How Does Shame Develop at an Early Age?

Shame often begins during early childhood due to parenting styles and early experiences (see my article: Shame is at the Root of Most Emotional Problems).

How Does Shame Develop at an Early Age?

There are a number of factors that influence the development of shame at an early age including:

• Parental demands for perfection

• Lack of parental warmth

• Harsh criticism

Harsh Criticism and Shame

• Physical, emotional and sexual abuse

• Emotional neglect
  

• Witnessing domestic violence

• Emotionally unstable parent(s)

• Unpredictable or unstable parenting

• Parents who abuse substances or engage in other impulsive or compulsive behavior

How Does Childhood Shame Show Up in Adulthood?

Children who grow up being shamed will grow up to be adults who experience shame, which can affect all their adult interactions, including romantic relationships, familial relationships and relationships with work colleagues.

Shame during childhood often leads to repeating unhealthy patterns in adulthood (see my article: Why Are Childhood Trauma and Shame Affecting You Now?).

Here are some of the ways that childhood shame show up in adulthood:

Self Sabotaging Behavior: 

• Aiming too low

• Settling for less

• Self abandonment including neglecting your own needs to please others (see my article: Fawning as a Trauma Response)

Shame and Self Abandonment

• Avoiding commitment which can include fear of rejection and feeling inadequate (see my article: An Emotional Dilemma: Wanting and Dreading Love)

• Pushing away or distancing yourself from a romantic partner because you believe you're not good enough

• Perfectionism including striving for unrealistic and unattainable goals which adds to your feelings of inadequacy

• Decreased self care including neglecting your own needs which can have a negative impact on your mental and physical health

Sabotaging Relationships:

• Ignoring red flags in a relationship including dismissing early warning signs of an unhealthy relationship (see my article: Letting Go of Unhealthy Relationships)

• Shaming, controlling or domineering behavior to manipulate your partner and take the focus away from your own insecurities

Shaming, Controlling and Domineering Behavior

• Creating negative narratives including interpreting your partner's actions as a form of  rejection or disapproval--even when these actions are not

• Withholding feelings including avoiding vulnerability and conflict by withholding by emotions

Impact on Emotional Connection and Intimacy

• Problems relating to others because shame makes it difficult to develop and maintain healthy relationships (see my article: Overcoming Sexual Shame and Guilt Due to Cultural Issues)

Shame in Relationships

• Difficulty with vulnerability including fear of rejection or criticism which can make it difficult to open up to be emotionally vulnerable

• Fear of rejection due to shame which can lead to self sabotaging behavior and emotional distancing

• Difficulty with forgiveness due to shame can make it difficult to forgive yourself or your partner, which is an obstacle to feeling good about yourself and problems with relationship repair (see my articles: Learning to Forgive Yourself and The Psychological Stages of Forgiveness)

Getting Help in Therapy

Shame is a complex emotion which can be very challenging to overcome on your own (see my article: Overcoming Shame in Therapy).

Getting Help in Therapy to Overcome Shame

If you can relate to the signs mentioned in this article, you owe it to yourself to get help in trauma therapy.

A skilled trauma therapist can help you to overcome the debilitating effect of shame so you can lead a more fulfilling life.

Also See My Other Articles About Shame:

How to Overcome Shame Spiraling

Clients Struggling With Shame Can Leave Therapy Prematurely

What is the Difference Between Toxic Shame and Healthy Shame?

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 helping individual adults and couples (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.

 

How to Deal With Resentment in Your Relationship

Resentment can fester and grow until it destroys a relationship. 

Rather than allowing resentment to grow and harden, it's better to find ways to overcome resentment as problems come up.

Dealing With Resentment in Your Relationship

What is Resentment?

Resentment can include the following:

• Anger
• Disappointment
• Discontentment
• Frustration
• Feeling mistreated
• Indignation
• Irritation
• Disgust
• Holding onto a grudge/an inability to let go of anger

Dealing With Resentment in Your Relationship

• Difficulty accepting apologies
• A chip on one's shoulder
• Animosity
• Hostility
• Hatred
• Bitterness
• Antipathy
• Antagonism
• Ambivalence about the relationship
• Ruminating about feeling mistreated
• Avoiding topics that can lead to arguments and more resentment
• Experiencing tension in the relationship
• Feeling emotionally disconnected from a partner
• Reacting in a passive aggressive way rather than confronting problems directly
• Feeling invisible
• Feeling unlovable

What Are Common Triggers of Resentment in Relationships?

Some of the most common triggers of resentment include:

• Feeling unseen and unheard by a partner
• Feeling put down/criticized
• Having unrealistic expectations of a partner
• Dealing with a partner who insists on always being right
• Dealing with a partner who is frequently forgetful or late
• Feeling taken advantage of by a partner
• Feeling burnt-out by ongoing unresolved problems in the relationship

How Does Resentment Affect a Relationship?

Resentment can affect a relationship in many different ways depending upon who feels the resentment and how long the resentment has been going on, including:

• Harboring anger and bitterness towards a partner that leads to expressing pent up anger unexpectedly and harshly
• Feeling less empathy for your partner
• Withdrawing emotionally from your partner
• Withdrawing sexually from your partner

Dealing with Resentment in Your Relationship

• Feeling disgust and/or disappointment for your partner
• Complaining a lot about your partner to others
• Feeling anxious about the relationship
• Feeling physical tension and stress-related health problems as a result of the relationship
• Feeling like you want to get away from your partner
• Feeling like your opinions don't matter to your partner
• Feeling ignored
• Feeling confusion and/or ambivalence about the relationship
• "Walking on eggshells" with your partner
• Wanting to end the relationship

How Can You and Your Partner Prevent Resentment From Building Up?

It's a lot easier to address issues as they come up instead of allowing resentment to grow and harden:

• Address problems as soon as they arise 
• Learn to communicate and express your feelings in a healthy way
• Keep your expectations realistic. Don't expect your partner to meet every single expectation that you have. Instead, focus on what's most important to you.

Tips on How to Overcome Existing Resentment

If you and your partner have avoided dealing with the resentment in your relationship, you're going to find it challenging. 

Here are some tips that can help:

• Acknowledge the Resentment: If you want your relationship to improve, you both need to be able to acknowledge your own and your partner's resentment--even if you both spent years avoiding it.

• Work on One Issue at a Time: Rather than "kitchen sinking" each other with a whole litany of complaints, focus on one issue at a time. Listen to your partner instead of getting defensive or responding by barraging your partner with your complaints.

• Be Aware of Your Part in the Resentment: You might be aware of your resentment towards your partner, but are you aware of the role you might be playing?

• Remember Your Partner's Good Qualities: In order to put your feelings into perspective and to help you reduce resentment, try to remember your partner's good qualities.

• Learn to Compromise: If you and your partner can find a compromise that you each can live with, this can go a long way to reducing resentment. By talking over the problems in your relationship, you and your partner might be able to come up with reasonable compromises so you can each feel heard and taken care of in the relationship.

Get Help in Couples Therapy

If you and your partner have been unable to work out your problems on your own, you could benefit from seeking help in couples therapy.

Getting Help in Couples Therapy

A skilled couples therapist can help you to identify the areas where you're stuck and help you to make decisions about your relationship--including whether you want to remain together or you want to end the relationship in an amicable way.

Rather than struggling on your own, seek help from a licensed mental health professional who works with couples.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, 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 Josephine Ferraro, LCSW - NYC Psychotherapist.

Relationships: How Is Getting Pressure From Your Partner Different From Consensual Sex?

Sexual pressure is also known by the term "sexual coercion" and I'll use these terms interchangeably in this article.

Sexual Pressure vs Consensual Sex

Before delving into sexual pressure vs consensual sex, it's important to define sex as I'm referring to it in this article.

What is Sex?

If you've read some of my other articles about sex, you probably know that I usually have a broad definition of sex that goes beyond heteronormative penis-in-vagina sex.

So when I discuss sex and sexual activity, I'm referring to:

• kissing
• intimate touching/petting/stroking
• erotic massage
• sucking
• fingering
• cunnilingus (performing oral sex on a woman)
• fellatio (performing oral sex on a man)
• anal sex
• penetrative sex/intercourse

And so on.

What is Sexual Coercion and How is It Different From Consensual Sex?

Sexual coercion occurs when someone manipulates, threatens or uses other pressure tactics to try to get you to have sex that you don't want.  

Sexual Pressure vs Consensual Sex

In many situations involving sexual coercion your partner continues to pressure you into having sex even after you have been clear that you don't want to have sex.  

In other words, the other person just won't take "no" for an answer and keeps trying to get you to change your mind.  This refusal is the opposite of accepting that sex should be consensual (see my articles: What Are the Basics of Sexual Consent? and What is Enthusiastic Sexual Consent?).

In this article, I'm focusing on people who are in committed relationships as opposed to people who are casually dating or hooking up (for those situations see my articles: Sex Research: Heterosexual Women Often Find Hookups Less Sexually Satisfying Than Men and Can Hookups Be Safer and More Sexually Satisfying For Heterosexual Women?).

I'm also focusing on sexual coercion that doesn't include physical violence, which would be domestic violence, which is a separate topic.  

Sexual coercion can, however, include emotional abuse and gaslighting.

What Are Common Sexual Coercion Tactics?

If you have turned down sex, your refusal should be respected by your partner and that should be the end of it.  

Sexual Pressure vs Consensual Sex

Unfortunately, some people have poor sexual boundaries and they don't respect your right to turn down sex or they interpret your refusal to have sex as a sign that you don't care about them (more about that later on in this article).

Some common sexual coercion tactics include:

• Guilt Tripping
• Making Threats
• Emotional Blackmail
• Other Forms of Manipulation

The following short fictionalized scenarios describe common situations in which a partner uses sexual coercion:

• Guilt Tripping: Joe got angry after Lisa responded to his sexual overtures by saying she wasn't in the mood for sex.  He told her that if she didn't have sex with him, she wasn't fulfilling sexual her responsibilities as a wife, which included making sure that he's sexually satisfied.

• Making Threats: After Jean told her wife, Rita, that she wasn't in the mood for sex, Rita responded by threatening to withhold money she had already promised to lend Jean.

• Emotional Blackmail: When Bill's husband, Tom, refused to have sex with him, Bill got angry and, in the heat of the moment, he threatened to tell Tom's parents about his alcohol problem.

• Other Forms of Manipulation: Dave felt impatient when his wife, Tina, told him that she wasn't in the mood for sex, so he badgered her relentlessly to have drinks with him. He told her that she just needed to "relax" to get in the mood for sex.

There can be many other ways that someone can pressure or coerce a partner into having sex.

Being in a Relationship or Marriage Doesn't Mean Automatic Sexual Consent

Many people believe that if they're married or in a committed relationship that their partner "owes" them sex.  But in a healthy, autonomous relationship where each partner is differentiated, their relationship doesn't mean automatic sexual consent.

Sexual Pressure vs Consensual Sex

Anyone who has ever been in a long term relationship knows that, over time, sexual passion usually isn't the same as it was during the initial phase of the relationship.  

Although there can be differences, for most people the passion begins to dissipate within the first two years of the relationship.  This is a separate issue which I have discussed in prior articles (see my articles: Overcoming Sexual Boredom in a Long Term Relationship and Reviving Your Sex Life).

It's also true that it's common for two people in a relationship to have discrepant sexual desire, which means that they each experience sexual desire in a different way.  This is normal, but it becomes a problem when the two people in the relationship don't know how to negotiate these differences. This is also a common topic that couples discuss in sex therapy.

Similarly, one person might experience spontaneous sexual desire while the other person might need more time to get sexually turned on because they experience responsive sexual desire.  Even though both types of sexual desire are normal, when this difference creates problems in the relationship, it needs to be discussed and negotiated.  This is another common topic for couples in sex therapy.

What You Can Do If Your Partner is Trying to Pressure You Into Having Sex

There is no one-size-fits-all answer to this problem because each situation can be very different, so you need to do what you think is best in your situation.

As long as you feel safe, it's often helpful to reiterate to your partner that you don't want to have sex and tell your partner that you don't want to be pressured.  In addition, tell your partner that pressuring you won't change your mind (see my article: How to Talk to Your Partner About Sex).

You could also suggest other things that you would be willing to do with your partner--like cuddling on the couch (if you're up to it) or going for a walk.  

Understanding Sexual Pressure vs Consensual Sex

If you think your partner is interpreting your refusal to mean that you don't care about them anymore, you could also reassure your partner that you still love them, but you're just not in the mood for sex.  In addition, you can both read my article, Coping With a Sexual Rejection From Your Partner, to be able to talk about this openly.

What If Your Refusal to Have Sex is Part of a Bigger Problem?

No one should ever have sex when they don't want to do it. Sex should always be consensual.

However, there's a difference between refusing sex occasionally because you're not in the mood versus you don't want to have sex with your partner most of the time.  This can be indicative of bigger sexual problems (see my article: Have You and Your Partner Stopped Having Sex?).

One blog article can't possibly cover all the possible reasons why someone in a relationship doesn't want to have sex, but some common reasons include:

• Shame
  
• Guilt
• Lack of sleep
• Depression
• Anxiety
• Poor body image
  
• Hormonal fluctuations
• Low testosterone
• Erectile problems
• Lack of sexual experience
• Sexual performance anxiety
  
• Fear of pregnancy
• A history of sexual abuse/unresolved trauma
• Painful sex
  
• Problems with the way one or both partners initiate sex
• Sexual boredom or lack of sexual satisfaction with your partner
• Problems with orgasm or an orgasm gap 
• Anger and resentment
• Loss of trust due to a history of infidelity
• Other problems in the relationship

Getting Help in Sex Therapy

It can be difficult to resolve sexual problems in a relationship without professional help.

Sexual Pressure vs Consensual Sex

Sex therapy, which is a form of talk therapy, is often helpful in resolving sexual problems (see my article: What is Sex Therapy?).

There is no physical exam, nudity or sex during sex therapy sessions (see my article: What Are Common Misconceptions About Sex Therapy?).

Individual adults and couples seek help in sex therapy for a variety of reasons (see my article:  What Are Common Issues Discussed in Sex Therapy?).

Rather than struggling on your own, seek help from a licensed mental health professional who is a sex therapist so you can have a more fulfilling sex life.

About Me

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

I am a sex positive 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.

What Are the Most Common Misconceptions About Sex Therapy?

This is the first article in a series of articles about sex therapy where I'll begin addressing the most common fears and misconceptions that people have about sex therapy and some of the most common issues addressed by sex therapists (see my article: What is Sex Therapy?)

Sex Therapy For People in Relationships

There are many misconceptions about sex therapy which, as a sex therapist, I would like to address in this article.  These misconceptions and their related fears often keep people from seeking much-needed help in sex therapy.

Common Problems and Misconceptions That Keep People From Seeking Help in Sex Therapy

Some of the most common problems and misconceptions include (but are not limited to):

• Shame: Shame is a big reason why people, who could benefit from sex therapy, don't go.  Many individuals and couples who are having sexual problems don't know that their sexual problems are common, so they feel too ashamed to see a sex therapist. However, whether the problem is lack of sexual experience, low libido, problems with sexual desire discrepancy in a relationship, premature ejaculation, erectile unpredictability, painful intercourse, a desire to explore consensual non-monogamy or BDSM or kink, or a variety of other issues, these issues and other sexually related issues are common in sex therapy.  

Sex Therapy For Individual Adults

• Fear of Being Asked to Do Things They Don't Want to Do: Many people who have misconceptions about sex therapy fear that the sex therapist will ask them to engage in sexual acts they would be uncomfortable doing (group sex, threesomes, and so on).  But sex therapists focus on what the clients want.  They don't have their own agendas.  

• Fear of Being Judged or Criticized: Many people fear the sex therapist will judge them for their problems or their desire to explore certain areas of sexuality, like kink or BDSM (Bondage, Discipline, Dominance, Submission and Sadism and Masochism) as one example.  The reality is that most sex therapists are trained to discuss these issues in a sex positive and nonjudgmental way. 

Sex Therapy For All Genders and Sexual Orientations

• Fear of What Will Happen in the Sex Therapist's Office: There are people who fear they will have to take off their clothes or engage in sex in front of the sex therapist. However, there are no physical exams in sex therapy, no nudity and no touching.  In fact, a sex therapist's office is just like any other therapist's office.  Sex therapy is a form of psychotherapy which is also known as talk therapy.

Sex Therapy Online

• Fear of Sexual Boundary Violations: As mentioned above, there is no nudity or sexual acts in a sex therapist's office.  You and the sex therapist talk about your problems and there might be assignments for you and your partner(s) to try at home and come back to discuss the following week, depending upon the issue and how the sex therapist works.  Sex therapists don't have sex with their clients.  That would be a serious ethical and legal breach.  Also, a sex therapist doesn't talk about her own sexual experiences.  In other words, sex therapists are licensed therapists who must maintain legal and ethical boundaries with their clients.  

What Are Some of the Most Common Issues Addressed in Sex Therapy?

Most sex therapy begins with the clients discussing what they want to work on in sex therapy.  As previously mentioned, these issues include but are not limited to:

• Lack of Sexual Experience (for all genders/sexual orientations)

• Sexual Anxiety

• Sexual Shame

• Lack of Sexual Confidence or Sexual Self Esteem

• Problems Talking About Sex With Partner(s)

• Low Sexual Desire or Problems With Sexual Arousal

• Sexual Desire Discrepancy or Sexual Frequency Disagreements in a Relationship

• Problems With Body Image That Interferes With Sex

• Problems with Having an Orgasm For Both Men and Women

• Painful Sex

• Erectile Dysfunction

• Premature Ejaculation

• Sexual Compulsivity Including Compulsive Use of Pornography

• Sexual Boredom or Lack of Sexual Pleasure

• Understanding the Conscious and Unconscious Meaning of Sexual Fantasies

• Understanding the Difference Between Sexual Fantasies and Sexual Acts

• Understanding Your Erotic Blueprint

• A Desire to Explore Kink, BDSM (Bondage Discipline, Dominance, Submission and Sadism) or Fetishes

• A History of Sexual Abuse That Negatively Impacts Current Sexual Pleasure

• A Wish to Explore Polyamory or Opening Up a Relationship to Include Other Partners (also known as Consensual Non-Monogamy)

• Problems With Sexual Intimacy After an Affair

• Problems With Sexual Intimacy After Having Children

• Problems Understanding Sexual Orientation or Erotic Orientation or Sexual Fluidity

• Other Emotional or Mental Issues Interfering With Sex

What Happens in Sex Therapy?

Now that I've addressed some of the most common fears and misconceptions people have about sex therapy and some of the most common issues addressed, let's begin a discussion about what actually happens in sex therapy.  I'll go into further detail about this in my next article.

What Happens in Sex Therapy?

Both individual adults and people in relationships, including monogamous and non-monogamous relationships, attend sex therapy.  

As previously mentioned, sex therapy is a form of psychotherapy, which is also known as talk therapy.

Sessions can be in person or online.

The initial session is for clients to discuss why they are seeking help in sex therapy.  

For a variety of reasons, many people feel ashamed to talk about sex, so part of the sex therapist's role is to help clients get more comfortable talking about sex without experiencing shame.  

Sex Therapy Online

It's also common for clients to want to get comfortable with a sex therapist before they really open up to talk about their sexual problems in detail, and skilled sex therapists know how to facilitate this.

Other clients might feel more open and comfortable talking about sex right away.  So, the sex therapist can begin getting a sexual history from the client(s).

Getting a comprehensive sexual history taking is an important part of the initial stage of sex therapy.

When Should You See a Sex Therapist?

If you have tried on your own to resolve sexually related problems without success, you're not alone.  

Many people seek help in sex therapy, and you could also benefit from seeing a sex therapist.

A sex therapist can help you with practical steps to resolve the underlying issues related to your sexual problems.

Rather than struggling on your own, if you're having sexual problems, seek help with a licensed psychotherapist who is a sex therapist.

You deserve to have a fulfilling sexual life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Couples and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples.

I provide in-person and online therapy.

To find out more about me, visit my website where I have many articles about sex therapy as well as other topics: Josephine Ferraro, LCSW - NYC Psychotherapist.

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

How to Talk to Your Partner About Sex - Part 2

I began a discussion on how to talk to your partner about sex in my prior article with suggestions, including do's and don'ts to introduce the topic with your partner. In this article, I'm providing a clinical vignette to illustrate typical sexual problems in a relationship and how a couple is able to work through these problems in couples therapy.

How to Talk to Your Partner About Sex

A Common Problem: It Can Be Hard to Talk About Sexual Problems With a Partner
As an experienced therapist who works with individuals and couples, I have found that many people have difficulty talking to their partner about sex, especially when there are problems.  Even in relationships where people have been together for many years, they often feel shy or awkward to talk about sex with a partner.

Why Is It Hard to Talk About Sex With a Partner?
There are many reasons why people feel uncomfortable and avoid talking about sex, including:

• Cultural or Religious Taboos: It's not unusual for people, who were raised in a particular religion or culture where talking about sex is taboo--even with a spouse of many years, to experience difficulty in expressing their sexual needs or talking about sexual problems.

• Family History: For people raised in a family where sex was seen as "dirty" or secret, talking about sexual problems can be challenging. Also, in families where there were poor boundaries around sex (e.g., parents walking around naked in front of children or having sex in front of or within earshot of children), these children often grow up to be adults who experience problems with sex in their relationship.

• Sexual Trauma: When there is unresolved sexual trauma (for either a man or woman regardless of sexual orientation), it's often difficult to separate out the traumatic experience from the current relationship.  The act of being sexual in the current relationship can trigger memories of being sexually abused, which makes it hard to talk about sex or to even engage in sexual activities with a partner.

• Body Shame: Many people, especially women, feel ashamed of their body. There are many reasons for this, including a history of being shamed about their body, sexual abuse, popular and unrealistic images of men's and women's bodies, etc. So, talking about sex, which involves the body, feels too embarrassing.  

• Fear of Being Rejected: For many people the idea of initiating a discussion about sex with their partner brings up fears of being rejected. Their fear might involve an outright rejection of them or a fear that their partner might also have things they don't like about them with regard to their sex life. This fear often inhibits people from bringing up the topic of sex.

There are also countless other reasons why people avoid talking about sex with their partner.  This avoidance ensures that the problem probably won't be resolved with the possible effect that the couple grows apart (see my article: Relationships: How to Get Closer When the Two of You Have Grown Apart).

Clinical Vignette: How to Talk to Your Partner About Sex
The following fictional vignette is a composite of many different cases so that there are no identifying features of any one person or couple. This case illustrates the sexual presenting problem, the effect of the problem on the relationship, and how it gets resolved in couples therapy.

Amy and Joe
By the time Amy and Joe came to couples therapy, they were already considering divorce.  In their mid-40s and married for 20 years with children, they decided to try couples therapy to see if they could salvage their relationship before they filed for divorce.

Just like many other couples who come to couples therapy, Joe and Amy told their couples therapist that they had "communication problems."  For many couples, presenting their problem to the couples therapist as a communication problem takes away some of the shame and awkwardness they feel about coming to couples therapy (see my article: Mental Health Awareness: Reducing the Stigma of Going to Therapy).

Their couples therapist recognized that, in a general way, they did have communication problems, but this description of their problem was too vague.

Knowing that many couples come to couples therapy because they're either having problems with sex or money (or both), the therapist normalized this by asking each of them specific questions, including questions about their sexual satisfaction in the relationship.  She had already informed them, when they called for the consultation, that a sexual assessment was part of the initial stage of therapy, so they were aware that they would be asked these questions.

Initially, both Amy and Joe hesitated before they responded.  They looked at each other awkwardly as if to get a response from the other as to what they should say.

In response, the therapist told them that problems with sex is a common reason for coming to couples therapy for many couples.  Once again, this was a way of normalizing the topic of sex by letting them know that it's a common problem for many couples.

In response, Amy laughed nervously, "Gee. I didn't know that. I always assumed that everyone else is having 'swinging off the chandeliers' sex every night."

With a reddened face and looking down at the floor (rather than at Amy or the therapist), Joe said, "So, you think everyone else is having more and better sex than we are?"

Amy just looked away rather than respond, so Joe, who was sitting right next to Amy on the therapist's couch, said, "You're not saying anything, so I'm guessing that you have a problem with our sex life that you haven't told me about. Is that right?"

Looking away from Joe, Amy winced, "Well..."  And then she stopped and looked at the therapist as if for guidance.

So, the therapist stepped in at that point and said, "It seems to me that you both still care about each other--otherwise, you wouldn't be here. When you contacted me for the consultation, I mentioned to you that I get a sexual history from each person in the relationship for every couple that I see.  Why don't we start with me getting a sexual history from each of you" (see my article: Why It's Important to Talk to Your Therapist About Sexual Problems).

Based on the sexual history assessment that the therapist did for Joe and Amy, she found out the following salient facts:

• Neither Joe nor Amy had much sexual experience with each other or with others before they got married.
• Despite their limited sexual experience prior to marriage, each of them assumed, before they got married, that their sex life would work out on its own without having to talk about sex and without having to put in any effort.
• Both of them felt awkward talking about sex with each other and would prefer to avoid it if they could.
• Amy's family was very religious and neither parent ever talked to her about sex. Sex was considered a taboo subject in her family. She found out about sex by reading books when she was a teenager, but she never discussed what she read with anyone.
• Amy didn't get her period until she was almost 14 years old. She was self conscious at school because all the other girls had already developed breasts, but she was "flat chested" (her words). As a result, the boys in her junior high school often teased and body shamed her about this, which made her feel even more ashamed. She never told anyone about this until now.
• Joe's family was the opposite of Amy's family: His parents had very loose boundaries. They often walked around naked in front of Joe and his siblings.  They would also have sex in the living room after they thought Joe and his siblings were asleep.  But, in fact, Joe and his brothers and sisters would hear them and feel uncomfortable and embarrassed.
• Ever since he entered into puberty, Joe felt ashamed of his penis size.  When he was in high school, the other boys in the locker room would brag about having big penises and about their sexual conquests. This made Joe feel ashamed.  The few times that he was sexual with other women, before he met Amy, he never wanted women to see his penis, so he always insisted on having sex in the dark.  He secretly feared that, due to the size of his penis, he couldn't satisfy women sexually, which contributed to his shame about sex and his sexual awkwardness--even with Amy.
• Both of them denied a history of sexual trauma or abuse.
• Joe had a vague sense that he wasn't satisfying Amy sexually, but he felt too ashamed to talk to her about it.
• Amy often "zoned out" during the rare occasions when she and Joe had sex. She rarely had an orgasm, and she usually couldn't wait until it was over.
• Neither of them felt comfortable talking about sex initially, but answering the therapist's questions from her sexual assessment made each of them realize that they weren't the only couple who had these problems.
• Both denied any extramarital affairs during the marriage.
• Both of them eventually admitted that they were dissatisfied with their sex life together, but both felt too ashamed to discuss it before coming to couples therapy.

Gradually, Amy and Joe were able to open up more about their sex life in couples therapy.  Amy was the first one to broach the topic of their almost nonexistent sex life in the last several years.  After hearing Amy speak, Joe said, "I thought you didn't want to have sex, so I didn't want to bother you."  In response, Amy turned to Joe and said, "That's weird--because I thought you weren't interested and I didn't want to bother you about it."

Over time, they were able to talk about being somewhat satisfied with their sex life when they first got married.  Each of them acknowledged that this changed after they had their second child.  They often felt too exhausted to have sex and they also stopped prioritizing their sex life--until it dwindled to having sex, on average, once every few months.

The more they were able to talk about their sexual history, the freer each of them became to talk about the problems in their sex life.  Prior to this, they weren't sure what caused them to drift apart (leading to talk about a divorce).  Each of them just assumed that the other wasn't interested in the marriage anymore.

They each said that they still felt sexually attracted to the other.  They also agreed to go away on a relaxing vacation to rekindle their relationship.

When they returned, they seemed much closer. They also told their couples therapist that they made love several times while they were away on their weeklong vacation.

Amy talked about being bold enough to bring sex toys on their vacation, which they had fun using. She said she had more consistent orgasms while they were away.  In addition, she told their couples therapist that she had developed a new appreciation for her body, including her small breasts, and sh realized that Joe still found out attractive.

Joe talked about being more sexually adventurous about exploring different sexual positions.  He also discussed that they engaged in oral sex for the first time, both fellatio and cunnilingus, and they found it fun and enjoyable.

Using Emotionally Focused Therapy (EFT) For Couples, their therapist helped them to identify and change the patterns in their relationship that were causing problems for them.  They continued to make progress and they each made a commitment to save their relationship by continuing in their couples therapy.

Conclusion
Regardless of sexual orientation, age, race or other identifying factors, sexual problems are common in many relationships.

There can be many factors that contribute to the problems, which can be addressed and overcome in either individual or couples therapy.

The fictional vignette presented above gave a particular set of problems, but there are many other types of sexual problems.

Getting Help in Therapy
If you and your partner are having sexual problems, rather than avoiding the problems, you owe it to yourselves to get help.

Resolving the sexual problems in your relationship can rekindle and salvage your relationship.  So rather than waiting, get help from an experienced therapist who works on these issues so you can have a more satisfying relationship.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, EFT and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Therapy).

I work with individual adults and couples.

I have helped many individuals and couples overcome problems related to sex, including sexual trauma.

I am currently providing teletherapy, also known as online therapy, telemental health and telehealth (see my article: The Advantages of Online 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.