WEBINAR-VIDEO: TRAUMA, DISSOCIATION & SEXUALITY

okay good morning welcome and thank you for participating those of you who've heard me before i want to say that this is going to be a very different kind of webinar and what's different about it is i've got some fresh thinking you know it's interesting just a as an introduction i started my work with john money at johns hopkins and i worked in the sexual problems gender clinic there and worked a lot with sex offenders and sex addiction and after i left there i went to masters in johnson and worked in sex therapy for 10 or 15 years and it's an interesting kind of background to have because as time went on i decided i wanted to change my focus to working with trauma and dissociative disorders and so i spent many years working in a dissociative disorders clinic and then over time i wanted to learn more about eating disorder and so eating disorders have a lot of things about them that are very different very different and very similar to sexual addiction but i realized when i worked with eating disorders that no matter how much work i had done with women i really didn't understand women in their relationship with their bodies uh as a man and so you know i basically lived with anorexia for many many years trying to understand that and at this final evolution of where i am now i keep getting incredibly new insights and i having done this for more than 50 years it's always surprising to me that i haven't plateaued and that i'm learning new things every day for my clients so these webinars are my attempt to sort of put together what it is that i'm realizing that i didn't know before and when i realized that i realized that so many of the books that i've read are missing these really key components so that's what i want to say today so that will be my introduction and where i started really was i had this interesting experience at johns hopkins where i went to school of getting to meet john bolby who came in for a semester and mary ainsworth was there and had her courses at the university and so i was brought up with attachment theory and so i developed a developmental perspective on psychopathology and that was the time when couchetti and all that wonderful work in developmental psychopathology began to evolve and it was a whole different lens of looking at psychopathology which was you know that people present with eating disorder sexual addiction with alcohol and drugs and what's so interesting is that the symptom is where they present but that's not really what the problem is a symptom is a manifestation of the problem so behind all symptoms is the problem and so you know the question with each client is to ask yourself what's the problem we're working on here and that's what i'm going to be talking about today the symptom is developed as a survival strategy oftentimes it was necessary back then to survive but now it's a dinosaur that's hurting the person the symptom is logical and rational two and two always equal four and if you have a person who's really interested in being tied up and whipped and urinated on in order to get sexually aroused there's a damn good reason for it and so i tend to think more ideologically than phenomenologically and the symptom remission is dependent on understanding the logical development in other words i believe that you have to have a developmental perspective i think in order to treatment you have to know the contributing factors and that's very different than traditional psychiatry okay so that's sort of the way i think now let's get down to work i read this interesting article by janeau and shore lately it was called intergenerational enactment of the trauma the role of unconscious self-systems and i'll give you a reference for it but this article was really shook me up and i'll tell you why it says more understanding is needed into the psychological and physiological process underlying intergenerational transmission of trauma intergenerational transmission means that you know you what you pick up from your family of origin and what they picked up from their family of fortune a child who herself did not suffer sexual abuse for example but is nonetheless subjected to her mother's overly promiscuous attitudes or conversely strict rigid approach to dating will inhabit many shades of her mother's fears emotional reactions to men and defensive adaptations now when i read that to you it sounds sort of obvious you know we have intergenerational transmission of shame but when i think about that what i realize is that we're missing the boat if you talk about treating trauma the first thing you think about is ptsd trauma and when you think of ptsd trauma you think of exposure therapy or cognitive reprocessing therapies and yes that's very effective for ptsd we go to the next step and say well what about complex trauma complex trauma is being an environment of inescapable stress where you're involved every day with terrible overwhelming neglectful things in your life how do you treat that and we've become more sophisticated than that in the last five years but i promise you that the real problem with the most of our clients is not just ptsd and not just complex trauma but a third type of trauma which we have not well named which is intergenerational trauma and that most of the bad things that a person is doing has is more related to that so for example if a woman comes in and says i keep picking destructive men in relationships i when i'm having sex with somebody i find myself you know terrified and not aroused we want to do sex therapy which you know approaches the symptom but that's necessary but not sufficient and the reason is because there's underlying trauma and so sometimes people would go to maybe they were sexually abused or maybe they don't remember it or maybe there was complex trauma but what we don't go to sufficiently is the realization that actually in most cases the sexual symptoms are related to the intergenerational transmission of shame and how do you do exposure therapy with someone who didn't actually experience the trauma the mother or the grandmother experienced the trauma and that's the question i want to beg a little bit today and they say emotional intensity among survivors and their children are expressed in hyper and hypoarousal affective states such as fear mistrust and helplessness now i'm saying to you that sexual inhibitions sexual addictions sex dysfunctions are all related to what this is saying hyper and hypo arousal affective states such as fear mistrust and helplessness that bleeds into the erotic system consequently the child's trauma suffused unconscious map unique to each individual is made up of many shades of emotions and meanings echoing a parent's emotional and cognitive self-states i love when people use words and say exactly what needs to be said and that's why i give you these quotes i love that echoing because you know john money my teacher used to call that love maps and a love map is an echoing of the unique map inside somebody's brain of what turns them on and it's so interesting to wonder why it is that a person picks the same destructive partner my father was an alcoholic i've married three alcoholics why is that that's the intergenerational transmission or trauma and i want to talk about what causes it and how to treat it and indeed a wide ranging studies have demonstrated that children of trauma survivors generally suffer high levels of cortisol now what is this what we know is that the definition of post-traumatic stress that rachel yehuda offers us is a dysregulation of the downloading of the acth cortisol system it's the criteria for ptsd so what she's saying here is that there are now data showing that some children are born with ptsd and they've inherited from their parents not doing the work about their own ptsd now the number of cases that i have seen where you know the mother was raped molested and done no work on that at all and is a phobic she gets into a relationship with a man who has his own set of issues in one case the man is primarily homosexual and starts exposing his genitals in public and then they have three kids and they homeschool them and each of them has their own set of sexual problems each of them related to how they process what happened in the family of origin and if you have that person come in and you say oh what causes your asexuality and they try to give you words for it and they might say well this happened to my child but are they ever going to be able to articulate what it was like living in a family system with a mother who did not work through her own rape married to a man who's out to exposing himself in a family-based shame where they isolate and home school and then if you get down to the ideology how the hell do you treat that and that's what we're going to be talking about today in the first picture slide you don't all have a copy of but we're going to insert them this is the presentation that i just talked about the client comes in and i call this dead eyes and in the dead eyes you see it with the dead eyes that they come in and okay she has sexual inhibition she doesn't really turn herself on maybe i should get a divorce maybe i don't love him how do i know if i love him i think i'm better off alone long ago i realized that most sexual problems were disorders of intimacy it's kind of interesting to think historically you know i did sex therapy at masters in johnson 10 session sex therapy for a long period of time and the in this sex therapy you know you could deal with surface issues but how do you really get down to in a brief therapy working with sexual inhibition you know that has the roots that we're describing in some ways and how do you help her deal with her mother's rape when it happened to her mother and didn't happen to her all right emotional intensity among survivors and their children is expressed in hypo and hyper arousal affective states okay so the child's trauma develops an unconscious map and made about emotions and meetings echoing the parents and so she is actually working through her mom's sexual inhibitions subconsciously okay so all right so now let's add to this what we see with an adolescent you know we have covid they're locked in their room they are given their computer or ipad they're having hyper arousal because they're pubertal and they're having social anxiety because they're not interacting with people they already have low self-esteem because of social anxiety and trauma or complex trauma intergenerational trauma and so they lock themselves in the room and what do they do they look at pornography now that's an epidemic which we're beginning to see they become absorbed with the pornography at a time when their brain is differentiating at an incredibly rapid rate and most individuals begin looking at porn at age 11 and in many ways it shuts them off you know being in their room looking at their device they become dissociated they become one with that and now add to it the absorption that absolve with sexual arousal anyway so you know you're fantasizing now what are you fantasizing well you know i tend to open these websites up you know to be able to understand something about my clients and you know i i guess i must say i i'm rather horrified by what i'm seeing on there which is you know there are 10 million people looking at these sites that are rather uh i mean terrible things or are being depicted and so what we're doing is we're frying into our children's brains images that are indelible and imprinted in there in some way and now 10 years later i see them when they get into a committed relationship and they're having one hell of a hard time to be able to make love with their partner so i don't want to be too negative because there is good pornography i guess in the sense of anything that allows people to see passionate caring people care for each other and be sexual and get a sex education so uh there might be positive factors and negative factors it's just that we're at a crazy state in its development so what happens is they get unrealistic expectations like you would be even when looking at the playmate of the month you get an over dependence on the visual rather than touch and it's oftentimes dehumanizing turning person and other into object accelerating factor is that you know people are getting an education and um they're dealing with their loneliness and intimacy difficulties but in destructive ways so what we're seeing is a whole new generation where it's endemic on a public health level of being fried into their brains pornographic images and it does change the whole nature of everything we do and i think that the more we understand dissociation the more we can begin to help such individuals and so that's what i want to talk about overuse of internet pornography is similar to a dissociative condition there can be a huge amount of distortions i mean my client comes in he says i spend three hours looking at pornography and i say okay how you do that and he says what i do is i edge i go to the point of almost reaching orgasm and then i go back i go edge again go back i turn one thing arousing on and then i turn something even more arousing on and then turn something more arousing on and what they're doing is by edging is they're they're increasing you know they're almost developing tolerance right in front of you because they need more and more in order to get the same arousal and they're frying that into their brain and do they're going to a dissociative trance which is you know dissociation is absorption acute narrowing complete loss of awareness immediate surroundings i mean jesus what can be more uh dissociative trance than that unconscious movements on the mouse or the computer searching over and over for intense erotic stimulation and linking to sexual addiction and dissociation to the addict cell so to a person who's had trauma literally there there's a fragmentation of the personality and ego states that kind of get into some deviant stuff and they can be a dr jekyll or mr high so what we do is we used to have you know sex above the belt being beautiful and wonderful and romantic sex will blow the belt being dirty and disgusting and filthy and save that for the one you love and that distinction that was 30 years ago now can be set into ego states and there can be an ego state that is the bad you and the ego state is the good you sometimes the old days we used to call that the madonna [ __ ] thing but now these madonna [ __ ] things become discrete states in the brain that become more and more distinguished because they're fed with pornographic imagery and so the parts of self become even more distinguished and so what that looks like is you know you'll say to a person what happens when you masturbate what happens when you're having sex with a partner and what we're getting is intrusion of ego states so you know it's like give an example you would go to make love with your husband and a child part jumps out and says ew this is dirty disgusting but if you go out with some guy at work where you're doing something illicit another part comes out and what's to seduce him so we have a part that's sort of seductress we have a part that's little girl and these parts are distinctive and it's obviously very confusing to the client and so you're beginning to understand the dissociative nature and how these subset systems get built into the brain and you know if you set a fmri up you could actually see different parts of the brain being activated when the child self is out versus the seductive part of self and this can be pretty damn confusing if you're getting married because the first when you're dating somebody you you might find yourself very highly aroused and then on the day you get married you might lose all your sexual interest and it's profoundly confusing to the couple but i would say i probably have seen that presentation more than 100 times so i just want to as i leave this section reminds you of the ten sexual problems using porn and so i really ask people to have abstinence from porn and i tend to ask them to find certain sites that oftentimes are created by women or have much more passion and are not done with great illicitness but are kind of beautiful and lovely and want to begin to change the imagery but personally more rather more than not i'd rather them have a complete absence from pornography while they're learning to make love with their partner mother nature tends to be fairly robust then we can repair this but whatever now you can say yeah porn doesn't require internet you're absolutely right but what we're seeing now is you know that the fact that the internet is so quickly is easy and available at three o'clock in the morning that people are going to that but i must say you know people are going to craigslist and other sites and they're having hookups uh and we need to talk about that and obviously you can have other forms of pornography all right i want to now move to my favorite topic which is i want to add to it that if we're talking about dissociation we're almost always talking about disorganized attachment and the reason we are if you haven't seen this is if you remember stroff at minnesota and his colleague agawa they followed longitudinally children who had disorganized attachment for 30 years and eventually they looked at the ones who were age 19 and what they found was that children who had a history of disorganized detachment in adulthood presented with dissociative disorder and that the disorganized attachment was more predictive of dissociation than even trauma was now that was mind-blowing because what we always thought was trauma created the dissociation now we realize it's more the disorganized attachment creates the dissociation so if i'm saying that we have clients who are highly susceptible to dissociation now beginning to have separate ego states they are probably having disorganized attachment and so for the last 20 years i've been trying to come up with modeling modalities to treat disorganized attachment and adulthood and as some of you know from my past webinars the place i went for that is to marry maine she developed the adult attachment interview and i got myself trained in the adult attachment interview so that i could learn how to assess and diagnose disorganized attachment and then come up with interventions to be able to repair it okay now you all know that when dissociation prevails there's a fragmentation of the self-system most of my clients who are addicts come in they say i don't know who i am i feel like i'm an imposter i am codependent i do what other people want me to do and the idea then is that they're highly built with otherization what happens then is they there's a disorder of the self-system they don't know who they are and there's a disorder of the emotional regulation system because they don't learn how to deal with these strong intense emotions and so what they do is they turn to alcohol or drugs as a way of modulating their affective states well in a very similar way a person can turn to eating disorder and if you don't eat you're going to be fairly numb or you're going to get fairly high and that's becomes a way of regulating so jean briere used to talk about how these addictions are ways that people eventually discover to regulate a dysregulated emotional system and if they're born with ptsd and they're born with a dysregulated cortisol system then they're going to be highly susceptible to addiction now bring sexual arousal in now the sex addict then turns to the whatever it is that is the order of their their sexual map they plug into that in a dissociative way as a way of regulating and so they masturbate two or three times a day and condition themselves if i feel sad i masturbate if i feel lonely i masturbate i feel hungry i masturbate any emotional state can be modulated by the output of the behavior and so the reason that's important is as soon as a person practice abstinence all the stuff that they have not dealt with they still don't know how to deal with so they don't know how to deal with loneliness they don't know how to deal with anger they don't know how to deal with sadness the way the rest of us do because over the years at 4 5 6 7 8 9 10 they've never learned how to deal with these states without using their sexual arousal so abstinence is only the first stage of treatment and it's the same thing with all addictions once a person is abstinent and under control that's when the therapy actually begins so in our program which is a partial hospitalization program it's like go somewhere else get out get sober and then once you get sober let's begin therapy and that's a very different way of thinking uh and so a partial hospitalization program for us was the treatment of choice because now that you're sober from eating disorders sexual addiction alcohol drugs now we can really get what's underneath it and actually there's more similarities than there are differences in how you to deal with that although there's a unique knowledge base required for sex addiction it's different than alcoholism which is different than for eating disorder i've had all three experiences so it's allowed me to be able to get perspectives i never could have gone any other way i'm saying to you that dissociation sets the stage for the loss of true self so we get back into winnicott kohut and the object relations theorist because our clients are coming in with a false self and what we're trying to do is see the development of the real self now if you want to read anything on seeing the development of the real self where do you go masterson of course so what i want to say here is sometimes we keep reinventing what we already know and if you haven't read masterson if you haven't read kohut if you haven't read basic object relations theory that's where it's at and that's at the key of all of this stuff and that when we make something complex let's go to the simple the most simple thing we can say is that the true self becomes corroded with a badness and honest to god over a 50-year experience as a clinician every single client comes in with shame shame shame and they feel like they're defective and nothing you say in cognitive behavioral therapy no matter how many times you ask them to objectify to test out to look at irrational belief systems and do that old cognitive behavior good stuff it's necessary but it's rarely sufficient because shame is in the affective system not in the cognos system so what we're doing is we're talking to the ceo cortex and helping the false self become more false oh yes i know that i am a good person but i why do i feel like i'm a bad person and if we don't get to the deeper levels of what's in the affective system it's going to influence them unconsciously and the unconscious is still going to affect them so now you've been able to change their belief systems about themselves but it doesn't seem to go down to the roots in varieties of ways so there's always a question how does one change the shame-based systems and the first thing to remember is it's not about what happened to them it's about what they inherited intergenerationally from their family of origin and that's really an important concept to be able to get but stick with me because this is exciting stuff all right now this shame stuff you know it's like when i worked with anorexics the the if i listen to the voices in their head it was overwhelming it was i i just had one client just write down you know what they were getting in a 15 minute period we're talking about self-hate of enormous proportions and anxiety up the gazoo because everything here is generated out of anxiety you know and whatever it is that's going on in group this is the stuff that's going on in their head and you know trying to be able to get them to realize that in a cognitive behavioral way and work with it is certainly an essential step uh we do it it's necessary but what i'm saying to you is it's never sufficient now think of this with regards to sexuality you get nude with another person you're excessively vulnerable and suddenly you begin to get flooded with thoughts of perfectionism of self-hate i'm dirty i'm a [ __ ] sex is scary whatever you have a lot of negative attitudes that were transmitted intergenerationally about sex that flood your mind and get in the way but even more important is the affect that gets flooded in this is disgusting now imagine a husband and wife coming in and the husband's saying i want oral sex i'd like her to go down on me and the wife says it's just disgusting i hate the smells i think it's disgusting you know when i think about it i want to puke well you know a sex therapist would begin to work behaviorally with that and what you found in sex therapy is you got to change their attitude before you can change their behavior as long as you think something is disgusting you're never going to eventually be able to do it with comfort so exposure is useful but changing people's attitudes is necessary but now let's say that there are longer routes to this and it's tied to um discussed that the mother transmitted around the body around sexuality around weight and and it's tied to so many other issues it's funny it's like something when i was younger i didn't know so much and it was easy to treat this stuff but now that i'm older and i know so much i realize how complex this stuff is and how how much i was missing early on in my career and so you know that's why a lot of people get better but then they relapse because there are layers that have to be done and what you're doing may be necessary but may not be sufficient and if we followed up our clients for a long period of time we'd probably find that the vast majority of them relapse i remember when i first began to read the work in marital therapy and you know i was really an excellent marital therapy when i was a therapist when i was 30. you know i did richard stewart stuff and i did really good marital therapy and then you know along came the research saying that you know the vast majority 80 of our clients were relapsing and divorcing and what we were doing wasn't effective and we had to reinvent marital therapy well i guess i'm sort of saying the same thing as i read the books on sex therapy you know the the traditional books that are out there all 10 of them or something that what i see is what's in there is good stuff and it's necessary but we're missing the core and aspect of this i don't know any book that really gets down to what we're talking about today which is the dissociative nature the splitting of the cell system how you root the development of self-system and understanding that all sexual problems are problems of intimacy and attachment and therefore you must treat the intimacy and attachment disorder that underlines the sexual disorder if you really want longevity with regards to change of the symptoms now you say well mark that's really weird coming from somebody out of masters and johnson because masters in johnson were saying that you can sleep treat this in 10 sessions with 80 effectiveness like what the hell is wrong with you and the answer to that is yeah you probably can treat in traditional sex therapy through brief therapy but what i'm saying to you is that what marshall lanahin said was our job is not just to get rid of the symptoms it's to help create a life worth living and in a similar kind of way that i said to bessel van der kulk okay we can treat ptsd effectively i buy that but don't get an illusion that that's effective treatment because treating the ptsd is necessary but it's not sufficient it's necessary to treat the ptsd but now we have to help the person create a life worth living and what we've not done is delineated the steps to be able to do that and now i'm saying this with regards to sexuality we can get rid of a sex addiction we can get rid of erection problems but we underneath those symptoms someone is waving a red flag saying i am having disorganized attachment and i have major intimacy problems and i keep going through relationship to relationship in a destructive way i don't understand why you're taking away the symptom but you're not treating the problem underneath the symptom and that's really what i want us to understand far better so this sounds also esoteric let's get down to a case i have a guy who comes in and he likes to have prostitutes beat him and he's married has kids and he feels like uh that he's going to end up getting divorced and losing his job when they find out that he actually is hiring prostitutes and so i access the part of him that's out doing the dirty deeds and it that part comes out and it is very dissociative and i taped the session and here's what the client says and i want to read it to you because i learned everything from my clients so i want you to ask yourself what do you learn from this client the part of self that goes out with prostitutes and has the prospect and says sex is dirty it feels good but i want no part of it it only makes life miserable your penis will fall off if you have sex too often all it's good for is causing trouble you can't feel sex you can only hurt it after all my mom uses it to [ __ ] my dad and johnny that's all men are good for so mom can [ __ ] them well [ __ ] them all i don't want to have sex it's evil and good for nothing it only makes me feel bad it's why mama's never home she's out [ __ ] hurting men i wonder if she has other kids i hate sex i cut my dick off mom would let like me better she hates boys she just wants their dicks she keeps them on her trocy shelf johnny and dad are fools they think she wants their super useless dicks well everyone knows that their ugly and should be cut off i'd cut yours off if mom asked me to after all what's it good for it just gets you in trouble that's why mom like my sister julie moore she doesn't have a dick girls always call the shots you can't put your stupid dick inside of them unless they let you and they only let you if you beg them and plea and you're good at that because you can only please mom by giving her your dick she makes you such a fool sex is her toy to enslave men she uses it to control johnny and my dad and they hate her but because of sex they're tied to her what weaklings they are if they would stop wanting to have sex they could not control them they're like robots she pushes their buttons with sex they're idiots and just they deserve what they get she doesn't do anything and they follow her sex smell because they have no brains i like beating off the brine sperm goes right where it belongs into the toilet i always want brian to beat me off he does it really good see sex is dirty but we need it to survive look with dissociative disorders what you look at what's called an in a entrance ritual and an exit ritual the entrance ritual is sex is dirty it feels good but i want no part of it there's your inhibited sexual desire and the exit ritual sex is dirty but we needed to survive isn't that interesting now thank goodness i taped this because like you know i couldn't have written all that down and in it is the the door into the treatment of my client and if i didn't know this the question is how could i treat it and so this is now what i do with all of my clients i identify the sexually compulsive part of cell with a sexually inhibited part of cell and i access that ego state usually using internal family systems therapy ego stage therapy gestalt therapy for some sort of affective way i've not been trained in somatic reprocessing which i hope to correct because that probably is the treatment of choice but in all of these i'm able to get this kind of data and when i get these kind of data it it teaches me what i need to do with the client in order to get better you're probably saying what the hell do you do and i will tell you this is like those new shows on tv where like you watch the episode then you have to wait a week for the next episode to figure out what happened okay so um before we get to that i got to give you the full picture so we're talking about the development of the cell and this split off cell systems but the other side of this is the affective system because you know everyone knows that trauma is encoded within the affective system and it's the affective system that's really going to be so critical and so there is that jean briere beautiful example i talked about earlier which is what he said in 1992 was these activities provide one of the fault temporary distraction interrupt them of dissociative dysphoric states anesthesia of pain restoration of control distressed incompatible sensory input temporary filling of emptiness self-soothing and specific relief of guilt or self-hatred okay now [ __ ] does that like say it perfectly i mean what is a person doing they come in they're making love with their partner but man they're using it in a whole different way you know when i was treating eating disorders the first thing i learned was never talk about food in the way that i use it because for an eating disorder client their relationship with food is in no way similar to your relationship with food if you don't have an eating disorder they are using their bodies as objects the food as objects and their internal relationship that their what their mind is doing with food you have no frame of reference of so if you say something that applies to you you would be wrong if you tried to apply it to them and so i needed to understand the internal ways that the person was thinking about food to treat the eating disorder now the same sort of thing about sexual addiction eating disorder is not about food sex addiction is not about sex oh [ __ ] what does that mean it means that it's like a red herring that's pulling you off it's about affect and dysregulated affect and the person is binding their affect with some addictive behavior and so they're using it as a way of getting back under control they're using it as a way of numbing themselves they're using as a way of self-soothing and when you then give them abstinence they don't know how to control themselves they don't know how to self-sue themselves they don't know what to do with that intense emotional self-hatred they have and so that's where the therapy begins and those things are not about sex they're about anxiety they're about emotions they're about affect and many of our clients particularly those who have avoided an attachment have absolutely no window into their affective system they don't know how to feel they don't know how to experience feelings and i'll express feelings they don't know how to use feelings they are lexa-thymic okay now you know maybe i'm preaching to the choir here because all people who deal with addictions know this but it hasn't been sufficiently applied to our understanding of these different hypo and hypersexual states so self-care self-care self-care self-care once you become abstinence the primary focus of therapy is teaching a person how to take care of themselves how to nurture themselves how to be able to calm themselves down how to be able to recognize their emotions and be able to deal with their emotions and on the self side to recognize their values their esteem and their cohesion when you don't have a self you don't really know what you're living for you don't know why you're living and you've never really thought about it much so if you say what's your life about what are your goals in life what's important to you in life and what are your explicit values of how you live your life if you don't have a self you really don't know that so i began to study acceptance and commitment therapy hayes work because it seems so valuable in helping a person begin to differentiate some clarity about who they are and star wars starts with their values and their values about self and others and my general belief is that you can't like yourself unless you know what your values are explicitly and you live a life committed to living within your values and so if it is not in your values to steal and you steal you are going to hate yourself and so it's important to know what your values are and where they come from and if your values come from what you think other people think of you you're in trouble so what one's values have to come from is internal not external and to to go through that moral development stuff that kolberg used to talk about and get to the point where you can have an adult value system now when i would treat sex offenders what i learned was the most important intervention was beginning to develop empathy empathy where you no longer wanted to hurt another human being now how do you help a person develop empathy answer you begin to help them look at what blocked their natural unfolding of empathy which is trauma and as you would begin to do the trauma work empathy would begin to emerge and so the way i was trained you don't have to teach people to have a natural function you just have to remove what the roadblocks were for a number of years i worked in a prison and then i worked for probation and parole with rapists i did that because i couldn't even imagine how a person could rape it i had no frame of reference how a person could get to be that disturbed and what i found was that these individuals that i was working with had severe trauma in the first year or two of life and neglect and as i began to work with the trauma and neglect wow that what began to emerge in terms of affect and emotion and empathy and compassion was beyond my comprehension i don't think anybody in that system would would believe what i what i saw happen and so it's removing the blocks that cover over that then allows that to happen how can you love if you don't have empathy and compassion and empathy and compassion needs to be looked at now i've said from jean brier that these are ways of getting under control when everything seems out of control i.e trauma then you need something to get back in control if you're in an environment of neglect and you can't trust the people who take care of you and you don't feel safe and you're scared all the time you're going to reach for something and so with the eating disorder clinic you know food was the answer so binge eaters you know taught me an enormous amount where you know you gain 200 pounds and it's the only way you can feel safe and in control and so as i learned to treat binge eating disorder i understand another aspect of how you deal with sex addiction because it's your way of being in control when you're terrified alone so if you're a little boy and you have no friends and they people are mean to you and bullies beat you up and you can't talk about it with anybody you don't know your feelings and you're numb and you have avoided attachment you know reaching out for a sex addiction would obviously be the treatment of choice now if we stop the sexual addiction i.e sobriety oh my god look at all those years of things that didn't happen developmentally that you don't know how to do it'd be like throwing somebody out of a parachute without out of a plane without a parachute and so you know i often think that that practicing abstinence and the way 12-step programs do it it's a little bit dangerous because he wants to get a person in control of their addiction they're going to be cold turkey and they're going to be flooded with all that terror and fear and they need somebody by their side to be able to teach them what they don't know and so you know the programs have ways to be able to do that by talking to others but these are actually real skill deficits and habits that they haven't learned and so i i always encourage people in 12-step program to be an individual psychotherapy all right so what the food and sex addiction have in common is alleviating sexual tension for self-soothing and uh feelings of emptiness uh and they're more similar than they are different okay now let's get down to it there's a a book by shafiz on dissociation that you know is a game changer um it's such an interesting book and what he says i'm going to give you a couple of his quotes because they're breathtaking he says that from a dissociative process perspective thinking about how the normative but separate domains of sensuality and sexuality create a need to discover the subjective nature of a person's sexuality an extensive real sensuality might exist during sexual activity sexuality without sensuality needs investigation okay sexuality without sensuality needs investigation underline that the absence of a clear and coherent sense of being present one's body and experiencing the sensations associated with sexual activity including sensual ones is an indicator of the dissociative isolation of somatic experience from its awareness the human need to hold and be held is missing in action when this isolation traumatic experience occurs wow the woman says i'd rather be knitting than having sex and while i'm doing it with him i'm a million miles away but he never notices okay now that's sex therapy right now sexuality without sensuality needs investigation we call that [ __ ] and it's oriented towards orgasm and so many people when they're having sex aren't there won't believe this but a million years ago dr masters and i at masters and johnson were very interested in sexual fantasy patterns and what we began to do is ask people who were not clinical more about their fantasy patterns he wrote about this in his book called homosexuality and perspective and in it what we found was that most people when they were making love were not thinking about their partner they were away in their fantasies and the stuff that was going on their head was very surprising which is and i'm not talking about a clinical sample a normative sample people they were thinking about nothing they were thinking about emptiness they were thinking about noises they were thinking about people without faces and there was a lot of imagery of violence that would come in and it would be required to turn them on and so what we concluded is that when most people are making love they're not present in their bodies and their minds are being distracted in order to turn them on now if that was true at an endemic level in the population we had a public health problem and the public health problem was not just that people were not knowing how to make love with their partner mechanically but in their heads they were so filled with shame related to sexuality that their mind were not allowing them to be erotic and sensual and their dissociation was of such an agree that they weren't even with their partner they were a million miles away or if their partner was a million miles away they didn't even notice so you know so much of what masterson johnson did was mindfulness mindfulness and so all this new revolution and mindfulness as you apply it to sexuality is recognize that most people have body dysmorphia dr masters used to say as a gynecologist i never met a woman who is satisfied with her breasts either they're too big or they're too small and the same thing can be true about people on diets everyone's on a diet they're too fat they're too thin they're too this or too that our inability to be in our bodies and to be able to be able to relive our bodies now you know there are so much of this is realized now i mean the tantra approach to sex you know people who are doing bodywork the somatic therapist i mean you know i i know i'm not saying anything you don't already know but this needs so much more attention um with regards to sexuality because i'm telling you that if you read the traditional sex therapy books there's not a lot of this stuff in there and um this is where it's at and part of the reasons i'm in there is because people have not had enough experience and we're working with dissociative disorders and we're all kind of recognizing that in a lot of these new modalities like emdr or ifs or ego states therapy or you know the variety var a variety of other therapies voice dialogue therapy so on they're all waking us up to this new door the other thing that he says in this book which i love is that well we will get there in a minute i'll hold that sentence okay so our approach to sex therapy then succinctly is entitlement and so what masters and johnson taught me is that you say to the client is understandable given what happened to you what you've done to yourself as a result of what was done to you and the destructive influences on your choice of partner and the relationships you created you do not feel sexual and what was missing from that was it's understandable that growing up in your family and the family's family that your family grew up in and the shame that you imbibed from that and then what happened to you as a result of that and what you've done to yourself so there's like six layers of stuff that we have to get through you're entitled not to feel sexual now you could say well how does that help because it immediately takes the pressure off our partner doesn't feel loved if we're not turned on by them but it has nothing to do with whether you love or turned on by your partner really it has to do it's an inside job on an outside job and so it's an inside job not an outside job means that the work has to do with your relationship with you not your relationship with them your relationship with you so you say well do you do individual therapy or do you do couples therapy and the answer is yes i do individual therapy and i do couples therapy and i do another kind of therapy which is i like seeing the individual with a partner in the room because then the partner says holy [ __ ] i thought it was about me i see it's really about his mother's mother and it takes all the pressure off that in the relationship and the person then stops putting the demands on the partner to perform when they understand the depth of where these things come from and so if i have my therapy of choice is to do individual therapy with a couple all right so sexual desire is largely anxiety driven in the earlier phases like romantic love there's a part of self that comes out i call it the um the seductive part of self where you want to conquer your other and you conquer others because each person is like you are what you eat each person that has sex with you makes you feel like you're a worthwhile person and if you're empty inside you need to put marks on the wall so adolescence is filled with that because it's a time when the self system is beginning to differentiate and you know neurons that fire together wire together and says dan siegel and our goal of psychotherapy is integration so what we're doing in adolescence is we're integrating a real self and as the self is getting integrated we may need many others to know that we're okay so we [ __ ] in order to be able to feel good about ourselves but for some people it's like insatiable you go on and on and on and i used to find that in the gay community people would have what are called tricks and you'd go to a gay bath house and you would [ __ ] somebody and then you'd get high and then you would drop down it would like be doing crack and you get down so low that you'd have to have another trick in order to get back high again and then you would fall and so bath houses were a lot like doing crack they were incredibly addictive up down up down and at the end the person would be suicidal and really need to do something about that because they felt so bad about themselves and so um what we're doing then in the less extreme cases is as we have affairs what we're doing is we're taking the emptiness of self and trying to fill it by oh that person wants me and if you don't love yourself you need external verification of lovability and so you know that's the basis of codependency is helping a person have an eye before they have a we and be able to deal with their own dependency needs next slide all right so the apparent compulsion to repeat these tragic scripts is desperate unconscious effort to get coherence and you know what we're really trying to do with repetition compulsion is fix something you know jean jean briere used to talk about there's a repeater system in the brain and you if you watched let's say your father beat up your mom and you'd say you know i love my mother i love my father but i hate what my father does to my mother and so on it resulted in different ego states inside the brain because the only way you could make sense of that which made no sense is to have disparate dissociative systems in the brain so now that you've got this brain with different dissociative systems and so what happens is later you marry your third alcoholic husband you promise yourself you're not going to marry an alcoholic husband but then you marry your third alcoholic husband why is that because an ego state that is split off from you i.e unconscious is trying to figure out what happened and why it happened and so jean staller you used to say that our life is dedicated to reliving the trauma in disguised form that says it a lot and shatters says that in this way the repetition compulsion is a tension between dissociative processes active by fear and associated processes unresolvable confusion it's a dissociative puzzle so the common features of sexual and dissociative disorder is a vulnerability to dissociative episodes of depersonalization dead eyes secretness as a way of life i don't know why i lie i just lie all the time when i don't need to relationships have a quality of falseness i love you wow what do those words mean and is it coming from your head or from your heart and what is love and why is it we're so interested in that word when it means so little the rigidity of cognitions and distortion of thinking standards of perfection are adopted in hopes of gaining acceptance and approval i have to have the perfect body i have to really be a great lover um you know it's a perversion because you feel like you're you're always living like in fear that someone's going to think you're a premature ejaculator and tell everyone at 17 years of age even though you're age 40. you feel powerless in relationships you're afraid that someone's going to abandon you because all the kids in high school did or all the girls in high school did an unconscious level they're reliving those fears in disguise form all right so i'll tell you interesting story there was a guy named loud humphreys i don't know if you remember him around 1965 to 68 he did this interesting study which is he looked at men in the tea room tray and he would passed himself off as a voyeur and he'd watch people put their penis through glory holes and then have the penis sucked on to the other end and the reason he was so interesting is because the question is how can anybody get an erection when you don't you see anybody on the other end and you know if you think about that how horrifying it is you can imagine somebody with all the violence doing something damaging to your penis so he would ask them what are you thinking about when you're having sex and what he found was that they weren't thinking about anything and as i talked to dr masters about that what we discovered was that there are a group of people which we call bypassers and bypassers are people who don't seem to need a partner to be desirable now why am i talking about 1964 study because as i look at what's happening on the internet my clients are telling me that three o'clock in the morning they're depressed and lonely they call up and they have someone on craigslist visit them at three o'clock in the morning and i'm thinking to myself who in the hell would have a stranger come visit them at three o'clock in the morning in their own apartment and i'm reminded of loud humphries and a bypasser so they come in my office and i say what if the person is not pretty what if they're haven't taken a shower what if they're this what if they're that and the person says it doesn't really matter and that interests me not only does it interest me because it's so odd but interests me because it's so common hookups are of epidemic proportions and they make no damn sense because it's so dangerous and so i think we have to go back and we have to revisit this concept of bypassing now i think that a lot of people are having sex with their husbands and wives and they're bypassing that is that they somehow in their mind be able to um at some point be able to go away in their mind and to be able to not be present and why is it that a person would bypass well because there's so much shame and so much trauma associated with sexuality that natural function comes through but they have they can't allow themselves to imagine so an ego state steps in and numbs them out and so their sex actually with a partner becomes addictive they're masturbating in someone's vagina using pornography of the other person really okay now all this you're thinking to yourself seems articulate and right but what do we do about it and so now i want to go to the last phase of what i want to say all that i've said so far is about disorganized attachment disorganized attachment is a dissociative phenomena it means that there is a splitting of the self-system it means that there are ego states and it means that there's an intimacy disorder okay now how do you treat dissociative disorganized attachment answer in the adult attachment interview what we do is the way we score a person as disorganized attachment is one they have loyalty to their perpetrators meaning that they come in delusional and they think my life was fine my parents were great everything was good now loyalty to the family is a neutralizer of recognizing how much intergenerational transmission there is of shame it's antithetical so the first step is to begin to do family of origin work where the person does what they call it meninger plain old therapy i love that concept plain old therapy if you read the meniger people they have what is called mindfulness generated therapy mentalizing therapy reflective function therapy and if you haven't read fonaghi i really recommend or if you get a chance to listen to him he's mind-blowing but fonaghi who's at maudsley sometimes at menager um he gets it and he began a whole revolution in what is called metacognitive therapy and metacognitive therapy really needs some discussion such bear with me because these terms sound so esoteric but if i explain it to you you'll get it in metacognitive therapy a person is able to watch themselves think and so it's looking itself through an airplane watch themselves think that's metacognitive therapy and a lot of what marshall linehan was teaching us was metacognitive therapy and that's why it was really effective with that problem but in metacognitive therapy what you're doing is you're breaking the loyalty to the family and develop what we call fresh thinking fresh thinking is beginning to re-examine what you've always thought and determine whether it is indeed true so plain old psychotherapy means we're not going to look at our life through rose-colored glasses anymore but we're going to go back when i did my own therapy i talked to my brother i talked to my two sisters and i they're older than me and i would ask do you remember this do you remember that and i tried to get validation and verification of some of the things that i remembered and felt growing up and as i reconstructed the pieces of the puzzle it was almost like a puzzle and it was missing pieces in some ways and i would do reconstructive work around that puzzle and it allowed me to be able to know things and see things that i had never known or seen before example of that i asked my sister do you remember a policeman bringing me home when i was really young she said when you were so young you could barely walk at 10 o'clock at night the doorbell rang and a policeman had you at the door and he found you like 20 miles away from home it was funny because none of us knew you were missing and we couldn't imagine how you got there now i love that story because it helped me make sense of about a hundred other things that didn't make sense to me about you know i was the fourth of four children and uh you know i was uh they were sick and tired of having kids and a lot of things followed from that but as i began to do that the rose-colored gases disappeared and it wasn't that i learned to hate my parents it was that i learned to understand what happened to me and as that happened a lot of things happened in my therapy and my personality began to change now if i use that as an example what i'm saying to you is that metacognitive is being able to look at things through a different lens and the lens of where was he 20 miles away from home when he was five or six years old no one knew the policeman brought him home is a lens that i wanted to look at things through and it's metacognitive and valuable in understanding other aspects of what happened in my life now that's metacognitive kind of thing now in when you're dealing with disorganized attachment what you're trying to do is allow a person to be able to integrate now there are parts of self that then get manifested and so you know that a part is there when your feeling is out of proportion to a situation so let's say somebody dies but you can't grieve it properly let's say a boyfriend or girlfriend breaks up with you and you you can't and you go into a crazy state that's not like you let's say you have rage attacks all those are windows into disorganized attachment they're separate ego states that present themselves and each of them is a gift to the therapy because if you follow the rage if you follow the unresolved grief if you follow the sexual addiction if you follow the inhibited sexual desire each of these states will lead you back to the events developmentally that came in and allowed them to unfold in some ways and bringing those states into consciousness is what psychotherapy is about unconscious coming into consciousness plain old psychotherapy and so metacognitive therapy is essential for beginning to work with these dissociative states so i went ahead and i started researching metacognitive therapy and apparently in social psychology they've done a ton of work under metacognitive states and they've begun to delineate specific metacognitive states and dissect it out in varieties of ways and now what i've done is i've taken some of that work some of it was done in italy um and metacognitives there's a metacognitive scale which you can look up under google which was done in italy it's just incredibly precious and as you begin to look at these metacognitive states we can be able to an example would be one of the things in the metacognitive is called decentering and decentering is where you see everything through your eyes but you can't look at it from the perspective of the other now why is that important because what is trauma trauma is an absorptive state and what is empathy empathy is the ability to look at what's happening to another person as separate from what happened to yourself if you're a sex addict you are not able to de-center and you're not able to feel empathy and what you're doing to another person hurting another person you can't feel you the the skill of de-centering is a metacognitive skill that a person learns how to do when do you learn to do that you know probably at the age of 12 and 13 where were you at age 12 13 you were in your room looking at computers so it's what you didn't learn at that point so because we could do top-down interventions and our brain is incredibly robust so much of this can be done in good psychotherapy but what we have to delineate is what has to be done in order to be able to do it so it's not that i'm against cognitive behavioral therapies i want much more targeted cognitive behavioral therapies which are oriented towards the developmental skills and the affective recognition of what didn't happen at age four five six seven eight nine and i'm saying that's necessary for a person to develop true empathy and compassion and de-centering from yourself or another person well that's an example of a metacognitive skill so when the meninger people caught on to was in metacognitive therapy you know i read the book i wasn't getting it until i really understood what i'm saying today which is that the real treatment for disorganized attachment has to do with understanding metacognitive states and doing much more metacognitive based therapies and that's the work that i'm beginning to do now and i'm encouraging you to read up on it because the ultimate thing that reminds you of is that that we are treating disorganized attachment we are treating dissociative disorder and when i did a study at my previous treatment center i first hundred clients i gave the adult attachment interview to and of those hundred clients over 90 percent had disorganized attachment and i said i am not going to treat the eating disorder i'm going to treat the disorganized attachment because those are the ones are going to get better from eating disorder and when i did that that's what turned out to be true now you say well what else is in this treating of disorganized attachment not only is the metacognitive work but the first thing that mary maine said is that you have to have a cohesive coherent collaborative narrative a cohesive collaborative coherent narrative now what the hell does that mean well you do a timeline with a client and look at what they remember well i forgot the first 10 years of my life well that's dissociative and so in reconstructive therapy what we want to begin to do is put the 10 years back into their narrative a coherent cohesive collaborative narrative now what is coherence nobody knows what the hell that means coherence means that the way you think and feel and act makes perfect sense and that if you go back in a developmental perspective we will identify that two and two always equal four what gets put in the computer always comes out of the computer now if you go back to that thing that i read to you where i the person says sex is dirty as an entrance ritual and it's why was he having prostitutes beat him because sex is necessary we need it to survive but sec if you if you need sex then you're bad so the best way not to need sex is to bring a prostitute in and pay them well that's a perfectly reasonable solution to that dilemma but now you know what the dilemma is you can help the person resolve it in some way that's why i say even though it seems crazy it's perfectly rational so coherence means that a everything a person does make sense including being urinated on or having no sexual arousal and two there is a developmental origin to that and three you must learn what the developmental origin is in order to treat the person effectively and so coherence is beginning to do this deep kind of work of beginning to integrate once past present and future as what dance eagle says is necessary for psychotherapy and then part of a coherent collaborative narrative is something which is called reflexivity reflexivity is the ability to reflect on your own experiences remember how they felt and to feel them and so a person who's been sexually abused does not want to remember how they felt they don't want anyone to remember it and a lot of the psychotherapies say oh don't do memory work don't allow the person to go back and remember it it's just a revictimizing experience and i mean the problem with that is that um in many ways it's playing into the dissociation dissociation is don't think about don't feel bypass and what trauma work is is allowing a person to have one foot in the past and one foot in the present and to be able to work on memory without being re-victimized i'm remembering what basil vanderkol said last week to me he said we forget that trauma is about terror trauma is about terror and a lot of people are using the word trauma wrongly as oh this bad thing happened to me when you have ptsd you experience terror and exposure therapy is the treatment for terror because if it's unconscious it's like and if you can't remember it every time you go to have sex with somebody your unconscious is going to be triggered and you're going to get that terror while you're making love and how can you be intimate with somebody you're terrified of that's the ultimate puzzle of disorganized attachment how can you be intimate with somebody you're terrified of your own mother your own father they you needed them but they terrorized you and terror is different than fear it's a much greater proportion and so being able to have reflexivity means that you remember how it felt and why it felt that way and that you can then have internal states of feelings intentions needs and so on and so what we want to do is we want to bring the emotional system back online so that they can not only observe what they're thinking about what they're feeling and how numb they are because so much of this stuff is unconscious no when you're nude with another person you are incredibly vulnerable if the light's turned on you're even more invulnerable and it is a catalyst to all the unconscious shameful unfinished business of the past and what we want to be able to do is to be able to wake up emotions and affective systems so in our program i mean what we do is every group six hours a day how do you feel what are you going on in your body let's get back in your body what are you going to do with those feelings in your body where do you think that anger went to where do you think the anger is going to go and what are we going to do with that anger because it's all suppressed and stuffed in there that rage because when you are feeling terror you are going to feel rage and if you don't do something to release that rage then the person is stuffed with it in varieties of ways so the most of my career i have tried to define what is an intimacy disorder and intimacy disorder is just organized attachment the same person that you fall in love with you are terrified of and you have an approach avoidance and sometimes you're preoccupied love me love me love me and then when they finally come it's like run like hell i'm scared to death and what kind of partner are you going to pick and what are you going to reenact with that partner relationships are alive and you recreate all that unfinished family of origin business when a couple divorces it's such a rich opportunity to begin to look at what happened in their family of origin that they've repeated in some way and reenacted and recreated because usually their divorce has little to do with their partner it has to do with happening their family origin and what they recreated with their partner and they're not a victim actually they're the one who's perpetrated themselves you've turned their partner into their perpetrator because they're a masochist and they're recreating a lot of the pain that they once had in certain ways okay so i think we're probably at a good point we could begin to take some questions mark you've got a couple of questions in the questions area and we also have some questions that came in in the chat let me summarize those for you they're around disorganized attachment and particularly linked to the mother and can intergenerational trauma come down from an abusive father as well as attachment disturbances with the mother yeah thank you those are good questions um you know the the number one cause of dissociation is having a dissociated parent dissociated parents create the associated children so that's a really important thing to remember and um that disorganized attachment can come from a parent who's women are kissing you one minute slapping you across the face and that is really confusing in certain ways now why do i pick on the mother um good question i think it becomes even more confusing when you have a family where a lot of strange things are happening and particularly the high degree of divorce people going to live with mother people going to live with father i think they're getting it from both directions so probably a lot of the things that i've said is about using the mother is erroneous it's it's always both so as you mentioned the international aspects for the clients received from their mothers what about the association connected with the father who was sexually abused as a child is your experiences who you found differences uh good question um i think it's complicated and i think it's whether you're a boy or whether you're a girl and uh i think it's highly individualized because you know at certain ages kids seem to have mother hunger where at certain ages they seem to have father hunger and for example when they get to be there's this wonderful book called father hunger and a lot of people find that father hungers was behind a lot of anorexia and so uh that's a good example of how a different manifestation can be related to disorganized attachment with one person versus another but truth be told i don't know the answer i i need to think about that much more and study it if you if you've thought about it i appreciate what you could contribute second one i work with portrayed partners betrayable trauma and sex addicts they present with disorganized attachment because they're uh not can a person develop disorganized attachment later with a new trauma um i think that's a controversial point i don't think so i think disorganized attachment is has to be laid down in the first five to seven years of life and it's a critical period and the reason i say that is because um these patterns that we're defining um in the strange situation seem to be so long have such longevity but oftentimes we recreate those patterns later in life so i suspect that it'd be hard to if somebody had secure attachment in early life i think that they're unlikely to develop disorganized attachment later even with severe trauma there is one here that says can dissociation be multifactorial yeah i mean part of it is the problem with the definition of dissociation you know bessel says there's primary secondary and tertiary association and uh the kind association today we're talking about is a fragmentation of the self-system um which is more tertiary dissociation but depersonalization is another form of dissociation and a lot of us have dead eyes that's depersonalization and then dissociation can come from you know when you're experiencing a ptsd trauma leaving your body and a lot of people leave their bodies while they're having sex and that's primary dissociation so those are different aspects of dissociation all three of them are oftentimes true with with our clients and the way you treat each of them is radically different i put this one what assessment do you use to measure disorganized attachment well there's lots of them now and they correlate with one another in inconsistent ways you know everyone thinks the gold standard is the adult attachment interview and then there are pencil and paper uh ways to measure it in my groups i use the pencil and paperweight so that people have a frame reference of what they are but rarely do people not know they they can look at themselves pretty clearly and put themselves in a category but i like the adult attachment interview i've been trained to give it i've been trained to score it and i do that uh basically uh with all my clients one of the questions in the all-attachment interview is um tell me three adjectives to describe your relationship with your mother growing up and then the person will say well we're very close and i'll say tell me a story about being very close and the person will say well um one time when i was sick um she called and she arranged for my sister to pick me up and take me home from school and that would be an example of uh potentially disorganized attachment because the story doesn't match very close on the other hand if the person said i i grew up thinking my mother and i were very close but as the years came on i looked at that and i realized that my mother was busy at work all the time and the only time we really got together was you know on weekends and we could have really friend-like conversations but i think i needed a mother i didn't need a friend that would be secure attachment because the person is metacognitive is able to look at it in varieties of ways so that's an example of how you begin to use the adult attachment interview to really understand your client and after i was trained in it i felt like i could do much better psychotherapy mark how about how can you help a young person develop a healthy sexuality well first of all what kids learn from what they see not from what you tell them so sex education is a bit of a misnomer giving people information about sex is not necessarily sex education what one has to do is give information about sex but you know they're getting it all over the place but they need you know john files used to say we teach sex to children like sending a ship out to sea without a rudder and what he meant was the ship would go out and just run around in circles you were exposed to sexuality all over the place and you know seven to ten year olds are looking at the visuals on their computer but we're not providing the guidance of how to guide the ship and that guidance has to come from what kids see not what they hear and so you know if you're laughing every time you're talking about sex you're sending shame messages and if every time it's brought up you turn the tv off you're sending messages and so on and so in effect if the parents have some have done their own work and are not transmitting shame around sexuality and presented in a healthy way that's sort of the best sex education dr masters used to say there's nobody in america who's grown up with healthy attitudes about sexuality and um i don't i don't know if that's true or not but i think we're all affected by that in some ways so what is sex education it begins in the family and is not only taught about sex but it's about love when i was younger i used to teach a course called love education at johns hopkins and the first class i taught i was 21 years old had 700 people in the class and there was no book on it i just had to figure out what to teach about love education by myself now there's lots and lots of material on this but what we need is to separate sex education from love education in preparation for relationships and preparation for relationships need to begin at a very young age because how we relate to self how we relate to others and how we relate to the world around us is doing trauma work how we relate to self how we relate to others how we relate to the world around us and so i do a lot of work in values clarification and you have to know your values and then you have to have value clarification and exercises to begin to ask yourself um how you think and then to respect each individual's values and values clarification we've got one here can you link cheating to trauma cheating to trauma yeah yeah i i think of cheating as an intimacy disorder i think of cheating as a re-enactment as a repetition and it always has its roots in intergenerational trauma and i'll give you an example one of the clients presented and he was a sex addict and he had an affair with his wife's best friend his wife got a separation and he tried to commit suicide so they brought him into our clinic and i'm a developmental theorist so i tried to do family of origin work and his mother the clues where his mother went to church every day and um he her father was sort of uh would watch television every night but there was nothing ptsd-ish there was nothing complex trauma-ish uh there was nothing i could find so i brought a family and i brought first his brother in and i said to the brother you know your brother tried to commit suicide i'm trying to help him i'm sort of desperate to know more about the family of origin this is the time to talk about any secrets is there any secrets in the family anything that you think of that might be important they said oh no my mother was holier than now she went to church every day but there was one thing odd my ears go pricking up one thing on what's that my brother and i were at the shopping mall and one day we turned the corner and my mother was kissing another guy and we couldn't imagine i said oh so i said okay so i bring the mother in alone and i say anything you could tell me no there's nothing you can tell well the boys tell me that they turned the corner and they saw you kissing another guy mother's eyes get really big she and she starts downloading i was incested by my father growing up for 10 years i never told anybody about this is the first time and she starts crying boo hoo okay now what is the mother being incested since it's a secret how could that cause the son to be a sex addict mission impossible do you think they're related absolutely and so as i i went into group therapy i talked to the guy in group therapy we're talking about why he did what he did to his wife he doesn't know he doesn't know he doesn't know do you think it might be related to your mother no not really to my mother's holier than that loyalty well um how about the time when you saw your mom kissing that guy this guy is a black belt in karate he gets up and he goes into this karate position and he starts coming towards me and it's like happening in slow motion but i'm scared to death and the entire group gets up grabs him and holds him down and they can barely hold him down he's so out of control so finally we get him settled down get him back in his chair and say well i think we must have hit something important because i'm an astute psychotherapist you know and holy [ __ ] the rage in this guy was just father's second buddy well if your mother goes to church every day and you see her in one way and you see her kissing somebody it would be very hard to get some clarity about those two scenes and put them in your head so your amygdala would grab it put it down and store it in storage and it would stay in state dependent memory until later something from you know activates it in some way and so your your body repeats it in disguise form as a way to figure out what happened why it happened because our brains seem to have these repeater systems that they're trying to make sense of things that make no sense at all so i find that true in all these cases it's always about unfinished business we've got one more question how does disorganized attachment connect to polyamory or ethical non-monogamy you really want to get me in trouble don't you okay that's a very complex question and i start as a sex therapist with non-judgmentalism i do not have my judgment on anybody else about anything if it works for you that's great but here's this is where my butt comes in everybody listen to my butt anything that enhances intimacy i'm in favor of anything that blocks intimacy i am not in favor of and so if so if you like people urinating on you to make love with them you you i want to treat you i do not feel like that is reasonable and so i'm not saying anything goes i say that if something pulls you closer to other people including pornography i'm in favor of it anything that pulls you away from your partner is an intimacy just or avoid an attachment i'm against people use polygamy in that kind of a way the old data on open relationships was really clear most of the people with open relationships ended up divorced the data on that is indisputable but that doesn't mean that applies today many people with open relationships are able to have very good marriage or committed relationships with another and if it works more power to you great on the other hand there are many of them are dealing with disorganized attachment and intimacy disorder by using open relationships and when they finally go to the divorce court they wish they hadn't done it and that's a subset so defining which subset it is which is really unclear so you know the term i use is ego syntonic where you go dystonic if it's ego syntonic great and when it becomes ego dystonic come in we'll help you and okay one more here using metacognition how do you determine that the person's defense system is safe for them to relinquish evaluating ego strengths perhaps the answer is to go slow you know when you're doing trauma work the golden rule is do no harm and we're you know you teach people grounding containment first you do family of origin work you develop a healthy safe relationship with the client you develop a secure attachment with a client and only then do you begin to take some of this stuff off the shelf and you do it in a titrated way and do a piece of work and then find out if the client is able to work through that and then get better and then you take another piece off and so on and so um most of us who do trauma work have learned from our mistakes and we're we go very slow if we're going to air we're going to go soo slow i like our model treatment because we we treat people usually for two months and we see them three times a week so in three times a week you develop really tight relationship with people and then they have the other groups to give them the the cognitive piece of it in the affect of peace and you do a lot in a short period of time and as they change it gives them more energy to change but every session is you're evaluating ego strength if a person gets disorganized you will see it there they'll begin to have thoughts that are disorganized they begin to feel like they want to relapse on their addiction you know and so you in our state our client our model you earn the right to do trauma work by stabilizing we will not treat you for trauma unless you're stable and if you're feeling unstable you better get stable if you want to do your trauma work here so people have a lot of motivation let me give you an example we treat eating disorders if you want to work on your trauma you need to eat the food and you need to stop binging and purging if you're able to do that you belong here and we'll do trauma work that's a lot of motivation because a lot of people want to do that work if not go back to another clinic where you can do work on sobriety and if this is your fourth clinic go to your fifth one but get sober then we can help you it's a catch-22 you're going to keep relapsing until you do the deep work but you can't do the deep work until you stabilize stabilize come here and we'll do the deep work then you won't relapse and that's the most defensible model but we will not work with people who you know who we feel like we're going to hurt thank you all for attending i'll see you later you

Channel: HARMONY PLACE MONTEREY with Dr. Mark Schwartz

Views: 111,564

Keywords: mental health, psychology, attachment, addiction recovery, trauma, dissociation, sexual disorders, intimacy disorders, sex addiction, dissociative disorder, dr. mark schwartz, mark schwartz, harmony place monterey, marriage therapy, intergenerational trauma, betrayal trauma, affairs and cheating and intimacy disorders

Id: IysE2ApEFtQ

Length: 100min 40sec (6040 seconds)

Published: Sat Apr 16 2022