I am a therapist with 15 years of experience providing couples therapy to couples in Silicon Valley. In engineering terms, I’m an expert at human-to-human user interface: communication. Because I’ve been centered in Silicon Valley my whole career, I’m also familiar with how one member of a couple being an engineer affects their communication patterns, and how those inputs shape the outputs they receive from their partner. So, while still knowing almost nothing about engineering, I think I’m well-positioned to offer some insights on how the AI revolution may or may not affect human-to-human interactions.

Let’s start by identifying common fears.

The Fears: Will AI and Communication in Relationships Suffer?

The fear about AI is that it will harm our ability to connect with each other[i],[ii]. I think this fear comes from some other specific fears:

1. A fear that sycophantic AI agents will erode people’s ability to tolerate the real needs and annoyances of other people.
2. A fear that we’ll be so focused on communicating with bots that we won’t seek human communication.
3. A fear that using AI will affect our problem-solving^[i] or critical thinking skills.

The Opportunity: How AI Prompting May Improve Communication in Relationships

I’ve been using AI recently for website tech support, blog post editing to maximize SEO and AEO, and small-business strategizing. As I used it more, I became less convinced of the validity of the fears listed above. I was encouraged that there are some great opportunities embedded in the AI revolution.

Nate B. Jones has a YouTube video/Substack post describing a Four Disciplines Framework for how AI prompting is evolving. He suggests it actually mirrors good human communication and might inadvertently teach you good communication skills as you use it. I agree. The positive effects on communication may not be limited to the business application Jones describes. They may also apply to relationships.

The Four Disciplines Jones describes are: Prompt Craft, Context Engineering, Intent Engineering, and Specification Engineering. I’ll review each and describe what I think they will teach AI users about human communication.

How Could Prompt Craft Improve Communication Skills?

Jones describes prompt craft as including the following key elements: clear instructions, examples and counterexamples, guardrails, an explicit output format (e.g., what file format do you want this in), and ambiguity resolution.

This sounds to me like really good consent communication. No, I don’t mean just sexual consent. Let me explain. A common problem I see in couples comes from the fact that they love each other very much. But they help each other without consent. A classic example is the empathy-versus-solutions response when your partner is complaining about a problem. It’s only a problem if they didn’t want what you offered. And you gave them what they didn’t want because you didn’t ask. They didn’t prompt you correctly to generate the desired output. Consent begins with knowing what you want and asking for it.

So, when you’re telling your partner what you want, you need to become skillful at prompt engineering. You need to tell them in unambiguous terms how to do what you want, give examples of what to and not to do, explain how they’ll know if they’re doing the wrong thing, specify what form to deliver in, and explain how to check in with you if they aren’t sure.

Human Prompt Engineering Example

Please clean the kitchen thoroughly. That’s the dishes, counters, stovetop, kitchen table, the floors, and taking out the trash and recycling. I don’t expect you to wipe out the fridge. Please do check the cabinet door and drawer faces to make sure there’s no food on them, but otherwise, leave them alone, too. When you’re done, look over the kitchen. If you see any messes, anything out of place, or anything obviously dirty, please clean that too. I need this done before Sunday at 6pm. If you aren’t sure whether something needs to be done, how to do it, or where something goes, please text me and ask.

Let’s put all three of these things together so you can see it all at once:

How Could Context Engineering Improve Communication Skills?

In Jones’ framework, Context Engineering is a way of managing tokens, the currency of processing power in AI engineering, to get the job done by the AI agent as efficiently as possible. The sub-skills of context engineering he identifies include system prompts, tool definitions, retrieved documents, message history, and memory systems.

In human terms, those translate to the how and the why of the task, which tools to use (and where they are), guides, and past experiences that can be referenced to understand the request or how to complete it.

Human Context Engineering Example:

It is really important to me that the kitchen is clean by 6pm because I’m having friends over that night. This is the first time these people are coming over, and I want to make a good first impression. Because I’ll be volunteering with them all day Sunday, I won’t be able to do any of this cleaning, so I need you to do it for me. The dish soap and dish rag are at the sink. The mop is in the hall closet. The scrubbing powder, if there are any stains on the counter, is under the kitchen sink. New tablecloth and fabric napkins are in the drawer under the kitchen utensils drawer. If you need help remembering where things go in the cupboard, remember that there are labels in each cabinet about what goes there. Thank you, you know from past conversations how important acts of service are to me. You did such a good job the last time I asked, and it made me feel really loved. [This references the partner’s memory that acts of service are a love language. Specifically, the most important love language for the speaker.]

How Does Intent Engineering Improve Human Communication?

Intent Engineering, according to Jones, is “The practice of encoding organizational purpose, goals, values, trade-off hierarchies, and decision boundaries into agent infrastructure.” It “tells agents what to want.” This is how you get the AI to do the job in a way that supports the organizational objectives, not just fulfill the task. In one example, Jones describes how failed intent engineering leads to lower customer call times but higher customer dissatisfaction.

In human relationships, failures at the intent-engineering level lead to deep trust issues. In my experience, more likely, nothing was actually communicated. Humans fail each other at the intent engineering level frequently in the following ways:

Assuming we have the same intent.

The first problem is a common form of self-oriented thinking. It is neither selfish nor narcissistic. It just doesn’t grasp at a deep level that other people are fundamentally different from me. It is an error to assume that they value, feel, or perceive the same things I do. Children develop the theory of mind[iii], the capacity to know that other people experience things differently, at a young age. Some research suggests that capacity continues to develop into adulthood[iv]. Indeed, in my practice, many adults have difficulty remembering that their partners feel, value, and experience things differently inside.

“Any decent person would want the same thing,” and “I think it’s reasonable to expect these things” are both examples of this kind of error. This leads people to assume that they don’t need to, or shouldn’t need to, explain why they are making the requests they are making.

Believing you should know my intent, and if you don’t, that’s your failure, not mine.

People in long-term relationships often make this error. As the song goes, “If you don’t know me by now, you will never ever know me.” (Harold Melvin & The Blue Notes, 1972, and covered by Simply Red in 1989). But what people fail to realize is that human intent engineering needs regular updates. As long-term couples age, they need to take the time to recalibrate their mental models of each other. So, yes, you need to tell him that, “Yes, I used to like fried chicken, but now I prefer grilled chicken.”

This is because of the reminiscence bump[v]. That is, the fact that our memories are better for early developmental experiences. In addition, we pay much closer attention when falling in love. So, it is a lot harder to remember something new your partner says than something they told you when you were together in college or when you first got together.

Regular updates are also required because your partner is growing and changing, too. Their internal values, feelings, needs, and emotional landscape are evolving. So how they interpret you changes over time, even if you stay the same.

So, the reality of human communication is that in order to communicate well with our partner, we have to know ourselves well. This allows you to provide complex requests that are resilient to the unexpected.

Intent Engineering Examples:

“Please get red roses at the flower shop to have on the table tonight for dinner.” Is different from, “Please get red roses, but if they don’t have that, any red flower will do. I want to match the napkins.” Is different from “Please get red roses, but if they don’t have red, get white, or yellow in that order of preference, because roses are mom’s favorite. If they don’t have roses, don’t get any.”

Let’s see what intent engineering can add to our example about cleaning the kitchen.

I’m having these people over because I want to deepen my friendships with them. I want to make a good first impression. I appreciate situations like this where we can function as a team. Oh, if you’re running short of time, sweeping the floor but not mopping it could be okay. And if you feel like it is getting close to 6pm and you could start something new, but might not get it done in time, then it’s better for me that you not start it. Cleaning chaos while people arrive is counter to the impression of a neat and orderly team that I want to give.

How Does Specification Engineering Improve Human Communication?

In Jones’ model of AI engineering, specification engineering provides a larger scaffolding for all work done by agents for the company. It allows smaller pieces of AI work to fit into larger production contexts (AI or human) seamlessly, even if different AI agents, or different people, pick them up.

If you’re lost, don’t worry. This is about to make so much sense when we bring it down to the human household level.

One of the big problems of a modern family, the reason that this time feels so stressful, is that our culture is the most complex in human history. Let’s just take one tiny slice, and you’ll see it really easily. How many different types of insurance do you have?

• Health insurance
• Dental insurance
• Eye insurance
• Car insurance
• Home/Apartment insurance
• Life insurance
• Long-term/Disability care insurance
• Business liability insurance or professional insurance
• Pet insurance

In addition to this, you may have a variety of other protection services you pay for as add-ons to other services that are essentially additional kinds of insurance, like car warranty, computer care plan, antivirus plan, and credit protection services. The list goes on. Running a household, even a household for one, requires the skills of running a business. I didn’t say “small business” on purpose.

Specification Engineering is the solution to the stress caused by all of this complexity, and it allows a household to run smoothly. Let me give you an example you’ll be able to read more about if you want to: Family Meetings. A good family meeting doesn’t just process some information for an hour once a week. A good family meeting coordinates each family member’s capacities with the family’s needs, so that everything flows together. A family meeting helps maintain an existing routine when disruptions occur.

Household Specification Engineering Example:

• A family meeting decides what the meal plan is, so that
• When grocery shopping happens, the shoppers know what to buy, so that
• The cook has the food they need on the days they need it, so that
• Everyone has the food they need to do their homework, childcare, chores, and play.

A good family meeting, weekly routine, and chore assignments are the specification engineering of a well-run household. Even if someone else has to take over dinner one night, the meal plan said what dinner was, the grocery shopper already got the food, and the recipe box or the cookbooks describe how to make it.

If you’re thinking that’s a lot of work, you’re right. But not doing that work is a lot of work and creates a lot of stress, too.

That’s why, sometimes, the best couples therapy interventions I do are to help a couple have good family meetings, have family values conversations, and create a good family routine. Sometimes, relationship problems result from household chaos. Yes, that chaos is often caused by an impossibly challenging world. It isn’t the couple’s fault.

Conclusion: Are There Positive Consequences of AI on Human Communication?

To summarize, based on what I’ve seen, I’m actually excited about some of the ways AI will teach us to communicate. Because we know an AI isn’t human and only knows what we tell it, we’ll be forced to develop conscious self-awareness of what we want, how we want it, why we want it, the broader context in which the request sits, and what it serves. Then we’ll become practiced at communicating that awareness. If we let them, those skills will also make us better at communicating with other people.

My Real Fears About AI’s Impact on Relationship Communication

With that said, there are three fears that I still have about AI’s impact on human communication. I’ll present them briefly, along with an opportunity.

Fear 1 : Sycophancy Fear Updated

None of the skills above includes vulnerability. If bots teach us to be vulnerable by opening up to them, will we stop opening up to each other?

Opportunity: In practice, I’ve already seen some of my clients practice opening up with a bot. They use that training ground to refine their communication, and later bring it into therapy or to their partner.

Fear 2: Skills/Class Gap Acceleration

I fear that people who use AI agents and who already have critical thinking and emotional humility will be able to use and transfer these skills to their human interactions. But will people without these skills be trained by the agents to develop them? Or will they be relegated to using bots to confirm their own biases?

Opportunity: AI agents can be trained to help people develop these skills. Companies may even be motivated to make sure the agents do this as much as possible. The more unskillful you are at prompting the agent, the more iterative passes you’ll make trying to complete your tasks. That’s inefficient for your time and tokens, uses provider compute capacity, and decreases your satisfaction with the product. The more an AI product becomes humble and asks you for all these pieces of information before executing, the higher your satisfaction will be.

That might teach us what questions we need to ask of each other. Using our kitchen-cleaning example from earlier, the cleaner could also ask questions to elicit the information that my examples filled in.

Fear 3: Human attention is a valuable resource.

We can’t communicate with each other without human attention. And AI bots are hungry for our attention. It is their purpose to exist. Will our economy free our attention for each other or just devise more ways for our attention to be drained to fuel corporate bottom lines?

Opportunity: Major industrial changes can and should free workers to enjoy more of life. If the AI revolution, which allows workers to accomplish more in less time, also precipitates a reduction in the workweek length and an increase in workers’ time off, then it may earn its keep.

Is AI Going to Be Good for Human Communication?

The answer is ultimately up to us. AI, like other tools, is what we make it. Industrialization created machines that could be dangerous to workers and communities. Unions gave workers the strength to bargain for their safety. Government regulations further proscribe how companies could use machines to make a profit and how much risk to workers, the environment, and people is and isn’t tolerable. That’s going to be no different for AI and communication in relationships.

If you want to work with a therapist who thinks deeply about human communication, has practiced in Silicon Valley for 15+ years, and can use technology-speak to teach human connection, please contact me.

[i] Kennedy, B., Yam, E., Kikuchi, E., Pula, I., & Fuentes, J. (September 17, 2025). How Americans View AI and Its Impact on People and Society. Pew Research Center. https://www.pewresearch.org/science/2025/09/17/how-americans-view-ai-and-its-impact-on-people-and-society/

[ii] McClain, C., Kennedy, B., Gottfried, J., Anderson, M., & Pasquini, G. (April 3, 2025). How the U.S. Public and AI Experts View Artificial Intelligence. Pew Research Center. https://www.pewresearch.org/internet/2025/04/03/views-of-risks-opportunities-and-regulation-of-ai/

[iii] Wellman, H. M. (2011). Developing a theory of mind. In U. Goswami (Ed.), The Wiley-Blackwell Handbook of Childhood Cognitive Development (2nd ed., pp. 258–284). Wiley Blackwell.

[iv] Carlson, S. M., Koenig, M. A., & Harms, M. B. (2013). Theory of mind. Wiley Interdisciplinary Reviews. Cognitive Science, 4(4), 391–402. https://doi.org/10.1002/wcs.1232

[v] Munawar, K., Kuhn, S. K., & Haque, S. (2018). Understanding the reminiscence bump: A systematic review. PloS one, 13(12), e0208595.

AI Use Disclosure: I created all the sections, headings, concepts, examples, and tables in this blog entry unless otherwise noted and cited. I used AI to copy-edit the original human-created manuscript (3,386 words) into a new version (3,491 words) to meet SEO/AIO/GEO/AEO needs (letting the bots serve the bots). Please let me know how you feel about my using AI in this way in the comment boxes below. I read all the comments myself.

I work with many couples puzzled by changes in their sex lives. Sometimes they are not dramatic shifts like affairs or mismatched libidos. Sometimes, couples just experience confusing, slow declines in erotic connection. Couples now stick to routines, partners question why former turn-ons stopped working, and love remains, but desire fades, even when nothing seems wrong.

These problems are often the same, just seen from different angles. One image helps couples understand them all: stress and sexual arousal are the common thread.

Imagining Your Turn-Ons as a Mountain Range

Imagine your turns on as a mountain range. Every peak represents something that can create desire, increase arousal: a particular kind of touch, a feeling of connection between the couple, a context that feels safe and playful, a fantasy, the way your partner looks at you across a table. Some peaks are tall; they turn you on a lot. Others are more modest; they might warm you up, but only sometimes, or you need multiple of these turn-ons to get there. Together, these peaks form the full mountain range of your erotic life.

Two important principles to keep in mind about this mountain range:

1. Each mountain range is unique. Your partner’s mountain peaks are different from yours.
2. Even your own range of turn-ons shifts over your life and with your environment.

The Flood: What Stress Does to Your Erotic Landscape

When stressors like work pressure, financial worry, parenting exhaustion, or unresolved conflicts build up, it is like a flood rising over that mountain range. The water doesn’t necessarily cover desire completely, though it can. What it reliably does is cover the shorter peaks. Subtle turn-ons like being at ease, that shirt that makes your partner’s eye color stand out, or maybe a little weekend afternoon boredom can get submerged under stress. For some, only the tallest peaks (that is, your most powerful, most robust turn-ons) or the easiest peaks (that is, the way you always do it) remain accessible. For others, if the foothills are submerged, there’s no way to reach the higher peaks; the gap is too great.

This is the mechanism behind the connection between stress and sexual arousal that researchers have been documenting for decades. Bancroft, Graham, Janssen, and Sanders (2009) described sexual response as a dynamic balance between excitation and inhibition, and relationship distress, unresolved conflict, and chronic stress are among the most potent inhibitory forces in that system. In this analogy, the mountain and the flood. In her book Come as You Are (2021), Emily Nagoski popularized another analogy of the gas pedal and the brake to describe the excitation and inhibition systems.

Why Do We Always Have Sex the Same Way?

This is a common bedroom challenge among long-term couples. It’s usually framed as a complaint, “We’ve gotten into a rut,” or “We used to be more adventurous,” or “I feel like we’ve lost something.”

In the context of the mountain range and flood analogy, what’s usually happening is simpler than a fundamental change in sexuality. The flood has risen high enough that only the easiest peaks remain accessible. As a result, you use the pleasure pathways that still stand above water—the familiar scripts, positions, and ways of initiating that stress hasn’t submerged.

Understanding this reframes the problem in a hopeful way. The variety isn’t gone. It’s submerged. And what is submerged can, in principle, be uncovered.

Why Did That Thing That Used to Turn Me On Stop Working?

Clients sometimes come to me worried about this one specifically. When a behavior, a context, a dynamic that was once a reliable part of their erotic life has quietly stopped working, they get scared. They want to know if this signals a permanent loss of something in their erotic landscape. Or they are afraid it is a sign that they and their partner have grown apart in some fundamental way.

Often, the relevant erotic peak was never the tallest in the range. It was a mid-range peak. It worked well when the flood was low, but now it sits underwater as life has gotten harder, or the relationship has accumulated more unresolved hurts over time. It hasn’t disappeared. It has just become temporarily inaccessible.

Brotto and Basson (2014) found that relationship quality and emotional closeness were significant moderators of sexual desire and response. That is, the quality of the relationship is narrowing what is available sexually. The effect of stress is real; you are not crazy.

How Do We Get Back What We Lost Sexually?

The connection between stress and sexual arousal means there are two ways to restore access to more of the sexual mountain range: lower the stress flood, or make the remaining pleasure peaks more accessible. I’ll describe both in the next two sections. However, for many couples, this is actually the wrong question. The metaphor makes this clear: if a major flood is covering mountain peaks, the landscape has probably permanently changed. The goal is not to regain what you had erotically, but to work with the new landscape to experience as much as it has to offer today. There may be new unmapped peaks out there to discover, and that’s exciting.

How Does Lowering Stress Improve Sex?

Lowering the flood usually means addressing what is raising it. Eliminate stress and sexual arousal can emerge. In couples therapy, this might mean any of the following, or a combination of them:

• Working through the layers of unresolved conflict.
• Replacing conflict-induced emotional distance with connection.
• Refreshing emotional resources to replace exhaustion.
• Educating the couple about real sex instead of pornography or erotica created fantasies about how sex flows.
• Helping the couple approach the challenge of the flood so they can climb the mountains as a team, rather than criticizing and blaming each other.
• Creating an intimacy plan that works with the ecology of your weekly or monthly floods of stress. That way, you’re not trying to climb any peaks when the stress is highest.

For individuals (often as a supplement to couples), therapy might include:

• Anxiety reduction tools
• Embodiment tools. Pleasure is a physical experience. When you focus on the past, the future, or your partner’s experience rather than your own, you won’t notice your own pleasure. Sex therapy teaches ways to stay aware of your body’s sensations. That’s why Sensate Focus is a basic sex therapy tool (Weiner, 2002).
• Helping the client identify what preparations they need for mountain climbing. For example, some people need a shower and an hour of relaxation to let the flood waters recede before they try mountain climbing.

How Does Communicating More Improve Sex?

To make pleasure peaks more accessible, focus on creating direct paths to eroticism. It’s like paving a mountain path. It is hard at first, but lasting. Here are some examples:

• Sharing desires (things you actually want to do) or fantasies (mental images, scripts, or places your mind goes but which you may not want to enact) with your partner outside of the bedroom on a day when you’re not going to have sex. This makes it easier to say, “Hey, could we try that thing I mentioned a couple of weeks ago?”
• Treat sex and intimacy as skills to practice. When trying new things (like toys, words, or positions), it feels awkward at first. Set clear practice times and separate them from “game time” to lower pressure and expand your lovemaking repertoire.

When you know the role of stress in sexual arousal, it becomes clear why lowering stress maximizes pleasure. Communicating with your partner maps out these capacities, helping you discover how to touch and be touched to create pleasure. This helps you rediscover or even improve upon your past sexual experiences.

If you’d like to work with a licensed psychologist who understands the connection between stress and sexual arousal (and can teach it to your partner), I invite you to contact me.

References

Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The Dual Control Model: Current status and future directions. Journal of Sex Research, 46(2–3), 121–142. doi: 10.1080/00224490902747222

Brotto L.A., & Basson R. (2014). Group mindfulness-based therapy significantly improves sexual desire in women. Behavior Research and Therapy, 57, 43-54. doi: 10.1016/j.brat.2014.04.001. Epub 2014 Apr 18. PMID: 24814472.

Nagoski, E. (2021). Come as You Are: The Surprising New Science That Will Transform Your Sex Life. New York, NY: Simon & Schuster.

Weiner, L. (2022). Sensate focus touch in sexual health and sex therapy: A critical literature review. The Journal of Sexual Medicine, 19(2), S152. https://doi.org/10.1016/j.jsxm.2022.03.350

Though I didn’t set out to become an expert in ADHD, by default, I have ended up working with ADHD fairly often in my practice. This is because ADHD causes relationship challenges when it is unmanaged or when the partner of someone with ADHD doesn’t understand it. In the end, it is fairly simple, and as you probably know, very difficult nevertheless. I’m a licensed psychologist in California, with a Ph.D. in clinical psychology, and these are the six practical elements I use to help my clients manage their ADHD: Sleep, Diet, Exercise, Medications, Therapy, and Mindfulness.

I usually say most people need a minimum of three of these well-dialed in to manage their ADHD, but honestly, my experience says that it is just an upward benefit slope. The more of these you use, the better managed your ADHD will be. Let’s review each one.

How Does Diet Help Manage ADHD Symptoms?

Section TL/DR: Your brain needs the right food to ADHD less, but only the right amounts. I can help you manage this.

Eating well can maximize your cognitive capacity. What does that have to do specifically with ADHD? Well, for one thing, being low on blood sugar can be bad for your ADHD symptoms (even though I know you can kind of thrive in a hyper-focus black hole without eating for many hours). This is because your dorsolateral prefrontal cortex (the brain area that directs attention) thrives on glucose, so if your blood sugar is low, you’ll have difficulty directing your attention where it needs to go or keeping it where it needs to be.

That may not be a problem as long as you’re hyper-focused on the right thing, but heaven help you once you realize how hungry you are and then realize the snack you bought two weeks ago is in the back of the cupboard, and aren’t those the beans you were going to use to make chili . . . oooh, chili! . . .

But the other challenge of ADHD and diet is that if you are too high on sugars, or too many simple carbohydrates, it’ll be hard to focus too. The sugar may make you feel restless, making it hard to keep still. The carbohydrates may be dulling, making it harder to motivate. So, what to do?

Core recommendations to manage eating for ADHD:

• Hide the goodies: Put snacks and sweets hidden away, or better yet, don’t have them in the house in the first place.
• Make fruits and veggies easily accessible, already washed or prepared. This means apples in a bowl right out on the counter, and washed and cut veggies in the eye-level shelf in the fridge. Nuts at hand on the desk for ongoing snacks
• Pre-prepared meals, and for some clients, smaller meals, eaten more often, are better.

How Does Therapy Help Manage ADHD Sleep Issues?

Section TL/DR: You probably need more sleep, but have trouble getting it. I can help with tailored interventions.

Sleep is a cornerstone for mental health of all kinds. Anyone who wants to maximize their wellness and minimize the impact of their mental health should be paying attention to quality sleep as a cornerstone, but when it comes to managing sleep for ADHD specifically, there are some key elements to consider.

Sleep Onset Problems

Subsection TL/DR: ADHD Sleep Onset Problems are usually structure problems or impulse control problems. I can help with both.

Stayed awake till 2a again because you were completing that project before the 8a deadline? Or were you telling yourself you should go to bed, but just couldn’t make yourself stop what you were doing long enough to do so? ADHD related sleep onset problems are usually either structure problems like staying up to finish a deadline or, impulse and attention regulation problems like getting stuck on your phone.

Therapy helps manage ADHD sleep-onset problems by assessing the type of problem and gives you concrete and ongoing support for addressing your specific sleep-onset challenges. For example:

• Using time in the session for you to create small accountability deadlines. For example, getting you to email your colleague, “Can I show you how the big project is coming along and get your input tomorrow?” or to email your boss, “Hey, can we schedule a meeting 3 days before the big deadline so I can show you my draft?” This helps you use therapy to create real-world accountability, so you make incremental progress before the real deadline.
• Sucked in by an app? We’ll identify in session ways to limit the app from deleting it, to limiting it in your phone’s settings, to creating alarms that will interrupt you (yes, more than one). Up late playing video games? We won’t just talk about how you need to stop; we’ll find ways to time box your fun time, set timers when you begin, or put the power cord on a vacation timer.

Notice how I emphasize action in session as much as possible? We have to catch this moment of attention and make sure it is making a difference for you when you aren’t thinking about the session. More about that in a minute.

Early Waking Problems

Subsection TL/DR: Early waking is the most common ADHD related sleep problem I see in my practice. By hearing what you experience when you wake, we’ll strategize tailored solutions for you.

The ADHD challenge with sleep is usually early waking. Most of us have a sleep cycle of around 90 minutes. Between those cycles, we are in the lightest sleep, and we change positions. When a person has ADHD, after about 6 hours of sleep (4 sleep cycles), people with ADHD often wake up too much. Their minds start to hear birds chirping, or they start thinking about what they need to do during the day. Then they can’t shut their mind off, they wake up early. And usually feel fine, but . . .

Most people need 8 hours of sleep (a 5^th sleep cycle +/- a little time between cycles) in order to be fully balanced. The person with ADHD may not even feel the effect of only getting 6 hours of sleep, but if they ever got another sleep cycle, they would likely feel the benefits.

So, therapy for managing ADHD helps the client stay asleep by:

• Checking in regularly with you about your sleep cycles so you don’t forget how important it is.
• Reviewing sleep disruptions like early waking and troubleshooting actionable solutions. For example, being a little warmer can often help people stay in deeper sleep. Or guiding you to keep the room darker so the light doesn’t wake you up as much.

Once we have some things for you to try, I’ll ask you to set an alarm for after the session to help you remember to implement the suggestion. That’s because I’m not going to just come up with ideas; I’m going to help you implement them, recognizing that your ADHD is a barrier.

Good job reading that whole thing. That was a long one, but the next one is shorter, so you can do it!

How Does Therapy Help Manage ADHD Exercise Challenges?

Section TL/DR: Brain does better when you get out your zoomies. I help you exercise without getting rigid about how.

There’s a strong connection between cardiovascular health and cognitive functioning. For people with ADHD, you can also get physical restlessness, zoomies, out by exercising. Here are my top recommendations:

• Minimum of 30 minutes of exercise, any time, any type. <=That’s good and much better than nothing.
• Mid-range: Complete exercise 3 or more hours before bed so the exercise isn’t keeping you awake, and emphasize getting your heart rate up.
• Ideal: As much exercise as you can reasonably fit in, with a combination of strength-based exercise and cardio in the morning before you do anything else.

Notice how I emphasize a range of possibilities without getting rigid about what it has to look like to count?

How Does Therapy Help Manage ADHD Attention Problems?

Section TL/DR: Some people with ADHD swear by meditation. If that’s you, I’ll keep you on it. Otherwise, I don’t torture people with forced meditation.

Some research evidence suggests that mindfulness training is good for people with ADHD[1]. Other research meta-analyses are less conclusive[2], but still suggest some reductions in ADHD symptoms from mindfulness-based intervention. What’s clear to me is that most of my clients with ADHD find mindfulness excruciating. If it is already working for you, or you want to try it, we can incorporate it into your treatment plan. Otherwise, I don’t usually force it.

When I do include mindfulness-based interventions for ADHD, I usually teach a little bit in session and then outsource daily mindfulness practice to an app.

Good job, getting through that section!

How Does Therapy Support Medication to Manage ADHD?

Section TL/DR: Medication can help a lot of people and can be one important support, but I don’t push.

Whether you’re taking a stimulant, Strattera, or a psychiatric medication for another diagnosis, medication management of symptoms is an important aspect of ADHD management. I liken this to weight lifting. Sure, it is great if you can lift a heavy weight a few days a week. But since you have to lift this weight every day for the rest of your life, wouldn’t you like something to lighten the load?

There’s often a little grieving that goes into accepting medication support. A lot of people with ADHD grew up being told they should be able to do this. Especially highly-intelligent and high-performing people, as I see in Silicon Valley, often feel like, “I can do X, Y, and Z, I should be able to manage my ADHD without medications.”

But the thing is, ADHD is an invisible disability. I know you anticipate this big experience of relief and reward once you finally do “it” right. The irony is that for some of my most medication-resistant clients, medication is the support that finally lets them achieve their goals.

How Does Therapy Help Manage ADHD Structure Challenges?

Section TL/DR: You need help to manage the big stuff and the small stuff, and I have a lot of tools for that. I know this feels impossible. Read the section. You’ll see that I’ve got you.

Macro Structure

A core element of ADHD treatment is called externalizing the function. It means you take the part you have a hard time managing by just remembering, and you let something else in your life handle it for you. That’s structure. There are 3 main macro structures that I use with my clients, and I’m supportive of whichever one(s) work for you:

• To-do lists
• Calendars
• Routines

The thing is, we don’t expect them to work forever. There’s a trick to making this work. We let them fall apart, and then I use the last tool mentioned below in the How Does Talk Therapy Help Manage ADHD for Me? section. Aren’t you just dying to see what that is? Go ahead and scroll down to Constant Construction and Destruction. I’ll make sure you don’t miss anything.

Micro Structure

Those help take care of the macro parts of your life. Then there are smaller structures that can help you manage smaller moments like:

• Alarms – Yes, like setting alarms on your phone. But we’ll often do something I’ve never heard someone else suggest. I’ll help you regularly review the alarms in your phone and change the alarm ring tone (“Oh, what’s that noise! That’s something new” <= That makes it harder to just ignore), and we change the time by just a few minutes. This also helps break your attentional blindness so you notice and act on what the alarm was supposed to help you do.
• Tethers – Like literally seatbelting yourself to your chair at work. This can help you stay on task until completion. You say, “But sometimes I need to go to the bathroom? What do I do then?” Keep reading.
• Reminders – So you have to get up from your desk, but you really need to come back. How will I remember to come back? Maybe you tie a piece of string from the desk to a belt loop, or leave your glasses at the desk (But Eric, “I’m almost blind without my glasses.” Exactly)
• Behavioral Interrupts – This is like putting the shoes you’re going to wear immediately in front of the door and putting your keys in the shoes, and putting a post-it on the mirror saying your keys are in your shoes, and your shoes are in front of the door. These are ways of making sure that you can’t get to point B (out the door with your shoes on) without going through point A (getting your keys)
• Rewards – When you complete hard work doing things you don’t want to do, giving your brain a little reward helps a lot. I commonly recommend the following:
  • Sugar: Like one spoonful of ice cream.
  • Salt: Like a small bag of chips
  • Fat: Like ice cream or chips
  • Sex: Not literally in most cases. I mean a positive sensual experience, like a warm bath, rubbing your head, or listening to your favorite song.
  • Cash: Literally moving some cash from a “bank” to a “[Specific Anticipated] Reward” jar.
  • Video Games: Hey, it is fun to experience competence at discrete and achievable goals, and life gives us too damn few of those. Sometimes, we need to live it up.

The key to making rewards work is that they have to be experienced only when you get them as a reward. I know what you’re thinking, “So I only get to have ice cream as a reward?” No, but maybe only your favorite ice cream. It’s a negotiation; we’d talk and make it work for you.

How Does Talk Therapy Help Manage ADHD?

Section TL/DR: Only someone who understands how to treat ADHD knows how to write this much about it and then knows you are going to read the TL/DRs anyway. I’m cool about that and non-shaming.

If you scan back to the writing above, you’ll see many of the core elements of talk therapy for managing ADHD. The key elements are:

• Celebrate successes. ADHD loves a good cheerleader.
• Identifying the way ADHD causes problems for you.
• Trying to set management goals that could work for you.
• Then, because I understand how ADHD interferes with your ability to put that into action, we use time in the session to create the scaffolding so that your intention to make a change in the office goes with you out into the real world.
• Expect you to have ADHD, but don’t have it myself. One of the things that I love about working with people with ADHD is watching threads drop off their attention and me picking their attention up (without shame) and bringing them back.

Eventually, we get to a routine in the sessions. We’ve identified which of these management strategies you’re going to use, and we know how.

We review your core ADHD management strategies every session

For example, I might check in with a client every week on the same 5 things: Sleep, exercise, meds, structure, and that project at work. This means we don’t let ADHD distract you from constantly trying to manage these elements of your life.

Accepting Constant Construction and Destruction

Every other system for managing your ADHD, like Pomodoro, that ADHD workbook, the organizer, or that coach, has only told you a half-truth. The half-truth part is that they are great for managing ADHD. The false part is that they imply their system will work forever. The truth is that their system will only work for a little while.

Managing ADHD successfully in the long-term isn’t about finding the one right way to manage your ADHD.

Managing ADHD is about riding the ongoing waves of constructing management tools, watching them fall apart without shame, and then constructing new management tools with excitement.

Together, we surf the long-term waves of constructing your management strategies, watching them disintegrate, and then we create new ones. So, for a little while, you go to the new gym near your house, but then you stop going. No shame. That’s part of ADHD. First, let’s cancel your membership right now, before you forget. Then we focus on what is exciting you and what will help you exercise now. You want to try hot yoga? Awesome, until it isn’t. We focus on the core and let the contents change. [If you jumped down to read this section because you were in the structure section, go back up now and resume at the Micro Structures subsection]

Can Therapy Help Manage ADHD for Me?

Section TL/DR: Yes. Click here to work with me.

If you’re thinking you’d like to work with me for treatment of ADHD, click here and fill out my contact form before you forget.

You can read the rest of the resources here after you fill out the contact form.

What Are Some Resources for Managing ADHD?

Best books on ADHD:

• “ADHD 2.0: New Science and Essential Strategies for Thriving With Distraction—From Childhood Through Adulthood” by Hallowell and Ratey
• “The ADHD Field Guide for Adults” by Osborn and Gude.
• “The Couple’s Guide to Thriving with ADHD” by Melissa Orlov and Nancy Kohlenberger
• “The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps” by Melissa Orlov.

Best social media focused on helping ADHD:

• YouTube: @HowtoADHD.
• Instagram:
  • @drbotyler.
  • @neurodivergent_insights.
  • @catieosaurus.

FAQ

Q: Does therapy work for ADHD in adults?

A: Yes. When I do therapy like this, my clients’ lives, work performance, and relationships improve significantly. And, sometimes, we have to keep doing therapy because you still have ADHD and can use an external check. In those cases, I often decrease the frequency of sessions and sometimes even reduce the length to 25 minutes (down from 50 minutes). This helps me help you engage in the recreation of your management methods when they fall apart.

Q: What type of therapy works for ADHD?

A: This type of therapy is Cognitive Behavioral Therapy, with a heavy emphasis on the behavioral part of CBT. CBT is an effective therapy for a wide range of clinical issues, including ADHD, and research suggests that it increases the benefits of medication alone.

Q: Is therapy or medication better for ADHD?

A: To quote one article[3], “CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.” The lay translation is that therapy (specifically CBT, as I provide) is more effective with medication. In this study, after therapy ended, the benefits of therapy faded. Which is exactly why I sometimes do ongoing therapy for clients with ADHD, as I described in the answer to my first question.

YOU DID IT! YOU READ THE WHOLE THING! YAY!!!!

[1] Modesto-Lowe, V., Farahmand, P., Chaplin, M., & Sarro, L. (2015). Does mindfulness meditation improve attention in attention deficit hyperactivity disorder? World Journal of Psychiatry, 22, 5(4), 397-403. doi: 10.5498/wjp.v5.i4.397

[2] Kim, H.-H., Jung, N.-H. (2025). Mindfulness-based interventions for adults with ADHD: A systematic review and meta-analysis. Medicine, 104(37), e 44308. doi: 10.1097/MD.000000000004430

[3] Cherkasova MV, French LR, Syer CA, Cousins L, Galina H, Ahmadi-Kashani Y, Hechtman L. Efficacy of Cognitive Behavioral Therapy With and Without Medication for Adults With ADHD: A Randomized Clinical Trial. J Atten Disord. 2020 Apr;24(6):889-903. doi: 10.1177/1087054716671197.

With some regularity in my practice, partners of men bring him into couple therapy with the complaint, “He’s emotionally closed off” or “I don’t know what’s going on inside of him.” This is usually paired with the request, “I’d like you to help him open up.”

This makes sense. Many men are emotionally closed down. It isn’t just conservative men or men from strict religious backgrounds either. Plenty of men from progressive, educated, or upper-class backgrounds hide their feelings, too. This certainly damages the man’s relationships, especially his romantic or sexual relationships.

But with some regularity, something happens when the men I’m working with open their hearts for the first time in my office. The partner who had been begging for connection with his intimate and tender feelings responds with one of the following:

1. Criticism, “You shouldn’t feel that way,”

2. Evasion of responsibility, “I have a right to my feelings,” or

3. Dismissal, “Well, that’s not my fault.”

There’s a principle in relationship systems at play here, and we can learn a lot by examining this pattern.

Principle:

When a person grows emotionally, it will present a growth imperative to the people in their life.

This principle was in action in the first place. That’s what brought them to my office. When one partner drags the other into my office, it is because they have grown enough to stop tolerating an unsatisfying relationship or they have accepted they couldn’t make the change happen on their own. Their emotional growth brought a growth imperative to man in their life, “Open up your heart.”

And then he did. He grew. He found his feelings, and what he finds first is often pain: “I’ve felt criticized by you,” “You never create space for my feelings,”  or “You ask for emotional support, but when I ask for it, you emasculate me.” This complaint from him will often come out unskillfully because he isn’t used to sharing his big emotions. The partner may not be used to vulnerable complaints. So, they criticize, evade responsibility, or dismiss.

Radicalized manosphere influencers will take this process and declare, “Women say they want vulnerable men, but they don’t.” I cannot disagree more. In that moment, men who are opening up are like cave dwellers complaining that the sun is too bright. We’re at risk of withdrawing into the cave again, instead of acclimating to the light.

When you open up, two things may be true at the same time:

1. You need to learn how to give feedback in a skillful way that keeps your partner open to receiving it. AND
2. Your partner may need to develop the ability to tolerate your critique or the change in relationship dynamics.

This may not feel fair. You might feel like, “So, wait, you hurt me. That’s why I’m shut down. Yes, I’m having a hard time saying it kindly. That’s because I’ve been hurting for a long time. And now, you expect me to BOTH figure out how to feel AND figure out how to communicate my feelings gently at the same time?”  And you’re right, it is unfair.

It is also the way of things. When anyone does work, it seems that the only way to get others to keep relating to you and treat you with compassion is to process your pain with grace and gentleness. If you think about it, this is the same thing you needed earlier in your relationship. When your partner told you the things that closed you down, if they had said them more kindly and more gently, it would have been easier for you to keep your heart open.

On the other hand, if you don’t care about staying in the relationship, you can be as uninhibited in your anger as you like.

I’f you’d like to work with a therapist who understand men’s psychology and relationship dynamics like this, please consider contacting me.

If you’re looking for a podcast and you know you like my work, I encourage you to try one of these.

*** Three stars means this is one of my favorite episodes or something I highly recommend from this host.

All in Ya Head with Jamie Glick

Apple | Spotify. Release date: 2023/10/02. Description of the episode: This podcast episode was very casual. It was a lot like two bros talking about their relationships and consent over a beer.

***Change the Narrative with JD Fuller

Episode 1: Apple | Spotify |

Episode 2: Apple | Spotify | Website. Release date: 2023/10/13. Quotes from the episodes: “If there’s not something that you love, then you’re dangerous because if you don’t love something, then you don’t have any basis for empathy. Your pain comes because you are alive. Your pain comes because you love something. And if you can’t pay attention to and integrate that pain, you can’t mobilize your love.”

“It’s so important to understand that it’s a loss for men, and when they subscribe to a patriarchal culture as well.”

The Chill Factory with Jordan Friedman

Apple | Spotify | Website. Release date: 2023/11/26. Episode description: Losing sexual interest in a partner over time is very common and often stressful. It’s also true that non-monogamy or polyamory is a stress-reducing option for sexual frustration for a growing number of couples. Relationship and sex therapist Eric FitzMedrud talks with host Jordan Friedman about how to navigate the many questions and concerns for those considering it, including how to bring it up with a partner. Eric shares his own experiences with polyamory, discussing the pluses and minuses for him, his partners, and family.

***Expansive Intimacy with Jim Young

Apple | Spotify | Website | His book: Expansive Intimacy: How “Tough Guys Defeat Burnout”. Release date: 2023/09/28. Description of the show: Consent in the bedroom should be part of a larger cultural shift in the way we consider all of those around us, from our children to our co-workers. Eric explains the important step to keep fantasies from becoming obstacles to intimacy, body language cues that many partners overlook, and the best place to talk about consent.

Finding Brave with Kathy Caprino

Apple | Spotify | Website | Her Book: The Most Powerful You: 7 Bravery-Boosting Paths to Career Success. Release date: 2023/10/05. Description of the episode: Eric paints a clearer picture of consent-driven leadership, highlights some of the systemic barriers that hinder the creation and growth of a consent culture at work, and delves into the emotional responses that often make the word “no” so difficult to hear and accept, and what to do to shift that.

***Man Alive with Shana James

Apple | Spotify | Website | Her book: ***Honest Sex: A Passionate Path to Deepen Connection and Keep Relationships Alive***. Release date: 2023/10/12. Description of the episode: Six dimensions of wellness beyond sex, the difference between feeling love and skillfully delivering love, and what I mean when I invite men to “be a better a**hole.”

***Mistakes Were Made

Apple | Spotify. Release date: 2024/02/02. Episode description: In this podcast episode, Sarah and Alec asked me to turn on my man-translator capacities to decode difficulties often experienced when dating men. I ended up offering a number of scripts for men on what to say when you don’t know what to say.

The Orgasmic Lifestyle with Venus O’Hara

Apple | Spotify. Release date: 2023/08/15 Description of the show: I’m here to welcome you into the world of Orgasmic Living by hosting experts to discuss orgasmic topics such as nutrition, spirituality, personal development, sexuality, and more.

Playing with Fire with Joli Hamilton

Apple | Spotify | ***Coaching for Mono Folks Opening Up***. Release Date: 2024/03/02. Podcast Episode Description: No man can—or should—live up to the 2-dimensional, patriarchal image of what a man is supposed to be. So many people know that, but when we’re faced with difficult situations, it’s easy to slip back into outdated gender roles. In this episode, we’re digging into how you can develop the emotional skills you need to navigate these relationship challenges with more nuance and integrity.

Psychology Is with Nick Fortino

Apple | Spotify | YouTube. Release date: 2023/09/15. Description of the episode: The importance of men’s understanding of consent is at the forefront of this conversation.

The School of Wonder with Andrea Sher

Apple | Spotify | Her book: Wonder Seeker: 52 Ways to Wake up your Creativity and Find Your Joy. Description of the episode: We share with the audience the touching story of how we met. We also highlight the value and need in the world for the love in men’s hearts.

Securing Sexuality with Stephanie and Wolf Goerlich

Apple | Spotify | Website | ***Her books***. Description of the episode: This week, author Eric FitzMedrud is here to join Wolf & Stef in these conversations. Listen in as they chat about the evolution of masculinity, consent for men, what Ted Lasso can teach us about ethical tech, and what it means to be The Better Man today.

The Selfish Gift with Maggie Langrick

Apple | Spotify | Website. Description of the episode: ***If you are an author***, or interested in writing a nonfiction book to serve the world, then this episode is for you. It includes: 1) How Eric overcame his fear of writing the book—how he navigated processing his own errors around consent to honor those he has hurt in the past, and the rigorous vetting process he used to make sure they were okay with their stories being included. 2) His take on book promotion and being a public figure—and how being on social media and doing podcast interviews has made him more confident in his message.

Sex & Psychology with Justin Lehmiller

Episode 229: Apple | Spotify

Episode 300: Apple | Spotify | Website | His book: ***Tell Me What You Want: The Science of Sexual Desire and How It Can Help you Improve Your Sex Life*** [especially recommended for sex therapists]. Some questions discussed in the episodes: How does media depiction of consent line up with reality? What are some common things people get wrong about the influence of testosterone on sexuality? How can men eliminate sexual shame and reclaim their sexuality? How can you obtain consent without taking the excitement out of sex? What is the three-step consent process?

***Sexology with Dr. Moali

Apple | Spotify | Website. Release date: 2023/09/26. Description of the episode: A very informative episode, including examining the concept of sexual desire as a basic need, debunking common misconceptions surrounding love and intimacy, deliberate approaches to maintaining intimacy in long-term relationships, and more.

***Sidewalk Talk with Traci Ruble

Apple | Spotify | Website. Release date: 2023/09/19. Description of the episode: Traci feels so strongly about the potential of this book to radically alter sex from a pressure tug-of-war between partners to something magical. Dr. Fitz underscores the importance of men reconnecting with their tender hearts and nurturing authentic relationships. . . . The conversation takes an intriguing turn as they discuss the potential conflict between tenderness and sexiness. Dr. Fitz illuminates how embracing tenderness can create safety within relationships and enhance intense sexual experiences.

The Trouble with Sex with Dr. Tammy Nelson

Apple | Spotify | **Integrative Sex Therapy Institute [for Therapists]*** | Her books. Release date: 2024/01/08. Episode Description: Dr. Tammy talks with therapist and author Eric FitzMedrud about consent, modern masculinities, sex, and how to be a ‘Better Man’ to build more fulfilling relationships.

Untying Knots: Minds and Souls Untethered with Perry Clark

Apple | Spotify | ***Website for his therapy practice***. Release date: 2023/10/16. Description of the episode: We talk about connection, repression, trauma, and play. We also touch on myths and realities around mental health.

Vaginas, Vulvas, and Vibrators with Jordan D’Nelle

Apple | Spotify | Website. Release date: 2023/01/11. Episode description: The responsibility of asking for and giving consent is shared! Dr. Eric Fitzmedrud joins us for a thought-provoking discussion about the importance of ENTHUSIASTIC consent. We talk about how enthusiastic consent is different from traditional consent as well as how the roles in consent are not one-sided!

More episodes coming soon!

Here are links for more about my book or my services

How I Get to a Mental Health Diagnosis

Diagnosis in Context and Diversity

The Relationship, Not the Diagnosis, Is Freeing or Stigmatizing

I’ve already heard couples complain:

“I can’t believe we’ve only been quarantined for two days and I already can’t stand being with my partner.”

“I’m glad that we’re together, but we’ve been so distant for so long that I’m not sure what this is going to be like.”

“Either being quarantined together is going to bring us together or finally break us apart.”

Extreme circumstances try a relationship—it’s normal. With little notice, you’ve been thrust together for at least the next few weeks. The external circumstance is uncertain and many of the things that make being a couple challenging are likely to come up. Anxieties about money may cause conflicts about how to manage it. Children with cabin fever may expose cracks in your parenting team. Boredom is the best aphrodisiac but simmering resentments and different desires about sexuality may also come bubbling to the surface.

In abnormal times such as these, couples may go through all of these challenges—again, it’s normal. In this post, I’m going to offer a step-by-step guide for trying to turn your relationship from being another shelter-in-place stressor to one of the bright sides of having some time together.

Align the Vision and Create a Routine

Your usual way of doing things isn’t going to work now. No two people will have the same ideas about how to cope with this circumstance. You need to sit down together (just the adults, no kids) and identify what your goals are for this period of time. Common goals might include making sure that the kids maintain their educational progress, maintain an environment that allows you to work from home, reducing expenses, having time for you as a couple, or getting to some long-delayed hobbies or projects.

Identify some ideas about how to spend this time cooped up together, and/or goals that you both have, and then identify how to meet as many of these as possible. Make sure that you have time together and apart, time that is structured (like work), and free time for things like playing games and hobbies. Put a tentative weekly calendar on the fridge. If at all possible, as you align the vision, try to avoid win-lose decision-making processes that pit one person’s goals against another’s. Your couple and your family will function better if your schedule represents a diversity of values.

Vent the Frustrations and Cultivate Gratitude

Usually, when I teach couples this I invite them to use a tool I call “15-15”. Two times in a week set aside fifteen minutes for the two of you as a couple. One of those fifteen-minute periods is for venting frustrations. Divide the time in half so that you each have seven-and-a-half minutes each. Then, as kindly and respectfully as possible, identify what hasn’t worked for you since the last time you had a chance to vent. The other person doesn’t rebut or defend, they just listen in respectful silence. When the seven-and-a-half minutes is over, switch and allow the other person to express their frustrations. At the end of the time, you may keep talking, take time to yourself, or just go about life as usual. The goal of the venting is to prevent little things from building up and becoming bigger issues.

In the other fifteen-minute period, usually on a different day, you express appreciation for your partner. Again, you take turns of seven-and-a-half minutes each while your partner sits in respectful silence. It tends to feel pretty good to hear good things for those minutes.

Usually, I recommend couples do each of these check-in sessions once a week. Cooped up with COVID-19, you may find that you need to maintain more communication about what is and isn’t working. Don’t be afraid to increase the frequency as long as doing so is serving both of you.

If you’re a family with children or elders, I’d recommend creating some kind of family check-in. Some families do a “roses and thorns” check-in over dinner where you go around the table and each person says the best and worst part of their day. In my family, we do “high, low, silly, and gratitude”— that is, the best thing, the worst thing, something funny or amusing, and thanks to someone specific and what they did for you that you appreciate. A more formal family meeting with an agenda, problem-solving, and follow up is also possible, but even during this time of being cooped up that probably isn’t needed every day.

Identify the Bigger Couples Issues and Resolve Them

If you and your partner have a high conflict pattern, lack of sexual connection, hurts, or resentments from the past, those pains may be difficult to just push aside. Now is a great time to pick up a book for couples and try to do the work to solve those problems together. Here are some good books to read together to try to help you through:

• “Hold Me Tight: Seven Conversations for a Lifetime of Love,” by Sue Johnson
• “The New Rules of Marriage: What You Need to Know to Make Love Work,” by Terry Real.
• “Come as You Are: The Surprising Science that Will Transform Your Sex Life,” by Emily Nagoski
• “The Seven Principles for Making Marriage Work: A Practical Guide from the Country’s Foremost Relationship Expert,” by John Gottman and Nan Silver.
• “No More Fighting: The Relationship Book for Couples: 20 Minutes a Week to a Strong Relationship,” by Alicia Muñoz.

If you’re concerned about book costs, check your local library. There may be free digital downloads available through your library account. For working your way through old hurts, I highly recommend Sue Johnson’s, “Hold Me Tight,” Conversation 5: Forgiving Injuries.

A couple’s therapist can also help. During this time, many therapists are using telemedicine to provide their services. It may seem a little odd to think about using video conferencing for therapy, but many therapists and clients all over the country in remote areas have been using this method effectively for years. I haven’t been doing telemedicine for long, but I’m already seeing that the same kinds of touching, conflict resolving, and heart-opening transformations can happen via telemedicine as I’m used to seeing in my office.

May you, your relationship, your loved ones, and your community all be well during this difficult time. Remember to be kind, respectful, and do what you can to make this easier on the people who are stuck with you for the next few weeks.

It is a common complaint, and not just in heterosexual couples. I hear one partner complain that he watches porn when the partner wants to have sex. It can be hard to understand, so I decided to write a post to help people make sense of this common behavior.

This is my fifth in my How Sexuality Works series. Prior entries can be found at the links below:

• Sexuality Is a River
• What is Erotic and Why? Part I
• What is Erotic and Why? Part II
• Are We Sexually Compatible

Nature is efficient. Water flows in the direction of least resistance. Organisms of all kinds will adapt to their environment to conserve energy. This shows up in the sex and mating of animal species, like larger testicles and more sperm when there is more sexual competition among a species, but small testicles and less sperm when there is less sexual competition. When we get to humans, these principles apply too. This is one take on human sexual efficiency.

There’s a lot of concern about pornography among my clients. Many come in self-diagnosed or armchair diagnosed by their partners as “sex addicts” because of their masturbation and pornography viewing habits. I’ve written other blog entries (here and here) about the problems with the concept of porn addiction. Several professional organizations have come out formally against “sex addiction treatment,” including this statement from the American Association of Sex Educators, Counselors, and Therapists, of which I am a member. I also want to acknowledge that while I’ve gendered the title of this entry, men aren’t the only ones who watch porn. However, concerns about males viewing porn are orders of magnitude higher in frequency, and so I titled this post to catch that interest.

Why do some people like pornography so much?

There are some simple answers to this question. But I’ve found they don’t calm fears in concerned clients and their partners. Those answers include, “because it is pleasurable” or “because men are more visually focused, they prefer images and videos over written material”. The one answer that does seem to cultivate some compassion through understanding is this: Porn is easy to watch.

Sex, especially with a long-term partner, may include negotiation, interpersonal communication, effort to connect, associated thoughts, conversation, and experiences related to the stressors of running and maintaining a household and/or family, as well as the clean-up, cuddling, and aftercare with that partner. This is all great stuff. It is the raw material of intimacy and long-term connection. It is wonderful that sex can bond us with a partner through all of these aspects in just one encounter. But arousal and orgasm are so amazing that they have many more capacities than only strengthening the relationship.

A partner using porn alone for arousal and masturbation might be seeking a natural stress reliever, a natural sleep aid, a natural pick me up with fewer side effects than coffee, the opportunity to passively appreciate beauty, a fantasy of being desired (or many other kinds of fantasy), an erotic boost to bring into the relationship at another time, or any of the many other positive benefits that masturbation and fantasy might provide. He watched porn because it brings the promise of all of these.

But isn’t porn or masturbation like this a problem?

Like any coping skill, if it is the only one you’ve got, then having a limited set of coping tools might be a problem, but that doesn’t make the one coping skill a problem. The problem is the limited set of coping tools.

If the person lacks the ability to connect to their partner, and that kind of emotional connection is one of the relationship agreements, then yes, that’s a problem. But take note, nothing in that sentence says anything about pornography.

Here’s a tricky objection that I hear fairly often: “If my partner is watching porn and not bringing that erotic energy to me, then I’m not okay with that. If they were watching porn and still interested in me, I’d be okay with it.” In this case, the aggrieved partner sees pornography as taking something away from them that they desire very deeply. They see porn as getting in the way of their relationship needs being met. Almost every time, though, as I dig deeper into the couple’s lives and learn more, there’s a deeper issue at play, but it is hard to see. That is, there’s an imbalance in the ecology of the relationship. He watches porn because it is easier to do than have partnered sex. That requires a little explanation.

Water Seeks the Lowest Point

There is an ecology at play in our sexual lives. The water in a river seeks the lowest point. If we’re talking about the path of sexual interest as a river, then pornography offers a very low path. That is, very little energy is required for a person to find a conduit for sexual arousal through pornography. So if partnered sex is desired instead of pornography, there are three solutions. First, you could lower the energy investment required for partnered sex. You might tell your partner, “I’ll get a towel for the wet spot and take care of it later so you don’t have to” or “Let’s just go have quick hot sex and not worry about anything else going on for us for 10 minutes!” The erotic energy, like water, will flow in the direction of least resistance.

Second, try eliminating drains on energy for the relationship. If you and your partner have a history of criticism, contempt, defensiveness, and stonewalling (Gottman’s Four Horsemen of the Apocalypse), then having sex means getting enough arousal to get past those painful experiences. That requires a lot of erotic energy. Healing those communication patterns and becoming more generally loving and kind with each other will create a more conducive atmosphere for sex between the couple. Even then, individuals need enough water in the river of their arousal to get there.

Third, increase the water level of the river. Though some people experience an increase in sexual desire frequency under pressure, more people experience a decrease in sexual desire in light of stress. Stress diverts some of the energy we have for eroticism away. In the analogy, there is less water in our river. Sometimes, this depletes a person so much that they have nothing left for partnered sex. The little additional trickle of arousal created by a stimulating image or video can help a person access their sexuality enough to get the benefits of stress relief in masturbation but not enough to replenish their energy for partnered sex. Managing energy resources by working less, exercising more, eating right, sleeping more, reducing commitments, and taking care of yourself better can help if you have the capacity to make those changes.

In order for a person to have the water in their river so their eroticism can feed both the pornography watching branch and the partnered sex branch, they need to have enough energy and vitality left over so their energy can flow past the lowest point of porn to reach downriver and spill into the potential for partnered sex.

Practical Application

Does the person who watches porn work more than full-time? Most people have more energy and attention for partnered sex when they work less.

Does the person watching porn take care of household duties for other people often? We are often less ready for partnered sex when we’re overwhelmed with taking care of others.

How much verbal processing, interpersonal processing, negotiation, or planning does the person have to do on a daily basis? Often, people in cognitively or interpersonally demanding jobs feel too exhausted to use those skills at the end of the day. Can you work out simplified or gentle sexual invitation, acceptance, and consent negotiations to ease the process? Can you identify when the times for low demand at work are and coordinate partnered sexual time for those periods?

If These Ideas Don’t Apply to Your Situation

There may be some other situations that cause the barrier to partnered sex, too. First, if there are mental health issues like depression, ADHD, or OCD, these may play a factor in why he watches porn or does not engage with his partner. Treatment for that underlying mental health challenge may change the behavior, and because of that, porn isn’t the problem; the mental health is the problem. Second, sometimes even when there is adequate time and energy for sex, no interpersonal problems, a person might still pursue the easiest course of action. Porn is still easier to look at. In those cases, consider increasing the challenge to view pornography in non-shaming ways. For example, create an impossibly complex password on the internet router and then keep that password inside a difficult-to-access part of the home, like a box high up in a closet. If the person wanting to view pornography has to work to get access to it, they may find that today it would be easier to hit on their partner instead.

Just keep in mind, the problem isn’t pornography. In order for me not to eat a whole bag of chips, I need to do something like this, too. I keep the chips in the cupboard, and if I want some, I have to put a predetermined amount in a bowl, then put the bag back in the cupboard. Chips aren’t the problem. I’m just naturally inclined to eat fats, salts, and sugars as much as I can for evolutionary reasons. Since I have ready access to them, if I want to stay healthy, I need to limit how many I eat. Since we’re also inclined to preserve energy, a little inconvenience can go a long way to discourage unhealthy behaviors.

If this section still doesn’t cover your situation, reach out by writing a comment or sending me an email. I’d be curious to know what I’ve missed.

Conclusion

Rather than looking at pornography as an easy source of shame or blame, notice the ecology of the watershed for your sexual river and try to figure out how to get more water into that river in the first place. The energy we have for eroticism can only be used for eroticism after the other necessary needs are met. Our energy is a limited resource. We need to manage our lives well in order to preserve energy for watering the flowers in the fields downstream.

• Sexuality Is a River
• What is Erotic and Why? Part I
• What is Erotic and Why? Part II

How Can We Talk About Our Desire Differences?

At the beginning of a relationship, the question of sexual compatibility is an exciting one to explore as anticipation mingles with the newness of the relationship. You wonder if this new person could fulfill all of your wildest fantasies. In a long-term relationship, you may approach the question with feelings of dread. What if you aren’t compatible? What do we do then?

I’m going to use the metaphor of a river again to present a tool for opening a conversation about sexual compatibility with nuance that goes beyond a simple “yes” or “no” answer. First, I’m going to invite you to identify the sexual behaviors and interests you do and don’t have. Before you can identify whether you and your partner are compatible, you each need to understand your own sexuality. Second, I’m going to present you with a way to compare your sexual interests with your partner’s. So, print off the Sexual Compatibility Record (.pdf here), give one sheet to your partner and keep one for yourself, and read this entry and fill out the sheet. This is an interactive blog entry.

Your Sexual Compatibility Topography

Essential Sexuality (Dark Blue)

The first task is to identify the essential elements of your sexuality and write those down in the dark blue Essential Sexuality section. Don’t make this just the bare minimum that would prevent you from depression. Do identify what behaviors or partners make you feel like your sexual expression is full and complete.

Some Elements to Consider:

• Sexual Orientation: Most people cannot be healthy and happy if they are not able to find a way to express their sexual orientation. If that fits your experience, write it down in the Essential Sexuality column.
• Love: You may need a loving relationship with your sexual partner, and without that, even if they are doing all the right sexual things, the sex would feel stale. Write that down.
• Sexual Frequency: Maybe if you have sex less than once a month, you feel like something is dying inside of you. Write that down.
• Kinks: For many people, there are certain kink dynamics, roles, or practices that feel as essential to them as a sexual orientation.
• Relationship Styles: For some people, monogamy is essential. For others, there are non-monogamous relationship forms that are important.

The only caution I have is that if you are considering putting something here that you are also ashamed of, you may have a different experience of the central nature of that desire if you ever remove that shame. It may feel less essential without shame supercharging the eroticism.

Good for Vibrancy (Light Blue)

Many people have sexual fantasies, desires, positions, roles, or partners that they enjoy but which they don’t feel are essential. Maybe a dominant partner feels essential, but spankings are a bonus. Maybe a loving relationship is essential, and romantic words would be gravy, but not necessary. Write down anything that feels like a joyful abundance on top of an already full and vibrant sexual life.

Interested but Unnecessary (Dark Green)

Beyond the joyful abundance of the prior category, there may be a group of sexual behaviors that you aren’t quite sure what to think about, but you’d like to try. Whether this is a sexual position that looks compelling if you could just get your ankle to the right place, or that toy at the adult store that you keep thinking about with curiosity, “What does that feel like?” This category is probably the one that is the easiest to change. When you try something, and you like that experience, the sexual behavior will probably go into one of the earlier categories; if you don’t like it, the behavior may land in a category below.

Uninterested but Willing (Light Green)

There’s a great set of scenes in the movie “Analyze That” where Billy Crystal’s character, a therapist, is working with a couple. The man wants the woman to do some sexual-cowboy roleplaying because it turns him on. At the end of the movie, Billy Crystal says something like, “What’s the big deal? You put on the hat and the chaps and give it a try. It isn’t going to kill you.” This is the category of things that just don’t do much for you sexually. Though they aren’t a turn-on, if a partner was really into it, you could be a good sport, be generous, and do that for them.

Unwilling (Brown)

This is the category for sexual behaviors that you do not want to do. It might include words you don’t want to use or to be used for you, as well as positions that would hurt, things an old lover did that you now have bad associations with, or things that are just on your “no” list because that’s how you work.

Squick (Black)

The term “squick” comes from the BDSM community and refers to sexual interests or behaviors that gross you out or give you the creeps. This category is for behaviors that generate that feeling in you. This category is not a way for you to shame your partner for their interests. It is a subjective experience. When someone has a squicked-out reaction, it is probably hard to even have a discussion about the possibility of bringing it into your sex life together. If one partner squicks to another’s essential sexuality, the squicked partner probably doesn’t want to hear about that interest.

Compare For Sexual Compatibility

Now that both partners have filled out their own sheets, sit together and put Partner 1’s sheet on the left and Partner 2’s sheet on the right so the two dark blue “Essential Sexuality” columns are next to each other. You might want to note which sexual interests are on your partner’s sheet but not on yours, and then add that interest to your sheet in whichever column it fits for your interests. What I want you to do now is to imagine that you are looking at a topographical map of a river valley from the air. The two dark blue columns are the river’s baseline level. If the river doesn’t fill this river bed, there’s a bit of a drought in the sexual relationship. If the river is full, like the spring flow of a river, it will reach the light blue areas. In that case, there is a lot of erotic water in the river for nourishing the members of the couple in this case, and gratitude and abundance result. Sometimes, a couple might be able to foray into the “interested but unnecessary” dark green territory, like a river that branches out and supports copses of trees and forests. Maybe in very good times, a couple is even able to explore areas of “uninterested but willing” like branches of a river that reach all the way to plains and fields. But if the river is flooding the “unwilling” or “squick” areas of the map, there will be difficulty living in harmony with the river. Many times, sexual conflicts between couples come when one member is trying to push their partner into that brown or black territory, and they haven’t understood that their partner is different from them sexually. Your partner is always very different from you sexually because our sexuality is so unique.

Difference, Sexual Compatibility, and Incompatibility

Keep in mind that the two sides of the river valley for any couple almost certainly aren’t the same. One person’s side might get more easily flooded, the other person’s is harder to fill up. One person’s dark blue “essential sexuality” could be enough to flood the green areas of the other partner. Conversely, one person’s “good for vibrancy” might not be enough to fill the other partner’s “essential sexuality” river basin. But an apparent difference does not equal incompatibility. In fact, I can’t imagine any two people having the same map.

There’s good news if you are seeing differences when looking at these two maps. The first is that you have been honest enough to share the truth of the differences. The second is that you may begin seeing the adaptability of sexuality as you talk. One person might say, “Well, I did list that as essential, but actually, I’ve done fine without it for years. I guess it really is just ‘good for vibrancy’”. The other partner might say, “Oh, wow, I didn’t know that sexual behavior was so important to you. I’d like to talk about it more. I know that I put it under ‘unwilling,’ but now that I know how important it is to you, I guess I can at least learn more about it. Maybe in time I can shift it to ‘willing but uninterested’ or even more.” Maybe you work out a kind of seasonal flooding agreement where something special to one partner in the essential sexuality column gets filled on a birthday as the other partner allows the erotic waters of the couple to reach their “uninterested but willing” plains.

There’s even more good news: these sexual topographies can and often do change across the lifespan. Whether we’re talking about sexual orientation fluidity as identified by Lisa Diamond (link to her book) and others, or the way that experience and aging change our interests, you need not view either your own or your partner’s map as a fixed given. If you want to have a conversation about it, especially if you are interested in finding out whether it might be possible to shift something for your partner from a brown or black column to another, I recommend a simple process. Start by separating any actual or potential sexual activity from the discussion. So, maybe at a coffee shop or in the dining room alone, you ask, “Hey, I was wondering if I could ask you some questions about your ‘unwilling’ category from the sexual compatibility exercise we did. Would that be alright?” Then you try to do some active listening to understand more about the reason the behavior is there. Was there a bad experience with it in the past? Does your partner not understand something about it? Then, rather than shifting from listening to becoming a sudden apologist and advocate for the behavior(s) in question, ask if they have any willingness to change the category of that behavior. If yes, then ask how they would like to go about the process and if you could help or participate. Maybe somewhere in the conversation, you find a place to identify why you are asking by pointing out that it would mean a lot to you because that behavior is “good for vibrancy” for you, and then restate your desire to respect their boundaries and needs about it. Remember, it is a conversation. A dialogue. Not an opportunity to harangue your partner into giving up their sexual boundaries.

In the end, maybe the title of this post is a little deceptive. This tool doesn’t tell you whether you and a partner are sexually compatible or not. It is really a conversation starter. With this tool, you can find the inevitable differences between your sexual topographies and begin to figure out how to consciously direct and navigate the sexual energy in your relationship, the flow of the water in your collective river, to create compatibility.

Now that you have your maps, do you feel like you could use some help bridging the differences in your erotic maps? If you live in California, contact me. Otherwise, you can find referrals in your state here.