It is probably becoming clear to you by now what causes anxiety. Anxiety occurs when something happens that really doesn’t threaten your life, but still your body overreacts to it with full sympathetic-nervous-system activity. Physical signs of anxiety include cold hands and feet, tensed muscles (especially in the thighs and abdomen), rapid and shallow breathing, rapid heart rate, and a feeling of nausea or nervous stomach.
Because of the way the autonomic nervous system is organized, you cannot be relaxed and anxious at the same time. You gain control of your anxiety by consciously promoting relaxation. One way to reduce anxiety is through repetitive, slow, nonthreatening touching. Another way is through deep, slow, rhythmic breathing. If you are gradually taught to respond in a relaxed way to a previously anxiety-producing stimulus, relaxation will carry over to other anxiety-producing situations in your life.
How Sensate-Focus Exercises Help to Reduce Anxiety
The sexual healing program offers a series of sensual exercises that gradually become more sexual. The first few exercises are nonsexual and nonthreatening. You are simply training your body to relax. By the time the exercises become more sexual, you will be able to respond to a sexual situation with relaxation rather than anxiety. The process I recommend has much in common with that described by Herbert Benson in his book The Relaxation Response. According to Benson, four things are necessary for the relaxation response to occur: a mental device, quiet, a comfortable position, and a receptive or passive attitude. In the exercises that appear throughout this book, focusing on the sensations of touch provides the device that keeps your mind occupied. You will take a passive role during part of each exercise, and you should do the exercises in a quiet room and a comfortable position. As a bonus, learning how to decrease your anxiety by sustaining the relaxation response helps more than just your sexual functioning. It will also benefit your physical and mental health in general.
If you have a sexual problem, you have learned to associate sexual activity with the bodily changes produced by anxiety. In the program outlined in this book, you will learn three basic steps to dealing with the anxiety you may feel before or during a sensate-focus exercise. First, concentrate on the touch in order to occupy your mind. Second, breathe properly. When you become anxious, you hold your breath or you breathe too shallowly. To counteract this tendency, take deep, slow breaths that you can feel all the way down into your stomach (belly breaths). Third, consciously relax the muscles in your thighs, stomach, and buttocks. Even momentary tightening of those muscles can cause anxiety and interfere with your natural sexual arousal response.
Some people can experience very severe forms of anxiety, called panic attacks, panic reactions, or phobic reactions. (A phobia is a learned fear that is experienced to an incapacitating degree, such as a fear of heights, fear of snakes, or fear of being in enclosed spaces.) You may have a phobic reaction to the whole idea of sexual contact, or just to some element of the sexual encounter. Signs of this kind of severe anxiety reaction include profuse sweating, paleness, an extremely rapid heart rate, breathing difficulties, a feeling of tightness in the chest, and nausea, vomiting, or diarrhea. These sensations are usually accompanied by a feeling of unreality, extreme dread, or even the feeling that one is about to die of fright.
Psychologists have made great strides in the treatment of phobias, and even this very severe type of anxiety is usually completely treatable. I have successfully used the sex therapy program for anxiety outlined in Chapter 29 to treat many people with very severe sexual fears. However, if your sexual anxiety is quite severe, you might want to seek the assistance of a qualified therapist rather than attempt to deal with the anxiety yourself. You may need some antianxiety medication before you can begin healing your sexual problems.
If you do decide to heal your own problems, when you become anxious during any touching exercise, you will learn to tell your partner that you feel uncomfortable, and you will back up to an earlier exercise with which you felt comfortable. Only after you feel relaxed with one exercise should you add in elements of a new exercise.
You will also want to know how to respond if your partner becomes anxious during an exercise. If you are touching your partner as part of any exercise, you should be able to notice if your partner is anxious or tense. Obvious signs of anxiety include rapid and shallow breathing, a jumpy or quivering stomach, and muscle tension in the thighs and abdomen. If during any exercise you notice these signs in your partner, slow your touch down. Continue to touch your partner as slowly as you can. If the signs of your partner’s anxiety don’t go away, encourage your partner to take deep breaths. If necessary, stop the exercise and back up to a previous exercise with which you both felt comfortable.
When you are touching your partner, he or she may tighten up the leg muscles, especially during touching of the genital area. This muscle tightening is a learned habit that causes sexual problems and makes them worse. For example, in men who have problems with erections, tightening the leg muscles steals blood away from the penis. In men with premature ejaculation, tightening the leg muscles can trigger ejaculation. In men and women who have difficulty reaching orgasm, tightening the leg muscles can prevent orgasm. If you notice your partner tightening his or her legs, give the legs a very light tap or pinch to remind your partner to relax those muscles. If you notice yourself tightening up, consciously relax your legs. Three to five instances of your partner reminding you to relax during an exercise will usually take care of this habit.
Performance Anxiety
A particular form of anxiety is unique to sexual situations. It’s called performance anxiety. It stems from our fear of being watched or evaluated. Men, particularly, tend to think of a sexual encounter as a “performance.” A man might say, “I was with a woman, but I was unable to perform,” meaning, of course, that he didn’t have an erection. Thinking of sex as work or as some kind of performance put on for the benefit of your partner is an attitude that can only detract from your enjoyment of a sexual encounter.
In most areas of life we are trained to achieve. Those who work hard and succeed on the job or in school are valued in our society. They are the go-getters and the self-made successes. And from childhood on, we are encouraged to compete, an attitude that often helps us achieve work or school goals (although possibly at the expense of our mental health). Sexual activity, however, is an area in which this performance orientation has only negative effects. For example, men who have been successful in work often encounter difficulties with erections as they age. Success in business often means thinking many steps ahead of what you are doing in the present. In sexuality, thinking ahead leads to feelings of anxiety and pressure to perform, which can result in erection failure and other sexual problems.
There are many features of the sensate-focus exercises that can help you learn to take the pressure off yourself and decrease your anxiety. For example, the use of “active” and “passive” roles in the sensate-focus exercises is designed to make it difficult if not impossible for you to maintain a performance orientation toward sex. There is no point in working to please your partner if you know that he or she has been instructed not to provide you with any verbal feedback. The person in the active role has no real choice but to act for his or her own enjoyment.
As you do the exercises in this book, watch yourself for signs of performance orientation. If you catch yourself thinking, “I tried so hard, but the exercise just didn’t come out right,” recognize that you are looking at the activity as a performance situation. Stop trying. Experience yourself rather than judge yourself. Your sexual responses will happen normally if you relax, allow yourself plenty of time, and avoid putting pressure on yourself.
Which brings me to my next point: Don’t hurry through the exercises. You have been conditioned by our culture to believe that moving quickly wins you the most rewards. But if you rush through this program, you will not learn what you need to learn from each exercise, and you will have to repeat each exercise mo
re times. Paradoxically, the more slowly you proceed with these exercises and the less you plan or think ahead, the sooner you will find that your problem is a thing of the past. You will benefit more if you start the program with the thought, “I will have fun and enjoy myself,” rather than, “I will get better (or better at it) as soon as possible.”
Learning to relax during sexual activity and ceasing to view sex as a performance will also benefit other areas of your life. Clients have often reported to me that sensate-focus techniques helped them relax and concentrate in other areas, such as studying, listening to music, or cooking. Other clients have said they were actually more productive at their jobs because they learned to concentrate on the task at hand and no longer made themselves anxious by thinking ten steps ahead. There’s no room for multitasking during a sexual encounter.
Spectatoring
The term spectatoring was coined by Masters and Johnson. Spectatoring is one of the leading causes of performance anxiety. It means you’re thinking when you should be feeling or experiencing. An example would be a man who is receiving a caress. As his partner’s touch moves toward his penis he thinks, “I wonder if it will get hard. I bet it won’t get very hard. Uh-oh, it’s going down now.” Spectatoring does not mean literally watching your sexual performance with your eyes, but rather being unable to put a stop to obsessive thoughts about your response. Women, especially those who have difficulty reaching orgasm, can also be prone to this type of thinking. Maybe a woman is receiving a genital caress. As her partner moves closer to her clitoris, she thinks, “I wonder if I’m starting to lubricate. It feels a little wet down there. I wonder if I’ll have an orgasm this time.” As the stimulation becomes more intense, her thoughts switch to “I’m getting kind of close. I wonder if I’ll have one this time. Wait, now it’s slipping away. Darn, I was so close!”
Spectatoring tends to be a concern in men with erection problems and in women who have problems with orgasm. It rarely occurs with premature ejaculation, since the ejaculation is often over before the man has time to think about it.
Our society overemphasizes a visual-logical-verbal processing of sensory information, a pattern that can cause a person to be prone to spectatoring. The sensate-focus exercises you will learn in this book will return you to the tactile-emotional way of receiving and expressing information about your world that you used naturally when you were a child. The exercises will also help you become acquainted with your partner on a body level as well as on a mental level. The cure for spectatoring, therefore, is additional practice with sensate-focus techniques—in fact, overpractice. If your mind is totally focused on the touch, you will be unable to comment internally on your “performance.” Practicing sensate focus will help you learn the difference between focusing on your response and worrying about it. If spectatoring is a severe problem in any given exercise, back up to a less threatening exercise in which it was easy for you to pay complete attention to the point of contact between your skin and your partner’s skin.
Pressuring Your Partner
Throughout this book I will suggest many ways to stop putting pressure on yourself to perform sexually. However, your sense of being pressured to perform may not be all in your mind. For example, if your partner ever says things to you like “Did you come yet?” “Are you close?” “Why aren’t you hard yet?” “Can’t you last longer?” or even, “I want you to come now,” you are justified in feeling that you are being pressured.
If you are in the habit of saying things like this to your partner, please stop. If your partner says things like this to you, ask him or her to please stop. You may not have realized that these simple questions can create tremendous psychological pressure. Chapter 15 contains guidelines for giving verbal feedback to your partner—constructive, positive, and pressure-free ways for each of you to communicate your feelings about your sexual activities.
Although direct and overt performance pressure is fairly easy to recognize, pressure conveyed through nonverbal cues may be more subtle. Picture a sexual experience in which everything seems to be going fine, in the sense that both partners are functioning well and doing activities that they enjoy. Yet for some reason both feel uneasy. They may start to search for something to which they can attribute their negative or confused feelings: “I must be in a bad mood,” or, “I guess I’m just not feeling sexual right now.” What is more likely is that they have become caught up in a widening spiral of interpersonal performance expectations, each picking up on the fact that the other is thinking or worrying rather than enjoying the experience.
Let’s say a man is giving an oral genital caress to a woman. If he is enjoying himself and concentrating on exactly what he is doing (in other words, if he is focused on the sensations), then his partner is also free to enjoy herself and to focus on her own pleasure. However, if the man thinks, “I wonder if she’s enjoying this” or “I wonder how much longer I’m going to have to do this until she has an orgasm,” the woman will pick up on his attitudes and will realize that her partner is no longer concentrating on the touch but is instead having performance-related thoughts.
Your partner cannot read your mind, but he or she can tell if you are concentrating on what you are doing and if you are enjoying it. You may not know exactly what is going on, but you realize that something isn’t right because you feel uncomfortable. In that sense, anxiety can be a good thing because it alerts us to the fact that we need to refocus. In fact, we are picking up our partner’s nonverbal cues, which are often more honest than the activities that are taking place. We may attribute our feeling of discomfort to a thought like, “Something is wrong with me or my sexual response,” when instead we need to recognize that there has been a subtle shift in the quality of the sexual encounter. What will happen in the situation I have just described is that the woman will think to herself, “Uh-oh, he’s expecting me to have an orgasm pretty soon. I better fake it.” At this point, the sexual interaction becomes based on expectations, worries, and performance pressure, rather than on sensate focus and mutual enjoyment.
In another example, a woman might be caressing the genitals of a partner who has difficulty having an erection. Instead of enjoying what she is doing and concentrating on how her hand feels on her partner’s genitals, the woman may think—briefly—“I wonder when he’s going to get hard.” Her partner will instantly pick up on the fact that something is not right. The quality of her attention has changed. He may then think, “Uh-oh, she’s getting tired, she’s getting bored, why am I not getting hard?” Needless to say, if this situation isn’t remedied his problem will only become worse, because the performance anxiety will begin earlier and earlier in each subsequent sexual encounter.
Another source of sexual pressure is the idea that you are somehow responsible for your partner’s enjoyment. You need to take responsibility for your own arousal and enjoyment and learn to please yourself while accommodating your partner’s needs so that both of you can become aroused together.
How do you avoid these pitfalls of unwittingly putting pressure on your partner or of succumbing to sexual pressure your partner puts on you? First, become aware of the problem. If you feel pressure, any pressure, it means the pressure is real. At this point it doesn’t matter what caused it—you just need to get rid of it. If your first reaction is to think, “There is something wrong with me,” redefine the situation as, “I am feeling pressured due to something that is going on in this situation.” Then you can see the solution: to make sure you truly enjoy what you do by doing only what you enjoy. By practicing the sensate-focus techniques, you will learn what kinds of sexual behaviors you enjoy. Staying focused on what you are doing will increase your enjoyment, and your enjoyment in turn will leave your partner free to enjoy himself or herself. If an activity or situation is so uncomfortable or anxiety provoking that you can’t focus on it, stop and do something else with which you are comfortable.
You may be surprised to learn that the sexual positions you and your p
artner choose can have an effect on your sexual healing process. That is the topic of the next chapter.
chapter 4
Sexual Positions
There are many positions in which couples can have sexual intercourse. None of them are inherently good or bad, or right or wrong. However, some of them are more healing than others. In general, the face-to-face intercourse positions have more potential to help your sexual healing process because they are more intimate. In addition, some positions are better than others for dealing with specific sexual problems. In all of the treatment chapters (Chapters 23 through 31), whenever I recommend an exercise that includes intercourse, I’ll give you suggestions about which position I believe to be the best for that exercise.
The following are the main types of sexual positions. For each group of positions, I’ll tell you how to do the positions, the pros and cons from a physical standpoint, and the pros and cons from an emotional standpoint.
Male-Superior Positions
This is the group of positions many of us are most familiar with. Being the most traditional, they are the sexual positions that are typically depicted in Hollywood movies. In the basic missionary position, the woman lies flat on her back and her partner lies on top of her. There are several variations. The man can support himself on his elbows and knees or even on the palms of his hands and his toes, if he’s agile enough. Another version of this position is called the coital alignment technique, or CAT. In this variation, the man pulls himself up and forward toward the woman’s shoulders, causing his pubic bone to rub against her clitoris, and his penis to go in and out of her vagina more vertically than horizontally.
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