Interview with Dr. Marina Rosenthal: Unlocking the Secrets of Sexual Health and Intimacy through Sex Therapy

Episode Transcript
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Jacqueline Trumbull (00:00):
Hey guys, welcome to A Little Help for Our
Friends, a podcast for peoplewith loved ones struggling with
mental health.
Welcome back, little helpers.
Oh, my god, are we excited forthis topic and that is now the
third week in a row I've saidthat, but for real this time,
because we're going to betalking about sex.
We love talking about sex andKibbe and I kind of like delve

(00:23):
into this topic a little bit,like we wade into it.
But today we have clinicalpsychologist, high-conflict
couples therapist andASEC-certified sex therapist, dr
Marina Rosenthal.
She was here a few weeks ago.
You loved her.
I got many messages about howgreat that episode was.
So welcome back, marina, andthanks for talking to us about

(00:45):
sex today.
I'm so excited.
This is your favorite topic.

Dr. Marina Rosenthal (00:50):
I would say so.
Yeah, it's my favorite topicand um I I just really love
reminding everybody that sex isa part of life.
Sexuality is a part of life andlike let's, let's make sure we
actually talk about it.

And like let's, let's make sure we
actually talk about it.
So what do you?
Everything I know about sextherapy comes it's not even sex
therapy, it's just EstherBurrell.
So like this fundamentallydifferent thing from talk
therapy, like what exactlydifferentiates it?

Yeah, that's such a good question.
So sex therapy that was thatwas the question I had when I
started sex therapy.
Training and supervisionactually was like what are?
So sex therapy?
That was the question I hadwhen I started sex therapy.
Training and supervisionactually was like what are the
magic sex therapy interventionsthat I can learn and deliver?
And there definitely are some.
For the most part, sex therapyis more about a way of thinking
about sexuality, and thenthere's interventions that go

(01:40):
along with that.
There's certainly educationabout physiology and sexual
response and kind of like thefacts of anatomy and how sex
works, how desire works.
That is part of being a sextherapist or receiving sex
therapy.
But I think, more importantly,when you work with a sex
therapist, what you're hopefullygetting is somebody who is

(02:00):
willing to look at sex from alot of different angles, who
sees sex as important as part ofyou know, like human's identity
.
Whatever your relationship tosex is that it matters that you
deserve pleasure, that pleasureis an important part of life,
kind of like a human right ifit's something that you want.
There's a way of thinking aboutsex.
That, I would say, is theoverarching thing that makes sex

(02:21):
therapy different from regulartherapy.
And sex therapy certainly couldbe very much like talk therapy.
It's often somewhat behavioral,with some exercises to try some
things to actually apply intoyour sex life, but sometimes
it's very similar to traumatherapy or sometimes it's very
similar to other forms oftherapy.
So it can kind of look at a lotof different ways and it's more

(02:43):
of a philosophical frame thatthe therapist comes in with.

Dr. Kibby McMahon (02:46):
That's awesome.
What are the typical problemsthat people come to you for what
is like the most common issuethat people are asking help with
?

Yeah Well, so issues that would fall under
sex therapy, kind of juststarting there, like broadly,
there's sexual function issuesthat sex therapists can help
with.
So that's things like erectiledysfunction or premature
ejaculation, pain during sex ofany kind.
Those are all things that youknow you can certainly go to a
medical provider for, but youcan also receive support from a

(03:20):
sex therapist, particularlyafter you've seen a medical
provider who's kind of ruled outthat there's something else
going on or wants to coordinatecare In particular, like pelvic
floor.
Physical therapists are reallygreat to pair up with your sex
therapist if you're having painduring sex, for example.
So function issues, like thingsare not going the way I want
them to, my body is notquote-unquote performing the way

(03:43):
I want it to.
Now, part of sex therapy isoften reframing the way we think
about sexual performance andhaving more flexible and
expansive options available forwhat sex can be and what
pleasure can look like.
So that might be part of it aswell.
I would say the most common sextherapy concern that I get as a

(04:03):
couples therapist is infidelityrepair, but other common ones
include desire discrepancies,where one partner has a much or
not even much a different desirefor amount of sex or type of
sex and the couple wants to workthrough that Increasingly
working with folks aroundnon-monogamy and how they

(04:25):
structure their relationships,whether one person uses
pornography and the other personis uncomfortable with that, and
how they're navigating that intheir relationship kink, all
kinds of things.

Really it's very expansive I'm like I'm
trying to think of where to gonext because I'm sort of buzzing
with all sorts of things.
I mean, I guess one thing I'mwondering about is how much of
what you see is a just like it'sactually a problem they're

(04:57):
having in the bedroom versuswhat they think might be a
problem.
Um, so like my genitalia isn'tnormal or my performance isn't
normal, or like when you weresaying expanding flexibility
around what sex can mean, Iwould think a lot of people
would balk at that, in partbecause there's this belief like
if we're not having penis andvagina sex, then there's

(05:19):
something wrong with ourrelationship, something wrong
with our sex life.
That's not real sex.
So just a lot of kind ofsocietal beliefs coming in.

Yeah, I mean that's, I would say, in
many ways across presentingissue, the most common sex
therapy intervention is kind oflike normalizing that sex can
mean a lot of different thingsand helping people see their own
sex lives more expansively, andthat's a data driven approach,
the you know, the research showsthat couples who continue to

(05:48):
have sex later in theirrelationships, like as they get
older, have more expansive sex,and this makes total sense,
right?
Nobody continues to again,quote unquote perform exactly
the same way decades at a time.
Illness, pregnancies, menopauseall kinds of things can change
the way your body behaves, andso having a flexible way to

(06:10):
approach intimacy is so, sohelpful.
Something I'll often say tocouples who are getting really
stuck on this is like, okay,like so let's say that it's all
or nothing, right, you can haveyour penis and vagina sex Again,
that's assuming a heterosexualcouple, but you can have that or
nothing.
That's one option.
Or you could have that, or youcould have 25 other things.

(06:32):
Maybe the answer for yourpartner is no on the penis and
vagina sex one night.
Is it really for you Then?
I want nothing.
Is that a better option thanlet's cuddle naked or let's make
out and build tension fortomorrow night, when I think I'm
going to be more available.
You know really anything.
That could be a very wide menuof sexual options, and the more

(06:53):
options a couple has, the morelikely they are to actually tap
into those options and be sexualwith each other.

So interesting.
What do you think people's mostcommon misconceptions are?
Because, like I, like thatyou're talking about the
different options.
Are there certain ways thatpeople come in thinking sex is
or get?

wrong.
People are often really worriedabout sexual compatibility in
terms of whether you and yourpartner match up with how much
sex you want and the type of sexyou want.
And definitely life is a littlesimpler if you and your partner
are just like a perfect Venndiagram that overlaps and looks
like one circle.
Like that might be simpler, butmost people aren't going to

(07:44):
have that, at least not all thetime.
You might have that perfectoverlap during some seasons,
like maybe when you were firstdating, you were perfect circles
overlapping each other, and nowthat you have children, you're
not.
Or now that you're in a reallybusy season at work, you're not.
And so helping people seedifferences in terms of desire
with a little bit less fear is abig part of my role.
Like actually it's okay if yourpartner wants to have sex more

(08:06):
than you.
Like this is a workable, normaldifference.
We don't need to be in a panicabout it, especially if you can
talk about it and you canacknowledge that desire and you
have pathways for personalpleasure.
I think that's really important, right.
Like your partner is not goingto fulfill every single sexual
urge need that you have.
So continuing if there's adesire discrepancy, continuing

(08:27):
to have a way to engage inpleasure by yourself can be
really important, and just notseeing it as such like a
relationship deal breaker, likeoh no, you don't want to have
sex three times a week and Iwant to have sex three times a
week and you want to have sextwo times a week.
That's a terrible thing and wecan't make it work Like no, it's
really not that binary.

I feel like in a long-term relationship,
I've always dreaded the timewhen I would stop wanting to
have sex.
Not that I necessarily knowthat that will happen, but it's
such a recurring, I think,narrative with like I mean even
like literature, podcast, media,wherever friendships and I can

(09:14):
see how that happens thedopamine isn't hitting quite so
much as it is in the firstmonths.
Do you see that happening formen as much?

you see that happening for men as much?
Yeah, it it maybe not as much,but it I definitely see desire
changes and low desire in men,and I think when men have lower
desire than their femalepartners, there's a lot of shame
that comes up around that.
Um so like, yes, I definitelyhear about it more in
relationships between men andwomen, with women having lower
desire.
But it's really hard to unlatchthat from societal issues that

(09:50):
drive women into these reallyimpossible division of labor
situations.
So, you know, sometimes it'sjust hard to tell.
It's like if the playing fieldwere really equal, would she
want to have sex more?
She might Like we don'tactually know that if she had a
second to herself, and sometimesthat's a relationship issue,
but some of it is alsostructural and societal, and so
even just normalizing that ofwe're placed in these impossible

(10:13):
roles and positions and thatcan be a really big desire
killer that can make you notwant to have sex.

Well, and sex is pretty inconsistent for
women in terms of pleasure, withfewer orgasms and fewer
internal orgasms and it beingkind of a physically taxing
experience.

Yes, I think it's an old, like Dan
Savage, I don't know commentjoke.
That's basically like if menhad to get fucked every single
time they wanted to have sex,they wouldn't want to have sex
as often, and I think that's itright.
There's it's a higherinvestment activity for the

(10:52):
person being penetrated, and Ithink that's true of any any
type of penetrative sex.
It's just like takes more outof you, requires more cleanup,
like comes with some some costsand some extra stuff in the way
that like like, say, oral sexjust doesn't.
And so again that's coming backto like well, what if that's on
the menu?
What if, like, mutualmasturbation is on the menu,

(11:14):
then would that change theanswer?
If we could let go of the idealike it has to be just this one
way, would it change your answeror your availability?
Especially if and often this isthe like issue in heterosexual
relationships like if shebelieved yes, that actually is
okay, that is, that's great,it's awesome, let's fool around,
let's make out, let's whatever.

(11:35):
There's no pressure.
If we took the pressure out ofit, then that interest can come
back.
When there's a sense ofpressure and, like my partner is
going to be terriblydisappointed and maybe sulk or
pout, then I mean that's likethe biggest desire killer ever.

Been there.

How do you navigate that discrepancy in
desire, you know, for frequency,or just like when one person,
one person, initiates and thenthe other person doesn't feel
like it, that could feel reallyrejecting, and so that can you
know, like then people don'twant to initiate.
Because how do you deal withthat where there is that initial

(12:19):
like um acceptance of rejectionfeelings around it?
Do you just prescribe a certainnumber of initiation?
How do you work with that, withcouples.

Yeah, it's a good example of how sex
therapy is both like othertherapy and also not like other
therapy.
So in some ways this is just arejection, tolerance thing.
Yeah, sometimes someone doesn'twant to do a thing with you.
That's part of being a person,it's part of being in a
relationship.
If you pout every time yourpartner doesn't want to play
cards or see the same movie asyou like, that's not going to go

(12:53):
very well either.
With sex it's particularlyproblematic because, um, the,
the associations that you makearound sex really determine
whether you're going to want tohave it again.
So if now your association iswhen my partner initiates and

(13:15):
I'm kind of on the fence, theythrow a little hissy fit.
Now we've kind of coded that into the sexual script and that's
part of it.
And again, that's just not aturn on, I think, for anybody.

This is very validating.
I mean, it's interestingbecause when you talk about
playing cards, like if I rejectsex, it well what you're talking
about it did have something todo with my partner, but like if
I reject my current partner forsex, it has basically nothing to
do with him and all about menot wanting to play quote

(13:48):
unquote cards.
Like sex is sometimes hard.
I don't always feel like doingit.
You know it's like variablyrewarding, um, but yet it's
taken as such a rejection of theself.
You don't want to have sex withme, it's about me.
Oh my God, I would think someof the work would.
Don't want to have sex with me.
It's about me.
Oh my god, I would think someof the work would be on like
unpairing those, those things.

Yeah, something that is about that
right, because you don't havethe same desire, like the same
draw to them as when you firststarted dating, right?

so there actually kind of is like a yeah,
but even when I first starteddating him, it's more like I
just wanted to be all over him.
It's not like I wanted um,sorry the talk.
It's not like I wanted to behaving sex every single second
of the day.
I just wanted to be around himand, like, touch him, yes, but

(14:37):
sex is that's, an activity thatmaybe I wanted to do with more
frequency back then, but it's.

I don't know.
Yeah, I mean certainly there'sa place for feedback and I mean
that's actually the place tostart.
Often if there's some sort ofchallenge happening in a sexual
relationship, like oh, I feellike I'm not as interested
anymore, or like one partnerfeels rejected is like how do we
make it as fun as possible foreverybody involved?

(15:03):
How do we make it so sosatisfying?
Start there rather than withhow frequent, because not always
, but sometimes.
If you can make sex awesome foreveryone involved, it will get
them up to their like personalmax, their comfortable max of
like.
You know what?
When sex is great, I actuallydo want to have it once a week.
When sex is mediocre, I don'twant to have it once a week,

(15:24):
because why would I want to dosomething mediocre on a weekly
basis?
Um, and when it's um also hasagain that like variability.
When there's options for whatyou do that are lower investment
, that don't require, you know,I think, particularly for women,
like the whole full deal,shower and the shit, the
grooming and the you know,whatever it is you do to prepare

(15:46):
for sex, that can feel veryweighty, so like are there
options where you can still beintimate but not feel like you
have to do all that, are there.

I mean, we do do a lot, we ready ourselves
for this activity.

Yeah, yeah , we do it's, it's, it's a
burden, it's it's time consuming, um, and and there is so much
cultural baggage, I think, forboth men and women, where, you
know, women feel that they haveto be a certain amount of
seductive and present a certainway, and then men's value and
self-worth is so tied into beingable to seduce their partners

(16:23):
that then that's where thatrejection comes from.
It's like, oh, I'm not valuablebecause, like, I'm supposed to
be able to unquote, make herwant me when, yeah, it might not
have anything to do with him.
It might be like, oh, I had abad day, or it might be, you
know, cycle related.
Like, just like not aligned forme right now.
Um, it might be any number ofthings.
It might be right, like thereis a place for this, and this

(16:45):
does sometimes come up in sextherapy.
It might be like, actually,yeah, you don't do things that
are that fun for me, or it seemslike you're really focused on
getting off and you're not thatinterested in whether I got off
or whatever.
It might be like that'scertainly a relevant thing to
bring out.
Um, and part of part of workingtoward a better sex life is
making sure again, likeeveryone's having fun.

How do you?
What kind of techniques arethere um therapy for, let's say,
women who have troubleorgasming?
Is that like a common problem,or is that just something that's
a holdover from Cosmo?

like at all ever, under any
circumstances, versus havingtrouble orgasming with a partner
, versus having troubleorgasming during penetrative sex
.
And so a big part of sextherapy is like education around
.
Just you know, like thelikelihood of orgasm during
penetrative sex it's not thathigh.
A lot of women just won't.
The clitoris is not inside thevagina and most women orgasm
from direct stimulation of theirclitorises.
So it makes a lot of sense andjust just like aligning people

(17:58):
with reality can be a part ofthis, where it's like actually
you don't have an orgasm problem, you have like a, I have a
vagina.
Reality, and so like, let'sjust like align the sex that you
have with the anatomy that youhave.
So I would say that's the morecommon version is like
expectations around havingorgasms without appropriate
stimulation.
Definitely some people struggleto orgasm at all or
specifically with a partner.

(18:19):
They can orgasm on their own,but they can't with a partner,
and for both men and women thatcan sometimes, or like
regardless of anatomy, that cancome down sometimes to like the
repertoire of masturbation thatsomebody has come up with, um,
sometimes people masturbateeither with very specific tools,
um, or to very specific contentand it gets like rigid, and so

(18:41):
there are like behavioraltherapy techniques that you can
use to kind of like decouplethose um stimuli from the sexual
response.
So that's definitely somethingthat can be done like developing
more, redeveloping,resensitizing different types of
touch, a kind of classic butstill good sex therapy.

(19:02):
Intervention is sensate focus,which is sort of like mindful
touch.
It's a series of stages inwhich partners touch each other
not to make the other personfeel good, but to just follow
your own interest and be reallypresent and mindful and notice
like what does their skin feel?
Like?
Where do I want to go next?

(19:23):
And obviously this is within acontainer of consent, but like,
as I'm touching my partner, likethis part of their skin feels
warm, this part of their skinfeels firm, this part of their
skin feels soft.
That interests me.
And following interest in amindful way rather than focusing
on like I have to turn them on.
I have to turn them on rightnow, because that's often where
people get stuck when they starthaving sexual response issues.

Wait, tell us more about that.
So it's not about the personbeing touched, it's the person
touching like you know what Iwant?

to have an orgasm right now, and a hundred
percent of the time I'm goingto be able to do it.
It's like sleep.
You cannot force yourself to goto sleep, just like at the drop
of a hat and because it'soutside your direct control,
trying really hard to do itdoesn't work.
Um, in the same way that lyingin bed, going like I have to
fall asleep right now.
If I don't fall asleep rightnow, I'm only going to get six
hours of sleep and that's notenough for me.
I'll be a wreck tomorrow.

(20:31):
That doesn't make you fallasleep.
And so releasing some of thatcontrol over your sexual
response and developing interestand sensation is a really
useful framework, and we can dothis either in a structured way
through this, like sensate focusstyle intervention, but it's
also just like a way of thinkingabout sex, like how do I be
more focused on?
Just like how things feel, whatdoes it feel like?

(20:53):
And certainly if you're in afunctional, functional, healthy
state, you can focus on whatfeels good and following
pleasure.
But if there's sexualdysfunction and following
pleasure sometimes doesn't workbecause it's like it's high
pressure, right, it createsexpectation like okay, so that
feels good.
Am I going to lose my erection?
That feels good.
Am I taking too long to have anorgasm?

(21:13):
He's going to get bored right.
And so taking away thatpressure and expectation and
instead entirely focusing onjust like mindful self-awareness
of the sensation.

I mean the amount of chatter going on in
people's heads is insane.
If I, I mean if I just thinkfrom the woman's perspective.
I mean some things.
I just think from the woman'sperspective.
I mean some things I've had inmy head are like better, be
really good at sex or he's goingto leave.
Being good at sex means beingreally enthusiastic about sex.
So, okay, are you enthusiastic?
Well, not really, but okay,like I, better act like it.

(21:44):
Okay, like now.
Am I seeming like I'mperforming?
Are these noises I'm makingweird?
Am I like slutty for having Idon't know XYZ, like desire or
this sex at all?
What do I look at that fromthis angle?
Should I have been too long inthis position?
If I stay in this position fortoo much longer, does that mean

(22:05):
I'm boring at sex?
Then we just go back into thecircle.
I mean there's like releasingthat chatter is a lot, and then
for men I would think theperformance anxiety would be
quite high.
Yeah, so is that so sensate?
Focus is I mean that it seemslike a mindfulness technique to

(22:29):
kind of curtail some of that.
Do you do a lot of likecognitive restructuring work as
well in sex therapy?

Yeah, I think a lot of what we've been
talking about, in a way, iscognitive restructuring.
Like sex doesn't have to bepenetrative to count.
Like how do we reframe whatthat means?
How do we reframe thedefinition of sex?
Like a classic sex therapyintake question that anybody
listening can ask themselves islike what is my definition of
sex?
What does sex mean to me?

(22:58):
And you can talk to yourpartner about that Like, how do
we as a couple define sex?
And if our sex life is healthy,what does that mean?
What does it look like when wehave a healthy sex life?
Because these are not just likesimple, there's one answer
questions.
So, yeah, I think cognitiverestructuring is a huge part of
it.
Practicing behavioral skillsSometimes people got really bad

(23:19):
sex education and so, likethey're not great at certain sex
skills, right, like they haveincorrect anatomical awareness.
You know, especially, I think,for men partnered with women.
Sometimes they've just receiveda.
I think for men partnered withwomen, sometimes they've just
received a lot of garbage aboutlike what women are supposed to
like, and then paired with awoman who might have received a
lot of garbage about like oh,I'm not supposed to be that

(23:41):
demanding, I don't really likethat.
But he seems to like it, so Iguess we'll do it.
That's something he likes.
Um, I've definitely talked topeople who've had long, long
relationships where somethingwas happening in their sex life
and it turns out neither of themliked it and they both thought
that they were doing it for theother person.

Like what You're just taking me back to
all my 20s.

Like mundane.
I mean it can be mundane, itdoesn't have to be totally
salacious, right, like, oh, like.
I think he really likes kissingmy neck.
It must be a turned on for him.
But actually it's so ticklishfor me, I don't.
I don't prefer it, and theyjust haven't brought it up.
And much more commonly, themost common kind of unfortunate
thing that happens is that inheterosexual relationships,

(24:26):
women have something they reallywant or need out of their sex
life in order to make it goodfor them, and they just don't
feel empowered to ask.

What is the role of fantasy?
I could see how I mean it couldenhance orgasm, but I could
also see and like, enhance theexperience, add fun and play.
But I could also see how itwould separate the partners.
So that they're both kind of indifferent worlds.

Yeah, I think you know a lot of people
can sort of lightly slip in andout of fantasy in a way that's
very functional and so if, ifthat's you, you know, if you
have moments during sex whereyou kind of like go away into
imagery or somewhere else, Idon't think there's anything
problematic about that at all.

(25:15):
Fantasy, where you really, inorder to experience pleasure,
need to mentally go elsewhere,need to really picture something
else, can be an intimacy killer, right.
Like if your partner, in orderto orgasm, always know, always
has to go completely silent for10 minutes and you know their

(25:36):
body isn't moving and stuff andthey're picturing something in
their head that that can be alittle alarming and just feel
more disconnected.
So I think it's a balance.
I don't think and again, thisisn't one of those like right
wrong things.
This is how does it feel foreverybody involved?
Um, I can see a framing of likehow incredibly intimate that
you feel comfortable being inthe presence of your partner,

(25:58):
but going wherever you need togo, like going to the most you
know in intimate parts of yourfantasies with them right there,
like that's actually kind ofhot, right, and I can also see
it as like they left me behind.
They're not here anymore,they're just off in their own
thing and I'm just a body.

So it really is going to depend on the two
people and how they feel aboutit.
What do you do in that?
Let's say there's a problemthere.
Let's say they're the partnerwho is kind of feeling on the
out when that their partnerfantasizes, but that's what they
need to get off or that's whatthey, that's what they like.
How do you change, like whochanges?

(26:39):
You know who has to do the workto come together.
What do you do?

yeah, it's such a good like.
This is how therapy always is,couples therapy in particular,
where it's like everyone,everyone changes and also
everyone doesn't change, kind ofsuch a both end.
So in a case like that, thenyou know, we would want to get
clear about what feelsunsettling and what what the
problem is.
Right, like OK, I feel reallyabandoned.

(27:06):
When you're silent for longperiods of time during sex and I
know that you're fantasizingabout things that are outside of
the two of us, that feels, youknow, really kind of like
violating to me in a way thatsometimes people feel about that
and the other person's likeyeah, I get it, but like that's
how I have an orgasm.
I don't know how to have anorgasm a different way.
So we might do a bunch of things.

(27:26):
We might try to address that,like having an orgasm in
multiple situations.
There might be some likeinflexibility there and often
people this goes back to howthey like learned how to
masturbate and just like did itover and over again in the exact
same way, reading the samestory or watching the same porn
or touching themselves the sameway, picturing the same thing

(27:46):
over and over again for likedecades, and there can be
retraining around that right,like it's not not like
retraining who you're attractedto, but just sort of like.
Do I have to always picturethis one scenario every single
time?
So that's certainly an optionon the table.
Another option is that maybeduring certain types of sex they

(28:08):
negotiate out like hey, I wantus to be connected, can you stay
with me, and then afterward,like you know, I'll participate
in helping you have an orgasmand you can go where you need to
go, like working out like whendo I really need you here with
me and when do I not need youhere with me?
Helping the person who feelsabandoned, maybe rethink what it
means.
Does it have to mean thatthey're abandoned?

(28:29):
So there's like a multi-prongapproach.

Have you gained any insight onto why rape
fantasies are so prevalent withwomen?
Just random little insertion.

Yeah, they're so, so prevalent.
And it's interesting because Ifind most women wouldn't put it
that way, but we do know thatit's the most common fantasy put
it that way, but we do knowthat it's like the most common
fantasy it is.
Yeah, yeah, it is.
You know.
So rape fantasies are likeconsensual, non-consent or

(29:02):
forced seduction there's allthese different ways to call it,
because I think, understandably, like we want to be thoughtful
about how we talk aboutfantasies that are not actual
sexual assault.
Right, because the fantasy isnot.
I actually want to experience asexual assault.
It's I want to experienceknowing that I consented to
something.
But like playing with thistaboo, this idea of forced sex,

(29:26):
again in this completelyconsensual container, even if
it's a fantasy and you'refantasizing like, oh, but what
if it really happened?
It's still a completelyconsensual container, even if
it's a fantasy and you'refantasizing like, oh, but what
if it really happened?
It's still a completelyconsensual container, like the
nature of the fact that you'refantasizing about it makes it
consensual, with the exceptionof and I wouldn't categorize
this in like the rape fantasybucket for trauma survivors, who
sometimes have like intrusiveimages coming up of their actual

(29:47):
assaults or of similar events.
It's kind of like a different,more like obsessive thought loop
type thing.
But for somebody who just likethe way that they masturbate is
like they find it really sexy tothink about, like what if I was
just taken?
You know there's whole genres ofromance devoted to this.
It's a very popular trope andidea to play with.

(30:08):
So I mean the like historicalanswer that I think has some
truth to it is that you know,women didn't have historically a
way to claim their own desireLike you couldn't just be like
I'm horny, I want to have sex, Ilike sex.
And so Fianna, saying sizing,about having sex taken from you,

(30:30):
was a way to access, likewanting sex.
So that's kind of one of thelike classic explanations.
Something I think that isprevalent kind of in today's
world is like women have a loton their plates, are doing a lot
, and so the idea of just likecomplete surrender to something
similar to you know, interest insubmission can have an appeal

(30:54):
to you know, interest insubmission can have an appeal.
Sometimes it's like, oh, Iwatched this one movie when I
was 12 and it just really stuckwith me and now now it's in my
head and it's part of my arousalpatterns Like sometimes there's
not a logical reason.

Spam's pretty much aligned with my
independent hypothesizing, whichis just that, like women have
to, so much goes into, yeah,asking for sex or having sex.
Like will I?
Will my number go up too much?
Will this guy call me again?
What will my mother think?

(31:26):
What will my future husbandthink like?
And if you can just erase allof that negotiation, um then it.
What a relief and that's trulysexy Like to not have to think
so much.
Get like, wind yourself into aknot trying to figure out if you
should even want the sex or ifwanting the sex is enough of a

(31:48):
reason to have sex.
I mean, that's all such asexiness killer.

Yeah, all of that like worry tends to be a
sexiness killer, in the sameway that for um, penis havers
like thinking about, like am Igoing to be like the best lover
ever?
Am I gonna, you know, likereally take her to the moon with
my equipment here?
Um, that is also a huge bonerkiller.
Right, like that's one of themain interventions around

(32:16):
erectile dysfunction is justsort of like it's not that big a
deal Like your penis might getflacc of.
Like it's not that big a deallike your penis might get
flaccid.

That's something that happens, yeah
what about if there's like afantasy, for example the rape
fantasy or something else, whereit brings up a lot of shame?
Or there's it's like this is myfetish or kink or whatever, but
my partner is upset by it?
Or I find it disturbing Likecan people retrain into other

(32:47):
kinds of fantasies or adjacentactivities, or is it kind of
like more about acceptance andleaning into something like that
?

Yeah, I mean so someone it's sort of
like with anything.
Any mental health issue wheresomeone else being distressed
about your symptoms is nevergoing to be like quite enough of
a reason to have the symptomsbe a problem.
If you're like completely fineand there's no functional
impairment, the fact that yourpartner is like, yeah, but I
really don't like this about youis not a reason for it to be a

(33:18):
problem, for it to be like adiagnosis.
If we were talking about amental health issue and that's
often how I see peoplenavigating these sorts of things
where it's like, well, whatdoes it mean about you that you
want this?
I would generally place that onthat person asking the question
like, what does it mean to you?
And you know like what happensfor you when you think of your
partner having that attractionand you know know how can we

(33:41):
reconnect and accept the factthat they have that attraction?
That's assuming, obviously, thatthey're doing like legal and
consensual things that arewithin the container of whatever
like monogamy agreements acouple has.
So I think sometimes this topicis just like very, very
triggering for people who have ahistory of infidelity in their
relationships because it's like,well, yeah, it matters what

(34:01):
they're into because they'regoing to go have that type of
sex on the side.
And so like I'm putting acaveat out here, that like I'm
saying that within a monogamousrelationship, as long as what
your partner is doing is afantasy, that they're not
violating your relationshipagreements, I personally take
the stance that it's not yourjob to tell them like ew, that's

(34:22):
icky.
Of course you could decide youdon't want to be with somebody
who has certain types of sexualinterests, but the reality is
you're not ever going to knowfor sure that you know all of
your partner's sexual interests.
And what you teach your partnerwhen you have a huge disgusted
reaction, when they say like oh,I'm actually really into this,
is like, don't tell me that infuture, that's icky, I don't
want to know.
You teach them to lie to you.

I guess how ?
I don't this is a half-bakedquestion, but like, how much do
you find that kink reallycenters itself in a relationship
?
I mean, if somebody has adominance fantasy, that's.
I guess it's just a degreesquestion.
But I guess, like, can it workif you've got this kink and your
partner doesn't like it?

(35:06):
Like is it worth finding adifferent relationship?
And I mean, I guess I wouldassume that depends on how
important that kink is to you.
But um, it also seems to belike a degree of kink is a
little bit out of your control.
So yeah, that works.

Yeah, I mean, I think you're right on
and like the degree is going tobe the big linchpin here.
Um, I do think in part this issometimes why people explore
non-monogamy, because it's likeoh, actually I don't want to end
this relationship, but mypartner does have an interest
that I'm not interested inparticipating in, like in any
way, shape or form.
I do sometimes see people getgood success with like okay, I

(35:44):
don't want to do that, but like,I'll talk about it with you.
We can pretend we're doing it,we can talk about doing it.
We're not going to do it, butlike, I'll talk to you about it.
And that's thede-stigmatization part, that
just knowing like my partnerdoesn't think I'm icky, they are
accepting of me, that's nottheir thing, but they're like,
willing to, they're willing toplay.

(36:05):
That can be a huge game changer.
That's not going to be the casefor everybody.
You can't like be playful aboutsomething that truly you have
like a very distressed,triggered reaction to Um, so it
might not be available, butsometimes that's enough.
Sometimes that takes the edgeoff of like okay, I don't get to
actually do this thing, but weget to talk about it.
We can even like incorporate itinto our sex life without doing

(36:25):
it.
Talk about doing it but notdoing it.
That might be enough.
Opening up the relationship isan option and then, yeah, for
some people that might be a deal.
Barker.

How would you suggest people couples who are
not in sex therapy to ask eachother for something like this,
like you?
What you just said before stuckin my mind that women have a
really hard time asking for whatthey want, and I think men too.
You know in different ways, butif there's like, oh, I want to
explore this new thing, or Iwant to explore and it's
especially people are in along-term relationship, or you
know how, how do you just bringit up in the moment might be

(37:05):
tough, but how do you?
sit down and say hey, hubby, youknow what I really want to do.
Like, how do you do that?

Totally, I , yeah.
So a few things I think canhelp with that.
One is, although you certainlyhave a right to make sexual
complaints and if you truly havethem, you probably should make
them If there's things thatcould be shifted without
complaining, it's probably bestto focus on what you want rather
than being like.
You know, what disgusts me iswhen you kiss me like that.

(37:33):
It's just the worst feeling andit reminds me of my uncle, like
you know, like he has a beardand your beard is scratchy.
And you know, like whatever,like you're describing it that
way is going to shut them down,make them feel so ashamed and so
being able to, whenever you canagain, this isn't always
possible like, make it fun, makeit sexy, like you know, what I

(37:55):
love is when you do XYZ, likewhen you kiss me really softly.
That feels so good, that's myfavorite.
What?
What is the one question Ireally like for couples after,
after sex, like right afterhaving some sort of sexual
encounter, is asking like, whatwas your favorite part?
And then it'll cue your partnerto reciprocate that question
Like, oh, who's your favoritepart?

(38:15):
And you can say like, oh, whenyou did X, y, xyz.
So if they're already doing it.
This is very behaviorist of me.
Like, if they're already doingit, reinforce that they're
already doing it.
Right, like, praise it in themoment, show that you're into it
.
Um, if it's something that theyhaven't yet done but you want
them to do, I think you know youhave a lot of options.

(38:36):
You can, um bring it up, youknow, kind of like before sex,
as part of a bit of options.
You can, um, bring it up, youknow, kind of like before sex,
as part of a bit of like aflirty conversation.
You can do it in a text If it'ssomething that you don't think
is going to be like shocking tothem.
Um, if it's, if it's a bigticket item that you've never
approached, maybe don't do itthat way.
But if it's something that's onthe menu already, like you know
, it'd be super fun tonight is,if you X, y, z, um, so so,

(38:59):
finding ways to make it a littlebit lighter and less like.
I have some critical feedbackfor you.
Are you ready?
Because that tends to turnpeople off and make them feel
like they did something wrongrather than just like, hey,
we're just like going back andforth and chatting about things.

I wonder.
So I had this experience forthe longest time of men being
like tell me what you want, tellme what you like, and I didn't
know.
I mean some things I maybe knew, but in other ways I was like I
don't know.
I've never really analyzed howsomebody has gone down on me and
thought like, okay, this is thething that I like and that's
the thing I don't like, and um,and then, and then I think

(39:35):
there's probably some I don'tknow.
Just part of me is a little bitlike shut down to understanding
exactly what I want and like.
And why do you deal with that?

Totally Well.
Yeah, I think that's reallycommon.
That's how a lot of couples tryto talk about.
Sex is like hey, do you haveany fantasies?
And the other person's like no,and then that's it.
It's kind of like the end ofthe conversation.
If you Google yes, no, maybe,lists, there's tons of these
that are just like free andeverywhere and they are sort of

(40:06):
what it sounds like lists whereyou can check off like yes, no
maybe to different activitiesand then compare them and that's
a really great like externalthing that you can look at and
be like do I or do I not likethat?
And sometimes seeing the optionhelps you know the answer
versus having to come up with itand generate it yourself.
So that's a fun tool.

(40:27):
I feel like that's a fun kindof like sexual date night to do
together and then talk about.
You don't even have to have sex.
That's something that I alwaysencourage is like just talking
about your sex life in apositive way.
Is your sex life?
That's part of your sex life,the dialogue you have about it.
It's not separate from it.
So that's one way I think, thatpeople can get more in tune

(40:48):
with what they like and don'tlike.
Um, I think you know, if you'reworking toward that mindful
self-awareness of sensation,like going toward interest in
the moment and then likereinforcing it, live of like, oh
, like I like like a lightertouch that feels really good, or
like I really don't like alighter touch, it gives me like
the heebie-jeebies when ittouches me really lightly, um,

(41:11):
moving, if you have like aconsent, easy consensual
relationship where this iscomfortable, like moving your
partner to like press just alittle bit firmer, not
necessarily the kind of like umdreaded, like blowjob head press
, but um, like you know, ifthey're, if they're, um, if you
want them to be a little bitmore firmer, like pressing
firmly on their, their skin sothat they can feel that

(41:32):
sensation, like there's somesubtle reinforcements that you
can use.
Um, dirty talk okay, likeharder, like you, whatever.
So that's how you communicatethe interest.
But yeah, I think that, likefantasy reading, these are ways
to figure out, like what you'reinto.
I also don't think there's likean answer.
Sometimes, when people don'thave one particular kink or

(41:54):
they're not like identified witha particular type of sex, it's
like, am I supposed to have somesort of like complex answer to
what I'm into sexually?
And it might be like I don'tknow.
I like sex, I like kissing andlike these seven sexual
activities and that's about itand that's fine.

I've never actually heard someone talk so
much about the retraining pieceand like learn, and so I'm still
puzzling over that andwondering in this kind of
scenario, is it like it's likepeople have their things that
they like and then it's likerelatively fixed or how flexible
can you get in terms of whatyou like?

(42:33):
Like?
If someone asked me that, youknow I'm thinking about like
okay, there's certain thingsthat I have always liked, but
then some things have changedover time.
And now I'm thinking about likeokay, there's certain things
that I have always liked, butthen some things have changed
over time.

And now I'm thinking like, how malleable
are people's like preferences?
Not like I'm no longer going tolike that thing.
It's that like.
Is it possible for me to likeother things too?
Um, and I think that can behelpful.
It's not like, uh, I'm tryingto change you framework.
It's like we're trying toexpand the number of things you

(43:09):
can do.
Only if it's disturbing to thatperson, right, like if I'm
perfectly fine with my one waythat I can have an orgasm, and
it like requires three pillowsand, like you know, a massage
wand from the nineties.
Like, fine, that's fine, youdon't have to have an orgasm any
different ways.
But like, if, if that's notdoing it for you, if it's
causing problems for you, thenlike being able to gradually

(43:33):
loosen, lighten up the intensityof that sensation, gradually.
Like, make the pillows lessfluffy.
That is an option.
Um, women are a little bit moresexually flexible, but it's hard
to say if that's like.
I don't at all have the answerto this like.
Is it biological versus like?
Are women given more space forsexual expression and there's
less baggage about like?
Um, that means like for men.

(43:55):
I think there's so much of likethat means I'm not a man or
like.
That means I'm gay Y Z, and sowomen, generally speaking, do
have a little bit more sexualflexibility, Um, and that's
something that we see.
But yeah, I don't think of itas like changing your
preferences.
I think of it as expanding whatworks for you.

Speaking of gay, um, I just read the book
the tragedy of heterosexualityby this lesbian sociologist and
it was like it was extremelyvalidating to read this book and
the premise of it.
I mean, I'm going to be veryreductionist here is why do men
and women seem to hate eachother?
and yet date each other.
Um, where you know I mean somuch of.

(44:39):
So many of their interactionsare unpleasant, creepy, um, a
lot of women saying things likemen are trash women having to,
like you know, tweeze everysingle hair on their bodies just
to be like prepared for sex.
And she was comparing this toqueer sex where, it's like many
more body types are consideredsexy.

(45:00):
Um, maybe different kinds ofintimacy are considered sexy.
Um, there's a lot more likeplay and flexibility and I don't
know if this has more to dowith um, there's been less like,
um, of a societal consistentmessaging around what kind of
sex is okay, but I don't know.

(45:22):
Do you see significantdifferences with your queer
clients around sex, or do yousee things that come up for them
?
Or do you see things that maybeheterosexual people could like
take from them?

Definitely that.
I mean you know queer coupleshave desire discrepancies, have
sexual you know, differences interms of interest.
Like there's terms of interest,it's definitely not like a
panacea for all sexual ills.
There is really interestingresearch that kind of goes with
what you just said that women inrelationships with other women

(45:56):
who have vaginal pain that'slike diagnosed as vaginal pain
do not experience it asproblematic because there's no
pressure for intercourse and soit's like great, I don't have to
do the thing that hurts.
So it's not distressing to methat I have this pelvic pain.
Versus women and heterosexualrelationships who have pelvic

(46:18):
pain, it's distressing becausethey are trying to have
intercourse and the intercoursethen hurts.
And of course there are thingsyou can do for pain during
intercourse and the ways toimprove that and hopefully
resolve it.
But I've stuck on that as justso interesting that, like you
know how, how positive to beable to have this thing where

(46:39):
it's like oh yeah, I do havethis thing with my body but
actually it's not a problem atall, cause we can just
completely work our sex aroundmy body and the way that it
functions.
So that's, I think, an exampleof something that, like,
heterosexual couples reallycould take from queer couples as
like can we just like work withwhat we've got?
Can we like work with whatwe've got on a given day in

(47:00):
terms of interest, in terms ofbodies?
I think is much more common inqueer relationships so
interesting.

This whole conversation is making me think
about how much we go into sexwith such like blinders, on with
very specific expectations and,um, like beliefs.
Can I do this?
Can I last this long?
Am I this big?
Is my vagina like that?
Blah, blah, blah.
And then it's really more aboutlike exploration and
understanding the realm ofpossibility.

Yeah Well, that comment really begs a
whole other conversation aboutthe role of porn.
But that might be a bigger canof worms.
Please tell us that, becauseyeah, let's dig into that.

Is that?
How can porn be helpful orharmful in your practice?
Have you seen?

Yeah, I mean I'm like porn neutral and I
try to be really clear aboutwhere I'm coming from around
porn, both like on social mediaand also with clients, because
some people have very, verystrong stances and I just always
want people to like know whatthey're getting.
So I'm porn neutral, which islike porn exists.
Porn is a thing that is in theworld.
Um, there are forms of pornthat are more ethically made and

(48:12):
if the ethics of your porn areconcerned, like those are
options.
Um, people use porn Like I I'mkind of just straight down the
middle Like it's a, it's asubstance, basically it's a
material that is available andpeople are going to use it in a
lot of ways.
I do not take the stance thatporn is cheating, which can
sometimes anger people on theinternet.
I would just say that out frontin case you're listening and

(48:35):
you're like what does she thinkabout that?
I'll tell you what I thinkabout that I really believe in
people's like right to privatesexual expression and that you
you know what turns you on andhow you masturbate, as long as
it doesn't involve like anotherhuman being, sort of like live
with you.
That that's up to you.
So I'm not not down to helppeople tell their partners

(48:57):
they're not allowed to use porn.
However, I do recognize thereare some concerns that can come
up around partners' porn usethat are very relevant to the
relationship and are things thatI work with.
So, yeah, porn can be just, youknow, whatever.
For people it can be somethinglike oh yeah, when I want a
quick orgasm, it's something Ilook at.
It has nothing to do with oursex life.

(49:17):
We have as much sex as we wantto have.
It has nothing to do with oursex life.
We have as much sex as we wantto have.
It can set up reallyunrealistic expectations about
sex.
That's a thing right, like itcan do that.
I don't think it has tonecessarily, but it can, and
I've definitely seen that happenwhere expectations about what
types of sex acts are just kindof like gradually getting more
and more intense and whencouples that don't have an

(49:40):
agreement about like oh yeah,we're interested in kink that
there's this just likeintensification of like everyday
sex the vanilla sex is gettingless vanilla.
Basically related to pornconsumption is something that
I've kind of observed, whichmaybe isn't a problem Like.
Maybe for some couples it'slike great, we're learning new
things.
But if your partner is sort ofsubtly being influenced by porn

(50:02):
and expecting things from youthat are not your desire, that
can be a problem.
I do think you know, just from alike physiological standpoint,
if somebody has a morecompulsive relationship around
porn, especially as guys getolder, they may have difficulty
bringing sexual energy to theirpartner if they are masturbating

(50:25):
a lot period.
Often it's paired with porn,but I guess it isn't necessarily
paired with porn.
But if you're masturbatingtwice a day, like as guys age,
they're just going to have adifficult time bringing any
sexual energy to theirrelationship.
Like the semen is gone becauseit's been spent elsewhere.
So that can come up as an issue.
I mean it's so, so nuanced andlike complicated to talk about.

(50:48):
But yeah, my stance on porn iskind of like it exists and we
have to grapple with it and somecouples can use it within their
sexual relationship in a reallypleasing way and others, you
know that doesn't work for.

Yeah, I I'm very like, generally pro porn,
but I have seen in my 20, in mysad 20 dating life where you're
you're hooking up with someoneand you're like you got this
move from porn, Like I don't.
I don't think I could be wrong,but I don't think women like

(51:20):
what you're doing.
It's just like you're just liketrying to buff out a, you know,
a scratch on your car.
This is not something.
We're in a position that youknow.
We're aiming to be visible tosome like imaginary camera.
I mean, this is not working.

Yeah, I did various practicum at college
counseling centers in mypostdoc too, and so I got lots
of like bad hookup story contentin sessions and definitely that
I think, especially for youknow, especially for more casual
sexual encounters where youdon't have that context of like,

(51:58):
hey, actually I don't like that, like don't do that, um, where
that might be harder to say thatsort of like pornification of
daily life, like, yeah, I thinkit's a thing, um, yeah, I don't
know that I would go so far asto say I'm like pro porn, but
I'm not anti-porn either, I'mporn neutral.

I'm kind of anti-porn, so we've got this to
actually.

I mean.

I'm not, I'm not like holy um, I just
wish all porn were directed bywomen, I guess.
Yeah, because I wonder, you know, if, beyond the expectations
for like particular sex acts,there's also.
So I don't watch porn, but I'lltake a gander occasionally, and
it's just it.
And by a gander I mean I don'tdo any deep dives or anything
like that.
It'll be like what's on Pornhub, right, what are the trends

(52:40):
these days?
And the one common denominatoris all the shit that the tragedy
of heterosexuality is talkingabout, like really debasing
women and really gnarlyrelationships between the man
and the woman in the scene, andthen, you know, terrible sex.
So I don't know, I don't have aproblem.
Yeah, that's a bummer, I meanthere's.

so that's yeah, directed by women is a
great option.
Paying for it, you know, thisis when there's a difference.
You know, say I was workingwith a couple who, you know, one
partner uses porn and the otherpartner is really uncomfortable
with it.
Often, where we might end up,at least as an option, option is
like let's start paying forporn, let's stop like whatever

(53:23):
comes up on Pornhub is what Iconsume.
Like let's start beingpurposeful about, like what I
invite into my sexual fantasies,because there's just much
better quality porn if you payfor it, which makes sense
because I think you can make abetter quality product if you
got paid for it more directly.
And then there's some modernlike porn slash sexual education

(53:44):
platforms that I've seencouples use and enjoy, like
there's one called OMG.
Yes, that is like both sexeducation and also has videos,
and so you know it is a reallydifferent framework.
So I think that can be a nicecompromise if there's a
difference around expectationsabout porn.
Like I'm not going to watchporn.
Where we're worried like wasthis person exploited?

(54:06):
Where we're really concernedabout kind of the messages that
the porn is sending, althoughcertainly, you know, I don't
ascribe to the idea that likethere could be very feminist
porn that looks on the surfacedebasing to women, because maybe
that's just the interest.
Yeah, right, exactly so.

(54:28):
Um, you know, I don't thinkthat all feminist porn.
Actually, this was a reallyinteresting thing.
I taught human sexuality, um,when I was in grad school and I
showed porn clips in the class,um, which is an interesting
thing, and I did.
I didn't ask permission from,like the school, I just kind of
did it and it worked out.
And so, you know, I sourced allthese different types of porn
clips and part of the exercisewas like what is feminist porn?

(54:50):
If we're watching pornographyand assessing it for being
feminist, like what does thateven mean?
And one of the things thatstudents kind of consistently
came up with was, you know, thefocus on like consent and the
visible pleasure was reallyimportant, not necessarily what
the clip was like.
And so I showed clips that weremore like romantic and often

(55:11):
initially people would be like,well, I thought that would be
the feminist porn.
But like it's not necessarilyjust because it's like soft and
romantic and like a littlesquishier feeling, just because
it's like soft and romantic andlike a little squishier feeling.
It could be hardcore, like BDSMporn, and it could still be
really overtly feminist,depending on how those sex acts
are framed and set up and howthe consent is shown, and like

(55:32):
what's happening with the powerdynamic, like can still be
really feminist pornography.

Yeah, I mean, I think part of what I
object to is just that the, thegirl, is always kind of
portrayed as like stupid, likedumb, and I don't whatever.
Any of this can happen infeminist pornography too, but I
just I will anyway.
And I'm also worried about,like, the younger generation and
they are not going to pay forporn and so they're going to

(55:59):
consume whatever is at the topof Pornhub and I'm concerned for
society.
But maybe that'll be for thenext generation of therapists to
work there.
I don't know.

Maybe there'll be a movement of like
pay for your kids' porn.

Yeah, I think the only question I had
left was like what do you dowhen there has been a history of
sexual assault that isimpacting the sex life of your
patient?

Yeah, and that's something that often
people are dealing with, bothlike in their individual therapy
and then also in their couple'stherapy.
And so, you know, on theindividual level it's like
trauma treatment to address thattrauma.
On the couple's level, I thinkyou know you can bring the
partner in to just reallyunderstanding why certain things

(56:49):
might not be available, helpingthem, you know, have more
compassion and understanding,because sometimes it might seem
kind of idiosyncratic, it's likewhy would me like you know I'm
a safe person why would me likebrushing up against your
shoulder be sort of stressingfor you?
And people can personalize that.
So education to the partner ofkind of like how trauma symptoms

(57:10):
develop and how they work, thatit's really not personal.
Sometimes one person will youknow the person who's
experienced a sexual assaultlike they really want to take
back more of their sexualactivities.
They don't want to be sort oflike letting trauma triggers
decide for them what sex actsthey participate in, and so then
there can be kind of likecoping strategies for like, okay

(57:32):
, this is my.
You might experience, you know,a trigger.
You might experience, you knowsome, some sensation during sex,
like what's the plan when thathappens?
Um, there's a really nice old,older book, um, by Wendy Maltz.
It's called the sexual healingjourney.
Let's see what it's called thesexual healing journey.

(57:55):
Um, that has a lot of likereally nice exercises and like a
very sort of practical approachto dealing with triggers that
come up during sex and like kindof healing sexually, both
individually and as a couple.
So that's like a very widelyavailable on Amazon option.
Yeah, it's a really challengingthing.

(58:19):
I recently answered kind of thisquestion in my newsletter and
the question writer posed it as,like my boyfriend keeps doing
something that he knows I don'tlike due to my sexual assault
history, but he has ADHD and isreally impulsive and he keeps
doing it during sex.
And I thought it was such aninteresting question and I

(58:41):
really thought a lot about itbecause, um, you know,
especially with the written wordand without an actual couple in
front of me, I know that peopleare likely to kind of polarize
and be like, well, that's a dealbreaker, like that's violating
consent, that's, you know,sexual assault on its own Like
you should break up with him.
Or like, well, he has ADHD, hecan't help it and like you know,

(59:02):
you need to be compassionate tohim.
That there's we're reallytempted to polarize and see this
in a very black and white way.
Um, and and you know kind ofwhere I came down to with that
particular thing, which isn'texactly what you asked but I
just think is interesting um wasthat there's like appropriate
boundaries that need to be set,that there's like appropriate
boundaries that need to be setright.
Like, if someone keeps violatingyour boundaries, then you need

(59:23):
to decide, like, what am I goingto do?
Am I going to continue to besexually available, knowing that
this might happen again?
Am I going to limit my sexualavailability?
Am I going to ask for certainsteps to ensure that this can't
happen again?
It really made me think, youknow, especially thinking
through.
Well, does it matter what thesex act is?
I pretended that it was kissingthe person's neck, but what if

(59:47):
it wasn't that right?
Like, what if it was a moreintimate sex act?
That would probably change theanswer too.

I did think of one more question, but I
don't want to steal it Go for it.
Okay, my last question is youwork with high conflict couples
and a lot of people in thoserelationships describe the
rollercoaster and therollercoaster is bad, but it's
also good because top of therollercoaster it's really fun
and passionate and maybe in thatpassion can be a reason why you

(01:00:16):
stay in it and I would thinkthat has all sorts of
implications for sex and maybe amisuse of sex, like after
fighting the sex is really greatand maybe that can encourage
fighting.
Any kind of notes on that?
On that?

Dr. Marina Rosenthal (01:00:33):
dynamic.
Yeah, sometimes when I postabout the intersection between
high conflict and sexuality,people be like there's no way
these types of couples arehaving sex.
And of course, some highconflict couples don't, um, but
a lot do.
And it is exactly what you'redescribing quite often, where
there is that rollercoaster andmakeup sex is a really big
ritual, um and and it's likeokay, we know, we're okay.

(01:00:57):
But that does tend to reinforcethe like toxicity and the ups
and downs, and so I, you know,kind of like tend to recommend
delaying makeup sex.
Like don't fall into bed, right, as you're, okay, we made up,
Now we get to have this, becausethat really reinforces like
this is what we get after.
We're horrible to each other.

(01:01:18):
Make sure you fully close theloop.
Make sure you actually properlyresolve the conflict.
What people often do withmakeup sex is like they resolve
it just enough to start makingout and then afterward it's like
everyone has good, happyhormones and they're no longer
in the mood to keep fighting, sothey just move on, which can be
fine once in a while, but ifthat's your main conflict

(01:01:40):
resolution strategy, it's reallynot going to work.
So, you know, sex is awesome,but it's not a good like
perpetual conflict resolutionstrategy If it means that you're
actually avoiding the problemsthat you're fighting about.

Dr. Kibby McMahon (01:01:55):
Great.
Do you um?
Where can people find you ifthey want to?

you know, get more resources, or even are
you taking new clients, or I'mtypically full um, something I'm
starting to do a little bitmore often is in-person
intensives in portland, oregon.
So, in general, my caseload isfull for ongoing clients.
But, um, if people either arein Oregon or have the ability to

(01:02:22):
travel to Portland, which is afun city, um, that that's a way
to work with me.
If that's something you'reinterested in, and that
information is on my website andthen you can reach me for just
like, general um, generalcommentary on relationship
complexity.
Um, on both Instagram and Tikat DrMarinaRosenthal, and if you

(01:02:43):
click to either of those places, you'll see a link and it will
lead you to various resourcesthat you can check out, some of
which are free my blog, variousways that you can hear more from
me.

Jacqueline Trumbull (01:02:57):
Awesome.
I do recommend you check Marinaout on Instagram at Dr Marina
Rosenthal.
I do not tend to follow a lotof psych accounts.
They irritate me, but I do likeyours, um, and you do address
complexity in a lot of differentways and I really appreciate
that, because that's difficultto do in a 90 second clip.

Thank you, that's nice praise thank you,
that's nice praise.

Jacqueline Trumbull (01:03:27):
well, we will see you all next week.
This was a really gratifyingtopic to have an expert on,
because it's usually just kibbeand me talking about our our own
experiences or hypothesizedexperiences.
So thank you for giving us somelegitimacy for this and thank
you for coming on for a secondtime.
Maybe we'll see you again, butfor now I love it.
Thank you for having me.
Thank you everyone forlistening and we'll see you next

(01:03:48):
week.
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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Interview with Dr. Marina Rosenthal: Unlocking the Secrets of Sexual Health and Intimacy through Sex Therapy

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