Talking about Sex
- Category: Psychotherapy and Recovery Work
The Center for Healthy Sex did a wonderful mailing letting the local Los Angeles community know about my upcoming presentation on Friday, 9:30 - 11:00 a.m. March 30.
Thank you, Douglas Evans, Tom Bliss Alex Katehakis. I'm moved by your conscientiousness and support.
Readers, please take a look at my program topics and let me know what questions you have or stories you'd like to share.The sexual life of an adult woman with an eating disorder can be harrowing without her knowing why or what she can do to help herself. I'll be speaking to clinicians and interns. This is an opportunity for you to let them (us) know what you wish they (we) knew already.
Title: Women, Eating Disorders, and Vulnerability to Dangerous Liaisons
- Does your eating disordered client have a stalker in her life?
- Does she have one night stands and obsess when the person doesn't call?
- Has she been raped?
- Does she know she's been raped?
Joanna Poppink, MFT shows us how the sexual feelings, vulnerabilities and behaviors of adult women suffering from eating disorders are a vital part of effective treatment and how clinicians can work with a client in this highly charged and sensitive arena.
She will be addressing topics such as:
- Responding to obliviousness of abusive reality without alienating your client.
- Moving through issues of shame to support a needed maturation process without evoking crippling self incrimination.
- Understanding the metaphor of dangerous activities that may be an attempt to resolve an issue underlying the eating disorder.
- Using journal writing and guided imagery in treatment.
- Therapeutic restraint.
- Recommended readings.
The mailing also includes my bio information. I'll include it.
My questions to you are:
- What would you like to see discussed among clincians and understood?
- How would you recommend that this topic be brought into the psychotherapy?
- What would be a relief for you?
- What would shut you down?
- What might keep you engaged so you can not only bear your feelings but also share them with your therapist?
- How do you suppose client and therapist can be partners, working together with diligence and kindness, to explore and resolve the sexual hurts and harmful patterns in the sexual life of an adult woman with an eating disorder?
Thank you so much for considering the possibility of responding to any of these questions or adding your story or vignettes of your story. You can help us to help you.
Joanna Poppink, MFT, is a licensed psychotherapist since 1981 in Los Angeles, California. She is also an author and lecturer. In her practice Joanna incorporates the latest findings of brain development and mindfulness practices in order to help women evolve beyond their dependence on eating disorders and move into a life of freedom and health. She is the author of highly praised Healing Your Hungry Heart: recovering from your eating disorder, 2011, Conari Press.
Erotic Intelligence: Igniting Hot, Healthy Sex While in Recovery from Sex Addiction by
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I think therapists need to have thorough knowledge of what can happen in sexual experiences so they are not shocked by anything a patient tells them.
The therapist's emotional response, even when controlled, has a powerful impact on a patient, especially when related to sexual behaviors and fantasies. Perhaps, if a patient realizes the therapist is controlling an emotional response, the impact is even greater.
The therapist and the patient need to be able to meet candidly, without
judging or fear of judgment so these areas and their meanings can be explored.
Both people need to have patience with each others and with themselves.
Thank you again, Tracy.
Briefly off the top of my head:
Yes, there was the use of sex to bring about an almost instant gratification of needing to feel likeable/wanted/good at something
I seduced men because I liked the feeling of power and being in control
I used shallow sexual, short-ish term relationships as a substitute for proper relationships, because I believed that if people got to know the real me they woud see how bad/unlikeable/unloveable I was, and I would be rejected and pushed away - I was unloveable as a whole, the sexual relationship was the best I could hope for (that makes me cry so must be significant)
Those are the obvious ways of using sex to deal with the things that I also used my ED to deal with too, but there's a lot more stuff tied up in sex for me too...
my sexual kinks are a reflection of the attitudes and control mechanisms used by my parents...if I allow myself to be subjected to that same level of humiliation and violence almost as foreplay,then I feel free to enjoy the sex...and it is more pleasurable as a result
I was violently raped by a work colleague, partly because I didn't have the confidence to enforce a boundary that I felt should've been there, because I was scared that I would get talked about and riduculed at work... I was working away, and normally you would meet colleagues in the bar or reception in an evening to go out for a bite to eat and a few drinks, and on this particular trip it was just me and 2 of my bosses, and I was last back to the hotel, so I called one of them to say I was back and to just give me 20 mins to get ready and I would see them in the bar, and he was fine, and said my other boss had figures to prepare so prob wouldn't make it. 5 mins later there was a knock on my door, I thought it was someone from housekeeping or something like that, opened it and he was there. I felt uneasy, and wanted to not let him in and insist that he waited for me in the bar...but in my head it was "he's my boss he's not going to try anything, he's prob being friendly and so it would be rude for me to turn him away, If I send him away he will go back to work and tell everyone what a prude I am cos I wouldn't let him in my room and they will all be talking about me and laughing about me behind my back, I'm a bad person for thinking that he might be anything other than honourable..." and so I let him in.
I like sex, and it is important to me, more than it might be to most people, because my entire life was controlled to such a degree by my parents - mother especially, that my sex life is the only thing that she can't control, that is still mine!
The other thing that I think is worthy of consideration, is erotic transference, as I think it is probably quite commonplace in ED therapy, but very difficult to disclose....but whilst those secret fantasies go untalked about and bubble away under the surface, I think it makes talking about sex in therapy more awkward, sort of like a belief that the therapist will be able to tell that the erotic transference is going on, if we talk about sex and sexuality.
Sex is easy to talk about in therapy, once your relationship is at a certain level...but not before....and I'm not sure how the therapist is supposed to sense when that time is right
Just my collection of thoughts anyway
If you think of more, please bring it on.
An near impossible question I have relates to women who have been raped and don't know it. They may accept the one time event as the normal way that person has sex. Sometimes women are married for years and don't realize that sex with their husband is rape every time. Sometimes group "play" in a hot tub turns into a rape she doesn't recognize by name.
Shame can really cloud perceptions and appreciation of a woman's genuine experience.
I think quite often that women don't know what respect looks like in a sexual sense, until they are shown it, but prior to that they would never really conceive what that looks like for themselves, well enough to actually be able to seek it, and their partners may not see that they are perpetuating the abuse, because the woman thinks, that that is what she wants, and the partner wants to please the woman.
I have 2 examples of this:
A friend told me how an ex girlfriend of his liked him to perform certain sexual acts on her that he felt must be excruciatingly painful, and which always felt uncomfortable about performing, but if he showed reluctance she would get quite unhappy and angry with him, and he felt that as these acts obviously brought about greater pleasure and satisfaction for her than anything more conventional could, that he felt it would be churlish to refuse.
I did ask him if he thought that she may respect him more if he actually refused, but he said not, he thought it would be the end of their relationship.
And the reason I asked him if he thought she might respect him more, is because I saw a guy who when I asked him to perform violent and humiliating acts upon me, he said "if it is REALLY what you would like, as long as you know that I will not get anything out of it for myself, it's not my kinda thing" ...and as things progressed, he couldn't do it, he didn't have it in him to hit me hard enough to bring about any satisfaction, and he eventually said "look, I'm sorry, I can't do it, I don't hit women, and I certainly don't want to do anything like that to someone I care about, it feels too wrong"...and I was frustrated, deflated, it was a total anti-climax...I didn't appreciate his caring at the time. But afterwards, when I had time to reflect, upon that, and also the way he was with me in general, so tender, so respectful - it was completely alien to me at that point ...but I now hold him in the highest regard for that - whilst at the time is wasn't the great sex I wanted, afterwards it was the best sexual experience I've ever had.
But without that experience, I would probably agreed with my friend, that if that was what his ex enjoyed, then there was no harm in it
And she knows that I am scared of "losing my mind". This is where her patience comes in to play.
Other topics don't invoke such strong feelings for me in therapy. But this topic was about sex, and these are the feelings I have.
Shh, you learned, at least in this once instance, that tenderness and caring can help move you through a rigid place where the only pleasure allowed had to be pain. You developed within the relationship so that humiliation could be replaced with respect. You discovered more dimensions to your ability to have sexual pleasure. Brava and so important.
Tracy, one way to get away from the intolerable reality is to dissociate. Another is to go crazy, even for a short period of time. It's a kind of death where you can't be reached because you, Tracy, no longer exist.
It makes abundant sense that you would be afraid of losing your mind when losing your mind is a powerful way to protect yourself from your terrible experience.
What I want to talk about with the clinicians is the challenge of finding the beginning place to work. The way I see a clinician meets a person in these sensitive areas is by beginning in a place the mind and spirit can tolerate. That beginning place may seem to have little or nothing to do with sex or memory.
Art? Working with clay? Movies and theater? Sketching body sculptures?
Watching healthy children in safe, protected and active physical play?
Interacting with animals? Yoga? Dance? Poetry?
Activities that evoke emotional and physical feelings - gently - with conversation, associations, journal writing. Never did the 12-step saying, Easy Does It" be as relevant as working in this area.
Finding the beginning place and working very very very slowly - and even more slowly than that, I think is key.
What do you both think?
it feels like allowing it back is too dangerous. I don't talk to my T about any of this. I didn't include it in answering the "other than food, how do you hurt yourself" question last week. Can't go there.
You shared! Can you say anything - not more about the subject itself - but about how you were able to share at all?
I'm looking for beginning places, where a person can tolerate a gentle brush with the subject. You found yours. I'm wondering how you did.
Thank you again, Laura.
You could also get one of those expression charts with the faces that show different emotions...sad, happy, angry, worried, surprised, mischievous...and have the client circle different emotions they are feeling and then perhaps discuss the emotion if the client is able and willing...explore as safely as you can.
I do want to talk more about this topic and I will. Healing and growth in this area comes with tiny steps with pauses for rest and gradual adjustment to increased awareness.
Congratulations on knowing when to pause. A pause can be a few minutes or even a few weeks. There's no rush. Slow and gentle is best.
Personally I found that some sexual stuff did come up in my head quite naturally during the course of therapy...it just didn't come out of my mouth, I was too scared to raise it, so I used to push it back down as best as I could.
There needs to be something from the clinician that goes beyond the general level of reassurance that therapy is a non-judgemental environment, something more, something to counteract the client feeling that "I know you're not judgemental, but this is different, this is the ultimate in 'badness' and shamefulness,...if I tell you this you won't want me as your client anymore, and if the one person who seems like they care, rejects me, then there is no hope left..." and a fear that you will plunge into despair so great that there is no point in living.
So it is far too dangerous to talk about sexual stuff
So some work on trust, strengthening the therapeutic relationship, possibly something on the different types of things that therapists get to hear about from clients, something that can reassure that the therapist is used to hearing sexual disclosures amongst other things.
In terms of making women question their sexual relationships, it might be possible to show film clips relating more broadly to all aspects of relationships some "better" than others - a mixture of modern screen, old black & white films and childrens films. This could be used as a basis for a discussion about relationships - what do "real" relationships look like? are (respectful, tender, loving) relationships portayed in films "real" or are they pure fantasy & fairytale? What makes healthy & unhealthy relationships? Are ther particular types of people that you associate with more and less idealised relationships? What qualities do those people have? etc
Creative activities that may help to coax feelings - painting emotions, attributing complex layering and blending of shape and colour to various emotions, examining our own artwork and noting any physical sensations they bring about, and looking at other pieces and describing the response they evoke, how they make us feel within our bodies etc
That's all I can think of really x
I'm especially moved and challenged by Shh saying that sexual material came into her mind while she was in session with her therapist but still couldn't bring herself to speak of it.
Periodically, when I'm working with someone I'll tell them a brief story about me or a former patient or a person in the news or a character in fiction or nonfiction that lived out a situation not unlike what my patient is experiencing. Maybe I should do that more with sexual issues.
What do you think? I will bring up something general, like an affair or infidelity in marriage. And I do bring up stalker stories more within the past eight or so years as I see how often people with eating disorders can attract stalkers - and at times - be a stalker, mistaking obsession for love.
Would hearing tiny stories about sexual issues show you that your therapist was at ease and understanding with this material and, therefore, might be at ease and understanding with you? Or would those stories scare you and make you pull back even more?
Maybe there's a threshold of tolerance you could help me understand. I'm looking for the kind of stories that would alert you, open you, probably startle you a little - just a little - but also give you a sense of relief and greater safety and free you to speak.
Is there a way to get to such a place?
(you reminded me, I acquired a stalker too, several years ago - scary time!)
I don't know if it's relevent to you, but one thing I also felt about disclosing the rape to my therapist, was that because it was very brutal/violent/painful, I didn't want to have to subject her to the details, I felt I needed to protect her from it.
You bring up something that is possible to talk about in terms of healing once real trust, earned trust, is solid.
By trust, I mean more than knowing that your therapist is compassionate, cares about you and will stand by you.
I mean trust that your therapist can bear what you have to say, can tolerate your experience, be steadfast in herself and with you at the same time.
This is why patients "test" their therapists even when they don't know it. It's about finding out what the therapist can bear. A patient wants to have some evidence that her therapist will not be horrified or paralyzed, shocked or too dismayed to carry on the work.
It's my job as a therapist to keep learning, growing, developing myself and to keep learning about the human condition so that I am genuinely not shocked or horrified to paralysis. My tolerance has to be real.
My patient will know if it's not.
Please don't read this thinking that I am or think I am a Buddha who can tolerate everything. I can't. But, I know what I can't and those situations and people are not in my practice. With eating disorders, I have a pretty good idea of the kinds of painful and horrific experiences that may be present in the person's past or here and now life.
My awareness is not general. It's specific, down to nitty gritty details. And sometimes, maybe often, those nitty gritty details hold a clarifying path to solid recovery.
We are partners in the therapeutic journey. We don't protect each other. We respect each other's limits and communicate as best we can as we proceed...and proceeding includes pausing when necessary - often that's often.
my therapist does share stories and examples. She watches very close to see how much I can tolerate...she knows she has gone too far if I drift off. Then she backs off. I think this approach is akin to "emotional stretching"...loosening up that trauma muscle a little bit at a time until it doesn't "pull" so much. I think that is what my therapist is doing with me...slowly, but surely..moving ahead ever so slightly...not losing my trust by pushing me further than I can handle at any given time. I appreciate that more than anything.
I know what you mean about the session not being long enough sometimes...I feel that by time I get my courage up to talk about something critical, the session is almost over. Or perhaps I sabatoge the attempt by unconsciously waiting???
I can have long runs where I am able to bury the pain of my abuse and get thru my days fairly easily, where I can not let myself feel terribly bad about the fact that I suck at relationships...but in therapy it's all there, looking me in the face and hard to avoid. Sometimes I want to run out of the office and avoid it all. Yes, it is very hard. I want to figure it all out, and I am sure you do to, as well as the rest of the ladies on here. I am just so very grateful to have a wonderful and patient therapist..
What's up? Your comments are so valued and appreciated. I read what you say several times and think about it.
I suppose I may be slow in responding because I want to respect the space you need.
Please tell me if I'm off track.
I read and identified with what you wrote and yes I am sorry that I haven't responded to you or Tracy on this thread as I normally would, but not because what you said has been overlooked,just because I am time pressured and I already feel like I am writing "essays" rather than brief responses, and trying not to let them get too long.
I also think Lori, that it is no bad thing when you don't know someone or their situation very well, to just read/listen and try to get an understanding of who that person is and what is going on for them before commenting.
I have learned that sometimes when I post on here, thoughts come up that are not easy to bear, but it is actually beneficial in the long term to be left with those thoughts for a while, to learn to tolerate them and try to make sense of them for myself, without somebody else coming in and either triggering them further (if they say the wrong thing) or taking away from me the opportunity to grow and heal myself (if they say what I feel I need to hear).
I find really often, people who are talking sensitive issues or about therapy, express how they feel ignored, unsupported, like people don't care etc ...and they are genuine, valid feelings, but what people don't always appreciate that part of therapy and healing is learning to tolerate your own feelings and learning how to soothe and care for yourself - which I think you can only really achieve by being left alone sometimes with difficult feelings.
I'm glad you said how you felt, and I'm also glad that you are contributing to this thread - it is good to hear other people's experiences and the more of us who contribute, then the more chance there is that people who find it difficult to contribute will come on here and find something that they identify with that helps them.
I'm sorry if I upsert you - it wasn't my intention!
Lori, thanks for sharing! I do like reading your posts..I love your honesty. It's ok to feel upset. Atleast we know you are telling us how you really feel, good OR bad.
As long as you think that feeling good is the normal state and anything else is wrong or sick or crazy or unfair or wicked or dangerous or on and on, you will experience yourself as riding a roller coaster that nosedives, crashes and brings devastation from which you can barely emerge.
Feeling everything...and I mean everything... is what it means to be human. If you don't accept your humanity how can you heal from anything?
Or live among other humans --- whose feelings cover the full range as yours, by the way.
The zen koan to live by forever is, "Be the ocean, not the wave." Waves climb. They reach beautiful and powerful heights. They crest. They fall in a downward rush. They crash into the sea. On and on and on. Up and down and rolling.
Be the ocean, with all its depths and complexities, with currents and various life forms. The waves on top, sometimes frothy, sometimes wild, sometimes flat and nonexistent, or choppy or storm tossed or in gently even patterns are the normal fluctuations of the surface.
Don't identify with your surface. You are much more than that.
And about self pity: dealing with it is what I love about journal writing. The first paragraph some days and first few pages on other days are often all complaints. You complain, cry, vent, blame, mutter and rage. But, when you give yourself a minimum of three full pages to write you usually finish up all that venting before you reach your end point. Then you have to keep writing to honor your commitment to yourself, even if you don't know what else you have to say.
What comes out next is often quite useful. You've gotten past the self pitying complaining with no harm done, and you get to see a little of what's really you. Over time you find out more.
The problem with complaining and voicing self-pity to others is that it burdens other people with your personal process that you need to get through. Even if they are patient with you, they can't lift those states from you. Therapists know how to listen to this without judgement and without taking on the issues. Other people don't know how.
So tell your therapist. Pour them all into your journal writing and then see what happens on the other side.
It's more than okay to feel upset. We need all our feelings. They give us information about the world and ourselves and each other. The first lesson is that human feel everything. It's normal.
Not one person in this thread is a burden - at least not to me. Not a bit.
We share and share and look at what we share and find context for it. Leaving anything out leaves us with holes in the picture.
You have not been a burden. Not at all. Your posts are gifts.
"Practice" is the key word. You practice. Most of the exercises in Healing Your Hungry Heart are designed to help you slow down and be present for what's happening in the moment. Following them is one way, a powerful way, to introduce yourself to being the ocean and not the wave.
Even watching the ocean - in real life - or on film or video - can help teach your unconscious and your psyche to see the difference between the ocean and the wave. You gradually learn that the waves are created and destroyed on a regular basis forever, but the ocean always remains.
I said I would come back to you on the types of stories that I felt might serve to encourage women to open up about sexual stuff in therapy...but it is hard...
..as I think (okay, I don't know a subtle way of saying this, so it is what it is)...if by disclosing details or telling a story, there are elements of promiscuity, or behaviours that could be taken as "whore-ishness"...the potential for those to make the client feel kind of "why is she telling me this - does she think I'm some kind of whore?" and then the whole shut down, pulling away from your therapist, relationship going backwards not forwards thing, kicking in.
So I'm really not sure
I'm trying to think how my relationship evolved with my therapist, to get to a point where I could talk openly about the sexual things...
...and I think the answer to that is tied up in erotic transference. Because I guess if you are the type of person who uses sexual behaviours as part of your ED, then you are the type of person who ends up in the erotic transference situation ...and once you've disclosed that to your therapist and explored it and talked it through ...then I guess talking about anything else is not such a vbig deal, at worst it is on par, but usually easier.
The difficult point is raising the erotic transference feelings in therapy. I reached a point where I felt I had to raise it because it was eating away at me and just too confusing. But I was lucky because I asked a therapist friend and I asked you too, and you both told me that I needed to talk about it in therapy. And I remember having a session where I kind of said that I'd felt so confused that I'd talked to a therapist friend about how I felt about my T, and that my therapist friend had said I needed to raise it in therapy, but couldn't get any further...and my therapist just said "I think it's too uncomfortable for you to talk about those kinds of things yet, with me"...
...and I remember feeling like, "why am I being so stupid, I can seduce any man, I can talk sex with anyone, why can't I do it?"
And I did, a few weeks later, force myself to talk about it with her, and in the weeks and months that followed I disclosed everything else, that I needed to disclose
I don't know if any of that helps...it's not about stories...but I think a lot of people do suffer the anguish of erotic transference, but never find the guts to raise it.
So maybe that is the answer...maybe talk about transference with clients, different kinds of transference, maybe use anger as a starting point and gradually get to the eroticised stuff?
Thank you for sending this. Eroticism in the transference is a powerful influence on how therapy proceeds. Left unaddressed it limits progress. Addressed it releases blocking energy and frees both the therapist and client to work more deeply.
It takes trust and courage and willingness to take a calculated risk while all the negative self talk clamors, "Don't do it. The consequences will be terrible."
It may be that people can't "find the guts to raise" this issue because they haven't healed enough yet and/or haven't developed a strong therapeutic bond yet to be capable of taking that calculated risk.
Again, thank you for writing this before my presentation deadline. What you share is very helpful.
Wow, so I avoided ths hole conversation when it happened because I was dealing with my sex abuse with my therapist and i wasn't sure I could handle anymore. But I'm finding this very interesting because during this time I got the courage to share the details of my abuse with my therapist (took over 2 years, but it happened) which was the first time I ever told anyone. I absolutely loved her response. She put her clipboard down will i shared. At first I thought she was showing me how much attention she was giving me but then I realized she didn't need to take notes because it wasn't what I was saying as much as it was the fact that I was saying it. It made it about me and not what the abuser did.
Since that day i have found it easier to talk about sex with her, although I keep asking her if it's OK (not sure why, but it makes me feel less like I'm burdening her). Tuesday we were talking about sex and my PTSD and something came out of my mouth that I swore I'd never tell a soul!!! I so badly wanted to take it back, but she took it and compassionately showed me that it's unprocessed shame that is giving this thing so much power and creating so much fear in me.
So how I'm stuck between fear that other things might just fall out of my mouth and feeling relieved that I told someone (even if by accident). I'm also stuck between believing her that this thing is normal for survivors (I'm not a pervert!!!) and feeling like I can't face her because she now knows. My wise mind is sure that's my shame talking, but the other parts of me are really scared of my next visit. This is part of the reason I'm trying to figure out this shame thing; I just didn't recognize it before and I'm still not sure what it looks like.
Anyway, I'm glad this conversationn stuck around for when I was ready to read it.
Thanks everyone for sharing so much!!!