Dr. Rose is a Sex Therapist and practices at San Diego Sexual Medicine. She is both AASECT Certified Sexuality Therapist Supervisor and AASECT Certified Sexuality Educator Supervisor, a Licensed Marriage and Family Therapist (MFC 53079), and Eye Movement Desensitization and Reprocessing (EMDR) Trained.
Essentially, Dr. Rose is a relationship GURU and helps couples have a more fulfilling sex life which enables people to have a more satisfying quality of life. She uses her specialized clinical skills and theoretical knowledge to address pressing sexual concerns and enrich their relationship.
Here we discuss what brings people to see a sex therapist, what the treatment process is like, and the common issues she helps patients with.
Cheryl: What is the most damaging misconception about sex, and as a result, you're seeing people in your practice?
Dr Rose: I think this is such a great question. There's three different misconceptions that I think often keep coming up throughout my years in practice. One is that sex should be spontaneous.This is such a fallacy. So often as relationships progress, life can get more complicated, people have kids, maybe potentially dual careers. Couples really need to make a conscious effort to prioritize sexual activity and schedule it. If both members are waiting for this perfect opportunity where sex is spontaneous and they both feel the urge to engage, they may end up waiting forever. So that's like a big one that people come to me is like, "Oh, sex should be spontaneous. We should both want to do it."
The other misconception I think is often common is that sex has to be this serious thing. If couples aren't afraid to laugh and be silly during sexual activity and be vulnerable with themselves, it can often prevent them from being more creative and things in the bedroom can end up getting stale. So a big part of what I do too, I think, is helping the couples to realize that it doesn't have to be this serious activity because 50 years from now, if you don't start being vulnerable and expanding your repertoire, it might end up being a long 50 years.
And then I think the biggest fallacy or misconception that I work with is that sex has to be this penile-vaginal penetration that always ends in orgasm. Being a therapist myself, I mostly work with sexual dysfunction. If you have this belief and then as you get older, maybe you have some erectile difficulties or there's difficulty with menopause and lubrication and something new. Or even just over time, if you are kind of rigid in your thinking that it has to be this performance, penile-vaginal thing that ends in this orgasm, you can miss out on a lot of other things that could be great in terms of physical connection,which is like deep kissing or oral sex or sensual touching. So I think these are definitely the three big misconceptions that I have seen over time.
Cheryl: Yeah, for sure. Okay — if a couple were to come and see you, what would the treatment process look like?
Dr Rose: I think it can look different for everyone. For me specifically, I work from what we call a bio-psycho-social approach to treating different sexual health conditions. I work with a sexual medicine physician who deals with the biological side of things and then a number of pelvic floor physical therapist that deal with the musculoskeletal. But in general, I think therapy or the treatment process often just involves like a really thorough assessment.
So, like me conducting a really good history. So it's not just about the sexual concern that I'm interested in. I am interested in that obviously. That's why often people do come to sex therapy, butI want to know about their family of origin, their relationship with alcohol and recreational drugs, their mental health history, because all of those things impact the couple. And then once in treatment, it's really just learning if it's with a couple like, okay, what's the couple coming in for and then what are some ways that we can try to meet their treatment goals.
Cheryl: What are signs of a couple in trouble and when should a couple pursue therapy? What gets a couple to come and to see you? I know it is really challenging for some people to make the commitment to see a therapist.
Dr Rose: This is in some ways a kind of a complicated question... So, couples can come can come for sex therapy, but often when you ask me what is a couple in trouble, what I actually think about is when are they really in trouble in terms of their relationship? John Gottman has done a lot of research around this area. He talks about the four horsemen, which is if a couple has contempt, criticism, stonewalling, and defensiveness.
If I see a couple having these issues in terms of communication with each other, it kind of trumps even the sex therapy part. Like if they can't even talk about anything without getting defensive or being mean, that's a sign. Those four things are most likely to lead to divorce so that needs to be addressed first. Some couples will have sex issues, but not have the couples issues or relationship issues. There's lots of different reasons that couples pursue sex therapy. I think the biggest, if there's any type of distress that you want to work with, even if there isn't that much distress and you're just wanting to build a relationship, I think therapy is helpful.
I also want to mention that the sooner that you come to therapy is often the better. As a therapist, it can be really both sad and frustrating is a couple could have something, a concern, but then they have 20 years of luggage around it. You know?
Whereas sometimes if they would have come in earlier, we wouldn't just be sorting with through the issue and 20 years of luggage which is the issue itself. I know sometimes it could be hard to have both members agree to go to therapy. So if your partner refuses to go, you could attend individual therapy yourself or read self-help books for your marriage.If they're unwilling to attend couples therapy, but willing to read those books, you could do that together. Also, if your partner is not willing to attend therapy with you, I also think that that also should give you information about your partner and how they value the relationship.
Me: Right. I've definitely known people and couples where one partner is just so against therapy and I guess talking and sharing those deep and personal issues with someone else. I know people who've gone without a partner and have just, in a way, still taken that into their relationship. Self-help books and things like that could be a great tool.
Dr Rose: Yeah. And then also recognizing that if you do go to individual therapy, you can only change yourself. So you can't change your partner, you can only change yourself.
Me: In terms of cultivating intimacy, what are some good habits or sexual goals for a relationship?
Dr Rose: This is a really good question. When I'm thinking about this, I'm thinking of prioritizing the relationship and being open and honest regarding your communication. Even in answering this and thinking sexual goals, this is going to look differently for everyone, because I can say like, "Oh, set the goal of prioritizing your sex life a certain amount of time or whatnot." But in the end, some couples, if they have this prioritizing the relationship and open and honest communication, maybe they choose as a couple that sex is a lower priority in their relationship.
As long as both members of a couple are on the same page regarding these things, it's not an issue, right? If it's causing distress. So I think just like with everything, if you can have open and honest communication and be respectful of each other and prioritize your time together, I think couples can overcome almost anything.
Me: That's great. In your practice, how do you help couples reconcile desire discrepancies?
Dr Rose: Some ways to do that are just to help couples to find something that works for both of them and then also exploring pleasure. So let's say one of the partners is potentially not having sexual desire because either they're not aware of their body or don't know what pleasures them, kind of also exploring what helps each of them.
So, Emily Nagoski wrote the book “Come As You Are”. She talks about your sexual desire as being a car, and we all have things that put our foot on the gas pedal and there's things that put our foot on the brake. And so helping that couple both explore like what are some things that puts your foot on the gas pedal and what are some things that put your foot on the brake, and how do we get to a place where it works for both of them.
But also recognizing that desire discrepancies to a degree are normal. We're all human beings. The chances that a couple will have sexual desire at the exact same time or the exact same level is, I mean, a little unrealistic. That's kind of going back to the first question you asked, like sex has to be spontaneous. So sometimes even planning sex can help with desire discrepancies as well. So scheduling an amount of time that works for both of the couple.
This is honestly a very complicated question. Again, every couple is going to look differently. Every different therapist, the process might look different. It's a really common question and it's a really common concern.
Me: What are some tips for dealing with sexual boredom?
Dr Rose: I definitely think kind of going back to the first question as well, the fallacy that sex has to be serious. I think the more that you get comfortable with being uncomfortable or vulnerable with each other during sexual activity, the more room it allows you to think outside the box as a couple and have fun, laugh at yourself, explore different things.
I often also personally recommend sexual enhancer products. There is a ton of them out there. You can go online. I call the vibrators, the hearing aid for the clitoris. There's masturbation sleeves. There's lots of things too that couples can do with each other to just expand their repertoire. I'll often also will talk about going to the dollar store and just getting $10 worth of stuff, and then just kind of experimenting, trying to make a use for whatever you find, like a feather duster or spatula, whatever, chocolate syrup, whatever it is.
Me: Yeah, yeah, yeah. Sounds fun.
Dr Rose: So really, just communicating and being willing to be vulnerable. Maybe you might try something and not like it, and then just decide, okay, well, let's never do that again. But without ever trying something, you might not know that you do.
Me: I do feel like with doing different things like that, that will even help with your communication around sex, because you're going to have to share what you like, what you didn't like. Back on the topic of intimacy with couples that you see — how do you help couples restore intimacy if there's been a disconnection?
Dr Rose: I would want to know what led to the disconnection. Were there relationship issues going on? Were those four horsemen showing up, or what has prevented them? What's gotten them into the position that they're in, in the first place. So kind of like a doctor, what are the symptoms present? Why is the person having heart palpitations? Let's figure that out first... You know, doing a proper exploration and then treating or restoring or helping the couple based off of what led to that.
I personally like to sometimes use sensate-focus to help couples really get back into it if they haven't engaged in any sexual activity for a while. So this involves just kind of taking turns, being the receiver and the giver and touching each other sensually, basically being mindful. Mindful touch, but with each other, (not just mindfulness with yourself) and slowly getting back into being more sexually intimate with each other again.