My first posts for this blog were a series of articles about sexual values and how they might operate in therapy for sexual issues (see the first in the series here). At that time, I was early in the development of steering my practice toward a focus on sexual issues. I knew that I needed to understand my personal sexual values, or they could interfere with treatment for clients. I decided that when personal values are difficult to avoid in therapy, it is best to acknowledge the values that you are operating under. To that end, I identified how consent, sustainability, generativity, and adaptability are values that I bring as the therapist. I wrote those posts with the intent that the transparency could allow clients to better choose whether my care would be a good fit, and as a check for me. If I can identify where my values are, I hope I can better identify when my values conflict with those of the client and therefore can be more cautious about imposing my values on my clients. I don’t know that there’s anything wrong with this approach, but I believe that I have since then learned that sexual health is a better way to guide clients who want to evaluate or change their sexual behaviors.

Treating Out-of-Control Sexual Behavior

Two colleagues of mine in the American Association of Sex Educators, Counselors, and Therapists, Douglas Braun-Harvey and Michael Vigorito, describe a treatment model for out-of-control sexual behavior (OCSB) in their book on the topic. The types of presenting issues they are treating are the same as those that may be referred to in the popular culture as sexual addictions (a term I have written about here). However, the term “sex addiction” has no diagnostic validity. Another colleague, David Ley, in AASECT has written about the problems with “sex addiction” in his book, The Myth of Sex Addiction.

One core aspect of the OCSB treatment model resolves the challenge that psychologists have in determining what defines unhealthy sexuality without imposing personal values on the client. This is a challenge in the profession because there are limited and problematic actual diagnoses for sexual behavior problems. Braun-Harvey and Vigorito resolve this dilemma by defining healthy sexuality instead of trying to define unhealthy sexuality. To do this, they utilize the World Health Organization’s definition of healthy sexuality and glean from it six Sexual Health Principles. I now use those principles extensively in my practice and will share them here with brief descriptions.

Consent

Consent refers to the willingness of all participants to engage in the sexual behavior and/or to bear witness to the sexual behavior they are engaging in. When people are engaging in nonconsensual sexual behaviors, another type of treatment (typically from a forensic psychologist).

Non-exploitation

This refers to the absence of power used to coerce consent. Some methods of exploitation include using power over (like when a boss coerces a subordinate at work into sexual favors), money (for example when someone needs money for survival so they agree to sexual behaviors to get the money), or withholding knowledge (for example, in an affair if the partner knew about the affair, they would no longer consent to the relationship with the cheating partner).

Protection from HIV, STIs, and unplanned/unwanted pregnancy

This includes allowing people to make informed decisions about the risks they take when engaging in sexual behavior with you and protecting yourself from risks to your health.

Honesty

Not everyone wants to know everything, but honesty means that everyone is informed about what is important to them. One way that I’ve learned to talk about this principle with my clients is to ask about what the explicit and implicit commitments of the relationship in question are and whether they include informing the person about the behavior in question. Most of the time, my client has a fairly clear response that helps them understand whether withheld information is more about privacy or more about secrecy.

Shared Values

This includes shared values from the community level to the interpersonal level. So, behavior abiding by shared values is legal and abides by the relationship agreements that have been made between partners. I still have some challenges with the legal aspects of the “shared values” principle, as I have described more completely in my entry on (Sexual Values That Didn’t Make The Cut). However, looking at shared values as a lens on whether the client will experience shame or other mental health consequences of their behavior, and therefore whether it will be healthful, this principle is spot on.

Mutual Pleasure

This doesn’t always include orgasm, but it may. This doesn’t always include simultaneous pleasure, but it may. When I’m working with individuals, this principle is still relevant because sometimes, challenges arise in a person’s sexuality because they don’t allow themselves pleasure, and they don’t acknowledge and accept what does bring them pleasure. When doing relationship therapy, I make sure that each person is allowed the freedom to have an individual erotic landscape and to find pleasure in their shared activities.

Conclusion: Sexual Health Guides Treatment

After several years in practice, my personal sexual values haven’t changed, and if you are interested, you can read about them starting with this article, Sexual Values: One Therapist’s Provisional Set. I examined those values and wrote about them originally because I thought that being aware of them would help me insulate my clients from my biases. I also thought that broadcasting them would help potential clients determine whether I’d be a good fit for them. However, now that I have been exposed to Braun-Harvey and Vigorito’s excellent exposition on treating Out-of-Control Sexual Behavior, I can use a more empirically validated set of therapeutic principles for the care of my clients and their sexual health.

Legal

When I first made my list of sexual values for a presentation to a class on Human Sexuality, I almost didn’t include this value in the first place. The history of making sexual diversity, sexual expression, and sexual practice illegal is ripe with more than enough examples to have made me cautious about this value from the beginning. I ended up including it but with an asterisk. I knew that many practices that I thought of as normal (like teenagers engaging in sexual activity other than penetrative penis-vagina sex) were illegal in some municipalities (California). I also knew that from municipality to municipality or state to state, the laws about sexuality are different, including almost everything from the age of consent, the legality of consenting sex in front of other consenting people, like at a sex club, and more.

Because of those hesitations, I did end up including the value of legality in my early presentation but with an asterisk. I tried to explain during the presentation that what I meant by legality was the importance of navigating legal issues consciously. Now though, I just don’t believe that society has the right to irrationally, irresponsibly, and randomly require people to become conscientious objectors to engage in sexual behaviors that are common and pleasurable. Teenagers should be allowed to explore their sexuality with developmental peers (including making some mistakes) without fear of being labelled a sex offender. I also realized that the other values like consent and sustainability would still challenge many behaviors that might be out of control or exploitative. Therefore, I have taken the value of legality off the list.

Relational, emotional, & attaching

When I originally created this list, I included the value that sexuality allows for the person to relate to others, to have and express emotions, and to build attachments. I thought that this value could still honor asexual people by saying that even the absence of sexual behavior can still include friendships, romantic attractions, and community relationships. I also thought I could side-step a critique about this value from kink and poly-folk by the caveat that I’m not saying that the person someone has sex with must be the person they are relational, emotional, and attaching to.

I now think that I just don’t have any reason to include it. While I understand best and can best treat clients who are interested in relationships, emotional intimacy, and romantic attachment, I am in no position to judge someone who doesn’t desire those intimacies with people. The eventual removal of this value from my list began when I first encountered object-sexuals and I realized that I have no objective criteria with which to judge someone with that manifestation of sexuality. I found that instead, a quick question that I have used for many years caught me from applying that judgment. I asked myself, “Is the pain in this community caused by their behavior or by the intolerance of people outside of the community?” Since it seemed to me that the pain in the object-sexual community was caused more by the intolerance of others, I had to let this value go.

Non-injurious

I used to try to maintain this value on the list despite being welcoming of kinky (or BDSM) behaviors by saying that I meant that the injuries were unintended and/or irreparable. As I came to understand more about kink though, I realized that this value simply couldn’t be maintained. Sometimes despite the best planning and preparation an accident can happen. Why would I label an injury problematic in one person when the source of the injury was a sexual behavior but label another person normal or even admirable if their injury comes from dedication to an intense sport? Furthermore, people make irreparable or difficult to repair choices about their sexuality (and many other aspects of their lives) all the time including piercings, sterilization, or child-bearing. Why would I chose to identify any of those behaviors as problematic when the value of sustainability identifies what could be challenging in the behavior and allows for the freedom to choose personal sexual expressions.

Conclusion

For the reasons described, my sexual values list has evolved over time. I find myself wondering which of the 4 values that I still retain will fall away next. This is one of the beauties of the field of sex therapy to me. Every time I am challenged by something new I have an opportunity to challenge my assumptions. Human sexuality is so diverse, each person’s eroticism is so unique, that I think studying it and being of service to people for their sexual issues will help me to continue to evolve long after I have retired.

Other posts in this series:

• Sexual Values: One Therapist’s Provisional Set
• Consent
• Sustainability
• Generativity
• Adaptability

Call for a 15-minute consultation about therapy with me, 650-814-7823

Sexuality changes as we age

Sex changes throughout the lifespan. Many people experience a decrease in sex drive with age. People in long-term relationships often find that their sexual activities and interests change over time. You might see or read about something that you want to try so the change is positive. Other times, the realities of a medical condition have an impact of your sexual expression that is less desirable. But there is something fundamental behind the response cycle to any of these changes. Are you open to them? Are you willing to face the challenge of trying something new? Are you willing to face the grief of letting something familiar go? The challenge of discovery, the new intimacy that emerges by exploring new sensual territory can be eroticizing. The principle of adaptability invites a careful look at what exists now and invites people to not simply reject the new. Adaptability requires facing the current reality just as it is and deciding from there what will or won’t work for you in a relationship. This requires tremendous courage.

Sexuality changes with life circumstances

If you have a new baby, your sex life just changed. Do you have intense stress at work? Likely it is affecting your sex drive (for some people it will increase, for others it will decrease). Remodeling your home? That takes a toll too. Out-of-work? Going back to school? Every major change in your life may also likely to affect your sex life. Those changes may affect your sexuality in one way and affect a partner’s sexuality in another way. Noticing the changes, discerning whether they are acceptable to you, deciding whether you want to do something to preserve your sexuality as it was or to allow the change you notice to your sexuality, are all ways that people can enact this value of adaptability.

Sexuality takes place in reality

Romance novel sales have increased significantly due to the existence of ereaders. The 46th most popular website on the web as of this writing is a pornography site (ahead of craigslist.com and netflix.com). Fantasy relationships and fantasy sexuality are all around us from ads on buses and magazines in the waiting rooms to romance novels and porn. We can easily become enamored of these fantasy realms. It is so easy to compare what happens in our bedrooms with what happens in these fantasy depictions of sexuality. Even if you aren’t someone who partakes of such fantasies, it also easy to compare the insides of our relationships with what we see of our friends’ relationships. Even if we incorporate our fantasies into the actual play of our sexuality, there is always a bit of difference between the mind’s eye and reality. A flake of makeup out of place, a scripted line misspoken, a seam that pops on an outfit. Life does not include multiple takes to get it just right and you can’t edit out of life the chapter where your partner forgets to bring the lube despite an otherwise supportive relationship. Being willing to acknowledge and accept the difference between fantasy and reality by looking at it directly seems to me to be an important aspect of adaptability. We recognize the impossible perfection of our fantasy and adapt to the imperfect but hopefully loving reality that is actually a part of our lives.

Sexuality looks different with different partners

Different sexual partners bring different energies and different ways to our sexual experiences with them. It could be easy to compare one lover to another saying, “You are more this” or “He was more that.” But most of the time what we are talking about is the difference between who we are with one partner and who we are with another. Maybe you are more sexually liberated with your old girlfriend than with your wife. But why was that? Was it because that relationship was doomed from the beginning so there wasn’t a risk in expressing your eroticism? Maybe because you imagine your marriage as lasting your whole life so your erotic expression is more of a risk? Maybe you were more free with Matt than Mark but is that Mark’s fault or is it about the different kinds of permission that you give yourself when you are with Matt? What would happen if you gave yourself that permission with Mark?

Adaptability is about acknowledging and accepting that the partner or partners that I have will necessarily evoke different things in us than another partner or partners. Once acknowledged, we can adapt to the reality of our partners by letting ourselves discover what this partner can bring out of us, by taking personal responsibility for staying connected to the aspects of our sexuality that are important to us regardless of our partner, or by deciding that we need different partners.

This entry has identified 4 reasons that sexual adaptability is important, sexuality changes as we age, sexuality changes with life circumstances, sexuality is different in reality than fantasy, and sexuality is different with different partners. However, this is not an exhaustive list of the reasons for the value of adaptability.

Other posts in this series:

• Sexual Values: One Therapist’s Provisional Set
• Consent
• Sustainability
• Generativity
• Values that didn’t make the cut

Call for a 15-minute consultation about therapy with me, 650-814-7823

This principle came to be on my list in college. I was a member of several campus religious groups and interfaith groups. In a discussion with a minister in one of those groups, she began to talk about her objection to the Catholic Bishops’ emphasis on the procreative nature of sexuality (see paragraph 2366) as the defining element of it. Her objection was that the vast majority of sex, even for very prolific couples, does not produce offspring. She identified that childbearing years are limited and yet that sexuality most often continues after menopause in heterosexual couples and often takes place during times of infertility. As I have continued to develop my expertise and experience as a sex therapist, I have continued to find that indeed, this value of sexual generativity seems to hold value to a wide array of sexual diversities. But if you agree or disagree, please post a comment. I welcome input.

The fountain of generativity.

There are a lot of perspectives that I could use to identify the source of generativity in sexuality but I will limit myself to four. First, from an attachment perspective, sexual behavior with a partner is one way of experiencing physical closeness, touch, and oxytocin (a bonding hormone) that can help increase attachment security between partners. Second, in joyful sexuality, though most of us are not lithe athletes or supermodels, we experience a partner who wants us and accepts us as we are. This acceptance can help us feel more confident but can also help us feel more caring, altruistic, and be accepting of others. Third, sexuality includes physical activity, the release of endorphins, includes aerobic exercise, stretching, and more. These physical health benefits reduce stress and can allow us to respond more clearly to other tasks throughout the day. Fourth, to engage in joyful sexual behavior we need to know ourselves, acknowledge our needs, be vulnerable, and maybe even open ourselves to someone else’s needs. In that way, sexual expression can encourage us to grow and develop as people.

The fruits of generative sexuality.

If a person feels more attachment security, more accepted, has had a workout, and is sensitive to their own ongoing development, who cares? What difference does that make in the world? From my perspective, everyone benefits. Children of a sexually generative person, have the benefit of a more securely attached parent, a parent with less stress, and a parent who has their needs more satisfied and who is, therefore, better able to consider the needs of their child. Family members may find the sexually generative family member more engaged, less emotionally dependent, and more generous. Friends of a sexually generative person may find more enjoyment, humor, and warmth. Coworkers of a sexually generative person may enjoy a work environment free of sexual tension from that person, and a coworker more at ease under pressure, more productive, and more creative. The community around a sexually generative person may find a welcome to diversity, a safety in community support, and permission to be exactly who they are.

The limits of time.

One of the core pieces of wisdom from the polyamory community for me is that love is infinite but time is not. Heeding that wisdom, I would not want to gloss over here that engaging in sexual expression to cultivate generativity requires an investment of time. Sexuality does not become generative just because you have it, or just because you orgasm, or just because it was a work-out. A lot of sex doesn’t necessarily lead to a never-ending virtuous cycle of productivity at work, community involvement, and engagement in interpersonal relationships. The energy used for sexual expression, like the energy for a workout does generate more energy, creativity, etc. but it is not an infinite resource. Exactly how much time you must invest in your sexual expression to make it generative, and exactly how much time to preserve for the rest of your life is a calculus only you can figure. Furthermore, which sexual activities to and not to engage in to maximize the generative value of your sexuality is also something only you can figure out. What great questions to be asking!

The use of generativity in sex therapy.

This value is useful in therapy because it can be a development inducing aspiration. I might inquire of a client about their sexual expression, “When you do that, does it give you a sense of joy and fulfillment afterward?” If the client experiences shame then something is amiss, if not with the behavior then maybe with the client’s sexual beliefs or with a partner or community response to the behavior. Generativity can also be helpful in removing a genital focus or an orgasm as goal orientation. For people with medical issues or medications interfering with sexual response, shifting to an orientation of cultivating generativity can really change the conversation. With generativity as the focus instead of trying to get somewhere in the sexual encounter, the conversation shifts to how to engage either alone or together in a way that makes the person more loving with others afterward. The conversation shifts from “What do I get out of sex?” to “How does sexuality support the rest of my life?”.

That is how this value brings me joy as a therapist. When an individual or a couple finds joyful sexual expression, they come back into the office beaming with a wide smile. They are not just happier in the sexual context but their joy spills over into other aspects of their lives as generativity. As a sex therapist, I get to play a small part in helping that cup overflow and that fills my cup too.

Other posts in this series:

• Sexual Values: One Therapist’s Provisional Set
• Consent
• Sustainability
• Adaptability
• Values that didn’t make the cut

Call for a 15-minute consultation about therapy with me, 650-814-7823

In the last blog entry, I described the elements of consent as a sexual value. In this entry, I am describing the value of sustainability. However, I realized that I have not explicitly stated the importance I place on whether or not these values are sensitive to diversity. I believe strongly in the importance of diversity, not just as a politically correct value but as something that makes for just, healthy, and vibrant communities. So in developing these sexual values over the years (they have changed, and I expect them to change more), I have always sought to review whether they allow for a maximum amount of cultural diversity, ethnic diversity, sexual orientation diversity, sexual expression diversity, and sexual desire diversity. So, if you have any concerns about how these values welcome a diversity that is important to you, I invite you to comment or challenge me. That is how my values will continue to evolve. If you want to leave a comment, the process does not require that you leave your name. I will respond to anonymous comments.

Sustainability is a word with a certain cachet in business parlance today. It has almost as much innate meaning as “green,” yet many companies like to use it. While we might have an idea of what it means that a particular product is sustainably harvested, when I apply this vague term to sexual values, it may not explain itself. I see sexual sustainability as a two-part value. First, in sustainable sexuality, today’s sexual expression is practiced in such a way that it does not foreclose options for future physical health or sexual expression without conscious choice. Second, in sustainable sexuality, today’s sexual expression is not foreclosed upon for the sake of past or future sexual expression. This may sound circular, but it should make more sense with a couple of examples.

Sexual expression does not foreclose future expression.

I will give some examples. Sustainable masturbation is done with a frequency and in a way that allows physical recovery. This includes masturbation methods that do not injure the person’s genitalia or risk that the practice would prevent or impair future masturbation. It also includes masturbating in locations that are appropriately private and will not violate social norms. Another example would be making sure that if a person is practicing BDSM, the frequency of the practice, the acts engaged in, and the safe, sane, and consensual practice allow incidental injuries to heal, and maintain community relationships. That is, the BDSM practice allows both communal and individual expression of sexuality in the future.

People do sometimes choose to limit their future sexual expression. For example, a man who feels that he does not want any children or who feels that he has enough children might elect to have a vasectomy. This choice does eliminate the future sexual expression of procreation (he hopes), but he engages in this process consciously, after careful consideration, and likely in dialogue with any current long-term sexual or romantic partners. So what does this mean about the past?

Past sexual expression does not foreclose ON present expression

Let us imagine Janisha and Marco, who have been married for 5 years. One year ago, Marco had an affair. Since that time, Janisha has said that she is not ready to have sex again. Marco, trying to be respectful of the pain that he caused his wife, has not pressed the issue but continues to feel that it is important for the two of them to return to a shared sexual life. The two of them have talked through the emotions of the affair, but not the sexual ones. In many ways other than sex, their relationship is positive.

This could be an example of unsustainable sexuality between the couple, and both are contributing to that lack of sustainability. Janisha is contributing to it by not working openly to reincorporate sexuality back into their life together, which might require resolving more of her emotional pain about the affair. Though Marco is trying to be respectful and to accept responsibility for his actions, he is contributing to an ongoing tension by accepting the absence of sexuality in their lives, which is painful for him. He is, in essence, agreeing with Janisha that his actions are not worthy of forgiveness and accepting a punishment.

Janisha and Marco might find this situation manageable, but since there is unresolved tension about their sexual life together, an undercurrent of bitterness, resentment, and anger may begin to pervade their interactions. In this case, the past has foreclosed upon sexual expression of both people in the present, including the way their sexual passion might express frustration at infidelity. A barren patch of soil devoid of nutrients that is packed down and compressed cannot grow anything. It might be easy to maintain, but it doesn’t qualify as sustainable agriculture. So it is with this couple.

Future sexual expression does not foreclose upon present sexual expression

Sometimes, as adults, we make compromises when two or more of our values come into conflict with one another. There are some examples of this that I will provide in the future Sexual Values: Adaptability blog entry that could easily look like the future foreclosing on the present. One example would be a couple not having sex but staying monogamous for months after the birth of a new child. Exactly which behaviors count as the future foreclosing upon the present and which would count as good expressions of adaptation is not something that I have a magic formula for or a list to describe. Rather, this is exactly the kind of fodder for critical thinking that I think helps my clients come to their own understanding of their values. I will provide one example of a situation that I think does qualify as the future foreclosing upon present sexual expression.

Imagine a young man, Phuoc, in his early 20s who has grown up in a religiously conservative background but who has since left that background. He grew up in a context where right and wrong were clearly defined, and this cultivated in him a strong sense of morality and ethics. Now, though he has left the faith of his childhood behind, he continues to pursue right action in the world through his current values. This moral sense is a strength for him. And a vestige of his conservative upbringing is that he is concerned that masturbation will impair his ability to have the “right” sex with a partner when he gets one, and so he attempts to abstain from masturbation in the present in favor of an anticipated future. But Phuoc does not succeed in abstaining from masturbation all the time, and when he does masturbate, he feels that he has behaved in an immoral way.

From the perspective of the sustainability value, the costs that Phuoc pays in the present in terms of shame, tension, and low self-esteem now are high, and the dividends for the future are doubtful. It is even possible that his uncertainty about his sexual response cycle and the goodness of his sexuality will make it hard for him to share his sexuality with a partner generously and without inhibition. In a case like this, the future promise of the right way to be sexual has eliminated a clear path to sexual expression in the present.

In this example, I would be cautious about simply telling Phuoc to masturbate. In general, I am very cautious about telling people what to do or not to do with their bodies. However, I might explore with Phuoc what he thinks about masturbation. What his experience is about what happens when he masturbates despite his best efforts not to and would inquire about his idea of how this is or is not sustainable. With these questions, I would look to foster in Phuoc a continuing dialogue between his values and his experience of his sexuality.

The importance of present sexual expression

The history of sexual oppression and repression is long and painful. It is an oversimplification of these crimes against our own humanity to say that they have been barbaric. And it would be a mistake to think that this oppression is in the distant past. We remain afraid of our sexuality because of its power, and many people and groups continue to try to oppress sexual expression because of that power. But what we see in the history of sexual oppression is that sexuality is impossible to stop.

Whether it is parents trying to stop teenagers from having sex by not talking about it, or police trying to stop people from being homosexual, or Facebook trying to stop people from expressing their inner divas [<-link broken: Described how Facebook’s effort to force drag queens to use their legal names was damaging to performers, artists, musicians, and others who for safety or expressive reasons sought to present other names or parts of self with the Facebook profile], sexuality is a force that cannot simply be rejected.

This entry has focused on three ways of viewing the value of sexual sustainability: (1) The present does not foreclose upon future sexual expression, (2) the past does not foreclose upon the present, and (3) the future does not foreclose upon the present. As I conclude this entry, though, I realize that these values could also have been phrased more in the affirmative: (1) current sexual expression supports future sexual expression, and (2) present sexual expression is free and authentic. Or, even more to the point: Sexuality requires an expression in the present. Like all aspects of nature, we ignore or repress it at our peril. In the next entry, I will write about a value I have referred to already, generativity.

Other posts in this series:

• Sexual Values: One Therapist’s Provisional Set
• Consent
• Generativity
• Adaptability
• Values that didn’t make the cut

Editor’s Note 05/24/2017: Since writing this series I have updated the principles that I use to guide therapy for sexual issues. For an updated view, see this post on Sexual Health Principles.

Contact Me

In this blog entry, I will identify the elements that I think comprise full consent. Just remember, these values and my ways of understanding them are conversation starters only. I hold these values loosely, and I could at any moment encounter something that requires me to reevaluate them. If I brought this value up in treatment with a client, I would not say, “These are the 4 elements of consent, and see here, you violated elements 2 and 4.” Rather, I would be inclined to bring it up, inquire about how the client understands the concept, and if appropriate, I might share some of the ideas that I am sharing here.

To me, this is a more nuanced concept than simply, “Yes, you may do that with me, and I will do this with you.” Though it is foundational, for me consent is predicated on 5 components: clear relational and sexual commitments, consent in advance, an ongoing process, informed consent about risks, and a willingness to encounter the unknown.

Clear relational and sexual commitments

The value of this component of consent is easy to illustrate through two vignettes. First, imagine a pair of lesbians who hook up sexually at a party. One is into having a good night and little sexual fun with no commitments, but the other believes this liaison is the beginning of a relationship. If the two women discuss what they are looking fo,r even very briefly, they can discover the discrepancy.

Then one or the other can change their expectations or call off the encounter. Without that discovery process, both could feel shocked and hurt after the encounter, to be asked to uphold the expectations of the other person. This vignette illustrates that consent is not about just getting the “yes” to a specific sexual behavior. In this case, both women might have consented to all the whats and hows of the sexual encounter, but they have very different whys of the sexual encounter. In couples therapy, I help both members explain their relationship and sexual commitments.

My second vignette illustrating the relationship commitment aspect of consent has to do with infidelity. Imagine a heterosexual married couple that has made explicit commitments to monogamy, but the wife is unfaithful. Her husband did not consent to the attachment risks, the infection risks, or the social risks of her infidelity. He consented to a relationship where he wouldn’t have to face those risks. Her affair violates his consent.

For this reason, infidelity is experienced as a violation. Often, when providing therapy for infidelity, I need to work with the cheating partner to help that person understand why their partner feels violated. In a couple of cases, I have found a conversation about consent as something that might include a sexual and relational context helpful.

Consent in advance

People enter a very different frame of mind during a sexual encounter. Seconds before the blissful cresting edge of an orgasm is not an appropriate time to ask for permission to explore a completely new territory. A yes under such circumstances is not likely to be given with a full consideration of the risks and potential consequences.

For example, imagine two men, José and Marcus, in the throes of a first sexual experience together. José prefers a path of safer sex. Marcus was less concerned about it but agreed to follow José’s lead. Yet in the final moments before his orgasm, Marcus asks to remove the condom. This could really be an unfair question. Even if José said yes in the throes of passion, he might later regret it and be upset with Marcus for asking during a compromised moment. Consent is given at the beginning of an encounter, when the general parameters are laid out and followed through to the end.

an ongoing process

Our partners and we change over time. A “no” one day may change to “yes” and a “yes” may change to “no”. As we engage freely in a sexual relationship, however long or short that may be, we bear the responsibility to ourselves to update our consent with our partners as our desires, needs, and joys change. As we act upon the consent our partners give to us, we also need to maintain an openness to our partners’ changing parameters of consent. An acrobatic 20-year old may be more able to consent to some vigorous sexual positions than a senior citizen. And some things, like having sex while gazing into each other’s eyes, that the retired couple may be better prepared to consent to than 20-somethings hooking up for the first time.

Informed consent to risks

The risks of a sexual encounter are not just about sexually transmitted infection risk, status, or the choice(s) of safer sex methods and pregnancy prevention. Interpersonal risks might come with sexuality. For example, imagine a man and woman who are very excited to be starting their sexual and romantic relationship together and who both agree that they are embarking on a long-term relationship. Yet the woman has a new, exciting job prospect looming just around the corner, which would require a move to a different state. The man in this situation would be unable to consent to start the sexual aspect of their relationship without knowing that his emotional and sexual investment in the relationship comes with the risk of a sudden end to the relationship if she moves away.

discovery

Even in a brief sexual encounter, we are agreeing to learn something we don’t yet know. It could be as simple as learning how I respond to this person’s touch. Or as complicated as the partner discovering a desire for a new act that they never had before. For longer-term relationships, we agree to learn things that neither of us knows yet. For as long as the sexual encounter or relationship lasts, we enter the private unfolding umbra of another person’s psyche, and we bring them under ours. This aspect requires an attitude of acceptance that we bring to our partners. We cannot anticipate what the sexual encounter will teach us about either ourselves or our partner.

Because new things will be discovered by me and my partner, with consent to discovery, I can realize that my partner’s ongoing development and self-discovery is not an act against me but a natural process that I witness. Without consent to discovery, I can have the experience that my partner is hurting me or doing something to me as they develop.

Imagine how a person with and without consent to discovery might respond to the following sexual discoveries in a relationship: a wife discovers that her husband likes wearing panties, a man discovers that his husband likes a “dirty” act; one partner’s unfolding sexual orientation is different at the end of a long-term relationship than when it started. With consent to discovery, these new developments may be greeted with surprise and inquiry instead of blame and shaming.

Discovery is not a pre-agreement that we will like what we discover. The discovery may be joyful, surprising, challenging, shocking, painful, confusing, or more. Naturally, consent like this cannot be given unless we are willing to be who we are and to accept that as well.

Therefore, this aspect of consent requires maturity, equality between partners, and self-acceptance. Certainly, not all acts or sexual relationships require the same gravity or breadth of openness to discovery. I am aware as I write this that it may not even be a central component of consent in many brief encounters, yet my experience as a relationship therapist tells me that, at least in long-term relationships, it might be important to acknowledge and cultivate consent to discovery.

With all the requirements above, it should be obvious that abusive relationships or relationships founded upon sexual secrecy obviate the potential for full consent. The full engagement of every person is a requirement of consent. This entry attempts to identify some components of that consent beyond the details of bodies and choreography.

I am suggesting that to give it fully we need to be aware of our sexual and relational commitments; to give and abide by consent in advance; to be willing to renegotiate our and our partner’s(s’) consent; to disclose, know, and accept the risks of our sexual activity; and we need to be willing to encounter the unknown in our partners and ourselves. To me, when viewed through this lens, sexuality challenges us to grow and mature, to be compassionate with others, and to be self-aware. What an exciting challenge!

Other posts in this series:

• Sexual Values: One Therapist’s Provisional Set
• Sustainability
• Generativity
• Adaptability
• Values that didn’t make the cut

Editor’s Note 05/24/2017: Since writing this series, I have updated the principles that I use to guide therapy for sexual issues. For an updated view, see this post on Sexual Health Principles.

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In the United States when the word “values” is used in the media, it is often being used by people with conservative religious or political values as a code word for “the way people who look like me and think like me do things and the way I want you to do things”. But in my experience values are community and individual standards that we aspire to maintain and which we use to guide our behavior. I think that liberal thinkers are less comfortable using the word “values” because they are justifiably cautious about how my “values” can be imposed on others as a source of discrimination, exclusion, and oppression.

However, as a therapist, I find a discussion about values to be very important. Because I am cautious about the power dynamics inherent in the therapeutic relationship, it is very important for me to have an open conversation with you about your values. For example, if you are calling for “sex addiction” (a term that is not very useful clinically) it is important to me to find out whether and how your sexual behavior is in line with or out of line with your values. Once I understand your values, I can provide treatment that is respectful of those values.

Of course, I have my own biases that I bring with me to every therapy session. Though I can aim toward objectivity (itself a value) I can never truly be free of my biases. As I enter into a treatment relationship with you, our values enter a dialogue. I try to remain cautious of the risks of unconsciously imposing my values on you while we enter that dialogue.

One of the best ways that I know of to prevent that potential harm is to be conscious of my values and how they inform the care that I give you. So, over the years I have identified my 4 core sexual values that guide both my own behavior and that inform my clinical practice. They are Consent, Sustainability, Adaptability, Generativity, and Attachment. In the next 5 blog entries, I will discuss each of these values in turn and the values I have discarded. I will explain them, how to use them with clients, and how I hope that they are sensitive to a vast array of sexually diverse identities, practices, and feelings. Before those entries, I want to explain why I would choose to use a set of values at all given the risks. There are 4 main reasons that I hold and share these values:

• For clients: Values can guide you toward health instead of simply guiding you away from pathology. In my experience, I have found a positive goal to be a much more beneficial way to help clients reach their sexual expression goals in treatment than to focus more on what the clients don’t want to do. If you already know your sexual values you wouldn’t need to hear mine as part of your treatment. But if you find that something in your sexual behavior isn’t working for you, maybe hearing my values can help you articulate your values.Another important benefit for clients of a values conversation is that sometimes the values are the problem. If your values cause you shame, but your behavior isn’t a problem, it can help the treatment for us to begin a values dialogue instead of having an unproductive conversation where I tell you to just stop feeling shame.
• For colleagues: If it is helpful for me to be aware of these values and to consider them in treatment for clients, they may also benefit my colleagues. And, if my colleagues see flaws in these values as they might be applied to clients, I hope they will offer me that guidance.
• For myself: I welcome and invite feedback so that my values can be challenged by readers. If I am missing some way that these values might either inhibit my own health or might incline me towards oppressing others, I can receive feedback and challenge or change these values.
• The value of values: Though it is important to be cautious about the potential harm that values can cause if we impose them on others, values seem important to me. Especially in the cultural landscape of the 21^st century where we have an ever-increasing exposure to sexual materials, an expanding range of sexual behaviors available to us, and a morphing set of expectations for our sexual relationships, values can help us make choices from among these options that can help us feel authentic, integrated, and that can help us maintain our relationships (sexual and otherwise). Furthermore, the sexual ethics that we espouse allow our communities to recognize what to expect from our behavior. Our values form a ground upon which we make commitments (sexual, romantic, or otherwise) to our community members. Our values allow our communities to hold us accountable and to help us when we do not succeed in practicing our values.

I imagine that some readers may be wary of this discussion. The history of marginalization, judgment, oppression, shaming around sexual issues is so vast, that a discussion about values will almost necessarily raise fears among marginalized populations of many kinds. I hope that you will find that I hold them as ideas for consideration and interpretation, not proscriptive decisions about how I think other people should behave. The values are concepts that I have my own interpretations of and when I share them with you I invite you to discern whether this is a value we share or not. When it is not shared, then I invite you to articulate an alternate value (to clarify your values in contrast to mine). When it is a shared value, I encourage you to interpret it on your own and to decide what that means to you about your behavior. I hope this description about how I use the values decreases fears about harm, and I would understand if it did not.

Some readers, especially my professional colleagues, may be wondering what the evidence base for this value set is. There is no research evidence for this value set. I do not believe that it needs to be evidence-based. Science is a very powerful tool for discerning and understanding what exists in the world. It can help us develop a wide variety of technologies but it does not answer for us whether or not we ought to use those technologies. Our values and our ethics guide those decisions. While our ethics can be informed by science, but our ethics help us make choices from the range of scientifically possible options. So, you will find that these values are biased and based on personal choices. They are informed by a deeper set of values that I hold like compassion, nonviolence, honoring diversity, and respect for nature. I hope that they are of service.

Other posts in this series:

• Consent
• Sustainability
• Generativity
• Adaptability
• Values that didn’t make the cut

Editor’s Note 05/24/2017: Since writing this series, I have updated the principles that I use to guide therapy for sexual issues. For an updated view, see this post on Sexual Health Principles.

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