The "L" word, Sex

Those of you who read this blog regularly know that I rarely use the "S" word.

That John Lennon Song, Mind Games

And yet, here we are, associating it with the "L" word, Love. Is that even politically correct?

Sex in some relationships has been described as marital glue. It is what keeps many couples together when all else fails. Sometimes, it shouldn't, keep them together. Sometimes we're glad it did.

It sells.  Boy, does sex sell. It would seem that without it, nothing sells.

Twenty-five percent of divorced couples blame sex.

People like me are called upon to treat it, to treat problems with it, problems about it (cheating, sexual assault).  You would think everybody wants it, sex, but that's certainly not true at all.

Some merely want to express love in a physical way, and that it can be, an expression.

We've discussed how to use code to signal one's willingness for it, how that can be romantic.

"Honey, come into the bedroom, I have something I want you to look at."  

Or perhaps better,

"Kids, we're taking a nap.  Keep the fighting down."  

Other posts about it have suggested that problems with the mechanics, especially, are usually problems with communication. It is also difficult to communicate about because what we want feels so . . . private. To communicate about private things we have to feel safe, we have to trust. We all have numerous reasons not to do that, not to trust. Yet trust in a relationship that is sexual is everything.

Ironically, many singles assume sex to be a natural, safe part of their relationship. They trust too much and sometimes get burned, come to therapy to talk about it. That lovely piece of themselves, the part that trusted others in relationships erodes, changes. That is something to mourn.

But it is a coming of age thing, too. We really shouldn't trust just anyone. And trust, guess what-- has to be earned-- usually over time.  Lots of time.

A sex therapy is a type of relationship therapy. Meaning it is about both, trust and communication, that old faithful of any therapy, really.  If a couple can't communicate about how to load a dishwasher, then communicating about their most sensitive desires is going to be difficult, too.

"This way!"
"NO! This way!"

Not loving, not at all.

Oh, let me segue, it's my blog. 

I am always amazed at how the Old Mighty determined the male and female anatomy to be so different. (The Old Mighty is the way my grandfather referred to the Creator of the Universe). She worked it so that we have no intuitive knowledge about how the apparatus (fine, anatomy) of the opposite sex operates, even feels.*  Here we are, so alike, and yet in this difference, and those differences in our brains, we're only able to empathize with one another if we talk pointedly about ourselves. Leave the code at home.

My hunch is that we're made differently because where there is pleasure, cheap, clean, unadulterated pleasure, we are motivated to communicate to share it.

And the beat goes on.

I want to blame television, the movies.  In the media it seems to be all about intercourse, nothing else.  Someone doing someone. Even this language, seriously.  Doing? Think of the scenes you've seen on Madmen or another show. Doesn't the emphasis seem to be on penis-vagina sex, except for an occasional on-your-knees job, a sacrifice to make someone happy.

As a young trainee at Loyola University Medical School's Sexual Dysfunction Clinic in the 80's, I almost fell off my chair when Domeena Renshaw, a pioneer in the field, pronounced,

"Only one in five couples have successful intercourse." (Meaning both partners experience orgasm.)  "We just aren't made that way." (Meaning that we will both be satisfied during intercourse.)

Then she proceeded to show us slides that clearly indicate that the clitoris isn't in a physiological position to be especially excited by the penis. Location, location, location.  During intercourse the clitoris, the female center of arousal, isn't stimulated directly by the penis. The male's sex organ is sexy, certainly unto himself, but not to the clitoris.

Now of course you will argue this, because Mr. P is sexy, and beautiful, and can be involved in the pleasuring process as a willing, delightful participant. And the more compliments he gets, the happier he is, as is his wearer, who enjoys an improved body ego. And that's an important thing, I think, for both partners, loving their bodies and communicating admiration and love for what are probably the strangest parts.

That alone is a pick me up for Mr. P, encourages him to stand up and be counted. (Fine, I'll stop).

Mr. P's self-esteem (I couldn't stop, sorry) falls quickly if he feels the success of the party depends upon him, that the responsibility is all his. Ms. C. feels the same way when the circumstances are reversed.

So sex therapists will discuss this, the importance of relating lovingly, admiringly, giving as well as taking,  participating in a mutual process of pleasuring.  We suggest, too, that because of complementary anatomies, the way we are made, it is foreplay that matters most, not intercourse, no matter how it is demonstrated on television. The director of the show has no need to show the foreplay; the sponsors are waiting.

The largest organ of the body is the skin, and it needs attention in all kinds of places, not just those naughty bits that Monty Python used to tease about. Foreplay is all about that, the rest of the body.

But we can't assume that even this, touching other parts, other areas of skin, will be a good thing. We need permission, an invitation really, to touch someone, even if we're partners. It may be covert permission. We may already have it. After years, some of us merely know. Permission granted. Without permission, some people get very anxious at the very idea, being touched.

So let's say that permission is granted.  There are potential problems, however, permissions aside. In many cases Mr. P will be to blame for not cooperating. We'll talk about that case right now.

A young man, could be you, could be your brother, your son, your friend, calls a therapist for help.  Hopefully, he thinks, this is a sex therapist. The therapist, who has marketed herself with all the right Google key words, might hear that he wants sex therapy but might hedge her advice.

 If you are not in a committed relationship it is likely to be an evaluation, not sex therapy, not from me, anyway. 

Why? What's this?! It doesn't seem fair at all!  How is someone supposed to get into a committed relationship while being a failure at sex?

Excellent point, which is why we schedule the visit, not wanting to be unfair, and evaluate, maybe even suggest a treatment plan. But these recommendations are likely to have little or nothing to do with the mechanics of sex. They are relationship recommendations.

Our young man has never had real relationship problems, or problems with sex. He has had partners before his current relationship. He does not use drugs or drink. His parents are together and seem happy and he has never heard sex as a dirty word.  In his current relationship he is losing his erection because he is suddenly very anxious while putting on a condom.  He has an anxiety problem, he says, but only about performing in the sack and only in this relationship.

This is pretty common, losing an erection, or in the case of females, losing focus. Men often lose theirs in the process of putting on a condom. Getting back to the party feels like starting over.

So start over, we say. 

Whenever this happens, erections, arousal, drifting away, a couple is instructed to start over.

"And is she helping you at this point, when you both notice what you're labeling as a problem?" asks the therapist.

"What do you mean, helping?" He is lost.

"Well, either emotionally or physically. Either by loving you with words or actions.  Are you telling her what she could do to get you back into this?"

No, of course not.  She is expecting him to get it up.   After all, this is his job. Her pleasure is supposedly within his agency.

It is so backward, I feel. We used to have this expression, not popular, apparently today, not in the age of Fifty Shades of Gray, that you have to be responsible for your own orgasm.

Taking responsibility for one's own climax means many things, among them wanting to feel in the mood when we know our partner is in the mood or certainly will be, preparing mentally and physically for time together. But it is also telling a partner what we want, exactly, when we're actually making love (there's that word). We're the only ones who know the answer to that, to what makes us feel good. It is a nice process, too, a learning experience when we don't know what makes us feel good, when there are two eager learners, working with trial and error.**

The dysfunctional cycle or homeostatic feedback loop of the case:

Two partners, A and B are involved in the love making process, except that only A feels responsible for the success of a "date".  Suddenly:

A has trouble with his erection while putting on a condom, or at any other time.

B waits for A who is having trouble with Mr. P., who seems to be taking a nap.

A begins to get anxious, fiddling with the condom or worrying that this will never happen. Mr. P isn't waking up.  Wake up, damn it!  Mr. P doesn't cooperate under pressure.

B is becoming impatient, is considering what is on television.

A worries that B is going to abandon him, drop him. The two aren't committed after all. Meanwhile, Mr. P is not looking his best, is nowhere to be found, has disappeared altogether.

B looks at A, accusingly. Well?  When are we going to get back to it? (Note, not What can I do to help?)

A's anxiety rises with every passing second. Mr. P is hardly breathing.

B to A:  Call me when you've fixed this problem.

A's fears are realized. Our young man has learned that he had better fix this or he'll never have a normal relationship. He calls a sex therapist.

What do you mean, Is she helping me with this?  No! Why would she?  

The Beatles liked to sing in the song Mind Games, which I'm pretty sure is about sex, but in code,

Love is the answer.  

Work on that, we say. The rest is commentary.

therapydoc

*Our DNA is approximately 95%  alike, yet we still use the language, the opposite sex..  I think that is because that five percent weigh in when we interact in this way, in a potentially procreative, sexual way.

**This is why some of us recommend sex in the format of a committed relationship. If you assume you have until you are a hundred years old, give or take a few years, to figure it out, there is less stress. Trial and error, lots of words and audible breathing, and this falls into place rather quickly. Oh, and deserved trust, lets not forget.

P. S. John Lennon died December 8, 1980. A fan killed him, I think.  We could comment on that all day long, I suppose.

Hope Springs-- Eternal

Meryl Streep as Kay in Hope Springs

Name of the film: 

Hope Springs

It is a feel good movie.  Already I'm getting new business. So I feel good.

For so many young couples in therapy, that word eternal has absolutely nothing to do with reality.  The phrase if from an essay on man by Alexander Pope.

They are right, of course, to be skeptical about the longevity of hope as it applies to human relationships, about eternal.  The newness that a young couple feels, the excitement, the arousal, the thinking that this could last, has to change over time as we vie for what we want, strive to meet our individual needs.

That's how we're made, most of us, self-protective. And we desensitize to a steady diet of almost anything; even our partners lose their glitter, just like a favorite brand of cereal.

Worse, if we stay together for many years, unless communication is direct, kind, well received, productive, intimate, it is likely to be received poorly.  When problems aren't resolved to the satisfaction of two, not one, an inventory grows, a list of grudges.  And the goodness, whatever the good used to be, is squashed by resentment, the bad.

We might be bad at math, but when it comes to our relationships, we're great at keeping score.

YES, THERE ARE SPOILERS

I'll keep the spoilers to a minimum. Does it spoil the movie to say that Steve Carelle, as Dr. Bernie Feld,  makes a cracker-jack couples therapist? Is he worth 4K to treat a couple for what we see as an hour a day for six days straight?

Suffice it to say that no therapist is worth 4K to spend 6-10 hours with you, and it is unlikely to be successful.  I get the couples who go through these magical workshops six to twelve months later, when it is obvious that the intensive week failed. In my humble opinion, you'll get the same with a well-trained couples counselor who might even be covered by your HMO, meaning is being paid $60-$90 dollars for a 45 minute session.  The couple pays $10-$50 of that out of pocket.  Swipe goes the Visa.

And of course, I have to complain that Steve, as Dr. Bernie Feld, does not provide nearly enough of the psychoeducation a couple needs in therapy, especially not about sex. Couples hang on to sex education, every word. Need a couple's undivided? Talk about sex.

Oh, let's do that for one moment. Sex is a natural, physical need, like breathing and, well, defecating. That it has been relegated to intimate relationships, committed relationships, is not a shame, rather a human cultural development (or you could say, if it is your cultural belief, a God thing). When it is good, and when it lasts in a relationship, it becomes a glue, a way of saying, You're My Number One.

That is comforting as our wrinkles begin to show, as the bellies go to flab.

What happened to Kay and Arnold?

Wonderful lessons in this movie, nothing you need to read about here. The movie will eventually be on HBO.  But Dr. Feld  wouldn't have turned anyone off had he addressed intimacy fears more directly.  He never brings in family of origin, or how affection matters in life, especially in marriage, how that begins with Mom and Dad, as do our unmet needs, our habits, our attitudes-- what we think is okay and is not okay when it comes to sex.  But we only have 90 minutes.

The main beef for those of us who study relationship therapies professionally, is that the therapist doesn't get out of the couple system quickly enough. He finally tells Kay to speak directly to Arnold on Day 4. He, the doctor, asks the questions and wants the answers directed to him.

A couples therapist wouldn't want to be in any of those conversations.
Therapist:  "Tell Arnold how you feel about your very best time having sex."

So much better than,

"Tell me about your very best sexual experience."

No wonder poor Arnold walks out on him.

therapydoc

Satisfying the Girl

When things come in threes, I write about them. I think, this can't be an isolated issue, maybe it isn't random, not if it's coming in threes.

A guy tells me that he has found a solution to dating anxiety. I'm interested in the solution, I really am. But first, of course, want to know

Why should a guy have dating anxiety?

After all, there are two single women for every single man, probably three. A man can have six eyes and he'll still be a hot property in certain circles.

Hold constant (control for) any predisposition toward anxiety, anxiety disorders in the past, anxiety disorders in the family, post-traumatic stress disorder, child abuse, obsessive-compulsive disorder; hold all that in abeyance, and there's still a likelihood, or so I'm hearing, that dating is scary as hell.

I don't mean to be glib. I understand why people are anxious about dating. It's the rejection that's terrifying. Rejection hurts, and the chances of being rejected after a first date are rather high, actually. This we understand.

What's confusing is not the anxiety, but what men are doing now to resolve it. To resolve dating anxiety, men are taking Viagra. Young guys. We're not talking just the Medicare set.

Apparently they're sure that women expect a really good performance in bed. Nobody's watching Oprah or Dr. Phil, or Dr. Laura or Dr. Ruth, not as much as we once thought. If they did they would know that a good sexual relationship does not depend upon a good performance by anyone.

On television, thankfully, and even in most of the books in the self-help section at the book store, we learn that a woman is supposed to be responsible for her own sexual satisfaction. If she's interested in this, sexual satisfaction, and she should be, since this is great marital glue (don't get me started, I don't know if it works as glue if you're not married)

(a) she should try to connect with her partner while she's alert, not about to fall asleep,

(b) both of them should focus on their sensuality, wake up the brain, stimulate all five senses,

(c) she, especially she, since he's had his sexuality in his hand since he learned how to urinate, but she should get to know her body, understand what makes her happy (I know, I know this is an unpopular suggestion, especially for some people who have religious concerns, one day we'll give it more time) and

(d) if she wants him to feel he's doing something, then she has to tell him what to do to pleasure her.

True story. Guy calls me for marital sex therapy. He says,

“She’s too small. Maybe we need a pelvic floor therapist, or maybe you. The doctor thinks we probably need a sex therapist like you, but I think a pelvic floor therapist.”

I haven't a clue what this is, a pelvic floor therapist, am hoping this is a sex therapist. This young man has called me many times before, but we've never met. He's never satisfied with my telephone assessment of the situation, yet I still hear from him every six months or so, feel we're old friends. (He could be a she, or maybe an avatar, we're not outing anyone here).

I reply,

“There’s no too big or too small. You need a relationship therapist, one who understands sex therapy, or a sex therapist who understands relationships.”

“No, she’s too small.”

End of conversation. No too big, no too small. At least one of us is clear on this.

That had to be said, that there's no too big, no too small. A couple has to manage with what they have and can, should, try to enjoy the process, try to figure it out. Somehow.

So if size doesn't matter, then what does?
You guessed it:
(1) communication,
(2) discussion of mechanics and myths about sex,
(3) practice at home, and
(4) resolution of emotional interference.

Why would anyone think that you can have all that, and what you don't have can be resolved, all on a first date? Surely it takes a long time to get any one of the four right, let alone all four. Most couples who come to a sex therapist have been working at it a long time and have given up. They've already spent a few years getting to know one another, getting to know one another's likes and dislikes, exploring and talking day after day, year after year, and even then, it just isn't working. They know there's baggage, too, that is in the way, even secondary trauma. We'll never get it right! There's something really, really wrong here!

This isn't second nature, really, a sexual relationship, or any other kind of relationship, to tell the truth. But we'd best focus.

Sexual behavior as a couple is learned, and it is learned in process, from one another, since there are two of you. And you both have baggage, attitudes, histories. It can years to learn to communicate in certain areas, about certain things, without fear, embarrassment, or anxiety, for some of us. And people get so angry at one another! When we communicate anger, intimidation, power, or dominance it can be a huge turn off (I know, I know, the exceptions).

And there are many of us who are depressed, and nothing kills libido like depression, nothing; and past traumas, too, like incest, or other sexual abuse, abortions, not sexy. Really not.

Then there are the mechanics of sex, the how-to's, and these are, perhaps should be, trial and error, too, and there's a lot of room for error, so it can take years, without direct communication, without straight talk, honesty, to develop a mutually satisfying sexual relationship. The joy is in the process, really.

Then there's that whole trust thing. Sex and trust go together. How are you supposed to have that on a first date? A second date? Surely you fool yourself, you say, Oh, this person's had that vasectomy, and then, surprise, he was kidding. Or she says, You're the only one, and she's checking her phone. You get hurt and your trust issues get worse, not better.

This is why people like me don't even feel it should be happening without commitment, sex. Crazy, I know, and so unpopular, so unreasonable, that this is likely not going to catch on. But it's too important, sex, too integral to what makes a healthy couple healthy, content, establishing a good relationship while naked. The reality of sex is that it exposes us. Who wouldn't be terrified, seriously?

Let's draw a parallel to aggression to explain this phenomena, the pressure to satisfy the girl, the pressure to have sex in general, no matter the status of your relationship.

It's compelling that the Saw movies are in their seventh year. Every year there is another one of these very, very violent, horrible, graphic movies. People go to them, we think, to master their fear of violence. If you see the film often, or you see a new one every year, eventually it doesn't upset you, the thought of cutting off your own leg, and well, you're tough. You're strong. You've desensitized to your fear.

Some of us would disagree, however, that this is what makes a person strong. If this is what makes a person tough, seeing violence and not feeling anything, not being affected, then that person's definition of strong is perverted.

The corollary is sex. We can regard this fascination with sex, this insistence upon it, because it is supposed to be a loving act, the flip side of violence. And we can see the obsession with it in the same way. Have it often, have many partners, do it perfectly, and at some point you will be immune to the anxiety, the embarrassment of taking off your clothes, of someone seeing you for who you really are.

That's pretty sad, isn't it? In a good relationship, one that is trusting, loving, caring, and kind-- taking off your clothes might still be embarrassing, but it's a good kind of embarrassing, a shy kind of embarrassing, even, an intimate one.

You might say, for example, "I've gained five pounds this winter," and your spouse will say, "Don't ever lose them! I love them! I love these pounds!" For he knows that you are responsible for your own weight, too, and he doesn't want to work your program, he just wants to make love. And he loves you.

And in a good relationship, one that is committed, you are staying the night, so staying the night isn't even a question, it happens all the time, it's not a big deal. So theoretically, if you have that, commitment, you can roll over when you're both a little tired of sex play, and say, Goodnight, even if everyone's not completely satisfied, and it's okay.

But not anymore. Oh, no. Committed or not committed,

NO! YOU (I) MUST BE SATISFIED OR FORGET IT! WE CAN'T POSSIBLY CONSIDER GOING TO SLEEP YET!

Where are people learning this?

This dysfunctional pressure to reach orgasm is perhaps a reaction to what could have been the rule, perhaps even as recently as forty years ago, a covert rule that men didn't need to concern themselves with female satisfaction. Nice girls didn't like sex. So slam-bam, thank you ma'am, theoretically ruled. But perhaps that whole thing was a myth, that men who loved their women ever even did the slam-bam, thank you ma'am thing. Yet the reaction formation for sure is alive and well.

Now, men have to perform, their needs are important, but hers are, too, and she's demanding a performance, or so some of the guys feel. The guys are thinking they have to be studs again. THEY have the secrets to female satisfaction, and if they don't, well, no second date. So of course they're anxious, because in their minds, and apparently in hers, too, what makes it great, sex, is that erection.

Zachen v'aitzen Columbus. (Yiddish for, What in the world is wrong with this picture? Don't ask me for a direct translation. Find my mother, ask her.)

This is fantastic news for the makers of Viagra and Cialis. Forget that only one woman in five has orgasm during intercourse, anyway, with or without these drugs. Forget that without an intimate understanding of a partner's arousal, physiology, and how much he or she had to eat, meaning how extended, distended, in other ways one might be, that there's no way one partner can help the other achieve orgasm. Forget that foreplay should take a half an hour, intercourse maybe five minutes, maybe ten, or it's going to hurt, certainly will irritate her. None of this matters. It's all about Mr. P.

It shouldn't baffle us that the importance of sex has taken on such magnitude that a man will take a medication that could be dangerous, just to be sure to please a date. This is horrible and is indicative of a related issue, that we have grown accustomed to instant relationship gratification (hand me my phone, please, I need to read my email NOW). She wants it now. Or so he think. Why waste time?

Nobody's taking the time to nurture the relationship.

And the joke is that people think they can nurture their erection, their arousal, without it.

therapydoc

Lust and Love: Part One

I don't know if we'll ever get to Part Two, but there's a lot on the cutting floor.

On New Years Day, National Public Radio played a Best Interview of 2009 with famous sex therapist Dr. Laura Berman, who is an inspiration, seriously. But Laura had nothing of substance to say about the L-words, as far as I can remember, so somebody should. I understand her new book has pictures, by the way.

Is it possible we’ve never discussed this, lust and love?

Let's get right to it then, start with lust.

There’s a lot to be said in favor of lust, without being facetious. Twenty-five percent of all marriages dissolve due to sexual problems. So it stands to reason that lust might be factoring in there somewhere.

Maybe it's there, but not reciprocated or appreciated. Or the object of lustfulness is someone outside the dyad, a lady, a gent. And if lust is there for someone else, and it isn't there X2 in an ostensibly committed relationship, then that dyad (two-some) could be in trouble. Heaven forbid. But it happens.

Which is why I'm thinking it needs to be bi-directional, it really does. Both partners need some luster at the same time in the same place at least some of the time. And it totally gets a bad rap, lust, and maybe it shouldn't, which had to be said, because without it, without the arousal associated with lust, sexual relations can be a real pain, as in painful. And who needs that?

And there's the idea that although sexual intimacy is only one of the five intimacies,* it facilitates the others, is a metaphor of every process, every problem in the relationship. Thus it is high on the hierarchy of couple needs. Associate lust, as we've just done, with sexual intimacy, and working the lust matters. It's a good thing, not bad.

Have I lost any subscribers yet? Oh, give me time.

Sexual intimacy, which should include lustfulness, looftness, whatever it was Woody Allen used to say when he was expressing his love/lust in one of his neurotic films, feels good, and it's free. So it has to be good for marriage, can surely be the marital glue, way up there on the list of intimacies.

That said, if a couple is not married, is not legally or emotionally committed, then good sex can be glue for that couple too, making it harder to get out when intellectually, emotionally, rationally, you know it's not a good match.

Still, it's hard to say, I have to go now, when a vibrant part of you wants to stay.

Lusting for a bad boy/bad girl, just one of those things so many people lust for, or lusting for an ex, can be easier than living with one of these 'til death (or divorce) do you part. People cut bait, are capable of rational decisions, even when the lust refuses to relocate. We get out of dysfunctional or second-rate relationships and think back, sometimes years later, with a fondness and desire. You bet.

There are clergy-people who tell us to extinguish the flame. But the brain has a mind of its own. We can fight the process, crack a mental whip, control the wandering, but it's difficult. Just like any other obsessive, ego-dystonic (annoying) thoughts, these refuse to leave home.

Sex therapists suggest distraction, focus upon the body, the senses, not thoughts, if they make us feel bad or conflicted. We're supposed to get into our five senses and how they affect our internal arousal, search inward, deep into the self, beneath the skin, although skin is good, too, touching it. We focus on the body, find a wave of arousal,** and zero in on what makes the body happy, the source of stimulation that makes it so appealing, this reaching for higher heights.

Call it meditating with a purpose.

Then, once it is located, once that certain predictable, happy-centered neurological pathway is found, we coach the main squeeze. Instruct a partner accordingly.

So simple.

Except for the instructing a partner, and taking instruction part, difficult for some couples. Which is a problem, illustrates the salience of problem-solving intimacy, a topic for another day. For a partner who doesn't want to give instruction (too embarrassed) denies the other an opportunity to pleasure her (let's just say it's a her).

And a partner who doesn't want to take instruction (let's say it's a him) reduces the chance that his partner will feel pleasure.

It is like saying,

I want to give you a present, one that will make you really happy, but I don't want you to tell me what you want, how you want it delivered, or when.

I'm assuming that what I've got to give is what you want, because you couldn't possibly not want what I've got to give. Right? Please tell me that's so.

Without hints from the other, we're lost. This is all especially sticky for people-pleasers who go ahead and say, It's so. When it isn't.

Ah, but if there's no issue taking instruction, then once this is accomplished, the instruction, the humbled down student is very sexy indeed and will listen, follow, and soon add individual polish. Together the couple finds that variations on a theme are infinite.

And exceedingly intimate. More intimate, surely, than wandering where the brain prefers to go, along those short-cuts, the exes, the models, the movie stars. Of course, not everyone worries about the short-cuts. Indeed millions celebrate vibrant brain circuitry, grateful that it is being put to good use. We're not judging.

But for those with too much guilt to fantasize about the mail-person, the gardener, the babysitter or the boy next door, for those who wish that extra people in the psychological bed would just go away, working the lust the natural way is a prime directive.

And in this process, lust becomes a function of love. For what we've just described above is nothing, if it is not love. You can't tell just anyone what makes you happy sexually. You just can't. Some of us have to love someone to do that. It's so embarrassing. You're only going to tell someone you love, someone who is in it with you for the long haul, someone you know will move mountains so as not to disappoint, at least furniture. Working every one of the intimacies feels like moving mountains, you realize, over time. Sex is just one of those mountains.

What's all this got to do with the Pina Colada song?

I was tired of my lady
We'd been together too long
Like a worn-out recording
Of a favorite song
So while she lay there sleeping
I read the paper in bed
And in the personal columns
There was this letter I read

If you like pina coladas
And getting caught in the rain
If you're not into yoga

It's his lady who answers the ad, if you remember, and she likes pina coladas, obviously, and getting caught in the rain, just like him. But he doesn't know it, not until he meets her a second time. He's tired of his lady, he doesn't even know her, and he's stepping out on her.

You gotta' wonder what it is they talked about.

therapydoc

*Sex is only one out of the five intimacies. Tweak them and other problems disappear. Tweaking well, unfortunately, isn't always easy.

In no particular order, The Five Intimacies:

(1) emotional intimacy
(2) sexual intimacy,
(3) problems solving intimacy,
(4) work intimacy, and
(5) recreational intimacy

No particular order.
That said, I'd place sex high on the list-- emotional intimacy higher.

**This wave of arousal is what the yogis call kundalini (correct me if I'm wrong), and worth the search, the game of hide and seek. You can play it alone or with your partner. Makes it more fun. Call it a joint marital responsibility.

"Am I getting warmer?"

"Yes, and a little to the left."

Domeena Renshaw, world-renowned sex therapist, a psychiatrist, tells us that sexual arousal is one's own responsibility, whatever that means. This may not sound very romantic, but is the case for developing one's own appetite. She also says that sexual arousal is tucked somewhere between the belly and the brain. It isn't necessary to limit your research, is the truth.

When I fall in love: Libido and people pleasing

Caveats, warnings, (1) it's written in code. (2) this isn't about people who live with abusive spouses. (3) some people do change for the worse and it may not be possible to love them forever. (4) that's okay, (5) yes, you will find permission to think about sex in this post, so if you have a problem with that, use your own discretion about reading on.

Now can I write already without everyone getting all upset?

The song, written by Edward Heyman and Victor Young, came out in 1952. Doris Day sang it in the movie One Minute to Zero. I wasn't born, not yet, but would be soon. Others re-recorded it, most memorable, Nat King Cole and Johnny Mathis, crooners of the highest order.

Woke up with it yesterday for some crazy reason, and didn't want to lose it:

When I fall in love it will be forever
Or I'll never fall in love
In a restless world like this is
Love is ended before it began
And too many moonlight kisses
Seem to cool in the warmth of the sun

When I give my heart it will be completely
Or I'll never, never, never give my heart
And the moment I can feel that you feel that way too
Is when I give my heart to you

Boy, he's going to hate me for this.

F.D. bursts through the door, purposefully strides through the hallway to the kitchen for his second cup of the day. I've been looking at him carefully recently, admiring his features, seeing through the gray, thinking he hasn't changed very much over a couple of decades or more. His basic personality, the guy I married is still very much there.

Change, you should know, comes up all the time in therapy. A patient had said to me just the other day, The things I loved about him when we first met I can't stand anymore. I said to the patient, Let me take you back there. Let's get a better look.

We change, but we don't change all that much. Change is not all that predictable and not usually permanent.

For many of us, for sure, our libido changes, sometimes a lot. When I trained in sex therapy at the Loyola Sexual Dysfunction Clinic in Maywood, Illinois, Domeena Renshaw, one of my doc/psychiatrist mentors, said many things that made sense at the time and make even more sense to me now. She talked quite a bit about something called "focus." Focusing on one's own sexual arousal is key in sex therapy. Quit thinking about everything, eveyone else. Think about what you like. Pay attention to yourself.

This is hard for some people. Especially when we're conditioned to thinking of the other person. We want HIM/HER to be happy. (or we'll get rejected?!)

Some people are so out of touch with their own needs and wants that they'll deny even having them.

Ironically it can lead to conflict. A person tries to please a partner but assumes too much and ends up doing the wrong thing. Not only is he upset because of the energy wasted, but his dissatisfied partner isn't happy, either.

You can see how the marital problem would get played out in the bedroom. He's thinking he knows what she wants, she's thinking she knows what he wants (or if they're gay/lesbian, etc., you can change the genders). But in fact, the guess work is just that. Thinking only about the other person isn't necessarily good for marriage, or for sex!

You have to focus on yourself.

Domeena really pushed the idea that a person's arousal, one's libido (in this case drive for sex) is one's own responsibility. This was a super big concept in the early 80's and should be even now, but our popular culture persists in selling the notion that arousal is what happens when one is lucky enough to have scored an experienced lover. He'll (she'll) take you there, so to speak.

I read this all over the blogs.

But think back. When you fell in love? When I fell in love? How was that libido? Perfectly marvelous, I think. The object of our desire didn't have to do anything. All he or she had to do was cast a glance in the right direction. You had me at hello, we say.

Now it takes an hour and a half.

It's his fault? It's her fault? My fault? Your fault? We've changed so much?

That libido. We had it, remember. It was a natural thing, like breathing, an "awakeness". Food, unimportant. Sleep, who cared. But play, share feelings, gaze, flirt, make-out for hours? Now we're talking. I'm in love.

Libido is technically "drive." Freud said we were born with 2 of them, one for aggression, one for sex, love. This is probably the best thing we can learn from Freud. The rest is commentary.

So how do we get back a drive for making love? We want that physical desire but it's elusive, feels like it's gone forever. We weren't supposed to have lost it in the first place, you know.

But we do, of course we do. Over time it's easy to get tired and cranky and out of touch with being a sexual person. Stress, depression, anxiety, too many substances (legal or otherwise), and certainly, certainly anger derail our attention. We defocus. And our coping strategies, especially eating too much, will likely steal it away.

Add to that relationship problems.

And add to that, What you don't use, you lose. Those neurological pathways need travel or they atrophy.

And the guys aren't all that different. Women often complain to me that their male partners are always ready to go, always in the mood, still. After twenty or thirty years of marriage, sometimes, they'll be complaining about this. They're wrong, of course. Young guys, sure. They should be ready. But as men get into their 30's, 40's, 50's and above, they need a lot of touch and attention. And touch and more attention. Physical attention.

But they were born with an organ to look at and play with, whereas some women, MANY women don't know where their sexual organ, the clitoris, is (is this a bad word? in some cultures it's removed surgically, like a circumcision).

So women will say that they aren't instantly aroused like men because they can't see their arousal and really don't even feel anything close to arousal. A healthy guy wakes up with a morning erection. Normal physiology. A woman, unless she has trained herself to pay attention to her body probably won't wake up and go, hmmm, my body's surely aroused. We're in a fog, most of us, I think. We don't see anything different about ourselves in the shower, either, except perhaps more cellulite.

A guy's arousal (think code) is pretty obvious and it can turn him on, make him feel sexual. He wants to share that information and we're likely going to say, "Shut up, go away, I just woke up." But he's just being friendly. Childish sometimes, but friendly. (This depends on context, of course, we're not talking about meetings in a bar, we're talking about meetings in your closet).

Sometimes you might see a little girl who is obviously very in touch with her sexual feelings, maybe she's rocking or being demonstrative in some other way. Parents will discourage that behavior instead of saying to her, take it under the covers. We're embarrassed by it.

Then as adult women we wonder where our libido went. We sublimated it for many years, woke it up with romantic love, then let it go back to sleep. We then continue the tradition by encouraging our daughters to sublimate theirs, too.

De-sublimating isn't so easy.

I'm not going to even try to minimalize this, but within the context of a committed, tepid to warm relationship, add love, affection, communication and caring, and a person's libido can be coaxed back to life. It can be coaxed back to life with no relationship at all, actually, with a little personal attention.

Satisfying sex with a partner for sure requires good-excellent communication about what is pleasing, what feels good. Mind reading (can't stress this enough) fails in the bedroom, as it fails everywhere else. Everyone's different. What pleases one person is ticklish to another. Words are good. Demonstrations, better.

So it's all about that, in the end, when we're talking about resurrecting a libido in the context of a relationship. It's about polishing the relationship. A few tweaks of change, a few actions and words, and a libido can literally spring to life.

But even if you live alone, a little attention to yourself is a good thing. A lot of attention is better. It's like watering an almost dead plant.

But it's there. The drive is there (although it might be latent) . We're born with it. As long as we're breathing, even in menopause, it's there. Different, perhaps. Oprah had a show on this topic recently, so it must be true, with Nora Ephron who wrote a book. Maybe check out her book. I haven't read it.

As a therapydoc, however, I push the good sexual relationship in marriage as a good thing, because it's marital glue. And it's fun. It's supposed to be fun. It's one of those things, maybe the only thing that a couple does exclusively together, and nobody else needs to hear about it, except perhaps a local sex therapist, who is going to tell both of them, by the way, that it is not only their relationship they have to improve, but their focus. Especially her focus, most likely. It starts with people focusing upon themselves and where they're at to get where they want to go.

So if a woman wants that kind of relationship, the one she sees on television where the guy flirts with his wife and she flirts back and we just KNOW they're going to skip dinner and probably go right to bed, well, that woman has to find her libido, her sexuality. That feeling.

It's within her reach, literally. I'll tell you to begin the search early in the day, be more like he is in that way, more focused on yourself and your physiology, your physical feeling of arousal. And keep it all day long. It's okay. When you're hungry for food, wait a few minutes, don't eat so fast. Think of that other drive. Less fattening, more fun. In some ways, more satisfying.

Oh, and one more thing. Sure, he can be a part of the search committee. Why not? But you had best direct him. Guys need a LOT of direction.

And maybe sing to him, When I fall in love, it will be forever. He may need some encouragement, too, if it's been awhile. You could get scary.

Copyright 2007, TherapyDoc

The Sunny Side of Therapy :) :) : ) :) Positive Psychology

This is an FYO on a popular news item in today's Wall Street Journal.

There's a feature story called, "The Sunny Side of Therapy." It's about focusing only on the positive, a person's true resources, strengths, etc. I was surprised the article didn't refer to "blessings."

Now you know I'm a pretty positive person, but I just have to tell you.
This is bunk with a capital B.

It's all well and good to try to stay there, to try to stay happy and to think pleasant thoughts. I heartily recommend it and in family therapy whack bubble bursters over the head with a newspaper (WSJ?).

But when a person is suffering from depression or any of the disorders in the DSM-IV, for that matter, it's going to take a lot more than positive psychology to get well.

Positive psychology is nothing new. Therapy docs have been relabeling problems for years, ever since family therapists (plug, here) found that symptoms were functional for people. People like their symptoms. They not only get attention for them, but they communicate with them.

Even support for "everything's relative" has been around for decades. Broke your ankle? At least you didn't break both. (thanks Y.)

It's actually good to pick yourself up, brush yourself off, and start all over again. Once you can.

Real therapy, good therapy gets in there and resets the bones, cleans out the infection. It requires a little more than applying a Band-Aid.

Those snake oil salesmen made it all up to advertise in the Journal.

There. I've said it. Have a happy day!

Copyright 2006, TherapyDoc