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.

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