Deepening Intimacy Can Trigger Sexual Dysfunction
Speaker Series featuring Dr. Daniel Watter, Ed.D. Interviewed by Lana Seiler, MSW, LCSW - Director of Trauma Services at All Points North Lodge:
Daniel Watter: So, I'm Dan Watter and I'm a clinical and forensic psychologist, most of my work focuses on sex therapy and that's what I'm going to be talking about today.
Lana Seiler: It’s really great to have you, I loved working with you in the little bit that we have had. I definitely respect your work. Let’s start from the beginning: where are you from, where are you living, and what are you are doing now?
Daniel Watter: So that's kind of a short story because where I'm from is where I live now, which is in New Jersey. I was born and raised there and have been practicing psychology for over 35 years there.
Lana Seiler: Wow and so you have a private practice?
Daniel Watter: A group private practice, there are 18 of us in the group. It’s a multi-specialty group so we don’t do all of the same kind of things. Most of my practice, as I said before, focuses on sexual issues - everything from sexual dysfunction to the evaluation of sexual offenders. A big part of what I do, actually, over the last 15 or so years is I do a lot of work for the licensing boards. So, a lot of licensees from the medical board, the board of psychological examiners, social workers, and dentists who end up sort of crossing sexual boundaries with patients.
Lana Seiler: Oh, interesting.
Daniel Watter: Yeah, I do a lot of evaluation and treatment of them. So that’s taken up a lot of my time.
Lana Seiler: So, we talked a little bit about this before but how did you get into what you do?
Daniel Watter: So, it’s kind of a funny story. I was doing just a general internship at a family counseling agency in Tuscaloosa, Alabama. This was back in the late ’70s. There would get people coming in with problems with sexual function or sexual questions, sexual identity, whatever it might be. They really didn't know what to do with them. There was very little training back in those days and so the folks in Alabama figured, well, since I'm from the Northeast, I've probably heard everything, so they'll give them to me.
That's kind of how I started. I quickly realized I didn't have much training in sex therapy myself so as I continued on in my own studies, I went for specialty training in sex therapy.
Lana Seiler: So I do want to hear more about that, how did you build into what you do now? I definitely want to talk about what you do now in more detail, but how did you flush out your education, your specialty training, and what did that path look like?
Daniel Watter: Well, I was very lucky - and I know some people might not call it luck - but I think I've been lucky, I really do. I found a doctoral program with a sex therapy specialty track at NYU, and so I went there. And really the advice that I had gotten was to not do that because back in those days the idea of specializing seemed to be too limiting. It was looked at as you're going to limit yourself, it's not going to be easy to build a practice that way, but nothing could have been further from the truth.
Lana Seiler: We still hear that sometimes today.
Daniel Watter: Yeah, we still hear people say that today. But especially for an area where there really is a need like sex therapy, I think it was a very good decision to specialize. Then, I was able to do some really nice training after that. I did training with Albert Ellis post-doctorly at The Institute for Rational Emotive Therapy. People always recognize him for RET or REBT or CBT but he was one of the early sex therapists and one of the founders of a couple of really big sex therapy professional organizations. I learned a lot there, and I just managed to build a nice referral-based practice. Most of my patients have come to me through urology but also OBGYN, psychiatry, family practices, I mean people were talking to all of their doctors about their sexual difficulties, so that’s how I kind of got started on that.
Lana Seiler: And what kept you going in it? It’s interesting, right? Sex therapy is interesting. What is it that sort of kept you interested in it?
Daniel Watter: Well it’s interesting, but it’s also very challenging. And it is also one of those areas that there's so much room for debate. Where we are today and what we assume to be correct about sexuality and sexual function changes all the time. I mean it's just so much more complex than we ever realized, and the idea of helping people find their way through that complexity has just always been a challenge that I find so gratifying, so it has not been hard to stay interested and active because it's really a lot more varied than it might sound. I do a lot of teaching and lecturing, and I do a lot of writing too which I enjoy. I’ve published several book chapters and articles, and that's another piece of it. There's so much to do, so it's not boring.
Lana Seiler: Yeah, I can imagine that. So, we do a lot of trauma work here at All Points North Lodge, and it is one of the cornerstone foundations of our treatment model. I know that you have done a lot of work on looking at non-sexual trauma or sexual trauma, sex addiction issues, and other sex issues. So tell me a little bit about that and that connection.
Daniel Watter: So that's been part of what's made my work so interesting in the last 10 or 12 years. I was trained to do sex therapy in the very traditional way. And sex therapy was always (and still is today) predominantly a sort of behavioral, symptom-focused approach to treatment. Someone comes in with a particular symptom - erectile problems, orgasm problems, desire problems, whatever it may be - and you try and target that symptom with a series of behavioral exercises and some cognitive-behavioral work.
But there were parts of that that never really resonated with me. There are some people for whom that works just great, but there were so many people who I would see get better, but then they would come back. The problems might return or they might come out in some other ways, and so I started really thinking a little bit more about what the dysfunction or the problem really means to the person who is experiencing it. It was more of a movement towards more depth-oriented therapy. As I said earlier in my career, I studied with Albert Ellis later on, then I studied with Irvin Yalom and studied the existential approach to therapy. That just took me by storm. It was career-changing, and it was life-changing.
Lana Seiler: Game-changing, yeah.
Daniel Watter: So what I started to think about more was . . . let me give you an example of one of the things they typically teach in sex therapy. For men with erection problems, for example, the problem was performance anxiety. And that’s a very common explanation - that the man has problems with erections and then he starts worrying about it and that anxiety makes it worse, which is then a problem.
It is a factor. I’m certainly not saying it’s not a factor, but it never really sat well with me that that was a causative factor because most of the people I see have a good history of sexual functioning with the person they're with. They have been together a long time, sex was fine, and then something goes wrong. And to me, why would you be so anxious about performing with this person that you had a good history with for a really good amount of time? It just didn't seem to make a lot of sense.
So, I started to think about looking more carefully at the timeline of when these things started and how they looked when they presented and taking more of a developmental life history as opposed to the sex history specifically.
What I started to see more and more of was that a lot of times, the sexual shutdown changes were really the result of something that was being triggered from much earlier on in their lives. I say non-sexual trauma because there's a lot written about sexual trauma. It’s not hard to figure out why someone who has been sexually abused or sexually assaulted or sexually traumatized might have difficulties with sex.
It’s not hard to understand that part of it, but most of the people that I see have not had sexual trauma. Some have, but many have not had sexual trauma. They have no idea why they're having problems, so one of the very common presentations that I see (and I'll stay with the example of male erectile dysfunction because it's so common) is that when relationships are casual, they seem to have no trouble, but then what you would often see is this relationship deepening event occurs.
I hear couples say all the time, “The sex was great, and then we got married and then we didn't have sex anymore.” Or “It was great, then we got engaged” or “we had a baby” or whatever it might be - this sort of relationship deepening experience.
Lana Seiler: Which could be traumatic.
Daniel Watter: Which could be traumatic, but I think it really triggers trauma. And it tends to trigger the non-sexual traumas like attachment problems. These are people who have had issues in their past with abandonment, loss, or suffocation and engulfment. And so what happens is the relationship deepens, and it sets off this panic. Then what happens I think, is I always look at the unconscious as really a protector.
The way I conceptualize the unconscious is it tries to protect you from pain. And one of the ways that it often protects people from the pain of abandonment, the pain of loss, etc., is by shutting them down sexually so that they don't get too deeply involved or too far involved. So as they get married (or it may be as they formalize their relationship), they start to worry more about “what's going to happen if this person leaves me?” They start to worry more about "am I going to lose my autonomy? Am I going to end up suffocating or being suffocated?" Something like that. Then what happens in the case of male erectile dysfunction, their penis kind of speaks for them. It’s the unconscious voice that’s sort of shutting you down. That's like saying, "Look, we're not going here, we're not going here." I see this a lot, and working with these people and sort of trying to get them to see how this may be related to some earlier trauma, you can see it in their eyes. It resonates and it strikes them, and you just know you're on the right track. As opposed to just focusing on the symptom, correction really starts to look more at trauma, with trauma work.
Lana Seiler: Trauma therapy, yeah. It’s so interesting because we see this so often in trauma therapy and trauma work - how those symptoms come out in life when something is triggered. When something is activated, we see it everywhere else. Of course, it would make sense that it would happen in their sexual lives too. There’s such an intimacy component.
Daniel Watter: Well that’s where people often feel the most vulnerable, and so it’s the perfect arena for that. A lot of people don’t even recognize the things that have happened to them as traumatic because they’re the little “t” traumas.
Lana Seiler: Relational trauma - I mean yes we conceptualize it as little “t” but like my friend Ryan Soave always says, “If you put some sandpaper on a wall for long enough, you have the same hole that you would as if you would if you hit it with a sledgehammer.” So little “t” can really turn into big “T” trauma.
Daniel Watter: Yeah that’s right. The bottom line is it’s really not all that different. So, what I'm going to be talking about tomorrow though is a little different. It's kind of the other end of the spectrum which is sometimes called the sexual addictions. I have seen and I've collected now somewhere around 50 cases of people (mostly men but some women) whose sexual behavior has really kind of spiraled out of control in a very uncharacteristic way following a confrontation with mortality.
Lana Seiler: Wow.
Daniel Watter: These are often people who had early traumas of early parental loss or early death. And when they have a confrontation with mortality, that brings it close to them in their adult lives. The existential thinking is that sex is sort of the antidote for death anxiety (sex the life-force etc.), and so they very often just spiral in uncontrolled ways into sexual acting-out, so that’s what I’m going to be talking about tomorrow.
Lana Seiler: Interesting. Do you see - and just briefly because we only have a few more minutes - but do you see sex addiction as an addiction?
Daniel Watter: So probably the best way I can describe it because that is a huge debate in the sex therapy communities...
Lana Seiler: I guess that’s not the best question for a few minutes but...
Daniel Watter: Well but my answer is kind of short. I do not look at what we call sex addiction as a singular phenomenon. I think that’s because I have seen some people who do very, very well with traditional addiction-oriented 12-step model programs, and I've seen others who didn't do well with those. I’ve seen others who respond really well to more trauma-related therapies. I've seen others who didn't do so well. So I actually think (and then again this is my criticism of sex therapy in the early days) that by focusing on the behavior as opposed to what's driving the behavior, it's very difficult to know which therapy is going to work best. So, I don't argue with the term “sex addiction” to people who come to see me. They almost always use that term and a lot of professionals who I respect highly use that term. So, do I think it's an addiction? Maybe, just for some people but I don't think it is for everybody.
Lana Seiler: Yeah makes sense. Well thank you so much, it’s been really nice to have you.
Daniel Watter: It’s my pleasure. Thank you.