Three main ideas stood out to me from the reading, presentation and wiki regarding childhood sexual abuse. First, the prevalence is alarming. As a mother of two daughters, it feels unacceptable to consider that there is a 25% chance each of them will experience some type of sexual abuse. I feel like children are socialized to think about "stranger danger", but as we learned the likelihood of a family member or close friend sexually abusing a child is much higher. Additionally, the risk factors seem somehow "unfair"; essentially children in single parent or step family homes are at great risk of sexual abuse. Divorce and remarriage are such commonplace in our society; I never considered increased risk of childhood sexual abuse as a fall out of this trend.
The second statistic that saddens me is that women who have experienced childhood sexual abuse are twice as likely to get divorced. Again, it seems so "unfair" that the pain of their childhood affects their happiness in adulthood. It also highlights the importance of therapeutic intervention, both with girls if the abuse becomes apparent, or with couples when the abuse is divulged. The stress of past abuse was portrayed well in the group's case vignette: what appeared as low sexual desire did not stem from a couple relational problem, but if the abuse history had not been revealed, the secret would have continued to drive a wedge of misunderstanding and hurt between the couple.
The final statistic shed some hope for me. Binik and Hall asserted that not all people who are victimized by sexual abuse then experience sexual problems in adulthood. While I understand the correlation would not be surprising, it reminds me that individuals are so unique. Just as we learned that when counseling and LGBTQ couple we should not assume that their problems are related to their sexual orientation, I think it is important to not automatically assume that current sexual problems are the result of childhood trauma. Again, I believe emotional healing is the key to severing that correlation; as therapists we have the opportunity to help a person walk away from a legacy of pain.
Wednesday, April 22, 2015
Friday, April 10, 2015
Thoughts about therapy with LGBQT Clients
Two concepts really stood out to me from the first video we watched in regards to counseling LGBQT clients. First, I like the idea of a sexual orientation continuum- not just a flexible or sliding scale for how one identifies their gender, but a continuum of sexual orientation awareness. The therapist explained that the process begins with awareness, and then hopefully transitions to acceptance and then integration. She identified four main categories on this continuum:
1. Little or no awareness that the root of current sexual or relational conflict might be sexual orientation based.
2. Aware of being homosexual, but not at all accepting of it (she identified these people as homophobic).
3. Aware of sexual orientation, and accepting it in some areas of life but not all domains
4. Aware, accepting, and integrating sexual orientation into all domains of one's life
One key point she made about helping clients who are still in that first category of sexual orientation exploration is that we as therapists have the opportunity to help clients recognize the possibility and importance of gay relationships. Later she mentioned that we can try to help distill some homophobic fears by validating lesbian and gay relationships as being at "the same caliber" as homosexual relationships.
My second take away thought would probably relate to folks who are in the fourth, and maybe third stage along the continuum. I believe it was during the second video, and we also discussed this concept in class, but basically it is important to remember that LGBQT couples are likely seeking counseling for "everyday problems". I say that this is more likely for individuals and couples further along on the orientation continuum because I am hypothesizing that if someone is just beginning to explore the idea of a "new" sexual orientation, this could cause some distress in their life, and so it may be the primary concern and thus their reason for seeking counseling. However, for individuals or couples who have established their sexual orientation (at least within himself or herself), they are just as likely to be dealing with aging parents, promotions, financial struggles, and all the stressors that any other couple faces. This concept resonated with me because I think sometimes when we (or at least I) concentrate so hard on being sensitive, I end up hyper-focusing on the difference. While it is important to use respectful language and be accepting of our client's relationships and choices, that does not mean I should assume that is the reason for stress in their life, or even the "thing" they want to talk about at all.
1. Little or no awareness that the root of current sexual or relational conflict might be sexual orientation based.
2. Aware of being homosexual, but not at all accepting of it (she identified these people as homophobic).
3. Aware of sexual orientation, and accepting it in some areas of life but not all domains
4. Aware, accepting, and integrating sexual orientation into all domains of one's life
One key point she made about helping clients who are still in that first category of sexual orientation exploration is that we as therapists have the opportunity to help clients recognize the possibility and importance of gay relationships. Later she mentioned that we can try to help distill some homophobic fears by validating lesbian and gay relationships as being at "the same caliber" as homosexual relationships.
My second take away thought would probably relate to folks who are in the fourth, and maybe third stage along the continuum. I believe it was during the second video, and we also discussed this concept in class, but basically it is important to remember that LGBQT couples are likely seeking counseling for "everyday problems". I say that this is more likely for individuals and couples further along on the orientation continuum because I am hypothesizing that if someone is just beginning to explore the idea of a "new" sexual orientation, this could cause some distress in their life, and so it may be the primary concern and thus their reason for seeking counseling. However, for individuals or couples who have established their sexual orientation (at least within himself or herself), they are just as likely to be dealing with aging parents, promotions, financial struggles, and all the stressors that any other couple faces. This concept resonated with me because I think sometimes when we (or at least I) concentrate so hard on being sensitive, I end up hyper-focusing on the difference. While it is important to use respectful language and be accepting of our client's relationships and choices, that does not mean I should assume that is the reason for stress in their life, or even the "thing" they want to talk about at all.
Friday, April 3, 2015
Paraphilia Ponderings
I think the most salient thought from the paraphilia presentation is small but important: not all pedophiles are child molesters, and not all child molesters are pedophiles. I think it's a sensitive subject for most, but as a mother, I admit the hair on my neck bristles a little when I think about either category of folks. It was helpful to have my stereotypes questioned a bit, and understand that a lot of people with pedophilic disorder are actively working to fight their urge to interact with children in a sexual manner. Likewise, the discussion about reporting laws gave me a new perspective: I thought mandated reporting protects children, but if it is causing people to avoid therapy (understandably!) then its actually increasing the risk of sexual contact with minors.
I appreciated the video on the wiki explaining different types of paraphilias. It helped to normalize these forms of sexual expression. My forms of sexual expression have been fairly "normal" by most standards, but I believed myself to be pretty open minded to be accepting of other people's expression. This presentation more than any others thus far humbled me because I was invited to confront my own biases. I know that I still have (inner) work to do before I find myself face to face with a client who has a paraphilic sexual expression. I also need to continue to let the difference between paraphilias and paraphilic disorders sink in. As one of the other students so eloquently stated: I need to make sure I'm not "yucking" other people's "yum"!
I appreciated the video on the wiki explaining different types of paraphilias. It helped to normalize these forms of sexual expression. My forms of sexual expression have been fairly "normal" by most standards, but I believed myself to be pretty open minded to be accepting of other people's expression. This presentation more than any others thus far humbled me because I was invited to confront my own biases. I know that I still have (inner) work to do before I find myself face to face with a client who has a paraphilic sexual expression. I also need to continue to let the difference between paraphilias and paraphilic disorders sink in. As one of the other students so eloquently stated: I need to make sure I'm not "yucking" other people's "yum"!
Wednesday, March 25, 2015
Thinking about sex and disabilities
So much to think about from this weeks' presentation, with helpful information that extends to both couples with all ability levels, and parenting wisdom for all families. I specifically resonated with the PLISSIT acronym that was both in Binik and Hall's book and in the presentation. It reminds me of the stages of grieving in that processing traumatic events usually requires more than one step. I think beginning with permission to resume sex and to grieve changes also highlights the balance of life: persevering and moving forward while acknowledging and grieving the things that are lost to us.
I was especially drawn to the chapter regarding people with disabilities. During my undergrad, we spent a few different days exploring the world through the lens of people with physical disabilities. I spent a day in a wheelchair trying to access public spaces. We also played wheelchair basketball and amputee soccer. We spent a final day trying to navigate the world without vision. We learned a great deal about how accessible (or not accessible) our community was. We were also inspired athletes who had overcome physical disabilities who were white water rafting, skiing, playing basketball, and soccer. But we never talked about, nor did I consider, what sexuality or sexual intimacy would look like for these people. I do not know if I would have recognized my bias of viewing these people as asexual, but I am embarrassed by this oversight. I was so impressed by the very overt accomplishments and challenges these individuals had been able to overcome, but I had failed to see them as adults with very typical desires and sexual interests. Binik and Hall reported that PWD are the largest minority group in the US; it is vital that we view these people as just that: people. Such a small part of the wiki, but one of my favorite parts is the diagram for different sexual positions for individuals who use a wheelchair. It normalized the situation and presented the obstacle in a straightforward and easily surmountable manner.
I was especially drawn to the chapter regarding people with disabilities. During my undergrad, we spent a few different days exploring the world through the lens of people with physical disabilities. I spent a day in a wheelchair trying to access public spaces. We also played wheelchair basketball and amputee soccer. We spent a final day trying to navigate the world without vision. We learned a great deal about how accessible (or not accessible) our community was. We were also inspired athletes who had overcome physical disabilities who were white water rafting, skiing, playing basketball, and soccer. But we never talked about, nor did I consider, what sexuality or sexual intimacy would look like for these people. I do not know if I would have recognized my bias of viewing these people as asexual, but I am embarrassed by this oversight. I was so impressed by the very overt accomplishments and challenges these individuals had been able to overcome, but I had failed to see them as adults with very typical desires and sexual interests. Binik and Hall reported that PWD are the largest minority group in the US; it is vital that we view these people as just that: people. Such a small part of the wiki, but one of my favorite parts is the diagram for different sexual positions for individuals who use a wheelchair. It normalized the situation and presented the obstacle in a straightforward and easily surmountable manner.
Tuesday, March 10, 2015
Reflections about Orgasm Disorders
A few scattered thoughts regarding orgasm disorders:
From the presentation/wiki page:
I find it interesting that the prevalence of FOD is reported to be as high as 42%, but that number is not actually based on diagnosing orgasm issues with the DSM's FOD criteria. This inconsistency bugs me. Doctors do not diagnose broken bones by some arbitrary set of factors they decide on. Fractures are not diagnosed by "concepts", personal criteria, or according the the patient's complaint. If sex is going to be medicalized, then accurately medicalize it. The problem with quasi-medicalization is that facts, like 42% of women suffer from FOD, sound "legit" and people readily accept it as truth.
Likewise, I appreciated the snapshot of a google search for orgasmic disorder. It is telling to see what society views as both the causes and the "cures" for orgasmic disorders. I fear couples are going to be very disappointed when 10 new magical positions do not provide an instant cure.
Finally, I like the link/information about Standard Operating Procedures for treating FOD. I agree with McKenzie; while the title makes the information sound very stark, I feel like its a great concise starting point for thinking about starting points when working with women/couples with orgasm issues.
From the videos:
Tiffani, you encouraged us to look past the "cheese" and focus on what the couple was processing regarding the woman's vaginismus... but I was totally suckered in to the "cheese". I felt so much empathy for this couple; the woman especially was fighting against such powerful and reinforced negative messages about sex. I felt like the video was effective in suggesting just how distressing this condition can be for women; she talked about considering swerving her car into oncoming traffic to end her suffering. Low desire and arousal definitely causes tension in relationships, but the inability to have any intercourse at all seems likely to be even more stressful, heightening all those feelings of shame, guilt, inadequacy, and helplessness. The botox treatment is interesting, and I can see the appeal of an "instant" fix, or at least a jump start to the psychological work that needs to be done. It seems a little less practical however; I imagine the cost alone makes the procedure inaccessible to most women.
From the book:
I found the "three windows" approach an interesting framework for explaining the biopsychosocial information that would be helpful to collect when treating a woman with FOD. The current situation, the vulnerability of the client, and addressing health related factors seems like it would give a clinician a comprehensive starting point for assessing etiology of FOD in a client. Also, the diagram on page 103 expands upon this "three windows" concept, which really helps carry the framework from assessment to treatment. I am curious how often this structure is used by sex therapists, and if it proves to be as successful as it seems potentially to be.
From the presentation/wiki page:
I find it interesting that the prevalence of FOD is reported to be as high as 42%, but that number is not actually based on diagnosing orgasm issues with the DSM's FOD criteria. This inconsistency bugs me. Doctors do not diagnose broken bones by some arbitrary set of factors they decide on. Fractures are not diagnosed by "concepts", personal criteria, or according the the patient's complaint. If sex is going to be medicalized, then accurately medicalize it. The problem with quasi-medicalization is that facts, like 42% of women suffer from FOD, sound "legit" and people readily accept it as truth.
Likewise, I appreciated the snapshot of a google search for orgasmic disorder. It is telling to see what society views as both the causes and the "cures" for orgasmic disorders. I fear couples are going to be very disappointed when 10 new magical positions do not provide an instant cure.
Finally, I like the link/information about Standard Operating Procedures for treating FOD. I agree with McKenzie; while the title makes the information sound very stark, I feel like its a great concise starting point for thinking about starting points when working with women/couples with orgasm issues.
From the videos:
Tiffani, you encouraged us to look past the "cheese" and focus on what the couple was processing regarding the woman's vaginismus... but I was totally suckered in to the "cheese". I felt so much empathy for this couple; the woman especially was fighting against such powerful and reinforced negative messages about sex. I felt like the video was effective in suggesting just how distressing this condition can be for women; she talked about considering swerving her car into oncoming traffic to end her suffering. Low desire and arousal definitely causes tension in relationships, but the inability to have any intercourse at all seems likely to be even more stressful, heightening all those feelings of shame, guilt, inadequacy, and helplessness. The botox treatment is interesting, and I can see the appeal of an "instant" fix, or at least a jump start to the psychological work that needs to be done. It seems a little less practical however; I imagine the cost alone makes the procedure inaccessible to most women.
From the book:
I found the "three windows" approach an interesting framework for explaining the biopsychosocial information that would be helpful to collect when treating a woman with FOD. The current situation, the vulnerability of the client, and addressing health related factors seems like it would give a clinician a comprehensive starting point for assessing etiology of FOD in a client. Also, the diagram on page 103 expands upon this "three windows" concept, which really helps carry the framework from assessment to treatment. I am curious how often this structure is used by sex therapists, and if it proves to be as successful as it seems potentially to be.
Wednesday, March 4, 2015
Thoughts about Desire and Arousal...
As a co-author of the wiki-page, I am quite familiar with the information on the page. Likewise, preparing for the presentation resulted in careful reading of the applicable chapters as well as what felt like a mind-numbing amount of articles. You Tube also offers no shortage of videos about arousal and desire... although one side note: trying typing "Male Desire Disorder" or anything of the like. I found that MOST videos were still about females. A frustrating discovery, and a poignant example of our societal thought that men don't have a "problem" with desire; that is, after all, the cornerstone of their masculinity. As Tiffani pointed out, the void of male desire dysfunction is not actually true in the clinical world. I wonder what it feels like for a man who is struggling with low sexual desire; it cannot help to also feel like a social outlier because of it.
One topic that bubbled to the surface of most readings, which I hope we did an adequate job representing on our wiki-page, is the importance of the initial assessment. As an emerging therapist, I think it could be easy to jump too quickly to trying to solve the "problem". If all focus is steered to desire and sexual functioning, the approach will become very medicalized, and is likely miss relational and psychological factors contributing to low desire. Listening for clues in the client's sexual history, current relationship status, and any secrets they have not disclosed to their partner, are much more likely to highlight the etiology of a specific case of desire dysfunction.
One topic that bubbled to the surface of most readings, which I hope we did an adequate job representing on our wiki-page, is the importance of the initial assessment. As an emerging therapist, I think it could be easy to jump too quickly to trying to solve the "problem". If all focus is steered to desire and sexual functioning, the approach will become very medicalized, and is likely miss relational and psychological factors contributing to low desire. Listening for clues in the client's sexual history, current relationship status, and any secrets they have not disclosed to their partner, are much more likely to highlight the etiology of a specific case of desire dysfunction.
Tuesday, February 24, 2015
Sexual Healing... In the First Order sort of way...
Helpful thoughts from Sexual Healing:
First off, interviewing was done well in that both individual and couple interviews were depicted; this diversity is important for letting both partners feel like they have freedom to express ideas they might not be ready to share in front of each other yet.
Some good information came from a few questions as well; it was important to know about the individuals' sexual history, what had worked well in the past, if low sexual drive was a lifelong experience or not. It was particularly helpful to know that one of the women had been sexually abused as a small child, and to walk through what that might mean in her life as an adult woman. Shawn's wife was able to comment essentially that their sexual script had reduced to a very limited number of options- again, good information for a therapist.
Now for the Critique:
Differentiation. Or the lack of it. At one point Debbie basically made a plea during her private interview for differentiation, for some space to be herself. Instead, all of the assignments involved building intimacy through fusion. Debbie's husband, with the best intentions, asked "How do I get you started?" Two of the assignments highlighted were the "surrender date"and the rock climbing field trip. Both had elements of excitement, trust, and adventure. Both had potential to enhance a couple's relationship, but not mend it. In the "surrender date" the husband was told to"take responsibility for both of their needs"... thereby directly contradicting her interest in greater differentiation. The rock climbing exercise was used because doing fun things- especially scary things- together, is supposed to increase intimacy.
So many of the "interventions" in the show were not inherently bad. Dates are great. Field trips to sex shops and experiments with new toys or fantasies is likely to provide a exciting experience for a couple. And doing "stuff" together like rock climbing can create fun memories. But none of these activities in and of themselves gets to the root of increasing desire by strengthening self-validated intimacy. The "success" couples experienced during their week and the clinic are likely to be first order changes that do not affect who they inherently are as couples- more importantly, who each person is as a "self, in relationship."
First off, interviewing was done well in that both individual and couple interviews were depicted; this diversity is important for letting both partners feel like they have freedom to express ideas they might not be ready to share in front of each other yet.
Some good information came from a few questions as well; it was important to know about the individuals' sexual history, what had worked well in the past, if low sexual drive was a lifelong experience or not. It was particularly helpful to know that one of the women had been sexually abused as a small child, and to walk through what that might mean in her life as an adult woman. Shawn's wife was able to comment essentially that their sexual script had reduced to a very limited number of options- again, good information for a therapist.
Now for the Critique:
Differentiation. Or the lack of it. At one point Debbie basically made a plea during her private interview for differentiation, for some space to be herself. Instead, all of the assignments involved building intimacy through fusion. Debbie's husband, with the best intentions, asked "How do I get you started?" Two of the assignments highlighted were the "surrender date"and the rock climbing field trip. Both had elements of excitement, trust, and adventure. Both had potential to enhance a couple's relationship, but not mend it. In the "surrender date" the husband was told to"take responsibility for both of their needs"... thereby directly contradicting her interest in greater differentiation. The rock climbing exercise was used because doing fun things- especially scary things- together, is supposed to increase intimacy.
So many of the "interventions" in the show were not inherently bad. Dates are great. Field trips to sex shops and experiments with new toys or fantasies is likely to provide a exciting experience for a couple. And doing "stuff" together like rock climbing can create fun memories. But none of these activities in and of themselves gets to the root of increasing desire by strengthening self-validated intimacy. The "success" couples experienced during their week and the clinic are likely to be first order changes that do not affect who they inherently are as couples- more importantly, who each person is as a "self, in relationship."
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