Social Anxiety

Making a presentation at work, introducing yourself to a new neighbor, or attending a social gathering: How do you feel in these situations? While many people experience some amount of discomfort in social situations from time to time, for people with social anxiety these types of events can lead to intense feelings of distress. People with social anxiety often feel awkward or out of place in social situations, and worry that others will sense their discomfort. They may experience physical symptoms such as a racing or pounding heart, sweating, shortness of breath, chest tightness, or upset stomach.

In many cases, people with social anxiety end up avoiding social situations entirely in order to avoid these distressing physical and emotional symptoms. While avoidance does work in one respect (no trigger, means no symptoms), it results in the person missing out on both social and work-related opportunities. It also tends to reinforce the message to the person that they are not capable of handling social situations. Over time, the number of situations that cause social anxiety may actually expand, and the person’s ability to cope with distress decreases.

With therapy, a person can increase their ability to cope with situations that cause social anxiety. Cognitive Behavioural Therapy (CBT) is one type of therapy that is an effective treatment for social anxiety. CBT teaches a person tools that work to reduce anxiety and increase coping skills so that a person no longer needs to avoid social situations and doesn’t experience the intense distress associated with social anxiety.

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Therapy for Couples Considering Non-Monogamy

Non-monogamy, or having an open relationship, refers to a relationship in which the partners have agreed that the relationship is not monogamous. In a blog post last year, I wrote about open relationships and whether or not they are a real option for a long-term relationship (spoiler: sometimes they work and sometimes they don’t, just like monogamous relationships). In the past year, the topic of open relationships or non-monogamy has continued to be a common one in the popular press, and we’re also seeing more discussion of it in academic circles.

As a couple and sex therapist who works with both monogamous and non-monogamous clients, I’ve been happy to see the increased attention to alternate forms of relationships. But what if you’re currently in a monogamous relationship and considering making a change, opening up your relationship to a non-monogamous one? While popular press includes some resources for couples in this situation, there is almost nothing on the topic in the academic literature to help support couple and relationship therapists working with clients in this situation. This is a significant issue, since most therapists lack any formal training on non-monogamy, and many people still hold negative assumptions about consensually non-monogamous relationships. So I decided to do something to begin to address this gap in resources for therapists.

Based on a review of the current research on non-monogamy and on my own clinical
experience as a couple therapist, I wrote an article titled: Couples Exploring Nonmonogamy: Guidelines for Therapists (Bairstow, 2017), published in the Journal of Sex & Marital Therapy. This article provides therapists with information about how to increase their capacity for working with consensual non-monogamy and with couples who are considering becoming non-monogamous.

But if you’re looking for a therapist, how do you know if they are knowledgeable about non-monogamous relationships? If you are currently in a monogamous relationship and looking for support as you consider transitioning to a non-monogamous one, or if you are in a consensually non-monogamous relationship and looking for counselling or therapy, there are a few steps you can take to increase your chances of finding a qualified therapist. Take a look at the therapist’s website, do they make any reference to alternative forms of relationships? Talk to the therapist and ask them if they have experience with consensual non-monogamy, and about their perspective on non-monogamy. Finally, word of mouth can be helpful to find a qualified therapist. Consider asking friends or posting in online forums for consensual non-monogamy to ask for the names of therapists who are experienced in working with non-monogamous relationships.

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Sex and Shame

Many of the sex therapy clients I work with report feelings of shame in relation to sex. In some cases, the shame is linked to a religious upbringing. Although the message to wait until marriage for sex does not have to be a negative one, for many people this message is conveyed in a way that implies that sex is wrong or dirty. Some people from non-religious households grow up with similar messages about sex, often communicated in an attempt to avoid teen pregnancy but resulting in the message that the individual should not have sex or even want to have sex. And for some, the idea that sex is shameful is conveyed by the lack of discussion about it growing up, suggesting that sex is taboo.

For women, sexual shame is sometimes linked to a double standard, a separate set of rules that apply to women but not to men. For example, rules about the appropriate number of partners one should have, whether or not casual sex is acceptable, whether or not it is okay, or even if one should enjoy sex– some women have gotten the message that “nice girls” shouldn’t want to have sex at all. In some cases, women perceive that these double standards aren’t right, but find it difficult to break free from their impact. And in other cases women believe the double standard, thereby adding to their feelings of shame.

Many of the clients I see realize that shame is getting in their way, preventing enjoyment or their full participation as a sexual being. Sexual shame can make it difficult to communicate with your partner, to express what you like and don’t like, or even to know your preferences in the first place. Sexual dysfunctions such as erectile dysfunction, premature ejaculation, inability to orgasm, sexual pain, and low libido can all be related to sexual shame.

Shame about sex and sexuality is difficult to overcome, but sex therapy can help. Therapy to address sexual shame may include an overall exploration of compassion for the self. Messages about the meaning of sex and the context in which it should happen are also an important part of addressing shame. Therapy should be tailored to the particular characteristics of each individual, allowing them to develop their own sexual expression that is consistent with their values.

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Anxiety and Sex

In my previous post, I discussed anxiety in general. In this post, I’ll discuss anxiety specifically in relation to sex.

Anxiety and sexual dysfunction go hand in hand. Whatever the sexual difficulty (low desire, erectile dysfunction, premature ejaculation, delayed ejaculation, pelvic pain, or inability to orgasm) anxiety is usually involved to some degree. In some cases, the anxiety is present at the start of a sexual encounter, as performance anxiety or self-consciousness about one’s appearance. Even in cases where anxiety is not present at the outset, once a sexual encounter begins to go differently from the way one had hoped, anxiety can set in. This anxiety then results in the person being up in their head with thoughts and worries. Thoughts might include: This isn’t working. Why am I not turned on yet? Can my partner tell that I’m not into this? Is my erection strong enough? Will it hurt? My partner will be disappointed if we don’t have sex.

These thoughts increase the anxiety, and also take the person away from being in the moment in the sexual experience. Focusing on the thoughts means that the person is less likely to notice the pleasurable sensations that would normally facilitate the sexual response (desire, arousal, and orgasm). This increases the chances that the sexual encounter will not go the way they want it to, and in turn, increases the anxiety for the next time, and the cycle continues.

As with anxiety related to non-sexual situations, treatment for sexual anxiety involves two different approaches: challenging negative thoughts and relaxation. Included in the relaxation approach is the cultivation of a low-pressure approach to sex. Individual sex therapy can help develop these skills, and in some cases couple sex therapy is also helpful to re-integrate a focus on pleasure rather than anxiety.

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Anxiety: Symptoms and Treatment

What is anxiety? Anxiety refers to worry, fear, or the sense that something bad may happen. Anxiety isn’t always negative. It can serve as a warning system, calling our attention to danger. Anxiety may help us avoid dangerous situations or exercise extra caution, thereby protecting us from negative consequences. However, anxiety can also be harmful when it causes us to avoid too many situations out of over-blown fear. Think of the difference between avoiding walking close to a cliff edge vs. avoiding going to a party. In the first situation, anxiety is protecting us from the danger of injury or death due to falling. In the second situation, anxiety is protecting us from feeling uncomfortable in a social situation; but in the process anxiety is also preventing us from social connection and the possibility of an enjoyable time. In the scenario with the party, anxiety is in over-drive and is functioning more as a negative influence than a protective one.

Anxiety includes thoughts, bodily sensations, and actions. Anxious thoughts include worry or fear about what might happen, for example, “I’ll say something stupid at the party and make a fool of myself”. Anxiety can cause physical sensations such as rapid heartbeat, chest tightness, shortness of breath, or knots in the stomach. Actions stemming from anxiety tend to fall into one of three categories: fight, flight, or freeze. The fight response can cause us to lash out, flight causes us to avoid situations, and freeze can leave us stuck not knowing what to do.

We can’t get rid of all anxious feelings, partly because some anxiety is helpful to us. However, we can develop ways of coping with anxiety to limit its negative impact on our lives. Treatment for anxiety can include two different types of approaches: relaxation and challenging our thoughts. Relaxation techniques can be used to calm down the nervous system and our racing mind. Challenging our thoughts can help us see alternatives to the event we’re worried might occur. As a therapist, I help people learn ways of managing anxiety and their reactions to stress using these two types of techniques. Anxiety can be a useful tool if we learn how to manage it, and therapy can provide the strategies to do so.

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Call for Participants: Research Study on the Inability to Have Sexual Intercourse

In addition to working as a sex therapist in Toronto, I’m also a doctoral student in Human Sexuality at Widener University. As part of my dissertation for my PhD, I am recruiting participants for a study on the experience of people who are in heterosexual relationships but have been unable to have sexual intercourse (or penis in vagina sex).

My interest in this topic stems from my work as a sex therapist. I’ve worked with numerous individuals and couples who have been unable to have sexual intercourse, despite wanting to do so. Reasons for this inability include vaginismus, pelvic pain, erectile dysfunction, premature ejaculation, and sexual fear or sexual phobia. While the inability to have penile-vaginal intercourse–often called unconsummated marriage or unconsummated relationship–isn’t a problem for some couples, those who seek treatment from a sex therapist report significant distress. Despite this, there is little in the academic and research literature on this topic.

My goal is to address this gap in the literature by interviewing men and women who have been unable to have intercourse in their current relationship. Study participants will take part in a one-time interview, answering questions about their experience. I want to report any positive or negative impacts experienced by people in this situation.

Are you in a heterosexual relationship and unable to have intercourse? Please share your story. Results of the study may help guide future research and clinical practice. For more information about this research study and how to participate, contact me at or 416-545-9908.

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Keeping Connected Broadview/Danforth Office has moved!

Keeping Connected’s Broadview/Danforth office, inside Proactive Pelvic Health Centre, has moved! Proactive has moved to 235 Danforth Ave. Suite 400 (between Broadview and Chester subway stations). As of June 7th, 2016, all Keeping Connected Broadview/Danforth appointments will be at the new location. There is street parking available on the Danforth, as well as two Green P parking lots nearby: on the Danforth at Playter Blvd. and just north of the Danforth on Erindale Ave. There is also street parking available on the surrounding residential streets.

Keeping Connected continues to offer individual, couple, and sex therapy services at both offices for concerns such as: anxiety, depression, couple communication, conflict resolution, emotional intimacy, infidelity, low desire, erectile dysfunction, pelvic pain, painful intercourse, vaginismus, and unconsummated relationships. Proactive Pelvic Health Centre continues to treat men, women, and children with pelvic health concerns such as incontinence, pelvic pain, and pelvic organ prolapse.

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Do Open Relationships Really Work?

It seems like lately there’s been more talk then ever about open relationships. Open relationships, or relationships that are consensually non-monogamous, include a variety of relationship structures in which all members have agreed not to be monogamous. This can include committed relationships where one or both partners have casual or purely sexual relationships outside of the primary couple, and relationships where one or both partners have more involved relationships outside of the primary relationship. Other non-monogamous relationships don’t use the term “primary relationship” because of the hierarchy of importance it implies. Instead, they have a network of multiple relationships.

Regardless of the particular structure of a consensually non-monogamous relationship, one might wonder if an open relationship can really work. This is a valid question, given our society’s focus on monogamy. From government benefits to the wedding industry to movies and television, the relationship structure that is emphasized is that of one couple (typically a heterosexual one, although this is changing), with no other romantic or sexual relationships outside of the couple. When we do hear about non-monogamy, it is often about the devastating effects of infidelity. Within this context, it makes sense that one might wonder if non-monogamous relationships can be successful.

In fact, consensually non-monogamous relationships may compare in satisfaction to monogamous relationships. Although more research is needed, one study found no difference in relationship satisfaction amongst non-monogamous gay couples compared to monogamous couples. In another study with consensually non-monogamous couples, participants noted numerous benefits to their open relationships, including an expanded support network and relationships to meet multiple needs.

Certainly there is the possibility that a consensually non-monogamous relationship will go poorly. There may be jealousy, strains on finances and time, or conflict and miscommunication. Of course, the same can be said of monogamous relationships. And many people believe they are in a monogamous relationship, but in fact they are not. As a relationship therapist, I have seen happy non-monogamous relationships and unhappy monogamous ones, and vice versa. Regardless of whether one’s relationship is monogamous or consensually non-monogamous, relationship satisfaction seems to come down to the strength of the connection between partners and the ability to communicate about difficult topics.

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Endometriosis: A Source of Pelvic Pain and Infertility

March is Endometriosis Awareness Month. Endometriosis is a complicated disease in which tissue similar to the tissue that lines the uterus grows in other parts of the body. Typical sites include areas of the abdomen, such as on the ovaries, on the fallopian tubes, in the pelvic cavity, and on the ligaments supporting the uterus. The lining of the uterus reacts to changes in a woman’s cycle by growing, breaking down, and then shedding through the vagina as a woman’s menstrual period. In a similar manner, the endometriosis tissue also reacts to a woman’s cycle by growing and then breaking down. But in this case there is no way for the tissue to be shed out of the body, resulting in the development of inflammation and possible scarring. This inflammation and scarring can then cause pelvic pain and infertility.

Endometriosis is very common, affecting approximately one in ten women of reproductive age. Despite, this, it is under-diagnosed and poorly understood. One of the reasons endometriosis is difficult to diagnose is because the symptoms can often be mistaken for something else. Symptoms include: pain with menstrual periods (before and during), pain with intercourse, gastrointestinal difficulties (diarrhea, constipation, nausea), and infertility. The symptoms of endometriosis can appear differently in each woman with the disease–another reason it may not be diagnosed.

Endometriosis is a chronic disease, meaning there is no cure, but there are treatment options available. The cause of endometriosis is unknown. Treatment may include: pain medication, hormonal treatment to stop ovulation, and surgery. There isn’t one single treatment that is effective for all women with endometriosis, and some women still experience symptoms even with treatment.

For many women, painful intercourse and infertility are the most distressing symptoms of endometriosis. These two conditions can contribute to depression, anxiety, low self-esteem, and relationship stress. Endometriosis can severely impact a woman’s quality of life.

If you suspect that you have endometriosis, the first step is to talk to your doctor. Because endometriosis is under-diagnosed, you may need to be persistent to find a doctor who can give you a diagnosis. Keep at it! Painful intercourse and severe pain with your period are NOT normal! You may also find it helpful to see a sex therapist for support on the emotional and relational impacts of endometriosis. Anxiety, depression, relational stress, infertility, and painful sex are all topics that a sex therapist can help you with. No one should have to live with the pain and distress caused by endometriosis, but at least you don’t have to be alone as you navigate your treatment options.

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Five Ways to Strengthen Your Relationship Over the Holidays

It’s the most wonderful time of the year! So the song goes, but in reality this time of year is often very stressful. If you celebrate Hanukkah or Christmas there are family obligations, presents to buy, and special meals to cook—leading to stress on finances and time. Some workplaces are busier at this time of year, and understaffed with employees taking holidays. If you have school-aged children, you need to find childcare or new ways to keep them entertained. On top of all this, we rarely see the sun. With so much going on it’s easy to find your relationship under stress at this time of year.

With this in mind, here are 5 suggestions to strengthen your relationship over the holidays:

1) Set aside some time for just the two of you as a couple. This could be taking a walk in the neighbourhood to enjoy the festive lights. If you have children, it might be sharing a cup of tea or hot chocolate after the kids have gone to bed. It doesn’t have to be a big time commitment, but should involve the intentional decision to spend time as a couple.

2) Share your favorite childhood memories from this time of year. If it’s hard to come up with positive memories, talk about traditions you’d like to start. Couples with children can share this conversation (and the next two) with the whole family if they wish.

3) Take time to reflect on the year. What were the highlights? The challenges? How did you change and grow over the year?

4) Plan for the year ahead. What would you like to do more of in the New Year? As a couple or family, what do you hope to be able to reflect on next year?

5) Make a commitment to continue to strengthen your relationship if you need to do more work to get the closeness you want, whether that be spending more time together, reading a book on relationships, or going to couple therapy. Couple therapists are trained to support and guide couples in working through conflicts, improving communication, and increasing emotional connection. Couples don’t need to be in dire straits to benefit from couple therapy. Therapy is an investment in your relationship.

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