge. According to the Anxiety and Depression Association of American, anxiety disorders affect approximately 40 million US adults aged 18 and older.

One might not be surprised that folks who already suffer from anxiety will feel a spike in their anxiety levels when a mass shooting or terrorist attack occurs. According to a Gallup Poll taken soon after the Las Vegas mass shooting 39% of Americans are either very worried or somewhat worried that they or someone they love will become a victim of a mass shooter. These levels were similar to a poll taken right after the San Bernadino mass shooting. So how do people with anxiety seek out comfort? What is interesting to me is that while most of my female clients (whatever their sexual orientation) feel comfortable in seeking out comfort verbally from their partner or friends, most of my male clients are reluctant to ask their partner/spouse directly. However, they may ask indirectly by initiating some type of physical touch, whether a cuddle, a hug or some sort of more direct sexual signal. Why might that be?

Men and Comfort, an oxymoron?

Most men are acculturated to repress their fear outwardly. They’re taught that to be “real” men they need to be tough and indifferent because that is the way you win and get ahead. Never show your hand when it comes to cards, in business and at times in romantic relationships. Thus there’s a small menu of emotions that are socially sanctioned in American life (although there’s some variance depending on your cultural background). Some of these common emotional expressions include: anger, rage, disdain, belittling others (either in humor or with aggression), frustration, disgust and physical extensions of these emotions.

American men (this includes those that identify as gay, bisexual and queer) are taught that they have to be the ones that their partners can lean on. But in the years I have worked with men from diverse ethnic, cultural, religious and orientations, I have witnessed there’s one place they can experience a wider menu of emotions. This is in the sexual and erotic realm. Through a sexual scenario a more vulnerable side (even if most men aren’t even conscious of it) emerges, and sex isn’t just something he is performing or doing. It becomes the place he goes to be held, rocked, whispered to allowing him to feel accepted, loved and yes comforted.

Meaning of Sex and Death Anxiety

When I work with men I help them become more aware of their own fears and how they might learn how to express their worries and concerns to their partners in other ways beside being withdrawn, belligerent, complaining or in some cases angry when their partners turn them down for sex. I help them uncover what sexual activity with their partner means to them in the larger significance of their lives. For some it is a return to connection that is beyond having to prove themselves, for others it’s a space they can be gentle givers of pleasure, for others it’s where they’re given free reign to lead which quiets their fear of lack of control in the outside world. And for others it’s a haven from death.

Death Anxiety and The Lack of Living Fully

Irving Yalom, the famous existential therapist and writer has written about his theory of death anxiety can keep people from truly living deeply, including shutting off their sexual desires. He wrote: ““…the more unlived your life, the greater your death anxiety. The more you fail to experience your life fully, the more you will fear death.” But when faced with death either through a terminal illness or at the top of the World Trade Center, a man urgently calls their partner and/or family to tell them in an emotionally authentic voice how much they love them, finally freed of society’s chains of decorum.

Ask for Comfort without Shame

When a massively violent event occurs like the Tree of Life Shooting last weekend, it tears into our day to day lives and threatens our own sense of safety. It is the human condition to want to reach out, to hold a partner close and to give and get comfort through touch. It’s our primal urge when we’re born and it’s a haven against our own fears regarding our own eventual deaths. I always let clients know that inside all of us are the children we used to be; playful, eager to learn, and longing to be comforted when we’re frightened. This need is not something to be ashamed of. The increase in mass shootings are fear-inducing for all Americans and for all humans. If you have a partner, let your guard down, tell them of your fears and invite them to comfort you and offer yours to them. If you don’t have a partner, reach out to friends, your community, attend one of the hundreds of interfaith vigils that are still occurring across the country and offer to give and receive a hug. The only way through this is to confront pure hate with pure love and authentic comfort.

Remembrance of Sex Past: Talking to Kirra Cheers about The List

April 30, 2018

Sari Cooper

Sex Therapy Theater Uncategorized No Comments

Modern sex, digital dating, hookups and contemplating past sex with a partner are all topics covered in THE LIST Kirra Cheers’ upcoming immersive photography project in NYC. I am so looking forward to leading a talkback after the May 19th show which poses the question “what would your exes say about you?” after a friend gave her a list he had made of all the sex partners and experiences he had had.

Here’s a preview interview with her. For those of you who don’t know Kirra’s work, she is the photographer behind the viral sensation Tinderella in which she photographed the men with whom she went on dates gleaned from Tinder to explore different aspects of modern digital dating life.

WHY?

SC: It seems like this piece flowed out of your first show Tinderella, that was a study on digital dating, what was the initial spark that was triggered when you were gifted the List? What were some of the questions about sex you were looking to answer?

KC: I saw the list of names as a puzzle. Each name represents a moment in time they shared together. I wanted to know, if I could piece together the moments, what would the narrative of his life look like? As with Tinderella, I play the role of the unreliable narrator, calling for the audience to reflect on their list and how people might judge them based on their time together. This experience of self reflection is different for everybody based on age, gender and individual experiences. Where one person might question, how many is too many? Another might reflect on how much they have changed as a person or who they may have hurt along the way.

HOW?

SC: In the work of sex therapy, we help clients get comfortable, get embodied, and help them articulate what it is they’re looking for in a sexual scenario? Did you find that the majority of partners with whom K had sex were open about their needs with him?

KC: As a society, we are used to being fed this lie that men want sex more than women. I think that women are more sexually adventurous than we give them credit for. There was definitely this conversation about wanting sex and expecting so be satisfied but there seemed to be a communication breakdown in exactly how to achieve that goal. This might be because they didn’t feel comfortable expressing their needs or perhaps they were still exploring their sexual desires.

SC: Often I hear from men who are single and dating that they aren’t as concerned about their partner’s sexual pleasure if they’re clear the sex is a hook-up and they’re not interested in getting emotionally close with them. Did you hear a range of reflections on how giving K was in the bedroom? Did it tend to coincide with how long they saw one another?

KC: Reviews on his sexual performance vary greatly. Everything from, the sex was “transactional” to it’s “the craziest sex I’ve ever had”. Hard to believe they were talking about the same person. I think it had more to do with how attractive he perceived them to be and therefore, how much time and effort he was willing to invest.

CONSENT

SC: Given the viral nature of the #CatPerson story in the New Yorker this past December, were there many women who expressed ambivalence during the act that they felt unable to express? Did many partner regret the experience? It sounds like one woman felt that the hookup was not consensual on their part? Did she ever tell him?

KC: I spent some time reflecting on why she opened up to me and chose to share her experience. I think that this was her way of telling him. It’s a hard read and unfortunately an experience that I believe most women will relate to in some way. There seems to be this accepted grey zone where it’s ok to pressure someone into an experience they’re not comfortable with. I used to think it was a matter of education but I’m not so sure anymore. Men understand consent, they just choose to ignore it. I think the problem lies in a power dynamic that has been exploited for far too long.

SC: Were these hookups freeing for some of the women who, like K were looking for sexual expression without commitment? What else did they discover about themselves in the process?

KC: Absolutely – many of the women on ‘The List’ are at a stage in their early adult life where they are exploring what they like and don’t like. It was refreshing to hear about women taking control of their sex life and feeling “empowered” by the experience.

TRANSFORMATION

SC: When sex therapists conduct what’s called a sexual history in therapy, we are looking to find out the influences on the way a person regards themselves as a sexual person, the influences of home, culture religion and how they explored their desire if they were allowed to. Did you feel his journey through these encounters/relationships had an intention behind it, questions he wanted answered or was their more emphasis on proving something to himself or others?

KC: I ended the project at no.38 because I felt that he was beginning to have experiences just so they could be documented. In fact, I would go as far to say that he enjoys having an audience and has continued to explore that thrill in his sex life. As a somewhat quiet or shy person in his day to day life, I think he enjoys exploring a different side to himself when it comes to sex.

SC: What most surprised you about the way your own relationship changed with K over the period of the project? Did you discover further vulnerabilities of his as you delved further into the project? Do you feel his choices of partners reflected a wide palette of facets to his personality or were they more similar than you could have guessed?

KC: We definitely became closer friends over the time that I worked on the project. He allowed me full access to his personal life and at no time seemed embarrassed or uncomfortable with the information that was shared. I was very impressed, if the tables were turned I may have had a crisis of identity. He seemed content to accept that this was their experience, even if it differed from his own.

INTENTION

SC: Why do you think K gifted the list to you in the first place?

KC: K enjoys surrounding himself with interesting or eccentric people that can orchestrate different experiences for him. For K, this was the ultimate walk down memory lane. He is now in a committed relationship and I often wonder whether the experience was somewhat of a sexual renaissance, allowing him to grow in a new direction. Perhaps we should all reflect on our list and learn something along the way.

THE LIST runs for a limited engagement Fridays & Saturdays, May 18-26 at 10pm at the Steve and Marie Sgouros Theatre (115 MacDougal Street). Tickets can be purchased online for $20 at https://thelistbykirracheers.com/.

“Prurience” Exposes 3 Controversial Topics in America: Sex, Porn Addiction & Recovery

April 9, 2018

Sari Cooper

blog Couples Therapy play Sex Therapy Theater Uncategorized No Comments

While I’m not sure in what order they should be listed, I have spent years helping people say the unsayable, articulate what turns them on, and supporting their journeys in coming to terms with the particular consensual erotic interests they find most compelling. At CLS, we also help those who tell us they have a porn addiction or who find that their porn gazing has become out-of-control. In a recent performance called “Prurience” created and performed by Christopher Green at the Guggenheim’s Works & Process Series, Green created a space in The Wright restaurant that while not a safe therapeutic environment, still encouraged some participants/audience members/performers to communicate what they are erotically drawn to when watching porn or how their porn watching became what they deemed to be an addiction.

Green invited participants into an unusual immersion/theater which was a combination of a 12-step sex addiction meeting, a confessional, a one-way-mirror-interrogation, and a-funhouse-mirror-maze. I was lucky enough to interview Mr. Green during his show’s run in NYC given how it reflects on some of the issues our clients are confronting given their porn use whether as an out-of-control behavior on their own or wanting to incorporate the fantasies they enjoy with a partner or spouse

I wondered if the impetus to create the piece coincided with the changes in UK laws regarding pornography. Green stated: “Funnily enough no, it happened all at the same time. Suddenly when I was writing it, David Cameron became obsessed with it and started legislating and talking about porn all the time.” In 2013 Prime Minister Cameron proposed having all porn blocked by internet providers in the UK, where Green grew up.

The audience is invited by the person we think of as the leader of the Prurience group, an American artsy-man with an effeminate inflection in his speech played by Green, to make a circle with the chairs as usual before the “meeting” begins. He is apologizing for being late and haphazardly setting up the product table in the corner, offering up swag printed with the Prurience logo. Once settled, he begins the group by asking participants to share their first memory of seeing porn for the first time. This question aligns with many of the questions we ask at CLS when conducting a Sexual History as part of a full bio-psychosocial assessment to learn about our clients, their families of origin, their education regarding sex (formal and otherwise) both through self-pleasuring and/or partner sexuality.

In this immersive theater experience, several participants shared the discovery of their father’s Playboy, or a friend’s older brother’s stash of videos, or searching online at sites like Pornhub. In our practice, clients express how they watched their parents hold hands, or kissed a “crush” for the first time in 5^th grade at a friend’s house party or happened upon porn online at age 14. The firsts of our lives leave an imprint, and at times it is so strong that it becomes a go-to fantasy that one seeks to recreate again and again whether in one’s imagination, online, or with a partner.

In “Prurience” we are led to believe that the members of this so-called self-help group are struggling with so called porn addiction. While the term sex addiction was not accepted as a formal DSM5 diagnosis, nor has it been accepted by the American Association of Sexual Educators, Counselors and Therapists (AASECT), the terms sex or porn addiction has been popularized enough by people like Patrick Carnes, the unscientific YourBrainonPorn site and the many rehabs that continue to charge thousands of dollars to help people with sexual behavior they may find out of control, sinful, shameful and unfaithful.

At CLS we work with people who struggle with Out of Control Sexual Behavior or hyper-sexual behavior that have put their relationships, family and livelihoods at risk. In a structured, thorough assessment process we discover what other overlapping challenges, potential diagnoses, past trauma and/or relationship dynamics are contributing to the behavior and collaborate with the client on the treatment goals and individualized plans we recommend.

In the Prurience porn addiction meeting one soon hears from people who are revealing ever more detailed descriptions of what they like to watch, what they desire and the level to which these desires haunt their waking and sleeping hours. The comments are sharp, humorous, disturbing, self-flagellating, erotic, disgusted and intriguing.

SC: How important was it for you to create an Uber-reality of a 12-step meeting?

CG: “Yeah, I wanted to unsettle people because one of the effects of porn as we know one of the effects of porn is it’s deeply troubling, or arousing in the fundamental sense of the word. It alerts us and wakes us up…I wanted to try and replicate that in a theatrical setting”.

SC: “Like in a parallel process kind of experience?”

CG: “Yeah, absolutely.”

The term I used in this last question, “parallel process” is a psychotherapeutic term to express the feelings or dynamics that crop up in the relationship between a supervisor and a therapist who is telling the supervisor about a particular client. While relaying the issues, the dynamic may well unconsciously mirror the dynamic that is occurring between the therapist and their client.

In his run on the West End in London, Green told me that some audience members got up at the break and walked out, never to return. They were too disturbed, or embarrassed or uncomfortable to stay through the 2^nd part. The topic of porn is still rarely brought up in general therapy but in sex therapy, we try to help clients describe what turns them on so that they can articulate it to their partner(s). If a person is into porn, or erotic novels or other fantasy-type trigger, describing a scene or exchange can help them formulate what it is that fires up their erotic ignition.

Green wondered how I felt at witnessing his role as group leader who didn’t really “hold” the members of the porn addiction recovery group in a safe space by setting clear boundaries on the length of people’s contributions or the intensity of what was shared even when someone seemed to be in a high risk situation. I thought it was an astute question since in fact I was quite aware that the experience was theater and that his playing the role in a passive manner was intentionally done. It certainly unnerved some folks who felt unsure of what was to come. Much like getting on a roller coaster that might make you nauseous, many audience members were rattled by the tea break.

This lack of structure and support that one sees in the group is NOT like a professional therapeutic experience where a therapist lets a client know what comes next in the process, allows the client to ask questions, holds their fears so that they don’t become overwhelmed and may stop someone who becomes hurtful to another. The therapist closely monitors the clients’ experience, and checks in to ensure that the sessions are going at an emotional pace that they can handle.

I asked Green about the fact that the group didn’t seem to have a performer playing a partner who has suddenly discovered their partner/spouse’s compulsive sexual habits and come to the group to express their shocked, hurt and angry reactions. He let me know that in fact in the original version of the piece there had been a female character who had discovered her husband’s porn use and ostensibly came to the meeting as almost one would go to AlAnon to get more education and support but that in the final edits made by the dramaturge, he lost this character which saddens him at times.

In our work with a client wanting help with their compulsive sexual behavior at Center for Love and Sex we at times work with the individual and refer the couple to another therapist for couple/marital counseling. in other cases we’ll work with both the couple and each partner individually if it seems like a better plan. Like any secret kept hidden for years, the ripple effect after the discovery of an out-of-control porn problem has tremendous impact on both the partner with the issue and the relationship. For many of our clients the recovery of Out-Of-Control sexual behavior includes the opportunity to speak about all sorts of issues (including their sex life) which had been swept under the carpet for years.

We help them understand the behavior, treat the underlying or coinciding disorders that might have contributed to the behavior and then help them and their partners begin the long road to rebuilding trust, expressing hurt, articulate anxiety, and describe erotic desires. The split-off part of their self that was continually numbed out through the compulsive behavior can now emerge and be known not only to the individual but to their partner. And the therapist helps them stay grounded through the at times painful, anxiety-ridden process.

I’ll quote Chris Green with his perceptive reflection on therapy and theater to end this blog:

“I think a lot of therapy is sitting with discomfort isn’t it? It’s being able to turn your face towards the thing you normally turn away from. And it’s.. to put that into theater you have to sit with discomfort, you have to encourage people to sit with discomfort. And it’s only through that that we make any breakthroughs in life” .