It was six years ago this week that the local government enacted the first shelter-in-place order in response to the Covid-19 pandemic. This was the beginning of the hunkered-down lifestyle: some working from home, some not. Lots of comfy clothes. Ordering everything for delivery. Canceling plans: travel, concerts, and eating out. Creating your Covid bubble of safe people to socialize with. Learning how to Zoom. Getting your school-age children to focus on their online classes.

At that time, we really did not know what we were in for. Setting politics aside completely, I think it is easy for people to forget that the reasons local authorities across the country enacted the shelter-in-place were threefold

Let me share something personal. A year ago, I had a routine medical screening done. Needless to say, I physically felt a little, shall we say, mishandled by the technician who conducted the screening. Not a lot, but just enough to make the experience mildly startling. I promised myself that this year, when I went to get that routine screening again, I would inquire about trauma-informed care.
When I arrived in the room this year, I asked the technician (same facility but a different technician from last year) if they were trained in trauma-informed care. This technician, as kind and as proficient as they were, told me they did not know what that was. I was more shocked about this year’s technician admitting they did not know what trauma-informed care was than by how I felt physically mishandled last year.

To start, resentment is a complex emotion rooted in anger and typically involves feeling slighted in some way. In my clinical experience, because of a sense of being slighted, mistreated, or wronged, many people direct their resentment toward someone else and focus on that person and the mistreatment. And since I am a sex and couples therapist, in my office, someone else is typically their partner.

The resentment-having partner typically copes with that resentment in a variety of ways, from passive-aggressive communication to withdrawal to shutting down emotionally. (Notice I did not say they talk to their partner about it.) None of these are effective long-term strategies, but most people say they do not know another way to manage their resentment. And between the feeling of resentment and those strategies, that person’s interest in and desire for sex with their partner inevitably decreases.

In my sex therapy practice, I see a respectable number of couples in heterosexual relationships where the presenting issue is that the male partner has been engaging in sexual behavior with other men and has kept this secret from his girlfriend or wife…until it was no longer secret. Needless to say, by the time these couples come to see me, their relationship is in deep crisis. I would like to address a few of the common issues that these couples face.

Friends, it has been a tough—what? I was going to say several years, thinking back to 2020 and how the pandemic forced us to quickly and dramatically pivot how we practiced. But in reality, I think it has been a tough last decade. Between political turmoil, social unrest, economic uncertainty, and more, there is no shortage of current national and international events that affect us all to one degree or another. And I am writing this in early June 2025 with what appears to be a very turbulent summer ahead of us.

This brings me right to my point. Graduate schools and internships trained us to help our clients. But what if it is we who need the help? In our 21st-century world, we are not sitting on the sidelines, unaffected by the issues many of our clients come to us for support with.

I work with a lot of monogamous couples in sexless marriages. And when I say sexless, I mean couples who have not had intercourse or any other sexual/erotic activity for 5, 10, 15, or 20 years. It is not uncommon for me to see a couple who has not had any type of sexual or erotic touch between them for 25 or 30 years. I am talking no orgasms, no sex of any kind.
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Some of these couples report zero touch between them, while other couples report giving and receiving other forms of affectionate touch to each other, like holding hands, hugging, long kisses, holding and caressing each other naked, even showering together. Couples’ behaviors run the gamut and what they do and don’t do are unique to each couple.

Let me tell you about a former client of mine.
They were a couple married for almost 40 years, with grown children who had successfully launched. They were both in excellent physical health and were active in their various communities. They reported parenting their children cohesively with only rare episodes of differing parenting philosophies, were almost always financially stable, handled each’s aging parents with compassion and healthy boundaries, and enthusiastically supported each other’s careers and personal hobbies. They were excited about a new phase of their lives: they had young grandchildren, and he was close to retirement.

As a sex therapist, many of my clients sheepishly admit they have never really talked about sex in a “grown-up” way. Meaning maybe they have made jokes, used innuendo, or used slang to talk around sex. I think this is fairly common, and so, of course, I hold no judgment. For some folks, it is pretty daunting to show up to sex therapy and be asked to participate in a respectful dialogue about sex. So, I want to address one important sexual conversation folks should have. Because, in my professional opinion, having this conversation with a potential sexual partner might lead to some really great sex.

​I wrote this blog over two years ago and it is by far my most viewed blog. I continue to receive attention for it. I have had both colleagues and the general public reach out to me from around the world because of it. (Hello Canada, hello Australia, hello Hong Kong, and hello Bermuda!) It has been inspiring to see how far it has reached. Members of the general public, mainly wives and girlfriends, consistently say it has helped them gain a new, usually more compassionate, perspective on their husband’s or boyfriend’s “porn problem.” Colleagues have said it has helped them both better conceptualize the issue of a “porn problem” with their individual and couples clients, and they have also referred their clients to read it as a way to further the psychotherapeutic process they are engaged in. I am so happy it has been helpful to so many.

I​ have been a licensed psychotherapist working full-time in private practice for 17 years—and practicing longer than that if you count my time working as an intern therapist at a few agencies and clinics. While I do not keep track of the number of clients I have worked with, it has been a lot. So, I think it is safe to say I have observed a few things about intimate human relationships. While some issues are unique to the couple I’m working with, there are others that are universal to all couples. There are some things I wish I could tell every young (in age or length of relationship) couple at the start of their relationship. 

While I have written about the topic of sexual responsibility before, the issue has been coming up a lot recently with my private practice clients, so I think it is worthwhile not just to revisit the topic but also to take a deeper dive.
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Twice in the recent past, different clients have said the following to me: “We are still processing something you said to us a little while ago.” Of course, this piqued my interest, so I asked what I said that had an impact on them. “You said, ‘An erection is not a call to action.’” Ah, yes.

It's finally here!

As a sex therapist for years now I realized that there was all this talk about the need for porn literacy…yet no one was actually creating such material.  So, after lots of work, I have created an online course called Porn Literacy 101​.

This course is for everyone (not just therapists, although if you are a therapist you are highly encouraged to watch it too, you just won’t get CE’s for it) and is about precisely that: how to think about and relate to porn in a more nuanced, 21st century way.  ​

​One of the more common problems a couple has who seek out a sex therapist like myself is what is clinically referred to as a "low-sex" or "no-sex" marriage. My colleague Barry McCarthy defines a low sex marriage as having sex less than 10 times a year.

What I see commonly happen in sessions is that many partners take this situation personally. They also tend to assume a lot.

Have you ever felt about sex: “I want my partner to want it. Because when they do, the sex for us both is so much better.”
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As a sex therapist, this is a common sentiment in long-term, monogamous relationships and one I hear often (Note: this is different than saying, “I want my partner to want me sexually.” Another topic for another time.) There’s a lot going on in this statement and this is a short space to discuss it, so let’s get to it

In that day’s sex therapy session, the topic was body hair. But the process was about something else entirely. As we like to say in therapy, it is and isn’t about the content—and with this couple, the content was the heated topic of body hair.
Let me first explain some things. Therapy is about both content and process. Content is the what you talk about while process is how you talk about it. Any good therapist understands that powerful and effective therapy involves toggling between content and process, but ultimately, healing occurs on the process level.