Ep 141: Sex Therapy, Sexual Disfunction and Porn Addiction with Dr. Ian Kerner

Illustration by the talented @safiabahmedschwartz

What is sex therapy and how is it different from other forms of therapy? What are some common concerns explored through sex therapy? What should you expect from a sex therapist and sessions alone or with partner(s)?

In this episode, Effy and Jacqueline chat with nationally recognized sex therapist and the author of She Comes First and So Tell Me About the Last Time You Had Sex, Dr. Ian Kerner. They discuss the advantages of sex therapy for those who are looking to address struggles around erotic intimacy and sexuality, solo or with partners. Ian shares his practical and solutions-focused approach, which takes a closer look at people’s sexual scripts by analyzing the last time they had sex.

To learn more about Ian Kerner
Ian Kerner, PhD, LMFT is a licensed psychotherapist and nationally recognized sex therapist who works with individuals and couples on a range of relational issues that often lead to distress. He lectures frequently on topics related to sex and relationships, with recent presentations for the Psychotherapy Networker Symposium, the Ackerman Institute, Tony Robbins, The Society for Sex Therapy and Research and TED 2021. Ian is the New York Times best-selling author of She Comes First (Harper Collins) which has been translated into more than a dozen languages and more recently So Tell Me About the Last Time You Had Sex. He is the co-founder and co-director of the Sex Therapy program at the Institute for Contemporary Psychology. He lives with his family in New York City.

Website: iankerner.com
Resource: aasect.org

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TRANSCRIPT:

Ian

So I think a lot of women just struggle under the expectation of what desire is supposed to look like when in fact, their experience of desire is completely natural. It's just different.

Effy

Welcome to the curious Fox podcast for those challenging the status quo in love, sex, and relationships. My name is Effy Blue.

Jacqueline

And I'm Jacqueline Misla. And today we're talking about sex therapy between sex educators, therapists and couples coaches, it may not be easy to distinguish the role that sex therapy can play. In fact, our conversation with today's guest really changed the way that I've been approaching sex and sexual diversity with my partner.

Effy

To learn more about sex therapy, we went to a renowned sex therapist whose latest book brought the tool using sex therapy to the masses.

Ian

Hi, I'm Ian Kerner. I am a psychotherapist here in New York City specializing in couples and sex therapy.

Effy

Dr. Kona is a nationally recognized sex therapist and author who lectures frequently on topics related to sex and relationships, including a 2021 TED Talk. In his first book, she comes first spoke candidly about how the prevalent reductive penetration focused take on sex, left him alienated and made a case for prioritizing female pleasure through oral sex along with step by step instructions. With its striking papaya cover, it was a hit in his latest book. So tell me about the last time you had sex. Ian introduces the idea of analyzing our sexual scripts as a way to navigate conversations with our partners heal when needed and create mutual pleasure. I have never

Jacqueline

been to a sex therapy session. But honestly after our conversation within I think that my partner and I should attend the session are too.

Effy

Interesting. Tell me more.

Jacqueline

So I think I mean, it's what we were discussing in the interview, right? I think we have different libidos. Now,

Unknown Speaker

we've been stuck in some routines, I think we are not as passionate are curious as we used to be. So it is good. And it presses all the right buttons and pulls all the right levers, if you will. But there's like that, like something special that's missing. We've been trying to figure it out on our own. And I think our conversation with Ian helped me realize we don't have to be alone.

Jacqueline

We don't have to do it by ourselves.

Effy

Yeah. Makes sense. Right? I think also, just having a place to put that stuff is helpful. You know, and I think some of the things that we don't really know where to put that stuff. I mean, between us, we like it cuz we talk about that stuff, right? But an average person don't really have a place where they can have those conversations, not just Eric like to air them and to be solution focused or like have resources and that kind of stuff. So it kind of makes sense.

Jacqueline

Yeah, I think honestly, it's even challenging if you're used to talking about sex, or within sex positive communities or non monogamous communities where you're dialoguing about this more, because in my mind, at least, and there's a false sense of, I should know what to do. Or we should be able to talk our way through it. Or if we just share our feelings, each with each other, the solution will become clearer. And that's just that hasn't been the case when I'm, you know, if I'm like, I would like more sex. And she's like, well, I don't like.

Unknown Speaker

Right, exactly, then I'm like, Alright, I don't actually know what to do next. Like, I don't I don't know what to do here. And I think, you know, in the conversation with Ian, it helped me really understand the distinction between I, of course, know, the distinction between foreplay and, you know, sex, which, by the way, it feels very blurry. We've been having conversations with folks over the last few episodes where we're like, Well, what is actually the difference, like it was all part of the same thing. But I understand the distinction between kind of the build up, if you will, and then more intense kind of physical and sexual interaction. And I think I was focused on the sexual interaction, the physical part of it, as opposed to the psychological build up. And that distinction, I think, is going to make a difference in my sex life.

Effy

True. Also, I think just realizing that initial honeymoon sex is not, it just doesn't last forever. It just doesn't rape because we know this from just

Jacqueline

keeps telling me that everyone I know keeps telling me that, but I know No, I know you're right. I know you're right. And it's not even that though it's not even that I want to get back to that though, that would be great. There is something nice about knowing the person that you're with. So that that does bring like a different dimension of comfort level, and you can try new things and stuff like that. It's more, the having it be spontaneous is not the word, but just like that, like, Oh, I gotta have this thing as opposed to, should we? Sorry, I mean, I gotta wake up early. So like, not too long. But like, Yeah, okay. Like not that. That's also fun. Yes to that. Yeah. But then also the, who cares what time it is and who's around like, I need you right now.

Effy

Sure that I hear you. I hear you again. I think the beginning that's biochemically reinforced, right? But yes, we can't have that forever. Otherwise, humans wouldn't do anything. They'll just like, just be having orgies. That wouldn't necessarily be a bad thing. But unfortunately, we evolved out of it. To just those who hang around just had endless orgies, I guess, got eaten by lions. I feel like they should actually have had more like offsprings. So I don't know what happened. But yeah, I mean, I think we are by convention, religion is you have a true story. What happens to all good things? That's why we can't have nice things. So yeah, I think some of it is just just biochemistry. Like it, we're just can't sustain that kind of, I'm engrossed in this person's, like sexual aura. And I think the other thing is, I think what Ian talks about in the interview, like the sexual scripts, which I love that he talks about that, and it needs, and then for me personally, whenever I've been able to sustain that, in any relationship, it's been through a separate channel, that just stays kind of sexy and sexual at all times. Like, it doesn't change. Yeah, so there is like, life is happening. And there's this like, underlayer that is just continuous, sort of sexy, whatever it takes you touch sexy talk, sex, sex itself, you know, sex fan, so like keeping going and writing it, rather than try to tap in, like, go in and out of it. I think, like task switching, if you will, like, I don't think like toxic, the when you task switching, then it feels like task switching, like what you were saying you're like, Well, I don't really want to schedule in, I don't really want like, but I think it's because you are essentially task switching, you're like, I'm gonna stop doing this, and now I'm gonna have sex. And then now I'm gonna, you know, not have sex, or something else, right? So I think for me, I can't do that tax, that task switching when it comes to sex. So I have to have an under sort of current of just that thing running. Imagine like, imagine your communication with a slack with Slack, which for you? I know it is.

Jacqueline

Because I'm always actually on Slack. Right? Yeah.

Effy

So like having a, you know, a six channel that is kind of in its own channel that just keeps going?

Unknown Speaker

No, that totally makes sense to me. I think that the distinction that I realized is that it is actually undercurrent always going on for me. And I assume that's kind of what's happening to everyone else. But I realized that it's not necessarily you and I are going to be speaking with Emily Nagurski soon. And in her book, she talks about the distinction between breaks and gas, and within your sexual kind of desire. And I took the quiz, we'll talk more about it in the conversation with her but when I did, I realized I have very few breaks actually and a lot of gas. When my partner took it, she has many more breaks than I do. So she's like, dirty laundry, no dishes in the sink. No. And I'm like, those things don't matter. Like I'll have sex on the dirty laundry like I don't, that doesn't. And so I think that because it actually takes less effort to turn me on where to get me in a sexual space because that like undercurrent is always there. I think I've become lazier about creating that space intentionally. Because I'm like, if someone's like, let's go, I'm

Jacqueline

like, Alright, let's do it. Like I actually don't need much to like get there. But other people do apparently. r&d by all the time apparently, which is which we should have a whole episode about that at some point because that is also very burdensome. Let me just say it sounds delightful. It is not. But because that is the case. I think I have put less effort in to the psychological and kind of the hours leading up to potential sex and play, making that space start to build towards sexy, because it's not something that I have needed. And that happened naturally in the beginning, as you said, we're like building up towards sexy all the time, because we're just like into each other. And now not

Unknown Speaker

so much. So I was happy, I was really glad about this conversation with you. And I think I think it made a big difference. And it helped me understand, frankly, what sex therapy is, because I've been in this space for a really long time. And I was still not clear about it.

Effy

Yeah, no, I hear you I get asked is a question that I get all the time when I refer people to like sex therapy, like you might you might benefit from sex therapy people just like we don't know, we don't know what that is. So in that is how we started our conversation with Ian, we asked him what is six therapy? And how is it different from any other form of therapy? You

Ian

know, I think when people go to therapy, they're often expecting that they're going to need to meet every week, they might even end up being on a couch, it's going to be a process that goes on and on. And the therapist is going to just, you know, drag things out for years potentially. And I just want to disabuse anyone of that notion, sex therapy can be very solutions oriented, I generally assign a lot of different homework assignments to individuals and couples. So I allow a lot of space in between sessions, sometimes it's two weeks, three weeks, even more, depending upon what kind of experience does someone need to have out in the world to kind of bring back data that's going to be relevant to the work that we're doing. So there's a real strong relationship between the conversations that we're having in session and what's happening out in the real world. And, you know, basically, with sex therapy, generally, we are in a kind of a solutions oriented format, we're looking to help individuals and couples solve problems that are getting in the way of them sexually connecting, so sometimes that can take a few sessions and might take a half dozen sessions, or it could actually be in a single session, there can be a lot of you know, psychoeducation, along with practical advice, so it is also can be very practical and advice oriented. You know, sex is a topic that most of us don't grow up talking about, right, most of us didn't grow up in communicative sex positive homes, we grew up in either sex negative homes, or more likely sex avoidant home. So as a whole, as a culture as a society, we are avoiding generally taught conversations about sex. And that includes in traditional therapy as well, in traditional therapy, it can be hard to feel safe to bring up sexual topics or to have those conversations with a therapist. So I tend to think of sex therapy as a place that is really inviting your sexual self into the room and is going to pay attention and give respect to your sexual self and ways that probably don't occur in other kinds of relational environments, including traditional therapy.

Jacqueline

I love that definition. It also it makes me think about to your point, there is no sometimes space to go there is no place, where do we go to talk about that thing to learn from that thing to dig into that thing to explore it? That that does not exist? Yeah, I

Ian

mean, I agree. I mean, certainly I know from my own personal experience in life, that you can be lying in bed right next to someone and be inches apart, but actually feel 1000s of miles apart and disconnected. And it saddens me that a lot of people also have that in their therapy experience or their couples therapy experience. I've had a lot of people who have come in and they say, Yeah, I'm in individual therapy, I'm just not comfortable talking about sex with my therapist. And I find that to be really interesting. And I have a lot of couples who come in and say, Well, we were doing couples therapy, and we really wanted to talk about sex. But the therapist really avoided the topic or said, Well, if we can fix your relationship and get you communicating as a couple will solve the sexual problems and and that couldn't be, you know, farther from the truth.

Effy

You know, as a relationship coach I saw aligns with with my experience as well, I specifically deal in non monogamy, which somehow opens the door to be able to talk about sex more and in that how people are kind of placing each of these conversations in different places, like they have their individual therapy, and they have their couples therapy, and they go somewhere else talk about sex. So that that really makes sense to me. I am curious what what are some of the common reasons we're come on the common problems that that people tend to seek six therapy for? Like, what are the highlights?

Ian

Yeah, I mean, I would say that I see 25 to 30 patients a week. I mean, I'm very active as a therapist, especially when I'm not writing and the issues that tend to come in in a given week, you know, let's just say between couples would certainly be desire issues and desire discrepancy. I'm gonna say that that's probably the number one issue where people are in different desire frameworks that aren't really aligning. And so they're in either sexless relationships or one partner feels sex starved or another partner feels sex pressured. So those desire issues are really big. I think if we start to look at sort of more classic male issues and female issues that that also come in on the on the men's side, I'm dealing a lot with a erectile unpredictability, commonly would be called erectile dysfunction or erectile disorder, I, I tend to try and avoid terms that are overly scientific or pathologizing in some way, but a lot of erectile unpredictability. And interestingly, increasingly younger and younger men guys in their 20s guys in their 30s, who, you know, they can wake up with erections, they can masturbate without a problem, but when it comes to some kind of partnered interaction, they lose their erections or they can't maintain their erection. So, so that's a big issue. Another big issue for men is early ejaculation, which is actually the most common sexual problem that that men of all ages deal with. There's a lot more shame attached to early ejaculation simply because we don't have a pill to solve premature ejaculation. So you know, the pharmaceutical industry has really allowed for a lot of dialogue around erectile issues, but early ejaculation tends to be more in the background. And a lot of men have a lot of shame around it. And there's there's a there's a lack of understanding.

Effy

We hear this a lot, right early ejaculation early for what how do we define what is the baseline?

Ian

Certainly I encounter a man who can can maintain a jacket LaTorre control for anywhere from five to 15 minutes and seven or eight minutes tends to be the average in fact. So I mean, plenty of guys who can are solidly within the average spectrum who feel that they're suffering from early ejaculation because they want to be able to last for 20 minutes or 30 minutes that that is not early ejaculation. Early ejaculation is having a loss, a consistent loss of a Jackie dilatory control that really is leading to individual distress, partner distress and really interrupting the ability for partners to become aroused together and enjoy sex together.

Jacqueline

So Okay, back to FES question. Even the term early ejaculation implies that there's a specific time when it should happen, or at least that once there is a jack Ulation sex is now over?

Ian

Well, you know, men usually post a jack Ulation unless they're quite young and quite fit return pretty quickly to a pre aroused state and, and are unable to become aroused again without some interval of time dependent upon age and, and lifestyle. And so because so many sexual events are defined around intercourse and because intercourse, so pathetically fails to adequately stimulate the clitoris. Many women are left sort of mid arousal or not having orgasms. And I guess we can just say ask what is the importance of orgasm and should saxbee orgasm focused but I think orgasms are really nice and when one partner is having them and the other partner isn't. That's a discrepancy.

Effy

Yes, we did a whole episode in the orgasm gap. So we totally understand that there should be enough orgasms to go around visa.

Ian

Well, I would just quickly add on the male lists that delayed ejaculation or lack of orgasm is also becoming a more significant issue, as well as a lot of men coming in wrestling with their relationship with porn in some way and trying to understand their relationship with porn, and often self describing themselves as porn addicts.

Effy

How do you define porn addiction?

Ian

You know, people blame I'm finding that a lot of people blame porn for a lot of problems that they're having. In the bedroom. Right? A guy will come in who's suffering from erectile unpredictability, and one of the first places he'll go to is I think I've messed up my brain because of porn, or, you know, there's an issue in the bedroom between a couple and the partner, let's just say in a heterosexual couple, the female partner may say, yeah, like, it's from him watching so much porn or I catch him watching porn all the time, right. And this idea of catching someone is interesting too, because a lot of men experience sexual arousal in a spontaneous or impulsive manner, which which might be different than how some women experience desire. So one partner may be identifying the other partner is being an addict, simply when they're operating within the normal parameters of their desire framework. So people come to tend to come in self describing themselves as a porn addict when they're absent desire when they're having sexual function issues, partners will come in and again, yeah, describe their partner is secretly masturbating to porn, you know, redirecting energy that should be in the relationship elsewhere, sometimes engaging in relationships through technology that go beyond porn into like, you know, chat rooms. And, you know, I think the porn is and masturbation are really easy. Sitting down to masturbate to porn is a relatively stress free activity, you're not being watched by anyone, you're not being judged. You don't have to perform to any particular standard, you don't have to worry about a partner's pleasure, you don't have to worry about communication and consent and, and a whole list of things that make relational sex complex. And so I think what most people who come in identifying as a porn addict are actually experiencing, they're actually experiencing the natural complexities of relational sex. And they're having issues with very natural complexities and noticing, hey, when I masturbate, it's really easy. And I masturbate to porn, and I do that pretty consistently. So I think that, you know, a lot tends to get blamed on porn, people come in identifying as porn addicts, and generally feel like they have to be abstinent and abstain, you know, completely from porn that really set someone up for failure. There's no scientific data. Really, there's no quality peer reviewed data suggests that porn rewires the brain or creates addiction in the way that like alcohol, or substance would substances would so using the term addiction, it's just absolutely the wrong term. So I never use that term in my practice. I just say when, when a sexual behavior is problematic, so I just talk about problematic sexual behaviors. And generally, a patient will say, Well, why aren't you calling it addiction, and that's an opportunity for some psychoeducation. And the course of action is not abstinence, or giving up porn or giving up sex, it's usually what we would call like a harm reduction model or a moderation management model, just taking something that feels out of control or problematic and getting it to a place where it feels in control on a non problematic.

Effy

Yeah, it makes sense. I definitely understand the sort of low barrier low barrier to entry to masturbation and porn, right? It's especially these days are just literally an arm's reach one arm reach to your phone and one arm reach to your genitals. And then have you go, I guess that that makes a lot of sense to me. And I think I would also be curious about whether the idea of porn addiction sort of sits more in the bucket of the way that we treat, say, Instagram or Tiktok, like that kind of addiction, that kind of probably benefits from regulation and moderation rather than an absolute absence.

Jacqueline

So you shared that your female clients have their own set of concerns that they bring to a session.

Ian

You know, very often there's a desire discrepancy, because desire is depicted in the media as something that's like spontaneous and explosive, and it's like rushing into each other's arms and always being ready. It's a very unrealistic model of how desire works. And it is a model that actually is more suited to men who experienced desire very often in a highly reactive way and can see something sexy and really feel it in their genitals and want to move on it now, not to say that women don't see some Being sexy and registered as sexy, they absolutely do. But especially in a long term relationship, it's not likely trigger the trigger the arousal platform in the same way as it does man. Like if my wife is coming out of the shower, and she's looking cute in that towel, I can really feel that in my body and I'm like, ready to move. If she's ready, you know, she can see me coming out of the shower, and I may look okay, in a towel, I really look good to, to her at least, but it's not going to trigger that sexual desire in the same way. So I think a lot of women just struggle under the expectation of what desire is supposed to look like, when in fact, their experience of desire is completely natural. It's just different. So there's a level of self pathologizing that happens with women around desire, like I'm broken fix me, I should be like this. So, so desire problems are quite common.

Effy

Do you find that across women in general? Or do you see it differ between queer women and straight women?

Ian

So everything is general? You know, I hate to sort of gender stereotype. And men come in just as often with low desires, you know, women do and, you know, it's a hard question because I'm a sex therapist, and I'm working on sexual problems. And that's how people are presenting. So if I am working with a lesbian couple, or I'm working with a queer couple in some way, and they're having desire issues, I mean, that that is how they're presenting. So I would say, at least in my work, it's it's pretty universal, gay men, same same thing will come in with the exact same issue. So I would say that these issues are more universal than not.

Effy

Okay, cool. Okay. Difference in desire for for women. What else do we have? Yeah, I

Ian

mean, I think a big one is probably the topic discussed in a previous episode, you said like the orgasm gap, you know, the fact that so many common sexual behaviors that are intercourse based especially really failed to adequately, persistently consistently stimulate the clitoris really leads to, you know, a gap in pleasure and a lack of synchronization in a couples arousal are so that's, that's a huge issue.

Jacqueline

And you you literally wrote the book on that. So I know that you have lots of experience around around that gap yet.

Ian

Yeah, no, she comes first. Yeah, that really came out of my own youth, my own sexual youth and my own struggles with my own sexuality and sexual problems and trying to connect and really internalizing what I caught up kind of call like the intercourse discourse and, and one way of having sex that was really just frustrating and caused a lot of self defeat. So she comes first really came out of my desire to kind of show up differently during sex and make use of the skills, the talents, the intuitions that I did have, and really get away from that intercourse discourse and understand the importance of the clitoris and to become clitoris, so to speak. So, and that is a term that I did coin. I'm just getting myself any product or anything. Yes. I created as far as I know, I created the term clitoris, se, clitoris. And if I enter it, and I would challenge someone to go back to any kind of literature and find those terms being used before she comes first. I won't mind if they find them. I just, I just want to, you know, give myself a little bit of props.

Effy

Those are usually words we throw them around, like it's good to know they come from you. Okay, okay. That's pretty good. Yeah, I just know that book because I find I mean, it's a great book. I also think it appeals just men to men. Like I think it's appealing. It speaks to men from a man like perspective, which I think is is good. And also the color. I don't know what it is the color with the papaya just like sticks in my head. It's like what it's there very few colors. I can just like call up in my head. That book. She comes first like the papaya just pops in my head.

Ian

And it's a papaya with a banana in the background. Right? So the papaya is like heavy in the foreground. It's a big papaya and it's a very small banana in the background. That's

Jacqueline

fantastic. Because I know your your your follow up book. He comes next it has the reverse. It has the banana in the forefront who papaya in the back.

Ian

Yeah, exactly.

Jacqueline

So I want to transition back to the conversation and actually we can reference your most recent book which is so tell me about the last time you had sex with I think it's a fantastic title. Because I do think that for me, at least, it captures what we talked about in the beginning of the conversation around that safe space. It feels like it, there's no judgement, it feels like it's rooted in curiosity, it feels like it's rooted in storytelling where I can tell my experience. And so wondering if you can talk a little bit about what what happens within the sex therapy space? Like, what is it like and what can people expect from sex therapy?

Ian

Yeah, so I'm pretty ambitious in the first session, which is usually 75 to 90 minutes, I want someone to come in and really feel like they presented their problem. And for me to really be able to walk around that problem using a few different kinds of lenses, really like a biological lens, a psychological lens, or relational lens, like I really under want to understand. And that's the fascinating thing about sexes, right? Like, somebody could be experiencing the side effects of a medication, or they could have grown up with, you know, beliefs around how sex is supposed to go. Or they could simply be be bored or angry at their partner, or likely, like all of the above. So I love that sex is so complex. And so when someone comes in with a sexual problem, I really want to, like walk around, like, take a tour around like it's its own planet. And generally, you know, people really, again, because we don't talk about sex, we don't really get to think about sex in a analytical way. So most people don't really know why they're experiencing what they're experiencing. They just sort of know what they're experiencing. So I'm also interested in the why. And generally, usually within about 20 minutes, I've gotten a good sense of the issue. 20 minutes to a half hour, I've made someone feel very safe. In my practice, I'm really honoring their sexual self, they're being vulnerable with me, I'm asking provocative questions around the issue. And I'm, they're being compelled to use words like penis, and clitoris, and masturbation and words that they're probably might be a little uncomfortable with. And then I always ask the question, so tell me about the last time you had sex, or most of the time, I'll ask that question. You know, and that's because I really want to understand sex and action, right? I can't be there. I'm not in the bedroom, while or wherever they're having sex watching something happened. But I really want to understand how sex unfolds. Because more than likely, the way they're approaching sex has a lot to do with the problem that they're experiencing. And the way the problem is being reinforced. So I find a sexual event fascinating. It's like, it's like a complete universe of its own, or it's a little, it's a little skull, like shard of glass, like a shard of a mirror, but you look in that shard, and you kind of can see the whole relationship in so many ways. And so I'm interested in like, how did you decide to have sex, you know, of all the things you could have been doing in the world? Like, why was it sex? And who initiated? And how did it get going? And once it did get going, you know, what happened from there? Like, what behaviors Did you engage in? What behaviors? Didn't you engage? And I'm always so fascinated, people often come in thinking they know themselves sexually. So well, I don't do that. Or I can only come this way. Or I'm, I'm done with that thing, you know, and so I'm always interested in, you know, what are the behaviors that people are engaging in? What's on the table? What's off the table? How do they build arousal together? Are their arousal, arcs happening and sync? Who had orgasms? Who didn't? Where the orgasms asynchronous? Were they simultaneous? Was the experience of sex a positive one? Did you feel connected afterwards? Or did you feel emotionally and psychologically satisfied? And then what about the space in between sexual events? Like what are you doing to connect one sexual event? To the next one? Are you just suddenly just showing up for sex? Or are your sexual selves interacting in the space in between sex so I'm really interested in that sexual event and, and all everything that I described, all of those, that sequence of behaviors, physical, psychological, and emotional, constitute what I call the SEC script, right? There's a narrative there is a beginning, middle and an end. And it's a contained event and, and there's a narrative. So I really want to look at it as as a script, like a script for a play or a movie, and we want to talk about it and ultimately, we want to, like rewrite that script. And in truth, most couples and I work with a lot of couples and a lot of couples who are in new relationships. But also a lot of couples in long term relationships tend to have a default sex script, we don't really want to think that we have a default way of of having sex, we want to think that we're incredibly original and spontaneous all the time. And not that there isn't room for a lot of originality and spontaneity. But we do tend to have sort of these default SEC scripts that are either working, and if they're working fantastic, I'm probably not seeing you, you know, because you have something that's really working, that's getting you where you want to go. Or maybe it's not, maybe it's only working on a functional level, but it's no longer working on a psychological or emotional level. But But generally, I'm tend to work with couples, where the default sex script just isn't working for both partners. And so we need to really look at a sexual event. Look at what is the script that underlies the sexual event? How can we edit slash rewrite that script to create mutual pleasure?

Effy

That's super interesting. I'm curious to what creates that script? Is that something that we're born with? Is that something that is created through experience, internal factors, external factors? Probably D, all of the above. But I'm kidding. I'm curious to your, your thoughts on it?

Ian

Yeah, I think first off that our personal sex scripts are really defined by the cultural sex scripts that we internalize around us, you know, with heterosexual couples. And this is an area where heterosexual and queer couples are heterosexual and gay couples differ. If I'm going to ask a heterosexual couple to tell me about the last time they had sex, I'm going to venture right now that 95% of them will describe a sexual event that heavily focuses around intercourse or wanted intercourse to be the focus in some way, and it didn't happen. And so immediately, I think that there is a cultural sex script that really privileges and promotes just one sexual behavior, you know, a penis in a vagina, or a penis and an anus. You know, it's just one behavior amongst dozens of potential behaviors. And so, I think that the cultural sex script tends to define the personal sex script, there was an interesting study of gay and bisexual men around their most recent sexual events that we've looked at 25,000 gay and bisexual men, and only 35% of those 25,000 even had intercourse in some way, the last time they had sex. So it's such a disparity between how, you know, the sex scripts that a heterosexual couple might come in focusing on versus in this case, gay men who are much more focused on sexual behaviors that we would consider outer course or foreplay, kissing, hugging, manual stimulation, oral stimulation, genitals pressed against genitals, as opposed to genitals being inserted into other genitals. And so there was a lot of freedom. I don't remember the exact number, but I think it was like 10, non intercourse based behaviors that were predominantly being engaged in, that led to 1000s of different organizations 1000s of different sex scripts and sequences of how those behaviors were put together, that you just don't find in heterosexual couples. So I think, you know, certainly with queer couples that are operating out of that heterosexual paradigm, there's much more freedom to invent and create sex around your own pleasure.

Jacqueline

There's a lot that you're saying that's resonating. I think something that I'm thinking about is the sex script that worked for a long time that works psychologically and physically. And maybe now in your references. Maybe it still works physically, right, you're pressing the right buttons, you're pulling the right lever, so stuff is happening, but psychologically, you're just not as engaged. You're not as turned on it, you're you know, it takes longer for you to to orgasm. I'm wondering, how does one break those scripts? In my personal experience, I play a lot with my partner in power dynamics. And generally our script is I am more of a bottom and she is more of a top and that's the dynamic and I know that it's her desire that that role switches and so we play with that sometimes, but at some point in the midst of it, she just switches characters again, if you will, and switches kind of back to default and then I'm thrown off and so you know, interested in when we are even true I intentionally to break that script to be it's really challenging.

Ian

Yeah. So I think what you're describing is, you know, a sec script that once worked for a couple of maybe even in the beginning of the relationship when there was just so much newness and excitement providing that psychological stimulation, and you're describing a sec script that that still works in terms of delivering some basic arousal and orgasm, but it's really dehydrated and desiccate and have kind of like psychological material. And I think that that's a big focus in my new book. And it's a huge focus in my practices that, again, our sex scripts, because we don't talk about sex, so many of us are largely defined by physical behaviors. So when I asked a couple to describe the psychological behaviors that they engage in, they're often tongue tied and can't answer the question. So you know, what you and your partner are already doing is bringing psychological novelty into the sex script. And I think that that's hugely important. And you're engaging in what some kind of roleplay or scene that I would describe as being face to face, and that it's you and your partner, you're interacting directly with each other around some kind of erotic theme that psychologically stimulating. And that's fantastic. And that's actually where I want to get so many couples. But you know, I should say that my practice is probably 65% couples versus individuals. And it's probably 65%, heterosexual versus LGBTQ plus. So many of the couples that I work with, especially heterosexual couples, don't have the ability to engage in power dynamics or to engage in roleplay, or even to share a fantasy and if I asked them to go home and share a fantasy with each other, I can almost guarantee that they're not going to do it, because they're either not going to be able to access the fantasy, there's going to be shame around it a fear of judgment, confusion. So most couples I work with have to start in what I would call side by side, generating side by side such psychological arousal, before getting face to face. And that means Reading Literary erotica aloud together listening to an erotica podcast watching ethical porn together, there's so much fantastic sexual media that's being developed today just designed to turn on and arouse and, and, and titillate. And hopefully, I can move a couple from being faced side by side, excuse me, to being face to face in their psychological interaction. So I think bringing psychological arousal into the sex script is crucial, doing that from an early phase, being able to make sex a source of play, or figuring out how to do that. But now you described something interesting, Jacqueline, which is at a certain point, you've like, have the novelty, but then something kind of switches, and it becomes confusing, right. So this is the paradox of sex, which is, in some ways, we want to be really activated psychologically, and turned on psychologically, but at a certain point in a sex script, I would contend that we need to be absorbed, and we need to be able to sort of let go of the outside world, and even let go of our partner in a certain way, and just really become absorbed and present in our own arousal. And that's, that's true of men. That's true of women, especially for women, studies have shown that as women are getting aroused, and close to orgasm, and through orgasm, as one part of the brain is lighting up that's really associated with sexual stimulation, another part of the brain is really going dim and dark. And and and that's the part of the brain that's really associated with scanning the outside environment, and staying connected to the outside environment. So in some ways, bringing all of this novelty into a sec script is incredible. But it doesn't always allow us to get as deeply absorbed as we need to be. So I think that having a lot of psychological arousal in the beginning, sort of the first 30 or 40, or 50% of a sec script is fantastic. But then being able to transition into kind of just rhythmic behaviors that work, being able to transition into that functional part of the sex script that allows you to become absorbed and and ultimately to release through orgasm is really important. So I think we're always looking to combine the new with the old if that makes sense.

Jacqueline

And I like what you're saying to that makes sense to me around the newness and the novelty can exist within the sexual that within the psychological arousal space and Then once we find ourselves there, if we go back into the sexual scripts that feel comfortable and, and, you know, make us feel connected, that that's okay, that not everything has to be new, but that we really instead could focus instead of using our sexual space to be new to use that psychological space. I like that.

Ian

Yeah, yeah, that's right. I mean, at a certain level, like, novelty is interesting, because it challenges the brain to think it's bringing something new, and thinking is great, but at a certain point in sex, you don't want to be thinking anymore, you just want to be lost in it. And so I work with plenty of couples who are out there having like, novel adventures, and yet aren't necessarily sexually satisfied.

Effy

That actually really speaks to my experience, I talk about sex, I write about sex, I educate around sex, all the ways that sex can be, I can engage in it yet, when I'm having sex, when I'm in the middle of it, I am nonverbal, not non logical, like all of that shuts down. And I can't if I was to then called upon to foreplay, the roleplay or to somehow narrate my experience, even in cases of consent. It's a very different I actually feel like two separate people. They're engaging in this like now that and now you're saying, like a part of your brain shuts down? I'm like, Yeah, because I have to, like, stop what I'm doing, engage a part of my brain, find my words and narrate my experience, which takes me out of my sort of sexual experience. And then to slide back into it again, is definitely work.

Ian

Yeah, once that flow is interrupted, very difficult to get back into that flow,

Effy

right? Absolutely. And I've even like, we're talking about novelty. I've spent a lot of time in sex positive community, I've educated it sacrifices and play parties, and, and all that kind of stuff. I've been in those spaces. Yet, when I'm, in my own experience, all that kind of stuff kind of just becomes backgrounds, that the things that apparently arouse me up to that point are no longer significant. And I'm sort of him sort of into my body, in almost my own experience. So having heard you describe that I'm like, oh, yeah, that's exactly how I feel.

Ian

Yeah, it's really about ego dissolution, right, at a certain point in arousal, and especially into orgasm, like, sort of all those ego boundaries are kind of dissolving. And the incredible thing about sex is, they're dissolving in the presence of someone else, you know, with all of that sensual, interest, psychic connection. So that's an incredible experience, if if you can make it work, but I think we need those experiences of ego dissolution, I think it's one of the reasons that, you know, psychedelics are so popular right now. And so much of psychedelics are coming into psychotherapy, because they allow for ego dissolving experiences. And you know what, when you're having an orgasm, your brain's opiate system is activated. It's the paradox to get turned on during sex, and also to get turned off. And by turned off, I mean, to turn off the working parts of our brain.

Jacqueline

I imagine that there are so many of us, and I'm certainly in this care in this category, that have been trying to deal with these issues on our own or on our own with our partner partners. And it is challenging to break out of something when you're in the midst of it. And so it seems like there's a tremendous value for sex therapy. How does one go about finding the right sex therapist?

Ian

I think you're right, that you don't have to spend a lot of time with a sex therapist. But if you're not able to have these conversations, they're going to be hard to facilitate on your own and there are you know, there are good authors writing books, Emily Indigo skis come as you are a steroid parole writes, I'd like to think that, you know, I really designed my book based on years of doing sex therapy, so sort of trying to almost have me in the room with my process, but if you can find a live sex therapist, that's amazing. I mean, I'm back to seeing people in the office. So a lot of people are still doing zoom. Probably the best place to go to start would be the directory at a sect.org A S E C t.org. It stands for the American Association of sexuality Educators, Counselors, and Therapists. And so to be a therapist within a sect, you also have to be a licensed therapist in a different domain. So I'm licensed in marriage and family therapy. And a sect also has pretty rigorous requirements to becoming certified. I think you have to have 150 hours of didactic education 300 hours of supervised clinical experience, so I would definitely suggest starting with a sec to find a sex therapist or or just reading about your therapist. And all therapists you know, usually have websites and bios and a lot will say Oh, I'm also a sex therapist. Anybody can call themselves a sex therapist and fine, go ahead and call yourself that. But it would be, you should drill down a little bit on a person's qualifications, especially as people are grappling with non monogamy and shared sexual adventurousness and a lot of new issues that are, frankly out of the domain of a lot of sex therapists. So there's lots of ways to find yourself to a sex expert who can help but I think it's incumbent upon you to sort of drill down on their credentials to have these conversations with you. And again, a sect is a great place to start.

Jacqueline

And it's a great resource. If someone is listening to this podcast, and now wants to have a conversation with a partner, any tips around how to start that? I mean, certainly, I think they can send them this podcast and say, listen to this, let me know what you think. But any thoughts around because it you you started the conversation by saying it is really difficult, and we don't get practice and talking about it? So how can someone start the conversation?

Ian

Yeah, so if someone's listening to this, and they're not having conversations, they're probably aware of the problem that they're having. Right? They don't have desire for their partner, or they don't like how their partner stimulates them, or they're having some sort of sexual function issue. So you're probably very aware of the problem. And if you're like a lot of couples, you're probably able to complain about the problem, right? So. So if you can talk to your partner, more than likely, you're able to probably complain about it, like, oh, I, we never have foreplay, or everything's about intercourse, or why do you lose your erection? Or why do we need to pull out the lube? Or we're not sexually adventurous enough? Whatever it is, right? I'm sure you can issue it as a complaint. What I always will ask someone is okay, great. You know what the problem is? What is it you actually want? Like, what is the solution to the problem? Oh, I really just want to have an orgasm from oral sex. I don't get off during intercourse. Or I imagine us dipping our toes into a sex party and just watching whatever it is, there's some kind of solution, right? With sex, the solution is probably a sexy solution. I mean, I've had couples who specifically only want to schedule sex therapy on Thursday and Friday night, because they find it hot. They're talking about sex, they're talking about fantasies, they'll go have dinner, or they're coming from dinner, and then go home and have sex, there's just something about talking about sex, that can really become a sexy. So if you know what the problem is. Now, you know what the solution is, I bet you can frame that solution in the form of a desire or a fantasy. And I think that that's what you should present to your partner not, you know, you suck at for play. But more as you know, what is your fantasy of foreplay? And how does it connect with your partner? So that's probably where I would start. I would also say to know that there's kind of secondary emotions and primary emotions and secondary emotions are our kind of like defensive emotions, like if you confront me with something I'm not good at, I'm likely to say, Well, you do the same thing, or I only do that because of you. And that's like a very defensive secondary emotional response. Underneath it is a primary emotion. I feel rejected in some way. I feel not good enough. And so I think if you know, you're talking to a partner, just be aware of the primary emotions that are more than likely underneath those secondary emotions and, and try and talk to the primary emotions try and invite the primary emotions into a conversation and, and don't do battle with those secondary emotions.

Jacqueline

That is fantastic advice. Profound, fantastic advice. And yeah, I think it has I mean, certainly personally for me, I'd as we, as we're having the conversation, I'm thinking about some things that have are coming up in my my sexual dynamic, and I'm walking away with some next steps and saying, Okay, I'm gonna try this. I'm gonna try that. I think you have taught us a lot about sex taught us a lot about ourselves. I'm interested before we transition and this conversation, if we just learn a little bit more about you, and some important questions that we would love to ask you, just to dig into you a little bit more. The first of which is, is there one piece of advice that you would give to your younger self about love or sex or relationships?

Ian

I would say don't live a life of silent desperation have the time urge to communicate to a partner, even if it's the first date, and you're just getting to know someone, I would tell myself, have the courage to communicate about yourself sexually, rather than hide some part of your sexuality, or conform in some way or try to do something that you just can't do. So I think it would be be I would advise myself to be more open, more vulnerable and more communicative, and ultimately to seek partners who cared about having that conversation, cancer that everyone wants to have that conversation. But yeah, that's probably the advice I give to myself.

Effy

That's great, great advice. I shall give that to my younger self. What is one romantic or sexual adventure on your bucket list?

Ian

So I've been married for about 21 years together for about 25 years, we have like a fantastic working sex script, there's nothing that I would want to change in terms of sex inside the bedroom. I definitely don't have aspirations for non monogamy, I'm very attracted and connected to my partner. And so I do think of myself as largely a monogamous person. I guess the idea of some kind of shared sexual adventurousness, that might take us out of the bedroom would be really interesting, and probably a little, like, too old now to be appealing at a sex party in any way. So I don't know, like, what that would mean, like, you know, that old guy over there, something like that. But I could see us engaging or brainstorming around some shared sexual adventurousness that will take us outside of the bedroom.

Effy

That's funny, I wrote a book on sex parties. So I can tell you that you will do fine and it's like, it's hardly any good sex party is just so broad in its in its audience in its in its whoever is there, I think a lot of people assume that you're going to show up to the next party, and you gonna be surrounded by models, and like young hot bodies. And that said, there are some parties like that they they're just very different in nature. But I think the ones that are really grounded in community and pleasure and some sexual adventuring, I think you'll fit right in.

Jacqueline

Our next question is how do you challenge the status quo.

Ian

I think every day individuals or couples are coming in with internalized beliefs about sex, that are based on some sort of cultural message that they received either about how they're supposed to perform in bed or show up with a kind of sexual functioning or not do certain things or not fantasize. And I think that I'm constantly challenging those internalized beliefs and asking, you know, why you believe that? Like, why do you believe you're a sex addict? Why do you call it addiction, I think I'm just constantly challenging the internalized beliefs that people come in with around sex. And I frankly, I do that too, for a very functional reason. People want help, they want change. And they have to be flexible. If you can't be flexible in how you're going to define sex, and be expansive, and your definition of what sex can be and can look like if all you want is your narrow sex script. And you just want that to work and it's not working, I probably am not going to be able to help you as much as if we can challenge what we believe about sex and what got us to this place and really take a more expansive view.

Effy

Yeah, that makes a lot of sense. Okay. So we are a curious bunch around here and we are curious about what you're curious about lately.

Ian

I think I'm very curious around psychedelic assisted psychotherapy, and what that could look like in a sex therapy context. So I've done in the last year, a lot of training around integrating ketamine into psychotherapy. And I've had a number of my own journeys with ketamine and experiences of ketamine psychotherapy, and have been incredibly transformative. So I'm continue to be interested in psychedelics, how they can benefit my own journey in life, but mainly how they can help with the process of therapy because therapy is difficult. People really need to, they need to process trauma, they need to undo very rigid beliefs, they need to find capacities in themselves confidence that they've never had, they have to expose themselves to new situations. And that requires more than just talk.

Effy

Yeah, no, totally, totally. We actually did an episode with DD Vega, who talked to us about psychedelic therapy and how it can help with trauma and especially sexual trauma. So fascinating, fascinating. Topic. Thank you so much. Thank you for your time. And thank you for the work that you're doing out there. And it's really important, and I'm so glad that you're creating spaces for people to challenge their sexual scripts and looking at new ways of being sexually self expressed.

Ian

Thank you for the opportunity to spread the world and to reach beyond my little office.

Jacqueline

If you want to learn more about Dr. Ian Kerner, visit his website, Ian kirner.com. Or you can find him on Twitter at Ian Kirner on Instagram at Ian Kirner LM ft. If you have questions about sex therapy want to share your experience or just want to connect with other foxy listeners? Then Head to facebook and join our Facebook group at we are curious foxes. If you find our episodes interesting, helpful or amusing. Then please share our podcast with a friend quickly read the show, leave a comment or subscribe on Apple podcast or follow us on Spotify and Stitcher. It's a few seconds of your time but it makes a big impact for us. Our gorgeous website is filled with reading lists, blog posts and past episodes that will help you indulge your curiosity around love sex and relationships. Visit us we are curious foxes.com And if you want to support the show, then join Patreon at we're curious foxes, where you can find many episodes podcast extras that couldn't make it to the show. And we're 50 videos from educator led workshops. Go to patreon at we are curious foxes. And then finally, let us know that you're listening by sharing a comment, story or question you can email us or send us a voice memo to listening at we are curious foxes.com Or you can record a question for the show by calling us at 646-450-9079

Effy

This episode is produced by Effy Blue and Jacqueline Misla with help from Yağmur Erkişi, our editor is Nina Pollock, with whom we feel nothing less than healthy mutual pleasure. Our intro music is composed by Dev Saha we are so grateful for that work and we're grateful to you for listening as always Stay curious friends

Jacqueline

oh I don't know why my voice was so high

Effy

okay clunky Wow nicely. Look at that one shot. Starting the recording

Effy

Oh, can you hear me? Oh, can you hear me?

Jacqueline

Oh, by myself...

Effy

Curious Fox podcast is not and will never be the final word on any topic. We solely aim to encourage curiosity and provide a space for exploration through connection and story. We encourage you to listen with an open and curious mind. And we'll look forward to your feedback. Stay curious friends.

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