Can spending money really make you happy? Ask any woman, and of course…well, you know the answer. Shoes, lipstick, a new outfit. It’s in our DNA. Ask any man, and…well, you know. He’ll reflexively check his wallet.
But can buying things really make us happy? Well…sort of. If we are purchasing an experience rather than a material item.
It turns out, what really makes us happy is buying experiences! Dinner instead of shoes! A show instead of lipstick! A hiking vacation instead of a new outfit! OK, ladies- one, two, three…”Say WHAT?!”
According to a study by Ryan Howell at the San Francisco State University, people who purchase experiences instead of things have greater life satisfaction and well-being. Particulary extraverts. But everyone needs a balance, including introverts. Most people think it’s things that will make them happy, but really, they need both. Things AND experiences.
The upshot? Experiencing new things together will help increase your intimacy with your partner. According to John Gottman, relationship expert and researcher, experiencing new activities together will enrich your marriage. And who doesn’t want that?
P.S. If you don’t, maybe it’s time to see a counselor.
What if you’re having marriage problems and your husband doesn’t want to go to therapy? Can you go to couples therapy alone? According to a recent article in the Wall Street Journal, yes you should!
Couples therapy is very effective for relationship problems because both partners have the opportunity to understand the dysfunctional patterns and dynamics of their relationship. By addressing both sides of the equation, progress can be made much more quickly. But each party must be willing to look at his or her own behavior, and how it contributes to the relationship dysfunction. If they cannot, then the couples session rapidly turns into a ping pong match of blame. Guess what? Not taking responsibility for your contribution to the problem is not going to make your partner more cooperative and willing to make the changes you deem necessary. Rather, he or she will likely become more defensive, and before you know it you are paying a counselor a lot of money to hear you fight just like you do at home. Not helpful.
That’s why interspersing individual therapy with couples therapy can be very effective. A lot of counselors won’t do this because it complicates things; it can create alliances and make one partner feel “left out”. Confidentiality also gets stickier: what if one partner tells you they are having an affair? However, when managed properly, adding individual sessions to the couples modality can be very beneficial. A few years back when I started doing this I noticed I got a lot more information a lot more quickly, and was able to be much more effective in the joint sessions. Yes, it’s trickier to manage but the client ultimately benefits. And that’s really what this is all about!
If your partner is not willing to go at all, then by all means go yourself. If you are willing to be honest about your behavior, and be vulnerable enough to admit where you are wrong, you can still see results from individual therapy focused on relationship issues. Once your partner starts to see changes, he or she will probably be more willing to participate with you, which will enhance the results you’ve already received from the individual therapy. Furthermore, a good therapist can uncover unhealthy beliefs, attitudes and patterns of behavior within yourself that you may have been unaware of. Even if this relationship doesn’t work out, you’ll want your next one to, right? By addressing internal dysfunction you greatly increase the likelihood that you will not only attract, but be able to keep, an emotionally healthier and more compatible mate.
According to a recent study described in the ScienceDaily (January 2012), cognitive behavioral and psychodynamic therapy helps those with a depressive personality just as effectively as those without. According to the article 44% of the population have depressive personality traits. This study is important because it suggests that those with a lower level of depression, but chronic, can benefit from talk therapy. It also adds to the evidence base showing that cognitive behavioral therapy is effective for depression.
For someone with depression, it may be much more difficult to seek help. And not just because of the usual- shame, embarrassment, fear of talking to a stranger, etc. But because people with depression have difficulty mobilizing in ways people without cannot understand. Having depression is like walking around all day with a heavy wet blanket draped over your head and body. The world looks dark, and it is difficult to move. In fact, it’s simply easier to stay in one place and hide underneath the blanket. Unfortunately, that’s the last thing you should do. Yes, I’m talking to you.
What should you do? Call a mental health professional today and make an appointment. You’ll feel much better. And then keep the appointment. Do what the therapist suggests. And if you don’t like the therapist? Find another one. Keep searching until you find one you trust and are comfortable with. Studies show about 40% of therapeutic change is a result of the strength of the therapist and client relationship. So call today!
According to a recent article in Psychotherapy Networker (January/February 2012) by Andrew Weil, there really isn’t any evidence that SSRIs are effective, and furthermore, doctors really don’t understand how they work. Why is this? The answer, as is true with many things in life, is “follow the money”. Drug companies make huge profits everyday by prescribing these types of drugs to people. Therefore, those in the medical field do not have an incentive to research or focus on data that indicates SSRIs may not be effective.
According to Weil, the most recent analysis published in JAMA (Journal of the American Medical Association) rates the effects of SSRIs as “nonexistent to negligible”. In fact, much of the perceived effectiveness has to do with the placebo effect- the idea that if you’re doing something, anything to help your depression you will feel better, so your depression will lift. The truth is that the medical community does not really understand the role that seratonin plays in depression. They know it does, but they don’t understand the mechanism of how it works. Scary, right?
Yet there are doctors everyday, including general practitioners (even scarier!) prescribing these pills to people Now, I’m not saying that they don’t have any value…I’m just suggesting that caution should be in order; buyer beware because the medical doctors generally won’t. You need to be your own best advocate in your health care!
What DOES work for depression? Many studies show that Cognitive Behavioral Therapy is effective. Altering your thoughts and perceptions will eventually make you feel better. Now, for a person with depression that is a very difficult thing to do. And, if you’re really depressed, perhaps SSRIs can actually be helpful. But make sure you go to a qualified doctor, preferably a psychiatrist who keeps up with all of the latest research. And, if you’re going to go on meds, combine it with talk therapy. There is research suggesting that meds combined with talk therapy is more effective than just meds alone. So find a good therapist, too. The good news? Depression is one of the most treatable mental illnesses!
Recently I attended a lunch where Pam Iorio, former mayor of my home city, Tampa, spoke. She said something absolutely brilliant that she should patent: “Chart your own course.” Only I hope she hasn’t yet because I want to use it in this post.
So you need to know where you are going. What are your biggest goals? Are your current day-to-day activities meeting these goals?
Only you hold the steering wheel of your life. Others may try to direct you. If you don’t chart your own course, others will. Do you really want other people determining the direction of your life?
As Ms. Iorio states, she had five strategic goals during her tenure, and said “no” to any activity that didn’t support these five goals. How do I remember that she had five? She repeated it at least four times in her speech. This woman knows her course.
I reflect upon this as I sit here this morning trying to figure out what to do first. Just this morning alone, I had two places I needed to be at the same time. I had to ask myself, which activity most directly supports my goals? And, I had to let one of them go. Unfortunately it was the “fun” one. Then, immediately after that, I received two invitations for two things that sound great, but don’t directly contribute to my goals. Yep, “no” to both of those as well.
I then started thinking about all of the times I say “no.” It’s frequent. I usually feel somewhat guilty…but I cannot be in two places at the same time, and I cannot say yes to every invitation that comes along or I won’t make progress toward what is important to ME. I also need down time. Yes, down time contributes to my long-term goals because it allows me to recharge and go on to accomplish more.
So, what are your goals? Are you charting your own course, or allowing others to lead you? Do you spend your time reacting to other people’s demands, or making your own?
Now, back to that dissertation I’ve been postponing…
In my first radio broadcast, I am interviewed by Drs. Chuck and Jo-Ann Bird on sexual desire, particularly differing sexual drives between partners. I cite research, as well as provide suggestions for bridging this divide. Listen now:
People ask me all of the time if I accept insurance. The answer is “no”. I have many reasons for this, with most of them centered around my clients’ well-being.
One of the major reasons I don’t accept insurance is that I would need to code you, as my client, with a psychological disorder. This is required by the insurance companies. Yes, I have to not only tell them that you are “crazy”, but what type of “crazy”. But it doesn’t stop there. This diagnosis goes into your permanent medical records, which are supposed to be kept confidential. However, as we know, technology is a lot of wonderful things; secure and confidential not always among those wonderful things. For every password-protected system there is a hacker who has made it his/her personal mission to enter. Just the fact that your records are “out there” places you at additional risk. Not to mention the legal and legitimate searches, which means you could get denied coverage in the future for a “pre-existing condition”. To sum it up, the diagnosis is permanently and centrally recorded, and could therefore be discovered by others.
Yet, even I was surprised to read about CNN’s Medical Correspondent Elizabeth Cohen, who discovered that ALL of her private medical information was actually online! Yep, it was all on the internet! All it took was her social security number, birthday, and address. Right there in black and white was every medical diagnosis and treatment from 2003! According to Dr. Steven Schwaltzberg, associate professor of surgery at Harvard Medical School, “There is more information out there about people than could ever possibly be realized.”
So, my refusal to accept insurance is in great part to help you protect information you may not have known required protection.
For CNN’s full article click here.
I had an interesting experience yesterday I would like to share.
Like women do every day in the U.S., I made an appointment to talk to a new hairstylist. I was considering switching, and wanted to talk with the new one before doing so.
Within five minutes, I began to feel odd. Uncomfortable. Almost surreal. The place had a weird energy- there was no reception area, there was nowhere to wait, and I had to search around to find who I was looking for. Stop being such a snob, I told myself.
But then it got a bit stranger. I started to feel uncomfortable with the person. I’m not sure if it was the disjointed speech, the slightly disheveled appearance or the fact that this person’s hair looked bad. Really bad.
Never trust a skinny cook, a poor stockbroker or a hairdresser with bad hair.
Still, I doubted myself. The longer I spent with this person, the more uncomfortable I became. I felt disconnected, out-of-place. I could not follow what was being said. The topic jumped back and forth from hair color to where I lived and worked and what nationality I was. These questions are too intrusive, I thought. Still, I did not get up to leave. Why? I doubted my gut.
Walking out to my car, I just had this really bad feeling. I thought, this is silly. What do I have to be upset about? Then I realized. It was my gut telling me not to go back to that hairstylist. The more I considered the facts (the inordinate amount of time it would take, the fact that this stylist had lots of openings and they were still in school, the inappropriate conversation) I realized an amazing thing: My gut was correct! My gut has always been correct! Whenever I have listened to it, I have never been sorry.
At least when I verify it. I never listen to my gut without verification.
So, what does all of this have to do with you?
Listen to your gut. Then verify.
When you visit a counselor, whether it’s me or someone else, pay attention to how you feel when you are around that person. Don’t just look at the credentials on the wall or the price. If you get that “bad feeling”, ask yourself: is this person really listening? Do they care? Does their style of communication fit with mine (does the conversation feel comfortable)? Are they focused or do they seem distracted? Do they change topics suddenly and seem to forget what they have just told you?
If your “bad feelings” are verified with observable facts, don’t go back. Find another counselor. Keep looking until you find one you feel comfortable talking to. Research shows that the counseling relationship accounts for approximately 40% of the outcome. If you don’t have a good relationship with your counselor, your chances of success are already down to 60%. Why do that to yourself? The work you do in counseling is difficult enough without adding an artificial challenge. So…listen to your gut. Then verify.
According to the November 6, 2010 issue of Science News, researchers in Switzerland have discovered that the longer people are married to each other, the more ignorant they become of their partner’s likes and dislikes. Two psychologists studied 38 young (19 – 32 years of age) and 20 older (62 – 78 years of age) couples. The younger couples were able to accurately predict their partner’s food preference 47% of the time, but older couples were only able to do so 40% of the time. Similar ratios were found with regard to movies and kitchen design preferences. According to the article by Bruce Bower, this is due to the fact that older couples pay less attention to one another because they are more firmly rooted in their relationship. Compounding the issue, older people were also more over-confident in their ability to predict likes and dislikes than the newer couples were.
It’s the old “taken for granted” syndrome. Familiarity breeds laziness. Not good. As a relationship counselor, I fight every day to help couples overcome this phenomenon. It’s twin sister, “I can read your mind”, is also a problem. Spouses, especially when married for a long time, think that they can predict what their partner is thinking. This is not a problem when they are correct. But when they are not…Amazingly, I’ve actually seen situations where the partner has to argue with the mind-reader about what he or she is actually thinking.
Understanding and awareness of this general mind-reading tendency in long-term relationships is just the first step. Couples need to develop new behaviors, which can be challenging for long-term couples. Further complicating things, old resentments and emotions may be tied up with the mind-reading. If that is the case, it may be time to visit your relationship counselor.
To get more information about the benefits of relationship counseling, please visit my website, and take the relationship quiz, or give me a call at (813) 404-9215.
According to a recent study from the University of Southern California, men shut down emotionally when arguing with their significant other. Any wife or long-term girlfriend will tell you they didn’t need a study to tell them this. Or, as one of my colleagues succinctly puts it: “That’s from the DUH journal of counseling.” But, what is newly discovered is that when men are under stress, the regions of the brain associated with understanding social cues become disengaged from other parts of the brain. Thus, they withdraw. Women, on the other hand, don’t seem to have this issue. Women’s brains stay coordinated regardless of how much stress they are under. At least with regard to reading emotions. I’m not talking about lost car keys here.
This is why so often in the pursue/withdraw dynamic, the pursuer is usually the woman. What happens is that the woman will want to discuss an issue, the man doesn’t appear to care (remember: they are having trouble reading social clues right now), so the woman begins to get frustrated and escalates her irritated behavior, which causes the man to withdraw more to avoid her anger, which causes her to yell louder, yeah, we can see where this is going.
Whereas this scientific explanation is not going to address this dysfunctional dynamic in your relationship, it may depersonalize it. Ladies, it may not be that your man doesn’t think your concern is important, it could be that part of his brain has temporarily shut down. You may be able to put yourself in his shoes, but he can’t return the favor right now.
Of course, your issues may be deeper than this. Take the Relationship quiz on my website (about halfway down on the right) to see if couples counseling may be beneficial. If you think it might be, give me a call at (813) 404-9215.
Until next time,
Barbara LoFrisco, LMHC, LMFT, Dip.ABS
Source: Parade magazine, October 24, 2010, p. 13.
Sunday’s St. Petersburg Times contained a very interesting article titled “Living, not buying, is what matters.” Did you read it? If not, or even if you did, here is my take.
The article profiled a couple who lived for their stuff. They were in jobs they hated so they could make payments on the debt they took on so that they could buy lots of stuff. Stuff they didn’t really need. Or really want. “Stuff” ultimately controlled their lives.
Said couple, inspired by a web post about living with less, decided to pare back in a big way. They moved to a studio apartment and limited themselves to 100 personal items. They sold their cars and gave away most of their clothing. What else did they get rid of? Their $30,000 debt. Now, one partner works part-time in a business she loves, and the other is pursuing a doctorate. By getting rid of their stuff, they made room in their lives for what really matters.
The research seems to back them up. People gain more satisfaction from experiences than they do from accumulating stuff. As Elizabeth W. Dunn, an associate professor in the psychology department at the University of British Columbia, states: “It’s better to go on a vacation than buy a couch, is basically the idea.” Thomas DeLeire, an associate professor of public affairs, population, health and economics at the University of Wisconsin in Madison, agrees. He found that out of nine categories, the only one that really made people happy was leisure: the vacation rather than the couch.
Other experts agree that people seem to be cutting back on consumption, but it is unknown how much of that is due to the poor economy and how much is due to a life-changing epiphany, like our couple. Regardless of the reason, people are reaping the benefits.
There are many reasons why experiences seem to be more beneficial. One is that a shared leisure experience strengthens social bonds, and, as I am continually telling my clients, a good support system is essential to mental health. Another reason is that it takes longer to process an experience than a purchase. Think about it. How long did it take you to stop being excited about your shiny new leather jacket vs. the wonderful mountain vacation you just took? This phenomenon even has a name: “hedonic adaptation.” There is no parallel term for becoming accustomed to experiences. What does that tell you?
Take it from Roko Belic, a Los Angeles filmaker who moved to a trailer park so he could surf more. Before you scoff, think about what is really important. Is it stuff or surfing? Roko is happier living more simply so he can pursue his passion: surfing, not sitting around looking at his stuff.
I hope this inspires you to take a look at your life. What are you dragging around that you can get rid of? How can you simplify? What is really going to make you happy? Is it the 40″ flat screen TV or the trip to Montana? I, for one, am going to start researching Montana. Today.
I look forward to your comments.
Source: St. Petersburg Times, Sunday, August 15, 2010
Botox may do more for you than just erase wrinkles. According to a recent study done by psychology graduate student David Havas of the University of Wisconsin-Madison, women injected with Botox took an average of one-quarter of a second longer to read a sentence describing an angry or sad situation than they had before the procedure. Interestingly, they took no longer to read about a happy situation.
This supports the idea that facial expressions trigger and intensify relevant feelings, rather than simply reflecting them. Thus, someone who has frozen the muscles that show anger or sadness, may take longer to have negative emotions. This could have a detrimental effect on face-to-face interactions, in which even a small delay in evaluating emotion may create misunderstandings and hurt feelings. According to Nicolas Vermeulen, a psychologist at the Catholic University of Louvain in Belgium, Botox patients may react the wrong way to angry situations, putting themselves at risk.
Source: Science News, July 31, 2010
Wondering if you should get couples counseling? I am a Licensed Mental Health Counselor, a Registered Marriage and Family Therapy Intern, and a sex therapist. In my work with couples, I have noted common areas in which troubled couples tend to be deficient. This list of ten questions that I have created will help you evaluate how well your relationship is functioning.
If you answer “no” to one or more of the questions, then it is likely that counseling will help enhance your relationship. The more questions you answer “no” to, especially questions 6 – 10, the greater the need for couples counseling.
1. Do both of you have some sort of outside support system, such as friends or family?
2. Do the two of you spend time alone together on a regular basis, interacting with each other, or do you find yourselves in silence whenever you are alone?
3. Do you explore new activities and places with your partner?
4. Do you take time to let your partner know you appreciate and love them? Is this often enough for your partner?
5. Do you share information about yourself or feelings with your partner that you don’t share with others? Do you do this on a regular basis?
6. Do each of you feel accepted and loved for who you truly are?
7. Do you speak respectfully and lovingly toward each other?
8. Do you feel comfortable bringing your problems to each other? Do both of you feel heard and understood?
9. Do you tend to solve problems as a team, rather than individually and then arguing about them later?
10. Do you deal with issues as they arise, rather than avoiding them?
How did you do? Many couples can usually improve in at least one of these areas. Sometimes, couples simply aren’t aware that there are areas of their relationship that can really benefit from some improvement. If you are having trouble addressing these areas, couples counseling can help. For more information on couples counseling, please visit my website.
* This list was developed after consulting similar lists in Lambos, W.A. and Emener, W. G. Cognitive and Neuroscientific Aspects of Human Love : A Guide for Therapists and Researchers, and Horton, Lee (2008), Crumbling Commitment: Managing a Marital Crisis.
Today I took a little field trip. As a clinically trained sexologist, this little trip should have been no problem. Yet, I felt compelled to enlist the assistance of my supervisor, who graciously walked me through the process. As I nervously pulled into the parking lot, I noted that I was 10 minutes early. No way was I going into that store by myself. I called my supervisor to tell her I was in the parking lot. Fortunately, she had pulled in directly ahead of me and was waiting patiently for me to get out of the car.
I went to a store that sells sex toys. For clinical and educational purposes, you see. “Intimacy enhancers” such as vibrators, cock rings, videos, clothing, you name it and they’ve got it. Flavored stuff that heats up, things that spin, roll, vibrate and light up. Some things I couldn’t figure out at all. As a trained clinician, I felt a little silly asking for help. But ask I did and the salespeople willingly opened up the package and explained how things worked, allowing me to hold items to check texture, pressure, and what not.
The store is clean, well-stocked, well-lit and organized. Sort of like a Target for dildos. The salespeople were dressed in conservative clothing and were professional. However, the sheer choice of product was a bit overwhelming. Is it really necessary to have an entire wall of rabbit style vibrators? Is there really a big difference between the pink, the purple and the camouflage? Should I chose one with flashing LED lights? I mean, what is the purpose of the lights, anyway?
Then we took a walk down the fetish aisle. I consider myself pretty open-minded but I was surprised not only at the sheer variety of restraint devices, but the creativity. There was a bed that you could buy specifically for BDSM use. Wow. And lots of various contraptions, most of which had a dildo on one side or end. There was actually an entire section for nipple clips, complete with weights or feathers, however you like your nipple clips.
About a half an hour into our little trip, I began to feel a bit numb. I mean really, how many fake penises can you look at before they all start to look the same? An hour into it I could no longer make good decisions and realized it was time to wrap things up before I purchased the $89.95 rolling tongue. (Which, by the way, felt like a real tongue. Cool product).
If I felt somewhat uncomfortable and almost completely overwhelmed, how might someone without clinical training feel? Maybe more people would visit these stores if they had a guide for their first time.
My recommendation: this is a clean, well-stocked store that women would feel comfortable entering. However, due to its sheer volume of products, I do not recommend it for newbies.
According to the June 19, 2010 issue of Science News, there may be a genetic link to the level of emotional damage done by bullying. Researchers at Duke University, North Carolina, found that kids with a short version of the 5-HTT gene were more likely to be emotionally upset by bullying, often severe enough to warrant mental health treatment. And, teenage girls with a short version of this gene were also more likely to become depressed after being socially excluded or lied about.
This is a handout I prepared for couples entering therapy. Although it is oriented toward working with me, I think it provides concise and valuable information about the couples’ therapy process:
Welcome. By asking for help with your relationship you are making a statement about how important it is to you. Because it is important to you, It is also important to me. Therefore, I have prepared this handout to help you get the most benefit out of our time together.
I would like you to take a moment and think about why you would like to do couple’s therapy. “Because my wife/husband wants me to go” may be the only answer you have right now, and that’s OK. But, it would be helpful if you could take some time and think more deeply about it. Think about what you really want from your relationship. What is your “dream relationship”? Be as specific as possible. Think in terms of the goals you would like to have for your relationship.
Generally, it is more helpful to think about what you can change about yourself rather than what your partner can change. If you both can do this, the couples’ therapy has a much greater chance of working. Besides, you are in direct control of yourself, not your partner. On the other hand, it is also useful to have a clear (and realistic) idea of what you would like your partner to change. I say “realistic” because it is important to consider your partner’s strengths and weaknesses in this process.
It is also useful to think of your partnership as a “system.” As parts of that system you will naturally affect one another. A good analogy is an air conditioning system. In that system, if the air temperature gets too hot the thermostat kicks on the A/C, which then cools the temperature. In a very similar way, couples can either heat each other up, or cool each other down. I will help you discover such patterns and we will work on ways of altering them so a stable “temperature” is maintained.
The issues in your relationship have probably developed over many years, and so it makes sense that it may take several sessions to help you repair them. Like any bad habit, changing unproductive relationship patterns will take time and effort. But the rewards are great.
One final thought. It is natural and healthy for couples to argue. It is unrealistic to think that two humans with different temperaments, behaviors, and experiences will never disagree about anything. It is how you disagree that matters. I will help you learn how to “fight fair.” It is through a process of negotiation and compromise that relationships can grow and improve.
I look forward to working with you.
According to a 2010 survey conducted by the Institute for Divorce Financial Analysts, the recession appears to have affected the divorce rate in some interesting ways.
Thirty-eight percent of analysts report a decrease in the number of divorce cases they handle, with 25% reporting an increase.
Common reasons for the increase:
- desire to reduce the cost of their divorce (most common)
- economic climate is straining marriages
- people exploring options prior to hiring an attorney
Common reasons for the decrease:
- people are afraid to divorce while unemployed
- people cannot afford to live apart
- people cannot afford to divorce until economy improves
- not enough money to hire a financial expert
The housing market has also affected the behavior of splitting couples. Because it is more difficult to sell their homes, people are coming up with creative solutions:
- both stay in house and live in separate rooms (most common solution)
- renting house to third party
- renting apartment, and taking turns staying in apartment (kids stay in house)
- one stays in house and pays rent until market improves
What does all this mean? The general trend appears to be that couples are staying together longer; whether they are postponing divorce, or simply forced to continue living together due to finances and the housing market. Either way, couples could benefit from learning to communicate better, get a long better, and understand each other more. Couples therapy can help with all of that.
Couples therapy isn’t just for couples who want to stay together. Having an objective third party present can help couples learn how to communicate better and diffuse tension. Couples often have “blind spots”, things one or both partners cannot see because of past hurts or resentments. A couples counselor can gently point them out, to help the person gain a greater perspective on the situation.
As an experienced couples counselors, I have helped many couples communicate more effectively. Clients have reported that their relationship improved even though they ultimately decided to split up. An improved relationship can mean a less acrimonious split. So why not call and make an appointment today?
Barbara LoFrisco, LMHC
Female Sexual Pain is a prevalent, yet commonly misunderstood and misdiagnosed group of disorders. Let’s begin with some definitions. Sexual pain disorders are defined in the DSM-IV TR as either dyspareunia or vaginismus. Dyspareunia is pain associated with intercourse that is troublesome to the individual and not caused exclusively by medical conditions. Vaginismus is an involuntary spasm of the outer third of the vagina that prevents sexual intercourse, causes the individual distress, and is not due exclusively to a medical condition. Vulvodynia, pain in the vulvar, and its subtype, provoked vestibulodynia (also referred to as vulvar vestibulitis), pain in the vulvar vestibule area, are both types of dyspareunia. Clinically, it is difficult to separate dyspareunia and vaginismus, as they often occur together.
Female sexual pain disorders are prevalent and can have devastating effects on women’s health and happiness. Statistics vary, but most researchers estimate that the rate of dyspareunia is 20% in the general population. Vaginismus rates seem to be lower, with the National Institutes of Health reporting rates of 30% in a primary care setting and 1 – 5 % in the community. Because many researchers have found healthy, positive and satisfying sexual behavior to be important for women’s health and happiness, these statistics point to the importance of accurate diagnosis and effective treatment to women’s well-being. Yet, according to one research study, only 60% of pain sufferers seek treatment, and only 40% receive a diagnosis.
If these disorders are prevalent and can have such a negative effect on women’s health and happiness, why don’t clinicians have a better understanding of these disorders? One reason is that the research and clinical community can’t seem to agree on how to conceptualize these disorders. The main disagreement seems to center around whether or not these disorders should be classified, and therefore treated, simply as pain disorders; or if there is something “different” about them that warrants inclusion into their own unique category. Another reason could be the lack of research. Although recently there is renewed interest, historically there has been a dearth of information on the topic. Finally, there is confusion and misunderstanding about the etiology of the disorder.
Because it is thought that there are psychological elements to pain, many practitioners include psychological and behavioral elements when treating female sexual pain disorders. Researchers have reported that women with a sexual pain disorder can benefit from sexual education, improving sexual skills, improving communication, physical therapy (such as vaginal dilation or Kegel exercises), addressing cognitive disorders; and using behavioral interventions like sensate focus, visualization and relaxation exercises.
Because Cognitive Behavioral Therapy addresses the connection between thoughts, feelings and behaviors, many researchers think CBT may be a viable alternative in treating female sexual pain. The main idea behind using CBT is that by changing the thoughts around the pain we can actually change the pain experience.
Several research studies have shown that CBT (whether in group, individual, or bibliotherapy format) is initially somewhat effective in treating female sexual pain disorders. However, a few studies indicated that biofeedback, Supportive Psychotherapy and medication were equally or more effective. In fact, one study showed that vestibulectomy (excising a portion of the vulvar) was significantly more effective. However, both vestibulectomy and medication are considered more invasive treatment than CBT, making them less desirable.
CBT is not completely benign. One study showed that it decreased marital satisfaction. A possible reason for this is the lack of any type of couples’ therapy. And, not all studies showed lasting effects. Interestingly, non-randomized studies showed lasting effects, but randomized studies did not.
More research needs to be done with regard to the effectiveness of CBT for female sexual pain. In particular, there was a lack of information on individual treatment, and how the inclusion of couples’ therapy might affect the results.
It is my experience and opinion that many interpersonal and relationship factors are present in most sexual experiences for women. Sex does not occur in a vacuum. For most women, factors such as how the woman feels about herself, how she feels about her partner, her past experiences, how she perceives her partner feels about her, etc., are relevant in a woman’s sexual expression. Because female sexual pain is associated with the genitals, and is usually experienced during some form of sexual expression, it is my opinion that female sexual pain is tied to the sexual experience. Because sexual experiences are tied to relationship factors, therefore so is female sexual pain. Thus I disagree with the opinion that female sexual pain should be treated as any other pain disorder. Rather, it needs to be addressed both in a sexual and a relational context.
It is these unique features of female sexual pain that indicate the need for more comprehensive interventions. Treatment should include some form of assessing how the woman feels about herself as a sexual being, her body image, how desirable she feels she is, how she views sexual expression, her past sexual experiences and what her parents may have taught her about sex. There is a possibility that a woman’s negative view of herself as a sexual being could block good and positive sexual feeling and create tension, thus making the pain worse. This could create a vicious cycle: as the pain gets worse she thinks more negatively about her sexuality, which worsens the pain, and so on.
Relationship factors are also important to consider. Most women present because they cannot have sexual intercourse with their partners, which is negatively affecting their relationship because it is inhibiting intimacy. Some women present with not wanting their partner to touch them in a sexual way due to the fear of pain. Either way, it is inarguable that the couples’ intimacy is adversely affected. Once intimacy is reduced, it is much easier for the couple to begin building misunderstandings, hostility, and eventually, resentments. For the woman, once this happens it is likely she will blame herself, which will worsen the negative thoughts she has about her pain and her genitalia, thus worsening the condition. For the man, he may feel frustration but not communicate his feelings to his wife because he is afraid of making the situation worse. All of these negative dynamics are appropriately fodder for couples’ therapy.
In conclusion, female sexual pain is difficult to understand and treat due to differing clinical conceptualizations and the lack of research. Unfortunately, this condition is prevalent and can have deleterious effects on a woman’s well-being. Although initial results from CBT treatment appears to be positive, future research and study is necessary, particularly in the areas of individual CBT treatment and the inclusion of couples’ therapy.
Think you can’t afford psychotherapy?
A recent study done by the University of Warwick and the University of Manchester (http://www2.warwick.ac.uk/newsandevents/pressreleases/therapy_32_times) shows that 4 months of psychotherapy is as effective at increasing happiness as a pay raise of 25,000 pounds ($37,500 in U.S. dollars with today’s exchange rate). These researchers studied thousands of subjects, comparing their happiness levels before and after 4 months of psychotherapy. What they found was that it would take 32 times an 800 pound ($1200 U.S. dollars) cost of therapy to achieve the same happiness levels.
This study has huge implications to our understanding of happiness, and also the cost/benefits of psychotherapy. The results from this study point to the fact that money does not make us happier, that happiness is originated from within ourselves. Therapy can address internal factors that inhibit happiness. Furthermore, although therapy is expensive, it is a much more effective investment in your well-being than obtaining (or holding onto) your money.
You may wonder what exactly sex therapy is and whether or not it’s for you. Issues or questions about sex or intimacy are very common and nothing to be ashamed or embarrassed about. According to the Mayo Clinic, about 1/3 of all adults have a question or concern about their sexuality.
lack of desire
difficulty achieving orgasm
concern about sexual practice: “am I normal?”
more satisfying sex
less anxiety about sex
more positive self-image
Here is more information on sexual counseling/sex therapy from the Mayo Clinic:
To find a provider, look for someone who is certified by a board of sexology, such as the American Board of Sexology (ABS) or the American Association of Sexuality Educators, Counselors and Therapists (AASECT), or someone who is legitimately advertising themselves as a “sex therapist” (can demonstrate that they have had the 120 hours of training required by the state, and 6 months of supervision).
For more information on the services that I provide, including sexual counseling, please visit: