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NYC Psychotherapist Blog

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Showing posts with label sex. Show all posts
Showing posts with label sex. Show all posts

Thursday, August 28, 2025

Expanding Your Perspective About 1ntimacy

Many people think of sex as being exclusively penis-in-vagina (also known as P-in-V), but sex is so much more than P-in-V (see my article: Understanding Your Sex Script).

Expanding Your Perspective About Intimacy

P-in-V sex for heterosexual couples is one aspect of sex, but it's important to develop a broader perspective about sex, which is the purpose of this article.

Why Is It Important to Develop a Broader Perspective About Sex?
A broader perspective about sex includes:
  • A Validation of Non-Penetrative Activities: Non-penetrative sex is also called "outercourse" to distinguish it from intercourse. There are many other non-penetrative sexual activities that are pleasurable. These activities are often referred to as "foreplay", but that word diminishes sexual activities that many people prefer. It's also a narrow heteronormative view of sex that invalidates what many people like (see my article: Changing Your Sex Script).
Expanding Your Perspective About Intimacy
  • An Improvement in Sexual Satisfaction, Especially For Women: The majority of women don't orgasm from penetrative sex alone. Many of them require clitoral stimulation to have an orgasm or for sex to even be pleasurable. Expanding the definition of sex to include other forms of sexual stimulation can lead to more fulfilling sexual experiences for women (see my article: To Improve Intimacy, Get Off the Sexual Staircase).
Expanding Your Perspective About Intimac
  • LGBTQIA+ Experiences: Defining sex as P-in-V invalidates the experiences of gay, lesbian, bisexual, trans, queer and asexual people. An expanded perspective of sex includes all consensual pleasurable activities between partners.
  • A Non-Performative Perspective on Sex: Focusing exclusively on penetrative sex can create pressure, anxiety and stress. For instance, when sex is seen as solely penetrative, it can place a lot of pressure on men to maintain an erection, which can develop into an anxiety spiral that creates problems with erections. Broadening the definition of sex allows partners to focus on mutual pleasure rather than performance (see my article: What is Performative Sex?).
Expanding Your Perspective About Intimacy
  • An Accommodation For Different Abilities and Preferences: For people who have different sexual abilities due to aging, physical pain or other conditions, non-performative sex can be a fulfilling alternative. It also offers other options for couples who might prefer other sexual activities than penetrative sex (see my article: 5 Common Myths About Sex in Long Term Relationships).
Expanding Your Perspective About Intimacy
Getting Help in Sex Therapy
Many individual adults and couples would like to broaden their sexual activities, but they don't know where to start.

Sex therapy is a form of talk therapy where a sex therapist focuses on sexual issues (see my article: What is Sex Therapy?).

There are no physical exams, nudity or sex during sex therapy sessions. 

If you have been having sexual problems you haven't been able to resolve on your own, you could benefit from seeking help from a licensed mental health professional who is a sex therapist.

Rather than struggling on your own, seek help in sex therapy so you can have a more fulfilling sex life.

About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT Couples Therapist, Somatic Experiencing and Certified Sex Therapist.

I work 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.




Friday, June 20, 2025

11 Characteristics of Happy Couples

All relationships go through challenges from time to time, but happy couples tend to have certain characteristics in common:
Characteristics of Happy Couple
  • Trust and Honesty: Along with effective communication and active listening, happy couples build a foundation of trust and honesty.
  • Mutual Respect: They value each other's feelings and perspective. They also respect each other's individuality.
Characteristics of Happy Couples
Characteristics of Happy Couples
  • Prioritize the Relationship: Even though they have friends, they work and they maintain relationships with family members, they prioritize their relationship as being the most important relationship. 
Characteristics of Happy Couples
Getting Help in Couples Therapy
As I mentioned earlier, all couples go through challenging times.

If you and your partner have been unable to resolve your problems on your own, you could benefit from getting help from a licensed mental health professional who works with couples.

Characteristics of Happy Couples

A skilled couples therapist can help you to overcome the obstacles in your relationship if you wish to stay together or help you to end the relationship amicably and with respect (see my article: How to Get the Most Out of Your Couples Therapy Sessions).

About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapist.

I have over 20 years of experience working 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.

Sunday, June 8, 2025

Relationships: "I Love My Partner, But I'm Not In Love With My Partner"

A common issue that comes up in individual and couples therapy is that one or both people in a relationship feel they love their partner but they're not in love with their partner (see my article: How to Develop Your Relationship Beyond the Honeymoon Phase).

"I Love My Partner, But I'm Not in Love With My Partner"

Many people will say they were once in love with their partner, but they no longer feel that way. They worry about what this means for them as individuals and for the stability of the relationship.

Transitioning From In Love to Mature Love
As I have discussed in prior articles, relationships often start with that heady, passionate, in love feeling, known as the limerence, which lasts anywhere from a few months to a couple of years (see my article: What Are the 3 Stages of Limerence?).

"I Love My Partner, But I'm Not in Love With My Partner"

After that, as the couple deepen their emotional connection, those initial feelings usually transition into mature love.

This is the time when the couple deepen their communication, develop emotional honesty and mutual respect for one another to build a lasting connection that includes emotional vulnerability, empathy and a commitment to personal growth as well as the growth of the relationship.
  • Moving Beyond Infatuation: During the initial stage of a relationship, you might feel intense romantic and sexual feelings. You might even have a sense of being swept away.
"I Love My Partner, But I'm Not in Love With My Partner"
  • Evolving Connection: As the heady feelings subside, if the relationship is going well, you both focus on understanding each other's wants, needs and values.
  • Developing Open and Honest Communication With Empathy: If the relationship is going well, you both feel comfortable enough to share your thoughts and feelings with a lack of judgment and a sense of vulnerability. This helps you both to develop emotional intimacy and trust, which is essential to a strong relationship.
  • Learning to Adapt: Transitioning from the heady in love phase to a relationship with a deeper connection requires patience, flexibility and a willingness to adapt to changes in the relationship.
Clinical Vignette
The following clinical vignette illustrates the challenges of transitioning from the passionate "in love" phase of a relationship to a more mature loving relationship. It also illustrates how couples therapy can help. As always, this case is a composite of many different cases with all information changed to protect confidentiality.

Sue and John
Five years into their marriage, John began to worry about his feelings for Sue. He knew he loved her, but he no longer felt in love with her the way he used to feel when they were together the first two years.

For a while, he didn't know how to talk to Sue about this because he didn't want to hurt her feelings, so he avoided it. Instead, he began spending more time on his own at night and he waited for Sue to fall asleep before he went to bed.

After a year had passed and they stopped having sex, Sue asked John if there was anything wrong. Initially, John told her that there was nothing wrong. He made up excuses about being too tired and stressed out to explain his lack of sexual desire. But after they went on a romantic vacation to the Caribbean and John still didn't want to have sex, Sue knew there was something wrong.

"I Love My Partner, But I'm Not in Love With My Partner"

After Sue insisted on knowing what was troubling him, John admitted reluctantly that he loved her but he wasn't in love with her.  

At first, Sue was very upset. She accepted that her own initial passionate feelings had changed to a more mature way of loving. But she was afraid that since he was struggling with his feelings, this meant he was going to leave her. In response, John told her he wasn't sure what it meant, so he suggested they seek help.

Their couples therapist was also a sex therapist. She normalized their situation. She said most relationships go through this transition after a while and they could both learn to adapt.

She helped them to develop a deeper emotional connection with each other by helping them to develop new relationship skills for this phase of the relationship. Specifically, they found ways to communicate in an open and honest way, to share new interests, and to rekindle their sex life.

Over time, they both began to enjoy this phase of their relationship. They realized that, even though it might not be as "exciting" as it had been before, what they had together was so much more than just excitement and passion. They had a deeper connection that continued to develop.

Conclusion
The heady and passionate in love phase doesn't last forever in most relationships.

Once couples learn to appreciate the mature love that has developed over time, most of them wouldn't trade that for all the sexual and romantic excitement they felt during the early phase of their relationship.

Getting Help in Couples Therapy
Many couples need help to transition to the mature phase of love.

Rather than struggling on your own, seek help in couples/sex therapy.

A skilled couples therapist can help you to have a more loving and fulfilling relationship.

About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (couples therapy), Somatic Experiencing and Sex Therapist.

I have over 20 years of experience working 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.















Wednesday, January 22, 2025

Arousal Non-Concordance and a History of Sexual Abuse

In an earlier article, I wrote about arousal non-concordance to explain what it is and to normalize it as a common experience for many people (see my article: What is Arousal Non-Concordance?).

Arousal Non-Concordance and a History of Sexual Abuse

What is Arousal Non-Concordance?
Arousal non-concordance occurs when there is a disconnect between how someone feels physically and how they feel emotionally and psychologically.

Arousal non-concordance can occur when someone feels physically aroused, but they don't want to have sex. 

It can also occur when someone wants to have sex, but they don't feel physically aroused.

What is the Difference Between Sexual Desire and Sexual Arousal?
Arousal non-concordance highlights the difference between feeling sexual desire and sexual arousal.  

Sexual desire is a psychological state. It's a state of mind which is often described as being "in the mood" to have sex.  Desire is often influenced by thoughts, emotions and the particular context a person is in.

Sexual arousal is a physical response which can include changes in erection and lubrication. 

Sexual arousal is often triggered by visual or physical cues or memories.

Sexual desire and sexual arousal often go together--but not always. This is evident with arousal non-concordance.

Examples of Arousal Non-Concordance
The following short vignettes are just a few examples of arousal non-concordance:
  • Liz and JaneLiz feels sexually turned on when Jane kisses her. But when Jane touches Liz's genitals, she discovers Liz feels dry. As a result, Jane assumes Liz doesn't want to have sex so she stops kissing her. She assumes that if Liz was turned on, she would be lubricated. So, Liz tells Jane that, even though she's not wet, she really wants Jane, so they continue to kiss and make love.
  • Mary and Bill: Bill touched Mary's genitals and she knew this meant he wanted to have sex. But she had a headache and she wasn't in the mood. She told Bill that she loves him, but she would rather wait until the morning to have sex after her headache goes away. Bill was confused and said to Mary, "You're so wet. I don't understand how you're not in the mood." Mary explained to him that her body was sexually aroused, but she wasn't  desiring sex at that moment. By the morning, Mary's headache was gone away and she and Bill enjoyed sex.
  • John and Ed: John and Ed were in bed when John told Ed that he wanted to have sex. But during foreplay Ed noticed that John wasn't getting an erection so he stopped kissing and touching him because he assumed that John didn't desire him. At that point, John explained that, even though he really desired Ed a lot, he sometimes had problems having an erection when he was anxious. He said he just needed to relax. So after they cuddled for a while, John felt calmer and he was able to have an erection.
Arousal Non-Concordance and Memories of Sexual Abuse
Arousal non-concordance can occur under many circumstances, including while having memories of sexual abuse (see my article: Overcoming the Trauma of Sexual Abuse).

Arousal Non-Concordance and Memories of Sexual Abuse

The concept of arousal non-concordance is important to understand when there is a history of sexual abuse.

Many children and adults, who were sexually abused, might have felt physically aroused when they were being abused--even though they had no desire to be sexual with their abuser

This happens because the body can become sexually aroused even though the person has no desire to have sex (see my article: Coping With Trauma: Managing Sexual Abuse Triggers).

It's common for people who were sexually abused to get confused about why they get physically aroused with these memories because they don't know about arousal non-concordance. They feel like there's something wrong with them or they were to blame for the sexual abuse. But, in fact, there's nothing wrong with them at all and they're not to blame.

Everyone is different. Some people who were abused feel ashamed and guilty about getting aroused by the memories.

Other people accept their arousal as a common experience and they're not bothered by it.  

Other people incorporate their earlier experience in a roleplay with a partner to feel empoweredIn other words, when the original experience occurred, they had no control over what was happening to them. But in a roleplay with a partner they use their imagination to feel in control and they experience a different outcome

In that sense, the roleplay becomes healing for them.

Getting Help in Therapy
Most licensed mental health professionals have no sex therapy training and don't understand arousal non-concordance.

Getting Help in Therapy

If you want to work through issues around arousal non-concordance, including a history of trauma, you need to work with a psychotherapist who has training in both sex therapy and trauma therapy.

Rather than struggling on your own, seek help from a psychotherapist who has the expertise you need so you can live a more fulfilling life.

About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapist.

With over 20 years of experience, I have helped individual adults and couples to resolve sexual and/or trauma-related issues (see my article: What Are Common Issues Discussed in Sex Therapy?).

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.












Wednesday, January 15, 2025

Communication: Are You Uncomfortable Talking to Your Partner About Certain Topics?

As a couples therapist and certified sex therapist in New York City, I meet with many individuals and couples where one partner feels threatened by the other partner's thoughts and fantasies about other people.

Talking About Fantasies

Usually the partner who feels uncomfortable believes their partner shouldn't need to think about someone else.  This often results in arguments and power struggles with the first partner feeling threatened and the other partner feeling intruded upon.

Psychoeducation About Sexual Thoughts and Fantasies
When I work with clients who are struggling with this problem, after I assess that there is no active infidelity, I provide psychoeducation about thoughts and fantasies:
  • Thoughts and fantasies aren't reality.
  • Thoughts and fantasies don't necessarily indicate intentions and real life experiences.  Thoughts are just thoughts--they're not facts.
  • Thoughts and fantasies about other people have nothing to do with you. These thoughts don't mean your partner doesn't care about you or they aren't turned on by you.

Talking About Fantasies
  • Romantic and sexual thoughts and fantasies often come unbidden and they usually have little or nothing to do with the actual person your partner is fantasizing about.
  • Respect each other's personal boundaries and privacy: If hearing about your partner's fantasies about other people makes you feel uncomfortable, let your partner know. And if you're the one who wants to share fantasies about someone else and you know your partner is uncomfortable with it, don't talk about it (see my article: Setting Healthy Boundaries in Relationships).
  • If your insecurity about your partner's fantasies are rooted in earlier problems (e.g., unresolved childhood trauma or prior infidelity), get help from a licensed mental health professional who has expertise in this area.
Clinical Vignette
The following clinical vignette, which is a composite of many cases, illustrates how a couple can work through this issue in couples/sex therapy. (Note: Even though the vignette below discusses a heterosexual couple with heteronormative dynamics, this is also a common problem in LGBTQ+ relationships too).

Nan and Bill
Nan and Bill were married and in a monogamous relationship for 10 years. They were both happy with their sex life, but Nan didn't like when Bill shared his sexual fantasies about other women.  

Whenever Nan heard Bill talk about random women he fantasized about, she felt insecure and wondered if he felt she wasn't enough for him.

Her insecurity was exacerbated by her family history where her father often compared her  unfavorably to her older sister (see my article: Reacting to Your Present Circumstances Based on Your Traumatic Past).

Her father would praise her older sister's grades, her athletic ability and her ease with making friends. He would often say, "Why can't you be more like your sister?"

When she was a child, Nan struggled to get good grades, so every time her father criticized her and praised her sister, Nan felt diminished and insecure.

Bill thought sharing his sexual fantasies with Nan would spice up their sex life. He said he had no intention of actually having sex with any of the women he fantasized about and he had never cheated before.

After Bill realized that Nan was uncomfortable with his fantasies, he stopped sharing them.  But, by that time, Nan couldn't stop wondering about his fantasies about other women. 

Even though she knew she would feel uncomfortable, she would frequently ask him if he was still fantasizing about others. It was as if she couldn't stop herself from asking.

Bill didn't want to hurt Nan, so he would reassure her that he loved her very much and, whatever thoughts he might have about other women, had nothing to do with her or their relationship.  

But no amount of reassurance from Bill helped Nan to feel secure.  She trusted Bill and she knew he wouldn't cheat on her, but she couldn't stop asking him about his thoughts.

After a few months of arguing, Bill and Nan sought help from a couples therapist who was also a sex therapist. 

After getting a thorough family and relationship history for Bill and Nan, the therapist realized that Nan's problem with Bill's fantasies were rooted in her history.

The therapist helped Nan to become aware of her insecurity and separate her unresolved childhood trauma from her relationship with Bill. Nan also sought help in trauma therapy to work through the unresolved childhood trauma.

Nan and Bill Talking About Fantasies

After a while, Nan realized she also had fantasies about other men and some women.  Before attending sex therapy, she never allowed these fantasies to go far in her mind because she felt guilty about them. 

But, once Nan realized that Bill got sexually aroused by her fantasies, she shared them with him. At that point, she wanted to hear Bill's fantasies because, after she got over her insecurities, she also got turned on by them and these fantasies enlivened their sex life.

Conclusion
Everyone is different when it comes to sharing and hearing about fantasies.  

For a variety of reasons, some people feel uncomfortable and other people get turned on. 

Talking to Your Partner About Fantasies

Both reactions are equally valid. So, it's important to know yourself and your partner enough to know what works for you as a couple.

If knowing that your partner's fantasizes about other people makes you feel insecure, you would  benefit from knowing whether this insecurity is rooted in earlier experiences--like Nan in the composite vignette above.  If so, seeking help in therapy for the issues that are getting triggered will help you.  

Similarly, if you feel guilty about having sexual thoughts and fantasies about someone--even though you know you would never act on these thoughts--you could be feeling guilty because you mistakenly believe these thoughts mean you're cheating.  This kind of guilt is often rooted in earlier issues.

Above all, know yourself, know your partner and respect each other's boundaries. If you don't feel comfortable sharing sexual fantasies about others, you have a right to keep your private thoughts private. And if you're okay with your partner having sexual fantasies but you don't want to hear about them, you have a right to set a limit with your partner.

Getting Help in Couples/Sex Therapy
Power struggles about sexual thoughts and fantasies are common in many relationships, but if this issue is creating a problem in your relationship, seek help from a licensed mental health professional who has training and expertise in this area.

Rather than struggling with a problem that could erode your relationship over time, seek help sooner rather than later.

Once you and your partner have worked through these problems, you can have a more fulfilling relationship.

About Me
I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and certified Sex Therapist.

With over 20 years of experience, I have helped many individual adults and couples to work  through their problems, including unresolved trauma (see my article: What is a Trauma Therapist?).

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.

















 

Sunday, September 15, 2024

Relationships: What Do Couples Talk About in Couples Therapy?

Are you and your partner considering couples therapy?

What Do Couples Talk About in Couples Therapy?

If you've never been in couples therapy, you might be wondering whether or not you need to talk to a couples therapist.  

You might also wonder what couples talk about in their sessions.

I've written this article as a way to normalize couples therapy in general and some of the most common topics that couples discuss.

What Do Couples Talk About in Couples Therapy?
Here are some of the most common topics couples discuss in couples therapy:

Life Transitions and Stressors: Major life changes can add enormous stress to a couple's life. These transitions often include:
Communication
Identifying and working on unhealthy communication patterns and recognizing the particular negative cycle a couple goes through can save a relationship including:
  • Identifying and working on triggers that lead to arguments and other misunderstandings
  • Identifying ineffective strategies the couple has attempted to use
  • Learning effective strategies to improve communication and create positive cycles
Trust
Trust is a major topic for many couples.

Establishing trust in the relationship is essential to a healthy relationship. 

What Couples Talk About in Couples Therapy: Trust

This includes:
  • Understanding the root cause of infidelity or other breaches of trust
  • Rebuilding trust after infidelity
  • Coping with doubt and suspicion
  • Problems related to differences in level of commitment to the relationship
  • Distinguishing current problems vs. problems related to past relationships or family of origin issues
  • Setting clear boundaries both partners can agree on
Sexual Compatibility
No two people in a relationship think and feel exactly the same way, so it's not surprising that desire discrepancy (also known as mismatched libido) is the #1 topic that brings couples into sex therapy which is a particular type of individual or couples therapy.

    See my article: What is Sexual Desire Discrepancy?).

What Couples Talk About in Couples Therapy: Sex

Aside from desire discrepancy, the other most common issues discussed in sex therapy include:
  • Loss of sexual desire in one or both partners and loss of trust after infidelity
  • Erectile unpredictability which includes loss of erection, premature ejaculation and delayed ejaculation
  • Lack of sexual experience

Roles and Responsibilities
A frequent topic in couples therapy that I hear from clients is how roles and responsibilities are shared (or not shared) by the couple. 

These include imbalances in various areas:
  • Household responsibilities
  • Financial responsibilities
  • Childrearing tasks
  • Decision-making tasks
  • Planning
A couples therapist can provide a safe environment for the couple to negotiate these issues without hostility (see my article: Sharing the Mental Load).

Family Dynamics
Family and culture often have a significant impact on a relationship, especially when the people in the relationship come from different familial and cultural perspectives. 

Talking about family and cultural dynamics in couples therapy allows the couple to discuss these issues in an environment where each partner feels safe so they can negotiate differences.
    
    See my articles: 



Quality Time
A common problem for many couples is how much time they spend together including one partner wanting to spend more time than the other (see my article: Learning to Compromise About How Much Time You and Your Partner Spend Together).

A couple can explore their mutual interests and hobbies as well as areas each of them might want to explore on their own without their partner.

Future Plans and Goals
Creating relationship goals is an important aspect of being in a relationship (see my article: 10 Relationship Goals to Create a Stronger Relationship).

What Couples Talk About in Couples Therapy: Future Plans and Goals

Couples therapy is an ideal place for couples to identify and negotiate individual and relationship goals.

These plans and goals can include:
  • Identifying individual goals
  • Identifying shared relationship goals
  • Negotiating individual and shared goals that might be different
  • Making a plan together to achieve these goals
Getting Help in Couples Therapy
If you and your partner have been unable to work out your problems on your own, seek help from a licensed mental health professional who is a couples therapist.

A skilled couples therapist can help you to work through your problems so you can have a more fulfilling relationship.

About Me
I am a New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapist.

I work 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.