Areas of Practice

Sex Therapy

Sex Therapy is a subspecialty of psychotherapy, focusing on the specific concerns related to human sexuality. People of all ages, creeds, health status, ethnic backgrounds, whether partnered or single, may benefit from working with a psychotherapist who specializes in this area.

Certified Sex Therapists use specialized clinical skills and theoretical knowledge to help people solve their sexual concerns (aasect.org). Sex Therapy typically focuses on the following areas: desire, arousal, orgasm, and pain. I also counsel on sexual addiction/compulsivity and sexual trauma.

Relationship/Couples Counseling

Whether you and your partner are having a sexual issue, or just having trouble in your relationship, I am happy to work with you. As a marriage and family therapist, I think systemically about most problems. This means I take a close look at all factors, and people, that may come into play. I am pragmatic in my approach, and utlize concepts from Bowen, Gottman, Schnarch, and others.

Couples counseling is best for people who suffer from communication difficulties, life adjustment issues (for example kids, a new job, moving), sexual concerns, and for those who find themselves in repeated, unhealthy patterns of functioning. Sessions usually consist of a combination of individual and couple counseling.

Trauma

In addition to working with couples and individuals with relationship and sexual issues, I also treat various forms of trauma. Trauma can be more overt, just as surviving a severe auto accident, or it can be more covert, such as growing up with an emotionally abusive parent. Regardless of the type or severity your trauma, therapy can help alleviate any symptoms you may be experiencing as a result. Symptoms are many and vary from case to case, but some of the more common ones include hypervigilance, difficulty sleeping, feelings of dissociation, and physical reactions, such as migraine headaches. Research suggests that people who have experienced trauma are less likely to effectively cope with stressful situations in the future. I typically utilize EMDR (Eye Movement Desensitization and Reprocessing) as my approach to treating trauma. To read more about EMDR and its application, visit www.emdr.com

Low Sexual Desire/ Discrepancy in Sexual Desire

Rarely do I see a partnership in which both individuals equally initiate sex, or in which one is always willing to be sexual when the other initiates. Instead, most couples consist of a “high desire” and a “low desire” partner. The messages we get from TV and movies don’t do much to debunk the myths about what is normal for sexual desire.

Unless there is a purely physiologic reason for low sexual desire, I usually find that both individuals have patterns that contribute to the discrepancy. Of all the sexual dysfunctions, this is the one that requires the most extensive assessment because there are so many factors that may be to blame. Sexual desire is one of the most complex – and one of the most common – concerns that I see.

Difficulty with Orgasm

Of all the sexual dysfunctions, orgasm is the one most shrouded in myth. I should be able to orgasm every time I am sexual. Sex won’t be enjoyable if I don’t orgasm. I should be able to have simultaneous orgasms with my partner. These are common, but incorrect, beliefs that people hold about the female orgasm. In fact, only about 25-30% of women are able to have an orgasm from intercourse alone.

If you are only able to have an orgasm under specific circumstances, if you are unable to have an orgasm at all, or if you are dissatisfied with the quality or frequency of your orgasm, sex therapy may be able to help.

Erectile Dysfunction

Second to low sexual desire, this is the most common complaint from my male patients. ED is a very troubling concern. Many men attach much of their sexual self esteem to the quality of their erections.

Erectile dysfunction is defined as the inability to attain or maintain an erection during sexual activity. While medications may be useful for some men with ED, they usually do not help when the problem has a psychological cause. Talking to your therapist can help weed out what may be the psychogenic origins for your inability to develop and/or maintain an erection.

Premature/Rapid Ejaculation

Men tend to think they should be able to “last and last” during sex. As a matter of fact, most men last between 2-10 minutes on average once rapid thrusting begins. If you last less than 2 minutes or if you last less than you think is satisfactory for you and your partner, there are techniques which may help elongate the time you maintain an erection before ejaculating.

Remember, sex doesn’t have to end with ejaculation! You have heard of foreplay, but how much do you know about afterplay? There are many things you and your partner can enjoy sexually after you have had an orgasm.

Sexual Pain

Sexual pain, or dyspareunia, is an umbrella term that refers to any pain one experiences during sexual activity. Both women and men may suffer from pain during sex. With women, the pain is usually due to vaginismus (an involuntary spasm of the pelvic floor muscle) or vestibulodynia (inflammation of the vestibule, the tissue that surrounds the vaginal and urethral openings). There are many other causes of sexual pain, but these are the most common. Vaginismus usually has a psychological component and is best treated using a combination of psychological and physiological treatments.

Regardless of the type of pain you are having, therapy will help deal with any underlying anxiety or depression that causes or comes as a result of the pain. 

Sexual pain is less common among men, but it does happen. It is most often physiologic in origin, but may have a psychological component as well. Your therapist will help you differentiate the causes and outline the best course of treatment for your pain.

Sexual Addiction/Compulsivity

Sexual addiction is defined as any sexually-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one's work environment. Sexual addiction has been called sexual dependency and sexual compulsivity.

Sexual addicts make sex a priority more important than family, friends, and work. No single behavior pattern defines sexual addiction. These behaviors, when they have taken control of addicts' lives and become unmanageable, include: compulsive masturbation, compulsive heterosexual and homosexual relationships, pornography, prostitution, exhibitionism, voyeurism, and indecent phone calls, to name a few. Even the healthiest forms of human sexual expression can turn into self-defeating behaviors (sexhelp.com).

Sexual Abuse/Trauma

Any history of sexual abuse or trauma may impact your current sexual functioning. Trauma may be more obvious, such a rape, or may seem less evident, as in the case of an unhealthy relationship with someone in a position of power.

Trauma has many faces and can present itself in many ways. You may not even be aware of the impact your trauma history has on your sexual functioning or in your current relationship. Regardless of the level of your sexual trauma, therapy may help alleviate some of the residual effects.

Sexual Paraphilias

A sexual paraphilia is defined as having an arousal to an object, person, or situation that is out of the norm. Usually this causes significant interpersonal distress and impairment in functioning. The types of paraphilias vary greatly, but some of the more common ones include voyeurism, exhibitionism, and transvestic fetishism.

Gender Identity

This is perhaps one of the most difficult inner struggles people face. Feeling like you were born in the wrong body, struggling with issues around masculinity and femininity, living in two different worlds – one public and one private – has the potential to cause significant depression and anxiety. It is very important that you receive therapeutic support as you embark on this journey of self exploration and change.

Sexual Orientation

Whether you are just beginning the process of questioning your sexual orientation or are starting to come out to friends and family, therapy can help alleviate the fear and anxiety of this process. While the world is moving toward more acceptance of the gay population, many people still hold on to faulty beliefs about homosexuality. I am happy to work with you individually, you and your partner, or you and your family as you go through this process.
I am also an Alt-Friendly Therapist, and welcome people of all preferences and orientations.

Codependency

While codependency may manifest itself in many ways, I think the Jeffrey Young’s definition of self-sacrificing behavior sums it up: “consistently and voluntarily putting other’s needs above your own, which will eventually result in anger and resentment and a loss of self-esteem.”

People who suffer with codependency often have difficulty setting appropriate boundaries, may have unstable relationships, or suffer from feelings of worthlessness or guilt. Codependency usually stems from an unhealthy family-of-origin system.

The therapeutic work for codependency will focus on understanding how patterns from your childhood affect your current relationships and will eventually move toward changing unhealthy patterns of interaction.

Stress and Anxiety

Like trauma, the symptoms of chronic stress and anxiety are many. Some of the more typical anxiety disorders include Generalized Anxiety Disorder, Panic Disorder, Social Phobia, Obsessive Compulsive Disorder, and Post Traumatic Stress Disorder. Anxiety is a normal human emotion, but sometimes it can become overwhelming and debilitating. Living life under constant worry, having difficulty sleeping, or feeling plagued by obsessive thoughts is no way to live. I typically use Cognitive Behavioral Therapy and/or EMDR in my treatment of anxiety disorders. It is important that thoughts, feelings, and behaviors are addressed. If you feel like stress and anxiety are interfering with your life, call for an appointment. I will do an assessment and together we will determine the best course of treatment and management for you.