Common Questions Part II
What is the process of couples counselling and how can we prepare best to get the most out of it?
The first meeting with a couple is an assessment to get a map of all the factors that contribute to the strengths and difficulties in the relationship.
Some areas to be explored at the beginning could include questions about the following:
- Current medication and significant health issues, whether current or in the past
- How the couple would describe the issues that bring them to therapy
- What relationships were like with parents and other significant family members
- What were some major family events, such as divorce/death/illnesses
- What was their experience of school - how successful were they academically/sporting-wise, was there any bullying, etc?
- The current picture; such as work, friendships, financial pressures, and any other significant issues, e.g. ageing relatives.
Sometimes people find it helpful for the therapist to meet each individual separately before a joint session, but it is up to the couple to decide this.
Sessions can be 50 mins or 90 minutes, depending on what best suits the needs of the couple, and this is to be agreed at the beginning.
The usual pattern of attendance would be an initial 4-6 sessions on a weekly basis to gain momentum. After that it may be reduced to fortnightly, due to cost or time restraints. However, meeting much less than fortnightly tends to diminish efficiency.
Sometimes people are concerned about being able to communicate the issues, or to answer questions, and that is ok! Being able to say that you are stuck, confused or unsure are all helpful pieces of information and does not in any way prohibit you from benefiting from therapy.
Common Questions Part I
Some people may have concerns about entering into psychosexual therapy and this can result in a considerable delay in getting help when it is needed. This is unfortunate, as problems can become more entrenched over time. It would therefore be preferable to seek support sooner rather than later.
Below are some common questions that people often have about psychosexual therapy, and the answers that may serve to alleviate your concerns.
1. What if I’m uncomfortable or too embarrassed to talk about sex?
People are often embarrassed to talk about sex, and worried about what happens in the sessions. It’s worth bearing in mind that the therapist is usually extremely experienced and used to talking about sexual issues. They are very skilled at putting your mind at rest and asking structured questions that are relatively easy to answer.
2. Is there any nudity involved in the sessions?
Absolutely not. It is part of the ethics of @07 that there is no physical contact with clients, except perhaps shaking hands to greet each other.
3. Do I have to be in a relationship to go to psychosexual therapy?
If you are in a relationship, any sexual issues you have are best solved by working together as a couple. However, if you are on your own and not at peace with yourself sexually then therapy can help a lot.
4. What kinds of problems do you treat?
A psychosexual therapist will treat anything and everything that contributes to sex not being as enjoyable or rewarding as you would like it to be. This can range from relational issues through to the impact of medicines, illnesses, problems with sexual function, etc. For more information about common issues, go to: @08, @09 and @10.
5. Are our problems bad enough to get help?
Many people ask this, and a related question may be “am I too old?” or “should I accept the way things are?” The thing to remember is that severity is not important. If things are not working as well as you’d like, if things are disappointing or upsetting for either or both of you, or if things change, it is well worth coming to therapy. Some people come with milder issues but find that the outcome is very significant in their lives. In essence, no issue is too small.
6. Are you going to give us exercises to do?
It is very common to give people exercises or homework to do throughout the course of psychosexual therapy. They are often communication exercises or improving habits/resources in the relationship. Most often the real work of therapy is done outside of the sessions, when theory is put into real life practise.
Teenagers do not necessarily want to discuss sex with parents as it is a private and a sensitive topic. However, I believe it is possible and immensely valuable for a family to be able to sit around the table being comfortable to share their curiosities around sex and relationships, as it is such a healthy and natural part of teenage life.
Many wish for their children to have a different experience of parenting and relationships than they themselves have had. Religious backgrounds can contribute to this as they can imbue a sense of shame and guilt about sex at worst, and at best, often a sense of awkwardness. Parents often wish to support their children in this delicate area but are slightly at a loss as to how to do it, however the teenage journey is too complex to manage on their own or with only their peers.
We live in times where teenagers are subjected to many messages around sex and relationships and the Internet and social media are key influences. Parents need to develop a coherent strategy to approach this that remains consistent between them, built on understanding rather than shame and guilt. It is up to parents to determine whether this is about firm boundaries, flexible boundaries, allowing children to make their own decisions or a combination of these. It is important for teenagers to navigate the Internet safely, learning about safe practice around issues such as sending images, meeting strangers online, and posting personal content on social media sites. It it also hugely beneficial for parents to discuss pornography with their children; to talk about how it objectifies women and men and to identify its two-dimensional nature that is totally lacking in emotional and relational content.
Learning to discriminate what constitutes a healthy relationship is a vital skill for young people and this is unarguably helped by parents modelling a healthy relationship, recognising that the way you relate as partners is offering positive or less positive messages to them. Skills such as the capacity to empathise and recognising when someone is being overly controlling are essential tools for helping teenagers make better decisions about their relationships.
In my experience, parents care deeply about these issues but often lack the confidence to address them skilfully. It’s my firm belief that exploring and discussing the issues with each other and possibly a professional can lead to a more confident and skilful approach to this complex parenting challenge.
Lifecentre - Unlocking the past, Surviving the present, Reclaiming the future.
Lifecentre is a UK based charity that supports male and female survivors of rape and sexual abuse of all ages. They offer a national helpline and a counselling team based in Sussex, England.
Lifecentre specialises in counselling survivors of rape and sexual violation, whether this has been a recent incident or historical. They are open to all male or female survivors, adults and children, regardless of race, colour, nationality or ethnic origin, gender, disability, sexual orientation, educational status or religion. Lifecentre offers helpline support with separate telephone helpline services for Under 18s and adults, and a text helpline service for all age groups, run by appropriately trained volunteers. They offer both face-to-face and email counselling, with professionally trained counsellors, to survivors of all ages and their supporters, whether these be close family members or friends, or partners of survivors affected relationally by sexual violation.
Many rape and sexual trauma centres haven’t managed to resolve having positive images of men and Lifecentre have worked really hard on this. I highly recommend their services. To find out more, visit their website: lifecentre.uk.com.
The menopause is a natural part of the ageing process which occurs as a woman’s oestrogen levels decline. It is probably pointless to try to describe the menopause but more useful to capture how personalised it is. The menopause varies greatly in the range and severity of symptoms, timing of onset and duration. In some ways it is like puberty in that it is a significant life transition, however puberty has a considerable degree of commonality while menopause is typified by uniqueness and difference. Because of this it is important for women not to compare their symptoms with others, but to talk to each other about their experience.
There are stereotypical symptoms of menopause, such as hot flushes which can be variously impactful, but the range of symptoms and how they are experienced varies enormously.
Intimate relationships can be affected in a number of ways. There is often an over focus on sexual issues; libido, arousal and physical responses such as lubrication can all be profoundly affected. However, being hot and ‘moody’ can result in a partner and/or children to be pushed away while the very thing that both partners in a relationship need at times is reassurance and love. The challenge here is how to keep emotional trust and closeness.
It is helpful to remember that menopause always happens in a context. Professionally a woman may reach the highest levels of demand in her work, right at a time when her resources are depleted by the menopause. Or, she may be dealing with a loss of some aspects of her female identity right at a time when her children are fleeing the nest. Women often find the impact of the menopause on their work place quite distressing. Issues of focus, clarity and perception can all be variously affected and often compounded by both relational tensions and physical symptoms.
It is also important to acknowledge that medical treatment of some of the symptoms have developed considerably from the HRT (hormone replacement therapy) approach of the recent past. More subtle treatments (such as other medications or talking therapies) of various symptoms are increasingly becoming available.
What to do
Give yourself permission to experience your own symptoms and their significance in a personally felt way. Acknowledge that it can be impactful in work, at home and in intimate relationships. Don’t compare yourself to others - your experience is unique. Journal your own symptoms and consider their impact on you.
There is no need to suffer alone - know that there is support out there and you can choose to seek help in dealing with this complex life transition. Discuss with a psychosexual specialist to explore what can be treated medically and what could benefit from talking therapy.
Fertility, conception, Pregnancy, Birth and Children
The whole process of having a family can have a variety of effects on a couples relationship and their sex life.
Trying to get pregnant can often skew the sexual relationship. Sometimes the women will try and ensure sex happens at her most fertile phase in a way that sends the male a message that sex is for having a baby not because they love each other. Ideally, it should seem like both to each of them. When sex becomes just about conception then the quality of experience and performance often declines. In my counselling in central London I often find myself helping couples in how they manage this process more skilfully.
Pregnancy often affects the quality and nature of sex. During pregnancy the female hormones change dramatically and this in turn can have a profound effect on libido. So libido can go up or down at various stages of pregnancy. In addition issues such as morning sickness in the first trimester and physical discomfort during the later stages of pregnancy can have a profound effect on appetite for sex. Equally fear of doing some damage to the pregnancy can often effect a man’s attitude towards making love.
Birth is often a wonderful experience, but the process often leads to both partners views toward the women’s body changing, and this in turn can have an impact on sex. In my psychosexual work in Portsmouth I often run small groups for couples who are recovering from the impact of pregnancy and birth on their relationships and sex lives.
The bringing up of children can have a profound effect on a couples relationship and sex lives.
I will talk more about this in my next article. However, a couple of areas that often have an effect are the young infant sleeping in the same room or even in the same bed. This often leaves both parents preoccupied about disturbing the baby or being overheard. Equally, breast feeding can change both partners feelings about the female body often in positive ways, but it can often impact upon sexual behaviour.
Online Therapy - Skype & FaceTime
I find that I am treating more and more clients on line. Some of my clients have moved overseas or are travelling extensively. Other of my clients would find it difficult to get to my clinics due to the pressures of work and children. Skype or FaceTime provide really good tools for face to face contact with individuals and couples. I prefer if possible to meet clients face to face for initial assessment as face to face does enable one to get a ‘real feel’ for the nature of an individuals or couples difficulties and the way therapy can best meet their needs. However, I am working with some clients that I have never meet in person and feedback is that online therapy still works well from a client’s perspective.
I have couples who have recently had a child, and being able to have therapy in their own home without disrupting the baby’s routine has been very welcome, and avoided unnecessary stress. Online therapy has also proved a useful resource for those with mobility difficulties or other impediments to travelling to a clinic.
I have to say whilst initially reluctant to work online based on my commitment to a personal relationship with my clients, I was persuaded to try it by a few clients. Suddenly, I find myself doing 20% of my work on line, and I find it every bit as rewarding as face to face work, with the added benefit of knowing I have improved access to my services.
Empty Nest Syndrome
Empty nest Syndrome does not refer to a clinical condition but it does refer to a commonly experienced set of issues that individuals and couple have to grapple with as their children leave home.
The range of issues and their severity can vary enormously and therefore recognising the situation and treating it is complex and subtle. This is compounded by the fact that it often occurs alongside other complex life changes such as the menopause, health issues, or changing work circumstances.
The moving away of children can cause a real sense of loss. This loss can be of day to day issues but it often results in a loss or confusion of our identity. This may be most true for women but it is also true for many men. In addition to these adjustments it often results in a couple having to face complex issues about their relationship. Many couples have spent the last 20 years on a shared project that has taken much of the time and resources that they they have left after work and sleep. This often results in them neglecting to nurture their relationship. They may have a sex life that has deteriorated or disappeared. They may no longer share interests or a common understanding of what their marriage is about.
Many couples seek therapy to try and resolve these issues as they fear that their marriage may be at serious risk. I am often struck by how quickly and simply the situation can be addressed and improved. Getting the couple to identify bad relational habits and start to replace them with healthy well resourced time together can create a platform to reinvent the marriage and identify common ground. It often involves developing individual personal development as well.
When it works it is really rewarding therapeutic work. It often involves repairing physical intimacy, and identifying early cracks in the relationship alongside supporting a couple in getting to know each other as they now are. It is also common for it to have other benefits for example I have often seen the parents change the nature of their relationship with their children. Updating and developing an adult relationship with your adult children can be one of life's great journeys.
Should you feel you would like to explore these issues please do not hesitate to contact me.
Loss of Libido
One of the most common sexual problems that men and women come to clinic reporting is the loss of libido (sex Drive) frequently due to too much work or depleted resources.
The causes are manyfold but one of the main contributory factors is doing too much. For women in particular, the combination of work, children and running a home leaves them with very little energy for anything else. It is also true to say that many men have exhausting jobs and very long hours of work not to mention the increasing demands of family life with busier partners.
Recognising the causes of loss of libido and attempting to rectify them will not necessarily enable libido to naturally recover. It is sometimes helpful to see the libido as like a garden. It needs many conditions to recover from years of neglect. One needs to get rid of the weeds aerate and feed the soil ensure sufficient water and sunlight. at this point you can plant seeds and over a period of time small shoots will occur. If you tend to the shoots and look after them over a period of time they will will grow into healthy robust plants that can withstand the vagaries of even the english weather.
Reclaiming libido is often complex and paradoxical. If you try to ‘be more sexual’, libido will often diminish.If you soldier on libido will often decline. If you put the problems right libido will often continue to flatline. Sex is a habit as is feeling sexual. If you anticipate regular and fulfilling sex then libido will tend to operate at healthy levels. However, if libido has declined to very low levels it is important to notice little green shoots, then tend them carefully, and do not try to grasp at it like it was a vigorous young plant.
Libido is a complex and precious part of our wellbeing and when it has been neglected it is important to take care to rectify the situation in a patient and attentive manner.
The impact of online pornography on young men
For many teenage boy and young men the first exposure the get to sex will be by online pornography.
This is a very worrying development in modern society. It can give young men several unhelpful messages about sex women and men. Firstly, the message is that sex is not about relationships and is almost entirely about males getting their ‘physical pleasure’ without regard for the emotional and relational aspects of sex and intimacy being given any regard. Secondly women are largely portrayed as objects for mens pleasure and issues of the emotional or relational needs of women being almost entirely disregarded. Moreover, Young men are being exposed to many practices that are not necessarily enjoyed or practiced by most couples in loving committed relationships as though they are normal common and to be expected in sexual relationships. It is even more worrying that internet porn is highly addictive and users can spend large amounts of time view porn to the neglect of forming relationships and developing intimacy skill. Many young women are reporting going further sooner with sex due to boy friend pressure which is another worrying dimension of this growing problem.
I find in my clinic more and more men coming to deal with their addiction and get help forming relationships or support in repairing the damage that the habit has done to existing relationships.
It is really important that parents engage in education their sons and daughters about the true nature of sex and intimacy and the negative impact that porn can have. I am pleased to note that more parents are discussing these issues in therapy and exploring ways of managing these issues with their teenage children.
Relationship and sexual care for cancer patients
I have been delighted to be welcomed with open arms by several different groups of professionals caring for cancer patients. There is definitely an increasing awareness of the need to support cancer patients after initial treatment in other areas of their lives that the illness and its treatment have effected.
Oncology Teams including Macmillan nurses and charities such as cancer-wise are offering all sorts of help support and therapy for cancer patients and their families to deal with the impact of the disease. Regular health and wellbeing events are offered by west sussex NHS across the county. I have been invited to speak about the effects of the disease and its treatment on Relationships and sex. My message on how much relational and sexual improvement can be achieved with a little expert therapy was received with real enthusiasm by many at these events.
I hope to be working closely with these teams to support cancer patients over the coming years.