A 1999 study (Berman J, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Urology. 1999;54:385–391) found that 43 percent of women suffer from some type of sexual dysfunction. That’s nearly half of all women! There is a lot of history and research behind how we got to this 43 percent number, but simplifying it comes down to the medicalization of female sexuality.
Dr. Leonore Tiefer is an author, researcher, educator, and therapist who has spoken out against the problems she has seen in viewing female sexuality through a medical lens. Dr. Tiefer uses the metaphors of dancing and digestion.
Dancing is something we learn, a skill that is built over time. Dancing has history and culture that informs it. Our enjoyment of dance, and our participation in it can change throughout our lives. People experience differently, but it is often something we share.
Digestion on the other hand is a process that happens to us. It is something that is consistent over the course of our lives, and deviation from the standard is a problem requiring treatment of some sort. We have healthy digestion and unhealthy digestion. Unless there are problems, we don’t spend much time considering our digestion, and sometimes we feel uncomfortable talking about when things aren’t working the way they’re supposed to.
Dancing is a helpful metaphor for looking at sexuality through a behavioral lens, and digestion is more applicable to a medical model. Both approaches have their place, and certainly those experiencing sexual concerns would be wise to rule out obvious medical issues, but Dr. Tiefer suggests we spend more time considering the cultural, educational, behavioral and relational issues that impact female sexual health.
Sex therapy is one area of mental health that
doesn’t always get talked about. Many
individuals feel hesitant to bring up sexual concerns with their therapist,
waiting until later in the therapy process to introduce the topic. Others misunderstand what sex therapy is, and
continue to struggle on their own.
What is sex therapy?
Sex therapy is therapy to improve sexual
functioning and treat sexual dysfunction.
Sex therapy can be done in individual and couples therapy.
What happens in sex therapy?
Just like other areas of therapy, in sex
therapy, the therapist will complete an intake process with the client to
gather information on the nature of the problem and begin to create a treatment
plan. This plan might include goals
about visiting with a medical doctor to rule out or diagnose medical issues.
Is sex therapy safe for my value system?
Just like other areas of therapy, your
therapist is trained to be respectful of and work within their client’s values
system. If you have any concerns that
the content of sex therapy might not fit within your values, talk to the
therapist up front. Talking about our
sexuality with a therapist can be a new experience, and that might feel
uncomfortable, but therapists want to make you feel as safe and at ease as
Will the therapist take sides?
The therapist’s job is not to prove one person
right and one person wrong, but to explore the history and nature of the
concern. The therapist will help the
couple or individual explore their beliefs and values surrounding sex,
identifying and helping to shift harmful or inaccurate beliefs, and provide
resources and educational materials. The therapist will create a safe,
supportive environment as the clients create new, value congruent, healthy
patterns of behavior.
What can a sex therapist help me with?
A sex therapist can provide support, education
and hope in creating sexual wholeness.
They can work with a broad range of sexual issues. Desire discrepancy (where one partner has a
higher or lower libido than the other), problematic sexual behaviors (particularly
compulsive, or what are sometimes referred to as addictive behaviors), LGBTQ
issues (orientation concerns, transitioning, or parenting), trauma, infidelity,
“sexless” marriages, orgasm concerns, ED/premature/delayed ejaculation, painful
intercourse, polyamory, kink, pornography concerns, or resolving
If you have been struggling with an area of
your sexuality or sexual relationships, but have been hesitant to talk about
it, schedule an appointment with Alice at 801-944-4555 today. Sexual health is an important aspect of good
mental health, and you do not need to suffer alone when there is hope and help
If you think back to the last time you experienced a crisis in your relationship, you may remember the feelings of panic and fear. You may even remember feeling uncertain about whether your partner was going to be there for you.
In those moments, it is easy to let our fear build, until it transforms from a few sparks into a full-on house fire. When our relationship-house is on fire, we turn to the person we need the most for help. In our panicked state, we don’t always have the mindset to calmly explain that we are in crisis and need help. More often, we attempt to let our loved one know that we are in crisis, that our house is on fire, by throwing little bits of the fire in their direction. What we intend as a “hey, I’m really hurting right now, and I’m scared and need to know that you’re here for me”, comes out as anger directed toward the person we are turning to for help.
If I throw fire at my partner’s house, they’re going to take protective measures to keep their house from also catching on fire.
This intensifies whatever cycle has already been occurring in the relationship. One partner feels uncertain, and lashes out (when really, they’re looking for reassurance), the other partner backs away further, uncomfortable with the intensity of the first partner. This backing away leads the partner to feel further abandoned, and deeper into their crisis, fanning the flames, and turning the small bits of fire they throw at their partner into a raging fireball.
If we can understand this cycle, and recognize it when it happens, we can begin to stop it. Initially that might look like a “hey, I see what we’re doing here- we’re in our fire cycle”. Next one partner might say, “yes, I know I’m lashing out, because I’m anger, and under the anger is fear that you aren’t going to be here when I need you”. Or the other partner might say, “I see you lashing out, I know you feel anger, but I want you to know I’m here for you”.
If we can acknowledge the anger and the more vulnerable emotion behind it, we can slow the cycle and find connection in our relationships.
If you find yourself stuck in this cycle, and need help getting out of it, set up an appointment with Alice today by calling 801.944.4555.
One of the most common statements I hear from women when it comes to sexual dysfunction is, “I know it’s important to my husband, and I want to give that to him, but I just have zero desire for sex. I’m just broken!”
Our culture feeds us the line that there is only one kind of sexual desire. It tells us that sexual desire should suddenly appear, that it’s a wave of hormones that hit us out of the blue. We’re going about our day, filing paperwork, prepping meals, filling the car up with gas, and WHAM, we’re hit with an urge to have sex.
Now sometimes that happens, and when it does, it’s called, according to sex educator, Emily Nagoski, spontaenous desire. Many individuals experience spontaneous desire at least some of the time. Research seems to point toward men experiencing spontaneous desire far more often than women. Women are more likely to experience what is called responsive desire.
Responsive desire means that desire builds in *response* to positive sexual cues.
What does this mean? This means that a woman who finds herself in bed with her partner at the end of a long, tiring day, isn’t broken when she’s not interested in sex. It just means she lacks context for sexual excitement. She’s normal. Not broken. Too often our culture treats women as broken when their sexual response isn’t the same as men’s sexual response. We treat men’s response as the default normal, and anything less than that makes us feel like there’s something wrong with us.
Unfortunately, the idea that we’re broken is one extra hurdle to developing a satisfying sexual relationship with our partner.
Emily Nagoski gave a Ted Talk last year where she shared two keys to sexual well-being. They are confidence and joy. Nagoski states that confidence means knowing what is true about your body. Joy is loving what is true.
If you are someone who feels broken because your experience is not the spontaneous desire depicted in every romantic comedy you’ve ever seen, knowing that your desire, which builds in response to safety, loving connection, physical touch, or other sexually relevant stimuli, is normal, can help you know what it true about your body. Accepting this part of yourself as good and valid can help you love what it true.
For help working through sexual desire discrepancies in your relationship, or if you struggle to accept and love what is true about your body or your own sexual experience, schedule a session with Alice today. 801-944-4555
Who has ever said yes to something but were internally screaming a no?
We all have people asking us for time, money, attention, physical or emotional connection, labor, and on and on. Helping others, giving them our time or attention is a good thing, so I want to clarify that boundaries are not just about saying no. Boundaries are about making thoughtful choices which allow us to say yes to the things we want to say yes to.
We humans are social creatures. We are driven to seek connections with others. Forming connections, or attachments, helps us navigate challenges in life. Much like a toddler will cling to her parent’s leg, step away to explore, then run back when they need reassurance. Saying no to a request goes against our need to connect with others. However, when we repeatedly say yes to things we don’t feel good about, we can end up neglecting our own needs. This turns an act of kindness that helped us feel good and brought us joy, into a burden that we feel resentful of.
Resentment is an interesting experience. It’s a low simmer, just under the surface, that tells us something isn’t right. Something about the situation feels off. We might feel taken advantage of, unheard, or manipulated. Each experience where we feel resentment adds a link in our chain of resentment. They build upon each other, and if we continue to carry the chain around, and add to it, it will get heavier and heavier. This resentment chain makes it difficult to want to say yes to anything, because we’re constantly on guard, looking to protect ourselves.
Setting boundaries allows us to set down the chain. When we can stop carrying it around, we’ll have more energy to make the kind of thoughtful decisions that bring us joy.
Why is it hard to set boundaries?
-fear on loss/abandonment/loneliness
-fear of anger
-fear of self perception (I’m a good person, good people sacrifice for others)
-fear of approval (will other people think I’m a good person?)
-guilt for disappointing or hurting someone.
Feelings of resentment, fear, or guilt are indicators that there is an area of your life that needs boundary work.
Here are three concrete tools for helping to establish boundaries in your own life.
1. Have a Plan
It can be difficult to think clearly if you feel put on the spot. Having responses planned out ahead can help buy you time to evaluate whether the request is something you are willing or able to meet. One example, “I’ll have to check my calendar, but I’ll get back to you” can buy you some time to evaluate if the request is something you have the time/energy/desire to meet.
2. Don’t Explain
Sometimes, in an attempt to soften our “no”, we offer explanations that may or may not accurately represent our true reasons for saying no. This can be dangerous as it gives the requester the ability to counter with an adapted request that may feel more difficult to refuse.
3. Offer an Alternative
Offer an alternative if there is one that you feel good about. “I’m not able to make that planning meeting, but I will write up my proposal and email it to you before friday”.
All of us have boundaries. Whether we communicate them openly or not, we are setting boundaries. Holding back, or acquiescing out of fear or guilt means we are setting an loose boundary that will likely lead us to feel resentment. Setting clear and proactive boundaries allows us to form relationships with others, free of resentment, and allows us a greater sense of peace and joy.
If you are struggling to set boundaries in your life, and would like help learning how to make changes to reduce feelings of fear, resentment, or anger, call and schedule an appointment with Alice. 801-944-4555.
I often hear stories from men and women who discover their partner has sexual secrets. Sometimes those secrets involve pornography, sometimes they involve infidelity, sometimes they involve fantasy or sexual preferences. The individuals who share these stories with me often feel betrayed because the expectations they had about the sexual agreements within their relationship were not kept. The first problem to address is that most of the time, these sexual agreements were unspoken.
I want to encourage couples to make these unspoken agreements spoken. All couples should talk about their expectations for their sexual relationship. In order to facilitate this discussion, here are six principles that constitute healthy sexuality. Spend some time with your partner and discuss each one, what it means to each of you as individuals and how it relates to you as a couple. (One word of caution, avoid having this discussion during or after sex. Those times are likely to bring with them heightened vulnerability, which if the discussion is difficult in any area, can lead to increased defensiveness and conflict. The discussion will go much more smoothly if you schedule it for another time.)
Consent in this context means that someone has given permission for something involving their body to occur. Are there sexual behaviors in your relationship that you’d like your partner to ask specific consent for each time? Are there sexual behaviors that you don’t feel your partner needs to ask first? Talk about these, and create clear guidelines to shape how consent looks in your relationship. Remember that feelings about specific sexual behaviors can change, and it’s okay to change your sexual agreements in the future.
Non-exploitative means that one partner does not take advantage or manipulate the other into sexual behaviors. This includes using power dynamics to coerce the other person. Are there behaviors that one partner participates in hesitantly? Use this opportunity to talk about what those behaviors mean to each partner. If there are exploitative behaviors in your relationship, this is an area where reaching out for help with a therapist may be necessary to resolve them and set healthy boundaries.
3. Protection from STIs, HIV, and Unplanned Pregnancy
If either person has had previous sexual partners, have they been checked for sexually transmitted infections or HIV? What is the plan surrounding birth control?
Are both partners able to be fully honest about their sexual history, and is there room in the relationship to honestly discuss fantasy and sexual preferences?
5. Shared Values
Creating sexual agreements are crucial for couples, and the largest part of the discussion will likely revolve around values. What behaviors fall within your value systems as individuals and as a couple? If there are value differences, can you create workable compromises? If there are value conflicts within a relationship, a professional can help explore resolutions that feel workable to both partners.
6. Mutual Pleasure
Sadly, many individuals grow up with the idea that sex is something men like and women tolerate. When this is the background, women can feel used and resentful about sex, even when they’re otherwise happy in their relationship. Breaking out of this mindset is going to be difficult if the couple has not found mutually pleasurable sexual activities. If one partner wants a specific type of sex exclusively, and the other partner doesn’t enjoy that activity, neither partner will be able to truly experience the kind of sexual relationship that is fulfilling and strengthens the relationship.
If after reviewing these six principles, you find some areas that you and your partner need help with, schedule an appointment with Alice today. 801-944-4555.
A few months ago, I stood on the edge of a 15 foot cliff overhanging the ocean. Several family members had already jumped and were calling to me to join them. This may not seem like a particularly high distance to some, but it was high enough for me to activate an internal battle.
Part of me wanted to jump. The water was clear and beautiful. My family was having a great time in the water below. Part of me was afraid of hurting myself. Internal Family Systems (IFS) is a theory that uses the idea that all of us have internal “parts”, which generally work together, creating the unique individual that we are. When our parts are not fully integrated, we can experience internal battles, which cause difficulty in our ability to function the way we would like.
IFS categorizes our parts as managers, firefighters, exiles, and Self.
Managers act as our protectors. They are manifest as controller, striver, judge, caretaker, passive, pessimist, planner, and self-critic. These managers work to keep things in our lives going smoothly to avoid pain or rejection.
Firefighters are also protectors, but do so in a reactive way, attempting to soothe our exiles through compulsive behaviors, distraction, or rage.
Exiles are the parts of us that hold pain and vulnerability. Our managers push them away to protect the rest of us from having to experience the pain, shame, dependency, neediness, worthlessness, or grief that exiles carry.
Our Self is the core of who we are. Our Self is calm, curious, compassionate, connected, confident, creative, and has clarity. When we are able to look at the world or situations with these eight “C’s” we’re working from our Self. When managers, firefighters or exiles take over we lose our ability act from our true Self.
As I stood on the cliff with my internal battle, I wasn’t able to recognize the various parts involved. Looking back on the experience, it’s much easier to identify the manager that created anxiety, the one that told me “if you jump, you’ll get hurt.” I can also identify the manager who told me that I had better jump to avoid being teased by my family. It was this manager who pushed through and reminded me that the cliff wasn’t that high, the water was clear, and that everyone else had jumped safely.
Often, the internal battles our parts engage in are of more significant consequence than whether we will be teased for not jumping into the ocean. Sometimes our care-taking managers prevent us from setting clear boundaries with others, leading to resentment or exhaustion. Sometimes our firefighters seek to soothe scared exiles by numbing with behaviors or substances that are not in line with our value system. When this happens, our managers beat up on our firefighters, and our firefighters respond by doubling down on their soothing behavior.
When we experience these internal battles, it’s tempting to try to ignore or reject the parts of us that seem to be causing the problems. Instead of ignoring or rejecting (which doesn’t work anyway), we can start a conversation with these parts to examine why they are behaving the way they are. We might discover that our firefighter is pushing us to lash out in anger in an attempt to protect our exiles from having to experience the pain of rejection that we’ve felt before. We might discover a manager who constantly tells us we’re lazy is really just terrified of becoming the thing it was called as a child. Understanding why our parts behave the way they do, we can begin to have some compassion for them. Compassion helps us soothe the internal battles and increase our ability to act as our true Self.
If you recognize some of these kinds of parts within yourself and would like help integrating them, call and schedule a session with Alice today. 801-944-4555.
In couple’s therapy, one skill that I regularly work on with clients is increasing the ability to communicate effectively with their partner. Sometimes our communications get twisted up with fears, expectations, and familiar patterns, which can be difficult to break out of.
One tool that I find useful is to “go meta”. Meta means self-referential. Another way to view it is the thoughts we have about our thoughts (or our words).
If you are feeling hurt that your partner forgot your lunch date, you might lash out at them in anger. As you are lashing out, if you examine the thoughts in your head, you might discover that you are lashing out because you are angry and you are angry because you are hurt. You are hurt because having your partner forget your lunch date triggers a fear response in you that tells you your partner doesn’t value you in the way you hope they do. The story you are telling yourself, that your partner doesn’t value you is scary, and that fear drives the hurt and the anger to more speaking out in anger because it matters to you so much and you really want your partner to see your hurt, and in turn, see you.
Speaking the meta means that instead of lashing out, you verbalize this internal dialogue. You might try, “It really hurt me that you forgot about our lunch date. I know you love me, but when things like that happen, part of me worries that you don’t really enjoy spending time with me. That scares me, because spending time together is so important to me and really helps remind me how much you care”.
Being able to share the fear that had previously remained tucked away inside your head creates vulnerability instead of anger, and reinforcing that the vulnerability is there precisely because your partner is so important to you helps create a place where your partner will also be able to express vulnerability rather than defensiveness.
Next time you find yourself in a sticky spot with someone you love, examine the thoughts you have about the words you are saying. Where are those words coming from? You might find those thoughts give you greater insight into what the real issue is. Figuring out the real issue is the beginning of greater effectiveness in your communication with your partner.
If you and your partner could use help identifying these meta thoughts, and learning new ways to communicate with each other, schedule an appointment with Alice today. 801-944-4555.
When I was a small child, my family had several large German shepherds as pets. I don’t remember the times those dogs jumped on me and knocked me down, though I have been told it happened. I do remember growing up with an intense fear of large dogs. Throughout my childhood, when I saw a large dog, my primary instinct was to run away.
Unfortunately for the young-child-me, dogs enjoy a good game of chase. By running away, and encouraging the “big scary dog” to chase me, I was reinforcing my own fear: that dogs were scary and should be avoided at all costs.
Anxiety is often a “big scary dog”. We feel the discomfort, and seek to avoid it by running away, or avoiding situations that cause anxiety. When we avoid anxiety-provoking situations, we reinforce in our brains that those situations are unsafe, creating a cycle of fear and anxiety that grows the more we avoid specific situations.
In order to retrain our brain, we have to confront the big scary dog. This can be an overwhelming task, so it is important to have tools to draw from. Three helpful tools are box breathing, positive affirmations, and challenging thinking errors.
Take a deep breath, filling your lungs completely while imagining moving your lungs in the outline of a square. At each corner, pause and hold the breath for 4 seconds, then exhale along the next side of the square. Breathing in this way helps to regulate your nervous system, increasing your sense of calm.
Words are powerful, and we tend to believe the words we tell ourselves. A friend recently recounted her experience on a climbing wall. “I was doing really well, until I looked down. At that point I panicked and told myself, “I can’t do this”, I sat frozen for several seconds and then let go of the wall, letting the ropes catch me and return me to the ground.”
If we constantly tell ourselves “I can’t do this”, “This is too hard”, or “My anxiety is too high for coping right now”, we are likely to give up early or avoid the situation entirely. When those thoughts pop into our minds, we can replace them with a positive affirmation. “I can do this”,“I am capable”, and “I’m stronger than I feel” are all positive affirmations that can help push back against the anxiety that is preventing us from reaching our goals or functioning in daily life.
Challenging Thinking Errors:
Thinking errors are irrational patterns of thinking that often come along with anxiety or depression. As with positive affirmations, we can replace thinking errors by challenging them. Common thinking errors include all-or-nothing thinking (where we view things in very black and white terms), mind reading (where we assume we know what another person is thinking), filtering out the positive (where we focus entirely on the negative, and ignore anything that might counter our current thoughts), and emotional reasoning (taking our feelings as signs, i.e., I feel scared, so I shouldn’t attend this event).
Recognizing then challenging these kinds of thinking errors can help us confront our anxiety by reminding our brain that there are other ways to see the world and we do not have to be stuck in our anxiety.
If you have tried utilizing these tools and need more support in confronting the big scary dog of anxiety in your life, Exposure and Response Prevention (ERP) therapy can help retrain your brain to see the dog not as a snarling beast, but as something more approachable. ERP therapy is effective in treating anxiety as well as obsessive compulsive disorder.
If you are struggling with these issues, schedule an appointment with Alice in either the Bountiful or Cottonwood Heights office at (801) 944-4555.
All of us experience stress. Beginning in childhood, stress is a normal part of daily life. This tension will build until we seek some kind of comfort. In our childhood, we likely sought solace from our parents (picture a toddler who clings to her mother’s leg, branches out to explore, then returns to the security of her parent). As adults we exhibit similar behaviors :we seek out our safe places to help us gain confidence to explore and take risks, or to cope with the stress of life.
If we reach out to a loved one and they understand us, or are “attuned” to our needs, we feel the comfort of human connection. This builds our emotional resilience, or our ability to cope with future stress. These are the foundations of building a secure attachment. Secure attachments increase our ability to tolerate stress and creates a positive cycle, helping us thrive in spite of the challenges life throws our way.
On the other hand, if we reach out and our loved one rejects us in some way, we might feel isolated. Humans are a mighty resilient species, and many individuals are able to find ways to cope despite the lack of a secure attachment figure. Sometimes however, we seek comfort in ways that are not in line with our personal values. Problematic object-focused comfort-seeking strategies can include overeating, social media or pornography use, or drugs or alcohol. When our attempts at comfort-seeking go against our value system, we are likely to feel some shame, which can lead us to continue our problematic comfort-seeking. This creates a negative spiral, which can lead to compulsive behaviors, emotional frailty or rigidity, and insecure attachments as we seek to hide our behaviors from those around us.
Even the most problematic comfort-seeking behavior serves a purpose; if it didn’t, we wouldn’t keep turning to it in spite of the problems it causes in our lives. Understanding the purpose the behavior serves and learning (or relearning) how to form secure attachments to other people are the beginning of overcoming unwanted compulsive behaviors.
If you identify with this pattern of behavior and want to change, schedule an appointment with Alice at 801-944-4555 today. She works with individuals or couples who are seeking healthy ways to cope with stress and heal hurt relationships without shame.