March 31, 2025 • 61 mins
In today’s episode of the podcast, we’re doing something a bit different. This episode features a course from my new company, Not Boring CEs (don't worry - Abundance isn't going anywhere).
At Not Boring CEs, we offer an engaging way to earn your asynchronous continuing education credits without sacrificing enjoyment. You can listen to the training sessions on the go through the Not Boring CEs podcast (available on all major podcast platforms) or watch the video content before completing the required CE quiz and evaluation to receive your certificate.
Here are a few more of my favorite on-demand CEs that you can access right now:
- “Harry Potter & Trauma Renegotiation” with Kellie Hayes, LPC
- “The Mental Load” with Maggie Holland, LMHC
- “Headache Psychology” with Emily Foxen-Craft, PhD, LP
As a special offer to all of our podcast listeners, you can receive a $50 discount by using the coupon code ABUNDANCE. Join us today and never be bored by continuing education again!
To learn more about today's featured guest, Dr. Erika Miley, visit https://www.abundancepracticebuilding.com/blog. To learn more about Not Boring CEs, visit https://notboringces.com/.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) So I started a new business to help
therapists with the clinical side of practice.
It's called Not Boring CEs and what you're
about to hear is one of our trainings.
You can listen and learn for free and
if you wanna get CEs afterwards, you can
head to notboringces.com and join us.
Because you're an abundance person, you can get
$50 off our annual membership with coupon code
(00:21):
ABUNDANCE.
We already have all the asynchronous trainings your
license allows with more coming every month.
Actually enjoy your CEs and do it on
the go at notboringces.com.
Dr. Erica Miley, also known as Dr. E,
has helped professionals with their discomfort treating patients'
sexual health concerns for the last eight years.
(00:41):
She provides intimate training through workshops, keynote presentations,
and writing.
As a subject matter expert in neurodiversity and
sexuality, Dr. E presents sexual information in easy
to understand ways so healthcare providers can give
access to the higher quality care their patients
need.
Her background in research and as a professor
for institutions such as Whitworth University and Modern
(01:01):
Sex Therapy Institutes, make Erica uniquely qualified to
train healthcare providers.
Welcome, Erica.
I'm excited to have another amazing CE today.
I'm here with Erica Miley of, say your
website again, cause it just fell out of
my head.
You're good.
The Center for Mental and Sexual Health.
Here we go.
Thank you.
(01:23):
And from the title of this podcast and
also from the website, we're going to talk
about sex today.
We're talking all things sex.
I feel excited.
So- This is why the boring stuff,
like we're not doing boring, like sex can't
be boring when we're training about it.
Please no.
I mean, I've seen people make sex boring,
(01:45):
which is why I was like, I need
to see a company that doesn't do that.
So yes, let's keep these things that are
inherently interesting, interesting, please.
So where can we start with like human
sexuality?
Let's just start there.
Let's just start with one of the biggest,
most misunderstood things in the world.
Let's go there.
(02:06):
I mean, you're talking about something that, I
feel like, especially in the United States.
Now I will stick specifically to the United
States because there are other countries that do
sex education and how we see human sexuality
and human development, human sexual development, they do
it better.
(02:27):
There are quite a few Nordic countries, Germany,
there's a level of comprehensive sex ed and
human development education that starts from the time
people are children.
And in the United States, we refuse.
And we've refused for a very, very long
(02:48):
time.
And so there is an entire field of
study called sexology, which I have my PhD
in clinical sexology.
So all things sexuality and how our mental
health and our bodies are all connected, those
of us who are sex therapists, we are
(03:10):
coming at mental health issues from a frame
of how is it impacting your sexual interests,
your desire, your identity?
How do you incorporate those things into your
life?
Because again, to bring us back to all
of us, really don't have a sense of
(03:33):
really good sex education from the time we're
young children.
So, so many people have taken their sexual
selves, their desires, their identity, who they're attracted
to and pushed it aside because of lack
of knowledge, trauma.
I would say 80% of my caseload
(03:56):
has a religious trauma that is associated with
sex.
And they're in marriages, long-term relationships, couples,
throuples, like all kinds of different kinds of
relationships.
And those experiences and not getting information absolutely
is impacting their ability to grow, their ability
(04:18):
to incorporate their own identities in their lives.
And so essentially what we do as sex
therapists is tackle this big, big thing of
human sexuality.
And we incorporate it every single, I mean,
most of us, I would say, I'm speaking
kind of grandly for our, my field, I
(04:40):
would say every session, I am going to
bring it back to gender identity.
I'm going to bring it back to how
are you experiencing desire?
Oh, you went to a form of church
or a religion or your family ascribed to
a religious doctrine that kept you from understanding
(05:01):
that, oh, I'm attracted to primarily AFAB people
assigned female at birth or AMAB people assigned
male at birth.
Or actually I might be pan, I'm attracted
to lots of different kinds of people with
lots of different kinds of presentation.
(05:22):
You and I, we've talked many times about
how I could be here all day, but
ultimately we use sex as our lens to
try to understand so many other parts of
our mental health and our experiences with our
body.
Absolutely, so when we talk about human sexuality,
(05:45):
there are a lot of dimensions to it.
Is it helpful to find some of those
dimensions so that anybody who is listening, which
I mean, I think there may be some
dimensions, I don't know, but anybody who's listening
can be clear about exactly what we're talking
about with human sexuality.
So we've talked about like gender identity, we
talked about who you're attracted to sexually.
(06:08):
Yes.
Desire.
Pleasure, we haven't really talked about but I'm
assuming it's in there somewhere.
Yes, absolutely.
What are we missing?
We, there are parts of our experience.
If you live in the world, like I'm
(06:28):
kind of using a case study in my
head as we're talking about this.
And I kind of pull from different clients
as we're talking about this, not sharing their
personal information, but giant themes that come up.
So I have had many black clients have
to try to understand their familial trauma, but
(06:49):
also being in a relationship where neither person
was able to experience desire without fear desperately
attached to it.
And sometimes it was because of their systematic
experiences they've had.
Sometimes it's because of the religious upbringing that
(07:10):
they've had.
So I'm kind of using a broad framework,
but race is part of how we experience
sexuality.
Pleasure, you've already identified it.
Pleasure or how do you experience pleasure sexually
or non-sexually?
Because a lot of times our brain will
put it all together and not really understand
(07:32):
the difference, especially if you have a trauma
history.
If you have, we've already talked about the
religious framework of what desire or not experiencing
desire could look like, that includes pleasure.
The dimensions of human sexuality touch, I would
(07:52):
argue, every part of us as humans.
I tell when I'm working with, when I'm
doing consulting with therapists, I am constantly telling
them, when you open the can of sex,
you are pouring gasoline on all of their
issues.
If you talk to your clients about sex
out the gate, you absolutely will find out
things you never would otherwise.
(08:14):
You will see in a relationship how they're
tearing themselves apart on the inside individually and
together.
It is, it truly is the gasoline to
all of our other stuff.
Right.
So, okay.
We talked some about cultural, social.
(08:37):
Can we talk some about individual factors?
Aside from maybe, like maybe trauma experiences.
I'm thinking about how neurodivergence might impact sexuality
or eating disorders or all of these, or
even non-clinical things that are just temperament
(08:58):
-based that might be impacting sexuality.
Can we dive into some of that?
Absolutely, absolutely.
I mean, neurodivergence in particular is my wheelhouse.
So my entire dissertation is about ADHD and
how ADHD symptoms impact AFAB people's sexual functioning.
So again, that lens is super narrow.
(09:18):
We're looking very specifically how ADHD for a
body that was born female would maybe even
look different or their symptoms could look different,
but also how those symptoms impact their ability
to access sexual desire with a partner might
(09:40):
look different than maybe a neurotypical person.
The people I've worked with with eating disorders,
the shame about body truly, truly impacts how
they can actually access non-sexual pleasure and
sexual pleasure.
So the tendrils are, and can be very,
(10:02):
very deep.
And I truly think that I will continue
to come back to, if we're not including
human sexuality in our initial screening, it doesn't
mean that I think every person needs to
be a sex therapist, but I do think
we need to, as clinicians, have a comfortability
with asking these questions to be able to
(10:22):
suss out, oh, this is where maybe a
person in eating disorder recovery has recovered to
a certain amount, but they start to try
to have a sexual relationship with somebody and
they might actually take 10 steps backwards.
Exactly, yeah, yeah, absolutely.
I've seen that as an eating disorder therapist.
(10:44):
Things were going so well and then all
the old stuff comes right up because it
was also linked with trauma or it was
linked with all sorts of things with body.
Are there some temperamental differences that have been
studied or that you've seen anecdotally with sexuality?
(11:04):
I would, I mean, some of the, this
is the baby parts of the field of
sexology because those of us who, because I
also do sex research, so there are lots
of mental health issues we have never explored,
oh, how does it connect to sexual behavior,
(11:27):
sexual interests, sexual identities?
For instance, there is some more recent research
that's coming out that's putting, correlating the likelihood
of queerness with neurodiversity.
Like, we got a new frontier here and
I'm not going to be bold and say
(11:48):
it is, it's always connected because, we don't
know.
We don't know.
Now, if someone tends to be a more,
if they lean on anxiety to deal with
life, that usually follows suit with sex.
(12:09):
So they may struggle with, oh, I really
get in my head when I want to
initiate any kind of pleasurable activity with my
partner, whether it be sexual or non-sexual,
or I need a certain type of interest,
(12:29):
like a kink interest to even clear out
some of the anxiety I might experience from
sex.
So oftentimes when I'm working with people who,
initiation is one of the big, huge things
that comes to us as sex therapists.
They come in and go, I don't know
how to initiate any kind of sex with
my partner, or we've hit a roadblock together
(12:51):
where we're really struggling to initiate together.
So we essentially rewind and we go, okay,
so how do you know what you're interested
in?
And can we figure out what you're really,
really interested in to be able to help
you get through that anticipation paralysis that you
hit before you let yourself engage with sexual
(13:13):
pleasure?
So I'm kind of like, I'm giving a
lot of examples of what us sex therapists
do and kind of the lens we look
at.
But the reality is that every clinician is
going to come across some sexual issue, some
issue around identity, attraction, or not.
(13:35):
The asexual population of our planet has, there's
not a near enough research on all of
those folks and how they experience desire and
romance.
And it's deeply connected to whether they were
given permission to just exist as themselves.
(13:55):
So I think, especially when we come back
to things like neurodiversity and eating disorders in
particular, that's kind of you and I's wheelhouses
together, that it's kind of a microcosm of
what kind of shows up in our offices
when a therapist gets to the point where
they feel like they're outside of their depth
(14:18):
and or they have gotten to the point
where they are uncomfortable because they're facing a
client who's dealing with some of those similar
things sexually that they are.
Yeah, I'd love to talk about that therapist
discomfort.
I mean, it's just, it's the clinical version
of what we have going on in our
culture around sex.
(14:38):
It's something I talked about in my graduate
program aside from forced sex, or it was
like from a trauma lens exclusively, but never
from a pleasure lens, rarely from a connection
lens.
So what I'm thinking about therapists right now
who were maybe raised in households that didn't
talk about sex, who surrounded themselves with friends
(15:01):
who didn't talk about sex, or if it
did, it was like, maybe this kind of
like taboo exciting thing that only that one
friend talked about.
I was that friend.
Yeah, I'm looking at you there.
And then, there are adults who are maybe
have been in relationships, they've had sex, but
(15:21):
they've still got some discomfort around other people
talking about sex around them.
And so the idea of in an intake
with a client when you're just finding out
anything at all about them to dive into
this conversation that they don't even have with
their best friend.
How can we support them?
(15:41):
What would be helpful for them to baby
step their way in?
Teach us everything.
We need 25 more hours.
But I think, I honestly think that this
actually begins, I mean, we wish it would
begin in graduate school.
There's so many things.
There's so many things that we would wish
would begin in graduate school so that you
(16:04):
could at least dip your toe so you
wouldn't be in the intake with a client
for the first time when you might hear
about sexual pleasure or orgasm or, oh, I'm
on a bipolar medication that is completely, it's
given them anorgasmia, which is the inability to
experience orgasm.
(16:25):
And the medication is the absolute thing.
And therapists, when they get uncomfortable, they dismiss
those things quickly because of that discomfort.
Like I said, it is the gasoline sex
and human sexuality is the gasoline to our
own stuff.
And more than likely, a therapist is going
to come up against their own lack of
(16:47):
information and feel that imposter syndrome.
Like, how could I possibly help this person
if I don't know what any of this
is?
So I wish it was grad school.
My next step is I wish every clinical
supervisor did their due diligence to become really,
really, at least informed around sexuality and come
(17:11):
see a person like me, do consultation, get
their own supervision about it, and then also
doing their own therapy work about it because
the gift they could give is being sitting
with that baby therapist coming up in the
field, not necessarily in age, just in experience.
And they can give that gift of those
conversations individually, so it's not so overwhelming because
(17:35):
I did have a human sexuality.
Oh, I had one human sexuality class in
my master's degree and it was taught by
a person who, one, was deeply uncomfortable with
sexuality themselves, and two, the people in the
room who were the most uncomfortable took all
(17:56):
of the oxygen out of the room.
I'm not angry with them about that because
I see why, I know why.
And the discomfort then overtook every part of
it.
Right, because it wasn't the leader who was
comfortable enough to address it.
Exactly, or talk about how it was going
to impact them when they were in with
(18:17):
a client.
And my wonderful, wonderful mentor, Dr. Ricky Siegel,
he was my sex therapy supervisor.
He talked about, and he doesn't say this
with judgment, but with a similar perspective, he
loves to see LMFTs come and get good
(18:38):
sex education, even if they don't decide not
to be sex therapists or certified sex therapists,
because he always says, hey, look, it's a
plumber who can work on toilets when it
comes to the LMFTs.
And I'm like, if you are working within
relationships in any way, shape, or form, you
absolutely need to have a really good background
(19:03):
in human sexuality, because it's so integral to
how we connect as human, non-sexually and
sexually.
Pleasure, I talk to my clients all the
time about how pleasure, joy, some of the
more intense experiences of feeling can actually be
just as disruptive as deep, deep depression or
(19:26):
sadness, because it's intense in its experience.
And if you don't know how to work
with it, it absolutely, you would avoid it,
just like you would try to avoid any
other feeling that you would deem as negative.
Right, right.
What is the most common reason that people
(19:48):
come in to sex therapy, clients?
Now for me, I'm, you know that I'm
the nerd, so I'm gonna get the neurodiverse
folks, the folks that have either been diagnosed
or not, and they are coming up against
(20:10):
sensory issues.
They're coming up against things that trying to
focus during sex, and they're wondering why, because
they enjoy sex and are eager to have
a sexual life with their partners.
But as far as on average, what we
all see, the most common things that we
see are initiation.
So initiation with any partner, and we would
(20:34):
also see desire discrepancy.
Those are kind of the two big pieces
that comes in our office.
I would say I get at least a
call a week about especially desire discrepancy.
And a lot of that comes from the
initial feelings of a relationship.
(20:56):
The big chemical swings that make us all
feel really, really great.
And a lot of times people think that
in a long-term relationship, the way that
your relationship started is that sexual connection should
be taking place the entire time.
And so we break down how, that's kind
(21:18):
of a myth.
And it takes you anywhere from, what do
the Gotlands call it?
The limerence phase.
Is that what they say?
So they don't know that, oh, you could
be at six to 18 months before y
'all get used to each other's hormones that
you cause in one another.
And the sex will probably start to change
(21:42):
around that time.
It doesn't necessarily mean that frequency would necessarily
change because how we experience desire and the
way that I really like to think about
it and Dr. Emily Nagoski's book, Come As
You Are, is really, really great way to
kind of introduce yourself to this idea, which
(22:02):
is that desire is like gas and brakes.
And they're going all the time.
It's not just one or the other.
And I think understanding that, oh, this is
happening all the times.
Oh, when you're at work, the brakes are
on more than the gas is on.
It doesn't mean the gas isn't on, especially
if your partner's sending you nudes or your
(22:23):
partner's like sending you interesting things they'd like
to do to you later.
Yeah, there might be some more gas that
day.
But most of the time at work, you're
gonna have a lot of brakes on.
But as, if you don't know what your
gas and brakes are, how will you know
when you're with your partner that those initial
(22:46):
flood of hormones, as they start to dissipate,
how will you know how to lean on
the gas when you want to, rather than
when you feel like you have to in
the beginning?
Right.
I think about too, Emily Nagoski talking about,
oh, my brain just went, like spontaneous arousal
(23:07):
versus responsive arousal.
Can you talk a little bit about that?
Yes.
So as far as, and we have arousal
non-concordance too.
We could be here just all day just
about this thing, but something to understand is
that not all of us experience spontaneous desire.
(23:29):
Not all of us experience desire that kind
of comes on over time.
We might experience a little bit of like
a different versions of both.
And also no one, no one taught us,
no one.
And I learned more about this when I
(23:51):
did sex offender treatment than I did anywhere
else, which is that your body, your genitals
can react, but your brain can be doing
something altogether different.
Your brain can be in terror.
It can be doing a grocery list, which
is what a lot of my AFAB people
with ADHD do.
(24:11):
It's their task lists that they run, run,
run, run, run through their head.
So, but your genitals will still respond when
stimulated.
So I wish any therapist just even knew
that part, which is that desire and arousal
is different and experienced differently by different people,
(24:33):
especially depending on who they are aroused to,
the kinds of identities that they're attracted to,
or even just if they have a kink
interest, which we absolutely know today that the
interest in kink and power dynamics during sex
consensually is incredibly erotic for a lot of
(24:58):
people and a vast majority of us, rather
than thinking that only a small group of
us like kinky things or kinky power dynamics.
So again, I need like an hour on
each one of these.
Maybe we'll schedule one.
I'm like.
Well, can we, would it be helpful to
(25:19):
talk case studies?
I know that you have some in your
head.
Would that be a good way to kind
of flush out some of these points?
So the case studies that I'm, the one
in particular that I'm thinking of, because it
is something that I see so frequently, this
case study is kind of like a combination
(25:40):
of at least 15 clients in my brain.
So this person is an AFAB person who
grew up in a very religious and I
would say, toxic, patriarchal, structured family.
(26:01):
And once you became a certain age, you
were expected to act like an adult woman
without any guidelines for what that actually looked
like.
And once you started developing physically there, all
of your, the interests of this person had
to be the idea of like only girls
(26:22):
can do those things or only boys can
do those things.
I'm using binary language because this is the
language of these clients.
When they finally get to a place where
they're in puberty and they start exploring masturbation,
they hit this point of deep shame because
no one is either talking to them about
(26:44):
what masturbation looks like and how early it
begins, or they're actually shaming them using religious
doctrine to even like, you can't touch your
body because it is a sin against God.
It is a fill in the blank with
your religious toxicity of choice.
So by the time they get to a
(27:06):
place where they're in high school and they're
experiencing desire, the desire connection is with sin
or that is bad and wrong and I'm
bad or wrong for wanting to engage in
those things.
And so, and on top of that, for
any of my queer clients that are experiencing
(27:28):
the same thing, not only that, like, oh,
I'm supposed to only like this version of
a human and if I do, that is
also bad and wrong and I am broken.
So we go from having no education and
all of the education that is there is
either absent or abusive and it results in
(27:51):
then this tie for a client between desire,
their bodies, and sex and identity that then
they shut down every sexual interaction that they
have with themselves and they become physically numb
to the idea of sexual pleasure until they
(28:12):
get to college, if they did go to
college.
And they start having partners, but then fast
forward, spoilers, this person has never experienced an
orgasm and is 40, in their 40s.
(28:35):
This person, again, a bunch of people in
this one person is the pipeline I see
as a sex therapist.
Again and again and again and again.
And so they come into my office and
this person is in tears because for the
(28:56):
first time in their entire lives, they've actually
met somebody that they're attracted to and their
body is doing things that they've never experienced
before.
And they're in deep amounts of pain and
shame and their partner wants to support them
and has no idea how.
(29:17):
And so we spend a lot of time
doing education individually together with their partner and
then we build the bricks of sexual pleasure
slowly but surely.
Depending on the person and their trauma history,
sometimes we have to start with non-sexual
pleasure which really sucks as a therapist when
(29:39):
you come across a client and I know
you get this when somebody comes to your
office and they are honestly telling you they
have no idea what non-sexual pleasure feels
like.
Yeah.
Yeah, I've definitely seen a lot of that
in my clients with eating disorders.
Yeah.
(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) So I started a new business to help
therapists with the clinical side of practice.
It's called Not Boring CEs and what you're
about to hear is one of our trainings.
You can listen and learn for free and
if you wanna get CEs afterwards, you can
head to notboringces.com and join us.
Because you're an abundance person, you can get
$50 off our annual membership with coupon code
(00:21):
ABUNDANCE.
We already have all the asynchronous trainings your
license allows with more coming every month.
Actually enjoy your CEs and do it on
the go at notboringces.com.
Dr. Erica Miley, also known as Dr. E,
has helped professionals with their discomfort treating patients'
sexual health concerns for the last eight years.
(00:41):
She provides intimate training through workshops, keynote presentations,
and writing.
As a subject matter expert in neurodiversity and
sexuality, Dr. E presents sexual information in easy
to understand ways so healthcare providers can give
access to the higher quality care their patients
need.
Her background in research and as a professor
for institutions such as Whitworth University and Modern
(01:01):
Sex Therapy Institutes, make Erica uniquely qualified to
train healthcare providers.
Welcome, Erica.
I'm excited to have another amazing CE today.
I'm here with Erica Miley of, say your
website again, cause it just fell out of
my head.
You're good.
The Center for Mental and Sexual Health.
Here we go.
Thank you.
(01:23):
And from the title of this podcast and
also from the website, we're going to talk
about sex today.
We're talking all things sex.
I feel excited.
So- This is why the boring stuff,
like we're not doing boring, like sex can't
be boring when we're training about it.
Please no.
I mean, I've seen people make sex boring,
(01:45):
which is why I was like, I need
to see a company that doesn't do that.
So yes, let's keep these things that are
inherently interesting, interesting, please.
So where can we start with like human
sexuality?
Let's just start there.
Let's just start with one of the biggest,
most misunderstood things in the world.
Let's go there.
(02:06):
I mean, you're talking about something that, I
feel like, especially in the United States.
Now I will stick specifically to the United
States because there are other countries that do
sex education and how we see human sexuality
and human development, human sexual development, they do
it better.
(02:27):
There are quite a few Nordic countries, Germany,
there's a level of comprehensive sex ed and
human development education that starts from the time
people are children.
And in the United States, we refuse.
And we've refused for a very, very long
(02:48):
time.
And so there is an entire field of
study called sexology, which I have my PhD
in clinical sexology.
So all things sexuality and how our mental
health and our bodies are all connected, those
of us who are sex therapists, we are
(03:10):
coming at mental health issues from a frame
of how is it impacting your sexual interests,
your desire, your identity?
How do you incorporate those things into your
life?
Because again, to bring us back to all
of us, really don't have a sense of
(03:33):
really good sex education from the time we're
young children.
So, so many people have taken their sexual
selves, their desires, their identity, who they're attracted
to and pushed it aside because of lack
of knowledge, trauma.
I would say 80% of my caseload
(03:56):
has a religious trauma that is associated with
sex.
And they're in marriages, long-term relationships, couples,
throuples, like all kinds of different kinds of
relationships.
And those experiences and not getting information absolutely
is impacting their ability to grow, their ability
(04:18):
to incorporate their own identities in their lives.
And so essentially what we do as sex
therapists is tackle this big, big thing of
human sexuality.
And we incorporate it every single, I mean,
most of us, I would say, I'm speaking
kind of grandly for our, my field, I
(04:40):
would say every session, I am going to
bring it back to gender identity.
I'm going to bring it back to how
are you experiencing desire?
Oh, you went to a form of church
or a religion or your family ascribed to
a religious doctrine that kept you from understanding
(05:01):
that, oh, I'm attracted to primarily AFAB people
assigned female at birth or AMAB people assigned
male at birth.
Or actually I might be pan, I'm attracted
to lots of different kinds of people with
lots of different kinds of presentation.
(05:22):
You and I, we've talked many times about
how I could be here all day, but
ultimately we use sex as our lens to
try to understand so many other parts of
our mental health and our experiences with our
body.
Absolutely, so when we talk about human sexuality,
(05:45):
there are a lot of dimensions to it.
Is it helpful to find some of those
dimensions so that anybody who is listening, which
I mean, I think there may be some
dimensions, I don't know, but anybody who's listening
can be clear about exactly what we're talking
about with human sexuality.
So we've talked about like gender identity, we
talked about who you're attracted to sexually.
(06:08):
Yes.
Desire.
Pleasure, we haven't really talked about but I'm
assuming it's in there somewhere.
Yes, absolutely.
What are we missing?
We, there are parts of our experience.
If you live in the world, like I'm
(06:28):
kind of using a case study in my
head as we're talking about this.
And I kind of pull from different clients
as we're talking about this, not sharing their
personal information, but giant themes that come up.
So I have had many black clients have
to try to understand their familial trauma, but
(06:49):
also being in a relationship where neither person
was able to experience desire without fear desperately
attached to it.
And sometimes it was because of their systematic
experiences they've had.
Sometimes it's because of the religious upbringing that
(07:10):
they've had.
So I'm kind of using a broad framework,
but race is part of how we experience
sexuality.
Pleasure, you've already identified it.
Pleasure or how do you experience pleasure sexually
or non-sexually?
Because a lot of times our brain will
put it all together and not really understand
(07:32):
the difference, especially if you have a trauma
history.
If you have, we've already talked about the
religious framework of what desire or not experiencing
desire could look like, that includes pleasure.
The dimensions of human sexuality touch, I would
(07:52):
argue, every part of us as humans.
I tell when I'm working with, when I'm
doing consulting with therapists, I am constantly telling
them, when you open the can of sex,
you are pouring gasoline on all of their
issues.
If you talk to your clients about sex
out the gate, you absolutely will find out
things you never would otherwise.
(08:14):
You will see in a relationship how they're
tearing themselves apart on the inside individually and
together.
It is, it truly is the gasoline to
all of our other stuff.
Right.
So, okay.
We talked some about cultural, social.
(08:37):
Can we talk some about individual factors?
Aside from maybe, like maybe trauma experiences.
I'm thinking about how neurodivergence might impact sexuality
or eating disorders or all of these, or
even non-clinical things that are just temperament
(08:58):
-based that might be impacting sexuality.
Can we dive into some of that?
Absolutely, absolutely.
I mean, neurodivergence in particular is my wheelhouse.
So my entire dissertation is about ADHD and
how ADHD symptoms impact AFAB people's sexual functioning.
So again, that lens is super narrow.
(09:18):
We're looking very specifically how ADHD for a
body that was born female would maybe even
look different or their symptoms could look different,
but also how those symptoms impact their ability
to access sexual desire with a partner might
(09:40):
look different than maybe a neurotypical person.
The people I've worked with with eating disorders,
the shame about body truly, truly impacts how
they can actually access non-sexual pleasure and
sexual pleasure.
So the tendrils are, and can be very,
(10:02):
very deep.
And I truly think that I will continue
to come back to, if we're not including
human sexuality in our initial screening, it doesn't
mean that I think every person needs to
be a sex therapist, but I do think
we need to, as clinicians, have a comfortability
with asking these questions to be able to
(10:22):
suss out, oh, this is where maybe a
person in eating disorder recovery has recovered to
a certain amount, but they start to try
to have a sexual relationship with somebody and
they might actually take 10 steps backwards.
Exactly, yeah, yeah, absolutely.
I've seen that as an eating disorder therapist.
(10:44):
Things were going so well and then all
the old stuff comes right up because it
was also linked with trauma or it was
linked with all sorts of things with body.
Are there some temperamental differences that have been
studied or that you've seen anecdotally with sexuality?
(11:04):
I would, I mean, some of the, this
is the baby parts of the field of
sexology because those of us who, because I
also do sex research, so there are lots
of mental health issues we have never explored,
oh, how does it connect to sexual behavior,
(11:27):
sexual interests, sexual identities?
For instance, there is some more recent research
that's coming out that's putting, correlating the likelihood
of queerness with neurodiversity.
Like, we got a new frontier here and
I'm not going to be bold and say
(11:48):
it is, it's always connected because, we don't
know.
We don't know.
Now, if someone tends to be a more,
if they lean on anxiety to deal with
life, that usually follows suit with sex.
(12:09):
So they may struggle with, oh, I really
get in my head when I want to
initiate any kind of pleasurable activity with my
partner, whether it be sexual or non-sexual,
or I need a certain type of interest,
(12:29):
like a kink interest to even clear out
some of the anxiety I might experience from
sex.
So oftentimes when I'm working with people who,
initiation is one of the big, huge things
that comes to us as sex therapists.
They come in and go, I don't know
how to initiate any kind of sex with
my partner, or we've hit a roadblock together
(12:51):
where we're really struggling to initiate together.
So we essentially rewind and we go, okay,
so how do you know what you're interested
in?
And can we figure out what you're really,
really interested in to be able to help
you get through that anticipation paralysis that you
hit before you let yourself engage with sexual
(13:13):
pleasure?
So I'm kind of like, I'm giving a
lot of examples of what us sex therapists
do and kind of the lens we look
at.
But the reality is that every clinician is
going to come across some sexual issue, some
issue around identity, attraction, or not.
(13:35):
The asexual population of our planet has, there's
not a near enough research on all of
those folks and how they experience desire and
romance.
And it's deeply connected to whether they were
given permission to just exist as themselves.
(13:55):
So I think, especially when we come back
to things like neurodiversity and eating disorders in
particular, that's kind of you and I's wheelhouses
together, that it's kind of a microcosm of
what kind of shows up in our offices
when a therapist gets to the point where
they feel like they're outside of their depth
(14:18):
and or they have gotten to the point
where they are uncomfortable because they're facing a
client who's dealing with some of those similar
things sexually that they are.
Yeah, I'd love to talk about that therapist
discomfort.
I mean, it's just, it's the clinical version
of what we have going on in our
culture around sex.
(14:38):
It's something I talked about in my graduate
program aside from forced sex, or it was
like from a trauma lens exclusively, but never
from a pleasure lens, rarely from a connection
lens.
So what I'm thinking about therapists right now
who were maybe raised in households that didn't
talk about sex, who surrounded themselves with friends
(15:01):
who didn't talk about sex, or if it
did, it was like, maybe this kind of
like taboo exciting thing that only that one
friend talked about.
I was that friend.
Yeah, I'm looking at you there.
And then, there are adults who are maybe
have been in relationships, they've had sex, but
(15:21):
they've still got some discomfort around other people
talking about sex around them.
And so the idea of in an intake
with a client when you're just finding out
anything at all about them to dive into
this conversation that they don't even have with
their best friend.
How can we support them?
(15:41):
What would be helpful for them to baby
step their way in?
Teach us everything.
We need 25 more hours.
But I think, I honestly think that this
actually begins, I mean, we wish it would
begin in graduate school.
There's so many things.
There's so many things that we would wish
would begin in graduate school so that you
(16:04):
could at least dip your toe so you
wouldn't be in the intake with a client
for the first time when you might hear
about sexual pleasure or orgasm or, oh, I'm
on a bipolar medication that is completely, it's
given them anorgasmia, which is the inability to
experience orgasm.
(16:25):
And the medication is the absolute thing.
And therapists, when they get uncomfortable, they dismiss
those things quickly because of that discomfort.
Like I said, it is the gasoline sex
and human sexuality is the gasoline to our
own stuff.
And more than likely, a therapist is going
to come up against their own lack of
(16:47):
information and feel that imposter syndrome.
Like, how could I possibly help this person
if I don't know what any of this
is?
So I wish it was grad school.
My next step is I wish every clinical
supervisor did their due diligence to become really,
really, at least informed around sexuality and come
(17:11):
see a person like me, do consultation, get
their own supervision about it, and then also
doing their own therapy work about it because
the gift they could give is being sitting
with that baby therapist coming up in the
field, not necessarily in age, just in experience.
And they can give that gift of those
conversations individually, so it's not so overwhelming because
(17:35):
I did have a human sexuality.
Oh, I had one human sexuality class in
my master's degree and it was taught by
a person who, one, was deeply uncomfortable with
sexuality themselves, and two, the people in the
room who were the most uncomfortable took all
(17:56):
of the oxygen out of the room.
I'm not angry with them about that because
I see why, I know why.
And the discomfort then overtook every part of
it.
Right, because it wasn't the leader who was
comfortable enough to address it.
Exactly, or talk about how it was going
to impact them when they were in with
(18:17):
a client.
And my wonderful, wonderful mentor, Dr. Ricky Siegel,
he was my sex therapy supervisor.
He talked about, and he doesn't say this
with judgment, but with a similar perspective, he
loves to see LMFTs come and get good
(18:38):
sex education, even if they don't decide not
to be sex therapists or certified sex therapists,
because he always says, hey, look, it's a
plumber who can work on toilets when it
comes to the LMFTs.
And I'm like, if you are working within
relationships in any way, shape, or form, you
absolutely need to have a really good background
(19:03):
in human sexuality, because it's so integral to
how we connect as human, non-sexually and
sexually.
Pleasure, I talk to my clients all the
time about how pleasure, joy, some of the
more intense experiences of feeling can actually be
just as disruptive as deep, deep depression or
(19:26):
sadness, because it's intense in its experience.
And if you don't know how to work
with it, it absolutely, you would avoid it,
just like you would try to avoid any
other feeling that you would deem as negative.
Right, right.
What is the most common reason that people
(19:48):
come in to sex therapy, clients?
Now for me, I'm, you know that I'm
the nerd, so I'm gonna get the neurodiverse
folks, the folks that have either been diagnosed
or not, and they are coming up against
(20:10):
sensory issues.
They're coming up against things that trying to
focus during sex, and they're wondering why, because
they enjoy sex and are eager to have
a sexual life with their partners.
But as far as on average, what we
all see, the most common things that we
see are initiation.
So initiation with any partner, and we would
(20:34):
also see desire discrepancy.
Those are kind of the two big pieces
that comes in our office.
I would say I get at least a
call a week about especially desire discrepancy.
And a lot of that comes from the
initial feelings of a relationship.
(20:56):
The big chemical swings that make us all
feel really, really great.
And a lot of times people think that
in a long-term relationship, the way that
your relationship started is that sexual connection should
be taking place the entire time.
And so we break down how, that's kind
(21:18):
of a myth.
And it takes you anywhere from, what do
the Gotlands call it?
The limerence phase.
Is that what they say?
So they don't know that, oh, you could
be at six to 18 months before y
'all get used to each other's hormones that
you cause in one another.
And the sex will probably start to change
(21:42):
around that time.
It doesn't necessarily mean that frequency would necessarily
change because how we experience desire and the
way that I really like to think about
it and Dr. Emily Nagoski's book, Come As
You Are, is really, really great way to
kind of introduce yourself to this idea, which
(22:02):
is that desire is like gas and brakes.
And they're going all the time.
It's not just one or the other.
And I think understanding that, oh, this is
happening all the times.
Oh, when you're at work, the brakes are
on more than the gas is on.
It doesn't mean the gas isn't on, especially
if your partner's sending you nudes or your
(22:23):
partner's like sending you interesting things they'd like
to do to you later.
Yeah, there might be some more gas that
day.
But most of the time at work, you're
gonna have a lot of brakes on.
But as, if you don't know what your
gas and brakes are, how will you know
when you're with your partner that those initial
(22:46):
flood of hormones, as they start to dissipate,
how will you know how to lean on
the gas when you want to, rather than
when you feel like you have to in
the beginning?
Right.
I think about too, Emily Nagoski talking about,
oh, my brain just went, like spontaneous arousal
(23:07):
versus responsive arousal.
Can you talk a little bit about that?
Yes.
So as far as, and we have arousal
non-concordance too.
We could be here just all day just
about this thing, but something to understand is
that not all of us experience spontaneous desire.
(23:29):
Not all of us experience desire that kind
of comes on over time.
We might experience a little bit of like
a different versions of both.
And also no one, no one taught us,
no one.
And I learned more about this when I
(23:51):
did sex offender treatment than I did anywhere
else, which is that your body, your genitals
can react, but your brain can be doing
something altogether different.
Your brain can be in terror.
It can be doing a grocery list, which
is what a lot of my AFAB people
with ADHD do.
(24:11):
It's their task lists that they run, run,
run, run, run through their head.
So, but your genitals will still respond when
stimulated.
So I wish any therapist just even knew
that part, which is that desire and arousal
is different and experienced differently by different people,
(24:33):
especially depending on who they are aroused to,
the kinds of identities that they're attracted to,
or even just if they have a kink
interest, which we absolutely know today that the
interest in kink and power dynamics during sex
consensually is incredibly erotic for a lot of
(24:58):
people and a vast majority of us, rather
than thinking that only a small group of
us like kinky things or kinky power dynamics.
So again, I need like an hour on
each one of these.
Maybe we'll schedule one.
I'm like.
Well, can we, would it be helpful to
(25:19):
talk case studies?
I know that you have some in your
head.
Would that be a good way to kind
of flush out some of these points?
So the case studies that I'm, the one
in particular that I'm thinking of, because it
is something that I see so frequently, this
case study is kind of like a combination
(25:40):
of at least 15 clients in my brain.
So this person is an AFAB person who
grew up in a very religious and I
would say, toxic, patriarchal, structured family.
(26:01):
And once you became a certain age, you
were expected to act like an adult woman
without any guidelines for what that actually looked
like.
And once you started developing physically there, all
of your, the interests of this person had
to be the idea of like only girls
(26:22):
can do those things or only boys can
do those things.
I'm using binary language because this is the
language of these clients.
When they finally get to a place where
they're in puberty and they start exploring masturbation,
they hit this point of deep shame because
no one is either talking to them about
(26:44):
what masturbation looks like and how early it
begins, or they're actually shaming them using religious
doctrine to even like, you can't touch your
body because it is a sin against God.
It is a fill in the blank with
your religious toxicity of choice.
So by the time they get to a
(27:06):
place where they're in high school and they're
experiencing desire, the desire connection is with sin
or that is bad and wrong and I'm
bad or wrong for wanting to engage in
those things.
And so, and on top of that, for
any of my queer clients that are experiencing
(27:28):
the same thing, not only that, like, oh,
I'm supposed to only like this version of
a human and if I do, that is
also bad and wrong and I am broken.
So we go from having no education and
all of the education that is there is
either absent or abusive and it results in
(27:51):
then this tie for a client between desire,
their bodies, and sex and identity that then
they shut down every sexual interaction that they
have with themselves and they become physically numb
to the idea of sexual pleasure until they
(28:12):
get to college, if they did go to
college.
And they start having partners, but then fast
forward, spoilers, this person has never experienced an
orgasm and is 40, in their 40s.
(28:35):
This person, again, a bunch of people in
this one person is the pipeline I see
as a sex therapist.
Again and again and again and again.
And so they come into my office and
this person is in tears because for the
(28:56):
first time in their entire lives, they've actually
met somebody that they're attracted to and their
body is doing things that they've never experienced
before.
And they're in deep amounts of pain and
shame and their partner wants to support them
and has no idea how.
(29:17):
And so we spend a lot of time
doing education individually together with their partner and
then we build the bricks of sexual pleasure
slowly but surely.
Depending on the person and their trauma history,
sometimes we have to start with non-sexual
pleasure which really sucks as a therapist when
(29:39):
you come across a client and I know
you get this when somebody comes to your
office and they are honestly telling you they
have no idea what non-sexual pleasure feels
like.
Yeah.
Yeah, I've definitely seen a lot of that
in my clients with eating disorders.
Yeah.
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