Intimacy Issues: Understanding and Overcoming Barriers

Suzanne Noble: I'm very excited to welcome our new sponsor, Higher Nature, who have created Rekindle, which I'm currently trying out and is working a treat. A 100% natural libido-enhancing supplement for women, which contains clinically backed ingredients to give your sex life a boost. And who doesn't want that? This week's episode has been sponsored by Oh My Bod, shifting the evolution of pleasure. Hi, this is Suzanne Noble, and you're listening to Sex Advice for Seniors. And today I'm back with Indigo Stray Conger, all the way in Colorado. Don't worry, we've already had all the conversations beforehand about living in America and everything. We don't need to revisit any of those. And I think the last time you were on the show, we were talking about moving into kink, open relationships. We've done quite a bit of that actually, since I last spoke to you.

Yeah.

And we've got some other— we've got some other shows coming up around that. So I don't really— I don't really want to revisit that. So I think one of the interesting things that perhaps we didn't talk about was the fact that you do somatic psychotherapy. Yeah. And what is it exactly? We didn't, we didn't really go into all of that. So I'm curious to know, as part of your practice, what is somatic psychotherapy?

So somatic simply means body-integrated psychotherapy. And it can mean a whole lot of different things, just like talk therapy can mean a lot of different things. It's really founded in more Western somatic practices, so a lot of actually European practices. Um, and some of those can be hands-on, some of them are movement practices, some of them are more around self-awareness, and there's not any contact between practitioner and client. And then there's been a lot also Eastern influence from my own practice. I'm a yoga practitioner and a yoga teacher, so a lot of Eastern spiritualities and Eastern practices also informs my work.

And what particularly attracted you to this, this type of psychotherapy?

Yeah, so to take it way back, I grew up very academic, accelerated academics all throughout my life. And when I went to college, I already had a year of college under my belt and I went to New York University. And they— I went to a program there where they basically said, you've already done the basics, so you can study whatever you want and get a little more curious. And I really moved away from typical academics and started to explore some other pieces. So, sociology and psychology, sure, but also a lot of theater classes in Western somatic modalities, Alexander Technique, Gendler Technique, Rosen Method, things like that. My parents were not thrilled that I was spending money rolling around on the floor and making noises and exploring myself. But, but really, it made me realize how that certainly back when I was in elementary school in the '80s, it's probably similar in the UK, that there's absolutely no no self-awareness, body awareness. It's all academics. It's all sit in your chair, learn mathematics, learn grammar. And so there was this whole world that opened up to me about how you know yourself, how you become a healthy and authentic being. And so I graduated undergraduate with a degree in the visual and physical expression of emotion. I didn't know what somatic psychology was at the time, but that's basically a description of somatic psychology. And then I went into graduate school once I discovered that somatic psychology existed and got to study it some more.

Wow. That's quite a journey. And you mentioned that you use neuroscience and mindfulness also to help clients reconnect with their bodies. Could you walk us through what does that actually— process actually look like when you're in a session with a client?

Sure. So now that I'm in Colorado, I'm in what's called a no-touch state. So when I was in California, I could roll around with clients. I could do hands-on work with clients. Now in Colorado, you're really not even supposed to shake your client's hand or give them a hug. So, um, I'm using a much more narrow scope of the modalities. And then since the pandemic, I only work virtually with clients too, so it's narrowing it even more. So a lot of what I'm doing with clients is coaching with them around self-awareness practices, mindfulness practices that they're doing outside of our session time. And then I also do quite a bit of EMDR, which is eye movement desensitization and reprocessing. And we can do that virtually with one another through a ball bouncing across the screen or through sounds in the ears, alternate sides. So we're working with bilateral stimulation, particularly for trauma to start to rewire the body and rewire the neurophysiology in the brain to be more adaptive and be more integrated.

And I'm curious to know, because I've done, I've done the MDR around issues. Yeah, around intimacy sort of issues. How, for those who don't know, how can, how can that help when it comes to trauma or just actually improving our relationships?

Sure. So EMDR is one of the, if not the most respected treatment for straight trauma, so PTSD symptoms. Most of the studies have been done with war vets, for example, have more classic PTSD, a startle response, panic attacks, things like that. But it can also be applied more broadly to people who have CPTSD trauma that's a little bit more pervasive throughout the life, sexual trauma history, for example, and also for folks who have anxiety responses that may not be classified as traditional trauma. And what it does is it takes us out of the cognitive brain. So when we have a panic attack, for example, we're not thinking, oh, I'm in a scary situation, I should make myself have a panic attack right now. Our body is doing that unconsciously. It's taking us on a road all its own because our body has learned that this is maybe the best coping mechanism. And with EMDR, what we're doing is we're slowing down the body's response system and we're reprocessing it. We're making it adaptive. Of. So we're taking old memories, we're reclassifying them so that they're less triggering. Oftentimes people will report that they start to see those memories in third person, or that they feel more distant or less emotional from those memories. And then when we're in triggering situations that might have otherwise caused panic or anxiety, we have a different neurological response to them. And all of that is really happening without having to think or will ourselves into it. It's happening by slowing down and allowing our body to do the work for us.

And do you— I mean, what are some of the common challenges that people come to you with specifically when it comes to improving their relationships and using the techniques that you just described? What do you say?

Sure. So with EMDR, I'm typically not using that in couples therapy, for example, but I will use that with one person within a couple or an individual client who's having issues with intimacy. Commonly, people will have difficulty with intimacy when they do have sexual trauma history, for example. And so they may be with a partner that they feel very trusting of, that they love, but something in them is shutting down when they are trying to be intimate with their partner. So the work that we're doing is we're going back to those early traumatic memories, or we may even be using a very recent memory of feeling like they're shutting down with their partner. And we're slowing that down, and we're using the bilateral stimulation, and they're letting their mind and their body to go where they need it to go while that bilateral stimulation is happening so that hopefully they are able to not have that automatic shutdown that was occurring before.

And one of the things I was thinking about, and you may go, no, no, it's never— it doesn't work like this, was that often one of the, you know, there's obviously in later life, there's physical challenges that sometimes take place, right? And things like vaginismus, for instance, used in those circumstances where people might have actual physical challenges, you know, the clenching up. Yes. Yeah, absolutely.

So if it's vaginismus, or if it's a combination of the tense tension and the sexual pain, for example, usually there is a psychological component to that. And sometimes it's the psychological component that started the physiological component. And sometimes there's something physiological like childbirth. That was the start. But then now it's become psychological because there's a fear of the pain, there's a fear of the tension, there's a whole stress cycle that's happening around it. So a little bit with chicken or the egg, it doesn't even really matter whether it started psychologically or physiologically. We want to be addressing both in tandem. So I won't just be addressing this with clients through EMDR and through psychological and somatic strategies. I'll also want them to be seeing pelvic physical therapists, for example, in most cases. Because if we're working on untangling the psychology, but now they have this tension pattern, what I'm doing is not going to help them that much. And if they're just seeing a physical therapist who's working with them on the tension pattern, but they still have the whole fear and anxiety cycle, it's not going to help them either. So we really have to do both simultaneously.

Yeah. And, oh, I've completely lost my train of thought here. I was completely engaged there thinking about, thinking about, yeah, thinking about what goes on with with women in that way, with, with things like vaginismus. And, and similarly, because I suspect there are also men who are struggling with erectile dysfunction, which also can be psychological.

So, and, you know, yeah, it's very similar for men in terms of whether you're talking about quote-unquote premature ejaculation, they're ejaculating faster than they would like, erectile dysfunction, they're having trouble getting or maintaining the erection that they want to have, or they might be having trouble having an orgasm at all, or in the time that they want to be having it. All those problems are really similar in the sense that once they start, there's an anxiety pattern that develops around it, and we have to start to address the anxiety pattern and not just use Viagra for the physical symptoms. Like, Viagra might be very helpful, but we also want to be starting to see what's happening for you in those somatic cues and in that anxiety cycle in your brain and your body when you're entering into sexual situations. Now that you've had this happen a few times.

I know I get it. It came back to me now. What I was, what I was thinking was the times that I've done EMDR, one of the reasons why I did it is because it's quite quick. Often people don't want to go to therapists for years. And often they think of therapy and think, I'm going to need to go into therapy forever in order to sort myself out over this. And EMDR is typically quite quick.

Yes.

Is that what you've— is that kind of your aim to get them? Because I know some, some therapists want to, want to untangle as much as possible and some just want to actually, let's just deal with the issue and then you can move on with your life. What's your approach?

So EMDR absolutely can be quick, so quick that it can be disconcerting for people. I was working with someone who had more classic PTSD from having been in battle and he'd been dealing with these PTSD symptoms for years. And once he did EMDR for a couple sessions and he wasn't having these startle responses. Then we had to do a few sessions with him having to reorient. He was disconcerted that he wasn't having these responses because it had been going on so long. It was part of his identity. He didn't think that it was ever going to go away. So in general, yes, I'm not a therapist who touts myself as in 1 to 3 sessions you're going to feel amazing and everything's great. But I'm also— my goal is not to keep people in therapy every week forever for years and keep talking about their problems. I want to move at the pace that their body and their psychology are able to move, which for some people is more rapid and for some people is slower. And for some people, it's cyclical. You get, you get some great response early on and then you go about your life and then some other things come up again and we revisit.

Yeah.

Yeah.

A friend of mine had a very similar response to EMDR because I've done it a few times and it was super quick and I was like, great, I've sorted myself out. I can just move on. I have to say that there's, you know, there's always still some lingering things that I could probably be dealing with. But a friend of mine went and, and it was around an issue around eating. And at the end of the session, the therapist just took out a bag of Maltesers and said, hey, would you like one? And he just picked it up without thinking and ate it and then came back and went, that could not possibly have worked that quick. And then he was able to believe it, right? So yeah, I mean, I think the thing is you have to kind of go in with a willingness to believe that these sorts of, you know, ways of healing people do actually work. Otherwise, they probably only work for a temporary basis and somebody just teaches them their brain again that, that, that, that didn't work.

And, you know, I not only believe that it can work and you don't actually have to believe that EMDR is going to work for it to work, which is what can be disconcerting about it for some people. But, but also, do you really want it to work? So going back to the, the vaginismus example, it's very common for these to develop when there's other issues in the relationship. So you have a client that is saying, I really, really want this to go away. I hate being tense. I hate being in pain. I want to be able to have sex. But then when we dig down into it, do you really want to be having sex with your husband who is, you know, not being great in the relationship? You're doing all the labor in the household. You're the main breadwinner. You have a lot of resentment towards him. So if we fix this problem, you're gonna have to have sex with your husband, and maybe you actually don't want to. So then we have to do some other work behind that to really even see if you do want to heal these physiological symptoms, what then? Where do we go then? And that's often a much harder thing to fix. Do you want to stay in this relationship? Is your partner willing to work on this relationship? There's a lot more complex questions there. Yeah.

And you know what, there's— that came up recently. I don't know whether you follow someone called Dr. Kelly Casperson. She—

yes, yes, she's good.

She did this thing recently talking about coercive sex, which, you know, she just said not enough has been talked about. Part of the, you know, I hear a lot from women who say, I don't feel sexual anymore, or I don't want sex anymore, or sex isn't fun, it's painful and everything. How, how many relationships are based on the whole notion that sex is purely about pleasuring a man, and that women put their own pleasure second. And so therefore, all the sex that they probably ever had has been not really with them completely on board, right?

Exactly. Yeah. And there's a difference between consent and enthusiastic consent, which is why it's so great that that's become part of the vernacular, right? Because, oh sure, I guess I'll have sex with you because you've been hounding me. Technically, that's consent. Is it enthusiastic? No. And if you don't have enthusiastic consent, it doesn't mean that you can't have sex necessarily. Plenty of people do. But are you going to be having great sex? Are you going to be having an orgasm? Probably not. And then suddenly you feel like, oh, it's something about me that I'm just less sexual as I get older. No, it's that you're not working with somebody who has any interest in getting enthusiastic consent and having fun with you as opposed to begging you for sex.

Yeah, absolutely. And one of the things that you talked about is about when you're working with people on relationships and intimacy is about something called attachment theory. What is that exactly?

Sure. Attachment theory is, is very much in the zeitgeist these days. And most of my clients who come to me, they have a sense of, oh yes, this is what attachment style is. And there's— there are a lot of different books and TikToks on attachment, a lot of different language around it. The most simple explanation of it is that attachment is a spectrum. So if we're perfectly secure and in the center, we don't have a physiological reaction or an emotional reaction to our partners having a physiological or emotional reaction. We're able to stay pretty grounded and deal with what's right in front of us. Most of us are not in that secure place all the time. And so we tend to— forever. Yes. I don't know many people who report being there very often. So most of us tend to lean towards what's called anxious or avoidant, and those both sound negative, but they're really not. It means, does your nervous system get more agitated and seek regulation from your partner? That's the more anxious attachment. Or avoidant, does your nervous system want to pull away and regulate yourself? And again, that's a very simplified example of what attachment is. And when we're in long-term relationships, both of our attachment styles can get more and more triggered and cyclical with our partner. And it can feel like, oh, our relationship is getting less healthy, or maybe we're not meant to be together. When really, if you get to know your own attachment style and your partner's attachment style, you can start to say, oh, my body is reacting to you in this way, and then your body is reacting to me in this way, and we can slow it down and we can have more agency over what's happening in this moment.

Yeah, my son says I'm an avoidant, but I just say I'm a— just to note, I have a very high bullshit barometer. So when I sense bullshit, I pull away because I'm not— it's not that I'm avoiding anything other than putting up with a lot of crap that I just don't think I should be putting up with. But yeah, that's, that's my way of looking at it. And yeah, I mean, it's funny, attachment and avoidance, calling it avoidant attachment styles versus attachment theory changes it because of course attachment styles, I see on TikTok literally all the time from people who probably know absolutely nothing about them.

But it's true, there's a lot of misinformation out there about it, right? Like a lot of times people say, oh, if you're avoidant attachment, you're an introvert. It has nothing to do with whether you're introverted or extroverted. There might be some overlap, but those are two totally different concepts.

Yeah. So you mentioned that you studied in NYU, but then I know that you actually went and did a lot of training in San Francisco.

Correct. Yeah. So I went to graduate school in San Francisco at the California Institute of Integral Studies. It's a mouthful. A hippie school right downtown in San Francisco. And It's one of only, I believe, 3 programs in the, in the US that have a somatic psychology program. And so it's, it's an unusual program to say the least. And we get all the traditional talk therapy elements so that we're able to gain licensure in that state. But then we also have all of this information about the somatic modalities as well that we're weaving into our work.

And how did being in San Francisco at that time with all of the, you know, diversity in that great city and being in such an open and like an incredible place. How did that inform your— the work that you do?

Yeah, so starting as a therapist there was great because it was the default that people weren't coming in in Christian, cis-het normative relationships. And so right from the get-go, I was able to get used to asking people, what does your relationship mean to you? What are your agreements with each other? What are your expectations with each other? What does sex mean to you? And those are questions a lot of therapists, they make assumptions going in, oh, we're working with this cishet normative template, with this mononormative template. Of course, we're not talking about kink. Of course, we're not talking about other people being involved in your sex lives. And instead, that's not the assumption that I make. And predominantly, it's not what I work with now either.

And so what year was this?

Let's see. So I started graduate school in 2006.

Okay, so, you know, not— it wasn't like not a huge amount of people were talking about all of this kind of stuff 20 years ago.

Yeah, I mean, it was definitely around, and in San Francisco it was definitely around, but it was much less, you know, in TV shows and on social media and things like that. Now, now everyone knows what non-monogamy is. They might think it's something weird over there and they've never met someone who did it, but they know what it is. Back then, a lot of the vernacular hadn't developed yet. A lot of the nuances weren't out there yet.

Yeah, and I think also if that's the way Do you find that that's because that territory is now so familiar to you that it's the area that you feel most comfortable in working with the LGBTQ population, working with people who want to be ENM? Yeah, because that's sort of, you know, that's how you, that's how you got your start, right?

Yeah. And even in San Francisco, I was the person that my colleagues sent people to when they felt a little out of their depth. They were like, oh, Indigo is more comfortable and savvy with sex and sexual situations and non-normative populations. Because even in San Francisco, sadly, graduate schools to become a therapist, at least in the US, have zero requirements for sex. If anything, you're lucky if you get like a weekend in basic human sexuality. So there's little training, there's little integration of that. And that's why I'm so passionate at this point in my career about being an asex certified sex therapist and being a supervisor who helps other therapists integrate sex into their their practices because it's an important part of the work. It's a huge gap if you don't include that in your training.

Yeah, and it's really funny because I was speaking with my former co-host Zoe Kors, who in— during our conversation, she was talking about the fact that part of the reason why we stopped co-hosting this was that she wanted to work with creating a training program for couples therapists that integrated sex. And she said so many things, you know, that one of the issues around their couples therapy especially is that sex is not really part of the discussion. Yeah. Right. And I was really surprised to learn that because surely if you don't talk about that, then you're missing a whole—

I have couples who come to me all the time and say we had a couples therapist. We went to her for 6 or 7 years. She never asked us about our sex life. How could you work with someone for 6 or 7 years and not know if your clients are having sex and what that sex looks like and where the issues are around sex? It's crazy to me.

It is crazy. And when you think about it, the fact that all these people are coming out of, out of school being trained to do this work without including this component— yeah, it's totally nuts.

It really is. It's starting to change now. Programs are starting to include sex therapy certifications embedded in the program, but it is still something that you have to opt in for. It's not a requirement for licensure.

And that's what— and that's what Zoe said. Yeah. And then, and then she decided that she wasn't, she wasn't as keen on doing it as she thought she was at the beginning.

A lot.

But yeah, it is because it's a whole nother, as you said, it's a whole nother addition to their their extensive training that they've already done. So, you know, yeah. And so you talk about being one of the fewer, you know, there's less than 10 people in Colorado that have got this AASECT certified sex therapy level. What unique insights does that bring to your work?

Yeah, so there's, there's less than 10 supervisors in the state of Colorado. We've got lots of great certified sex therapists. And it's been wonderful that AASECT has just exploded in last decade or so. When I joined, it was a relatively small group of folks. Now we have so many students and therapists that are passionate about this. And I really love working at that supervisory level because I do get to work with clinicians who are adopting this model into their work and seeing all the different modalities that they're bringing to it and applying to the sex therapy lens that I may not in my own practice. They're not all somatic therapists and are all attachment-based therapists. They have their own lens. But sex is important in all of them.

Yeah, what do you— and just talking about that, I mean, this area seems to be evolving all the time. I've obviously spoken to dozens of different types of therapies, therapists, sex therapists, sexologists, somatic therapy, like all sorts of different people. What are— what is it that you're seeing coming through that, that's really informing now the work that is being done to help couples, especially those in later life, embrace, embrace their sexuality and the way they approach relationships?

Well, one thing that's happening right now in the zeitgeist is more knowledge and awareness around perimenopause and menopause. And that's not necessarily just in the therapy realm, but in the world in general. There's a lot more books coming out, celebrities speaking out around their own process with this transition in their lives. People are taking ownership of their own bodies and their own process instead of just taking whatever the, the message of the day is from the medical community. The medical community goes back and forth on, oh, we— you have to have hormone therapy, you can't have hormone therapy during this part of your life, these supplements are great, these supplements are terrible. And instead, because there is so much information out there in the age of the internet and social social media, people are sifting through it on their own, particularly female-bodied individuals, and saying, oh, I'm in perimenopause. What does that mean to me? What are the symptoms that I'm having? And also, is this just a bad thing, or is this something that is also a healthy transition in my life? And can I have even better sex? Can I have even more self-aware sex and partners who are more self-aware around where my body's at, at this stage in my life?

Yeah, I mean, I'm seeing a lot of, a lot more discussion, even just very, very recently, about the decision about not having sex. Yeah, I'm seeing a lot more conversations about people being really quite forthright in saying, you know what, I'm not, I don't want to have sex. Even young people and older people. I think I hear a lot from men about the fact that they're, you know, their wives have got low libido and they don't want it anymore. They're not interested or whatever. But I'm also meeting younger people now, we're talking about being asexual, talking about having no sexual desire. We're seeing a lot more conversation about young people not having sex as much as older people. I'm quite interested. I'm just myself intrigued about the fact that not having sex now is almost as radical a statement as it used to be to say, I love having sex and I want to have loads of sex with lots of different people. It seems like that conversation is really exploding in ways that I'm finding quite interesting because there used to be a lot of shame about being kind of, you know, about being promiscuous, right? Nobody ever really talked about the fact that they never want to have sex ever. And now it seems like everybody's going, yeah, I don't need it.

Yeah, for a long time, like you said, particularly for female-bodied individuals, it was shameful to say that you actually enjoyed sex, that you wanted to have it, that you were seeking it out, particularly with multiple partners. And but we are such a sex-forward culture that even during that time period, that was the dominant narrative, right? Is sex, sex, sex. Everyone wants sex, even if it's in secret. Everyone wants sex. And, you know, about 15, 20 years ago is when asexuality first started started being a term that people started to understand. And I remember there were some documentaries at the time of asexual folks being in Pride events and things, and they're very much the pariahs. It was like, we've worked so hard to be sex-forward. Please don't tell me about your asexuality. And now they're starting to be a little bit more of an integration and understanding that not everyone is sex-forward. Doesn't necessarily mean they're asexual, but they may be demisexual. They may be more graysexual. Not everyone is this mega sexual, sex-first, sex-forward person.

Yeah, I only heard the word demisexual yesterday in an article that I read, and I was like, oh my god, this is another, yet another term that I didn't know about, which is, you know, somebody— yeah, well, what I read was somebody who needed to feel an emotional, strong emotional connection before, before they would have sex. And if they—

well, and they find it strange, they never were the people who had the posters of like the cute boys on their wall because it was like, how would I be attracted to someone that's just a picture? That doesn't make sense to me. I'm attracted to an emotional connection. I'm attracted to something beyond your nice washboard abs.

Right. And this woman who wrote this article was saying that Rebecca Ferguson, she's great. She's got this Substack called 3,000 Orgasms where she tracks her orgasms. She does orgasm data. It's fascinating. But she was saying that I think it was her anyway, I'm sure it was. She was saying that, yeah, she went on a date with somebody and the date— there were multiple dates where they just kind of got to know each other. And then when they finally started having sex, he whispered, I love you, in her ear. Really? Like, are we at that point? And I thought, oh wow, that's something I only do when I have really amazing sex and my endorphins and all the go a bit mental and then words come out of— spilling out of my mouth that actually mean absolutely nothing.

Yeah, that word means something different to different people and in different moments when you have different chemicals roaring through your body.

I do warn them though that I, if I ever say those 3 words in that moment, that they must know that I don't mean it unless, you know, we've known each other for a very significant period of time, but sometimes it just happens after the first date and that's stupid. Yeah, anyway, but, but yeah, I mean, I think what I'm seeing, I'm certainly seeing like a lot more, and I think maybe it's because of Field as well, the dating app Field is, I'm just seeing a lot more words out there for all different types of relationships that I never knew existed before. And in addition to, you know, all the different words for sexual identity, I'm just seeing like, just like, I think, I think Field's glossary, I'm just doing a break, they have quite a glossary. Yeah, it's 31 words. Right. It's 31 separate words. I'm trying to break them down by, by category so that because otherwise I'd have to write a whole book just to, just to dissect this field glossary. But anyway, where can people find you, Indigo?

I'm at Mile High Psychotherapy. That's my private practice in Colorado. And I have a blog on my website, milehighpsychotherapy.com. With articles I've contributed to, articles and pieces that I've written, podcasts like this that I've been on.

Yes, I saw our last podcast on this. And is there anything else that you'd like to— any, any one practical tip that you'd like to give our listeners?

Be in your body. It's a wonderful home to live in.

Sounds good to me. Lovely to speak to you again.

You too, Suzanne Noble. Bye-bye.