BDSM and Kink: What Are the Different Types of Sub-Dom Relationships?

I began a discussion about sub-dom relationships in my prior article, BDSM and Kink: What is a Sub-Dom Relationship?.

BDSM Sub-Dom Relationships

I'm continuing this discussion by defining the different types of sub-dom relationships and providing a clinical vignette to illustrate one of the types, the Master/Servant relationship.

What Are the Different Types of Sub-Dom Relationships?

The following sub-dom relationships are among the most common:

• Training Relationships:  The dom trains the sub on how to be a sub.  The dom is like a trainer or teacher.  The dom acts as a guide or leader, and the sub can take on certain roles such as pleaser, brat, tester, baby or servant (to name a few). The dom must be trusthworthy, caring, consistent, available and reliable. When neither person has any experience with these types of relationships, they can hire an experienced BDSM practitioner to train them.

• Master/Servant: The focus in this relationship is for the servant to provide service to the dom, including taking care of the dom's clothes and other sexual and non-sexual acts of service.  The servant takes pleasure in doing things for the Master and the Master enjoys the control and having the sub do things done for them. With regard to sexual acts of service, the servant often feels free of guilt and shame about wanting kinky sex because the Master gives permission.

• Sub-Dom Bondage Style: This relationship focuses on creating bondage harnesses or suspension scenarios. This requires a lot of trust between the sub and dom as well as considerable skill.  

• Caregiver/little or Age Play: The dom acts as an older caregiver (mother, father, caregiver, aunt, nanny or other authoritative person).  The sub can act like an infant, a young child or a teenager. Caregiver activities include nurturing (like bathing, hair brushing) or punishment (like spanking). The sub gets to feel taken care of by the dom.

• 24/7 Relationships: The individuals enter into an ongoing permanent sub-dom relationship, which can be renegotiated.  The sub-dom role is usually fixed and there's usually no switching of roles.

Female-Led Sub-Domme Relationships

• Female-Led Relationships (FLR): Traditionally, this is an ongoing BDSM relationship where in heterosexual relationships the woman is dominant and the man is submissive (this dynamic can also occur between lesbians, bisexual or trans women). The woman, also called the femme, is the decisionmaker over the sub.  The decisionmaking can involve anything from telling the sub what clothing to wear to managing the sub's finances.

• Keyholders: This relationship is associated with chastity play. The sub agrees to allow the dom to tell them when they can touch themselves, have an orgasm and so on.

Clinical Vignette

The following clinical vignette, which is a composite to protect confidentiality, is one example of a sub-dom dynamic in a Master-Servant relationship:

Nina and Ted

Five years into their marriage, Nina and Ted became curious about exploring a Master-Servant relationship, so they took a BDSM sub-dom workshop.

Although they had a very good sexual relationship, they wanted to spice up their sex script by exploring BDSM.  After learning about the different types of sub-dom relationships, they decided to try the Master-Servant dynamic where Ted was the dom (the Master) and Nina was the sub (the Servant).

Throughout their relationship Nina and Ted had developed a loving, trusting relationship, which was key to their developing a healthy Master-Servant relationship.

Whereas Ted had a more dominant personality, Nina tended to be more submissive--although she could be assertive at times and she felt comfortable setting boundaries.

They learned their roles under the private mentorship of a BDSM trainer.  

When it was time to negotiate an agreement between them, they saw a sex therapist who was a kink-allied therapist (see my article: What is Sex Therapy? and What Are the Most Common Misconceptions About Sex Therapy?).

Part of their sub-dom agreement was that this was an exploration of BDSM. They agreed to work out particular power play scenes where Nina provided Ted with acts of service, like laying out his clothes, shining his boots and certain sexual acts they both enjoyed.  They didn't want a 24/7 relationship because this didn't suit either of them mentally or emotionally.

Although both Ted and Nina liked power play and other kinky activities, prior to engaging in a sub-dom dynamic, Nina often felt guilty and ashamed about it afterwards because of her conservative religious upbringing.  So, entering into a scene where Ted, as the Master, was in control of what they did sexually took away Nina's guilt and shame.

They experimented with the sub-dom dynamic privately for six months by adding it to their sexual repertoire a few times a month.  Whenever they engaged in a Master-Servant scenario, they checked in with each other to make sure they were both physically and emotionally comfortable.

In their everyday life, they appeared like any other couple.  They went to dinner, the movies, shopping and attended regular social events. There was nothing in their outward appearance that indicated they engaged privately in sub-dom sexual activities.

Once they became comfortable with their sub-dom relationship, they confided in close friends, who were open minded, supportive and curious.

Nina and Ted were aware that local sex clubs had BDSM sub-dom events, but they preferred to engage in this dynamic privately behind closed doors.

They reassessed their situation a year later and talked about their experiences with their sex therapist.

Nina felt the sub-dom dynamic was a sexual awakening for her.  She discovered sexual aspects of herself that she had been unaware of before, including how sexually turned on she felt when in her role as the sub when she provided Ted with sexual and non-sexual service (see my article: Women's Sexuality: Tips on Sexual Self Discovery).

Nina realized that being the sub in a sub-dom relationship helped to open her up sexually and, over time, even when she and Ted weren't doing a role play, she felt freer sexually without the guilt and shame she would normally feel.  So, in that way the BDSM sub-dom relationship was emotionally healing for her.

Ted liked being in the role of the guide and protector with Nina.  He took his responsibility to be attentive to her emotional and sexual needs very seriously before, during and after sex, including in their aftercare activities where they cuddled in each other's arms.

They experimented with switching roles where Nina was the dom and Ted was the sub.  They each found it fun to switch occasionally, but they discovered that Ted was naturally a dom and Nina was naturally a sub so they mostly kept to these roles.

Over time, Nina and Ted continued to explore many aspects of BDSM, including bondage and rope play.  

They discovered that including the sub-dom dynamic as part of their sex script allowed them to be much more emotionally and sexually vulnerable with each other, which brought them closer together (see my article: Vulnerability as a Pathway to Greater Emotional Intimacy).

Consent is Essential

Many people think of the movie, 50 Shades of Grey, when they think of BDSM sub-dom relationships. But even though the movie introduced the concept of a contract/agreement, there was such an imbalance of power between the two main characters that their relationship couldn't be considered consensual.

Taking the time to work out a written agreement can make all the difference in a BDSM sub-dom relationship in the long run (see my article: What You Can Learn From the Kink Community About Consent).

Conclusion

There are many ways to set up a sub-dom relationship depending upon the needs of the people involved. The vignette above presents only one particular way of doing it.

A Sub-Domme Lesbian Relationship

Although the clinical vignette presented a heterosexual couple, sub-dom relationships are not just for heterosexual relationships.  There are many people in the LGBTQ community who practice BDSM sub-dom relationships.

In addition, couples often switch roles between being the sub or the dom.  It's a matter of preference for each person.

There are now many reputable sites for learning about sub-dom relationships, including Kink Academy.

In my next article, I'll discuss tips for exploring sub-dom relationships: Are You Curious About Exploring Sub-Dom Relationships?.

Getting Help in Sex Therapy

If you're curious about experimenting with a sub-dom relationship, you could benefit from working with a kink-allied sex therapist.

Sex therapy is a form of talk therapy where there is no physical exam, nudity or sex between the therapist and client(s).

A skilled kink-allied sex therapist can help you work out a mutually beneficial agreement as well as work on other issues that might come up.

About Me

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

I am a kink-allied 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.

BDSM and Kink: What is a Sub-Dom Relationship?

I've written about BDSM (Bondage and Discipline, Dominance and Submission, Sadism and Masochism), kink and fetishes in prior articles (see my articles: What is Kinky Sex? and What is Power Play?).

BDSM and Kink: What is a Sub-Dom Relationship?

My focus in this article is specifically on the sub-dom (submissive-dominant) relationship which is part of BDSM and kink (see my article: What's the Difference Between a Kink and a Fetish? and Destigmatizing Sexual Fantasies of Power and Submission).

Although not every sexual role play includes BDSM, role play is usually considered an essential part of BDSM.

What is a Sub-Dom Relationship?

A sub-dom relationship is a consensual, eroticized exchange of power. 

The "DS" in BDSM stands for the dom-sub relationship.  The power differential between the sub and the dom is often written as "D/s" where the D is capitalized to reflect dominance and the s is a small letter to reflect the submissive role.

Although there are some people who are in 24/7 sub-dom relationships, most of the time these roles are part of a specific role play or scene that is negotiated and consented to beforehand to reflect the particular boundaries set by the sub and the dom  (see my article: What You Can Learn From Kink Culture About Consent).

In other words, the role play is based on what the sub wants to experience and what the dom wishes to do.

In addition, there is relative equality between the sub and the dom within the consensual boundaries of what has been negotiated between the two individuals.  

Although outwardly it appears that the dom has more power, the sub is the one who is giving over power to the dom, and the sub also has the power to stop the dynamic by using a safe word (a word that both people agree upon beforehand which means that everything stops the moment the sub uses that word).

What is the Role of the Dom?

The sub-dom dynamic is an exchange of power where the sub gives over power to the dom.

The role of the dom in a sub-dom role play is to use the power and control that the sub has consented to in a scene.

A Woman in the Dominant Role is Called a Domme

The dom's most important role is to create a safe and trusting space while being assertive and direct as to how the scene plays out. 

The dominant person can be a man or a woman. When a woman is in the dominant role, the word is spelled "domme."

What is the Role of the Sub?

The role of the sub is to consensually agree to give up control to the dom.  The sub usually feels empowered by giving up control to the dom in an agreed upon scene.

A Sub Feels Empowered By Giving Control to the Dom

In order to give up control and experience this kind of vulnerability, the sub must trust the dom.  This is why it's so important to have clear agreements, including an understanding of the agreed upon limits.

What Are the Different Types of BDSM Role Play Scenarios?

A sub-dom role play can involve providing service, exhibitionism, bondage, discipline (spanking or impact play), the eroticization of intense sensation (also known as sadism and masochism).  

In general, it can involve whatever the two people agree to in the context of a sub-dom role play.

There are many different possibilities in terms of the different kinds of role plays. It all depends on the interests of the dom and the sub.

Although the possibilities are endless, here are some of the more popular sexual role play scenarios:

• Teacher and student
• Boss and employee
• Master and slave
• Doctor and patient
• Client and stripper
• Photographer and model
• Police officer and motorist
• Handyman and a woman who is at home
• Homeowner and maid

What Are the Different Types of Sub-Dom Relationships?

There are many different types of sub-dom relationships, including, as mentioned earlier, 24/7 relationships where each person remains in their respective role all the time as part of their relationship.

I'll discuss the various types of sub-dom relationships as well as tips on how to explore sub-dom relationships in upcoming articles on this topic: What Are the Different Types of BDSM Sub-Dom Relationships?

Getting Help in Sex Therapy

People often want to explore sub-dom dynamics, but they don't know how to start.  

Often, guilt, shame and emotional insecurities get in the way (see my article: What is Sex Therapy?).

Working with a skilled sex therapist can be helpful (see my article: What Are the Most Common Issues Discussed in Sex Therapy?).

Sex therapy is a form of talk therapy. There is no nudity, physical exam or sexual activities between the therapist and client(s) during sex therapy sessions (see my article: What Are the Most Common Misconceptions About Sex Therapy?).

Rather than struggling on your own, seek help from a skilled sex therapist who can help you to explore new sexual dynamics or overcome other sexual issues.

About Me

I am a licensed New York City 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 email me.

How Existential Anxiety Contributes to Out of Control Sexual Behavior (OCSB)

I began a discussion about Out of Control Sexual Behavior in two prior articles, What Causes Out of Control Sexual Behavior (OCSB)? and Treating Out of Control Sexual Behavior in Sex Therapy.

Existential Anxiety and Out of Control Sexual Behavior

Although there is no one particular cause for OCSB, in the last article I discussed certain common contributing factors to OCSB such as Attention Deficit Hyperactivity Disorder (ADHD) and mood disorders such as depression and anxiety.  

Before going further, I want to emphasize that even though I'm discussing contributing factors to Out of Control Sexual Behavior, I'm in no way implying that people are unable to control their behavior or aren't responsible for their behavior.  Regardless of the possible contributing factors involved, each person is ultimately responsible for their own behavior.

What Are Existential Thoughts?

Basically, existential thoughts focus on the meaning and purpose of life and one's own mortality.  

For instance, people, who allow themselves to engage in these thoughts, struggle for a while with the aging process and thoughts of death.  But many of them eventually come to accept the limitations of their particular life, including death, and this acceptance allows them to find meaning and purpose in their life (see my article: Making Peace With the Aging Process).

Erik Erikson's 8 Stages of Psychosocial Development include the 7th Stage, Generativity vs Stagnation, which occurs during middle adulthood, which was originally thought to be from about the age 40 through to 65 (although with longer life expectancy, as compared to Erikson's time, many people believe that middle adulthood or midlife now extends into the 70s and beyond).

With regard to existential issues, Erikson's 7th Stage of Psychosocial Development represents a time when people consider the meaning and purpose of their life and what they can contribute that will have a lasting impact and legacy beyond their life.

This stage can last years and it can bring much anxiety, referred to as Existential Anxiety, along the way, especially if people try to avoid or suppress these thoughts.

What is Existential Anxiety?

In the current article, I'm focusing on Existential Anxiety as a contributing factor to OCSB as discussed in Sex Therapist Dr. Daniel N. Watter's book, The Existential Importance of the Penis.

Existential Anxiety

Existential Anxiety is the dread or panic someone experiences when they confront the limitations of their existence, including death.

For instance, one example is someone who experiences Existential Anxiety in midlife when they realize they feel stifled in their current circumstances or they haven't accomplished the things they wanted to accomplish earlier in their life (see my articles: Midlife Transitions: Reassessing Your Life and Midlife Transitions: Living the Life You Want to Live).

To make matters worse, they might realize that, due to their age and other life stage circumstances, they won't achieve what they hoped for in their life.  This realization can precipitate Existential Anxiety and an emotional crisis.  Some people refer to this as a "midlife crisis." 

Part of grappling with Existential Anxiety is accepting that death is an inevitable part of life.  This acceptance can serve to enrich life by encouraging people to live a meaningful life in whatever time they have left.

How is Existential Anxiety Related to Out of Control Sexual Behavior (OCSB)?

I believe the vast majority of people get through the psychological challenges of midlife and resolve their Existential Anxiety--even if they struggle with it for a number of years.  

However, there are many people who go through a long and difficult time with this stage and, in an attempt to ward off their Existential Anxiety, they engage in out of control behavior, including Out of Control Sexual Behavior (OCSB).

According to Dr. Watter, Existential Anxiety, especially fear of death, often involve sexual thoughts and behavior because sex is experienced as a life force--the opposite of death.  As a result, Out of Control Sexual Behavior is often used a maladaptive way of coping by repressing or neutralizing these fears.

Other instances where OCSB can manifest is when someone reaches the age when a parent died.  For instance, when a married man reaches the age when his father died from a massive heart attack, he can experience such overwhelming anxiety that he attempts to suppress this fear by engaging in extramarital affairs (see the clinical vignette below).

According to Dr. Watter, this is often uncharacteristic behavior for this person who doesn't understand what's driving this sexual behavior.  

It's important to note that, Existential Anxiety, doesn't always lead to OCSB--even among people who increase their sexual behavior due to the anxiety.  Existential Anxiety can lead to increased sexual activity that's not always out of control.  

But for the purpose of this article, I'm focusing on OCSB and how Existential Anxiety contributes to it.  

Clinical Vignette: Existential Anxiety and Out of Control Sexual Behavior (OCSB)

The following clinical vignette illustrates how Existential Anxiety contributes to OCSB.  As always, this vignette is a composite of many different cases with all identifying information changed or removed to protect confidentiality.  

Jack

When Jack was 10 years old, his father died suddenly from a massive heart attack.  His father, who was only 40 years old, had hardly ever been sick in his life, so his sudden death was a shock to the whole family, especially to Jack, who was close to his father.

Early Loss and Trauma

After his father died, as a young boy, Jack would often worry that his own heartbeat was irregular and that he might die suddenly too.  He would ask his mother repeatedly to feel his heartbeat and she would assure him that he wasn't having a heart attack.  

During adolescence, Jack and his friends were preoccupied with girls, and his fears of death weren't as much a part of his awareness.  He went on to date, enter into relationships, and he eventually got married to Celia.

Jack often thought about his father throughout his life, but he was especially preoccupied with these thoughts as he approached his 40th birthday because this was his father's age when he died.

Several months before his 40th birthday, Jack became so anxious that he had difficulty sleeping through the night.  He had frequent nightmares about seeing his father in the distance and trying to overcome obstacles--crowds of people or other physical barriers--to get to his father, all to no avail. He often woke up shaking in terror and bathed in sweat.  

During that time, Jack was assigned to manage a project at work where his boss, Alan, asked him to mentor a junior employee, Tina.  Alan assigned Tina to be Jack's assistant on the project, which included a trip to California to visit the project's client. 

Tina was an attractive single woman in her early 30s who admired Jack and who was eager to learn. Until then, throughout his 10 year marriage, Jack had never been faithful to Celia.  He often had sexual fantasies about other women, but he never thought of actually having an affair with another woman.  He loved his wife and he was satisfied with their sex life.  

But spending a week at a California hotel with Tina, who made it known that she was sexually attracted to Jack, turned out to be too much of a temptation, and they began having a passionate affair which continued when they returned to New York.

Although Jack felt guilty about cheating on his wife and lying to her about his late nights, he couldn't remember a time when he felt more alive.  His fear of death and nightmares about his father subsided.  

Although the affair ended when Tina moved out of state, Jack sought out other younger women who would be willing to have sexual affairs. At the time, Jack had no awareness that his sexual affairs were related to his fear of death.  

A few months later, Jack was having multiple affairs with several women during the same time period. He was upfront with these women that he was only interested in having affairs and he had no intention of leaving his marriage because he loved his wife and son.  He justified his uncharacteristic behavior to himself by telling himself that what his wife didn't know wouldn't hurt her.  

A year later, Jack was involved with three simultaneous affairs. He didn't know any of these women well and he was unaware that one of them, Becky, was emotionally unstable.  Even though their agreement was just to enjoy sex with no strings attached, Becky became emotionally attached to Jack. 

In a desperate and misguided attempt to have Jack to herself, Becky contacted Celia and told her about the affair.  Becky hoped that, by revealing the affair, Jack's wife would leave him and then he would be available to her.  

Celia was shocked and devastated by Becky's call. When Celia confronted Jack about Becky's call, he admitted that he was having multiple affairs and he was deeply upset that he hurt Celia.

During the two weeks when he stayed at a hotel at Celia's insistence, Jack had time to think about his infidelity and how it might cost him his marriage (see my article: Why Do People in Happy Relationships Cheat?).

While he was at the hotel, he ended all his affairs, including his affair with Becky.  She tried to manipulate him into continuing the affair with her by threatening to commit suicide. But although her threats frightened and angered him, Jack refused to allow her to manipulate him.

When Celia allowed Jack to come home, she told him that, although she was very hurt and she didn't know if she could trust him, she felt she had invested too much emotionally in their life to end the marriage.  So, she said she would be willing to work on their relationship if he was willing to attend couples therapy (see my article: What is Emotionally Focused Therapy For Couples?).

Couples Therapy For OCSB

Their couples therapist recommended that Jack also attend sex therapy to deal with his Out of Control Sexual Behavior (see my article:  What is Sex Therapy?).

Over time, he realized in sex therapy that he never overcame the loss of his father and, as he approached the same age as when his father died, his Existential Anxiety contributed to his OCSB.

His sex therapist was also a trauma therapist so, over time, Jack worked through the unresolved trauma of his father's death and his related existential fears about his own death.  

Gradually, as Jack worked through his early loss, he no longer felt the urge to ward off his existential fears of death by having extramarital sex.  He and Celia also gradually reconciled their marriage in couples therapy.

Conclusion

Out of Control Sexual Behavior (OCSB) can have many different contributing factors so there is no one-size-fits therapeutic approach.

An important component to overcoming OCSB is to understand the underlying issues, which are often unconscious, as in the vignette above about Jack.

Although the vignette is about a heterosexual man and OCSB is often associated with men, OCSB can occur with heterosexual women or in the LGBTQ population.

Unresolved trauma often leads to compulsive behavior due to the overwhelming anxiety involved.  This is true even for people who wouldn't normally engage in sexually compulsive behavior but who seek comfort in the sense of aliveness or distraction they experience in sexual affairs.

Understanding the underlying reasons for OCSB in no way condones it but, along with sex therapy, it's a positive step in changing this behavior.

Getting Help in Therapy

Out of Control Sexual Behavior is difficult to change on your own.

Rather than struggling on your own, seek help.

Individuals and couples attend sex therapy.

A skilled sex therapist who is also a trauma therapist can help you to overcome OCSB so you can lead a more fulfilling life.

About Me

I am a New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: What Are the Most Common Misconceptions About Sex Therapy).

In addition to being a Sex Therapist, I am also a Trauma Therapist (see my article: What is a Trauma 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.

What Causes Out of Control Sexual Behavior?

Is Compulsive Sexual Behavior a "Sexual Addiction" or "Out of Control Sexual Behavior"?

The topic of compulsive sexual behavior (also known as hypersexuality) is a controversial topic in the mental health field because there are opposing views as to how to define it, what causes it and how to treat it. 

Treating Out of Control Sexual Behavior in Individual Sex Therapy

Some mental health experts believe compulsive sexual behavior is a sexual addiction and others see it as out of control sexual behavior (see my article: Treating Sexual Compulsivity: Is It a Sexual Addiction or Out of Control Behavior?).

As I mentioned in my previous article, language matters, especially in the mental health field.  

In the interest of being transparent about my professional views as a sex therapist who is sex positive, I want to emphasize that I do not see compulsive sexual behavior as an addiction, and I believe psychotherapists and other healthcare practitioners do clients a disservice by labeling it as an addiction.  

In my professional opinion (and the opinion of many contemporary sexual therapists in the field), not only is labeling sexual compulsivity as an addiction harsh and shame-inducing, it's also counterproductive in terms of treating it.  

Unlike alcohol and drug misuse, people who engage in compulsive sexuality can't be expected to give up sex.  Rather than pathologizing compulsive sexual behavior, a sexual health approach is more effective when a sex therapist looks for the underlying issues for each individual rather than taking a one-size-fits-all cookie-cutter approach that is often found in sexual addiction treatment.

The main proponents of the Out of Control Sexual Behavior (OCSB) perspective are Doug Braun-Harvey, LMFT and Michael A.  Vigorito, LMFT who wrote Treating Out of Control Sexual Behavior: Rethinking Sex Addiction.  

Instead of viewing this behavior as an addiction, they see it as sexual behavior that is out of control.  In their view it's a sexual problem but not a sexual disorder or an illness.  This is an important distinction between the OCSB and the sexual addiction approaches.

Other proponents of the OCSB view, like Dr. Neil Cannon, see sexual compulsivity as being related to unresolved trauma, unresolved mental health issues, relationship issues and problematic habits.

Out of Control Sexual Behavior (OCSB) and Problems With Self Regulation

The Out of Control Sexual Behavior perspective is a newer concept as compared to the sexual addiction model.  

The term OCSB, as defined by Braun-Harvey and Vigorito, refers to problems with self regulation of consensual sexual thoughts, urges and behavior despite negative consequences where the thoughts, urges and behavior feel out of control to the individual (the emphasis on "consensual" means that the OCSB model isn't meant for nonconsensual urges which lead to criminal behavior, like sexual assault or rape, which is treated by specialists in the mental health field who work with offenders).

OCSB focuses on hard to control sexual thoughts, urges and behavior rather than seeing the problem as a diagnosis or clinical disorder.  When someone engages in OCSB, they find it difficult to stop when they try to stop.  

Assuming that the sexual behavior is consensual, feeling out of control doesn't necessarily mean that an individual is out of control.  It's a subjective experience, so what feels out of control can mean different things to different clients.  This means that clinicians need to explore how each client experiences their sexuality.

What's the Difference Between Enjoying Sex and Out of Control Sexual Behavior (OCSB)?

Sex between consenting adults is a normal part of adult life among people who enjoy sex. Consensual sex is meant to be an enjoyable and pleasurable part of life.  

Out of Control Sexual Behavior, on the other hand, isn't about pleasurable sex. It's also not determined solely by sexual frequency because many people have pleasurable and frequent consensual sex which isn't problematic.  

OCSB involves repetitive thoughts, urges or behavior that create negative consequences including (but not limited to):

• Friction or conflict in a relationship, including the demise of a relationship due to infidelity (see my article: Why Do People in Happy Relationships Cheat?)

Treating Out of Control Sexual Behavior in Sex Therapy For Couples

• An excessive preoccupation with sex that interferes with daily activities, including work, studying and other activities

• Sexually inappropriate behavior on the job or in other areas of life, including sexual harassment or predatory behavior

What Causes Out of Control Sexual Behavior?

The causes of OCSB are not well understood and the sex therapy field could benefit from more research in this area.

Here are some of the current day hypotheses about what causes OCSB:

    OCSB and Attention Deficit Hyperactivity Disorder

Many mental health experts believe there is a correlation between OCSB and Attention Deficit Hyperactivity Disorder (ADHD).  

However, this doesn't apply across the board to everyone with ADHD. 

Some people with ADHD experience hypersexuality, which is a very high sex drive and others experience hyposexuality, which is a very low sex drive or lack of interest in sex.  

Both hypersexuality and hyposexuality can cause problems in a relationship.  

Hypersexuality related to ADHD can also cause problems with 

• Impulsive and compulsive sex 
• Risky sexual behavior
• Unprotected sex
• Unwanted pregnancy
• Cheating on partners in both monogamous and consensually nonmonogamous relationships
• Other related problems

It has been hypnothesized that the connection between OCSB and ADHD can be linked to:

• A Need For Stimulation: Some people with ADHD have a strong need for stimulation which can lead to excessive urges for new and exciting sexual activities that lead to higher stimulation.

• A Propensity For Risky Behavior: ADHD can involve an increased risk of sexually compulsive behavior as well as substance abuse.

• Escapism: People with ADHD often use sex as a form of self-regulating behavior to escape or self-medicate for stress and anxiety.

A comprehensive psychological assessment by a psychologist or a knowledgeable psychiatrist is necessary to either diagnosis ADHD or rule it out.

Currently, children who exhibit ADHD symptoms can be evaluated through their school psychologist and treated accordingly.

However, many adults with ADHD were not diagnosed when they were children because ADHD was either unrecognized or not understood, so many individuals with adult ADHD need to seek out their own assessment, diagnosis and treatment by ADHD mental health professionals.

    OCSB and Mood Disorders: Anxiety and Depression

Although many people with ADHD suffer with OCSB, not all OCSB involves ADHD.

Many people with anxiety or depression have problems managing their emotions, and they engage in hypersexuality as an attempt to regulate their emotions (see my article: Developing Skills to Manage Your Emotions).

They engage in hypersexuality as a way to seek temporary relief from their depressive or anxiety-related symptoms.  In those cases, what appears to be a sexual craving is often a maladaptive way of coping.

Hypersexuality can relieve symptoms related to the mood disorder, but since it only provides temporary relief, individuals with mood disorders will feel the urge to  be hypersexual again when their symptoms of anxiety or depression re-emerge.

    OCSB and Existential Anxiety

Existential anxiety is a dread or panic when an individual confronts the limitations of their existence.

Out of Control Sexual Behavior and Fear of Aging and Death

Dr. Daniel N. Watter, an existential psychologist and sex therapist, writes eloquently about the connection between men with existential anxiety and Out of Control Sexual Behavior in his book, The Existential Importance of the Penis.

Among other topics, Dr. Watter discusses how a fear of aging and death can precipitate uncharacteristic out of control sexual behavior among men.

Existential anxiety and Out of Control Sexual Behavior will be the topic of my next article.

Getting Help in Sex Therapy

Out to Control Sexual Behavior is treated in sex therapy because most other mental health professionals have no training or expertise in OCSB (see my article:  What is Sex Therapy?).

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

Fear, shame and guilt often prevent people from getting help in sex therapy.  This is one reason why it's important to choose a sex therapist who has a sexual health perspective instead of an addiction or illness perspective.  

Understanding the unconscious underlying reasons for OCSB is key to achieving sexual health.

Whether the underlying issues involve anxiety, depression, ADHD, trauma, existential dread or other issues, once the underlying issues are discovered, a skilled sex therapist can help you to resolve these issues so you can have a pleasurable sex life without feeling out of control.

If you believe you're suffering with OCSB, seek help from a licensed mental health professional who is a sex therapist.

Taking the first step of contacting a sex therapist is often the most challenging, but it can also bring you a step closer to feeling in control and having a pleasurable sex life.

About Me

I am a licensed New York City 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 email me.

The Mind-Body Connection: Developing a Felt Sense of Your Internal Experiences

In a prior article, Developing Your Inner Sense of Being Calm, Grounded and Centered, I began a discussion about developing the ability to be calmer and more grounded and centered in your body. I also provided techniques for how to do that.  But what if you don't have a sense of what's going on in your body and you're having a hard time connecting? That's the topic for this article (see my article: The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Mind-Body Connection: Developing a Felt Sense of Your Internal Experience

Developing a Felt Sense of Your Body
Since the mind and the body are connected, it makes sense that what goes on in the body affects the mind and what goes on in the mind affects the body.

Most people are so accustomed to focusing on their thoughts that they don't have experience paying attention to their bodies.  When asked to sense into their bodies, they have no idea how to do this, so this is something I teach many clients in my psychotherapy private practice in New York City and I'll address in this article.

What is a Felt Sense?
A felt sense is an internal bodily awareness that develops as you become more attuned to what's going on in your body.

The concept of a felt sense was developed by the American philosopher, Eugene Gendlin, and it refers to the connection between the mind and the body.  According to Gendlin, who developed Focusing therapy, the felt sense is a combination of emotion, awareness, intuitiveness, and embodiment.

When people begin to practice getting a felt sense, the experience is often unclear to them. Initially, people often describe it as a vague sense of their inner experience.

On the most basic level, they might experience it as various sensations in their body, aches, tension, soreness, tightness and so on.

As they practice and become more attuned to their body, they might begin to become aware of other physical sensations as well as emotions that are linked to those sensations.

How to Begin to Develop a Felt Sense of Your Body
When I work with clients, I often teach them how to develop a felt sense of their body so they can be aware of their emotions and where they feel these emotions in their body.  This is a valuable skill to have in therapy because it allows you to sense what you're feeling and the progress you're making in therapy.

Whether you realize it or not, you've had the experience of having a felt sense of your body many times.  You just might not be accustomed to thinking about your experience in that way.

For instance, when you wake up in the morning and you have a vague sense that you have a sore throat, in order to figure out if your throat is dry or if you really have a sore throat, you might sense into your throat when you wake up, then again after you have a drink of water and later on when you have your coffee or tea.

This sensing in is an initial experience of having a felt sense, and it could include any part of your body.

You can practice doing this when you wake up in the morning by sensing into different parts of your body to develop an increased awareness of your body.

Becoming More Attuned to the Mind-Body Connection Through a Felt Sense
As you become more aware of what's going on in your body, you can begin to connect bodily awareness with your emotions.

I often teach my psychotherapy clients, who are disconnected from what's going on for them physically and emotionally, to develop this skill.

Since emotions are held in the body, you can begin to become more attuned by paying attention to muscle tension in your body.

For instance, you might become aware that whenever you feel angry, you feel tension in your stomach.  Or when you're anxious, you feel tension in your shoulders or lower back, and so on.

How Trauma Affects the Mind-Body Connection
By definition, trauma is a psychological response to an experience that's overwhelming for the individual. What matters is the individual's subjective experience of the event(s).  What might be overwhelming for one person might not be overwhelming for another.

When someone experiences trauma, s/he can lose an ability to experience the felt sense and the mind-body connection.  This is called "dissociation"  or "emotional numbing" which is a self-protecting mechanism to keep the traumatized person from being completely overwhelmed.

There are various degrees of dissociation on a spectrum from mild to severe.  Usually, the greater the impact of the trauma on the individual, the more dissociated s/he becomes.

Although this emotional and physical numbing is self protective, it also creates problems for the individual because s/he has a decreased awareness of emotions and bodily sensations (see my article: What is Emotional Numbing?).

Emotional numbing can decrease awareness of emotional pain but, unfortunately, it also decreases awareness of positive emotions too like joy and happiness.  It can create a feeling of emotional flatness and rob the individual of a rich emotional life.

Emotional numbing can make it difficult for the individual to know what s/he feels at any given time.  Aside from making it difficult for the individual, emotional numbing can create problems in a relationship (see my article: How Trauma Affects Relationships).

Getting Help in Therapy
Many people have a difficult time sensing the mind-body connection, especially if they have suppressed their emotional and bodily awareness because of traumatic experiences.

Experiential therapists, who use mind-body oriented therapy, like EMDR, Somatic Experiencing and AEDP, work with clients to overcome the clients' blocked sense of emotions and bodily sensations so they can be aware of their felt sense and live a richer, more fulfilling life (see my articles:  Why Experiential Therapy is More Effective Than Talk Therapy and Experiential Therapy Helps to Create Emotional Breakthroughs).

If you're struggling with unresolved problems that create obstacles for you emotionally and physically, you could benefit from working with an experiential therapist.

Many therapists, including me, are providing online therapy (also known as teletherapy or telehealth) while they're out of the office due to the COVID-19 crisis.

Overcoming your problems in therapy will allow to live your life to the fullest.

About Me
I am an experiential therapist who is licensed to provide psychotherapy services, which include psychodynamic psychotherapy, EMDR trauma therapy, AEDP, Somatic Experiencing, sex therapy, clinical hypnosis and EFT for couples.

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.

What is Emotionally Focused Therapy For Couples (EFT)?

Emotionally Focused Couple Therapy, also known as EFT, was primarily developed by Canadian psychologist, Dr. Sue Johnson in the 1980s.

See my articles: 

EFT Couple Therapy - Overcoming the Negative Dynamic in Your Relationship That Keeps You Stuck

EFT Couple Counseling: New Bonding Can Replace a Negative Cycle in Your Relationship 

How EFT Couple Therapy Can Help You to Improve Your Relationship). 

Dr. Johnson established The International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) in 1998, and the center provides training for psychotherapists in EFT.  There is also an EFT Center in Greater New York (NYCEFT).  EFT is now being used internationally in psychotherapists' offices, hospitals, clinics and in other therapeutic centers around the world.

Emotionally Focused Therapy For Couples

EFT draws on attachment theory, which focuses on the earliest relationship between caregiver and baby, and also the enduring emotional bond between adults.

EFT is also based on Carl Rogers' person-centered psychotherapy, which takes an empathic stance in therapy.  In addition, EFT the theory of adult bonding to help couples understand their individual dynamics and the dynamics in their relationship, including whatever negative cycle they might have developed that keeps them stuck.

What Are the Stages in Emotionally Focused Couple Therapy (EFT)?
There are three stages of EFT Couple Therapy:

• Stage 1: De-Escalation:  As part of the first stage of EFT Couple Therapy, the EFT couple therapist begins by assessing the couple's interaction style, which cause conflicts.  She also helps the couple to identify the negative cycle/attachment emotions, and frames the problem based on the cycle, attachment needs and fears.

• Stage 2: Restructuring the Bond and Changing Interaction Patterns:  During the second stage of EFT Couple Therapy, the EFT therapist assists each person in the relationship to voice his or her attachment needs and deep emotions.  The EFT therapist coaches each person on how to express acceptance and compassion for the other partner's attachment needs and deep emotions.  Each member of the couple is also coached in how to express his or her own attachment needs and emotions and how to discuss the issues that are causing conflicts.

• Stage 3: Consolidation:  The EFT couple therapist coaches the couple on how to use new communication styles to talk about their problems and come up with new solutions.  The couple also learns to use the skills they learned in EFT couple therapy so they create and use new interaction patterns after they leave EFT couple therapy.

Conclusion
EFT Couple Therapy is a well-researched method that helps couples to improve their relationship.  It has been studied extensively and shown to be effective.

Emotionally Focused Couple Therapy

EFT Couple Therapy was developed by Sue Johnson, and it is based on attachment theory, Rogerian therapy, and a theory of adult bonding.

There are three stages in EFT (as presented above).

Although the stages are presented in a linear way in this article, in reality, just like any other form of therapy, the process isn't always linear.

Since the couple is coached to identify and change the negative cycle in their relationship, they learn to stop blaming each other.  Instead, they learn that there are "no bad guys"--just a negative cycle that they can learn to change.

For more information about EFT Couple Therapy, see Sue Johnson's book, Hold Me Tight.

Getting Help For Your Relationship in EFT Couple Therapy
If you and your spouse or partner are stuck in a negative cycle, you owe it to yourself to get help from an EFT couples therapist.

Your EFT couples therapist can help you to restructure the bond in your relationship so you change the negative cycle, express your emotional needs and gain acceptance and compassion for your partner's and your own emotional needs.

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

I work with individuals 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 regular business hours or email me.

Also see my articles:
What Happens in Stage One of EFT Couple Therapy?

Stage One of EFT Couple Therapy: A Clinical Example

EFT Couple Counseling Helps Couples to Move Beyond Reactive Emotions and Destructive Arguing Cycles

What Happens During Stage Two of EFT Couple Therapy?

Stage Two of EFT Couple Counseling: A Clinical Example

Why Does EFT For Couples Focus on Emotions?

EFT For Couples: The Importance of Primary Emotions to Improve Your Relationship