Arousal

Rob felt responsible for his mother and very guilty about being too selfish, hedonistic, ambitious, or aggressively assertive. He developed the irrational belief that if a woman saw him as too ruthless or selfish in taking sexual pleasure, she would feel left out and hurt. Therefore, Rob was tentative in bed with his wife and ultrasensitive to clue

Gender differences, though real, are not as profound as one might expect. The only relevant question is: what pathogenic beliefs do dominance and submission solve?

Sexual fantasy, then, has the challenge of surmounting these emotions in order for excitement to take place. Because shame and rejection are common experiences, many common sexual fantasies function to negate them. Characters must be drawn, details chosen, scenarios plotted, and roles defined to this aim. One woman I treated imagined seducing her v

Nowhere are adults more dependent than in the relationship they have with their partners, and at no other time was this dependency as strong as it was in childhood. Therefore, the normal emotional dependency in long-term relationships inevitably contains echoes of these earlier attachments. There is an old joke that says that when two people have s

Patients actively use therapy to establish the conditions that will make it safe enough for them to confront their painful and irrational beliefs and feelings. On the simplest level, they seek to be understood, and when they succeed, as Carl did, they begin to feel safe.

Bob, who was visibly uncomfortable as we spoke, went on to tell me that he also felt uncomfortable with crude sexual language. He never described having sex with a woman as “fucking” and felt uneasy with words like “cunt” or “cock.” He felt that these words degraded women and reduced lovemaking to something animalistic.

This dynamic of identifying with our parents and treating others as we were treated by them is referred to by psychoanalysts as turning passive into active. It is another unconscious distortion of the golden rule: Do unto others as you would have others do unto you becomes Do unto others as others once did unto you.

A final example of the power of unconscious perception and chemistry involved a man who grew up in a strict fundamentalist home and felt ashamed of his body and sexuality. He found himself drawn to women who were somewhat exhibitionistic. He unconsciously sensed that their comfort with their own bodies, with their own sexuality, would rub off on hi

Just as my understanding of sexual fantasies is based on the concept of safety, so, too, is my understanding of the process of psychotherapy. People can face painful memories, feelings, or thoughts, or brave the dangers of making changes in their core attitudes, only if it is safe to do so.