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The three ripples of sexual therapy

Patients come seeking sexual therapy not out of pure curiosity, but rather from an edge experience: this is the last refuge after a long period during which they realize that coping alone is not improving their current situation. 
They arrive tired and helpless, defeated and full of guilt and self-criticism. For most, arriving at the clinic is not a high point but a matter of shame for their inability to resolve or change the situation.

Along with them, a noisy mass of inner voices comes to the therapeutic space: despair, hope, past experiences, traumas, and relationships, body image, and guilt. 
They all enter together, within one body, leaning against the armchair and wondering where to start. 

It is quite a complex experience to be a facilitator in the face of all these: to be placed as the representation of hope, healing, or change, to be the one who contains or listens in a way they have never been listened to, to support but not to invade, to hold but also to provide.


Focusing on sexual issues is like any other focusing work: listening to a story, working with physical sensations, deep, inquisitive, empathic attention; yet one crucial distinction between focusing and focusing on sexuality issues is the ability to remain present while confronted with the powerful forces operating within the sexual field. 
Knowing how to work with the particular guard dogs that this field presents, flooding, trauma, sensitivity to exposure, sexual tension, and certain sensations that might be felt in the genitals. 


The ability to be extensively present while leaning back with these issues depends on three factors: 
1.    The degree of personal work we have done with our own sexuality
2.    The level of experience we have working with the forces operating in the field of sexuality. 
3.    Supervision
Usually, in the first session, after hearing the story, the emotional experience, and the reason why this is the right time to start a process, we talk about the three ripples of sexual therapy - meant to create order and calm the many parts that require attention.


The Three Ripples
I like to divide working with sexuality into three ripples.
The first ripple focuses on the relationship we have with sexuality. 
It is the one in which we will present the constellation from which we come and the experiences that created the sexual persona that we are. In the first ripple lies the story that wants to be told, and although it is most often expressed in couple’s sexuality, it is connected to deep and twisted issues within us.

In the first ripple, we will be working on the relationship a person has with his own body, traumas, education, and family. 


The second ripple deals with sexual relations - it contains the first circle along with the question: how it all meets another person’s sexuality. 
In these stages, we talk about sexual relations, performance, attraction or frustration, guilt, sexual orientation, and most importantly, communication.


The third ripple is sexuality in the world. 
The essence of this ripple comes from the first two ripples, but it can also be expressed independently as it pertains to sexuality as a life force. 
The third ripple investigates joy, passion, the ability to be expressed in this world from a living, creative, and grounded place. 
The third ripple can result from everything we encounter in the first ripple and sometimes be the reason for it. 

Of course, it is impossible to fully separate these ripples; perhaps it is not most accurate to describe them as ripples but as tangent circles. But the advantage of this sorting is it allows the client to understand how to start deepening and what the big picture is.

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