Susan Kolod, Ph. D

By Sue Kolod Ph.D.,

Source: Rawpixel/Shutterstock

As the holidays approach, many people look forward to spending time with family. The warmth and familiarity are undeniable, but with that comes the threat of arguments and renewal of bad feelings. How can we avoid the bad parts and simply enjoy this most wonderful time of the year?

We psychologists have a theory called “regression”, which in very general terms, means reverting to childhood roles and behavior. This can especially happen during stressful times, like the holidays, and all of a sudden a middle-aged adult is acting like a 14-year-old.

Why does this happen?

To our parents, we will always be a child no matter what our age. Even if you are a mature person, parents may still worry that you are not eating well, not wearing warm enough clothes in the winter, not hanging out with the right people, or not fulfilling your dreams. As your parent’s child, you may automatically respond to this with the same frustration and defensiveness you experienced when you were a child trying to establish your independence.

This type of regression is often self-reinforcing. In other words, your parent says or does something that reminds you of your childhood struggle for independence, inducing stress. You then respond as you did as a child, and your parent, in turn, treats you like you’re still a bratty teenager.

Take Melanie, a successful lawyer in her mid-40’s. As a teenager, she was irresponsible, always arrived late, and had problems with drugs and alcohol. Since then, she’s pulled her life together. However, when she goes home for the holidays, her parents still remember their flakey, irresponsible teenage daughter who caused them so much worry. When Melanie is reminded of this by their actions or words, naturally she is irritated, upset that her family seems to ignore how much she has changed. She is hyper-sensitive to jokes about her lateness, or stories of past bad behaviors, which put her on the defensive with her family and set her up for fights with them.

Doug is a photographer in his mid-thirties. Although his parents and siblings have always known that he is talented, for years he was never able to make much money. Now he is finally able to support himself and is gaining a reputation in his field. When he goes home for the holidays, his parents fall back into the habit of concern and worry about his financial situation. He experiences their concern as a lack of faith in him and a refusal to see what everyone else in his life can see: that he is becoming a success. When this dynamic gets going, he becomes sullen, reinforcing his parents’ concern that he hasn’t grown up.

How to Prevent Regressing

If you feel family members are treating you like a child, particularly the child you used to be but are no longer, try not to react in a defensive, knee-jerk manner.  Stay calm, step back, and reflect on how they are making you feel. Then decide to react in a manner that will not reinforce their image of you as a dependent child. Here are some things to try instead:

• When family members tease you about your past behaviors you have outgrown or overcome, don’t be offended.  If you get angry or defensive, that may provoke more teasing. If you don’t respond, they will probably stop.
• Don’t be afraid to remind the family of your successes. They love to hear about it!
• Keep in mind that if your parents express worry or concern about your future, it doesn’t mean they think you are still a child or will fail. Worrying about your child, even your adult children is a common reaction in parents. It’s really about them, not you.
• Sibling rivalry is present throughout the life cycle. You may feel your brother gets all the attention or your sister is more loved. When this occurs at family gatherings, it can be very painful. However, what you don’t realize is that your envied brother or sister probably has his or her own reasons to envy you.  Try to keep that in mind.
• If you have children yourself, notice the ways in which you may induce regressive behavior in them by treating them in ways that remind them of times when they were more dependent than they now are.
• Offer to help cook, do the dishes, or run errands. If you’re feeling stressed or picked on, go for a walk, watch a movie or start talking to those family and friends who aren’t behaving this way towards you.

Remember: regression is a two-way street. Your parents are regressing too. So when your parents or family start to treat you like a child, the worst reaction is to start acting like one, too.

Happy holidays!

Susan Kolod, Ph.D. is Chair of the Committee on Public Information and editor of the blog, Psychoanalysis Unplugged at the American Psychoanalytic Association. She is supervising and training analyst, faculty, and co-editor of the blog Contemporary Psychoanalysis in Action at the William Alanson White Institute. Dr. Kolod has a private practice in Manhattan and Brooklyn.

Maintaining therapeutic boundaries are vital to your mental health

By Susan Kolod, Ph.D.

“There’s a force more powerful than free will: our unconscious. Underneath the suits, behind closed doors, we’re all ruled by the same desires. And those desires can be raw, and dark, and deeply shameful.”

Source: Shutterstock/ESB Professional

These opening lines, spoken by Naomi Watts playing the unhinged psychotherapist Jean Holloway in the Netflix series Gypsy, have great truth.  But, from the mouth of Dr. Holloway, they are a rationalization for her disturbing boundary violations of her relationships with her patients. For example, Dr. Holloway initiated a sexual relationship with the ex-girlfriend of a patient, sought out and befriended the daughter of a patient, and allowed a patient to live in a secret apartment she kept in Manhattan.

The show raises interesting questions about how much involvement therapists should have in their patients’ lives. There are times when some contact outside the session is inevitable, such as when a therapist and patient live in a small town.

However, it is a fundamental rule in psychotherapy that the therapist maintains appropriate boundaries between herself and her patient. In fact, psychotherapy simply will not work and can be potentially harmful without these boundary limitations, sometimes referred to as the frame. They are:

1. No physical contact with a patient.
2. No relationship with a patient outside of the consulting room.
3. The therapist should not treat close relatives or friends of the patient.
4. No practical advice to a patient.
5. Maintain objectivity and neutrality toward the patient and avoid excessive worrying/thinking about the patient.
6. Seek supervision if you are tempted to, and before you do, violate any of these rules.

Although not every violation will lead to disaster, and some flexibility may be harmless or even appropriate in certain circumstances, the failure to take seriously the potential for disaster from any boundary violation is a grave error. Trouble happens most often when the therapist is tempted to think she is above these rules, not subject to temptation, or can handle this particular situation. That is when consultation with a supervisor may be most helpful.

The therapeutic relationship is not a friendship because the therapist and patient have no relationship outside the consulting room. That doesn’t mean that the therapist has no feelings towards the patient. In fact, many patients evoke extremely strong emotional reactions in their therapist: reactions of love, lust, curiosity, envy, competition, and even distaste or hatred at times. The feelings evoked in the therapist by the patient are calledcountertransference, and the feelings that the patient has for the therapist are referred to as transference.

Transference and Countertransference:

First identified by Sigmund Freud, transference is one’s reaction to another person based on feelings and patterns of relating that were established in early childhood, often towards a caretaker, usually a mother and father. Transference reactions are not limited to the therapy relationship. In fact, we unconsciously transfer feelings derived from our earliest relationships onto many of our adult relationships.

In psychoanalytic therapy, transference is something to be examined, explored, and understood. The therapist also examines and explores her countertransference feelings as a way of understanding the effects a patient is having on her. This examination of the countertransference gives the therapist insight into the patient and protects her from inadvertently acting in ways that may interfere with her functioning in a non-judgmental and objective manner. Problems ensue when the therapist is unaware of her countertransference.

Psychoanalytically-trained therapists have themselves undergone psychoanalysisprecisely so that they can become aware of their own unconscious patterns of thought and behavior established early in life. As a professional, when Dr. Holloway realized how her patients were affecting her, she should have sought consultation and possibly gone back into analysis.

What is an enactment?:

Edgar Levenson, a preeminent psychoanalyst, notes that therapy truly begins when the therapist recognizes that the kinds of interactions the patient describes as having with other people have begun to occur in the consulting room between the patient and therapist. These situations are referred to as enactments.

For example, in sessions, Sarah often focused on her unhappy interactions with friends and family. She complained they were frustrated and fed up with her and didn’t want to listen to her problems. At a certain point, she began demanding of her therapist in a distraught tone, “What should I do? Just tell me what to do!” The therapist, against his better judgment, felt compelled to give Sarah advice, something which he refrained from doing with his other patients. Sarah never followed the advice and the therapist began to note how frustrated and fed up he felt towards her.

Sam, a handsome and engaging young man, sought therapy because he had been unable to establish a loving relationship. He reported on his whirlwind courtships with one woman after another, which inevitably led to his finding a flaw in the woman and then losing interest. The therapist looked forward to sessions with this patient, in part, because he was so pleasing and complimentary. When she noticed that she was having romantic fantasies about him, she realized she was becoming involved in an enactment of his seductions and knew where it would lead.

The ability to discern and examine the presence of an enactment requires that the therapist maintain the frame and keep clear boundaries with the patient. With Sarah, the therapist realized he and Sarah were enacting the very problem they had been discussing. Once the therapist noticed this, he was able to step back from the advice-giving and explore with Sarah the foundations of her frustrating pattern of demanding and then rejecting advice.

In the case of Sam, the therapist realized that she and Sam were enacting his pattern of seductions. She could then focus on exploring the reasons for this behavior and how it interfered with his development of loving relationships with women.

The therapy relationship can and should evoke strong feelings in both therapist and patient that are vital to effective treatment. But those feelings can only be used therapeutically if they are explored and understood, but not acted on. The rules of the frame, which prevent boundary violations, are critical to therapeutic success.  And that is why your therapist cannot, and should not, be your friend.

The joy of self-love can be powerful and sustaining.

Narcissism is bad, right? Google search is flooded with questions: “What is narcissism?” “How can you tell if your partner is a narcissist?” “Am I a narcissist?”

So my patient Adele was surprised and intrigued when I told her that we needed to work on developing some healthy narcissism. “Is there any such thing as healthy narcissism?” she asked in disbelief, “I thought narcissism was negative.”

The diagnosis of Narcissistic Personality Disorder is indeed very negative and includes characteristics such as arrogance, preoccupation with oneself, a need for constant admiration and, most importantly, a lack of empathy for others. But narcissism itself is not positive or negative–there is a continuum from healthy to pathological.

What does healthy narcissism look like?

Adele is a beautiful, highly intelligent and creative person who does not recognize or appreciate these qualities in herself.  She mentioned in passing, that she never looks in the mirror. You may remember that in the Greek myth, Narcissus falls in love with his reflection. Adele is never in love with her reflection and this creates problems for her. When completing a difficult project at work, she experiences no pleasure or satisfaction, just a grim sense of “on to the next problem.” When people comment on her style and grace she is disconcerted. In her romantic life she is surprised and taken aback when someone attractive shows an interest in her.

Healthy narcissism is related to self-esteem and self worth but is not exactly the same. It’s taking pleasure in one’s beauty, in the workings of one’s mind, in the accomplishment of a tough job well done. It is ecstatic joy in oneself. Although the joy of healthy narcissism can be a fleeting sensation, it is powerful and sustaining.

Healthy narcissism is exemplified in the song from West Side Story, I Feel Pretty.

I feel pretty,
Oh, so pretty,
I feel pretty and witty and bright!
And I pity
Any girl who isn’t me tonight.

I feel charming,
Oh, so charming
It’s alarming how charming I feel!
And so pretty
That I hardly can believe I’m real.

The Narcissistic Phase of Childhood Development

Complete preoccupation with oneself is normal and expectable in children at a certain age. The Narcissistic Phase of development begins at around the age of two—the same time children begin to talk. During this time children start to use words like “I”, “mine” and “no”. During this phase, children frequently behave as if the world revolves around them and have little concern for the needs and desires of others.

The eminent child psychologist, Margaret Mahler described this phase as a “love affair with the world.” Picture a two-year old running down the street with a broad smile on her face, Mom frantically chasing after. If development proceeds, as it should, the child learns, through close contact with parents, friends and teachers that those people also have needs and desires. Egocentrism diminishes and the child develops concern for others.

Healthy narcissism or a “love affair with the world” is something that adults can retain, although it no longer depends on being the center of the universe. It is that joyous, euphoric feeling of taking pleasure in oneself and one’s impact on the world.

Why is healthy narcissism important?

Healthy narcissism is important for a variety of reasons: If you can experience ecstatic joy in yourself it can help you through difficult times. For example, if a person can derive narcissistic pleasure from a difficult job well done, it can sustain that person through times of frustration and failure, thus preventing the likelihood of burnout. Likewise, taking joy in one’s beauty and positive impact on others can provide resilience during times of disappointment and heartbreak.

For a variety of reasons, some people don’t retain or develop healthy self-love.  Here are some examples:

An extremely self-centered parent may demand all of the attention from the child, not leaving room for the child to revel in herself. When Carina was a child, she believed that her mother knew everything and was perfect. As Carina got older, she learned that to get attention and approval, she needed to bolster her mother’s belief in her own omniscience and perfection. If Carina asserted her needs, she got the cold shoulder—or even worse. This was not an environment in which Carina’s healthy narcissism could flourish.

Some children never develop healthy narcissism because they fear that others will envythem. If a child learns that they will be punished or treated in a hostile manner if they excel, that child will hide or diminish the impact of their excellence, even hiding it from themselves.

Does it feel wrong to accentuate and revel in your good qualities? Think about what it brings to mind: fear of envy or the “evil eye”? Worries of being conceited? If so, reframe your healthy narcissism as gratitude for what you have been given. Being thankful for your natural talents may be a way to appreciate them without feeling too egotistical. Remember that the ability to take joy in yourself is a quality that can sustain you through the rough times in life.

Susan Kolod, Ph.D., is a supervising and training analyst, faculty and co-editor of the blog Contemporary Psychoanalysis in Action at the William Alanson White Institute. She is Chair of the Committee on Public Information of the American Psychoanalytic Association. Dr. Kolod has written numerous chapters and articles about the impact of hormones on the psyche. She has chapters in 2 new books: Alike/Different: Psychoanalytic Perspectives on Identity and Difference (Routledge) and Unknowable, Unspeakable and Unsprung: Navigating the Thrill and Danger of Living amidst Truth, Fantasy and Privacy(Routledge).

It depends what kind of sexual problem you are having

By Susan Kolod, Ph.D.

Flibanserin or “Addyi” is the first drug approved by the FDA to treat Hypoactive Sexual Desire Disorder (HSDD) in women. The drug will become available on October 17th. There has been much discussion in the media over whether the drug is pro or anti-feminist. But the really important question is, “does it make you horny?”

How Does Flibanserin Work?

Flibanersin treats desire, unlike Viagra, which improves performance. Flibanserin is not “female Viagra”–Viagra is taken before sex and it pretty much assures an erection. Flibanserin must be taken every day and is being marketed as a drug to increase desire. So how does Flibanserin actually increase sexual desire?

To find out, I spoke to the expert on rat sexuality, James Pfaus, Ph.D., and learned how Flibanserin affects female rats with the hope this might shed some light on how it affects women.

Pfaus, Professor, Concordia University and President Elect, International Academy of Sex Research, gave me a crash course on the sexual behavior of female rats. Female rats love sex and make their desires known very clearly. They pursue sex actively with partners they find attractive and avoid sex with rats they don’t find attractive. They love to have their clitorises stimulated with a paint brush. No slut-shaming among rats.

In Pfaus’ lab, rats whose ovaries had been removed were administered a low dose of estradiol and then Flibanserin. The low dose of estradiol created a sex hormone scenario similar to women going through menopause. Usually, a female rat whose ovaries have been removed and is given a low dose of estradiol will not initiate or “solicit” sex. After a

two day trial, Flibanserin restored these rats to their normal rate of solicitations. Impressive results!

However, human sexuality cannot be observed so easily, nor is it so straightforward. In the drug trials, some women were given Flibanserin and others a placebo. All were asked to keep a diary of their sexual experiences. They also met with a psychologist once a week. Self-report, especially about sex, is notoriously subjective and often inaccurate.

Diary responses were analyzed for SSE’s or Satisfying Sexual Events. An SSE can be anything from masturbation to multiple orgasms with a partner to intimate touching. It is a broad and somewhat vague concept–it just measures how many times you “did it,” the “it” being something defined as sexual. So an SSE doesn’t really capture the experience of desire.

Flibanserin appears to be a lot more effective with female rats than with women. The increase in SSE’s was only .7 per month for women as compared with an increase in sexual solicitations of 3.94 per month in the rats!!

However, human SSEs and rat solicitations may be two different things.

Appetitive and Consummatory Motivation

Pfaus makes a distinction between “appetitive” and “consummatory” motivation in sexuality. Appetitive motivation is the first phase of a sexual encounter and involves the initiation and anticipation of sex. Appetitive behavior moves the animal (human and non-human) towards an attractive potential sexual partner and is more indicative of spontaneous desire. For example, female rats will press a bar to get access to a male sex partner. This is appetitive behavior.

In humans, appetitive motivation includes such behavior as flirting, planning for a date, fantasizing about a date.

Consummatory motivation, on the other hand, leads to actual physical interaction and completion of the sex act. In female rats, lordosis–arching the back and sticking out the buttocks so the male can mount her–is a consummatory behavior. In humans, foreplay, touching and actual sexual contact, and orgasm are consummatory.

It is possible that different drugs help with problems in one phase, but not another. Pfaus suspects that Flibanserin increases appetitive motivation. In other words, it might help a woman to feel sexual desire towards a partner, to anticipate sex with that partner, and to be motivated to initiate sex.

Three other drugs, still being tested by the FDA, Lybrido, Lybridos and Bremelanotide, may effect the consummatory sytem by maintaining excitement throughout the sexual encounter and facilitating orgasm.

Who Will Flibanserin Help?

Flibanserin, Pfaus suspects, will be most effective with women who are highly organized and always planning ahead. They may find it difficult to be “in the moment.”

For example, Stacey and Linda have been together for 18 years and married for the last 5. They have 2 small children. Stacey is highly organized both in terms of the household and at her job. She often feels overwhelmed by all of her responsibilities. Although she is very attracted to Linda, she is unmotivated to initiate love-making because she is always planning the next thing. This is exacerbated by feelings of resentment towards Linda who is not helping enough with the kids and the housekeeping.

While the interpersonal issues need to be addressed, Flibanserin might help Stacey to feel spontaneous desire and to be “in the moment.” The drug could be a good adjunct to couples’ therapy.

Flibanserin might be less helpful for a woman who can experience spontaneous desire but can’t sustain her excitement. Some of the other drugs to treat HSDD such as Lybrido, Lybridos or Bremelanotide, still being tested by the FDA, could be more helpful with difficulties maintaining excitement and reaching orgasm. These three drugs do not need to be taken every day—only before having sex, like Viagra.

The best outcome would be that a number of different drugs will become available as adjuncts to psychotherapy, couples therapy and sex therapy. And that women will be comprehensively informed about the risks and benefits. Women are entitled to make the best choices for themselves about what makes them horny and helps them to enjoy sex!

Susan Kolod, Ph.D., is a Supervising and Training Analyst, member of the Faculty, co-Editor of the blog, Contemporary Psychoanalysis in Action and on the Steering Committee of the Eating Disorder, Compulsions and Substance Abuse Program (EDCAS) (link is external) at the William Alanson White Institute (link is external). She has lectured and written about the impact of hormones on the psyche with a particular focus on sexuality, menopause and the menstrual cycle. She is in private practice in Brooklyn and Manhattan.

By Susan Kolod, Ph.D.

If you want to lose weight, the solution is simple: eat less and move more, right? Everyone one knows that. But eating less and moving more is a lot easier for some people than others. It is easiest for people who are in the normal weight range and have perhaps gained a few pounds over the holidays. New research explains why this approach often fails with obese individuals. And why some calories are better than others when seeking to lose weight.

The role of hormones

Feeling full or hungry, energetic or lethargic, can be traced to certain hormones—in particular, leptin and insulin. Normally, when a body’s fat cells are filled with stored fat they release the hormone Leptin, which tells the brain to eat less and move more. However, when a person becomes obese this “signaling” goes awry. Leptin is not longer released and the message to the brain becomes “eat more and move less.” Thus eating more and moving less, thought to cause obesity, may actually be the RESULT of obesity.

Sean Lucan, M.D., M.P.H, Albert Einstein College of Medicine in New York City and James DiNicolatonio, Pharm.D., Mid-America Heart Institute of St. Luke’s Hospital, Kansas City Mo., conduct research on weight loss, obesity and public health issues. They suggest that the culprit in the perpetuation of obesity is refined sugar, rapidly absorbable carbohydrates and the hormone Insulin. Refined sugar and starches cause blood sugar to rise. The rapid elevations in Insulin results in a precipitous drop in blood sugar. This causes food cravings, especially for sweets.

Over time, the overconsumption of refined sugars and starches can result in “Leptin resistance,” which leads to an inability to determine fullness. Thus, the result of a dietheavy on refined sugar and starches is increased appetite and decreased activity—a dangerous cycle, and difficult to reverse. The researchers conclude that it’s not the number of calories consumed that accounts for obesity, but rather the type of food consumed—refined sugars and starches in particular. These foods can make changes to the brain that interfere with the ability to determine fullness and cause lethargy.

The problem with “eat less, move more”

Lucan and DiNicolantonio explain why an approach that advocates eating fewer calories is inadequate and simplistic, “By this thinking, a calorie’s worth of salmon, olive oil, white rice or vodka would each be equivalent and each expected to have the same implications for body weight and body fatness.” In fact, proteins, fats, carbohydrates and alcohol each have different effects on hormones relevant to feeling full. Lucan and DiNicolantonio suggest more nuanced thinking about weight loss. That is, some calories satisfy appetite and promote energy while others promote hunger and energy storage—in other words, not all calories are the same.

In addition, if you simply eat less food and consume fewer calories, you will become more tired and hungry—therefore, less likely to want to move more. The cravings for high-calorie foods increases with deprivation, making it more likely that binge eating will occur.

What foods make you want to eat less and move more?

It is more important to consider the type of food than the number of calories consumed. Some foods make you want to eat less and move more—other foods make you want to eat more and move less.

For example, fat, which is high in calories, can satisfy the appetite and promote activity. Nuts, dairy products, oily fish and olive oil are high in fat and calories. But these foods make you feel full and energetic. This makes is possible to eat less and move more, which leads to sustaining weight loss.

Diets that simply restrict calories and pay no attention to the types of food consumed can backfire especially among obese individuals who have become leptin resistant.

In order to reverse leptin resistance, it is necessary to change the types of food to those that will re-calibrate the signaling to the brain—and will promote a feeling of fullness and energy.

A public health issue

It does very little good to blame over-consuming inactive adolescents for getting fat. The advice to simply consume fewer calories and increase exercise is counter-productive. New research suggests that overconsumption and inactivity are caused by neurohormonal changes related to a diet filled with refined sugar, starches and processed food. Promotion of whole/minimally processed food with plenty of “good” fats such as olive oil, oily fish and nuts address the cause, rather than the effect. And may also address the sense of failure and hopelessness many obese people experience when they are told to simply, “eat less and move more.”

Volume 50:3, 484-491

2014

READING THE FEMININE MYSTIQUE ON THE 50th ANNIVERSARY OF ITS PUBLICATION

By Susan Kolod, Ph.D.

Young women are becoming equal partners in the hookup culture, often just as willing as young men to venture into sexual relationships without emotional ties.  But research suggests hookup regret is twice as common among women as men.

Is that because women are “hard-wired” to be monogamous? Researchers say no—it has more to do with sexual satisfaction. Or lack thereof.

The “Hookup Culture” has generated a wealth of research on how both men and women respond to casual sex. These studies conclude women are much less likely to orgasm in a hookup as in a committed relationship, and that hookup regret is often linked to an unsatisfying sexual experience.

Justin R. Garcia, an evolutionary biologist at the Kinsey Institute at Indiana University, studied 600 college students and found women were twice as likely to reach orgasm in serious relationships as in hookups. Both men and women sometimes experience hookup regret, but Garcia found women are twice as likely to have a negative reaction later on.

Likewise, Paula England, a sociologist at New York University, in a study of 24,000 college students over the course of 5 years, found only approximately 40 percent of women had an orgasm during their last hookup involving intercourse, while 80 percent of men did. By contrast, roughly three quarters of women in the survey said they had an orgasm the last time they had sex in a committed relationship.

England suggests that for women, practice makes perfect—in other words practicing sex with a partner is far more important for a woman to achieve sexual satisfaction than for men. Communication, which is a key element in a woman’s sexual satisfaction, is less likely in hookups.  “Women are not feeling very free in these casual contexts to say what they want and need.” Another problem, according to England, is that women may still be stigmatized for having casual sex.

Most of subjects in these studies were heterosexual. But Terri Conley, a research psychologist at the University of Michigan, did a study involving bisexual women. She found that if a bisexual woman was approached by both a man and a woman for casual sex, she would be more likely to accept the offer from the woman. Why? Less likelihood of disease, violence or stigmatization and greater likliho0d of sexual satisfaction with a female stranger than a male stranger.

Conley challenges the argument that gender differences relating to casual sex are “hardwired” i.e. biological or evolutionary in nature. She examined the following assumptions:

1. Men think about sex more than women
2. Women orgasm less frequently than men
3. Men like casual sex more than women
4. Women are choosier than men

She suggests that these gender differences have more to do with societal factors: prohibition against women expressing sexual desire, and the greater risk of being subjected to sexual assault and disease. According to Conley, when these conditions are factored out of the equation, women and men appear to enjoy casual sex similarly.

Furthermore, if a woman finds her sex partner attractive, sexually skilled and non-judgmental she is just as likely to engage in and enjoy a hookup as a man. And she will most likely not regret the experience.

But before a woman can communicate what she wants, she has to know what she wants. Sex education does not teach women how to have good sex, let alone ask for what they need.

In a recent New York Times article on this subject, In Hookups, Inequality Still Reigns (November 11, 2013) a young woman reports sex education in her school was aimed at stopping teenagers from having sex entirely; there wasn’t any discussion of how to achieve satisfaction. She noted thatporn can be a great source of sex education but in porn people don’t tell each other things like, ‘Oh, my foot’s falling asleep, we need to move.”

Men’s sexual anatomy makes it is easier to achieve orgasm, whether the sex occurs within a committed relationship or not. Women’s sexual responsiveness is more complicated and requires the woman know what she wants and be willing to ask for it. Her partner must be mindful of the time and attention required to ensure the woman achieves orgasm.

It is quite common for women to disconnect from sexual experiences in hookups, particularly if they are drunk or high. It is just too difficult to stop things once they get started. As one female patient reports, “I just decided to pretend it wasn’t happening.”  She describes being in a trance-like state during a casual sexual encounter and regretting it afterwards.

An unsatisfying sexual experience like this can have lasting negative consequences, resulting in feelings of shame, depression and low self worth.

In taking sexual histories of women who were having problems with arousal as they went through menopause, I found regret over unsatisfying or risky sexual encounters could linger. During the “Sexual Revolution” of the 60’s and 70’s, as now, there was considerable peer pressure to be sexually adventurous. Some of the sexual experiences women reported occurred under the influence of drugs and alcohol, and with multiple partners. While these experiences may have felt adventurous at the time, they are now recalled as painful, humiliating and even traumatic. This may be due to the fact that the woman was not really enjoying herself—just pretending and going through the motions in a very disconnected way.

What is the takeaway for young women today?   Know what you like and want sexually and make sure to communicate this to your partner. It is never a good idea to disconnect and pretend you are enjoying sex if you are not. These reactions lead to feeling “used.”  Hookups aren’t for everyone, but they don’t have to be a source of dissatisfaction, shame or trauma. If you have a great time with a casual sex partner, you are less likely to regret the experience afterwards!

Susan Kolod, Ph.D. is a Supervising and Training Analyst and co-Editor of the blog, Contemporary Psychoanalysis in Action at the William Alanson White Institute. She has lectured and written about the impact ofhormones on the psyche with a particular focus on sexuality, menopause and the menstrual cycle. She is in private practice in Brooklyn and Manhattan.

Dr. Kolod will be speaking at the Division 39 Meeting in New York City at the Sheraton Hotel on April 24^th, 2014. The topic is The Female Body in Psychoanalytic Treatment.

What makes scandals so interesting? A good scandal can be titillating, outrageous, entertaining, satisfying and edifying—it allows us to feel superior, to pity or despise the transgressor and to get vicarious pleasure, all at the same time. It becomes a “feeding frenzy.” People can’t get enough of it—every morsel is chewed and devoured like delicious rich cake.

Scandal allows us to fantasize about the lives we don’t lead. In Adam Phillip’s new book, Missing Out: In Praise of the Unlived Life he makes the point that everyone lives several parallel lives—the life we actually live and the lives we feel we SHOULD or COULD have been living. Depression, anxiety and other types of dissatisfaction result from the frustration one feels that he or she should be living a different, more exciting, more daring, sexier life. Scandals allow us, through fantasy, to vicariously experience an “other” life, while leaving us reassured that we are better off in our ordinary, non-scandalous existence.

What exactly is scandal? Scandal derives from a Greek word for “snare,” implying that one is “snared” into moral failure.  Scandal was originally a term used to denote a discredit brought upon religion by “unseemly conduct in a religious person,” especially if it encourages a lapse of faith in another (Merriam Webster).

Today, scandal has a spectrum of meanings, including discreditable or immoral conduct, damage to reputation caused by such misconduct, and malicious or defamatory gossip, whether or not well founded. “Scandal” and “Slander” share the same root.

Scandal is relative. What causes a scandal at one time or in one place might not in another. There can be no scandal without a scandalized public. Former Prime Minister of Italy Silvio Berlusconi’s solicitation of underage prostitutes resulted in his arrest, but apparently, no significant scandal. According to Italian filmmaker Paolo Sorrentino, that is because, in Italy everyone loves a party. (New York Times, Sept 8, 2013).

On the other hand, the scandal of former Congressman Anthony Weiner who ran and lost the primary election for Mayor of New York City is remarkable for what he did NOT do. “He did not commit adultery. He did not break up a marriage. He did not employ the services of a prostitute. He did not stalk. He did not misuse public funds…He did not have inappropriate physical contact—or any physical contact—with any person.” His scandal resulted solely from “pixels on a screen.”  Herzberg (New Yorker Magazine, August 28, 2013).  Or, perhaps, from his persistent lying and acting foolishly in public.

Scandal takes on a life of its own, and, sometimes, the actual facts of the matter are of little importance. As the dictionary definition above implies, the gossip may be more enthralling than the details of what really occurred.

Every person struggles with impulses to break the rules, to violate boundaries. These unacceptable attributes are rejected in oneself but are embodied in the scandalous person, who becomes larger than life. Similar to watching porn or a horror film, one can experience terror, outrage, extreme anxiety, sexual excitement and relief, without having to engage in risky behavior.

Here are 5 reasons we love scandal:

1. Vicarious pleasure in the rule-breaking of another. Transgression is titillating. Every person is tempted to break rules and boundaries but for the most part, resists. The scandalous person has given into temptation.
2. Pleasure at the punishment of the transgressor. There is a sense of moral satisfaction when the scandalous person is humiliated or punished. It restores faith in the orderliness of the moral universe. Scandals exaggerate the sense that there are good and bad people.
3. Pleasure at watching someone “get away with it.”  In Missing Out, Phillips writes that “getting away with it” occurs when you obtain the forbidden object of desire without paying penalty. The unpunished transgressor allows us to imagine this (potentially thrilling) experience.
4. Pleasure at being asked to forgive. This elicits a feeling of power and triumph in the person to whom the request is made. The transgressor has to grovel, and forgiveness can either be granted or denied. This provides the non-transgressor a feeling of superiority, however fleeting.
5. And perhaps most importantly, distraction from the tedium of one’s own difficult everyday problems. Reading about the scandals that have beset others is a great distraction. Not only does it take our minds off our problems, it also assures us that our problems are small and manageable in comparison.

We all have parts of ourselves we don’t want to acknowledge that wish to do harm. These disowned parts are easily projected onto the alleged perpetrator who is experienced as repellent and alien. Abby Stein, Professor of Interdisciplinary Studies at John Jay College of Criminal Justice notes, “In the presence of perpetration we may be repelled but we are also excited. In an odd way, people who have done awful lurid sexual things to others are not just interesting—they are downright sexy.”

When someone breaks the rules, violates boundaries, it can be upsetting to observe. But reactions to scandal are more complicated than simple moral outrage. If it were just outrage, people would not become so fascinated and involved. It is the combined reactions of outrage and disgust on the one hand, and fascination and titillation on the other, that makes scandal exciting. That’s where fantasy and vicarious pleasure take center stage.