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Making the decision to consult with a sex therapist is a difficult one for anybody.  People would want to be sure that the therapist wouldn’t judge them for their sexual likes or dislikes, nor be disparaging or dismissive of their sexual problems.  In essence, almost everyone needs to find a therapist with whom they can feel safe, understood, and who can help them.

For gay men, the choice is usually simple.  They would want help from someone who understands them from the inside out.  Someone who has had experiences similar to their own, and knows first-hand the struggles they deal with on a daily basis.  And who better than another gay man to help them overcome their sexual difficulties and concerns. 

Logic would seem to hold that people who consider themselves “straight” would likewise be best served by a sex therapist who also identified as straight. Yet the surprising truth is that many straight people, both as an individual and as a couple wind up getting the best results resolving their sexual concerns by seeing a gay sex therapist.

Here are just some of the reasons a certified sex therapist who identifies as gay might be just be the perfect fit for heterosexuals looking for help with sexual problems:

1. Heterosexual woman often feel safest discussing their sexual concerns without the fear that the therapist is aroused or is somehow “getting off” on hearing the details of their sexual lives.  In our society, typically a man wouldn’t be asking a woman about what she likes to do sexually, or her fantasies, or her difficulties unless he were interested in having a sexual involvement with her.  So many heterosexual women simply don’t feel comfortable discussing these things with a straight man, no matter what is credentials nor level of training.
   
2. Heterosexual men have their own concerns when it comes to sex therapy.  In our society men traditionally are competitive with each other for a women’s sexual attention, and the admission of sexual of not preforming in a manner that would satisfy any woman, is not typically comfortable for a straight man.  When consulting with a gay male certified sex therapist the man has the comfort of being with someone who would not be interested in his female partner sexually, so there is no sense of competition.  This is often a big relief to the guys who might otherwise be too uncomfortable with the sex therapist to take full advantage of the sex therapy.
   
3. Often when people decide to come for sex therapy, the feel bad about on some level about their sexual interests or functioning.  Almost all gay men growing up in our society have had to come to terms with such feelings.  They have been fed so many negative images of people who share their interests.  For this reason it is easy for a competent gay sex therapist to fully understand how your sexual interests or functioning may make you feel like an outlier, or like someone who just doesn’t fit in.
   
4. Similarly, gay man know firsthand about fearing rejection because their sexual interests differ from the norm, or societal expectations.  Many people who believe that the things they like to do sexually or are interested in are not common, may shy away from involvements for fear that they will be rejected.  Having come to terms with precisely such issues, a competent certified gay sex therapist will be able to know exactly where you are coming from, and easily understand the fears.  He will be able to help you find ways to conquer these fears so that you might go ahead and enjoy you sexuality with others without fearing rejection.
   
5. Many people who seek sex therapy do so because of worries about their ability to perform  By definition, gay men growing up in a society where heterosexuality is the norm feared that they would find themselves in a sexual situation in which they were expected to perform but simply couldn’t.  Who better than someone who has experienced that worry themselves to help to overcome your concerns about being able to perform sexually?
   
6. Many people who seek sex therapy worry that their sexual interests aren’t “normal.”  Perhaps they are into some form of kink, or have a particular “fetish” or must engage in a very specific fantasy to have sexual enjoyment.  Here we have two pieces of good news.
   
   The first is that many sexual interests which have been long considered rare or pathological, according to research by Dr. Ogi Ogas (A Billion Wicked Thoughts) are far more common than had been thought.  And more recent understandings of variations in sexual interests are no longer considered an expression of psychopathology.  Like those of you who have worried that there is something “disturbed” about your kinks and fetishes, most gay men grew up believing that their sexual interests and responses where pathological in some way.  This can create a significant obstacle to sexual enjoyment and fulfillment. 
   
   A gay certified sex therapist is almost always the best person to help with overcoming the negative effects of feeling stigmatized. And can help you achieve more comfort with your sexuality without the fear of judgement.
   
7. Not everyone is in sexually monogamous relationships.  While some people prefer sexual exclusivity, there are many different patterns of sexual partnerships.  Often people will worry that a therapist, especially a heterosexual therapist, will try to push them into sexual exclusivity as the best outcome. 
   
   My doctoral project examined the question of whether being in a sexually exclusive relationship is a sign of mental health.  At least among gay men it is not.  My subjects were as likely to show signs of mental health or mental illness regardless of sexual partnership style. Historically gay men had avoided pair bonding as it made them the objects of ridicule, and often seem far more accepting of non-sexually exclusive relationships than their heterosexual counterparts. 
   
   So if your sexual relationships involve anything beyond sexual exclusivity, you are probably going to find a gay certified sex therapist comfortable with what works for you as opposed to what you “should” be doing.

To sum up, while a good clinical psychologist with certification as a sex therapist is qualified to provide quality sex therapy, many heterosexuals find themselves much more comfortable working on their sexual issues with a gay therapist.

Sexual tastes and appetites vary enormously from person to person, just as tastes in foods do. Someone might love for example the flavorful and intricately spiced foods of Southeast Asia, while their partner might be happier with the relatively unseasoned foods of Northern Europe.

Sexual appetites are not much different and a common concern when two people meet is that they fear that they are “sexually incompatible” because one partner savors and delights in a particular kink or fetish, which simply does not appeal to their partner. While this seems to most like an insurmountable problem, my experience is that of the many sexual worries and complaints that people come to my office asking for help with, this actually is among the simplest to fix, and the results might surprise and delight you.

Ronny and Mike came to see me after dating for about a year…

They told me how they had met at a club, enjoyed their first few dates with each other. They immediately liked each other very much, and felt a strong physical attraction. Yet when they started having sex with each other they both described it as “Okay.” but that it lacked the passion and fire that they had hoped would be there. Early in the relationship, the times they had sex together dwindled and neither really looked forward to it. Both Ronny and Mike were sad because they really wanted to feel “hot” for each other, and actually said that they loved each other, but it was just not being reflected in their sex life.

Ronny began to feel bad about herself and was wondering how she could make herself more sexually appealing to Mike. Finally Mike told her that he didn’t want to mention it, because he was afraid of Ronny rejecting him, but he had hidden from her the embarrassing fact that that women’s feet are an enormous turn on to him, and that in fact the day that he met Ronny, she was wearing sandals and he immediately started to fantasize about how sexy it would feel to him if she would let him kiss and admire her feet, and in fact he became practically orgasmic at the thought of her stepping on his face with her bare feet will he kissed them.

Mike tried early on in the relationship to test the waters and during foreplay once said: “Want me to kiss your feet?” Ronny giggled and said “Eeeww, no my feet stink.” and without giving it much thought, they continued. Mike on the other hand, made a mental note never to bring that up again.

While the specifics of Mike’s love for women’s feet, and the fact that it held less than zero interest for Ronny, you can substitute any kink or fetish that one partner may have that is in no way shared by the other. What Ronny and Mike did that turned their dull sex life into the passion they both craved can be followed by any couple in a similar type of situation. It will require a little bit of patience, and plenty of practice (but that can be a lot of fun too) and the pay-off is well worth it.

Perhaps the most important thing to begin is to calm your fears.

Mike was ashamed and worried that Ronny would consider him a “freak.” Yet by simply talking with your partner about what turns you on, the kink moves from the world of the shameful to the matter of fact, no different than some people spicy food, and some like it blander. So Mike telling Ronny about his fetish was an extremely important first step, and to the best of your ability this should be without judgment.

Ronny actually had a bit more to do. She had accepted that while it didn’t interest her, Mike’s fetish was no sign of a sexual disturbance, but simply a favorite taste of his. Also, her self-respect as a woman made her question whether she was being true to herself if she were to give into a man’s sexual fantasies that she didn’t share. This is an important concern, and it is best to keep in mind as they did, that doing something for a lover that pleases them is in no way giving up one’s right to choose, as long as no one is being coercive. Just like going to an Indian restaurant because your partner loves the food, is not giving up your freedom to choose, it is going along with something because it makes someone you care about happy.

And the last piece that took Ronny a bit to work out was that it felt to her that Mike’s interest in her feet detracted from his overall attraction to her, both in terms of her body and as a person. Once she appreciated that it in no way detracted from Mike’s overall interest in her, but rather a specific thing that he particularly liked, it was much easier for her.

Once Ronny and Mike had gotten past these obstacles, they were ready to start putting things into practice!

The important thing for Ronny to remember was that it was fine that Mike’s interest didn’t turn her on. And with that attitude she became willing to let Mike do as he played, and accommodated his wish to have her put her foot on his face. Uncomfortable at first, it soon felt fine to Ronny and she noticed that nothing bad happened. Further to her surprise and delight, Mike soon became the passionate lover she wanted. He was not only excited by playing with her feet, but felt so appreciative and his affection while having sex with her increased intensely, as she had always hoped.

But the most surprising result to the two of them, and this is how it almost always unfolds, she began to get excited by how she was able to turn him on, and began to love looking forward to sex with Mike. At the end of the day, they had not lost anything and expanded their sexual repertoire.

I often follow up with patients after the sex therapy is complete. Ronny and Mike stopped in to the office and told me that overall they have become much more adventurous sexually with each other, and are very content. With a smile, Ronny told me that Mike gives her a pedicure every two weeks and she thinks other women should be envious.

To learn more about my services, please click the tabs above and reach out when you’re ready to speak on the phone about how we might be able to work together. You can reach me directly at 212-242-2219.

Don’t let this happen to you! My friend and neighbor Jimmy rang my bell some time back and was in tears. His wife, and mother of his children had just told him that she wanted to separate. He was shocked because he hadn’t imagined that she was so unhappy in the marriage.

“Baby”, he said, “What’s wrong? Whatever it is I’m sure we can work it out. I’ll ask our friend Eli if he could recommend a couples’ counselor.” Her response was firm. “The problem Jimmy is that I can’t stand looking at you face another minute.” Truth is there were some explicatives in her remark, but you get the idea that she had had it; she was done and was not turning back.

I wish that I could say that this was a unique story, but I’ve heard it before. Another friend of mine only found out about his wife’s complaints about him in the divorce papers! He was not particularly aggressive in his career, while she was. As far as he knew they had had a happy arrangement in which she was the major breadwinner and he contributed some to the family income. It had never been mentioned that she resented working so hard, and wanted him to contribute more to the family’s income.

While these examples are fairly extreme, they illustrate one of the most basic problems that couples encounter and can put a relationship into danger of falling apart. Specifically, that is poor communication which can undermine the most loving relationships.

Ironically some of the very things that people do hoping to improve a relationship, backfire. There may be lots of things that they feel or think about, but never utter because they worry about hurting their partner’s feelings, or don’t want to get into an argument. Or perhaps even more common, one or both of you feels dissatisfied but can’t quite put your finger on what is bothering you.

Perhaps the most common sign that you would benefit from couples’ counseling is the experience that you’re getting into arguments with your partner over “stupid things.”

People frequently come in saying that they’ve been arguing but they both agree that the argument seems to be over something trivial, yet the feelings were strong. This almost always indicates that the couple is either not aware of what is actually bothering them, or if they do have some awareness of what is bothering them, they haven’t found a way to express it.

This is essentially a communication problem.

A skilled couple’s therapist can guide you through this by helping you open the lines of communication and sharing your feelings with your partner. In fact, it almost always winds up being a huge relief to both partners.
I recently worked with a couple who constantly argued about their dog. He had more available time than she did and would frequently take the dog on errands with him. The dog apparently quite adorable, was always attracting people’s attention. They both agreed that the dog needed lots of exercise, but it would just infuriate her to hear about or see on Facebook posts of her partner out with the dog.

The arguments would usually go along the lines of her saying that he knows that she is going to take the dog out for an hour long walk when she gets home, so he didn’t have to take the dog with him on errands. This was in spite of the fact that that they both agreed that the dog needed a lot of exercise, and his taking the dog out was certainly doing the dog no harm. They both agreed that this was probably a “stupid argument” but they would repeatedly go there as if pushed by an unseen hand.

The problem was essentially that neither could identify what they were “really” arguing about.

In couple’s therapy, we did a series of exercises that allowed each of them to get closer to what they were feeling. Of course it had nothing to do with the dog. He was quite gregarious, and she fairly private. The image of him walking around town and getting into conversations with people left her feeling vulnerable and exposed. Once this was clear it became much easier for the couple to work directly with their feelings, and not surprisingly, they stopped arguing about the dog.
A close cousin to arguing about “stupid things” this is the feeling: I get mad (he gets mad) for no good reason.

Again there are arguments about things both consider trivial, yet the arguments can be intense. They seem sometimes to “pop up out of nowhere.” This too is an indication that there has been a breakdown of true communication, and it would be wise to consult a couples’ therapist.

“We don’t seem to enjoy our time together” or the feeling that, “our usual activities no longer seem to give us pleasure” are signs that something has gone amiss in the relationship, but the couple doesn’t seem to be in a position to identify what the problem is. Instead, they continue to try to do the things that they have loved doing together in the past, but get the feeling that it no longer gives them joy.

With a competent couples’ therapist, the couple is able to figure out, and address what in fact seems to be troubling them and starts to work on it directly.

Finally, and this to me is the saddest situation I tend to come across in my practice, a couple comes in and reports that they just no longer seem to enjoy each other’s company and do not look forward to seeing each other. To me, this is an indication that the couple has waited a very long time before seeking the help of a couples’ counselor. Usually at this point the couple tells me that they don’t feel they can go on like this, but rather than separate they what to figure out how to make things better.

My advice to you is to be encouraged. It can be done. The truth is, had you taken action earlier, there may have been less to do, but all hope is not lost provided you take action now.
In short, notice the signs early that couples’ counseling may be helpful. And don’t be shy about making the phone call to the therapist. My experience has been that couples who intervene early, have much less to disentangle before going on to develop the tools they require to have a mutually rewarding relationship.

If you’re ready, reach out to me so we can speak on the phone about how we might be able to work together. If you’re in the NYC metro, you can reach me directly at 212-242-2219 to talk about a personal appointment to work on your marriage.

The level of sexual desire, or how much sex one you want, is influenced by any numbers of factors. These could include stress, how one feels towards one’s partner at a given moment, physical wellbeing, age, as well as drugs and medicines. But just like everything else in life, there is tremendous variety between people in how much or how little they desire sex. For some people very infrequent sex or no sex at all feels perfectly sufficient, while I have had other people in my practice who report that at a minimum they would like to have sex once a day, but preferably more.

In the bad old days people could be diagnosed as either hypo-sexual (too little sexual desire) or hyper-sexual (too much sexual desire). But in fact in all of my years is graduate training, and years as a sex therapist, nobody has ever been able to tell me the “right” amount of sex to want. In fact, there is an old joke in the sex therapy community in which hypo-sexuality means that you have sex less frequently than your therapist does, and hyper-sexuality means that you are getting it more than your therapist gets it.

So the chances of both you and another person liking sex with the same frequency is fairly slim. It is no more likely than two people having the exact same appetite for food, but when it comes to sex, different levels of sexual appetites in a relationship if not handled well can lead to hard feelings, guilt, anger and resentment. But the problem is far from insurmountable, and can be easily handled and the situation resolved so that it never becomes an issue in the relationship again.

The first thing that is important to determine is if the situation is as simple a difference in level of sexual desire. So, just as one example, let’s say one of you experiences pain when having sex making it unenjoyable, and as a result tries to avoid having sex. You might like the idea having sex, but because it has become associated with discomfort, you are reluctant to even try. This is not truly low sexual desire. In fact you do want to be having sex, but the pain interferes with actually doing it. In this case you might want to get a physical examination either by a gynecologist for women, or a urologist for men. Or a proctologist if the pain is when attempting penetrative anal intercourse. Assuming that the physical examinations turn up nothing wrong, a competent certified sex therapist can guide you through a series of exercises that can attenuate, or get rid of the pain altogether.

Another important factor is paying attention to the internal nature of how you become sexually desirous. No exclusively, but for many woman, desire FOLLOWS arousal. A simpler way to say that is once the woman can get herself aroused, of is aroused by a partner, she first then starts to want sex. Had she been asked a few minutes before becoming aroused if she would like to have sex, her response may have been: “No, not particularly.”

It is also important to take into account that some people do in fact want to have sex, but either traumatic or other life experiences have made it feel uncomfortable to them and they feel too anxious to tolerate having sex. This too is not truly low sexual desire, but rather there are concerns that get in the way of the person feeling their full sexual desire. Fortunately, these concerns are of the type that sex therapists work with on a daily basis, and can usually be resolved in sex therapy, opening the door to sexual desire.

Finally, there is one more thing that may seem simple but I have found in my practice that many people do not pay enough attention to. Spend a little bit of time paying attention to how you and your partner approach each other. Is it in a manner that tends to turn you on? Some people go for a slow romantic build up, and like a particular type of atmosphere, i.e. soft lights and sensual music. For others, more of a turn on might be an aggressive approach, and perhaps being in a place that feels a little “sleazy” like the cheap motel room, or out in the garage. These are all questions of personal tastes and not directly questions of level of sexual desire. So it is important that you communicate to your partner(s) what turns you on, and that you both make efforts to include that in the equation.

If none of the above-mentioned things is interfering with your sex play, and one of you wants it much more than the other, that you have what can truly be called discrepant sexual desire. Like in the old Woody Allen movie, I have had people in my office tell me that the other one “wants it all the time.” When asked the answer might be 2 – 3 times per week. When I interview the partner, and I ask the same question, the response comes back: “Practically never. We’re lucky if we have sex 2 or three times a week.” This is really a discrepancy in sexual desire. Both partners enjoy sex, enjoy how they go about having sex, but one simply wants to be doing it more frequently than the other. While there is no way to make their level of sexual desire exactly the same, there are things that you can do to accommodate different levels of sexual desire.

Perhaps the most important place to start for the person with lower sexual desire would be what I have heard referred to as sexual altruism. This is not giving in to someone’s sexual advances when you do not want to have sex, which is close to feeling coerced, and not good for the individual, nor the relationship. Instead, it is providing something for your lover because it gives them pleasure and that you then have the opportunity to derive pleasure from the fact that you are giving your lover pleasure. Folded into that, many people can also derive pleasure in that situation for know how much they are desired by their partner.

Beyond that, which is basically what the person with the lower desire can do, there are things that you may do as a couple, providing that you are both open minded. There will be times that the person with less sexual desire really doesn’t want to have sex at all. Talk about this in advance. Could your partner than masturbate? If so – it’s better to have them do it in your presence, rather than having to sneak off to another room, which tends in the direction of pulling the two of you further apart sexually. See if the two of you might lie side by side as the one masturbates, and perhaps if the other is in the mood you can assist.

The general idea is that you both get the chance to feel sexually fulfilled, and neither of you feels resentful of the other, and it is enjoyable for both of you. If I can help you, don’t hesitate to reach out 212-242-2219, I’m happy to help.

Why Straight Rural Men Have Gay “Bud-Sex” With Each Other is the title of Jesse Singal’s article on sexuality in this week’s (Dec. 18, 2016) New York Magazine. In it she describes the work of the University of Oregon’s sociology doctoral student Tony Silva who looked at rural white men who identify as “straight” and have sex with other men, in his paper Gender & Society.

The subjects of his paper were 19 straight (or mostly straight) identified men who had advertised for male sexual encounters in rural areas. Perhaps the simplest way of describing the findings is that the men interviewed tended to be masculine in their behavior and enjoyed sex with other masculine men, but it did not detract from their identity as heterosexual.

One needs to understand that “being gay” is an identity, and not an objective fact. It is how one thinks of oneself, just as one might think of themselves as “Italian” although they are a 3rd generation American and only one set of their grandparents had entirely Italian blood. In my years of practice I have come across men who rarely have sex with woman yet identify as straight, as well as men who have sex almost entirely with woman yet identify as gay, and of course, all points in between.

One of the interesting findings reported by Singal is that an important piece of preserving their identities as straight men was that they themselves were masculine in their behavior, as were the men that they liked to have sex with, thus giving it the feel of sex between straight men. There was a clear rejection of men who identified as gay, or displayed stereotypical feminine behavior.

This was a particularly interesting finding to me. To me, it exemplifies that while sexuality in and of itself can be fluid, how one identifies or thinks of themselves may be more strongly influenced by the cultural demands around them.

These men where all from rural areas and perhaps both due to prejudice and lack of exposure, may not have been aware that gay people come in all shapes and sizes, as well as likes and dislikes. For me personally, an important part of being gay is that I enjoy masculinity. In my early coming out experiences I sometimes felt pressured by other gay men to “be myself” and stop “trying to act so butch.” But that was who I was. It didn’t make me “less gay” or inauthentic. Nobody was acting. It is in some ways the inverse of what many of these men must have experienced where the cultural demands where for masculinity, which would be at odds with identifying as gay or bi-sexual.

Another interesting aspect in this report is that the men almost uniformly denied an emotional connection to each other. Yet they also reported enjoying activities together that go beyond a casual sexual hook-up. One reported always meeting for coffee with his male sexual partner, another shopping trips, or weekends together. And while the caring seems genuine, it also seems to be kept on the level of “Buddies” and was not allowed to reach any deep emotional level that might be misunderstood as “being in love.”

Here I think we brush across a very interesting key point that I have thought about for many years. Specifically that a masculine society holds stereotypical female behaviors in contempt. So the idea of men occasionally having sex with other men is not what is abhorrent to the greater world, but rather a man acting in any way that would be considered traditionally feminine.

In fact in the article at one point sex between men is referred to as “helping a buddy out.” Helping a buddy out is what men do for each other, like changing a flat tire. Baking cookies for him, getting “all sweet for him” are things that woman would do and therefore spoken of pejoratively.

I have heard many men over the years laugh about a camping trip, or being drunk and one of them giving the other a blow job. In the discussion, the sexual exchange is usually treated as a routine thing that is liable to happen in those circumstances. Not a terribly big deal where all the guys involved are straight. But to walk like a girl, or throw like a girl or fight like a girl that is what makes you the object of contempt. It is that which gets you labeled a sissy or a faggot, and makes you the object of public scorn.

Perhaps that explains why some straight men will have sex with other men, but are terrified by romantic attractions to anyone, male or female.

Dr. Eli Mayer is a sex therapist for couples and individuals in New York City. If you’re looking for help understanding what’s happening in your bedroom, give Dr. Eli a call (212) 242-2219.

Feeling depressed? You are far from alone. In fact, depression is so common that mental health professionals often refer to it as “the common cold” of mental disorders. According to data released by the National Institute of Mental Health in 2012, it is estimated that roughly 16 million Americans have had at least one major depressive episode that year. That’s 6.9% of the population! And according to the World Health Organization, over 350 million people suffer from depression worldwide.

Is it Depression or Sadness?

All of us become sad at various points in our lives. This is both normal and a healthy expression of emotion. For example following a loss or disappointment, any healthy person would feel sad. What distinguishes depression from everyday sadness is that it doesn’t seem to go away. If the sadness persists over a period of weeks or longer it is likely that you are depressed.

Here are some other feelings that are quite common when someone becomes depressed: Feelings of “emptiness” extreme irritability over minor things, anxiety and restlessness, easily angered, loss of interest in things that usually interest you, repeatedly thinking about things that have gone wrong for you, feelings of hopelessness, and thoughts of death or suicide.

There are also common physical signs of depression that you can look for. These include a change in appetite. Some of us lose our appetite when we are depressed, while others start eating more as a way to comfort themselves. Sleep changes are also typical.

Some people when they are depressed find it hard to fall asleep or to stay asleep, others may experience a debilitating fatigue and may sleep much more than they typically do. And people when they are depressed often have a hard time concentrating or making decisions.

So the important thing to remember is that sadness is transient and usually people can point to a specific cause (i.e. I am so sad that my best friend is moving far away) and depression just doesn’t seem to go away, and it is often hard to tie it to a specific event.

What should I do if I think I might be depressed?

The first thing that anybody who is experiencing these symptoms should do is to make an appointment with and see their doctor. This is important to make sure that you do not have any physical illness that may be causing your symptoms. If the doctor finds you to be in good physical health, it is likely then that you are suffering from depression, and that trying to “snap out of it” won’t work.

It is important that you get treatment for your depression which can both alíviate the symptoms but also can put you on much better footing in the future so that you are much less likely to experience severe depression in the future.

Should I take antidepressant pills or go for psychotherapy?

Many people like the idea of being able to simply take a pill and their depression will go away like one might take an aspirin for a headache. It’s a nice idea, and not without some validity, but unfortunately, it’s unlikely that taking antidepressant medication alone will give you the best result.

A study published in 2014 in the Journal of The American Medical Association (JAMA) 452 adults diagnosed with Major Depressive Disorder where randomly given either antidepressant medication alone, or antidepressant medication with psychotherapy. The results were consistent with those of many previous studies. Specifically, that antidepressant medication combined with psychotherapy leads to a higher rate of recovery from depression than medication without psychotherapy.

So the short answer is taking pills for depression will not be as likely to result in relief from the depression as the being in psychotherapy and taking medication. That particular study compared Cognitive Behavioral Therapy with medication to the group taking medication alone. Cognitive Behavioral Therapy is often used in research studies because of the various forms of psychotherapy available, it most easily lends itself to research. But there are many forms of psychotherapy and other non-pharmacological treatments.

A very recent study published in the journal, Evidence Based Medicine, 2016, 21 (6) 214-221 conducted what is called a “meta-analysis” in which the results of hundreds of studies are reviewed. In this particular study, the investigators combined 367 previous studies (a total of 20,000 patients) to try to see what types of non-pharmacological treatments help depression the most.

These treatments included psychotherapy, naturopathic therapy, as well as things such as increased physical activity (running, going to the gym). Once again it was clear that these interventions all seemed to help reduce the symptoms of depression, but the relative effectiveness remains unclear.

So there is no one right type of non-medication therapy for depression for everyone. In fact, the authors conclude that while these type of therapies are helpful, which should be chosen should be based on the individual’s “values, preferences, clinical and social contexts.”

How it’s gone for people in my practice:

Many people try to find a good therapist if they are feeling depressed and they have tried everything that they could, but the depression lingers. Often people will say things such as they feel depressed, but they don’t know why. It’s been my experience that psychotherapy can be remarkably helpful in those situations.

People get a chance to share their concerns in a completely confidential, non-judgmental setting, and we get a chance to understand more about the internal workings of their depression and find ways to address it so they experience relief. For many people, this is quite sufficient, and they never go on antidepressant medications.

Some people first come into psychotherapy after having tried medication and in time their depression returned; the medication seems to have lost its effectiveness in spite of the doses being increased and additional medications added.

From my perspective as a psychologist, this tends to happen because they have never had the opportunity to resolve the underlying issues at the root of their depression. The changes in brain chemistry provide temporary relief, but as the brain adjusts to the chemical changes caused by the medication, it becomes the new normal.

I see it a bit like you might get a charge of energy when you first start to drink coffee, but in time, as the body acclimates to the caffeine boost, a cup in the morning is needed just to feel “regular.” While antidepressant medication is not known to be addictive like some other classes of drugs, that does not imply that it will always give you the same “boost” that it did when you started the treatment.

The perfect combination:

When someone comes to my office and is concerned about their depression, one of the things we do together is to evaluate how severe it is, and whether their symptoms seem tolerable to them. I personally don’t feel that people should or shouldn’t take medication, but it is an available option. When someone is suffering from a very painful depression, and they are open to the idea, I send them to an expert for a medication evaluation and typically are prescribed the antidepressants that are best for them.

Repeatedly what I have seen in my practice is the antidepressant medication gives you the lift you need to be able to work on the root causes of your depression in therapy. The therapy allows you to start making some permanent changes while you are feeling the relief initially provided by the medication.

In time many people in my practice feel that they no longer need the antidepressant medication, and under the supervision of an expert slowly discontinue it. As indicated earlier, there is no one right way that fits everyone, but with a sensitive and caring therapist, combined with the proper medication, if needed, can make your history of depression exactly that; History!

If you’re in the New York metro and this article speaks to your experience, you’re not alone. I can help if therapy is the avenue you want to pursue. Reach out to me directly at 212-242-2219, or contact me by email at [email protected].

Psychotherapy had unfortunately earned a bad reputation decades ago when the prevailing view in the field was that the only form of “healthy’ sexual activity was penetrative sexual intercourse between a man and a women.  Any deviation from this was considered an expression of psychopathology and carried such derogatory labels as “perversions.” 

Indeed it wasn’t until 1973 that the American Psychiatric Association would even allow for the fact that not all people who enjoyed having sex with someone of the same sex were sick and in need of treatment to “cure” them. Fortunately, much has changed over the years in the attitudes of society, and there is much greater room for sexual expression than in previous years. 

Still because of this painful history, and because to this day there is far too much ignorance in the field, people who may not identify as specifically gay or straight, or for that matter fall neatly in line with being either 100% male or female, fear that should they seek help from a psychotherapist, or a sex therapist, that they will be told that they are “abnormal” and that the very things they take pleasure in doing, or how they experience themselves will be what the therapist wants to change.

Each of us, no matter where we appear on the spectrum of gender or sexual expression, are vulnerable to the same sexual concerns that people work on productively in sex therapy. 

For example, heterosexual women are not the only ones who may experience difficulty achieving an orgasm, or pain during orgasm or intercourse.  Similarly, it’s not only straight men but rather anybody with a penis who may experience difficulty maintaining erections or orgasming much sooner than they would like to. Sexual concerns that are amenable to sex therapy can and do affect all types of people regardless of how they identify, or what particular likes or dislikes they have when it comes to having sex.

I wish that I could report that things have changed so much in the field of Psychology and Sex Therapy that no one needs to worry about being labeled “disturbed” based on their sexual interests or their experience of themselves.  But unfortunately, that is not universally the case. 

Even in this day, there are professionals who would see you as disturbed if you didn’t simply identify as either a man or a woman, and plenty who if you, for example, you enjoyed BDSM or a kink that they were not comfortable with, who would try to help you “get rid of the problem.” 

There are no shortages, for example of therapists who is you liked having sex very frequently would label you a “sex addict.”  Conversely, if you weren’t particularly interested in sex, you might be seen as having a disorder of sexual desire. There is an old joke in the sex therapy field in which the definition of “hypo-sexuality” is that your therapist is having more sex than you do, and being labeled “hyper-sexual” means that you are getting it more than your therapist.  As we all know most jokes would not be funny at all if there wasn’t a grain of truth in them. 

And although fortunately a number of states have outlawed trying to change a minor’s sexual orientation, in most of the United States it is perfectly legal to do so, and in every state it is legal. for an adult to go into therapy to try to change their sexual orientation, even though there is absolutely no evidence that any type of therapy can change one’s orientation. 

We now understand that there really isn’t any relationship between the nature of one’s experience of their gender or the nature of one’s sexual expression and psychopathology. 

In a good sex therapy, or in a good psychotherapy, the goal is for the person in therapy to gain increasing comfort with the nature of their own sexuality.  To be able to embrace it and to overcome obstacles to sexual enjoyment.  And this is true for everyone, not just people who identify either as solidly male or female or are free of any “kinks.” 

So as a consumer, it is important that you seek a sex therapist who can work with you and not against you.

If you are interested in benefiting from sex therapy, here are some important things you should do to ensure that you will be engaging in a treatment that will be helpful.

The first thing that you want to look for is the therapist’s credentials. 

Do they have a doctorate in psychology, and if so is it in Clinical Psychology?  Are they licensed to practice psychotherapy in the state in which you live?  Unfortunately many of the titles that people use such as “sex therapist” and “psychotherapist.” are unregulated in most localities meaning that anyone can call themselves a sex therapist or psychotherapist with any training.

Next, see if they are certified as a Sex Therapist or Sex Therapy Supervisor by the American Association of Sexuality Educators Counselors and Therapists (AASECT). 

At the moment this is the only national organization that offers certification in Sex Therapy.  So the combination of and advanced degree and certification by AASECT as a sex therapist is usually a pretty good indication that the person has been well trained.

The next thing you should look for is what professional organizations does the therapist belong to?

For example, if they belong to the National Coalition for Sexual Freedom (NCSF) it is usually a pretty good indication that they are comfortable with a broad range of sexual expression.  If however they belong to an organization for “addiction therapists” it may be, but not necessarily so, that they will view your sexual interests as an addiction, and prescribe abstinence.

If the above checks out, if you are comfortable letting others know that you are interested in Sex Therapy, you might ask friends if they might recommend someone with whom they’ve had a positive experience. 

But at the end of the day as long as the person you are considering as a therapist is properly credentialed, the most important thing is the goodness of fit.  By goodness of fit I mean that they are someone you feel comfortable speaking to about intimate details of your life.  And that they seem to understand you and are not judgmental about your interests.  I don’t think that there is any good way to ascertain that other than meeting the therapist in person.

You can call and schedule an “initial consultation.” That is you haven’t yet decided to see this person for psychotherapy or sex therapy, but rather that you would like to meet with them to see if you feel that you will be comfortable working with them. 

Be prepared to tell them briefly about your concerns.  They may have questions for you so that they might understand you better, but remember that you are the consumer, and be sure that you are comfortable with the answers they give you. 

All of the above considerations apply whether you are seeking sex therapy as an individual, or as is often the case, as a couple.  A good place to start your search would be on the websites of organizations such as AASECT or NCSF, or popular find a therapist websites such as Psychology Today.  I wish you the best of luck with your search, and remember that good sex therapy is available to everyone, you just need to be an educated consumer.

And of course, if you’re in the New York City area and in need of a sex therapist, you can always reach out to me. My case load is often full, but I’m very happy to speak with new inquiries and if I can’t work with you, I’m happy to refer you to other qualified sex therapists in the NYC metro. You can reach me directly at 212-242-2219. 

All couples who have a physically intimate relationship are likely to experience peaks and troughs in their sex lives. Like other aspects of any relationship which ebb and flow, this may not be a serious concern. But when sexual issues begin to negatively impact the relationship, it may be time to consult with a licensed psychologist who is also certified as sex therapist.

Left unattended to, these issues may create friction or lead to resentment which can destroy an otherwise good relationship.

If you recognize any of the following warning signs in your own situation, sex therapy is indicated, and could be the key to saving your relationship:

1. DISCUSSING SEX LEADS TO ARGUMENTS:

If discussing sex leads to arguments, you and your partner are unable or have lost the ability to work together on overcoming roadblocks to a good sex life. Try as you may to approach the subject, attempting to discuss it only seems to make things worse. This often leaves one or both of you feeling guilty, accused, or inadequate (and very few people feel sexy that way). Left unattended, these feeling will undermine even the strongest relationships.

A skilled, experienced psychologist with expertise in sex therapy will be able to help you develop the skills to overcome the roadblocks which have you from communicating your way to a better sex life.

2. SEX FEELS LIKE AN UNAPPEALING OBLIGATION:

While at the start of your relationship sex may have felt exciting and enjoyable, it has now lost that appeal. In some cases, it feels like an obligation that one or both of you actively try to avoid and in other cases, sex may have never felt appealing.

You had hoped that in time you would come to enjoy it more, but that has not happened, and things may even have gotten worse. If left unchecked, the frustration and resentment created by this dynamic can lead to a crisis in the overall relationship.

Discomfort with sexual involvement is far more common than many imagine. Long established sex therapy techniques have proven effective in helping many people to overcome their fears, anxieties and discomfort with sexual activity.

3. ONE OF YOU WANTS IT A LOT MORE THAN THE OTHER:

This is called Discordant Sexual Desire, which basically means that you and your partner have different levels of appetite for sex. Just like our appetite for food, sexual appetite varies from person to person.

With a skilled sex therapist the partner with the lower level of sexual desire develops the ability to take pleasure from satisfying their partner’s sexual needs, while the partner with the higher level of sexual desire learns that their partner’s lower desire does not mean that they don’t find them sexy.

4. I’M NOT INTO THAT ANYMORE:

As odd as it may sound, experts, such as Dr. Lisa Diamond, have found that sexual interests are “fluid” meaning that they tend to change over time and may vary in different situations. So a couple may begin feeling very stimulated by a particular interest and in time it may become less interesting to one or both of them.

Sex therapy helps couples who face that dilemma develop and incorporate new interests. And the very good news is that that ability to use sexual fluidity to enhance one’s sex life can last a lifetime, and helps a couple maintain a robust sex life over the course of their lifetimes.

5. TIRED OF THE SAME OLE SAME OLE:

Some people find routine and familiarity comforting, but for many according to Dr. Jack Morin, novelty and uncertainty are tremendously erotic. The thrill of being with a new partner may wane, and people may fall into a routine which tends to feel unexciting and bland.

In fact, typically couples will in the beginning of the relationship test different ideas with their partner, but if their partner seems uninterested they scratch it off the list of possibilities. As a result instead of their sex life expanding over the course of time, the repertoire becomes narrow. It’s about as exciting as knowing that you will have boiled chicken for dinner every day.

Sex therapy can help people develop comfort with trying new things in bed. Keeping with the food analogy, it becomes more like developing your cooking skills allow you to try new and different recipes with confidence. In fact, as any good cook would tell you, in time you don’t need a recipe at all!

6. THAT’S TOO FREAKY FOR ME:

This is a common complaint when one partner has a particular “kink” or interest that the other doesn’t share. The flip side of that is when one person has an interest, particularly a fetish or some form of bondage and dominance, and they report that they would never want to do that with someone they are close to because they have “respect” them.

This is akin to what in the old days was referred to as the “Madonna-Whore complex.” In sex therapy people learn to become comfortable sharing their interests with their partners, and partners who are initially uninterested often become thrilled with how they can turn on their partner. So what starts out as “too freaky” often becomes lots of fun.

7. THE MORE WE TRY TO FIX IT, THE WORSE IT GETS:

This is a typical complaint of people not only who seek sex therapy, but almost any form of psychotherapy. Basically, we all try to take care of problems without consulting an expert.

For example, you might not consult a specialist for a headache, you would try to take care of it with remedies that you are familiar with such as aspirin, or ibuprofen. But if doing whatever you can think of gives you no relief or only seems to make things worse, you probably should consult an expert.

This is especially true when it comes to sex. People will become so discouraged by repeatedly negative experiences that they stop even attempting to have sex.

The skilled sex therapist can evaluate the problem, and will often provide “homework assignments” tailor made to your wishes and fears.

In most cases people who had long abandoned the hope of being able to enjoy sex, find themselves not only beginning to enjoy it, but ask themselves: “Why did I wait so long to get help with this?”

8. OPENING THINGS UP ONLY SHUT US DOWN:

Many people in sexually exclusive relationships will try to address the problem of diminishing sexual satisfaction in the relationship by “opening up” the relationship by inviting others to join one or both of them in sex.

Often people will consult me having done this to find out that it pulled them further apart rather than fixing their sexual concerns. The problem isn’t that opening up the relationship was necessarily a bad idea, the problem is that the couple never had the chance to take on the sexual problems between them, so the addition of others does no good.

In my practice I often ask people in that situation to temporarily suspend other involvements and we work directly on their sex life together. Once that is in order the couple is free to be exclusive or non-exclusive as they please.

If you can say “that’s me” (or us) in any of the above scenarios then chances are a consultation with a sex therapist like me will set you on a much better path. If you’re ready to discuss your situation, I am a sex and couples therapist in the New York City metro. You can reach me at 212-242-2219 for a consultation to see if working together is the best next step for your life.

The Short Version:  Dr. Eli Mayer faced discrimination as the first openly gay doctoral student in his graduate program. But after he graduated and started his practice, the AIDS crisis hit, and many of his gay patients in New York City appreciated that he could relate to them. Initially, Dr. Mayer focused on traditional psychotherapy, but after studying sexuality, he became a certified sex therapist. Today, his patients, who are couples and individuals, benefit from a blend of both techniques. Many couples find comfort with his sex therapy techniques and often achieve results faster than with traditional psychotherapy.

When Dr. Eli Mayer was applying to his doctoral program in the early 1980s, he kept his sexuality quiet because he knew some universities wouldn’t accept an openly gay student. His decision to come out during his second year at Yeshiva University put his academic studies in peril when the faculty became divided over whether to expel him. He stayed in the program, but some people there would never speak to him again.

Dr. Mayer went on to become a licensed clinical psychologist. After graduation, at the height of the AIDS epidemic, he started a practice as one of the first openly gay psychologists in New York City’s Greenwich Village.

Dr. Eli Mayer’s personal experiences as a gay man help him understand his clients.

“This neighborhood was like the land of the living dead; it was like jumping out of a horror film,” he said. “I had many patients coming in and out, and some would die very, very shortly after.” Dr. Mayer’s own experiences uniquely positioned him to empathize with and support young gay men grappling with illnesses and death.

Dr. Mayer continued practicing traditional psychotherapy, but over time, he said it became routine and boring. Many of his patients often didn’t see results for years, if ever.

Dr. Mayer said he had always been fascinated by human sexuality, but had learned very little about it in school, so he began studying it extensively. He became a certified sex therapist, which allows him to approach therapy with a unique perspective.

His work can create positive change much faster and provide significant, lasting benefits for individuals and couples — especially in their sex lives.

Being an Openly Gay Sex Therapist Means He Can Relate to Patients

When Dr. Mayer came out as gay in graduate school, he experienced discrimination. But his sexuality became an asset when he opened his practice because it helped him relate to his marginalized gay clients during the AIDS crisis.

He has also made a name for himself as a trusted resource for gay men, the transgender community, anyone else in the LGBTQ+ spectrum, and those exploring alternative lifestyles, including non-monogamy. Dr. Mayer lends a nonjudgmental ear and can empathize with his clients’ struggles coming out and facing discrimination. His approach is relaxed, jovial, interested, and concerned, he said, which is often a breath of fresh air to those who feel misunderstood.

Dr. Mayer was surprised to learn that being gay also makes him an effective therapist for straight couples. He finds that his sexuality can put his straight male and female clients at ease, and his practice is an equal mix of gay and straight clients, he said.

Dr. Mayer has a theory about why straight couples gravitate to him. “I think when people are going to talk about what’s going on in their sex lives, women don’t like doing that with a straight guy so much — it’s uncomfortable,” Mayer said. “But to a gay man, it’s like talking to their hairdresser; it’s no big deal.”

Additionally, Dr. Mayer said straight men often prefer to talk to him because they don’t feel comfortable having their sex lives analyzed by another straight man.

Combining Psychotherapy and Sex Therapy for Better Results

As far as Dr. Mayer knows, he’s the only openly gay licensed clinical psychodynamic psychologist who’s also a certified sex therapy supervisor east of the Rockies. His skills and personal experiences help him get better results for his patients.

Dr. Mayer has been practicing standard psychotherapy for 25 years, but he enjoys how his patients often see faster results through sex therapy.

“With psychodynamic psychotherapy, people walk out of my office after being with me for 15 years and say, ‘Maybe that helped,’” he said. “Now that I do sex therapy, people skip out of my office after six months saying, ‘Dr. Mayer, you’re a genius, I never thought I’d have sex again!’ That’s one of the things about sex therapy; it tends to be quick.”

“In traditional psychotherapy, you figure out what it has to do with and what (a client’s) anxieties are. The connection is there, and they see it, but it makes no difference. With sex therapy, you start from the other end.” — Dr. Eli Mayer, Clinical Psychologist and Sex Therapist

Sex therapy works from the opposite end of the spectrum of traditional psychotherapy, Dr. Mayer said. For example, if someone comes in because they have problems getting erections when they’re with their boyfriend, but not when they’re alone, there could be two different approaches.

“In traditional psychotherapy, you figure out what it has to do with and what the client’s anxieties are. The connection is there, and they see it, but it makes no difference,” Dr. Mayer said. “With sex therapy, you start from the other end. You might say, ‘Well, do you like giving blow jobs? Would you have an erection if your man gave you a blow job?’ And you work from there. It’s more practical. You have a real sense of what’s going on and how to work with it.”

Men and Women of All Ages Come to Dr. Mayer

Dr. Mayer helps patients of all ages — from their 20s to their 80s — and one of the most common problems he sees is with long-time couples who used to have great sex, but things have fizzled. He enjoys helping them find the spark again.

“People often come because of concerns that prevent them from getting into a sexual relationship,” Dr. Mayer said. “For guys, it can be erectile dysfunction or other forms of anxiety, and for women, it can be the pain of intercourse and also general anxieties about sex.”

Dr. Eli Mayer offers clients a wide range of counseling options.

Another common reason clients come to Dr. Mayer is that they think there’s something wrong with them — when there isn’t.

“People often will come for things they believe are problems, but aren’t,” he said. “I teach them how to manage them, so things like fetishes or unusual interests, or things that are pretty normal, but it somehow got into their heads as kids that, ‘Oh my God, this is terrible.’”

Creating Powerful Changes in the Lives of his Clients

Dr. Mayer said he loves his profession and has seen some amazing things happen in his clients’ lives, which gives him great satisfaction and motivation to continue.

“The most powerful thing that happens is when someone comes in believing that their sexual desires are strange or terrible, or they couldn’t talk to somebody about it, and they find out it’s OK,” he said. “Learning to be comfortable with all parts of yourself, and how to work that into a relationship — that’s always the stuff that feels like, ‘Wow, what a shift.’”

Dr. Mayer suggests tackling problems head-on and working with your partner on difficult issues. Open communication can be challenging, but Dr. Mayer said he got into the field to help clients build better lives and stronger relationships.

“It’s such a wonderful feeling when you see people’s lives are improving as a result of the treatment,” Dr. Mayer said. “That’s why I’m doing this.”

This article was written by Emily Starbuck Gerson and was originally published on DatingAdvice.com. The original can be seen here.