The Los Angeles Times ran a couple of articles on January 11, 2010 on the issue of whether or not a Doctor of Psychology (Psy.D.) was worth any more than the paper it was written on.  Apparently, there is a group of psychologists that feel (since research does not back them up) the Psy.D. is a lowly substitute for lazy folks that don’t quite have what it takes to handle the rigor of the more highly prized Doctor of Philosophy (Ph.D.) in psychology.  Their reasoning is that because more schools that turn out Psy.D.’s are independent schools, which have a higher acceptance rate than Ph.D. programs that are attached to a university.  Psy.D.’s, they argue, don’t do research and therefore aren’t equipped to provide science-based psychotherapy.

Horse rubbish.  I am a proud possessor of a Psy.D., the only drawback of which is that Ph.D.’s like to take pot shots at my degree.  In fact, when I was in grad school I remember dreaming that a fellow Ph.D. student parked her Cadillac on my then rather sad-looking front lawn; talk about an inferiority complex.  I’ve gotten over that, though–and my lawn has been replaced with water thrifty plants, to boot.

What the heck is a Psy.D., you might be asking yourself.  Well, it is based on the so-called “Boulder model” of training, which came out of the University of Colorado at Boulder.  The idea was that those psychologists that wanted to practice psychotherapy needed to have more clinical training and supervision.  In order to provide top notch services, the Psy.D. needs to be able to evaluate research and implement it in the clinical setting.  To that end, the Psy.D. writes an extensive review of an area of research literature for a dissertation, as opposed to doing a piece of original research.

For my doctorate, (more…)

As important as our sexuality is, I doubt very much whether many people review their sex life over the past year and ponder a vision of what could be possible in the New Year.

The “oh” decade (years 2000 through 2009) brought us a war over abstinence-only sex education, an injection was introduced to help women avoid HPV, and more pills and potions were created to ensure an erection, create desire, or make sex feel better.  We were also witness to multiple sex scandals, from Larry Craig sending Morse code in a public bathroom to Mark Sanford lying about hitting the Appalachian Trail when in actuality he was winging his way to see his soul mate in Argentina.

Also in this decade were a slew of books about low desire, no erection, no orgasm, ejaculating too quickly or not at all, tantric sex, no sex, and the difficult-to-define too much sex aka “sex addiction.”   (More on this latter topic next week.)  It’s difficult to tell if the world is really a better place despite the efforts of so many well-meaning authors.

If I could make some wishes for the year ahead, they might include:

• Couples would talk to one another about their sex life in the same way they talk about what breed of dog to get or what refrigerator to purchase
• Men would stop measuring their self-worth by their erections, and women would do the same.
• Women that don’t enjoy sex would admit it’s because they have never told their partner what to do to make sex enjoyable.
• People would understand that sexual problems that take years to develop can’t be resolved in a single 50 minute session.  Couples wouldn’t wait years to see a therapist, making their problem all the more complex.
• Pharmaceutical companies would state in their ads for antidepressants, anti-anxiety medications, sleep medicines, and sexual aids, “Try psychotherapy first.  You may not need medication at all.  And if you do, your therapist can refer you to a psychiatrist for treatment.”  Ideally, however, such advertising would be banned.
• Sex education would include information about the serious decision-making and responsibility involved in choosing to be sexually active.
• Every pregnancy would be a wanted pregnancy.
• People that are frustrated by monogamy (more…)

If you regularly read my blog, you may have noticed I haven’t posted anything in over a week.  Here’s why:  I have a book contract, and most of my creative energy is going into that endeavor.  It isn’t an easy book to write, and it isn’t a book that is going to make me rich, but it is, I think, an important book, one that takes another step toward de-stigmatizing mental illness and helps couples struggling with sexual issues.  There is no other book available that is like it, and as we go into the next year, I’ll share more about it.

So forgive me for not being current. The blog is important not just to me, because let’s be honest, a blog is a marketing tool, but it is also important to my readers.  Most of them are unseen, but occasionally people email me to let me know that they read something helpful in one of my posts.  I am contacted by people around the globe, folks that have very little access to good information on sexuality.

I enjoy sharing what I have learned and my perspectives.  Sex really is important to quality of life; when it isn’t working it makes people quite miserable.  If I can help someone untwist some strange myth, or identify the name of a problem, or give some good information or a link to something important, that is gratifying for me.

I was an elementary school teacher for a decade, so I am always teaching.  I don’t always know if I am having an effect, but I assume that I am and keep marching forward.

I hope the next decade brings us all closer to true sexual health–the freedom to express our sexuality in the way each person sees fit, without exploiting or being exploited.  I hope I can add to that effort in a meaningful way.  I hope more people have want they want:  Satisfying sex with a loving partner.

Today a major pharmaceutical company announced that preliminary studies of an antidepressant call Flibanserin suggest that the drug helped premenopausal women experience more sexual desire and greater sexual satisfaction.

The announcement created the usual cascade of media attention generated when the topic is sex–especially when it is made by a powerful pharmaceutical company with a rich budget for PR.  Make no mistake, image is going to be a huge factor in how the company will be able to market and sell the drug to women.

This brief article and interview with Dr. Jennifer Ashton on CBS seems pretty balanced.  Dr. Ashton mentions that for women the topic of low sexual desire is complex.  There’s a lot more to it than “plumbing,” as it seems to be for men who have Viagra and other PDE5 inhibitors to help them out.  That’s an important distinction, because the media is calling Flibanserin “female Viagra.”  It sounds like an apt analogy, but isn’t really.  PDE5 inhibitors work to keep blood in the penis.  This new drug for women is a psychotropic medication, meaning that it works on the brain.

Another balanced article appears here, in which two OB/GYNs discuss the pros and cons of medication.

On some level, this reminds me of what initially occurred when Prozac came on the scene.  Many people that took it felt that it enhanced their personality, and this caused a discussion of so-called designer or lifestyle drugs.  Is Flibanserin a lifestyle drug?  What do you think?

I can understand a need for the drug.  Sometimes women undergo medical treatments or have life events that truly seem to throw them so out of balance that they cannot recover their sex drive.  For example, recovering one’s libido after a severe bout of post partum depression is very difficult, so an antidepressant that works specifically on drive has a certain attractive quality.

My concern is that the medication be touted not as a cure all, but as an adjunct to psychotherapy, or as a second line treatment when psychotherapy has been attempted but failed.  Take the example of post partum depression.  Certainly it has a hormonal component, but it is always much more complicated than that, often having to do with a woman’s identity, her relationships, her own needs vs. the needs of her infant, and so on.  Can one pill really do so much?  Would it be better to look within, in the context of counseling, to understand the root cause and further one’s own development, or to take a pill and skip that part altogether?

What do you think?  If this drug is ever approved, should ads be plastered all over TV, like ads for ED drugs?  Or should ads be limited to a select audience of women, e.g., placed in publications for mothers of children under the age of 5.  Canada doesn’t allow drug advertising, but we do.

What do you think?  I’d love to read comments.

What a treat I had in store when I contacted Kim Airs, the “sexpert” for Pipedream, a humongous manufacturer of sex toys.  Not only is she incredibly humorous, but she also suggested that we could invite local members to learn about sex toys and tour the factory.

Talk about having a blast and a half.  I’m the Western Regional Rep for AASECT, the largest organization of sexuality therapists, educators and counselors, so I get the opportunity to call and welcome new members.

So we aimed for Friday, November 13.  We only had a few members attend, including AASECT past president Patti Britton and new member Holly Richmond, but a good time was had by all.  First, Kim gave us a tour of the giant showroom filled with racks and racks of toys of every type, color, material, and purpose imaginable.  She pulled vibrators out and put in batteries so we could feel the difference in intensity.  She let us examine Japanese-style masturbation sleeves for men.  And we learned all about the different lubes (Pipedream’s bestseller is a lube called Moist).  Then there’s the Fetish line—not for the faint at heart, but certainly intriguing for anyone who wants to try roleplay.  Dominatrix and slave in a box!

Sex toys can be an important part of sex therapy treatment.  They let men and women experiment with sensation, either privately or together.  They help with orgasm in a way that is low key and non-pressured but still very arousing.  Things like lubricants permit both vaginal and anal intercourse to be more comfortable.  For people who don’t have a partner, they can be essential.  For people that do, they are a terrific adjunct.

Okay, so seeing a giant tub filled with disembodied purple penises is a little weird.  And watching the mild-mannered Latino men and women going about their jobs as if they were making widgets was unexpected.  The factory is incredibly clean and organized, though.

One of Kim’s jobs is to answer questions from people that have bought their products, even though they don’t sell anything directly to the public.  She told us that when one woman complained that her husband bought her a dildo that was too large, she naturally told the woman that the product couldn’t be returned, “but perhaps you can use it as a doorstop.”  In the anything goes world of sex toys, it’s a perfectly fine answer.

Last words from Kim for women on how to pick a sex toy:  “Use your eyes.  If one sense is drawn to a certain shape or color, that’s your body telling you something, so pay attention.”

Thanks, Kim, for an entertaining and fascinating morning.

(In photo L to R, Dr. Patti Britton, yours truly, Holly Richmond, and Kim Airs.)

If you didn’t see “Sex Rehab” on Monday night, let me clue you in:  If ever there was a misbegotten first episode of a program, this was it.  Dr. Drew Pinsky may have tried to compensate for the titillating scenes of gratuitous sex by asking the new group of addicts deep questions, but I don’t think it worked.

If you are struggling with a sexual addiction, then tuning in to Dr. Drew’s program probably wasn’t going to be of any help.  If anything, it could be damaging.  The program showed graphically the kind of behaviors the women that were addicted were involved in, e.g., bondage.  Interestingly, they did not show the men that were addicted half naked and acting out.  What does that say about how women are depicted in our culture?  What does it say about exploitation?  And if, as we learn, the women are acting out sexually because of molestation, emotional neglect, and other terribly sad issues, isn’t the program just contributing to their addiction by glorifying the depiction of what go them into rehab in the first place?

Then, there is the whole question of addiction.  If a person is molested and then acting out sexually, that is (more…)

Just a few days ago I posted about persistent genital arousal disorder (PGAD) aka restless genital syndrome. Then SNL did a tasteless skit about it.  What if this was a character portraying someone with Tourette’s disorder?  Would that be funny?  I don’t think so.

If you watch the skit you’ll see that the actress says that pretty much anything can cause PGAD.  Not so.  It seems to have to do with damage to the pudendal nerve.  Although it can have a psychological component, there is also a biological basis for its manifestation.  And even if it was purely psychological, why should PGAD or any other psychological disorder be a target for stigmatization?

Anyway, I left a comment.  Maybe you will, too.

Just quickly, want to get this off my chest.

Certainly one of the things that drives up healthcare costs is poor mental health. It is a fact that people use their primary care physician to treat depression, anxiety, and a host of physical problems that can be resolved just as readily in the psychologist’s office as with a pill, e.g., irritable bowel syndrome, skin disorders such as psoriasis, and erectile dysfunction.

Physicians’ time would be better served helping people that have medical illnesses, not mental disorders. While psychotherapy may seem expensive, it is no more costly than most doctor’s visits. In fact, psychotherapists charge less per hour because they have little overhead, e.g., there is not much need for administrative help or a large number of patient rooms.

I am not saying that healthcare reform is or is not the answer. Just saying that perhaps, perhaps, if we paid more attention as a nation to mental and emotional well-being, our skyrocketing medical costs might be lower.

What do you think?

That’s the question that someone recently posed to me, wanting to know if a marriage could continue if both spouses simply agreed that their sex life wasn’t very interesting, that sex wasn’t very important, and that their relationship worked well enough in other departments–parenting, finances, socializing–that they could stay together and simply do without.

Answer:  I suppose.  Before I moved into the field of sex therapy and had a more general practice, there were folks that confessed to me that they hadn’t had sex with their partner in a year, or two, or five.  Generally, they stayed in their marriage because of children and finances.  And generally, they were unhappy with the state of affairs, but felt that this was the best course of (in)action.

But being in a sexless marriage didn’t mean that they weren’t having sex.  Probably about half of those folks eventually drifted into an affair or, in the case of men, availed themselves of prostitutes. And then there was always the internet and the comfort of one’s own hand.

In my view, this is simply solving a problem with a problem, creating yet another level of complexity to a poorly resolved situation.  Affairs take energy, prostitution is still illegal, and both carry the risk of an STD.  These two solutions, plus the use of porn, create a huge but silent divide in terms of any intimacy that might be afforded by the marital relationship.

Rather than putting effort into avoiding sex, why not tackle the problem of an impoverished sex life?  Put on your emotional hip waders and splash into the river of relationship to try to sort things out together.  What is missing that you need?  Is it more respect and intimacy outside the bedroom?  Mutual interests that create a feeling of togetherness?  Permission to explore one’s inner fantasies with one another?  Better technique?  Improved lifestyle so that there is energy for sex?

Can a sexless marriage be normal?  Perhaps, but why would you want it to be?

A radio ad for a broken windshield caught my attention–not for the reason the advertisers wanted to, but because I heard it as a perfect metaphor for what happens when couples don’t deal with their problems:

Mr. Jones had a tiny chip in his windshield.  He went through a car wash on a hot day and CRACK!  His windshield shattered!

Are you ignoring a problem in your relationship?  Have you made the problem as tiny as a chip in a windshield because you are afraid to bring it up, or don’t know how to deal with it?

Sometimes partners fear that their entire relationship will split apart if they talk about what’s bothering them.  People keep things bottled up for years, sometimes decades, figuring that it’s better to just keep quiet.

But you know what happens.  The same annoying behavior happens over and over.  You hold in your feelings.  Steam builds up.  Crack!  Now there’s an argument with ugly words and hurt feelings.  And somehow, the issue that really irritated you in the first place gets lost.

Sometimes the therapy office becomes a safe place where partners can learn to communicate what discourages them about their relationship.  In my own practice, that’s sometimes about sexual frustration.  But sometimes it’s other issues, like feeling ignored or criticized.

The little chips get filled in and smoothed over.  Couples learn that their relationship is stronger than they had imagined.  This is when they see that they really do love one another; they picked each other for a reason.

I don’t want to be too Pollyanna*.  Not every couple works things out.  They have basic incompatibilities that were ignored, or so much anger and resentment have built up due to poor communication and relationship skills that they have worn each other out.

But like that chipped windshield, most couples do find that their relationship can be salvaged–though the process may take a little longer than what is promised in that radio ad.

*FYI for trivia collectors, Pollyanna was a character in a novel and later a movie that lost the use of her legs in a car accident, then showed unending optimism, even exclaiming when she opened a surprise package, “Oh, what beautiful crutches!”