The Pomegranate Institute Blog

Could it be clitoral adhesions? A sex therapist explains.

schotkowski@gmail.com — Sun, 07 Sep 2025 13:00:02 GMT

It’s a part of your body that’s supposed to bring you pleasure. But what happens when it doesn’t? What if touch feels uncomfortable, numbed out, or even painful? Clitoral adhesions are a little-known, surprisingly underdiagnosed issue that can impact sexual health. Let’s talk about it!

A refresher on the clitoris

When most people think clitoris, they’re thinking of the glans, the part of the clitoris that is visible. The actual clitoris is much bigger, about 9-12 centimeters long and has internal structures that extend down the sides of the vulva.

The clitoris has over 10,000 nerve endings , which is twice as many as a penis.

If this surprises you, you’re not alone! The clitoris was only described in full detail in 2005 in an article in The Journal of Urology . Helen O’Connell and her colleagues argued that “those omissions not only hinder surgeons’ ability to perform surgery on the clitoris but also reflect a dominant culture of misvaluing the female body”

What are clitoral adhesions?

Basically, it’s when the hood gets stuck to the clitoris itself. You might also hear more technical language like “fusion of the prepuce to the glans clitoris.”

If you want to see pictures of what this looks like, Dr. Rachel Rubin has some great comparison slides of a clitoris with adhesions and one without .

What causes clitoral adhesions?

Clitoral adhesions can be caused by a variety of vulvovaginal conditions like lichen sclerosus , long-term hormonal birth control use, physical injuries, or hormonal changes like menopause.

One study found that 23-33% of people with vulvas had some degree of clitoral adhesions. 17% of which were menopausal, 73% of which had a history of hormonal birth control use, 59% of which had a history of at least one UTI and 56% of which had a history of yeast infections. We don’t know these conditions cause the adhesions, or if they are correlated.

Signs and symptoms

Some people have clitoral adhesions and have no symptoms, but others have significant pain and don’t realize the adhesions are the cause.

One study examined college-aged women who were undergoing a routine women’s health exam, and they found that 58% of women had some form of adhesions, and 25% of women had major adhesions.

Another study found that 22% of women who were seeking treatment for sexual dysfunction had clitoral adhesions.

For some people, the adhesions cause general pelvic pain, hyper or hypo sensitivity in the clitoris, or the feeling similar to having a grain of sand stuck in your eye (this is called foreign body sensation).

Clitoral adhesions can cause or contribute to sexual dysfunction, they may make it more difficult to have an orgasm, or mute the intensity and pleasure of the orgasm.

Why are clitoral adhesions so often undiagnosed?

Clitoral adhesions are diagnosed by physical exam, usually by a gynecologist, but even qualified medical providers can miss them, or be unaware of the significance.

Rachel Rubin , a urology and sexual medicine physician, is quoted on her website as saying: “In fact, most doctors—even gynecologists and urologists—receive no training in medical school or residency programs on how to examine the clitoris or its underlying pathologies.”

What to do if you think you have clitoral adhesions

You can always grab a mirror and take a look! See if you can retract the hood of your clitoris easily and without pain. If you’re unsure, or if this self-exam is uncomfortable, see your gynecologist, and don’t be afraid to tell them you think you have clitoral adhesions.

What kind of treatment options exist?

A procedure called “lysis of adhesions” involves very gently breaking up the fibers connecting the clitoral hood and the clitoris, so the hood can retract and the clitoris can be exposed.

The procedure involves applying a very strong topical numbing agent to the clitoris, and then injecting more numbing agent on either side of the clitoris. Once you’re totally numb, your doctor will very gently use a tool called a fine Jacobsen mosquito forceps (they kind of look like fancy tweezers) to break up the adhesions. You won’t feel any pain, but it might feel weird, like a rubber band is being pulled apart.

The procedure also involves removing anything that has built up under the clitoral hood, like keratin pearls and smegma.

What are the outcomes of the lysis of adhesions?

Most patients experience significant improvement. One study reported that:

76% had a reduction in pain
71% noted improved sexual satisfaction
63% experienced increased sexual arousal
64% reported increased ability to orgasm

Importantly, no one in the study reported worsening pain.

Not every gynecologist performs lysis, so you might have challenges finding a provider. The International Society for the Study of Women’s Sexual Health has a provider search feature that might help locate providers.

When we have patients who suspect they have clitoral adhesions, we refer them to the Centers for Vulvovaginal Disorders which have offices in Tampa, Washington and New York City. Dr. Goldstein literally wrote the book on pelvic pain ( When Sex Hurts ), and his team take great care of our patients.

How can sex therapy help?

The Pomegranate Institute specializes in providing sex therapy to patients suffering from vulvar pain disorders (like lichen sclerosus, vulvodynia, vestibulodynia, Genitourinary syndrome of menopause (GSM), and HSV).

We help patients process the emotional impact of being in pain, and teach evidence-based strategies for reducing pain.

If you’re looking for a sex therapist in Massachusetts, reach out !

How the Four Horsemen of the Apocalypse Wreck Relationships—and How to Stop Them

schotkowski@gmail.com — Fri, 22 Aug 2025 20:00:00 GMT

The “Four Horsemen of the Apocalypse” is a term coined by Dr. John Gottman to describe behavior during arguments that are most predictive of relationship trouble: criticism, contempt, defensiveness and stonewalling.

In our couples therapy practice, we help patients all over the state of Massachusetts learn to recognize the four horsemen during arguments and figure out new ways of communicating.

No one argues perfectly, and spotting these patterns in your own relationship doesn’t mean you’re doomed—it just means there’s room to grow. Let’s take a closer look at each of the four horsemen and what you can do instead.

Criticism:

Amira and Seth are arguing about a local polyam meet-up they recently attended. Amira thinks that Seth drinks too much, and that his behavior impacts how people in the community will see them.

A complaint about Seth’s drinking might look like:

“Seth, I am genuinely concerned about your drinking, it seems like every time we go out, you say you’re only going to have 1-2 drinks, and it always turns into 6 or 7. I’m worried there is something going on here”

Criticism, where the focus is on Seth as a person, rather than his behavior, might look like:

“Seth, you always do this to me! Every time we go out, you get falling down drunk, and I have to take care of you, it’s so embarrassing, it’s like you’re purposely trying to make sure we have a bad time every time we leave the house.”

Contempt:

Contempt shows up when you communicate disgust about your partner, and a sense of superiority over them.

Paul and Anders are arguing about Anders’s partner Lesley. Paul feels like Lesley is trying to “lasso” Anders away from Paul.

“Anders, you’re so stupid if you can’t see what Lesley is doing. I used to think it was so cute that you always saw the best in people, but now I actually think it’s kind of delusional. I’m just so sick of having to bring these things to your attention because you’re too clueless to notice!”

Defensiveness:

It’s understandable to want to defend yourself during an argument, and sharing your perspective in order to help your partner understand you better can be a meaningful part of repair (which we’ll talk about later on). But when it comes to impending apocalypse, defensiveness refers to trying to shift the blame off of yourself and onto your partner, which only escalates the conflict further.

Claire and Madison are arguing about whether or not to attend a play party. Initially they RSVP’d “yes” and they have a relationship agreement to only attend parties together, but now Madison is saying they have a headache and don’t want to go:

Claire: “Babe, why is it every time a play party rolls around you mysteriously come down with a headache? It feels like you don’t want to go, and if you don’t want to go, just say that!”

Madison: “I don’t understand why you’re on my case about this right now! What about last week when you were supposed to do the grocery shopping and you asked me to do it because you weren’t feeling well? I didn’t give you a hard time about it then, but I cancel one party and suddenly I’m the worst?”

Stonewalling:

Stonewalling is when you stop actively listening, mentally check out of the conversation and refuse to re-engage.

Steven and Abrose are arguing about an invitation Steven received to a have coffee with his ex. Steven wants to go and Ambrose is uncomfortable with him going. Efforts to talk it out have failed, and Steven is shutting down.

Ambrose: “Steven! Can you get off your phone for 5 minutes so we can finish this conversation? I don’t think it’s ok for you to get coffee with your ex alone.”

Steven: *rolls his eyes, scrolls on his phone and refuses to talk*

Ambrose: Oh, real mature! So, you’re not even going to talk to me? You get to just decide to be done with the conversation?

What does it mean if the Four Horsemen show up in your arguments?

Think of any one of the Four Horsemen as a signal flare that it’s time to check in and pay attention to the health of your relationship.

The Gottmans found in their research that the presence of the Four Horsemen are highly suggestive if not predictive of the impending end of the relationship.

This makes sense, if you are actively disgusted by your partner (contempt) and you don’t see the point in engaging in conversation with them (stonewalling) it’s probably a sign you don’t actually want to be with them anymore.

While the Four Horsemen can indicate trouble ahead, the good news is that they’re learned behaviors—and that means they can be unlearned. With practice, self-awareness, and support, couples can build stronger, more resilient relationships.

How couples therapy can help you break the cycle of fighting with the Four Horsemen

John Gottman outlined the research from his Love Lab in the book The Seven Principles for Making A Marriage Work . The book itself is absolutely worth a read, in fact, a subsequent study found that couples who read the book and completed the workbook together significantly improved the quality of their relationship.

We’re going to summarize a few of our favorite findings.

Nurture your fondness and admiration

Gottman explains that the positive feelings we have about our partners can help override or mitigate a lot of hurt feelings that happen during arguments, but in order for this to be an effective strategy, we have to strengthen these positive feelings.

Think of your partner as a treasured friend, not just your romantic partner. Are you watering the garden of your friendship? One way to do this is to scan for qualities and actions that you appreciate. This could take the form of a gratitude list, sticky notes left on the fridge, or sappy texts sent in the middle of the work day.

In our contempt example above, Paul could take a deep breath and remember how Anders’s romantic optimism is actually one of the things he loves best about his partner:

Paul: “Anders I genuinely love that you can see the best in anyone, in the middle of such a hard world, your softness is a bright spot, but I feel very protective over you, because I don’t want people to take advantage of that goodness, and I don’t want you to ever lose that optimism.”

Turn towards your partner

Gottman explains that we make “bids” for attention, affection, humor or support, and our partner can either turn towards, or away from these bids. Repeatedly turning towards your partners bids can strengthen the relationship.

In one study, they observed newly married couples and then followed up with them again in 6 years. The couples that were still married “turned towards” their partner’s bids 86% of the time, whereas those who later divorced only turned towards the bids 33% of the time.

During an argument, our bids can get covered up by anger and other negative emotions, so try to sift for the “bid” that is present behind the difficult emotion.

Compromise

Gottman clarifies that compromise is not the same thing as agreeing with your partner. Compromise starts by sincerely considering your partner’s position and making sure you understand it.

Try listening to your partner talk for 3-5 minutes without interrupting them or butting in to defend your perspective, or litigating why you’re actually right. Just listen, and then summarize what you heard, and give your partner the opportunity to offer clarity, and then look for a bid that you can respond to, or a piece of common ground.

Let’s go back to Madison and Claire, Madison could have heard the “bid” behind Claire’s frustration as a genuine desire to spend time together, sharing novel experiences. Instead of getting defensive in an effort to “prove” that Claire also cancels things at the last minute, Madison could have offered another way to connect:

Madison: “I’m hearing that spending time together doing something fun and new is really important to you, is it ok if we skip the play party tonight, but make a plan to go to that new restaurant we’ve been meaning to try this weekend?”

Soften your start up:

A harsh or fast start up is often a recipe for criticism. Try slowing down and incorporating techniques like:

Naming how you share responsibility for a shared problem
Naming how you feel
Focusing on a specific instance of behavior (even if you think there is a pattern) and focus on behavior rather than who someone is
End with articulating what you need in positive terms (not negative ones)

In our example of Amira and Seth, and gentle start up could look like:

Amira: Can we talk about how to make polyam meet-ups go well for both of us? I recognize that I get anxious in group settings and I really want things to go well, and my anxiety probably makes me a little more likely to focus negatively on your behavior. I’m worried when you drink more than a few drinks, people will lose sight of how wonderful you are, and focus instead on how drunk you are, do you think it would be possible to set a drink limit that we both agree to stick to when we’re in a group setting?

Soothe yourself and soothe each other

Fights can be really emotionally dysregulating to everyone involved, and it can be hard to “fight fair” once everyone is outside of their window of tolerance.

Try taking a break to self soothe and making a specific plan for when and how to come back to the conversation.

Regulation could look like:

Pausing the fight til after dinner
Going for a twenty minute walk
Taking a warm shower and putting fuzzy pjs on
Doing a meditation exercise together
Snuggling for 20 minutes

Steven and Ambrose could have tried co-regulation when Steven started to shut down, as stonewalling is often an indicator that someone is outside of their window of tolerance. Ambrose could have suggested switching gears rather than continuing to argue with Steven:

Ambrose: Hey, I’m picking up that you’re really checked out of this fight. Would it help if we took a break for thirty minutes and then tried to continue this conversation another time? We could watch a show, or go for a drive and just chill for a bit?

Want to learn more about the Seven Principles? Want to see how they can be applied to Queer relationships, kink-forward relationships and non-monogamous relationships? If you’re in Massachusetts and you want to talk to a sex and couples therapist reach out !

Why I Love Virtual Sex Therapy – A Massachusetts-Based Therapist Explains the Benefits

schotkowski@gmail.com — Sat, 09 Aug 2025 14:00:02 GMT

I didn’t always imagine myself working virtually. Like many therapists, I started my career face-to-face, with boxy chairs, weird office art, and a waiting room that smelled like stale coffee and staler cigarettes. But over time—and especially as the world changed—I found that something surprising happened when I moved my practice online: it got deeper, warmer, and more accessible.

As a sex therapist licensed in Massachusetts, I now work with clients all across the state: from small towns with no local therapists to busy parents who finally get to go to therapy without leaving the house. And I’ve come to believe, wholeheartedly, that virtual therapy isn’t just “good enough.” It can be really, really good.

Today on our blog I’m covering some of my favorite things about virtual therapy.

Accessibility: Online Sex Therapy Anywhere in Massachusetts

The Pomegranate Institute is based in Western Massachusetts, and Franklin, Hampshire, Hampden, and Berkshire counties are absolutely chock full of some wonderful therapists that I am lucky to call friends and colleagues. The state of Massachusetts actually has the highest number of therapists per capita , which is awesome, but doesn’t always translate into accessibility.

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) , (the licensing body for sex therapists) only lists 50 sex therapists in the state of Massachusetts.

I’m a licensed clinical social worker and sex therapist, and my specialty is providing treatment to patients with erotically marginalized identities . This means I offer a very niche sub-specialty, in the specialty field of sex therapy.

It’s important to me that patients who need this kind of specialty care, no matter where in the state of Massachusetts they live, can access it. Virtual therapy means patients can pop into my waiting room with a click of a button, no commute necessary!

It also means patients are more likely to be able to take time during their work day to attend therapy, because they are just stepping away from their desk for 50-minutes, rather than two full hours.

Lower Cost Without Compromising Care

Not renting an office means my business has fewer expenses, which means therapy with me costs less.

The average cost of private pay therapy in Massachusetts is $190.00 per session , whereas I charge $175.00 per session.

More Privacy for Sensitive Conversations

Online therapy offers an increased level of discretion. It means my patients don’t have to walk into an office that says “we talk about kinky sex here!” and they don’t have to risk seeing people they know in the waiting room.

I choose to live in Portland, Maine but maintain my license to see patients in Massachusetts to offer them an additional layer of privacy protection. We aren’t going to run into each other in the grocery store and it’s much less likely that we know any of the same people.

Comfort, Connection, and Cat Co-Workers

I absolutely love that my patients and I can both relax in the comfort and privacy of our own homes. I like to set the thermostat to 72 degrees in the winter, wear sweatpants, and give my 22-lbs cat the opportunity to jump into my lap whenever he wants, this is my optimal work environment, but for other people it would be a nightmare.

Online therapy means my patients and I can surround themselves with our own creature comforts, without distressing or inconveniencing each other.

Logging on to therapy from home also gives me a unique window into the lives of my patients. I learn things about their favorite snacks, and whether or not their home environment is supportive of their mental health.

Better Attendance, Fewer Cancellations

The best kind of therapy is the kind of therapy you’re able to attend as often as you need to in order to make progress. Since I switched to 100% remote therapy, I’ve noticed my patients are less likely to cancel visits, and so am I!

If one of us has a mild cold, we’re still able to meet. My patient can still see me if they’re allergic to Bouillabaisse (the aforementioned feline co-worker) and I can still see them if they’re a smoker or wearing products that contain methylisothiazolinone (both of which I’m super allergic to).

Virtual therapy increases accessibility for patients with chronic medical conditions, chronic pain, or recent injuries.

Evening Sessions Without the Safety Risks

When I was first working in community mental health, I would often be the last to leave the building, in the winter, when it was pitch black, and the parking lot lights were iffy. It was scary, and it made me reluctant to see patients after the sun went down.

In my private practice, where I am 100% virtual, I sometimes see patients as late as 8:30 PM. Virtual means neither of us have to worry about a creepy parking lot walk. Evening online therapy means I can offer increased access to patients that work traditional business hours.

Yes, Virtual Sex Therapy Really Works

On-line therapy is generally found to be as effective as in-person therapy . As a sex therapist, I’m able to use all the tools that I would use in an office setting, virtually. I also think the smidge of emotional distance helps people feel more comfortable talking about their sex lives.

I admit, when telehealth started to be implemented on an unprecedented scale during the pandemic , I was skeptical. But I’ve been pleasantly surprised! If a therapist has genuine regard for their patient, I think this translates over the internet. The feedback I get from my patients has been overwhelmingly positive, the consensus is that the pros outweigh the cons, and I’m thrilled to be able to offer a modality that works for me and my patients.

If you’re curious about virtual therapy, and looking for a sex therapist in Massachusetts, reach out , we’d love to show you the perks of online therapy

What It’s Like to Go to Couples Therapy - with a Sex Therapist

schotkowski@gmail.com — Thu, 24 Jul 2025 22:00:00 GMT

The Pomegranate Institute offers relationship therapy, whether you’re a monogamous couple, a non-monogamous couple, a polycule, or a queer platonic partnership. In our practice, we say “relationship therapy” but the SEO gods have declared with have to say “couples therapy” if we want google to show you this article (rude) so we’ll say couples therapy, but just know a little piece of our soul is dying.

Why do people go to couples therapy?

People come to couples therapy for all sorts of reasons — not just because something is “wrong.” Sometimes it’s to strengthen communication, navigate life changes, rekindle intimacy, or learn how to support each other more fully.

In our practice, we see people seek couples therapy for:

Getting stuck in the same old argument over and over again
Needing support making a major life decision (like having kids, or moving)
Deciding whether or not they want to open the relationship
Mismatched sexual desires, kinks, or libidos
Supporting each other through grief, illness, trauma or major transitions (like perimenopause, or a career change)
Wanting to reconnect as romantic partners
Processing infidelity or other breaches of trust

Does my relationship have to be in trouble to go to couples therapy?

No! Think about it like getting an oil change, or baby botox , it can be part of preventative maintenance.

We can teach you skills for strengthening your communication so you can be ready to have tough conversations, before they turn into unsolvable fights.

Do You Have to Talk About Sex in Sex Therapy?

Most of our patients seek us out because they want to talk about a project related to their sexual health, this could include talking about:

Mismatched libidos
How to “turn on” your partner and be aware of what turns them off
Opening up about trying new things in bed
Disclosing new information about sexual preferences (like who you’re attracted to, or kinks and fetishes)
Defining the relationship and articulating clear boundaries for what partnership is going to look like
Unpacking cultural shame around compulsory monogamy
Evaluating ways that “couples privilege” accidentally shows up, even when you’re trying to be non-hierarchical

If you want to learn more about what sex therapy entails, check out our article What Happens in Sex Therapy? A Realistic Guide to What to Expect .

On the other hand, some of our patients choose to work with us because they figure sex therapists are non-judgmental people by nature who aren’t going to bat an eye at whatever they want to discuss. And this is totally true!

Why does our practice focus on polyamory-affirming therapy?

We’re passionate about supporting patients in non-traditional relationship structures. Our entire practice is dedicated to erotically marginalized identities. This means we’re focused on serving patients who are at risk of being discriminated against in and out of the therapy room because of aspects of their identity like queerness, non-monogamy, kinks, fetishes, or involvement with sex work.

We think polyamory is a valid relationship structure, and we want to support our community in getting the best quality care possible!

What do you actually do in couples therapy?

In our work with couples — including those in non-monogamous, queer, or nontraditional relationships — we use something called the Developmental Model of Couples Therapy . This model sees relationships not as “healthy or unhealthy,” systems that move through different stages over time. Each stage has unique challenges and opportunities to strengthen the relationship.

This involves stages like:

Bonding: the initial stage of a relationship where you’re focused on falling in love and blending your lives
Differentiation: wanting to re-introduce a bit of separateness or individuality
Practicing: starting to explore the world outside of the relationship
Rapproachment: coming back together with lessons learned

If we want to learn more about couples therapy what should we do first?

The Pomegranate Institute offers a free 30-minute consultation to prospective patients who live in Massachusetts. In a consultation, people can meet us, tell us a little bit about what brings them to therapy, and ask us questions, all so they can figure out if they are comfortable working with us.

What happens next?

If the stars align, and everyone (the therapist and all of the people who are going to be coming to appointments) say “yes”, then we can go ahead and schedule intakes for everyone. An intake is a longer appointment (90-minutes) where we’ll review some paperwork (our financial agreement, notice of privacy practices, consent to receive therapy, etc.) and then talk about what you would like us to know in order to be an effective therapist for you. We might talk about:

Your unique perspective on the project that brings you to therapy
Your past experiences in therapy
Your upbringing
Your relationship history

How does privacy work in couples therapy?

It’s important to us that we strike a balance between privacy and collaboration. When you start therapy, you’ll give us written permission to attend therapy together and acknowledge that you know we don’t keep big secrets (affairs, job loss, medical diagnoses etc.) from your partner.

The majority of our sessions will take place as a group, and the session notes will be shared with each person who attends.

We maintain separate charts for each person in the relationship, so that everyone can access their own treatment record and can message their therapist privately. We do this because we want to deconstruct the expectation that one member of the couple is going to be the default “manager” of therapy, and responsible for scheduling or canceling sessions.

How Often Do We Meet, and for How Long?

“How long does couples therapy last?”

It depends on the project that brings you to therapy, sometimes folks stay in therapy for a few sessions, but it’s

“Do you offer virtual sessions?”

The Pomegranate Institute offers virtual therapy to patients living anywhere in the state of Massachusetts.

“Can we see you as individuals too?”

The Pomegranate Institute offers individual therapy and relationship therapy, but we don’t mix and match.

Interested in Couples Therapy in Massachusetts? Let’s Talk.

If you’re curious about starting couples therapy we’d love to chat!

At The Pomegranate Institute, we offer inclusive, sex-positive therapy for couples of all kinds, including those in non-monogamous or queer relationships. We’re based in Massachusetts and offer virtual sessions across the state.

Click here to schedule a free consultation – we can’t wait to meet you!

What Monogamous Couples Can Learn from Polyamorous Relationships

Thu, 10 Jul 2025 20:15:00 GMT

At The Pomegranate Institute, we specialize providing sex therapy to non-monogamous patients in Massachusetts. Polyamory isn’t for everyone, but the lessons we learn from our patients teach us so much about relationships. Today on the blog, we’re covering ten things monogamous folks could learn from non-monogamy.

Communication

If you’ve ever read a Feeld bio (the dating app much beloved by non-monogamous folks) then you know non-monogamous folks LOVE wordsmithing.

Whether it’s talking about relationship agreements, the boundaries they have with their other partners, what draws them to non-monogamy, and how they manage its challenges, non-monogamous folks are good at having serious, sometimes fraught conversations.

You don’t need to want to sleep with multiple people in order to borrow the lesson of improving your communication in your relationship. Whether it’s trying Ester Perel’s Where Should We Begin – A Game of Stories, a couples therapy workbook like Sue Johnson’s Hold Me Tight Workbook , or learning more about how attachment theory can help you understand relationships, every relationship could benefit from centering communication as an essential tool.

The art of the google calendar

Polyamory jokes abound about partners with a shared google calendar . But a lot of arguments unrelated to non-monogamy could be solved with more careful management of the google calendar. How often have you seen people fight about lack of clarity around in-laws visiting, kids sporting events, and whose turn it is to take Baby Jeff to the vet?

Polyamorists are also great at checking in with their partners (who also need to check in with their partners) before making or changing plans. Book club got moved from Thursday to Friday? You best believe Jessica is going to text Susan about this ASAP because that impacts her and Tavinder’s D+D plans.

Treating your partner as a fully realized person who also has a busy life (even if they’re hanging out at home on the couch with the cats) is a relationship preserving practice.

Jealousy is not the enemy

Non-monogamous folks understand that jealousy is just an emotion, it can ebb and flow, and it doesn’t necessarily need to be an indicator that prompts a massive change to how you’re living your life.

The goal of polyamory is not to live jealousy-free, it’s to not let jealousy run the show.

Remember that scene from Finding Nemo where the vegetarian sharks insist that “fish are friends, not food!” ? Same idea, feelings are friends!

Differentiation

When we do relationship therapy, we practice a type of therapy called The Developmental Model of Couples Therapy. The Developmental Model is a type of therapy that explores the different developmental stages that relationships go through, and how folks experience, resolve, or get stuck on certain stage-specific challenges.

After the initial bonding stage, relationships are faced with the stage of “differentiating”, a stage characterized by appreciating that each member of the relationship is a different person, with different needs and preferences. Sometimes, this stage feels like a crisis, to go from being in limerence (a type of love characterized by infatuation and enmeshment) to someone wanting a smidge of space every once in a while? Disaster!

Non-monogamous relationships tend to place a higher value on differentiation, in a way that preserves the relationship. While an aspect of this may involve having romantic relationships with multiple people, non-monogamous folks are also likely to value time spend in the pursuit of individual hobbies, time with friends, time learning new things, and exploring the world and community.

Maybe your idea of differentiation doesn’t involve dating someone in addition to your partner, but it’s a great reminder to think about the things in your life that you value, and whether they are also getting the benefit of your attention alongside your relationship.

Cultivate compersion

Compersion is a neologism that refers to experiencing joy about the joy your partner is experiencing in one of their other relationships. Think of it like an inverse schadenfreude (joy because someone else is having a bad time).

While the term originated specifically to talk about their happiness in another romantic relationship, it’s a great reminder to think about being happy that your partner is happy. Maybe your first inclination is to get the ick when your partner wants to host their fantasy football draft at your house, but try slowing down and appreciating that they’re happy, and you don’t have to like fantasy football to like seeing them happy.

Polyamorists will often refer to compersion as the “holy grail” of non-monogamy, meaning it’s something they are actively searching for, but not obtaining easily. So don’t be too hard on yourself if it takes practice.

Make your boundaries crystal clear

Polyamorous folks are more likely than their monogamous counter-parts to explicitly define the relationship. This could mean clarifying expectations around how much time partners will spend together, or how much privacy they wish to maintain about their sex lives when it comes to inquisitive friends or family.

Monogamous folks might be more likely to make assumptions about a commonly held set of boundaries, but much like confusion over Victorian flower guides that had slightly different meanings for different flowers, people might make different assumptions that can lead to massively hurt feelings. Maybe someone makes the assumption that being in a relationship means spending time with exes one-on-one is no longer appropriate, while someone else thinks this is no big deal.

Taking the time to clarify exactly what you mean when you say “we’re a monogamous couple” can avoid a lot of future arguments.

Get explicit (about sex)

In our practice, we find that non-monogamist patients place a high value on being able to talk about sexual health. Whether this involves a discussion about turn-ons and turn-offs, or kinks and fetishes, safer sex practices, and getting tested, polyamorous folks see this values-driven practice.

Non-monogamous folks may be better at these conversations in part because they have more practice having them. Maybe you don’t intent to have multiple partners, but you can still practice refining these conversations.

Get off the escalator (if you don't want to be on it)

The “relationship escalator” is a phrased coined by polyamory blogger Amy Gahran that describes expectations around pace and presumed up-escalation of a relationship. Moving from meeting, to monogamy, then cohabitation, marriage and children.

The relationship escalator puts a tremendous amount of pressure on people to either advance, or end the relationship.

Non-monogamous folks have practice allowing relationships to ebb and flow, or get off the escalator entirely. Sometimes a nesting partner (a partner you live with) becomes someone you don’t live with but keep dating. Sometimes you have a child with a partner you don’t live with, or raise children with partners you aren’t romantically involved with.

This “choose your own adventure” approach applies to both non-monogamy and monogamy. You can decide what’s right for you and your partner, and you can decide that things have changed, it isn’t a criticism of either of you to get off the escalator and build something new.

Leave the dominant cultural discourse behind

We’re not saying there are “no rules” in polyamory, but more often than not, these rules are carefully chosen based on what works well for the relationship itself, not a culturally proscribed set of standards people are expected to mash themselves into.

Maybe you’re monogamous, but you don’t want to live with your partner, or you do want to live together, but sleep in separate beds ( sleep divorces are becoming more and more common! ) The world is your oyster!

Maybe this article inspired you to give the Scandinavian sleep method a try (one bed, two comforters), or maybe it has you thinking deep questions about your relationship. Whether you're exploring non-monogamy or just want to deepen your relationship as a monogamous couple, our Massachusetts-based sex therapy practice can help. We offer affirming, evidence-based care tailored to your needs, and we’d love to meet you !

How to Use Out-of-Network Insurance Benefits for Therapy in Massachusetts

schotkowski@gmail.com — Wed, 25 Jun 2025 10:30:00 GMT

Navigating mental health care can be challenging, especially when insurance networks are limited. Understanding how to utilize out-of-network benefits can open doors to specialized therapy services in Massachusetts Today on the blog we’re covering answers to questions like “can I get reimbursed by my insurance for therapy?” “can I use my FSA/HSA benefits to pay for therapy?” and “what’s a superbill?” So if you want to learn about how mental health reimbursement works in Massachusetts, read on!

What Are Out-of-Network Therapy Benefits?

Some insurance plans offer out-of-network benefits, which means they are willing to reimburse you for a portion of the costs you spend on your healthcare, even if it is with a provider outside of their network.

These benefits are more common with PPO plans and less common with HMO plans, so if you need a reminder on the difference, click here !

How much does my healthcare really cost?

Before we talk about how to get your insurance to reimburse you for what you spend on therapy, let’s talk about the different expenses involved with health insurance.

Premium : a fixed amount of money you pay to your plan every single month, no matter how frequently or infrequently you see a healthcare provider.

Deductible : the amount of money you have to pay out-of-pocket for services, before full coverage kicks in. Before you meet your deductible, you are paying a greater portion of the total cost of the visit, after you meet your deductible, you are paying a significantly lower amount.

Co-insurance : refers to the practice of splitting the cost of a visit between you and your insurance company. Before you meet your deductible, you are paying a greater percentage and your insurance is paying a smaller amount, after you meet your deductible, you are paying a smaller amount and your insurance is paying a larger amount.

Co-pays : A fixed amount that you pay for an office visit no matter what. If you’ve already met your deductible, this might be the only thing you pay.

Out-of-pocket-maximum : the maximum amount you might have to pay out of pocket each year. Once you pay this amount, the insurance covers 100% of the charges they have agreed to cover.

How Much Does Therapy Cost?

This depends a lot on your insurance, and also on your therapist, but let’s look at a few examples.

Example 1: Astrid has commercial insurance with a $500/month premium, a $2,000 deductible, a $40 office visit co-pay and a $60 specialist visit co-pay and a $10,000 out-of-pocket maximum. Her therapist is in-network with her insurance plan, and her insurance company and the therapist have negotiated a rate of $134/visit. This means, even if the therapist would prefer to charge more money than this, this is the maximum they are allowed to charge. Until Astrid meets her $2,000 a year deductible, her therapy sessions will cost $134/visit. After she meets her deductible, she is responsible for paying the specialist co-pay of $60/visit. This is because her insurance plan has decided that all telehealth visits are automatically specialist visits, and Astrid sees her therapist virtually.

Example 2: Marcus has Masshealth for insurance, which is the Massachusetts version of Medicaid. He is eligible for this insurance because of his limited income, and he does not pay a premium, deductible, or co-pay. If he were to see a therapist who is in-network with his insurance, it would cost him $0/session. Marcus has been having a hard time finding a therapist who accepts his insurance, so instead he sees a therapist through Open Path Collective, where the therapists have agreed to offer a sliding scale of $40-70/visit.

Example 3: Janice has commercial health insurance similar to the plan Astrid has, but she cannot find a therapist who accepts her insurance plan, who has current openings, and the expertise in her particular mental health concern. Janice chooses to see a therapist who does not accept insurance, who has extra knowledge and training in her project. She pays $200.00/visit.

Example 4: Genevieve has Medicare (insurance that people who are 65+ or eligible for certain kinds of disability are eligible for). Genevieve pays $185/month for Medicare. Therapy is considered a Part B benefit, meaning Medicare covers 80% of the cost, and she is responsible for 20%. Genevieve also has a Medicare supplement, which costs $200/month. Supplemental insurance covers the 20% co-insurance for Part B benefits that Geneiveve would normally be responsible for. So if Genevieve can find a therapist who accepts Medicare, she will not have to pay anything additional out of pocket.

Do Most People Pay for Therapy Out of Pocket?

In some of the examples we talked about, people chose to see a therapist who was out-of-network with their insurance. This is actually pretty common, the National Alliance for Mental Illness reports one in four people receiving mental health therapy use an out-of-network provider . Some of this is driven by necessity, with folks having a hard time finding an in-network therapist who has current openings, but there are also several benefits to seeing an out-of-network provider like:

More specialization: Therapists with advanced training or niche expertise—such as sex therapy or pelvic pain—are more likely to operate outside of insurance networks.

Shorter wait times: Out-of-network therapists often have more immediate availability, meaning you may be able to start sooner instead of waiting weeks or even months for an opening with an in-network provider.

More flexibility: Insurance plans sometimes place limitations on the number of therapy sessions you can have, the types of therapy they’ll cover, or even which diagnoses are eligible for reimbursement. Working with an out-of-network therapist gives you and your provider more freedom to decide what kind of care is best for you—without needing to fit your experience into a diagnostic box.

More privacy: When you use insurance, your therapy records can be audited by your insurance company. This means they can read the highly personal notes your therapist keeps about the details of what you discuss in therapy. Choosing to work with an out-of-network therapist can offer an extra layer of privacy protection. For our sex therapy patients, especially those that want to discuss kinks, fetishes, non-monogamy, or sex work, there’s peace of mind knowing that no one will be looking over their shoulder.

How to Check if You Have Out-of-Network Coverage for Therapy

You need to call your insurance plan and ask questions like:

Do I have out-of-network benefits for mental health treatment?
Can I access these benefits before or after I meet my deductible?
Is the reimbursement a fixed rate or a portion of the therapist’s fees?
Do my benefits cover certain CPT codes and not others? (A CPT code is the language providers use to communicate to the insurance company about the duration of the visit. Some insurance plans will only cover sessions of a certain length).
Do my benefits cover certain providers and not others? (For example, clinical social workers, clinical psychologists, marriage and family therapists and mental health counselors are all different flavors of “therapist” some plans might cover certain providers and not others).
How do I submit a superbill?
How long will it take the claim to be processed?

If I’m seeing a therapist who is out-of-network, how do I get reimbursed?

If you have determined that your therapist is out-of-network, and your insurance offers out-of-network benefits, you can ask your therapist for a “superbill”.

A superbill is a specialized type of receipt that will include:

Your name, address, date of birth and phone number
Your therapists name, national provider identification number, tax ID and license number
The CPT code that describes the type and length of visit you were seen for
The mental health diagnosis you were treated for
Confirmation that you have already paid your therapist for the visit

Your therapist can generate a superbill for every visit, or for several visits on a monthly basis, and then you submit them to your insurance company. The reimbursement process should take about a month, but it might take up to three months.

Since most therapists use an electronic medical record (though not required it is highly incentivized by things like the HITECH Act ) they can generate a superbill with the click of a button. There are also companies like reimbursify that can help you submit and track out-of-network claims.

How Much Will I Get Reimbursed for Therapy?

The Pomegranate Institute sees a range of different responses from insurance companies when it comes to out-of-network benefits in Massachusetts. Here are some examples:

Jessamin’s insurance told her that they are willing to reimburse her for 60% of the cost of her therapy sessions once she meets the deductible associated with her plan. Her therapist charges $175.00, which is the average national cost for out-of-pocket therapy . Since her deductible is $2,000, if she accesses no other healthcare, she will pay her therapist’s full fee without any reimbursement for twelve visits. Afterwards, her insurance will reimburse her for $105 a session.

Cole and Alec are seeking relationship therapy. They have out-of-network benefits through their insurance plan, and their insurance reimburses them for a fixed amount of $100.00 a session. Their insurance only reimburses for a 60-minute session, not a 90-minute session.

Jasper has out-of-network benefits for mental health, and his insurance plan reimburses for twelve sessions of therapy a year at the therapist’s full fee, once he has met his deductible.

Can I Use My Flex Spending Account or My Health Savings Account to Pay for Therapy?

FSAs and HSAs give you the opportunity to set aside money pre-tax to pay for healthcare costs. They are different accounts, though some people have both. If you need a refresher on the difference, fidelity has a great primer .

In general, you can use your HSA or FSA to pay for therapy , so long as the therapy is provided by a qualified and licensed provider, and is for the treatment of a diagnosed medical condition.

Is The Pomegranate Institute an out-of-network provider?

Yes, The Pomegranate Institute doesn’t take insurance. If you want more information about why therapists choose not to accept insurance, check out our article Why So Many Therapist’s Don’t Take Insurance Anymore – Especially in Massachusetts.

We are happy to help patients submit claims for insurance reimbursement. We do it all the time, and our patients have had reasonably good experiences getting reimbursed.

I think I want to try getting reimbursed for therapy, what should I do next?

If you’re looking for a Massachusetts sex therapist who knows about insurance reimbursement, the Pomegranate Institute would love to meet you! You can schedule a 30-minute consult to see if we’re a good fit by clicking this link , it will take you right to our calendar!

What Is Sliding Scale Therapy? How to Find Affordable Mental Health Care in Massachusetts

schotkowski@gmail.com — Wed, 11 Jun 2025 07:00:00 GMT

What Is Sliding Scale Therapy?

Sliding scale therapy is when a therapist offers reduced cost therapy sessions. Sometimes they offer the same reduced rate to everyone, and sometimes the rate “slides” up or down depending on someone’s income or financial hardship.

Why Do Some Therapists Offer Sliding Scale Rates?

Therapists offer sliding scale therapy because they want to make therapy accessible to folks who benefit from but would not otherwise be able to afford their services. This might include patients who don’t have health insurance, or patients who have insurance but cannot afford to use it.

I save twenty-five percent of the spots in my calendar for sliding scale appointments because it aligns with my values of keeping my therapy practice inclusive.

Which Patients Are Considered Uninsured or Underinsured?

Uninsured means someone has no insurance, but they might still be looking to access affordable, low-cost therapy.

Under-insured means someone has insurance, but the fees associated with using their insurance are high. This might be because of their plan’s deductible, co-pay, or the amount of money they have to pay as co-insurance before they meet their deductible.

For example, let’s use this case of a recent Massachusetts patient who has insurance. They have a plan with a $30 office visit co-pay, a $60 specialist co-pay and a $3,000 deductible. Their therapist is in-network with their insurance company, but they have to pay the “max allowable” charge until they meet their deductible, and then afterwards they will be responsible for the co-pay. This sounds ok so far, but in the this case, the insurance company’s “max allowable” is $134.00, this means the patient is going to pay $134.00 each week for twenty-two weeks until they meet their deductible, and then their cost will drop to just the co-pay. If $134.00 a week is unaffordable for the patient, they would be considered “under-insured”.

A patient might also be considered underinsured if they have insurance, they can afford the terms of their insurance coverage, but they are unable to find a therapist that that takes their insurance. Even though Massachusetts has the highest per capita number of behavioral health providers in the country , this doesn’t necessarily translate to ease of access. Even though Western Massachusetts is saturated with a number of wonderful providers, we frequently hear from prospective patients that they have been searching for a therapist for months, and we are the only provider who has returned their call.

How Are Sliding Scale Fees Determined?

Every therapist has a different practice, I choose to offer one fixed rate of $55.00 per therapy session for everyone, because I don’t want to muck about in the private financial situations of my patients. This involves a bit of an “honor system” where folks tell me they meet the criteria, and I trust them.

Other therapists might use a bracket system where they offer a few different rates that correspond to different total household incomes. Other therapists use a “pay what you can” system, where they offer a range, like “my sessions cost between $40 and $100” and ask patients to pay what they can afford.

Where Can I Find Sliding Scale Therapy?

The Pomegranate Institute partners exclusively with Open Path Collective , they are a “grassroots nonprofit organization committed to closing the mental health gap.” Prospective patients pay a one-time registration fee of $65.00, which grants them access to a therapist database of over thirty thousand therapists who have agreed to accept sliding scale spots between $35 and $70 a session.

Other on-line directories like Psychology Today , TherapyDen , and Inclusive Therapists can help you search for therapists that might be a good fit for you, and therapists often indicate in their profile if they offer sliding scale, and what their rates are.

In Massachusetts, Community Behavior Health Centers offer crisis services and outpatient therapy, and can help folks find affordable, low-cost therapy. In Western Massachusetts, clinics like The Center for Human Development , Community Services Institute , and River Valley Counseling Institute offer sliding scale therapy.

If I Want to Access Sliding Scale Therapy at The Pomegranate Institute, What Can I Do?

Check out our profile on Open Path Collective , and then complete your registration . Open Path will send us email letting us know you’d like to work with us, and we’ll reach out to you in a day or two. Not quite ready to sign up, but want to ask some more questions? Reach out ! We’d be happy to chat.

Why So Many Therapists Don’t Take Insurance Anymore — Especially in Massachusetts

schotkowski@gmail.com — Fri, 16 May 2025 20:24:17 GMT

The Pomegranate Institute doesn’t take insurance, and people want to know why.

In this article, we’ll go over the top reasons therapists don’t take insurance.

Administrative Burden

Insurance is hard for patients and providers to use. For patients, it can be hard to understand if their therapist is in-network with the specific insurance plan they have. Then they need to understand their deductible, co-pay, and out-of-pocket maximum. Even if a patient is paying several hundred dollars a month for their insurance, and they have a low co-pay for office visits ($20 or $30) they might be paying upwards of $100 a session until they meet their deductible.

For therapists, they need to set up contracts with each insurance plan. The applications are arduous and take time to process to such an extent that there are credentialing professionals that specialize in helping therapists complete these applications. Credentialing professionals charge money that may be unaffordable for therapists who are new to private practice. Therapists also have very little ability to negotiate their rates with insurance companies.

Each insurance company has their own system for requesting reimbursement, and the time it takes the therapist to submit the claim is not time the insurance company pays for. Larger agencies will often staff a full-time billing provider to manage the claims submission and claims revision process, but this is not feasible for someone in solo private practice.

Low Reimbursement Rates

The reimbursement rates for therapists are low and increases have not kept pace with inflation. This means therapists need to see a larger number of patients a week in order to afford a living wage. When I worked in a community mental health clinic and saw patients with all different insurance types, I was required to see 40 patients a week in order to stay benefit eligible. This did not account for the time I spent outside of sessions writing progress notes and treatment plans or talking to patients and their family members on the phone. This meant I was working 50-60 hours a week, but only being paid for 40 hours.

A study led by Dr. Carina Vocisano which collected data on therapist and patient outcomes from 1996 to 2014 found that therapists who saw fewer than 25 patients a week had better clinical outcomes than therapists who saw more than 25 patients a week. Therapists who saw more than 25 patients a week were also at a greater risk for burnout and emotional exhaustion.

In writing this article, it was difficult to find validated examples of what the reimbursement rates for different insurance plans actually is. Insurance companies do not publish this information, and they prevent therapists that have contracts with them from disclosing this information, under risk of losing their contract.

Delayed Payments and “Clawbacks”

Insurance companies do not pay claims in a timely fashion, with some plans taking up to 90 days to pay the therapist for work completed. This is not a realistic financial model for self-employed therapists, especially those that are the financial head of their household. There are some companies, like Alma or headway , that act as an intermediary between therapists and the insurance company. The therapist documents the work they have performed, and the platform submits the claim on their behalf, and pays the therapist directly once the therapist completes their portion of the work. In exchange, the platform charges a monthly fee and keeps a portion of the claim. These platforms don’t disclose what portion of the claim they are keeping, but they can be a good option for therapists who want to take insurance but want to reduce the administrative burden, but it does involve accepting a lowered rate.

“ Clawbacks ” refer to a practice where the insurance company has already paid the claim, and then months or even years later conducted an audit and determined that the therapist violated the contract (usually in some very minor way) and then “claws back” all of the money they paid. This means a therapist might suddenly lose $30k. The most common reason for a “clawback” is the insurance company saying that the patient was not mentally ill enough for therapy to be justified. For example, if a patient starts going to therapy because they are depressed, and therapy helps improve their depression, and they stay in therapy in order to maintain their progress, their insurance company might say this doesn’t meet their “medical necessity” criteria.

Diagnostic Requirements

Insurance companies require therapists to provide a mental health diagnosis in order to say that a patient meets what they call “medical necessity” criteria. As a sex therapist, this can be challenging, because someone might be coming to talk about their sexual health, but might not meet the criteria for a specific mental illness. For example, let’s say I’m doing relationship therapy with a married couple who want to talk about revitalizing their sex life after having children. They’re struggling with a very normal developmental milestone, there’s no “mental illness” that means “we haven’t had sex in a while because we’ve been busy raising our family”.

Limits on Sessions

Insurance companies may set caps on how long a session can be, or how many sessions a year a patient is able to access. This might vary based on diagnosis, but this is information that can be hard for patients and providers to access, which means that they can suddenly be notified that their benefits have run out and they need to stop seeing their therapist until the limit re-sets the next calendar year.

Documentation Requirements

Therapists who take insurance have lots of different rules they have to follow regarding how they document sessions and a patient’s progress in treatment. These rules are cumbersome and may include documenting things that the patient and therapist do not find helpful. For example, a therapist might find it helpful to write down the new things they learned about the patient’s history, but the insurance company would rather see specific examples of how the therapist is measuring the severity of the patient’s symptoms and what specific coping skills they are teaching for treatment.

Privacy Concerns

In the contract patients sign with their insurance company when they sign up for a particular insurance plan, they give their insurance permission to communicate with and request records from their healthcare providers. This means representatives from your insurance company can read the very personal notes your therapist keeps about the details of what you talk about in therapy. These records can be used to review whether or not your sessions meet medical necessity criteria, but they are not necessarily going to be reviewed by someone with a similar level of education and expertise as your therapist.

Though privacy laws prevent this, patients are still apprehensive about their private medical information being shared with their employer, especially if their employer is subsidizing their health insurance plan. And certain jobs (like those with certain types of security clearance) might have legal options for accessing medical records.

Having Insurance Doesn’t (Necessarily) Make Therapy Affordable

As plans with high deductibles become more common, patients may be stuck paying the max allowable visit charge for most of the calendar year. The “max allowable visit charge” refers to the insurance company’s definition of how expensive they think a session should be. It will usually be slightly lower than the therapist’s self-pay rate, and it will be much higher than the co-pay the patient was expecting to pay. We know of an example where a patient had a $30 co-pay for office visits and $60 co-pay for specialist visits. The insurance company said that any visit that took place over telemedicine was automatically a “specialist” visit, so the patient was already bracing for a co-pay twice as high as they first expected. Then they were told they actually had to pay $134 a session (their plan’s “max allowable”) until their deductible was met. In practice, this meant paying $134 a week for twenty-two weeks out of the year.

What Does This Mean for Patients in Massachusetts?

As more therapists opt out of taking insurance, it can be harder to find a therapist who is in-network with your plan. Insurance companies have also been criticized for maintaining what is colloquially called a “ ghost network ” which refers to the practice of maintaining lists of providers that they know are out of date, in order to save money.

Many therapists (myself included) believe that the therapist and patient should direct the course of treatment, not insurance companies. We believe we are able to offer better quality services when we spend more of our time on our patients, our continuing education, and our own mental wellbeing. We believe opting out of insurance helps us protect patient privacy and run a more sustainable business that ensures we can be available to our patients long-term.

We hope this article helps you understand why many therapists, including us at The Pomegranate Institute, choose not to take insurance. If you're looking for a sex therapist in Massachusetts, click here to book a consultation.

The Best Beginner-Friendly Anal Sex Toys for Pleasure and Comfort

schotkowski@gmail.com — Wed, 07 May 2025 20:00:00 GMT

If there’s anything our Google Search Console has taught us, it’s that people love talking about butt stuff.

Anal sex is on the rise, with more people of all genders and sexual orientations giving it a try. The International Union of Sex Workers found in their research that the number of adults who have tried anal sex is on the rise, up from 31% in 2001 to 40% in 2022. Millennials, like the ones The Pomegranate Institute is chock full of, are the generation most likely to explore with giving and receiving anal penetration (73%), analingus (45%), and pegging (18%).

Our article A Beginners Guide to Anal Sex is the most popular article on our website, and, delightfully, becoming one of the ways people find our practice.

So in the spirit of giving the people what they want, we’re here to talk about beginner friendly sex toys to try first if you’re thinking of trying anal sex.

It’s ok to try stuff

As a pleasure-positive sex therapist, one of the things we say the most often is that you’re allowed to try stuff, just for the sake of trying stuff. You’re allowed to try stuff you think you’re really going to like, and you’re allowed to try stuff you’re not so sure you’re going to like. Trying something doesn’t mean you’re declaring an allegiance, picking a team, or making a statement about who you are as a person.

Save the spontaneity for another time

Spontaneous sex can be great, but spontaneous anal sex? Not so much. If you want to give anal sex a try, it’s best to set yourself up for success. Maybe “practice” is as far as you get, because you find something in that bucket you really enjoy, and maybe it paves the way for having a pleasurable experience with anal penetration in the future.

Here’s 10 of our recommendations for things to try

Plugs

Anal plugs for beginners are a great way to start exploring anal play because they’re straightforward and easy to use. They’re designed to sit inside the anus, without moving around a lot. This means once they’re in, you can go about the rest of your business! For some people, this means getting frisky and just exploring the sensation of being slightly full, and for others it means doing chores around the house and realizing that having something up your butt is actually pretty uneventful.

Plugs we recommend for beginners include:

Jeweled heart metal buttplug She’s cute, she’s whimsical, and she’s only 2.5 inches, the perfect toy for beginners. Since this one is made out of zinc alloy, it’s safe to use with silicone lubricant, easy to clean, and you can pop it in the fridge for 10 minutes, or in a bowl of warm water for temperature play.

Lovehoney Classic Silicone Beginner's Butt Plug This plug has a flared base for peace of mind, and the flexible but firm texture of silicone is great for beginners. Silicone toys need to be used with water-based or oil-based lubricant.

Beads

Anal beads are great for beginners because they’re friendly looking and the retrieval ring makes it easy to control how far in they go, while making sure they can’t go to far or get stuck.

Lovehoney Classic Silicone Anal Beads 10 Inch These silicone beads are nice and flexible, and their relatively narrow circumference is a great way to experiment with smaller sizes.

Lovehoney Sensual Glass Iridescent Anal Beads These are made from borosilicate glass, which makes them waterproof and compatible with all types of lubricant. The rigid texture and gentle arch are a great way to explore what angles work best for you, and they’re just so pretty!

Wands

Wands are great for solo play, and for starting to incorporate anal stimulation with a partner. They’re stable enough to be moved around with one hand while performing oral sex. Using them while having penetrative sex takes a bit more coordination, but if you’re feeling adventurous, go for it!

Njoy Pure Wand Made out of stainless steel for a sleek and heavy feeling, wands are great for exploring your G and P spot.

Sets

If you like being efficient with your sex toy purchases, sets can be a great option! They give you flexibility as you get more and more comfortable, so you can find the size and configuration that work best for you.

b-Vibe Rechargeable Anal Training and Education Butt Plug Set has an anal douche, lube applicator, and three different rechargeable plugs that measure 3.5, 4, and 5 inches around.

For even more options, the They-ology Wearable Dilator has 5 different sizes.

Dildos

If your goal is to receive penetration from a partner, dildos can be a great way to work up to a length and girth that resemble that of the strap-on or penis of the penetrating partner. Make sure the dildo you’re using has a flared base as is compatible with the type of lube you like to use (remember, like degrades like, so silicone lube isn’t compatible with silicone toys).

The Avant D14 Heart of Gold Dildo is harness compatible, and has a strong suction cup that allows it to be mounted to most smooth surfaces (like your shower wall), made out of silicone and curved in a way that supports G and P-spot stimulation, we love its multitasking abilities!

If you like your sex toys hyper-realistic, the Lifelike Lover Classic Realistic Dildo 6 Inch is Lovehoney’s staff pick. It comes in 4 different colors, has 5 inches of insertable length, and is nice and flexible.

DP Strap Ons

These toys are designed to facilitate double penetration, they can be worn attached to the shaft of a penis, or a strap on. Some people use them to train up towards a threesome and some people like the full sensation the toy produces.

The Lovehoney Double Fun Vibrating Rabbit Double Penetration Strap-On is a real workhorse, the rabbit ears vibrate against the clitoris, the strap-on is attached with both a cock and ball ring, and there is a six inches of insertable length.

The Double Penetrator Cock Ring Anal Vibrator Strap-On has a unique spine feature that allows the shaft to be manipulated into exactly the right angle, but once its set, it will generally stay at that angle during sex. This toy can also be adjusted for vaginal penetration (where the penetrating partner is using their penis to perform anal sex, and using this strap-on to penetrate the vagina).

Double ended

Double-ended toys are great for instances where both partners enjoy receiving anal stimulation, or if one partner wants to receive vaginal stimulation while their partner receives anal.

Strap-on-me Slim Silicone Strapless Strap-On Dildo 6 Inch is a great option for folks with vulvas who don’t love a harness. There’s a “pony” (not sure where this name comes from, but that’s what they call it) that sits inside the vagina, while the shaft sits inside the partner receiving penetration.

Together 2.0 Vibrating Double takes double penetration and elevates it with technology. The toy will sense muscle tone changes in one partner, and change the vibration to match the intensity for the other. The toy can be used for both vaginal and anal stimulation.

Sex toys can be a great way to add novelty and curiosity to your sex life, whether that's with a partner or solo. We hope this article gives you lots of good ideas of things to try, but if you want to talk to a pleasure-positive sex therapist about how to have good anal sex, reach out ! We love helping the adventurous and inquisitive folks of Massachusetts build healthy, fulfilling sexual relationships and navigate their personal intimacy journeys.

What Happens in Sex Therapy? A Realistic Guide to What to Expect

schotkowski@gmail.com — Sun, 13 Apr 2025 18:05:40 GMT

Curious about sex therapy? Learn what to expect in a session, how to find a certified therapist, and what myths to forget.

The Basics

Sex therapists are therapists that have advanced training in sexual health. They provide treatment for a range of things like:

Sexual dysfunction : any problem that is interfering with you having sex that is consenting and pleasurable

Communication : how to have tough conversations about sex and intimacy

Understanding the impact of your mental health condition on your sex life , and how sex you enjoy can be a part of mental health treatment

Who is a sex therapist?

“Sex therapist” isn’t a protected term in the state of Massachusetts. This means someone can technically call themselves a “sex therapist” if they have an interest or aptitude in talking about sexual wellbeing.

But usually, a sex therapist refers to a type of therapist. This could be a clinical social worker, psychologist, mental health counselor or marriage and family therapist. Each of these professions have masters degrees or doctorates in their field, and they have a license to practice therapy. This means they’ve completed a certain amount of education, and had their work supervised by someone more senior in the field for a certain number of years. In order to keep their license, they have to complete professional development to stay up to date on developments in their field.

If a therapist chooses to pursue advanced education in sex therapy, they’re doing this after they’ve already licensed to practice independently.

Many sex therapists will talk about being “AASECT certified” and what this means is they have completed a specific set of requirements outlined by the American Association of Sexuality Educators, Counselors, and Therapists .

To be AASECT certified, you must complete advanced education in human sexuality, even more hours of supervised practice, and supervision in both individual and group settings with colleagues with more seniority in the field.

The requirements take around two years to complete, and are so intensive that many programs offer a PhD in clinical sexology that fulfills the AASECT requirements.

If someone is an AASECT certified sex therapist, they will have the initials “CST” for “certified sex therapist” after their name, listed with their other licenses or degrees.

What isn’t sex therapy?

Sex therapy is not sex work . A sex therapist will not have sex with you, or touch you at all. They will not role play or stimulate sex acts. They might show you how certain devices work, but they will not demonstrate on themselves or you.

If a sex therapist asks detailed questions about your sex life, it is for treatment, not their sexual gratification or yours.

Sex therapists will end treatment with you if you send them explicit content or masturbate during sessions. If the therapist is soliciting any of this material from you it is a red flag, and it means they have stepped WAY outside of their professional code of ethics.

Does insurance cover sex therapy?

Insurance will generally cover sex therapy, but there are some big “Ifs” to consider.

Is the therapist in-network with your insurance plan? Most sex therapists have left insurance panels as the reimbursement rates offered have neither kept pace with inflation nor the cost of pursuing advanced education in sex therapy.

Does your insurance plan offer out-of-network benefits? Some insurance will reimburse you for costs that you have spent on your healthcare. Sometimes they reimburse you a percentage of the cost, or up to a certain amount, and these benefits may only be available after you have met your deductible for the calendar year.

The sex therapist needs to be able to diagnose you with a specific mental health condition so they can report to your insurance company that they are providing a medically necessary healthcare service. This could be something specific to sexual health like erectile dysfunction or something related to the emotional impact of the sexual health problems you are having, like depression.

What can a sex therapist help you with?

Sex therapists can provide support for a range of scenarios like:

A monogamous couple that is thinking of opening up their relationship, they want help strengthening their communication and strategizing about boundaries.

A female patient has been experiencing sharp pain in her vulva every time she attempts penetrative intercourse since her C-section last year. She is in pelvic floor therapy to treat the cause of her pain, but wants to explore some strategies for revitalizing her sex life.

A couple have a sex life they enjoy, but one partner recently disclosed a kink that the other partner isn’t into at all. They are wondering how to manage this desire discrepancy in a way that is “fair” to both of them.

A polyamorous adult is struggling with increased conflict between two of their metamours (people who have a partner in common but don’t date each other). The hinge partner (the partner in common) feels confused about what their role is for managing the conflict between their partners and wants some support exploring this.

A male patient experiences erectile dysfunction when he has partnered sex, but not when he masturbates. His urologist has told him the problem is psychological. He feels frustrated and confused about what to do next, and wants some help.

A patient who was sexually assaulted last year has been struggling to experience orgasm since the assault. She feels safe and happy in her current relationship and frustrated that she can’t “get there” she is worried there is something wrong with her.

A couple with a toddler find that their sex life has diminished since becoming parents. They are attracted to each other, but they feel like “ships in the night.” Their new role as parents has left them with little time and energy to feel like sexual beings, and they want to find a way to tap back into that energy.

What happens during sex therapy?

A sex therapist will probably start by asking you what brings you to their office. They’ll invite you to share as much or as little about this as you’re comfortable. Sex therapists often use the PLISSIT model , which involves:

P: permission giving : The therapist will share that they ask all of their patients about their sexual health, and will ask permission to introduce the topic.

LI: limited information : The therapist will address specific questions the patient has, and try to correct any major myths and misconceptions.

SS: Specific suggestions : The therapist will ask some questions about your sexual health and if you want, offer some specific strategies.

IT: Intensive therapy : If the therapist thinks you would benefit from psychotherapy to address your concerns, they will offer this. They might work with you themselves, or suggest a colleague who has expertise in your specific project.

What kinds of questions will a sex therapist ask you during an appointment?

Sex therapists might ask questions about:

Your experience with sex ed when you were growing up

Your early sexual experiences

Your partner preferences

Your safer sex practices

Your current sexual activity

Your experience with dating and relationships

Your experience with marginalization, discrimination, and sexual violence

Your experiences with pain during sex

Your experience with things like low desire, difficulty achieving or sustaining and erection, and difficulty experiencing an orgasm

Your experience with shame, guilt, or conflicted feelings about your sex life

How can a sex therapist help with sexual problems?

Education : sex therapists will help you fill in the gaps in your sexual health education in a way that is pleasure-positive.

Technology and other tips : sex therapists might have suggestions for specific bedroom techniques, positions or equipment that can help make sex more comfortable, pleasurable or adventurous.

Communication : sex therapists can help you talk to your partner(s) about intimacy, and find ways to problem solve barriers to having sex that is worth having. This could involve understanding how your drive differs from that of your partner, and how to seduce them in a way that makes them feel seen and heard.

Understanding : sex therapists can help you explore your own erotic template, the unique set of things that are turn ons for you. This might involve thinking about the origin of these fantasies, how to unplug them from any guilt or shame you are accidentally holding, and how to authentically express them in your real life.

Considering sex therapy?

Whether you're facing a specific challenge or just want to explore your sexual wellness, reaching out to a sex therapist can be a powerful step. Contact us today to learn more or schedule a consultation.

Thinking of Opening Up Your Relationship? Ask Yourself These 10 Questions First

schotkowski@gmail.com — Fri, 14 Mar 2025 16:00:00 GMT

Here at The Pomegranate Institute we love working with Massachusetts couples who are thinking of opening up their relationship.

Opening up can be exciting, nerve wracking and sexy. And what’s sexier than a long list of questions designed to spark thoughtful discussion? We’re not saying you need a relationship agreement for every single item on this list, but here’s some ideas to get the conversation flowing:

Your values

When making important decisions, it can help to think about your values, and how you want your values to be connected to your actions. How does your commitment to a consensually non-monogamous relationship model connect to your values?

How much bandwidth do you REALLY have for external relationships?

We recommend doing a time study and a review of your budget to determine how much bandwidth you have for external partners. You may value the idea of seeing a partner multiple nights a week, but after a time study, realize you have time/money for a date out of the house once every 2 weeks. This can also be a great time to check in about whether your existing budget and division of domestic labor feel equitable. Non-monogamy won’t necessarily create new issues, but it will heighten dynamics that are already in place so it’s important to address these issues now. We love Eve Rodsky’s Fair Play card game to explore this with your partner.

What kind of non-monogamous relationship structure are you aiming for?

From swinging to kitchen table polyamory there’s so many different ways to be non-monogamous. Not to mention all the new lingo you’ve got to learn! Do you have certain structures you’re drawn to? Or are you open to connecting with people and seeing where those relationships take you? And if you need a hand with all the new vocab words, check out our article The Non-Monogamy Glossary .

What degree of “outness” do you want to have?

Will friends, family, co-workers, kids and social media know you have multiple partners? Will dating certain people unwittingly out your partner as polyamorous in a way they are not comfortable or yet ready for? How will you share this information with new partners, so they can make an informed decision about whether they are comfortable participating in a relationship with these terms?

Who will you date?

Are you open to dating anyone and supporting your partner dating anyone? Is it ok to date mutual friends? Significant exs from past monogamous relationships? Co-workers? Your partner’s co-workers? Friends of your partner? Partnerships where there is a significant power imbalance (like workplace subordinates or partners with large age gaps)?

What will you do on dates?

Are there certain romantic activities that are reserved for your current partner that will not be available to your new partners? This could be something as specific as “dates at the restaurant where we got engaged” or involve questions like living arrangements, having children together, fluid bonding (fluid bonding describes a sexual relationship where the members of the relationship are not using any kind of barrier method during sex), celebrating holidays, going on vacation together, buying expensive presents or experiences, celebrating major life milestones, comingling of finances, posts on social media or terms of endearment.

If you have children will they be involved?

If you have children, do you anticipate new partners meeting children? Seeing photos of your children? (For the love of god please don’t put photos of your kids in your dating profile). Do you anticipate them participating in any shared parenting decisions? Do you imagine them having the opportunity to maintain a relationship (if they and/or your child wishes) with your child if your romantic relationship ends? How will external dates impact the division of childcare responsibilities?

How integrated will your new partner(s) be?

Do you anticipate new partners meeting your family? Your partner’s family? Do you anticipate new partners meeting your friends? Your partners friends? Do you anticipate your partner meeting your other partner(s)? Do you anticipate people having relationships with their metamours (a word that describes the partner of your partner) without your involvement?

How involved in non-monogamy community do you want to be?

Is it important to you to make friends with other non-monogamous folks? Do you anticipate dating people who have experience with consensual non-monogamy? Could you see yourself dating someone who was brand new to this relationship structure? Could you see yourself dating someone who is open to dating someone polyamorous, but who does not intend to date other partners themselves? To what extent is it important to you to confirm that the partner(s) of your external partners know and are consenting to being in a polyamorous relationship? Would you date someone who was interested in dating you, but having an affair?

How will you prioritize romance in your current partnership?

Does this involve scheduling a date night? Planning a shared vacation? Try to make sure you’re doing something beyond the administrative tasks of being in relationship (like cleaning the house, paying bills, and caring for children). There is a phenomenon called “new relationship energy” that describes the intense limerence phase of a new relationship, how are you going to cultivate awareness of this so that you can enjoy it, while also celebrating the “established relationship energy” of your existing partnership?

Will you veto?

Will your current partnership contain any hierarchical items like a “veto” where an existing partner can veto a potential external partner either for certain reasons or any reason or a “gender exclusivity” policy (like a, don’t make us say it “one penis policy”).

What will your safer sex practices be?

What will your safer sex practices be and how will they differ across different relationships? When will you use barrier methods? With certain partners? For certain sex acts? The vast majority of people don’t use barrier methods for oral sex, but it’s important to remember that many STIs are highly transmissible via oral sex. What will your testing practices be? Many people choose to get tested every 3 months, with additional testing as needed. What will you get tested for? A standard panel includes chlamydia, gonorrhea, trichomoniasis, Hep C, HIV and syphilis. Will you get tested for HSV? Will you ask your partners about HPV and whether or not they have been vaccinated for it? AFAB folks may get tested for HPV if they are of a certain age during a GYN exam, but folks AMAB are not routinely tested. How will you manage the risk for pregnancy? Are you open to being sexually active with folks who are willing to use barrier methods but not a secondary form of birth control? Are you comfortable talking to people about their beliefs around pregnancy termination? Have you thought about the appropriateness of going on PrEP? How will you manage sex toys? (generally we don’t recommend sharing sex toys across partnerships even if you wash them between uses).

How will you strike the balance between privacy and healthcare transparency?

To what extent will you discuss your sex life with external partners with your partner? There is a distinction between letting them know a sexual relationship has begun and communicating any health information that informs choices your partner makes, and sharing details about the intimacy itself. Is your external partner comfortable with details being shared, or would they prefer this information remain private? What information is your partner comfortable hearing? Are their different boundaries for sex and non-sex stuff? Is your partner comfortable with you sharing information about them? Information about your own emotional experiences in your partnership? Some people choose to set boundaries around not asking external partners to provide emotional support to a relationship they are not in, and to instead seek this support from friends or family when it is needed.

What happens at home?

Can external partners come over to the shared home? With advanced notice? When your existing partner is home? When they are not? Is it ok to have sex with external partners in the home you share with your current partner? Are there areas of the house where this is and is not appropriate? Is there any etiquette to be observed (like changing the sheets afterwards)?

How to text?

What kind of boundaries exist around texting other partners when you are with a partner? Would you prefer your partner not text their other partners in front of you? Would you prefer certain activities (like date night) are phone free?

Ending a date

Are there situations in which your partner can be “recalled” from a date they are on? Childcare emergencies? Medical emergencies? Emotional difficulty? Feeling icky about the date your partner is currently on?

When to mention a new partner

At what point do you want to know about external relationships? When there is a new dating match? After a first date that seems to have gone well? Sex? When the relationship is formalized?

Managing conflict

If there is conflict between metamours (people who are dating someone in common but who do not date each other), how will it be managed? What is the responsibility of the “hinge” (meaning the shared) partner? Will the metamours be responsible for managing their own conflict? Will the hinge partner mediate?

Keeping the lines of communication flowing

What is the system for checking in about these relationship agreements, how well they are working, and what updates, if any are called for? How will you keep track of what you are trying and what you are learning?

Ok, we know that was more than 10 things to consider

But we hope this gives you a framework for sifting through what is important to you to consider as to pursue non-monogamy. If this article left you with more questions than answers, reach out ! We love helping the non-monogamy-curious folks of Massachusetts explore!

Should Polyamorous People Get Tested for Herpes?

schotkowski@gmail.com — Wed, 19 Feb 2025 16:57:31 GMT

Today at The Pomegranate Institute, we’re talking about one of the questions we get asked most often.

Let’s start with a quick herpes refresher

Herpes is a contagious viral infection caused by the herpes simplex virus, there are two types, HSV-1 and HSV-2. We used to refer to HSV-1 as “oral” herpes and HSV-2 as “genital” but we know that you can get infected with either strain in either place, and we’re seeing an uptick in HSV-1 infections in the genitals, likely due to an increase in oral sex (yay!).

Herpes is transmitted through skin-to-skin contact, when a contagious area comes into contact with a tiny break in the skin on the mouth or genitals. Most people will have their first herpes outbreak somewhere between two and twenty-one days after exposure. The first outbreak is usually the most severe, and then the virus goes dormant, hanging out in the nerve root. Some people never have another outbreak, whereas others have multiple outbreaks a year. We are still learning more about what triggers outbreaks and what might help keep the virus dormant.

It's estimated that more than 50% of the population have HSV-1, and about 12% (one in eight) people ages 14-49 have HSV-2. Many people have herpes and don’t know they have it, usually because the signs are so mild they are mistaken for another condition (like an ingrown hair, jock itch, or a pimple).

Herpes is not curable, but it is treatable. Antiviral medications like acyclovir, famciclovir, and valacyclovir can be taken at the first sign of an outbreak to reduce the severity, and some folks choose to take antivirals every day for “suppressive therapy” to reduce the likelihood of future outbreaks and decrease the likelihood of transmitting the infection to serodiscordant (partners who do not have HSV) partners.

Why is this a hot button issue for polyamorous folks?

There’s a debate about whether or not polyamorous folks are at increased risk for sexually transmitted infections. On the one hand, more sexual partners means more opportunities for infection. On the other hand, polyamorous folks may implement more careful safer sex and testing practices that mitigate this risk .

So how do safer sex and testing practices apply to herpes?

Currently, the CDC does not recommend asymptomatic testing for HSV. This means it will not be including in a standard STI testing panel (which tests for chlamydia, gonorrhea, syphilis, HIV, hepatitis C, and trichomoniasis).

If HSV is highly contagious and sexually transmissible, why not get tested for it?

First, the risk of a false positive is much higher for HSV than it is for other STIs. The U.S. Prevention Task Force estimates that 50% of positive test results diagnosed by the IgG test are false positives . Second, herpes isn’t associated with serious health outcomes, it is essentially a pesky skin condition. One of the main reasons we do asymptomatic testing for other STIs is that, if left untreated, they can lead to serious health consequences like pelvic inflammatory disease or infertility.

So why might someone still choose to get tested?

We hear from lots of non-monogamous folks across the state of Massachusetts who choose to get tested for HSV, even if they are asymptomatic. We like the expression “risk aware sex” (as opposed to safe sex) to describe the goal of being aware of the specific risks that sex with you and your partners and their partners entails. Proponents of risk aware sex might argue in favor of testing even though the health consequences of herpes are minor and the risk of asymptomatic transmission is low.

So what should you do?

We encourage everyone to ask a lot of questions about what their partners’ safer sex practices entail. Don’t end the conversation when someone says, “I get tested for STIs regularly and I use condoms”. Here are some questions we love to ask:

1.) How often do you get tested for STIs?

2.) Which STIs do you get tested for?

3.) Do you get cite specific testing? If someone is having oral or anal sex, cite specific testing involves swabbing the anus and back of the throat in addition to a urine and blood test. This is because STIS like chlamydia and gonorrhea absolutely love colonizing the back of your throat. If you do a urine test only, you might still have an asymptomatic case present only in the back of your throat, which means you are able to transmit it during oral sex.

4.) Do you use barrier methods when you have oral sex? In our practice, we find when someone says they “use condoms all the time” they usually mean they use condoms when they have penetrative sex. STIs are still transmissible during oral sex. We’re not in the business of telling our patients what safer sex practices to follow, but we want your sex to be risk aware!

5.) How much information do you feel like you have about the safer sex practices of your partners other partners and their partners? It’s helpful to know if this is information freely exchanged, or if folks assume but don’t know.

At The Pomegranate Institute, we believe anyone who wants to get tested for HSV should get tested! It’s not for us to say people “should” get tested but we do think non-monogamous folks should be able to explain their perspective on why or why not. We think a transparent conversation about risk-aware sex is one of the greenest flags there is. If you want to learn more about HSV, check out our article The Sexiest Thing You Can Do Is Not Be a Jerk About Herpes , and if you’re in Massachusetts and you want to talk to someone about your safer sex practices, reach out !

What is Molloscum Contagiosum? Symptoms, Treatment, and Prevention

schotkowski@gmail.com — Fri, 07 Feb 2025 18:15:00 GMT

The pesky little (sometimes) STI you’ve probably never heard of.

What is Molloscum Contagious?

If you’re anything like the majority of patients at The Pomegranate Institute, you’ve been blissfully unaware of molluscum contagiosum - even if you’ve had a comprehensive sexual health education.

Molloscum contagiosum is a temporary, pesky but not painful, very contagious skin disease caused by a double-stranded DNA poxvirus.

So why is a sex therapist in Massachusetts talking about these tiny little bumps? Because molloscum contagiosum can spread through sexual activity.

How is Molloscum Contagiosum Spread?

Molloscum contagiosum spreads through skin-to-skin contact with the affected area of another individual, or through touching contaminated objects like clothing, towels, razors, or toys. While transmission can be through sexual contact, non-sexual contact is much more common.

In 2010 there were approximately 122 million diagnosed cases, mostly in children ages two to five. Sexually active teenagers and adults can also be impacted, and folks that are immuno-compromised are at greater risk.

Since most people are unfamiliar with molloscum contagiosum, they may have it and not know it. Symptoms are not painful and generally go unnoticed or are mistaken for another skin condition. It can easily be mistaken for conditions like acne, ingrown hairs, keratosis pilaris (aka “strawberry skin”) or HSV. This means someone infected may be at risk of unwittingly spreading it to other people.

In our practice, we often see the virus jump from children to adult members of their household (often by sharing towels) and then between adults during sex.

How is Molloscum Contagiosum Diagnosed

Molloscum contagiosum is not something that would show up in a regular STI panel. It’s diagnosed through physical exam, not through urine or blood tests. This is why it’s important to make sure that your routine screening includes a physical exam, and to be familiar with what your own genitals look like, so you are more likely to notice changes like small bumps that look slightly different from your normal bumps.

A provider evaluating for molloscum contagiosum will be looking for firm, white or flesh-colored, dome-shaped papules, a characteristic divot or dimple in the center may be visible. We’ll go ahead and let you google up close photos yourself, but most people with the condition are incredibly surprised to hear they have it, that’s how subtle the symptoms are.

A provider might use a technique called “dermoscopy” which involves looking at the skin with a special light and magnifying lens to help differentiate between suspected molloscum and other skin conditions.

How is Molloscum Contagiosum Treated?

Molloscum contagiosum generally resolves on its own in about six months, so sometimes treatment isn’t even recommended. But it is possible to “autoinoculate”, meaning spread the virus from an infected spot on your body to a non-infected spot on your body, especially if you’re having a hard time leaving the bumps alone. Sometimes covering the bumps with a waterproof bandage is enough to sufficiently reduce the risk of the bumps spreading.

There’s also a bunch of questionable home remedies out there, like applying apple cider vinegar or tea tree oil to the bumps, covering them with duct tape, “frosting” (applying a thick layer of lotion like cake frosting) the bumps, or applying retinol and a hydrocolloid patch. We don’t recommend any of these strategies because you risk irritating the skin and making it easier for the virus to spread.

If the bumps are located on or near the genitals, or somewhere a partner is likely to come in contact with during sex, your provider might recommend treating them with cryotherapy, which involves applying liquid nitrogen to the bumps for about 8 seconds. If you’re worried about hearing “liquid nitrogen” and “your vulva” in the same sentence, don’t worry, the sensation is a really localized to the bumps themselves and feels like the tips of your fingers or ears getting cold on a winter walk. It’s uncomfortable but not painful. Several rounds of treatment may be necessary to ensure all the bumps have been addressed, and new ones are not forming, so your provider will likely recommend several visits to check the progress of your treatment.

The molluscum contagiosum virus infects only the outermost cells in your epidermis (called keratinocytes). This means, that unlike other viruses, the molloscum contagiosum virus no longer exists within your body after your symptoms resolve.

When To See A Healthcare Provider?

If you think the virus was spread from sexual activity, your next steps are to get treatment and do what you can to stop the spread, just like you would with any other STI. It’s important to notify current and recent partners, and make them aware that the virus can spread through non-sexual contact to other household members. Try not to turn it into a “whodunit”. With some very rare exceptions, it’s unlikely someone knowingly transmitted the virus to you.

For most of our patients, the hardest part of having molloscum contagiosum is making changes to their sexual practices until everyone has received treatment and the virus has completely cleared. This usually takes around 6 months, but cases can last longer due to the risk of auto-inoculation.

If you're feeling frustrated in the wake of a recent infection, or getting worried about the risk of one, reach out ! A sex therapist can help you navigate the stress. We love talking to the health-conscious and health-anxious folks of Massachusetts about their sexual health!

Non-Monogamy Glossary: Essential Terms for Ethical Non-Monogamous Relationships

schotkowski@gmail.com — Sun, 19 Jan 2025 01:00:00 GMT

Is it just us, or does it feel like the hardest part of non-monogamy is all the new lingo you’ve got to learn?

Ok, that might be a SLIGHT exaggeration, but it does feel like there’s a bunch of new vocab words to memorize if you want to sit with the cool kids in the cafeteria. As a sex therapist in Massachusetts, I'm firmly team “You CAN sit with us” and The Pomegranate Institute is here to help people exploring non-monogamy and polyamory navigate relationships gracefully with a bunch of new vocab words.

Words that All Kind of Mean Non-Monogamy:

Some people use Consensual Non-Monogamy, Ethical Non-Monogamy and Polyamory interchangeably, and other people think there are important distinction between the terms. Some think “ethical” is too mellifluous to define, and prefer “consensual” because it has a clearer definition. Some people abbreviate Polyamory as “Poly” but we don’t recommend this. In 2015 a Polynesian tumblr user put out a call to action to remind folks that “poly” was already in use to refer to the Polynesian community and to ask non-monogamous folks not to use it.

Styles of Polyamory

There are a lot of different relationship structures covered under the umbrella of non-monogamy. Some terms describe the degree to which partners and their other partners spend time together.

Comet : Refers to a connection that, like a comet, is fleeting but special, and may re-occur with less frequency that other types of partnerships and may involve less regular communication between connections. If Amy is dating Matt, and Matt goes to a conference every year in San Francisco, and he spends romantic time with Jessica, they might refer to each other as comet connections.

Parallel Polyamory : Relationships that do not overlap or have any cross-over. If Amy is dating Matt, and Matt is dating Jessica, Amy and Jessica are not dating, don’t generally spend time together, and might not even ever meet, but both are aware that each other exists.

Garden Party Polyamory : So named because partners don’t necessarily hang out often, but might all see each other at a garden party, or other special event. If Amy is dating Matt, and Matt is dating Jessica, Jessica and Amy both attend Matt’s birthday party.

Kitchen Table Polyamory : So named because partners spend a decent amount of time together, to such an extent that they could all hang out around the same kitchen table. If Amy is dating Matt, and Matt is dating Jessica, Amy, Matt and Jessica all go out to brunch on the weekends.

Lap Siting Polyamory : So named because partners are so close to their partners partners that they can imagine comfortably sitting in their laps. If Amy is dating Matt and Matt is dating Jessica, Jessica feels comfortable sitting on Amy’s lap. For some, this term has an added sexual connotation of implied overlap between partners, in this case, an implication that Jessica and Amy will share some sort of sexual contact.

Other words that have to do with the setup of a relationship:

Closed polycule/relationship: The people in this relationship are not currently open to dating new people. Sometimes, this is called a vessel which describes taking a temporary pause on pursuing new connections.

Don’t Ask, Don’t Tell : Partners have given each other permission to date externally, but have asked to not hear any details at all about these external relationships.

Egalitarian Polyamory : All relationships are considered equally important, without a hierarchy. Partners strive to dive resources equally or equitably across relationships.

Hierarchical Polyamory : Having a hierarchy refers to some relationships being considered more important than others. Some use words like primary and secondary partner , to draw this distinction. Some people who practice hierarchical polyamory prefer to say that a secondary partner is taking up a “smaller” not “lesser” part in their lives. Phrases like nesting partner , to describe a partner you live with, or anchor partner or administrative partner to describe a partner that you jointly manage aspects of life with (could be co-parenting, co-mingled finances, or designating a partner as a healthcare proxy) might also play a role in defining a hierarchy.

Polyfidelity : A polycule that is closed, all members agree to be faithful to their existing relationships within the polycule and not to seek new connections. Sometimes polyfidelity implies a degree of egalitarianness between the different relationships, but not always.

One Penis Policy: This describes a relationship structure in which a man has given his female partner permission to date, but with the request or “rule” that she only date other women. We’re not fans of this policy (for hopefully obvious reasons) and the wording itself is transphobic as it focuses on genitalia and not gender identity.

Open Polycule: members of this polycule are open to pursuing new connections.

Solo Polyamory: Someone who prioritizes individual autonomy while pursuing multiple romantic connections. So if Matt is dating Jessica and also dating Amy, he likely doesn’t live with, share finances or co-parenting responsibilities with either.

Throuple: A type of polycule involving three people who are all dating each other. This is different from a “ V ” which involves a hinge partner and their two external partners who are not dating each other.

Words that have to do with experiences you might have in non-monogamy:

Ambiamory: Describes a relationship structure or pattern of attraction that could be monogamous or polyamorous, depends on the specific partners involved. Jessica might describe herself as someone who sometimes dates monogamously and sometimes dates polyamorously, she is open to either, and happy in both types of relationships.

Autonomy-prioritizing polyamorist : Value autonomy above all else in relationships. May find boundaries restrictive or controlling. The opposite values of a “transparency-prioritizing polyamorist”.

Compersion: the opposite of Schadenfreude (joy at someone else’s pain), experiencing real joy when witnessing or hearing about a partner’s positive experience with another partner. Often referred to as the “holy grail” of polyamory, this is something people aspire to experience. My favorite part of this word is that it was supposedly coined when members of a well-known commune consulted a Ouija board looking for a word that could capture this experience.

Cuckoo: named for the cutthroat little bird (not the derogatory name for someone with a mental illness), a cuckoo is someone who plans to behave so badly towards their metamour that they drive them away, allowing them to pursue a monogamous relationship with their partner.

Couple privilege: The advantages that an established couple has in society and in the polycule.

Cowboy/Cowgirl/Cowpoke: Describes someone who is trying to “ lasso ” their partner away from their other partner(s) and into a monogamous relationship.

Dyad: refers to two people that have a relationship with each other, could be romantic, could be platonic.

Established Relationship Energy (ERE): Describes the positive emotional experience of being in a long-term partnership.

Exclusion jealously: The fear that as your partner starts dating someone new, you will be excluded, or feel excluded.

Frubble: A cute British word for feeling a little bubble of compersion.

Fluid bonding: Partners who don’t use any barrier methods (condoms, dental dams, gloves) when they have sex. Sometimes in polyamory, some partners within a polycule or constellation may be fluid bonded and others might not be. So if Matt is dating Amy and also dating Jessica, he might be fluid bonded with Amy but not Jessica.

Hinge: Refers to the partner who is dating two other partners. In the example we have been using where Matt is dating Amy and also Jessica, Matt is the hinge partner.

Langdon Chart: A chart that describes current and past romantic and sexual relationships. Named for Kevin Langdon who developed the chart to describe sexual relationships between members of science fiction fan culture.

Limerence: sometimes mistaken for love, limerence describes the early states of romantic attraction that border on obsession and are heightened by the uncertainty of not knowing if the object of your desire feels the same. Limerence can be connected to new relationship energy .

Metamour: your partners other partner that you are not dating. Some people know their metamour exists but don’t have individual relationships with them, and others have platonic relationships with their metamours.

Metamorsel: describes the experience of thinking your metamour is a cute little snack.

New Relationship Energy: describes getting swept up in the energy and excitement of a new relationship. Some people can get addicted to the high of new relationships and chase them often, this is called an “ NRE junkie ”.

Other Significant Other: Refers to a partner who is not your primary or nesting partner.

Platonic Life Partner: A deep and committed life partnership that involves a degree of entanglement (like living together or co-mingling finances) but does not involve sex or romance.

Polybomb: Refers to dropping the “bomb” of wanting to be polyamorous into a previously monogamous relationship.

Polycule: People who are in a network of non-monogamous relationships.

Polysaturated : Describes the experience of being saturated, swamped, or maybe even overwhelmed by existing partnerships. Usually identifying polysaturation means you plan to not seek out new connections.

Polywog: Cute word to describe children in a polycule.

Sneakarchy: The experience of trying to practice egalitarian polyamory, but finding hierarchy creeping in in unexpected ways.

Transparency-prioritizing polyamorists : Value lots of communication about boundaries, hearing about their partner’s other relationships, and building trust. The opposite values of an “autonomy-prioritizing polyamorist”.

Unicorn: Usually refers to a bisexual woman who is open to dating or having sex with couples.

Unicorn Hunters: Generally derogatory term for a couple that is seeking a bisexual woman to have a threesome with. They are implied to be pursuing the sexual experience rather than wanting to form a meaningful relationship, and there is a degree of exploitation or sometimes even biphobia inherent in this behavior.

Wibble : The opposite of “fribble”, refers to feeling a flash of jealousy.

Whether you’re thinking of opening up your relationship, or an experienced polyamorist with a thriving polycule, we hope this glossary adds some fun new words to your lexicon. If this article made you want to talk to a Polyamory-affirming sex therapist, reach out! We’d love to meet you.

Is Bed Rotting Bad For You?

schotkowski@gmail.com — Fri, 03 Jan 2025 21:57:20 GMT

Bed rotting, a popular trend involving lying in bed all day, engaging in passive activities and ignoring your to-do list just a little has divided the internet. Is it a self-care re-set or a recipe for sinking deeper into a doom-filled depressive spiral? Here on the blog today we’re exploring the pros and cons and offering suggestions for how to make the most of your time in bed.

The Basics

Now, there are no real rules to bed rotting, you can rot on the couch, in bed, alone, with a phalanx of furry friends, and be as occupied or stagnant as you want. Sometimes bed rotting involves staring into the void until it stares back, sometimes it involves juggling three different screens (we like laptop, kindle, phone) an elaborate skincare routine, and snacks.

Bed rotting involves saying “not today” and giving yourself permission to take the day off. Whether it’s grief about the election results, a chronic pain flair, or just a serious case of the morbs , bed rotting means pressing pause on all but the most essential responsibilities.

The Downsides

Detractors of bed rotting warn that decomposing in bed runs the risk of taking a bad mood and making it worse, and we would be remis if we didn’t review the potential risks:

Disrupted sleep

Bed rotting could potentially disrupt your sleep in two ways. If you get enough rest, your body might not be particularly sleepy when your bedtime rolls around. This can start a downward spiral of staying up later, and sleeping in, which could be a problem if you or your family are on a traditional business hours schedule, and of course, you risk your very life if this means feeding your cats breakfast 20 minutes later than usual.

Some people also find that spending too much time in their bedroom not sleeping creates confusion. If your brain gets too used to being in bed and being awake, this might make it harder to fall asleep when you want to fall asleep.

Feeling ashamed of being unproductive

In the hellscape that is late state capitalism, productivity has been weaponized to such an extent that taking a break is characterized as “lazy” or “weak willed”. By definition, bed rotting means taking a break from your responsibilities list which can sometimes feel like an act of rebellion. If your inner monologue is already prone to perfectionism and self-criticism you might notice a drift in your thoughts towards all the things you “should” be doing, which defeats the point of taking a nice long rest.

Doom scrolling

For some people, unfettered access to media is a risky thing. Think of what happened when your parents got on Facebook , do you want that for yourself? Probably not. Some of this depends on how friendly the content your social media algorithm pushes on you is, if you’re seeing a steady diet stream of pop culture analysis, booktok recommendations, and shelter animals who learned to love again after getting adopted, maybe this is less of a risk. But if your feed leans towards hardboiled reporting on all of the ways in which our world is currently on fire? That might make you feel worse.

The Upsides

This is not an unbiased article, at The Pomegranate Institute, we’re big fans of a bed rot, we think the downsides can be mitigate with minor tweaks, and the upsides of having a real rest are worth celebrating. Here are a few of our favorite reasons to rot:

Be a Goose

No one will ever be as right as the iconic Mary Oliver when she said: “You do not have to be good. / You do not have to walk on your knees / for a hundred miles / through the desert repenting. / You only have to let the soft animal of your body / love what it loves.” (Oliver, 1986).

Slowing Down

In a hustle culture world, slowing down is something worth practicing. You don’t have to be a millennial with a tumblr inspired arrow tattoo (an arrow can only be shot by pulling backwards and letting go! So profound.) to see the value in taking a minute for yourself.

How to Make the Most of It

We think bed rotting can be enhanced by adding a sprinkling of conscious activities, frankly, if we stare too long into the void our contacts start to dry out! Here are some of our favorites:

Add a smidge of movement

We’re not suggesting you run a 5k on the same day you’re planning to bed rot, but there’s lots of movement exercises you can do from the comfort of your own bed. Some of our favorites include: legs up the wall (against your headboard if you have one), legs on the chair pose, happy baby pose, and a variation of dragon pose where you rest your forearms on your bed as you bend forward.

You could also try some toe yoga , dry brushing, or using a massage gun to work on anything that feels tight or stiff in your body.

Skincare

Indoor time is a great time to do the more labor-intensive aspects of your skincare. You can get as fancy or stripped down as you want. Maybe today is the day you finally try those c ollagen sheet masks that are all over your for you page or stick with adding the classic and utterly cost-effective CeraVe moisturizing cream to any slightly dry spots. If you’re looking to do a deep dive into skincare, you could check out: Dr. Michelle Wong , Javon Ford , or A lexis Androulakis and Dr. Christina Basias Androulakis

Give your snack a hat

If you’re going to snack, try give your snack a hat! This is a catchy way of reminding you to add something with protein to your snack. We don’t snack shame here! And we don’t believe it’s particularly productive to tell people to snack less. Instead, try adding something nutritionally dense to your snack. This might mean adding a scoop of protein powder to your iced coffee, having some Parmigiano Reggiano (which has a deceptively large amount of protein per ounce) with your chocolate, or using your potato chips to scoop some tuna salad.

Think about your lights

We love a three-screen day as much as the next girl, but some people find the blue light really disrupts their ability to get a good night sleep. To mitigate the impact, you could try getting “10 before 10”, ten minutes of sunlight before 10 AM, a strategy popularized by neuroscientist Dr. Andrew Huberman . You could try blue light blocking glasses or filters on your devices, or try adding some red light in your room when its time to wind down. We love the red light attachment on our theraface pro and we always turn this red lamp on when we’re winding down for the night.

Indulge

If bed rotting feels decadent to you, really lean into it. Maybe today’s the day you finally try caviar (we have a soft spot for Imperia’s limited edition amur caviar ), or you eat macarons instead of cake, or get the really really good chocolate (shout out to the Munsen’s chocolate milk chocolate fudge truffle). If this feels hard and immediately gives you a case of the guilt ferrets, try asking how you would spoil a loved one who’s been going through a hard time lately, because you are your own dear loved one!

Learn something new

Can you scroll with a little bit of purpose and learn a new fun fact about the world around you? If Mr. Weasley were bed rotting, he would finally get the chance to learn how airplanes stay up. Maybe this silly little fact leads to your next hyper fixation, or maybe it’s just an opportunity to add to your collection of facts you can rattle off about the wives of King Henry VIII.

Connect with all your creatures

The reel I saw most often when researching bed rotting was the one that goes “next to every girl rotting in bed is her cat (or dog) rotting with her”. If you have pets, bed rotting could be a great opportunity to connect with them and give them their favorite thing in the world, your attention. I have a very skittish rescue cat (Baklava) who is terrified of me at least some of the time, but if I’m under the covers, she has decided I’m very unlikely to eat her, and she gets very brave and snuggly real quick. In a world where we must, tragically, be separated from our animals a lot of the time, bed rotting might just be a way to give your pet their favorite day (don't rot in bed for you, do it for Baklava!).

A solo sesh

As a sex therapist, I would be remis if we didn’t mention the opportunity to get a little frisky during your time in bed. Whether your solo sesh time is a chance to practice self-love, try something new (check out this list for a recap of 2024’s best toys), or see how many orgasms you can have in a 24-hour period, the health benefits are too many to count or to fit into this article.

We’re ending this article with a (solo) bang, hopefully it gives you some things to try the next time you’re in the mood for a hurkle-durkle. And if you want to talk about ways of incorporating meaningful rest in your life, reach out! We love talking about pop-culture inspired self-care!

How to Explore Your Sexual Desires and Preferences: A Guide to Sexual Self-Discovery

schotkowski@gmail.com — Tue, 01 Oct 2024 19:43:38 GMT

“So what do you like in bed?” A question that is meant to be thoughtful and flirty can sometimes strike a chord of terror.

What if we aren’t sure of exactly what we’re into? What if we’re into something specific but we’re nervous about how our partner might respond? What if we’re into something, but only sometimes, under certain circumstances and the particulars are kind of complicated? Today at The Pomegranate Institute we’re helping the horny, curious and sometimes trepidatious folks of Massachusetts explore their erotic landscape.

Check in with your body are you HALT?

The 12 step communities popularized the acronym HALT – hungry, angry, lonely, tired – as a way of being on the lookout for things that might put your sobriety in jeopardy, but the expression is also a useful one for framing states of mind that might hinder difficult conversations. While discussions about your turn ons and turn offs can be fun and sexy, they can also be stressful, and it’s worth trying to set yourself up for success by hosting these conversations at a time that you’re sober, well fed, well rested, calm, and feeling connected.

Take a quiz

If you find your mind going blank when you try to come up with bedroom-based activities, sometimes it can be helpful to see a big old list of examples, and notice what jumps out to you.

The Kink Test focuses on what they call “kink archetypes” like “Rope Bunny” and “Alpha sub”. You can take the survey anonymously, or give them your email address if you want a saved copy of your results. The quiz will give you example scenarios and ask you to rate to what extent you agree with each, ranging from 0% to 100%.

Example questions include: “Would you like to tie your partner up during sex?” And “Do you often feel free to unleash your animal instincts in bed like growling or biting?”

The Spicer App is designed to be used with a partner. You can link your profile to your partner’s using a secure code, and each of you can answer sex questions on your own devices and then see a list of common “yes” and “maybe”. Users have the option to submit their own questions to post to their partner, and you can even keep a record of activities you’ve already done together.

Read erotica

A virtual walk through kindle unlimited is a great way to normalize that if you can dream it up, someone wrote a book about it, and someone else is masturbating while they read it! Whether it’s fan fiction, aliens, or dinosaurs, you can find it on on the internet. Some of the most popular titles include:

Ali Hazelwood books, standalone books leaning more towards romance and slightly less smut, with a side of fan fiction ( The Love Hypothesis was originally written as a Reylo ship). If you like forbidden love between werewolves and vampires, try Bride , if you like physics and the “fake dating” trope, try Love, Theoretically .

Duskwalker Brides series by Opal Reyn , the dedication of which is “to all the MonsterFuckers out there, this book is for you. Don’t pretend that you’ve never wanted to be railed by some human eating dark entity that has a skull for a face – you saw the cover, you knew what you were getting yourself into, and you still chose to open this book and read it.”

The Priest Collection by Sierra Simone, a you guessed it – priest – forbidden romance which left some goodreads readers saying “I felt the need to go to confession and I’m not even Catholic!”

Ice Planet Barbarians series by Ruby Dixon, human women get stranded on an ice planet and invariably wind up having sex with 7 foot tall blue aliens.

Unicorn Pleasures series by Cecilia Chase , did you ever what someone to describe exactly how to fuck a unicorn? Then this one is for you!

Tipping the Velvet and Fingersmith by Sarah Waters , an extremely well written mix of historical fiction and lesbian coming of age stories.

Goliaths of Wrestling books by Lily Mayne, paranormal gay romance involving a wrestling team.

Erotica can be a great way to sample new things in the privacy of your own imagination, if you’re not quite ready to try something out in real time. You can give it a read, and see how it makes you feel, maybe it gets you hot and bothered, maybe it doesn’t, either way, it’s all ok!

Talk to your friends

The best way to get good at talking about sex is to talk about sex. And if talking to the person you’re actually having sex with feels too nerve-wracking, try talking to your more libertine friends.

This doesn’t mean getting inquisitive about something someone would rather keep private, it can involve talking about “this book I saw in an article on a therapist’s website” or a movie, or swapping some low stakes stories. Practice, and notice that the sky doesn’t actually fall down if you talk about S-E-X, and build up your confidence, until, much like Jessica Day in that one episode of New Girl , you can say “penis” without giggling.

Meditation

It can be hard to identify what a “yes” might feel in your body. Try imagining a really positive memory that is non sexual. For me, it’s recreating Marcus’s chocolate cake from The Bear with some friends for my birthday. It instantly evokes warm, silly, and relaxed feelings. Now imagine something from the sex menu that is an easy “yes” for you, something you know you like, how do the feelings in your body shift? Notice this, then go back to your happy memory and reactivate those feelings. Now, imagine something on the “maybe” list. What comes up for you? How does this shift compare to when you thought of something on the “yes” list?

Is the kink-positivity in the room with us?

People will always be titillated by sex stuff, and sex is absolutely worth giggling about! But sometimes sex jokes find their punch line by making fun of kink in a way that comes across as distinctly mean spirited. For example, Nikki Glaser has a bit that conflates liking to be called “Daddy” in bed with being sexually attracted to children. Her comedic timing is admittedly hilarious, but when we laugh, share and promote this kind of content, we make it harder for our kinky friends to come out and find each other. If you’re dropping this video in the group chat to general applause, is your friend who’s into age play or ABDL left with the impression they have to keep this to themselves? As you explore your own interests, it’s ok to realize there’s a wide swatch of the sexual landscape that just isn’t for you, and you’re absolutely entitled and encouraged to communicate this to partners, but it’s important to do this in a way that doesn’t convey shame or disapproval for what other consenting adults like to get up to in the bedroom.

If you’re looking for tips on how to communicate about your interests without kink shaming, check out our article “How to Not Kink Shame Your Partner” and if you want to talk about your yess, nos and maybes with a pleasure-positive and kink-aware sex therapist, reach out! We love helping would be kinksters across Massachusetts lead joy filled lives!

A Sex Therapist's Beginner-Friendly Guide to Anal Sex

schotkowski@gmail.com — Mon, 02 Sep 2024 21:30:00 GMT

Anal sex is nothing new, but depending on your social circle, it may still carry some stigma as a sex act. Here at the Pomegranate Institute, we’re devoted to bringing you pleasure-positive, comprehensive sexual health education. So read on for a beginner-friendly guide to anal sex.

According to Data published by the CDC based on the National Survey of Family Growth, 35.9% of women and 42.3% of men had ever had anal sex. This particular survey found that queer women were more likely to have had anal sex than heterosexual women, whereas heterosexual men were more likely than queer men to have had anal sex. Other studies have found completely different rates of anal sex between heterosexual and queer men, which probably speaks to the difficulty to surveying strangers about their sex lives.

The takeaway is that anal sex is definitely happening, and probably more often than people talk about. Lack of open communication creates stigma which makes it harder to access comprehensive sexual health education and pursue pleasure without shame.

So let’s do a deep dive on anal sex, why folks might like it, and what you can do to set yourself up for success if you decide you want to try it.

Why do people like anal sex?

Notice we said “people”, and we said it on purpose, anal sex is something all bodies, regardless of gender identity or sexual orientation might enjoy. You might enjoy it because it’s an opportunity try something new with your partner and shared novel experiences are important to your relationship, or because you have a prostate and prostate stimulation activates the nerves attached to your prostate (your prostatic plexus) which feels good, or because anal sex stimulates the nerves within your vaginal wall, which also feels good. Bottom line, regardless of the constellation of parts you personally possess, you have nerve endings in that part of your body that facilitate the experience of pleasure.

So you want to try it, what next?

Good anal comes down to three things: consent, communication, and preparation. Let’s break them down.

Consent

Consent is a necessary part of all sex, and consent should be an on-going conversation, regardless of the duration of your relationship with the person you’re planning on having sex with.

There are lots of pop culture moments that make a punchline out of surprise anal sex, and while we admit to giggling at our fair share of them, it’s important to remember that this is in fact a consent violation. You shouldn’t be trying new things in bed without talking to your partner first. Consent needs to be specific to the sex you’re having this particular time. Exchanging racy and enthusiastic texts about their willingness to give anal a try, is not the same thing as someone consenting to receive anal sex today, from you.

When you talk about anal sex, be specific, are you talking about penetrating someone with fingers? Tongues? Toys? A strap-on of a particular size? A penis using a barrier method? And don’t assume it’s clear that both of you are on the same page about who is penetrating who, you both have the capacity to give and receive, so make this explicit.

Communication

Take a moment to think about your own motivation for wanting to try anal sex. Is your interest genuinely free from pressure or coercion? Is there a part of you that is worried the other person is going to be mad at you, disappointed, cheat, or end the relationship if you say “no”? If so, this muddles consent. True consent is free from coercion or pressure. If you’re the person pitching anal sex to your partner, are you hosting the conversation in such a way that supports them saying “no”? You don’t want to have to worry that someone said “yes” to appease you when they really wanted to say “no” but didn’t feel comfortable speaking up. You want to be able to trust that their “yes” is an enthusiastic yes, so if it’s not a “hell yes!” It’s really a “no” or a “not right now”.

Think about the sex you’ve had with this particular person so far. Have you felt comfortable speaking up? If you wanted to try something new, or make an adjustment, how was that feedback received? If something felt physically uncomfortable, did you say something? Or did you wait for the sex to be over? You are much more likely to have good sex of any kind with someone you’re comfortable talking to about the sex you’re having, but especially when it comes to trying something new. If you can’t say “yes” to these questions with confidence, maybe there’s some work to do on your communication before trying anal.

And let’s be honest, sometimes anal gets messy, whether that’s a literal mess, or just sitting with the vulnerability of negotiating desire and new experiences, you want to do this with someone who can do this with you. If you quite literally shit the bed in front of them, how will you feel? Are they someone who will laugh it off, help you clean up, and give you a forehead kiss, or will they be a jerk about it?

Manage your Expectations

Remember the first time you tried any kind of new sex act, did it go super smoothly? A slightly rocky start doesn’t mean you don’t enjoy that particular sex act, it might mean you need more communication, fine tuning, and practice. You are absolutely allowed to say “well, we tried it, that was not for me!” But we would encourage leaving space for the idea that most things in sex get better with a little practice.

And we’ve said this before, but we’ll say it ‘til we’re blue in the face, you’re allowed to try stuff without having to declare a like, love, or allegiance to it. Trying anal means you’re a curious, open-minded person, it does not necessarily say anything about what kind of sex you like, who you like to have sex with, or what your gender identity or sexual orientation is. Give yourself permission to try things without attaching meaning to them.

Preparing for Anal Sex

Prep should include a comprehensive safer sex conversation, lubrication, the hygiene practice of your choosing, some sort of training or foreplay, and might include recreational drugs.

Have a Safer Sex Conversation

We say “safer” sex rather than “safe” sex, because no sex act is 100% risk free, the goal is to have informed consent about what your risks are, decide what risks you’re comfortable taking and what risk mitigation looks like to you.

People who have receive anal sex are at a slightly higher risk of anal cancer than people who don’t . This is thought to be related to the increased risk of HPV infection. There are vaccines to prevent to prevent the most common strains of HPV infection, and use of barrier methods greatly reduce the risk of HPV, but it is possible for HPV to infect areas of the body not covered by barrier methods so the risk is not completely eliminated.

Anal tissue is more fragile than vaginal tissue and more likely to tear, tearing increases the risk for anal fissures, and STI transmission. Lubrication greatly reduces the risk of tearing, as well as increases the comfort and pleasure of anal sex. The risk of HIV transmission when barrier methods aren’t used is slightly higher than it is for vaginal sex . There are several strategies for reducing the risk of HIV transmission including use of barrier methods, use of post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and the use of antiretroviral therapy (ART) by the partner with HIV to maintain an undetectable viral load. When someone has an undetectable viral load they cannot pass HIV to someone else through sexual intercourse.

We encourage you to have on-going conversations with your sex partners about your testing practices, and what kinds of barrier methods you plan to use for what kinds of sex acts. Even if you are fluid bonded to your partner, and even if you are both monogamous, we still recommend barrier methods for anal sex.

You Need Lubrication for Anal Sex

The anus, unlike the vagina, is not self-lubricating. You need lubricant for safety and comfort. The kind of lubricant you choose is a matter of personal preference as well as what other products are going to be incorporated into your sex. Silicone lubricant will generally be the most long-lasting and smooth feeling, and it’s compatible with latex and non-latex barrier methods, but it degrades silicone sex toys. So you might switch your toys to metal or glass, or switch your lube to water-based. Water-based lube is safe to use with silicone toys and won’t degrade latex, but it will dry out faster and need to be reapplied. Oil-based lube is not compatible with latex barrier methods, but is ok to use with silicone sex toys.

If you’re looking for specific product recommendations as well as other gadgets that make incorporating lube in anal sex easier, check out our article Let’s Get Wet: Everything You Ever Wanted to Know About Lube .

Hygiene

There are a range of hygiene practices when it comes to anal sex, for some people it involves a shower and a wet wipe, for others they prefer to douche. If you’re curious about enemas and anal douching, we recommend trying this out on a separate occasion to figure out how to get the hang of it and how your body will react.

This article published by Self has a great “how to” guide filled with tips for douching.

Otherwise, try to have a bowel movement beforehand, but don’t stress out overmuch, feces is stored in the rectum not the anal canal. If you think you might want to add anal sex to your routine regularly, make sure you’re getting plenty of fiber in your diet, and if not, supplement! This could be something as boring as adding benefiber or Metamucil to your smoothie or protein shake, but we also love the recipes published by @bottomsdigest .

How to Warm Up for Anal Sex

We think you’ll set yourself up for success if you try a range of different anal sex sensations and see what floats your boat. And while it can be fun to explore these together with a partner, there’s something to be said for figuring out what works for your body on your own before bringing someone else into it.

There are lots of different sex toys designed specifically for anal play, make sure you’re using one of these, because they have flared based to prevent things from getting vacuum-suctioned right up there and stuck. There are toys of different shapes: like anal beads, plugs, dildos and prostate massagers toys. Toys also come in different materials like silicone, metal or glass. Some toys vibrate, some don’t. And there is an extremely wide range of sizes, shapes, colors, and concepts ranging from hyper-realistic to surreal.

If your goal is to have receptive anal sex where your partner penetrates you with their penis, you’re going to want to work up to this in terms of size. Starting with fingers (your own or a partner’s), or buying a set of plugs that allows you to gradually work up from something small to something larger is a great way to feel out if the sensation of being penetrated by an erect penis is one you might enjoy, and what steps you need to take to get there.

We’re also going to put a plug in for both partners having some idea of what it’s like to be penetrated. We think the best givers are those who have also received. We’re not saying you should only receive anal sex from people who will let you peg them but it’s helpful for the penetrating partner to have some idea of what the sensation feels like. Anal sex is a uniquely intense sensation and it can be difficult to explain it if you have no concept for what it feels like. You want your partner to have an appreciation for the sensitivity of this particular sex act.

Do You Need To Take Drugs for Good Anal Sex?

You absolutely do not need to do drugs in order to enjoy anal sex. But some folks incorporate muscle relaxants or poppers. Poppers are alkyl nitrate compounds, that when inhaled act as a vasodilator and produce a brief and mild feeling of euphoria, warmth and dizziness. Poppers can be helpful for anal sex because they cause the tissue in your anus to relax. But they aren’t totally without risk, they can lead to a precipitous drop in blood pressure during sex which can lead to myocardial infarction and even sudden death, and this risk is more likely when combined with erectile dysfunction drugs like Viagra. Other risks include glaucoma, contact dermatitis, asthma, nasal ulcers, nitrate poisoning and chemical burns.

At the Pomegranate Institute, we maintain that the decision about what substances you put in your body is your choice, and we’re not going to tell you what to do. We want you to have access to the information so you can decide what works best for you.

What's the Best Position for Anal Sex?

You might think having the receiving partner on their hands and knees, ass up is the best position to facilitate access, but we find this isn’t a particularly beginner-friendly position. We actually recommend good old-fashioned missionary, either with a pillow under the receiver’s hips, or at the edge of the bed with the person doing the penetrating standing up. These positions allow you to maintain easy verbal and non-verbal communication with your partner so you can check in throughout, and the familiarity and visibility can help you relax into it.

No cross-pollination

We love the clip of Laura Prepon explaining to her daughter on that 90s show that “once a nay-nay’s been in a nah-nah it can’t go in a hoo-hoo” and that’s the basic gist of it. Once you’ve started to have anal sex, even if you’re using barrier methods, you can’t switch to another kind of intercourse without some type of cleaning and fresh barrier. You rarely see the bathroom breaks, showers, and baby wipes in mainstream porn, but they’re a necessary part of sex to prevent infection.

You’ve prepped, now what?

As with any kind of sex, foreplay is an important part. With anal, your foreplay might include some anal-specific play. If someone with a clitoris is on the receiving end of anal sex, foreplay might look like inserting a finger or a small plug while engaging in a lot of clitoral stimulation until you’re feeling really relaxed, warmed up, and maybe even have had an orgasm. For someone with a prostate it might look like stimulating the prostate with fingers or a toy.

Speaking of prostates, we recommend trying to find yours before you try receiving anal sex for the first time. Take your finger palm up, and insert it into the anus, towards the belly button, about two inches, you should feel something sort of bulbous, that’s your prostate! To stimulate it, try a “come hither” motion (stroking upwards towards the belly button), tapping it like you’re ringing a doorbell, or tracing small circles.

Hanging out here might feel really good, and like all the exploring you want to do, if so that’s great! If you want to try more penetration, make sure you’re adding enough lubricant (more than you think you need), and talk about what “more” looks like to your partner. Is more another finger? A bigger toy? A dildo that they insert themselves? A strap-on that you wear? Your penis?

If you’re inserting a bigger plug, dildo, or penis, you’re going to encounter the initial resistance of your partner’s sphincter muscle. Slowly keep going. For the person on the receiving end, it will feel like a stretching sensation, and maybe even a pop, like you’re pulling a lollipop out of your mouth suddenly, but nothing should hurt. If you feel pain, show down, stop, back up or take a break. If you feel an intense stretching sensation and this feels okay to you, you can stop or keep going. Find a depth of penetration that’s comfortable for you, it might not be all the way, not at first. It depends on you and your partner’s parts, how relaxed you are, how much practice you’ve had, and what thoughts have been going through your head lately.

The person receiving should be the one giving feedback about speeding up, going deeper, or changing the angle. If the person doing the penetrating isn’t sure what to do next, ask!

Afterwards

Make sure you’re leaving some room to debrief after sex and post-sex cleanup are over. If you’re newer to anal sex, it probably doesn’t make sense to schedule it for right before you have to rush out the door to a parent-teacher conference. Try to carve out some time to chat about what worked well and what might need to be adjusted. Is this something you both enjoyed and want to try again?

It’s normal for unexpected negative feelings to pop up. We’re a shame-saturated culture when it comes to sex, and even if you are your partner(s) have adopted a more sex and pleasure-positive framework, you can still internalize things from the dominant cultural discourse. Since anal sex is a sex act that still carries some stigma in certain circles, your negative feelings may be indicative of this internalized shame, rather than a lack of enjoyment. Who in your life can you talk to about these experiences and get support uprooting shame from your bedroom?

Talking to a sex therapist can be a great way to explore your sexual health in a safe and supportive environment. We can help with tips and techniques and help you frame pleasure as an important part of your well-being. If you're in Massachusetts and you want to talk to a sex therapist who's down to talk about anal sex, reach out !

A Sex Therapist's Guide to Dating Mindfully

schotkowski@gmail.com — Mon, 19 Aug 2024 19:00:00 GMT

Sex therapy is all about fostering pleasure-filled connections, something that can feel hard to do in the world of on-line dating.

Dating is hard, dating in the age of dating apps where human connection is gamified is really hard! It becomes all too easy to get trapped in an endless cycle of binging on apps, feeling shame and regret, deleting the apps, getting bored, and feeling lonely. Read on for our top 10 suggestions for dating more mindfully.

Know Your Criteria

If you’re on the lookout for something specific in partnership, be honest about what that is, and how flexible or not flexible you are. When we get into a swiping frenzy, we start to lose sight of this, and our filter becomes wider and wider as we try to fill whatever need is going unmet.

If you’re only open to dating “masculine of center folx with leftist politics who aren’t allergic to cats and are working in the arts”, hold yourself to this, and notice when you start to drift away from this goal. Do you drift more the later at night you stay on the apps? Are you more likely to compromise on what you’re looking for if you’ve recently been rejected or felt the perception of rejection? It’s one thing if you change your mind because your criteria have changed “Maybe it’s not their fault if they’re stuck in a corporate job for work, so long as they have creative hobbies” but if some other external force (like loneliness) is making you shift your criteria, this is something to pay attention to.

Know Your Values

Acceptance & Commitment Therapy is a type of therapy that fosters behavior change by helping to strengthen a connection to your value system. One way to do this is to write down a list of things that are important to you about the kind of person you want to be in the dating world, and keep a physical copy of the list near you while you’re on the apps.

This might include things like “I am someone who treats people with the kindness I would like to receive”, “I am prioritizing meaningful connections over instant gratification”, or “It is more important to me to honor my boundaries than it is to be liked.”

Dating apps are designed to be really visually stimulating, we’ve had patients compare them to slot machines at a casino, and we think that’s a great analogy! Having something concrete to look at while you scroll can help you stay centered in the right frame of mind.

HALT

You’ve heard us paraphrase this acronym from our friends in the 12-step fellowship before, but it’s worth repeating: hungry, angry, lonely, tired. If you’re any of these things, it’s best to put the phone down, and walk away.

For you this might mean something as extreme as “stay off the apps when you’re having a manic episode” or something as gentle as “When I’m tired, I’m cranky, and I’m not in the best frame of mind for meeting new people with an open heart, I should stay off the apps if I’ve had a poor night sleep the night before”.

Notice what kind of states make you receptive to connecting with new people, and what kind states make this a turn-off. In general, we’re advocates of doing your scrolling sober, during daylight hours, and when you’re emotionally stable. We recently shared with Brides our suggestion that you should give yourself a 90 day window after a breakup where you stay off the dating apps for their feature “ 12 Expert-Approved Tips to Help You Get Over Someone You Love After a Difficult Breakup ”

Set A Time Limit

One recent study found that millennials spent an average of 10 hours a week on dating apps , practically a part-time job!

The amount of time you can spend per week on a dating app without getting burnt out is going to vary from person to person. It might depend on how long you’ve been on the apps this particular go around, how much screen time you have in other areas of your life, and how over-stimulating you find on-line dating in general.

It might be helpful to get a baseline of how much time you’re already spending, so you can assess whether or not this is too much and then scale back from here. This might be hard to do if you’re logging in and out over and over throughout the day. Instead, try setting aside a dedicated chuck of time as “dating app time”, and setting a timer, start with an absolutely maximum of an hour a day, and scale back from there until you find an amount of time that lets you look forward to the process and stay engaged.

Avoid Oversaturation

Our friends the non-monogamy world have the phrase “ polysaturation ” to describe the phenomenon of being someone who is open to dating multiple people, but someone who is currently “full” either because of emotional bandwidth or scheduling logistics.

Non-monogamous folks will tell you that there are all sorts of variables that determine when and how they reach polysaturation. It’s not a one size fits all approach, but you might have some general goal posts that are helpful.

Maybe this means being aware that you can hold a conversation with 2-3 different people simultaneously before the details start to blur together and your enthusiasm starts to wane. In this case, you could make the choice to not swipe for any new matches until you’ve made decisions about these existing matches.

Or perhaps you realize going on one date a week means you don’t see your friends as often as you would like, and you don’t want to prioritize your romantic life at the expense of your friendships. Think of it like lines on a coloring book page, you can make the choice to color outside the lines later on if you choose, but the outline helps hold you accountable.

If It's Not Fun Don’t Do It

There is a difference between mild social anxiety, or “first date jitters” and full-on dread. If you’re experiencing an unusual level of anxiety, misandry, or hopelessness, take a page from this quote usually attributed to Bansky: “if you get tired, learn to rest, not to quit.”

Part of mindfulness is tolerating the in-between, rather than oscillating between “all” and “nothing”. What would it be like if you set your profile to incognito mode for a week, without deleting it entirely? Could you tolerate receiving some information, but less information? What about setting your profile to “inactive” instead? Are there ways of practicing engaging with the information that dating apps offer without immediately going into a frenzy? Could you practice reading 10 profiles, and then putting your phone down and doing something else? Just as a skill building exercise?

Remember, These Are Real People

Dating apps are designed to mimic the feel of a game, and some people argue they’re designed to get you to spend more money on paid subscriptions by creating sub-par experiences that keep you reluctantly swiping. In the haze of x-ing out your standout matches and screenshotting cringe profiles back and forth with your friends, it’s almost possible to forget that these are real people on the other side of the phone.

Losing sight of the humanity of it all does not bode well for finding meaningful connections, so how do you remember that these are real people? We like imagining our matches sitting in our favorite coffee shop (implausibly dressed in whatever outfit they’re wearing in their profile pictures, of course) describing themselves the way they do in their dating profiles out loud. Something about this exercise helps us humanize them just enough to remember to extend the same courtesies that we would want extended to us as fellow human beings.

Know Your Triggers, Plan Accordingly

There’s emerging research that suggests unless your self-esteem is unusually impervious and high, dating apps aren’t great for your mental health . Knowing that the process of putting yourself out there, being vulnerable, facing potential rejection, as well as the possibility of discrimination that comes from having any or intersecting marginalized identities, can bring some tough stuff to the surface and necessitates having a plan.

Try to identify what specific pain points dating apps bring up for you, and what you’re going to do to manage them. Hint: for most of us, they exacerbate an underlying distortion that involves themes of unlovability, unworthiness, and/or hopelessness.

Let’s say for example you notice dating apps bring up fears of “I’m NEVER going to find my person, I’m going to be alone FOREVER” If you have this distortion swimming around in your brain every time you open a dating app, it’s understandably going to skew your behavior in a pretty frantic direction.

Can you use your Cognitive Behavioral Therapy skills to evaluate this distortion for accuracy and helpfulness? What evidence do you have that this belief is true? What evidence do you have that this belief might not be as true as it feels in this moment? Maybe that exercise helps you say “It’s hard to find genuine connections and I’ve had bad luck lately, but I’ve found love before, and I have every reason to believe I can find love again. The statement “I’m never going to find my person” is a fear, not a fact.”

Maybe you need to be like Collin in Ted Lasso and develop your own personal mantra, his was “I am a strong and capable man, I am not a piece of shit” and his own therapist chimed in to remind him that he didn’t need the second part.

Know The Difference Between Attraction and Attention

We’ve all seen the TikToks that start with “Am I attracted to him or is he just…” these videos capture the nuance of someone possessing a quality we find attractive (tall, texts us back, has a cute cat, seems to actually grasp the concept of intersectional feminism in a non “dog whistle” sort of way, knows about retinol, said something kind about their ex) as being distinct from being attracted to that person. One of the most common “or is he just” that we see is some variation of “they’re paying attention to me, and I like attention.”

It's tempting to pursue connections based on attention, and dating apps have evolved to incentivize this. Bumble developed a “bee line” where paid subscribers could see anyone who liked their profile ahead of actually matching with them, probably because we’re inclined to like people who we already know like us.

How can we recognize that it’s normal to like attention, and to expect attention as a normal part of the “getting to know you courtship” without letting attention have undue influence over our choices? It might be as simple as asking “would I still like this person if they hadn’t made the first move?” Or changing the way you use apps to focus on who you are pursuing, rather than who is pursuing you. Maybe this means being more vulnerable and making the first move more often, because this is a better indicator of the people you are interested in, and you’re going to wait and see if they’re interested in you. Or maybe you’re going to use your profile in “incognito” mode, so folks can’t see your profile unless you like their profile, meaning only people you’re already interested in will be able to interact with you.

A related issue is getting your butterflies mixed up. Do you feel a flutter from the kind of butterflies that signify sparks flying? Or do you actually feel anxious, and you’re mislabeling this as a attraction, because this is the emotion you’re expecting to feel on a first date?

We love Logan Ury’s viral Post-Date 8 reflection questions for helping operationalize whether or not you actually like someone well enough to go on another date with them, or are just cruising high on the vibe of positive attention.

Get Your Needs Met

There’s nothing inherently wrong with wanting attention, we love attention! It is a basic biological imperative to connect to our fellow human beings. But if this desire for attention and affection is making you behave on a dating app in ways that aren’t in alignment with your value system, this is something to examine.

If you notice that dating apps highlight how lonely you feel, then it might be worth finding other ways of getting this need met. Can you reconnect with friends or family? Try new hobbies? Be of service? Go to therapy and talk about why “lonely” feels like such a difficult emotion to tolerate?

As a thought exercise, think of you on a day when you feel really connected to your social network, how does that person behave on a dating app? Are they on the app at all? How much time do they spend there? How do they handle rejection from people they don’t know, who don’t know them? If you haven’t felt connected to your social network in a while, it’s ok to “borrow” the behavior of someone who is a bit more well-rounded, choose one of your friends who seems to have found a balance, and get curious about their dating habits, how do they do it?

If You’re Dating Differently, Share

At the risk of sounding like a cheugy millennial that would have this embroidered on a sign in their powder room “a rising tide raises all boats.” If you’re out there trying hard to date a little differently in an effort to preserve your sanity and increase the chances of fostering meaningful connections, let folks know!

It’s polite to give folks a heads up if your dating behavior is going to be different than the social norms they’ve become accustomed to. Maybe you’re going to check your messages once a day, text for thirty minutes, and say “hey I enjoyed chatting, let’s catch up later in the week, I find binging on a conversation too early on when I get to know someone hasn’t led to me getting to know someone very well in the past, so now I like to take things a little slower, are you open to that?”

If any of these mindful dating practices have led to positive outcomes for you, don’t keep it to yourself, share! We believe in spreading good dating karma, even if this person isn’t the next great love of your life, if there’s an opportunity to leave them in better shape than you found them, share what you’ve learned! We hope this positive energy comes back to you in another form.

Again, Dating is Hard

It’s hard to put yourself out there, and it’s hard to be seen and be known by another person. It’s hard to sift through the messages our culture sends us about dating that we’re trying to unlearn, while trying to tune into our own intuition, and listen a little less to our inner critic. If you add any sort of non-traditional relationship structure or kink-forward component, then there are additional sub-culture specific considerations that can be both wonderfully affirming and wildly confusing.

At the Pomegranate Institute, we’re here for all of it! The messiness, the misery, the glimmers, and glimpses of hope, and whatever else you find along the way. If you want to talk about mindful dating with a sex therapist in Massachusetts, reach out , we can’t wait to meet you!

The ABCs of BDSM Safety: Understanding Key Acronyms for Safe Practices

schotkowski@gmail.com — Sun, 04 Aug 2024 16:00:03 GMT

Safety acronyms are a cute and informative way of conveying the principles of informed consent and safety that are central to BDSM.

As a sex therapist, I'm invested in helping you find a philosophy that guides your play, so let's dive in to the history and nuance of different safety acronyms.

SSC: Safe, Sane, Consensual

SSC emphasizes that all activities are undertaken in a manner that emphasizes safety, sound judgment, and with the full consent of all parties involved.

Safe, Sane and Consensual was coined by David Stein in 1983 when he was serving on a committee of the newly established Gay Male S/M Activists (GMSMA). He recalls drawing inspiration from his childhood experience of being wished a “safe and sane” 4 ^th of July. The intention of the committee was to distinguish themselves from “harmful, antisocial, predatory behavior.” At the time, there were concerns that predatory doms were taking advantage of folks who were new to the scene, and encouraging them to push the boundaries of their own desire, comfort, and safety. David has a very comprehensive blog post on the nascent activities of GMSMA that is absolutely worth a read in its entirety.

It is crucial to acknowledge the work that our queer ancestors did to center informed consent within the community, and to make it such a visible part of their activism in the wider world.

RACK: Risk-Aware Consensual Kink

RACK places a similar emphasis on consent, but shifts the focus from “safety” to “risk-aware” because not all kink-related activities are objectively “safe”. Risk-aware asks that everyone involved take responsibility for understanding the risks involved, and deciding if the level of risk is acceptable.

RACK was first proposed by Gary Switch , best known as a contributing editor for Prometheus Magazine, a publication of The Eulenspiegel Society, the first BDSM organization founded in the United States. Reports on the details vary, I’ve heard some say RACK was first pitched on Prometheus’s USENET list, but I personally love the version of events that involves Gary pitching it on a TES-friends list in 1999.

In his own writing on the subject, he speaks about the importance of including “kink” in the acronym to make sure people are clear what exactly we’re talking about, and because it makes a “snappy” acronym.

He also points out that the “sane” part in SSC can be difficult to operationalize, what one person considers sexy another person might consider “insane” when it comes to kink play. Other BDSM activists have also pointed out that it is unintentionally stigmatizing to members of our community who live with mental illness but are still perfectly capable of consenting to kink play.

Gil Kessler, a longtime GMSMA board member clarifies in his writing on SSC that “sane” was intended to mean “knowing the difference between fantasy and reality” in the sense that “You may know how to do something, and even get consent for it, but it may be best left for one-handed reading.”

PRICK: Personal Responsibility Informed Consensual Kink

In researching this article, I couldn’t find consensus on the author of PRICK, but most sources agree that PRICK evolved after RACK.

PRICK places extra emphasis on the notion that you can’t really give consent unless it’s informed consent, and each member has a personal responsibility to seek out the information they need to make an informed decision.

Sometimes, in D/s dynamics, there is a mistaken assumption that because someone is taking a dominant position and perhaps taking more control of a scene, they have more responsibility for the safety of themselves and their scene partner(s). While it is absolutely true that thinking about safety is an essential component of being a good dom(me), this is a collaborative, and shared responsibility with all participants. PRICK makes this explicit in a way that can be a helpful reminder for folks in these kinds of dynamics.

CCCC: Caring, Communication, Consent, and Caution

CCCC was coined by Williams, Thomas, Prior and Christensen in 2014 in an article in the Journal of Human Sexuality titled “From “ SSC” and “RACK” to the “4Cs”: Introducing a new Framework for Negotiating BDSM Participation ”

The authors explain that they chose to “reframe safety/risk-awareness” under “caution” because doing so “carries less discursive baggage” and supports participants thinking about risk in ways that go beyond the strictly medical perspective commonly considered under “risk-aware”.

They choose to place and emphasis on caring and communication as values they see as essential to BDSM relationships. They are also hopeful that their inclusion will help correct “lingering misperceptions from outsiders that BDSM participation is somehow inherently abusive, violent, or rooted in psychopathology”.

The Practical Application of Acronyms

When it comes to safety acronyms, you don’t have to pick a team and pledge your undying loyalty to one, versus another. Each of them can be a great starting point for talking about how you approach safety and consent in relationships of all flavors.

If someone has no knowledge of any of these acronyms, this is something to get curious about. Is this indicative of a lack of knowledge? If so, how interested are you in playing with a newbie? I don’t say this derisively, folks that are new to the scene can bring a fresh energy that can be invigorating and help us consider things from new perspectives. But there are power dynamics to be sensitive to when one person is empowered by a lot of knowledge, and their partner is not.

What if their lack of awareness of safety acronyms is indicative of the fact that they just don’t care about consent or safety all that much? If someone has been in the kink scene for a while and they have no awareness of safety acronyms, given the accessibility of information in the digital age, this strikes me as concerning. Perhaps not irredeemably concerning, but it should prompt some serious questions about how what understanding they do have about how to center consent and safety in a kink-forward relationship.

We Hope These Acronyms Make You Think

Maybe this article provides some historical context for the acronyms you already know and love. Or maybe it offers new acronyms to add to your collection, kinksters LOVE acronyms, am I right?

Either way, whether your play is SSC, RACK, PRICK or CCCC have fun! And if this article made you want to talk more about negotiating consent and safety in BDSM with a pleasure-positive and kink-aware sex therapist in Massachusetts, reach out , we would love to meet you!

How to get the most out of your therapy sessions

schotkowski@gmail.com — Sun, 21 Jul 2024 22:00:00 GMT

With therapy costs rising and your sanity hanging on by a thread, it’s important, now more than ever, to feel like your therapy sessions are actually helping you change your life. Today on the blog we’re reviewing our top tips for getting the most out of your therapy sessions.

Take notes

A lot of traditional psychotherapy is “insight-oriented” meaning, behavior change happens because new insight is gained, but what happens if you forget all the insight you painstakingly uncovered during your therapy session?

One study found that patients immediately forget between 40-80% of information shared by a healthcare provider.

You may be more likely to remember information you yourself uncover, as opposed to information your therapist shares or recommends to you, but the risk of getting fuzzy on the details in the week between appointments is higher than you think.

At the Pomegranate Institute, we send all of our notes to our patients between sessions, so they have a written record of what was discussed. We find this enhances their recall in between sessions, and it helps make sure we’re on the same page as a treatment team.

If your therapist isn’t sharing notes with you, you can always ask, concurrent documentation, a style of documentation where the patient and therapist collaborate on the progress note together, is becoming more and more popular. If this isn’t an option, try to carve out the fifteen minutes after your therapy session to write down the three most important things you learned in therapy. You’ll be pleasantly surprised by how much these sentences jog your memory.

Manage a realistic schedule

Maybe you agreed to meet weekly because that seemed like the classic thing to do. It’s what your friends are doing, people on TV are doing, and what your therapist’s other patients are probably doing (you assumed). But if you genuinely don’t have time to give therapy your undivided attention on a weekly basis, don’t meet weekly. We have patients that meet twice a month, or even once a month. The best frequency is the frequency you can sustain.

The same goes for time of day. You and your therapist need to weigh the risk and benefit of the need for therapy relative to the disruption that it causes to your schedule. If you can’t realistically manage leaving work an hour early, excusing yourself for a long lunch break, getting up early, or adjusting your schedule in another way, don’t do it. You don’t want to wind up in the kind of therapy session where you need a therapy session to debrief about the stress attending your therapy session is causing you!

Pay your invoices

You want your therapy sessions to be about you and the projects that are most important to your mental health. Having to use even a few minutes to have an awkward conversation about unpaid invoices is not going to feel like a productive use of your time. It’s going to leave you and probably your therapist feeling guilty and a little embarrassed, and you don’t want to introduce those dynamics into the relationship if it can be avoided.

If money management isn’t your strong suit, ask if your therapist can set up your account on auto-pay, if they’re using any kind of electronic health record, this will be available with the click of a button. And remember, most therapists include a financial agreement in their consent paperwork in which you promised to make payment at the time services were rendered, and understood services could be terminated if you failed to do this.

Debrief

We love the old joke about CrossFit being an inverse fight club in the sense that people who do CrossFit NEVER shut up about CrossFit (sorry to anyone that knew us circa 2011-2014). But part of the reason CrossFit is so successful as a system of exercise is that it encourages people to remain connected to their community even when they aren’t actively WODing. So be a little like Sara Sigmundsdóttir or Brooke Ence and TELL people about what you learned in therapy.

Your brain learns best by repetition, and therapy is just one hour of about 100 waking hours a week. If you’re trying to change your life, you need to reinforce what you learned by repeating it a lot. Talking it over with people you trust is a great way to rehearse the changes you’re trying to make, and your loved ones can help hold you accountable if they see you start to slip.

Prepare

Try to give yourself a ten-minute buffer before your therapy session starts. Go to the bathroom, grab a snack, take a few deep breaths, read your progress note from last session, review the list of things you wanted to discuss this session, and decide which is the most important to cover, and try to find a few moments of internal stillness.

Try to do something that signals to your brain that you’re switching gears to a different and important time. Whether that’s lighting a candle, dimming the lights, or listening to a specific song, the ritual will help create a climate for optimal learning.

Be honest about what homework you can do

Your therapist is probably going to give you homework, which lately our field has been rebranding as an “action plan”. This might involve reflecting on a certain topic that you’ve started to explore in session, or practicing an exercise, or committing to a particular behavior change. Set yourself up for success by being honest about what you have the time and energy to work on.

If you’re working on your sleep hygiene, and you’re trying to get up earlier in the day, and you have the end goal of getting up at 6 AM every day, but you’re currently getting up at 11 AM, don’t tell your therapist you’re suddenly going to get up at 8 AM every day when you know you’ve been feeling depressed and exhausted lately. Instead, say that you could realistically get up 15 minutes earlier three times in between now and when you see her next.

This will save you the crummy feeling of having to say, “I didn’t do it” or “I forgot” when your therapist says “So how did it go?” at the start of your next session. A theme we’re repeating a lot here is the importance of small, sustainable changes.

HALT

An acronym we’re borrowing from our comrades in 12 step fellowship is H.A.L.T. which stands for Hungry, Angry, Lonely, Tired. As you’re getting ready to go to therapy, check in, do you need to grab a quick snack, or something to drink? Virtually every therapist I know is going to say they would rather see you eat and drink during therapy rather than be hungry and thirsty to the point of being distracted.

If you’re feeling sleepy to the point of it negatively impacting your session, are you within the window of time where it’s ok for you to have a boost of caffeine? Will a snack help with this feeling? A couple jumping jacks? Energizing ice pack to the back of the neck? Or is this good feedback moving forward that the 8 AM session you scheduled thinking it would help kickstart your week is just going to be filled with yawns?

Be realistic about what privacy you have access to

Most therapists have encountered the unexpected session being conducted from a bathroom, car, or Starbucks parking lot, and we’re no strangers to kids popping in. This isn’t meant to call out any patients who have run into unforeseen emergencies and had to pivot at the last minute. We get it! We’re fine with it, we’ll make it work and we want to see you!

But we are curious about what the plan is for your regular, scheduled therapy session and whether this plan supports you have access to the kind of privacy you need to talk about the kinds of things you need to talk about in order to get the maximum benefit you deserve.

Be realistic about the relationship

Whether or not you like your therapist matters more than you might think it does. Countless studies have documented that the strength of what we call the “therapeutic alliance” is one of the strongest predictors for good treatment outcomes. Said another way, therapy won’t be as effective if you don’t vibe with your therapist.

If you don’t like your therapist, you should stop seeing them and find a therapist you like better. This is much easier said then done, we know, but we hate to see you waste your time, energy, and financial resources on something that isn’t working well. For tips on how to end a relationship with a therapist check out our article “Break Up With Your Therapist (But Not ‘Cause You’re Bored)” and for help finding a new therapist try “How Do I Find a Therapist”

At the end of the day

Therapy is an investment in yourself, and with a few small adjustments, the time and money you spend can be put to work working a little harder so you can live your best life. If you’re ready to work with a therapist who will work as hard as you, reach out , we’d love to meet you.

10 Things My Therapist Says All the Time

schotkowski@gmail.com — Fri, 05 Jul 2024 15:00:02 GMT

From the sweet, to the silly, to the absurd, a good therapist zinger can make you stop and think long after your shawl wearing, bespeckled friend of Freud (or whomever you’re choosing to accompany you on your journey to the inner sanctum of your mind) has finished delivering them with a quirk of her eyebrow. In honor of all things cliché, here are a few of our favorite therapist expressions

Feel it to heal it

We work with a lot of over-thinkers in our practice, who don’t necessarily love hearing this. They’ve become masters at understanding their feelings, but they prefer not to dwell on them. They’ve reaped the maximum benefit of insight-oriented psychotherapy, they see the connection between having a parent who was emotionally distant and having a string of partners who aren’t ready to commit to a long-term future, and they’ve made a very logical game plan for breaking this pattern. But sometimes it feels like something is missing.

Experiencing the full spectrum of human emotions, even distressing ones, even ones that make us feel vulnerable is part of how we heal. So many of us were taught that weakness, crying, bad, giving in, moping.

Facts aren’t feelings

The Pomegranate Institute specializes in Cognitive Behavioral Therapy, a type of therapy that emphasizes detaching and detangling from the thoughts you have. Just because the thought pops into your head, doesn’t make it true. CBT just because you think it, doesn’t make it true. Alice (of Alice in Wonderland) even goes so far as to say: “Sometimes I believe in as many as six impossible things before breakfast.”

In our practice, we work with our patients on drawing a distinction between feelings and facts, sometimes you feel like a “useless waste of space” but this doesn’t make it true. Part of our job is to help create a little bit of a buffer between these thoughts and your sense of sense and what you know to be true about yourself.

Find out before you flip out

In the eight episode of the third season of the infinitely quotable Ted Lasso, Ted is having a meltdown because he has leapt to the conclusion that Jake (the couples’ former therapist) is going to propose to Michelle (his ex wife) on their trip to Paris. He is explaining his reasoning to the Diamond Dogs, who are at first sympathetic to how difficult its going to be for Ted to watch his ex-wife get re-married, but then they realize Ted is getting worked up over a hypothesis that he hasn’t actually confirmed, leading Trent to say: “Ted. You can't worry about something that hasn't happened yet. And Higgins to add: “Ooh, what he said. If anything, you should find out before you flip out”.

Confirmation bias is a kind of thinking error where we start to focus on information that confirms the bias we are already holding, while also discounting any evidence to the contrary. “Finding out” would require us to slow down and try to collect information without attributing meaning to it, something that are, understandably, pretty bad at.

In the end, Michelle doesn’t get engaged to Dr. Jacob (thank goodness) and Ted gets some much-needed redirection about enjoying his time with Henry rather than fixating on an outcome he can neither predict nor control.

Right now doesn’t mean forever

Cognitive Behavioral Therapy teaches us to be on the lookout for certain patterns in our thoughts called “thinking errors” that can exacerbate how crummy we feel about ourselves, others, and the world around us. Overgeneralization is a kind of thinking error where we make a rule or an expectation with a limited amount of information. For example, if we’re struggling with a painful injury, we might have the thought “This is going to hurt forever” or if we’ve just been chastised by our boss we might have the thought “I never do anything right”.

“Right now doesn’t mean forever” reminds us that the moment we’re in right now isn’t necessarily a representative sample of what our life has been like and will be like. It’s a reminder to slow down and not make a prediction based on the single moment you’re in right now, especially if the moment is emotionally significant.

It’ll pass

We are unabashed Fleabag stans at TPI, and this last line from the hot priest is devastating in its degree of emotional honesty and quotability. There is an acknowledgement that the love they share, while real, isn’t enough to change their circumstances (it’s God, isn’t it?). It also speaks to the idea that it doesn’t have to be permanent to be worthwhile. It will pass, but boy was it glorious at the time.

The good stuff will pass, the bad stuff will pass, the hot priest reminds us to enjoy the moment we’re in without clinging on to it too tightly.

If you can name it, you can tame it

While we’re on the subject of Fleabag, for those of our patients who are “ big readers with no friends ”, and lovers of the fantasy genre, the notion that names have power is not a surprising one.

Likewise, for our patients who attend any kind of 12 step programing , there is an emphasis placed on naming the nature of a problem as the first step in someone’s journey.

In our work as a Cognitive Behavioral Therapist, we place a lot of emphasis on identifying thinking errors as the first step in evaluating them for accuracy and then modifying them, or “catch it, check it, change it” if we’re being extra pithy. The point being, regardless, of your fandom, or theoretical orientation, naming is an important part of the process.

What is grief if not love persevering?

We did not have the Marvel Cinematic Universe saying something devastating about grief on our bingo card, but here we are! Few pop culture moments have made their way as deeply into the therapy space as the moment when Vision and Wanda are discussing the death of her brother, and Vision says: “Because it can't be all sorrow, can it? I've always been alone so I don't feel the lack. It's all I've ever known. I've never experienced loss because I've never had a loved one to lose. What is grief, if not love persevering ?”

We’ve heard from countless palliative care and hospice social work colleagues who were floored by this scene when they first saw it and have continued to use it with their patients and families ever since.

If it’s hysterical, it’s historical

We don’t love the inherent misogyny in the use of the word hysteria, but we do love an excuse to explain the etiology of this condition. Hysteria comes from the Greek word hystera for womb. The diagnosis pre-dates psychology, but was popularized by early psychoanalysts like Freud, who believed the physical suffering of women could best be explained by their unfertilized womb wandering around their bodies in search of sperm. If you were having migraines for example, it was because your womb had migrated to your head. The cure was sometimes rest or hypnosis, but more often a recommendation for pregnancy.

Colloquially, hysteria evokes a certain ungovernable emotional excess, and there is always an implied feminine quality to this unseemly display of emotion.

Buried under this pile of sexism, is a reminder that if we are having a reaction to something in the present that feels outsized, it may be because we’ve hit a pain point that is historical, and it is this historical pain point we need to revisit.

Nothing changes if nothing changes

Our friend Taylor over at TDHC Counseling Services ( TDHC Counseling Services - Taylor Hilst Cardelli ) loves this phrase because it points out our inherent resistance to change and reminds us that “if you want something different for yourself you *must* do something you haven’t done before, which may mean doing something outside of your comfort zone.”

Be curious not furious

Our very first social work supervisor passed this expression down to us and it remains a favorite, nearly fifteen years later. Curiosity is a powerful antidote to all sorts of grubby emotions, including anger that we’re a little too quick to jump to.

Since we’ve already opened the pop culture floodgates in this article, we’ll also point out that Ted Lasso does a beautiful monologue about curiosity while he trounces Rupert at darts in Rebecca’s defense during the first season, though he uses the Walt Whitman quote: “Be Curious, Not Judgmental”

You’re not healing to be able to handle the trauma, you’re used to that, you’re healing to be able to handle the joy

This one is making the rounds on social media, and while we’ve seen it a few times, we haven’t been able to trace it to a specific content creator, so if you know, let us know, we’d love to give them credit!

We love this one, because it speaks to something we see in our practice every day, our patients who come from trauma are very practiced at it, they’re very comfortable and steady in disaster, even to the point of feeling like they thrive in it. Sometimes they are less comfortable with the notion of thriving in the calm. We tell our patients that we want them to retain the skill set of being steady in a crisis, while also being able to let their guard down in moments of true joy.

Did we miss any cliché but useful therapist catch phrases?

Does your therapist use a different phrase that you love, hate, or love to hate, but secretly love? Let us know! And if you’re looking for a therapist who will help you make real, sustainable changes while dropping the occasional zinger, reach out , we can’t wait to meet you!

How to Overcome First Date Anxiety: Tips from a Sex Therapist

schotkowski@gmail.com — Fri, 21 Jun 2024 15:00:02 GMT

First dates… Just typing the words made us walk away from the keyboard in search of a sweet, beautiful baby cat to kiss on its cute little cat head. We talk to so many patients who DO NOT want to go on a first date but do want to find love and connection. And with relationship violence a real risk, especially for folx who inhabit marginalized identities, it can genuinely feel like dating is not worth the risk. Today on the blog we’re covering what anxiety is, what it looks like on dates, and how to mitigate it.

What even is anxiety?

Anxiety is a combination of two things, an overestimation of the severity of a threat, and the underestimation of our ability to cope with a threat. That is not the same thing as saying NO danger exists in the world of dating, but it is important to recognize that our brain is exaggerating the likelihood of our feared outcome coming true.

What is your feared outcome? And how likely is it?

To paraphrase a famous Margaret Atwood quote, Men are afraid that women will laugh at them, women are afraid that men will kill them. This gruesome reality is probably part of what makes you anxious and we’re not going to blow a cloud of toxic positivity smoke at you and try to tell you that this reality doesn’t exist.

But we are curious, what else are you worried about? Is it tripping on the sidewalk in your new heels because you didn’t break them in? Pooping your pants because IBS + first date jitters + a spicy margarita + a jumpsuit you need to be a contortionist to unzip is not a great combination?

Take a minute to evaluate the likelihood of your feared outcome. Maybe the answer is something as simple a wearing platform wedges instead of stilettos, or ordering a mocktail, wearing a black maxi dress and carrying a spare pair of underwear in your purse.

Hope for the best, prepare for the worst.

We once saw an Instagram post lamenting the reality of being attracted to your only natural predator, and it hit us like a ton of fucking bricks. Sometimes it can be really hard to cultivate the dialectic of being aware of the potential danger of dating AND cultivating a sense of romantic optimism.

Whenever possible, do both. Share your location with multiple friends AND daydream about whether you would look better in a mermaid silhouette or suite with a crop top on your wedding day. Be open to meeting new people AND take that self-defense class, carry pepper spray in your purse, and give yourself permission to bail the first time someone says something that gives you the “ick” without worrying that it makes you look “rude” or “crazy”. Be furious that sometimes this still isn’t enough, and people, predominantly women, women of color, and queer folx, are still scared, hurt and sometimes killed.

Surf the wave

High anxiety, especially the kind associated with panic attacks tends to peak in intensity and then dissipate after about 10 minutes. But when we describe our dating anxiety, we tend to insist the entire dating experience is dreadful from start to finish. Its probably more realistic to say that most parts are uneventful, a few parts are pretty good, and one or two moments are intensely anxious. Try to identify the specific moment that causes you the most anxiety and brainstorm ways to mitigate your specific pain point.

For example, we once worked with a patient who realized her anxiety centered around the worry that she wouldn’t recognize her date and that the resulting social interaction of walking around a coffee shop looking for them would be too awkward for her to handle. So she started showing up early, and sending a text with very specific directions of where she was sitting and what she was wearing, which saved herself and her date from this jittery moment. She also started tracking her anxiety at various moments across different dates and noticed that it spiked sharply at the beginning, and then almost completely dissipated. She had been describing herself as a “very anxious” dater, when her anxiety only represented a fraction of her dating experience.

Opportunity to practice saying “no” when stakes are lower.

We work with a lot of patients who are recovering perfectionists and people pleasers. They are pouring their hearts and souls into the gloriously painful work of setting boundaries, something that is very hard to do in established relationships.

A wonderful thing about a first date is that it can be an opportunity to practice saying “no” and setting boundaries when the stakes are lower. You don’t know this person, do you really care if they like you? (Yes, we know you care, you care about everything, but you’re working on caring less, right?)

So maybe your main objective is going on a first date and being open to making a genuine connection with another person, but what if you also took the opportunity to try a low-stakes “no”? Try saying: “I’d actually prefer to sit at a table” when they suggest sitting in the bar or telling your server that they did in fact get your order wrong. If you decide not to see them again and you think it’s reasonably safe to do so, consider sending that text that says: “thank you for dinner Tuesday night, you were right, the wine selection was amazing! I wanted to be up front and say that I don’t see this going any further, I felt like the way you talked about your ex was a little mean spirited and if that’s the way you talk about women on a first date then I don’t think we’re going to be a good match.”

Setting and holding boundaries on first dates will help you work up to adjusting the boundaries you have been holding in existing and meaningful relationships. It gives you a chance to workshop what works and doesn’t work, and to recognize that the sky will not in fact fall down if you say “no” or “I don’t like that”.

Can the before or the after be fun?

Maybe you don’t like dates, and that’s ok, being in a partnership with someone, and going on casual first dates are very different things. While you wait for one to turn into the other, can you make the process of dating fun, even if the date itself isn’t?

Could you invite friends to come over and hang out while you get ready? Could you plan an extra luxurious bath or topping laden pizza when you get home?

Adjust expectations

We have a patient who says that any date where she A.) doesn’t get murdered and B.) learns one new thing is classified as a good date. In her case, her curiosity is a stronger motivator than her anxiety. This is a vastly different definition of success than “I’m going to meet the love of my life today”. But it means she is genuinely delighted to learn that waffle towels really do dry faster, or that she doesn't need to call a plumber to install a bidet, she could definitely do it herself.

Feel free to borrow hers, or find your own definition of success like “my winged eyeliner matched on both sides today and I didn’t cry it off” or “I found a great new restaurant I’m going to take my friends” or “I confirmed pickeball is a sport I would never willingly play again”.

Pay attention to how your anxiety clouds your interpretation of a date

As much as we're encouraging you to adjust your expectations for the sake of mitigating your anxiety, it’s also important to notice how anxiety may be warping your expectations.

For example, if you’re feeling proud of yourself for combatting your anxiety and going on the date anyway, is this giving you the mistaken impression that you really like the person, when you just like yourself?

Is it possible that you’re considering going on a second date because a second date is less anxiety-provoking than a first date, and you really don’t want to have to go on a first date again? Do you really want to feel like you’re “winning” dating, by locking someone down? Notice if your motivations for continuing a connection are less about the specific person and more about the pressure you feel to advance the relationship.

Find a system for evaluating your dates

Logan Ury a behavioral scientist and Director of Relationships at Hinge developed something she called the Post Date 8 to help people evaluate first dates, questions include: 1.) What side of me did they bring out? 2.) How did my body feel during the date? 3.) Do I feel more energized or de-energized, than I did before the date? 4.) Is there something about them I’m curious about? 5.) Did they make me laugh? 6.) Did I feel heard? 7.) Did I feel attractive in their presence? 8.) Did I feel captivated, bored, or something in-between?

To wrap it all up

It is more than ok to get anxious at the thought of going on a first date, and we wouldn’t blame you if you decided to have a good hurkle-durkle instead. If you do decide to venture out, we hope these strategies help you negotiate your anxiety so you can focus on deciding whether or not the person lucky enough to be sitting across from you is worth your time. And if you’re looking for someone to spill your dating tea to, and get professional strategies for managing anxiety, reach out, we’d love to help!

Cut Yourself Some Slack: Strategies for Being Less Hard on Yourself

schotkowski@gmail.com — Thu, 06 Jun 2024 15:00:00 GMT

If we were making a list of phrases we use most often in therapy, “cut yourself some slack” would definitely make our top 10. In our practice full of anxious overachievers who think perfect can and should be achieved, we say it a lot. Since this is way easier said than done, we’ve compiled 10 of our favorite strategies:

How much responsibility do you actually have for this?

It’s not uncommon to assume too much responsibility for something when it goes poorly and too little responsibility when it goes well! Is it actually your fault that the project failed to launch by the target deadline? Or was there a combination of complicated factors, some of which are totally outside of your control? Try making a pie chart and assigning yourself a piece of the pie that represents how much responsibility you feel like you have, and then, after you evaluate your distortion, how much responsibility really own.

You’re probably not the worst

You very well may have made a mistake, but was your mistake dangerous, oppressive, and/or harmful? If it was, yes, you have some serious work to do. If it wasn’t, and it was just garden variety “not great” try to remember you aren’t a supervillain from a Bond film actively out here trying to ruin peoples’ lives. Sometimes making a list of cartoon villains in your head as a comparison point is helpful. That doesn’t mean behavior up to this line is automatically excusable, but it might help to have a counterpoint to your propensity to assume that you are simply the “worst” any time you make a mistake.

You’ve done well in the past

It’s tempting to let this VERY bad thing overshadow the rest of your life to such an extent that you become temporarily convinced you’ve never ever done anything right in your entire life.

Try writing down a list of both wonderful things and regular old reasonable things you’ve done lately. If you’re having trouble with this, ask a friend.

If you couldn’t do it, can it be done?

In the Brothers Grimm version of Cinderella, her stepmother tells her that she can only go to the ball if she picks all the lentils out of the ashes of the fireplace in two hours. This is supposed to be an impossible task, not a task that a super industrious, careful person can accomplish, its only through the intercession of the turtledoves that nest in the tree planted on her mother’s grave aka MAGIC that that she is able to do this and go to the ball.

If you made a mistake, is it because you were set (or set yourself) a “lentils in the fireplace” kind of task, where there is no way a regular person could actually accomplish it? If so, this is not your fault!

You’re a person, not a robot

Maybe it can be done without magical intercession, but can it be done without sleep, food, rest, breaks to see your loved ones, breaks to move your body, and breaks to see what tiktoks have made their way over to Instagram?

Your spreadsheet of deadlines might have forgotten to take in to consideration that you need slightly more maintenance than a succulent. Adjust accordingly, and try to remember that rest is a necessary human function, not “being lazy”.

You’re aiming for sustainable, not perfect

Maybe you can do it, but you can’t do it all the time, and this has you feeling really crummy. Maybe you used to be able to do it, but you can’t do it right now, and not living up to your own hype doesn’t feel good.

This life is a marathon, not a sprint. We’re trying to come up with a plan that feels sustainable for the long run, and perfectionism is rarely that. I like the analogy of a marathon because we would never say a marathon runner is lazy, but they’re clearly adjusting their pace for the length of the race. Adjust your pace to what you can sustain!

Whose voice is it?

Our inner critic is rarely our own voice. Whether it’s a parent, our boss, our 2nd grade soccer coach, or our very own Miranda Priestly, someone once upon a time told us we needed to do better, and we took it to heart. As children, young people, and people newer to the work of healing, it’s understandable that we internalized feedback from trusted authority figures without much thought. But as people who are further along in our journey now, we get to reevaluate this.

Maybe the people who told us to “do better” “try harder” “toughen up” “stop crying” and “get it done no matter what” were wrong, or wrong some of the time. Try asking, “how well is that working out for them?”

Who profits off your shame?

If the patriarchy, capitalism, racism, heteronormativity, fatphobia, or any other ism benefits from you feeling ashamed of yourself in this moment, and you are actively working on deconstructing these forces in your life and in the world, then part of fucking up the system is returning this shame back to sender.

Remember where you used to be

While healing isn’t linear, and you may be on a little bit of a backslide right now, there’s a version of you in the past that wished and hoped to be where you are now.

Check in with this version of you, look at photos, read old progress notes, messy Instagram captions, anything to remember that you’ve made progress and are probably going to continue to do so.

What would you tell…

We’re usually much nicer to our loved ones than we are to ourselves. What would you tell your best friend if this happened to them? What would you tell the overall-wearing, front-bang having bespeckled version of you at age six? Why do they deserve kindness and gentleness and you don’t?

To summarize

Without knowing you, and the specifics of your situation, we’re pretty confident in saying you deserve to cut yourself some slack. We hope these exercises help you get started, and if you need more support and you live in Massachusetts, reach out, we’d love to help!

How Do I Find a Therapist?

schotkowski@gmail.com — Thu, 23 May 2024 15:00:01 GMT

If we’re being honest, we’re tired and overwhelmed just typing the title of this article. Finding a therapist is exhausting. Finding a therapist who seems reasonably qualified, has openings, will call you back, and who you vibe with? Seems impossible. We’re going to do our best to offer some tips to make this process a little less grueling, may the odds be ever in your favor !

Where to look

Google

When you google “therapist + near me + keyword that describes your problem” your search results are going to depend on two things: google ads and search engine optimization. Therapists can pay to have their website pop up at the top of your search window, this doesn’t mean they are the most qualified, it means they paid to be there.

Letting google ads guide your search isn’t necessarily a bad thing, therapists who are investing in a marketing plan that speaks to a specific niche probably do have some advanced training, qualification, or dedication to serving that niche.

Search Engine Optimization is a little more complicated. SEO is the process of making your website more visible in search engines like google. It involves trying to understand the algorithms used to rank websites. Writing an article like this, where you hope a prospective patient will google “how to find a therapist” and google will rank your website as legit enough to show up on the first page of search results, is one way that SEO helps therapists and patients find each other.

Directories

Psychology Today: Psychology Today is a website that the vast majority of therapists in private practice will have profiles on. Therapists pay a monthly fee for their profiles, and you can narrow down your search results by town, type of therapy, insurance, gender of the therapist and price.

Unfortunately, there doesn’t seem to be much rhythm or reason to how Psychology Today ranks the order in which it shows you therapists. There is no way to filter out therapists who say their practice is full, and it can be overwhelming to try to sift through hundreds of different profiles.

Niche-specific websites

There might be other websites that exist to find therapists who specialize in your specific reason for seeking treatment. At the Pomegranate Institute, we specialize in treating folx with erotically marginalized identities. You can find us on our website and psychology today , and we maintain profiles on the Polyamory-Friendly Professionals Directory and Kink-Aware Professionals Directory .

Asking for recommendations

People are seeking therapy in historic numbers , with some estimates suggesting that as many as 1:4 adults have sought therapy in the last 12 months. On the one hand, this means therapists are seeing a greater number of referrals than ever before, and on the other hand, it means you have a wider pool of people to ask for recommendations.

All therapists will have policies about managing what is called “dual relationships” in treatment, and part of what this means is that they won’t see someone who is closely connected to an existing patient, to maintain appropriate privacy and boundaries. But every therapist will draw this circle a little differently. You probably won’t be able to see the same therapist as your sister, or your best friend, but your cousin? Your hairdresser? That nice lady at the gym who always re-racks her weights?

If someone has an amazing therapist, you can also ask them to ask their therapist for recommendations. Most therapists have supervisors, colleagues, and friends that are also therapists and we’re happy to provide suggestions if we think we know someone who might be a good fit.

Calling your insurance company

If you’re going to try to use your insurance for therapy, you can call them and ask them for a list of local providers. They don’t maintain detailed information about the specialties or availability of these providers, and many patients find that this list is out of date and confusing. The term “ ghost network ” was coined to describe the phenomenon of insurance companies maintaining what looks like a robust referral list that is actually filled with inaccurate or misleading information, with some advocates alleging this is done deliberately as a cost saving measure.

Speaking of my insurance, why does it seem like no one takes my insurance anymore?

An increasing number of therapists have stopped taking insurance. Reasons include:

Failure for insurance reimbursement rates to keep pace with expertise, inflation and cost of rendering services
Administrative hassle: the paperwork required to submit insurance claims is extensive and time-consuming and it can take months for insurance companies to pay claims even when the paperwork is submitted the same day as the patient is seen
Privacy: there are certain situations where your insurance company can request to audit your therapist’s records to ensure they are following the rules. Some therapists choose not to take insurance to offer their patients an increased degree of discretion.

If you can’t afford the out-of-pocket costs of seeing a therapist, some therapists have what is called a “sliding scale” where they will offer one or two slots a week at a deeply discounted rate to people who cannot otherwise afford their services. Not all therapists advertise this, so you may need to ask to see if this is an option.

Community mental health centers may have grants to support sliding scale therapy on a broader scale, and may even extend this coverage to people who have health insurance, but have a prohibitively high deductible. Open Path Collective is a not- for-profit that matches therapists willing to offer deeply discounted ($40-70 per session) treatment with prospective patients.

If you feel overwhelmed looking at the options, here are some considerations that might help narrow it down.

The kind of therapist:

The letters immediately after someone’s name will tell you what kind of license they hold, examples include:

LCSW/LICSW: Licensed Clinical Social Worker and Licensed Independent Clinical Social Worker
LMFT: Licensed Marriage and Family Therapist
LMHC: Licensed Mental Health Counselor
MS, MA or MSW: this indicates someone has a master’s degree in a therapy-related field, but they don’t have a license. This most likely means their degree is new (less than two years).
PsyD/PhD: Clinical Psychologist, a PhD involves a training program that is slightly more research oriented, whereas a PsyD program is more clinical. PhD programs tend to be more competitive and PsyD programs are a newer kind of degree.

The staff at The Pomegranate Institute are Licensed Independent Clinical Social Workers, meaning they have a master’s degree in social work, and have practiced for at least two years under the supervision of a more senior social worker and passed two exams and are now licensed to practice independently. Social work is a kind of therapy that tends to emphasize a social justice stance and the importance of understanding someone’s mental health in the context of their environment.

Level of licensure

Some therapists have master’s degrees in their field, and some have doctorates. A doctorate doesn’t necessarily mean a therapist has more clinical experience than someone with a master’s degree. Doctorate programs often include considerable training in psych testing or research, so it’s important to consider how long someone has been in practice in addition to their degree.

Theoretical orientation

Theoretical orientation describes what kind of therapy a therapist practices. Some therapists will say they are “eclectic” meaning they do a little bit of everything, and some will specify expertise in a specific kind. Modalities you will see frequently include:

CBT: Cognitive Behavioral Therapy is a type of therapy that focuses on the relationship between situations, thoughts we have about a situation, and how we feel. CBT assumes that distortions in our thinking can have a negative impact on our mental health, and treatment focuses on evaluating these distortions for accuracy and helpfulness, and trying to identify and modify their underlying core beliefs.

EMDR: Eye Movement Desensitization and Reprocessing is a kind of therapy that was developed to treat how traumatic memories are processed and stored in maladaptive ways as part of disorders like Post-Traumatic Stress. EMDR involves watching a ball bounce back and forth on a computer screen, or holding vibrating paddles (among other strategies) while targeting specific experiences.

Psychodynamic: Psychodynamic psychotherapy involves exploring the connection between past significant life events and present functioning. This treatment assumes that this insight is incredibly therapeutic and will help you change your behavior moving forward.

Since Smith College School for Social Work is psychodynamically oriented, it’s a popular modality in the Pioneer Valley, where the Pomegranate Institute is located.

DBT: Dialectical Behavior Therapy was developed to treat Borderline Personality Disorder. It involves 4 modules: mindfulness, balancing the dialectic of acceptance and change, improving distress tolerance and interpersonal effectiveness.

Somatic Therapy: Somatic Therapy focuses on the connection between mind and body and emphasizes the use of body-based strategies for healing.

IFS: Internal Family Systems involves exploring the different parts (exiles, managers and firefighters) and the relationships between the parts are core self (protection, polarization and alliance)

Generalist versus specialist

In school, most therapists are trained to provide basic interventions to a wide range of people, and most entry-level jobs will focus on doing the same, providing standard therapy to the widest range of people possible. Some therapists will continue to stay broad in their focus, and other therapists will pursue advanced training in working with specific patient populations in specific ways. How important to you is it that your therapist is well-rounded versus an expert in something in particular?

The Pomegranate Institute focuses on treating patients with erotically marginalized identities, like people who are LGBTQ, have kinks, fetishes, are involved in sex work or practicing ethical non-monogamy.

If I find a therapist with openings, what questions should I ask to determine if they’re the right provider for me?

“What experience do you have treating people with my specific reason for seeking services?”

This will help narrow down whether you are seeing someone who has an awareness or expertise in treating the projects that bring you to therapy.

“How many years and what kinds of experiences as a therapist do you have?”

Knowing that your therapist is experienced is helpful, but it might also matter to you that your therapist is of your same generation, has lived experience with the project that brings you to therapy, or shares certain marginalized identities with you. Some therapists will make this an explicit part of their marketing, and some will be more reserved about disclosing this information.

“Do you have someone that you see for supervision, consultation, or your own personal therapy?”

It might not be a full blow red flag if the answer is “no” but we consider some kind of professional support to be an essential component of good therapy. Do you really want to work with someone who makes recommendations they don’t road test in their own life?

“What steps will you take if I experience a psychiatric emergency?”

All therapists have a legal obligation to intervene in cases where their patient is at risk of imminently ending their life, someone else’s life, or their patient discloses knowledge of child abuse, elder abuse, or the abuse of a person with a disability. This mandate supersedes their obligation to protect patient privacy, and they may take steps like calling the police, calling your emergency contact, or calling the applicable state agency.

Understanding how a therapist handles crisis situations, how comfortable and familiar they are working with people who experience suicidal thoughts or have a history of suicide attempts will help you determine if this therapist is the right one for you.

“What is your cancelation policy?”

Requiring 24 hours’ notice if you need to cancel or reschedule is fairly standard. Some therapists will charge their full session cost for sessions canceled outside of this window, and some will charge a reduced fee. Some therapists will make exceptions for unavoidable emergencies, and some will not. It’s not uncommon for a therapist to say “I won’t charge the cancelation fee if we can reschedule for something that same week.”

“What does your rate cover and not cover?”

Does the therapist charge extra for between session phone calls? Consultation with your former therapist? Collaborating with your couple’s therapist? Or are these things included in the session rate?

“What kind of availability do you offer in-between sessions?”

There are privacy laws that govern how therapists can communicate with their patients outside of session, but there’s some wiggle room in how the particulars happen between providers.

We have a patient portal that allows our patients to send us secure messages in-between sessions, we utilize this rather than email or text message. We are happy to discuss scheduling or progress on the week’s action plan over portal message but may suggest a phone call or extra session when it seems warranted.

“What kind of access to my medical record will I have?”

New rules like Disincentive Penalties for Information-Blocking Providers and the Cures Act have increased the access that patients have to their medical records, but therapists will have different processes for facilitating this access.

We choose to send our patients the progress notes we write after each appointment so we can make sure there is consensus about what we discussed and what we’re recommending. We think reading these progress notes helps reinforce the insights our patients gained during their appointment, and this way, they can focus on the session itself, rather than trying to take their own notes.

At the end of the day…

As much as we love a good spreadsheet, nothing beats meeting someone (virtually or in person) and sussing out whether they are someone you could see yourself building a relationship with.

Researchers call the relationship between therapist and patient the “therapeutic alliance” and there’s some good data to support the notion that the strength of this alliance is not only a good predictor of therapy outcomes , but might actually matter more than other variables like type of therapy or therapist experience.

If this article has peaked your curiosity about whether or not our staff would be a good fit for you, and you live in Massachusetts reach out! We offer a free 30-minute consultation so prospective patients can ask questions like these and get to know us.

Break Up with Your Therapist (But Not 'Cause You're Bored)

schotkowski@gmail.com — Tue, 07 May 2024 15:00:00 GMT

Finding a therapist is hard. You google, ask friends for recommendations, and spend hours ironing out the logistics of “Do they take my insurance?” “Are they an expert in helping people like me?” “Do they have an openings that fit my schedule?” and “Will they ever call me back?” When you finally do find someone, it can be tempting to cling on to them for dear life, but sometimes, you need to let them go. Breaking up with your therapist, much like any other kind of breakup is no picnic. Today on the blog we’re exploring the whys and hows of ending therapy.

Let's start by talking about some of the reasons you might be ready to stop seeing your therapist

Expense

Therapy can be expensive. You may be paying out of pocket for services, or have heath insurance plans with high deductibles that require you to pay the entirety of the session fee for months at a time. Ending therapy for financial reasons isn’t the same thing as saying therapy isn’t worth the money, you may just not have it in your budget.

Scheduling

Maybe you really tried to make that Wednesday 3 PM time slot work, and it just doesn’t. Maybe getting to the appointment leaves you cranky and frazzled, and you need a therapy session to unpack how stressful getting to your therapy session is.

Reaching a plateau

You may have accomplished what you initially set out to accomplish in therapy, and while you still enjoy the process, it may feel like you’re spinning your wheels a bit. Maybe this is because the work that needs to be done next is work you feel ready to do independently, or maybe you need to consult with someone who has a different training and expertise.

Misaligned values

You might have learned something new about your therapist mid-way, or you might have hoped that something wouldn’t matter much and it turns out it does. It’s ok to say you want to see a therapist that shares certain values, and only you can decide how much emphasis to place on shared values and experiences.

Ethical violations

Therapists are not exempt from making mistakes or bad decisions. Sometimes these ruptures offer an opportunity for repair and meaningful amends that can strengthen the relationship, and sometimes they’re just plain unacceptable.

Vibes

Something is off, on paper, everything lines up, your therapist is qualified to address the things you want to work on, they are a reasonably pleasant person, and they ask the right questions, but something still doesn’t feel right. If you can feel this energy, chances are, your therapist can too. While it may be hard to explain, vibes are a perfectly good reason to move on and look for a different provider.

Ok, I want to stop seeing my therapist, how do I do it?

Sitting with it

First, let's check, are you sure? Is this a decision that just occurred to you? Have you been feeling this way for a while? Across different feeling states? Do you feel ready to manage your intrapsychic life on your own, or start the process of finding a new therapist? Have you talked about this decision with people you trust? If you're saying "yes" a lot, it might be time to move on.

To ghost or not to ghost?

Should you tell your therapist you don’t want to see them anymore? Should you cancel all of your appointments and not schedule new ones? Most therapists would prefer to hear from their patients that they don’t want to see us anymore, but we get it, this is awkward! On the other hand, if you try to ghost, your therapist will probably contact you several times in a variety of ways, and depending on the nature of the work you have been doing together, they may even assume something terrible has happened. Depending on what kind of agreement you and your therapist made at the start of treatment, they may even contact your emergency contact. A polite but firm: “I really respect the work that we have done together, but I have thought about this a lot and decided I want to stop seeing you.” may make you want to hide under the covers, but it will likely save you a lot of back and forth.

To have a final session or not?

Your therapist may suggest having a final “termination session” to discuss the end of your treatment. This might involve looking back at the progress you’ve made, and making a game plan for what to do if you want to reach out in the future. For some, this can feel celebratory or cathartic, and for others, it can feel unnecessary and a little awkward. The choice is yours. Many therapists will suggest it, but you are allowed to say no!

Giving feedback.

Asking for feedback is an important part of the therapeutic relationship, hopefully it’s something your therapist has done regularly throughout treatment. The end of treatment can be a powerful place to offer feedback about what worked well and not well about therapy. Feedback might be about the therapy itself (“you said the phrase, ‘how does it feel, sharing this information with me now?’ way too many times, I experienced it as alienating rather than engaging”), or about the treatment environment (“I know you asked if it was ok to have your dog in session with us, but the dog was already in the room when you asked, and it caught me off guard and I felt pressure to say yes”).

Should you request your records?

There are laws that protect your right to access your medical record. There may be some circumstances where a therapist can redact or restrict certain information, and they can charge a nominal fee for the printing of said record. You may decide this information helps you process the work you did, or it may feel like a bit too much of a peak behind the curtain. Other therapists practice something called “concurrent documentation” where they collaborate on progress notes with their patients during sessions or send them to the patient to review every week. Having these records may also help form a bridge between this treatment episode and the start of therapy with a new provider.

How to maintain continuity

If you choose to re-enter treatment in the future, you may find it helpful to have your former therapist be in contact with your new therapist. You will need to give formal written permission to do so, and give feedback about the parameters you are comfortable with. For example, do you want your former therapist to send your treatment records? Have a 20 minute conversation about the general nature of the work you did? Most therapists, Pomegranate Institute staff included, are delighted to have the opportunity to talk to our colleagues, and help our former patients get settled in treatment. You should clarify whether there will be a cost from either therapist associated with this conversation. Some therapists include it in their session fees, others will charge a per minute rate for the call.

Contacting licensing board

Your therapist may have done something so egregious that you want to file a complaint with their licensing board. This will open a formal investigation into their behavior and may result in a suspension or termination of their license. There are different licensing boards depending on what type of therapist you are seeing. The letters at the end of their name will tell you what kind of therapist and what board to contact. Each board has a page on the Mass.gov website, and complaints can be filed electronically.

When you're ready

If this post made you realize you're ready to graduate from therapy, congratulations! Just know that it's normal to ebb and flow in and out of therapy. You may want to seek treatment again in the future, it doesn't mean you failed! And if you're a Massachusetts resident looking for a new therapist, reach out, we'd love to meet you!

How Do I Get Over My Ex?

schotkowski@gmail.com — Tue, 23 Apr 2024 15:00:00 GMT

Here at The Pomegranate Institute, we believe in the radical and transformative power of all relationships, and wow is it hard when they end. On the blog today we’re talking about 10 strategies for grieving a breakup.

Temporarily indulge in your grief

Breakups are sad, regardless of the “rightness” of the decision to end the relationship or who broke up with who. Give yourself permission to feel sad, and really lean into the sadness for a set period of time (we like 3 full calendar days). Bed rot, order takeout, take two baths a day, look at photos from your relationship while listening to Nothing Compares 2 U on repeat, do whatever you feel inspired to do (within reason, let’s keep you out of debt, out of jail and out of the hospital if possible).

Break the habit

Do you miss your person with a devastating degree that probably means you should get back together or is your brain just pattern oriented and missing the routine you established? Give yourself a chance to figure out how much you miss them if you aren’t addicted to the little dopamine hits of seeing them all the time. We recommend going 90 days absolutely no contact and then re-evaluating. No phone calls, no texts, mute them on social media and avoid in-person events where you’re likely to run into them. Why 90? This is about how long it takes to break a habit or start a new one.

Identify and purge triggers

We’re big believers in temporarily removing any signs of your person from your home/car/work, not necessarily forever, but at least for 90 days. More obvious examples might include photos of the two of you together, or gifts they gave you, but notice what other objects in your environment trigger especially strong memories.

Maybe your phone case reminds you of how excited you used to get when they texted you, or your morning coffee mug reminds you of how they used to bring you coffee in bed on the days they got up before you. Get a new phone case and switch to a different mug, make whatever little tweaks and changes to your environment you can.

Adjust your schedule

Maybe every Friday night was doordash night, and you find yourself missing your person right around the time you get hangry on Friday afternoon or waking up to a “good morning” text made you feel like your day was set up for success. Try scheduling new activities during these times, or asking loved ones to keep you company. Maybe you really do love starting the weekend with takeout and this is a ritual you want to continue with friends, and maybe you always hated getting up early on the weekends and you’re looking forward to sleeping in.

Track a new special interest

Passing the time will move faster if you have something else to track. Maybe you’re finally going to read Emily Wilson’s translation of the Odyssey, or finish the “couch to 5k” running program. We love using a habit tracker to create a physical representation of this progress, and there’s some good data to support the notion that tracking you progress will make you more likely to stick to it! It can be tempting to see the post-breakup window as a “waste” and something to just “get through”, but having an accomplishment to celebrate can help us see the value in slowing down and taking this time for ourselves.

Set boundaries

We love the notion of staying friends with exes, but your friendship is a precious thing, not a consolation prize for someone deciding they no longer want to be with you romantically. Without clear boundaries, you might find yourself giving the same degree of time, emotional investment and affection away, as you did when you were in a relationship. We recommend making a plan with your ex to take an intentional break from communication of any kind. At the end of this window, you can check in with yourself to see if you want to pursue a friendship with this person. It’s also helpful information to have, if you ask for space, and they trespass on this boundary, is that the kind of friend you want?

Don’t hop back on the apps

How many times have you gotten excited about a date only to realize they were hung up on their ex and not as emotionally available as they claimed? Send out the good dating karma you deserve to receive, and don’t start dating again until you’re ready to connect with new people.

If something more casual floats your boat, go for it, so long as you’re honest about your intentions! And remember, the end of a relationship is a great time to get STI tested but be mindful of testing windows (some STIs will take 12 weeks to show results, another reason we love a 90 day refresh).

Treat yourself

Dating is expensive! Grief math is thinking of all the money you’re going to save not going out to eat or buying presents for your future mother-in-law, and investing that money in yourself. Whether that’s maxing out your Roth IRA, paying down more of your debt, or trying that new laser facial, treat yourself and remember the most special and longest lasting relationship you will ever have is with yourself.

Reflect on what you loved and will miss

While the good memories are still close to your heart, write some of them down. What will you honestly miss about the relationship? Write a nice long list (bonus points if you really feel your feelings and cry and snot a little bit) and tuck it away for a time when you’re ready to reminisce.

On a separate occasion, unless you want to do the emotional equivalent of Barbenheimer , make a list of everything that wasn’t a perfect fit about the relationship. Every time your intuition whispered to you “maybe this isn’t my person”. If that part of you feels hard to access right now, that’s ok, save it for another time, or ask your loved ones. Keep this list close, and read it whenever you’re tempted to reach out during your no contact window. Do you really want to cross your emotional picket line for someone who thought it was endearing to correct the spelling in your text messages?

Aim for abundance

Our staff are Cognitive Behavioral Therapists, a kind of therapy where we’re trained to identify distortions in our thoughts that contribute to our mood and mental health. It’s normal to feel like a breakup is the end of the world, and we don’t want to minimize this! There can be devastating, real consequences to ending a relationship and, on the other hand, our brains are most likely exaggerating the severity of this, and minimizing our ability to cope. Once you’ve given yourself permission to wail and gnash your teeth a bit, try to remember that not only are you worthy of love, but when you’re ready, you’re capable of going out there and getting it.

In conclusion, breakups are emotionally devastating, and its not unreasonable to need professional help. If you’ve gone through a breakup recently and you need some support while you grieve, reach out , the Pomegranate Institute would love to support you.

10 Things We Loved About Tongue Tied

schotkowski@gmail.com — Mon, 08 Apr 2024 18:30:00 GMT

We’re big nerds here at the Pomegranate Institute and love staying up to date on the latest research in our field and swapping book recommendations with our patients. But we know y’all are busy and don’t always have time to read the whole thing. So welcome to our TL;DR series, where we summarize key points from our favorite books.

Up first is Tongue Tied: Untangling Communication in Sex, Kink and Relationships by Stella Harris (Published by Cleis Press September 11th 2018, 306 pages).

Stella Harris is an intimacy educator who has a vision of a “world where everyone has access to accurate and shame-free information about bodies, relationships, and pleasure from day one.” Tongue Tied “gives readers straightforward advice on how to conquer their fears, identified their needs, and feel positively empowered” and reminds us that “you can’t get what you want unless you ask for it”

Here are our 10 favorite things from Tongue Tied

Talk early and often

We’ve been conditioned to see “asking” or “talking” about intimacy as something that ruins the moment. Too often, we’re basing our decisions on the absence of a “no” rather than the presence of an enthusiastic “yes”. And when we want to communicate, to ask for something different, we’ve been quiet for so long, that it can feel impossible to bridge this gap. Harris advocates for communicating about small, relatively low stakes things from the very first date, to build a strong foundation for communication. Saying: “do you prefer a handshake, a hug, or a wave when meeting new people?” transitions more naturally to “I would really like to kiss you right now, would that be alright?” which can build to “tell me how you’d like me to touch you right now”.

Be explicit about your boundaries and expectations

Language is a beautifully imprecise communication tool. Things that we think have a universally understood definition rarely do. Harris uses the example of what constitutes infidelity in a monogamous relationship to highlight that people often have strong, but unarticulated beliefs on these topics that can vary widely from those of their partners. She encourages people to “define their terms” in order to reduce the risk of hurt feelings later on and even includes a handy list of things to talk about with new partners.

Go into more detail with your safer sex talk

Speaking of operational definitions, safer sex practices is another place rife with problematic assumptions. Lots of people have a conversation about their sexual history, testing practices, and safer sex practices, but Harris points out a lack of precision leads people to take on more risk than they think they are. For example, some people may say they “always” use condoms, when they mean they use condoms when they have penetrative sex, but not oral sex. Chapter 8 has examples of specific questions to ask.

Don’t fake your orgasms

Faking conditions our partners to repeat whatever they are doing when give our best Meg Ryan impression . If this isn’t something we actually like, we’re going to be stuck with it forever. She suggests using positive language to describe what we like: “I really like it when you touch me like this” and if we need to ask our partners to change up their approach, we can offer: “I think it would feel really good if you…” In her chapter on difficult conversations, she writes about what to do if you’ve been lying to your partner about the big O.

See your partner’s “no” as a gift

Harris encourages us to reframe hearing “no” as a good thing. No means our partner trusts us enough to say “no” when they mean “no”, which means we can trust that their “yes” means “yes”. She even goes so far as to say it’s a yellow flag if someone perpetually says “whatever you want.”

Have a state of the relationship talk

A state of the relationship talk is a reoccurring talk about the health of your relationship. It might include things like: needs and definitions around sex, household logistics, vacation planning, major life changes, schedules for the week ahead, planning date nights, and debriefing after an argument. Harris recommends scheduling them, and taking notes. A written record helps make sure everyone is on the same page about what was discussed, and can help you look back at your progress as a couple.

Its ok to try things

Harris uses the metaphor of different flavors of ice cream to describe the notion that it’s ok to try something you aren’t sure you’re going to like. Maybe chocolate is your go to flavor, but you’re curious about how “bone marrow” tastes. It doesn’t necessarily mean you’re declaring a preference or allegiance to this flavor. Same with sex! You can try something without it saying anything profound about your sexual orientation, gender identity, or preferences.

Expand your definition of intimacy

We’ve been conditioned to concentrate our definition of intimacy on penetrative sex that ends in orgasm. So if someone says “do you want to have sex?” and we don’t want to do this, we might get in the habit of saying “no”. A broader definition of intimacy, with more options leaves more room for both people to find something on the menu that they do want.

Harris also advocates de-centering an orgasm as the most important goal of sex, and instead focusing on all the different ways that bodies can experience pleasure. Try asking your partner if they want to receive oral sex, make out while the office is on in the background, or get a scalp massage while taking a bath. Maybe this leads to more, maybe it’s a chance to connect to your partner without feeling pressure to perform a certain way.

It’s hard to tell your partner what you want if you don’t know, and sometimes it can be hard to figure it out

Harris emphasizes the message “you can’t get what you want unless you ask for it,” while also acknowledging that sometimes, we might not know what we want, even if our partner solicits this feedback. She includes exercises like “pulling fantasies out of media” or “exploring sensations” and has recommendations about how to screen porn and erotica for ideas, and how to make a “yes, no, maybe later” list.

In conclusion, we love Tongue Tied as a beginner friendly, pleasure-positive, stigma-busting conversation starter. The chapters are short and sweet, and thought provoking enough to spark real conversations with loved ones. If you’re interested in more books like it, check out our resources page and if you want to talk with a therapist near you about healthy communication, reach out !

10 Ways to Build Better Sleep Habits

schotkowski@gmail.com — Mon, 25 Mar 2024 07:00:01 GMT

The average human will spend 26 years of their life in bed , sleeping, and yet, some of us are really bad at it. Through no fault of our own, whether we’re counting sheep or partaking in heavy duty pharmaceuticals, the zzzzs continue to elude us. At The Pomegranate Institute, we’re all about making small, sustainable changes, and habits to support more restful sleep are no different. Today on the blog we’re tackling sleep hygiene. So if you want to spend more time in bed (sleeping) read on!

Get up at the same time every day.

We’re going to start with a controversial and unfun suggestion first. If you do battle with an alarm clock during the work week and cherish the idea of sleeping in on the weekend, the idea of getting up early sounds not only dreadful but counterintuitive. You NEED to catch up on sleep when you can, right? Unfortunately the pesky little part of your brain responsible for maintaining circadian rhythms is much more susceptible to suggestion if go to sleep and wake up at the same time every day.

It's important to set a realist goal for a daily wakeup time. Maybe you want to be one of those 6 AM “early bird gets the worm” folks, but if you’ve been hitting the snooze button 10 times every morning since college, this change isn’t going to happen overnight. Try adjusting your bedtime and wakeup time by 15 minutes each week, until you reach a compromise that you and your body can live with.

Make your bedroom all about the Ss

Our brains love patterns, and we can harness this preference to help create sustainable change. Inspire your brain to associate your bedroom with the Ss: sleep and sex. Whenever possible, avoid hanging out in your bedroom unless you’re sleeping, or, you know…

If this isn’t possible, try using other context clues to distinguish between your bedtime bedroom and your hangout bedroom. Only put your pjs on when you’re going to bed, don’t watch TV or work on your computer in bed, open the blinds during the day, and don’t get under the covers unless an S is involved.

Light

The outdoors light cycle is your friend. American Neuroscientist Andrew Huberman goes so far as to say that 2-10 minutes of sunlight first thing in the morning is one of his “top 5 actions” to support mental and physical health. He explains that morning sun helps prompt the body to release cortisol (a stress hormone that we want to peak early in the day) which not only helps our circadian rhythm stay on track, but also supports our immune system, metabolism and ability to concentrate.

Huberman also advocates for afternoon outdoor sunlight exposure, when the sun is nice and low in the sky, in order to remind your brain that it’s time to start winding down for the day.

Whenever possible, stage the lights in your home to reflect the outdoors. This means bright light in the morning, and softer dimmer lights in the evening. Bright light inhibits melatonin in your body, a hormone that contributes to the feeling of sleepiness. We love using red light in the evening, starting around 8 PM.

Cell phones

Speaking of things we aspire to, no cell phones in the first hour of the day and no cell phones for a hour before bed is probably the healthiest thing, but we understand this isn’t realistic for many people. Again, breaking it down into small steps and increasing until you find the maximum dose you can tolerate may be more manageable. For example, if an hour cell phone free is intolerable, what about 10 minutes? 20 minutes? What can you live with that still underscores your commitment to the behavior you’re trying to change?

Blue light shining into your eyes right before bed is a confusing message to send your brain, it signals “wake up!” when you’re trying to go to sleep. If you’re married to your nightly Instagram scroll, you could try blue light blocking glasses or changing the filter on your screen . Every little bit helps!

Worry journal

If you notice worry keeping you up at night, try keeping a worry journal next to your bed. Each time a worry interrupts you, write it down. You’re promising your brain you’ll call the pediatrician in the morning, it doesn’t need to harass you about it all night long.

It might also be helpful to try a meditation like “ leaves on a stream ” where you practice noticing, but not responding to worries. Easier said than done, we know! But practicing this during your waking hours can help this behavior not ruin your bedtime.

Natural sleep aids

When it comes to natural sleep aids, there’s lots of products on the market, and a mixed bag of research about their efficacy. Meta-analyses have found consistently positive results for Amino acids, vitamin D and melatonin supplements , with suggestions to do more research on the potentially promising benefits of magnesium, zinc, resveratrol and nitrate supplementation.

We encourage trying one new ingredient at a time, and discussing the specifics of dose and potential interactions with your healthcare provider.

Personally, we love drinking tart cherry juice (high in melatonin) two hours before bed, and you’ll have to pry our sparkling maple water (high in magnesium) out of our cold dead hands.

Relaxation activity

Create a transition routine that signals to your brain that you’re winding down for the evening and headed towards sleep. Try things you find relaxing that don’t involve bright light, whether it’s taking a bath, working on a craft project, listening to a book on tape, or doing some gentle yoga.

On days when you don’t feel like you have a spare minute to relax, try taking 10 slow deep breaths and saying “I’m getting ready for bed now”.

What you put in your body does matter

The amount of alcohol, caffeine, sugar and overall volume of food you consume during the day does matter, and it matters more the closer you get to bed.

Again, the key to sustainable change is to make changes you’re willing to live with long-term. So if you equate being caffeine-free to living in hell, don’t do it! Try giving yourself a cut-off, like no caffeine after 2 PM instead.

Alcohol is a sneaky little trojan horse when it comes to sleep. Despite its classification as a sedative, alcohol only gives the impression of helping with your sleep. That evening glass of wine may make you feel drowsy and initially help you fall asleep, but it wrecks havoc on your body’s ability to properly cycle through the sleep stages and it will harm the quality of your sleep in the long run . If you’ve had a night of heavier than usual drinking, you’re better off staying up, having a few extra glasses of water, and going to bed when you’re sober or soberish.

If you want to change it, track it!

If you’re thinking of implementing any of the suggestions in this article, try tracking them! You’re much more likely to stick to a new routine if you track your progress, and see tangible proof that you’re succeeding. For maximum impact, it’s helpful if you have a visual representation that you can see every day, like a habit tracker on your fridge. Try tracking one small habit for a month, and for bonus points, offer yourself a meaningful reward if you make it to the end of the month having met your goal.

Consult a professional

Poor sleep is a serious problem. Lack of sleep is costing the U.S. economy up to $411 billion each year. If you find yourself trying things on this list without much success, this doesn’t mean you’re lazy or that you’ve failed. You might have a serious sleep problem that would benefit from professional consultation. Primary care providers, sleep specialists and therapists all play an important role in helping identify potential problems and find solutions that will work for you.

If you want to talk to a therapist near you about your sleep habits, reach out !

Let's Get Wet: Everything you Ever Wanted to Know About Lube

schotkowski@gmail.com — Sun, 10 Mar 2024 09:00:01 GMT

Today at The Pomegranate Institute we’re covering the good, the bad and the slippery when it comes to personal lubricant.

Let’s dive right in and get wet, why would someone use lube?

There’s a silly little myth out there that using lube indicates you or your partner aren’t sufficiently aroused or arousing, or that something is wrong with your body. This couldn’t be further from the truth!

When people with vulvas get aroused, blood vessels dilate so that more blood flows to the genitals, which prompts vaginal glands and mucous cells to secrete fluids. The lubricant our bodies naturally produce can feel amazing, but the amount waxes and wanes and isn’t necessarily sufficient for fun, pain-free sex of all flavors.

Factors like where we are in our menstrual cycle, menopause, using birth control pills or other medications, or just the thoughts swirling around in our own heads can impact our natural lubrication, regardless of how turned on we feel.

AND not all kinds of sex involve parts of our body that lubricate naturally ( hey anal sex !) and we want to be prepared for all bodies and opportunities we might encounter.

Lube can also be an important part of your safer sex practice that helps reduce the risk of bleeding and tearing.

There are 3 different types of lube each of which might be the best for different bodies having different kinds of sex under different circumstances.

Water-based

Water-based lubes generally get their texture from Aloe leaf gel or cellulose. They rinse off easily, are less likely to stain, and won’t damage the integrity of condoms/dental dams/gloves, or silicone sex toys. The downside is they get absorbed by the skin quickly, and need to be reapplied more frequently.

Brands we love:

Playground Love Sesh Water-Based Lubricant

Good Clean Love Almost Naked Personal Lubricant

Silicone-based

Silicone-based lubricants have a thicker consistency and tend to last longer, they are safe to use with condoms/dental dams/gloves, but should be avoided if you are incorporating sex toys made out of silicone. If you want to still use sex toys, try ones made from stainless steel or glass . Silicone-based products also carry a higher risk of staining.

Brands we love:

Swiss Navy premium silicone lubricant

Maude’s Shine Silicone lubricant

Oil-based

These lubricants have one main downfall, they degrade latex (but not nitrile and polyurethane).

If you want to reach into your pantry, give coconut oil or evening primrose oil a try

If you’re in the mood to try something extra, consider:

Überlube luxury lubricant : A silicone-based, hypoallergenic lubricant that comes in a beautiful glass bottle, and has adorable travel sizes.

Quim’s Smooth Operator serum : water-soluble, latex-safe, and contains Hemp CBD and other ingredients designed to increase blood flow, promote pelvic relaxation and reduce pain.

Revaree by Bonafide : a hyaluronic acid suppository for people with vulvas that can help address vaginal dryness, itching, burning, and painful intercourse.

You’ve got a lot of great options to choose from, so how do you narrow it down?

There are personal considerations and practical considerations. Practical considerations like, what kind of sex are you having? Will you be using barrier methods? Sex toys? Having anal sex? This might steer you towards one type of lube over another.

For folks who are actively trying to get pregnant, the Mayo Clinic recommends looking for lube that is hydroxyethylcellulose-based, PreSeed or ConceivePlus have several research-based studies behind them to support their claims that they are fertility friendly.

Then there are personal preferences like: how does the texture feel? Smell? Taste? Sound of the bottle opening and closing? How easily does the bottle tip over, stay shut, or start to make weird squelchy noises half-way through your session?

The good news, is you have lots of choices to find a lube that fits the bill for the sex you like to have and whatever other personal preferences are at play for you. In general, we recommend looking for products that are free from parabens, phthalates, petrochemicals, GMOs, mineral oil, glycerin and anything that has a flavor, fragrance or warming ingredients. This will steer you towards products least likely to provoke an allergic reaction. If you have a specific allergy to work around, the website SkinSafe can help you check product ingredients against certain allergies.

If you’re trying out a new product for the first time, the safest thing to do is patch test a small amount of lube on somewhere other than your genitals and wait a few hours to see if you have a reaction. If not, give the product a try during solo sex, and then with a partner.

How to keep lube out of your sheets, or deal with stains if it comes to that

Using a lube shooter or a hands free lube dispenser can help make sure the lube is going exactly where you want it to go, and nowhere else.

Keeping towels and wipes close by for easy cleanup and thinking about the material of your sheets can reduce the likelihood of stains. Fabrics like cotton and linen are more likely to stain than something synthetic like microfiber. We swear by Bella Coterie luxury bamboo sheets as being pretty stain resistant.

If you do get lube on your sheets, baking powder can help absorb the stain, dish soap or sex toy cleaners can help lift the stain, and tossing your sheets in the wash right away is your best bet for making sure the stain doesn’t set.

We hope this article has given you some fun ideas for having slippery, safer sex. And if you’re interested in consulting with a pleasure-positive therapist about your sexual health, you can book a consult on our website

When Is It Ok to Ghost Someone?

schotkowski@gmail.com — Tue, 20 Feb 2024 21:37:44 GMT

Here at The Pomegranate Institute, we love ghosts if it means a woman with a complicated backstory and a cool outfit. But we aren’t fans of the dating trend of suddenly discontinuing all conversation in order to indirectly end a relationship. Today on the blog we’re taking a look at why this trend persists, and what the alternatives are.

A rabbit hole of research for this article led us to the first whisper of “ghosting” on the internet, a hilarious relatable parody music video written by Hannah VanderPoel called “ Ghoster’s Paradise ” first posted in March of 2014. The video quickly went viral, and soon every popular press outlet from HuffPost , Vox , and The New York Times , were talking about it and saying “same, girl!”

Early content focused on the humor of being delulu enough to believe someone with a supercomputer in their pocket really liked us, and had a VERY plausible reason for taking three days to text us back.

There was something cathartic in naming this out loud, and realizing it wasn’t just us, it was happening to hot, funny, interesting people everywhere.

This behavior became so ubiquitous it was almost normalized. And with the reluctant acceptance of ghosting came a veritable Scooby squad of dating behavior so cringe it got its own name:

Ghostlighting : When someone ghosts, and then gaslights you when you try to confront them.

Breadcrumbing : Texting someone back just often enough (but not often at all) to keep their attention, either to keep them on the back burner for the future, or because you like the attention.

Orbiting : Cutting off all contact, but “orbiting” around their social media. Think the guy you went on a date with once 3 years ago who still fire emoji reacts to all your stories.

But Why Though?

We found several factors that impact the likelihood that someone will ghost:

The belief that sending a text saying you don’t want to continue the relationship is mean, meaner than ghosting

The degree to which on-line dating has created a “gamified” experience that allows users to suspend their awareness that they are talking to real people who have lives an emotional experiences as valid and complicated as their own.

Lack of social or environmental overlap with dates leads to the belief that “no one will know” that they ghosted.

The consensus seems to be that ghosting isn’t very nice, but it’s a relatively harmless way of avoiding the momentary discomfort of telling someone you don’t want to see them again.

But is ghosting really consequence free?

No of course not. It can leave people wondering, even ruminating on what went wrong, especially in the absence of any clear information. This kind of perseveration isn’t good for our mental health, it can chip away at our self-esteem, our confidence and our capacity for romantic optimism.

Here at The Pomegranate Institute, we’re superstitious enough to believe in dating karma, and genuinely believe that sitting with the complicated feelings involved in being vulnerable with another human being, is an essential component of dating.

We would love to see less ghosting, but before we dive into the alternatives, we would be remiss if we didn’t mention some scenarios where ghosting is entirely appropriate. If you have any concerns about your personal safety, whether it’s “just a feeling”, or someone has said or done something that makes you feel uncomfortable, you don’t owe them an explanation or any further communication.

But let’s say the date was fine, maybe even good, but just not your cup of tea right now. You don’t want to waste their time, or your time, and you want to be clear but kind. What do you do?

This concept is apparently so radical that we don’t even have a cool pop culture name for it yet, we’re calling it “ anti-ghosting ”

Bumble suggests this formula for sending an anti-ghosting text: 1.) start with a salutation and a genuine compliment 2.) give a specific reason for ending things 3.) gently close the door on future possibilities, examples could include:

Hi Sam, thanks again for that delicious dinner on Thursday. I’ve given it some thought, and while I enjoyed swapping music recommendations, I didn’t feel a romantic connection with you. I wish you all the best.

The thought of sending a text like this may make you want to throw your phone across the room and then hide under a pile of blankets, so take a deep breath, and remember that you’re treating a fellow human being the way that you would want to be treated, and the discomfort you are feeling with peak in intensity, and then dissipate, and probably not come back.

You’re very brave (ken) for being the one to initiate an important but slightly awkward conversation, so do what you need to do to positively reinforce the behavior. You absolutely deserve a little treat! You may also want to make a plan to spend time with friends or do another dopamine-promoting activity while you wait for a response.

Speaking of responses, brace yourself, just because you’re being very mature and having this conversation doesn’t mean the other person will be receptive to it.

Some people may respond negatively to your efforts to be kind but firm, with passive aggressive statements like “I agree, 0 chemistry” Ouch.

If that’s the case, add the interaction to the “trash takes itself out” category and do your best to move on. Easier said than done, we know. But you can pat yourself on the back knowing that you tried to be honest, kind and a little vulnerable, and we sincerely hope that good energy comes back around to you!

In conclusion, relationships, be they serious or casual, vanilla or kinky, monogamous or non-monogamous are messy, but laying a strong foundation for open communication will serve you well when you do find the right someone(s). And if you want to talk over your dating misadventures with a pleasure-positive therapist near you, reach out ! We can’t wait to meet you.

The Sexiest Thing You Can Do Is Not Be a Jerk About Herpes

schotkowski@gmail.com — Thu, 01 Feb 2024 02:49:40 GMT

Herpes: a pesky, unfun skin condition with horrible stigma attached to it, stigma that – as pleasure-positive people – we're all responsible for deconstructing.

In a society where vestiges of Puritanism are evident and “purity culture” is alive and well , sexually transmitted infections (STIs) in general carry a stigma . However, herpes (or HSV)— despite being in most cases fairly innocuous for healthy and nonpregnant people —is, in particular, perceived as a kind of “ Scarlett Letter .”

Stigmatizing references to herpes in popular culture abound, from Romeo and Juliet to Inside Amy Schumer and Saturday Night Live . Whether it’s John Oliver comparing herpes to terrorism or a joke on Bob’s Burgers that implies getting herpes would be worse than being killed , the cultural messaging is clear: “herpes is the worst thing ever, and if you get it, so are you.”

For folks who find out they’re HSV positive, carrying the burden of stigma and shame can make them less likely to disclose their status to sex partners and negatively impact their psychological health . There are over 1,000 posts on Reddit that contain the words herpes and devastated.

The stigma surrounding STIs in general, and HSV specifically, is rooted in negative societal attitudes towards sex, misinformation, and fear. Destigmatizing HSV requires challenging misconceptions by providing accurate information and fostering empathy and understanding by promoting open and non-judgmental conversations about sexual health.

In this blog, we aim to do just that.

Read on to learn about herpes and what to do if you test positive.

What is herpes?

Herpes is a sexually transmitted infection caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).

HSV-1 used to be called “oral herpes” (or cold sores) and HSV-2 “genital herpes.” However, we now know that people can catch both HSV-1 and HSV-2 in either the mouth area or genital area. Both forms of HSV are treatable but not curable.

Herpes is more common than you think.

In the United States, 50 – 80% of adults have HSV-1 , with most people getting it from being kissed by an infected friend or a relative in childhood.

Around 12% of people between the ages of 14 and 49 in the US have HSV-2, and 90% of them don’t know it . This is because their symptoms could be either so mild as to go unnoticed, or they could be completely asymptomatic.

Symptoms of HSV

Symptoms of both HSV-1 and HSV-2 include small blisters that fill with fluid, then break open and scab over before fading. The severity of symptoms can vary greatly from person to person. For some, the condition is painful. For others, symptoms are so mild that they’re mistaken for something else, like an ingrown hair, razor burn, or pimple.

There’s an ‘incubation period’ between the virus being transmitted and first having symptoms. For most people it’s 2-12 days, but for some people it could be much longer . If you start to experience symptoms of herpes, it doesn’t necessarily mean you were infected recently—the infection could have happened years ago.

When herpes is first transmitted, the infection travels through nerves and settles in the sensory nerve ganglia (either the ganglia adjacent to the spinal rope in the lower back, or the ganglia behind the cheek bone).

A protein in our body called interferon gamma wraps around the virus and keeps it dormant. When the virus is in its dormant stage, it’s still detectable in the body through testing but it doesn’t present as the active disease or produce symptoms.

However, sometimes the virus re-activates and travels away from the ganglia to the affected tissue (lips, genitals, etc.). This re-activation of the virus produces an outbreak or flare-up of symptoms.

Symptoms are generally more severe during a first outbreak and may include a fever, body aches, swollen lymph nodes, or a headache because the body hasn’t yet developed an immune response to the virus.

Some people have asymptomatic herpes , meaning the virus is present in their bodies but they’ve never experienced an outbreak.

Scientists are still studying what causes the virus to reactivate. For some people, it never happens. For others it happens occasionally, and for some outbreaks occur more frequently (five times a year would be considered frequent).

Some people who have HSV are able to identify certain patterns or triggers that are associated with more frequent flare-ups. These include sun exposure, stress, menstruation, other infections, or foods that are high in arginine (certain nuts and seeds, dairy, certain animal proteins, and chocolate).

What are the recommendations for screening?

Generally, the CDC and U.S. Preventative Service Task Force (USPSTF) do notrecommend universal herpes screening . Instead, they recommend herpes testing for people with active symptoms.

Widespread screening isn’t recommended because HSV-2 is mostly asymptomatic and can’t be cured , and there’s a high probability for false positives. The lower someone’s risk of HSV infection, the higher their probability for a false positive test result.

Since false positive test results generate unnecessary suffering , the overwhelming medical consensus is that the risk of stigmatizing people outweighs the potential benefits of generalized screening.

Tests

If you have symptoms that could be herpes (such as a blister or a sore), a provider will take a swab and perform either a culture or Nucleic Acid Amplification Testing (NAAT).

NAAT is far more accurate, because a culture requires a large enough amount of the virus to be present, which may not be the case if the lesion is small or already healing.

Blood tests can be used when a person has no visible symptoms but is concerned about having herpes. Blood tests, which look for herpes antibodies, include both IgM and IgG tests.

IgM tests are generally not recommended because they don’t distinguish between HSV-1 and HSV-2 and can cross-react with other viruses in the same family, giving those false-positive results that we discussed above.

While IgG tests are more accurate, it takes time for the antibodies to reach detectable levels in the body, so it’s generally recommended to wait 12-16 weeks after potential exposure for a more accurate test.

If you Test Positive

First thing’s first: double check which test was performed.

Researchers from the University of Washington in Seattle and the Westover Heights Clinic in Portland found that patients with low positive HSV-2 results on commercial EIAs ( enzyme immunoassays ) frequently tested negative with the more sensitive Western Blot. The recommendation from the lead author was to get a confirmatory Western Blot test .

Keep in mind that testing positive doesn’t necessarily mean you were recently exposed to herpes. You could have been asymptomatic and having your first outbreak months or years after the initial infection.

Treatment

For many people, the diagnosis is the most traumatic part of herpes-- the actual symptoms themselves are usually mild and respond well to treatment.

Treatment includes antiviral medication (such as Acyclovir, Valacyclovir, or Famciclovir). Antivirals might be taken at the start of an outbreak to help reduce severity of symptoms, or every day (called suppressive therapy ) to reduce both the risk of a future outbreak and the likelihood of transmission to partners.

Antiviral medication is most effective if you take it continuously as suppressive therapy, or if you start taking it during the prodromal phase (when you feel a little “off” or feel a tingling sensation in places you would normally get a sore, but don’t yet see one). It’s less effective if you start taking it when you already have symptoms, though it can still help shorten the duration and severity of an outbreak.

Other things that you can do to reduce discomfort during an outbreak include:

Wearing loose fitting cotton clothing.
Remembering to wear sunscreen every day.
Sitting in a warm bath (without soap).
Applying a cold compress.
Using a device like the Frida Mom Upside Down Peri Bottle or a bidet to squirt warm water during urination to reduce the discomfort of urine touching a lesion.
Some people find it’s helpful to eat foods high in lysine and low in arginine .

Sex With Herpes

People with herpes can absolutely have great sex and great relationships.

Open communication with your partner about safer sex practices and steps to reduce the risk of transmission are key. Remember, your partner may already have antibodies for herpes without knowing it, and you may want to discuss the risks and benefits of them getting antibody testing.

Barrier methods can reduce risk of transmission, but it’s important to remember that both transmission from lesions and asymptomatic shedding can occur on places not covered by barriers like condoms or dental dams.

You should never have sex when lesions are present, healing, or when you feel prodromal symptoms that indicate an outbreak is coming (some people get a strong tingling sensation in the days prior to an outbreak).

Transmission via asymptomatic shedding of the virus is still possible, though much less likely. Asymptomatic shedding can greatly be reduced by suppressive therapy (taking anti-viral medication every day).

Support

Remember, herpes is actually very common, and there’s a lot of support out there.

Here are some organizations that offer support and community for people navigating a positive diagnosis and living with herpes:

Something Positive for Positive People
Herpesite
The American Herpes Foundation National Herpes Hotline: (919) 361-8488

There are several content creators who produce hilarious, relatable, and supportive content about living with herpes. Some of them include:

Here are a few articles that share first person accounts of navigating life after diagnosis:

Living With Herpes - What I Wish I’d Known Before My Diagnosis
Both Sides of a Breakup : He Couldn’t Get Past the Herpes
I Have Herpes HSV-1 - This Is How I Date & Disclose It
The Truth About Dating with Herpes, Women Tell All
23 Women Reveal How They Tell Someone They Have Herpes

There are also several dating websites and apps geared towards folks that are HSV-positive, however, there’s some legitimate concern that they might actually reinforce stigma .

Conclusion

STIs are very common. In fact, they’re a natural aspect of being human.

Barry Marguiles, a biology professor at Towson University, likes to tell his students that herpes viruses are “extremely common pathogens that have actually sort of evolved a fabulous coexistence with us [since] in most cases, nobody ever knows they have them.”

As William A. Knaus wrote in 1976 for the New York Times Magazine, “herpes viruses are part of our individual and collective ecosystems—like bacteria and pollution. We cannot get rid of them without getting rid of ourselves.”

It’s 100% possible to be HSV positive and live a fulfilling life, both in terms of sex and dating, and everything else. It just may require learning some new skills and behaviors to make sure you’re taking the best possible care of yourself and others.

If you or your partner have recently been diagnosed and you’re struggling, schedule a complimentary consultation with The Pomegranate Institute, we’re here to help!

Silly Little Ways to Chill the F*** Out

schotkowski@gmail.com — Wed, 17 Jan 2024 01:14:41 GMT

Sometimes you just need to chill. And while we know you’re a VERY SERIOUS person, delving into your silly side can help when you need to chill. So here’s a collection of exercises that are sweet, simple, and a little goofy to help you calm down.

Breathe like a bear : This book by Kira Willey and Anni Betts may be written with kids in mind, but its chock full of adorable illustrations and different breathing patterns to try, and if you have little ones in your life, it’s a great opportunity to practice co-regulation

Square breathing breathe in for 4, hold for 4, exhale for 4, hold for 4 and repeat

Acupressure : Check out this video from Yasuko Kawamura, who shows you how to find GV 20, CV 17, and H 7.

Physiological sigh : two short inhales through your nose, one slow exhale through your mouth

Butterfly hug : place your hands in the shape of a butterfly over your sternum, and tap the wings one by one while gently pressing down

Alternate nostril breathing : Close your right nostril with your thumb and inhale through your left nostril and exhale through your left nostril. Then close your left nostril and breathe in through your right nostril and exhale through your right nostril. Alternate back and forth for at least 5-9 rounds of breathing.

Body double with someone who is already calm: Body doubling is a phrase coined by ADHD advocates to describe the phenomenon of working alongside someone else in order to complete tasks like homework or chores. Co-regulation also works for moods, find someone who’s already chill, bonus points if you can match your breathing to their breathing, if no one around you is chill, go find some chill people in a coffee shop, bookstore, or library.

Make an Instagram collection of silly little things that make you happy (we love fluffy cows (@ranchbythebeech), cobblers repairing shoes (@americascobbler), and the video of Tom Holland dancing to Rihanna on Lip Synch Battle)

5,4,3,2,1 technique : name 5 things you can see, 4 things you can feel, 3 things you can hear, two things you can smell, one thing you can taste

Sour candy: speaking of taste, try this tiktok viral strategy of eating a piece of sour candy , the unexpected taste can help redirect your brain, and as Betty White reminded us, you’re not you when you’re hungry . Our favorites are the Yum Earth Lollipops

Progressive muscle relaxation : A technique where you first tighten the muscles and then gradually relax them. You can try it with just your face, or with your whole body.

Movement snack : You don’t have to squeeze in a full workout if you’re not in the mood. Just a few minutes of moment, whether its holding a plank, pacing around your living room, hauling that 20lbs bag of kitty litter out of the basement, or strapping on your pleasers and trying to master the twisted sister, can be enough to reap the relaxation benefits

Mamalian diving reflex : The sensation of very cold water hitting our face sends a message to the vagus nerve, which controls the parasympathetic nervous system, leading to an involuntary reflex that includes our heartrate slowing down. You can go full on cold plunge, or dunk your face in a bucket of ice water. Your might want to see how your body feels about cold exposure by rubbing an ice pack on the back of your neck or chest first.

Dance it out: Christina and Meredith knew that sometimes you just need to dance it out. We love Blame it On Your Love , Hips Don’t Lie , the Song-a-long from Eurovision Song Contest: The Story of Fire, Let it Go from Frozen, and Surface Pressure from Encanto

Cry it out: Sometimes, when you’re feeling crummy, you just need to cry it out. Getting the tears flowing might be the thing you need to discharge your pent up energy and go about your day. For me, its page 748 in Kingdom of Ash when Asterin says “Live, Manon”, for Billie Eilish its watching Spirit

Watch something triumphant: is your anxiety being triggered by justice sensitivity? Watch something that reminds you of good triumphing over evil. Maybe it’s the moment when Sam says “on your left” ,when Éowyn says “I am no man” or when Captain Von Trapp rips up the NAZI flag.

Remember, chilling out doesn’t mean stifling your feelings, like those silly little therapists say, you’ve got to “feel it to heal it”. But since not every moment is available for deep reflection and cognitive restructuring, we hope this article helps you get through the day. And when you’re ready to do a deep dive on why you feel the way you do, reach out , The Pomegranate Institute would love to help you process!

How Worried Should I Be About STIs?

schotkowski@gmail.com — Sat, 30 Dec 2023 21:01:35 GMT

Getting tested. We should all do it, probably more often than we do, and some of us get really anxious about it. At TPI we believe information is a powerful antidote to fear, so read on for our myth busting, stigma fighting, and sex positive guide to STI testing.

The mere mention of sexually transmitted infections, or STIs, can generate significant anxiety, and conversations around sexual health are often shrouded in stigma and shame . The truth is, STIs affect individuals of all walks of life, regardless of age, gender, or sexual orientation, and they needn’t be a source of shame for anyone.

For someone with anxiety, both worrying that you might have an STI and the prospect of getting tested to find out can be agonizing.

Engaging in responsible safer sex practices not only promotes personal health but also contributes to a broader culture of well-being and awareness. As we work towards living the transparent, honest, and informed lives that constitute a cultural shift towards true consent , STI testing emerges as a pivotal component, bridging the gap between individual wellbeing and a collective commitment to a healthier and more aware society.

Safer Sex Practices

Anyone, regardless of age, socio-economic status, the type of sex they’re having, or who they’re having sex with can get an STI. There is no 100% prevention method, which is why we say, “ safer sex practices ” instead of “safe sex practices.”

However, there are many things that you can do to reduce your risk.

For example, we know that consistent and correct use of latex condoms reduces the risk of sexually transmitted disease (STD) and human immunodeficiency virus (HIV) transmission.

Consistent use means using a condom every time you have sex; STI transmission can occur from a single sex act. Correct use of a condom entails using it through the entire sex act without slippage, breakage, or leakage.

Non-latex condoms are somewhat more prone to breakage , so if no participating sex partner has a latex allergy it’s probably best to stick with latex. Keep in mind that oil-based lubricants can weaken latex condoms (and some kinds of non-latex condoms as well), so water-based or silicone-based lubricants are safer.

It’s also recommended to use barrier protection for all kinds of sex acts, even though people rarely use condoms or dental dams for oral sex . This is because, while the risk of transmitting HIV through oral sex is extremely low , many other STIs are highly transmissible through oral sex .

STIs Happen

The CDC reports that around 1 in 5 people in the United States have an STI. Some STIs are even more prevalent. For example, the Human Papillomavirus (HPV) is so common that 85% of people—or nearly every sexually active person who hasn’t been vaccinated— will contract HPV at some point in their life .

This is all to say, contracting a sexually transmitted infection is something that happens to many people. If it happens to you, it has absolutely no bearing whatsoever on your character. It doesn’t mean you’re “dirty,” irresponsible, that you’ve failed in your attempts at safer sex practices, or that life as you once lived it is over.

Once we remove the stigma and normalize frank conversations about sexual health, getting tested for STIs stops being scary and starts being attractive because, ultimately, it’s a way of caring for others and for yourself.

Self-respect and empathy are sexy.

Getting tested is a foundation of safer sex practices.

Ok, so, we’ve established consensus: STI testing is sexy ! But, what now?

How do I even begin? What do I get tested for, where, and how often? What do I expect?

We got you!

How often should I get tested?

You should always get tested immediately if you have symptoms that might possibly be an STI. For example, the appearance of sores, unusual discharge, flu-like symptoms, and burning or pain when you pee or have sex would all be reasons to book an appointment. However, the absence of symptoms doesn’t mean absence of STIs, so don’t rely on symptoms as your sole indicator of when to get tested.

As a bare minimum, you should get tested once a year, even if you’re in a monogamous relationship.

When you find yourself in-between sex partners, that’s a time to get tested.

If you have multiple sex partners, you should get tested every 8-12 weeks, and if you’re involved in sex work, you should be tested even more regularly. Performers working within the adult industry testing program FSC-PASS are required to get tested every 14 days .

As long as you have these minimum bases covered, the sky’s the limit. Do your thing--- get tested as often as you want!

What should I get tested for?

Generally, if you walk in and say, “test me for everything,” you’ll get screened for: Chlamydia, Gonorrhea, Syphilis, Trichomonas, HIV, and Hepatitis C. In other words, “everything” doesn’t literally mean everything.

For example, it’s not common practice to test for herpes (HSV) if you’re asymptomatic, and the CDC only recommends testing for HPV for people with a cervix who are 30 and up, and even then, only every couple of years.

Your provider may offer population-specific recommendations, like these published by the CDC , but ultimately the decision about what to get tested for is yours alone.

Options for STI Testing

These days, there are more options than ever for seeking out STI testing.

Sexual health clinics are a great resource, especially if you don’t have health insurance. They generally offer sliding scale options for payment if you’re not covered. Massachusetts has many excellent clinics, like Tapestry in Western Mass and Health Imperatives on Nantucket.

If you’re not really feeling the face-to-face interaction, there are several mail order testing services available. Check out:

You can also, of course, always go through your primary care provider if you have one.

STI Testing Methods

STI screening can include urinalysis, blood drawing (either a finger prick or a blood sample taken from your arm), and site-specific swabs.

The testing method will depend on:

The STI: for example, Hep C and HIV are always blood tests.
How you have sex: for example, if you receive unprotected anal sex a rectal swab might be indicated for certain tests.

If you have symptoms, a provider will examine you and might make recommendations for additional non-STI testing. This could include screening for a UTI, yeast infection, bacterial vaginosis, or cytolytic vaginosis.

Understanding STI Testing Windows

The amount of time it takes after intercourse for a new infection to be detectable varies widely depending on the STI and the testing method.

STI incubation periods can range from a week to twelve weeks. Chlamydia and Gonorrhea, for example, have shorter incubation periods than Syphilis, Hepatitis and HIV.

For this reason, it’s important to keep relevant timelines in mind relating to sex acts and sex partners, and to discuss the particulars the test(s) you’re getting with the person conducting the screening.

This is also a crucial conversation to have with new partners , in order to understand the accuracy of their testing practices. For example, if someone got tested several days after a sexual relationship ended, and received negative and non-reactive results, it may be that the window of time between possible exposure and screening was not long enough to detect possible STIs .

Under-appreciating incubation periods is the number one whoopsie-daisy we see in our practice, and understandably, the calendar math gets a little complicated if you're juggling sex with multiple partners and their multiple partners. Do your best to keep track, and try to hold some grace and compassion for yourself and the other people in your sex bubble.

Understanding Clinic Notification Practices

Different agencies and providers have different practices about how test results will be shared, and getting clarity on this process can help mitigate anxiety while you wait.

Ask questions about how soon the results will be available, and how results will be shared with you. Sometimes these answers depend on whether the tests are negative/non-reactive or positive/reactive.

For example:

Some clinics may publish all test results on their patient portal that you can view as soon as the results are back.
Some clinics require that results are reviewed by the provider that conducted the screening before being released, which could lead to a small delay.
Other clinics require that positive/reactive test results are communicated by phone call, rather than patient portal.

We've had patients call us in a panic because they called the clinic to ask for an update on their results, and they were told "our Nurse Practitioner is going to have to call you back." Understandably, they assumed this meant their results were positive, when it turned out, at that clinic, the Nurse Practitioner who ordered the tests had to review them all before they were allowed to be shared with the patient, regardless of what the results were. Knowing this practice ahead of time could have meant skipping a good hour-long meltdown.

It's also helpful to factor in how long results will take. For example, if your test is Thursday afternoon, you might not see results until Monday afternoon. We love a Tuesday or Wednesday appointment whenever possible!

Worrying while you wait

The Pomegranate Institute specializes in treating worriers! It’s normal to worry, even if your likelihood of having an STI is low.

Make a game plan for how to spend the time while you wait:

Run down the clock: schedule little projects, errands, or activities to help pass the time.
Make plans to connect with loved ones to keep your thoughts occupied.
Remind yourself that this feeling of intense worry is not permanent; you will eventually have a definitive answer.

Be on the lookout for thought distortions and practice your CBT exercises to evaluate thoughts for accuracy and helpfulness.

For example, the automatic thought: “I’m going to test positive and my life will be over!” is a really stressful distortion. Remind yourself that most STIs are curable, and all are treatable .

Testing, Testing, 1, 2, 3: Talking to Partners about Getting Tested

We need to normalize talking to prospective partners about their STI testing practices.

Ask detailed questions about how often they get tested, what they get tested for, and what their safer sex practices are. We've found that people will colloquially say they "always" use barrier methods with their partners, when in reality, what they mean is they use barrier methods when they have penetrative sex, but not when giving or receiving oral sex.

We're big fans of asking to see recent test results, and not feeling guilty. Try saying: “I get tested every twelve weeks and I like to share my test results with new partners; are you open to sharing your results with me?”

Remember to use verbiage like “my most recent test results were negative and non-reactive” rather than “I’m clean,” to avoid the implication that people who have experienced positive STI results or currently have an STI are “dirty.”

If you Test Positive and Need to Notify Past Partners

Say you do, in fact, test positive. What now? A positive diagnosis can feel overwhelming but luckily there are many resources to help.

First off, the place where you receive your testing will have recommendations about notifying past partners and how far back into your sexual history to extend.

Folks who have experienced a history of domestic violence in their current or past partnerships may have concerns about how disclosure may impact their safety.

There are anonymous notification systems that can send generic messages to past partners via phone or email, such as:

Keep in mind that some testing clinics may have a requirement to report positive results to the department of public health.

For circumstances where you do feel safe informing a current or past partner about your positive status, but you’re unsure of what to say, try: “Hey there’s no easy way to say this but I just tested positive for chlamydia. I’m not sure when I was infected, but you should get tested, and I would really appreciate it if you kept me posted on the results.”

Try not to frame positive test results as a “whodunit.” You aren’t realistically going to discover who transmitted the infection to you, and it’s much more likely that it was transmitted without the person knowing they had it.

Lastly, ask if the clinic has Expedited Partners Therapy , a process where partners of the index patient (the person who just tested positive) can get treatment without:

having to wait to be seen, and
wait for test results.

Making a Plan

You may be worrying while you wait because you're a worrier, but your worry might also be an indication that something about your own safer sex practices need to change. Each time you get tested is an opportunity to reflect and decide if you want to change your plan moving forward.

For example, if you find yourself especially worried about your risk for HIV, now may be a good time to discuss PrEP with your healthcare provider.

Or maybe the screening process highlighted that you don’t have as much information as you thought you did about what safer sex practices your partner is following with their other partners-- now is an opportunity to revisit this conversation !

Conclusion

Prioritizing regular and transparent STI testing practices is not just about fostering a safer culture around physical intimacy, but also about dismantling the stigma associated with positive results.

Testing is an important part of safer sex, but it doesn’t make you “unsafe” if you test positive.

Remember, STIs are bacteria and viruses that spread from person to person during sex-- they aren’t a judgement on your character or your worth as person or a partner.

If you’d like talk more about this, schedule a free consult at The Pomegranate Institute.

How to Not Kink Shame Your Partner

schotkowski@gmail.com — Tue, 05 Dec 2023 18:17:28 GMT

Craving a dose of 90s nostalgia and wondering how to hold your own boundaries in the bedroom without kink shaming? Read on.

As a child of the 90s, my first exposure to kink and kink shaming was the Sex and the City episode "Politically Errect" The second episode of the third season sees Carrie dating a politician played by a pre-Mad Men John Slattery . After their first sexual encounter, he discloses that he has waterworks kink :

Carrie: Is there anything you want or need that I'm not doing?

Bill: No... well, maybe one thing.

Carrie: What?

Bill: Well, I would love to get you in the shower.

Carrie: Mmhmm.

Bill: And get each other all fresh and clean.

Carrie: Well that sounds nice.

Bill: And then...let you pee on me.

We get a brief look at Carrie’s expression of stunned disbelief, and the scene cuts away to her discussing the interaction with her friends. Later, Carrie expresses her reservations to Bill:

Carrie: Bill, can I talk to you about something?

Bill: Yeah, ok.

Carrie: I’ve been giving this peeing thing a lot of thought and while I think it’s totally fine that that’s what you’re into, I just – It’s just never really been my thing

Bill: Oh yeah?

Carrie: yeah, so I thought instead, um, maybe you could close your eyes and I could dribble warm tea on you. That might feel good. Or maybe you might think it’s fun to hear the sound of running water when we have sex. And if things got really serious between us, I could maybe even leave the bathroom door open sometime, although, honestly I’m not really sure how comfortable I would be with that either.

Carrie’s efforts to find a kink compromise are interrupted by Bill telling her that his campaign advisors don’t think it’s a good idea for him to be dating a sex columnist, and he breaks up with her. This leads Carrie to write a thinly veiled article about him in her next column, titled “to pee or not to pee?” and the episode ends with Bill’s look of mortification as he reads the article.

Re-watching the episode I was struck by how quickly Carrie shifts from trying to find a way to honor his interests and her own boundaries to “outing” his kink, which the episode seems to consider a justified act of revenge for getting dumped (sidebar: knowing you’re going to break up with someone, and waiting until just after you sleep with them again is a dick move, but we don’t kink shame here)

As a pleasure-positive and kink-aware therapist, I couldn't help but wonder

How can we treat ourselves and our partners with compassion when we uncover areas of sexual incompatibility?

Especially for those of us that consider ourselves open-minded, or kinky, it can be a surprise to hear our partners mention something that it turns out we aren’t into. We may worry about what it means for the state of our relationship, and we may feel a surge of icky emotions like guilt, shame, or even disgust.

How can we be honest about our boundaries without veering into kink-shaming?

In Stella Harris’s book Tongue Tied: Untangling Communication in Sex, Kink, and Relationships , she gives some concrete suggestions for how to respond if a sex partner shares something with us that we aren’t up for. She recommends starting with expressions like:

“I really appreciate the vulnerability it took to share that with me”

“I appreciate you trusting me with that”

“I’m so glad you feel comfortable sharing with me”

“Thank you for telling me”

And moving towards:

“I don’t think there’s anything wrong with that, but it isn’t my cup of tea”

“It doesn’t bother me if you do that, but I don’t want to participate”

“I don’t think that’s for me, but I’m glad you told me about it. I love you” (Harris, p. 129)

But what if you’re struggling not to yuck someone's yum ?

Return shame back to sender

Remember, we exist in a sex negative culture, even if we personally have sought out a more pleasure positive existence. If hearing about someone else’s kink invokes a feeling of shame, it’s a good bet that this shame is something we were taught, not something that we consciously picked for ourselves. Understanding the origin of these biases can help us to uproot this shame.

In this episode of Sex and the City, discussing Bill’s kink highlight’s Carrie’s own discomfort about urinating in front of a partner. It may be that Carrie’s own internalized shame about her body’s elimination processes interfere with her ability to see the potential for intimacy and sexiness.

Get curious

Education is a great antidote to shame. Maybe part of our initial *shudder* reaction is that we don’t know very much about that specific kink, and in the absence of real information, we’ve made assumptions, and you know what they say about those. Learning what our partner likes about their kink, how it makes them feel, how they discovered this was something they were into can help demystify. This doesn’t necessarily turn a “no” into a “yes” but it may help us be more supportive of our partner’s interests.

Carrie could have checked out this Allure article A Beginner's Guide to Golden Showers and Piss Play Fetishes or this Esquire article Why Some People Enjoy 'Watersports' - And What It's Really Like and asked Bill about whether or not his interest in getting peed on was connected to an interest in BDSM or a particular desire to feel humiliated by his partner. Learning more about what turns him on about this sex act, might have helped Carrie continue to brainstorm ways to participate that were not only acceptable to her, but potentially sexy. Or maybe not.

If it’s a “no” say “no”.

Later on in Tongue Tied, Stella Harris argues that telling our partner “no” is actually a wonderful thing: “I’m excited when someone says no to me, because it means if/when that person says yes to something, I can believe them. Being able to trust that someone can and will say no means that I can try more adventurous things and know that the other person is doing them because they really want to, and not because they’re trying to please me (Harris, p. 130)

What Next?

Carrie and Bill’s relationship begins and ends within the confines of the 30-minute episode, but what if they had decided to stay together, what then? Would there be enough sex acts in the “enthusiastic yes!” column for both of them? Is Bill’s interest in watersports something that he enjoys but could do without? Or does it feel like a necessary component of his sex life? Are the compromises Carrie suggested of interest to him? Or do they not quite fulfill what he finds sexy about it? Is there room in the relationship for Bill to meet that desire elsewhere? Through pornography? Erotica? Sex workers? Other romantic partners? I won’t hold my breath that the reboot will do any better of a job of answering these questions, but I love to wonder.

And if you’re a Massachusetts resident wondering how to talk to your partner about your kink, and you’d like some help, reach out , The Pomegranate Institute specializes in working with folx with kinks and fetishes.

Is There Such a Thing As Ethical Porn Consumption? (Heck Yes!)

schotkowski@gmail.com — Sat, 28 Oct 2023 22:01:51 GMT

Curious about how you can support sex workers, combat harmful stereotypes, and find porn platforms that prioritize ethical practices? Read on.

People have been producing and consuming erotic imagery since the Paleolithic era . So-- irresoluble debates about the subjective line between tastefulness and obscenity notwithstanding-- porn isn’t new. In the age of the internet, however, it seems like smut is everywhere. Depending on who you ask, the entire internet is basically porn — or maybe it’s actually more like 5% .

Regardless of how much online content is in fact X-rated, as the World Wide Web extends its all-pervading tentacles ever further into every aspect of our daily lives, it’s undeniable that pornography of any flavor is increasingly available to anyone, anywhere, at any time.

Gone are the days of having to don a trench coat, wig, and oversized sunglasses to slink past your nosy neighbor into the backroom at the local video rental shop to snag a selection of steamy VHS tapes for your long weekend of solo spelunking .

As the explosive growth of online space has facilitated instant, free, and anonymous access to X-rated material, porn has become simultaneously increasingly normalized and increasingly contentious .

Is internet porn a bit of harmless fun— the contemporary incarnation of an ageless form of human expression ? Or is it, as some of its most vocal critics claim, an unprecedented scourge on society which promotes violence against women, corrupts tender children, wrecks marriages, and kills heteronormative procreative boners ?

Given mainstream porn’s generally warped portrayal of sex and often murky production processes and labor practices--- is it possible to engage with this industry ethically?

Our perspective is that ethical porn consumption is absolutely possible, but it requires us to be intentional about the sites we’re engaging with and how we engage with them.

In the same way you might choose Free Trade coffee or chocolate in an attempt to avoid unintentionally fueling demand for child slave labor in the Global South, making sure you’re not inadvertently supporting harmful practices through your selection of sexy media requires a little bit of conscious thought.

Let's explore.

What is Ethical Porn?

The word "ethical" gets thrown around a lot when discussing various aspects of the adult entertainment industry. However, there’s no established consensus on what exactly makes porn ethical.

In our view, porn can be considered ethical (or not) based on two factors: how it was made, and the content of the porn itself.

To the first point, sex workers deserve to be safe, respected, and well-paid for their labor. Therefore, for porn to be ethical it must be produced in a safe environment where everyone is of age, consenting, and happy to participate. Also, as in any other business, everyone involved in all aspects of its production must be compensated fairly.

Ethical porn, in other words, centers workers' rights.

As sex educator Evie Plum explains, in ethical porn, “[t]he performers’ pay, safety, and treatment is put first and is fair. Consent, sexual health, and credit are paramount.”

Dr. David Ley , certified sex therapist and author of Ethical Porn for Dicks, A Man’s Guide to Responsible Viewing , provides the following perspective:

“Ethical porn is a media where the performers are paid a fair wage for their work, treated with dignity and respect, not expected to engage in acts against their will, and where sexuality is recognized as a diverse, individual experience.”

This brings us to the second, more hotly debated element of ethical porn: the content.

For many feminists, porn that caters to the male gaze is inherently problematic . Further, it’s been frequently argued that mainstream porn may perpetuate harmful stereotypes about marginalized groups, create unrealistic expectations around bodies and sexual performance, and negatively impact viewers' ideas about consent, pleasure, and intimacy.

Many ethical porn sites are therefore founded on the principle of rejecting the male gaze by centering a diverse set of bodies and inclusive narratives that work towards dismantling the harmful myths and stereotypes that may be propagated by mainstream porn.

How Can We Recognize Ethical Porn When We See it?

In order to make sure the content you’re consuming, or considering consuming, is ethical, consider the following hallmarks of ethical porn:

· Fair wages and healthy working conditions for the cast and crew.

· Avoids proliferating harmful stereotypes.

· Inclusive (body size, age, ethnicity, etc.).

· Sex workers are performing scenes they enjoy; they have input on the script, their partners, etc.

· It’s real and relatable; a range of safer sex practices is incorporated.

· There’s transparency about the process of verifying age and consent of performers.

· If the site focuses on submissions from the public, there’s a transparent vetting process.

Supporting Sex Workers: How Your Consumer Behavior Can Amplify Ethical Porn Practices

Let’s be very clear about something. People who perform in porn are sex workers. If you’re consuming porn, and want to do so ethically, you should be asking yourself, “ how can I support sex workers ?”

The first and most obvious answer to that question is that you should be paying for your porn.

“Free” content can be pirated or stolen, and there are a lot of questions about extremely important issues--- such as consent--- that have been raised about content on many of the major free sites .

The bottom line? If porn is available for free on the internet, you simply can’t be sure it was produced ethically. And, even if it was produced ethically, it’s hard to know if it’s been made available for free with the consent of the people who originally produced it.

So, we can support sex workers by being informed consumers and making sure that our money goes to sites that operate in a way that reflects our values.

Here are some examples of ethical porn sites:

Of course, we’d be remiss not to mention OnlyFans . OnlyFans has revolutionized the way adult content creators interact with their audience by allowing them to define their own boundaries and monetize their own content on their own terms. Check it out , and remember to tip generously!

But--- hear us out.

The fact is, being an ethical consumer of porn goes far beyond just paying for your content and being a good tipper. With great porn comes great responsibility.

Say you’re paying for, and enjoying, ethically produced porn. We salute you! We now invite you to ask yourself, “what else am I doing to support sex workers ?”

Are you working to decriminalize and destigmatize sex work ? Are you creating, through your actions, a world in which it’s safe for your friends to tell you they engage in sex work?

By considering these questions, we can spark real conversations about what it means to make ethical porn more accessible and widespread and address the systemic issues that stand in the way of a Sex Positive Utopia .

Beyond how we vote with our dollars, it’s essential to fight for the rights of sex workers and create an adult entertainment industry—and a broader society-- that respects the safety and autonomy of all its members.

These conversations can be fraught. Since sex workers are particularly vulnerable to certain harms and forms of exploitation, some people, including some feminists, believe that sex work should be prohibited. It’s our perspective that no labor under capitalism is ever free from exploitation and that we should continue to make the world safer for sex workers and everyone else by advocating for ethical labor practices and fair treatment across all industries .

Be the Orgasmic Change

Ultimately, porn is a reflection of the larger society whence it emerges. There is both very ugly, and very beautiful stuff out there. We live in a white supremacist heteropatriarchal capitalist world order, and much mainstream pornography symbolically reinforces the uneven power relations that both undergird and permeate this global culture.

However, with the rise in accessible, alternative, ethical porn, it's both our privilege and our responsibility as viewers to make sure we're supporting sites and creators who embody our values.

Be the orgasmic change! Bring about the seismic shift! Give thanks for sex workers! Fight for their rights! And consume porn that looks like the kind of world you want to live in.

Are you a sex worker living in Massachusetts and seeking therapy? Reach out ! We would love to hear from you!

Why You Should See a Kink-Aware Therapist--- Even if You’re Vanilla

schotkowski@gmail.com — Wed, 13 Sep 2023 15:45:24 GMT

The Pioneer Valley is known across the country for its embrace of alternative lifestyles, and therapists across Hampshire County, Hampden County, and throughout Western Mass have higher-than-average kink awareness. Here’s why that could benefit you, regardless of your sexual practices or preferences.

What is Kink and Why Does it Matter for Therapy?

Merriam-Webster defines kink as “unconventional sexual taste or behavior.” Kink is an umbrella term that covers a diverse range of practices and identities, including but not limited to BDSM (short for Bondage, Discipline and/or Dominance, Sadism and/or Submission, and Masochism), consensual non-monogamy, and polyamory.

People who are interested or involved in activities considered kinky run the risk of receiving therapy or counseling that is at best uninformed, and at worst, stigmatizing and harmful.

Recognizing the increasing need for competent, compassionate, and inclusive care for people of diverse sexualities and gender identities, the Kink Clinical Practice Guidelines Project provides a working set of best practices for kink-affirming therapy.

The Kink Clinical Practice Guidelines Project identifies three levels of kink-affirmative therapy:

Kink-friendly: a kink-friendly therapist has minimal awareness but an openness to not pathologizing kink.
Kink-aware: a kink-aware therapist has a specific grasp and knowledge of kink-relevant issues and has worked with kink-identified clients.
Kink-knowledgeable: kink-knowledgeable therapists most have the most knowledge about kink-relevant issues and are the most affirming of kink-identified clients.

Ok, But I’m Not Kinky. Why Should I Care?

Seeing a kink-aware therapist has several advantages, no matter which issues you’re working through or where you’re at in your mental health journey.

Kink-Affirming Therapists are Focused on Boundaries and Consent

All kinds of sex should involve a discussion of boundaries and consent.

However, kinky sex involves a wider menu of possibilities. As such, kinky sex partners need to openly communicate to clarify shared interests and establish boundaries (being into kink doesn’t mean you’re into all kinks), and continually check in with one another about consent as participants’ mental and physical states evolve.

Similarly, all therapists--in theory—are adept at respecting boundaries and establishing consent.

However, there’s a spectrum, and different degrees to which mental health professionals center these issues as a focus of their practice.

A kink-aware therapist is more likely to ask if you’re comfortable talking about a certain topic in session. For example, you may have disclosed a history of sexual trauma, but a kink-aware therapist won’t presume that you want to talk about it during a particular session.

A kink-aware therapist is more likely to say, “Is there anything you would like to tell me about how you grew up?” as opposed to, “Tell me about your childhood.”

All therapists are trained to consider the ways in which their relative position of authority has an impact on the clinical relationship, but a kink-aware therapist may have more tools in their toolbox for navigating these themes with their patients.

A kink-aware therapist might be a particularly good fit for someone who has felt hurt or betrayed by authority figures in the past.

Kink-Affirming Therapists are Non-Judgmental

A kink-aware therapist understands that there are more kinks out there than flavors of ice cream. They appreciate and celebrate this range of human expression and aren’t shocked by it.

This goes beyond sexual preferences.

A kink-aware therapist understands that human behavior is a vast landscape. They’re unlikely to shame or blame you for having what may seem like a strange or unusual reason for seeking services, or what appears to be an outsized response to stress in your life.

Knowing that your therapist is unlikely to bat an eye (which is not the same as not caring) may help you feel more comfortable bringing up the things you need to talk about.

A Kink-Affirming Therapist Won’t Pathologize You

Defusion, a concept from Acceptance and Commitment Therapy , refers to the idea that, while something might be an important part of your life, it’s not the sum total of your life and doesn’t define who you are.

If you’re into kink, a non-kink aware therapist might focus on that as the root of all your problems. On the other hand, a kink-aware therapist will likely just see it as one part of your life that’s of equal importance to everything else.

Kink-Affirming Therapists Understand the Importance of Aftercare

Aftercare refers to the practice of care-taking that occurs after a sexual experience. It's a time to check in, reframe mindset, and help avoid the dom-sub drop (intense and potentially negative physical and mental feelings that sometimes come up after a BDSM scene).

Sexual aftercare might include talking about the sex that was just had, cuddling, showering, or sharing a meal.

In the context of therapy, aftercare awareness means your therapist is more likely to be better at time management, having intentional warm-ups and cool-downs to buffer the intensity of the session.

So, whether or not you’re into kinky sex, your kink-aware therapist isn’t going to interrupt you mid- crying jag with snot running down your face by suddenly chirping "I'm so sorry but we're out of time for today, see you next week!"

Providing Kink-Affirming Therapy means a Commitment to Continuing Education

Since kink isn’t a topic that’s covered in most grad programs, if a therapist is specializing in it, it means they’re pursuing advanced training. This most likely indicates that they value ongoing learning and prioritize staying on top of new developments in the constantly evolving field of mental health care.

How to Find Kink-Affirming Care

Therapists can submit listings to the Kink Aware Professionals Directory identifying themselves as kink-friendly, kink-aware, or kink-knowledgeable.

Many therapists may also refer to themselves as kink-aware, kink-affirming, or kink-friendly in their bios on Therapy Den and Psychology Today .

You may come across therapists who describe themselves as “pleasure positive” or “sex positive,’ but keep in mind there’s no vetting process for those designations.

Patients based in Massachusetts seeking a kink-aware therapist can request a free consultation here !

Perfectionism and Starting Over

Thu, 03 Aug 2023 13:28:59 GMT

Do you struggle with perfectionism? Have you fallen out of a routine that used to bring you peace or joy? Sometimes picking up the pieces to start over can seem like an insurmountable task. Here are some techniques from Cognitive Behavioral Therapy to help you get past the anxiety and overwhelm so you can begin again.

What is Perfectionism?

‘Perfectionism’ refers to a pervasive tendency to relentlessly seek flawlessness and set impossibly high standards for oneself.

While perfectionists are often high-achievers, perfectionism is a quietly debilitating trait that can also present as chronic procrastination . This is because constant self-criticism, nagging fear of failure, and an inability to feel deserving of one's own accomplishments push many perfectionists into a state of near paralysis .

Why Might a Perfectionist Have a Particularly Hard Time ‘Starting Over?’

It’s hard for anyone to get back on the proverbial horse after taking a tumble. While sticking with a habit or routine once you’re in the flow of things is relatively easy, starting a new habit or getting back into a lapsed routine is a lot harder , and takes around 90 days of consistency.

In fact, people who’ve fallen out of a once solid routine often have a really hard time getting back into it—even more so than if they’re starting brand new habits.

For folks with perfectionism, there’s a lot of cognitive distortion that makes this kind of behavior change particularly difficult.

Cognitive distortions are patterns in our automatic thoughts that can lead to negative emotions and self-sabotaging behaviors. These distortions or patterns involve interpreting situations in a way that does not align with reality and can contribute to the development or maintenance of mental health issues like depression and anxiety.

Cognitive distortions often involve automatic negative thoughts that happen spontaneously and may not be entirely accurate.

Cognitive Behavioral Therapy offers tools and techniques to identify, challenge, and replace automatic negative thoughts related to perfectionism with more balanced and realistic ones.

By questioning the evidence supporting the beliefs that underlie perfectionism—which often involve extremes and all-or-nothing thinking —it’s possible to cultivate a more moderate and self-compassionate perspective.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that focuses on identifying and changing negative thought patterns (i.e., cognitive distortions) that contribute to harmful behaviors and emotional distress.

CBT has been extensively researched and is considered an effective treatment for a wide range of mental health issues, including depression, anxiety disorders, phobias, post-traumatic stress disorder (PTSD), and more.

CBT can help perfectionists by creating awareness around the negative thoughts and critical self-talk that keeps them stuck in cycles of self-sabotage.

Let’s explore how we can put some techniques from Cognitive Behavioral Therapy into practice to help perfectionists start over .

Cognitive Behavioral Therapy for Perfectionists.

Let’s pick an example of a perfectionist who wants to start over.

Say you want to start going to the gym again after taking a long break.

If you find you’re encountering a lot of resistance or inertia, take a minute to stop and identify your thoughts.

Try not to criticize or correct them at first, just “catch” them. Imagine cloud watching.

The automatic thoughts are clouds drifting across the “sky” of your mind. You notice them, but don’t hold onto them.

Automatic negative thoughts might include, “I’m never going to be as strong as I used to.” “I’m so lazy.” “A smarter person wouldn’t act this way.”

Once you identify these thoughts, you can then evaluate them for accuracy and helpfulness.

For example, how true is the statement, “I’m never going to be as strong as I used to be?” While it may be true that you’re currently less strong than you used to be, it’s also true that it’s entirely possible to build muscle again.

Some questions to ask yourself in order to evaluate the accuracy of your automatic negative thoughts might include:

“What evidence do I have for and against this?”
“If a close friend said this to me, what would I say to them?”
“I seem to have predicted the worst-case scenario—what is the best-case scenario? What is the most realistic?”

Evaluating our automatic thoughts for accuracy can help us realize that we’re unconsciously participating in a lot of thinking errors. Some common thinking errors include:

Catastrophizing (believing that something will happen that’s so unbearable that you won’t be able to cope).
Fortune-telling (jumping to a negative conclusion about what’s going to happen).
Personalizing (holding yourself 100% responsible for something not totally under your control).
All-or-nothing thinking (believing that total success or utter failure are the only options, with nothing in the middle).
Overgeneralizing (making a rule or a pattern after a single event or series of coincidences).

Identifying thinking errors isn’t about shaming, blaming, or criticizing ourselves for being “wrong.” It’s about recognizing that these distortions are interfering with our ability to make behavior changes and are common symptoms of the things we’re in treatment for (e.g., depression, anxiety, crippling perfectionism, etc.).

Working with a CBT Qualified Therapist.

By integrating Cognitive Behavioral Therapy (CBT) techniques into your daily routine, you can challenge and reframe perfectionistic thoughts, embrace imperfections as part of the human experience, develop more balanced and realistic goals, cultivate self-compassion, and foster a healthier, more fulfilling relationship with yourself and your achievements.

Remember that overcoming perfectionism is a gradual process, and it's okay to encounter setbacks along the way.

Working with a qualified CBT therapist who can tailor a treatment to specifically address individual needs and challenges related to perfectionism can help you navigate the obstacles that inevitably pop up in the healing journey.

CBT is a collaborative and structured approach. With consistent effort and the right support, folks who may be struggling today can learn to manage their perfectionism, get back to the activities that once brought them joy, and lead more fulfilling lives.

Are you a perfectionist living in Massachusetts seeking compassionate and highly effective mental health care? Request a free consultation here !

The Pomegranate Institute Blog

Could it be clitoral adhesions? A sex therapist explains.

It’s a part of your body that’s supposed to bring you pleasure. But what happens when it doesn’t? What if touch feels uncomfortable, numbed out, or even painful? Clitoral adhesions are a little-known, surprisingly underdiagnosed issue that can impact sexual health. Let’s talk about it! ﻿

A refresher on the clitoris

What are clitoral adhesions?

What causes clitoral adhesions?

Signs and symptoms

Why are clitoral adhesions so often undiagnosed?

What to do if you think you have clitoral adhesions

What kind of treatment options exist?

What are the outcomes of the lysis of adhesions?

How can sex therapy help?

How the Four Horsemen of the Apocalypse Wreck Relationships—and How to Stop Them

The “Four Horsemen of the Apocalypse” is a term coined by Dr. John Gottman to describe behavior during arguments that are most predictive of relationship trouble: criticism, contempt, defensiveness and stonewalling.

Criticism:

Contempt:

Defensiveness:

Stonewalling:

What does it mean if the Four Horsemen show up in your arguments?

How couples therapy can help you break the cycle of fighting with the Four Horsemen

Nurture your fondness and admiration

Turn towards your partner

Compromise

Soften your start up:

Soothe yourself and soothe each other

Why I Love Virtual Sex Therapy – A Massachusetts-Based Therapist Explains the Benefits

Accessibility: Online Sex Therapy Anywhere in Massachusetts

Lower Cost Without Compromising Care

More Privacy for Sensitive Conversations

Comfort, Connection, and Cat Co-Workers

Better Attendance, Fewer Cancellations

Evening Sessions Without the Safety Risks

Yes, Virtual Sex Therapy Really Works

What It’s Like to Go to Couples Therapy - with a Sex Therapist

Why do people go to couples therapy?

Does my relationship have to be in trouble to go to couples therapy?

Do You Have to Talk About Sex in Sex Therapy?

Why does our practice focus on polyamory-affirming therapy?

What do you actually do in couples therapy?

If we want to learn more about couples therapy what should we do first?

What happens next?

How does privacy work in couples therapy?

How Often Do We Meet, and for How Long?

Interested in Couples Therapy in Massachusetts? Let’s Talk.

What Monogamous Couples Can Learn from Polyamorous Relationships

Communication

The art of the google calendar

Jealousy is not the enemy

Differentiation

Cultivate compersion

Make your boundaries crystal clear

Get explicit (about sex)

Get off the escalator (if you don't want to be on it)

Leave the dominant cultural discourse behind

How to Use Out-of-Network Insurance Benefits for Therapy in Massachusetts

What Are Out-of-Network Therapy Benefits?

How much does my healthcare really cost?

How Much Does Therapy Cost?

Do Most People Pay for Therapy Out of Pocket?

If I’m seeing a therapist who is out-of-network, how do I get reimbursed?

How Much Will I Get Reimbursed for Therapy?

﻿

Can I Use My Flex Spending Account or My Health Savings Account to Pay for Therapy?

Is The Pomegranate Institute an out-of-network provider?

I think I want to try getting reimbursed for therapy, what should I do next?

What Is Sliding Scale Therapy? How to Find Affordable Mental Health Care in Massachusetts

What Is Sliding Scale Therapy?

Why Do Some Therapists Offer Sliding Scale Rates?

Which Patients Are Considered Uninsured or Underinsured?

How Are Sliding Scale Fees Determined?

Where Can I Find Sliding Scale Therapy?

If I Want to Access Sliding Scale Therapy at The Pomegranate Institute, What Can I Do?

Why So Many Therapists Don’t Take Insurance Anymore — Especially in Massachusetts

The Pomegranate Institute doesn’t take insurance, and people want to know why.

Administrative Burden

Low Reimbursement Rates

Delayed Payments and “Clawbacks”

Diagnostic Requirements

Limits on Sessions

Documentation Requirements

It’s a part of your body that’s supposed to bring you pleasure. But what happens when it doesn’t? What if touch feels uncomfortable, numbed out, or even painful? Clitoral adhesions are a little-known, surprisingly underdiagnosed issue that can impact sexual health. Let’s talk about it!