Transforming Sexual Narratives - Suzanne Iasenza

Suzanne Iasenza is a sex therapist in New York City who specializes in human sexuality, sex therapy for individuals and couples, sexual orientation and gender identity. She is on the Faculties of the Institute of Contemporary Psychotherapy, the Ackerman Institute for the Family, and Adelphi University’s Derner Institute Postgraduate Program in Psychoanalysis.

Suzanne's Book...
TRANSFORMING SEXUAL NARRATIVES: A Relational Approach to Sex Therapy

https://www.suzanneiasenza.com

Transcript

Transforming Sexual Narratives
Todd Zemek Speaking with Suzanne Iasenza

Todd Zemek (00:00:05):

Sex can be one of the most amazing, exciting, powerful experiences you can have. Sex can help us feel more alive by being lovingly responded to on so many levels at once. However, when sexual connections aren't possible, we can be thrown into doubt, confusion, fear, and the pain that comes with relational distance. As a Manhattan based sex therapist, Suzanne Aza has devoted her professional life to helping individuals and couples in these situations. And Suzanne is the author of a Gem of a book I love this book, transforming Sexual Narratives, A Relational Approach to Sex Therapy. Suzanne's on the faculty of the Institute of Contemporary Psychotherapy, the Ackerman Institute for the Family, and Delphy University's Donor Institute in the postgraduate program. And psychoanalysis. Thanks for joining us today to talk about sex. Suzanne Iza.

Suzanne Iasenza (00:00:54):

Thank you, Todd. I'm so glad to be here.

Todd Zemek (00:00:57):

I'm going to start with a statement rather than a question. Okay. You should have a Netflix show. <Laugh>. I would love if you went to Netflix and you said, I am a sex therapist in New York City, and I think they would interrupt and just give you $4 million.

Suzanne Iasenza (00:01:12):

<Laugh>. There you go. There would be an endless stream of questions, that's for sure.

Todd Zemek (00:01:16):

I'm imagining that this has just been part of your life, the, the fly on the wall experience, one to learn, but the, the other, just this human curiosity, where do I fear within this spectrum? Within this range? So what's been your calling here of every potential that you could have explored? What is it about sex therapy that's really spoken to you?

Suzanne Iasenza (00:01:38):

Well, it's really interesting, Todd, because initially I didn't set off in my professional life to be a sex therapist when I was in graduate school working on my doctorate, actually, I was in search of a research topic for my dissertation. One of my best friends at the time was, at the time the AIDS crisis was at all time high in New York City. And she was in the Department of Health safer sex work. And she had a PhD in sexology actually. And so I was out to dinner with her once saying, I don't know what I want to do. You know, it's so hard to do a dissertation. She said, why don't you do something on sexuality is endlessly fascinating. So I said, wow, I never even thought of that. And so she said, let me send you my dissertation, see what you think. And her dissertation was on how women's sexual lives were after having breast cancer and mastectomies and chemotherapy.

(00:02:27):

I sat down with that, Todd and I stayed up all night reading the whole thing. I found it so fascinating on so many different levels because sexuality is so multi-dimensional. It involves medicine and a biology, psychology, sociology, history. It involves our emotions, our minds, our bodies. I mean, it's affected by race and ethnicity and religion, right? And so I, I sat there and I fell in love with this idea. So I did my dissertation on sexuality and then I got the bug. Then I thought, I'm going for post-doctoral, you know, training insects, therapy. It's something I want to specialize in. And the rest is history.

Todd Zemek (00:03:05):

It's so great to be just caught up in the power and the flow of that stream and just knowing that you're in the right place in terms of that flow and that sense of alignment. It's something that I'm noticing in my practice is that when the topic gets shifted to sex or the lens gets really focused on sex, there's this moment where the tone starts to shift. In my experience, the word actually seems to capture something of that transition. And there's like a breath or a beat, and that says like, actually, it's like if you want the real story and there is something about sex that starts to align all of these different parts of the truth physically, emotionally, in terms of the narratives that we carry

Suzanne Iasenza (00:03:50):

All the way from the very beginning of people's lives. Todd, like when I do sexual histories, I begin with the question, what's your very earliest memory of sexuality? And that is such an incredible question for people to sit with. And sometimes of course they'll come back to me and say, what do you mean by sexuality doctor? And I'll say, actually, what do you mean by it? You reassociate to that. Hmm. And it's amazing. People come up with all sorts of different associations actually to that word, sexuality. But when they come up with the first memory, it's such an important one to spend time with and to deconstruct, you know, because was it a positive experience? Was it a negative one? Was it a discovery of pleasure or yearning? Or was it one that involved coercion or hurt or to betrayal? And, and then not only what was the multi-level experience of it, but then what were the narratives, as you said that come out of it? What meanings did the person make of that first experience? What did it say about themselves, about sex, about trust, about safety? And people are amazed when we unpack like that first memory, how much can be contained in it that then really interweaves in their life through many relationships afterward. So then, and then after that, you look at the family system within which this, this first memory happened, right? And the rest is, you know, you unpack so much.

Todd Zemek (00:05:11):

I imagine as an experience that would often be a lifetime first, where someone would soberly say, I'm actually curious, where have you been? What have you experienced?

Suzanne Iasenza (00:05:24):

Yeah. How do you narrate your sexual story? How do you understand how you became the sexual being you are now? And it's so really, I think, impactful for people. I work with a lot of people in their sixties, seventies, eighties, and I love the 80-year old’s who come in Todd and say, I do not want to die without having a good sex life. I lived, you know, maybe 60 years in a marriage with no sex or bad sex, but I'm, we're not going to go to the grave without good sex. I, the 80-year old’s have taught me everything I know. I'll say that right here on the air. That's amazing. I really give great gratitude to the 80-year old’s because they, they really are an example of you're never too old to have a sexual life. And often we think we are too old because we're dealing with much too narrow a definition of what sex is. They just have that life force that's say, no, we want eroticism to be part of our lives. However that gets defined.

Todd Zemek (00:06:18):

And death can be a great trigger for life, can't it?

Suzanne Iasenza (00:06:20):

Sure can. I mean, even with h I v, it's kind of funny the context within which I became a sex therapist. Things were so urgent then in New York and around the world, you know, the sex equals death idea. And how could you still be intimate with a partner but not put yourself at risk? But then other people were saying, I don't care. I need that level of connection. It was a very kind of a heightened time. It's so interesting how that life force can inter and the death force urgency can interweave with sexuality.

Todd Zemek (00:06:50):

Mm-Hmm. And so your approach has such heart because you are interested in people's experience and the way they've been related to or way they've been intruded upon or neglected in terms of narrative therapy. What's so appealing about that? What's so empowering about narrative therapy? So first of all, what is it?

Suzanne Iasenza (00:07:08):

Well, it comes from your neck of woods. 

Todd Zemek (00:07:11):

From Adelaide I think.

Suzanne Iasenza (00:07:14):

Michael, yeah, our darling Michael, did you ever get to see Michael White talk?

Todd Zemek (00:07:20):

No, but when I've met people who have, it's the, like they've met God and I've had people using that word.

Suzanne Iasenza (00:07:27):

That's right. Or the Beatles <laugh>. Neither one <laugh>. But I must say one of my peak experiences, my whole professional life, I was giving a talk at the fan psychotherapy or conference, which is this enormous conference in Washington DC every year. And I was giving a talk with two other people about just looking at the dynamics between women who are lesbians and their mothers. So, we went out and we interviewed moms and lesbians and moms talking about having lesbian daughters. Well who's in the room when we, when we come into this room to present? But Michael White's sitting in the back, I almost thought I was going to faint. And then afterward he came back to it. This is the way Michael is he. And he comes up and he says, I love this. This is so great. Think of all the levels of the narratives.

(00:08:11):

He said, now what you want to do is take these tapes of the mothers talking about having lesbian daughters and get a group of mothers and show the group of mothers the tapes of these mothers talking about half lesbian daughters. And then tape that and then talk about that. And he was already thinking about all these levels of meaning and narratives and how people's narratives interact and how do they influence people's experience of an event with a thought. Probably he's right. If all those levels of mothers talking about those daughters and many of those stories had pain, you know, mothers really struggling, you know, what did I do wrong? Have a lesbian daughter. These were heterosexual moms. And he was really talking about the power for narratives to be transformed. And how does one transform narratives? Often with things like externalizing the problem, normalizing the problem, reframing the problem, really seeing how our narratives about ourselves or our couples or our sexuality could be anything that makes us feel broken.

(00:09:09):

Whatever problematic discourse isn't about us, it isn't true about us. It was given to us in a way, in the cultural narratives, in the familial narratives, in the religious narratives. It doesn't matter all the different sources. So the way that he externalizes the problem is one of the things I find the most powerful in helping people really start to heal. Because when they come in and they say, Suzanne, I'm broken sexually. And I'll say, well how's that? And they say, well, I don't feel any sexual desire anymore. So, right, I'm broken. I'm the problem. And I would, the, one of the first things I would say is, where'd you get the idea? You have to have desire to start sex. And they would look at me like, I'm crazy. That question's a narrative question. I'll say, you know what? I think what's happening is you're trying to fit your sexuality into a model that doesn't work for you.

(00:10:00):

Because there are many other models to see the shift on people's faces, Todd, like in a first session people cry, you know, they're like, what do you mean I'm not broken? And of course, there could be a lot of grief because they could be, have lived with this feeling of brokenness for years. They could have lost relationships over this brokenness. So Michael's work was just so profoundly impactful on people to externalize the problem, well, no matter what it is. And then to give, once people don't feel broken anymore, then they can re-author. He would say what they want that life to be. So, it's not only, you know, shifting the frame, but also allowing for space for them to find their own story of how they want to live their life.

Todd Zemek (00:10:42):

Wow. Artistically, what a gift, as you say, peak experience. To have an artist like him come in, review your art, point you in that direction. Oh, oh. And a way as if the stream wasn't powerful enough. Yeah. That, that must have been just unforgettable. It

Suzanne Iasenza (00:10:57):

Was over the top.

Todd Zemek (00:10:58):

And then similarly, when you are with patients, they would be the moments that would be unforgettable for them. That the privacy or the secrecy would be a space in which they would be fused with those narratives as a prison. So the light would shine through the clouds when you start opening some of those doors in that way.

Suzanne Iasenza (00:11:18):

And I often tell people, you know, secret or shame is like a mushroom. It really blossoms in the dark. And for people to come into the safety of the therapy room and to be able to take those mushrooms out, you know, people have told me, I never told anyone this sexual fantasy I think is so terrible or never told anyone that I had an abortion, you know, 20 years ago or whatever they're telling. It's almost sometimes I feel like, gee, I could hell a collar on and be like, you know, a priest in a church. They're coming to confess to me. But it, they lay down their burdens and it's so re it's, it's first of all such an honor and so sacred. But then to have the kind of body of work that I pulled together in this book, of all the people that taught me over the years, Michael White and even Freud actually Freud was remarkably open in terms of bisexuality and other things.

(00:12:12):

Robert Stoller's work is very important to me. I mean, there are several people and it's integrative. Like Michael White really came from family therapy systems work. And Robert Stoller for instance, was a wonderful psychoanalyst in the United States who really pushed the envelope on what we used to call perversions and to really challenge how do we put people in categories that they're sick but we're not, how does that work? So he really challenged our at tendencies to cord off what makes us feel most uncomfortable. And it's not so long ago, like at least in the history in the United States, you know, when you look at the history of sexology, it, it's not that old. I mean when you think about Kinsey for instance, Alfred Kinsey was just a professor in Indiana and he wasn't even a se, there was no such thing as sexology then. But he was like a, he was an entomologist.

(00:13:03):

He used to categorize wasps. I mean he <laugh> wasps meaning not the person wasps, I mean the insect wasps. And you know, he, he was an expert at it. So, but what was he an expert at categorizing things, right? It's very interesting. And then he would just graduate students would come in who were married or whatever, coming in and talking about their science project. And then before you knew it, they were saying, I'm having a hard time with my husband and my wife. And before you know it, students were starting to turn to professors to talk about their personal problems. And at that time they didn't even really have counseling departments like they do now at certain colleges. So they put the word out to professors and saying is, would anyone like to volunteer to be here for these students? And Kinzie was one of them.

(00:13:48):

And then before you know it, he's collecting the stories, just they could collects the different wasps. And he's starting to realize, oh my god, there's a such a category and a diversity of experiences called, because you know, I don't know how many gold wasps there are, but apparently there are like a lot of gold wasps. Who knows. And so he applied that same like curiosity about diversity to wasps, to sexuality. And the next thing you know, he developed one of the most important surveys of sexuality and wrote two groundbreaking books on male and female sexuality masters in Johnson or the other team in St. Louis, Missouri who started the watching people have sex behind a one-way mirror. Can you believe that? All the way back in the sixties, this is, you know, and recording and then being able to say this is what we call sexuality. But both of them put sexuality on the map in a way that never occurred before. That was the birth really of the field of sex therapy, at least in the United States.

Todd Zemek (00:14:48):

So really validating just that mature idea of difference, that there's room for difference here. And if it had never been spoken about formally or publicly prior to that, there would've been no frame for difference diversity whatsoever.

Suzanne Iasenza (00:15:01):

And the Kinsey reports I think were the most impactful in the sense that they were two, these two enormous books. I don't know if you ever saw them, the ones on mount, they're enormous and they flew off the shelves, you know, when it went out. Cause everybody I think thought very kind of purely, this is going to be really hot <laugh>. Well all it's is major pages filled with all these statistics. <Laugh> card, there's a one picture to look at that could be exciting. But what he did was he documented the great diversity of topics to sexually that up to that point were never talked about. Homosexuality was one. But even beyond homosexuality, premarital sex was very, you know, verboten at that time. And also bestiality, he wrote about, he wrote about sexual fantasies, I mean things that nobody ever really documented. So it really documented the real presence and diversity of sexual expression and urges. And, and he got a lot of flack for it of course. I mean there was a lot of political and religious and psychoanalytic folks just really being very upset by it. But it was a groundbreaker. I mean you can't go back once that was published.

Todd Zemek (00:16:09):

So if that's relatively recent, what would be your commentary on our maturity culturally as it relates to sexual dialogue?

Suzanne Iasenza (00:16:17):

You know, is, that's a really good question Todd. Because I think we're a little bit kind of paradoxical in our how far we've come. Because in some ways, you know, you could look at let's say marriage equality that happened in the United States not too long ago. Now gay folks can get married. I never thought I'd ever received that in my lifetime. It's like it, it almost happened at lightning speed. It only took a couple of decades. You know, Stonewall, which was the big homosexual revolution in the United States, only happened in 1969. So I think between 69 and 2000 whatever, I mean it was only 20 years of 25 years. On the other hand you can look at how still we have hardly gotten a real grasp on all the sexual abuse that's going on and how to prevent it, all the abuse and of children and how to prevent it.

(00:17:05):

How to educate parents to protect their children or to identify those things. The internet is as we know, a force for good for sure. It, you know, that little, that gay or that transsexual kid in the middle of a co country, right? Who could want to kill himself or might have 20 years ago or 10 years ago. He can get online and he can find a community right of other kids'. It's a lifesaver. But also, eight year old’s could go on to Google in one minute and find a porn site and be so flooded and overwhelmed with what they see. And then they could develop a sexual, a relationship to self and to sex that then can create sexual dysfunction 10 years later. So we have to help our kids be porn literate. We call it, you know, to that pornography is not sex therapy.

(00:17:55):

I mean it's not sex education and how do you help kids really relate to the internet in a way that they can educate themselves, but they, but not miseducate themselves. And there are, as we know, people online who also access kids online, which isn't so great through these sites. So there's a real mixture I think, of people's knowledge about sex and openness, about sex. There's still, at least in the United States, some religious still negativity in sex education happening in the schools in the way that might really help kids more in the United States. As much as we're so progressive. We're also very not, you know, there's a split there and maybe there'll always be a split between more openness and then shrouding in secrecy

Todd Zemek (00:18:39):

In terms of openness. And you're talking about the relationship between parents and children. One of the things that struck me when you're talking about taking the sexual history is that you would just show such respect and it's like, okay, well we're going to take our time with this. So you're saying three to five sessions if we need more, so be it <laugh>, there's this great frame of respect. And that was, that was really liberating for me. It was this like, actually you know what, this is bigger than 20 minutes. So, to give it that respect, and I assumed that one of the things that was happening there was that from a self-psychology lens that there was this mirroring process that you have value and this part of you has value. I get a sense that you are so intimately conscious of that.

Suzanne Iasenza (00:19:29):

I'm glad you bring in self-psychology because one of my favorite people I talk to talk about in my book and I talk to my patients about is Heinz cohort's work, where he talks about the mirroring impact of parent with the child and how children grow up and really develop their self-esteem and their sense of, I'm a valuable and desirable and lovable person from just what is done non-verbally. It's not even what verbally a parent might say. So I will talk about this with patients and say, imagine the little boy going into the kitchen and mom is cooking and she's chopping, she looks up, she doesn't say a word, but just how she looks at him. He knows, she feels you are the love of my life. You are the apple of my eye. I am so happy you were born. You are just valuable and desirable just the way you are.

(00:20:17):

When I describe this to patients, Todd, so many of them begin to cry. And it's so interesting because I don't know why they're crying, and you don't know. Some people will cry and say, oh my God, I was so lucky. You know, my mom made me feel that way. Or my dad or you know, my parents didn't. But every time I went to my grandmother, there she was, other people could be crying saying, I don't even know what you're talking about. I never had that. Or they'll start un unpacking the stories. Oh, I had a mom who when she looked up, I knew it was with you again or a and or could have been added. It would could be combined with words. I'm so sorry you were born, you ruined my life. There are all these incredible stories of the opposite. And then when I do work all these years later, Todd, doesn't matter how many decades later, and let's say a person is struggling with desire later on in life, sexual desire and let's say their partner, I'm trying to sell them on the idea of willingness.

(00:21:15):

You don't have to enter with desire. Why don't you make a decision and enter with willingness? It's people who never had the gleam in the eye who often had the greatest trouble embracing willingness over desire. Well, why it makes sense in a way, if you never felt inherently desirable from way early, it's hard to even have the flexibility to say, okay, now let's try willingness and desire. We could just wait for desire to show up or see where else it is in the cycle of sexuality. But for people who never had that desiring cream in the eye, then to ask them to be able to have their partner enter into sex with willingness instead of desire could feel like a retraumatization or a re-wounding. So that's another reason why it's so important to go back and do a relational sex history. Not one of just the data of when did you start menstruating, when did you start dating? You want to also get the sense of the relational context within which this child became a sexual being and how much was there that made them feel inherently valuable, desirable, loved, cause that comes along for the ride with all its narratives into adulthood and gives them much more flexibility to deal with the slings and arrows of adult sexuality anyway. Like nobody gets through the, their whole adulthood without challenges to their sexuality.

Todd Zemek (00:22:34):

And I think that's a really interesting point for people listening is that and such a, a common experience is, you know, for people to say, well I, I didn't have anything bad happen to me. There wasn't anything on paper that I can point to that would make sense of this. But from what you're saying, it may have been the absence.

Suzanne Iasenza (00:22:52):

Oh, totally. It could be the absence, not, yeah, they're the sins of coalition. The parent who sexually abused them or physically abused them or emotionally abused them verbally and they're the parents who then there was a void. There was no there, there was no one to mirror them and to help them figure out who they are, but also just to feel valued and loved. And they're right. Those are like what we might call the small T traumas or more what we call the attachment traumas or wounds as opposed to some people say the big T trauma, my father incested me for 10 years, I was raped in college. You know, those are ones where there's actual physical harm was done to the child, but there are all these other subtle relational issues. Right.

Todd Zemek (00:23:37):

As they say, it's impossible to give what you haven't received. Yes. And I imagine that generationally here, yeah, we've got some stories about the fact that perhaps life was more devoted to survival rather than the tone of loving connection and not really having any story or any frame or template to move into relating with that gleam in the eye as you're saying.

Suzanne Iasenza (00:23:58):

No, that's a really good point because even with loving parents, I've had people tell me my parents loved me. I know they did. And they're not, they're not really denying anything. But they could have been parents, let's say, who were working class, owned a business let's say, and they, from morning to night they were there working and the kids were kind of left to, you know, just make their way. It was like a survival thing. And the whole idea of emotional nourishment or mirroring, I mean it would be, it just wouldn't be in the picture. And those classes, you know, you put food on the table, you put clothes on your child, you know, roof over the head, you're cooking right? And your parents love you, what else do you need? Well we know now that there could be more that they need and those could be harder histories to do to help people access that sometimes.

(00:24:40):

Cuz people can feel very loyal to their parents or very invested in the story that everything was perfect as a child. So you have to tread really lightly. I'm not there to really give them different narratives. I'm there to just help them question or be curious about what narratives were there. And then there's a, the intergenerational transmission or trauma, let's not forget that like when I work with Jewish people, I ask about Holocaust history or with African Americans. I ask about the history of slavery, indigenous folks, the, you know, the genocide that happened with tribes, genocide that happened during war or immigration experiences because we now have plenty of evidence that there's this intergenerational transmission of trauma that then someone now, even though, let's say great-grandfather died in the Holocaust or were those folks perished? There are narratives that came down generations about that trauma, that more communal trauma.

(00:25:37):

And how does that affect people's ability to be put all their eggs in one basket with a partner, includes sex and love in a relationship. You can say, what does that have to do with the Holocaust? Well it can have a lot to do with the sense of danger, the sense of trust, the se or lack of safety in the world could be digested and then experienced on an intimate level. So there's so many levels you can imagine why you need at least three to five sessions to let people unpack their whole history, including generations back.

Todd Zemek (00:26:06):

Very, you introduce the idea that this is what we are going to do or this is an area that could be helpful. How do you introduce that? I imagine the, the responses would be, you'd have quite a bit of diversity there as well.

Suzanne Iasenza (00:26:18):

I, I can get a diversity of responses actually some people for whom they're coming in with such an urgency. Many people are coming in with such an urgency because they've suffered too long with whatever the sexual issue was. And for some couples it could be like you're the last caboose on the train, you know, if this doesn't work, this is a deal breaker, we're going to break up. Or there could be that kind of frame so that the idea of not working immediately on the sexual issues now every week, but instead either devote ourselves to the individual ones or alternating between couple sessions and individual ones. They could already see, oh boy, this is going to be a few months process at least just to finish the histories. When are we going to get to sex? You know? So some people might have some concern about it that way for that reason.

(00:27:05):

Other people are not very introspective and don't want to be, some people even know the traumas that were back there and don't want to talk about it. They feel very, or things that they feel ashamed about or secrets that they have. So there could be a lot of reasons why some people may resist it. Other people like just absorb it like they're on the desert. Oh, drinking the water. They feel. Many people tell me actually more than not that just going through the sexual history process changed their life. For some people actually even the sexuality in the couples starts or changes as a result of the sexual history taking, you know, because part of the history is not just a collect data, like in the old days when we used to be trained, it's you do a history just to collect the data. It's a relational conversation.

(00:27:50):

It's a therapeutic process. So when we identify, when someone identifies, oh I remember that, and then we stop and they say, wow, what are you feeling right now? And they start crying or they, and they tell me whatever the story is, let's that their father died. It doesn't have to be a sexual or body related story. It can be a real loss or something else that changed their life died when you were five. How do you think that affects your sexual or intimate life now? And people begin to unpack that and realize how this feeling of you can lose someone at any moment. I can't throw it all in there. I am not going to love and have sex with the same person. It's just too much. I can't bear it. If I connect that much and they die on me now, that would've been a completely unconscious narrative they were living with that was affecting them.

(00:28:37):

Now when we uncover that kind of material and reframe it or really bring the great amount of compassion to it, people can really lighten their load and, but they release shame. They release guilt. I help them understand like if someone was a trauma survivor, sexual trauma survivor in childhood, they could say I deserved it. I didn't tell my mother, my father was having sex with me. And I'll say, Lena, wait a minute, let's think about a five-year-old being able to first go through that betrayal in the first place with their father. And then you're going to tell your mother and they'll say let's say they have a child. They'll say, well your son is five. Think of your son being able to do that. You know, and that you really help them be able to understand they could be living with a tremendous amount of guilt or shame or self blame that you begin to help them question or reframe or unpack. And so it can be a remarkably therapeutic experience, not just a data gathering experience.

Todd Zemek (00:29:33):

Is that something that people could do outside of therapy and to, for people who aren't in therapy, the interested in personal growth would reflecting on their own sexual history and some detail like that

Suzanne Iasenza (00:29:44):

They could, you know, like some people who are reading my book now for instance are not therapists, but they're writing to me saying, oh my God, this was the best book. And I read it, you know, I, I intentionally wrote it actually it is for therapists, but I intentionally wrote it to as simply as I could so that anyone could understand it. You don't have to be a psychologist to understand most of it. And people were saying, I'm never, it made me go back and ask myself what was my first memory? And then I thought just the question of what happened to my child that that could be affecting me now with my partner or my spouse. So yes, I think people can be curious in general and start to identify that kind of material most of the time that they might need to speak with a counselor if they wanted to go more deeply into something. But it is a self-reflective process that hopefully people are curious about in general. It just gives a frame for it, you know, and a kind of outline on what kinds of things to question yourself about.

Todd Zemek (00:30:55):

In terms of couples sharing their sexual histories. I imagine that's something that could be an opportunity for, for great closeness and could be fraught with danger as well.

Suzanne Iasenza (00:31:07):

You bet. I mean that's why a lot of therapists will ask me, why do you do your sexual histories with the partners separately? Alone instead of in front of each other? And that's a really good question. Cause they often say, well there are pros and cons to doing it each way. Like the pro which you're implying is to have them together is if let's say you're doing the complete history with one partner and the other one's watching, they could learn about their partner in a way they never knew. They could have empathy and compassion for their partner the way they never knew. They could even say, wow, I was making our problem now all about me, but they've had this issue in past relationships so it's really not just about me. Those are the good things. But the downside is that most people probably would censor themselves in some way or another if their partner's there either consciously or unconsciously.

(00:31:55):

And there's certain areas of people's sexuality, which I would put in the private department, not the secret department, but the, the department where they really might not want to talk about it with a partner there. And frankly I wouldn't want to ask them with the partner there. Give an example like masturbation history. For some people masturbation is a highly private experience. They don't tell their partner they're masturbating or when, or what they fantasize about while they're masturbating is very private. And they could even be embarrassed or ashamed by some of the things that excite them. They would never want their partner to know that. One other example is I ask people, what was your peak sexual experience in your whole life? What was your peak sexual experience? So let's say this 40 year old woman wants to say, you know what Suzanne, my peak sexual experience was with my college boyfriend.

(00:32:45):

And guess what? Her husband is not her college boyfriend. Does her husband need to be in session hearing that? No bill, would it be helpful? I don't think so, but would it be helpful to me so that I could get into that? Well what do you think? Why, what was it about him or you or the context that was so peak about that and why can't you have that with your husband now? So those kinds of things I put not in the secret department, like it's something that they should tell their, their partner that is actually doing harm to the relationship. It's more helps me understand how they became the sexual being they are.

Todd Zemek (00:33:20):

So maintaining some right to separateness or some right to privacy. That's right. I guess that's just a healthy differentiated self.

Suzanne Iasenza (00:33:27):

You would hope so. But some folks get very threatened by those separate ones and then that does give you actually, Todd a clue that this might not be such a differentiated couple. And I don't know if you know David Scharch's work like Passionate Marriage. It's a great book. He was a family therapist who was trained in family therapy, which basically looks at differentiation. How differentiated are people from their parents or from their partners And with the belief that there is a certain amount of differentiation that's healthy and there could be a certain amount of merging with a partner that actually is very unhealthy. Like you can't say have a different opinion than your partner or can't tolerate a different opinion from your partner that's not very healthy. And his whole premise was that people have sexual problems basically are not differentiated enough. That was his premise. I think it's a little bit universalizing about differentiation, but I do think it's quite a lot to it. And one way it can show up is when I say, by the way, I'm going to be doing sexual histories over the next few months separately. I could see on the looks on the face whether people look like terrified <laugh>. You never know what reaction there is. But sometimes I have to process it with them because they're threatened.

Todd Zemek (00:34:35):

I can imagine that guilt or shame or fear or just the uncertainty. Speaking of which, you talk about one of the key other ideas in your book is that at the sexual menu. So yes.

Suzanne Iasenza (00:34:45):

Tell

Todd Zemek (00:34:45):

Us a little bit about that. What's the sexual menu?

Suzanne Iasenza (00:34:48):

I thought, you know, it just works well with me because I am from Italian background. My grandparents were born in Italy. We love food in our family. The idea of food and sex not being so different is not a new idea, but it's a way, it's an a kind of exercise I developed that I thought was a playful way, a poignant way I think to help people be able to, to express what their sexual preferences are without shame or without embarrassment. And to be able to negotiate differences in sexuality. Just like with food, so many times I'll say to patients, well let's think about it. You really like Italian food and you really like Chinese food. You don't shame him that he likes Chinese food or that it, you know, you should enjoy Italian. Instead, what do you do one week? You say, okay honey, let's go to the Italian restaurant this week because that's your favorite and next week we'll go Chinese because it's your favorite.

(00:35:39):

Or if you go to the restaurant together, I might be ravenous, you might not be. I might say, well I want a six course meal. And we might say, oh I'll have a little appetizer. Or let's say you're not hungry at all. You might say, you know what honey, I'll come and I'll keep you company and you eat and I'll keep you company. And I use those analogies to come back and say, why couldn't sex be handled that way? You know, it's very normal for different partners to have different preferences. How could you begin to talk about your different preferences without shaming or criticizing judging yourself or the other? And then how could you negotiate a good enough? Doesn't have to be your, you become a carbon copy, but enough of the overlap so that people can feel fulfilled as much as possible.

(00:36:21):

So then I have them actually do the menu exercise where I send them home and I just say, write down on a piece of paper everything you could think of that's sexual, sensual, erotic. And don't judge yourself. Don't say This is too kinky, this is too vanilla. What's Suzanne going to think? What's my partner going to think? Try and just put it out there. Then you're going to come in and you're going to share those menus with me. This is an example where one person watches, because when I then process it, one person will share their menu and the other one just listens. No crosstalk, no questions. And then what they do is they see how a conversation of curiosity can happen between two people without judgment. And then the, it's like a role modeling,

Todd Zemek (00:37:04):

Mirroring one and modeling for the other. You bet. Yeah. Nice. Great.

Suzanne Iasenza (00:37:07):

Yep, yep. And then and then there's no crosstalk and then we do the other person, no crosstalk. And then we open the floor and we begin to talk about the two menus. And then they can make a couple menu from the two separate ones. So I have them go home and choose all the items that right now they could put on a joint menu that they could do sooner rather than later. And then make another list on the ones that one of them is not ready to do yet. And then you could really, between the sexual menu and willingness, you could, people could start to become sexually active sooner rather than later.

Todd Zemek (00:37:41):

So within that safety they can start to play. They can start to experiment and play at a level that's been agreed upon.

Suzanne Iasenza (00:37:49):

That's right. And for let's say survivors of any kind of boundary transgressions or sexual abuse, this could be a real anchor for them because part of the problem with abuse like that is that their body wasn't their own. Someone, you know, took over control of their body and safety. When they have a list of things they've agreed to with a trusted partner, then they could go into having an experience and feel safer than if just go home and have sex much too unstructured, much too fearful that it could go into a territory that feels too reenacting of the abuse that they live through. So it's a really great one for anyone who actually also has gone through boundary transgressions

Todd Zemek (00:38:28):

That we can do that safely, we can do that playfully.

Suzanne Iasenza (00:38:31):

That's

Todd Zemek (00:38:31):

Right. Again, which might be the, the first time that's ever happened. You were talking earlier about the relationship between arousal and willingness. Mm-Hmm <affirmative>, what are the conditions that are required for willingness? Because I imagine that that would be part of what may have been stuck or frozen for people

Suzanne Iasenza (00:38:47):

Willingness is, you know, I borrowed that from Joanne Lulu's work. She's one of the people whose models is in my book and it's a later model. It's one that what sexuality is much more expansive than masters in Johnson was or Helen Singer Kaplan's was, which were basically linear models. So Helen Singer Kaplan's probably the model that everyone still is operating from. It's a Triassic model that just has desire, arousal and orgasm. That's it. There it is. And the belief though was that everyone will operate just like that. You have desire, then arousal, then orgasm. When you think about that, that's a little bit ambitious to apply to every human being regardless of race and ethnicity, gender, sexual orientation, gender identity, whether you were traumatized or not, whether you had any attachment wounds in childhood, no matter how old you are. Whether you're taking an S S R I for depression, that actually can affect your desire level or arousal or orgasm potential.

(00:39:44):

There's so many things that can really interfere with that model, you know, that could make someone feel like they're broken. Whereas lulling her, she right away said, I think we need more, more components. And she kept desire in her model, but she, the first step was willingness where she felt, you know what desire isn't in everyone at the same level nor over the same amount of time. It's variable. Which it very much is actually. And now we have studies that really say there are two kinds of desire. There's what we call spontaneous desire, which is what we always thought desire was, which is like that horniness that you know, want wanting or needing sex. And then there's what's called responsive desire, which is someone who doesn't have that horniness to start sex but actually could feel desire once they start sex. So it actually, that's where willingness comes in.

(00:40:35):

It's like willingness to be responsive to experience, responsive desire. So it really is a decision. I like, you know, I, I tend to think that the mind is not our friend when it comes to sex. It's actually not our friend with most things. I think most psychologists we wouldn't be practicing if it weren't for the mind, right? Because the mind usually when people are not feeling good about themselves, the mind is not saying good things. Let's put it that way. <Laugh>. And when it comes to sex, the mind very often is not saying good things. Oh, I gained five pounds, my penis is too small, my breasts sack too much. Oh, we're never going to have a good sex. I'm not going to have an orgasm. You know, the mind is so busy that it doesn't give the body a chance just to be there and enjoy itself.

(00:41:17):

The idea that the mind can be used for good in sexuality, that you actually can use it to be willing. So that could mean, you could say, you know what, I'm just going to set up a sex date every week with my partner. That's it. And if we have a broad enough sexual menu where we could do anything, including non-genital things, non-orgasmic things, we can watch a porn movie or we read a book or we can, we get to define what erotic life is, that then people can have the power to enter into a physical experience. And what studies have shown is that from some people, that actually desire can be there, but not in the beginning. That once you get into it with willingness and the body gets aroused, desire follows arousal instead of precedes it. Rosemary basal and her team in Canada discovered this and it was so compelling the research that they went to the diagnostic manual committee, the DSM committee, and change the diagnostic code. So women cannot be diagnosed with sexual desired disorder anymore. Yay. Unfortunately, men still can be, which I don't think is fair frankly because a fair number of men I work with desire follows arousal. It doesn't proceed it. So eventually, hopefully just des desired disorder can get out of the diagnostic process I think would be really a gift.

Todd Zemek (00:42:36):

I imagine there'd need to be a fair amount of safety in order for that willingness process to get started.

Suzanne Iasenza (00:42:41):

Yes, you're very much right because some people will say, well gee, you know, like isn't that what could happen in a couples where there's domestic violence? People are willing, sure they're deciding to because they're afraid. If they don't, you know they're going to get abused. Absolutely. It's a contextual variable. You have to assess the system before you even would bring in the idea of willingness and you have to assess the history. Because for some people willingness could even feel too dangerous. Some people are so vigilant because they've been so physically abused that they can't even imagine being willing. It feels like that's a big stretch. So I created this in the book, I talk about this, I created a willingness continuum. So say there, here's where the continuum could be helpful. So instead of being willing or not, which is much too big a jump for someone for let's say who had a lot of body trauma that I created a willingness continuum that goes from totally aversive to having any sex.

(00:43:33):

Like minus zero to zero, like neutral about having sex this week. Not excited, but you know, we're really even willing but not averse to it. And then all the way toward being willing and being able to sign on. So that with someone who's really traumatized or has a very strong aversion to sex, you want to give willingness on a continuum so that if somebody goes from negative 10 to negative five in how much they dread sex, you could say how that is great work. Look at that. You went from negative 10 to negative five, that's amazing. Then they can go from negative five to negative one. Now they got to neutral about dreading sex or being excited, fabulous. You know, so that to give people as broad an opportunity to see improvement is also really important because sometimes, I think sex therapy doesn't work because it goes way too fast, it's way too behavioral.

(00:44:26):

It doesn't take in all the relational and the unconscious and the bars are set too high. Like when people do sensei focus, which is that progressive touch, some therapists will come to me for supervision in a case and say, Suzanne, I gave them the sensei focus. I don't know why, you know, it didn't work. And I'll say, well what did you tell them? And some they'll say, well I took them to tell them to take all their clothes off and for an hour just start touching each other. First of all, I say someone who hasn't had sex in 10 years, you're going to tell them to take all their clothes off and touch for an hour. I mean, there's no structure, there's no small incremental changes, there's no you know, really letting them first start with their clothes on then slowly take clothes off. So some people just move through these behavioral assignments way too quickly for people.

Todd Zemek (00:45:11):

Sometimes there'd be huge discrepancies in desire or what people were sharing in terms of their sexual menu might be a very, very basic level. Others might be radically adventurous in what they were wanting to put on that list. Mm-Hmm. <affirmative>, I imagine the grounding containment that you offered could provide, even if there were fears that oh my god, I'm not going to go anywhere near that. Just the discussion of well what could we do? And having some successful playful interaction as a starting point that could be revolutionary for what's possible.

Suzanne Iasenza (00:45:49):

Yes. And you could be so creative and imaginative about it. Let's say if we took the person who's super kinky likes B D S M or wants to get into spanking or something and the other person is like, you got to be kidding me, I would never, I don't want to be hit or beaten up. First of all, the ways that people don't understand things, they'd need to be educated. What could be possible? Well maybe that person who really wants to practice that kink, whatever it is, and the other person can't go near, I might say, I wonder if you could first read about it. Could he or she pick their favorite kink story and could you read it together? Maybe he could or she could read it to you. Well maybe now you could pick a kink story and read it to him. Could you do that for how long?

(00:46:32):

Oh, you can't do it for a half hour. Maybe you could do it for 10 minutes. So first it could be with through reading or maybe they can view something. He or she could be involved in it some way and they could hold them while they're doing whatever they're doing. Maybe they'd accompany him or her to a kink club, but not participate but be their partner. There're and back, you know, so there are these different ways where you find the path of least resistance that still might encompass the real desire of the other. Because when you do have partners who have very different sexual preferences than how they going to work that one out, some people open the relationship actually. And that could be an option where they may create a very respectful and safe kind of contract where a person could go out. I've had couples where once a month they could go out to a kink club or once a month they could experience something else that the other partner doesn't like to do or isn't good at, frankly.

(00:47:27):

But that's only one option. I mean, people can find, I often say like in a Venn diagram, you have a big circle that's one person, a big circle that's the other. And you just want to see can you overlap it just enough. We have like good enough sex. Barry McCarthy, one of our cherished sex therapists in America would say, just can't we help them aim for good enough sex? Not like the high bar of like, you know, mind blowing sex. You know, it's, it's people sometimes have remarkable expectations. You got to help them become a little bit more humble in, in what one can achieve over the long haul with two separate people.

Todd Zemek (00:48:02):

And I guess this is why so many couples come in saying that they, they haven't had sex for so many years, it's just been too scary to even start the conversation. That's right. So the potential for any actual relating in that space is just absolutely negated.

Suzanne Iasenza (00:48:18):

And that's why I think the sexual history is also there's so many purposes for them. Well one of them can be, it's the first time the person talked about sex period with anybody. So they hadn't talked to their partner for 20 years about it, but they could talk to me about it because I'm safer, right? I'm not the partner and I'm an expert. Right. And I have an ease of talking about sex that is very kind of down to earth and respectful, but explicit. For some people, they're amazed at how open they became over the course of the therapy where they could talk about clitoris and orgasms and anal sex or anything else that they never thought they could ever talk about.

Todd Zemek (00:48:55):

One of the things I see very, very frequently in my practice is couples in their fifties mm-hmm. <Affirmative>, they've gone through those developmental phases, falling in love, raising a families, starting a business, all of these things. And so they've been able to adapt in terms of a lot of the external demands. The price of that has been some of the internal has been really neglected.

Suzanne Iasenza (00:49:16):

Yeah. It's, intend, you know, because when you really think about it, even if you want to pay attention to the internal or the interpersonal, like the marital relationship, there's a big demand as people know who have kids, to have them and raise them safely and well. And then maybe you have elderly parents who are getting sick at the time you're raising your children and then you have businesses that you, that you're working in or careers if it's a two career couple. So that it is not uncommon that at that time when kids launch, I see a lot of couples in that 50 ish area that their last child is getting ready to launch and they look at each other and say, who are you? <Laugh> <laugh>. I mean I know you're, you're John's father or Mary's mother, but you know, I don't know who you are as a pro. I don't even remember. I vaguely remember a honeymoon. I vaguely remember falling in love. But boy there's a big gap between us.

Todd Zemek (00:50:10):

Maybe you've done an adequate job in terms of the routines around the house recently your performance has been slipping but you haven't noticed anything about this private part of me. That's right. And our contract is, I've had to keep quiet so as not to That's

Suzanne Iasenza (00:50:22):

Right. Inflame. Either there was a lot of fighting or there more likely if there were a good team as a parents very often all that hurt and anger and rejection and sadness about it is internal. So part of the work is to start to unpack that in a safe way and to reframe it. You know, many times I'm very like Michael White, very into normalizing and externalizing problems. And I often will say, you know, you're along with a lot of couples at your age that they were so into being good parents. You know, they're almost like these kind of three kinds of couples who are parents. They're the ones that are kind of what we call the relationship focused parents. But those are the ones that so privileged the marital relationship that the kids really get short into the stick. And though I've heard these stories where parents are flying all over the place and they leave the kids with take separate holidays.

(00:51:12):

Yeah, the separate holidays, you the whole thing. I think, wow, how did, that wasn't really a gleam in the eye, was it? You know? And so they had a great example of the parental couple as a romantic unit. That's the gift. But the downside was they got no mirroring it. That's a real cause. Then you can have the other side who were like super parents. They became parents and they forgot that they were a romantic couple. So that actually they neglect and they left to decide the romantic relationship in service of being the best parents they could be. Okay. That's very nice. The kids turned out wonderfully except for that they didn't get a role modeling of what a romantic relationship looks like. Because one of the things I talk about and I assess in sexual histories is tell me about the parental couple, if they had one and what kind of couple were your parents?

(00:52:01):

Were they loving? Did they, did they seem they were still in love? Do you think they had sex? Did you ever overhear it? Dami and daddy ever go and lock the door and say, don't come unless the house was burning down, whatever. How did you know your parents had a, A couple and some say they were a terrible couple. Either they were fighting and awful or they feel like they probably never had sex after once they had the kids. It's not as damaging as the marital couple that neglects the kids. But but it's not great that they didn't integrate some sort of romantic couple. And then there are their folks that really do manage to eek out a balance. It's a big challenge, but a lot of the young couples I see now that even aren't pregnant yet, but they're thinking about it soon.

(00:52:45):

Many of them not only is the agenda, but we also want to get back to sex. Because somehow it fell off the chart just as a couple. But they're very frightened about the next stage. Like what happens when we start to have kids. So we start talking about it and preparing for it and talk about how does sex during pregnancy look? How does sex after birth look? How do you imbalance it? Oh, isn't that wonderful? Oh yeah. And for those couples, I think, wow those couples are more lucky than the people in their fifties or sixties who've now lost 20 and 30 years of a romantic experience with their partner. They have to deal with all the grief, the anchor, the hurt, and now the kids have launched. You know, so it's like great job. But now our marriage is in a shambles or we're so disconnected. Now that doesn't mean they can't get back on track. Many of them do. But it's a lot of work that they could learn like these younger couples who come in almost afraid before they have the kids. Fabulous. Let's get the skills in there now

Todd Zemek (00:53:41):

Afraid with good reason for what they've Yes. Most likely observe. How amazing to have an elder to basically talk about the road ahead. Yeah. And then what to expect and what to do. Not if but when we hit these points. Absolutely. That's certainly other developmental stage that I see. Not just the empty nest but the, the empty nest for the day when kids start going to school. And there's a little bit more time

Suzanne Iasenza (00:54:03):

These days with Covid by the way, so many, at least people <laugh>, everybody's living together now, you know, so that even if the kids goodbye, have a good time and mommy and daddy could get like a little quickie in before they went to work. Forget it. I mean they're so stretched. So many parents I'm working with now because they're trying to work at home remotely, which is hard enough. And then they have kids at home and they're trying to school them in between because kids are not learning as well online as they would in person. Actually, I'm doing a workshop in a month from now called Dating in Love during the time of Covid because first of all, dating's a big thing. You know, what about if you're single now, how in the world you can't go to a bar, you can't go to a restaurant, you can't go to a club or a gym.

(00:54:46):

Where are you going to meet people? Even then, how do you begin to become intimate when you could hurt each other? You know, you don't want to, you don't want to get each other sick or you don't want to get your mom sick or your grandmom’s sick, you know, if you live with them. So dating is really a challenge. And then just being a couple during covid, some couples, you know, some couples are doing much better because they're spending so much more time. They don't have to commute to work. They're home more, more time with the kids and they are actually, it's almost like a second chance at love. It's very beautiful to see. And they're really doing it in terms of sexuality. They have the time and the energy. Other folks though, who were already the cracks were there or they are going really, it's a stretch. Like they would love to go to divorce court but they can't, you know, they have to get through this and it's awful to live under the same roof and not be able to get away from anyone <laugh>, you know. And so it's, it's not a boring time to be a psychologist I must say. Right. Todd <laugh>.

Todd Zemek (00:55:45):

That's true. Very, very true. Speaking of being a psychologist, I had to ask about erotic transference.

Suzanne Iasenza (00:55:51):

Mm. Okay.

Todd Zemek (00:55:53):

When we are addressing some of these issues, often there can be an idealization of the therapist, there can be the secrecy of an attraction that mimics other secrets. Mm-Hmm. <affirmative> just really interested to hear any of your thoughts on how that's presented, how openly it's spoken about with therapists and then how it's addressed in therapy.

Suzanne Iasenza (00:56:15):

That's a good question. I think many times since I work with couples and individuals, that kind of material emerges and is a little easier quote unquote to work with individuals because some therapists might say it's harder because they get more nervous that it's just him and I, right? Or her and I. But actually there's the freedom almost like doing the sexual histories that they could be free to say they have a crush on me or they're wondering about me or however they want to use me in that good way of who do I represent to them because when there's erotic transference, I encourage people talking about it because it's about me, but it's also not about me. It's about something unfinished or wished for that what didn't happen with someone more significant than me from their past. So it's part of when you do analytic work, we believe is curative, you know, it really helps toward people working through things.

(00:57:04):

And we take the first hit meaning even if it's negative transference, in this case eroticism is put in the positive, but people could also not like you as a therapist and be angry at you all the time. But because they were always angry at their dad and never could say so, right? Or whatever. And then we work through it, we talk about it, you know, and help them understand how much of it's about me, but how much it's about who or what that you need to heal. It could be a little trickier in couples because since they are two separate people, you can have a half of a couple who have an erotic transference toward the therapist but not the other one. And so now it could bring up it, depending on how differentiated that couple is, it could be handled quite easily or well or therapeutically or not, it could be divisive.

(00:57:49):

 Let's say with a couple where one person was attracted to me, it was a discrepant desire case and the person who's attracted to me is the one also who is denying the sex to their partner. Imagine that dynamic. So that partner gets to observe energy toward me that they don't get from the partner. So when you have the triangle, any kind of transference or dynamic is something to watch. Like Bowen would say, triangles are normal. We have all triangles in our families and so forth. And what makes a triangle unhealthy is not the fact that it exists, but it's when it, it changes like from an equilateral where people are equally distant or connected to a isosceles triangle where one person's left out or excluded and the other two are an alliance. And it's not just the fact of that, but it's how rigid it gets and the reactivity about it.

(00:58:39):

So if you think about erotic transference in a couple situation, you want to, as a therapist, I'm very aware of the impact on the other who's not failing the erotic transfers and how do we understand it and talk about it. I actually find it helpful when people go there. It's not that often that people will, because usually if they have those thoughts, some people won't share them that easily. Sometimes the way it'll come out is they'll talk about someone else as a third, let's say a friend that they had over for dinner and then one person noticed the other. And that could be a way indirectly that they could be saying that triangle feels difficult. And then I might say something like, well gee, I wonder how this triangle feels. Did that lack of equilibrium ever show up here? Or any of those erotic feelings ever show up here? So I'll go for it, I'll raise it. You

Todd Zemek (00:59:28):

Would be eliciting the opportunity for more of the fullness of that experience once that narrative had been supported. That could be fertile ground for something else perhaps.

Suzanne Iasenza (00:59:41):

Oh totally. Because many times it's not really sexual. Like many times it's about attachment or it could be about some kind of way that one woman had an erotic transference toward me and would talk about my breasts, which could sound like wow, how to deal with that. And as I didn't resist it, but had her talk more about it, she then came up with this memory of this beloved nanny she had who had big breasts and she grew up in an alcoholic family that was very ne neglectful and abusive. So this nanny was her island of safety and of security and she remembers falling us, she couldn't sleep as a kid and she falls asleep on the nanny's breasts and listened to the nanny's heart. So what seemed to be initially quite eroticized like she really wanted my breasts really as we began to unpack it was really about something so much more deeply attachment oriented.

(01:00:32):

And it was a way of saying, I feel nurtured in this place like I did with that nanny and how healing this is feeling and how safe. So to be able to tolerate his therapist, hopefully you're trained in this way to be able to hold that space. And if we feel uncomfortable our own cells, we go get our own therapy or supervision right? So that we make sure we hold the space to understand what comes up. Whether it's in a dream form. Sometimes patients can come in also with an erotic dream toward the therapist and I usually go for it. Oh, there's a short woman with a, with glasses in your and that you made a pass out and went home and went to sleep. Gee, I wonder what woman, what kind of short glasses do you know? <Laugh>. <laugh>.

Todd Zemek (01:01:12):

That's great, that's great. But I'm sure clients pick up again that the tone that you were talking about, they're picking up on the tone that that's okay, that this is, this is, this is welcome.

Suzanne Iasenza (01:01:22):

Yes, there's a lightness about it, there's a curiosity, there's a safety about it. You're not gonna get judged or criticized about it. I think people know that space. Is

Todd Zemek (01:01:31):

That the biggest obstacle to people reaching out for help in terms of sometimes, you know, people would delay seeking therapy for any embarrassment or shame in general about being dysfunctional or not being smart enough or not being capable enough or strong enough for generic issues. What's the biggest obstacle to people reaching out for help, not just with relationships with, with sexual issues?

Suzanne Iasenza (01:01:51):

Yeah, I think with sexual issues especially, it usually has to do with shame or guilt or fear of being criticized or judged because either they're doing it themselves. Many times people are doing themselves and in addition they felt it happening from other sources. And it could be from family or it could be from society. So in the older days, let's say for a gay person to come for help and actually with gay people, they wouldn't go help because in the older days in our career they would want to be converted. You know, the therapist would try and change gay people to be heterosexual. So that can't imagine that message is pretty negative, right? Or with trans people now if they go to a therapist who doesn't understand gender fluidity, that they can be pathologized as, oh what traumatic thing happened that you wanna be a boy instead of a girl and they don't understand gender queerness and fluidity.

(01:02:44):

So, so many people could feel have been pathologized frankly in our field. I'm not proud to say that, but I think it's true. Some people wouldn't come for that reason. Some people of color don't come because they see certain practices of therapy as being white and being not culturally sensitive enough to really understand what their voice or their perspective is. So it could be all those kinds of fears and others could be more emotional fears. Like people know if you go to therapy, you're probably going to feel more pain. Like often I'll tell patients in the beginning, this process, you're probably going to feel worse before you feel better because you're going to be opening things up and you're going to be honest in a couple about all this pain. That's not a bad sign, but it is going to be painful. And some people just don't want to go there, they don't want to feel that much pain. So they kind of on some level know to go to therapy means pain and they would rather go drink or gamble or, you know avoid or they can't use food or other things to soothe themselves instead of go to the source of the pain and go to therapy.

Todd Zemek (01:03:44):

So for people who are listening, they're in their car, they're listening on their headphones right now, they've been inspired by this conversation, this is something that in their heart they know actually that could change my life. What would your advice be? Mine would be read your book.

Suzanne Iasenza (01:03:58):

Yeah, that could start, yeah, read my book and other, there are a lot of really good books out now

Todd Zemek (01:04:03):

There's certainly on your website of, of saying you've got a, a recommended leading list.

Suzanne Iasenza (01:04:07):

Oh yes. If they went to my website, I have my home recommended of my favorite books and I think they're great books and there are eBooks. Now you can get free eBooks even from the library. So if you don't want to buy a book because it's too expensive. Yes, I would say, you know, go to my website, read the books, educate yourself. They're also very good videos if you go onto YouTube and so forth. There are different videos about Sensei focus and other kinds of sex education videos. So educate yourself. If you have a partner you could talk about these things with, you could see if you can gauge him or her, them into it. And then maybe you will allow yourself to even, I've had some people come and say, could I just have like maybe 10 sessions with you or 12 sessions with you?

(01:04:49):

 And for some people I'm fine doing that by the way. And for some people they just wanna have a little kind of contained experience at first. Or what they'll do is go to workshops. Like we have several people in the country like John Gottman's work and David Schnitz used to do these where they're actually weekend experiences where you could go either as an individual or as a couple and that you can go and have a weekend to look at sexual enhancement or couple dynamics. So there are so many ways to learn and now online in, in so many things are online now, so you don't even have to get on a plane to go somewhere or spend the money on a hotel. So many of these things now are being put on Zoom because none of us can go anywhere in person practically. You could really sign up for workshops, couple enhancement workshops. Have a, a lot of friends in New York who, who do that, they do couple enhancement workshops and couples always find that really helpful. So don't give up. I'd say to the person driving and getting inspired

Todd Zemek (01:05:49):

For so many people, I'm sure that that wouldn't ever really have occurred to them. So that's great. If they've listened today, if they go to your website, check out some of these books, consider those weekends getting in contact with a therapist that they could be in control of how much or how

Suzanne Iasenza (01:06:01):

Little that's right. They can ask for a certain amount. Some, some therapists might do not do that, but some therapists would do it.

Todd Zemek (01:06:08):

Thank you so much for your book, for your work and for sharing this today. I've certainly experienced something of the flow in terms of what you were talking about as of, of this as an art form. So it's a delight to have some time with someone who's considerably further down the road than I've been. So thank you so very much. Oh,

Suzanne Iasenza (01:06:25):

Well thank you Todd. Thank you for inviting me. Really enjoyed it. Take care of yourself.