Sex Therapist at the Academy Awards, Part 2: The Courage to be Seen

Sex Therapist at the Academy Awards, Part 2: The Courage to be Seen

On the occasion of The Sessions being up for an Academy Award this year (Helen Hunt, for best supporting actress), we’re discussing some of the film’s implications  for sex therapy.  This is part 2. Something quite ordinary The Sessions tells the story one man’s extraordinary misfortune — paralyzed by polio at age 6 — and of his equally extraordinary courage in living, loving, and finding a place in the world.  It also concerns an extraordinary kind of sex treatment — sex surrogacy — where the therapist actually gets naked and has sex with her client. I don’t do sex surrogacy.   Neither do any of my colleagues.   Few sex therapists these days refer patients for sex surrogacy.   And not many sex therapists see clients who are as profoundly disabled as Mark O’Brien, the hero of The Sessions.    So on all counts, it’s hardly a typical story. But in one respect, O’Brien’s quest for sexual healing is completely ordinary — and entirely typical of the individuals and couples I see daily in my office. I’m referring to his intense ambivalence about getting help. Ambivalence, of course, is characteristic of all human endeavor.   And that’s certainly true about seeking any kind of mental health care.   But it’s in the realm of getting help for sexual suffering that the natural and universal human tendency toward ambivalence reaches perhaps its absolute peak. One of the movie’s most dramatic scenes has O’Brien, flat on his back as always, being wheeled to his first appointment with a sex therapist.  It’s an appointment that he himself made.  But he is screaming to be allowed...
Sexual Healing That Won’t Break Your Nose

Sexual Healing That Won’t Break Your Nose

  All things considered, the mental health profession comes off pretty well in this year’s new sex movie Hope Springs.  Marriage therapist and author Dr Bernard Feld, played by Steve Carell, is a fairly nice specimen by Hollywood standards. He’s likeable, intelligent, confident-but-not-a-shmuck, and commits no flagrant boundary violations.  You get the idea.   He’s an OK guy. He has one big problem, though — he’s a “destination therapist.”  Couples come to see him for a week of intensive marital work.  This has some obvious advantages, such as that the clients in his office aren’t too burdened by everyday concerns. The big disadvantage, though, of being a “destination therapist” is that you’re under time pressure.   This is a particular disadvantage when it comes to sex therapy. You see, the human sexual system doesn’t like working under pressure.   It’s naturally rebellious.  Put it under pressure, and it will be all too happy to disappoint.   In Hope Springs, Meryl Streep’s husband Arnold, played by Tommy Lee Jones, is a world-class passive-aggressive,  and hence is also happy to disappoint.  It would be hard to imagine a more reluctant therapy client. Dr Feld, trying to work quickly, chooses a forceful opening move.  He likens therapy to nasal surgery.   In order to open the breathing passages, one must first mobilize the bones of the nose by breaking them, then putting them back together. Surgical metaphors are rarely appropriate in psychotherapy.   And they’re virtually never appropriate in sex therapy.   Hit someone hard enough in such a sensitive place, and they’re not going to feel like making love. Feld’s forceful opening succeeds in knocking Arnold out...
Sexless in Nebraska:  Meryl Streep and Tommy Lee Jones in “Hope Springs”

Sexless in Nebraska: Meryl Streep and Tommy Lee Jones in “Hope Springs”

  A strange thing, mystifying In this new movie, Tommy Lee Jones plays an Omaha accountant named Arnold who won’t have sex with his wife — Kay, a sixty-something Everywoman played by a very likeable Meryl Streep. No sex, no physical attention, minimal eye contact, separate bedrooms.  The marital estrangement combination platter – with fries. True to life?  Absolutely.  It would be awfully nice if this were just a Hollywood dramatization.   But in fact it happens all the time in real life. Now what, one might ask, would cause Hope Springs’ Arnold to hang a “no trespassing” sign on himself, especially with such a nice woman as Kay for a wife?   The answer is surprisingly simple.  (Skip the following if you’re about to see the movie).   True to life Years ago, it turns out, Kay was feeling unhappy that Arnold wasn’t more fully involved during sex — that he seemed “ to want it, but not me.”   (True to life?   Absolutely.  It’s one of the more common complaints among married women in my sex therapy office.) Frustrated that Arnold wouldn’t listen when she tried to express how she felt, Kay briefly withheld sex, hoping to get his attention.  The plan backfired.  Feeling criticized and hurt, Arnold too went on strike.  Permanently. Before I became a sex therapist, I would have thought this incredible.  Now I find it utterly believable.  It’s the kind of emotional stalemate that often happens to individuals who can’t express themselves very well.   That includes a lot of folks. But notice something:  Even though the problem involves sex, it’s not really ABOUT sex. It’s...
Advice to Future Sex Therapists (and Other Topics)

Advice to Future Sex Therapists (and Other Topics)

Thanks to sexpert Megan Andelloux from Rhode Island’s Center for Sexual Pleasure and Health for permission to reprint the following interview (slightly modified) from her site www.thecsph.org What do you do in the field of sexuality? I’m a New York City psychiatrist and psychotherapist specializing in sexuality and relationship issues. I also write a blog, “SexualityToday,” on my website and on PsychologyToday,  focused on new developments in sexuality, clinical sexuality, and sexual medicine. Where are you based? Central Park West in New York City — right across from Strawberry Fields. What is your focus? What do you do? I spend most of each day consulting with individuals and couples about sex and relationship problems. Not many sex therapists are MD’s, and not many psychiatrists still do much psychotherapy. So I’m somewhat of an anomaly on both counts. I also think about sexual issues and write about them. What are your particular goals and passions in the field? I like to see the look on a person’s face when they begin to feel more hopeful about themselves. I also enjoy working with patients whom no one else has been able to help or understand. Why did you choose to work in this field? Why would a person choose to do anything else? Where did you go for school/training? Psychiatry at the Payne Whitney Clinic, New York Hospital/Cornell; then sex therapy training with Raoul Schiavi and Patricia Schreiner-Engel and their group at the Program for Human Sexuality at Mt Sinai School of Medicine in NYC. Most of my clinical education since then has been through involvement in the Society for Sex Therapy and...
The Search for Sexual Sanity Continues

The Search for Sexual Sanity Continues

June 2011   Now that Representative Anthony Weiner is reported to be seeking professional help, one question seems to be on many people’s minds: Help for what? That’s not clear.  Sending suggestive photos of oneself to young women is clearly personally and professionally hazardous.  But does it reflect a disorder requiring treatment? Common sense would say that it’s certainly a symptom of something.    But of what? There’s no real consensus about how to approach the issue. For example, there’s the question of whether such behavior might represent an “addiction.” Many people, myself included, think there’s something to the sex addiction idea.  But that the term over-simplifies something that’s often more complex.   We should also keep in mind that it’s not so easy to be sexually sane these days.    As a country, we’re very conflicted about sex.   We’re sensation-seeking and puritanical at the same time.    As my West Coast colleague Marty Klein writes concerning the Weiner affair, we’re fairly hypocritical about which sexual conflicts get labeled as scandals.   And there are people like Betty Dodson who say we might do better to just chuck the whole notion of sexual pathology. I recently returned from the annual spring meeting of the Society for Sex Therapy and Research (SSTAR), where this year the meeting featured a debate concerning whether or not certain kinds of hypersexual behaviors should be considered addictions. There are arguments to be made on both sides, and the matter is by no means settled.   Eli Coleman, a leading figure in the field, prefers the term “Impulsive/Compulsive Sexual Behavior (ICSB).” I like ICSB —  it hews closely to...