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March 14, 2022 by BHP Leave a Comment

Understanding Sexual Desire

All couples in long term pairings know something of the vicissitudes of desire. The sexual intensity that more often typifies the early stages of a new relationship cannot remain the same over years of familiarity. The up close and personal experience of day to day coupledom means witnessing one’s partner in their least attractive states, both physically and mentally. The intimacy of familiarity is double edged. Whilst bringing a sense of safety and security to a partnership it  inevitably over time erodes an experience of the unknown, of mystery and “otherness” in which early attractions were ignited.

The capacity for surprise enjoyed by new lovers is intoxicating, the investment in pleasing each other extremely high…each person keen to present the best possible version of themselves. This stage of idealisation is both necessary and natural but inevitably gives way to a more complex intimacy as couples get to know each other as whole (flawed) people….for better and worse. A sense of responsibility grows wherever we find ourselves caring about the well-being of another. Discovering the fears, insecurities and sensitivities of someone to whom we are growing close adds a layer of emotional complexity that on entering the bedroom can, over time become a vampire to desire.

 Sexuality and Shame

A shameful secret in many relationships today is a lack of sex. Diminution of sexual desire has become a source of shame (and blame) in a cultural context in which desiring and being desired are highly valued. The idealisation of sexual intensity becomes a burden to many people who experience its absence as a private and very personal failure. Many couples are plagued by the doubt that they are not having enough sex or at least enough of the right kind of sex. All too many people believe that something about their sexuality is either abnormal or wrong. With the exception of new lovers at the height of their infatuation vast numbers of people in our culture feel less than happy with their sexuality.

Our sexuality is forged in the cauldron of family life and cultural context. So attuned and wired are we to the feeling states of our early carers that it is virtually impossible to imagine a childhood utterly free from any feeling of guilt or rejection. Our sexual fantasies and preferences are always creative solutions to unconscious problems. They arise from a need to transcend feelings of guilt, worry, rejection and helplessness. To a large extent these feelings are an inescapable part of the human condition and sexual desire will always have to navigate the complex landscapes of our internal subjectivities.

Pleasure and Pain

Beset, as is so often the case by painful judgements, it would seem a courageous enterprise to seek a greater understanding of our sexuality. We might develop greater tolerance and compassion both for ourselves and others when we learn more about the very important personal (and cultural) meanings in our sexual responses and attitudes. Taking the shame out of sex and broadening the conversation about our appetites need not be a passion killer….  The unrelenting grip of shame over time undoubtedly will be. At the end of the day, sex will most likely always remain complicated but understanding its dynamics need not put a dampener on pleasure. A failure to do so may make pleasure far harder to share.

 

To enquire about psychotherapy sessions with Gerry Gilmartin, please contact her here, or to view our full clinical team, please click here.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin –

Reflections on freedom and security in a turbulent year

Reflections on getting back to normal

The Passage of Time and the Discipline of Attention

Intimacy: pillars and obstacles

Love and Family

Filed Under: Gerry Gilmartin, Relationships, Sexuality Tagged With: couples therapy, Relationships, sexuality

September 6, 2021 by BHP 2 Comments

I Never Thought My Son Would Watch Pornography

It was a decade ago that was listening to the radio when I heard this line being spoken for the first time by a mother who was describing the time the police came to her house to enquire after certain pornographic material which had been downloaded using the family IP address. She described the early morning raid by the police, the taking away of the family computers, the suspicion hanging over her husband – until it was discovered that it was the couple’s 14-year-old son who had viewed the material in a curiosity-driven trawl through multiple pornographic internet sites.

That may have been the first time I came across that line, but I have heard it many times since in the intervening period as I have moved into work supporting young boys and men in their efforts to free themselves from their addiction to online pornography.

Pornography and the Adolescent Brain

There has been considerable research in recent years into the effects of consistent use of pornography on the adolescent brain and, indeed, on the brain in general. To summarise a complicated process briefly, the plasticity of the adolescent brain (with all brains, actually), combined with a leaning towards hyper-arousal when it comes to matters of sex, leaves the teenage child prone to a vulnerability of dependence, which can be frightening in its speed and grip. The reward centre of the brain is hard-wired to be stimulated and demanding when certain things connected to the propagation of the species are on offer. Food and drink come to mind – but sex is important, too. As a species, we need to have sex to survive.

For the young adolescent, perhaps still some years away from a sexual encounter with a real person, the online world offers instead a kaleidoscope of sexual experiences at the touch of a button. In the secrecy of their bedrooms they are free to explore material that would have been unimaginable (certainly illegal to print) just a few decades ago. The brain does not know the difference between a computer and a real person. It just knows that its owner is excited sexually. Its reward centre is activated, and it releases that precious drop of dopamine, which will prove to be both curse and blessing, the first step on the road to addiction. To put it bluntly, for the child, it feels good – and the brain will begin to lay out the neural pathways which will make it easier to access that feeling in the future. As in all things – from football to depression – the brain gets better at what it practices.

As the boy becomes more habituated to the use of the pornography, so it becomes more difficult to achieve the level of arousal that was easily done on first viewing. In essence, the brain is developing a level of tolerance. The user has to find newer forms of stimulation – generally much riskier, more challenging sites – in order to satisfy the brain’s demands and to receive that precious dopamine hit. It becomes more difficult to focus on one item. The user will begin to hop from site to site in an effort to find the ‘best bits’; the whole purpose will become about gratification, generally marked by masturbation, which once achieved, is the signal for the whole cycle to start again. It all feels so natural. There are no drugs involved – apart from the delicious ones supplied by the brain. The parts of the body that react are doing so naturally. What can be wrong with something that feels so right?

Boys and not girls

The research on girls’ use of pornography is scant, but what does exist points to their usage as being considerably lower, and less frequent, compared with that of boys, something supported by anecdotal dealings with young people. Although many young girls (estimates suggest as high as 40%) will have viewed pornography, this is more likely to be out of curiosity rather than habitual usage. This might be partly cultural, partly to do with the way arousal works and develops in adolescents, partly to do with the interest in internet activity shown by girls generally (interestingly, figures in gaming addiction, a process which ‘piggy-backs’ on to the reward system, has similar figures in favour of boys’ dependency), and significantly to do with the type of pornography available, which is overwhelmingly produced for the gratification of men, with women in the role of the passive provider. Even the dominatrix – which alludes to a degree of power for the female – is a male construction, designed to gratify male desires. Given this context, it is no surprise that even into adulthood, the vast majority of pornography is consumed by men.

Meanwhile, in the real world

At the young man develops, they will want to practise their sexuality in the world around them. The difficulty for them is that their brains, accustomed now to being aroused by digital sexual-stimulus, will already have an idea of what sex looks and feels like, how their partner should behave and, significantly, they will already have internalised an idea that sex is something that involves their gratification. The notion that giving pleasure to others might be a fulfilling part of sexual engagement is something that is beyond their experience – even though their experience in some respects is a considerable distance ahead of where it might be in a non-digitalised world. For the habituated user of online pornography, it can be very difficult to come to terms with the fact that the person within their arms has feelings and desires which are unlikely to conform to those who have aroused their senses online. The online world will often present an exaggerated view of sexuality: breasts and penises are larger; bodies are firmer; all imperfections (and hair) are removed. For the habituated user, it can be very difficult to achieve any kind of arousal, and desire is lost – only to be found again back in the online world, where the brain, comfortable, primed and ready, can once again be gratified.

There is another difficulty that habitual users have to face. Their online experience will have normalised certain aspects of sexual behaviour that in the real world would be considered shocking or taboo. Even on the blandest pornographic sites freely available to all, one will find countless ‘sex with my stepmother/ sister/ etc’ as titles. It is as though it is the most normal, routine practice in the world. There really are no boundaries.

Disadvantaged Parents

It would be easy to be judgemental with parents whose children become habituated to online pornography. But there are a number of reasons for their ignorance and then denial regarding the habits of their sons. Firstly, unless they have used pornography themselves, they will have no idea how much is available – unfiltered, free and without the requirement of age verification – at a simple click of a button. It is hardly their fault that they just don’t know what they don’t know. Secondly, as pornography and issues more widely to do with sex are practised in areas of secrecy, there is often a barrier of shame which makes any non-judgemental discussion of the subject impossible for parents and children. Thirdly, and linked to the former point, the image of their children that many parents carry in heads often allows no room for an activity they themselves would find abhorrent. It is why so often when parents come to see me with their sons, they are in a state of shock. It is not unusual for them to apologise for the fact that their son is in this position, claiming plaintively that they ‘never thought their son would be using pornography.’

As youngsters become men

Unfortunately, many adult men who have to deal with addiction to pornography fail to do so until they are much older. Many of the clients I have worked with on the issue have endured many years of habitual use before being forced to seek help by circumstance rather than because they see it as a problem. It might be to with failed relationships; it might be because of worries to do with their increasingly poor sexual performance in real relationships – often manifested in low mood, anxiety or depression; or it might be that their sexualised treatment of a partner or friend is not appropriate for one reason or another and they feel a strong sense of shame. This last is perhaps worth highlighting as it has been the topic of national debate recently.

One of the dangers facing habitual users of online pornography is that they must deal with a blurring of the lines between what is real and what is imagined. Of course, we all do this to some extent when we watch a television show: we are adept at sorting what lies either side of that line between the real and the imaginary. But these television shows are not tapping into the reward centre in our brains; they are not linked to our areas of desire, gratification and reward as is the sexual instinct. On top of this, for many young people, they will have no experience outside of their online practices to guide them as to what is appropriate or not. They haven’t yet learned what is normal. If they make a mistake in this area, they could be left with a legacy of shame and regret – or much worse if their actions pass into illegality.

What can parents do?

My advice to parents is always very clear on this. Before you do anything else, contact your internet provider to make sure your controls are locked down – and never share your passwords with your children, or even enter a code when the child is in the same room. It is another story, but never underestimate the ingenuity of young people for discovering their parents’ passwords! Then talk to your child. Be curious. Take a parental interest in their internet history – not in a judgmental way, but one which seeks to understand what is going on for that young person. If your son is using pornography habitually, seek support for yourself and for them. Do not ignore it, for in any number of cases it will not go away. Research indicates that those who become addicted to online pornography are likely to be prone to low mood and depression, not surprising given that they may well be living a kind of double life, a part of which exists in a place of secrecy and shame. Those last two bedfellows are hardly the harbingers of happy, fulfilled lives.

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

To enquire about psychotherapy sessions with Kevin, please contact him here, or to view our full clinical team, please click here.

 

Further reading by Kevin Collins –

Why is it hard to make decisions?

Communication, communication, communication

Filed Under: Brighton and Hove Psychotherapy, Kevin Collins, Relationships, Sexuality Tagged With: addiction, Relationships, sexuality

November 23, 2020 by BHP Leave a Comment

Understanding Sexual Fantasy

The exploration of sexual preference and fantasy in therapy can be a portal to our inner psychological landscape. Unlocking the unconscious logic of sexual fantasy is one way of casting  a light on our internal world and of understanding the emotional and psychological difficulties that may have prompted us to seek therapy in the first instance.

Our sexual scripts are formed in infancy, long before the onset of mature sexual desire. Our early attachment experiences and the familial and cultural context into which we are born inform the psychological maps and templates for being (in the world) to which we both consciously and unconsciously refer as we develop and grow. We are evolutionarily wired and sensitively attuned to the moods and feeling states of our caregivers absorbing them all through a process of psychological osmosis.

The conflict of growing up

Whilst our lust and capacity for pleasure (according to the Freudian account) are instinctual, the road to pleasure is more often than not a complicated one. We are likely to experience myriad obstacles along the way (many that will later inform our sexual fantasies) guilt, shame, fear, rejection may all stand in the way of our experience of pleasure. We all (consciously or otherwise) feel guilty about something. Life is fraught with conflict – and from the get go. The conflict (for example) between our attachment to our families and to the developmental imperative to grow up, individuate and leave them is fraught with guilt and worry. We bring these unresolved and largely unconscious conflicts into our erotic lives.

The creativity of fantasy

The child of a depressed parent may grow up with a powerful sensitivity to and identification with the sadness of others. It may be hard for such an individual to fully connect to their own aliveness and vitality as sexual excitement is fundamentally incompatible with depression. In the imaginative realm of fantasy such an individual may be released from the burden of caring by populating their fantasies with dynamic carefree people, aroused, excited and turned on. It is not hard to understand, in this scenario, that when everyone is having a great time (and no one is depressed)  the fantasy serves as a creative permission to connect, without guilt or shame to one’s own desire.

An antidote to trauma

Many sexual fantasies can seem puzzling and hard to understand. One person’s turn on is another’s turn off after all. Arousal for some may come through being tied up and whipped, another’s from phone sex, group sex, sex with a stranger(s), etc, etc. All are plots of desire, many are attempts to draw on and transform past trauma. When someone is cruel or aggressive  in their sexual fantasy or practice it is not because they are inherently sadistic but rather that they are trying to solve a problem. It may be useful and illuminating to consider and understand why the normal pursuit of pleasure may require a particular imaginative scenario in order to be safely experienced.

Empathy and ruthlessness are important aspects of a healthy sexual relationship. Too much empathy (for the other) may be a dampener to our own desire and too much ruthlessness may render sex mechanical and devoid of emotion. Sexual fantasies can be attempts to counteract or transform beliefs and feelings that may interfere with sexual arousal and can provide an elegant ( if not always politically correct) solution to the problems of ruthlessness , guilt and shame.

When we  understand our sexuality we understand ourselves.

 

Gerry Gilmartin is an accredited, registered and experienced psychotherapeutic counsellor. She currently works with individuals (young people/adults) and couples in private practice. Gerry is available at our Brighton and Hove Practice.

 

Further reading by Gerry Gilmartin

Fear and hope in the time of Covid

Relationships, networks and connections

Paying attention to stress

Why does empathy matter?

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Gerry Gilmartin, Relationships, Sexuality Tagged With: Relationships, sexuality, Trauma

October 5, 2020 by BHP Leave a Comment

What is Andropause and what happens to men when their testosterone levels decline?

Schools will soon have menopause on the curriculum. Largely due to the efforts of psychotherapist Diane Danzebrink and her #MakeMenopauseMatter campaign. In 2019 Education Secretary Damian Hinds confirmed menopause will
become part of the Sex and Relationships curriculum for teenagers in the UK in Autumn 2020 alongside periods and pregnancy.

With the recognition that menopause needs to be better understood in the broader context of sex and relationships perhaps now we can begin to talk about men’s experience of changes in their hormones. Testosterone is the main sex
hormone (androgen) in men and the symptoms that men can experience as a result of reduced testosterone are called andropause. The hormone testosterone plays a role in the production of sperm, in the drive to have sex, in building muscle and bone mass, in the way fat is deposited around the body, in the facial and body hair patterns found in males and their deeper voices.

Men will experience hormonal changes as they age, levels of testosterone will start to decline from around 30 at approximately 10% every decade. It is important to note that testosterone reduction can also be affected by other
factors such as injury, cancer treatments, medication and chronic conditions including diabetes, obesity, kidney and liver disease. Symptoms include a lower sex drive, loss of body muscle and an increase in body fat, decrease in bone
density, fatigue, insomnia and difficulty attaining and maintaining erections*.

From research by the Centre for Men’s Health Clinic in Manchester, looking at men over 50 in the UK, Dr Malcolm Carruthers says: “Of the ten thousand men surveyed actually 80 per cent had moderate or high levels of symptoms suggesting they had testosterone deficiency. This shows that its not the rare condition that some doctors claim but actually its very common and almost totally untreated.”

Symptoms described by two patients attending the clinic and suffering from low testosterone, defined as Testosterone Deficiency Syndrome, share features with women’s accounts of menopause.

“Well I was 55 or there abouts and I was getting perspiration in my shirt and was getting really wet, I’m talking serious perspiration, tiredness and I had a lot of muscle aches particularly in my legs”.

“I was a fishing skipper for 23 years and was the type of person that woke up in the morning and rolled out of bed and was on the job, something to do” …  Then when I reached the age of 55 I began to feel that I was flagging and I got all sorts of strange to me symptoms, aches, pains, horrendous sweats and uncontrollable temper.”

What about the mental and emotional aspects of andropause? We need to acknowledge and better understand andropause and the impact on men and their lives and relationships. Symptoms of andropause include mood swings,
irritability, low-self esteem, memory and concentration problems and depression. These are familiar menopausal symptoms for women, however it may be harder for men to acknowledge these symptoms and to ask for help
because they are associated with female menopause.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

 

References –
Diane Danzebrink
https://twitter.com/hashtag/makemenopause

Centre for Men’s Health Clinic
Associated Press Television 11.3.2011
https://youtu.be/33aCzR4U9l4

*See an earlier blog about men’s use of Viagra here.

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Ageing, Angela Rogers, Relationships, Sexuality Tagged With: men's issues, Menopause, sexuality

April 22, 2020 by Brighton & Hove Psychotherapy Leave a Comment

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

The medical definition of sexual dysfunction in women is hypoactive sexual desire disorder (HSDD) that is low or no libido. Like men, women’s desire for sex is effected by all sorts of factors such as relationship issues, bereavement, physical illness and the side effects of medication, job loss or work stress, depression and anxiety, recreational drugs, hormonal changes through aging and pregnancy, child birth, miscarriage.

There are conditions such as vaginismus where penetration is too painful for women to have sex but for the moment I want to look at chemical attempts to address women’s loss of sexual desire.

Unlike Viagra which treats the mechanics of erectile dysfunction, new pharmaceutical treatments in the US that aim to improve women’s sexual problems act on the brain rather than the genitals because blood flow has nothing to do with sexual function in women. At the moment there are no licensed treatments for women’s sexual dysfunction in the UK, but two in US are available for pre-menopausal women, these are Flibanserin (Addyi) and Bremelanotide (Vyleesi). They work by enhancing the neurotransmitters in the brain that support sexual arousal, reducing inhibition and encouraging sexual excitement.

These medications demand some commitment from users. Filbanserin is taken orally every evening whether you plan to have sex or not and Bremelanotide is injected into the thigh or stomach about 45 minutes before sex, no more than once every 24 hours or 8 times in a month. There are side effects such as tiredness, nausea, headache, dizziness dry mouth and these medications should not be taken with alcohol or grapefruit juice, as this may lower blood pressure to a risky level.

HSDD treatments do not claim to make sex any better rather they claim to promote an increase in women’s desire to have sex. The research determines a positive result as a limited increase in sexual activity measured as one more sexually significant event per month.

I have looked at the anecdotal experience of US women posting online. HSDD medication is extremely expensive costing several hundreds of dollars and the jury is out on its efficacy. Many women commented on the side effects, for some there was no improvement and/or the side effects were intolerable but others were extremely grateful for the difference it had made to their sex lives.

In the UK Prelox, a herbal supplement, is marketed as improving sexual function for late reproductive and post-menopausal women. There were no adverse effects during the trials but there it was noted that any improvements maybe due to a placebo effect.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – why change might be so difficult

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Angela Rogers, Gender, Relationships, Sexuality Tagged With: anxiety, Relationships, sexuality

March 16, 2020 by Brighton & Hove Psychotherapy 1 Comment

Popping a bluey – young men and Viagra

Following on from my earlier blog about the physiological effects of Viagra, in this blog I am going to discuss some of the psychological and social issues that make young men pop a blue pill.

There is common notion that young men are constantly getting erections and always up for having sex. Various sources indicate the reality is different. Peggy Orensteins’s recent book ‘Boys and Sex’ cites a General Social Survey study showing young men between 18 and 29 are having less sex. This is indicated by the increase in the number of men who declare themselves abstinent, which rose from 10% in 2008 to 28% in 2019.

Orensteins’s conversations with young men reveal the extent of their performance anxiety. They fear that girls would be more knowledgeable and experienced and in contrast they will be unsatisfactory sexual partners. They are anxious that any inadequacy, such as not being able to undo a bra strap or coming too quickly will be broadcast to their peer group on social media and result in humiliation. They are also concerned that girls will take it personally if they can’t get an erection. Young men seem to feel that they are responsible for the success of a sexual encounter.

At the same time online pornography has set up unrealistic expectations about opportunity, performance and satisfaction. The Reward Foundation is an educational charity that focuses on the internet, love, sex and relationships; they have found a correlation between erectile dysfunction in young men and an increase in access to internet porn. Whether or not young men actually believe that the sexual relationships and encounters they view on screen are ‘real’, these representations have an impact. As a young presenter on VICE online magazine said, “In my head I’m thinking that girls will be expecting me to fuck them like a porn star.”

First dates or sexual encounters can be extremely anxious events. Dating apps like Tinder and Grinder make it easy to move on to a new sexual partner if the sex does not meet expectations the first time. This may increase pressure on men to have a prolonged erection or several erections and Viagra can be an ‘insurance policy’ or a ‘booster shot’ to ensure a good performance the first time they have sex with a new partner. If the relationship continues they may continue to take Viagra to maintain their performance and hide the fact that they took it in the first place.

So what’s the problem with young men using Viagra to perform better? If young men believe that the standardised notion of good sex is a good performance as Orenstein’s study suggested, we can see that taking Viagra would be a way to avoid some of the stress about being a good performer. Unfortunately this can create a psychological dependency making it more and more difficult to stop taking Viagra and harder to open up the subject with a partner. Like any kind of emotional withholding keeping Viagra a secret is likely to be a negative factor in a sexual relationship.

Good sex can be whatever is good for each couple and is far more nuanced and complex than a good performance. In a relationship of mutual consent sex can bring physical and emotional intimacy but sex does not always go smoothly, misunderstandings and disappointments happen. Exploring sexual dissatisfaction and difficulties makes people feel extremely vulnerable. By using Viagra to focus on performance, young men are avoiding the opportunity to speak honestly about what they expect and want from sex as well as finding out what pleases their partners. Trusting each other and exploring differences and desires together can build a stronger relationship as well as a more satisfying sex life.

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

A couple state of mind

Men, Sex & Aging in Relationships

Face to Face and Online Therapy Help Available Now

Click Here to Enquire

Filed Under: Angela Rogers, Gender, Relationships Tagged With: anxiety, Relationships, sexuality

October 16, 2017 by Brighton & Hove Psychotherapy Leave a Comment

50 years on, how free are we from homophobia?

This year has marked the 50th anniversary of the (partial) decriminalisation of male homosexuality in the UK. This has been responded to with a slew of television and radio programmes exploring current and past personal and political experiences of LGBT individuals and communities in the UK and elsewhere. This output has been matched by a large number of broadsheet and online articles on this subject. Some of these commentaries have pointed out how in our celebration of social progress we shouldn’t overlook the social and state owned prejudices that have caused much harm and damage to LGBT people.

For those interested and sensitive to these matters, it is perhaps clear that trans-phobia is still very much alive in our society. However, increased acceptance of homosexuality could give an impression that homophobia may no longer be an issue for people with same-sex identities and orientations in the UK.

This blog focuses on the continual difficulties for specifically LGB identified people due to past and continued impact of homophobia. Prejudices have become more submerged and hidden. There is now an added challenge for therapists to continue to recognise how these might be interplaying and undermining their LGB clients’ social and internal worlds.

Homophobia today

While open hatred towards lesbians and gay men is now less widespread, as a recent BBC documentary testified, it still exists.

Violent attacks aside, people in same sex relationships will still scan their environment before doing something as natural as holding hands in public. In many parts of the UK, being affectionate in this way with a same sex partner is still not deemed either comfortable or even safe enough. In other parts of the world, being openly gay is still very problematic. In some places, it is criminalised and extremely dangerous.

Homophobia refers to hateful (and possibly fearful) feelings towards people with homosexual orientation. When we talk about homophobia, we perhaps think about it being overt. However, this kind of social discrimination operates on many levels. More subtle, and sometimes unconscious, expressions and feelings of homophobia can be harder to tackle, understand, and talk about.

Despite social and legal progress, people with homosexual identities and orientations continue to feel excluded, marginalised, and unseen in this society because relationships are still regarded in the mainstream as heterosexual. How this continues to operate on a social level is complex and often unconscious. This mechanism is known as ‘heteronormativity’, meaning the norm is assumed to be heterosexual.

These social processes are similar to ways in which other groups can be discriminated against, for example on the basis of gender, ethnicity, disability, etc. These prejudices operate in such a socially ingrained way that they are mostly only visible to those in the minority group (and not always to them.) This makes it very hard to challenge or change them.

Internalised homophobia

Broadly speaking, internalised homophobia refers to homosexual self-hatred in relation to sexual orientation. These feelings have been absorbed, like everybody else’s, by living in a homophobic, heteronormative world.

Many LGB people still struggle with overt negative feelings towards their sexual orientation. These feelings might be particularly heightened prior to or grappling with ‘coming out.’ However, feelings of self-hatred, self-disgust, inadequacy and low self-esteem in relation to sexuality can surface at any time in the lives of those with same-sex desires or identities.

Like homophobia, internalised homophobia often seems to be discussed in terms of overt feelings. It is important that we are able to think about these internal processes on a more complex level to understand the less visible ways in which they may continue to undermine the well-being and confidence of gay and bisexual people. LGB individuals living in our current society may well find themselves struggling with less conscious sources of self-hatred that they may not recognise as having any link to homophobia.

This level of internalised homophobia is very difficult to tackle, as it seems likely that it begins early in childhood. In contemporary psychoanalytic thinking about sexuality, theories have emerged that support the idea that our sexualities begin to shape and orientate very early on in our lives (Lemma, Lynch 2015). In this context, it is suggested that responses from parents will heavily influence how all individuals feel about their expressions of sexuality at a young age. These parental attitudes may well be unconscious and shaped by prevailing social prejudices which again can be covert.

Impact and trauma

For some journalists writing on this subject in recent months, the damage has already been done. While things have improved in this country, past state and social attacks through criminalisation, arrests, unequal legal rights, stigmatisation and verbal and physical abuse have left individuals and communities hurt, angry and traumatised. In this way, we might think about the post-traumatic distress that some LGB people may still be struggling with.

Even without these traumatic after-shocks of the past, the negative impact of being gay in a modern society which still consciously or unconsciously operates as if everybody is straight should not be underestimated. Living in a world that marginalises or ignores who you are and who you love can be stressful and tap into earlier experiences of feeling unseen and overlooked.

While ‘coming out’ is less obviously problematic for gay people than it used to be, the experience of many working in specialist services is that it continues to be a struggle for many. Acceptance of one’s self may or may not be echoed by acceptance of friends and family. Cultural and religious differences may also continue to make this more of an ordeal for some than others.

We also certainly know that young people who identify as gay continue to be a highly vulnerable group in relation to homophobic bullying. This can lead to an increased risk of  self-harm, suicide, and the misuse of drugs and alcohol.

LGB people who have accepted their sexual orientation and worked through overt negative feelings are not invulnerable to social forces of internalised homophobia working unconsciously. These internalised feelings can exacerbate and complicate other difficulties such as shame, anxiety, anger, problems around sexual drives and body image. It is widely thought that homophobia can also play an important part in difficulties for same-sex couples.

Therapists working with homophobia

It seems to me in these more liberal and sexually fluid times, therapists need to be even more alert to the ways prejudices and other repressive forces continue to undermine our LGB clients. Homophobia and hetero-normativity operate on multiple levels in our societies. The internalisation of past and current social scapegoating, marginalisation and hatred can be emotionally problematic for even the most confident individual.

An increasing number of lesbians and gay men who come for therapy these days do not regard their sexual identity or orientation as a major problem. However, it is important that we bear in mind the social context in which they are experiencing the difficulties they do bring. These social mechanisms need to be understood as operating both externally and internally and on complex and often unconscious levels. While they may not need to be the focus of therapeutic work, there are likely to be areas where their influence will need to be recognised and actively engaged with.

Many lesbians and gay men continue to feel caution about the potential sensitivity and understanding of therapists towards sexual difference when seeking psychotherapy. Of course, any therapist seeing clients with same-sex desires and identities needs to be very aware of the ways in which homophobia might operate within themselves – whatever their sexual orientation.

In my view, affirming and supporting an LGB client’s sexual identity is essential but insufficient without being also vigilant to the hidden and sophisticated ways that homophobic processes, outside and within the individual, might work to exacerbate or create obstacles to their emotional development and wellbeing.

Claire Barnes is an experienced UKCP registered psychotherapist and group analyst offering psychodynamic counselling and psychotherapy to individuals and groups at our Hove practice.

Reference: Sexualities. Eds  Lemma, Lynch 2015

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Filed Under: Claire Barnes, Gender, Relationships, Sexuality, Society Tagged With: Psychotherapy, Self-esteem, sexuality

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