Are you having the sex you desire? Or has sex lost something over time? Ever wondered what actually happens in sex therapy?
I loved exploring the journeys of two couples in sex therapy with Dr. Ian Kerner, author of She Comes First and So Tell Me About the Last Time You Had Sex for this week’s Girl Boner Radio episode.
Stream the episode on Apple Podcast/iTunes, Spotify, iHeartRadio or below, or read on for a lightly edited transcript.
“Sex Therapy Stories with Dr. Ian Kerner”
a lightly edited Girl Boner Radio transcript
Dr. Ian Kerner’s path to becoming a sex therapist started with his own struggles with sexual dysfunction, namely premature ejaculation, which he talks about in his bestselling book you may be familiar with or recall from my interview with him a few years ago, She Comes First.
Funny story. I mean, I tried everything I could to become, you know, what I consider to be sexually healthy and functional.
It was pretty hard not being able to match the sex I wanted to have up in my head with my penis, basically. And so I double majored in human sexuality because I read every book there was to read—Kinsey and Masters and Johnson—and I tried everything and uh, numbing ointments, pills.
I tried, at one point, these behavioral techniques from Masters and Johnson called the Squeeze Technique and Stop and Start, and I remember trying to have sex once and my partner said, “Jesus, are we are we having sex here or are we parking a car?”
Youch. That, Ian said, sent him right back into exile. He can laugh about that now, but at the time it was rough. His turning point came during couples therapy in his 20s, where he finally really talked about his challenges.
And the relationship didn’t end up working out but I ended up doing individual therapy with the person. And while he didn’t help me to solve problems so much, having that space to open up and talk and feel normalized and just feel like I had a voice. I would say that was really the turning point, being able to start talking and sort of getting all of these thoughts that were jumbled out of my head and organized. And from there, I was really able to pursue a path to pleasure.
Ian said his journey to becoming a sex therapist involved coming out of exile, challenging cultural narratives around how sex is supposed look, finding his strengths and building what he calls sex scripts to create mutually meaningful and pleasurable experience. He continues to guide folks he works with in similar ways and to take similar steps.
The title of his latest book, So Tell Me About the Last Time You Had Sex, is a question he asks all of his patients.
Once I’ve learned about the problem, it could be—you know it could be anything. It could be low desire, mismatched libidos. In men it can be erectile unpredictability, early ejaculation; in women, pleasure, pain, orgasm issues.
But once I’ve kind of gotten a big picture of the problem, great! What do I do with that? We know what the problem is. How do we get on the other side of it? And you know, I work with patients who are, many of them are young, and therapy is really a cost for them and time is a resource, and they want to get on the other side of something quickly.
So I’ve kind of developed what I call—it’s almost like a sex-in-action approach—and I ask them, “so tell me about the last time you had sex.” And it seems like a really simple question, but underneath that question, for me, is the thinking that well, every sexual event, every sexual encounter has a beginning, middle and an end. There’s a story.
There’s actually a sequence of interactions that go along. And those interactions can be physical, they can be psychological, they can be emotional, they can be all three. But there is truly a narrative to one sexual event, whether it happened the way you wanted it to or got stuck in the middle somehow.
And so there is this sex script… Once I know about someone’s problem, and then I hear about their sex script, I start to hear how the problem is manifesting in the sex script. And then I have an idea of what to target.
So I’m really listening when I ask them to tell me about the last time they had sex. And I’m thinking about well, where are they in a sexual event? Like, how did things begin? Who initiated? How did they build arousal? What behaviors did they engage in, what behaviors didn’t they engage in? Was their mind-based arousal or just physical arousal? Did they stay in sync or did someone get left behind?
I mean, so I’m sort of thinking about the problem. I’m thinking about all these lenses. And I’m listening to how they construct a sexual event and what the sex script is. And then, literally, we’re going to rewrite that sex script because their sex script is reinforcing the problem. And I want to rewrite it to move towards pleasure.
I love how creative his process is. Maybe I’m a little biased, being a writer, but exploring and then rewriting your story seems like such a positive and intriguing way to approach challenges that can feel so perplexing.
His book, So Tell me About the Last Time You Had Sex, is full of stories from his experiences with patients, whose privacy and idenity he protects in various ways.
I asked Ian to walk us through two of the stories, starting with David and Kate, a couple in their mid-30s. Through therapy, he wrote, they “found their way to the other side of sexual impasses through discovery of power exchange as a shared core erotic theme.”
Ian said that sometimes sex scripts can be pretty surface level. David and Kate are a good example of scripts that go a whole lot deeper—and sort of back in time.Still, their work in therapy started with the last time they had sex.
You know as I recall, their current sex script involved a him always really been very solicitous, asking during the day if she would like to have sex, making sure she did, wanting to know what she enjoyed, what she wanted, always asking, “Did this feel good?” Asking her what she wanted.
And she just- it was like too much work, too much thinking, too many questions. Like sex is supposed to be spontaneous, it’s supposed to be primal. She just wanted to be desired, you know. And here, she was sort of like just being asked all these questions so they weren’t happy. And it was also resulting in having a lot of erectile unpredictability. So their sex script was getting very stalled out from the beginning.
After they explored their current sexual script, the one neither of them were happy with, Ian began to help them sort through their personal historical factors that led them there, and ended up finding some major connections.
David had grown up with a single, divorced mom. He had no relationship with his father. His mother was very embittered and angry and angry at the father, angry at men in general. This was a time when a lot of divorce was happening, and so there were often friends and aunts and just people around that were bitching about men all the time and sort of telling him, “Hey, you better be one of the good guys,” you know, things like that.
And he, literally, internalize those messages about being good. And to him being good was being like very cautious with sexual power. And really not-.
I mean, to him male sexual power was being a bad guy, you know. So he became extremely solicitous around everything—consent, uh, umm, communication—he was also very nervous, right, because he’s just, he’s just very nervous about being a guy and being sexual so he would also often suffer from erectile unpredictability.
Kate, on the other hand, grew up feeling pretty unseen at home, and met David when she moved to New York City to work as an actor.
She had grown up as the middle child in a kind of traditional family. But there had been like, kind of like a golden boy kind of big brother up in front of her who was sort of like the prince of the family and a younger sister, who was just very demanding of attention with a lot of her needs. And the parents were always focused on trying to help the daughter.
And Kate was literally sort of in the middle and kind of neglected and no surprise, like she came to New York wanting to be an actor, and I guess get some attention, right? I mean, that’s one of the things that was really lacking for her.
So to help Kate and David improve their sex script, Ian asked a series of questions about arousal.
So one of the things that I did is, I often ask couples like, “Well, what do you do to get aroused in the sex script?” In the beginning of the sex script, like once you’ve decided to have sex, you may not be turned on at all. You’ve just decided to be sexual, like, how are you getting turned on?
And one of the questions I always ask because every couple I work with, mainly they engage in just physical based arousals. Like their sex scripts have literally become just sequences of behaviors that have become kind of predictable, which was the case with David and Kate.
So I always ask my patients, “Well, what do you do to generate mind based arousal?” And it’s kind of a leading question, because what do you think people end up saying to me?
August: ‘What do you mean mind-based arousal,’ I’m guessing?
Yeah, and then exactly, and then I kind of explain, you know, sex therapy is a lot of psychoeducation as well along the way. That hey, you know, we know that women can get very turned on just from fantasizing. Some women can even fantasize their way to orgasms without ever touching themselves.
You know men, I sometimes send men home when they’re suffering from psychological erectile unpredictability, to go home—the next time they’re going to watch some hot porn to watch it but to keep their hands at their sides and to tell me what happened from there. And the guys come back, and they often say, you know, “I had a really decent erection within about two minutes and once I did touch myself like, man!” [snaps] So that’s the power of mind based arousal, hands off arousal.
As it turned out, David and Kate had little to no mind-based arousal in their sex script. And they were really interested in generating it.
Ian talks about two types of arousal: face-to-face and side-by-side.
Face-to-face is like being on a stage, being two actors and nothing but yourselves to create a world. So like role playing, make believe, sharing a fantasy. Teally communicating about the erotic themes and the things that turn you on.
As you can imagine, most couples are not ready to do thatPeople are shy, people don’t want to share their fantasies, they’re afraid of being judged. They don’t have that experience.
So then I talk about side-by-side, mind-based arousal, which is clinically called psychogenic stimulation: So why don’t you take in some erotic literature? Why don’t you read some erotic literature aloud? Why don’t you listen to some erotica podcasts? Why don’t you watch some ethical porn, and I’ll explain ethical porn.
David and Kate dabbled with some side-by-side stuff and watched some ethical porn, but Ian said that wasn’t really moving the needle. Then something Kate shared about her acting work spurred an idea.
Kate was working on a play, or a scene, from Venus In Fur, which is all about bondage and domination and the character’s a dominatrix. So I asked them to start rehearsing together and to start playing out the scenes together, which is kinda like a little side-by-side meets face-to-face. And they were comfortable. And now David, he’s always very timid. He’s always very solicitous. So in the play, actually, the dominatrix character’s the dominant one, and the guy is sort of the submissive.
So that worked really well for them in terms of sort of mapping to their current sex life, her sort of being the dominant one, him kind of being submissive and taking orders.
But it still wasn’t working.
She was like, “I just. This isn’t sexy to me. Like, I don’t want to be in charge. This just feels like more of the same.” It was very sexy to him and he was getting turned on because it was exactly what worked for his sort of erotic template, as it was kind of currently fixed.
So then I asked them, “Well, listen. Forget that it’s a dominatrix. Forget that it’s the guy. Switch roles. Just start learning the scene and switch roles. David, you play the dominant; Kate, you play the submissive.”
And David was ready to go for that, at that point, because again, it was also a script. And you know, that’s where we started to unlock something. And that’s where some real erotic heat started to come out.
They started to realize that, having created a safe place for this kind of play, David really enjoyed being dominant and Kate really enjoyed being submissive.
And, you know, it really played to their histories because everything that he had been exiling and holding back—his sexuality, his sexual impulsivity, his desire to objectify and eroticize in a healthy way—he’d really been restraining. So he got to really step into his power.
And you know what? A lot of submission is about being loved. It’s about intimacy. Like for her, I remember her saying, for her being tied up was like being hugged, in a way you know. So I think that she really got a lot of the attention that she was sort of missing.
So this is a few things. This is where sex becomes a reparative experience- I’m not gonna call them childhood traumas, but let’s just say childhood dramas, right? Sex becomes reparative and healing and tapping into erotic themes, tapping into your creative imagination, you know. That mind-based arousal is so important.
In a section of Ian’s book on rec-relational sex, he talked about a couple named Chris and Jonathan. Leading into the story, he wrote:
“Fire needs air, and I often emphasize to patients that, in addition to the procreative and relational dimensions of sex, there are also recreational aspects: sex as a source of fun, pleasure, adventures and play.” He points out that many people he sees who are in a committed relationship have lost the recreational aspect of sex, or perhaps never had it in the first place.
Very often, in especially in couples, sex is sort of based in the relational and qualities like connection, intimacy, a feeling of lovemaking. But then there are these also recreational parts of sex that are fun and adventurous and creative and wild. And I try and help couples to kind of create a model that I call rec-relational –
Basically combining those types of sex; the relational kind that’s mostly about connection, and the fun, adventurous type. When Ian started working with Chris and Jonathan, they were both in their 40s and had been together over 15 years.
At the start of their relationship, the sex was awesome.
…very hot and heavy, a lot of energy in the beginning, a lot of fun. Sex was really part of building a relationship that led to marriage.
Fifteen years in, though, sex had become sort of rote and blase.
They had hit a wall for a while, where they were just kind of in a sex rut. Jonathan, especially, had really lost desire. He was a little older than Chris.
And Jonathan just couldn’t seem to get turned on. He was prioritizing pretty much everything over sex. Doing laundry was more appealing. And his desire had shifted from more spontaneous (out of the blue) to responsive (only after sexy activities start happening) and he was starting to deal with erectile dysfunction.
Chris, who was a little younger, was not ready to give up on sex whatsoever, and, in fact, had a lot of adventurousness in him.
In therapy with Ian, the pair started talking about these dimensions.
And Jonathan began to speak really, um, kind of sadly and woefully about like, well, all the fun was really in his 20s, and that was in the 90s. And sex was tied up with drugs and partying and AIDS and risk-taking and like, casual sex and hookups.
And when he met Chris, Jonathan just wanted to give up on all—not give up—but leave it behind and evolve, and truly it was an evolution for him. To go from that sort of recreational model to intimate, relational sex was a huge leap.
A lot of patients, regardless of gender or orientation, remain split. Some can’t get from the recreational to the intimate,
And some can’t get from the intimate or relational to the recreational, and they remain in these splits.
You know so for Jonathan, going from recreational to relational is really huge, that now relational sex was again dehydrated, sort of desiccated of erotic life. So somehow, we just kinda got to talking about ways to start spicing things up.
One thing that makes Ian Kerner’s work as a therapist unique is that he virtually always goes to mind-based arousal as a tool—which is what ended up helping Chris and Jonathan, perhaps more than anything.
Chris and Jonathan had no problem with face-to-face stimulation. They just hadn’t been doing it.
And so we started just talking and I, somehow we just started talking about role playing and uhm they got on to this idea of like uhm, I think Jonathan said, “Well”—I asked him about their fantasies and he said—”Well, I’m a little embarrassed…”
And this was before everything about like the police and Black Lives Matter and everything. I don’t know if he’d say the same thing today but he said, “I really have a fantasy of like, being interrogated and strip searched by a hot cop,” and he’d never sort of talked about that.
Then he revealed his fantasy of being strip-searched by a hot authority figure, like a security guard. And he’s never sort of talked about that.
Another interesting thing here was that Jonathan was the top in the relationship and Chris was the bottom.
And Chris was like, “I would love to roleplay that.” In fact, he had had fantasies about topping Jonathan but hadn’t had a lot of experience with that.
So that was a case where they were able to roleplay that. I think it was actually close to Halloween, and I encouraged them to go to a costume store and they got props and they went to a sex toy store.
And I guess that’s an example of just some simple roleplay, some simple power dynamics, not necessarily unlocking core erotic themes like Kate and David, but just, you know, having fun and bringing the recreational back into your relational sex.
Chris and Jonathan’s story is a good example, Ian said, of how being willing to dip into shallow waters and move into intermediate and then the deep end can recharge a sex life that was pretty much dead on arrival.
If you’re hearing all of this and wondering about your own sex scripts, Ian said a good sign that yours are in a positive, healthy place is not feeling the need to seek support, such as sex therapy. If you’re ruminating about the sex you’re having or wish you were having, whether you’re single or in a relationship, it’s probably a good time to look into your sex scripts and consider changes. Ian’s book has tons of exercises and prompts to help you with that.
Getting awareness around your sex script, the one that works well for you, can go a long way. Ian recalls this from personal experience, back when he was really suffering with early ejaculation.
And I was putting all this emphasis on having to have sex, like intercourse, the way the cultural narrative sort of was. When I finally dismantled that and reclaimed my own, made my own sex script, and even sometimes put intercourse in the middle and outer course at the end, and I really got, you know, creative like.
Well, then I knew this is my sex script. And I’m gonna have to know this and advocate for it. Because if I just accept what I think a sex script is supposed to look like, or if I get nervous and I don’t communicate, well, then I’m not going to have satisfying sex. I’m going to go back to those problems.
So, in some ways, what I’m asking people to do is think first of all about like what works for you. Not just what turns you on, not just your sexual identity. What works for you?
Sex in action, he calls it. Sex gets expressed through encounters, so what do you need to feel safe and uninhibited in those experiences? And when you’re with a partner, you create a shared sex script, too. You want to get into a rhythm together, like dancing.
I honestly, I know couples, I’ve worked with couples where, you know, they’ve kind of been having sex the same way for five years, 10 years and longer, and they don’t say it’s predictable. They don’t say it’s boring. They just say it works and it’s comfortable. And it’s pleasurable, and it’s sensual, or it’s fun and it’s connecting.
Some good questions to ask yourself, Ian said, are:
Is the sex you’re having working?
Is it leading you to a place of pleasure?
What do you want to get out of sex?
Are you more of a sexual adventurer and your partner is more a creature of comfort? If so, he suggests finding a sort of middle ground, where comfort and stability meet adventurousness.
Is the sex you’re having or being asked to have creating anxiety? Or leaving you behind while your partner sort of does what they want? Those are potential signs that your sex script isn’t working.
You know, so it’s really just asking yourself to sort of walk around your own sex life. Put it sort of out there, externalize it, like put it out there as an event and just walk around it and think about it from a little bit of an objective and subjective place.
When considering your sex script, Ian also feels it’s important not only to think about turning on but about turning off.
And kind of what I mean about turning off is that, you know, especially with female sexuality, there have been studies that really show that as women are getting aroused and the closer they get to orgasm, that some parts of the brain are really lighting up, the parts that are associated with sexual sensation, but other parts of the brain are really deactivating and getting dim.
He pointed to research that shows that in that state, the brain produces alpha waves that are associated with meditation and being in flow state. So ask yourself what you need to get turned on, get engaged with erotic stimulation — getting your mind turned on, too…
Then at a certain point, really allow yourself to just kind of turn off and go into like kind of, you know, rhythmic sexual behaviors, whether they’re outer core based or intercourse based that really let you sort of turn off the thinking part of your brain and just be really present.
[a few bars of upbeat, acoustic music]
Learn more about Dr. Ian Kerner’s work on his website, iankerner.com, and find his new book, So Tell Me About the Last Time You Had Sex, most anywhere books are sold.
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Stream the full episode, which includes Dr. Megan Fleming’s thoughts on how to make sure you’re working with a good-fit therapist, up above or on your favorite podcast app!
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Very helpful content for me…