Sex Therapy

There are articles about sex all over the web — with evermore provocative titles attempting to get you to click and like. Most headlines know how to captivate: they lure us in by promising to reveal what women want or how to get a guy to fall in love. There are also heaps of material about the mechanics and biology of sex: hormones, orgasms, positions. Then, there are the evolutionary theorists explaining that men philander to spread their seed and that they prefer women with a .07 hip to waist ratio because they’re fertile. However, in all of the facts and figures about sex, we miss something.
We’ve forgotten that sex has meaning.
Sex doesn’t have a uniform significance for all or even for one across encounters and partners. It’s an existentially amorphous act. Beyond the imperative to procreate, sex has no inherent meaning. We construct the meaning. This is what makes it interesting. It’s fluid, and as we change, so does the allegory of our sex.
Sex isn’t just a biological act. It’s a social act. People are constantly playing roles and sexual preferences aren’t inborn, they’re scripts that serve a purpose. It’s a constant expression and ongoing exploration of who we are.
Sex is also a deeply personal act, full of unmeasured idiosyncrasies. Mass-scale research on the demographics of sex promotes broad generalizations about men and women and doesn’t capture the nuances that I observe talking to people in my private practice. I always have my patients describe their last encounter in detail: not just their moves, but their internal dialogue and fantasy. Sex is like a Rorschach test. We project parts of ourselves onto it: longings, trauma, feelings, and hidden parts of self not expressed in our everyday life. What turns you on right now tells a story about you, both about your history and who you are in the process of becoming.
My recent book The Men on my Couch — a look at what men reveal in psychotherapy and what their behavior really means — is full of examples.
Take Mark. Feeling trapped by his sycophantic office life, he played the Dom at S&M clubs, trying to whip his way back to a sense of authority. Take Bill, who tucked his kids each night only to go running for the nearest escort, not seeking sex itself so much as the thrill of transgression, played out against a life he found morally and creatively confining. Or take David, a man who so deeply in need of validation that he compulsively collected phone numbers at bars, even after he started dating the “woman of his dreams.”
The story is never the same. When a client comes in to talk — whether it be about a pornography compulsion or cheating on his wife with prostitutes — I never judge. Instead, I get curious. I wonder what he needs to feel, who he wants to be.
Whether it be the recent New York Times feature on college campus hook-ups or the headlines about straying politicians, none of it is mindless romping. I assure you, it all has meaning. One thing that has become clear to me in the practice of talking to people is that sex is rarely just sex.
In her book Self Analysis (1942), psychologist Karen Horney, a contemporary of Freud and one of the first to look at the social aspect of sex, described ten neurotic needs that motivate most interpersonal expression. When applied to sexuality, these needs can help explain everything from who we choose to sleep with and how many partners we want, to our capacity for fidelity and what turns us on. Here’s the list:
1. The Neurotic Need for Affection And Approval
2. The Neurotic Need for a Partner Who Will Take Over One’s Life
3. The Neurotic Need to Restrict One’s Life Within Narrow Borders
4. The Neurotic Need for Power
5. The Neurotic Need to Exploit Others
6. The Neurotic Need for Prestige
7. The Neurotic Need For Personal Achievement
8. The Neurotic Need for Self-Sufficiency and Independence
9. The Neurotic Need for Perfection and Unassailability
These needs aren’t pathological — we all possess them. Karen Horney observed that the need becomes neurotic when it forms into a myopic focus and a requirement for getting off. Psychology infiltrates sex — whether we want it to or not.
This isn’t about judgment, and of course not all cases of sublimated eroticism are unhealthy or destructive. We can use sex to celebrate emotions, even our very natural sadistic and masochistic impulses. This is erotic intelligence, not moral delineations of healthy or unhealthy sex. In order to overcome sexual repression, there was a movement to unconditional acceptance of all sexual preferences, but those of us working with sexual dysfunction know that the sexual life must be examined.
The new post-repression shift is toward conscious sexuality; an intelligent, reflective sexuality. Rather than blind rejection or acceptance; there are questions. What do I want sex to mean? How can I use sex to grow? To express myself? To be more adventurous? Less fearful? More lustful? More loving? How do I want to connect with this person?
These questions are hard to quantify and won’t be the subject of the next headline grabbing study, but they do represent the truth of the state of modern sexual exploration. A sexuality that is more than the sum of its hormones, orgasms and positions. One that is social, emotional and constantly evolving.