I'm a sex therapist. AMA!

I can not seem to stay interested in a sexual partner longer than 6 months. I try so hard and i really like the person but i find myself looking for another partner. I feel terrible about it but i just cant help it. Spicing things up makes no difference. Am i faced with relationship hopping for the rest of my life?

I'm so glad you're asking, because this is such a debilitating problem when it comes to relationships. I'm reminded of my favorite Rumi quote: "Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it."

I'd amend that a bit to say that you don't actively build against things so much as you are patterned to do so by your experiences. So, to best answer your question, you'd need to get in touch with what you begin to feel as you approach six months with someone. The six month mark is a big deal time in a relationship, and a lot of them end around here. It's when you start to really see someone, and begin to need to really show yourself. The fuller person shows up, and sometimes we don't like what we see, or we don't want to be more fully seen. It also tends to be the end of the intense bonding phase, and it's very likely that your system has a difficult time with that. This is where therapy can support you in exploring what got missed when you were first learning to differentiate from another person, which includes looking at what you're working with. As "alixinwonderland" suggested, sometimes it's a matter of finding the right person. That too takes a sort of practice. We aren't always good at pairing up with the people who can actually provide what we really want and need until the process is made more conscious.

You might like to read "Getting the Love You Want," by Harville Hendrix which is a very straightforward, but strenths-based guide to understanding this better. I also like "Getting the Love You Want" by Bader and Pearson. I wrote up a review of it here: http://heatherbrewermft.com/blog/?p=377, and focused primarily on this phase of relationship, because it really is one of the hardest.

Because i dont really want to hurt anyone i do keep partners at arms length a bit and i tend to just drift out of relationships more then abruptly cutting people off. Girls pick up on this fairly quickly and do get upset with me. I dont have an image of my perfect partner in my head and i am not sure that if i met them i wouldnt do the same thing. It's a horrible way to live and you look for another partner quickly to bring some excitement back and fill the urge. I have done this for the last 10 years. I am 30.

Ah. Ok, so the area to explore is in what you said first there. Why does it seem as though you'll hurt someone? Has that happened? Or did you watch that happen with someone else? It'll be very important that you understand how and why that became a fear, and then work to be open about being wrong about that by learning and practicing how to safely get closer and closer to someone. There are always deeper layers on which to connect, and that keeps sex exciting and pleasurable. Check out the book, or just do some reading (from trusted sources) on differentiation. And definitely consider doing this work in therapy- it'll be easier and faster!

How frequently do you see men in your practice who have a low (or almost nonexistent) desire for sex, whereas their wife/girlfriend is the one who is sexually frustrated? What kinds of things tend to cause this? And what can a woman do when her husband seems uninterested in sex (and is not having an affair, as a possible cause)?

My personal opinion is that this is much more common than is talked about, and a lot of women (and men) suffer greatly in secret, with no idea what to do about it.

This is such an important topic to bring awareness to! It definitely happens, and it happens way more often than one is lead to believe through media or even personal conversations. That can make it uniquely difficult to explore if either person feels shame (commonly, the woman will feel shame for being "too sexual" and the man will feel shame for not being sexual "enough").

What causes it typically has nothing to do with gender. Low desire is typically a block, and blocks are in place for a reason. I say typically, because some people do just have lower libidos than others. I'm assuming you're talking about a reduction in desire. A block, on the other hand, is a physical and emotional bracing against something that's being deemed unsafe. It's very important to understand why it's happening, which can definitely take time and proper support. Will he talk about it? What comes up if you ask?

What do, when ones wife's libido has completely disappeared?

You'll have to find out why that's happened. And remember that she may not know herself. Is she willing to talk to you about it?

Not without being defensive. From previous conversations it's because of the weight she put on after our first kid was born. She doesn't feel sexy, doesn't want to have sex. (Except when she's under the hormonal cocktail of fertility, apparently)

For me this sounds like sex, for her, has nothing to do with me. But then I feel selfish for wanting it when I know she doesn't. But dang, I made vows when we got married, but celibacy wasn't one of them.

Ah swell, you know what? I just got a lot of useful information out of reading about her relationship to her body, and to exercise. If she isn't comfortable with her body, then she's not going to want to be feeling it in order to have sex. Sex means feeling all kinds of sensations, which make a person very aware of the body in which they exist. It's part of why it's so wonderful. But if what she feels when she is present and embodied is un-sexy and unattractive, then of course she doesn't want to be reminded of that. And you don't want her to dissociate from that in order to make sex happen, either. Your wants and needs certainly matter just as much, and it sounds like what's needed is for her to be more active in working this through. It's going to be important that you are very warm and supportive about this, even if you're also giving her some firm nudges towards therapy or reading some good books about this. Approach it like it's a mutual struggle, because it is. And how you deal with it will help or hinder the process. It needs to be safe for her to explore and then share with you what's underneath her self-consciousness.

I also mentioned that there was useful information in finding out that she overdoes it and tires out. For a little re-patterning there, practice together doing small and easy things. This can be sexual things, if she's willing. Ask her if she'd be willing to kiss for a little while with no intention of moving towards heavier petting, even if you get aroused. Let her slowly re-inhabit her body in safe little increments. You'll get some nice contact out of that, too.

Because I can hear your frustration, I want to strongly encourage you to get support with this. If she isn't willing to do couples therapy together, go alone. It will help. If your frustration is too big and has built up over too long a period of time, it may be nearly impossible for you to be supportive and patient in the way that's needed for you two to get through this.

No throwaway...

But as a 22 year old virgin who's incredibly insecure about their sexuality, how can one help both be less insecure but also less afraid and tore up about being with someone who isn't a virgin/is much more experienced...?

Find yourself a lot of relief in the fact that you aren't starting from zero. No one does. You know things. Movies and television aren't entirely awful when it comes to imparting some information about sex. You can't trust media as a reliable source, but it has most certainly given you a sense of what you might like to try. If you masturbate, all the better! And if you don't, get cookin'. It will be important for you to know well what you like and love and really fucking love, and what you don't like so much or absolutely hate. And that's because each body is different, which also means that you'll have to learn about the body of any partner you're with anyway, and they'll have to learn about yours. To boot, you have the maturity of a twenty-two-year-old. Imagine how much better you'll be than a fifteen-year-old.

Check out some books and workshops on sex. Cleiss press is pretty great. If you live in a big city, find an informed sex store that offers classes (like the Pleasure Chest in Los Angeles). There are instructional videos on YouTube, but be particular about your sources. Be particular about any sources, looking for words like "sexologist," "sex-positive," "sex education," "sexual wellness," etc. Porn may also be a good resource for you, but not if watching others perform will worsen your insecurity, so judge that for yourself.

Finally, pick someone who feels really safe and warm. Ideally they'd know that it's your first time, so that they can excitedly share the experience with you. So many people would be thrilled to be someone's first. Find one that you're thrilled about, too, and enjoy the heck out of it.

Have you ever had a person who considers themselves asexual seek you out for advice?

I have and do! It's not always the reason someone comes in, but sexuality is always not the only means of exploration in therapy. When it is the desired focus, there's still plenty to explore! Feel free to ask a follow up- I imagine you may want to know something more specific.

What was the most uncommon/unexpected or surprising sexuality-related case/client you ever had?

Fun question! I'll have to think on this one to be sure that I maintain confidentiality. I'll get back to you later this evening.

This has been a really interesting question to ponder. What I'm finding as I reflect is that I've never been very surprised at what comes up. I think the closest I've come to something like that is when a client shares something about their sexual activities or fantasies that tells me something about them that I didn't know before. But that's exciting to me because it means I get to know them even better. One of my favorite things about my work is that I'm always learning new things about people, so maybe my struggle to give you a nice juicy answer is that I'm constantly working with the unknown. But what I learn about any individual always makes sense- at least once I know enough about them- because it's part of their unique experience. It's their reality.

I'll keep thinking for you, though, too. ;)

Swinger here, how many problems do you see people struggle with that are attributable to societal norms of monogamy?

Much of what people struggle with are societal or familial norms period. So much of therapy is figuring out how to get what you want and need by expanding your awareness of what is possible. So whether someone is polyamorous, swings, or is monogamous, it's about exploring where they see their limits and then broadening their abilities. What comes up for my clients who are in non-monogamous relationships is rarely different from the monogamous folk, because you're still dealing with a person's relationship to themselves first and foremost.

You're quite welcome. It's definitely a hot topic.

I'm off to my office for a few hours, folks. Keep askin' and I'll be back about 10pm PST!

What do you believe is the most common misconception/myth about sex?

Ooo there are so many! I suppose the belief that there's one healthy kind of sex is the underlying belief with most of them. But for your angry enjoyment, here are few big ones worth mentioning: -That sex means intercourse. -That it should be kept secret. (This is distinct from private.) -That you should be inherently awesome at it. -That women take longer to orgasm. (They take the same amount of time on average when their favorite spots- like the clitoris- are being directly stimulated.) -That men don't get emotional during or about sex. -That women want it less than men. -That orgasms should be the main goal.

Ok, who's angry? Rahr.

Thank you for doing the AMA. I find this field very interesting, and I would like to you some questions.

1. How did you join this profession? What type of educational background, how common are sex therapists vs. regular ones, etc.
2. What types of misconceptions are just the ~worst~ that you always have to hear when you tell people what you do? (I'm a chemist. I am often asked if I make can drugs or blow things up)
3. Is it common/does it get frustrating to deal with issues caused by blatant sexism/toxic masculinity/expectation that partner fills gender stereotype?
4. Do you have any interesting information or commentary on the positive benefits of BDSM relationships? (oddly specific, I know - that's what me and my fiance do, and I'm vaguely aware that it might have some beneficial qualities).

Thank you so much! And I hope that your AMA experience is a good one! :)

Ok, your first two I answered just now in my responses to ghostrees and gabrielle1106. I'll add that it's my belief that all therapists are or should be sex therapists. It's a somewhat redundant term, except that not all therapists have the comfort level that those of us who use the title do. But if you're in therapy with someone you really like, test the waters. You are likely to be pleasantly surprised. I happen to find it important to invite the conversation, which is why I make it clear that I'm willing to go there. I do the same with racism, homophobia, etc. When people have dealt with pain and embarrassment around a topic or experience, they won't automatically assume that it's safe. I want to make it clear from the get-go that it will be safe with me if and when they feel comfortable and ready.

And to add to #2, you can see some of those here. People sometimes assume that I mean I have sex with my clients. But the term is confusing. Art therapists use art in their practice, right? I don't mind the question. I only mind unchecked assumptions. Like your experience of having people assume that you would or could make drugs, I think what can come up is the fear of your potential power. On the whole, we tend to fear what we don't understand.

1. This is so interesting. While I'm dealing with -isms all the time, I don't often feel affected by a blatant display of them. That's not usually how it shows up. When it does, I usually know why. When I don't, it's actually pretty simple to get down to it. I have had instances where a client angrily utters "bitches" in reference to the entire population of women. Where I go with that is to wonder, "Which bitch in particular might we be talking about? What woman hurt this person?" That stuff doesn't come from no where.

I've felt a shot of adrenaline go through me maybe twice, and both times it was because something was said that was just so counter to what I feel I know to be true (both occasions that I can recall were transphobic statements). But if exploring that isn't in the client's best interest at the time, or they aren't yet ready, then we don't go there. It's not my job to get them to agree with me or to have my own agenda for someone. If I'm distractingly bothered by something, I process it with my own therapist. There are some instances when a therapist feels they can no longer work with someone because of triggers. Fortunately, I haven't had that experience thus far. And frankly, I love when a client's process inspires something to happen in my own work as a client.

1. That's a big, awesome question. The answer lies in how the BDSM play helps a person's body to release tension, to have a freer flow, to practice new things. That isn't always how that goes, and that doesn't necessarily correlate to a history of abuse or trauma (I'm asked that often). Would you like an example of somatic healing in BDSM play?

I'm only 26, but I've basically had no sex drive for months now (and this isn't the first time this has happened). I do have an anxiety disorder, but I don't know if that's the sole reason and I have no idea how to get my drive back. Any thoughts?

I'm sorry to hear that. That can be so upsetting! But I'm sure it arisen for a reason, so it's vital to figure out what that is. Since you mentioned that you struggle with anxiety, the question becomes about where the tension originated, and how you can practice something new. In all likelihood, an old anxiety is getting periodically triggered by something external. You may already have a sense of what that is. Anxiety is the body's alarm system. It tells us that something is unsafe and needs to change. But sometimes, it gets stuck in the "on" position. That means that the built-up tension didn't get a chance to be safely released. That's what an anxiety disorder is. And to heck with having sex while you're on high alert! Anxiety won't go away until your body deems it safe enough to turn off the alarm. I absolutely recommend that you treat yourself to therapy to get some relief from this. I also recommend that you concurrently practice meditation (Iyengar or Hatha- the body-based ones), yoga, swimming or anything else that helps you to be safely in your body. If you feel safe really getting at the sexual component, notice what arises when you masturbate or try to. The reasons "why not" will arise very quickly! But stay present with your body's sensations. The more embodied you can be, the more you can track about what's happening and understand what's needed. This is just like noticing that you're hungry, and then eating some healthy food that will satiate you. Learning to get more embodied will begin to restore some nice flow, which will give you back your typical energy (and sex drive).

so, I have noticed since I got out of an abusive relationship My sexual tendencies have gotten more extreme, not like rapey but i have gotten really into bondage and enjoy being choked, its gotten to the point where i dont care about having another relationship, because i dont think they will be down with choking out their boyfriend, did having an abusive girlfriend, break my brain into thinking this is what i want?

Good for you for extracting yourself from that. It's entirely possible that you laid some new pathways between intense sensations and pleasure, especially if you were together for a long time or it was physically reminiscent of what you grew up around.

Because this new play came out of an abusive situation, I strongly recommend that you explore it with a therapist. But know that it's possible you'll end up being happy as a clam with your new found tendencies, AND you are not alone in enjoying choking. Plenty of happy, healthy people safely engage in that kind of play. Stay a little concerned about it until you know more, but know that it may be a lot more complex that "this is bad and I have to keep it secret." We especially don't want you avoiding needed human connections because of it.

Look for a kink or sex-positive therapist in your area, or a trained and informed coach, if your options are limited where you live.

Also how did you get into this feild of work? What school offers this program of study?

I come from a family culture that fosters a lot of self-exploration and healing. I also sometimes ended up in a peacekeeping role as a kid, which meant knowing enough about what was going on with everyone to facilitate a harmony that worked for everyone. So I was predisposed! Most of us are. That's the factual reality behind the distortion of "all therapists are crazy." We aren't. I'm sure some are. But really we just learned a lot early on about the necessity of the role of the healer/helper.

When it comes to sexuality specially, my answers are similar- I was very fortunate to come from a feminist family. That made recognizing stifling and oppression a lot easier. I had a very potent moment of awareness about the importance of sex education, conversations and healing when I was in high school. I talk about it here:http://heatherbrewermft.com/blog/?p=400. Do a "find on page" search for high school, if you want to read just that part.

As far as where to study, you can be certified as a sex therapist through various schools. Would you like to let me know where you live? Regardless of your location, it will be important that you supplement your education with lots of books and workshops and consultations. Most universities offer sexuality courses as almost an afterthought, so you'll be left needing to find your own specialty training (which is fun anyway).

I lose sexual interest in all of my partners eventually. How do people continue to be sexually interested in each other once the initial spark has gone?

Some of this I spoke to above in my response to LazeeBoy2003, so you might like to read that.

Are you willing to share what typically comes up for you? Is it often around the same period of time with someone? Do you begin to feel disgust? Just disinterest? Fear? Etc. Are there similar threads of experience between partners like, "no one wants to try what I like?"

Can celibate people get therapy and will it complicate their lives and make them die early deaths?

No matter what's going on in someone's sexual life, they have sexuality. Asexuality, for instance, is also a type of sexuality. The exploration is about better understanding yourself and how you relate to others.

For the latter part of your question, I'm not exactly sure I have your question right... Therapy can absolutely be difficult and challenging. And sometimes things can feel worse before they feel better. But with a good relationship with a good therapist, awesome stuff can happen. I'd argue that that prolongs life.

Asexual people have sexuality? Isn't that a contradiction?

Doesn't asexual mean "lacking a sexuality"?

I understand your query, because yes, the word suggests a particular meaning that isn't actually intended. Perhaps think of it as asexual, but not asensual or aromantic. And it matters hugely that you understand what someone means if they call themselves asexual. Here's a fun interview I did with artist David Loret de Mola. He speaks to your quandry, amongst other things: http://heatherbrewermft.com/blog/?p=404

In your opinion, how can someone who's suffered sexual abuse at an early age heal from that trauma and emotionally prepare for sex? Surely there are better ways than just trying to learn experientially with each encounter.

This is so important. I'm so glad you asked. It's entirely possible to having a very rich, enjoyable and fulfilling sex life despite past sexual abuse. And there are definitely better ways than experiential sexual practices. Those often perpetuate the struggle.

As with anything, it depends on the nature of the abuse, especially the relational pieces. Speaking broadly, what we do is find where the tension of the trauma is still being held in the body, and then work on releasing it. Breath work is extraordinarily beneficial for this. You work on breathing deeply, and track where the breath is constricted. When you tune into the places of tension and begin to release them, old thoughts and emotions will arise, but this time they are dealt with as they always should have been. Slowly, the body returns to equilibrium and sex is no longer a challenge.

Throughout this process, I am right there supporting the client with whatever is needed. A huge part of the healing is the relationship between therapist and client, and this is more intensely true for someone with sexual wounds. Sexual trauma hits a person deeply, and can become terribly intertwined with their sense of self. Untangling it must come with a strong sense of trust and safety in the room, and the work is necessarily slow and gentle. Much of this can happen with a good, informed and aware partner, but I always, always recommend that this is done with the support of a professional.

I just did some writing on how to work on fuller embodiment, which you can read here: http://heatherbrewermft.com/blog/?p=470

And there is a completely awesome book about this called "Healing Sex" by Staci Haines. It's a comprehensive sex-positive guide to working somatically with sexual trauma. Here's my review of it: http://heatherbrewermft.com/blog/?p=341. I couldn't recommend it more highly.

What advice would you give to someone in a long term, loving relationship, where the partners aren't able to meet all of each other's desires? My SO regularly comments about essentially needing a surrogate for my desires she wants no part of, but is that really even an option or is it destined to screw with our relationship? Alternatively, can I alter my desires to be more suitable?

I have a strong tendency towards BDSM. While almost everything else about the relationship is perfect, she has no real interest and our sex life is unfortunately affected.

Start with "the ethical slut" and lots of conversation before anyone does anything regrettable. It's possible, but it's a minefield. Tread carefully and your dreams may (eventually) ... get some kind of wake up call and satisfy some of your desires.

This is an excellent answer. I second that reading that book, as well as doing some couples work before you try to open your relationship at all.

But before that, how much have the two of you done to understand each others' desires? Do you know what bothers her about some of the things you'd like to do. We so often assume we know why someone likes or dislikes something, but we're often wrong when it comes to fantasies! And more often than not, I've seen couples come to not only an understanding, but even appreciation and excitement about their partner's unique desires. It can really expand your sexual repertoire!

Likewise, you may be able to shift some of what you want to do. I don't mean stifling desires or pretending that they're being met, and it's possible that you'll decide not to pursue certain things for the sake of your relationship. But if you understand deeply your motivations for a particular type of sex play, then you might find that there are several ways to get those same sensations and emotions. BDSM play is a wide spectrum. I think you're likely to find a way that works for both of you. In the meantime, be patient with her process. She's uncomfortable for a reason, and you're more likely to get what you want if you support that.

Here's an article I wrote about sharing fantasies: http://heatherbrewermft.com/blog/?p=94 You might also like my guide to BDSM, which you can also find on my blog. Good luck! I hope you two have some great new experiences ahead!

Thank you for the considered answer. I feel like I owe an apology for jumping straight to the extramarital part of the answer, and I really appreciate the points about how to better communicate.

My pleasure! And what a kind thing for you to do to come back to say that. I'm really glad that you mentioned the book, and it may prove to be invaluable for them.

In the course of my marriage (around 9 years) my libido started off very strong in the beginning years, then slowed down considerably (i guess as expected), but recently has become very strong again. Is there a biological explanation or could this be purely psychological (such as acting out defense or displacement)? I don't see a noticeable change on the part of my wife that I could attribute this to.

There could absolutely be a physiological explanation, and you could check that out with a medical doctor. But in my experience, it's most often something more complex than a purely physical change. Physical changes themselves are often brought on by psychological or environmental circumstances. And it wouldn't have to be a change in your wife to which you're responding. Has anything particularly enlivening happened in your life recently? Anything especially calming? Are you in better shape than before? Do you have more free time? Alternatively, if you feel that it's problematically high, is there anything that may be triggering a push to bring in some new stimulation? I'm hoping that it's a pleasurable experience, and that you're just curious about who or what to thank.

Hmmm I think you gave me an idea. Thank you, this was helpful.

That's great to hear! You're very welcome!

Is sex addiction a real thing, or just a convenient excuse for serial cheaters?

It is indeed a real thing, but let's start by dealing with the pain that you've probably experienced personally. It doesn't matter what was going on for someone else, if cheating has affected you, then it's affected you. Nothing can negate that pain. And you certainly don't have to prematurely forgive it or pretend that you have. But you can understand it, and sometimes that provides a lot of relief.

I'd first like to comment that I don't really like the term "sex addiction." It suggests that there is a normal amount of desire and sexual contact, and that's just not quite how it works. It's also a misnomer, because it's not really sex that a person gets addicted to, but something about what the sex may be able to provide for them. VERY often, people who struggle with this are dealing with trouble bonding. Sex is an awesome way to bond if and when your system is capable of it. But for some people, a proper bonding and attaching experience didn't get to happen, and now their system doesn't really know what to do when the opportunity for it arises. They're stuck in a sort of physical abandonment. It can feel like an empty pit or a dark void. It's agonizing. You can imagine that a person would find any means necessary to come out of that place. Unfortunately, the sexual encounters only ever perpetuate the problem. What's needed instead is a safe, slow, conscious bonding process with... guess who? A therapist. ;) The healing experience is getting to have a solid, healthy, safe relationship with someone who's present and available.

I'm so sorry that you've been affected by this. You know, people are pretty good at making us feel how they do. If this person is still in your life, you may find some common ground in the fact that they probably walk around constantly feeling the way they made you feel. In the meantime, don't be afraid to be angry. Let yourself have your own mourning process with it. That too will be best supported by a therapist.

My wife and I are recently married, and we both waited until marriage to have sex. I find that it is actually a lot of work to get me off and to get her off. The whole process, from warming her up to the end of the after glow, can take over an hour. That, coupled with the mess, really actually has turned me off the the idea of sex. What can I do to improve my attitude and desire to have sex with my wife more?

I'm sorry to hear that sex has been a bit of a disappointment thus far! What a bummer, and especially after waiting. Fortunately, this is very changeable.

First off, I suspect that you've been affected by untrustworthy sources (like movies, tv or porn) and their messages about sex. It's not a quick and easy process where both people orgasm at the same time from the missionary position. It does take some warming up, and then some playing around until you find the right spots. If you don't masturbate, I highly recommend that you start. You both need to be intimately acquainted with your body so that you can communicate all the subtleties of what you like and dislike to the other person. You can most certainly do this together, as well, but it will be important that you approach it openly and enthusiastically. You can also read books or attend workshops to learn more about tricks and techniques. I have a list of resources here:http://heatherbrewermft.com/Fun_and_Useful_Resources_for_Sex.html And in case you don't know this: most women ONLY orgasm from clitoral stimulation. If a large portion of your time is being spent trying to draw out an orgasm from intercourse, then she could be getting stimulation that's much too indirect. And remember that both of you should be doing the work. If someone gets tired, change positions. You can take turns trying oral stimulation, or for what's often a nice little quickie, you can mutually masturbate. And mess-wise, it can be really handy to keep a clean stack of washcloths in a headboard or nightstand. Or if you're typically ejaculating on the bedsheets, you might consider changing that up to her stomach, her thigh, your chest and stomach or anywhere that's exciting to both of you. Ejaculate can be easily cleaned off of skin- not so much with the sheets and blankets.

But all of that speaks to physical techniques, and I'm wondering what emotional barriers might be surfacing for you. After reading all of those ideas, are you still left with similar emotions about it? If so, those are something to explore. Ideally you can do that together, but if you'd like to understand it a bit better first, then bring it up with a therapist. Sex is not an easy thing to venture into, and there is no shame in needing some support with the process. It's so very vulnerable, and feeling that exposed can be scary, especially after you've already committed to them for life. So if anything like that is coming up for either of you, be patient with yourselves, and find support for your process.

My wife has negative feelings about sex as a result of an ex who made her feel used and emotionally abused. Outside of going to see a sex therapist, what can I do for her? She tends to recoil or become withdrawn when I suggest new and very tame things. She's only comfortable when she is the one making suggestions. Sex becomes a one sided conversation.

I most highly recommend therapy for this. If she won't go for individual work, encourage her to go for couples work, reminding her that you'll be right there the entire time. Be patient and encouraging. Sexual abuse (and emotional sexual abuse goes in the same category) is one of the toughest things from which to heal.

Concurrently with therapy, or while you're in the process of getting in the door, read "Healing Sex" by Staci Haines. Read it together, if possible. It will be important that you are very informed about this so that together you can move past it.

What you're speaking to in regards to who initiates is a clear example of her sense of danger. If she initiates the suggestions, she has control, and therefore safety. Work to not take that personally. It's simply that her body was trained to be on alert. It will take retraining through practice, with the support of a professional, for her nervous system to re-stabilize. What you can take personally, and what feels wonderful, is being the person to show her how safe and beautiful sex can be. So keep doing your part to prove that.

Don't be afraid to express your frustration, but do work to keep it a mutual frustration, remembering that she's frustrated, too. Keep it a clean venting- out of the realm of blame or shame. Be in this together- both your experiences matter.

I don't get turned on the way I used too. No matter if it's a serious partner or a one night stand deal I just don't physically get aroused the way I used to. What could cause this? I also have an extraordinarily hard time reaching orgasm. I am a female 22 years old. What is wrong with me?

First of all, let's not word it as "something wrong." Your body is clearly saying something to you, so it's important to listen to it without putting judgment on it, which just makes it hard to hear. Consider what was happening when this first began. What was going on in your life? Did you just graduate? How did you/ do you feel about yourself and your life right now? There is almost always something that triggers a physical response like this. And then consider what's being triggered. A button got pushed. What is that button? Why is it there? It's best that you have the support of someone else as you look at these things.

Where you're getting stuck as you approach orgasm (or try to) has a lot of information. Do you take a long time when you're masturbating, too? If not, then we know that the struggle is more relational than physical. Take a look at this: http://heatherbrewermft.com/blog/?p=105 and see where you end up hitting a road block. Once you know that, what to do about it will be implied. But again, it's always best to have someone's support with this. We can only take ourselves as far as our existing boundaries.

How important is a man's size to a woman --really?

I have a few things to say here. Let's start with the good ol' "it depends." It can certainly affect intercourse if the man's penis is particularly small or particularly large. But let me encourage you to consider that intercourse or any type of insertion is only one part of sex. Clitoral and anal stimulation are favorites for a lot of folks, so be wary of over-focusing on insertion. Focus instead on getting to know what you like, and what your partner/ potential partner likes. If you haven't yet had sex (or have been scared away) and are concerned about potential partners enjoying what you provide, gift yourself with some books and classes on anything that interests you: oral sex, anal sex, mutual masturbation, etc. And don't forget that a significant portion of what's happening in a sexual encounter is mental and emotional.

How does sex therapy differ from sex-work? I know there's a difference, but I'm not entirely sure what the difference is and where.

Most people who call themselves sex therapists mean that, like myself, they are psychotherapists who specialize in sexuality. Sex work or sexual surrogacy, etc. typically involves having sexual contact as part of the healing process, which doesn't occur in sex therapy.

Here's a link to an interview I did with a local sexual wellness store. I say a good amount about that here: http://heatherbrewermft.com/blog/?p=400

It seems like through the years sexual taboos have been broken down. How far do you think this will go? Thanks!

I think you're absolutely right, and I believe that that's almost entirely wonderful. I suspect that it will continue to oscillate, especially generation to generation, with a steady trend towards increased comfort with sexuality as a topic and exploration. And I betcha sex education will become more integrated in schools in the next couple of decades.

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I love that you're asking. It can bring so much awesome to be able to do this! I wrote all about it here: http://heatherbrewermft.com/blog/?p=94.

Model it for her. Ask if she's willing to hear about one of yours, and then tell her about your fantasy along with plenty of "I like that because."

The mojoupgrade.com is fantastic (literally!), but limited in that it can be hard to get someone to dive into answering potentially vulnerable questions, and it also doesn't allow for your specific fantasies.

Ok! I'll be back again tomorrow evening from about 8-10pm PST, perhaps with some intermittent answering. Some questions are beginning to be repeated, so please scan for where yours may already be asked or answered. ;)

Ok, bedtime for me! I'll be back tomorrow from about 3-5pm PST. I'm loving answering your questions, you fabulous people.

I'm with my girlfriend for about half a year now, and I really love her an think she's really sexy and turns me on, but we managed only once or twice to have sex.

I had a hard time (haha) to get hard or stay hard. It never happened before, never with previous partners or while masturbating. I have the feeling it's because of fear or something, that I'll dissapoint her or something, because she had way more sexual partners than me. Is there anything I can do, to tell my lower half of the body, that I really want to do it with her?

First off, it's wonderful that you've got a lot of attraction here with which to work.. It is actually something that people sometimes overlook as part of the struggle, because some folks are used to not liking who they're with.

I'm sure your intuition is right there the cause is a fear. Sexual ability does not increase with more partners. You both have to get to know each other's preferences, so this is as new for her as it is for you. But this may run deeper than a surface-level belief, so keep an eye out for what in you may be getting triggered by this, because it'll keep popping up different places if you don't address it directly.

What might bring you some rapid change is practicing getting really good and calm before sex. It's counter-intuitive, but while sexual excitation is exactly that- an excited state- it's crucial that your muscles are going from relaxed to excited, not from tense to excited. Practice breathing slowly and deeply, working on relaxing all of your muscles (not just your lower half) as you breathe. Do this for at least two minutes. If you don't yet have the level of comfort to do this in front of her, then do it in the bathroom before you initiate sex. When that fear sneaks in, work that meditation magic on it of acknowledging the fear and then letting it drift off. Re-focus on your breath, and feeling relaxation in your muscles. Again, you may see the reason for your constriction surface when you practice relaxation, so have the support of a therapist at the ready.

Finally, don't forget that there are alllll kinds of things that you can do during sex that don't involve an erection. It's perfectly ok to be flacid in front of her for the entire show. This doesn't have to mean that the focus is purely on her pleasure, either. You have lots of erogenous zones aside from the pelvis. Tell her about them or find them together.

Happy relaxed sexy time!

Do mental health issues come up during sex therapy, and if so, how often?

It matters what you mean by mental health issues. My short answer is yes, always. The mind and body are intertwined, so you can't work in one realm without the other. Let me know if you meant something more specific.

1. What do you find to be the most common issue you provide therapy for?

2. Have you ever had to alert authorities about a client?

3. How has your profession affected your personal sex life?

1. That's easy to answer broadly: relationships. Everyone is looking for good, safe and pleasurable connection. I find it to be really heartening. It seems like the recipe for a lot of rich connections with so many people working towards it. And I get to see that happen all the time!

The sex-specific work is almost always resolving needs with beliefs about what's ok. There's so much secrecy with sexuality that a lot of people simply haven't a chance to safely explore it.

1. Yes I have, but not for anything related to sexuality.

2. Great question! I'm very big on being transparent, so I'll have to balance that with maintaining some privacy, which is important for my clients' work... Much of it could be summed up by something that Shar Rednour said at the Catalyst Conference last weekend: "Having education about your pleasure means a lot more pleasure." That has definitely been true in my experience. Not only physical pleasure, but emotional pleasure and connection and depth. It's pretty lovely.

For a little while I felt some pressure to be stellar in my sex life. You know, being a "professional" and all. But that didn't last long. I was able to recognize it as silly after a short time. That's just not how it works. There's always a dynamic. Even with masturbation.

I have had flashes of someone else's abuse pop up at inconvenient times, and that's really hard. Self-care and solid boundaries are vital to my work, and that stuff helps a lot. But I'm also just a person, I care tremendously about my clients, and being affected is a natural reaction to horrific events.

Overall, it's a gift not only to my sexual life, but life on general, because there are more and more things to learn and explore. I love that.

I have a lot of self hate and a lack of self confidence that has caused me to fear having sex for years. I'm a 22 year old woman and I'm still a virgin, mostly because of my self hate. How common is this and how do I get over it?

I'm really sorry to hear that. Some version of self-consciousness is very common, but how you get through it is entirely dependent on what created it. Definitely find yourself a therapist that you connect with so that they can help you explore it. They'll assist you in looking at the messages you received about yourself as you grew up, and help you to sort through everything. You have to have another person for this process, because the intensity of self-hatred is definitely keeping you from seeing things clearly. It can become too much a part of your identity. And for that, another person is required to be in the room with you to guide you back to seeing the awesome person that is you underneath all the junk sitting on top of it. Use the search engine on goodtherapy.org or psychologytoday.com to find someone you like the looks of. And don't you dare let money hinder you. There are always low fee therapists and clinics. A friend of mine pays $12 a session for his totally badass therapist.

You may also like to read my response to mcflyjr above in regards to virginity.

What happens if i masturbate daily, anything bad?

Lesser chance of prostate cancer.

It's true! Many of the benefits come from the release of tension, as well as oxytocin (all genders) and vasopressin (for males only), which increases all kinds of yummy feelings towards the self and others (if you let it).

Good news! Nothing bad! That is, nothing purely physiologically bad. And in fact, as someone mentioned, there are health benefits no matter what your gender.

But since you're asking, I'm going to assume that you have some discomfort with masturbation. If you feel guilty or ashamed (or anything unpleasant) about it, then I would call that something bad and I encourage you to explore that. I'd love to just fix it for you by telling you that it's ok, but I'm no match for years of you believing something else! Consider what you learned about sex and masturbation, particularly the unspoken messages, and then consider whether or not those things work for you. Do they match your intuition about it? What motivations might your parents/ teachers/ clergy have had in imparting that information? So much of therapy is removing the layers of junky stuff put upon us by others and by negative experiences. Get down there to you, and decide what's best for you. And do it with the support of someone else, but we can't explore or teach ourselves what we don't know. There are lots of resources out there, too. You might consider reading Betty Dodson's book "Sex For One" or my new favorite find "First Person Sexual" by Joani Blank to start.

No i heard both sides of, its good and its bad and wanted to see your side, thanks

My pleasure. And yours too, hopefully!

I used too be strictly attracted to older women. Around 10 - 20 years older than me (I'm 30). After courting and sleeping with a few, I now find myslef exclusively attracted to much younger girls. (18-22). I have no desire to hook up with girls my own age. What should I be learning from this?

Has the always been the case? When you first became sexuality active with partners, were you sleeping with older women? And if you're willing to share, do your fantasies match this?

I have issues giving head to women. I feel pukish. Is there anything I can do to control my reflex? The women themselves are clean and natural so it's not a hygiene thing.

There very likely is! Would you identify the emotions that go along with that for you? Pukish and ... horrified? disgusted? scared? angry? sad? I can give you a way better answer if I have just a tiny bit more information.

Hi, thanks for the AMA - What is your primary goal in therapy? If a couple is having trouble being stimulated, how do you even begin to fix their issues? Do you feel embarrassed at times ? Do THEY ?

My pleasure! Thank you for participating.

The goal is always a mutually created one, and therefore entirely dependent on who's in front of me.

And where to start also depends on where a couple feels stuck. There's a typical orgastic cycle that you could peek at, if you're interested: http://heatherbrewermft.com/blog/?p=105. Each person may feel challenged by different places in the cycle. We begin our work wherever there's the most energy, using existing strengths and resources as well as adding new ones. Would you like a random example? Or would you like to share a bit more?

I almost never feel embarrassed, because it's not my stuff that's being explored and I'm very comfortable with the topic. A huge part of my job is to have done a lot of the work as a client myself, and to know when my stuff comes up in the room. When it does, I name it, because it would be visible and/or felt in the room, and that's exactly the sort of thing that we are there to focus on- what's right here with us.

Clients definitely feel embarrassed at times. It's such a vulnerable topic. If there were no embarrassment, I'd be concerned! People have varying degrees of comfort about it based on what they've learned and experienced, but I'll tell you this: everyone feels relieved at having a space in which to share this stuff and to look at it together. Shame's only real power is in keeping you silent.

Have you ever worked with people who wanted to change their sexual orientation? Also, have you ever worked with people whose sexual orientation changed in the course of the therapy (in either direction)?

I don't believe that a person can change their sexual orientation, because it's not a choice. But I do have lots of clients who are coming out, or are trying to come out. On rare occasions I've had someone begin therapy in the hopes of suppressing their natural desires, but fortunately it gets very clear for them that that's not a sustainable route. I can't tell you what an absolute honor it is to support someone through really coming into who they always were. And those clients are some of the bravest and strongest people I've ever met.

What are your thoughts on female viagra?

If you're talking about Addyi, that's a simple one. I'm against it. It's not a "simple" drug like Viagra, which is limited to assisting with arousal. Addyi affects the nervous system like an antidepressant. I'm not against any use of medication, but an attempt to artificially boost the libido is a different matter. Low desire is there for a reason, and defenses should be honored and explored, not plowed through. When you find the source of the struggle, you know what to do instead to free a person up to feel desire once more.

I've been in a relationship with my SO for over 4 months. We are sexually active, however she has been very shy in showing me her body. She would need the room to be completely dark and she is always hiding under the blanket.

I don't think its because she is shy and I'm not pressuring her to do anything she doesn't want; but i just thought it is a bit weird.

Is there anything that I could do that would make her more comfortable being naked?

Well unless she's just cold or something like that, then I'd say she probably is shy. And it's probably not weird, because it happens for a reason. Most likely there's something that she's uncomfortable with having seen, and that could be something physical, but it could also be something more emotional. Sex is so vulnerable, and it creates in many people a desire to hide a little bit. It's wonderful that you aren't pressuring her, and because it sounds like you're approaching it safely and gently, you can probably invite her to practice incrementally showing you a little more at a time. You could even make it really sweet and flirty like, "How just this toe?" and then go on to give her a smooch or two along with some positive feedback. It will matter that she feels safe as this is happening. And it may end up being very important that she share the content of what happened to create this bashfulness in the first place. Be patient and kind- she may not know herself. But whatever it was, if you continue to show her how lovely it can be to be naked and visible, she'll likely grow to feel very comfortable with it. I'm glad she has your support for this!

What does the typical session consist of?

This depends entirely on what the client came in for. Somatic (body-focused) therapy can look from the outside very much like any other modality. What makes it different is the heavy focus on and inclusion of what's happening in the body. As we talk, together we track what's happening in the client's breathing, muscle tension, heart rate, etc. So when it comes to exploring sexuality, there's oodles of information there because it's such a body-based experience. Because the early muscular patterning of the body shows up very quickly when we talk about sex, we get to see where a person has blocks. Let me ground this in an example for you...

If someone comes in wanting to figure out how to have more sex in their relationship, we start to track what comes up when they try to initiate sex. Maybe she's attracted to and feels safe with her partner, but when it comes to asking for sex, her muscles tense, her heart rate skyrockets, and she just wants to hide. Once we tune into those sensations, we can begin to find their source. A common thing that comes up there is the fear of rejection or as being seen as "over-sexualized." Once we know the nature of the block, we can begin to practice a new way of being. In this scenario, we might do some deep breathing, some opening of the chest muscles, reality checking with the partner, etc.

You mention neurodiversity. What are some of the challenges you help people address that are related to that?

One of the very biggest topics in the room is often how the client can honor themselves, and how they can be understood and supported by others. This is very much any client's work, but with clients who are on the autism spectrum, for instance, we focus heavily on a sort of translation of experience. A lot of people are misunderstood and/or targeted for the ways in which they differ from many others (especially during their childhoods), so they tend to need a lot of space to explore what's possible when they aren't being told how to be.

It's one of my favorite areas in which to work, because I find it delightful to answer questions like, "Why do people have sex?" How does one answer that?! Well, we answer it together. We look at what they like about sex (or think they might), Somatic work is hugely beneficial here, because everyone's common language is the body. When you understand better how the body (and specifically: your body) functions, it's like having this secret code. Ultimately, that works for anyone, but lands really well for the concrete thinkers.

That said, it's a huge spectrum, so no two people's work will look the same.

Thank you for this answer and doing this AMA.

Do you talk with other professionals or autism advocacy groups to learn/develop techniques to improve your approach?

I do! I particular enjoy the work of Jade Ann Rivera (http://jadeannrivera.com/) Nick Walker (http://neurocosmopolitanism.com/), and Sara and Bob Yamtich (http://sarayamtich.com/ and http://bobyamtich.com/). I also attend consultation groups in addition to supervision, and I read books and try to stay current with the research. A big portion of my own work is to keep an eye out for my own blindspots. This is always important, but I sometimes wonder if internalized neurotypicalism is more rampant than other -isms, as it occurs cross-culturally. So I try to stay frosty!

Thanks for doing the AMA. Very professional, straightforward and fascinating to read!

Is there a common theme with many of your clients, such as needing better nutrition (and/or exercise) for improved sexual health? Or is it moreso mental than physical? (Even more spiritual than mental/physical?)

You're very welcome, and thank you!

Nutrition and exercise are definitely very important components of somatic work and sexuality, and I do make that a significant portion of most clients' work. Someone dealing with a lot of anxiety, for instance, won't be able to do much good work in therapy if they're drinking many cups of coffee every day. It would be next to impossible to help their nervous system find homeostasis if we were up against a daily input of something that does the opposite of that.

I appreciate that you're bringing up the spiritual component, because there's this sort of trifecta in therapy of balancing sensations, emotions and thoughts. You could also think of it as body, mind, and spirit. The "spirit" (whatever that means to you) component can often get missed, but is important to explore, because it tells us something about a person's locus of control. This in itself must be balanced, because if it's too far inside oneself, dealing with the external world will always be frustrating. And if it's too far outside (and this is where you sometimes hear people being accused of "spiritual bypass") then the person won't do enough for themselves, which can be scary, angering, depressing, etc.

Different people are in different places with all of these things, but most often, people begin therapy in need of some re-training on how to feel sensations and emotions. I think that this is largely due to how often we are encouraged to disconnect from these things. So when I ask, "What are you feeling?" it can be a struggle for many people to not give me a thought in response. But a huge portion of somatic sex therapy is about connecting to base input, which begins with sensation. One's sense of smell is always a great example. We finally got some rain here in Los Angeles last night, and today I can smell (sensation) the wet sage outside. I feel warm and nostalgic (emotions) when I smell that, because it reminds me of my childhood (thought/meaning). Being able to connect all three is vital to the process, because if you always skip right to thoughts, you end up doing the equivalent of writing up academic papers without any research.

It's easy enough to say, "I'm fine," when you clearly aren't, and somatics seeks to match the body's expression to the mind's. I'd say the spiritual aspect shows up in both realms.

Ok, I'm off to decompress for the evening! I'll see you cats tomorrow evening, probably about 11pm PST.

How do you feel about double ended dildos and anal?

Would you like to give me some more content? I'm unsure what you're asking.

Is your profession often suspected to be a front for prostitution?

You're the first! I understand that the term "sex therapy" can create a misunderstanding, and sometimes people think I mean sexual surrogacy, but that doesn't happen much and has never happened in person.

Is being a "sex addict" a thing? Or are people just really horny?

Take a look at my previous answer to Debutt. I'll add that it isn't about sex drive or libido, but a much more complex pull to meet a need that is largely emotional as well as physical.

Do your clients every hit on you?

I've never experienced anything that I'd call being hit on. I have had clients develop feelings for me, which is very normal and common in therapy. The entire space is focused on you, and the whole point is for you to feel like exactly who you are. That is a very appealing experience, so of course romantic feelings can come up. But those feelings are processed just like any others that arise in the room, and frankly, it can be very useful. This is especially true for people who have never had a healthy relationship. Within the boundaries of our professional relationship, they get to practice what it's like to have a really good, strong, safe connection.

could you put some sort of message on the webpage referencing the AMA so we know it is yours?

Here ya go! http://heatherbrewermft.com/blog/?p=501

you should edit the text of your original post and stick the url in there. :)

Done!

Sure! I'm about to create a new blog post for it. Stand by. ;)

Premature ejaculation....? How can I change this?

There's a term I don't care for, because who says what's premature? Apparently that's when your body is ready to ejaculate, so be kind and patient with yourself.

And let's first knock out a couple of things. How quick is quick? I've had too many men think that not lasting beyond twenty minutes (even forty-five minutes in one case) meant that they were ejaculating prematurely. The average length of time from insertion to ejaculation is three to five minutes. So maybe you don't need to sweat it so much. But ultimately, the issue is that you'd like to last longer. And even if you're dissatisfied with twenty minutes, that's changeable.

I also want to make sure that you know that if you're simply finishing before your partner does, that's very common. With vaginal or anal sex, it's either impossible or simply takes longer for the receiver to orgasm.

But again, you can absolutely do some work to exercise more and longer containment. First you must rule out physical causes, like inflammation or hormonal imbalances. If that's actually what's going on, you won't see any change without medical treatment. Psychosomatically, almost always what's happening in the body with what we call PE is that charge is unable to be contained. It's like having too small a balloon for the amount of air you want to fill it with.

What you do is practice expanding the container, which means working with your pelvis. (Again, don't do any of these until you've had a check up.) You can lightly massage your inguinal (groin) area, your sacrum, and your buttocks. You can also practice a pelvic rock. Standing up with your knees bent, inhale and rock your pelvis back so that your back is arched. With your exhale, rotate your hips forward. You should notice your neck moving back on the inhale and forward on the exhale. Practice this back and forth motion many times through. An IBP (Intergrative Body Psychotherapy( therapist can support you with this if any emotions arise, as they likely will. And I don't mean just the emotion of feeling like a goofball for doing this nutty pelvic rock. As you release the physical tension, you are likely to see a resurfacing of the reason you were bracing in the first place.

Breathing exercises and yoga are incredibly helpful for this, as well. Be particular about the yoga though, and stick to the heavily embodied types, like Iyengar or Hatha.

Is low or non existent libido more common in a homosexual lesbian couple than a heterosexual one?

Oh such a tricky question! I'm assuming you mean when both partners are experiencing low or non-existent libido. I can't speak to the statistics on this, but I think the answers probably lies in the fact that women tend to have more blocks to exploring low desire than do men. We're more often expected to not want it as much or as often, to be the recipients rather than the initiators, or simply be politely indirect or quiet about our needs. So if you're dealing with two women with low desire in a relationship, then maybe you see that problem perpetuated for longer.

Thanks for doing this AMA, just what I have been wanting to talk about. I am an older straight guy and a virgin. Here are my questions:

1) I can't seem to imagine having sex with someone I am not physically attracted to. Do I have a problem?
The reason I ask this is because I see a majority of my friends on the opposite end of the spectrum and would be willing to have sex with anyone and everyone.

2) Can sexual attraction be built over time even if there is no attraction at all in the beginning? Even if I get to know someone and like them as a person, the physical attraction doesn't seem to come with time.

3) I seem to be physically attracted to people outside my race in general which makes dating a lot harder for me. Is this normal or I am asexual or something?

1) There is definitely nothing wrong with you. Following your intuition is a good thing, especially when it comes to something so body-based. How could you not have some preferences? Having no preferences, as you're suggesting is the case with many of your friends, is something to be concerned about. That can stem from lots of places, many of which are worrisome: dissociation, lack of confidence (I'll take what I can get), negative beliefs about what's possible for sexual connections, etc. And, of course, your read on them could be wrong. What's most important is understanding that what works for them doesn't have to work for you. Sexuality is incredibly unique. Isn't that great?

I think the lingering thing here may be to explore how you choose your friends or what you get from them, and so on. Are you often left feeling different from them? Be curious about that.

2) This one is tricky. Yes, physical attraction can be built. Sometimes being surprised by your attraction once you get to know someone is especially pleasurable, because it means you weren't projecting onto them. Being open to attraction arising can be very important.

But are you starting with indifference? For instance, why bother with forcing a connection if you don't want it in the beginning? That's a particular thing to do to yourself that I encourage you to explore.

Alternatively, if you feel indifferent to almost everyone, then we know that something is going on in your boundary between yourself and the outside world. Then it's important to understand how that came to be. Were relationships devoid of attraction modeled for you when you were little? Did you see people hurt each other a lot in relationships? Things like that would certainly leave your system in a shut down mode. If it's never good, why bother to connect?

That's a lot of stuff to explore, which I definitely recommend you get support with. You'd get to see that come up with a therapist, too, and then you could explore it real-time. I know that can sound really challenging, but the payoff is so great.

3) What's wrong with being attracted to someone outside of your race? Shoot, if you aren't allowed to pursue the people you're actually interested in, then of course you're struggling to feel any sexual charge with others. Do you have structural limitations here? Like a parent who would disown you if you were in an interracial relationship? Or are you finding that population to be racist towards your ethnicity? Those are different challenges and will take you helping to create as many external changes as possible. Either scenario will need support.

All of your questions revolve around being unsure about your natural tendencies, and I'm noticing a strong feeling of wanting you to be gentler with yourself, and to trust yourself more. Maybe you're onto something with the distrust, and that's where having a therapist is incapable. Concurrently, I bet it would be tremendously helpful to have a regular, body-based practice. Look for an activity that requires your body knowledge, like yoga but it can be anything active. Do it regularly and listen to your body. You can also practice this with eating. Are you hungry right now? What does that feel like in your stomach? Or are you full? What do you notice about that sensation? If you're hungry, what would you like to eat? What would feel right? Go to the store or a place where you can see lots of foods if you have a hard time coming up with things on your own. Our dynamics show up about as readily with food as they do with sex. And p.s. this assumes that you haven't struggled with disordered eating. If you have, don't embark on that without a therapist.

You'll love trusting yourself more. I hope that happens for you very soon.

Did you see The Sessions with Helen Hunt where she plays a sex therapist who has sex with her clients? Is that something you support?

Spoilers to follow!

I just saw that pretty recently, actually! I liked it a lot overall. And I do support surrogacy in some cases. The client in the film is pretty much the easiest example, but there are many people who find it to be a wonderful and healing way to explore their sexuality and/ or heal something. I haven't yet referred a client to a surrogate, but I can imagine that happening at some point. That's partially to say that I think the useful occasions are fairly rare. Sex just IS scary, because the amount of vulnerability involved is very intense. That comes up with surrogates, too, as we see in the film. So I think that it takes a very unique set of circumstances to make it more valuable than it is risky.

That said, it's possible that my beliefs are greatly affected by the fact that I know viscerally that I wouldn't be able to be a client of sexual surrogacy. I have trusted colleagues that believe very strongly in it, so I'm staying open to finding blindspots I may have with it. I think the idea of sexual education including sexual contact makes a lot of sense (check out the deep history of prostitution, for instance), so I haven't quite been able to resolve that with my hesitancy to suggest it to clients.

There's one thing I'd like to note about the film, which is regarding the breached confidentiality when the therapist's husband reads the client's letter. We keep all kinds of precautions (locks and more locks and codes and P.O. boxes and encryption and code words and fake names and cryptexes) in place to protect against such things, and what happened was a major ethical mistake. So please know that that is very rare, and most therapists would be horrified by that. She was pretty horrified, but I wasn't sure she didn't have a role in it by perhaps giving out her home address.

Lastly, but perhaps most importantly... one of my FAVORITE things about "The Sessions" is that it's a rare case of the therapist-client relationship being portrayed very realistically. It's sort of too bad that it happened to be a relationship that includes sex, because I think it could accidentally perpetuate the notion that a high percentage of therapeutic relationships become sexual. That said, it's obviously very important that they got that part right in a movie that's spreading awareness about such a misunderstood practice.

Having no interest at making love with any girls, means that he is a gay?

Not at all. That's only one of many possibilities from a more complex sexual orientation to anxiety to depression. Would you like to give me a few more details?

Have you ever had to turn away a patient based on an inability to help them?

Also Zac didn't steal your brooch.

I have had to do that, but next to never, and it was because my practice private setting was not the level of care that they needed. I'd like to say a little more to impart a few things to you, but I can't think of a way to do that and still maintain full confidentiality. But I do want to to say that it is always an awful experience. The therapist-client relationship is such a strong and special bond (or should be!), and it feels very sad and very odd to have to end that.

Obviously brooch-stealers would be turned away immediately. Zac not included.

I am going through a dry spell for around 4 years (I'm a mal 31 old right now) and I don't think I have a big problem with it, but I guess that it is not normal to not have sex at this age, and I'm more worried about that I don't have a real problem with my dry spell (read: I don't care that I don't have any sexual relationship with someone).

Can this be normal?

Well number one, there is no normal when it comes to your sexuality. I think it's smart to be curious about your dry spell, but it could indeed just be an ebb and flow of your desire. In order to explore it, look at what was going on about four years ago. Have you been depressed? Did you just have a break up? Did you get a new job? Did you experience an illness? Did you put on some weight? Did someone close to you die, or did you see someone else lose a significant other? More broadly: why might it be good to not be very close to anyone right now? Very often things like this are set off by an event or series of events. It probably makes sense to your body. Do some self-reflecting and keep an eye on it. You may very well want to explore it with a therapist at some point.

"Sexuality is the best source of information about how you relate to others": can you explain this please? I'm not sure I understand and so can't tell whether I agree.

Somewhere in there, can you offer a contextual definition for "sexuality"? Just trying to understand.

And, lastly, what's one tip you would give to anyone regarding fostering a healthy sexuality / clear sign that they might need therapy in this?

Thanks for your ama!

Ok, so first of all, the presenting "problem" is never just about sex, but about a person accessing the self and expressing themselves to others. Let's look at a scenario. What happens during masturbation versus sex is always a great vehicle for exploring this.

Let's say that a person masturbates daily, usually in the afternoon, and uses a vibrator (the details of how, when, why and where matter a lot). When it comes to sex with their live-in partner, maybe they initiate two or three times a week at nighttime, and they don't bring in the vibrator. For the sake of simplicity and answering your question, let's assume that the partner would be cool with whatever this person brings into their sex life. You can see from this that there are differences in relating to this self versus the other. In therapy, we would explore different aspects of this in order to understand the dynamic. Maybe we'd find that the person isn't comfortable with her partner knowing that she masturbates daily, because she was taught that masturbation is unhealthy, or past partners shamed her for it, etc. Or maybe we'd find something slightly more complex, like that while her peak arousal usually happens in the afternoon, she isn't comfortable with that amount of light when it comes to partner sex. So she's comfortable with it in the total safety of solitude, but not with the vulnerability of being seen. Once we know we comes up, we can start to re-pattern things in such a way that allow the client to be more fully who they are naturally. Sexuality is the vehicle for exploring a person's go-to dynamics.

LOVE this question. Thank you for asking it! I'll get back to you after my client sessions!