Myths About Sex Therapy–Don't Let Them Stop You!
Is there a profession more misunderstood than sex therapy? Well, maybe undertakers and spies. But that's about it.
TV portrays us as sex-starved libertines. The internet shows us as relentless advice-givers: how to use handcuffs. How to give her endless orgasms. And too many sex therapists themselves encourage unrealistic expectations: basically, the greatest sex in the history of the world.
No, that's not who we are. And our personal lives our definitely not as glamorous as people seem to think.
Maybe you're interested in seeing a sex therapist, but these wild stories turn you off. So let's name and bust a few myths about sex therapy.
* Myth: We help women understand men, and help men understand women
I'm afraid there are some sex therapists who do this, but I think that makes them part of the problem rather than part of the solution.
Most of us don't do that. We tell people some version of "you don't need to understand men or women better, you need to understand George or Mary better." Unless, of course, you're having sex with a million men or a million women.
There are very reliable ways to learn more about your partner. It's not by learning about a category that has three billion people in it ("men", "women"), and extrapolating out to your partner. It's by learning more about your unique, real-life partner. To do that, talk with him or her. In my experience, people like being asked questions about themselves, even if they're a little embarrassed.
If almost every guy in the world likes fingernails on his balls during oral sex, and your guy doesn't,
–wouldn't you rather know?
–does it matter what all other guys like?
* Myth: We tell people how to make love
There's no one right way to make love. It would be foolish to think we have a magic formula, and that everyone just needs to follow it.
Actually, people do ask us for that formula all the time. Our job is to gently encourage people to stop looking for it, and to instead figure out what they want from sex at this moment in their lives—and explore how to create it.
Yes, that's harder than following a formula.
We do sometimes talk about the wrong way to make love: to create an event filled with pressure, shame, and disappointment.
Showing people the ways they're doing this, and helping them understand how that leads to the symptoms that have brought them to therapy, is an important part of our job.
* Myth: If someone was molested as a child, they probably can't have sexual desire or good sex as an adult
This belief started innocently enough, when society (and sex therapy) started to grapple with the truth of how many adults were molested as children, and how that can (note: can) affect people's adult sexuality.
But the whole process of understanding this phenomenon eventually got completely out of hand. Bizarre beliefs like "children never lie" and "lack of evidence can be evidence" and "any child who's interested in sex has been molested" were popularized in books, on Oprah, and by a trauma recovery industry that somehow sees molestation in virtually every unhappy person.
Our job is to help all people—including those who have been sexually exploited as children—locate their authentic sexuality, determine their values, and make sexual decisions that fit those values. We help people recover or pursue their interest in pleasure, closeness, and their own body.
* Myth: We give out Viagra like candy
Most sex therapists can't prescribe medication because we're not MDs.
But even if we could, most of us wouldn't encourage it half as much as many physicians (and patients) do. Sex therapists know that a lot of erection difficulties aren't penis problems; they're the result of either relationship problems or the well-known shame-guilt-anger-ignorance axis.
We take a complete history of every patient who comes in. So we're the ones who discover that your case of "E.D." is really a matter of you wanting to get erect when you've had 5 or 6 drinks, or when you're resentful at your girlfriend.
Your M.D. may give you Viagra in such a situation, but we don't advise it. We know it probably won't help, and we know what will: less alcohol, more self-awareness, more communication, and better choices.
* Myth: The gender of the sex therapist is crucial
Many people about to start sex therapy specify that they want either a male or female therapist. This is a common consumer mistake. And no, consumers don't necessarily know what's best for them in this regard.
A real professional has expertise that goes way beyond their personal experience. I am expected to empathize effectively with someone who has had a miscarriage, even though I've never had one. I need to know how cancer drugs affect desire (I don't have cancer), and how using Tinder, Bumble, and Grinder affect people (I don't use them).
I am expected to support people making decisions I'd never make, with handicaps (or advantages) I don't have, with goals I don't think are sound.
That takes a lot of skill and insight. And that's what we bring to every case. When people say "I'll feel more comfortable with [this or that gender therapist]," or "I'll be better able to open up with [this or that gender therapist], or "I'll feel more understood with [this or that gender therapist]," I rarely agree that they should limit themselves to half their community's therapists.
Sex therapy is a formalized way of challenging yourself. A highly skilled professional can help you do that regardless of their gender. If they do so effectively, you'll feel uncomfortable, possibly even angry or confused—regardless of the therapist's gender.
Besides, working with the "wrong" gender therapist is a great way of challenging one's gender-based prejudices—which may actually be an important part of the work.
* Myth: We sometimes have sex with patients.
No legitimate sex therapist has sex with patients. Or kiss passionately, or go on dates.
Sex therapy is actually unregulated in the US. Fields like psychotherapy, nursing, medicine, and social work are regulated, and those are the home disciplines of many sex therapists.
So my own clinical work is not regulated as "sex therapy," but I'm licensed as a marriage and family therapist. As such, I am subject to clear ethical standards, laws (like no sex with patients), financial procedures, and continuing education requirements. But this is as a marriage counselor, not as a sex therapist.
Except in Florida, anyone can hang out a shingle as a sex therapist. And, unfortunately, many unqualified people do. Some think it's easy (it isn't), or it's a way to make a quick buck (well, for some quacks it is), or it's primarily about sex (it isn't), or that their vast sexual experience, enthusiasm, and non-judgmental attitude qualifies them (it doesn't).
Sex therapy involves a unique relationship between professional and client(s). It is cleverly constructed so the therapist's wisdom can never be construed as self-serving. This helps the patient consider input they might otherwise dismiss. Once a patient believes that our advice or our insight mostly benefits us (for example, "Leave your horrible wife—and have sex with me"!), the therapy is pretty much over.
Is Every Unwanted Blowjob Rape?
"This case is a little different," the lawyer told me.
Two or three times a year I'm asked to be an expert witness in state or federal court. The request usually comes from an attorney defending someone the government has accused of breaking one of our many laws about sex.
So it wasn't unusual when Richard Corey (names and details have been changed; the story is absolutely true) contacted me several months ago. I had worked with the Detroit attorney on two previous cases, and we respected each other.
"This case is a little different," he said. "An 18-year-old man has accused a 72-year-old man—a long-time friend of the family—of giving him a blowjob he didn't want. The older man's been arrested for sexual assault."
The facts, in brief:
* It was in the younger man's bedroom, with his mother downstairs;
* The younger man does not claim there was any coercion or threats;
* The younger man was texting his girlfriend at the time, and said nothing to her;
* The younger man did nothing physically to push away or interrupt the blowjob;
* Other than handshakes, there was no previous physical contact between the two men;
* The older man has been married to his wife for 40 years.
The younger man ("Kevin") is unemployed and lives with his mother, who is on disability. The older man ("Baron") is a well-to-do landlord who has periodically helped them financially. There's nothing romantic between the older man and the mother.
When Kevin complained to his mother about the blowjob, she encouraged him to call the police, who took it seriously and completed a rape kit. They called in Baron, who at first denied the sexual contact. When the DNA swab showed otherwise, Baron acknowledged the contact and called his attorney.
The State painted Baron as a pedophile (although Kevin is an adult) who had been "grooming" Kevin for years. All Baron's previous help for this family? A long-term plot to get to Kevin. All Baron's non-touch of Kevin all these years? A sinister ploy to gain Kevin's trust. Kevin's failure to mention the blowjob while he was texting? Kevin was in shock. The failure of a physically normal 18-year-old to try to push away an old man? Kevin was simply paralyzed by shock.
Baron's lawyer recited the facts: no resistance from Kevin, no threats from Baron; letting Baron leave without confronting him upstairs or in front of his mom; no history (and no allegation) of Baron mistreating anyone, particularly any child, his entire life.
Ah, said the prosecutor, those predators are clever. They don't necessarily leave any trail of evidence whatsoever! They often behave just like normal people until the moment of (alleged) assault! And the climax of their argument: He denied sexual contact with the young man until confronted by the evidence!
Enter the sex expert—me. Thirty-five thousand hours of therapy with men, women, and couples, specializing in sexuality. Doctoral work, research, and publication in sociology.
Called by defense attorney Richard Corey, I answered questions for over an hour: Why might a married, conservative Republican man deny sexual contact with a younger man that had obviously happened? Why might a heterosexual young man call consensual sex with a man assault? How do sexual misunderstandings happen, and how frequently? How can we distinguish an unexpected blowjob with an 18-year-old from a pedophile's years-long campaign of "grooming" a boy?
The government cross-examined me—first by challenging my credibility (Do we really need a big-shot expert to tell us about sex?), then by challenging my facts (Do we really know actual facts about sexual behavior or motivation?), and as a bonus, my actual profession (C'mon, sociology isn't a real science, is it? And sexology—that's mostly just teaching people about orgasms, right?).
As I answered each question, Baron's life hung in the balance.
This being America, Corey didn't have to prove that Baron was innocent; the government had to prove Baron was guilty. Guilty of assaulting an 18-year-old man in his own bedroom with a blowjob the younger man didn't want, and was somehow unable to interrupt, even while he texted his girlfriend and his mother sat downstairs.
And the jury was so instructed: they weren't being asked to decide what happened. They weren't being asked if Baron was predatory or stupid or selfish, or gay or unfaithful or twisted. Each of the 12 people on the jury was being asked if the government had proven that Baron had harmed Kevin by giving him a blowjob he didn't want, and which Baron knew (or should have known) that Kevin didn't want.
This being America, the rules change when the subject is sex. We expect people to say "I don't want that mortgage" or "I'm allergic to penicillin." We don't require people to say "I don't want that blowjob," even when there is no danger of violence, no danger of losing employment, no danger of social media blackmail. They can claim the sex was unwanted afterwards. And in this particular case, they can claim that an unwanted, non-coercive blowjob in the comfort of your own home is a horribly damaging event.
And so the jury of twelve adults, taking their responsibility seriously, weighed the evidence and deliberated. And they found Baron guilty of sexual assault.
Baron was released to tidy up his affairs pending the Court's decision about his punishment. The State could have punished him with lifetime probation, with community service, or with five years of psychotherapy.
They also could have required him to register as a Sex Offender for 2, 5, 10 years, or the rest of his life. In that case he would have had to move out of his house (two blocks from a school), and would have been prohibited from attending Church when Sunday School was in session—even though his crime had nothing to do with children.
In actual fact—and I am NOT making this up—the State could have decided to invoke its indeterminate sentencing option, meaning he could have been sent to jail for the rest of his life.
That outcome did seem unlikely—although entirely possible. Because very few people expected a jury of twelve adults to find a 72-year-old man guilty of raping an 18-year-old man with an unwanted blowjob while the younger man was texting his girlfriend and his mother sat downstairs. But they did.
Baron's sentencing was scheduled for the afternoon of Thursday, May 25. I don't know what he was thinking when he awoke that day, but he already knew that the life he had been living was over. The only question was whether he wanted the life that the State was about to create for him.
He answered the question by shooting himself in the head that morning.
And that's who I'm thinking about this Memorial Day.
Have Orgasms, Don't Have Orgasms—Just Don't COUNT Orgasms
Some of my patients count orgasms. Sometimes they count their own, but more often, they count their partners'.
Both men and women do this.
"When my wife doesn't climax, I feel I haven't done my job," says Max. "When a boyfriend doesn't orgasm, I figure it's because I don't turn him on enough," says Maria. "I want to totally satisfy my husband every time, says Claire. "I don't want LaShonda to think I'm selfish, or that I don't care," says Marcus, "so I try to make her cum no matter how long it takes."
Listening to people say such things, you can imagine the pressure they feel.
Even under perfect circumstances, no one can possibly guarantee that they'll orgasm every single time they have sex. Therefore, pinning our sense of adequacy or masculinity or femininity on whether someone else climaxes (or we climax) is a big mistake. It makes sex more like work—with a high-stakes gamble built in—and less like play.
And that kind of pressure, paradoxically, makes it harder to orgasm.
How Men Work
When men are young, they often ejaculate quickly, way before they want to. If they want their female partner to climax from intercourse—or if she wants to—this makes it almost impossible (indeed, if it's possible at all; most women can't climax from intercourse alone no matter how long it lasts). The solution, of course, starts with focusing on non-intercourse ways for women to climax. But many women and men resist this, thinking that's not "real sex" or "normal sex."
In contrast, as men age they're less likely to climax at all. By 50, a man may only climax half the time he has sex, or may only do so via a hand, vibrator, or with anal stimulation. If someone's partner (female or male) feels personally insulted by this "failure," there's always trouble. Who feels worse—the guy who doesn't cum and feels he's disappointing his partner, or the partner of the guy, who feels inadequate?
The answer is both.
What can make an orgasm more likely for an older guy? Relax and focus on what feels good rather than imagining something sexy. And instead of trying to drive up the excitement by working harder (and possibly getting a numb penis), think of orgasm as the bottom of a valley of relaxation, instead. Fall into the orgasm rather than working hard to get it.
How Women Work
Women rarely have that come-too-fast thing when they're young—or when they're older, for that matter. Some women start climaxing regularly in adolescence; other women report that it takes years to learn how to climax—especially if they're used to partners who are impatient, lazy, or narrow-minded.
The key factors in female orgasm are self-acceptance (few of us have perfect bodies) and self-knowledge (for most women, the clitoris is the primary sex organ, not the vagina; and every clitoris has its preferences and idiosyncrasies). When one or both are in short supply, so are female orgasm. If a woman is trying to perform for her partner, of course that makes it even more difficult.
And for most women, the ability to tell a partner "I like this rather than that," and to gently insist that it be part of most sexual encounters, and to gently encourage that a partner learn to enjoy, not merely tolerate, the stuff they need to climax, is essential.
So…
Simultaneous orgasm? Forget it. If it lands in your lap, and if you enjoy it, great. For most people, it never does. Some people work hard to get this elusive experience. For most people, I think it's rarely worth the effort. If you love it, and you can easily arrange it, great. If not, skip it as a goal. If your partner demands it, educate them: "Honey, that's not how my body works."
Most importantly, both men and women should enjoy sex moment-by-moment, because there may not be an orgasm at the end. If you're not enjoying sex moment-by-moment, there is no orgasm big enough to have made getting there worth the effort.
Orgasm Equality?
I have a patient who talks about "orgasm equality"—that he should "give" his girlfriend an orgasm for every one that he has. He says it's "only fair."
I respectfully disagree.
Of course, a reasonable person wants their partner to enjoy sex. But how shall we measure that? The number of orgasms in a session, a weekend, or a month is not a very good way. And what about tonight? She may be in the mood for sex, but not to get completely wound up; she may be in the mood to cum, but her body doesn't cooperate; she may not enjoy the pressure of making things "even."
And remember, no one can promise they'll climax, and no one can promise they'll make you climax.
But of course a reasonable person cares about their partner. So I suggest we should go for "attention equality"—because that's something we can control. While you can't promise your partner an orgasm every time, you can promise your full attention every time. And you can commit that if you don't want to give your full attention, you'll say so. If your partner says they're OK with less than your full attention, you can both proceed; if not, you two can do something else.
I recently had a patient who knows a lot about baseball, so I explained it this way:
Even the best ballplayer can't promise he'll always get a hit, or that he'll get a hit on any given occasion. And he can't promise he'll always make a great catch, or that he'll make a great catch on the very next ball that comes his way. But he can promise that he'll pay close attention every minute of every game. As Pete Rose said about giving 100% effort, "Hitting is sometimes in a slump, fielding is sometimes in a slump, but hustle should never be in a slump."
And that's what we promise our partner: not an erection, not lubrication, not our orgasm, not their orgasm—but our attention. Because any time you initiate sex or agree to sex, attention should never be in a slump.
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