Fa'afafine people of Samoa

http://en.wikipedia.org/wiki/Fa%27afafine

After class this week I decided to look up the Island that was briefly mentioned in which it is normal and accepted for children to start out as females but to develop their male bodies and hormones later. I came upon this Wikipedia page that details the 3rd gender of Samoans, Fa'afafine. These are people who were male at birth, but loved playing with feminine toys and gravitated to much more stereotypical feminine activities as children, and had mostly female friends. However, as they got older they realized that they are of the 3rd gender and are neither female nor male. This has become so accepted in that society that they reject the ideas of homosexuality and transgender.

The most interesting thing to me was how the parents and society as a whole responded to this group of people, making it completely normal. Parents rarely discourage their male children from engaging in feminine activities, because it would be totally acceptable for the child to be Fa'afafine. In fact, most Samoans have at least one Fa'afafine friend.

This make me think about how our society views this type of behavior, with children acting outside of their gender stereotypes. The fact that we feel the need to label it as abnormal and dysfunctional says a lot about how little our society can tolerate. It also is evidence that gender is a social construct, which is something I believe.

In relating this back to therapy, this week's readings on cultural sensitivity and the readings we did on LGBTQ are that much more important. The most important point that I take away from all of these readings is not to make assumptions, and to ask about something if you are not sure and don't want to offend anyone. People come from all different types of societies that could be totally opposite from everything we have been taught, so it is that much more important to try to understand where they are coming from even if we don't personally believe in it or subscribe to those values.

Body Image

This week's reading made me think about how important it is to address body image concerns in the context of sexuality. Nearly all people have had body image concerns at some point in their lives, and it is very easy to imagine those concerns being carried over into the bedroom, during one of the most intimate, sensitive, and personal moments of a person's life. I think the reason this section stuck out to me more than any other we have read is for two reasons. First, it is something that everyone can relate to on some level. Second, body image concerns are often one of the underlying causes that present as another sexual issue, such as low desire or erectile dysfunction.

I noticed that most of the facts and assumptions about body image issues listed in the book matched up with criteria for anxiety. If I were to treat someone with body image concerns who was not presenting it as a sexual problem, I would likely use treatment methods for anxiety and self-esteem. The fact that this is a sexual issue tells me that there should be more of a relational component to treatment, but that ultimately treatment should be focused on the same themes.

This makes me think about the idea of self-differentiation in a relationship, and I would almost be more inclined to treat such a person alone rather than as a couple. My reasoning for this is because a body image issue is likely stemming from skewed beliefs about beauty and appearance, or from a lack of self-esteem and confidence. These are things a person should be able to learn about and adjust to on his/her own without using the partner as a crutch for other-validated intimacy. When we read earlier in the year from the sex crucible, we learned about the value of knowing oneself and being able to be happy and validated from within rather than from someone else's opinion or words. I think that this connects to the idea of body image because people who have issues being comfortable with sex due to body image concerns are likely unable to validate themselves from within, and therefore are overly concerned with how they look, either comparing themselves to those they have seen in the media or a perceived relationship threat.

Adolescents and sexuality

This week I had the opportunity to interview a member of my family about her beliefs and attitudes about sexuality, and the main point she emphasized most was how much she wished children had more and better education about it. I was thrilled to see that the chapters we were assigned to read for this week included information about teens and younger peoples sexuality, and made a point about how previous research and prevention programs do not adequately study this topic. I have been thinking more about how children are taught about sexuality since doing the interview, and I think the most important thing missing is a balance of information. Children and teens need to be informed about the good and the bad parts of sex, and to be prepared for any and all scenarios that could arise.

Another thing I have been thinking about following the interview and readings for this week are the gender differences in how children and teens are taught about sexuality and how they ought to be taught about it. Seeing as so many people have so any varieties of sexual difficulties that often begin in adolescence, it is clear to me that a better sexual education would be the first step in remedying this problem.

An issue that was brought up in the chapter is that an undesirable sexual experience at a young age might cause someone to be less willing to participate in similar types of sexual experiences in the future. However, I think that with effective sexual education including body image, positive and negative parts of sex, and normative sex practices, younger people would be less likely to develop fears and pathological behaviors surrounding sex.

Another issue that was mentioned in the chapter is that adolescents are expected to not achieve orgasm and to not function sexually like adults, so they are not generally diagnosed with sexual dysfunctions. This could be a problem if an adolescent actually does meet criteria for a dysfunction that will only become worse, but therapists and doctors turn the patient away due to age and assumptions about normative sex practices and desires. As a newer therapist, I would be less likely to pathologise for anyone to eliminate this problem, and would only consider a diagnosis it was something that would help the client. I would try to treat an adolescent with sexual difficulties like I would an adult with similar issues, but would try to do more educational work to supplement what the sexual education systems are lacking.

Pedophiles VS. Child Molesters

The most important thing I learned from this past presentation is that pedophiles and child molesters are not the same thing. In fact, pedophiles and child molesters are often confused but have a main difference in reality, which is that pedophiles have a sexual attraction to children whereas child molesters have actually molested a child, regardless of the reason. This has a lot of practicality for a clinician because I learned also about how a clinician who finds out a client is a pedophile is mandated to report it, even if the person has never acted on it and seriously wants to get help. This made me really disappointed and shows how much more people need to be educated and willing to work with people about taboo matters.

I also found it really interesting that all adults who are attracted to children are said to be pedophiles, even though there are different terms for attractions to different age groups. this kind of reminds me of how people commonly refer to the vulva as the vagina. It also screams a lack of education.

Something I particularly found helpful that this group touched on was the idea that even though there are all of these disorders, they are based on the "norm", which is based on something very private and is about what we cannot see behind closed doors. This is something I have been trying to decide how I feel about all semester in terms of whether I really think these sexual disorders are disorders at all, or rather just trying to pathologise the things that make people feel good when they are in private. If they are not hurting someone else, who is to say it is abnormal or a problem?

Lastly, I loved how much this group incorporated brain studies into their research because I love the brain and the mind and how they connect and affect each other. It was fascinating to me to read about how child molesters have differences in their brains, and was a great way for me to take a biopsychosocial perspective in looking at paraphilias.

In thinking about my approach to these topics of a therapist, it is so important for me to confront my biases and keep in mind that these are people who want to experience pleasure and good feelings just like everyone else, but simply go about it differently. Also, if someone comes to therapy for a problem like this they are at least admitting they are open to change so that in itself speaks volumes and should be a reason for a therapist to embrace the person's problem as something that they can handle.

Sexuality in People with Disabilities

This week we learned about a subject that I have never learned about before. Coming from a religious background, talking about sex at all was taboo and sex was certainly something that was saved for after marriage, and between a man and a woman in order to procreate. Because of these assumptions I grew up with, I assumed that people with intellectual and physical disabilities did not engage in or desire sex. I was so wrong. After learning a lot more about sex this semester, and throughout my life after I have distanced myself from the narrow view of sex I grew up with, I understand that almost everyone desires and engages in sex in some way.

I love how this group made sure to include different kinds of disabilities because the nature of every single disability is different, but that doesn't mean that treatment is impossible. In fact, one of the most important things I learned this week is that no matter what the disability is, a couple with a disability who comes in for sex therapy will likely be receiving similar treatment to a couple without disability. The main difference was the part about having to be open to being more creative in trying different things to make each partner feel sexual. However, in any type of relationship both partners should be open to trying things that would make their partner enjoy sex so working with a couple where one or both partners has a disability is not likely to be entirely different.

The main difference, and this is something that I have known for many years but was reinforced today, was how important it is not to talk down to someone with a disability and to approach them with the assumption that they are adults of average intelligence. It is important to gauge how much sexual education they have and what their personal experiences have been, but ultimately not to compare them too much to the general population of people with their disability because we cannot make assumptions about how it manifests in them.

In looking through the wiki, my favorite part was the myths and facts about how people with disabilities treat sex and the pictures and visuals that showed creative ways they can and do enjoy sex. I have also worked with kids and teens with intellectual disabilities and know that the idea of sex is shielded from them a lot of the time, so I felt that the inclusion of that section was crucial.

Orgasm Disorders- Reflection

This past week my group did our presentation on orgasm disorders and focused on Female Orgasmic disorder. It was much more difficult to find information on this disorder than we anticipated, and most of what we found was either about female sexual dysfunction (umbrella term encompassing multiple types of sexual disorders in women) or anorgasmia (one subtype of FOD). While most of the research was lacking in information or contained some misinformation, we were able to find a few factual sites and studies that aided us in learning more about the disorder.

One of the things that surprised me the most, which we included in the wiki but not in the class presentation, is that the only way to diagnose FOD is based on self-report. There is no test or objective way of knowing exactly whether or not a woman has FOD other than if what she says matches what is in the DSM. I found this to be sketchy, and it make me question the utility of the DSM. I have other issues with the DSM that I will likely rant about in future posts, but for now I will focus on the fact that many of the disorders in it are only based on self-report, which indicates that there is no criteria for what is "average" or "normal", which I believe means there is no basis for there being a disorder. Sexuality and orgasms are experienced on a very wide spectrum, so to say that the way one person or group experiences it is a disorder is difficult for me to come to terms with.

All that being said, I found this to be an interesting topic and it will definitely be helpful if I end up working in a place that does make diagnoses. This is a topic that definitely needs more research, as most of the studies we looked at indicated. Orgasms in general are something that everyone could use more psychoeducation about because I found myself learning things that seemed like they should be basic, common sense, but for some reason I had never been told. I still have questions about how mens' bodies function during arousal and orgasm so I would not be surprised if men have a lot of questions about how women's bodies function during those processes.

SIAD Reflection

In reading through the SIAD wiki page, I began to think about how this diagnosis might be different for the LGBT communities. In particular, I was thinking about one of the sexual events I went to for this class a few weeks ago in which a person told his story about how he self-defines as asexual. I was looking through the DSM criteria for a woman to be diagnosed with SIAD, and almost all of the criteria implies that women should want to be having sex and should be deriving pleasure from it. This made me think about how we have been talking about how so many different populations differ in what they find sexually appealing and what makes sex exciting, but how can all of this be applied to people who aren't even on the spectrum we have created? If a person identifies as asexual would they meet the criteria for a sexual disorder or would they be in a different category entirely?

Another thought I had while reading this blog had to do with the video of Russell Brand talking about porn. I took a particular interest in this video because I wrote my research paper last semester about the effects of pornography on relationships, and found that generally the effects were minimal and not harmful. However, the things Russell Brand was saying about how porn is only capturing one aspect of sex relates to a lot of what I had read about how men and women perceive the effects of porn differently and even use it differently. Overall, I thought this video was a good illustration of some of the main points that researchers have been looking at regarding viewing porn within the relationship construct.

I really liked how well this wiki highlighted the differences in desire for men and women. I have been struggling with the idea that men and women shouldn't be looked at as two entirely different entities so as not to make global generalizations about either group, but more and more evidence is showing that at least sexually, men and women truly are different. Some of the pictures and diagrams helped me to conceptualize how the sexual response cycles and sexual desire levels actually do differ, and it really helped me to be able to accept the different treatment approaches for men and for women.

Lastly, I really enjoyed the section about treating couples presenting with these types of problems in a therapeutic setting. It helped drive home the main points of the whole wiki and to give some practical application ideas for how to actually put these ideas into use. I particularly liked the list of thoughts women have about how men perceive sex, and assume there are just as many thoughts men assume women have about sex. I think this just proves how different people are and that a therapist who makes assumptions would be making a serious error.

Dr. Berman Video

We had the opportunity to watch 3 couples go through an intimate journey in Dr. Berman's sex therapy clinic through a video in class this past week. I was particularly impressed with some of her therapeutic skills, which showed some compassionate validation and great cheer leading when appropriate. I also heard her use some solution-focused questions and implement some really creative strategies for each of the couples' individual needs. She did a great job of using exception questions to focus on when and how the problem was occurring, and on normalizing behaviors and responses that the couples felt were abnormal. One really great outcome I noticed for the third couple was that they reported better communication overall in their relationship after working specifically with Dr. Berman on their communication in the bedroom.

However, there were some elements of Dr. Berman's practices that I did not agree with as much, including the fact that she still seemed to take a biological stance to approaching human sexuality. This may be due to her joint work with her sister, but it seemed somewhat contrary to the way we have been learning to approach sexuality from a therapeutic lens. Additionally, many of the treatments and interventions she implemented were treating arousal and not desire, which is not what the women were concerned about. These interventions included the couples games and activities she assigned for the couples to do at night, and in particular, the assignment for the youngest couple to go home and kiss each other, when they were clearly experiencing underlying relationship issues as evidenced by their reported fighting at least twice a day. On the same note, the oldest couple still left the clinic with the wife given a prescription for hormone treatments, which seems to undermine all of the relational work they did during their week-long stay. In sum, I thought Dr. Berman showed some great therapy skills when she interviewed the couples but fell short in being able to implement interventions that will likely lead to lasting change.

The Feminist Critique

The feminist movement has been a big driver in expanding research about women and sex. We have been able to see numerous studies about female sexuality, the female orgasm, arousal and desire in women, and female-specific disorders. Leonore Tiefer mentions the feminist critique in her book as an argument against some of the ways sex has been looked at in the past, saying that women were largely left out of the equation. Upon reading this, I became confused and wondered how Tiefer could imply that all women did not fit into the model of sex that was being studied, but that in general, men did. This idea implies that we can make generalizations about the way men think and feel about sex but not about the way women perceive sex. One of the main themes of these generalizations is the idea that men are not as concerned about emotions and drivers of intimacy as women are.

This got me thinking about how everyone is different in every way, which is one of the themes of postmodern thinkers we have been learning about in other classes. Based on this idea, I think a more appropriate approach to sex and sex therapy would be based on the assumption that every person is experiencing their own set of circumstances biologically, psychologically, and socially. Additionally, everyone should be treated the same when receiving therapy for sexual problems, in that there should be no assumption and no standard so anything can be considered "normal".

I was pleased to see that the Sex Principles and Practices book immediately addressed both female and male issues and gave biological, psychological, and social treatment options. This book seemed like it was written without making as many generalizations about what males or females might be looking for out of sex therapy and emphasized partner work. So, I suppose what I am trying to say in all this is that the feminist movement, while greatly empowering women, overlooked the importance of equality for all. Essentially, this is a critique of the feminist critique* of sex therapy. 

*Not a critique of feminism! Go feminists!

Endpoint

As Valentines Day winds down and people get back into their regular relationship routines, I got to thinking about a topic that I have thought about many times before. I thought about how I always see people doing grand gestures and buying expensive gifts for their partners, but it seems like there are usually strings attached. Many people are made to feel that if they don't "put out" on Valentine's day they are not showing appreciation for their partner's gifts. Since when does sex mean showing appreciation? My main issue with this whole scenario is that people are using this whole holiday- a holiday created for people to dote on each other and recognize how lucky they are- to get to sex. What about the rest of the day? What about all of the fun activities and the lovely dinner and the expensive gifts? How pure can the enjoyment of those elements be when there is an expectation for sex? Can all of those things be just as good if there is no sex at the end?

In thinking about this idea, I related it to something else I've been thinking about as I've been reading the Tiefer book and as we watched the Orgasm movie. The movie made a mention of an "endpoint", which immediately got me thinking about how the entire pharmaceutical industry is concerned with the endpoint- the orgasm. But what about the rest of the experience? While we were reading Tiefer I also felt that something was amiss. She had many great arguments for why women are overlooked by sex researchers and why biological reductionism is too simple, but she didn't really talk about refocusing people on enjoying the whole experience rather than the end. As a goal-oriented culture, it makes sense that our society looks for a concrete, measureable endpoint, but sex is more than a means to an end. I think people should be more concerned with enjoying the ride.

Bio

Bio:

I decided to pursue couples and family therapy because I am very interested in couples communication and relationship dynamics. I am very interested in emotional intimacy and how that affects relationships, and many other facets of relationships. I am not as interested in working with children because I am not so comfortable with the parenting aspect, but I hope to be able to grow in that area. In the past I have been involved with teen sexual abuse prevention and research on couples who were at risk for abuse. I hope that through this course I will be able to learn more about an aspect of people that was very privatized in my upbringing. I was raised in a religious community so it was extremely uncommon for families to discuss sex, as it was seen as something that should be saved exclusively for marriage. I am excited to discover more about peoples’ attitudes towards sex and about how my experiences have shaped the way I think about it.