Michael Aaron's Blog

Why Couples Therapy is the Most Powerful Type of Therapy

After many years of being a psychotherapist, specializing primarily in sexuality and relationships, it has become more and more clear that some of the most powerful changes I’ve observed have occurred in the context of couples therapy. Certainly many forms of therapy are helpful, but I think there are a few specific reasons why couples (or any kind of relationship) therapy seems most powerful. First and foremost, being in a healthy relationship forces people to change. Psychologist David Schnarch called relationships a “crucible” for this very reason– they act as an intense pressure cooker on individuals within the system. Because of this, couples therapy has certain advantages over individual therapy. Individuals that want to make a relationship work must learn to empathize, collaborate, and compromise with others, something that does not come easily for many. These flaws are more readily disguised in individual therapy since I may only see the person one time a week for 45 min and these kinds of situations obviously do not as commonly arise as they do in relationships where people see each other all the time. Couples therapy imposes a demand on individuals to change in order to have a more successful relationship, or else choose to move on and terminate the relationship. Such demands for change are not as evident in individual therapy. Along these lines, within the context of couples therapy, I can receive more than one input of information. In individual therapy, people often present their single perspective, which is often biased (why wouldn’t it be), so as a therapist, I am working with limited information. I […]

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Sex Addiction or Sexual Compulsivity?

For those unaware, one of the most hotly contested issues in sex therapy is whether or not sex addiction is a useful diagnosis and whether it even actually exists as a distinct addictive process in the first place. I don’t think that anyone argues that sexual behavior can be problematic or feel “out of control.” Indeed, the Out of Control Sexual Behavior (OCSB) model is gaining a lot of traction in therapist circles. The main concern with the sex addiction model, however, is that by placing sexuality alongside toxic and dangerous substances such as alcohol and hard drugs, it unduly stigmatizes sexual expression as inherently dangerous, taking us back to the Victorian dark ages of sexual repression. Indeed, one of the common criticisms of the sex addiction field is that clinicians untrained in human sexuality diagnose and pathologize individuals who stray from heteronormative and mononormative sexual expressions as struggling with mental pathology. Of course, there must be a middle ground between unquestioning validation and trigger-happy pathologization.  Earlier this summer, the World Health Organization (WHO) sought to find this median by releasing their latest International Classification of Diseases (ICD) 11. There’s a lot that’s positive in the new ICD 11 classification, and also consistent with AASECT ‘s position statement on sex addiction (and I should know, I was one of four co-authors of the position statement). Let’s go through it in more thorough detail (you can reach the synopsis here). First, WHO uses the terminology “compulsive” rather than “addiction” and classifies it as an impulse control disorder. This is significant because sex addiction proponents for years have tried unsuccessfully to point to some […]

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Moving Past Sexual Regrets

Over the years, I have been interviewed by countless magazines, newspapers, and other media outlets, but the one article that has garnered the most response and feedback by far is an interview I did with Vice in late 2016 on the subject of individuals that have lost their virginity later in life.  I have heard from people as far away as Germany and India for whom that article especially resonated. Indeed, the spotlight on communities of individuals who have experienced a crippling lack of sex has recently made headlines with the unfortunate car attack in Toronto by a self-described incel (involuntary celibate). Going back to the Vice article (which you should definitely check out, it’s excellent), its main thesis is that individuals who missed out on the normal sexual experiences of early adulthood often feel like a tremendous part of their identity or self-esteem is missing, which then propels them to seek to soothe that hole by making up for a prior lack of sexual experiences. In this blog post, I will focus on those individuals who have regrets about missed sexual opportunities, but the same advice will hold true for anyone with any other kind of regrets. I have often seen individuals who sought out sex workers as a means to catch up on their “numbers” and then opted for a self-diagnosed label of sex addiction when caught by a partner or spouse. Of course, this behavior is not a sign of addiction but rather an attempt to find validation, virility, and self-acceptance through sexual conquests. For this reason, a focus on sex as the […]

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Dealing with Anxiety About One’s Sexual Interests

Despite a very striking shift in our culture over the last several years towards more acceptance of diversity, I hear from many individuals every month that continue to struggle with discomfort around their sexual interests.  Often this anxiety stems from fantasies that these folks may find jarring, disturbing, or simply they are trying to make sense of. For previous articles on sexual fantasies, you can click here and here. As readers of this site well know, I always approach these situations from a nonjudgmental, collaborative, and humanistic perspective. While some fantasies or desires can be accounted for by some psychological need, many desires appear to be hard-wired and while we just don’t have enough strong scientific data to definitively assess whether kinks and fetishes are genetic, as I detailed in my book Modern Sexuality, new research appears to support that, in some people they may have an innate basis. At any rate, etiology, while interesting, often provides little of value in the way of eliminating or suppressing that desire. This is because, regardless of etiology, much of our sexual desires have become hard-wired, either through a genetic component, or through endless repetition, or a mixture of both. Even if the content of the fantasies or desires seems to shift over time, the overarching theme stays omnipresent while the specifics may change. For example, someone who craves an experience of humiliation may imagine being verbally thrashed, but then those fantasies can shift towards elements containing bondage or physical impact. While the content seems to shift, the underlying motivation fueling the fantasy remains the same. (Note: there […]

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Introducing New Alternative Relationships Certification Program

As I’ve written about in numerous other places on this blog, one of the more common situations I see in my practice is when a couple has been destabilized or thrown into crisis due to a new revelation from one of the partners about their sexuality. Some years ago, the most common type of revelation involved orientation, in which typically the male partner would be discovered or would initiate disclosure that he was gay. This was more common back before the kind of social acceptance that we are privy to now, but I certainly still do work with a number of men that still struggle in their coming out process. Nonetheless, these days I’m seeing more of a trend of “coming out” issues revolving around sexual interests such as kink/BDSM and nonmonogamy. Just as social mores around orientation have evolved, so has this social awareness affected other forms of sexuality, such as BDSM, polyamory, swinging, and other forms of non-traditional relationships. As part of this process, media, in the form of magazines, books, and television and film have shed light or even popularized such “alternative” types of relationships. With 50 Shades of Grey selling more than 125 million book copies and the movie version grossing more than $500 million at the box office, it is no surprise that a growing number of people are becoming more aware, less judgmental, and more curious to explore new sexual behaviors within their own lives. Much of my own work, including my book Modern Sexuality and my Psychology Today column, has been in the service of helping individuals process […]

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The Difference Between Privacy and Secrecy and Why It Matters

Whether it is dealing with infidelity, shameful sexual desires, or a host of other reasons, I often see couples struggling with ways to bring up and discuss uncomfortable issues. Often these struggles center around confusion over the difference between privacy and secrecy, an issue that is often discussed in my office, and one that I think requires further examination. Partners may feel unnecessary overwhelming guilt over not divulging private things, while others may think that matters of secrecy don’t require any transparency. Both are mistakes with predictably negative outcomes. So let’s get into it by first defining both terms. Privacy refers to matters that are not meant to be shared. These are issues that do not affect the relationship and may even be considered oversharing, as there is nothing positive, and perhaps even negative outcomes that can occur by bringing them up. A good example of this would be an erotic dream that an individual may have about an ex-lover. That dream may have strong emotional content and may certainly be worth examining further, but if the individual has no interest in seeing the ex again, then it really has no effect on the relationship. While discussing the dream with one’s partner may lead to an interesting conversation, it is not vital to the relationship, and may even backfire, as the partner may start feeling insecure or jealous about the nature of the dream. In other words, this is often a case of let sleeping dogs lie. I have seen numerous situations where individuals get bogged down in guilt and self-flagellation over the things they […]

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OCD and Sexuality

Sexual addiction/compulsivity is a trendy diagnosis these days and I have written much on this topic here and here . However, some studies have indicated a cormobid diagnosis of OCD for many individuals struggling with compulsive sexual behavior. Indeed one of the most common situations I have seen in my practice, which in my opinion has often been self-diagnosed by clients as sex addiction, could more readily be called homosexual OCD or HOCD, in which case the entire established paradigm is completely wrong. I will go into this in more detail further down in this post, for the moment, the most important point is that OCD type symptoms can create a tremendous amount of sexual distress and are very poorly understood and as a result, diagnosed. I’m going to assume that everyone reading this has a basic notion of what OCD means, but I think few people understand some of the underlying mechanisms fueling this disturbance. First and foremost, OCD sufferers experience a tremendous amount of fear, which might seem obvious as OCD has been historically categorized as an anxiety disorder (although in the DSM 5, the two are split into adjacent categories). But there’s a big difference between a general feeling of anxiety and a very deep and pointed fear. In the case of OCD, the sufferer fears something very specific, which the symptom itself only touches on superficially. In therapy, the client and therapist work together to dig deeper and figure this out. Often times the fear has less to do with sexuality itself and more to do with the underlying worry of being exposed, […]

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The Intersection Between Personality and Sexuality

This article originally appeared on my blog on Psychology Today and discusses ways in which personality traits manifest in sexual tastes, preferences, and behaviors. It’s a bit more scientific than articles I typically publish on this site, which mainly focuses on my clinical work as a therapist; however, I thought a number of my readers would benefit from and enjoy reading it. ————————————————————————————————————————————————————————————— One of the most fascinating aspects of sexuality is in understanding where it comes from. Specifically, from where do differences in sexual orientation and preference arise? Mountains of research have been conducted on orientation, focused on understanding distinctions in brain size and anatomy, prenatal hormone surges, genetic variations, and even disparities in finger length. However, especially when it comes to preference (not orientation), physiology is just one part of the equation. Indeed, as I will argue here, personality is a key missing ingredient in understanding individual sexual proclivities. Up until recently, not much has been written about sexuality and personality. What has been published has mostly come from a very psychoanalytic perspective, often equating deviations in sexuality (from a vanilla norm) to pathologies in personality. Only in the last few years has research emerged, studying specific sexual interests and corresponding personality traits from a rigorous, empirical framework. Let’s take a look at a few of these research studies and their implications. But before digging in, I think it’s important to take a deeper dive into understanding what personality is and how it is measured. The most standard way of measuring personality is using a test called the Big Five Inventory (BFI). Decades of […]

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Using Crisis as an Opportunity for Growth

As many might know, I write for many online properties such as PsychologyToday.com and Quillette. I usually don’t mix the content of these different venues, as they often have a different focus. For example, on this site, I write about specific clinical issues that may be of interest to my clients; on other sites, I write about broader cultural and sociological issues. However, I thought this piece, which originally appeared in Psychology Today in January would be appreciated by the audience reading this blog, especially as I reference many of the ideas regularly within my practice with my clients. Its original title was “Why Growth Most Often Occurs When We Fall Apart.” I hope you enjoy. ————————————————————————————————————————————————————————————- In many ways, our current society is set up to avoid as much pain as possible. Whether it is new technology, new medical or pharmaceutical advancements, or the self-help industry, everything is set up to make our lives easier, simpler, and more uniquely tailored to our every individual need. Even the names of products such as the iPhone and iPad nod to the symbiotic merger of products and people. But the question remains, does all of this avoidance of pain and seeking of pleasure really make us any happier or more resilient? Obviously, new technological and medical advancements have helped millions of people rise out of poverty or overcome disease, but overall our social levels of happiness haven’t risen. Indeed, studies have shown that use of social media such as Facebook is correlated with depression and unhappiness. Other studies have shown that there is some increase in levels of […]

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Expanding the Window of Communication

As a therapist that specializes in sexuality and relationships, about half of my clients are couples. Sure, many of them have some sort of sexuality-related difficulty, but fundamentally more often than not, most of my clients have deep-seated communication problems that make further progress impossible. Invariably, these issues in communication narrow the range of possible discussion. Since these couples don’t have the tools to appropriately manage conflict, or they are too defensive or reactive about certain subjects, the list of prohibited conversation topics increases while the possibilities decrease. Joe Overton, a public intellectual writing for the Mackinac Center of Public Policy, created a term known as the “Overton window” to describe the range of socially accepted public discussion. Overton theorized that politicians can only voice opinions within a narrow band inside the left to right political spectrum. Any politician who voiced an idea outside this range of acceptable opinions would see their career come to an abrupt end and experience ostracization. I often think of this socio-political phenomena as an appropriate metaphor for the difficulties my clients often experience. When I see troubled couples in my office, the Overton window is typically so small that the range of conversation has become limited to the most basic superficialities.  Instead of being able to negotiate common values, sexual desires, and fundamental concerns, they may only be left with rehashing plot lines from their favorite TV show. Just as political scholars might argue that a narrow Overton window is symptomatic of a troubled, dysfunctional society, so too, based on my clinical experience, a tiny Overton window is one of […]

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