Wednesday, December 30, 2009

Unlinking Sex and Drugs

Yesterday I posted a strategy for addressing sexual health issues. Today, I wanted to highlight the strategy can be useful for unlinking sex and drugs.

It is important to be aware how the linkage between sex and drug shows up. For some people, they need a drug to help them with sex. A number of people might use alcohol or pot, or other “downer” to help them address the anxiety they feel around sex. To help move toward sexual behavior, they ingest the drug to calm down.

For others, particularly meth users, the power they feel as a result of the drug creates such (false) feelings of self-esteem that they go overboard in the realm of sexual behavior. Meth as a sex drug has been documented elsewhere; what hasn’t been talked about is struggle with unlinking sex and drugs. I’ve worked with enough people who struggle and describe stories where months and years after their last use, any sexual behavior triggers euphoric recall on drugs. Many of their fantasies include drug use. When masturbating, the only way they “get-off” is by including chemical use in their thoughts. This is a major issue regarding recovery and sexual health

In all the examples above, the desire is to unlink the relationship between sex and drugs. In many ways, the strategy highlighted yesterday (SEE BLOG, 12/29/09) is the same strategy. I provide a few nuances here to clarify the process.

1) Start slow as well. Review the process as described.
2) When you move through the process, it is important to “tell on yourself” when you experience the linkage of sex and drugs. This will not be a quick process, but it is a matter of talking through the experiences as they occur. With your support system, be as descriptive, thorough, and honest as possible. The goal is to put everything on the table. In the process, you might discover something you need to address in your overall recovery.
3) As you move through the various stages, when you experience the linkage I would encourage you to take a break. For example, perhaps when you are making out with someone, and you experience the linkage of sex and drugs, it would be helpful to stop for a while. The experience may seem frustrating, and it probably will be. The key is to talk it through, including talking how you are experiencing the linkage. This also includes talking with your partner BEFORE the process as well. As I mentioned yesterday, couples therapy and support group for both you and your partner may be necessary.

Tuesday, December 29, 2009

Sexual Functioning and Development of Sexual Skills

When asked to define healthy sexual expression, many individuals first respond with the idea of sexual intercourse. They envision a typical explicit movie and assume that he/she needs to have sex “like them.” For many individuals, this is unrealistic.

A number of sexual functioning problems exist (See the topic on Sexual Functioning). In addition, many individuals struggle with sexual shame that they simply shut down any sexual energy. Individuals who struggle with sexual anorexia/sexual avoidance may believe they lack a level of competence in the skills to engage in sexual behavior. For individuals who struggle with sexual anxiety, the necessary skills evoke such anxiety that his/her performance results in unpleasurable experiences creating a cycle that leads to additional anxiety. Individuals who are sexually compulsive will sometimes focus on one type of sexual experience at the expense of all other types of sexual intimacy. In these examples, one goal of sexual health is the development of the knowledge, comfort, and skills to engage in a variety of forms of sexual expression.

Sexual Health requires self-knowledge, and the awareness to assertively communicate what you want. I’ve heard stories from individuals about how they were looking for one type of sexual intimacy, but didn’t know how to ask for it, or how to maintain the boundary if they knew what they were looking for. Many times, the individual and the partner don’t feel comfortable talking about the different types of sexual intimacy.

Below is a list of different types of sexual intimacy. They are listed, in my opinion, on increasing levels of intensity. Other clinicians may have a different order. While we may have different orders, it is generally believed that clients need to develop the skills at each level, moving toward increasingly complex skills. I use the metaphor of math skills. You start with addition and subtraction, moving to multiplication and division before learning about algebra and calculus. Only then would you teach statistics. My goal with this post is to highlight some basic skills and help you eventually move toward increasingly complex forms of sexual expression.

Instructions for the process:
Start with each step. Make sure you absolutely comfortable before you move to the next step. This process can be time consuming (think months). Some steps may be easier than others. It is important to develop and maintain open communication with your partner and his/her willingness to participate; this may require couples therapy. Obviously if you are struggling with this process, quickies or one-time encounters will interfere with this process. The key is to move slowly. When you feel anxiety or uncomfortable, say so, slow down and stop, if necessary. Comfort at each level is necessary before moving to the next step. After each experience, reflecting and talking about the experience is necessary. The debriefing can give you insight about what was easy, difficult, liked, disliked and whether or not you think you are ready to move toward the next step. If something is too uncomfortable or too anxiety producing, you may have to stay at that step for a while, or even move to an earlier step.

1) Looking
Often the first place to start is an awareness to whom you are attracted. What kind of person do you find attractive? What characteristics do you like? And the characteristics you don’t like. Focus beyond just the physical. If you can, think about why you answered the questions the way you did. Share your responses with your support system. Provide them with examples. Recognizing your attractions leads to the next step.

2) Flirting
Once you start to recognize your attractions, the next step is disclosure with the person to whom you are attracted. Often this is where people get stopped. This step requires addressing fears of rejection. In some cases, rather than dealing with rejection, people either shut down their attractions or settle for someone else.

3) Spending time together
Learning how to spend time together is the next step. Sometimes this may be simply going out to coffee or dinner, or a more formal type of date. Review the (future) topic on dating. Many of these activities can be integrated into this section.

4) Touching
Learning healthy, safe and respectful touch is a next step. This can involve simply holding hands, perhaps dancing or even light kissing. Being able to express what you like and don’t like is a part of this process. At this part of the development, the assumption is that you are “clothes on.” Future steps will introduce the experience of clothes off. At this point, the goal is to simply be comfortable with touch.

5) Kissing and Touching
At this step, you move toward increased physical touch. It is assumed that the clothes are still on, and that the touch focuses on areas other then genitalia and breasts. You might focus on touching parts of the face, hands, head, etc. Once you feel comfortable with types of touch in this area, moving toward touching breasts and genitalia over the clothes is the next step. As with all other steps, it is important to be aware of what you like/dislike and what feels comfortable/uncomfortable. Ongoing communication with your partner and support system is also assumed.

6) Nurturing and Full Body Touch.
In this stage, you still have your clothes on, but the level of touch has increased to the point where multiple parts of the body are touching. You may also be sitting next to each other on a couch, etc, or lying next to each other. This level of touch is sometimes described as “spooning” or laying front to back. As with the previous two steps, starting with touching non-genital parts of the body, moving toward eventual touching the genitals/breasts over the clothes.

7) Nudity
Moving up scale, the next level is being next to each other naked. This may have to start slowly, for example, simply being in undergarments before being naked. Again, starting off touching parts of the body other then breasts and genitalia is important. Once the touch is comfortable, move toward touching your partner’s genitalia as well as being comfortable with your partner’s touch is the next step.

8) Masturbation and Mutual Masturbation
Continuing up the scale of intensity, masturbating yourself in front of your partner and watching your partner masturbate is the next step. Many individuals struggle with shame, guilt, and embarrassment around masturbation. Reviewing the topic on masturbation may be helpful to help you increase self-awareness on this issue. Mutual masturbation (you masturbating your partner and your partner masturbating you) is the next step. At this point, orgasm isn’t the goal, simply being comfortable with the level of touch and sexual intimacy is the key. Perhaps when you are comfortable with the touch, orgasm through masturbation can be introduced at this level. Orgasm may be also be introduced at the later stages as well.

9) Fantasy
I believe fantasies are extremely powerful. I place them this far up the scale because I think they give others a views to the inner most part of the person. It takes a lot of trust to share your fantasy with your partner. This is where reviewing the topic on fantasy as well as your fantasies with your therapist may be helpful before sharing your fantasy with your partner.

10) Penetration
The next step is developing comfort with sexual intercourse. The first step at this point is feeling comfortable with penetration. Understanding what you like/dislike, and what feels comfortable/uncomfortable is the key. Learning strategies and positions for penetration are required as well. Some people struggle with penetration due to pain, shame, or fear. As with all stages, ongoing reflection and conversation in this step is important with your support system and your partner.

11) Orgasm
Clinicians disagree whether orgasm is required in the final stage. I place it at the end because many individuals do see it as the goal and they struggle with experiencing an orgasm. And, obviously, orgasm feels great. Orgasm isn’t always required or needed. It is included, however, because my goal is to help you develop the skills, comfort, and self-awareness to experience orgasm. At this step, all of what you learned in the previous steps is used to facilitate success at this step. It is difficult to provide universal instructions, so working with your support system and your partner is very important.

1) Review your sex timeline. What parts of the above process do you need to address?
2) What do you need to discuss with your partner?
3) Develop a plan to build your sexual experience and skills.

Sunday, December 13, 2009

Attitude of Gratitude: Sexual Health Mentors

A brief self-disclosure on a blog that is usually focused on clinical issues. I had a fortunate privilege to share brunch with one of my mentors, Eli Coleman. I take away two thoughts as I reflect on the experience.

First, everything I bring to the conversation is built on the shoulders of others. It is not possible for me to move the conversation on sexual health forward without the mentorship, support and encouragement from others. For those who don't know, Eli Coleman is the Director of the Program in Human Sexuality at the University of Minnesota. He was my adviser for my PHD, and wrote a generous preface to my book. He, along with others, has been part of my journey in this realm since 1993. In the 16 years, I remain inspired and encouraged.

Second, I'm aware of the isolation that occurs in this field. The cultural bias against talking about sexuality is powerful, even for myself. Answering the question "What do you do for a living?" leads to a reaction of hesitancy and anxiety (aka fear) by those asking the question. (I have a new appreciation of the difficult clients experience when I push for disclosure.) The implication of this "new" revelation affirms the need for all of us to talk about sexuality. I affirm my need to reach out and talk with peers for support, encouragement and affirmation.


Wednesday, December 9, 2009

Tiger Woods and Sexual Compulsivity

In all of the recent news on Tiger Woods, very little conversation has occurred beyond the titillating sexual behaviors, number of sexual partners, and the eventual impact on his marketing career. I would hope that somewhere in the conversation, the media would start to address questions of sexual compulsivity. Like many of the recent sexual scandals, we focus on the sensationalism without focusing on the emotional toll on those involved and the struggle many individuals have in the area of sexuality. (Just to note, not knowing the details, I will refrain in assessing Tiger Woods the person.)

This story is only one in a series of many stories to come. Who is next is irrelevant; the key for me is to help others get the services they need. Whenever something like this occurs, I hope people can use the story as a way to reach out for support, help and resources. There are many resources available including SASH.NET, and AASECT.ORG. Reach out and find some resources. Help your self, or help others get the help they need.

Living a Life I Love, workbook availability

I'm happy to announce that Living a Life I Love is now available on an expanded distribution network. You can now purchase the book via orders from any bookstore! This is a change that occurred today, but may take a few weeks to percolate through the paper/electronic distribution networks. Stop by your local bookseller today!

Sunday, December 6, 2009

Living a Life I Love: 6-week workshop

As part of my new job, I'm posting information on a 6-week workshop addressing sexual compulsivity. The goal is to help participants toward getting what they want in their relationships.

Start the New Year addressing sexual health issues in your recovery. Join a discussion group designed to help you address sexual health concerns. The goal of this workshop is to help you get the type of relationships you want. This workshop is for individuals who have questions about sexual addiction/compulsivity, or avoidance of sexual behavior (sexual anorexia). For many in recovery, sexual health concerns are the last topics to be addressed. The topics reviewed are:

Jan 6, Week 1: Acting out cycle/Safety Plans
Jan 13, Week 2: Sex Timeline/Behavioral Analysis
Jan 20, Week 3: Understanding your Timeline
Jan 27, Week 4: Co-factors of Sexual Compulsivity
Feb 3, Week 5: Prevention Planning
Feb 10, Week 6: Creating a Personal Definition of Sexual Health.

Group size is limited to 10 individuals. Space is limited. Cost is $170 for the entire 6-week series and includes the cost of materials, paid at the first session.
Weston Edwards, PhD, LP will facilitate the discussion group. He is the Clinical Director at Prism. He has 16 years experience working in the area of sexuality. For More Information, contact Dr. Weston Edwards, PHD, LP at 612 825 8714

Professional Changes

The next few weeks will see radical changes in my professional career. I'm happy to announce that I will be the Director of Clinical Services at Pride Institute and Prism. I will supervise the Outpatient Adult and Adolescent Intensive Outpatient Chemical Dependency Programs at Pride Institute. I will also supervise the new mental health program at Prism. In this role, I will develop the new program.

Prism is a new program providing mental health services. (Essentially I am moving my current practice to Prism.) Prism will provide specialty services in mental health, substance abuse and sexual health concerns. For many individuals, the problem areas overlap. Both mental health and psychiatric services will be available. Our goal will be to provide one-stop services.

Watch for future updates.