Sex Therapy Online

 

How can we work with sexual issues remotely? Surely it’s essential to at least have the option of working with the body?

I certainly thought this, and had steadfastly set myself against working online or by phone until shortly before the present health emergency. By pure coincidence, a potential client [let’s call her Robin] approached me through my website in late January 2020. Although she lived locally, she explained that coming to see me straight away was just too big an ask for her, and would I be willing to have a couple of sessions on Zoom, which she hoped would establish enough connection and safety for her to then move to in person sessions?

I wasn’t keen. When I left the therapy world, and embraced working with sexuality, I  thought of myself primarily as a bodyworker, working mainly through touch rather than words. That touch needed to be agreed, boundaried and safe of course, but touch was, I thought, my metier.

As time went on, and as I accumulated invaluable experience with actual clients, I gradually modified this view.

I discovered that what was essential to make positive change happen wasn’t what was done in a session, but what the client felt and specifically, how the client felt different. And particularly, that it was an absolute prerequisite for meaningful change that the client felt safe, listened to and in warm compassionate connection. For almost all clients, this was the foundation for any bodywork, and often it would take a number of sessions to get there. Of course, some clients didn’t want bodywork. They just wanted the chance to talk, to communicate. Others wanted guidance on how to broaden their sexual range, or to feel more confident in asking for what they want, which didn’t  need to involve touch at all.

 

Anyway, returning to Robin, I agreed to work in the way she asked, as the first step. Lockdown followed several weeks afterwards, which compelled us to keep working online. To my surprise, it was  surprisingly beneficial working in this way, and so I adapted my work for Zoom, working out ways of working with both individuals and couples.

The sessions are shorter: one hour instead of two, and more frequent, usually weekly, so there is a clearer continuity between sessions.

So, what sort of issues can be addressed in this way? Well, if you have a look at my questionnaire, which you can access on the website via Contact John > links and resources > EBL questionnaire, you’ll find it asks quite a lot of distinct questions, and you might speculate how we could work online with these. I’ll break this down to individuals and couples.

Working  with Individuals

Talking and Communication. We shouldn’t underestimate the power of this. We need to talk, to be heard, and to be constructively engaged with. Sometimes, when people talk to me about sexual issues, they haven’t  talked to anyone about them before.

Embodiment through somatic visualisation. One of the things I love doing is to work with a client to get them into a relaxed receptive state, then getting them to experience their body in a much more pleasurable, deeper way, using imagery, memory and association, as well as somatic and breath awareness,  which changes both how they feel about themselves and how they can relate to others. This works best with the cameras switched off.

Changing our Patterns. A lot of people feel stuck. So, for example, they might have quite monotonous and repetitive ways to pleasure themselves, but have no idea how to change. And likewise, with their partners and lovers. That’s exactly the kind of thing I can help with. I can help with masturbation coaching, and I can also significantly widen a client’s repertoire, both physical and emotional, so they can get off the treadmill of unsatisfying sexual engagement.

Learning New Ways of Relating. I have extensive experience of working with people so they can become able to ask for what they want, not endure what they don’t want, and become much clearer in their thinking about consent, so they can ask and answer “Who is this for?”

Learning New Perspectives on Sexuality. I work with multiple ways of approaching and thinking about sexuality which is a brilliant way to think freshly about and explore the whole varied terrain, to give you some ideas about what you might like to experiment with. So, for example, exploring tantric ideas of sexuality, exploring role play and fantasy, working with trance like states, and so on.

Learning new skills. A lot of people are very lacking in confidence about their sexual techniques or relating with a partner. I can help with that.

Working  with Couples

My online work with couples combines two things: Donald Mosher’s theory that there are three modes of human sexuality, and what I’ve come to call The Compass of Sexuality, which is my fancy term for categorising all the multifarious ways we view sex.

I meet with the couple online for an initial chat to see if we might be a good fit, and if they want to go ahead, and if I think I can help.

If they want to go ahead, I ask them both to fill in a detailed questionnaire, and then I speak to each of them separately, to get a sense of where the imbalances and issues in the relationship might be, and how these might be progressively resolved.

I then give them a couple of exercises to do in their own time, and meet with them a week later [20 minutes individually, and 20 together] to find out how they got on, correct any misunderstandings, attend to any mishaps, vary the exercises as appropriate, and give them further exercises.

I’ve found this works very well. Things which they might not have thought of before, or thought too risky, become much easier when they are done as part of an ongoing, open enquiry. Because I’m prescribing the exercises, there’s much less chance of shame or judgement. Any hiccups can be blamed on me, and they don’t stop the couple moving forward.

People often find online work easier. You don’t leave your home. You retain control. It’s more convenient. It’s patently safe. You can be anywhere: all you need is a computer and the English language.

If you’d like to chat with me to see if any of these ways of working are for you, please get in touch.

 

If one person feels something, that’s a personal issue. If a lot of people feel the same thing, that isn’t just personal; it says something about society too. The problem of sexual inexperience falls into this category.

We live in a hyper sexualised society, but a large number of us seem to have no or minimal sex, or have very unsatisfactory sex.

What’s going on?

Well, one factor is that we tend to view sexuality in terms of recreation, and of performance. It’s something that you do, not a central part of who you are.  We overemphasise the body and underestimate feeling and connection, partly because we often think of desire as a hunger. Like a hunger for food.  And we give the body only provisional value: if the body looks great and ‘performs’ well, then great, otherwise, not so much.

This Tinder-ising doesn’t work for a lot of people. But because the model is so dominant, they think there’s something wrong with them, rather than something wrong or incomplete with the model.

So, I get young women coming to me whose boyfriends have a very pornified idea of what love making should be, and they blame themselves for being inadequate. Other people can’t seem to get started, and don’t know how to.  It’s as if everyone else is speaking a language they don’t understand.

It’s really widespread, but silent, like a secret epidemic of shame.

I don’t do surrogacy work.  It can be very valuable, but often it operates within the dominant model of doing, rather than feeling, being and connection.  It’s those latter qualities I want to bring out when working with clients who have issues of sexual confidence and sexual inexperience, because it seems to me that inexperience is in some sense a choice -perhaps an unconscious one – not to participate in this dominant mode of low-feeling, high action performative sex.

So my starting point is not somehow to reconcile the client to getting out there and get with it.  It is to start with an open enquiry into what the body and the heart feels and wants. Starting from that place, we then ask what wishes, sensations and worlds can come into being.

My perspective is that feelings of perceived sexual inadequacy or inexperience are best addressed not by fixing the body, but by opening and connecting the heart.  Everything positive flows from that.

You can make an analogy with conversation. As a society, we tend to think that the point of sex is orgasm.  But suppose we imagined that the point of talking was to make jokes.  Well, no doubt that would work for some people. And those people, doubtless, would accuse others of having a low humour drive, or being unskilled at punchlines.

It’s a ridiculous analogy, isn’t it?  But is it really?  Sexuality, like communication, involves the whole, unique, feeling person.  The range of expression is endless. It’s not something simple and straightforward, like appetite. Although, of course, it does involve hunger.  But hunger for what?

More prosaically, a lot of people feel that they are unskilled at sex. They don’t know how to do what they think they should do. For example, a lot of women lack confidence when it comes to touching a man’s genitals, so they tend to follow what they’ve learned from porn, or from friends, who have probably learned from porn. And so, they will touch a man’s penis rather like a plumber would approach a blocked drain: fast vigorous, anxious to get the job done as soon as possible. But where can you learn how to touch differently? Well, from me, for one.

I don’t view it as just learning a technical skill, but as a way to get more confidence, and through that, finding a way of having more satisfying sex. So sometimes, in my work with a client, as a starting point I may work with them to acquire more skills, because that’s part of having more choice. If we’re under confident, we’ll either just do the same thing over and over, or we’ll be done to. And if that’s so, our society’s awful fixation on intercourse as the whole point of heterosexual sex becomes even narrower and more unsatisfactory. Being equipped with skills gives you the confidence which makes it possible to break out of this straightjacket, particularly if you are also equipped with a sense of what sex might look like from a tantric or kink or energetic perspective, for example.

 

A remarkably high number of women claim to have low sexual desire. The figures vary, but it’s anywhere between one third and two thirds.

 

When a figure is this high, does the problem lie with the thing itself, or how we think about it?

 

The standard model of sexual desire -along with much else – derives from Masters and Johnston. That model is desire, leading to arousal, leading to sexual activity. We feel sexual desire, we become aroused, and we then act that out.

 

And when a man and a woman first get together, it seems to be like that for both of them. But, as the relationship matures, the woman often feels there’s something wrong: she rarely feels sexual desire anymore. And if she doesn’t feel it, she doesn’t want to do it. And that becomes a problem for both parties.

 

Rethinking desire

 

But is the real problem how we think about desire?

 

Rosemary Basson certainly believes that to be so. She’s the Director of Sexual Medicine at the University of British Columbia, and in her view, the problem is that the standard model is wrong.

 

In her model, desire is the result of arousal, not the cause. The sexual cycle starts off from choice, not from desire. A woman experiencing emotional intimacy, but who is sexually neutral, is receptive to sexual stimuli. She allows it, or looks for it. This stimuli is then processed in the limbic system of the brain. If the emotional response to the stimuli is negative – you don’t feel close, you’ve just had a row, you feel terrible about yourself – you won’t feel sexually aroused, even if bodily it appears that you are. If your response is positive, you feel arousal, desire follows, and away you go.

 

How does this match up with your experience?

 

Shame is endemic in our society, yet nobody talks about it. Which is strange, because it is the silent killer of sexual love. The heart isn’t cut to pieces in battle. It unknowingly dies, like a sleeping person in a room gradually filling with carbon monoxide.

 

Shame reveals – and hence conceals – itself differently. For each person, and for each gender. 

 

With due regard for generalisation, for heterosexual men, it works something like the following abusive dialogue which a man has with himself:

 

  • I won’t be able to get an erection. I’m useless
  • I’ve got an erection, but I’ll lose it. I’m useless.
  • Maybe I won’t lose it but I’ll come too quickly. I’m useless
  • Anyway, she’s not had an orgasm, or at least not the one she’s supposed to have, so I’m completely useless

 

And because it’s shameful, it can’t be talked about. So if you’re a woman, trying to make sense of this behaviour, you might think your partner is selfish, inconsiderate, rushed, disconnected and performance focused.

 

Shame explains something weird about women’s experience of male behaviour: it’s really important for him that as a woman that you like the sex, but if you helpfully propose something to make it better, generally, he doesn’t want to know. Why? Shame again. Change is a admission of past uselessness, which is hard to bear.

 

As a woman, how does shame affect you? Well, you might think that you’re to blame if there’s any erection issues, because you’re not sufficiently attractive, or arousing, or sexy, hence there’s something wrong with you, or you didn’t have an orgasm, or at least, not the right kind of orgasm, which means there’s something wrong with you, and so on. Shame again, but slightly different in its location.

 

A person, finding the shame hard to bear, might attempt to displace it onto their partner, through blame. Silence, shame, blame. Shame doesn’t come bearing weapons, but cuts you to pieces regardless.

 

Between the sexes, shame is intractable if we don’t understand that both genders have it, but in slightly different positions, meaning that the shame of each gender is invisible to the other, unless we communicate.

 

Shame is kept in place by the false notion that sex is about performance rather than about connection, but it’s difficult to be inoculated against it whilst we have such an impoverished idea of what heterosexual sex is, namely that it’s about intercourse leading to orgasm.

A particularly tragic form is shame is when an older man, in what may have been and continues to be a very long and loving relationship, starts to have erectile difficulties. He will tend to avoid intimacy with his partner through a fear that it will lead to an expectation of sex, in which he will be unable to ‘perform’. But he can’t say this, because to do so would be shameful, and so the couple gradually drift apart, no-one saying anything.

A first step is to broaden our idea. In my work I gave couples examples of other forms of sexual encounter which aren’t necessarily orgasmic, but are connecting and heartfully intimate, not just sensation based, but deeply feeling. A large part of my work is to elaborate and expand upon our sexuality in such a way that it cumulatively engages all our erotic and connecting potential, and gets us off the treadmill of performance, and frees us from the burden of shame. 

One of my teachers said that the only cure for shame is courage. But it isn’t true. The only cure for shame is connection. But it takes courage to make that possible. I’m here to help.

 

When we talk about premature ejaculation, we’re really talking about several different issues, and it’s helpful to distinguish them.

 

The first is a euphemism for unsatisfactory sex, particularly for the woman. The man just comes too early. But what is it that is really premature, the ejaculation or the intercourse?

 

Because culturally we’re so fixated on intercourse ( the giveaway being that we regard everything else as foreplay, the warm up act for the main event), men will frequently initiate intercourse before the woman is ready. Women, understandably, are likely to find this selfish. But it’s important to be aware of men’s anxiety around their erection.  They are very frequently worried that their erection will suddenly go away.  This would, they think, expose them to shame and ridicule. So, they have to ‘use it before they lose it’.

 

One of our friends did a social history film about sex. The film is about 30 years old now.  She got a group of older people to talk about their early experiences of sex.  One of the participants, a man, said that it would never have occurred to him that woman got pleasure from sex. He paused and said “I would have thought that orgasm was a kind of beer”.  There was then a long pause, and his face got sadder and sadder, thinking of all the waste.

 

We’re not suffering from the results of patriarchy in this way anymore, thankfully. But instead of making our focus a lot wider than the act of  intercourse, we’ve simply added an insistence that men should be able to control when they ejaculate.  And then it is shameful for a man if he can’t do this. Where are we to find intimacy, connection and pleasure in this jailhouse of expectations?

 

Oftentimes, men look for technical solutions, so they can go on and on, like Sting!  But the solution is embodiment and connection, not a technical fix.

 

I work by reconnecting men to their bodies, by resensitising them, and by providing a safe space where these issues can be talked about, free of shame. I teach men about breathing, about how to be more aware of rising levels of excitement, and how to bring those energies down.  So rather than experiencing a sudden spike and it’s all over, you can reach a plateau and then continue. But the most important thing is that I emphasise connection, rather than performance.

 

If you think I can help you, please get in touch.

One thing that affects sexual confidence for couples is that a surprising amount of people have only had sex with one person: their present or former partner.

 

I sometimes get couples coming to me who have had a long relationship, but somewhere along the way, one of them loses interest in sex. Or, somehow, the sex has become perfunctory, or repetitive, or unsatisfying.

 

The nightmare couple, for me, comes in two versions.

 

The first is where the partner who has lost interest  and isn’t interested in enquiring why, or doing anything about it. They are there reluctantly, to humour or placate the other partner. I am probably their second stop, after Relate, which won’t have worked either.

 

The second, but less frequent nightmare couple is where one partner wants us to change their partner, without countenancing any change for themselves. So, someone might want me to magically make their partner desire them. Good luck with that.

 

I can’t work with either of these type of couples. They would be much better seeing me separately. That way, they can reclaim their sense of themselves as a feeling, sexual being, distinct from the relationship. Often, the pressure of the relationship, and the weight of familiarity leaves people feeling a bit disembodied.

 

The couples I can work with are people who are brave enough to look at their own behaviour, their way of relating, their expectations and their assumptions. Sometimes, I might think it better to refer them to a therapist I know and trust, for example, where one person doesn’t want to have sex because they’re resentful about something else in the relationship.

 

But very often there isn’t that. It’s just that the fire, mysteriously, seems to have gone out.

 

Familiarity is often the enemy of desire. What I mean by that is that couples often get into a way of having sex, and that way gradually becomes more and more impoverished, until it stops working altogether. It isn’t helped by us thinking that Sex is all about having an orgasm, rather than being an opportunity to connect, feel and experience, within which orgasms may happen.

 

So one of the ways I can help is by shaking things up a little. Identify who initiates, and change that. Experiment with different modes of sexuality. If one is always the do-er, change that. If one never asks for what they want, change that. Introduce  more options to experiment with. And always, focus on embodiment, connection and communication.

 

We can get very fixed around sexuality. Imagine you had to start and end every conversation with a joke, wouldn’t you get tired of that? Wouldn’t you see that there were loads of great conversations going unspoken?

 

If you want to work with me , I’ll usually meet up with you in a public place or online for a coffee and chat, so we can both see if we’re a good fit. If we are, then I’ll design with you a bespoke programme of sessions to take you in the direction most satisfying for you.

If you feel a bit stuck, and you both want to do something about it, please get in touch.

According to the NHS website “it’s not fully understood why the condition (vaginismus) happens. Factors can include: thinking the vagina is too small, negative sexual thoughts, previous sexual abuse or unwelcome telepathic interference from The Evil Fish Of Planet Thargon”.

 

Ok, I made that last one up, but really: what’s the matter with these people? Isn’t it obvious why it happens: the vagina has had unwelcome or painful experiences, and doesn’t want to have any more.

 

And it’s not just women.  Sometimes gay men have a similar response with their anus, and for the same reason. The body wants to protect itself.

 

And once that urge to protect against touch is there, is it really the best approach to talk about it?  Surely it’s obvious: if the body is responding to bad experience, the best way out is to give it a good experience.

 

What would that look like?

 

In my work with women and men, what I’ve noticed is that if there’s been unwelcome touch to a part of the body, the vagina say, then touch won’t be felt there at all, it will just be numb. Then, there will be a feeling of physical discomfort, burning, for example.  And after that, there will be an emotional response, often a feeling of irritation. Sometimes the order is different.

 

Once all of these feelings have been given voice, the body can then experience something different. But the residue of the bad experiences has to come out first.  This will only happen when the touch is loving, respectful and responsive to the body.  And there needs to be full trust and full dialogue between the giver and the receiver.

 

The work is very slow, but it is very heartful.

 

The most important thing is to create a process where the body can move from feeling powerless, tense and fearfully anticipating what’s about to happen to one where it is relaxed, present focused, empowered and able to feel what it feels.

 

And it isn’t just unwelcome touch from another that’s been experienced. Often, that unwelcome touch can come from ourselves, and our ideas of what our bodies should be doing and feeling. In my experience, people often think that their genitals should feel arousal in response to touch, and if they don’t, or don’t feel enough, the touch needs to be stronger and faster. And that sets up a vicious cycle, where we never quite get where we want to go. The solution to this isn’t to get the body aroused, but to get the body relaxed, and from there, arousal will naturally follow. It doesn’t need to be forced.

 

We can’t just jump from numbness to pleasure and arousal.  We have to re-experience with our body and with our whole being, what caused the trauma in the first place, but in a space which gives the receiver power, autonomy and direction, and which is lovingly relational.  We do not need to dwell in the pain.  With loving support it is possible to release the effects of the past and move on.

 

 

 

I was recently reflecting on sexuality and fertility.  One of my friends is an acupuncturist, and she told me that increasing numbers of women were coming to her with fertility issues.  One way she treats them is to increase their receptivity and their heart connection.  She imagined that couples trying to conceive thought of intercourse as a means to an end, a necessity, rather than the theatre of glorious pleasure. She thought if I could work with these clients, they could re-learn to receive, to feel, to experience, and not be so caught up in the goal of conception. And that would help them conceive. And it did.

 

Another friend is a student midwife. She wants to write a dissertation about sexual arousal while giving birth, but finds that the literature is silent on it.

 

A third friend is a physiotherapist working in the NHS. Her speciality is working with women who have problems with their pelvic floor. She can touch the women, obviously, but is absolutely forbidden to talk about pleasure.

 

This division and ‘scientific’ approach is all very weird, because pleasure, anatomy, conception and birth are all intimately connected.

 

Why?

 

Because pleasure is the proof of our bodies – of ourselves – working properly. Pain, or numbness, is what happens when there’s something wrong. It’s simple.

 

The erectile tissue in the vagina that becomes engorged during sexual pleasure has a function. It protects the vagina during intercourse. It seems pretty obvious that the same erectile tissue which is there to protect the vagina when the baby’s coming out, is the same tissue which during intercourse, produces the pleasure response.

It doesn’t seem a big leap to suggest that pleasure, far from being a side effect is, thankfully, central. It’s part of our joy in being alive. But if we’re stressed and our body is tense, which is where most of us habitually are, then we won’t feel this normal natural bodily pleasure: we’ll either feel nothing at all, or pain.

My work is about restoring your natural capacity for easy bodily pleasure. I believe that pleasure makes our bodies work as they should. And that includes fertility.

Lots of people think that erotic touch needs to be high energy. If a lot of sexual energy isn’t flowing, so goes the idea, then the touch isn’t working. I don’t think that’s true, and actually I would argue it’s positively harmful.

 

I say this because if you scratch beneath the surface of this idea, we find the further idea that our sexuality can be explained in a primarily energetic on/off button kind of way. If I stroke your face, you might feel all sorts of things: energetic, emotional, connective. But somehow that doesn’t apply to the genitals, which are thought of in quite a functional way: are they “working” or not? We then think of our sexuality as something separate from us: our genitals are like a slave that we can order about. But sometimes, the slave will protest.

 

I have thought about this when working with clients who have reported feelings of genital numbness. This seems quite widespread, particularly among women, and I think it’s misunderstood.

 

I don’t think that numbness means that the body isn’t working properly and needs fixing. Through working with a number of women, I’ve come to the view that numbness is the body’s response to being touched in a way it doesn’t like. And the solution is to work with the client to uncover the feelings underneath the numbness, and allow those feelings to be expressed.

 

Learning to feel again

 

One client felt that she was quite constricted, and when she had attempted sex, it had been painful. She felt both numb, and anxious about sex.

 

We agreed to focus on very soft, gentle touch. We agreed where and how she would be touched, so there would be no surprises. And we agreed to stay in dialogue throughout: she would tell me what she was feeling from moment to moment. This was a very slow process, as you might imagine, but as we carried on, it became clear to the client that she did have sensation, that she wasn’t numb in the physical sense at all, but that she was emotionally indifferent to the sensation she was feeling. Telling herself she was “numb” closed off any inquiry. Realizing this, she remembered that she would always feel anxious at the prospect of being penetrated.

 

Another client, who also reported feeling numb, when we worked together, again in the same slow way, actually experienced physical discomfort, then irritation, then both gradually disappeared. Her body’s reaction to touch it didn’t like had been expressed, and so didn’t need to stay, covered over by “numbness”.

 

We all came into the world with a love to be touched. But when we’re touched in a way we don’t like, there’s a reaction, and that reaction can get stuck in our bodies. To return to the analogy of the slave, if she can express herself, and be heard, and discover what she loves, then everything changes.