What is Sexual Health?

According to Doug Braun-Harvey, LMFT, co-author with Michael A. Vigorito, LMFT of Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and co-founder of The Harvey Institute, sexual health is comprised of six principles which include safety as well as pleasure.  

These six principles will be the focus of this article.

Sexual Health includes Safety and Pleasure

The concept that sexual health includes both safety and pleasure is different from what is taught in most sex education programs in the United States.

Unfortunately, most education programs limit sex ed to protection against sexually transmitted infections and unwanted pregnancy.  

But sexual health is so much more than that--it includes sexual pleasure.

The Six Principles of Sexual Health

The Harvey Institute identifies six principles of sexual health:

• Consent: Sexual health must be consensual.  Consent means that sex is voluntary between willing partners who are of age and able to give enthusiastic consent to sex.  Non-consent involving children often occurs in the home with relatives or family friends in the form of sexual abuse, sexual assault and rape.  With regard to consenting adults, it's important to establish consent at each step of sexual activity so that there can be safety and pleasure for everyone involved (see my article: What is Sexual Consent?).

• Non-Exploitative: Sexual exploitation is when someone uses their power and control over someone else to have sex.  Exploitation includes unwanted harsh behavior to dominate and take sexual advantage of someone who is unable to give consent, including children and people who have physical or cognitive disabilities.  Exploitation often involves alcohol or drugs to coerce people to have sex.

• Honest: Sexual health requires honesty between sexual partners. Communication is open and direct with all sexual partners.  Honesty involves being open about sexual pleasure, health, sexual experiences and sexual education. 

• Shared Values: Sexual values identifies a person's ethics and sexual standards which can differ based on a person's culture.  For instance, a person's values can differ with regard to the first sexual experience based on their particular culture.  When people get involved sexually, each person can have different values regarding particular sex acts or sexual turn-ons.  Sexual health involves people having open and honest communication about their sexual values.  It's also important for children and teenagers to get accurate answers to their questions about sex without adults communicating shame or discomfort.

• Protected Against Sexually Transmitted Infections (STIs), HIV and Unwanted Pregnancy: Anyone engaging in sexual activity needs to be protected from STIs, HIV and unwanted pregnancy.  Protection includes the use of condoms, birth control, adherence to HIV medication, taking PrEP (pre-exposure prophylaxis). Sex education about these issues needs to be medically accurate (fewer than 20 states in the United States requires sex education to be medically accurate).  

• Pleasure: Whether sex involves solo activity or partnered sex, sexual pleasure is a primary motivator to have sex.  Throughout the lifespan sexual health is a matter of balancing safety/responsibility with pleasure.  Sexual pleasure includes remaining curious about different ways of enjoying sex.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapy.

I am a sex positive therapist who works with individual adults and people in relationships.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Psychotherapy Blog: Understanding the Difference Between Compassion and Responsibility - Part 2

In my previous article, Understanding the Difference Between Compassion and Responsibility - Part 1, I began a discussion about people who are emotionally traumatized who confuse compassion with taking responsibility.  In the current article, I'm continuing this discussion with a composite scenario as an example of this dynamic.

Understanding the Difference Between Compassion and Responsibility

The following scenario is a composite of many different cases to protect confidentiality:

"Rose:"
When Rose was a child, she grew up in a household where her mother was abusing prescription drugs and her father was usually away on business.

As the oldest child, she was more aware than her younger siblings of their mother's drug problem.

By the time she was seven, she was already cooking dinner for her siblings, cleaning and washing clothes while their mother was passed out on the sofa.

Understanding the Difference Between Compassion and Responsibility

When her mother was awake, she often confided in Rose, telling her how depressed she felt.  Since Rose was only a child, she felt overwhelmed by these talks.  But she also felt a great deal of love and compassion for her mother.

So, not only was Rose taking on adult responsibilities for herself and her siblings, she also tried to comfort her mother and tried to help her to cheer up.

More than anything, Rose wanted her mother to be happy, and she thought that if she listened to her mother and was "a very good girl," it might make her mother feel better.  But, of course, it never did.

It wasn't until Rose was in her early 30s and ending her latest unhappy relationship where she was unable to rescue her boyfriend that she realized that she needed help.

As Rose talked about her history of romantic relationships, she described one relationship after another where she felt love and compassion for each boyfriend and she wished, more than anything, to save him from himself.

The men that she chose to be in relationships with were men with either gambling or abusing alcohol or drugs.

In each relationship, similar to her relationship with her mother, she felt it was up to her to rescue these men, but none of these relationships ever worked.

Understanding the Difference Between Compassion and Responsibility

Each time, Rose came away feeling that she "wasn't enough" and if she had been good enough, she would have helped these men to change.

We used a mind-body oriented therapy, EMDR (Eye Movement Desensitization and Reprocessing), to find the earliest memory of when Rose felt this way (see my article: What is EMDR?).

Rose remembered being seven years old and seeing her mother slumped on the couch, passed out on prescription drugs, as Rose was cooking dinner for her siblings.

She remembered feeling so compassionate for her mother, wishing that she knew what to do to make her happy so she wouldn't be so unhappy.

As an adult, Rose recognized that her feelings for the men that she tried to rescue were similar.

As we continued to process this earliest memory about her mother, I asked Rose if a seven year old child can rescue a mother.

Of course, Rose knew logically that this didn't make sense.

But, due to the way EMDR helps clients to integrate memories with new information, Rose was able to do something she had never been able to do before--she was able to feel this on an emotional level.

Then, something else happened that never happened before:  She began to feel love and compassion towards the child that she was growing up.

She realized, for the first time, how lonely and unhappy she was back then, and she imagined herself holding and soothing her younger self.

We also did an EMDR interweave where she imagined that, as a child, she had an ideal mother who would have cared for her.  She described what the ideal mother would have looked like, her scent, how soft her skins was, how loving she would have been towards Rose, and imagined this mother holding and soothing her.

The integrative process of EMDR made this imagined ideal mother come alive for Rose so that she could even close her eyes when she wasn't in a therapy session and imagine her soothing her.

Over time, Rose was able to mourn for her unmet emotional needs.

She also began to distinguish feeling compassion for someone vs taking responsibility for his well being.

She realized, on a cognitive and emotional level, that she no longer had to rescue people.  Even more than that, having worked through the early memories that were triggering her in her current relationships, she no longer felt the desire to do that.

Rose was, at last, free to nurture herself and have healthy, reciprocal relationships.

Getting Help in Therapy
The dynamic that I've described in the above composite scenario is an all too common one.

If this scenario resonates with you, you're not alone and you don't need to continue to repeat this dynamic in your life.

Getting Help in Therapy

You can get help from a licensed psychotherapist who knows how to help you to learn to distinguish feeling compassion and taking responsibility for others, and free yourself from this dynamic.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Understanding the Difference Between Compassion and Responsibility - Part 1

Understanding the difference between compassion and responsibility is often confusing for adults who were abused and traumatized as children.

Understanding the Difference Between Compassion and Responsibility

Compassion vs Responsibility
Since one of my specialties is helping clients to overcome emotional trauma, I see many adult clients who were traumatized and abused as children.

Many of these clients, as children, felt responsible for parents who were impaired either due to substance abuse, mental illness or for some other reason.  This is a common experience for children who became parentified children, which means that at a young age they took on the parental role with their parents and siblings.

This is a tremendous burden for a child to take on, but I often hear from adult clients that if they had not taken on that role, the household wouldn't have functioned:  There would have been no food, no clean clothes, the younger siblings wouldn't have been helped to get dressed to go to school, and so on.

The child who takes on this role isn't only robbed of a childhood, she also grows up feeling confused about the difference between feeling compassion and taking on responsibility.

Confusing Compassion and Responsibility: An Abusive Mother

So, for instance, there might have been a mother who drank excessively and who, while drunk, was physically abusive with the children.

But this same mother, when sober, might feel tremendous remorse for being physically abusive when she was drunk.  She might have apologized profusely, while sober, and promised her children that she would never do it again--only to repeat this cycle over and over again.

Confusing Compassion and Responsibility: A Cycle of Abuse and Remorse

In this situation, a child, who takes on the parent's responsibility often feels a tremendous sense of compassion for the mother when she is sober and remorseful.

This same child might feel that she cannot leave her younger siblings alone with the mother because she knows that if she leaves, her siblings will suffer at the hands of the mother.  So, she has to stay and take care of the family.

Staying to protect her siblings might mean missed opportunities to play with friends, attend after school programs, sports activities and the usual children's activities.

Later on, it might also mean that she will be too afraid to leave to go to college because she fears the household will fall apart without her there to pick up the pieces when her mother gets drunk.

It's also common for young children, who are abused emotionally and physically, to feel that they're responsible for their abuse.

These children will often say, "It's my fault that she got drunk" or "If I were a better daughter, she wouldn't have beat me."

Distorted Beliefs About Compassion and Responsibility Often Continue Into Adulthood
Even as adults, they often continue to have these distorted beliefs on an emotional level, and this can have tremendous repercussions for them.

Even when they understand logically that that their beliefs are distorted, on an emotional level, they continue to feel this way.

It usually affects how they feel about themselves, especially in terms of their self esteem or their ability to feel that they deserve good things in their lives.

Distorted Beliefs About Compassion and Responsibility Often Continue Into Adulthood

It can affect the types of relationships that they choose as adults, possibly choosing partners that they feel they have to rescue or take responsibility for in some way.

For instance, if, as adults, they're in a relationship with someone who is abusing alcohol and they feel compassion for their partner, they might feel that they must take on the responsibility for rescuing the partner--even if the partner is abusive.

In these cases, this is an unconscious repetition of what they experienced as children because they've grown up to feel that compassion equals responsibility.   So, they will often try to rescue their partner even when it comes at a great emotional, physical and/or financial risk to themselves.

In these situations, people might feel unhappy and trapped, but they don't see a way out because they feel they can't leave their partner.

Even when they do manage to leave an abusive relationship, they often get into another relationship where there is a similar dynamic and start the cycle all over again.

Once again, this is usually on an unconscious level, so they don't realize that they keep repeating this pattern each time.

It's not unusual to see this pattern continue from one generation to the next.

This dynamic also has repercussions for adults in psychotherapy who want to overcome childhood trauma, and I will address this issue in my next article (see my article:  Understanding the Difference Between Compassion and Responsibility - Part 2).

Getting Help in Therapy
Most people who were abused as children never come to therapy.  They continue to blame themselves for what happened to them as children as well as the abuse that they endure as adults.

They also continue to perpetuate the self destructive pattern of confusing compassion with responsibility.

If the dynamic that I've described in this article resonates with you, you're not alone.

Getting Help in Therapy to Lead a More Fulfilling Life

Although taking the first step is usually the most challenging, it can also be the most empowering.

Getting help in therapy from a licensed trauma therapist can help you to overcome the early emotional trauma that's keeping you stuck in your life.

Getting help in therapy can free you from your emotional history so you can lead a happier, more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.