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This paper examines the concept of ‘sex addiction’, and its increasing popularity since the emergence of AIDS in gay communities in the 1980s. Adopting narrative therapy’s ethical orientations of decentred yet influential positioning, and being in a ‘lifelong apprenticeship’, the author worked with a number of men to renegotiate their relationship with ‘sex addiction’ in their lives. This work included various maps of narrative practice, including the Statement of Position Map / externalising conversations, re-membering conversations, the absent but implicit, and deconstructive conversations.
What is ‘sex addiction’? The concept of ‘sex addiction’ seems to have grown rapidly in popularity in the last couple of decades. Some people are now convinced they are ‘addicts’ who, while perhaps being able to mitigate some of the effects of this on their lives, will never be able to change this ‘truth’ about their identity. This paper explores some of my attempts to understand both the phenomenon of ‘sex addiction’ and the affects of this idea on people, as well as work with clients to find ways to revise their relationship with this idea.
I come to this subject through a career working primarily with gay men. My first professional role was as a sexual health educator with the Queensland AIDS Council (QuAC) and I later went on to work for the AIDS Council of New South Wales in Sydney. The advent of AIDS in Australia triggered a great deal of fear towards and violence against homosexual men. In the mid 1980s, groups of concerned gay men came together to start a number of non-profit organisations to address the increasing stigmatisation and welfare needs of themselves and their peers. By 1989, some state health departments had made funding available for the purpose of educating so called ‘high-risk populations’ about HIV transmission. The AIDS councils took the position that a ‘sex-positive’ approach was critical to the engagement of gay and bisexual men in education strategies.
As is often the case when marginalised people join together, there was much opposition and hostility. Politicians, religious leaders, and media columnists fuelled calls for monogamy, an end to premarital sex, and prohibitions against homosexuality. There are, of course, documented histories of attempts to regulate sexual behaviour that well precede AIDS just as there are histories of opposition to these attempts to regulate. Gay men have been involved in aspects of both and during my employment with the AIDS councils, I met and worked with many men who favoured an approach to the prevention of HIV transmission that involved increased policing of sexual behaviour at a state and personal level. With respect to the latter, there were many instances of gay men criticising and even pathologising their peers for the frequency or type of sex they were having and calling for monogamy and celibacy in response to dominant discourses about gay men and their behaviour.
At this point, I think it is fair that I declare my concerns about approaches that pathologise individuals. I have found that when individuals are labelled as ‘disordered’ or ‘sick’, it makes it very difficult for them to move forward or develop a sense of personal agency about a problem. As a gay man who is also a counsellor and therapist, I am deeply committed to finding ways that free myself and others from such restrictive understandings and to working towards understandings that are empowering and affirming of who we are. When I started my private practice, I had a sense of the kinds of problems and difficulties I would be encountering. I was marketing my services to gay men because this seemed a good place to start for a therapist who had worked with gay men in organisations for a number of years. In some ways, it was not a surprise to find people were approaching me wanting solutions to the problem they were calling ‘sex addiction’. However, I did not realise how much I would have to consider how to approach this subject.
Soon after I started my practice, I was approached by James. James lived abroad in a country where he was considered quite wealthy by local standards. He described a deterioration in his mood and a history of a number of years struggling with what he was, for want of a better word, calling ‘depression’. He described it being like pieces of a puzzle he was unable to put together. He told me that despite having a male partner of 15 years who he loved, having a wonderful and privileged life abroad, he could not stop having sex with different men. He had not discussed this with his partner and he knew his partner would not approve. He told me that many of his sex partners were younger married men and the exposure of these liaisons could have devastating effects for many people.
James had begun to go through his life to find a cause for his behaviour, assuming that if he could find a ‘source’, perhaps he could do something about it. Was it because he was no longer attracted to his partner? Was he just being selfish? Was it something to do with his relationship to his father who had died many years earlier? James had heard something about ‘sex addiction’ and wondered if he too suffered from it, and whether it was something that he could not control. He had started thinking perhaps he was a ‘sex addict’. If this was the case, he believed there was nothing he could do but accept it. But he felt he had to at least seek treatment first. He asked to see me every couple of months when he would be visiting Sydney so that we could try to establish whether control was possible.
Meeting James started me thinking: What was my perspective on ‘sex addiction’? Was it something that really existed or was it just an idea? If I was going to help James, what did I need to know about this problem? How was I going to approach the issue with people? This article is the story of how I found myself questioning sex addiction.
Many of the ideas presented in narrative therapy have influenced my thinking about the subject of ‘sex addiction’. To begin with, I felt I needed to know a bit more about its origins. I did some Internet searches and came across recent media articles on the subject in relation to a couple of Hollywood personalities who had sought treatment. There were also a lot of web pages devoted to the subject and written from a Christian perspective. There were 12-step programs dealing with sex like they deal with alcohol and drug addiction. And I also found and read a couple of textbooks about it. Finally, there were quite a few practitioners in Sydney who were willing to work with sex addiction. It seemed there were plenty of professional people and services claiming to know the truth of its existence!
Yet I was sceptical. I have always been concerned about diagnoses or claims that behaviour can be categorised. A diagnosis carries an idea about measuring normality and even the worth of a person. A diagnosis carries an implication that there is an order that the person does not fit. Could the rapid rise of not only the popularity, but also the ‘reality’ of ‘sex addiction’ be an example of reification, where the idea has become a reality? Did the naming of ‘sex addiction’ infer its existence? What might it mean for someone to hear about ‘sex addiction’ and try to fit their life into these ideas? In terms of how to work with people experiencing – or being diagnosed with –‘sex addiction’, I pondered further questions such as: Who decides what is too much sex or when sex is ‘addiction’? How is it that certain people are able to make such truth claims? If someone was able to abrogate the responsibility for their actions on account of having an ‘incurable’ disease or disorder, what did this do to their sense of personal agency? How might this conclusion support a person to act towards others?
During this time that I was exploring these ideas around sex addiction, a man named Mark asked if he could see me about problems he was having associated with looking at pornography and dating sites on the internet. He was concerned that he might be experiencing ‘sex addiction’ and wanted help. Mark told me how his studies were suffering as a result of so much time spent on the Internet. He also attributed the demise of his relationship with his girlfriend, a committed Christian woman, to his viewing dating sites as this had compromised the trust she had for him.
As our conversations continued, Mark told me some history about his being excluded from activities and events in life and the effect this had had on him. Our dialogue quickly progressed to talking about inclusion and what gave rise to inclusion. Mark told me of his more recent efforts to be included, particularly in his family, and how he had been revising his relationship with his mother despite her death and their 20-year estrangement. I saw this as an opportunity to engage in some re-membering conversations about his family members that helped him come to a new understanding of how he had been bringing about inclusion (Russell & Carey, 2004; White, 2007).
Mark also told me about the emails he and his girlfriend exchanged and the realisation of how important it was for her that he acknowledge the expression of her feelings. He told me of how this continued contact was a new thing for him as he had previously always excluded ex-partners from his life rather than try to maintain a friendship with them. These alternative stories stood out for me as acts of resistance similar to those we hear if we listen carefully to stories of trauma. In his attempts to overcome the ‘waste’ and ‘broken relationships’ of his life, Mark had started making significant connections. By ‘talking’ relationships with others into ‘continuity’ he had started to experience greater inclusion and forgiveness.
After a few weekly sessions, we were both surprised to acknowledge that the time Mark spent looking at pornography since the start of our appointments had been minimal and he had ceased using dating sites altogether. His relationship with his partner was improving and they were talking more with each other about what they wanted for their relationship in the future. What was also surprising was that none of our conversations had been about ‘sex addiction’, the initial name Mark gave to the problem. We both thought that this was significant. In making the counselling appointment, Mark had presumed the task ahead would be associated with ‘self-control’ and that the problem reflected a deficit or weakness in himself. In making space for Mark to speak of his values, beliefs, and preferences, I was interested in hearing alternative versions of Mark’s life. Mark’s explanations of how he had been revising and working at maintaining relationships lead to a realisation for both of us that, far from being ‘weak’, he had been influential in making changes. It also made me think about the nature of ‘sex addiction’ and offered further evidence that it might be ‘just an idea’. And if it only existed as an idea, how powerful was it? How could I respond to this idea in a way that was empowering to individuals and communities?
I decided that to find out more, I would have to talk more with people who thought they might be experiencing ‘sex addiction’. So I advertised on the Internet that I worked with this subject. I was a little uncomfortable at first as my strategy flew in the face of what dominant therapeutic discourses tell us about professionalism. To ‘profess’ means to know. What did I know about this? I found some ideas concerning therapeutic orientation in narrative practice useful in this context:
Having convinced myself that I did not need to know everything there is to know about the subject, I still had another ethical question. Was it okay to advertise that I worked with ‘sex addiction’ when I was not even sure such a thing existed except as an idea? My answer to this was simple. Mark had expressed a lot of appreciation for my assistance in helping him with his problem, so I knew this kind of decentred approach could still be influential (White, 2007, p. 39). Advertising that I worked with ‘sex addiction’ was the easiest way for people who felt under its power to find me and I could with join anyone who was themselves at this point of questioning ‘sex addiction’. So I created some advertisements on free websites to indicate to people searching for Internet information about ‘sex addiction’ that I was prepared to have conversations about the matter.
Keith, a man in his 60s, contacted me after seeing one of my advertisements. He told me that he suffered from ‘sex addiction’, that it was a hard problem, and had been going on for years. Keith had been attending SLAA (Sex and Love Addicts Anonymous) groups – a 12-step program – and wanted to know whether I was prepared to help him with this because he had not been able to find a counsellor who had the knowledge to work in this area.
Keith had been to a number of different psychologists and doctors but not found anyone who could help him. One doctor had told him, ‘Well just don’t worry about it, just enjoy having the sex’. But for Keith, there were very big problems with this approach. Not only was he feeling guilty about keeping a secret of the sex he had with men outside his relationship, but his partner of five years, Xavier, had discovered that on one occasion, Keith had taken a stranger into the bed they shared. Up until this time, there had been much affection in their relationship and Keith really loved this, as it was not something he had experienced for much of his life. Since Xavier’s discovery, however, the affection they both enjoyed had virtually ceased and Keith reported that Xavier felt betrayed by the event. Keith did not know how to repair the situation. He was concerned to ensure it did not become any worse. Keith told me that he had been attending the SLAA groups for some time and while the problem had not seemed to improve much, he felt better for going as it felt like he was at least trying to do something about it. The idea that ‘sex addiction’ might be responsible for Keith’s situation was actually proposed by Xavier who had done some research about it on the Internet.
I was concerned about Keith’s expectations that I work within the SLAA model. It seemed he had devoted a lot of his time and thought to the SLAA groups. My unease was that ‘sex addiction’ was being portrayed as a disease by SLAA. But while I was uncomfortable with this, I did not see how I could expect Keith to simply drop this framework of understanding just because of my own reservations. How were we going to proceed? In the beginning, I did not know the answer to this question but I was curious about Keith’s experience with the problem and what he might have learned and might know from his own experience. I told him I had not attended SLAA groups but I was prepared to learn and valued this opportunity to meet with someone who was prepared to explain them to me. I proposed that I could contribute some skills around asking questions that might help us both to understand the best way forward. In my mind, I was thinking about the metaphor of co-researchers (Epston, 2001; Nosworthy & Lane, 1996). I had to be careful about this, however. As I got to know Keith, I discovered that he had not experienced much formal education and often was dismissive of his own knowledge with comments like ‘I’m not very smart’. I thought the best way to proceed might be for us both to explore and acknowledge what he did know about the problem.
I began with externalising the problem, asking questions about Keith’s relationship to it. Keith told me how he thought of it as The Compulsion and, since he was more comfortable calling it this than ‘sex addiction’, we began using this name for it. We looked at the effects of The Compulsion on Keith and what these effects meant for him, his life with Xavier, and his own sense of power. Some of this involved using the language Keith had learned from the SLAA groups. For example, he told me about ‘Intriguing’ which he explained was a kind of purposeful fantasising about someone one might see on the street or in a toilet block or elsewhere. Intriguing was something The Compulsion liked and helped make The Compulsion stronger. Keith told me he had direct experience of this.
We also spoke of what Keith wanted for his life with Xavier. Having sex with men in toilets and other places had never been a problem prior to the relationship. If he had not met Xavier he would not even be attending SLAA meetings or seeking help! This told me something more about the importance of his relationship with Xavier and we spent a whole session discussing the impact of The Compulsion on their relationship and why this was significant for Keith. In Michael White’s Statement of Position Map (White, 2007), we were at the ‘justification of the evaluation’ stage of externalising around this point, and found ourselves shuttling back and forward across Keith’s life making connections between events from the distant and more recent past. In speaking of his values and commitments, Keith shared stories from his life that explained why Xavier was so important to him, and the histories of their shared life that justified Keith’s focus on accountability. Through negotiating this experience-near and particular definition, mapping the effects of the problem, evaluating the effects, and hearing Keith’s justification of why he was taking this position in relation to The Compulsion, I was struck by his depth of knowledge of The Compulsion and I wondered how I might be able to encourage Keith to question it.
Keith had been explicit in wanting me to ‘find resources to help’ him. Rather than externally-produced resources, I thought it might be useful to write to Keith with a summary of what we had found together, creating a therapeutic document that could serve as Keith’s own resource. I have included it here as it provides a good overview of our conversations and highlights the strategies that Keith had indicated he was already using.
Dear Keith,
We have now met on four occasions and at today’s appointment, you agreed it might be useful if I were to write and summarise some of the conversations we have had in our counselling sessions.
You have told me that in talking of The Compulsion, your hope is to find ways to live with it, manage it, and control it.
You have told me about the effect The Compulsion has had on you, on Xavier, and on the relationship you both enjoy. You and Xavier have a lot in common and like doing things together. You have told me about how in the past it has been hard for you to get close to people, because you feared they would discover your sexuality. However, you also have experiences of honestly telling people about yourself which have resulted in people trusting you. You have told me about how the picnic, Xavier’s invitation to go on holiday, and interaction with his family have contributed to your hopes that you can patch up the relationship with Xavier. What part might honesty play in regaining trust with Xavier?
You have identified a cycling that The Compulsion does. Lately, it has been a lot better as it has been staying up the back and waiting. It is sneaky. When it is not strong, life is easier as you are not fighting it. We know that The Compulsion likes:
So together we have identified some of the resources that you have already found have an effect on The Compulsion, that have enabled you to live with it and that perhaps go some way in managing or controlling it. These are:
You also have an idea that talking with Xavier about these resources might help to keep The Compulsion weak. Xavier has, in the past, expressed a willingness to hear about your efforts to deal with The Compulsion. You would like to find out Xavier’s thoughts about the ways you are trying to manage and control The Compulsion. You have also talked of the possibility of Xavier attending one of our sessions and joining us in our investigations of ways to manage and control The Compulsion.
Someone at the SLAA group has suggested that you may need support when you go on holiday with Xavier. I wonder who might be available to provide support and how you might remain in contact with this support while you are away? Keith, in deciding which direction to go, it seems you have a great deal of experience and knowledge about this Compulsion from which to make some decisions. I have really enjoyed our discussions and finding out how you have been attempting to manage, control, and live with the Compulsion. I have also learnt a lot about this subject from our discussions. Now I am wondering about how you might be able to bring some of this knowledge and experience into your relationship with Xavier and into the SLAA meetings in order to further weaken The Compulsion.
I look forward to our next appointment.
Best regards,
Ash
Writing this letter provided Keith with documentation of our sessions and a point for starting to have a conversation with Xavier. It also enabled a reference point for our future conversations. I saw Keith once more before he went on holiday and then there were almost two months before I saw him again. When we next met, Keith told me that The Compulsion had been ‘way back there’ which was ‘really good’. It had subsided a lot since our last meeting and ‘did not cause a lot of stress at the moment’. His relationship with Xavier had improved and was ‘99% back the way it was’ with Xavier ‘singing and dancing’ around him all the time. The affection in the relationship had returned as well. Keith told me that he had not been attending the SLAA meetings but intended returning. He wanted to try to start ‘sharing’ as ‘they said things started to change when you start to share’. He also found that hearing stories gave him strength and this was important to keep The Compulsion weak.
But Keith had also started to question some of the ideas of SLAA, particularly that ‘abandonment leads to sex addiction’. When I asked him about this, he referred to an earlier conversation where he told me a story of asking a family friend about his mother:
Keith: She said, ‘She was hard, but she loved you’. And that’s how I know I wasn’t abandoned. My mother loved me, and I remember that.
Ash: So this idea of abandonment doesn’t fit for you?
Keith: No. I don’t know where they get that from.
We talked about how Keith had started out trying to fit into the ideas of SLAA but now he was only using the ideas he found helpful. Up until he went on the holiday, he had been very concerned that he had not been reading enough SLAA literature. But he had gone away ‘hoping it would just be okay’ with what he was already doing. After the holiday, he realised it had been okay. Now he was questioning some of the ideas of SLAA. This was significant as it meant Keith was giving some preference to his own knowledge rather than being confused because he did not understand the SLAA teachings or had a sense of failure about not having done his homework.
Having had these and many other conversations about ‘sex addiction’, I am more confident about asking questions of it. Looking closely, it seems like a jumble of cords that will take some unravelling. These cords are the lines of stories that have become tied and tangled and lost in a mess that is seen simply as ‘sex addiction’. Tangled together are ideas about sex and love, judgements and norms, stories about values, commitments, desires, hopes, and dreams. So it is hard to see ‘what follows from what’ or understand the connections or the continuity of those stories that are inspirational. As with other problems, people often approach me expecting I will have a kind of internal manual to work out a solution or course of treatment for them. But what has been confirmed by my investigations so far has been Harlene Anderson’s observation: we don’t need to solve the problem, the problem dissolves when we have conversations (Anderson, 1997).
I understand that, as a counsellor and therapist, I am in a privileged role within this process. Due to the nature of this subject, none of the people I have mentioned in this article were willing for me to include any information about our sessions that might identify them and it was important for me to respect that. I have consequently used pseudonyms and altered details or been general where necessary to protect the anonymity of the people who have spoken with me. However, I must express my appreciation for what they have helped me learn about questioning ‘sex addiction’. My conversations with some of these people continue and there will be other conversations with other people who join me to ask questions about ‘sex addiction’. Of course, there are so many other options for where I can take people in conversations if they are willing. For example, what possibilities might exist for an exploration of James’s association of life (White, 2007)? If Keith brings Xavier to an appointment, what might be gained from attempting some definitional ceremony practices or at least outsider-witnessing, with the couple (Russell & Carey, 2004; White, 2007)? How might the SLAA group act as a community of acknowledgement (White, 1997)?
What I think I have done here is nothing particularly grand or – dare I say it – ‘sexy’. It has been to simply start asking questions about a concept that has, in some quarters, taken on the status of a ‘truth’. In doing this, I have been listening for the alternative stories. I know these alternative stories exist wherever and whenever there is resistance to, or attempts to overcome, a problem. These are really just the beginning attempts to unravel stories around ‘sex addiction’ so as to make it possible for people to come to new understandings about their identities and relationships with others.
Anderson, H (1997). Conversation, Language and Possibilities. New York, Basic Books.
Epston, D. (2001). Anthropology, archives, co-research and narrative therapy. In D. Denborough (Ed.), Family therapy: Exploring the field’s past, present and possible futures (pp. 177–182).
Nosworthy, S., & Lane, K. (1996). How we learnt that scratching can really be self-abuse: Co-research with young people. Dulwich Centre Newsletter, (4), 25–33.
Russell, S., & Carey, M. (2004). Narrative therapy: Responding to your questions. Adelaide: Dulwich Centre Publications.
Suzuki, S. (2002). Zen mind, beginner’s mind. New York: Weatherhill.
White, M. (1997). Narratives of Therapist’s Lives. Adelaide: Dulwich Centre Publications.
White, M. (2000). Re-engaging with history: The absent but implicit. In M. White, Reflections on narrative practice: Essays and interviews (pp. 35-58). Adelaide: Dulwich Centre Publications.
White, M. (2007). Maps of narrative practice. New York: W.W. Norton.
This article originally appeared in The International Journal of Narrative Therapy and Community Work 2009, no.2
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Is Depression more common amongst gay men?
I often see this question or similar in counselling forums on Facebook and elsewhere on the net. And as a mental health counsellor who has worked with gay men for much of my career, it’s tempting to jump in with an answer. But what concerns me is what the answer to this question might mean for those asking or reading it. What effect does it have on us as individuals if we develop the idea we are more prone to depression? And how might we start thinking of our gay identity if we begin to believe in some kind of collective depression?
Depression is a very general word for a huge range of conditions. More to the point, it is largely considered a health issue these days when it also might be related to existential questions, life transition, burnout or adjustment to new life circumstances.
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Now I don’t want to suggest that we should not be concerned about health if we are, or someone else we know is, feeling depressed. But there is a long history of lesbians and gay men being viewed as disordered in some way, especially by the medical and psychiatric professions (I call it being ‘pathologised’). And while the idea that gay sexuality is a disease might be on the way out, there is still a tendency to look for and see abnormalities in gay men. This can be a self-fulfilling prophecy: we look for evidence of depression and we find it!
There is some research evidence that, currently, lesbians and gay men do present with higher rates of depression and mental health problems than people who do not identify as lesbian or gay. However, that’s not to say there’s anything about same-sex orientation that causes depression. For example, studies show that lesbians and gay men receive more improper treatment and discrimination from mental health professionals than general populations. If your doctor or therapist is treating you badly, it is not surprising that you might not get well! For the most part, science and common sense now prevails in countries like Australia, the UK, Canada and most of Europe. Psychologists, psychotherapists and doctors in those places – with a few exceptions – are generally now of the opinion that same sex desire and attraction is ‘natural and normal’. But misunderstanding, insensitivity and bad practice continue. We develop as adult gay men in a society with many informal rules and attitudes prejudiced against gay sexuality. Is it any wonder that the mental health of some lesbians and gay men suffers as a consequence?
At the same time, there is no common biological or genetic cause for depression that is unique to gay men or lesbians. I would propose that if we lived in a world without such strong gender roles, where our same sex sexual attraction and desire was considered as equal to heterosexual attraction and desire, there would be no differences in the rates of depression or anxiety between gay, bisexual or straight people. I’d like to think we are working towards a time like that.
In the meantime, it is just as important to understand the protective factors for gay mental health as the so called risk factors. When health is the focus, it is not surprising that a visit to a GP is often the first response for someone who is depressed. Doctors are concerned mostly with drug therapy including the prescription of medication like SSRIs. These include, for example, citalopram (trade names Cipramil, Celexa etc); escitalopram (trade names Lexapro etc); fluoxetine (trade names Prozac etc) and sertraline (Zoloft, Lustral etc). But many people who have been prescribed anti-depressants do not know that best practice for medication treatment of depression is a combination of treatment that includes talk therapy. Doctors usually refer to counsellors or therapists for talk therapy that might take the form of CBT (Cognitive Behaviour Therapy), other forms of psychotherapy such as narrative therapy or counselling for depression or anxiety. The important thing is that medication alone may not be enough – it might not even be required – and patients should at least be offered talk therapy. Gay patients should always be offered a gay-friendly counsellor, for example, a Medicare practitioner available for gay clients or a private therapist for gay men.
I always felt I didn’t fit in …
I never felt that I was cool enough or funny enough or good looking enough
It’s important to talk about problems. Sounding them out with an understanding gay counsellor can also be a way through our difficulties. It’s by talking about ourselves and our relationship to others that we get a sense of who we are, our identity. Research shows that development of positive identity for gay and lesbian people leads to adjustment and life satisfaction*1. An understanding gay therapist can help you start making connections and developing relationships with other gay men. Gay people who participate in activities with others enjoy higher levels of psychological well-being. Peer support is important when coming out as a gay man whether you are a teenager, middle aged gay guy or older gay man who has been married.
Times are changing. Just 6 years after his own experiences of homophobia as a schoolboy, Dr Mark McCormack returned to 3 British high schools to research teenage boys attitudes towards homosexuality*2. He expected lots of homophobia but found hardly any. Instead he found that boys were no longer expressing their heterosexual identities through homophobia & homophobic language, but through being inclusive of their gay peers and proud of their pro-gay attitudes. He found that being a gay teen did not not negatively affect a boy’s popularity, but being homophobic did. In the schools he examined, he found that boys were able to develop meaningful and loving friendships across social groups.
So let’s not write off the entire lesbian and gay population as at risk of depression! Let’s talk about our common experiences and share our personal stories with those who are willing to listen and support us. I work as an online therapist and counsellor for gay men and others. If you would like to discuss your circumstances or experiences with depression, contact me today and make an appointment.
*1. Hunter, Ski (2005) Midlife and Older LGBT Adults: Knowledge and Affirmative Practice for the Social Services. Binghamton, Haworth.
*2. McCormack, Mark (2012) The Declining Significance of Homophobia: How Teenage Boys are Redefining Masculinity and Heterosexuality. New York: Oxford University Press.
When her partner of 7 years announced over breakfast that he was moving out, Mia* was more in shock than anything else. The heartbreak came later.
“Everything seemed fine between us. I didn’t understand why he was leaving. I knew I was upset, but I wasn’t going to let myself sit around being miserable.”
Trying to put the relationship behind her, Mia quickly started dating and found she had no problem meeting men. But the relationships were short-lived and, in her words, tumultuous and disappointing.
“I was on a rejection roller-coaster and I couldn’t get off. I was even telling myself that it was my fault for meeting these guys.”
After several months Mia stopped going out and her frustration turned into depression. She realised she was not yet over the breakup and decided to find a counsellor.
According to the Australian Bureau of Statistics, one in three first marriages end in divorce. Whether married or not, leaving a relationship can be one of the most stressful and devastating life experiences to endure. Feelings of hurt, loneliness, regret, powerlessness and anger are quite normal in these circumstances. For Mia, separation was sudden and final, but many couples have months of instability before they decide to go their own ways. Whatever the circumstances, breakups can be tough and emotional.
There is no standard formula for recovering from separation but it is important to look after yourself physically and emotionally. Getting enough sleep, eating well, exercising and a balance of work, rest and play can all make a difference. Isolating yourself and withdrawing from other people is usually not so helpful.
Above all, talking about feelings and emotions is one of the best ways to manage stress and overcome heartbreak. Many of my clients fear their friends will tire of listening and have sought out counselling for an impartial perspective. Your GP should be able to refer you to a suitable practitioner. Whatever you decide, don’t be afraid to ask for help.
For Mia, online counselling was a game-changer.
“The Skype counselling sessions let me explore what I wanted in a relationship instead of trying to meet someone else’s expectations. I went from blaming myself to taking charge of my life. Now I respect myself more”.
If you’re struggling with separation or relationship issues and want to get your life back, contact me now to schedule a consultation. Make a webcam, instant message or email exchange appointment and start recovering today.
This article originally appeared in The Nest magazine in May 2013.
*name changed for privacy reasons
Individual attraction to both men and women has only been described as ‘bisexuality’ for about 100 years. What happened before that? Were people either straight or gay? I wasn’t around but I doubt it. Human sexuality is diverse and complex and always has been. It’s just our meanings and ideas about sex that remain confined.
Sex counselling often involves being asked questions about the ‘truth’ of sex and sexual orientation. As a sexuality therapist, people expect I will give them the answers to these and other questions. But the way we describe sex, identity and relationships is evolving and our understandings are shaped by the language and concepts we use. So let’s explore the meaning of Bisexuality together.
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Over the last 50 years, there have been dramatic shifts in ways sexuality is understood across Australia, the United States, Britain and the rest of Europe. Homosexuality was once regarded as a disease that could be brought on (or prevented) by a certain upbringing or social conditions. Now it is primarily considered to be part of natural diversity and scientists claim sexual orientation is established by genetic factors. Gay people are finding more and more acceptance but those who describe themselves as bisexual often feel misunderstood.
One of the consequences of the past 50 years has been that biological sex, gender, and sexual orientation have each been split in two and established as pairs of opposites:
And it’s assumed that these opposites usually fit together in certain ways:
Sound familiar?
One of the most obvious flaws in these ideas is that attitudes about what is masculine and what is feminine are not fixed and vary over time and across cultures. What is considered ‘manly’ in one country, for example, may not be considered ‘manly’ in another.
This dualistic way of thinking and alignment of biological sex, sexuality and gender is called Heteronormativity. Homosexuality has been accepted on the grounds of a simple difference in orientation from the norm. Gay people are encouraged to ‘come out’, claim their identity and follow the established patterns of their straight counterparts. The most obvious reflection of this is the equality and same-sex marriage movement that is sweeping across many countries including Canada, Spain, South Africa and now New Zealand and France. At the time of writing, the Australian government still considers only man-woman relationships to be worthy of the legal contract of marriage.
So what about bisexual people? Where do they fit in all this?
The answer is… Not easily!
Bisexuality is still lumbered with prejudice, just as homosexuality once was. For example, people who identify as bisexual are often assumed to be promiscuous. But exactly what is meant by ‘promiscuity’? There is no agreement. One definition of a promiscuous person is ‘someone who has more sex than you do’… think about it!
The dualistic (divided-in-two) way of understanding biology, gender and desire creates problems for people who want to identify as Bisexual. Firstly it suggests that we must have a preference for either men or women and that someone with, for example, male sex organs, automatically has more in common with other men than with women (or vice versa). But is that always true?
Secondly, it makes out sexual desire to be a simple and unchanging aspect of who we are. However the evidence is humans don’t fall neatly into biological sex categories. There are people who identify as transgender and intersex. And the descriptions ‘straight’ and ‘gay’ don’t suit everyone either. Both desire and sexual orientation often appear to change naturally over one’s lifetime although there is no evidence that doctors or therapists can make such changes occur.
Polyamory – loving more than one person – is how some people choose to practice their bisexuality. Others resist the popular prejudices but retain a claim to their identity within a monogamous sexual relationship.
But even the word ‘bisexual’ suggests a choice from 2 options. Is our attraction to a person really based so much on how effectively they stick to their expected gender performance (masculine or feminine) or how typical things look between their legs? In recent years, some people who used to describe themselves as ‘bisexual’ have started using alternative terms like ‘pansexual’, ‘omnisexual’, ‘polysexual’ or ‘queer’ in an effort to describe their sexuality more realistically and specifically.
Our sexual identity– gay, straight, bi, pansexual, queer or whatever word we adopt – is a description we choose ourselves or that others try to impose on us. For something as complex and hard to put into words as sexuality, perhaps it makes sense to use shared categories. But the idea that once we engage in a particular act it makes us something is simply that: an idea. Each of us has a unique sexuality comprised of desire, attraction, sensation and response. Experiencing the freedom to enjoy one’s own body and sexuality can be challenging, particularly when we come up against the expectations of others. It’s worth talking about, because expressing ourselves helps us to know ourselves and feel more secure in the identity we choose. I invite you to contact me if you would like to speak privately and confidentially about your sexuality.
© Ash Rehn 2013.
I am indebted to Kim Surkan from MIT (Massachusetts Institute of Technology) for many of the ideas in this article.
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What is the best approach to sex therapy? Psychoanalysis or brief, solution focussed counselling? Or is there an alternative? What should I look for in a sex therapist?
Before people start trying to find a sex therapist online, it’s common for them to reading comparisons between short-term, time-limited counselling interventions like CBT and long-term therapy such as the intensive sessions of traditional psychoanalysis. But counselling and therapy is a diverse and broad field and in fact there are many other options and variations available to those seeking help.
My own opinion of the various approaches to therapy and to the different methods and techniques for sexual problems is that the relationship – the rapport, trust and therapeutic collaboration built up between the practitioner and client – is probably more important than whether the consultations happen once a week for 2 months or 4 times a week for 5 years (or something in between). Of course, depending on their experience and preferences, individuals respond better to different approaches. But if you don’t get on so well with your therapist or they are uncomfortable discussing sexual issues, the type of therapy probably won’t make much of a difference in itself.
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Cognitive behaviour therapy (CBT) and short-term solution focussed strategies are commonly offered as treatment for difficulties with enjoying sex, concerns about preoccupation with sex or erection problems not caused by organic factors. If they are not a side effect (for example, of medication or alcohol use) and don’t have a basis in a physical condition such as diabetes or heart disease, sexual difficulties often have psychological causes like stress, anxiety or burnout, performance concerns and issues around sexual orientation or identity. Counselling can also assist where social cultural factors like conflict with religious or cultural values or societal taboos play a part in not feeling comfortable with sex or coming out and sometimes a therapist takes a role in correcting misconceptions about sexual practices such as masturbation or anal sex.
The appeal of CBT and brief counselling lies in the fact it is usually offered as a time-limited treatment and for many there is an implicit (or explicit) promise that they will be ‘cured’ or the problem will be ‘fixed’ at the end of the series of sessions. The widespread use of the expression ‘evidence-based treatment’ also suggests a kind of promise of effectiveness. My professional experience is that such treatments often work but in psychology there are no guarantees.
Psychoanalysis has been portrayed extensively – but not always reliably – in popular culture. Images of ‘patients’ lying on couches, talking about their childhoods to largely silent, fatherly-looking men and ‘doctors’ in TV series such as The Sopranos, Seinfeld and In Treatment are examples that come to mind. Of course the reality is often somewhat different, but traditionally psychoanalysts do meet with their clients several times a week and this pattern can go on for years. I have heard good reports from some people of the benefits of psychoanalysis but it is clear that it is not for everyone and once again, successful outcomes appear to be strongly dependent on whether a positive therapeutic relationship is established or not.
But what of those approaches that lie somewhere in between the typical 6-10 sessions of solution focussed counselling and months or years of intensive psychoanalysis?
I am not a psychoanalyst but I do sometimes work with CBT practices and short series of solution focussed therapy. I also have clients who have seen me for 2 years or more. Often these people have started out meeting with me once or even twice a week. After time they might have changed their appointments to once a fortnight and even eventually to once a month. In each case, we are not following a method or technique prescribed by a particular therapeutic model, but taking an individually tailored pathway through collaboration and what works best for them.
When it comes to sexual identity or sexuality, some of us benefit most from a kind of psychological ‘maintenance’. In other words, not intensive, long-term therapy and also not a quick-fix or method that promises results that cannot be guaranteed. Instead we can choose to have a regular and on-going relationship with a practitioner who acts, in the first instance, as a sounding board and confidante but also offers fresh ideas and suggestions you can try out as required. I have clients who identify as heterosexual, clients who describe themselves as gay men or lesbians and others who identify as bisexual. Others don’t use these expressions or are coming to new terms with who they are. I invite people to find their own language of identity.
One of the most effective aspects of therapy is the opportunity to talk openly and candidly with another professional on a regular basis. This is one of the benefits of talk therapy. Not everyone feels they can speak freely and openly about their internal life or personal thoughts. Regular and ongoing consultations with a counsellor or coach can assist in maintaining mental health similar to the way some people see a personal trainer or physical or massage therapist for body maintenance. Meeting for online webcam therapy or through email counselling offers a level of privacy and convenience that you might not get seeing a ‘face to face’ therapist. Talking freely about sex over time can help us to come to new terms with our sexual orientation, our identity and our sexual relationships with others or with specific issues like the use of pornography.
If you would like to know more about my services, please contact me by email to ask any questions.
Ash Rehn BSocWk, MA, MAASW (acc.)
online counsellor and webcam therapist
AASW accredited mental health practitioner
