InforMS: You are a therapist who works with people who have problems with sex and intimacy. Where do you start?
Jenny Glick: I talk with individuals and couples about their sex lives, or their lack of a sex life, what they dream about and hope for. I help them understand that we are all sexual beings even though our culture tends not to see us that way unless we are 25 years old and look like a model. I work with these issues from the bottom up and that goes beyond simply telling someone to “take some Viagra, use some lubrication, try a different position.” I help people learn to have a relationship with their bodies. If you don’t have a relationship with your own body, you can’t really expect your partner to know how to have one. Once they have a relationship with themselves, I teach them how to talk with their partner, who may feel criticized if they say, “I’d like you to touch me this way, not that way.” This is where sex therapy dovetails with couple’s therapy—it is very hard for most people just to ask for what they want sexually.
I also educate people about fantasy. Fantasy and anticipation are important aspects of a sexual relationship. Humans are the only mammals that can come to climax through thoughts. We tend to limit our thinking about sex to our sex organs but there is a lot of sexuality that is available outside the bedroom, that doesn’t involve touch. O en, what’s most arousing for people isn’t the obvious sexual stuff but the anticipation along the way, the electric charge that comes from thoughts, fantasies, and the emotional connection.
I help people understand that it is not their partner’s job to make them aroused. ink about sexual arousal on a scale of zero to ten; if you show up in the bedroom at a one, you haven’t really done your prep work, and that can set your partner up to fail.
Each of us needs to take responsibility for our sexuality and arousal. If I want to have sex with my partner tomorrow night and my arousal is at one, I can start working this up. Maybe I wear some nice lingerie or I start imagining how I’d like things to go, so when I show up in bed the next evening, I am no longer at one—I am at a seven or eight. If we are both doing this, we are both taking responsibility, instead of expecting our partner to make it happen.
InforMS: Sexual problems in MS can result from many issues. Do you work with or refer to other specialists, such as gynecologists, urologists, urogynecologists, or pelvic floor physical therapists?
JG: Yes, all of those. It’s standard procedure for our field to refer to other professionals who are what we call “sex positive”— professionals who have a real understanding of and comfort with these issues. Not everyone does. Practitioners, if they aren’t sex positives, will sometimes say or imply things that can be hurtful to the client, who already feels damaged—like this is all in your head. that’s pretty common. It is devastating to be told that if you are already feeling broken.
InforMS: How do you know if someone is a “sex positive”?
JG: Research websites. Or interview someone on the phone. Ask lots of questions. Do you specialize in sexual dysfunction? What is the focus of your treatment? I encourage my clients to be very proactive and let people know if they are apprehensive about the consultation. If someone isn’t willing to have the conversation with you, it may be a sign to find someone else.
InforMS: How would someone start working on these problems? Do people start with you or are they referred to you?
JG: It depends on what’s going on. Most of the people I work with start with me because they are having problem in their sexual relationship. But it is o en goes deeper than that because the problems have been going on long enough that other aspects of their relationship—like communication—are breaking down, and now they are fighting. So we start there, and while we are working on that, I send them to the urologists or the gynecologist, or the physical therapist to find out what’s going on. Couples who haven’t waited that long and aren’t having the relationship breakdown may have gone to a medical professional first. Maybe they have started with their primary care doctor and they get a referral from there.
InforMS: How are you different from a regular couples therapist?
JG: I trained initially as a marriage and family therapist. But because so much of that work is related to intimacy and sex, I decided to learn more about sex therapy. Most couples therapists are trained with the belief that if you work on the emotional piece, the sex will follow. And that’s a myth. So many of the issues going on with couples have to do with what’s going on in the bedroom, but many couples therapists don’t have much formal training in sex therapy.
Some people can have a great best friend relationship with their partner and feel emotionally connected, but the sex is kaput. They need to develop a sexual relationship with themselves and with each other and have a better understanding about what they want and need. We have this cultural belief that if we love each other and we have a strong life together the sex should just come naturally. And it just doesn’t for many, many people, whether you have a chronic illness or not. Maybe it does for the first five years, but then you have kids, or you lose a job, or you have medical bills, somebody gets sick and then there are all these barriers to intimacy. I work on the emotional part and the sexual part of the relationship in tandem. They go hand in hand — you can’t pull them apart.
InforMS: How do you find a therapist to help with intimacy issues? Is what you do covered by insurance?
JG: Sex therapy is a sub-specialty. Because of that, therapists may not be on insurance panels. One place to go to find a qualified therapist is the American Association of Sexuality Educators, Counselors and therapists or aasect.org. It is an international organization. People on that list go through a lot of additional training and supervision and consultation and they are reputable. If you are considering someone who is not a certified sex therapist, ask questions. What percentage of your work is focused on issues related to sex and intimacy? What kind of special or advanced training do you have in these issues? How do you work with people who are feeling stuck in their sex lives? Start there.
Jenny Glick is a licensed marriage and family therapist who holds a Master of Arts is Women’s Studies from the University of Arizona.
