When should you consider Sex Therapy

Approximately 35-50% of those who live with depression experience sexual dysfunction.

Let that sink in for a moment. Most cases that come into a therapy office seek treatment for depressive symptoms. Nearly half of those are experiencing some form of sexual dysfunction. Not to mention, many psychotropics used for treating anxiety and depression may also include side effects that impact sexual functioning.

According to the DSM-5, sexual dysfunction includes desire (being turned on/libido), arousal (how your genitals are working, ie, erections and lubrication), pain, and orgasm. In my experience, this is too narrow a scope and doesn't cover nearly enough of what goes on in the bedroom. I imagine if the criteria for dysfunction include (to name a few) performance anxiety, porn use, hypersexuality/compulsive sexual behavior, and dissatisfaction with sex life, that statistics may go much higher.

Regardless, this is a surprising statistic to me because prior to becoming a sex therapist, I had no idea just how common sex issues are. I went nearly 4 years without anyone bringing up sex unless it was related to trauma.

Maybe it's because of discomfort, maybe it's because my clients didn't know whether that topic was “allowed.” More likely, it could also be my own discomfort as their therapist, not wanting to seem creepy, inappropriate, and inexperienced. Looking back, I think I was worried that simply talking about sex would mean crossing the therapist-client professional boundary.

Part of understanding my client's experiences is recognizing that many of them have dealt with untrustworthy health providers and authority figures, so why would I add myself to that list? As therapists, we do so much to make sure there is a thick line boundary between client and therapist, that we create sterile versions of ourselves to be seen as safe. I will add that it is very necessary, but it can also make us come off as intimidating.

I've realized in training that this leaves clients with the moral dilemma: Is this too much, or maybe it's not a big enough deal to bring up to my therapist? Leaving them in silence and isolation in what's supposed to be one of the safest and healthiest relationships.

To break the ice, the silence, one of us must be brave, and the other must trust that all that would be spoken would be kept safe within the confines of a healthy therapeutic relationship.

I'll admit the first person to be brave wasn't me. What started this whole journey into sex therapy was one of my clients who trusted me and became brave enough to tell me they were afraid of having sex for the first time sober.

Not only was I moved by their courage and vulnerability, but I also felt helpless because I didn't have the tools to help them, and I just knew this was important. At the time, I had so many clients who had been using substances since childhood, which was also the time of sexual exploration and understanding identity. If this is one person telling me after years of building rapport, then he couldn't be the only one.

I'll admit that I signed up for sex therapy school on a whim, 4 days after that conversation.

When your intuition is telling you something that needs to change in how you connect with intimacy and your body. When you know something is 'off.'

It may seem minor, or it may be all-consuming and distracting you from the things that are most important in your life. Either way, talking to a professional is a great start.

Think about it like this: you have tried to deal with it and learn about it the best you could on your own. And not much has changed. Well, that's because these things are not meant to be dealt with alone.

Cross-culturally, we have rites of passage for puberty in which large communities welcome members with changing bodies into adulthood. But somehow, what is left out is instruction and guidance, which leaves us floundering to figure it out. We encourage community and education in every other facet of our lives, so why not sex and relationships?

We may not be able to change sex education on a large scale immediately, but change can start at an individual level.

Fortunately, in sex therapy, it's the therapist who will be brave enough to ask the right questions and work towards building and maintaining the trust of their clients to be able to talk about their most intimate lives.

If you feel like there's something that has been bothering you regarding your intimate life, feel free to schedule a 15-minute consultation. It not only allows you to see if I am a good fit for you but also provides insight as to whether you may actually benefit from sex therapy.

Toxic behavior, we need to un-normalize

If you have listened to my podcast “Things I meant to say naked,” I had an episode called “Can we be toxic while healing?” It focuses on toxic behavior and its possible antidotes. Toxic behavior does not disappear immediately when we start healing; Instead, we need to make a conscious effort to change.

Suppose you find that interesting and are more of a visual learner rather than an auditory learner. Then this blog is for you.

While reading the list of toxic behavior, I want you to ask yourself: Am I Toxic? Am I the toxic one? Which is a tough and challenging question to ask because, in truth, none of us likes being the villain in other people's stories, but it is when we challenge ourselves through a critical and compassionate lens that we allow ourselves to grow beyond current patterns.

Gossiping, Bad mouthing, Criticism, and Chisme

Are we reading into conversations about others who are not present in the room? Are we sharing information that feels very personal? Something that you feel like you only share with those very few close friends?

Understand that gossip and talking behind others' backs chips away a person's trust; they can tell for the most part that you are talking about them. Criticism and judgment from friends/friend groups and acquaintances can reduce self-worth. These are the people you are meant to trust, and they are forming biased opinions of your intimate life publicly for social clout. That really hurts despite its normalization and cultural significance.

It should come as no surprise that Julie and John Gottman identified criticism as one of the four horsemen of the apocalypse that can end relationships.

The antidote:

Observe the topics you spend most of your time discussing with others. If you find yourself talking about others most of the time, it would be tough to stop all of a sudden. Start by highlighting positive characteristics about that person, and shift the conversation towards compassion and empathy by expressing a desire to understand that person's perspective and efforts.

Inconsistent Behavior, Flaking, and Unrealistic Expectations

Do my words and actions line up? Or do I sometimes disappear, flake, or ghost without explanation? That kind of unpredictability leaves people feeling anxious, like they never know which version of me they're going to get. On the flip side, do you set high expectations for yourself about what you should provide in a relationship? Do those around you have high expectations that make you feel like it will never be enough?

Lack of consistency can be emotionally exhausting for the people around us. Over time, they may lose the ability to rely on you as a friend, partner, or colleague. Think about it like this: if they can't handle coffee plans, what will make me feel sure that they can handle the hard times?

On the flip side, if you are setting high expectations for yourself and others about what a friend ought to do, you will ultimately fail under unsustainable circumstances—creating a feeling of guilt towards yourself and resentment towards others who can't match your attenuating energy.

The Antidote:

Set realistic and expectations. What do I need and expect from myself and others in which we both feel safe, seen, and present? And the most essential part is to express that to others. I find it hilarious when people set silent boundaries that people cross and expect them to know them without expressing themselves. Sorry to tell you, we are not mind readers.

Emotional withdrawal and Stonewalling.

Emotional withdrawal and stonewalling are similar but not the same. Emotional withdrawal is the subtle pulling away of affection to express displeasure or as a form of punishment. One day you're warm and affectionate, and the next moment you are distant and cold. Stonewalling, on the other hand, is the complete shutting down and refusal to communicate—silent treatment. Both leave the people around you in emotional limbo and leave people scrambling to figure out “what's wrong,” with absolutely no clue, and leave them with the feeling that affection is conditional on your mood, and they shouldn't set you off.

The antidote:

The Gottmans suggest that stonewalling occurs when we are overwhelmed with emotion. In my experience, Dialectical Behavioral Therapy has great interventions to help folks self-soothe and not react destructively when we are emotionally triggered.

So, how does this look in real life? Take notice when you're emotionally withdrawing from others and focus on coping. The most important part, so we don't leave those around us scrambling, is to let people know we are soothing so we can address what's bothering us in a constructive manner.

Passive aggressiveness

Instead of saying what we really mean, we hint, we drop comments, we hope the other person will “get it.” But what it really creates is confusion and distance. People are going to distance themselves from you if they feel like you're going to criticize them constantly, subtly. The issue with passive aggression is that it is hard for those around you to identify in the moment, and therefore hard to call out, despite the real, immediate sting of the comment.

The antidote:

Passive aggression stems from our discomfort with expressing displeasure and conflict. The antidote here is not immediate; rather, the recommendation is to seek mental health counseling to build communication skills and your self-esteem.

Jealousy & Envy

I don't want to immediately label a feeling as toxic because I don't want to discourage a person from feeling their feelings or thinking of their feelings as wrong; Instead, I want to focus on the unresolved issues these feelings reveal and, often times, the maladaptive behavior they direct us towards.

Low self-esteem and social comparison beget jealousy and envy. When we don't have objective measures of our self-worth, we rely on social constructs or compare ourselves to others. This is rooted in insecurity. And rather than resolving our insecurities, jealousy can lead to controlling behaviors to avoid deep-seated feelings.

The antidote:

Gratitude is a powerful intervention for envy because it centers us in our own journey, but, truthfully, jealousy and envy are best explored with a licensed therapist.

Gaslighting

This is a serious one. It's emotional manipulation that makes someone question their memory or perception. Sometimes it's as simple as saying, “I never said that,” just to avoid conflict. But over time, it erodes trust completely. Can I trust someone who always makes me feel like I can't trust myself?

The antidote:

Gaslighting requires therapy dives into attachment, conflict avoidance, power, and control.

If any of these resonate with you, consider seeking therapy that will improve the quality of your relationships. If you're not entirely convinced or feel ready, then I encourage you to listen to my podcast “Things I meant to say naked,” to learn more.