Grief is the domain of relationship therapy

 

 

 

COSRT (College Of Sexual and Relationship Therapists) is the leading UK professional body regulating the specialist profession of psychosexual and relationship therapy. 

 

Therapists trained in a COSRT-accredited course will have the knowledge and experience working with loss: the loss of sexual desire, the psychosexual issues after an illness like cancer, relationship break-ups and divorce, infidelity, and so on. However, when it comes to bereavement and the particular grief it brings, it seems that our psychotherapy profession becomes split into the specialisation of bereavement counselling rather than relationship therapy when it could, in fact, be both. I argue that the loss and grief from bereavement is very much within the domain of relationship therapy. 

 

Relationship with love

When someone dies, the grief people feel is individual. The most important factor that shapes the grief is the quality of the relationship with the deceased person. Indeed, bereavement counselling is not only about helping with grief, but it is about understanding in depth the complexities of human relationships.

 

After a loved one’s death, the survivor experiences the loss of the relationship, the rupture of connection, the sound of someone’s voice replaced by silence, they will  miss and crave their loved one’s touch, their sense of humour, their presence. They also lose their sense of the future which had previously been imagined by the side of their loved one. If the connection was strong, the grief will be experienced as intense. 

 

Relationship with unloving other

As relationship therapists, we know that relationships are complex and multi-layered. Some people’s death may bring a positive feeling to the survivor. For example, if the relationship was abusive, if the connection was toxic, one’s death may bring relief and a sense of resolution. It may even bring happiness. This is a difficult topic because these issues are seldom discussed and those particular feelings usually come with guilt and shame: 

‘I should not be happy about someone’s death’

‘How should I grieve this horrible person?’

‘I’m a bad person for not feeling sadness’. 

With society’s expectation that bereavement comes with sadness and tears, many people feel the pressure to be inauthentic with their feelings. I think that relationship therapists are very well equipped to dive in these complexities.  

 

Relationship with sexuality 

For many, the death of a romantic partner is the death of their sex life. This is another taboo area because, again, society tells us that we should be sad about the loss of another but not for the loss of something about us: 

‘I’m selfish’

‘Does it mean I’m a sex addict?’

‘Does it mean I didn’t love my partner that much?’ 

There aren’t any therapists more equipped to help clients in these grey taboo areas than a COSRT-registered therapist. 

 

Relationship with self 

When someone loses a loved one, their heart can shatter. The relationship with their broken heart is very important. Being present with their experiences and not putting pressure on themselves to ‘get through grief’ requires honouring the connection with their self. People have to allow themselves to move with the flow of their emotions, just as much as they had to move with the flow of their partner’s existence. When the bereavement ruptures a strong connection, the heart doesn’t fully, there will always be a scar, and accepting the scar is honouring the deceased person’s place in their lives. 

 

The ‘rippling’ 

Existential psychotherapist Irvin Yalom says a dead person’s life echoes and influences the survivors long after their death, which then is passed on to the survivor’s survivors. Yalom calls it the ‘rippling’. This is a wonderful thing to think about, not to avoid thinking about the fact that one is dead but more about remembering the power of connection and human relationships. 

 

After 2020 and for many years to come, therapists are going to see more and more people who lost loved ones, those with broken hearts, those with complex grief processes. We, COSRT relationship therapists, can be at the frontline of the major mental health crisis ahead of us, ready to help the people in much need. 

 

If you want to be ready and equipped, you can join the short CPD course on grief offered by CICS  (Contemporary Institute of Clinical Sexology).  

 

 

Silva Neves 

 

 

 

The harm of the 12-step 'sex addiction' approach

 

 

 

I started the year 2020 speaking with Dr Joe Kort as a guest of his world-renowned podcast Smart Sex Smart Love  about the potential harm of ‘sex addiction’ treatments. 

 

The notion of ‘sex addiction’ and ‘porn addiction’ has been consistently rejected by the scientific communities worldwide because of the lack of evidence supporting it. A new study published in December 2020 by Grubbs et al. made a ground-breaking independent review finding  that the research methodology used in supporting ‘sex addiction’ and ‘porn addiction’ over the last 25 years was poor, further questioning the validity of the conceptualisation of ‘sex addiction’.  

 

The ICD-11 (International Classification of Disease) only endorsed ‘compulsive sexual behaviours disorder’ (CSBD) as a psychological condition. WHO (World Health Organisation) clearly states that CSBD is completely different from ‘sex addiction’ and these two terms must not be interchangeable. 

 

This is important because clinicians offer treatments that are congruent with what they label the condition they are attempting to treat. A therapist believing in ‘sex addiction’ is more likely to offer a treatment through the primary lens of addiction, despite the science not supporting it. It is when clients can be in danger of inappropriate treatment because their sexual behaviour struggles might be seen through the therapist’s own window of morality, rather than through the evidence-based knowledge of modern clinical sexology. 

 

Despite the science, there are still fierce disagreements and much confusion amongst clinicians. What is important to me is to alert the public affected by sexual compulsivity that they have choices about their psychological treatments. 

 

If you struggle with unwanted sexual behaviours that cause distress, please know that the ‘sex addiction’ conceptualisation is not the only way to think about your problems. A ‘sex addiction’ treatment and 12-step support groups are not the only choices. They are not the scientifically approved choices either. 

 

Why do I keep talking about it? 

Because I am concerned. 

 

As a result of the podcast with Dr Kort, unfortunately, I finish the year 2020 having heard stories from numerous people in the UK and Europe telling me about being traumatised by 12-step support group programmes, and by ‘sex addiction’ treatments. It is heart-breaking to hear so many people who originally struggled with sexual behaviours ended up feeling worse after their treatments. The common self-report from the victims of such treatments is feeling more shamed and more depressed about themselves and their sexuality than before. It is the dark unspoken side of the ‘sex addiction’ conceptualisation. 

 

Many sexual practices that are non-monogamous, unusual, or even extreme may actually be functional and harmless, but may be wildly misunderstood by therapists who have poor knowledge of the current sexology science and therefore might unduly pathologise their clients, which creates more harm for them. 

 

I heard on numerous occasions that people practicing BDSM (Bondage and Discipline, Dominance and Submission, Sadism and Masochism) were told that they were ‘addicted to BDSM’, which is grossly inaccurate. 

 

Many were told to be afraid of their sexual thoughts and fantasies as they were ‘triggers’ to avoid when in fact these were normal processes and responses to common sexual stimuli. 

 

A majority were told that watching pornography was bad, a piece of advice that is not clinically supported by the large body of research which found that pornography in itself has no impact on people’s mental and sexual health. 

 

All of the misinformation mentioned above – and more-  perpetuated by the ‘sex addiction’ ideology only encourage people to be erotically avoidant thus creating more problems for them. Many of the strategies employed by the people subscribing to the ‘sex addiction’ concept are in danger of doing accidental ‘conversion therapy’. 

 

‘Conversion therapy’ is the practice underpinned by the belief that sexual behaviours must conform to a strict concept of heteronormativity. Sexual behaviours outside of that heteronormative ideology is deemed a ‘disease’ that must be cured, or something undesirable that should be changed. In its original form, ‘conversion therapy’ is typically a practice attempting to ‘cure’ homosexuality. ‘Conversion therapy’ is now considered unethical in the UK and it is banned in some other countries because of the significant psychological harm that it inflicts on people. 

 

As you can imagine, within the wide spectrum of sexuality, many people who self-identify as heterosexual and who also have specific kinks or fetishes may be in danger of ‘conversion therapy’ disguised under the 'diagnosis' of ‘sex addiction’. For example, many people practicing BDSM consider it as an integral part of their sexuality. If a therapist calls it an ‘addiction’ and attempts to change it, they might be doing accidental ‘conversion therapy’. I call it ‘accidental’ because I believe that most ‘sex addiction’ therapists in the UK want to help clients with the best intention, however, due to poor or inadequate clinical trainings, they might not be aware that the therapy they offer can cause harm, and they might not know what to do differently. 

 

People struggling with their unwanted sexual behaviours actually need the opposite interventions. They need help to face their erotic world, being fully erotically-aware whilst learning to manage their emotions. They need support in examining the functions of their sexual behaviours and what the underlying precipitating and maintaining issues are, instead of staying focused on stopping the symptoms. With thorough erotic-awareness, and a sexology-informed treatment, sexual compulsivity dilutes and people can start to make the right choices for themselves and the partners they choose to commit to.

 

 

A psychological treatment is not supposed to induce shame and depression. I heard many people tell me that after a 'sex addiction' 12-step programmes and/ or therapy, they felt suicidal for the first time in their lives. Some became acutely fearful of their erotic world, fantasies and ability to relate to others, freezing in sexual situations. To me, this is not a good outcome of therapy or support groups. Many of these people spoke to me in confidence. Although I have permission to write this blog, they would not speak up about their experiences themselves because of shame. Many told me that they were blamed for not following their ‘sex addiction’ programme.

 

If it had been one or two people reporting such things, I would really not think much of it. But the great number of people telling me similar stories is concerning. In our psychotherapy field, the terms ‘sex addiction’ and ‘porn addiction’ are not challenged enough. 

 

There are many unheard voices who are alerting us of the great potential of harm, I think it is important that clinicians continue the conversation Dr Kort and I had, and to continue challenging the ‘sex addiction’ field, because, after all, we all have to be held accountable for the therapy we offer, and all of us must uphold our first ethical pledge: First, Do No Harm. 

 

If you’re a therapist wanting to learn how to treat compulsive sexual behaviours efficiently, safely and ethically, please contact CICS , the only UK Institute offering a Diploma level course teaching the sex-positive, evidence-based treatment going beyond the reductive ‘sex addiction’ thinking. 

 

 

Silva Neves 

There's no naughty list on cancelled Christmas, or is there?

 

 

 

This year’s Christmas’ Tesco advert ‘there’s no naughty list’ evokes something profound faced with adversities: emotional soothing through ‘treats’. We have all seen movies with a break-up storyline in which the heartbroken character reaches for the tub of ice-cream or the chocolates in the middle of a pile of tissues. Most of us have been socialised to receive ‘treats’ when we’re feeling down. It is therefore quite normal to discuss comfort eating without raising an eyebrow, especially in the challenging times of a global pandemic cancelling Christmas. 

 

However, it is quite another to discuss soothing ourselves on a bad day with sex. By sex, I mean a variety of activities: masturbation, watching pornography and masturbation, cybersex, sex with committed partner, sex with casual partner and so on. If you say you ate a whole box of chocolate on the cancelled Christmas Day, people would understand and you would probably receive empathy. But if you say you spent the day masturbated to pornography or logged on a cybersex website, you would probably not receive the same empathy; many might even think there’s something wrong with you, maybe you have some dark sexual sickness, like ‘sex addiction’. Indeed, when it comes to sex, there is always a ‘naughty list’ and it is not the sexy kind. 

 

The fact is that soothing difficult and painful emotions through sex is just as good a method as comfort eating and it is one of the many common and functional reasons why people have sex. Yet, it is not talked about because we are not socialised to think that way, and it is loaded with shame. 

 

This usually festive period is going to be very difficult for many people. We are told that the beginning of next year will be equally hard with maintained restrictions. It is not a surprise many people will have turned to sexual activities to soothe themselves. The problem is that they do it in shame, thinking it’s ‘wrong’. For many people, the sense of ‘wrongness’ is reinforced by their partner when they find out about it and take offence that the sexual behaviours did not include them. Some sexual activities can indeed constitute a breach of their agreement and be a betrayal causing chaos in the relationship. But often, it is just about misunderstanding. For example, many people watching pornography do not do so because they’re unhappy in their relationship, yet it is often perceived as a threat. 

 

This January, I’m convinced many people will call therapists asking for help for their ‘sex addiction’ or ‘porn addiction’ because of the shame they feel for soothing their emotions with sex rather than the ice cream. 

 

If it is you, before you make a call, consider this first: watching pornography, masturbating, cybersex or any other consensual sex is not bad or harmful in itself, according to numerous sexology research. In fact, there has never been any adequate evidence that sex and pornography are addictive, which is why the notion of ‘sex addiction’ and ‘porn addiction’ has been consistently rejected by scientific communities. 

 

There is no denying that some people struggle with sex and pornography, but it is not because of an addiction problem, it is because the sexual behaviour is the only method they have to soothe themselves. Just like food, if your only way to feel better is to eat chocolate, you could be eating a lot of chocolate in challenging times, to the point that it might feel out of control, like an addiction, but it is not. The best way to resolve these issues is to add more soothing resources, not to take away your existing one (adding more resources and becoming fully aware of your erotic processes will automatically reduce the compulsive feeling of the sole existing resource). 

 

The ‘sex addiction’ and ‘porn addiction’ programmes are primarily focused on helping you stop unwanted behaviours. There is hardly any good clinical evidence that these programmes are effective. They actually often have poor outcomes, just like diets have poor outcomes, because if you stop doing the one thing that makes you feel better, you will have a strong sense of deprivation, and you will struggle to stop for the long term (by the way, ‘food addiction’ is also a myth). When you ‘fail’ at the addiction programme, you will feel more shame, blame yourself for it, and… feel worse about yourself. In this pandemic time, nobody deserves to feel worse than they’re already feeling. 

 

If your sexual behaviours did betray your relationship commitments, you might definitely feel bad and guilty for hurting your partner. There are many ways that you can learn about your behaviours in a non-shaming sex-positive way so that you can make better future decisions that are aligned with your sexual desires, relationship commitments and values. I recommend psychotherapists who are educated in sex-positive, evidence-based modern sexology such as the graduates from CICS

(The Contemporary Institute of Clinical Sexology). 

 

You can also contact me, I’ll be very happy to point you in the direction of good therapists. 

 

But for now, if you want some extra tools for soothing your unpleasant emotions and navigate this difficult Christmas, you can head over to my Instagram page: @silvanevespsychotherapy; I posted Self-Care tips throughout November during the second England lockdown (#SelfCareNovember). 

These tips are obviously good all year round, in any difficult circumstances. Here’s a summary: 

 

1-    Connecting with nature 

2-    Taking a break from social media and news 

3-    Yoga practice 

4-    A cup of tea 

5-    Crying 

6-    Soothing scent 

7-    Sexiness 

8-    Sleeping 

9-    Connection with friends 

10- Pets 

11- Quiet 

12- Baking

13- Kindness 

14- Gratitude 

15- Doing nothing 

16- Masturbation and orgasms 

17- Know your people 

18- Music 

19- Laughing 

20- Accepting bad days 

21- Reading 

22- Comfort food 

23- Sex

24- Talking to yourself 

25- Swearing 

26- Water 

27- Happy Place 

28- Breathing 

29- Exercise 

30- Therapy 

 

 

Don’t despair. Your out-of-control sexual behaviour is not an addiction or a disease. It can be resolved with permanent positive change with the right treatment. If sex is one of your ways to soothe yourself, make sure it doesn’t breach the trust of your partner, and indulge, in moderation. 

 

Take care of yourself in these challenging times. 

 

Silva Neves  

 

Re-thinking sex since COVID-19

This week the deputy chief medical officer Dr Jenny Harries has announced that the UK lockdown could last six months. As we are currently in the middle of the COVID-19 pandemic, there isn’t any scientific data yet on how this might impact people’s sexual and relational lives, but we already have plenty of anecdotal information that can help us make some hypothesis. Sexologists debate whether there will be an increase in sexual activity and therefore create a new baby boom, or if the opposite will occur as the acute anxiety about the uncertainty of life is going to be an erotic killer and produce more depression and less sex. 

What we do know at this moment in time is that pornography viewing has increased, which is not surprising. Pornography and masturbation are good and efficient ways to soothe unpleasant emotions and it can also be a good distraction when people suddenly have more time. Dr Justin Lehmiller, a psychologist and sex researcher has previously noticed that the use of pornography reflects the events of the time, for example, there is more views of Christmas-themed porn around Christmas time. Lehmiller observes the same phenomenon applies to COVID time with many people searching for coronavirus-themed porn. Lehmiller explains that it can be an eroticisation of fear as it is common for strong emotions to be perceived as sexual desire or sexual arousal. Our ability to do so may be a mechanism to own and process the fear rather than being overwhelmed by it. COVID-related sexual fantasies can also be a way to process our fears. 

Sexologist Jack Morin writes that one of the emotional aphrodisiacs is anxiety and one of the cornerstones of eroticism is what he calls ‘overcoming ambivalence’. A well-documented psychological process informs us that we tend to feel more sexual when faced with death in a subconscious drive for survival. It will therefore make perfect sense that sexual arousal and activity become more prominent in COVID times. 

However, I wonder if there is a threshold in which the eroticization of COVID stops. It is now obvious that it will take a long time for the world to recover from this pandemic. As the death toll rises and more people become distressed at losing loved ones, careers and finances, our fear will turn into crisis survival with a fight, flight and freeze position which inhibits the erotic system. 

Our nation is being hit by a wave of grief because of the loss of the life and freedom we used to enjoy. There are different facets of grief. We can see denial every day with people not respecting social distancing. Bargaining is another aspect of grief when people think it won’t be that bad. They are perhaps the ones who find it easier to be erotic in these challenging times. Anger is also a common emotion of grief; and there is depression, one facet of grief that is anti-erotic. People will respond differently to their grief, and they will fluctuate between different states from one moment to the next. It is therefore not possible to predict the impact of people’s sexual and relational lives. Will there be a baby boom or not? Who knows? 

The Government has enforced a lockdown when it is only permitted to leave our house for essential things such as food shopping or exercising. Having sex is not one of them. Couples living together can continue to have sex with each other if they have no symptoms. If there are symptoms, the recommendation is to refrain from sex and not leave the house at all for two weeks. As the rules of self-isolation apply to household, the same goes with people who aren’t couples and sharing a home. I wonder if flatmates might develop a ‘new way’ of living together, where cuddling each other could become a form of ‘friendly comfort’. Human touch is so central to our well-being. 

However, for people who are single, this can bring complications. Not having sexual contacts for six months can be a big ask. This is when technology is a great resource: consensual sexting and webcam sex are good alternatives. 

Dr Markie Twist writes extensively about digisexuality as an emerging sexuality. It is a term to describe people being primarily sexual through the use of technology. I think that COVID-19 is going to bring forth this sexuality as a legitimate one rather than an ‘alternative’ one. 

I am starting to hear many anecdotal stories of what is happening amongst the single people who self-identify as gay men. They report their hook up apps going off the charts with people wanting to meet for sex. Most of these are an attempt to fantasise about meeting but not interested in acting on it for safety. Another cornerstone of eroticism according to Morin is ‘violating prohibition’. The fantasy may be to violate the Government’s prohibition and meet others for the ‘non-essential’ sex. That particular fantasy has taken shape with a specific sexual practice called ‘gloryhole sex’. According to gay men using hook up apps, the invitation for ‘gloryhole sex’ is on the rise. This sexual practice previously belonged to a gay sub-culture of ‘anonymous sex’, but now it may become more mainstream. We know that the virus is primarily transmitted through respiratory droplets and touching contaminated surface. There isn’t any evidence at this stage that the virus can be transmitted sexually with intercourse. Kissing is obviously a major pathway of transmission. Technically, if we stay away from one’s mouth and we wash our hands properly it is possible to have sexual intercourse safely. As long as there is no oral sex, and it is only intercourse, separated by a door or a sheet, not breathing into each other’s face, ‘gloryhole sex’ may indeed be a form of safe sex from coronavirus. The ‘gloryhole sex’ fantasy that currently appear on apps has some grounding in reality thus making it even more titillating: ‘we can really do it if we wanted to’. 

I do not condone breaking the Government lockdown rules. I do not recommend people leaving their house to meet strangers for sex. But as gay hook-up apps seem to be currently very active, we can take a moment to try to understand this phenomenon. The LGBTQ+ community has a trauma history as it was a population that was pathologized by authorities prohibiting sexual practices that were normative and natural for them. In the UK, gay people can now live with good human rights, but homophobia is still rife. It is therefore easy to understand that this particular community is more inclined to rebel against Government’s sexual prohibition because of past ostracization. Having said that, from the anecdotes I hear, the hook up app users have good common sense, they don’t act on their fantasies and don’t put themselves and others at risk. But the ‘gloryhole sex’ fantasy is going to become more arousing for gay men now, perhaps. 

It is worth noting here that masturbation has always been and will always remain a wonderful way to find sexual fulfilment in solo sex for heterosexual people and members of the LGBTQ+ community, across all genders, and is the safest form of sex for single people in coronavirus time. 

As a psychosexual and relationship psychotherapist pondering on all of this, I’m concerned about how we, as a profession, should listen, understand and assess people’s sexual behaviours during and post-COVID. 

The psychotherapy world pre-COVID was already divided between psychotherapists pathologizing some sexual behaviours that other psychotherapists believed to be normative. It is now more important than ever to re-think sexual behaviours because it will change and it will have different meanings. Some therapists judged some sexual behaviours like watching pornography, sexting, webcam sex as ‘problematic’ because they were perceived to be anti-intimacy. These behaviours now have become more mainstream and normalised as they are more popular ways of being intimate and sexual with others. As people become more comfortable with technology, these behaviours may remain some people’s primary way to be sexual post-COVID, thus seeing a growing population who may self-identify as digisexuals. Some sexual practices and fantasies such as ‘gloryhole sex’ may also be more mainstream after the pandemic. 

The crisis of COVID-19 will pass, but the world will somewhat be different. I invite practitioners, especially psychosexual psychotherapists and those of work with people who have compulsive sexual behaviours to find different ways to assess clients and be even more careful not to pathologise them unnecessarily. 

As a psychosexual and relationship psychotherapist practicing with a sex positive framework, I cannot ignore the observable new ‘trends’ in sexuality through anecdotes, so far, and I remain open to think of human sexuality with a different lens in a COVID world, and post-COVID world. I also encourage my colleagues to think of their clients’ sexuality in broader ways and with an open mind. Nobody knows the lasting impact of the virus on our world and our lives, but we need to prepare ourselves for understanding our human sexuality differently and supporting our clients the best we can through their grief, loss, trauma, relationships and sexual behaviours. 

Silva Neves 

How to look after your mental hygiene

I was interviewed a few times about the coronavirus anxiety. People have been asking me how to manage their anxiety about it. 

We’re told that things will get worse, numbers of infections and death rates will rise. It is all very alarming. And it is anxiety provoking. 

Obviously, it is normal to be anxious but it is also important to look after our mental health in this anxiety provoking period. 

As well as good physical hygiene such as washing your hands, it’s important to look after your mind hygiene. 

1- Feel the anxiety. Breathe through it. Tell yourself that it is normal to be anxious, and breathe more. You can count your breathing as it helps reduce anxiety. Do Not attach stories to the anxiety feeling such as ‘what if…?’. The worst case scenario thoughts that we attach to the anxiety feeling make the anxiety worse and then it is easy to become really distressed. Breathing through anxiety without adding stressful thoughts is actually hard to do, but with practice, it gets easier. 

2 - Limit your exposure to social media and news stories. Perhaps you can allocate a couple of minutes to update yourself on the progress of the virus, but after that, think of other things. Watch other things, like a comedy film, for example, or engage in your favourite hobby. 

3- Covid-19 is a serious illness. But we don’t need to be gloomy about it all the time. Even though it is a killer virus, we can still try to bring some lightness to our lives. Laughing does help our mental health. You might want to take the opportunity to introduce fun ways to greet people that replaces a hand shake, how about jazz hands? 

4- Sleep. Switch off. In this period of high stress and anxiety, our brain needs more rest. Try to get your 8 hours a night. 

5- Develop a practice such as yoga or Thai Chi. These practices are very good for helping us stay in the here and now. During that time, you can give your brain and body a rest from stress and anxiety. 

6- Use your common sense. Do wash your hands. Do be careful with social distancing. All of these things will help you feel in control. Keep doing these things. But don’t panic buy. Think of the elderly person who couldn’t get to the shop on time. I’m sure supermarkets will continue to provide toilet rolls for everybody as they have always done if we stay sensible. 

7- Let’s be kind to each other. We can all empathise with each other with our different levels of anxiety and fear. We can all respect each other with our different opinions. We can all accept each other whether we come from China or Italy. It is a global problem now. We all own it, so let’s be friends with each other and smile to each other. 

8- If your level of distress is so high that it stops you from living your life, please see a therapist. There are many things that can be done to treat anxiety. 

I wish you all a safe week.