Online Counselling or Face to Face Consultations in Sydney, Australia

Photograph of Ash RehnI’m Ash Rehn, counsellor, coach and Medicare Provider. Take a look around to find out more about my in-person and online services.

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Retroactive Sexual Jealousy: Talk Therapy to Redefine Masculinity and Sexuality

Troubled young handsome man, woman at the background on the sofaFeeling jealous about your girlfriend or boyfriend’s, wife or husband’s sexual history can lead to obsessive thinking, suspiciousness or controlling behaviour. For some guys it’s related to sexual performance anxiety. But Retroactive Jealousy, as it is sometimes called, is usually not a sign that the relationship is under threat from another party. This sexual jealousy often starts happening to a person whose sexuality has been repressed in their upbringing or by social conditioning. Restrictive ideas about gender differences between men and women can play a part too.

Therapy for Retroactive Jealousy

When men open up to me about their strong feelings of jealousy around their partner’s sexual past, stories about their own sexual repression are often voiced as well. This doesn’t necessarily mean they tell me about desire for sexual intimacy with other men (although sometimes men do open up to me about their shame of gay sex) but they might share different longings or stories of past events they’ve never spoken to anyone else about. Struggling to cope with sexual jealousy and the obsessive thinking that accompanies it can open up a realisation of the complexity of a man’s sexuality.

The Kinsey Scale, a linear range of sexual orientation from exclusively heterosexual to exclusively homosexual is now considered quite a dated model for understanding human sexuality (the Kinsey Scale is from the late 1940s!). I sometimes use another model that considers different dimensions of sexuality on several axes: Desire, Action, Orientation and Identity. We are more than who we tell the world we are and more than our actions might suggest. We are also not just our desires or the person we might be at any one point in time. Humans are sexual, emotional and rational beings. We change through our lives and our sexual selves can change and develop as well. On top of this we have cultural and social expections on us. How we relate to bisexuality or monogamy are just two examples.

For men experiencing obsessive thoughts about their partner’s past sexual adventures, or retroactive sexual jealousy, there can come a sense that they’ve been cheated out of experiences they might have enjoyed if not for their particular life course or the attitudes of those around them. ‘Healthy sexuality’ is a contentious concept. Men can be influenced in their actions by the way their parents raised them or the teachings of the church they attended or shame associated with a fear of rejection if they spoke or acted on their desires.

Pornography Addiction as a Reaction to Sexual Jealousy

Some men have reacted to sexual thoughts and feelings by trying to beef up their masculine identity or chase sexual success. Some have taken up the techniques of the Pick Up Artist (PUA) gurus, methods that rely on insulting and manipulating other people (women), by giving backhanded compliments, for example. Being a straight man is largely defined by not being something else, that is, not being a woman or a gay man (of course gay men also suffer from pressure to perform their masculinity in certain ways). Hidden within this is the harmful concept that women are less than men. This in turn gives rise to fragile masculinity and what has been termed toxic masculinity.

Some men turn to porn to live out their fantasies in private but end up fearing they have porn addiction or ‘love addiction’ or some kind of sex addiction. And some end up suffering from undiagnosed anxiety or depression as a result of the imbalances in their behaviour or declining self-care. Trying to ensure he is not a woman or not gay can have a man living a very restrained version of himself, refusing closeness to other men and treating other people without respect.

If it’s time you talked about sexual jealousy or retroactive jealousy, contact me. I specialise in making space where you can be heard and accepted and you feel you can be honest. You can meet with me in-person face to face or for online counselling over Skype webcam. We can also talk on a phonecall. Make an enquiry now and start making changes for the better.

Posted in Bisexuality, Masculinity, Sexuality, Uncategorized | Tagged , , , , , , , , , , , , | Leave a comment

How to Treat ‘Sex Addiction’: The Role of the Therapist

Naked aroused man wearing towelIs sex addiction really a legitimate mental health problem or just an excuse for sleeping around?

That was the question Tom Tilley used to open the Hack Live Sex Addicts programme shown on Australia’s public tv broadcaster the ABC this week. I’m sure a lot of viewers were hoping to get a handle on their sexual activity so they could start to feel more in control. But this important topic was again derailed by the usual polarising debate: is sex addiction a real disorder?

Mental Health Problem or Myth?

A few weeks ago a producer-researcher from the Triple J Hack Live programme contacted me. So is sex addiction real? Her question was familiar. Journalists ask this a lot. It also comes up socially at parties when someone mentions I’m an online therapist for ‘sex addiction’ concerns. The obsession about whether a diagnosis of sex addiction actually exists can chew up a lot of time, like it did on the Hack Live show.

My job as a therapist isn’t to decide categories of diagnoses. I’m here to listen, ask questions, help you make meaning and feel more comfortable about your sexuality or assist you to make changes to your sexual activities (if that is what you want to do). It’s not my role to sit in judgement of people or police their behaviour. Most of my clients have been giving themselves a hard time about sex or wasting time looking at porn even before they start seeing me. They don’t need me to do that.

Man with a bottle of wine sitting in front of a laptop

As usually happens when there is a debate asking ‘is sex addiction real‘, the meaning of addiction is similarly contested. Is sex addiction about brain chemistry or a behavioural issue or just something a person can’t stop? I don’t find these debates particularly helpful for people trying to gain more influence over their lives.

Is Sex Addiction on the Rise?

That’s another question loved by journalists and tv producers. It assumes sex addiction is one ‘thing’ when, if you ask enough questions and are genuinely curious, you’ll discover the concept of ‘sex addiction’ means many different things to many people. A one-size-fits-all approach might be a convenient way to market a tv show or sell a book but it can’t assist with such a diversity of experiences. In any case, I’m also not a statistician, so journalists are asking the wrong person here. They should be asking a researcher or epidemiologist. My speciality is counselling and online therapy for sex and pornography addiction concerns. It’s not collecting statistics or making claims about the prevalence of particular conditions.

There’s no doubt that people can experience some relief when their condition is given a label or recognised by those in authority. But recovering a sense of control goes beyond just putting your situation into the same tick-box as other people. If you’re concerned about what you’re doing sexually or how much you’re using pornography, it makes more sense to discuss specifically what is going on for you rather than generalise about other people.

Upset woman sitting on a bed while her boyfriend is sleeping with the camera focus on her

Enjoying Sex: Is Neuroscience Making Us Sick?

By the time Hack Live finally got into questions about causes of sex addiction, about a quarter of the episode was over. One of the men on the panel mentioned childhood trauma and sexual assault as possibly influencing his behaviour. Someone else indicated that not talking about sexual activities – keeping them a secret – made it harder to feel in control. It was hinted at that depression or personal troubles might ‘trigger’ someone into losing control of their sexual behaviour. Then the show was derailed again, this time by (pseudo) neuroscience.

Don’t get me wrong, I think we can potentially benefit from understanding how hormones and the chemistry of the human body affects behaviour. But neurochemistry is a highly complex subject. Those posts about hormones and neurochemistry you see on Facebook or Twitter or Buzzfeed are generally dumbed down versions of research findings. Scientists still have a long way to go before they have a clear understanding of the role and interaction of oxytocin, dopamine, serotonin and endorphins. One panelist on Hack Live made persistent references to a ‘hit of dopamine’, ‘dopamine rush’ and how sex ‘releases chemicals into the brain… like alcohol or gambling’. I wouldn’t have been surprised if it gave some viewers the impression that sex itself was pathological. Is having an orgasm bad for you? Of course it isn’t!

(Hetero)sexual Sex Addiction

When sex addiction is defined simply as a compulsion, it loses cultural context and becomes limited to an internal psychological disorder. The articulate psychologist Nikki Goldstein pointed out that rehabilitation centres are cashing in on the concept of sex addiction by treating it alongside, and in similar ways to, substance addiction. Again, by labelling particular sexual behaviour and situations as one ‘thing’ we risk failing with treatment that is specific enough to the circumstances of the person seeking help.

The most revealing aspect of the Hack Live Sex Addiction episode was what was not discussed. ‘Sex addicts’ were depicted as cheaters who betrayed their partners by picking up in bars and clubs or sneaking around looking at online porn (even on Instagram apparently). There was no discussion about the role or use of dating apps like Tinder. The difference between pornography as an enhancement to masturbation and actual sexual contact with another human being in real time was not explored. The impact of monogamy was mentioned only once and barely anything was said about cultural expectations around sexual fidelity apart from Tom Tilley’s ‘shocking’ (his words) visit to a swingers club. In what sounded like a vacation itinerary for some of my gay counselling clients, one man admitted to having sex up to three times a day with three different women. Why wasn’t anyone talking about sex addiction and masculinity or different sexual or gender expectations for men and women? Or transpeople? I wondered whether the ABC thought it might be too shocking for the audience to hear from some gay men on holiday. Sex positive activist Nev Spirovska did attempt to draw attention to the gender binary but the conversation kept returning to heterosexual sex addiction. Forget about claims of heteronormativity, I think at the very least Hack Live played it safe by not even considering gay men’s sexuality, let alone bisexuality or how to respond to a straight-identified man who goes in search of penis images on Instagram.

Homosexual couple at a romantic date outdoors - Multi-ethnic gay couple in love flirting and having fun

Treatment for ‘Sex Addiction’: Communication versus Shame

It was only really in the last 3 minutes of this hour-long programme that treatment directions for sex addiction concerns were finally raised. Cassie, the partner of self-described sex-addict Jason, had already pointed out that shame shut down conversations about sexual addiction. Then right at the end of the show she vowed that she and Jason would continue to look at the underlying issues and causes as to why he experiences these problems because generally it does stem from depression, anxiety, boredom or stress.

Thank you Cassie!

As an online ‘sex addiction’ therapist, this one of the most significant understandings that my clients can gain. All behaviour is a response. Anxiety, stress, boredom, depression, mid-life crises, suppressed gay (or hetero) identity, curiosity, love… all of these can factor into why we choose to act in particular ways. If we treat concerns about sex addiction – however you choose to define it – in isolation from their origins, we risk not only a relapse of the activities that are most concerning for the client, but the double-shaming that comes from a sense of failure. It also usually means no change in the sense of influence or self-agency the person has over their life.

Cassie also made the point that communication was the key to addressing sex related matters in relationship. I absolutely agree. Shame shuts down important conversations. Shame has people living double lives. In focussing on the truth claims about sex addiction, Hack Live barely touched on the diversity of stories of why we choose the sex we choose and how we can feel more in control or make choices about sex that work better for us.

If you would like to talk more about what sex means to you or have some conversation about the shame you feel about sex, contact me for an appointment.

You can like Forward Therapy on Facebook or follow me on Twitter or Instagram.

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Private Skype Counselling in English for Expats: Tips and Support for Your Journey

Man in hammock with a laptopCounselling expats, I’m privileged to be invited to hear stories from the private lives of those who trade comfort and familiarity for the unknown. While the expat experience is more often portrayed as glamorous and exciting, many find the reality of living in a different culture to be lonely and challenging, particularly in the first year or so. When what promised to be adventure sours, how can you recover a sense of satisfaction or happiness?

Over the past 7 years, I’ve worked with many clients isolated by geographical distance and culture. Some have been living in mining towns in remote parts of Australia, like Kalgoorlie or Roxby Downs. Others have moved to take jobs in global financial hubs like Hong Kong, Shanghai or Taipei or cities such as Abu Dhabi, Doha or Riyadh in the oil rich Middle-East countries. Online counselling is different to ‘face-to-face’ sessions but comes with particular benefits.

Sometimes the circumstances under which a person commences expat life may compound, rather than ease, the move to a different country. For example, I have worked with both straight and gay men who have started working in conservative Arab cultures following the the break-down of an intimate relationship or while trying to recover from separation. Both have experienced difficulties in meeting new partners, either because of the prohibitions against intimacy between unmarried couples or the laws against homosexuality (gay men’s depression can be significant in countries where homosexuality is illegal). The triple change of new job, new home and new relationship status presents opportunities but can also contribute to loneliness and isolation when there is no realistic forward plan. Sometimes isolation or boredom manifests in the formation of unwanted habits, like those reported by men concerned about porn addiction.

While the pay and salary packages of professional life in these places can be alluring, when the reality of day to day existence kicks in, it’s usually your mood that suffers. If this is your experience, if you are struggling with expat life somewhere and experiencing depression or anxiety, you are not alone. The stories I’ve heard reveal that encountering cultural differences, language-barriers, adjusting to climate and managing new relationships can all affect how someone copes with living in unfamiliar surroundings. Add to that a few unexpected but normal aspects of life – for example, ageing parents, financial stresses and health difficulties – and being an expat can easily feel overwhelming, even if the salary is relatively good.

Tips and Therapy for Expats

From working as an English speaking therapist and counsellor, here are a few take-away tips for those who have made, or are just about to make the move, as well as for those who are struggling right now.

Get out regularly if you can.
Particularly in the early stages, regular trips to more a liberal or familiar culture can help sustain your motivation and improve your endurance. Clients in China and Saudi Arabia for example have told me that, if it is manageable, taking a flight to another city for the weekend every 3-4 weeks has often helped them left off steam.

Build your network.
It might be hard to make friends where you are but having some social contact might be important, even if you are not such a social person. If you are in a capital city and can get to know someone who works at an embassy, you may be able to get into the best of expat life. And if you don’t think there is anyone to connect with nearby, try making some contacts in a nearby city or on one of those weekend trips away.

5 tips for making friends if you are gay or bisexual

Try to get into the local life.
As strange or awkward as their customs might seem there will be some sense in following the local ways. Whether it is sport or night-life or cultural events, the locals get something out of their customs and you may too, if you give them a chance. Particularly in Saudi Arabia those who have relied on using alcohol to help relax from work will have to find new ways to deal with stress.

Cut yourself some slack.
Be patient. Adjustment can take time. If you need to spend a bit more cash, particularly in the early stages, to make life comfortable where you are living, think of it as an investment that will pay off in the months years to come. Your mental health is important so don’t risk it for the sake of saving money.

Find yourself a confidante.
If you don’t have anyone in your city right now who understands, look abroad. These days the Internet makes it possible for us to stay in touch over video at little or no cost from anywhere in the world. If you don’t have a friend to confide in, you might want to consider an online counsellor or therapist.

Getting an outside perspective can be important if your mood is starting to spiral down. You can access confidential support online regardless of whether you are in Japan or Singapore or Qatar. Contact me today for information on fees and consultation times.

More information on Availability and Fees

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Sex and Performance Anxiety: Listening to the Body to Quieten the Brain

Muscled man in tiny briefsErectile dysfunction. Body Dysmorphia. Sex and Porn Addiction. The common factor is they all involve a man’s relationship with his body. Sensations in our bodies can tell us not only what we are experiencing but what we need to do to feel comfortable. The trouble comes when we forget to listen to them, or don’t know how to respond to them.

By the time a man has made an appointment with me to discuss erectile dysfunction, he’s often already convinced he has a testosterone deficiency or some other organic problem. Yet while low hormone levels certainly can affect erections, it’s usually a question of confidence or performance anxiety that is the cause of penile problems with these men, particularly those in their 20s, 30s and 40s. If in doubt, I will refer them to a sympathetic GP where they can have their testosterone levels checked. Sometimes a drug like Viagra or Cialis or Levitra is prescribed and can assist with confidence. Then they can get back in touch with me and return for an honest and non-judgemental conversation about sex.

When the Body Hasn’t Caught Up with the Brain during Sex

Technology is driving both improvements in health care and the way we communicate with others. Sure, it’s changing the world in positive ways, but I’d question whether these changes are always for the better. So called geosocial networking apps like Grindr and Blendr now make it possible to organise sex with someone without ever having met them in person. But how does the body catch up with what the brain is thinking? Short answer, it doesn’t always catch up!

In a world where we are simultaneously told ‘sex is dirty’ and ‘save it for the one you love’, organising sex-dates on a smartphone is developing into a cultural norm. Young men are encouraged to be alpha-males whose social standing derives in part from sexual performance and in part from relative youth. Is it any wonder that both sexually inexperienced and mature guys get performance anxiety when it comes to sex? The body just isn’t always ready or comfortable with what the brain is telling it to do. And why is that so shameful? Are we not also our bodies, our sensations and emotions, as well as the thoughts that drive us to use an app like Blendr or Grindr?

For some men, the difficult relationship to the body extends beyond an antagonistic approach to his penis (it’s not doing what I want it to do!) but also to his general appearance or size. This can be a kind of anger with the body (body, you aren’t what you should be!). For some, ‘not enough’ becomes a kind of private mantra. This isn’t just appreciating the results of working out regularly at the gym, being active or playing sports but the preoccupation with something that seems like a defect even though others don’t really notice it. It could be size, weight or proportions. For men it often appears as enduring dissatisfaction with muscle mass to the point they stop participating in social activities or intimate relationships because they don’t feel ‘big enough’. Others bulk up as a form of protection from anxious thoughts.

Anxiety and Disconnection from the Body

What guys term porn addiction, as well as the compulsive use of sex venues or erotic massage despite wanting to stop, can derive from an uncomfortable relationship to the body however these circumstances are diverse and vary a lot between men. Usually guys contact me because they want to stop looking at porn or for some reason, often what they describe as wasting time with porn. But what I’ve noticed for most is that, once a guy starts getting back in touch with how his body actually feels – the sensations he is experiencing – often the behaviour that concerns him ceases itself.

Disconnection from the body is often also present for those who have experienced sexual abuse. Some guys will keep persisting in sex that feels uncomfortable which in turn shapes their relationship with their partner. They can end up depressed or suffering other mental health problems.

All of these issues – sexual compulsion, unwanted porn use, body dysmorphia and psychologically based erectile dysfunction – are both expressions of and responses to anxiety. The treatment is fairly simple but benefits from regular therapeutic conversation to keep on track. Talk therapy for men can offer a breakthrough. Many guys suffer from comparing themselves to others. But every time you have sex, with yourself or someone else, how are you relating to your own body? Are you comfortable with what you are doing? Can you speak up, verbally or non-verbally, about what you would prefer? Can you practice this speaking up?

Do you really need Viagra or steroids or porn for your body to feel good during sex? Knowing what is actually happening in the body, what the body is telling you, takes some effort as well. It involves quieting of the brain and being receptive to the sensations you are experiencing. A partner who is committed to healing can help as well. When you’re completely absorbed in the present, that’s when you really feel what is happening.

If you would like to chat about your relationship with your body, contact me. It can be worth a conversation. Problems dissolve in dialogue and solutions present themselves when there is space made for honesty.

Posted in Anxiety, Body Dysmorphia, Pornography Addiction, sex addiction, Sex Therapy, Therapy for Men | Tagged , , , , , , , | Leave a comment

How do I Know if I have Depression, Anxiety or Mental Illness?

man holding two masks with different moodsIf you are asking this question, it’s a sign that you could benefit from speaking with a mental health professional. October is Mental Health Month with 10 October being World Mental Health day. Here are some tips on how to take care of your mental health and where to get help.

Warning Signs of Depression or Anxiety

Difficulty concentrating, feelings of worthlessness, insomnia, fatigue, irritability, loss of libido, pessimistic outlook, restlessness and agitation, feelings of panic, unusually suspicious, muscle tension without a cause, catastrophising…

It’s not necessarily that you are in the grips of a severe mental illness, but you’re probably getting the warning signs that your mental health is deteriorating. And just as you should pay attention to physical well-being, maintaining your psychological health is wiser than letting it go. As the proverb goes, prevention is better than cure.

Linked here is a quick mental health checklist you can do. If the results page recommends you see a GP or mental health professional (mental health social worker or psychologist), you can get help through Beyond Blue or contact me to make an appointment. If you are in Sydney Australia, I can provide you with the details of doctors who can assist you with a mental health care plan and you can receive a Medicare rebate if you choose to consult me or find another Medicare provider of focussed psychological strategies. If you are elsewhere, find out about online therapy.

The Power of Dialogue for Mental Health

Mental health apps and self-help books might be useful but they are not the same as having a conversation with a real person or being in the presence of someone who cares. At the same time, I know it can be hard to find a therapist, to make contact and turn up for an appointment the first time. It’s quite common that people leave it up to 6 months between reading my website and contacting me. And then it’s often another 6 months or more before they manage to book a session. So if you are putting off doing something about persistent worries or low mood, make a promise to yourself to do something during Mental Health Month.

Psychological problems can be quite debilitating if left untreated. A therapist I admire, Harlene Anderson, talks about the power of conversations to dissolve problems. That’s one reason I started offering online counselling. Appointments over webcam or through email exchange can feel easier to attend and I also offer phone sessions for those who prefer to be heard but not seen. Many who have met me online have made an in-person consultation in Sydney or elsewhere once they have felt more at ease. For others, those who live in remote places or are expats in non-English speaking countries, Internet based sessions mean they can still talk about what might be affecting their mental health when there are no professionals close at hand.

The foundations of good mental health are:

1. Getting enough sleep
2. Eating nutritious food regularly
3. Sufficient exercise
4. A balance of work, rest and play
5. Talking about your problems

Mental health counselling is an example of the fifth point and often assists in recovering the fourth. What might be helpful for you, right now?

Skills and Strategies for Recovering Mental Health

As an Accredited Mental Health Social Worker, I’m qualified to assess and provide focussed psychological strategies for anxiety, depression, relationship problems, adjustment issues, suicidal thoughts, life crises and trauma as well as a range of other presentations. A course of treatment can involve mindfulness practices, cognitive behaviour therapy, relaxation techniques, problem solving, developing skills for managing feelings and increasing capacity to interact with others. Previous experiences of therapy or counselling must be taken into account as well. So if you’ve had a bad experience with a psychologist or psychotherapist we can try to ensure that doesn’t happen again by looking at what went wrong or using a different therapeutic approach.

It’s worth keeping in mind that prevalent attitudes to mental ill health start from the perspective that the person is deficient, defective or disordered in some way or comparisons with what is ‘normal’. I question that. It is important that we also consider how ‘healthy’ behaviour has been constructed by our culture and upbringing. For example, many of the ideas we have about sex or masculinity have been passed down by religious traditions or parental conditioning. Feeling ashamed of your body or mannerisms or guilty about your sexual desires doesn’t necessarily mean there is anything ‘wrong’ with you. It might just reflect conditioning by family, schooling or unpleasant experiences.

Contact me now to find out more about my services or make an appointment.

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I wish you good mental health for October and beyond!

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