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Diane Gleim, LMFT, CST, CST-S - Guest
Diane Gleim, LMFT is a Licensed Marriage and Family Therapist and AASECT Certified Sex Therapist and Supervisor practicing online throughout California and in-person in Santa Rosa, California. As the first Certified Sex Therapist in Sonoma County, Diane treats the many diverse issues related to sexual identity, sexual expression, sexual behavior, and sexual relationships. Her clients include everyone with a sexual concern: individuals and couples ages 18-85, and the LGBTQ+, kinky, and poly populations. In addition to her private practice, Diane’s work also includes providing trainings and consultations on sex therapy; writing the blog "Underneath the Sheets" on Psychology Today’s website; and supervising sex-therapists-in-training. She has been quoted in various press and a guest on podcasts. Diane has been voted Sonoma County’s Best Sex Therapist by the readers of the North Bay Bohemian five times. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:31):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, PsyD: (02:21)
Today, I'll be speaking with Diane Gleim, who is a licensed marriage and family therapist and AASECT certified sex therapist and supervisor. She practices online throughout California and in-person in Santa Rosa. As the first certified sex therapist in Sonoma County, Diane treats the many diverse issues related to sexual identity, sexual expression, sexual behavior, and sexual relationships. Her clients include everyone with a sexual concern, individuals and couples ages 18 to 85, and the LGBTQ+, kinky, and poly populations. In addition to her private practice, Diane's work also includes providing trainings and consultations on sex therapy, writing the blog Underneath the Sheets on Psychology Today’s website, and supervising sex therapists in training. She has been quoted in various press and has been a guest on several podcasts. Diane has been voted Sonoma County's best sex therapist by the readers of the North Bay Bohemian five times. Let's listen to the interview.
Keith Sutton, PsyD: (03:21)
Well, hi, Diane. Welcome. Thanks for joining today.
Diane Gleim, LMFT, CST, CST-S: (03:24)
Hi, Keith. Thanks for having me.
Keith Sutton, PsyD: (03:26)
Yeah, so this is great. I know of your work—gosh, I think you did a training for the Redwood Empire chapter of the California Association of Marriage and Family Therapy on pornography and relationships, taking a sex-positive approach, a couple of years ago. I got to see some of that training and really liked your work. I’ve been very slowly working on AASECT certification with the American Association of Sex Educators, Counselors, and Therapists. I’ve done some consultation from you on cases, and I’ve really enjoyed hearing about your work and the ideas you’ve been talking about in the background. So, I thought it would be great to have you in for an interview. I’d love to hear about your work, but before we get to that piece, I always like to ask people about the evolution of their thinking. How did they get to doing what they're doing and the way they're thinking about their work?
Diane Gleim, LMFT, CST, CST-S: (04:27)
Sure. Yeah. Well, when I was an intern psychotherapist many years ago—I got licensed in 2007, so I’ve been doing this for a while—I quickly realized, when I was working at a community mental health clinic as an intern, two things: one, I was not prepared to work with couples—graduate school did not prepare me enough—and two, graduate school did not prepare me at all for working with couples around sexual issues. After speaking to a few other folks in the field in my community, I decided that I’d get licensed first and then immediately after that start pursuing a specialty in sex therapy. At first, I was quite ambivalent, I'll be honest, about pursuing the AASECT certification. It’s a lot of time, a lot of money.
Keith Sutton, PsyD: (05:36)
That's why I'm doing it so slowly.
Diane Gleim, LMFT, CST, CST-S: (05:38)
Yes, exactly. I wasn’t sure I necessarily needed it, quite honestly. If I got the training, did I really need the certification? So, I just pursued the training first, and then after I left a group practice and went into solo private practice, I said, you know what? I’m going to go for that certification. At the time, there was no one in our community, locally, who was a certified sex therapist, so I thought, that’s a great way to market myself, and to get my name out there, and to really pursue that specialty. In terms of my work with porn and porn issues, that also evolved over time. The pandemic really accelerated people’s relationship with technology.
Diane Gleim, LMFT, CST, CST-S: (06:40)
You know, we did Zoom therapy, people did Zoom school, Zoom exercise classes, Zoom church, synagogue, and so on. In my mind, that meant—people were consuming porn of all kinds on the internet long before the pandemic, of course—but the pandemic was like an accelerator. I realized two things: one, there was all this talk in the field of sex therapy about the need for porn literacy, that porn consumers need a better understanding of what they’re watching and its effect and impact on them. And yet, no one was creating such content or literacy, either for therapists or for the general public.
Diane Gleim, LMFT, CST, CST-S: (07:42)
And so what started as a training for mental health professionals, which is what you attended—wow, that was like three years ago now. Early 2021, I created a training for therapists. It was a three-hour training, I think. The first half was on porn literacy, and the second half was working with individuals and/or couples who were in conflict over porn. The porn literacy part was always viewed as foundational. With that foundation, you can work more effectively with individuals and couples who have porn problems. I created that training, and I’ve given it six, seven, maybe eight times now in the last three years at various places—from the CAMP Annual Conference last year to various sex therapy institutes.
Diane Gleim, LMFT, CST, CST-S: (08:44)
I get universally positive feedback, with people saying they’ve learned something either about themselves or gained a clinical nugget to take into their practice. The second piece of feedback I got was from a friend who said, “Gee, Diane, everyone needs to see the porn literacy piece, not just therapists.” So, that planted an idea in my head, to create a course that would take the porn literacy portion of the program and make it available to the general public. It was a lot of work to figure out what platform I wanted to use, how I wanted to get it out there, and whether to do a straight translation of all the clinical information for the general public or change parts of it.
Diane Gleim, LMFT, CST, CST-S: (09:44)
There were lots of decisions, all these micro-decisions to make. Last summer, I finally launched it on my website: Porn Literacy 101. It’s an on-demand course, and I say it’s beneficial for both therapists and the general public. I’m getting really great feedback from both the general public and therapists, saying it's excellent, that they found something helpful or useful about it. My hope is that it neutralizes some of the angst about porn that’s out there.
Keith Sutton, PsyD: (10:26)
There's a lot of controversy. A lot of people have very strong feelings in different directions,
Diane Gleim, LMFT, CST, CST-S: (10:30)
Yes, right. My view is that porn is neutral. Of course, there’s some icky, illegal stuff out there, but the vast majority of people consuming online porn are not going to those places or pursuing the icky, illegal stuff. But it's to get a better understanding of what’s drawing you to it and why, and what you can learn about yourself, your partner, and your relationship.
Keith Sutton, PsyD: (11:08)
Great. Wonderful. Perfect. Well, can I ask you to start by discussing how you conceptualize sex therapy, especially given your AASECT certification? I know a lot of people who do couples therapy, and they either don’t do a lot of the work with the sex in the relationship or they do couples therapy and do a little bit of the work in the sexual relationship but they don't have a lot of experience working with sex therapy. And then there are other folks who are sometimes just mostly sex therapy, not even necessarily doing much of the couples work, or where the couples aspect is secondary. I know it's such a long, in-depth process to get an AASECT certification, so I was wondering if we can talk about sex therapy and if you have a perspective on how that looks separately from couples therapy, the combination of being a sex therapist who also does couples therapy?
Diane Gleim, LMFT, CST, CST-S: (12:16)
Yeah, right. Your comments immediately make me think about the PLISSIT model, a foundational idea in sex therapy. Sex therapy follows a certain path, PLISSIT. It starts with the P, Permission: giving permission to have a problem with sex, to talk about sex, and to express oneself about sex. It’s all okay. There’s a place in sex therapy where we can explore that and try to seek some healing. The LI refers to the next step in sex therapy, which is Limited Information. That can be everything from sex education to information about sexual health, to statistics, to anything that's relevant to the client’s presenting problem. SS refers to Specific Suggestions. In so much of general therapy, we say that we don’t give suggestions or advice. However, in sex therapy, we give specific suggestions, oftentimes because clients aren't necessarily aware of them or have so much sexual shame that they can only see the problem, they can't stretch themselves to see a solution. If the PLISS part of sex therapy doesn’t resolve the problem, then we then move into intensive therapy, the IT of PLISSIT, which is mostly long-term therapy. I find the individuals—specifically, the couples that seek out sex therapy that fall into this intensive category, are often high-conflict or frequently avoidant couples, and they're going to need longer-term, more intensive work.
Keith Sutton, PsyD: (14:45)
For many of the couples that I sometimes work with, oftentimes, they're not doing well, and their sex life is not doing well. Coming from a couples first background—or not first, but more training in couples—oftentimes I feel like they just have to even begin to like each other before they're going to have a good sex life, and oftentimes there's just so much conflict. Or they're coming in and saying, "We're having these issues around sex," but they're not getting along, and it's hard to imagine them being able to have a good sex life with so much animosity or distance. How do you think about that, or how does someone doing sex therapy think about that?
Diane Gleim, LMFT, CST, CST-S: (15:35)
Ideally, for someone like myself, I prefer to have those clients come to me after they’ve done some amount of general couples therapy to learn things like—I mean I hate this term because it's too vague, but good communication skills, meaning no blaming language, “I” statements, owning their projections, working on active listening and empathetic listening. With those tools, when they have a sexual issue and they come to see me, we can just dive right into the sex part. I don't have to teach them those things or work through those other issues. That doesn’t always happen, and so oftentimes we start with those things, about projections and non-blaming language, "I" statements, empathy, a lot of differentiating skills.
Diane Gleim, LMFT, CST, CST-S: (16:47)
We can disagree, and I can empathize with your position, but that doesn’t mean I endorse it or agree with it. Holding one's own in a conflict while staying connected. Many people, when conflict happens, they each go to their respective corners. But how to stay connected, how to repair—these are important relationship skills. If there’s a conflict about sex, they need those skills. Whether they learn them from me or they learned them in a previous couples therapy session or treatment, it's what they need.
Keith Sutton, PsyD: (17:32)
Yeah. So a foundation is needed because these are oftentimes the hottest topics. It’s hard enough to talk about things around the house, but even harder to talk about sex. Particularly, the vulnerability is just so significantly heightened.
Diane Gleim, LMFT, CST, CST-S: (17:51)
So much more. Yep.
Keith Sutton, PsyD: (17:52)
There’s all this stuff around it. Do you have a particular orientation that you come from in your work with couples? I was hearing about the individuation and wasn’t sure if it’s more in line with Bader-Pearson, or Esther Perel, or--
Diane Gleim, LMFT, CST, CST-S: (18:10)
Yeah. So I use a combination of some psychodynamic approaches. I’m pretty eclectic, so psychodynamic, Ellen Bader’s developmental model, a lot of systems work with couples, particularly around sex. I find it especially helpful for maintaining the symptoms and understanding the secondary gains in maintaining the problem. Those I've found to be really helpful. Some CBT; it really depends on the presenting problem, and a lot of humanistic. At my core, I am a humanistic therapist, which is what drew me to sex therapy, like it's okay! You are okay and you’re going to be okay.
Keith Sutton, PsyD: (19:10)
Yes. Helping people accept themselves and be open, rather than feeling they must be a certain way.
Diane Gleim, LMFT, CST, CST-S: (19:19)
Right. And that really flies in the face of ideas people pick up from social media, from friends and family—all of those sources that tell people, "your sex life should be this way, not that way, and you should be this way, not that way."
Keith Sutton, PsyD: (19:44)
There are so many contradictions that come from the culture too. Oftentimes there are a lot of strong opinions against pornography, but there's a lot of use of pornography. So a contradiction between what's being told or taught and what's happening behind closed doors.
Diane Gleim, LMFT, CST, CST-S: (20:04)
Exactly. One of the things you said earlier made me think about how one of the things I tell a lot of couples—particularly after they've been together for ten-ish years or longer—that a common reason they come to a sex therapist is what we call a desire discrepancy, where one partner has a "higher" libido or desire while the other has a "lower" libido or desire. I remind people about how most of the time, they have never been in this position before. Even if they've been previously married, they may not have made it to ten years or longer in a relationship and experienced all that you experience with your partner, and all of those added layers of feeling, and disappointments, and resentments, and hopes, and dreams fulfilled, right?
Diane Gleim, LMFT, CST, CST-S: (21:07)
Not just the negative, but the positive. But it's so much more of a emotionally complex relationship. And I sat that the emotional landscape is totally different than the emotional landscape that was present at the beginning of the relationship—when sex was easy and required no effort, and libido was high. All those reasons. We as individuals have to work through all of those layers. There’s a real minimizing of that fact. Let's talk about how you've been together all this time and maybe been through the gauntlet: kids, mortgages, careers, saving for college, saving for retirement, taking care of older parents, whatever all the stressors are,
Keith Sutton, PsyD: (22:05)
—body and all the right pieces. Actually it reminds me of a couple I'm working with. It's a heterosexual couple. The guy, he's an engineer, said, "Just tell me what to do. I know the problem statement and—" I was like, well, it’s a little more complex than just A, B, C. It’s not as simple as doing this and fixing it.
Diane Gleim, LMFT, CST, CST-S: (22:27)
Yeah. He's—right.
Keith Sutton, PsyD: (22:28)
That one, uh, right.
Diane Gleim, LMFT, CST, CST-S: (22:30)
Yeah. He's wanting behavioral interventions and this is an emotional landscape.
Keith Sutton, PsyD: (22:35)
Yeah. I come from an emotionally focused couples therapy background perspective, so I'm usually looking at assessing what the level of safety is—and I don't mean safety like violence and so on, though of course that's important too—but just safety in, like, another heterosexual couple I'm working with. She always felt like he was ready to pounce, so that led to higher anxiety and a readiness to fend off. So that was not--
Diane Gleim, LMFT, CST, CST-S: (23:03)
Right.
Keith Sutton, PsyD: (23:05)
—helping with the desire. As I was thinking as you were talking about the difference in desire, I read some of David Schnarch's works, and he talks about how in all couples, there's always a high desire and low desire partner. Whether one wants it once a week and the other once a month, or one wants it three days a week and the other four days a week—that oftentimes it’s not perfectly matched.
Diane Gleim, LMFT, CST, CST-S: (23:26)
Right. And so--
Keith Sutton, PsyD: (23:26)
That's actually very common. And like you were saying too, after the honeymoon phase of the first year or so—or however long the person's honeymoon phase is—when they get into that long-term relationship and being able to maintain desire, connection, and sexual relationship—it's a lot of work, and it's very complex.
Diane Gleim, LMFT, CST, CST-S: (23:46)
I'm often reminded of—I believe it was Yalom in one of his books, said that he does not, or will not, work with any client who is currently in love.
Diane Gleim, LMFT, CST, CST-S: (24:05)
And that idea, that psychological process 'in love' is all projection-based, and they’re not seeing their partner clearly, they're not seeing themselves clearly—it is a hindrance, it's a barrier, it's distortion to psychological growth. Meanwhile, it's one of the best feelings you can have, and when that goes away, it's a thump. It's a falling off of that pedestal, and it's painful. That's when people often say, "You've changed," "You're not the person I married," or "I didn't sign up for this." These are common statements when I'm actually seeing my partner and myself more clearly, and how painful it is.
Keith Sutton, PsyD: (25:12)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (25:13)
Yep. And it's really the time to do the work.
Keith Sutton, PsyD: (25:17)
Yeah, definitely. Because there is a lot of work that can be done. I heard someone say that oftentimes, many couples don’t communicate about sex. They gave the analogy of if they never talked about the food they liked to eat but only got subtle cues from the dinners. Like they noticed that person turned their nose up at that—I'll never put that on the menu again.
Diane Gleim, LMFT, CST, CST-S: (25:41)
Right, right.
Keith Sutton, PsyD: (25:42)
They end up having this very bland, routine diet that's not really enjoyable for either person, because they've had to pick up on these little cues rather than talking about what they like, what they don't like, and so on. And many couples, when they even start talking about it, their sex life begins to blossom because they didn't even realize what the other person was interested in, or liked or didn't like, or so on.
Diane Gleim, LMFT, CST, CST-S: (26:10)
Right. I love that example about dinner and food preferences and all of that because similarly, in sex, one look or sigh, not necessarily of pleasure but a sigh of frustration maybe—the other partner experiences it and draws these huge conclusions, these universal, global ideas, without having any curiosity about what was that about or what was going on there. Breaking through that in sex therapy and--
Keith Sutton, PsyD: (26:49)
It was actually making me think of something. I was listening to a podcast, I sometimes listen to Sex with Emily, a sex therapist, and she was talking—or maybe it was someone else—but anyway, they were discussing how people often treat sex like a race to the orgasm. If there's even one bump or one trip-up along the way, it's like, boom, the whole thing's over. If there’s one sigh or something, they’re like, okay, forget it, and the encounter ends--
Diane Gleim, LMFT, CST, CST-S: (27:15)
Right.
Keith Sutton, PsyD: (27:16)
—as if it had failed, rather as something to actually talk about and just be there, and tune in to those moments.
Diane Gleim, LMFT, CST, CST-S: (27:25)
And it's so much easier for people in general to speak from a place of hurt and blaming and complaining—because there's almost no vulnerability in that—as opposed to, "This really hurt my feelings," or "I'm feeling really judged by you." That's an entirely different statement than, "You did this, you did that," you know, shaking a finger, wagging a finger kind of a thing.
Keith Sutton, PsyD: (27:56)
Yeah. Judged or rejected.
Diane Gleim, LMFT, CST, CST-S: (27:59)
Yep.
Keith Sutton, PsyD: (28:00)
For some folks, it's hard to really talk about and be vulnerable with their partner. They often get affirmation through sex. Whether it's about feeling desirable, or oftentimes there's this sense that sex should just be easy and "natural." In the beginning of a relationship, when there's a lot of that passion and intensity, there's that will-they-won't-they, do they like me or not. But later on, it's maintaining a good sex life.
Keith Sutton, PsyD: (28:34)
There's a lot of work.
Diane Gleim, LMFT, CST, CST-S: (28:35)
Because we change, right? We're not the same people we were, however long ago, at the beginning of the relationship. We, too, have changed over the course of those life experiences that I referenced—about children and mortgages and careers and retirement plans and college savings—all of those things. They change us. And who are we at each of those different phases or stages of a relationship? And we age, right? The effects of aging play a huge role on people's sexuality. Huge role.
Keith Sutton, PsyD: (29:17)
And psychological.
Diane Gleim, LMFT, CST, CST-S: (29:18)
Yes, absolutely. And there's not much out there, information-wise, truly helpful resources for the aging process. As my mother says, it beats the alternative. We can either adapt to this or resist it, and that creates its own set of consequences and circumstances.
Keith Sutton, PsyD: (29:52)
Well, as you talk about resources, maybe this is a good way to segue into pornography. Because this is one of the main "resources" that people are oftentimes looking to, and then maybe comparing their own sex life to pornography and potentially feeling disappointed or frustrated, or feeling that they're not able to have what they're seeing in the movies. Can you talk about pornography and your perspective on it? I know you've got a sex-positive perspective on it.
Diane Gleim, LMFT, CST, CST-S: (30:24)
Yeah. So first, let me also say for your listeners, that in addition to my clinical work, I also write a blog for Psychology Today. One of my most viewed blogs on Psychology Today's website is titled, "To the Wife Upset About Her Husband’s Porn Viewing: An Open Letter From a Sex Therapist."
Keith Sutton, PsyD: (30:49)
Oh?
Diane Gleim, LMFT, CST, CST-S: (30:50)
—where I talk about some of these issues. What I say in my porn literacy online course is that porn is full of symbolism, in a way that the average consumer probably doesn't recognize or understand. And porn never shows, for example, a man losing his erection.
Keith Sutton, PsyD: (31:21)
Mm-hmm.
Diane Gleim, LMFT, CST, CST-S: (31:21)
Porn never shows a woman saying, "Ouch, that hurts." These are just a couple of examples.
Keith Sutton, PsyD: (31:31)
Yeah, I agree.
Diane Gleim, LMFT, CST, CST-S: (31:33)
Right, and there’s a reason porn doesn’t show that. Because porn represents fantasy; porn represents sex without roadblocks, without those everyday obstacles that everybody has. And those everyday obstacles are the things that people seek out sex therapists for.
Keith Sutton, PsyD: (31:57)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (31:57)
Right? Erectile dysfunction is unsexy, painful intercourse is unsexy—both physically and psychologically, emotionally, relationally. And porn says, "No, we're going to create this world on screen that is completely absent of all the real-life problems, all the real-life stressors. Everything is green-lighted—there are no red lights or yellow lights in porn, and that’s on purpose. When people can understand that, then you realize it's not real life. And those actors, depending on what you’re watching, may or may not be even having "real" sex, depending on camera angles and aids of all kinds—let’s put it that way.
Keith Sutton, PsyD: (33:00)
It reminds me, too, of sometimes when talking to teenagers about sex or things like that, kind of bringing up and likening it to an action movie--
Diane Gleim, LMFT, CST, CST-S: (33:10)
Yes.
Keith Sutton, PsyD: (33:11)
That this is an action movie where you see these fight scenes and battles or things like that. All the laws of reality are kind of thrown out, and it's really doctored to be an exciting scene. Understanding that about pornography, that it's something that is curated, leaving out--
Diane Gleim, LMFT, CST, CST-S: (33:35)
Right.
Keith Sutton, PsyD: (33:36)
—a couple having conversations or a couple having moments of like, "Oh, hold on."
Diane Gleim, LMFT, CST, CST-S: (33:40)
Right, negotiation. "What do you want to do tonight?" "Here's what I'm in the mood for, this but not that—what do you think about that?" You never see any of that.
Keith Sutton, PsyD: (33:51)
Yeah. Well, maybe reference this article. What do you talk about, or what is the open letter to these—it sounds like heterosexual partners, kind of the female partner.
Diane Gleim, LMFT, CST, CST-S: (34:04)
Right. So the classic presentation of clients, at least in my practice: if it’s not the couple coming in to talk about one partner’s problematic porn viewing, then it’s often, in a heterosexual couple, the man saying, “My wife caught me again watching porn, even though I told her three times before I would stop. Now it's the third time she’s caught me watching porn, or she checked the history on my internet browser, and she told me I have to come to therapy. So, I found you." That’s a classic pattern presentation of mine. Meanwhile—there is something going on, in that scenario, for him and his relationship to pornography, but there’s also a couple’s issue.
Diane Gleim, LMFT, CST, CST-S: (35:10)
And that goes unaddressed, at least when he’s only getting individual therapy. Because she quickly labels him as the identified patient—the IP. "You're the one with the problem, you go to therapy." But there’s also some disagreement here on the role or place of pornography in the relationship, and that’s not being discussed. That’s one of the reason I wrote that blog article, to try to communicate some things to that partner, as his individual therapist, to say he understands he's broken a promise. But that’s an issue of his integrity.
Keith Sutton, PsyD: (36:01)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (36:01)
Right. That isn't porn's fault, that's his fault.
Keith Sutton, PsyD: (36:06)
Sure.
Diane Gleim, LMFT, CST, CST-S: (36:06)
Right. And we’re working on that. Oftentimes in heterosexual relationships, she says things like, “I don’t look like the women that he’s watching. I've seen some of the videos. I don’t have the size, or the shape, or the youth.” And so many times, those men have told me—I’m sure they’ve he's told his partners—"I don't compare her. I love her body, I love her, she’s my beloved. I’m not comparing." And yet, many women in that situation, if he tells her that, don’t believe him.
Keith Sutton, PsyD: (36:56)
Mm-hmm. Yes.
Diane Gleim, LMFT, CST, CST-S: (36:58)
Why is that? Is that her own low sexual self-esteem, or has he lied to her so many times she doesn’t believe him? So that’s an issue of integrity. This is what I mean by when only one partner goes to therapy—in this case, the one with the problem with porn—there's this couples dynamic going unaddressed. And then it becomes about me trying to fix him, but that often puts some pressure on him because the suggestions I offer—sometimes he says, "Well, that's not gonna fly with my wife."
Keith Sutton, PsyD: (37:45)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (37:46)
Again, missing an opportunity, of couples work.
Keith Sutton, PsyD: (37:50)
Talk about what to do together or something like that.
Diane Gleim, LMFT, CST, CST-S: (37:51)
Or, “Please believe me when I tell you I’m not comparing your body to theirs.” You know, there’s this couples dynamic that’s going unaddressed. So it becomes about, "How do I make her happy."
Keith Sutton, PsyD: (38:08)
Yes.
Diane Gleim, LMFT, CST, CST-S: (38:09)
Which is problematic. There needs to be space for him and who he is too, not just people pleasing to her.
Keith Sutton, PsyD: (38:16)
Yeah. This reminds me of the common EFT dynamic, the pursuer-withdrawer cycle. Oftentimes, many of the men are the withdrawers. They're just kind of wanting to keep the peace, prevent distance, so actually speaking up about why it's important or what it means to them, or bringing their own perspective in around their feelings—they're kind of like, no, throw that out the window, “happy wife, happy life,” rather than actually having a conversation to come to a place where both feel fulfilled and secure, and getting their needs met.
Diane Gleim, LMFT, CST, CST-S: (38:58)
Right. And that whole ideology—"happy wife, happy life" or "happy house, happy spouse"—is problematic to me. Because I hear that and I think to myself, how much of himself is he sacrificing?
Keith Sutton, PsyD: (39:14)
Mm-hmm.
Diane Gleim, LMFT, CST, CST-S: (39:15)
In order to people-please.
Keith Sutton, PsyD: (39:17)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (39:18)
And what are the long-term consequences of that?
Keith Sutton, PsyD: (39:20)
Mm-Hmm.
Diane Gleim, LMFT, CST, CST-S: (39:21)
Yeah.
Keith Sutton, PsyD: (39:22)
Well, and I imagine, too, it’s also a different perspective for each one. The wife might think, “If I were in that situation, I would be attracted to the person physically,” or whatever it might be. Whereas, for some of the men, it’s more anonymous or whatever.
Diane Gleim, LMFT, CST, CST-S: (39:39)
Sure. Right.
Keith Sutton, PsyD: (39:41)
Actually, this is one of the big pieces that I always find challenging around pornography—there's this conflict between base, id, sexual impulses and interests, being exciting. But on the other hand, it's the objectification, particularly in this case. There are also women looking at pornography, but the majority are male. This objectification, seeing the women as sex objects, and so on. So, holding both—respecting women and valuing partners, mothers, sisters, and so on—but also enjoying watching sex and seeing pornography, and how to reconcile those at the same time.
Diane Gleim, LMFT, CST, CST-S: (40:34)
Yeah. So my response to that is, particularly when it comes to film-based pornography, not erotica or literature—when I watch a movie with Brad Pitt in it, I might know a few things about his personal life, unfortunately.
Keith Sutton, PsyD: (41:05)
Sure, sure.
Diane Gleim, LMFT, CST, CST-S: (41:05)
But I also recognize he's acting. Because I know a few things about his personal life, I know that he’s acting on the screen. When we're watching porn, the average viewer doesn’t know anything about the performers or their personal lives, and that’s actually on purpose so that the imagery they're watching can be more believable. We’re not distracted in our minds by whatever it is we might know about their personal lives. Objectification has such a negative connotation these days. But there is such a thing as healthy objectification, and it does exist. We understand that those porn performers are doing whatever they're doing on camera for their reasons. I don’t need to be curious about what their deepest, darkest hopes and dreams are for their lives. They’re presumably consenting to what it is that they’re doing and understand that we don’t know who they are, and they’re okay with that.
Diane Gleim, LMFT, CST, CST-S: (42:31)
And keep in mind that not just women are objectified in porn, men are too.
Keith Sutton, PsyD: (42:36)
Sure. And I guess as we're talking about this, it makes me think that women have been more the victims of objectification when it's not in the context of wanting that objectification from a respectful partner. So, that’s often a big aspect of it, that it’s almost fueling some men's idea that this is how you can treat or see women without necessarily pairing that with a relationship. I know some couples where the wives love to be objectified by their husbands if they're feeling a mutual respect and support, and there's a connection and balance there.
Diane Gleim, LMFT, CST, CST-S: (43:31)
Well, and I think you're addressing something about like, objectification has an on/off switch. We can turn it on and we can turn it off.
Keith Sutton, PsyD: (43:40)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (43:41)
Right. And for couples like the ones you were describing, they turn it on at certain points, but then they also turn it off.
Keith Sutton, PsyD: (43:51)
Yes.
Diane Gleim, LMFT, CST, CST-S: (43:51)
Right. I'm not completely dismissing my partner's personhood and humanity, for entirety. It's, for this specific period of time, I'm gonna focus on this or that.
Keith Sutton, PsyD: (44:08)
Yeah. It’s the flexibility to move in and out of that space, within alignment with a partner—as a dance, almost.
Diane Gleim, LMFT, CST, CST-S: (44:15)
Yes.
Keith Sutton, PsyD: (44:16)
Being in tune or in sync together. And I think we had a conversation about a client I was working with, where this dynamic comes up in a number of couples that I work with, where sometimes, I'm working with one person who's got trauma who's paired with someone who's very even-keeled—somebody who's just a rock, they're stable and dependable. But later on, it gets kind of boring. They often end up wishing they had more emotional engagement or intensity in their sex life, wishing the person wasn't so passive, maybe, in the sex life. Oftentimes it's a double-edged sword: it's the thing that attracted, if they were passive, flexible, easygoing, stable, a narrow range of ups and downs, but then often times translates to a sex life that doesn't work as well.
Keith Sutton, PsyD: (45:14)
In one couple I was working with, she was wanting him to take charge a bit more, be more assertive sexually, but this was something that was very hard for him. He was a very nice, meek, and passive guy, so it was outside of his comfort zone. There was also a conflict he had around objectifying his wife or acting in these ways "bad guys" act. We were talking about that, this juxtaposition and conflict that happens.
Diane Gleim, LMFT, CST, CST-S: (45:54)
I do remember that consultation, Keith. I think—well, what I know is that the #MeToo movement really came about in the fall of 2017, and soon after that, there was a fascinating phenomenon in my practice where I was giving a lot of calls from new clients, individual men, who were coming to me specifically to process past sexual encounters, whether it was from 23 years ago or two years ago, about, "Was I appropriate, was I inappropriate?" There was some real anxiety in men about their sexual behavior. There’s this idea out there, called perpetrator fear, that a lot of men have, particularly heterosexual men. That became much more magnified after #MeToo.
Diane Gleim, LMFT, CST, CST-S: (47:09)
Which is that they have a fear of being perceived or accused of being a sexual perpetrator. And, I don't wanna—like you said—I don't wanna be a bad guy. I don't wanna be that kind of guy. And that's where things like consent, learning consent, all the nuances of consent, can happen. That's where focusing more on relational sex, which I define as a back-and-forth dynamic happening between partners where there's this sort of checking in ongoing, It's not like, do you wanna have sex? Yes or no? And then consent is done for the remainder of the encounter. No, it's, can I touch you here? Can you touch me there? Can we do this next? That there's this back-and-forth negotiation that is based in the relationship, not just in what I want or what I think I need.
Keith Sutton, PsyD: (48:22)
Yeah. Well, this is a good point that—I went to a workshop with Dossie Easton on cultural competency with BDSM couples.
Diane Gleim, LMFT, CST, CST-S: (48:31)
Yeah.
Keith Sutton, PsyD: (48:32)
She talked about, which I thought was really well put, that in a domination, sadomasochistic relationship, when there's a dominant and a submissive, the dominant can only really be dominant if they can trust that the submissive will tell them if something does not feel right. If they actually can trust that the other person is going to say something doesn't feel good or is uncomfortable, then they can be even more dominant or aggressive or whatever it might be in the sexual relationship because ultimately the submissive has the power.
Diane Gleim, LMFT, CST, CST-S: (49:14)
But it's predicated on the submissive knowing themselves: number one, knowing their limits; number two, feeling comfortable enough and having the skills to communicate.
Keith Sutton, PsyD: (49:24)
Exactly. I think back to that aspect of the safety, feeling safe to say, "Ugh, this didn't feel right," or "I'm not in the mood for that right now."
Diane Gleim, LMFT, CST, CST-S: (49:38)
Right. People often confuse consent as like this carte blanche green light.
Keith Sutton, PsyD: (49:49)
Like, this is kinda what we're doing tonight versus like, is going all in.
Diane Gleim, LMFT, CST, CST-S: (49:53)
What am I consenting to? Yeah. A step one, step two, step three, you know.
Keith Sutton, PsyD: (50:01)
As couples get to know each other better and better, it is a bit awkward, like learning to dance and stepping on each other's toes. "Oh, you're going that way? I'm going this way." Not just kind of in the mechanics of sex, but also what they're wanting and how they're wanting to encounter.
Diane Gleim, LMFT, CST, CST-S: (50:18)
Long-term couples often develop what we call a sexual script, which is when they "have sex," first they do A, then they do B, then they do C, then they do D. And that's their definition of sex. When a partner consents to sex, oftentimes that's assumed to be the A, B, C, D. But what if one partner wants just A and nothing else, or B and nothing else, or A and B? There's all these assumptions that couples make about sex. In sex therapy, we try to slow that process down and to really not just define but clarify what's happening, and why, and what are you wanting. "Tonight, I want this" doesn't necessarily mean, "Tomorrow night, I'm going to want this again." Maybe they'll want something different. I forget who it is, but they also talk about this sort of internalized image of our partner. We learn over time who they are, but it's also heavily based on assumptions and conclusions, and we stop being curious about who they really are.
Keith Sutton, PsyD: (51:44)
Yeah. Rather than taking a moment to understand why someone likes something, This applies to sex and pornography as well. Understanding what kind of pornography a person is watching—what they like about that. The other aspect, like you were saying, they don't have the backstories of these people. They're also playing a role. Even in erotica, there might be the role of the submissive person or the person who is just easy and just wants sex and there are no complications, like whether they got enough sleep that night; they're just up for whatever. And sometimes that's the fantasy. Understanding with couples what it is about what they're watching that is exciting, because a couple doesn't need to go out and have group sex, if one person's not interested in that. It’s about understanding what is the excitement about that.
Keith Sutton, PsyD: (52:44)
What’s important is being able to talk and bring some of those things into the relationship, whether it’s the novels that people are reading or other sources.
Diane Gleim, LMFT, CST, CST-S: (52:54)
One question I like to ask my clients, when they reveal that they view porn, and if they're comfortable I do some assessment around that—I ask them, "Who do you identify with in the porn you're watching?" And they first often go like, "What do you mean?" And I jokingly say, "The do-er, the do-ee, or are you an observer?"
Keith Sutton, PsyD: (53:23)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (53:25)
And the answers are fascinating.
Keith Sutton, PsyD: (53:28)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (53:29)
And I, and then I follow it up with, well, why do you think that is? Why do you think that you are identifying with whatever role you are identifying with?
Keith Sutton, PsyD: (53:36)
Well, I think it's also important to ask what they like about it. I had one couple where the wife was wondering about what it's like for him. He was saying, "Well, I like seeing the women enjoying, acting like they're enjoying or whatever," and she was surprised because she was thinking he would imagine himself as the man because she would imagine herself as the woman when she was watching porn.
Diane Gleim, LMFT, CST, CST-S: (54:04)
Right. Great point. Yeah.
Keith Sutton, PsyD: (54:06)
That’s happening to her. So again, just very different perspectives on that. This is such a huge topic, we could go on and on, but we’re out of time. Thank you so much. This is so important, and I really encourage therapists to dig deeper in this area of sex therapy. I think there are a lot of couples therapists who don't have this extra kind of training, which leaves out a really important piece. I think what you’re doing around pornography is really great, and things are changing with generations, also. The couples in their twenties are very different from the couples in their 50s, 60s about pornography.
Diane Gleim, LMFT, CST, CST-S: (54:50)
Completely. Well, thanks Keith. This was fun.
Keith Sutton, PsyD: (54:53)
Yeah. Appreciate it. Okay, great. Thanks a lot. Take care.
Diane Gleim, LMFT, CST, CST-S: (54:58)
Yeah, thanks.
Keith Sutton, PsyD: (54:59)
Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:31):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, PsyD: (02:21)
Today, I'll be speaking with Diane Gleim, who is a licensed marriage and family therapist and AASECT certified sex therapist and supervisor. She practices online throughout California and in-person in Santa Rosa. As the first certified sex therapist in Sonoma County, Diane treats the many diverse issues related to sexual identity, sexual expression, sexual behavior, and sexual relationships. Her clients include everyone with a sexual concern, individuals and couples ages 18 to 85, and the LGBTQ+, kinky, and poly populations. In addition to her private practice, Diane's work also includes providing trainings and consultations on sex therapy, writing the blog Underneath the Sheets on Psychology Today’s website, and supervising sex therapists in training. She has been quoted in various press and has been a guest on several podcasts. Diane has been voted Sonoma County's best sex therapist by the readers of the North Bay Bohemian five times. Let's listen to the interview.
Keith Sutton, PsyD: (03:21)
Well, hi, Diane. Welcome. Thanks for joining today.
Diane Gleim, LMFT, CST, CST-S: (03:24)
Hi, Keith. Thanks for having me.
Keith Sutton, PsyD: (03:26)
Yeah, so this is great. I know of your work—gosh, I think you did a training for the Redwood Empire chapter of the California Association of Marriage and Family Therapy on pornography and relationships, taking a sex-positive approach, a couple of years ago. I got to see some of that training and really liked your work. I’ve been very slowly working on AASECT certification with the American Association of Sex Educators, Counselors, and Therapists. I’ve done some consultation from you on cases, and I’ve really enjoyed hearing about your work and the ideas you’ve been talking about in the background. So, I thought it would be great to have you in for an interview. I’d love to hear about your work, but before we get to that piece, I always like to ask people about the evolution of their thinking. How did they get to doing what they're doing and the way they're thinking about their work?
Diane Gleim, LMFT, CST, CST-S: (04:27)
Sure. Yeah. Well, when I was an intern psychotherapist many years ago—I got licensed in 2007, so I’ve been doing this for a while—I quickly realized, when I was working at a community mental health clinic as an intern, two things: one, I was not prepared to work with couples—graduate school did not prepare me enough—and two, graduate school did not prepare me at all for working with couples around sexual issues. After speaking to a few other folks in the field in my community, I decided that I’d get licensed first and then immediately after that start pursuing a specialty in sex therapy. At first, I was quite ambivalent, I'll be honest, about pursuing the AASECT certification. It’s a lot of time, a lot of money.
Keith Sutton, PsyD: (05:36)
That's why I'm doing it so slowly.
Diane Gleim, LMFT, CST, CST-S: (05:38)
Yes, exactly. I wasn’t sure I necessarily needed it, quite honestly. If I got the training, did I really need the certification? So, I just pursued the training first, and then after I left a group practice and went into solo private practice, I said, you know what? I’m going to go for that certification. At the time, there was no one in our community, locally, who was a certified sex therapist, so I thought, that’s a great way to market myself, and to get my name out there, and to really pursue that specialty. In terms of my work with porn and porn issues, that also evolved over time. The pandemic really accelerated people’s relationship with technology.
Diane Gleim, LMFT, CST, CST-S: (06:40)
You know, we did Zoom therapy, people did Zoom school, Zoom exercise classes, Zoom church, synagogue, and so on. In my mind, that meant—people were consuming porn of all kinds on the internet long before the pandemic, of course—but the pandemic was like an accelerator. I realized two things: one, there was all this talk in the field of sex therapy about the need for porn literacy, that porn consumers need a better understanding of what they’re watching and its effect and impact on them. And yet, no one was creating such content or literacy, either for therapists or for the general public.
Diane Gleim, LMFT, CST, CST-S: (07:42)
And so what started as a training for mental health professionals, which is what you attended—wow, that was like three years ago now. Early 2021, I created a training for therapists. It was a three-hour training, I think. The first half was on porn literacy, and the second half was working with individuals and/or couples who were in conflict over porn. The porn literacy part was always viewed as foundational. With that foundation, you can work more effectively with individuals and couples who have porn problems. I created that training, and I’ve given it six, seven, maybe eight times now in the last three years at various places—from the CAMP Annual Conference last year to various sex therapy institutes.
Diane Gleim, LMFT, CST, CST-S: (08:44)
I get universally positive feedback, with people saying they’ve learned something either about themselves or gained a clinical nugget to take into their practice. The second piece of feedback I got was from a friend who said, “Gee, Diane, everyone needs to see the porn literacy piece, not just therapists.” So, that planted an idea in my head, to create a course that would take the porn literacy portion of the program and make it available to the general public. It was a lot of work to figure out what platform I wanted to use, how I wanted to get it out there, and whether to do a straight translation of all the clinical information for the general public or change parts of it.
Diane Gleim, LMFT, CST, CST-S: (09:44)
There were lots of decisions, all these micro-decisions to make. Last summer, I finally launched it on my website: Porn Literacy 101. It’s an on-demand course, and I say it’s beneficial for both therapists and the general public. I’m getting really great feedback from both the general public and therapists, saying it's excellent, that they found something helpful or useful about it. My hope is that it neutralizes some of the angst about porn that’s out there.
Keith Sutton, PsyD: (10:26)
There's a lot of controversy. A lot of people have very strong feelings in different directions,
Diane Gleim, LMFT, CST, CST-S: (10:30)
Yes, right. My view is that porn is neutral. Of course, there’s some icky, illegal stuff out there, but the vast majority of people consuming online porn are not going to those places or pursuing the icky, illegal stuff. But it's to get a better understanding of what’s drawing you to it and why, and what you can learn about yourself, your partner, and your relationship.
Keith Sutton, PsyD: (11:08)
Great. Wonderful. Perfect. Well, can I ask you to start by discussing how you conceptualize sex therapy, especially given your AASECT certification? I know a lot of people who do couples therapy, and they either don’t do a lot of the work with the sex in the relationship or they do couples therapy and do a little bit of the work in the sexual relationship but they don't have a lot of experience working with sex therapy. And then there are other folks who are sometimes just mostly sex therapy, not even necessarily doing much of the couples work, or where the couples aspect is secondary. I know it's such a long, in-depth process to get an AASECT certification, so I was wondering if we can talk about sex therapy and if you have a perspective on how that looks separately from couples therapy, the combination of being a sex therapist who also does couples therapy?
Diane Gleim, LMFT, CST, CST-S: (12:16)
Yeah, right. Your comments immediately make me think about the PLISSIT model, a foundational idea in sex therapy. Sex therapy follows a certain path, PLISSIT. It starts with the P, Permission: giving permission to have a problem with sex, to talk about sex, and to express oneself about sex. It’s all okay. There’s a place in sex therapy where we can explore that and try to seek some healing. The LI refers to the next step in sex therapy, which is Limited Information. That can be everything from sex education to information about sexual health, to statistics, to anything that's relevant to the client’s presenting problem. SS refers to Specific Suggestions. In so much of general therapy, we say that we don’t give suggestions or advice. However, in sex therapy, we give specific suggestions, oftentimes because clients aren't necessarily aware of them or have so much sexual shame that they can only see the problem, they can't stretch themselves to see a solution. If the PLISS part of sex therapy doesn’t resolve the problem, then we then move into intensive therapy, the IT of PLISSIT, which is mostly long-term therapy. I find the individuals—specifically, the couples that seek out sex therapy that fall into this intensive category, are often high-conflict or frequently avoidant couples, and they're going to need longer-term, more intensive work.
Keith Sutton, PsyD: (14:45)
For many of the couples that I sometimes work with, oftentimes, they're not doing well, and their sex life is not doing well. Coming from a couples first background—or not first, but more training in couples—oftentimes I feel like they just have to even begin to like each other before they're going to have a good sex life, and oftentimes there's just so much conflict. Or they're coming in and saying, "We're having these issues around sex," but they're not getting along, and it's hard to imagine them being able to have a good sex life with so much animosity or distance. How do you think about that, or how does someone doing sex therapy think about that?
Diane Gleim, LMFT, CST, CST-S: (15:35)
Ideally, for someone like myself, I prefer to have those clients come to me after they’ve done some amount of general couples therapy to learn things like—I mean I hate this term because it's too vague, but good communication skills, meaning no blaming language, “I” statements, owning their projections, working on active listening and empathetic listening. With those tools, when they have a sexual issue and they come to see me, we can just dive right into the sex part. I don't have to teach them those things or work through those other issues. That doesn’t always happen, and so oftentimes we start with those things, about projections and non-blaming language, "I" statements, empathy, a lot of differentiating skills.
Diane Gleim, LMFT, CST, CST-S: (16:47)
We can disagree, and I can empathize with your position, but that doesn’t mean I endorse it or agree with it. Holding one's own in a conflict while staying connected. Many people, when conflict happens, they each go to their respective corners. But how to stay connected, how to repair—these are important relationship skills. If there’s a conflict about sex, they need those skills. Whether they learn them from me or they learned them in a previous couples therapy session or treatment, it's what they need.
Keith Sutton, PsyD: (17:32)
Yeah. So a foundation is needed because these are oftentimes the hottest topics. It’s hard enough to talk about things around the house, but even harder to talk about sex. Particularly, the vulnerability is just so significantly heightened.
Diane Gleim, LMFT, CST, CST-S: (17:51)
So much more. Yep.
Keith Sutton, PsyD: (17:52)
There’s all this stuff around it. Do you have a particular orientation that you come from in your work with couples? I was hearing about the individuation and wasn’t sure if it’s more in line with Bader-Pearson, or Esther Perel, or--
Diane Gleim, LMFT, CST, CST-S: (18:10)
Yeah. So I use a combination of some psychodynamic approaches. I’m pretty eclectic, so psychodynamic, Ellen Bader’s developmental model, a lot of systems work with couples, particularly around sex. I find it especially helpful for maintaining the symptoms and understanding the secondary gains in maintaining the problem. Those I've found to be really helpful. Some CBT; it really depends on the presenting problem, and a lot of humanistic. At my core, I am a humanistic therapist, which is what drew me to sex therapy, like it's okay! You are okay and you’re going to be okay.
Keith Sutton, PsyD: (19:10)
Yes. Helping people accept themselves and be open, rather than feeling they must be a certain way.
Diane Gleim, LMFT, CST, CST-S: (19:19)
Right. And that really flies in the face of ideas people pick up from social media, from friends and family—all of those sources that tell people, "your sex life should be this way, not that way, and you should be this way, not that way."
Keith Sutton, PsyD: (19:44)
There are so many contradictions that come from the culture too. Oftentimes there are a lot of strong opinions against pornography, but there's a lot of use of pornography. So a contradiction between what's being told or taught and what's happening behind closed doors.
Diane Gleim, LMFT, CST, CST-S: (20:04)
Exactly. One of the things you said earlier made me think about how one of the things I tell a lot of couples—particularly after they've been together for ten-ish years or longer—that a common reason they come to a sex therapist is what we call a desire discrepancy, where one partner has a "higher" libido or desire while the other has a "lower" libido or desire. I remind people about how most of the time, they have never been in this position before. Even if they've been previously married, they may not have made it to ten years or longer in a relationship and experienced all that you experience with your partner, and all of those added layers of feeling, and disappointments, and resentments, and hopes, and dreams fulfilled, right?
Diane Gleim, LMFT, CST, CST-S: (21:07)
Not just the negative, but the positive. But it's so much more of a emotionally complex relationship. And I sat that the emotional landscape is totally different than the emotional landscape that was present at the beginning of the relationship—when sex was easy and required no effort, and libido was high. All those reasons. We as individuals have to work through all of those layers. There’s a real minimizing of that fact. Let's talk about how you've been together all this time and maybe been through the gauntlet: kids, mortgages, careers, saving for college, saving for retirement, taking care of older parents, whatever all the stressors are,
Keith Sutton, PsyD: (22:05)
—body and all the right pieces. Actually it reminds me of a couple I'm working with. It's a heterosexual couple. The guy, he's an engineer, said, "Just tell me what to do. I know the problem statement and—" I was like, well, it’s a little more complex than just A, B, C. It’s not as simple as doing this and fixing it.
Diane Gleim, LMFT, CST, CST-S: (22:27)
Yeah. He's—right.
Keith Sutton, PsyD: (22:28)
That one, uh, right.
Diane Gleim, LMFT, CST, CST-S: (22:30)
Yeah. He's wanting behavioral interventions and this is an emotional landscape.
Keith Sutton, PsyD: (22:35)
Yeah. I come from an emotionally focused couples therapy background perspective, so I'm usually looking at assessing what the level of safety is—and I don't mean safety like violence and so on, though of course that's important too—but just safety in, like, another heterosexual couple I'm working with. She always felt like he was ready to pounce, so that led to higher anxiety and a readiness to fend off. So that was not--
Diane Gleim, LMFT, CST, CST-S: (23:03)
Right.
Keith Sutton, PsyD: (23:05)
—helping with the desire. As I was thinking as you were talking about the difference in desire, I read some of David Schnarch's works, and he talks about how in all couples, there's always a high desire and low desire partner. Whether one wants it once a week and the other once a month, or one wants it three days a week and the other four days a week—that oftentimes it’s not perfectly matched.
Diane Gleim, LMFT, CST, CST-S: (23:26)
Right. And so--
Keith Sutton, PsyD: (23:26)
That's actually very common. And like you were saying too, after the honeymoon phase of the first year or so—or however long the person's honeymoon phase is—when they get into that long-term relationship and being able to maintain desire, connection, and sexual relationship—it's a lot of work, and it's very complex.
Diane Gleim, LMFT, CST, CST-S: (23:46)
I'm often reminded of—I believe it was Yalom in one of his books, said that he does not, or will not, work with any client who is currently in love.
Diane Gleim, LMFT, CST, CST-S: (24:05)
And that idea, that psychological process 'in love' is all projection-based, and they’re not seeing their partner clearly, they're not seeing themselves clearly—it is a hindrance, it's a barrier, it's distortion to psychological growth. Meanwhile, it's one of the best feelings you can have, and when that goes away, it's a thump. It's a falling off of that pedestal, and it's painful. That's when people often say, "You've changed," "You're not the person I married," or "I didn't sign up for this." These are common statements when I'm actually seeing my partner and myself more clearly, and how painful it is.
Keith Sutton, PsyD: (25:12)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (25:13)
Yep. And it's really the time to do the work.
Keith Sutton, PsyD: (25:17)
Yeah, definitely. Because there is a lot of work that can be done. I heard someone say that oftentimes, many couples don’t communicate about sex. They gave the analogy of if they never talked about the food they liked to eat but only got subtle cues from the dinners. Like they noticed that person turned their nose up at that—I'll never put that on the menu again.
Diane Gleim, LMFT, CST, CST-S: (25:41)
Right, right.
Keith Sutton, PsyD: (25:42)
They end up having this very bland, routine diet that's not really enjoyable for either person, because they've had to pick up on these little cues rather than talking about what they like, what they don't like, and so on. And many couples, when they even start talking about it, their sex life begins to blossom because they didn't even realize what the other person was interested in, or liked or didn't like, or so on.
Diane Gleim, LMFT, CST, CST-S: (26:10)
Right. I love that example about dinner and food preferences and all of that because similarly, in sex, one look or sigh, not necessarily of pleasure but a sigh of frustration maybe—the other partner experiences it and draws these huge conclusions, these universal, global ideas, without having any curiosity about what was that about or what was going on there. Breaking through that in sex therapy and--
Keith Sutton, PsyD: (26:49)
It was actually making me think of something. I was listening to a podcast, I sometimes listen to Sex with Emily, a sex therapist, and she was talking—or maybe it was someone else—but anyway, they were discussing how people often treat sex like a race to the orgasm. If there's even one bump or one trip-up along the way, it's like, boom, the whole thing's over. If there’s one sigh or something, they’re like, okay, forget it, and the encounter ends--
Diane Gleim, LMFT, CST, CST-S: (27:15)
Right.
Keith Sutton, PsyD: (27:16)
—as if it had failed, rather as something to actually talk about and just be there, and tune in to those moments.
Diane Gleim, LMFT, CST, CST-S: (27:25)
And it's so much easier for people in general to speak from a place of hurt and blaming and complaining—because there's almost no vulnerability in that—as opposed to, "This really hurt my feelings," or "I'm feeling really judged by you." That's an entirely different statement than, "You did this, you did that," you know, shaking a finger, wagging a finger kind of a thing.
Keith Sutton, PsyD: (27:56)
Yeah. Judged or rejected.
Diane Gleim, LMFT, CST, CST-S: (27:59)
Yep.
Keith Sutton, PsyD: (28:00)
For some folks, it's hard to really talk about and be vulnerable with their partner. They often get affirmation through sex. Whether it's about feeling desirable, or oftentimes there's this sense that sex should just be easy and "natural." In the beginning of a relationship, when there's a lot of that passion and intensity, there's that will-they-won't-they, do they like me or not. But later on, it's maintaining a good sex life.
Keith Sutton, PsyD: (28:34)
There's a lot of work.
Diane Gleim, LMFT, CST, CST-S: (28:35)
Because we change, right? We're not the same people we were, however long ago, at the beginning of the relationship. We, too, have changed over the course of those life experiences that I referenced—about children and mortgages and careers and retirement plans and college savings—all of those things. They change us. And who are we at each of those different phases or stages of a relationship? And we age, right? The effects of aging play a huge role on people's sexuality. Huge role.
Keith Sutton, PsyD: (29:17)
And psychological.
Diane Gleim, LMFT, CST, CST-S: (29:18)
Yes, absolutely. And there's not much out there, information-wise, truly helpful resources for the aging process. As my mother says, it beats the alternative. We can either adapt to this or resist it, and that creates its own set of consequences and circumstances.
Keith Sutton, PsyD: (29:52)
Well, as you talk about resources, maybe this is a good way to segue into pornography. Because this is one of the main "resources" that people are oftentimes looking to, and then maybe comparing their own sex life to pornography and potentially feeling disappointed or frustrated, or feeling that they're not able to have what they're seeing in the movies. Can you talk about pornography and your perspective on it? I know you've got a sex-positive perspective on it.
Diane Gleim, LMFT, CST, CST-S: (30:24)
Yeah. So first, let me also say for your listeners, that in addition to my clinical work, I also write a blog for Psychology Today. One of my most viewed blogs on Psychology Today's website is titled, "To the Wife Upset About Her Husband’s Porn Viewing: An Open Letter From a Sex Therapist."
Keith Sutton, PsyD: (30:49)
Oh?
Diane Gleim, LMFT, CST, CST-S: (30:50)
—where I talk about some of these issues. What I say in my porn literacy online course is that porn is full of symbolism, in a way that the average consumer probably doesn't recognize or understand. And porn never shows, for example, a man losing his erection.
Keith Sutton, PsyD: (31:21)
Mm-hmm.
Diane Gleim, LMFT, CST, CST-S: (31:21)
Porn never shows a woman saying, "Ouch, that hurts." These are just a couple of examples.
Keith Sutton, PsyD: (31:31)
Yeah, I agree.
Diane Gleim, LMFT, CST, CST-S: (31:33)
Right, and there’s a reason porn doesn’t show that. Because porn represents fantasy; porn represents sex without roadblocks, without those everyday obstacles that everybody has. And those everyday obstacles are the things that people seek out sex therapists for.
Keith Sutton, PsyD: (31:57)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (31:57)
Right? Erectile dysfunction is unsexy, painful intercourse is unsexy—both physically and psychologically, emotionally, relationally. And porn says, "No, we're going to create this world on screen that is completely absent of all the real-life problems, all the real-life stressors. Everything is green-lighted—there are no red lights or yellow lights in porn, and that’s on purpose. When people can understand that, then you realize it's not real life. And those actors, depending on what you’re watching, may or may not be even having "real" sex, depending on camera angles and aids of all kinds—let’s put it that way.
Keith Sutton, PsyD: (33:00)
It reminds me, too, of sometimes when talking to teenagers about sex or things like that, kind of bringing up and likening it to an action movie--
Diane Gleim, LMFT, CST, CST-S: (33:10)
Yes.
Keith Sutton, PsyD: (33:11)
That this is an action movie where you see these fight scenes and battles or things like that. All the laws of reality are kind of thrown out, and it's really doctored to be an exciting scene. Understanding that about pornography, that it's something that is curated, leaving out--
Diane Gleim, LMFT, CST, CST-S: (33:35)
Right.
Keith Sutton, PsyD: (33:36)
—a couple having conversations or a couple having moments of like, "Oh, hold on."
Diane Gleim, LMFT, CST, CST-S: (33:40)
Right, negotiation. "What do you want to do tonight?" "Here's what I'm in the mood for, this but not that—what do you think about that?" You never see any of that.
Keith Sutton, PsyD: (33:51)
Yeah. Well, maybe reference this article. What do you talk about, or what is the open letter to these—it sounds like heterosexual partners, kind of the female partner.
Diane Gleim, LMFT, CST, CST-S: (34:04)
Right. So the classic presentation of clients, at least in my practice: if it’s not the couple coming in to talk about one partner’s problematic porn viewing, then it’s often, in a heterosexual couple, the man saying, “My wife caught me again watching porn, even though I told her three times before I would stop. Now it's the third time she’s caught me watching porn, or she checked the history on my internet browser, and she told me I have to come to therapy. So, I found you." That’s a classic pattern presentation of mine. Meanwhile—there is something going on, in that scenario, for him and his relationship to pornography, but there’s also a couple’s issue.
Diane Gleim, LMFT, CST, CST-S: (35:10)
And that goes unaddressed, at least when he’s only getting individual therapy. Because she quickly labels him as the identified patient—the IP. "You're the one with the problem, you go to therapy." But there’s also some disagreement here on the role or place of pornography in the relationship, and that’s not being discussed. That’s one of the reason I wrote that blog article, to try to communicate some things to that partner, as his individual therapist, to say he understands he's broken a promise. But that’s an issue of his integrity.
Keith Sutton, PsyD: (36:01)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (36:01)
Right. That isn't porn's fault, that's his fault.
Keith Sutton, PsyD: (36:06)
Sure.
Diane Gleim, LMFT, CST, CST-S: (36:06)
Right. And we’re working on that. Oftentimes in heterosexual relationships, she says things like, “I don’t look like the women that he’s watching. I've seen some of the videos. I don’t have the size, or the shape, or the youth.” And so many times, those men have told me—I’m sure they’ve he's told his partners—"I don't compare her. I love her body, I love her, she’s my beloved. I’m not comparing." And yet, many women in that situation, if he tells her that, don’t believe him.
Keith Sutton, PsyD: (36:56)
Mm-hmm. Yes.
Diane Gleim, LMFT, CST, CST-S: (36:58)
Why is that? Is that her own low sexual self-esteem, or has he lied to her so many times she doesn’t believe him? So that’s an issue of integrity. This is what I mean by when only one partner goes to therapy—in this case, the one with the problem with porn—there's this couples dynamic going unaddressed. And then it becomes about me trying to fix him, but that often puts some pressure on him because the suggestions I offer—sometimes he says, "Well, that's not gonna fly with my wife."
Keith Sutton, PsyD: (37:45)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (37:46)
Again, missing an opportunity, of couples work.
Keith Sutton, PsyD: (37:50)
Talk about what to do together or something like that.
Diane Gleim, LMFT, CST, CST-S: (37:51)
Or, “Please believe me when I tell you I’m not comparing your body to theirs.” You know, there’s this couples dynamic that’s going unaddressed. So it becomes about, "How do I make her happy."
Keith Sutton, PsyD: (38:08)
Yes.
Diane Gleim, LMFT, CST, CST-S: (38:09)
Which is problematic. There needs to be space for him and who he is too, not just people pleasing to her.
Keith Sutton, PsyD: (38:16)
Yeah. This reminds me of the common EFT dynamic, the pursuer-withdrawer cycle. Oftentimes, many of the men are the withdrawers. They're just kind of wanting to keep the peace, prevent distance, so actually speaking up about why it's important or what it means to them, or bringing their own perspective in around their feelings—they're kind of like, no, throw that out the window, “happy wife, happy life,” rather than actually having a conversation to come to a place where both feel fulfilled and secure, and getting their needs met.
Diane Gleim, LMFT, CST, CST-S: (38:58)
Right. And that whole ideology—"happy wife, happy life" or "happy house, happy spouse"—is problematic to me. Because I hear that and I think to myself, how much of himself is he sacrificing?
Keith Sutton, PsyD: (39:14)
Mm-hmm.
Diane Gleim, LMFT, CST, CST-S: (39:15)
In order to people-please.
Keith Sutton, PsyD: (39:17)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (39:18)
And what are the long-term consequences of that?
Keith Sutton, PsyD: (39:20)
Mm-Hmm.
Diane Gleim, LMFT, CST, CST-S: (39:21)
Yeah.
Keith Sutton, PsyD: (39:22)
Well, and I imagine, too, it’s also a different perspective for each one. The wife might think, “If I were in that situation, I would be attracted to the person physically,” or whatever it might be. Whereas, for some of the men, it’s more anonymous or whatever.
Diane Gleim, LMFT, CST, CST-S: (39:39)
Sure. Right.
Keith Sutton, PsyD: (39:41)
Actually, this is one of the big pieces that I always find challenging around pornography—there's this conflict between base, id, sexual impulses and interests, being exciting. But on the other hand, it's the objectification, particularly in this case. There are also women looking at pornography, but the majority are male. This objectification, seeing the women as sex objects, and so on. So, holding both—respecting women and valuing partners, mothers, sisters, and so on—but also enjoying watching sex and seeing pornography, and how to reconcile those at the same time.
Diane Gleim, LMFT, CST, CST-S: (40:34)
Yeah. So my response to that is, particularly when it comes to film-based pornography, not erotica or literature—when I watch a movie with Brad Pitt in it, I might know a few things about his personal life, unfortunately.
Keith Sutton, PsyD: (41:05)
Sure, sure.
Diane Gleim, LMFT, CST, CST-S: (41:05)
But I also recognize he's acting. Because I know a few things about his personal life, I know that he’s acting on the screen. When we're watching porn, the average viewer doesn’t know anything about the performers or their personal lives, and that’s actually on purpose so that the imagery they're watching can be more believable. We’re not distracted in our minds by whatever it is we might know about their personal lives. Objectification has such a negative connotation these days. But there is such a thing as healthy objectification, and it does exist. We understand that those porn performers are doing whatever they're doing on camera for their reasons. I don’t need to be curious about what their deepest, darkest hopes and dreams are for their lives. They’re presumably consenting to what it is that they’re doing and understand that we don’t know who they are, and they’re okay with that.
Diane Gleim, LMFT, CST, CST-S: (42:31)
And keep in mind that not just women are objectified in porn, men are too.
Keith Sutton, PsyD: (42:36)
Sure. And I guess as we're talking about this, it makes me think that women have been more the victims of objectification when it's not in the context of wanting that objectification from a respectful partner. So, that’s often a big aspect of it, that it’s almost fueling some men's idea that this is how you can treat or see women without necessarily pairing that with a relationship. I know some couples where the wives love to be objectified by their husbands if they're feeling a mutual respect and support, and there's a connection and balance there.
Diane Gleim, LMFT, CST, CST-S: (43:31)
Well, and I think you're addressing something about like, objectification has an on/off switch. We can turn it on and we can turn it off.
Keith Sutton, PsyD: (43:40)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (43:41)
Right. And for couples like the ones you were describing, they turn it on at certain points, but then they also turn it off.
Keith Sutton, PsyD: (43:51)
Yes.
Diane Gleim, LMFT, CST, CST-S: (43:51)
Right. I'm not completely dismissing my partner's personhood and humanity, for entirety. It's, for this specific period of time, I'm gonna focus on this or that.
Keith Sutton, PsyD: (44:08)
Yeah. It’s the flexibility to move in and out of that space, within alignment with a partner—as a dance, almost.
Diane Gleim, LMFT, CST, CST-S: (44:15)
Yes.
Keith Sutton, PsyD: (44:16)
Being in tune or in sync together. And I think we had a conversation about a client I was working with, where this dynamic comes up in a number of couples that I work with, where sometimes, I'm working with one person who's got trauma who's paired with someone who's very even-keeled—somebody who's just a rock, they're stable and dependable. But later on, it gets kind of boring. They often end up wishing they had more emotional engagement or intensity in their sex life, wishing the person wasn't so passive, maybe, in the sex life. Oftentimes it's a double-edged sword: it's the thing that attracted, if they were passive, flexible, easygoing, stable, a narrow range of ups and downs, but then often times translates to a sex life that doesn't work as well.
Keith Sutton, PsyD: (45:14)
In one couple I was working with, she was wanting him to take charge a bit more, be more assertive sexually, but this was something that was very hard for him. He was a very nice, meek, and passive guy, so it was outside of his comfort zone. There was also a conflict he had around objectifying his wife or acting in these ways "bad guys" act. We were talking about that, this juxtaposition and conflict that happens.
Diane Gleim, LMFT, CST, CST-S: (45:54)
I do remember that consultation, Keith. I think—well, what I know is that the #MeToo movement really came about in the fall of 2017, and soon after that, there was a fascinating phenomenon in my practice where I was giving a lot of calls from new clients, individual men, who were coming to me specifically to process past sexual encounters, whether it was from 23 years ago or two years ago, about, "Was I appropriate, was I inappropriate?" There was some real anxiety in men about their sexual behavior. There’s this idea out there, called perpetrator fear, that a lot of men have, particularly heterosexual men. That became much more magnified after #MeToo.
Diane Gleim, LMFT, CST, CST-S: (47:09)
Which is that they have a fear of being perceived or accused of being a sexual perpetrator. And, I don't wanna—like you said—I don't wanna be a bad guy. I don't wanna be that kind of guy. And that's where things like consent, learning consent, all the nuances of consent, can happen. That's where focusing more on relational sex, which I define as a back-and-forth dynamic happening between partners where there's this sort of checking in ongoing, It's not like, do you wanna have sex? Yes or no? And then consent is done for the remainder of the encounter. No, it's, can I touch you here? Can you touch me there? Can we do this next? That there's this back-and-forth negotiation that is based in the relationship, not just in what I want or what I think I need.
Keith Sutton, PsyD: (48:22)
Yeah. Well, this is a good point that—I went to a workshop with Dossie Easton on cultural competency with BDSM couples.
Diane Gleim, LMFT, CST, CST-S: (48:31)
Yeah.
Keith Sutton, PsyD: (48:32)
She talked about, which I thought was really well put, that in a domination, sadomasochistic relationship, when there's a dominant and a submissive, the dominant can only really be dominant if they can trust that the submissive will tell them if something does not feel right. If they actually can trust that the other person is going to say something doesn't feel good or is uncomfortable, then they can be even more dominant or aggressive or whatever it might be in the sexual relationship because ultimately the submissive has the power.
Diane Gleim, LMFT, CST, CST-S: (49:14)
But it's predicated on the submissive knowing themselves: number one, knowing their limits; number two, feeling comfortable enough and having the skills to communicate.
Keith Sutton, PsyD: (49:24)
Exactly. I think back to that aspect of the safety, feeling safe to say, "Ugh, this didn't feel right," or "I'm not in the mood for that right now."
Diane Gleim, LMFT, CST, CST-S: (49:38)
Right. People often confuse consent as like this carte blanche green light.
Keith Sutton, PsyD: (49:49)
Like, this is kinda what we're doing tonight versus like, is going all in.
Diane Gleim, LMFT, CST, CST-S: (49:53)
What am I consenting to? Yeah. A step one, step two, step three, you know.
Keith Sutton, PsyD: (50:01)
As couples get to know each other better and better, it is a bit awkward, like learning to dance and stepping on each other's toes. "Oh, you're going that way? I'm going this way." Not just kind of in the mechanics of sex, but also what they're wanting and how they're wanting to encounter.
Diane Gleim, LMFT, CST, CST-S: (50:18)
Long-term couples often develop what we call a sexual script, which is when they "have sex," first they do A, then they do B, then they do C, then they do D. And that's their definition of sex. When a partner consents to sex, oftentimes that's assumed to be the A, B, C, D. But what if one partner wants just A and nothing else, or B and nothing else, or A and B? There's all these assumptions that couples make about sex. In sex therapy, we try to slow that process down and to really not just define but clarify what's happening, and why, and what are you wanting. "Tonight, I want this" doesn't necessarily mean, "Tomorrow night, I'm going to want this again." Maybe they'll want something different. I forget who it is, but they also talk about this sort of internalized image of our partner. We learn over time who they are, but it's also heavily based on assumptions and conclusions, and we stop being curious about who they really are.
Keith Sutton, PsyD: (51:44)
Yeah. Rather than taking a moment to understand why someone likes something, This applies to sex and pornography as well. Understanding what kind of pornography a person is watching—what they like about that. The other aspect, like you were saying, they don't have the backstories of these people. They're also playing a role. Even in erotica, there might be the role of the submissive person or the person who is just easy and just wants sex and there are no complications, like whether they got enough sleep that night; they're just up for whatever. And sometimes that's the fantasy. Understanding with couples what it is about what they're watching that is exciting, because a couple doesn't need to go out and have group sex, if one person's not interested in that. It’s about understanding what is the excitement about that.
Keith Sutton, PsyD: (52:44)
What’s important is being able to talk and bring some of those things into the relationship, whether it’s the novels that people are reading or other sources.
Diane Gleim, LMFT, CST, CST-S: (52:54)
One question I like to ask my clients, when they reveal that they view porn, and if they're comfortable I do some assessment around that—I ask them, "Who do you identify with in the porn you're watching?" And they first often go like, "What do you mean?" And I jokingly say, "The do-er, the do-ee, or are you an observer?"
Keith Sutton, PsyD: (53:23)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (53:25)
And the answers are fascinating.
Keith Sutton, PsyD: (53:28)
Yeah.
Diane Gleim, LMFT, CST, CST-S: (53:29)
And I, and then I follow it up with, well, why do you think that is? Why do you think that you are identifying with whatever role you are identifying with?
Keith Sutton, PsyD: (53:36)
Well, I think it's also important to ask what they like about it. I had one couple where the wife was wondering about what it's like for him. He was saying, "Well, I like seeing the women enjoying, acting like they're enjoying or whatever," and she was surprised because she was thinking he would imagine himself as the man because she would imagine herself as the woman when she was watching porn.
Diane Gleim, LMFT, CST, CST-S: (54:04)
Right. Great point. Yeah.
Keith Sutton, PsyD: (54:06)
That’s happening to her. So again, just very different perspectives on that. This is such a huge topic, we could go on and on, but we’re out of time. Thank you so much. This is so important, and I really encourage therapists to dig deeper in this area of sex therapy. I think there are a lot of couples therapists who don't have this extra kind of training, which leaves out a really important piece. I think what you’re doing around pornography is really great, and things are changing with generations, also. The couples in their twenties are very different from the couples in their 50s, 60s about pornography.
Diane Gleim, LMFT, CST, CST-S: (54:50)
Completely. Well, thanks Keith. This was fun.
Keith Sutton, PsyD: (54:53)
Yeah. Appreciate it. Okay, great. Thanks a lot. Take care.
Diane Gleim, LMFT, CST, CST-S: (54:58)
Yeah, thanks.
Keith Sutton, PsyD: (54:59)
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