Through its holistic, compassionate approach, this valuable guide empowers with knowledge, instills with confidence and gives women a direction for finding doctors who are truly knowledgeable about their disorders and able to treat their pain.  As is read in its introduction, “This book is the product of our passionate belief that all women with sexual pain need both physical and emotional support.” 

Deborah Coady and Nancy Fish provide a detailed, empathic guide that that offers a wealth of physical and emotional suppport. I highly recommend Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain.

Millions of women suffer from sexual and pelvic pain in America today, yet it is frequently misdiagnosed or not diagnosed at all.  Because of the multidisciplinary nature of sexual pain, which falls between the disciplines of experts, women have often been told that pain is “all in your head”  or that nothing can be done to help them.  As Coady and Fish point out, “We’re here to tell you that none of that is true.  Sexual pain is almost always caused by an identifiable, verifiable medical condition; it can be treated and is not in your head.” 

Nancy Fish had suffered from severe pelvic pain and had seen seven specialists before visiting Deborah Coady.  Coady, while having years of experience with women suffering from sexual pain, nonetheless took some time to uncover all of Fish’s difficulties.  Fish, like most women suffering from sexual pain, through inadequate treatment had several conditions that had compounded and spread.  A licensed certified social worker specializing in chronic illness, Fish found great hope in Coady’s insistence that she never give up on herself. She was inspired to form a partnership with Coady to help those with the chronic illness of sexual pain. 

Deborah Coady, through her personally developed teams of colleagues in neurology, dermatology, orthopedics, pain management, gastroenterology, urology, peripheral nerve surgery, physical therapy and psychotherapists, demonstrates in Healing Painful Sex how fruitful their holistic approach can be. As they write, “Even in your most difficult situations, you can experience a significant reduction in your pain and can find help for reintroducing sex as a joyous and nourishing part of your life.  We promise:  Things can get better.”

The book is organized into three parts. Part 1: Naming the Problem begins with the difficult situation of talking about sexual pain.  It helps the reader learn how to share her situation with one or two other people who can then help make medical decisions.  The book then discusses the often arrogant, uninformed or downright abusive physicians who exist.  As stated in the book, “The degree of incompetence, insensitivity, and indifference among gynecologists, other specialists, and general practitioners is hard to overstate.”  Hoping to aid their emotional healing along the way to ending their sexual pain, Coady and Fish outline the ways in which the reader can understand what to do when the doctors get it wrong. 

The first section of the book ends with a chapter dedicated to finding a doctor who will offer effective treatment and provides a detailed holistic guide on beginning one’s healing by following guidelines on pain, sleep hygiene, diet and supplements, exercise and relaxation techniques and learning of how to be gentle with oneself.

Part 2: Understanding the Problem, provides the reader nine chapters of detailed information covering the symptoms and conditions of pelvic floor dysfunction, vulvodynia, pudendal nerve pain, clitorodynia, pelvic organ problems, endometriosis, painful bladder, and irritable bowel syndrome, skin disorders, such as lichen sclerosis, and hormonal, surgical, and post-cancer causes of pain.  Interwoven with detailed explanations of the causes of sexual pain, the book contains full-page anatomical illustrations, checklists for particular disorders, and details on the types of tests needed as well as lists of the common misdiagnoses given for a disorder and ways to rule it out.  It contains details on how the various conditions can co-occur and affect one another.  It tells the potential patient of what to expect during an examination and offers guidance based on the doctor’s performance and recommendations.

Part 3: Overcoming the Problem presents valuable information and guidance devoted to fulfilling one’s life with the joys often taken away in sexual pain.  Coady and Fish hope to return libido, desire, partner intimacy, healthy relationships with friends and families to women undergoing sexual pain.  Their many personal case studies validate and underscore the valuable guidance they provide.  The book closes with excellent resources, including recommended books, helpful websites, psychotherapists, as well as relevant organizations and associations.

Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain
By Deborah Coady, MD & Nancy Fish, MSW, MPH
Seal Press: November 1, 2011
Paperback, 400 pages
$18

Whether it’s your first or fourth child, your relationship still sees a jolt. As Marter said, “The first child most often brings about the greatest life and relationship change, but each subsequent child affects a couple almost exponentially, widening the scope of responsibilities and compounding family and relationship dynamics.”

Having children can bring couples closer. But it also can chip away at a relationship if you’re unprepared for the potential pitfalls. Take this surprising statistic: Within three years of their child’s birth, about 70 percent of couples experience a significant slump in their relationship quality, according to the Gottman Relationship Institute.

The key in keeping a relationship happy and fulfilling is knowing what these pitfalls are, having realistic expectations and staying committed to each other. Below are three of the most common pitfalls and pointers to help.

Pitfall 1: Sleep deprivation

Everyone knows that having kids is exhausting. But you might not fully appreciate the fatigue. According to Marter, “the chronic and cumulative nature of sleep deprivation during the newborn phase is perhaps one of the most commonly underestimated challenges of new parenthood.”

Sleep deprivation sinks your mood, makes it harder to cope effectively with stress and exacerbates mood swings and anxiety. And that’s just what it does to each person.

Lack of sleep strains the relationship in various ways: Couples may fight about who’s doing more and sleeping less. Because couples are extra agitated and stressed, they might squabble more in general. And the primary caregiver may feel unsupported and alone and eventually resent their spouse, Marter said.

Pointers: Sleep when your baby sleeps, Marter said. “This may mean letting the laundry or scrapbooks wait and forcing yourself to nap. It might mean going to bed at 8 p.m., so that you can sleep during your baby’s longest stretch.”

What if your baby isn’t really sleeping? Marter suggested working with your pediatrician and reading other resources such as Healthy Sleep Habits, Healthy Child by Dr. Marc Weissbluth. If feedings are the reason your family isn’t getting much sleep, she also suggested checking out the La Leche League, and figuring out a feeding schedule that works best.

Ask loved ones for support and, if it’s financially feasible, hire help for household chores, a babysitter so you can take daytime naps or a night nanny, Marter said.

And work as a team. For instance, moms who are breastfeeding can pump so their partners or loved ones take turns doing the feedings.

Pitfall 2: Lack of intimacy

Sexual intimacy declines after having a baby, and not surprisingly, this can negatively affect your relationship. “Because sexuality is intensely personal and sexual connection is a major component of romantic relationships, sexual dysfunction or disconnection can become a significant problem for many couples,” Marter said.

The decline happens for many reasons. Physicians typically suggest that women abstain from intercourse for 4 to 6 weeks after childbirth. Even after that time, “women may experience or fear pain from intercourse due to the effects of delivery, an episiotomy, perineal tearing, and/or vaginal dryness due to hormone fluctuations,” Marter said. Couples also experience a decline in desire because of busy schedules, body image issues, fatigue and other concerns.

Pointers: Expect that intimacy will decline after childbirth. This is normal considering the sleep deprivation, new responsibilities and need for the woman’s body to heal, Marter said. Avoid viewing lack of sex as rejection or a sign of trouble in your relationship.

Be close and intimate in other ways, such as kissing, touching, snuggling or spooning, Marter said. Make time to physically connect with each other. Staying home and watching a movie is one way, she said.

“Good sex requires good communication.” Marter suggested talking openly about your needs, preferences and fantasies with your partner. These are some questions she suggested raising: “What is good about [your sex life]? When was it the best and why? What do you each desire? What schedule seems to work best for you? What gets in the way of having more sex?”

Also, work on your emotional connection. For instance, “Create at least 20 minutes per day to connect and talk about things other than the responsibilities with household and baby,” Marter said.

Pitfall 3: Responsibilities

In Marter’s practice, the most prevalent problem for couples is division of labor. Resentments inevitably peak when one partner feels like they’re tackling more tasks and working harder. “They may compare and become competitive or defensive about their responsibilities, schedules or the pros and cons of their work or role,” she said.

They also might glorify each other’s positions, Marter said. A stay-at-home dad might think his wife’s day at work is filled with swanky business lunches, interesting projects and a quiet commute, while he’s dealing with temper tantrums and dirty diapers. His wife might imagine him playing, cuddling and connecting with their child, while she deals with a difficult boss, endless deadlines and concerns over job security. “Then, when an issue like who is going to do the laundry comes up, the misunderstandings have created an environment ripe for conflict,” she said.

One of the problems is that couples usually don’t have a plan for how they’re going to divvy up responsibilities. Marter finds that many couples make assumptions about who’ll do what — often based on how their parents did things — which typically leads to confusion and conflict.

Pointers: Map out what your routine and responsibilities will look like, Marter said. And make sure it’s fair to both partners. Again, couples get into trouble when responsibilities are vague. One of Marter’s clients wanted her husband to help out in the mornings, but the couple ended up bickering instead. “By sitting down and reviewing the mornings tasks, the husband was able to select several items that his wife agreed would be helpful for him to manage,” she said.

When you’re figuring out fairness, remember that a relationship requires give and take. “For example, the husband of a client who is a teacher really steps it up during her grading periods and she picks up the slack when he travels for work,” Marter said.

Also, lower your standards, and let some things go. Another client of Marter’s, who was super stressed and worn out, used to iron all her baby’s clothes. Of course, getting enough sleep supersedes ironing. “Focus on the big things and let the small stuff go,” Marter said.

“The transition to family is simultaneously joyous, miraculous and wondrous and one of the most challenging life experiences and opportunities for growth,” Marter said. It helps for couples to have realistic expectations about parenthood and their relationship and to remain committed to working as a team.

Dr. Jung starts out by explaining the vast impact of sexual trauma.  He states that about “20-25% of girls and 10-15% of boys experience some form of sexual trauma before the age of 18.”  This is quite a large number if you stop to think about it.  In addition, we must consider the ripple effect of sexual trauma; the victim is unlikely to go on with life in the same manner so the people they associate with may be affected as well.  An interesting point is the financial aspect of these numbers.  He quotes a study performed by the National Institute of Health that shows a strong correlation between PTSD and sexual trauma.  Given the correlation, the study states that PTSD is associated with almost the highest rate of service use and may be the highest per-capita cost of all mental illnesses.

Dr. Jung’s discussion of historical and cultural figures and the impact sexual trauma had on their lives is quite interesting.  Overcoming such an obstacle, many were able to build an empire, so to speak.  Oprah Winfrey is one of the examples that he uses.  She has become an international icon over the years, reaching out to people with her television show, magazine, website, and now, her own TV network.  Even though she experienced sexual trauma as a child and had a very troubling past growing up, she was able to overcome her challenges and create a life of entrepreneurial endeavors, inspiration, and creativity.  His use of these famous characters is to provide an illustration of what he believes is the “astounding creativity and tremendous sensitivity” that victims may gain from the experience of sexual trauma.

The anecdotes of his own patients are a more personal approach to the face of a sexual trauma victim.  Jung describes the variety of symptoms that his patients suffered, typically providing one story for each of the forms of PTSD that he discusses.  The stories can get graphic as the patients relive the trauma they endured.  He couples the stories with letters written by patients, which give a direct view into the mind of the victim.  For instance, one letter was written by a patient that was molested by a priest.  The letter describes the emotional turmoil that the patient experienced.  The letter recounts the molestation, explains how he does not trust anyone, and harbors anger toward his ex-wife.  He goes on to say, “Somebody has to pay.  The smell, the texture, the taste in my mouth that has haunted my life…  I need to be vindicated.”  This is just one of the many stories shared by Dr. Jung.

After building this foundation for understanding the victim, Dr. Jung begins the arduous task of explaining the therapeutic process for victims.  From the crisis intervention to reliving their trauma, the healing process for a victim is often a bumpy road.  He explains the patience and understanding required of a therapist to assist a victim along the way.  He states:

It is important to recognize that there is no one word of wisdom, one magical advice or one great medication that will cure this vast, complex, human condition, for it is from the violation of one of the most personal, sacred and vulnerable foundations of human existence.

An important note that Dr. Jung addresses is that there is no complete resolution of sexual trauma; he likens this to how there is no perfect person.  This is something certainly that must be discussed between therapist and patient to assure that the expectations of the outcomes are realistic.  He continues this discussion in Chapter 5, which focuses more on the various medications, which may help patients deal with various symptoms of PTSD.

Finally, Dr. Jung rounds out Sexual Trauma with a section filled with advice to physicians, therapists, patients and parents.  He does make note that every patient is different; therefore, the advice is not a textbook manual for every case.  They are merely suggestions, which can be used to “acquire some sense of direction and to work through the challenges of the therapy process.”

Sexual Trauma is undeniably a strong text, which outlines a promising therapeutic approach to sexual trauma and PTSD.  I believe that it is a great resource for therapists and physicians.  For victims of sexual trauma, it may provide comfort and give them hope that there is a path to recovery. 

However, I do believe there are two drawbacks to the book that need mentioning.  First, I feel as though much of the focus is on the story telling of patients and famous sexual trauma victims rather than the actual therapeutic process.  Perhaps more explanations or descriptions of the steps involved in his process could have made this section more enlightening.  For instance, when discussing the process of transference, it is unclear how Dr. Jung would resolve this part of the therapy.  Rather, he merely gives examples of transference that he has experienced with patients and advises therapists to “be very giving, and generous of his or her time, attention and self, to allow the transference to occur unimpeded.”

Second, I regretfully must admit that the text is difficult to get through.  The content of Dr. Jung’s book is useful, informative, and interesting.  However, it is painfully obvious that the book was not edited well, or even at all.  There are errors throughout the text and grammar, spelling and style errors.  Specifically, the section on Marilyn Monroe was so atrocious I had to put the book away because of my frustration.  At times, the writing was so poor that I had to ponder the message that Dr. Jung was attempting to deliver.  It is truly a shame his message is so poorly delivered.

Sexual Trauma: A Challenge Not Insanity
By K. Elan Jung, MD
Hudson Press: 2010
Hardcover, 660 pages
$19.99

Collins, a former sex addict, is founder and director of Compulsion Solutions, an outpatient counseling service in the San Francisco Bay Area specializing in the treatment of men suffering from sexually compulsive behavior.  He is recognized as an expert on sexually compulsive behavior.  I find his book to be an excellent guide on ending sex addiction as it provides techniques that give intimacy to the reader’s true self and thus intimacy with others.

While Collins specializes in the counseling of sexually addictive men, his clients have included people of all sexual orientations.  For the sake of simplicity, his book is directed to heterosexual males, but as he points out, his techniques work for almost anyone.  As Collins notes, the ideas underlying his techniques can be applied with any sort of addictive behavior.  Early on, Collins points out a crucial fact about addiction, “ . . . that you can’t get enough of what won’t satisfy you! Objectifying and sexualizing people is a never-ending, negative process that yields a few minutes of excitement, a brief orgasm, then hours, days, weeks, months, and years of fear, pain, shame, self-doubt, self-criticism, judgement, and anger.”  Collins provides a collection of methods that support each other by challenging both the addiction as well as those inner voices that give rise to these negative feelings.

Collins forms the basis of his techniques as the differentiation between an individual’s true essence and the repetitive stories that the individual’s mind tells. These inner voices, or subpersonalities, Collins notes, are a normal part of the human psyche that shape the perception of oneself.  Since, however, they are not the essence of an individual’s true nature, they can be changed.  Collins quotes Eckhart Tolle, in The Power of Now, “Your mind is an instrument, a tool.  It is there to be used for a specific task, and when the task is completed, you lay it down.  As it is, I would say about 80 to 90 percent of most people’s thinking is not only repetitive and useless, but because of its dysfunctional and often negative nature, much of it is also harmful. Observe your mind and you will find this to be true.” Collins provides techniques for individuals to gain greater awareness of their own inner stories, giving them the ability to rewrite them.  While the utility of the mind is important to realize, Collins helps readers to set it aside and to live in the present moment.  As Collins writes, “Your real addiction is to your mind.”

Collins introduces his techniques by asking his readers to imagine themselves in the center of a personal amphitheater with the lights turned off.  The person standing in the center of the amphitheater is one’s self and the voices heard in the amphitheater telling one to check out new porn, visit a prostitute or repeat the typical addictive cycle are understood to be the addictive subpersonalities.   As Collins notes, these repetitive and dysfunctional stories and the personal behavior that results often seems automatic, but they are not.  By using the technique of having individuals “turn on the lights” in their amphitheater, identify, confront and reason with the voices, their stories and thus subpersonalities can be changed. 

Through the use of journaling and consciously directing these stories an addict begins to recognize “what’s always true,”  that one always has a choice.  By thus having individuals identify with the silent and true essence of their selves, rather than with the stories told in their mind, Collins points the way toward freedom from sex addiction.  As he writes, “When everything you do is fresh and you’re no longer living in reaction to your history, there are no preconceived notions, no story.  Your life will be different.”

While he refers to masters from Roberto Assagioli to Ken Wilber, George Collins has written a book that is, as he writes, “. . .not just based on what he read,” but based, perhaps more importantly, on his own previous experience as a sex addict as well as his successful counseling of sex addicts.  His book is well written, clearly based on deep principles, but written in a manner that anyone can pick up and make use of.  His inclusion of many techniques, from The Blonde in the Beemer: What to Do When You’re Out of Control to How Good Can You Stand It? Connecting with Yourself and Others shows that Collins understands the difficult, human process involved in breaking free from the cycle of sexual obsession. 

Through his own difficult personal experience and his later expertise in counseling Collins provides an excellent guide.  He satisfies his stated goal of helping his readers break the cycle of an unsatisfying life of sexually compulsive behavior and through the intimate connections they find with others make their life better.  Breaking the Cycle: Free Yourself from Sex Addiction, Porn Obsession and Shame is highly recommended.

Breaking the Cycle: Free Yourself from Sex Addiction, Porn Obsession and Shame
George N. Collins, MA with Andrew Adleman, MA
New Harbinger Publications: October 1, 2011
Paperback, 224 pages
$17.95

Right Here begins with a section on what to aim for in a relationship.  This first section contains five essays which all focus on one aspect of romanticism.  From opening your heart to falling in love, the first section of this book is just a primer; it gives us a glimpse of what we can expect in the future.

The second section of Right Here is called “Preparing the Ground.”  As the title implies, this section is about getting yourself ready for a relationship.  The main focus of this section is learning how to love yourself unconditionally.  Several of the contributors for this section provide meditation examples and exercises to help you get to know yourself.  The most basic of these exercises is to sit quietly with yourself and to really feel every emotion and thought that rushes over you.  I have done meditations similar to this, and I agree that it is the best way to get to know yourself.  You cannot spend quality time with anyone (not even yourself) if you are distracted.  This section also covers choosing a partner and even has an essay dedicated to the criteria that so many of us go by when choosing partners.

Section Three is called “Being in Relationship.”  This section covers dealing with the stress of marriage.  It also contains essays about being mindful of your partner.  One example of mindfulness given in one of the essays compares mindfulness in a relationship to the mindfulness of eating a baked potato.  You try to experience every flavor, but are overwhelmed by memories and emotions.  Eventually you lose track of where you began in the first place.  “If it’s this challenging to stay in touch with a baked potato,” Erik Hansen asks, “how much harder must it be to clearly perceive the person I love?”  Good question.

Erik illustrates his point further by giving an example of his wife.  One Sunday, she expects him to help her clean their basement.  After becoming frustrated that he is unable to read a book, he surrenders and helps his wife.  While he helps her, he begins to actually feel her presence.  She’s not just someone standing next to him anymore; she’s a living, breathing human being with her own life, her own goals, and her own will.  For once, he is truly aware of his wife.  Erik then clarifies that his wife in no way resembles a baked potato.

The remaining sections cover the hard parts of relationships: dealing with disagreements, the loss of love, and their ilk.

Throughout Right Here with You the focus remains on mindfulness.  I’m a practicing Buddhist, so this is not a new concept to me.  To people who know nothing about Buddhism, mindfulness may seem like just making sure you don’t hurt other people’s feelings.  It is, in fact, much more than that!  Mindfulness is not taking things for granted.  When you are mindful of your surroundings, you know that they are there; you experience them as they are.  In America today, we focus so much on the future that we lose sight of right now.  Mindfulness is about coming back to now.

I love how this book brings us back to our center.  The premise that to have a successful relationship with someone else, you must first have a successful relationship with yourself is an old one, but the premise is true.  In my experience, relationships fail because one of the partners in that relationship is trying to fill a void.  As a gay man who has tried to hide his sexuality by dating women, I think I stand as a perfect example.  Now that I’ve come to accept myself just as I am, I’m finally able to enjoy life.  Reading this book has helped pull me back to my center and, now, my relationships with my friends and family (I wish I could add “boyfriend” to that list) are much stronger.

If you’re stuck in a relationship that doesn’t seem to be going anywhere, or you’re tired of all the Christian rhetoric that fills many of the relationship advice books out there, I strongly recommend reading this book.  It will open you up to a world of new understanding.

Paperback: 288 pages
Publisher: Shambhala (August 9, 2011)
Language: English
ISBN-10: 1590309049
ISBN-13: 978-1590309049
Product Dimensions: 6 x 0.7 x 8.9 inches

She covers a wide range of topics. Specific areas include how lab rats differ from wild rats, the effects of ‘work,’ their pleasure, their mental and physical health mental and physical, eating habits, grooming, sex, parenting, and how they deal with overpopulation. Sound familiar? It should. While Lambert is clearly — and admittedly — a rat-lover, she consistently makes sure each section is knitted with the life lessons that we can learn from their behaviors. She also carefully aligns the sections; it is not meant to be read in a disorganized fashion where you simply choose which segment sounds the most interesting. She builds on the information that is given to you in previous chapters.

Lambert’s informal style makes the heavy science easy to digest and helps the book appeal to a wide audience. Even if you have a neuroscience background, I’d imagine this would still be a fun read. She is a storyteller and a vigilant academic, so you get both a good read and a lot of information as she continually cites other scientists, their studies, and their books. For this reason, this book would be a great jumping-off point if you wanted to begin to learn more about the field. Additionally, the last section is a complete list of every study or book she’s mentioned.

Lambert states in the beginning that rats are the most successful and adaptive mammals on the planet and that they may hold the secret to our own success. Lambert’s gentle humor in no way impedes her boldness — she says she hopes this book will leave her readers wondering “What would the rodents do?” when they are caught in one of life’s sticky situations.

Her boldness, however, does not mean that she jumps into theories. Instead, the logical thought progression she builds makes you a believer one step at a time. The first chapter briefly introduces the reader to Lambert’s life as a researcher and vast knowledge of rats. In the second chapter she states that “as we examine common factors between humans and rodent mental capacities, it is important to avoid both overestimating (anthropomorphism) and underestimating (anthropodenial) commonalities.” Science, for Lambert, is king.

After a brief but thorough overview, Lambert delves into the idea of ‘trust-fund’ vs. worker rats, a consistent thread throughout the book. Trust-fund rats, as you may imagine, earned their name by being simply handed treats (Froot Loops), while worker rats had to dig and search to find their treats. The worker rats seemed to have “more clearly defined associations between their efforts and obtained rewards in life and had a perception of being better able to successfully complete the task — something psychologists typically refer to as self-efficacy.” The worker rats spent 60 percent more time on impossible tasks than the trust-fund rats.

As an example of how quickly Lambert rolls into the implications for humans, she then explains how this idea led her to think about emotional resilience in humans. Thinking that “ if effort-driven reward therapy enhances resilience in rats,” it could do the same for humans “without the use of psychoactive drugs such as anti-depressants?” Work, therefore, may lead to healthier brains and resilience to stress.

She does this in each chapter, mixing a careful combination of story, facts, and connections between humans and rats. For example, she looks to the rat for answers in the health care system (are we too dependent and unable to look out for our own well-being?), as well as to the benefits of grooming (it can help heal and shows that an animal is in good health which, to Lambert, is a small sign of why we detest bad hair days).

Lambert even goes on to look at how rats respond to sex, finding in her studies that sex is shown to “build more complex brains.” She also examines how female rats choose mates in order to diversify their gene pool and give their offspring a better chance of fighting disease (yes, she even writes a potential rat singles ad). She then discusses the after-effects of sex: parenting. Again, the rats in the study can be quickly aligned with human counterparts. She focuses particularly on single rat moms that live below poverty level: the rats groom themselves less, have increased stress, and the children are compromised in development.

Personally, I’m a believer. Rats are survivors, as Lambert consistently points out, and “can respond to changes in the environment faster than other mammals.” With the constant mounting stress in the world and our daily lives, I’m happy to embrace anything that might reduce that pressure. Also, there has to be a reason why 85 percent of testing is done on rats and mice — they can’t be that different than us!

I enjoyed all the research Lambert collected and analyzed, but also that it is said in plain language, so it made for a fun read. Like psychology itself, this book is a wonderful combination of science and human understanding.

The Lab Rat Chronicles: A Neuroscientist Reveals Life Lessons from the Planet’s Most Successful Mammals
By Kelly Lambert, PhD
Perigee Trade: June 7, 2011
Paperback, 320 pages
$15

1. Get in touch with and understand the needs which affect your reactions and behaviors in a relationship.

Needs you are not aware of might be driving your reactions and behaviors. Are you, for example, driven by the need for love (which might drive you to be too submissive within a relationship?); the need for independence (which might drive you always to keep distance from your partner?), and so on. These needs often affect the way we react and behave in our relationships.

When you become aware of your needs and become able to free yourself from the impact they have over your reactions and behaviors, you will be able to behave with your partner in a healthy and mature way.

2. Understand the fears that drive your reactions and behaviors.

It is certain that you – like almost everybody else – have fears you are unaware of which harm your relationships, such as: the fear of commitment (which might drive you to escape from each and every relationship you begin to develop); the fear of being alone (which might drive you to jump into a relationship with whoever blinks at you); the fear of losing your independence (which drives you to be controlling with your partners); the fear of being hurt (which might drive you to be cautious with your partners, causing you never to dare to open up), and so on. Becoming aware of the fears that control you enables you to combat them and not let them interfere with your relationships.

3. Check whether your expectations are realistic.

It is great to have expectations! It is also natural to expect your partner to be there for you all the time; to love you unconditionally; to always understand you; to always remember your birthday. It is great to expect that you and your partner will always be in a good mood; will always be sexually attracted to one another, and so on.

If you find out that your expectations are not fulfilled, rather than getting angry at your partner, ask yourself whether your expectations are realistic and attainable. Often we set unrealistic expectations which cause us to become frustrated, disillusioned, angry and disappointed.

4. Ensure that your fantasies are realistic.

Fantasies are part of life. They give you something to dream about, something to look forward to. You might fantasize that your love will be just like in the movies; that your partner will supply all your needs; that the two of you will do everything together and never fight; that you will always agree on everything.

But if your fantasies are unrealistic and you hang on to them you are likely to harm your relationship. Therefore, think over your fantasies and determine whether they are realistic and attainable, or tend to verge on dream-like reality. The last thing you want is to ruin your relationship due to unrealistic fantasies. At the same time, for the sake of the relationship, you want to entertain fantasies which can materialize. The result is an important and attainable one.

5. Understand the messages which drive your interactions with your partner.

Messages you internalized while growing up affect your attitudes, reactions and behaviors without your being aware of it. For example, you might have been exposed in your family or the society in which you grew up to messages such as: “A woman should do everything for her partner” (driving you, as a woman, not to demand a mutual give and take with your partner); “Men don’t do housework” (driving you, as a man, never to participate in household chores); “Compromises are most important in life” (driving you never to insist on what’s important to you); “Self-fulfilment comes before relationships and family” (driving you always to take care of what’s good for you first), and so on.

Becoming aware of the messages that drive you and realizing how they affect your relationships enables you to consciously decide how to react and behave with your partner in ways vital to a healthy and satisfying bond.

6. Be willing to take responsibility for your part in the problems and difficulties which arise between you and your partner.

There are many who never admit they might be wrong. They fight with their partner to prove they’re right. This only escalates the problems. However, wherever there are two people there are often two opinions and two perceptions of “how things should be.”

When you become aware of what drives you to react and behave in your relationship the way you do, and of the ways in which you might harm your relationship, you become more willing to take responsibility for your part in the problems and difficulties which arise between you and your partner. Taking responsibility shows that you too might be wrong. Place the relationship in front of “justice,” and be willing to compromise.

7. Develop Self-Awareness.

Developing self-awareness means getting to know and understand what drives you to react and behave the ways you do in your relationship. It means understanding the needs and fears, messages, unrealistic expectations and fantasies which drive you to react and behave the way you do and the price you pay for it. It means realizing the ways in which you might harm your relationship, learning how to stop it from happening and becoming empowered to cultivate a successful intimacy.

Those who have developed self-awareness will tell you that:

• Developing self-awareness is a worthwhile experience which enabled them to get to know and understand themselves better;
• They are amazed by the personal and professional growth they’ve attained;
• By developing their Self-Awareness they have gained a sense of empowerment which helps them to be authentic and true to themselves;
• They are now capable of freeing themselves from needs and fears, messages, unrealistic expectations and fantasies which exerted power over them and are able to make conscious choices about the ways they react and behave in their relationships;
• They feel empowered to develop a successful intimacy.

Give Self-Awareness a chance – it really can make a difference in your relationship!

These consuming and crazy-making fights are generally fueled by unspoken and unnamed fears. Because most of us do not like feeling scared, we have spent years developing strategies to try to control our fear by squashing it or avoiding it. The problem is, fear does not like being forced out of town. It may ride away for a while, but it will come back, with its posse, armed and ready to force us to hear it and take it seriously.

It is often in a marriage or committed intimate relationship that our fear comes riding back into town, ready to avenge us for casting it out. We have treated fear as the enemy, so it has gone into fighting mode. In fighting mode, fear is ruthless.

In fighting mode, fear attacks by pulling us into a dark and catastrophic drama where we become so panicked and terrified that we can’t ignore the fear any longer. For example, perhaps a woman has a deep fear about being isolated and lonely. When this fear hits her periodically, she keeps it inside, trying to push it away. Eventually, the fear fights back, spinning a tragic story that features her husband as the ‘losing interest’ spouse who will eventually leave. Her mind, now controlled by fear, gathers bits and pieces of information that confirm and support this story.

Now, perhaps the relationship does need some work. Perhaps her husband has been distracted and has not been attending to the relationship. Perhaps her husband’s energy is unavailable because he is being attacked by his own fears. As in any relationship, these thorny issues of ‘give and take’ must continually be addressed and worked out.

Once fear has gone into attack mode, however, and the tragic story has been spun, there is no way to deal with these issues in a productive manner. Instead of a respectful and solution-focused conversation, the husband is now locked into the bad guy role. As a result, he may feel so trapped, frustrated and misunderstood that he is likely to lash out or run away from any discussion. This just confirms that he is the villain.

To further intensify the drama, perhaps the woman is now the villain in the partner’s fear-driven storyline. He is now seeing the woman as the demanding and ‘never satisfied’ demon in the story that was created by his underlying fear of ‘not being good enough.’ Now stuck in the demon role, the woman feels so trapped, misunderstood, and frustrated that her own story reaches a fevered pitch of terror. The relationship hangs on the edge of a cliff, with imminent doom and total destruction.

Coping with Fear in Your Relationship

It doesn’t have to be this way. There is another way to deal with fear:

1. Name the underlying fear. Some examples are: Fear of falling apart, fear of rejection, fear of not being understood, fear of being judged, fear of being alone, fear of loss, fear of change, fear of aging, fear of being overwhelmed, fear of your needs being ignored, fear of boredom, fear of lack of control, fear of failure, and fear of helplessness.

2. Tell your partner that you have some fear arising inside of you, and share those fears. Own your fears instead of blaming your partner. For example, say ‘I am feeling afraid of a loss of control of our finances’ instead of ‘You always have to be the boss with our money.’

3. Listen to your partner’s fears. Do not try to minimize, negate or ‘fix’ the fears. Do not try to bully your partner’s fear into submission. Do not belittle, humiliate, shame, and threaten the fear. Do not make snide remarks such as ‘Oh, you are always afraid of something,’ or ‘Why can’t you just relax and be happy for once?’ By trying to run the fear out of town, this technique to try to avoid a difficult conversation will backfire and leave you with a bigger mess.

4. Recognize that your partner’s fears are likely to trigger your own fears. For example, if your partner voices a fear of boredom, you may interpret this to mean that he or she is judging you as not being interesting enough, and you may feel a deep fear of rejection. It is important that you do not take over the whole discussion with your reaction-fear, and leave no space for your partner’s fear. On the other hand, it is also important that you make some room for your own fear, letting your partner know how you feel.

5. Focus on the fear and do not get detoured into specific details of the relationship. For example, don’t let ‘I feel fear of loss of control of our finances’ turn into ‘Why can’t you stop spending money on golf?’ Plan to discuss concrete and practical relationship issues at another time, when fear is not running the show. (And then stick to that plan!)

6. Contain the fears within boundaries. Recognize that these ‘fear’ talks will occur regularly throughout the course of the relationship, but keep each discussion within a reasonable time limit, such as 10 to 20 minutes. Kindly support each other to move on and enjoy life once the fears have been named and heard. Don’t set the boundary with anger and bullying by saying things like ‘Aren’t we done with this yet? Can’t you just let it go already?’ If one person is not done processing, gently but firmly plan for another time to talk the next day.

No one is very good at this. It goes against our lifelong patterns that have been set up to push fear away. Even if we move slowly in this direction, however, it can lead to a triumph of love over the destructive potential of fear, and make the difference between a relationship living or dying. That is not to say that love and acceptance transforms fear into rainbows and butterflies. Even within the arms of love, fear is still raw, painful, and deeply unsettling. But when fear becomes an accepted ‘citizen’ in the relationship, it is no longer the enemy. It’s just the colicky baby that needs your time and attention once in a while.

Olson focuses his narrative on members of his own demographic: mature men who have sex with men (MSM).  Counselors, families and friends of gay men, and anyone interested in the psychology and sociology of both sexual orientation and aging can benefit from reading this book.

MSM is an important distinction, because many of these men don’t think of themselves as gay.  Olson cites a 2006 study in The Annals of Internal Medicine in which ten percent of working-class and immigrant men in New York City who labeled themselves as heterosexual had sex only with other men.  Furthermore, MSM come from all communities, ethnicities, and socioeconomic levels.

Coming-out stories are as varied as the individuals who tell them; those of mature men are particularly underrepresented.  Olson tells his story from the perspective of someone who had come of age during the Cold War, when homosexuals were arrested, fired from their jobs, and classified as mentally ill.  By the time he came out in midlife, he was clueless about what being gay meant.  As a older man living in a youth culture, he felt he was over the hill. “[G]ay men who have been in heterosexual marriages have much more in common with each other than they do with gay men who came out early in their lives,” he writes.

By living publicly as straight for so long, MSM are isolated from the heterosexual communities they rely on and the gay communities they avoid or about which they are completely unaware.  They cannot speak openly and honestly about their true emotional and sexual selves.  By coming out, they risk losing the only support systems they’ve known: the families, friendships, and business associations (and sometimes careers) that they’ve worked for decades to build and maintain.

They also risk losing their lives from engaging in risky behaviors or from depression and suicide engendered by their isolation.  “Traditionally, men have met their partners through family and work associates, but this is impossible in a world where sexual orientation is concealed,” Olson writes. MSM are often faced with unsafe alternatives, coupled with invisibility. They comprise the majority of people living with HIV/AIDS in the United States, but that incidence decreases as acceptance of homosexuality increases.

Finally Out is written in a loose thematic style that combines memoir, psychological research, self-help guidance, and gay history, and draws considerable power from Olson’s own story.  Olson is particularly candid when relating his own experiences, which begin with growing up in a small Midwestern town.  Each chapter is rich with autobiographical material that encompasses his family background, his sexual sensibilities and experimentation as a boy, the double life leading to the end of his first marriage, his search for what it personally meant to be gay within a larger and diverse demographic, and his relationship with and marriage to Doug Mortimer, his partner of twenty-four years.

Olson’s first, heterosexual marriage to his wife Lynn illustrates the complexities, the agonies, and — for Olson — the inevitability of coming out in midlife.  His psychological insights and self-examination add valuable layers to narratives that are unsentimental and highly personal.

Olson also includes stories from other mature men living in diverse cultures.  Underpinning Finally Out is his survey of 132 MSM (median age: 60).  For older men, the coming-out trajectory differs considerably from that for younger populations.  Developmental processes that heterosexual men (who don’t have to come out) experience in late adolescence and early adulthood are delayed in men who discover their true sexual and emotional selves later in life.

Olson examines the mechanism of dissociation and denial that many MSM experience, especially when exposed only to gay stereotypes and demonization.  High-profile personalities like Senator Larry Craig and evangelist Ted Haggard viewed themselves as “men’s men who just wanted a blow job.”  Olson adds, “I know that’s what they were thinking, because that’s what I thought, too.”

Binary thinking creates an internal split between personal and public identity.  When conditioned to equate straight with good and gay with bad, MSM experience self-hatred when the person they know they are differs from the person they think they should be.  This self-hatred then leads to a heightened search for approval, which itself becomes a form of addiction.  One never attains the “ideal self” that one is “supposed” to be.

Instead, Olson asserts, “Letting go of the need for approval allows the coming-out process to begin.”  Changing one’s “ideal self” to be closer in alignment to one’s actual self is the only way to build lasting self-esteem.  For Olson, that included getting to know other gay men whom he admired and respected, rather than basing his self-assessment on values imposed from without.  Joining a gay fathers group changed his preconceived notions about gay men and provided crucial support.

He stresses that his own thoughts and experiences define what has worked specifically for him in his journey toward self-discovery.  One vignette about dressing in drag had caught my eye, not only because it illustrates the variety in gay experience but because of the stereotype itself.  For Olson, “If doing drag was an essential requirement for being gay — as the stereotype implies — it was clear that I might not fit in there either.”  In fact, transvestism is reported to occur more frequently in heterosexual than in homosexual men. In my opinion, this misunderstanding further underscores the complexity that occurs when public and private personas diverge, including among men who are actually straight.

Latter chapters focus specifically on what it means to be an older gay man in a population that has long been underrepresented and underserved.  Olson addresses issues of caregiving and disparities in the quality of care available to homosexual versus heterosexual populations.  Only about 20 percent of LGBT (lesbian, gay, bisexual, and transgender) seniors are as likely as their heterosexual peers to access needed services, and “many elderly gay men and lesbians feel forced to re-closet themselves,” reinforcing isolation.

Olson’s frank discussions about male sexuality throughout life include topics such as masturbation, Viagra, testosterone replacement, and attitudes toward body image and performance as one deals with the natural effects of aging.  But sex is just one expression of the emotional intimacy central to relationships.  “The majority of gay men, particularly those past the age of forty, want to have a loving and committed relationship with another man,” he writes.  Older gay men face the same challenges as the larger LGBT population with respect to marriage inequality and discrepancies in other basic human rights.  To those challenges are added the prejudices against an elderly population whose members are often denied hospital visitation, participation in end-of-life decisions, Social Security survivor benefits, and equal treatment of the assets they leave to a loved one.

LGBT individuals also have less of the social support system usually supplied by family, and elders are often segregated from their younger counterparts.  Olsen advocates more outreach to gay seniors, “the most invisible demographic.”

The book’s reference section includes a broad range of materials for further study.  Olson’s back cover bio states that he blogs at www.MagneticFire.com, but neglects to mention the excellent resources that his website includes and that are nowhere listed in the book itself.  These dozens of resources include general advocacy organizations like the Gay and Lesbian Task Force and the Human Rights Campaign; advocacy organizations specific to elders, such as AARP’s PRiSM Network and SAGE; Prime Timers Worldwide, for mature gay and bisexual men; the Straight Spouse Network; and many others.  Including this resource list within the physical book in any future editions would help fill its several blank pages at the end, and could also benefit members of Olson’s audience who are not Internet-savvy.

Finally Out: Letting Go of Living Straight, a Psychiatrist’s Own Story
By Loren A. Olson, MD
inGroup Press: April 8, 2011
Paperback, 280 pages
$15.95

Much of this has changed now. Women have jobs and careers, men may stay at home as the primary caregivers, and relationships run across a much broader spectrum than the old “He/She” model. For instance, now there are “He/ He” and “She/ She” models for couples. And there are couples who do not necessarily form a dyad. A “couple” could be in a committed triad relationship or be part of a larger poly community. There are numerous variations on these alternatives, and so it goes on. But what hasn’t changed much is that many relationships still run on unspoken contracts or implicit agreements regarding roles and expectations. When these contracts are broken, couples often get angry with each other and start pointing fingers.

Take the lesbian couple I was seeing last week. They had been very much in love until they decided to buy a house together. Shortly after their purchase, Suzy*, the main breadwinner, was laid off. She then had to take a job she hated in order to pay the mortgage and so that her partner, Chrissy*, could finish school. As a result, Suzy fell into a major depression and emotionally disappeared on Chrissy, who was at a loss as to how to get back the old Suzy she knew and loved.

The implicit agreement in their relationship was that Suzy held the role of emotional and material “provider” while Chrissy added the fun and spark in the relationship. Now this agreement was in jeopardy, which was upsetting the balance of their relationship. Chrissy fell into an abandonment depression and emotionally withdrew from the relationship. They came to my office five years later with complaints of “no sex” and “no emotional connection.” Their relationship was on the rocks.

Fundamentally, Chrissy was angry with Suzy for not upholding her end of their unspoken contract, which was to provide a safe haven of nurturing and comfort—not just by paying for the house but by providing emotional support as well. Suzy was disappointed that Chrissy was so distant and not much fun to be around. They were each secretly convinced that the problem lay with the other person and not with themselves.

I don’t go along with what I call the Blame/Shame Game. In other words, I don’t encourage finger-pointing; instead, I encourage couples to look at how they are each contributing to the negative situation they find themselves in. This approach creates opportunities to increase self-awareness and to grow within the relationship. Developing this ability to take responsibility for your own contributions is a fundamental ingredient if you want your relationship to serve as a vehicle for your growth. Let’s look at how this happened for Suzy and Chrissy.

As Chrissy began to explore more deeply what came up around her feeling “dropped” by Suzy after they bought their house, some very painful memories surfaced from when she was three years old. It was the era of Dr. Spock and Chrissy’s pediatrician had told her mother that it was not good to hold your child too much or spoil them, especially when they were upset and crying. Many mothers were being similarly misled about not comforting their child in distress. Unfortunately, Chrissy’s mother took this advice to the extreme and stopped holding Chrissy altogether. Chrissy went into a profound abandonment depression and completely lost trust in her mother. The mother-daughter relationship was still strained as a result of this abandonment.

For Chrissy, this trauma was locked in her muscular and cellular memory. It wasn’t until she had the experience of feeling abandoned in an intimate relationship again that the trauma started to resurface. Now she had two choices: She could either stay locked in feeling how awful and unfair it was that Suzy emotionally disappeared on her or she could use this situation as an opportunity to address the old abandonment wound that was surfacing.

Often, wounds that originate in a relationship also need to be healed within the context of a relationship. Chrissy had done a lot of work on her own to try to heal this deep abandonment wound around her mother, but in the end the real healing had to happen in a relationship. In this case, Chrissy had the perfect opportunity to use what was coming up in her relationship with Suzy as a vehicle for her growth and healing.

Chrissy made the empowered choice to stop blaming Suzy and, instead, really look at the deep sense of abandonment that Suzy had triggered in her. She did some powerful work in sessions to start to heal this. Suzy, inspired by Chrissy’s revelations during their sessions, started to look at ways she could show up more for the love of her life. She stopped blaming the economy and Chrissy’s educational needs for how trapped she felt and started to make choices that gave her more of a sense of empowerment. She started a health and exercise regimen that helped to boost her endorphins (the body’s natural mood enhancers) and increase her energy levels enormously. Much to Chrissy’s delight, Suzy’s sexual energy started to return. The two were safely on the road to repairing their emotional and sexual intimacy.

More importantly, Chrissy and Suzy both made the empowered choice to step out of blaming each other for breaking the unspoken agreements and rigid expectations in their relationship. They were willing to point the finger back at themselves and honestly address what was coming up for them. By doing this, they also made their relationship a safe container and a vehicle for their growth.

Perhaps Chrissy and Suzy found the secret to what makes a relationship last. After all, if they could grow within the relationship, then their relationship could grow with them. They didn’t have to leave the relationship because it had become too constrictive or didn’t meet their needs anymore.

* – Names have been changed to protect client confidentiality.

Following are three different scenarios from my sessions with queer couples that exemplify some of these common stressors.

Yvonne & Angela: How homophobia ruined our romantic vacation

After I asked a lesbian couple why they hadn’t taken a vacation together in five years, this is what they told me:

Yvonne: I took her on what was advertised as a “gay-friendly destination” but as it turned out, we were the only queer couple in sight! Consequently, she was really paranoid in public and wouldn’t hold my hand on the beach, or she would become really uncomfortable if I suggested a restaurant that looked slightly romantic. She’s a butch woman, so people were staring at her anyway because they couldn’t quite place her on the gender spectrum. It pretty much killed the romance factor out in public, and unfortunately it translated into the bedroom as well. She just couldn’t make that transition when we were alone. It was as if she didn’t take a breath until we got home. Needless to say, we haven’t been on an overseas vacation since!

Angela: I think on some level I just didn’t feel safe. I didn’t speak the language or know the people. They stared at me all the time. I think they couldn’t figure out if I was a guy or a girl. It might sound ridiculous, but I was expecting to be attacked at any moment. Consequently, my guard was up at all times.

This couple had to deal with a whole set of stressors that a heterosexual couple would probably never need to consider when planning their holiday (like having to find a “heterosexual-friendly destination”). Much of the travel industry is geared toward the romantic getaway, but those getaways are mostly aimed at heterosexual couples. This omission of queer couples is part of what is termed “heteronormative assumptions.”

[Heteronormative assumptions] refer to automatic unconscious beliefs and expectations that reinforce heterosexuality and heterosexual relationship as the ideal norm. Thus, heteronormative assumptions create a society where only heterosexual relationships are visible (McGeorge and Carlson, 2011).

Although the travel industry has become savvy to a whole previously untapped market and there are now ads for gay-friendly destinations on every queer travel site, the truth is that this can also be a marketing ploy. As Yvonne and her girlfriend found when they got to their “gay-friendly” destination, the locals hadn’t been informed!

Gloria & Maria: A pregnant lesbian couple’s first birthing class together

Gloria: I was so uncomfortable that we were the only queer couple in the room! On top of that the trainer had us do an experiential where she asked the fathers to go on one side and the mothers on the other. She at least corrected herself when she saw me standing there awkward and alone. I felt so humiliated!

The rest of this session was spent processing Maria’s feelings about the class and her ambivalence toward attending more classes. Although Gloria was sympathetic to Maria’s dilemma, she was also clear that she wanted Maria’s support at the birth and needed to know that Maria had the knowledge to provide it. In the end, despite the stress the first class had caused, they did go back for another class and found to their delight that there was a new trainer who was much more GLBTQ savvy and aware.

Again, these are not stressors a heterosexual couple would ever have to deal with. Being part of mainstream culture, it is easy for heterosexuals to take for granted the safety net that is automatically available. This is part of what is coined as “heterosexual privilege.” Furthermore, the lack of affirmative mirroring that queer couples receive has both subtle and gross implications.

“One of the less visible, but potentially most influential privileges that heterosexual individuals receive is an increased self worth that comes with being part of the dominant socially sanctioned group” (Hoffman, 2004; Worthington, Savoy, Dillon & Vernaglia 2002).

When who you are and how you love is not reflected in your world, whether on TV, in films, books or other forms of mainstream media, the effect on self-esteem is persistent and corrosive, once again creating more stressors for queer couples.

Disturbing comments from well-meaning family members

Even family members who are normally respectful toward a gay couple can fall prey to heteronormative assumptions. The following occurred during a session with a gay couple, one of whom was unemployed and looking for work. He had been offered a position overseas but had decided to turn it down because it meant being too far away from his partner.

Mike: Can you believe my dad encouraged me to take that job in Singapore with no regard for how it would affect my partner, who has a full practice here? It was as if he saw me as a single man, living with “a good friend,” but certainly no one to consider if I was being offered employment overseas. He would never say that to my heterosexual brother and his wife!

Bill: Your dad is always friendly to me when he sees me but hearing that makes me feel invisible.

Mike’s father was unintentionally hurtful by omission. The undermining quality that this lack of mirroring creates has a corrosive effect on self-esteem. Mike is left with the message that his relationship is less visible, less valid, and less valuable than his heterosexual brother’s.

In summary…

When I hold space for a queer couple in session, I am also considering factors outside the couple dyad, such as the effects of heteronormative assumptions and privilege that can exacerbate existing stressors in the couple. For instance, Gloria and her wife have all the stressors of being pregnant but not the knowledge that they are seen and held in a supportive community. Yvonne and her girlfriend finally find the time and money to take a vacation together only to discover they have to keep their guard up and don’t feel safe enough to express their affection and love for each other. Then, there is Mike having to deal with the crushing effects of unemployment on his self-esteem, only to have his father exacerbate this problem by unintentionally disregarding his long-standing partnership.

Queer couples simply don’t have the safety net that heterosexual couples can take for granted. Society does not provide the validation and affirmation that a queer couple could rely on for support during difficult times. The need for this validation and affirmation first has to be acknowledged by the individual or couple and then self-generated. While many queer couples have been very resourceful in generating their own safety nets by building their own communities and support systems, the freefall, in terms of the stigma of being an outsider and the resulting isolation, is ever present for those who do not.

Reference

McGeorge, C. and Carlson, T. S. (2011) Deconstructing Heterosexism: Becoming an LGB Affirmative Heterosexual Couple and Family Therapist. Journal of Marital and Family Therapy, 37(1), 14-26.

But while we’re taught not to sweat the small stuff and to pick our battles, it’s these tiny transgressions that can build and become big stumbling blocks in a relationship. (For instance, a longitudinal study of 373 married couples found that happy couples do sweat the small stuff and work to resolve these issues right away.)

So how do you resolve relationship annoyances without nitpicking, nagging or tiptoeing around your partner (and fuming on the inside)? Three couples specialists offer their tips for finding a happy medium and fostering a fulfilling relationship.

1. Get to the real issue.

All the experts emphasize that in most cases, it isn’t the texting, trash or messiness (or insert another “minor” issue) that’s the problem, it’s what the action represents.

In other words, “the crux of most conflicts in relationships” is what the irritation symbolizes in the relationship for each person, says Robert Solley, Ph.D, a San Francisco clinical psychologist specializing in couples therapy.

As psychologist David Bricker, Ph.D, says, “it’s never about the socks, it’s what you didn’t get from your father.”

But the underlying issues are easy to miss. Why? According to Solley, there are several reasons: Oftentimes, it’s tough to see our partners as profoundly different from ourselves, as “having different needs, wants, desires [and] ways of doing things.” We also use ourselves “as a standard of reference for how people should think and act.” Plus, instead of digging deeper, we’re more likely to focus on the “thing itself (or sometimes sidebars about what we meant, or said, or didn’t say, or did, or didn’t do) rather than the values and feelings.”

So what are the core issues? “At the heart of it,” Solley says, there’s usually the belief that our partners don’t accept or value us. “Or if they loved us, why wouldn’t they clean up the mess that they know upset us so much?” In a nutshell, it boils down to “unmet needs,” says Bricker, a Gottman Method Therapist, who works with couples and individual clients in lower Manhattan.

Getting to the real issue also gets couples closer to a solution. Bricker says that usually after about five minutes of arguing about an issue and its various details, the conversation becomes about something else entirely. That’s what you need to talk about.

2. Consider if it really bothers you.

It’s true that sometimes it’s best to pick your battles. But you need to make sure that this truly is a tiny thing. How can you tell? “Try to let it go and see how that goes,” says Michael Batshaw, LCSW, a NYC-based psychotherapist and author of 51 Things You Should Know Before Getting Engaged. It can help to ask yourself, “What’s this about for me? Why am I getting so upset about this?” he says.

But sometimes a sock is just a sock. What’s the difference? Your feelings about the issue just won’t “have that same energetic quality,” Batshaw says. When you can relinquish a minor issue without reservation, there’s probably nothing beneath the surface, he says.

Letting go of the battles that are not-so important means “recognizing that you and your partner are different people.” If how your partner folds laundry isn’t that big of a deal, tell yourself that you just have different ways of doing things and most importantly that “the connection between you will benefit from not jostling over something that really is relatively small for you.”

3. Don’t dismiss a key issue for you.

If “you’re dreaming about it, and you’re thinking about it, you’ll have to talk about it,” Batshaw says. For instance, he says that a partner might tell themselves that they’re probably too high-maintenance or they’re needy. But if you can’t drop the issue in your mind, then there’s something there you need to explore.

4. Use the softened startup.

When approaching their partner about an irritating issue, many individuals will use harsh startups, which just boost the chances of your partner getting defensive and getting hurt. Take the following example, Bricker says: He keeps leaving clothes on the floor, so she reacts by dropping them on his side of the bed, hurling insults at him, ignoring his texts all day or saying the place is disgusting.

Instead, Bricker suggests using a softened startup, which looks like this: “I know you’re working very hard, and you take care of the car and the backyard, which I really appreciate. But it upsets me when you don’t pick up your clothes. It’s something that takes just seconds.”

5. Be patient.

Picking up after yourself may come naturally to you, but it might not come that seamlessly to your spouse, Batshaw says. Whatever the issue is, your partner might need reminding here and there. Try to practice patience.

It’s anything but. Below, relationship experts weigh in on whether living together is a good idea and how couples can make that decision wisely.

Is Living Together a Smart Move?

Couples therapists have different opinions on whether living together before marriage is a wise decision. For instance, according to Susan Heitler, Ph.D, a Denver clinical psychologist and author of the book The Power of Two: Secrets of a Strong & Loving Marriage, “living together is putting oneself in a very vulnerable position,” especially if kids are involved.

When there isn’t a clear agreement, she says, “anyone can leave at any point.” However, “when there’s a clear commitment [of marriage], you learn to negotiate the rapids and come out on the other side.”

She also says that “there is significant research that the longer a couple lives together before they marry, the higher the odds of getting divorced.” One of the reasons may be that cohabiting without getting married usually means there’s something preventing you from making that commitment, and “pure living together doesn’t take care of” your issues, she says.

According to Robert Solley, Ph.D, a San Francisco clinical psychologist specializing in couples therapy, while “moving in together doesn’t solve anything…it might bring to light things that need to be worked on.”

What’s more, he says that cohabiting “is much more complicated than most articles (and the survey studies themselves) imply.” We just don’t have enough information to make a definitive statement one way or the other, he says. Moving in together without being married isn’t necessarily a sign of problematic underlying issues, he maintains.

There also may be other intervening variables at play, he says. For instance, Solley cites research suggesting that American couples who live together and take premarital education courses or see a counselor may not be at a higher risk for divorce.

When thinking about cohabiting, “The question is not whether the order of events will make a difference in a relationship, it’s how you feel about your relationship,” Solley says. Terri Orbuch, Ph.D, author of 5 Simple Steps to Take Your Marriage from Good to Great, agrees, saying, “I don’t think the situation should make the decision.” What should, she says, is “your relationship, how you work as a couple, how you feel about one another and how committed you are to each other.”

So moving in together really “depends on the couple and [the] reasons why you’re living together,” she says. Some couples want to cohabit because of convenience (e.g., one partner’s lease is up), saving money or the desire to see where the relationship is going. According to Orbuch, these reasons are not compelling enough to make the move. “You should not say to yourself I’m going to find out ____ by living together,” she explains.

Some experts do believe that living together can reveal whether you’re compatible. NYC-based couples psychologist Michael Batshaw, LCSW, who believes that it’s generally “more helpful to have lived with somebody” before marriage, says that “Certain things are essentially impossible to know in terms of compatibility if you aren’t spending every day with that person.”

On the other hand, Orbuch says that a wise reason to cohabit is “to strengthen a relationship, not to see if you’re compatible,” though she says that she’s known couples who’ve realized they aren’t compatible after living together.

LeVay, who is gay himself, addresses the broad range of human sexuality on two principal levels: traits found to differ according to gender, and the developmental mechanisms that potentially underlie those traits.  Chapters on gender variation in childhood and adulthood focus mainly on behavior and personality.  Chapters on the roles of sex hormones, genes, and differences in the brain and body explore the biology of sexual orientation in humans and in other species.  A chapter on “the older brother effect” examines the potential effects of birth order with respect to changes in the fetal environment.

LeVay first discusses the multiple meanings of the term “sexual orientation” and summarizes non-biological theories about homosexuality.  He presents cross-cultural evidence that goes counter to psychoanalytic and learning theories.  For example, “many (probably most) young people in our own culture develop an awareness of their sexual orientation while they are still virgins.”  In contrast, boys among the Sambia in New Guinea “are required to engage in sexual contacts with older male youths for several years before they have any access to females, yet most if not all of these boys become heterosexual men.”

Rather than ask, “What went wrong?” biological theories examine sexual variety as part of nature.  Homosexual behavior is common among nonhuman animals.  Graylag geese include male-male sexual pair bonds that can break up if females become available.  Male and female bonobos freely engage in both homosexual and heterosexual behavior.  Domesticated sheep include rams that refuse to mate with ewes, but that readily mate with other rams.

The question, “What causes homosexuality?” suggests a simplicity that doesn’t exist.  For one thing, definitions of homosexuality vary.  The expression of gender-atypical traits — feminine traits in men and masculine traits in women — also varies among individuals, in what LeVay calls “spectra of gender diversity.”  Those gender shifts account for variations within both homosexual and heterosexual populations.

In addition to sexual partner preference, gendered traits include toy preference, degrees of aggressiveness, cognitive tasks like mental object rotation, and anthropometric measurements like finger length.  They also include the size of brain structures, their degrees of connectivity, and the activities within certain brain regions.

Gender-atypical traits have also been linked to multiple developmental mechanisms, including levels of circulating sex hormones prior to birth, genetic differences, and the prenatal environment.  In addition, the interplay between those mechanisms and the timing of their appearance — not just of sex hormones, but of their receptors, and even of antigens — may steer an individual down different developmental pathways.

And one pathway may not fit all.  Different mechanisms may determine what causes an individual to be gay, lesbian, bisexual, transgendered, or heterosexual with gender-variant characteristics.  Gender-atypical traits also seem to promote reproductive success in heterosexuals; in a study of nearly 5,000 people, femininity in men and masculinity in women correlated with greater numbers of opposite-sex partners.

LeVay proposes that we view sexual orientation not in terms of same-sex and opposite-sex attraction, but in terms of gynephilia (attraction to females) and androphilia (attraction to males).  This female/male divide underlies the basic premise that gender-based differences drive sexual orientation.  Attraction to members of one sex or another is part of a “package” of gendered traits.

I found this book both fascinating and frustrating, the latter through no fault of the author.  LeVay points out that much of the research needs to be replicated.  Some studies have problems in their methodologies, such as small sample sizes or a “volunteer bias” from self-selecting subject pools.  Surveys could prove unreliable because respondents might be unwilling to acknowledge a same-sex attraction.  IQ tests with gender-weighted questions designed for heterosexual respondents might prove inappropriate for non-heterosexual respondents.

And differences between gay and straight men don’t necessarily apply when one compares lesbians and straight women.  “Most researchers who have studied the mental traits associated with sexual orientation have simply compared samples of gay and straight people, and have presented the results as averages,” LeVay writes.  “Thus, the diversity within the categories of gay and straight people tends to get ignored….It could be, for example, that gay people who are very gender-nonconformist and those who are more conventionally gendered arrive at their sexual orientations through quite different pathways, so lumping them together might muddy the picture.”

LeVay is thorough in his review of the literature, but the literature itself contains qualitative and quantitative differences that make the data subject to multiple interpretations.  As LeVay points out, “[W]ith sufficient ingenuity, any inconvenient finding can be explained away.”  For that reason, I would have liked to have seen a table, or a series of tables, weighting the different studies based on their strengths and weaknesses.

Also, as extensive as the literature is, its scope is limited.  Most of the existing biological research focuses on men.  Women are studied to a lesser degree.  Studies of bisexual and transgendered individuals are rarer still.

Controversy also exists around the tendency to “medicalize” gay people.  On the one hand, LeVay says, labeling children with a “gender identity disorder” invites stigma by assigning a medical condition to something that may have occurred naturally.  On the other hand, discrimination against people with gender-variant behavior and appearance, including the treatment of gender-variant children by adults and peers, creates psychological distress and suffering.

LeVay cites German neuroendocrinologist Günter Dörner, whose attitude toward homosexuality shifted from “a mental disorder that had a biological cause” to a cluster of traits with a “natural, nonpathological nature.”  I would add that Dr. Evelyn Hooker’s research in the 1950s found no difference between gay and straight men with respect to mental health.[1]

“[W]e need to think somewhat differently about sexual orientation in men and in women, and that cultural forces greatly influence how homosexuality is expressed in different societies and across the span of history,” LeVay writes.  “There are limits, in other words, to what we may hope to explain with biological ideas.”

He adds, “The scientific knowledge currently available does bolster the idea that gays and lesbians are distinct ‘kinds’ of people who are entitled to protection from discrimination.  But I also believe that there would be plenty of reasons why gay people should be accepted and valued by society, even if being gay were proven to be an outright choice.”  I couldn’t agree more.  As a woman who has self-identified as bisexual since the 1970s, my own sexual partnerships have focused on the individual rather than on a gender.

Gay, Straight, and the Reason Why includes a glossary and extensive bibliography.  Clinicians and researchers will appreciate LeVay’s comprehensive approach and his assessment of experimental methodologies.  Lay readers will appreciate his step-by-step guidance through the book’s more technical material.

Gay, Straight, and the Reason Why: The Science of Sexual Orientation
Simon LeVay, Ph.D.
Oxford University Press, 2011
ISBN 978-0-19-973767-3
Hardcover, 412pp.

Michael, 32, and Stacey, 29, had been married 5 years and were struggling with a sexual problem. Both of them feared that Michael was no longer attracted to Stacey, since he had not initiated sex in a long time and, during recent attempts, was unable to maintain an erection. Erectile dysfunction medicines were ineffective.

Notably, the couple had recently been through some family crises with Michael’s family of origin when some disturbing events came to light. That situation conceivably could have accounted for Michael’s initial lack of interest, as well as feelings of inhibition about any behavior he might have perceived as aggressive, including sex. However, although these events might have contributed to Michael’s initial retreat from sex and the negative spiral that ensued from Stacey’s reaction, they were not enough to explain the ongoing story between them.

The immediate reason for the couple seeking counseling at this time was Stacey having just revealed to Michael that she had had sex with another man, a one-night stand with a stranger. She described this episode as passionate but meaningless. She viewed her infidelity as a “cry for help” in the relationship and confessed to Michael about it immediately afterwards. She felt ashamed of her behavior and hopeless about being forgiven. She could not even forgive herself, knowing that she hurt Michael and forced his hand in the relationship. Michael, however, did not feel that Stacey was ashamed at all, rather, he saw her as minimizing the whole thing on top of having the presumption to expect “credit” for having been honest about what she did.

“I’m no longer attracted to my wife.”

Michael spoke privately in an individual therapy session about his lack of attraction to his wife, focusing on her weight gain and failure to exercise. Michael continued to insist that he did not feel “chemistry” towards Stacey despite the fact that, as they both agreed, they had enjoyed a mutually satisfying sex life earlier in the relationship and had apparent chemistry then.  Michael maintained that he saw Stacey more as a friend and would be willing to remain in the marriage without sex because he loved her and didn’t want to lose her. Stacey, however, made it clear that she would not stay in a sexless marriage, stating that it made her feel unattractive, rejected, and deprived.

Michael talked about not trusting Stacey, now that she had cheated on him, and felt that she was “dirty” since she had been with another man. However, he did not connect these feelings with his focus on what he viewed as negative aspects of Stacey’s appearance. Michael seemed angry with Stacey over her infidelity but played this down in her presence during the sessions, generally acting caring and congenial towards her. In contrast, however, at home Michael apparently often became quite angry and over-reactive during arguments about other less consequential issues.

Michael and Stacey had trouble staying with difficult conversations. Feelings often became too heated, ultimately leading to an impasse in which they would both shut down in anger.  During therapy sessions when they were able to safely talk and ask one another questions, they discovered that many of their assumptions were inaccurate regarding what the other thought and felt about various things that had happened in their relationship. Through this process, Michael and Stacey repeatedly learned the truth about how they had actually affected one another at key moments, and the meaning that different events had for each of them. A striking awareness on both their parts ensued on these occasions, when it became obvious that many hurt and angry feelings were the result of misunderstandings and misperceptions of each other. These incorrect assumptions harmed their relationship.

During much of the therapy, Michael’s erectile dysfunction appeared to be an untreatable problem between them. Michael and Stacey both knew that if this issue continued, their marriage would not endure. A time limit was imposed on the counseling, putting their marriage to the final test to see whether they could move beyond this stalemate.