What Every Counselor Should Know About Sex

1. What Every Counselor Should Know About Sex Rich Wedemeyer ODAPCA Spring, 2014

2. http://www.youtube.com/watch?v=PhJoOswhAFw

3. What We Will Cover 1. Does Anyone Know Anything? 2. What is Healthy Sex? 3. What Do People Actually Do? 4. What is Problem Sex? 5. What Can I Do as a Therapist to Help Clients?

4. What Is Sex? kissing? touching or stroking? mouth on genitals? intercourse?

5. Is Sex Important? We spend a lot of time imagining it, hoping for it, planning it, employing substitutes, denying it, yet very little time doing it.

6. Does That Feel Good?*

7. Sexual Intimacy

8. 1. Does Anyone Know Anything?

9. What’s Up? • Children rarely get significant sex education from parents • Comprehensive sex education is rare in U.S. school systems • Physicians have little training and no time to address it; they infrequently provide referrals • Therapists seldom get training in human sexuality

10. We are Silent on the Topic of Sex !! Sexuality for most people is an uncomfortable subject; after all it’s a personal, private matter. But not addressing it openly means we learn incorrect and partial information and develop a limited vocabulary. We may develop the sense that sex is bad, sinful, and forbidden. Anxiety and guilt interfere with healthy sexuality.

11. SEX Is Spoken Here!

12. Sex: Simple and Complicated Sex is “easy to do” but is underlain by complex physiology, social and cultural norms and admonitions, as well as multifaceted psychological substrates and sequelae.

13. Also: Time and Developmental Changes Intra-system Interactions Inter-system Interactions Microsystem: Biology Psychology Family of Origin Peers Macrosystem Exosystem Microsystem Individual Exosystem: School Religion Media Health Care System Macrosystem: Culture Gender

15. Why Do People Have Sex? recreation procreation curiosity improve sexual skills compulsion convey love or liking resume closeness express hostility alleviate boredom receive or give pleasure to feel desired

16. Sex is Driven By Our Needs for… • Closeness • Communication • Connection • Continuation • Contentment

17. Things You Might Not Know, and Might Want to Remember

18. Being in good physical condition, rested, with optimal stress, and being in a loving relationship are the best aphrodisiacs • For adults aged 20 to 59, women have an average of four sex partners; men have an average of seven • 75 percent of men always reach orgasm during sex, but only 29 percent of women orgasm

19. Erection medications: 65-80% effective, yet marketed as cure-alls • ED: 20% at age 40 + 1% per year thereafter • Sexual satisfaction ≠ orgasm, especially as we age • Relaxation + emotional safety = foundation for good sex, particularly as one ages and especially for females

20. Please Consider • Men: learn the value of emotional intimacy, physical affection, and non-quid pro quo sexual pleasuring (your emotional openness and connection is her turn on) • Women: learn to access erotic energy, and initiate sex (your interest and arousal is his turn on)

21. “Few people escape some form of sexual damage.” Stephen Braveman

22. We therapists must examine our own sexual history, current behavior, attitudes and our comfort with sexual issues if we ever wish to effectively help our clients with theirs.

23. What Sex Therapists Do • Think very broadly about the influences in clients’ sexual lives • Carefully parse out cause versus effect, where possible • Choose high gain, low risk interventions • Offer a more structured, educational, and recommendation oriented approach than most other counseling styles • Evaluate like no one else

24. Sample Assessment Tools Sex Therapists Use Men: • International Index of Erectile Function (15 item) • Erection Hardness Scale (1 item) • Rigiscan (device) Women: • Brief Index of Sexual Functioning for Women (BISF-W) • Derogratis Sexual Functioning Inventory (DSFI) • Sexual Self-Efficacy Scale for Female Functioning (SSES-F) • Female Sexual Function Index (FSFI) • Profile of Female of Sexual Function (PFSF) • Photoplethysmograph (device) Couples: • Sexual Desire Inventory • Cues for Sexual Desire Scale (CSDS) • Dyadic Adjustment Scale (DAS) • Inventory of Dyadic Heterosexual Preferences (IDHP) • Sexual Interaction Inventory • Golombok Rust Inventory of Sexual Satisfaction (GRISS) • Sexual Opinion Survey • Sexual event logs

25. and stereotypes

26. Without an erection, a man is sexually useless If we are in love, we should always have great sex Men always want sex Only women fake orgasms Single folks have more sex than partnered folks People in a relationship don’t (or shouldn’t want to) masturbate Condoms prevent STIs Oral sex prevents STIs

28. A Few More… All touching/affection should lead to sex If you're a truly great lover, you should know how to please anyone I shouldn’t have to ask you for what I want – you should know If you have to plan sex, and it isn't spontaneous, something's wrong Women don't like pornography Most women orgasm through intercourse alone All sex should lead to an orgasm Old people don’t want sex

29. TOSSEM

30. 2. What is Healthy Sex?

31. Healthy sex: among willing adults the activity conveys respect, is physically and emotionally safe, and fosters relationship strength

32. Examples of Sexual Behaviors Across Safe and Unsafe Versus Statistically Common and Uncommon Categories Common Uncommon Safe Unsafe

33. Good Sex? • Adequate muscle tone, stamina and flexibility • Sufficiently effective treatment of relevant physical problems or minimal relevant physical problems • Sufficiently effective treatment of relevant psychological problems or minimal relevant psychological problems • Adjustments of medications to minimize negative sexual effects, or to maximize sexual response • Optimal stress levels in all spheres

34. Good Sex: The Bigger Picture • Intentional Presence • Authenticity • Vibrant Attachment • Effective Communication • Displaying Erotic Interest • Transcending the Physical

35. 3. What Do People Actually Do?

36. Average adult couple: intercourse 61 times/year (but is this statistic useful?) • Average time for sexual intercourse: 3-10 minutes • “Hook-up” sex, recreational sex, sexual companionships, and committed romantic love relationships • All are potentially positive variants: it depends

37. Kinsey Institute Statistics, 2010

38. Americans' Sexual Behavior: A Few Items  Sex outdoors 57% Discuss fantasies 51% Faked orgasm (women) 48% Faked orgasm (male) 15% Sexually adventurous 42% First-date sex 29% Paid for sex (men) 15% Think about sex every day 70% (male) 34% (female) Enjoy sex a "great deal“ 83% (male) 59% (female) Cheated 21% (male) 11% (female)

39. Options for Sexual Expression

40. Options Celibacy Autoeroticism Sexual fantasy Fantasy enactment* Kissing and erotic touching Manual genital stimulation Oral-genital stimulation* Vaginal intercourse* Anal intercourse* *requires precautions

42. 4. What is Problem Sex?

43. Problem Sex • Sex is a problem when it is physically or emotionally unsatisfying to the individual or couple, or when the behaviors create distress in one or more spheres (relationships, work, home, etc.); leads to lack of physical or emotional safety • Problems can be mild, moderate, or severe • Anxiety plays a huge role! • One-event conditioning

45. Psychological / Social Origins of Sexual Problems

46. Psychological / Social Origins of Sexual Problems • Restrictive, uncommunicative FOO • Lack of comprehensive sexual education • Traumatic sexual experiences • Dysfunctional relationships • Some psychological disorders • Physical disabilities

47. Biological/Medical Origins of Sexual Problems Prescribed Medications Diabetes Hormones Skin Disorders Neurological Disorders Illicit Drugs

48. Common Problems for Couples Differences in Levels of Desire Differences in Desired Behaviors Inadequate Communication Differences in Differentiation

49. The Sexual Response Cycle

50. Some Dysfunctions in Stages of Response