2023 Top Therapy Topics

Couple in therapy. 2023 top therapy topics

What We Talked About in Therapy

As we conclude 2023, I’ve been reflecting on the recurring themes that presented in the therapy room this year. I know that many of my readers may also have some of these struggles. Know that you are not alone and it’s possible to feel better. I share some of them with you below in no particular order. 

Issue #1: Couples continue to adjust to post-pandemic life. 

Many couples continue to recover from the impact of the pandemic. Therapy seems to have focused on either healing relational wounds inflicted during the pandemic, or, adjusting to two partners sharing home space due to the “permanence” of remote work. 

During the pandemic, many couples struggled to share the same walls, day in and day out. Some experienced increased fighting, reliance on substances, depression, anxiety, lack of sex and general hopelessness. As a result, couples experienced deep relational wounds that still need healing. Our work has included processing the hurt feelings, restoring trust, working toward forgiveness and re-establishing safety and excitement in touch again.

On the flipside, other couples felt a real sense of team during the pandemic but weren’t prepared for the permanence of remote work. Space in the home doesn’t feel as free. The partner who may have always stayed home feels suffocated by the new work conditions. For these couples, our focus has been on the adjustment to this change, communicating needs, grieving pre-pandemic lifestyles, creating space and establishing healthy boundaries.

Issue #2: Women participate in marital sex out of duty, not desire.

Over and over, women told me that they didn’t want sex. Not only did they not want it, but they performed it anyway, out of duty. All of them thought something was wrong with them for not wanting sex, as did their partners.

In every case, my work began with the same message: “Let’s start by helping you stop having sex that you don’t want”. Alarmingly, this seemed like a radical idea to them. Our work began with establishing internal permissions – permission to say yes or no to sex, without guilt.

If their partners were involved in the therapy process, I also worked to help them take responsiblity for their own desire when their partner was tired, stressed, in physical pain, or simply not wanting to have sex. We redefined sex as a privilege and not a right and explored a concept that I call “buffet” style sex. 

Whether I worked with women individually or partnered, through psychosexual education, we worked to unpack and clearly understand desire, arousal, consent, sexual communication, and intimacy. We also created clear maps for what real intimacy looks and feels like over the relationship lifespan to help establish sexual intimacy worth wanting.

Issue #3: All humans can benefit from understanding their nervous system.

As human beings, we have pretty extraordinary internal mechanisms for survival. Intimate partnerships can kick your defense systems into high gear. Your nervous system constantly “reads the room”, assessing emotional, physical, mental and sexual safety. This includes interpretting your partner’s energy, tone of voice, body language, eye contact, words, passive aggressive and aggressive behaviors, always looking for safety and connection.

I’ve worked with many clients this year on helping them know their nervous systems better. They not only learned to identify when they would go into fight, flight, freeze or fawn state (defense mechanisms for survival), but also what triggered them to react. Even further, they developed coping skills for self-regulation, i.e. ways to bring their nervous system back into a state of safety and connection. 

It’s powerful to learn and understand how your body responds to stress. Knowing your nervous systems allows you to work with it instead of fight against it.

Issue #4: Everyone needs to move their bodies.

We all love to spend time up in our heads, thinking, planning, assessing, rehashing or rehearsing various thoughts. But when you want better mental health, better relationships and a more robust sex life, moving your body is key. 

Earlier this year, I heard the phrase, “Motion is Lotion”. It means that your body needs to move to lubricate your joints, circulate your blood to all parts of your body, increase oxygen to your cells, and strengthen your muscles.

I worked with folks by helping them learn how to stop living from the neck up, and instead, drop down into their bodies, and live from their whole bodies. This included exploring active movement on a daily basis, such as walking, dancing, yoga or pilates. We also discussed how to experience present centered awareness using the senses, including sight, taste, touch, scent and sound. We focused on creating whole body experiences.

Technology has had a profound impact on our daily movement. Remote work makes daily movement even harder. Many folks roll out of bed, into the kitchen for their coffee, then right  into the home office to access their computers. We don’t move our bodies enough!

Personally, I have found daily exercise to have profound impact, not only on my body, but in my thinking. Movement has helped me become clear, focused, motivated and strong. Clients have also reported similar results.

Therapy = Clarity and Change

Whether I’ve worked with women individually, or with couples in relationship counseling or sex therapy, we’ve talked about a wide range of topics that affect folks individually and relationally. 

All of my clients have trusted me with their journey and I’ve witnessed them work hard to find their own clarity, explore new ways of thinking and being, and improve connection to themselves and to others. Clients have found therapy to be life changing. 

If any of these topics feel familiar to you and you continue to feel stuck without improvement, professional counseling may help you. Remember, you don’t have to figure it all out on your own. Working with a licensed therapist can give you new perspectives, a space to explore different options, and new practices to try. 

It’s kind of like going to the gym. It can feel daunting at first but after the workout, you’re always glad you went because you feel more flexible, energized, stronger and better, in body, mind and spirit.

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