Sexual Healing

by Barbara Keesling

  Before you try to desensitize yourself to adult materials, start doing the breathing and relaxation exercises in Chapter 16 on a daily basis. Use your pulse monitor to check your heart rate both before and after the exercises. Give yourself a pat on the back when you notice progress in learning to control your anxiety symptoms.

  Once you feel like you’ve had some success using relaxation techniques to control your anxiety symptoms, and once you’ve made these practices a part of your daily life, you’re ready to move to the next step in the program. Here are some suggestions for desensitizing yourself to general sexual concepts and adult materials:• Read informational books about sexual techniques.

  • Take a human sexuality course at a local college.

  • Make a list of four-letter words or sexual words that you are uncomfortable with. Write each word several times in a row. Repeat each word out loud while looking in a mirror until you can say all of the words without becoming anxious.

  • Read passages of a sexy novel out loud while looking at yourself in a mirror.

  Next, put together a collection of sexually explicit materials that ranges from mild to very graphic. These could be still pictures or video clips or whatever. Arrange the materials in order from least graphic to most graphic. Starting with the least graphic material, look at each picture or clip for a few seconds. If you start to get anxious or experience rapid heart rate, back up to some of the material you were more comfortable with, or do some deep breathing and relaxation exercises. Your goal here is to be able to listen to or view the whole range of sexually explicit material without experiencing rapid heart rate. Keep a record of what you looked at, how much time you spent looking, and your anxiety level during each session, so you can see your progress.

  After you have successfully desensitized yourself to a variety of sexually explicit materials, do the sexual fitness exercises in Chapter 17 and the self-touch exercises in Chapter 18. Before you start the basic partner exercises in Chapters 19 through 22, I will explain again what shaping is (also see the discussion on page 240). Shaping is successive approximation of behavior. You may know shaping as the “baby steps” approach. This means that you identify a goal and are always moving toward it, no matter how small the steps you take or how little progress you make in every session, or whether you have to repeat behaviors or exercises a number of times.

  I’ll give you an example of shaping from animal psychology. Have you ever seen a movie or TV program that portrayed experiments that reward a rat with food pellets for pressing a lever in a certain corner of its cage? Does the rat press the lever correctly on the first try? Of course not. How do you think the scientists get the rat to figure out that pressing the bar causes food to appear? Through shaping. If you’re trying to teach the rat to press a lever for food, first you reward the rat with food whenever it goes to the side of the cage where the lever is. Then you reward the rat with food if it sniffs around the lever. Then you reward the rat if it touches the lever with its paw. Finally you must reward the rat with food every time it presses the lever. (This keeps the researcher busy—it kind of makes you wonder who’s really in charge.)

  To use this technique in treating anxiety problems, first you identify the particular behavioral goal you would like to reach. This will be different for each specific exercise. Let’s say the first exercise that causes you anxiety is a sensate-focus caress on your own genitals for twenty minutes. (This self-touch exercise is described in Chapter 18.) Let’s say you experience anxiety with this exercise after only one minute of doing it. Make yourself a chart labeled “1 minute,” “2 minutes,” etc., all the way up to “20 minutes.” The first day, do the exercise for one minute, and then follow with a session of deep breathing and muscle relaxation exercises. Check off on your chart that you completed one minute. Next time try for two minutes. Keep on doing these baby steps until you are up to twenty minutes.

  Then move on to the next exercise (arousal awareness or peaking), and make a “baby steps” chart for it. Break the exercise into as many small steps as you think you need to. All you need to do is make sure you’re always moving in the direction of the goal. This is important. The key to success using shaping is that in the next session you always either repeat a previous exercise or move on to the next step. You always move toward the goal, never away from the goal. Design your baby steps to ensure your success. If this means breaking your baby steps down into half minutes instead of whole minutes, then do it. The size of the steps doesn’t matter. What matters is that you proceed toward the goal. This approach may seem like it will take forever, but it doesn’t. At the “baby-steps rate” you can do several sessions a day.

  Once you have completed the self-touch exercises, you will be ready for the basic partner exercises in Chapters 19 through 22. Again, if you need to, break these exercises down into baby steps. The following are several ways to do this:1. If your goal is to be in the passive role in an exercise for twenty minutes, break it down into one-minute segments. Progress to the point where you can complete the full twenty-minute passive or active role before beginning the other role.

  2. Alternatively, you could alternate a minute in the passive role with a minute in the active role. Don’t forget to do deep breathing and relaxation after your successful completion of each baby-step interval. This is your reward for doing the exercise.

  3. If you have a problem doing the basic partner exercises at all, start with something even more basic, like a hand caress instead of a face or back caress. If either caressing your partner or being caressed causes you anxiety, start with something less anxiety-provoking like simply resting your hand on your partner’s hand or having him or her rest a hand on you for a short period of time.

  4. Devise some other system of rewards besides just breathing and relaxing. For each small assignment you complete successfully, reward yourself with something you like to do—watching a favorite television show, reading a magazine, eating a special food, relaxing in a hot tub, whatever.

  Remember, one of the principles of shaping is that if a particular activity seems scary to you, you can always think of something that is conceptually close to the activity but is less scary (e.g., a hand caress in place of a face caress).

  After completing all of the basic partner exercises, do the peaking and plateauing processes as described in Chapter 23 if you are a man or Chapter 26 if you are a woman.

  Specific Sexual Fears

  If you have a specific sexual phobia, do all of the preliminary exercises you can without triggering the phobia. Here’s an example of a woman who has a specific fear of doing oral sex with her male partner. She could do all of the relaxation exercises in Chapter 16, the sexual fitness exercises in Chapter 17, and the self-touch exercises in Chapter 18. She and her partner could then do all of the basic partner exercises up to the oral genital caress without triggering a phobic reaction.

  Next, she should make a chart that breaks oral sex down into baby steps. The steps might include resting her cheek against her partner’s penis without his moving, or resting her lips against her partner’s penis without moving. Then the steps could include licking her partner’s penis for thirtysecond or one-minute intervals. She should be able to think up ten or fifteen baby steps that each move her closer to the goal of having her partner’s penis inside her mouth.

  After she has successfully done oral sex a few times, she and her partner should work through the peaking and plateauing processes with intercourse. The strategy here is to alternate a fun and rewarding exercise like intercourse with the oral sex practice, making progress one baby step at a time.

  Remember that when you are learning to do an activity that you previously feared, you can’t expect to enjoy it right away. You have to get over your discomfort first. You go from discomfort to comfort before you get to enjoyment.

  Basic Desensitization and Shaping Chart for Someone with a Fear of Nudity and a Fear of Being Touched

  Here’s another example of a more bas
ic and universal phobia. Let’s say a man has a fear of being touched anywhere on his body. He can start the sexual healing program with breathing, relaxation, sexual fitness, and self-touch. Then he’s going to have to make several charts—one for each basic partner exercise in Chapters 19 through 22. He and his partner may be unable to start with a face caress or even a hand caress. Rather, his first chart may look something like the following:• He and his partner sit together on a couch with clothes on but without touching.

  • He and his partner sit together on a couch with clothes on and with their thighs against each other.

  • He and his partner lie next to each other on a bed with clothes on but without touching.

  • He and his partner lie together on a bed with clothes on and their bodies against each other.

  • He and his partner sit together on a couch with clothes on holding hands.

  • He and his partner sit together on a couch partially clothed without touching.

  And so on, up through being able to touch his partner’s face for a few minutes with clothes off. At this point he will be desensitized enough to continue with the partner exercises. Note that you can make any of the above steps into even smaller steps by breaking them down into time periods like thirty seconds or a minute. And remember to always follow each baby step that you accomplish with breathing and relaxation exercises.

  Finally, it’s important that you set up a reward system for yourself that has nothing to do with sex. Always keep your eventual goal in sight, and reward yourself for each step you successfully complete. The way to set up a reward system is to use the Premack Principle, in which you follow a behavior you don’t do often with one you do often. Here’s an example: Let’s say there are several things you like to do every day, such as read the newspaper, read a book, play the piano—whatever activity you enjoy enough that you try to do it every day. Every time you successfully complete a baby step in your sexual healing program, follow it with one of your enjoyable behaviors: Read a newspaper, read two chapters in a book, play piano for half an hour.

  You can see that you can make behavioral charts for any sexual phobia you have, including fear of fantasy or fear of sexually explicit materials. (A note to women: If you have a fear of vaginal penetration, you have vaginismus, for which there is a very specific treatment. See Chapter 30.)

  Severe Sexual Anxiety

  Let’s say that your sexual anxiety is so severe that you freak out and have a panic attack at the very thought of being touched. In this case we’re going to have to bring out the big guns: intense systematic desensitization. Remember that systematic desensitization involves gradually exposing yourself to more intense versions of the feared stimulus. You relax and breathe deeply each time a new stimulus is presented.

  There are two forms of systematic desensitization: in vivo and in vitro. In vivo (literally, “in life”) desensitization means that you learn to do a previously feared behavior in the real-life situation in which it occurs. Examples of in vivo desensitization are outlined in the preceding section, on treating specific sexual phobias, where I instructed you to treat them by gradually actually touching or being touched by your partner. However, some people have such intense sexual anxiety, often involving panic attacks, that they must first be desensitized in an artificial situation (in vitro, literally “in glass”) before they can relax enough to deal with their problems with a real partner.

  I’ll give you an analogy involving fear of flying, a fear with which I have extensive experience, believe me. In most cases of phobias involving flying, the treatment involves actually being in an airplane and doing deep breathing and relaxation exercises. However, there are some people who have such an intense fear of flying that they can’t go anywhere near an airplane without completely decompensating (falling apart). They have to be desensitized in an artificial situation before they can be desensitized in the real situation. This is sometimes called in vitro desensitization.

  In vitro desensitization is accomplished using what’s called an anxiety hierarchy, which is a person’s individual list of everything he’s afraid of, from least scary to most scary, along with point values on a scale of either 1 to 10 or 1 to 100. The list usually contains about fifteen items. A typical anxiety hierarchy for a person with fear of flying might include the following:1. Buying a plane ticket

  2. Packing the suitcase

  3. Driving on the freeway to the airport

  4. Parking at the airport

  5. Checking in at the ticket counter

  6. Going through security

  7. Hearing the flight called

  8. Boarding the plane

  9. Starting of the engines

  10. Backing away from the gate

  11. Taking off

  12. Hearing an unusual noise during the flight

  13. Turbulence

  14. Landing

  Let’s say you’re working with a therapist. Once you have compiled your anxiety hierarchy, you lie in a lounge chair. The therapist reads aloud each item in the hierarchy, starting with the least anxiety-provoking item. When the therapist reads an item, you close your eyes and visualize yourself in the scene. You breathe deeply and relax your muscles as you picture each item. You don’t move on to the next item until you have relaxed completely with the previous one.

  Obviously, you don’t do the whole list in one session. In fact, some people are so anxious that they need several sessions just to relax with one item. After you have completed the whole list, you’re ready for the in vivo (real life) desensitization process—in this case, actually getting onto an airplane and learning to relax in flight.

  Let’s translate this approach to a sexual situation. The first step would be to make up your anxiety hierarchy based on your particular sexual fears. Remember to list the items in order from least anxiety-provoking to most anxiety-provoking. For a man with generalized sexual anxiety and fear of nudity, the list might look like this:1. Being in the same room with a woman with the door closed

  2. Sitting on the couch next to a woman

  3. Sitting on a couch with a woman with thighs touching

  4. Holding a woman’s hand

  5. Kissing a woman

  6. Sitting on a couch with a woman while you’re naked from the waist up

  7. Sitting on a couch with a woman with both of you naked from the waist up

  8. Sitting on a couch with a woman while you’re wearing only your underwear

  9. Sitting on a couch with a woman with both of you wearing only underwear

  10. Sitting on a couch with a woman with both of you naked

  After you create your anxiety hierarchy, lie in a reclining chair or on a bed. Relax and take some deep breaths. Starting with the least anxiety-producing item, close your eyes and imagine the scene in detail. Relax and breathe as you visualize the scene. Use your heart rate monitor to see that your anxiety is decreasing. When you are able to breathe and relax with one item, move on to the next one.

  It’s a little tricky to do this without a therapist to monitor your progress, but it can be done. After you have completed the hierarchy, you will be able to move on to desensitizing yourself in an actual sexual situation.

  You can see that you can make up an anxiety hierarchy for any sexual fear or fears. I’ve just given one example here. If your particular fear is oral sex, make up a ten- to fifteen-item hierarchy that breaks down the oral sex situation into tiny components. If your particular sexual fear is intercourse, break down the situation leading up to and having intercourse into very small steps, all of which lead toward the goal.

  Prescribing the Symptom

  Some people have anxiety that is very severe and very resistant to treatment. There is another technique you can use if shaping doesn’t work for you. It’s called paradoxical intention, or prescribing the symptom.

  Prescribing the symptom works because of the way the human nervous system is set up. Remember from Chapter 3 that the two branches of the autonomic nervous
system are the sympathetic nervous system (the fight-or-flight response) and the parasympathetic nervous system (the relaxation response). What I didn’t say in Chapter 3 is that these two responses run on the same nerves, meaning that they can’t both happen at the same time. You can’t be anxious and relaxed at the same time. They are called incompatible responses.

  Prescribing the symptom is typically used in cases of fear of public speaking. Instead of learning relaxation techniques, the person with fear of public speaking is instructed to try to make himself as anxious as he possibly can. In fact, this has the opposite result, because you can’t will yourself to become more anxious than you already are. The net result is that you realize that nothing bad happens to you if you are anxious.

  This same technique can work for sexual situations. Instead of trying to activate your relaxation response, go into a sexual situation trying to make yourself as anxious as possible. Tell yourself, “I’m really scared. My heart is racing. I’m starting to sweat. Something really bad is going to happen to me.” You’ll find that the more you try to make yourself anxious, the more the opposite will occur. You’ll relax somewhat and realize that nothing bad will happen to you. (I suppose this also works because people are as contrary as they are.)

  An intense form of prescribing the symptom is sometimes used for people who have panic attacks. They are instructed to create the symptoms of a panic attack by spinning around and around really fast. Again, what they learn is that nothing bad happens to them. Prescribing the symptom helps a person get used to anxiety symptoms so that he or she is no longer bothered by them.