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Insights at the Edge
Tami Simon's in-depth audio podcast interviews with leading spiritual teachers and luminaries.
Listen in as they explore their latest challenges and breakthroughs—the leading edge of their work.
Alexandra Katehakis: Grown-Up Sex
Alexandra Katehakis is the founder and clinical director of the Center for Healthy Sex, specializing in therapy for sexual addiction and sexual issues within marriage. In addition to writing several books on the subject, Alexandra will be presenting on sexual dysregulation during Sounds True's upcoming Neuroscience Training Summit 2017. In this episode of Insights at the Edge, Tami Simon and Alexandra discuss the roots of sexual dysfunction and how to approach it in adulthood. They speak on "grownup sex"—a sexuality based in honest communication of needs, preferences, and desires for novelty. Tami and Alexandra also explore topics such as asexuality, sexuality without intimacy, and why orgasms are overrated. (58 minutes)
Tami Simon: You're listening to Insights at the Edge.. Today my guest is Alexandra Katehakis. Alexandra specializes in sexual addiction issues and sexual and marital therapy. She's the founder and clinical director of the Center for Healthy Sex in Los Angeles, and is the author of several books, including Erotic Intelligence and Sex Addiction as Affect Dysregulation. She's also a regular contributor to Psychology Today and the Huffington Post. With Sounds True, Alexandra Katehakis is a featured presenter in our Neuroscience Training Summit 2017, which runs from March 20 through March 29, and features leading presenters in the field of neuroscience, including Stephen Porges, Dr. Daniel Amen, Rick Hanson, Kelly McGonigal, and Joe Dispenza.
In this episode of Insights at the Edge, Alexandra and I spoke about the inability to self-soothe as an infant, and how that can lead in later life to sex addiction. We also talked about what she calls "grownup sex"—how couples in a long-term committed relationship can grow up from adolescent sex and take responsibility for talking about their needs and preferences, and communicating honestly about issues related to body image, aging, and desires for novelty. Alexandra and I touched on a wide range of topics, including the importance of preventing children from accessing digital pornography, the phenomenon of asexuality, the choice to be sexual without intimacy, and finally, how orgasms are overrated. Here's my conversation on grownup sex with Alexandra Katehakis:
Alex, you're one of the featured presenters in Sounds True's Neuroscience Training Summit 2017, and you'll be presenting on the topic of "Sex Addiction from a Neurobiological Point of View." Right here at the beginning of our conversation, I want to ask you what may seem like a very obvious question, but the answer isn't obvious to me. Which is, how do you know the difference—how does someone in their own life know the difference—between sex addiction and, "I just really, really, really like to have a lot of sex?"
Alexandra Katehakis: Well, that's a common question, Tami, so thank you for asking it. One of the differences, main differences, is that people who declare themselves "sex addicts" are in a profound amount of pain as a result of their sexual behaviors. So what may have started out as fun or being used as a way to sort of get out of one's head—or not deal with psychic pain that some people know or don't know they have—quickly turns into the proverbial albatross around their neck.
They'll have a high level of preoccupation with getting into the sexual experience, so sex becomes—there's a myopia, there's a shutting down of everything other than getting that experience. It becomes a collapsing of one's life, and people typically report messes—or what they call "unmanageability" in the 12-Step Program—as a result of having this kind of destructive, painful sex. Which is different from someone who likes to have sex, enjoys it, feels sensual, it feels enlivening to them, and what we think of as life-affirming.
TS: In your work directly with people, have you worked with people who aren't quite sure whether or not they have a sex addiction, and how do you help them in their own experience be able to come forward and say, "Yes, my name is so-and-so, and I'm a sex addict"?
AK: Well, all the time. People come in dubious—some people say they're sex addicts and they're actually not; some people's wives have told them they're sex addicts and they're not; some people don't think they are and they actually are. This term gets thrown around quite a bit now. It doesn't really fit the bill unless there's a lot of assessment that's done appropriately to look at whether there's a long-standing pattern of compulsivity, and if this person has, in effect, created these adaptive strategies that become states over time.
If, for example, you have a child who grows up in a very, very dangerous, dysfunctional, neglectful household, and they start to learn through fantasy—whether it's comic book fantasies or, more commonly we see today kids getting on the Internet and looking at Internet pornography as early as six [or] eight years old—and that is their sole way of regulating themselves or feeling good, what happens is that the brain starts to form around those patterned behaviors. So what is initially a coping strategy that helps that person manage difficult, lonely, sad, terrorized feelings, over time becomes who they are. And they therefore can't not do what they do. So, that's the point where we consider something is an "addiction"—that these are tenacious neural networks that are wired together in the brain because they've been firing together for so long.
So, just because somebody has an affair, or looks at Internet pornography, does not make them a sex addict. As I said, it requires a lot of scrupulous assessment to see if that's really true for each person—and then some people like that term, some people don't. I don't really have a bias about what people call it; I'm more interested in helping people get out of the snarl they're in and move towards a healthier, more life-affirming sexuality.
TS: Can you help me understand this idea of the brain pattern that somebody might be in, and how that could get somewhat cemented—if you will—if they've turned to sex as a way to help find relief from the pain of that pattern? I think that's what you were pointing to.
AK: Yes. This is a sort of wildly debated point, but one of the things we know is that dopamine is a neural hormone that lives deep in the middle part of the brain, and it is a way that we learn. So whenever something new or novel is brought to us, or that we see from the outside, that information comes in through the central nervous system—meaning through all of the five senses. And [if] it's novel, we get excited, and in that excitation, it's easier for us to learn. So, if you think about children learning new math skills, or art, or music, or anything of that nature, they're learning because of this dopamine state that they're in.
It's an excitatory state, and what we think about with sexual behavior that's excessive is that we think of it as a chronic disorder of the brain's reward system of motivation, of memory, and the related circuitry because this dopamine system is being excited constantly. The thinking is that it's the seeking of the sexual behavior, not the acquisition of it itself, that has someone get into these addictive loops. The thinking being that it's the dopamine that the person is actually "addicted" to, so the chemical is inside our own brain. We know this is true for people with food as well—that food can be very excitatory and releases a whole host of neurochemistry that has people becoming compulsive overeaters.
So does that answer your question?
TS: I think we're moving in the right direction. Help me understand this seeking behavior. It seems like with an addiction, whether it's sex addiction or compulsive eating, yes, there's the seeking, but I want the goal, too. In the case of a sex addiction, doesn't the person want the orgasmic goal? It's not just seeking. I want the goal.
AK: Sure. Actually, once the sex addict has the orgasm, the whole cycle is over. On the other side of that, they can become actually very dysphoric; so, as opposed to becoming euphoric on the front end in anticipation, when it's over, there's a gross letdown. And if that person is already depressed or anxious or very dissociative, that is not a preferred state. So, many addicts will do what we call "edging," where they're constantly working the edge of the arousal—not moving towards orgasm so they can stay in that high place.
The reward center is really driven by expectation of award, and many, many sex addicts will say it's about the hunt. So, this is the seeking system that gets activated, which is one of the major systems in all mammals. It's considered the granddaddy of the systems in mammals; these are affective systems, which create anticipation of reward, and that imprints a conditioned response in us. So once that's activated, the dopamine receptors continue to stimulate the activating behavior, and they reinforce this prospect of reward.
So, there are these reward-seeking actions like cruising on the Internet for sexual partners, or going to strip clubs or sexual massage parlors, or having anonymous encounters. All of these function as a self-reinforcing loop. If you all remember—or we all remember—Pavlov's dogs from high school biology, Pavlov would ring the bell and the dogs would come running for food. That's the loop that gets set up in the brain.
TS: So, then in your work with someone who identifies and says, "Yes, this is me; as you're describing this sex addict and this seeking behavior, this is me, and it's causing a lot of pain in my life, if I tell the truth," how do you work with such people to provide healing?
AK: Well, first, I take a very extensive history, because oftentimes these patterns get set not only in childhood, but sometimes really in infancy, depending on the level to which the person is chronically dysregulated, meaning unable to soothe themselves—wherein they're always reaching for something outside of themselves to make themselves feel better.
Sometimes if somebody recalls or knows that their mother had a very difficult pregnancy or she was anxious or depressed at birth, that tells us that she was likely unable to attune to her infant so that she could bring his or her systems to fruition in the way they are meant to be optimally. So, if she's anxious, her infant's going to be anxious. If she's depressed, the infant will be depressed. These are functions that get set up early, early on—some of which can be changed, some of which cannot down the road.
Also, if that person suffered any kind of emotional abuse, physical abuse, sexual abuse as a young person, or was grossly neglected, then they're going to have a lot of trouble with regulating themselves. When a child is left alone or abused, he or she will find ways of coping. It's sort of a natural adaptive strategy for survival. So, whether it's fantasy or compulsive masturbation or, as I said before, disappearing into Internet pornography or even making up stories in one's own head, all of those things are set up to make the pain or the sadness or the loneliness go away.
Oftentimes, children like that are set up to become addicts, whether they're drug addicts or alcoholics or gamblers or eating—it's hard to say why people choose which behavior to be compulsive with. But when they do, it's helpful for clients to understand why what they're doing makes a lot of sense. So, rather than feeling shameful or like they're bad or damaged or broken, we look at why it makes good sense that they would be doing what they're doing today because they adapted this a long, long time ago to survive. But, now it's keeping them from having a healthy relationship or a healthy sex life, or being able to even be in a relationship, if that's what they desire. That would be the start of treatment.
TS: Just the sense that you said—that this pattern of behavior, sex addiction, could begin as early as in infancy—that you could trace the roots for some people to very early in their life—I never would have thought that, because you think, well, you know, puberty, or later in life when you begin masturbating—like that's when something like a pattern like sex addiction might come on. But you're going deeper into the human's experience. You're going really early.
AK: Right. So, what you're saying is accurate; the pattern of sexual compulsivity would start to show up later—and it's really tricky, even in the teenage years, because teenage experience with all sorts of sex and sexuality. But usually people know by the time they're in their twenties. They'll say, "Well, when I was in college or at this time, I was already masturbating every single day and I'd been watching porn since I was eight," or something along those lines.
I'm not saying that infants become sex addicts right off the bat. I'm saying that their level of dysregulation internally—the inability to self-soothe—gets set up, and can get set up in infancy. We know this from the work of Dr. Allan Schore and many other affective neuroscientists, and certainly early child development specialists who look at what happens between the infant and his or her primary caregiver; and that it's evolutionary with the human species—and really, all animals actually need this interactive regulation from the primary caregiver to bring the structure and function of their brain and nervous system online so that it's optimally operating as we move into childhood and adulthood. Any chronic breaches in that that are not repaired and tended to are going to create problems in our nervous system. So, we will reach for something to make us feel better.
TS: I notice when I hear you give this view, there's a real relaxation around judgment—like, it's not this person, this young person at fault—they're on the Internet—but it's [about] tracing it back to their original sense of not having an attuned relationship with their caregiver. There's such an innocence in it.
AK: Yes. And sometimes it's not even the fault of the caregiver, because now—when I first started doing this work in 1998, we were talking about people looking at pornography as early as six and eight years old, but now we have a whole generation of people who report having two parents that were working, they were latchkey kids, and these are good, nice people who had no idea that their kid was coming home and was alone and lonely, and would flip on the computer, and—boom—pornography's right there. Any amount and anything you can imagine is right there, and these predominantly males get to be 20, 21 years old and they are wired to the computer. They only know how to have sex that way; they have difficulty with erections with real, live human beings.
So, through no fault of their own, they found themselves strapped to this problem and they want to get out of it because they know it's not right, it doesn't feel good. They don't feel functional.
Then there are many other instances with people that were sexually abused in childhood, or emotionally abused—which is predominantly what we see, at least what I see clinically in people that present with sex addiction. There was a lot of emotional abuse and emotional neglect. So, they felt very alone, lonely, not seen, not heard. So, they're seeking validation through sex, which makes sense because they're looking for touch and love and being wanted, but they can't really reciprocate it contingently or appropriately because it wasn't wired into or built into them. So, that's one of the things people have to relearn, or learn in recovery.
TS: Alex, here you are—you're a specialist in the area not just of sex addiction but sexual/marital therapy as a whole, and I'm curious to know a little bit about you and how this became your area of specialization.
AK: Well, that's a big question. I struggled with basic dating as a young girl. My parents—my father was an immigrant and my mother was born of immigrant parents, and my father was very strict, especially because I was female, so I wasn't allowed to date. My mother was really very much not wanting me to marry a Greek man; she wanted me to marry an American man. So, she was at odds with the choice that she made because she wanted, really, the American dream: I think all immigrants want their children to do better and have more and better. So, I didn't go through a healthy courtship or dating phase that many young people go through, where their parents steward them through adolescence appropriately and know the kid that they're dating, and know the parents, and make it all transparent and a normal developmental trajectory.
So, I started sneaking out my bedroom window when I was 16 and having sex with boys that were much older than I was because I couldn't do it in the light of day. So, it was very secretive, very shaming, really abusive to myself and harmful. Then when I was—by the time I was in my twenties, I had had sex with many, many different boys and men, and I didn't know what it meant to have a healthy sexual relationship. I hadn't seen it modeled to me. By the time I was 27, I was out of a bad long-term relationship with someone who was 16 years older than I, and my parents were divorcing after 35 years.
So, my whole world was topsy-turvy with sex and relationship, and when I decided to go to graduate school, I was really interested in the question of, "What is healthy sexuality, and what makes sex vital and erotic and long-lasting over time, and is that even possible? Or is that just an aspiration?" I inherited my own parents' intergenerational trauma; both of them were trauma survivors, my father from World War II and my mother from parents who suffered under war and bias from the countries they came from.
TS: You mentioned these questions that you were asking as a college student: "What makes healthy sex? Can it be vital? Can you have a sexual vitality throughout a lifetime in a committed relationship?" So, let's just start with healthy sex, because you named your center the Center for Healthy Sex in Los Angeles. What is healthy sex?
AK: That's a really good question. I still don't know, and I think that question in itself can be judgmental because I could tell you what I think healthy sex is, but it may not be healthy for you. So, I think that is a question that is meant to be explored in collaboration with a trusted other, where we talk about what is healthy for that person. So what's healthy for you and what's healthy for me may be different, but it's what we find to be true for ourselves—and that's why I think it's vitally important for people in recovery for sex addiction to ask that question of themselves over time.
There's a Zen saying that, "Before enlightenment, a mountain is a mountain and a river is a river, and after enlightenment, a mountain is a mountain and a river is a river." And likewise, with sex addiction and recovery from sex addiction, sometimes people will go through a recovery process and they'll say, "Hey, I'm really still very aroused by that thing I was doing when I was compulsive, and I'd like to still be able to do that thing." So, we have a conversation about how [you can] do that within the confines of boundaries or what is safe and sane and consensual for you, not abusive, shaming, or secretive.
These things have to get massaged; they need a lot of space to breathe. A lot of constructive conversations have to be had so that shame is no longer on the playing field, because shame is a big, big part of why sex addicts act out in secrecy. When people can get clear with themselves about what they like sexually, what's arousing for them, what has meaning to them, and they can take ownership of it, then it becomes a very different experience.
TS: It sounds like you're open to this being a wide range of what healthy sex is. Someone could say, "You know, I like to have sex once every three months. That's my vision of healthy, vital sex life." Is that OK, Alex?
AK: Yes. I mean, I think it would be OK. I'd say, "Well, what is it about the three-month mark that you like, and what happens to you at one month?" And if that person were partnered, "Well, what does your partner think about that? And if your partner wants to have sex every week and you want to have it every three months, how are the two of you going to negotiate what the high-desire partner does every week? Is that person going to masturbate with or without you? Do they want you to participate with them in some form of roleplay while you watch? How are you going to construct this thing called your healthy erotic sex life that's agreeable to both of you?"
TS: How do you help a couple do that? Let's say you had a couple who had this high disparity in their desire around sexual frequency.
AK: Well, I would start by really asking each party what about the frequency with which they like to have sex they like, and why they like it, and what that means to them. And also, so they could hear why their partner is unhappy with the frequency, and what the partner—the other person—may or may not need. It's really a conversation where we deconstruct the entire thing and put all the pieces out. And really, I sort of push that back into the system of the relationship and say, in other words, to the couple, "This is your problem. It's not my problem. This is your relationship. You've both brought this to the relationship. How are you going to solve this puzzle?"
Oftentimes, the first part of solving the puzzle is both parties being really honest—getting really naked with each other about what's true for them. That can be difficult to hear, because sometimes it's about attraction or difficulty with intimacy or being close. There are many, many people who are quite avoidant of sex; they can have sex with strangers—it's actually super easy to have sex with a stranger, right? It's hot, it's novel, it's exciting. It gets much more difficult to infuse novelty into a relationship over time when you're familial with that person and familiar, and they are your best friend and you're close with them. How do you turn that which is known into that which is erotic and exciting? Sometimes it's through these very conversations and speaking the unspeakable that novelty gets infused into the system.
TS: In terms of healthy sex, what would you say to someone who says, "You know, I don't need to feel intimate to have terrific sex, and I like it like that. Intimacy and sex, they're not particularly linked for me." Is that OK, Dr. Katehakis?
AK: Sure, it would be OK, but it would depend on what their preferred life is. I think that's important to consider too. I don't think there's any one correct way to live. So if somebody—and I've had many people struggle with that, especially as they get older, with I would say, males in their 50s and early 60s who say, "Hey, I've been having casual sex my entire life. I've never been married, I've never been in a relationship. I don't know if I can change this pattern. I don't even know if I want to." We'll talk about it, and sometimes what people come to is that, "It's too difficult for me at this point, I don't want to change that. This idea of close-in intimacy is just kind of a turn-off for me, and I'm just going to be a professed bachelor and know that I'm going to be a serial monogamist the rest of my life."
If a person is at peace with that, then that's great. That's their preferred sex life. If that person's in a relationship with somebody, they're going to have a harder time with that question, because if the partner's not on board with it then you've got a real dilemma. People have to decide what has more meaning to them: their partner, or their desire to be sexual with a bunch of different people. If it's the latter, then they have to leave the relationship, unless the couple decides they want to have a non-monogamous relationship.
TS: Let's turn to a monogamous couple—a couple that wants to be together for many, many years to come, and perhaps has already been together for many years, and there is a sense of boredom in their sex life. You talked about, it's not that easy sometimes to infuse novelty; that you have to take a risk. How do you help couples take the risks they need so that their sex life does become hot and exciting?
AK: For starters, many people just don't make eye contact when they're having these conversations. We tend to have them in the car or when we're sort of sitting around, maybe at the breakfast table having coffee, reading the paper, or there's some distraction. So putting people in two chairs opposite each other, knee to knee, making direct eye contact, is novel to the autonomic nervous system. So just that simple eye contact and really looking at the person that you've chosen, that you love more than anyone else in the world, that has your back, that's your person, is a very simple way to start to ignite some novelty.
Then, to deal with the grief and loss that we feel as we're aging—that we're no longer those people we were 10, 15, 20, 35 years ago—that we're much older versions of those young people that just sort of unwittingly got together and fell in love, and to be able to see that in each other and to have compassion for the other, and also see them as a sexual being.
Let me just back up—part of having compassion for the grief and loss is looking at our changing bodies, our changing faces, our lack of athletic ability in bed that we once had, and naming that and being able to say, "I'm not as free with my body anymore because I have difficulty looking at its changes in broad daylight," or, "I'm less attracted to you or these parts of your body for this reason, and that makes me feel even ashamed to say that to you." Being able to hear your partner saying that also, without collapsing, is a big part of the equation. Like saying, "Wow, I can see why you're not so attracted to my sagging belly. I'm not that attracted to it either, I've got to tell you, which is why I don't want you to see it." These are very poignant and painful conversations that also can create compassion and spark a love between two people that they didn't know was there.
Then the other part of that, after wading through those swampy waters, is asking people what their updated sexuality is. People update their wardrobes and their cars and their hair, but they don't often update what they like sexually. They're still doing what they did before, and they know one way to orgasm, but they don't really experiment with other things or other ways. Those are also things that people have to be challenged to do for themselves.
So, I would encourage people to maybe go to a sex shop together, find sex toys that are arousing to them, or even ones that they think are outrageous or stupid and they might just end up laughing hysterically in bed. It may not be sexy at all, it might just be stupid or funny, but that is connecting. Laughter, play states [are] very, very connecting, and the couple may end up throwing those things away and having sex with each other in a way that feels vital that they haven't in a long time. This is the kind of novelty I'm talking about. It comes from real honesty.
TS: I'm imagining being knee-to-knee, looking eye-to-eye, and starting to share some of the things you pointed to about how I feel about my own body, how I feel about my partner's body, what I want more or less of sexually. I mean, I think that's really big work. I think that's probably incredibly challenging for a lot of people.
AK: It is.
TS: It seems like there are a lot of skills embedded in being able to do that, or a certain platform of awareness or being. It's not just like [you can] snap your fingers and you can do that.
AK: No, and that's why people need good guidance from a good sex therapist that's not afraid to talk about sex and sexuality, and who also has the kindness and compassion to recognize how tender these conversations are—especially when we're talking about aging bodies, and time, and change, and love, and loss. Couples who have been together for a long time have been through so much together; none of us escapes that. All the trials and tribulations of loving and being in relationship.
We're very quick to get rid of our partners today; I've read statistics and statements where people who have affairs ultimately are not any happier than before they had the affair. They were looking for some lost part of themselves that they could have found with their partner, but they were too afraid of losing their relationship to come right out and say it. So, they make these sideways moves that have them jeopardizing their relationship anyway.
This notion of self-deception is very interesting to me. The way we deceive ourselves into telling ourselves that we're happy in our marriages or our relationships—but our sex life's not that great, or we're not that crazy about our partner, or we've got some resentments we're not really talking about. But we circumvent them, or we lie about them, or we adapt to them in the same way we do with rooms that have clutter in them or stacks of magazines that we're going to get to later or when we move.
We just tolerate things, and then we recognize at some point that we've woken up and a decade's gone by, and we've been tolerating that thing. Then we get angry, we blame and shame our partner, we put ourselves in victim positions, instead of really taking ownership about what we've done to ourselves. Like, "I put myself here; I tolerated this."
This is what it means, I think, to have an adult sexuality and to be a grownup, is to be able to really take the heat of what it means to be true to myself—and you may not like it, but at least I'm in my integrity and I'm not lying to you and I'm not cheating on you. I'm telling you if these things don't change, I am going to have sex with somebody else, or I want to have sex with somebody else. But I'm letting you know first; you're the first person to know, not the last person to find out.
TS: That's, I think, very strong and very helpful. Let's say somebody's hearing this, and they're like, "OK, there's a lot of truth-telling around our sexual relationship that is needed in my intimate partnership; I hear it. But I'm too ashamed of my body"—we could take that one, or, "I'm too afraid of rejection to share what my desires and fantasies are." I mean, I could imagine there are probably a list of reasons why people don't make this adult step. So, let's go through it a little bit—we can start with the shame. "I'm too ashamed of my body; I can't go there. It's too much shame."
AK: Well I would say, what are you ashamed of? What is the worst thing that could happen?
TS: Yes. OK. And underneath it is this fear of rejection—I'm going to be rejected, this is going to hurt terribly. Yes.
TS: I mean, I'm just sort of throwing these out as samples of what—you know.
AK: Sure. So, that person may say that, "I don't want my partner to reject me, and I don't want to hear that she or he doesn't like my body because I really don't want to make those changes. I'm too lazy, I don't want to exercise, or eat better. I just don't want to do it."
So, I would ask that person, or I would start to look at what that person—how they're holding their partner hostage. They're not really giving their partner the opportunity to speak up or say what they want or need, or what they like or don't like. They've already got it all figured out, and tightly battened down, and that's not love. That's about holding somebody in a place because that person's too afraid of hearing the truth that it sounds like they already know; they already know that they have shame about their body, and they're not willing to do anything about it. They're expecting their partner to live with this limitation. That is not—I don't think that's a clean way of relating to somebody.
TS: OK. You use this very interesting phrase, "grownup sexuality," versus some kind of, I don't know—
TS: Adolescent. Right. So, if you said, "This is what grownup sexuality looks like—healthy, grownup sexuality looks like this."
AK: Well, it looks like knowing your body, knowing what's arousing to you, and telling your partner. You mentioned that earlier, too—that a lot of people are afraid to tell their partners what turns them on because they're afraid of their partner's judgment of them. Like, "You're gonna think I'm freaky," or "You're gonna run screaming from the room if I tell you this," or, "You won't want to do it," or, "You'll think I'm gross."
We already project onto the other person what they're going to think about us without ever asking them, and that's a way of trying to control the other person's reactions, as opposed to really, fully, deliciously taking ownership of what it is that you like, and saying to your partner, "I don't know how you're going to react to this. I'm afraid of how you're going to react, so my tendency is to keep it secret from you. But I love you, and I really want you to engage with me in this. I want to play in this sexual arena with you, so I'm going to tell you. And I want to know if you can hear this and you can hear it without judging me, and just be curious about why I like this."
Let's say I like having sex with giraffes. OK?
TS: All right! Yes.
AK: To be super abstract. [Laughs.] So Tami's down with that, then, right? That's the kind of response!
TS: I like giraffes a lot, and it's strange imagery, yes.
AK: Right! That's the response you would want from a partner, like, "Wow, that's cool," or "Huh, that's unusual or weird, Alex, can you tell me more about that? Where did you get this idea? Have you ever done it? Did you do it before we met? What would that look like within the confines of our house, because our ceilings aren't that high?" It's like, how are we going to explore this together, as opposed to a reaction of, "Oh my God, that's disgusting," because boom, that's a shame hit right to the gut, and the conversation's closed down now and all we have is woundedness and pain and shame in the system. That's not going to go well at all.
But when it's open, that's what I would call a more adult conversation. It's the difference between groping under the covers in the dark versus having the lights on and being able to see each other and watch each other give and receive pleasure. Now, there's nothing wrong with groping if that's sort of fun and novel on occasion. But if it's solely the way people have sex, where they don't look at each other's bodies, they don't look at each other—just kind of putting their bodies together and getting it over with—that doesn't seem very grown-up or erotic to me.
TS: This may seem a strange question, and I realize you can't give me, probably, an accurate number. But if you were just to take a guesstimate, how many people—let's say in the United States—do you think, who are actually grownups—meaning they're of adult age—are actually experiencing grownup sexuality versus adolescent sexuality?
AK: Wow. I mean, I don't know. I would think the number's pretty low, but I would just say it's a coin toss. Maybe 50 percent.
AK: Yes. I would just guess. Look, with the advent of pornography—Internet pornography—and Fifty Shades of Grey, people are much more experimental with sex and sexuality now than they've ever been. I don't know how explicitly people are really talking about sex in long-term relationships, which is what we're talking about now; like over time, where people renegotiate their relationship and their sex lives, and they talk about their changing desire and tastes in sex and sexuality. That part is probably less than 50 [percent].
AK: But I do think younger people are talking about sex a lot; they're certainly having a lot of sex. But I don't know how much they're sustaining sex over time.
TS: A couple times, you've mentioned, in the context of sex addiction and just in terms of what's happening in the culture as a whole, Internet pornography and its pervasive use. I'm curious if you think there's something we need to be doing at the cultural level to control Internet pornography—what your views are on it.
AK: Well, this is a sticky wicket also, because I really think that porn is a speech issue, especially today. I'm stalwartly supportive of our First Amendment rights, so I don't think an anti-porn stance is helpful to anybody. Pornography is not real sex, it's porn sex. Even porn actors say there's a difference between porn sex and at-home sex. They're very different. It's like the movies. It's like La La Land—it's not real. And when it gets into the hands of children who are watching it consistently while their brains are not even fully formed yet, we're starting to see problems—intense problems—for people.
So I would like to see some kind of regulation with Internet pornography the way the UK brought opt-in and opt-out measures into their carriers—both Internet service providers and television providers or cable providers—where parents could actually have an opt-in or opt-out button so their children didn't have free access to porn. I mean, we don't give kids free access to alcohol or drugs, so why are we giving it to them with Internet pornography?
The other grossly missing thing in our culture is sex education. We have little to no sex education other than Internet pornography today. So, I would like to see sex education beginning in kindergarten, where we talk to children about their bodies and what they feel like, and their boundaries. I think this would help with less sexual molestation as well if children understood what was OK and what wasn't.
So we'd see less sexual abuse, we'd see more respect of their bodies. We would steward young people as they got older towards understanding adolescence—or puberty, rather—and what's happening hormonally and how their bodies are going to start to come online and they're going to want to have sex. And what a beautiful thing that is, and how instead of acting like they're not going to have sex, assuming that they are going to have sex, and how do we help them move towards a sexuality that feels honoring of their bodies rather than them just losing their virginity or having anal sex because they can't get pregnant that way, and traumatizing themselves in many cases—so that they wait longer, and when they do it, they do it from a place of security rather than anxiety.
We have a long way to go on this issue in our country, and it's not looking good currently. But I think parents can take those reins into their own hands, and hopefully some communities can as well.
TS: Now, the parenting issue around pornography does seem pretty clear, I think. Let's say somebody listening says, "OK, porn sex is different than intimate sex with a person. How do I know if porn sex is serving me or not? How do I know if this is increasing the vitality of my life, or is just some way that I'm not really relating to myself?"
AK: Well, I think that person would know that. I mean, when you say "porn sex," you mean somebody who's just watching pornography?
TS: Doing that—that's a regular part of their life.
AK: Watching pornography is a regular part of their life.
AK: The question is: is it additive, or is it problematic for them? When someone tells me that they can only get an erection if they're watching pornography, I would think, "Wow, the body is designed to get an erection by itself." Anytime somebody needs something, it's like you have to have a sleeping pill to sleep—that means that your brain is not producing melatonin or you have a mood disorder; the system is not operating the way it was meant to operate. It's designed in a perfect way, and if you're constantly having to use something in order to shore it up, then that means there's a deficit somewhere.
I like the idea of that which is holistic, that which is optimum. So, I would encourage people to work towards an optimum level of functioning, whatever that is for themselves.
But again, if that's a preferred way of being for them and they have no problem with it, then it's not a problem. I only see people who have problems because they come into my office; the people who don't have problems don't come.
TS: Yes. OK. Let's say somebody comes into your office, and their presenting problem is that they feel a kind of numbness or deadness; they don't feel turned on by practically anything. They don't feel like they have a real erotic life. How can you help that person?
AK: Well, it would depend on their age. You may know that there are a whole host of people today that are identifying as asexual—where they don't feel like they've ever had any sexual arousal. They don't have sexual fantasies, they're not interested in sex. They want companionship, but sex is not their thing. So, I would assess to see if that person identified as asexual because I wouldn't want to force sexuality on somebody if they didn't want it.
TS: So, first off, that's interesting, and I hadn't heard that there was a group of people that are now in a category that is asexual. So, that's new information for me, Alex.
TS: So that's—some people are just asexual? That's how it is?
AK: Yes. I mean, if you Google "asexuality," you'll see there's a whole community of people who identify as asexual. As I said, that would be one constellation of presentation of somebody. Somebody else, usually who is going to say, "I have this lack of desire problem," is coming to therapy because it's a problem for them. They want to feel desire or have desire. Again, I would be assessing for early childhood issues, to see how traumatized that person was, if they were dissociated and to what extent they were, if they had any felt sense in their body whatsoever, if they ever had had a relationship, had had sex, what that was like, where their attention was during sex—whether it was with the other person and in the sensations in their body, or if they were checked out somehow—dissociated in some way.
So, it really depends on the person and what their story is because our sexuality is as unique as our fingertips, I think. Everybody presents in a different way. People have different pain thresholds; some people are really into pain—they're into some extreme pain practices, or even middle-of-the-road BDSM practices, because pain and pleasure are very tightly bound with each other. Other people have a low threshold for pain, they can't stand any—it's like people that don't like spicy food. They can't stand any spicy anything. That's just how their systems are set up. It's really about an exploration with the other person about what's arousing to them, what they're interested in, what their preferences are, and how we can work towards those common goals.
TS: Well, I've saved one topic here for the end of our conversation. That's to talk a little bit about orgasm!
TS: I'm sure that you're going to offer a wide range of what is a healthy approach, if you will, to orgasm. But I'm curious to know in how you work with people who say, "I'm too orgasm-focused and I wish I wasn't," or, "I'd like to have multiple orgasms." It's a big topic, different for men and women, and from your work, if you could summarize for us some of the key points in how you help people deepen—I guess—the joy that's potentially there in orgasm.
AK: Well, I think orgasm, like most of our Western culture, is largely overrated, because it's all about the result, and sex has to be—it doesn't have to be. But when it's working well and beautifully between two people, it's often the exploration; it's the journey between here and there. When people are orgasm-focused, they don't orgasm—especially men, because that's performance anxiety. It's all about getting to the finish line, and not about breathing and slowing down and making contact with your partner, and exploring each other's bodies along the way.
This is one of the basic interventions on people that have difficulty with rapid ejaculation is just slow down and deal with—not deal with, but have the experience of all of the other ways of pleasure—giving and receiving pleasure—that don't have to do with penetration but have to do with feeling and experiencing and being intimate with one another. That is more difficult for a lot of people; they just want to hurry up and get to the end point that can—that stops the process of really savoring what's happening between two people. So, if people aren't into intimacy necessarily and they're just into getting off, they're always going to be racing towards the orgasm.
Similarly, with females who say they can't have vaginal orgasms—most women can orgasm clitorally much easier because there are lots of nerve endings in that area that can stimulate somebody to rapid orgasm, but learning to have a vaginal orgasm can take time. Some women can do it, some can't, but bringing breathing into the experience, slowing down, experiencing pleasure in the body in addition to what's happening between the two parties, is all part of creating a different kind of orgasm over time.
And orgasm is really just a big muscle spasm in the body—we want to make it this hot, sexy, romantic thing, but truly, it's a muscle spasm. And truly, I think both parties—or everybody—needs to be responsible for their own orgasm, meaning we all need to know what turns us on, what brings us to orgasm, what we need, and we need to bring that into the sexual experience and let our partner know about it also. Oftentimes, people get frustrated or angry that their partner's not bringing them to orgasm, or the converse of that is people feel like it's their fault that their partner's not orgasming. And it's not about you; your partner's orgasm is not about you. I think that's a difficult thing for people to get, also.
That's part of having an adult sexuality as well, is saying, "If you need lubrication, bring the lubrication that you like to the party. Don't act like you don't need it, and don't be ashamed that you need it. Talk about why you need it, why you like it, where you want it, and just bring it into the mix without being shy about it."
TS: I've been speaking with Alexandra Katehakis, and thank goodness she will be part of our Neuroscience Training Summit 2017. She will be offering a presentation as part of that summit on "Sex Addiction as Affect Dysregulation: A Neurobiologically Informed, Holistic Treatment." I'm so pleased that we're being able to include as part of the summit this year these perspectives on a neurobiologically informed, holistic treatment for sex addiction—and just to bring your voice forward, Alex. You're so brilliant, well-informed, and nonjudgmental, and you have such a broad view. I'm so pleased that Sounds True is working with you in this way, and thank you for the good work you're doing.
AK: Thank you for having me, Tami. I'm very excited to be part of this year's summit.
TS: Our Neuroscience Training Summit  takes place March 20 through March 29. Other featured presenters include Kelly McGonigal, Daniel Amen, Stephen Porges, Rick Hanson, [and] Joe Dispenza, and you can find out more at SoundsTrue.com.
SoundsTrue.com: many voices, one journey. Thanks, everyone, for being with us.