 Welcome to Shrink Rap Hawaii. I'm your host Stephen Phillip Katz. I'm a licensed marriage and family therapist. Most of us, not all of us, but most of us, came into this world because of sex. Isn't it a bit strange that the very act that is an essential part of our very existence has become the focus of taboos, shame, addiction, anxiety, compulsion, obsessions. My guest today is going to help us figure this all out. Welcome to Shrink Rap Hawaii, Dr. Janet Brita. Thank you. So it's about time that we got a good sex therapist here. There aren't too many. What did you say? What? There's two licensed sex therapists in Hawaii right now? Yeah, in Honolulu. Wow, so you just doubled it. Congratulations. Thank you. So I know one does not just hang up a shingle that says sex therapist. I think people would be curious, you know, what kind of training did you have to go through? Yeah, so my first degree is in social work and that's my first love and I have a master's in social work and I'm a licensed clinical social worker. And then in 2011, I went to the University of Michigan. They have a certificate in sexual health and education. And I did that for a year and a half and so I have a certificate from them in human sexuality. And in 2008, I went to get my PhD in clinical psychology and completed at my postdoc at the University of Minnesota. And that was a fellowship that focused on human sexuality. It's one of the few in the nation and internationally. So the past two years, I really did most of my specialized training at the University of Minnesota. So is there a typical client that calls you up? What are the people that call you and say I need help? Is there a commonality about what they're asking for help with? Yeah, most are calling and they're really anxious when they're calling. Most of them are calling for help about their relationship. Most are suffering from performance anxiety or they're feeling really worried about whether they're satisfying their partner or are they doing it correctly. This could range from either premature ejaculation or delayed ejaculation to women with painful sex or low sexual desire. And then there's other people that call with out of control sexual behavior, which is known in the media as sex addiction. And this is when individuals are having a hard time controlling the urges. So some people may use shopping or eating or going online and some people use sex as a way of coping. That could be with excessive porn or masturbation or affairs. And then I'm working with people with dealing with gender. So help with social or medical transition. So with transgender health. And I have some couples, same sex couples, just LGBTQIA affirmative care. I know it's getting like an alphabet soup. So working with just providing a safe space for people that are dealing with their sexual orientation or sexual identity was a lot of different things. Yeah, I noticed that you each time you talk about it, you differentiate, you make a difference between what you're calling out of control sex and addiction. What do you do that? It's very controversial and it's debatable. I was trained with a more out of control sexual behavior model or compulsive sexual behavior. There are debates on what to call this. I call it that because the way that I work with that problem is through a behavioral approach. So I believe that once we can identify the pattern of what's happening before, during and after, we usually call that a cycle. It can be better controlled versus somebody who is dealing with an addiction is coming more from a 12 step model or a chemical addiction model. And I don't see it in that way. I know this is very debatable. And if somebody is coming with me and they're working the 12 step program, that's fine. I'll work with them with that. The only disagreement I have about that is that it's very abstinent space and I find that difficult to manage because sex is an energy and it's part of our life and I don't necessarily. I would assume most people don't want to have no sex anymore. Yeah, I mean, it's difficult, right? It's like, just let's cut this off out of your life and you can't masturbate or you can't. And so that for some people, they need that. But it doesn't work for all. So I think the way that I approach it is more a behavioral approach. That's very heartening for me to hear, especially because even with drugs and alcohol, which is the more common addictions that you, there are a lot of people that are turned off by the 12 step model, either because they have trouble with the higher power part or by, you know, thinking, defining themselves as having an illness, right? Right. So it has more of that kind of pathologizing, shame-based. And I don't see it in that way. I think it's something that can get out of control and now it's really affecting your personal life and your relationship. And let's explore this in a more accepting way to see, so you can start to feel better. So I do this show because I'm selfish. I do everything from me. I'm a narcissist, but maybe. But what I'm thinking is that I work, a lot of my practice is with couples. Couples come to me. And among those clients, there's a decent percentage where there's been either an infidelity that's either real or perceived. And even if it's just perceived, that's real too, right? And then 95% of the time these days, somebody sees something on somebody else's phone and they go, oh, so look at all these text messages. They come in and they show me, look at these text messages. Look, look, high handsome, high beautiful, right? And then perhaps the person who's been doing that, whether it's the man or the woman, will feel like, yeah, this is something that I seem to be out of control with. Like there's a whole series of people he or she has been texting, been sending sex messages, right? I mean, it's gone all the way into our government, right? People have got lost their governorships or whatever because of that kind of stuff. So if you don't do a 12-step model, and somebody is saying, yeah, it is out of control. I mean, I guess that's the first step. It's like the client has got to feel like it's a problem for them, right? Or else they wouldn't be showing up unless they're being dragged in. Right, right, right. So what do you do when they come in and they say, yeah, I've got 2,700 names of women on my phone. Yeah, so I usually start off with an initial assessment and it's a very rich sex history. So really asking a lot about obtaining a background information, which includes an extensive sex history. So I'm asking about, for them to tell me about their first sexual experience to what is their current situation now, to what types of messages have you received about sex. And this is a snapshot, the first session, and then we can continue it on for the next, you know, two to four sessions on really understanding what's happening. And then I really ask them to let me know about what was the last time, let's say the last time you text this person. Let's talk about that moment. I want to know what's happening to you before you're sending out this text, what's happening to you during and after. So identifying the thoughts as detailed as possible, the feelings and the body sensation. So what's happening in your body? And most people are not aware of what's happening, either with feelings or body or thoughts. So this is like, whoa, this is... Yeah, that's new. I would say, oh, my finger is pushing the button. That's what's happening. Right. So we say, okay, let's pause for a moment. This is not to be judgmental. This is just to really understand and explore what's happening with you. And if we get that, we're trying to develop the, identify the pattern. What is the pattern? Because there is a pattern. It's like, I tend to do this when I'm anxious, when I'm bored, when I'm lonely. So you're also looking at what happened just before. Right. That's the main thing is trying to identify what's happening. What's the trigger? What's the trigger? Exactly. And that could be people, places, persons, things, feelings, feelings. And those are usually ignored. Because it's hard. Some people don't know what their feelings are. So I tried to encourage them to use their body as a way of signaling to them, like, what's happening? Okay, I'm having maybe a little rapid heart rate, or I'm, you know, having a headache. So let's pause. How are you feeling at this moment? I'm really glad that you said it, because when you say that you have a behaviorist approach, the classical cognitive behavioral therapy doesn't look at feelings so much. Right, right. So I was trained with predominantly CVT at University of Minnesota. And I'm very grateful for their training. But I went to Pacifica Graduate Institute, and that is a predominantly psychodynamic orientation. And then I went, you know, my social work degree is more of a systems approach. So I consider myself more of an integrative therapist. And I incorporate all these things like the body, I really believe in a more holistic approach like yoga is essential your, you know, those cam modalities, complementary alternative medicine, like those are essential too. So like, let's let's fit it all in. And I try to get as much incorporate a lot of those tools that I've learned throughout the years with with the client. Do you also go back with your psychodynamic training? Do you go back to family of origin stuff? Yeah. So part of the steps initially is with stabilizing the mental health. So oftentimes, there's depression or anxiety, may or may not, medication might be useful. And then once we have that stabilized or chemical use, getting that getting that stabilized identifying the pattern, what are your triggers? What are you doing now to for positive coping? Once you have like that foundation, then we're going to go into exploring your family of origin, because you have some tools now, it's going to be, it might be triggering going back to that time. So we're not going to go into that right away. If you're not able to regulate right now. So the other thing that I'm thinking of, I often find that there's some history of sexual abuse that happened in childhood. That's a lot more common than I think most people realize. And there's probably a, you know, there's a lot of shame around that. So it's hard to get to that, for people to remember that, or to acknowledge it or say it out loud. Right. Right. And but that must also influence what's going on with them in their relationship sexually. Absolutely. Because the body remembers. I mean, I think that, you know, so the body, I think develops these coping skills to survive. And then some what happens in when you're in relationship, you might not be in that threatening environment, but your body hasn't learned a new way relating with your partner. So it just takes its time and relearning relearning things. So I like that you said the body remembers. So it's almost like a PTSD thing. I think so. Yeah. Yeah. Yeah, there's somebody wrote a book called The Body Keeps the Score. Yeah, it's a really popular book. Yeah. Talking about how everything that happens to you is stored in your body. Yeah. So when a couple comes to you, and there's Mitch mismatching desire, how do you work with that? Somebody, one partner wants sex all the time and the other one, sell them? Right, it's very distressing for them for the individual and for the couple. And how do we create a space where we can be on the same page? And so part of that, again, is starting up with the sex history and getting information from the individuals. And then really challenging the couple. Well, first I asked a couple, what is their goal? So how are one person wants to have sex seven times a week and the person wants to have it once a year. So it's like, okay, how do we renegotiate this? This is, you know, we're not kind of balanced here. And so first is kind of getting them to some type of agreement. And maybe they agree to once every two weeks. Okay, that's, that's reasonable. Okay. And so how are we going to get there? And the number one thing is, which they don't like to hear is about scheduling, scheduling sex. And so the way you schedule your work, your hair appointments, your children's activities, you know, this is also needs to be on your schedule. This is going to be a time for you to connect with your partner. And it may not start off with intercourse. This is a heterosexual couple. It may start off with just building the base. And so one technique is called Senseate Focus Exercises. And I'll be a part of that. Yes, but talk more about it. So it's really taking the intercourse course out of the table initially. This is for a heterosexual couple. So they're developing, we're trying to encourage more of a sensuality, pleasure based approach, and taking away the performance goal orientated. Right, because a lot of times there's a lot of anxiety around performance. Exactly. And then that people get frustrated. And that's maybe that maybe that's why they've been avoiding it, because they don't feel they're good enough at doing it, or they either party, either party. Right. So it's like, okay, forget about this. So this really kind of it's a gradual introduction to some couples haven't touched in a while. So yeah, so it's about 15, 15 minutes each. I'm like, it's you can do this about sharing sensual massage. So clothes, there's no genital touching in the beginning and really reconnecting with your partner. So you're really identifying what is it like for you to touch your partner. And then for the partner receiving it's like what is it like to be touched in this way from my partner. And so then they talk about it like oh, that was really nice. You haven't touched me in that way in a while. Or this is really awkward. Right. And then do you ever I mean, I have to ask this. Do you ever do that in session? Will you ask them to hold hands or any kind of touching at all with a couple? If you're working with a couple? I'm not against that. But no, I haven't. I know I have not done that. I mean, I observe how the couple interact in session as far as proximity and physical touch. Are they comforting each other physically? But I have not at no. It's too scary for couples, you think? Well, couples are afraid they usually ask me are we going to do anything physical in the sessions? And I usually say no, it's not you're going to be doing this at home. When you're comfortable in the privacy of your own space, and then we'll report back in session. And what do you say when they say scheduling sex that sounds so unromantic? Oh, yeah, it's so boring. I know it does sound boring, but you're a modern family. And our house is not going to happen. And so if we're trying to shift, then this is something that unless what is your idea? How do you want to go about it? You have a different idea. Right, what they've been doing so far, obviously is not working. Right, right. So I'm like, let's let's let's give this a try. And so I know what I say. And what I find in my personal life is that scheduling sex is great because I have something to look forward to. Yeah, right? I guess if my partner is not so looking forward to my maybe, you know, she's got something to drag up. I hope not. Right, which can happen, right? Yeah, you know, like, oh, no, we have to have sex tonight. Right. And then I think the whole week also plays a role into what happens during the week. Exactly. Let's skip back to that because we have to take a break and we're going to build things up. Don't go away. I'm going to the game and it's going to be great early arriving for a little tailgate. I usually drink but won't be drinking today because I'm the designated driver and that's okay. It's nice to be the guy that keeps his friends in line keeps them from drinking too much so we can have a great time. A little responsibility can go a long way because it's all about having fun on game day. Let's go. Welcome back to shrink wrap Hawaii. I'm Steven Philip Katz and I'm still with my guest, Dr. Janet Brito and thanks for staying with us because we're now going to talk about the buildup. Setting the scene during the week. Right. So we have a sex appointment Saturday night. Right. So how do we get through to Saturday night? What should happen? So one one important thing that could help is identifying each other's love language. Have you heard of that? Yeah, that book. Yeah, and it's it's helpful. It's good information. So if my love language is acts of service, that means I like, you know, my partner putting gas in my car or, you know, making me lunch. That's love to you. Right. So it makes your lunch. Exactly. So the other person likes words of affirmation. So I love you darling. Exactly. So I love your hair. Exactly. I'm I'm doing this throughout the week on Monday. I'm acknowledging that insane. You know, you look great today. That sure looks fabulous on you. Thank you. Right. And I'm and I'm making your lunch. You know, you're you're doing you're building the stage. I'm helping with with the children if you have if you have kids. Right. So you're doing these intentional behaviors and actions to really show your partner that, you know, you're interested in you and you care you care about this. So that's why often you hear, look, you can't just come to me at eight o'clock on Saturday and expect to have sex. Right. Like when you don't talk to me all week. Right. Right. If there's some old resentments or I'm you've been mean to me or you haven't been available or you've been out of the house all week working. And it's it's difficult. There's no I call it like let's build some bridges. And every couple has different ones that they feel good about. So it's really that's the love languages thing. Right. And then what is it? Affirmation words of affirmation, quality time, physical touch, acts of service and gifts, gifts, right? Stuff, right? Right. Buy you a new dress. Right. You know, so that could be one way of like, oh, hey, maybe I can do a little bit of that. And so when when I think what couples have a problem with is they think, you know, that that what is that the golden rule is really backwards. Do one to others as you would have them do one to you. Because if I'm a guy that likes gifts and you're a person that likes acts of service, it doesn't work to get you a gift. Right. Right. Even though I would like that done for me, I have to understand that you would rather me make your lunch. Yes, exactly. And that is that that could be a bridge versus like a poison, right? It's like, oh, I'm doing this that I know you don't like this. So it's it's really kind of damaging. Right. Because I mean, it's kind of people get stuck. They say, yeah, but this is what I like to do. Right. Well, it's not about you. But right, it's about listening to what your partner is asking for. Yeah. And I think that goes a long, long way in into the bedroom. Ah, all that those bridges during the week. Yes, absolutely. And then once you're there on your date, it's really you don't it's uninterrupted time. I mean, you the kids are at the babysitter or they have somebody they're busy or they're sleeping or whatever, you're really creating a space, you know, right? Music, lighting, really seducing your erotic self like, OK, you know, creating that reducing your erotic self. Yes. So you're seducing yourself, yourself and your and your partner, right? But you everybody's individual, different about what is seducing to them. So it's really having these conversations. Like, I, you know, some persons might like this, like them lighting, you know, and some people might like they want all the lights on. I mean, so it really is people might want to do it in the elevator on the way to their office, you know, so it's figuring out what that is for you. And so having this, you know, half an hour doesn't have to be a lot or the phone's going to be off. Nobody's going to be interrupting you and you're really able to be in tension on focus and pay attention to each other. That's hard for people. It's really difficult, especially if there's a lot of hurts that have been so sometimes it could take a long time. Yeah, yeah. And sometimes it not only hurts, but it's awkwardness. They don't know what to do. Right. So sometimes I prescribe people to take each other on dates and there's such fear of performance anxiety on just doing that. Right. Like, you know, I'm going to take you to a dinner and I'm afraid she's not going to like the restaurant I picked out. Right. Because maybe there's a lot of criticism, right? And you've been listening. Yeah. So it's like, well, you've criticized me before. So I'm afraid to take these steps again because of these past things. And as hard as it is to say, just let it go. It's still sometimes simmers and carries on. So do you find that with some individuals you have to be very prescriptive? Because, you know, you're working with me and let's say I'm clueless. Like, I don't I don't know what to do, like, to build these bridges during the week. Can you actually, like, write down, so, Steve, this is what I want you to do. Yeah, I mean, absolutely. I mean, like, during the assessment, I'm getting a lot of information about what is your experience about having relationships, maintaining them. You know, have you had a history of doing this? What has it been like growing up with your family on how love is expressed? So I can get information about the express they love by screaming at each other. Right. So it's like, OK, this is all you've known. And now you're this is what you're doing. So sometimes people just aren't unaware and so learning new new ideas may and me helping them or giving them suggestions could be what's necessary for them. It's ticklish. Yeah, so it's interesting. So I asked you before during the break about meditation. Can meditation help couples with this part of their lives too? I believe so. There has been some studies and using mindfulness-based approaches with women with low sexual desire and women with a history of sexual abuse. And the research comes out of Canada. Dr. Laurie Brotto and actually did one of them. It was a mindfulness-based cognitive behavioral therapy approach. It was a group therapy set psychoeducational nature group and it was really helpful. The only thing is that it's time consuming. So if you don't have the time or energy because it's 45 minutes of guided meditation per day because you're really having to retrain your body and learn to relax. So some people don't have that time or energy to commit to that. And that's OK. I think that even 10 minutes a day is OK because we're so busy and the busier you are, the more time you need for a quiet time to really reset and relax your body. And sex is all about relaxing because if you can't relax, then it's going to be really difficult to experience pleasure in that way. So I really believe in mindfulness. And people can start off with apps or YouTube. They have body scans on YouTube or I like Headspace. It's a digital app. And it's a guided meditation and totally tells me what to do. Take it to take it. Yeah, it's free. Take a breath now. And so it really helps. So I do think that's an important skill to integrate. Yeah, and I ask couples sometimes to do it together. Like, would you both be willing to do this together? I meditate before we go to bed each night with my wife. Oh, that's great. Yeah, it's great. Yeah, we'll do 20 minutes. It's helpful, right? Yeah. It's wonderful. It's wonderful. And then I just read this woman, a performance artist. Her last name is Abramovic. She did this thing at the museum where people would come up and they would just stare at each other for up to an hour. And they were talking about all of the emotion that would come up. And I noticed that in couples that I work with, sometimes they can't even look at each other at all. Never mind for an hour. But I would try that sometime with somebody that you trust. Don't go up to a stranger. And just no talking, no touching. Just eye contact. I mean, you're allowed to blink, but not too much. And emotion comes up. We started giggling like crazy. Yeah, I think I know what you're talking about. Yeah. So, oh, he's telling me we got to wrap it up. It feels like we just started. Oh, wow, OK. Yeah. And is there anything else that you'd like to sneak in there before we cut off? Thank you for giving me this opportunity. I'm really happy to talk about sex therapy in Hawaii and it's great to be home. Call Dr. Janet Britton. Thank you so much. And thanks for joining us once again for Shrinkwrap Hawaii. See you next time. Aloha.