Therapist Unplugged
Therapist Unplugged
Intimacy and Overcoming Sexual Trauma with Heather Caballero: Part 1
What holds couples back from true connection? In this episode, sex therapy expert Heather Caballero dives deep into the challenges of intimacy and sexual trauma, offering tools to foster deeper, more fulfilling relationships. From tackling sexual disconnect to empowering therapists with essential skills, Heather sheds light on the often-overlooked dynamics of sexual communication.
Discover the dual control model, a framework that unravels the complexities of arousal and inhibition, and explore the concept of arousal non-concordance—where physical responses may not align with desires. Through relatable analogies and expert insights, Heather debunks societal pressures and encourages open dialogue to break barriers.
Whether you're navigating new intimate dynamics or looking to enrich an existing connection, this episode provides practical advice and transformative perspectives to help you prioritize and enhance your relationships.
Therapist Unplugged is brought to you by The Montfort Group. Each episode will feature the unplugged views of guests and fellow therapists as we navigate hot topics, therapy trends and the world around us.
*The Montfort Group provides a serene, calming setting where you can feel challenged, supported, and motivated. Our skilled therapists bridge specialized backgrounds and varied philosophies together to create one unified strategy. Rather than steer you away from your own natural abilities, we help you maximize your unique strengths. We do not view a broken history as the end of a story, we see it as an opportunity for a new beginning.
Well, Heather Caballero, I am so thrilled to have you participate in today's podcast, which is all about sex, intimacy, sex therapy, having those difficult conversations with your partner about sex, and I think I really bridged into it from.
Heather Caballero:I got really interested in trauma specifically and then, more and more, as I was reading and researching about it, I kept encountering specifically sexual trauma and I feel like that was my entrance point. I got really interested in working with sexual trauma. Entrance point I got really interested in working with sexual trauma and then it became that one of the hugely important parts of working with sexual trauma is that not only is there this specific relationship that someone has with trauma now in their life, but also that their relationship with sex has been changed and for some people they'd consider it damaged. And a huge part of working with it was about saying, like, all right, how can we rebuild this relationship with sex? And so I feel like I bridged into sex therapy that way and the idea of how do we rebuild our relationship with sex became something that I was hugely interested in and concerned with.
Laurie Poole:It's a really important topic. It's an experience that happens to many more people than we might imagine and it takes a lot of healing and work and intent to move through that.
Heather Caballero:And so many couples. Therapists don't necessarily have a background in it and it's not a required course in a lot of programs.
Laurie Poole:It's one of the optional available ones, but it's not necessarily required for the degree and, in my opinion, having at least a certain level of competence in working with sex and couples is so important, it's absolutely huge, and I think to your point, not only is there not enough training, I think that there are a number of therapists who are very uncomfortable talking about this themselves, and so that's part of what we bring into the room when we do therapy is, if you're not comfortable, as a therapist, being curious and asking very direct questions about a couple's sex life, then you are avoiding something which is what makes a relationship special, different than platonic friendships et cetera and I say this for both, you know, for any kind of sexual relationship between two people. Well, I am so glad that you're here today to talk about this, heather, because I think it's a really, really important subject. One of the questions I'm curious about are what are the reasons clients will come to you for quote unquote sex therapy?
Heather Caballero:There can be a lot of different reasons. Usually it boils down to a level of there is disconnect between us sexually, and there may be so many different factors depending on the person. What's causing that disconnect and when and how that disconnect has entered their relationship.
Heather Caballero:But, ultimately, it's typically about there is a disconnect and we want to do something about it. I think really that already when they come into my room for that, they've started with this idea of I am making sex a priority in my life, and I think that's a hugely unspoken factor. That's giant when it comes to building sexual intimacy and rebuilding that connection with someone is the idea that you're even making it a priority in the first place.
Laurie Poole:You know it reminds me too of in couples therapy. In couples therapy, I always want to know is that emotional connection and repairing emotional injury? Is that a priority? Because it's really hard work and if you're not both in it then it can be more challenging, certainly for the therapist but also for the couple. And so, using that as a starting place of curiosity, have you both decided that this is really really important and a priority to you and to the relationship, that energy that flows between the two of you? Yeah, absolutely. When a couple comes to you for sex therapy, is there a place you typically start with them?
Heather Caballero:So I think one of the biggest things in the conversation about sex is that there isn't really one you know, it's not really talked about and the conversation or the presented information that is out there is so narrow so as to kind of almost give the message to a lot of people at least this is the message I often encounter people having received that, oh well, if I don't fit exactly that, then I'm wrong, I'm deviant, I'm abnormal, kind of things, and that is a really powerfully harmful message for people to carry with them. And so not only is there actively not really a lot of conversation, but the conversation that is being had can create those messages for people. And so one of the biggest places that I want to start with is saying all right, let's learn some language to even navigate talking about sex.
Heather Caballero:I think it's vital to have, and probably the biggest starting point pieces that I use is talking about the dual control model. It's this theory, essentially, and this mechanism it works exactly like. This is that we have both a sexual accelerator. It is our gas pedal. It's always scanning our environment and around us. For is this sex related and kind of like should, is this like something to make me turn on, like kind of thing? And it hits that gas pedal arousal. And then there is also our breaks, our sexual inhibitor, and this one specifically. There are kind of like two types of breaks, but largely speaking, it is constantly scanning our environment to say, what are the?
Heather Caballero:reasons not to be sexually aroused right now, and it might be like, you know, we're in a business meeting or I'm in public or I'm really stressed right now or I'm not comfortable with my partner or with my body kind of things, and those things hit the brake, and so essentially one of the biggest processes with sex is that not only do we want to learn the things that are hitting our gas pedal and brakes, but then we want to start using those things to turn on the ons and turn off the offs, so that we take pressure off the brake pedal and put pressure on to the gas pedal.
Laurie Poole:I can imagine that couples are quite surprised as they explore the accelerators and the gas pedals and the brakes, as they start to think about this and share it with one another, because one of the things you said earlier was that there is this unspoken expectation, perhaps, that we gather from social media, from pornography, from things we read in women's and men's magazines or what have you, that we should all be really great at sex and that if we have to ask our partner what they like, what they don't like, or we have to express what we like or we don't like, that we are in some measure in a deficit.
Laurie Poole:You know that that means that there's something wrong, as opposed to the sharing of really important information that allows us greater attunement and knowledge right about our partner. And so I'm wondering if you can speak to that a little bit, because it seems to me that men and women and I'm talking about a heterosexual relationship here, so you may want to speak to a homosexual, gay, lesbian relationship but I think women have this unspoken assumption that men know what they're doing in the bedroom, which I think is grossly unfair, but I think it is something that men feel a lot of pressure about.
Heather Caballero:Yeah, first, to your point, most of the research that we have right now is, technically speaking, gathered by and large in heterosexual relationships, so we don't have as much hard data for homosexual relationships or even for people who are trans and non-binary. I do think that a lot of the deeper like hey, this is kind of how your brain responds to context, and the idea of the gas pedal and brake pedal that's true for everyone, that is a mechanism that we all have, and so I think they are decently applicable. But I do think it needs to be stated that, at least right now, the body of research that we have is based on heterosexual relationships, and hopefully that will change going forward. But right now that's kind of what we're working from, and so there is going to be at least a small amount of bias towards that in everything that we present, because that's where it's been gathered from. That being said, yes, I do think that there is this large prevalence, particularly for men.
Heather Caballero:This idea of you should be sexual, and there is this. You need to bring in this certain amount of sexuality to a relationship and, specifically, that being sexual is a desirable, needed trait in a relationship, and if you come in, you have to be really good at sex to be a desirable partner. And so I mentioned earlier that there's kind of two types of breaks, strictly speaking, and so one of those breaks is kind of how I described reading the environment. It is contextual kind of thing, it's a process, it's responsive to all those different behaviors. The other break it's like the handbrake in the car, and that one is failure based.
Heather Caballero:It is this idea of worrying that we will fail at sex, that we will not deliver, both for our partner and maybe for ourselves, that idea of feeling this pressure of like, well, I need to be turned on, I need to orgasm, and if I don't, that is failure.
Heather Caballero:It's definitely a different type of pressure and I think that it should be said that it's possible. If the handbrake is on, you can still drive the car, it's possible to get somewhere, but you're probably going to move a lot slower and you're going to take a lot more gas to get anywhere. But it's also definitely a huge amount of brake pressure. That is internal and existent in our lives and I think there's a lot of different ways it manifests for both men and women. But to your question, I think that there is particularly pressure for men in that regards of this is how they're supposed to be able to perform, and acknowledging needing feedback or trying something new or hearing those likes and dislikes from your partner is kind of an invite to opportunities to feel like you are failing, and I think that can be hugely hitting the brakes for people.
Laurie Poole:Can you speak to that a little bit more? When you say you know, a conversation about likes and dislikes can be an invitation to experience more failure, or to have the experience of failure when your partner is telling you, hey, I really like this or I don't like that, Is that what you're saying?
Heather Caballero:Specifically what I'm saying is it's an invitation to feel like they have failed in the past because their partner is telling them you need direction. That's kind of the message that can, at least subconsciously, be received of, hey, you need instruction, you need to be helped because you aren't good at it, and that can be a powerful message of failure that people receive and honestly, I think that it's almost subconscious, but I think that can be a huge deterrent to people for even having these conversations in the first place. It's at risk of triggering that.
Laurie Poole:It's a risk of triggering it. I'll be honest with you, I didn't think about it that way, except that I have certainly observed that many couples don't talk about sex because it is full of landmines. It's perceived as an invitation for criticism. If I feel as though I'm opening myself up to criticism which, frankly, depending on what a couple's feedback loop is like and how they communicate, anyways, that could very well be what happens is all they hear is criticism, as opposed to satisfaction, pleasing their partner and having an experience where they're both fully present, which can be a tall order, depending on what's going on in their relationship as well.
Heather Caballero:Yeah, Sometimes I find it almost a little easier if we were to put it in the context of like cooking for your partner. You've spent all of this time and effort to make this meal and you know you might have a certain amount of pride about that time and effort or how it turned out. And if the only thing you hear from your partner is it's too salty, then it's really deflating, it's really defeating, and I think there needs to be this idea of you know, just like for tastes, we have to hear from our partners like, ah, I love this ricotta on pizza, I hate tomatoes on pizza, and you kind of start to learn here's the kind of pizza I need to order, sort of thing through that feedback that not only do we need that, because knowing what your partner is going to like and dislike when it comes to food, that's not expected. No one thinks you should just innately know that about another person, even though taste is just as individual as sexuality.
Laurie Poole:I think that there's not only that but yeah.
Heather Caballero:But then there's kind of this idea of hey, maybe it's helpful to lean more into. Here's what is working well, that's right. And to come from it from that perspective. But it's also kind of vital that sometimes, if consistently it's too salty, eventually it becomes pretty important to say like, hey, I don't like this much salt.
Laurie Poole:It's all tempered, Also based on. It's almost like you can layer conversations, it's not? You don't have to chew the elephant all in one sitting, right.
Heather Caballero:It's over time.
Laurie Poole:It's over time. Yeah, unless there's something I can think of, a scenario where I said to someone I'm never doing X, just putting it out there like I'm never doing this, and so that immediately set up expectations. But I think it's. What I'm hearing is that these are conversations that can occur over a period of time in a loving, considerate way. This is what I really appreciate. Starting with those positives, this feels really good, or I really like this, or me I would love to experiment with this. You know that kind of thing. The other thing about speaking about men is that the metrics of men and sexual performance. It seems like there is a performative element around men and intimacy that women do not feel the same pressure with, because we have a penis that is hard or it goes softer or it's flaccid, and then that becomes sort of the barometer of what's going on in the bedroom, which, it seems to me, can apply just so much pressure to men in a way that women don't feel quite the same way.
Heather Caballero:I think that's true and it's a little bit more visible for men and it's a lot more visible yeah it's a little bit more of an entry requirement to kind of thing, and it's really true as well for women that their wetness level, how aroused they are, can be something that is also tuned into and considered for some people that sort of pre-rec level, but it's one. Our vaginas are always kind of a little bit wet because of the nature of their environment and how they're working. If we were to compare it, if the penis was always at least a little bit hard, then there would be kind of a little bit less of a differentiation.
Laurie Poole:Yes.
Heather Caballero:And so that's true for women. It isn't as necessary to sex for a woman to be particularly wet Is it necessary to good sex. A little bit more so, a lot more so.
Laurie Poole:Ask any post-menopausal woman how important wetness is. It's really important, yeah, you know, and things change with age also. Maybe that's content for our follow-up podcast. How does intimacy evolve over the years as our bodies change Because they do so? I just wanted to touch on that. For any post-menopausal women listening all five of our listeners I think that that's a really important point to make because, as ED becomes also more prevalent for men as they get older, because of blood pressure, because of physical illnesses and so on Anyways, that is a topic for another time. I just want to include what I feel is like a lot of pressure that men feel from a performance perspective. That is probably less true for women and again, I'm generalizing, but I think, because the metrics are obvious, there's a physiological reaction that we can see that when things don't work well or when there are challenges, then it's felt by a couple and often they have no clue how to navigate any of that.
Heather Caballero:I think, oh, I feel like I can't let this topic pass without getting into one of the things that is most important to me, you know, comes from working with sexual trauma. It comes from working with building sexual relationships. But so this concept called arousal, non concordance and essentially I have not heard that term before arousal, non concordance.
Heather Caballero:So what that boils down to is the idea that our genital response is not matching up with our internal experience of wanting or liking. So in this case, particularly for men, the idea of really enjoying it being turned on but not having the genital response, and that can work both ways. And so one of the really important things that I find a lot of times in sex work is this concept coming up, and particularly for women it tends to come up in the context of well, you wanted it, you were wet really speaks to our experience of wanting or liking, because there and the reality is that they're not one-to-one tied together. The dopamine reward system it's often talked about as a buzzword because it's essentially something's good. It sends fireworks through your dopamine reward system, kind of thing. But actually the dopamine reward system, while of course that pleasure is a prominent feature of it, talking about it only in the sense of pleasure is kind of like calling your face, your nose. It's a piece of it, but it's not going to give you the whole picture.
Heather Caballero:Yeah, and so in this case, the dopamine reward system is comprised of three intertwined but separable systems, and these are wanting, liking and learning. Learning, for instance, is something that's kind of Pavlov's dogs. We kind of associate stimuli together and so like. Specifically, a very simple example is that kissing is something that both through context of personal experience and oftentimes through media messages, we have learned is sex related, even though it's not necessarily speaking so biologically, but because of that it becomes a context of something that can lead to sexual arousal. That's right. And then perhaps specifically, parts of your partner, how they smell, can become sex related to you. And this is where we find a lot of experiments of like teaching rats to find the scent of lemons sex related or something like that, where it's essentially you know it takes something that for all of us is just neutral.
Heather Caballero:And then we build the context that we learn it's sex related. And then all of a sudden you can just pump the smell of lemons to a rat and it's just like time to go, time to have sex, kind of thing. And so arousal can happen when we find something is sex related, even if that thing is not wanted or liked. And so that's an important first context Liking, as a system essentially is do I like this thing, how much, how good is it, sort of thing.
Heather Caballero:And so oftentimes through the sexual response, we kind of find, going through learning, liking and wanting in the sense of is this sex related? Yeah, okay, do I like it? And the wanting system says do we want to get some more of that? And then and that's when we really find desire coming in with that wanting system, but you know, at the same time say, let's back this up to the system of salivating, because arousal, non-concordance, happens with every behavioral process that we have. And so, for instance, we can find something is food related in our brain. Pavlov's dogs found bells to be food related and so they start to salivate during hearing a bell. And does that mean they want to eat the bell? No, no.
Heather Caballero:It just means they've learned. It's food related and I think there's this really interesting thing where, if we were to bite into a mealy apple and then we see there are worms in it after we've taken the bite, we still salivate because there's food in our mouth, but no one looks at us and says well, you salivated, so you wanted the apple. You're just lying about how much you enjoyed it. No one says that for other systems. It's pretty uniquely applied to our sexual ones that we gaslight people into saying our bodies are the end-all, be-all of telling us what we want or like and it isn't. It isn't, and I feel like that.
Laurie Poole:Wow. Well, I think you've just cracked that false belief wide open, because the discordance or non-accordance, the non-concordance that you described, I think most people would never think about that relative to sexual desire, sex drive, libido, whatever you want to call it, they would never, they would never think about it in those terms.
Laurie Poole:They might think about it. You know, I want to have sex five times a week and my husband only wants to have it one time a week. They would think about in terms of those very, what they observe, what they understand. I think what you've described is how you can salivate even though you don't want that. Maybe you just don't want to suck that lemon. But man, you just think about sucking the lemon and you're like, next thing you know you're drooling out of the corner of your mouth, but it has nothing to do with wanting to suck a lemon it's just a response it's a response exactly.
Laurie Poole:Speaking of frequency, this seems to be another metric that I hear in my office, and I hear about sexless, what I'm going to call sexless, sexless marriage, but also couples questioning the frequency with which they have sex. What's the norm they have? I don't have an answer to that. What's normal for you guys? What do you wish it was? Where's the discord in all of this? But I just wondered if you had anything you wanted to say about frequency, because that seems to be something that comes up a lot, absolutely.
Heather Caballero:So I think let's start with that question what's the norm? And this is something that I find to be a profound and pervasive question when it comes to just sexuality in general. It's constantly discussed and I think it's because there's this constant pressure of feeling like am I normal? Is this what everyone else experiences? Is this typical? Because I must not be normal, because I'm not like my friend that I talk to. So what gives Am I wrong? Kind of thing. And it's so important to state first of all that, just kind of like we talked about before with taste profiles, no one says oh, you're completely wrong. And like you have broken taste because you don't like tomatoes or vinegar or anything like that. I mean, some people might be like I can't believe you don't like chocolate.
Laurie Poole:But you know it's.
Heather Caballero:No one tells us that we're broken, but that language tends to be a lot more around sex.
Heather Caballero:And so I think there is this concept in seeking normalcy and trying to find that number of what is normal, that is searching for reassurance, wanting to find this am I normal, am I not broken? Kind of aspect, and I think it's so important to say that sexuality, whatever yours is, is normal, it's unique to you and it's kind of like you know as, so long as things aren't hurting, then you're normal. And so that's one of the things I want to start with. And so if we set aside this idea of normal, I think we can get to this question of couples with is this number that you're at something that you want to stay at, or is it something that you're looking to change? And, generally speaking, for couples that come to see us, it is something they're looking to change and, more often than not, something they're looking to increase. And so I think then the question kind of becomes for you your sexuality, your relationship, what are some methods we can find that invite the opportunity for increasing it more into your lives?
Laurie Poole:Yes, I've never had a couple come in and say we're having far too much sex. It's so hard on our relationship. I've never had that. I don't have that.
Heather Caballero:Yet I've encountered it in some ways Specifically and usually in the one person wants it way more and the other person wants it way less. And specifically, I think to talk about it a little more in that context of both our brakes and our gas pedals. Something else that's really important to say is that part of our personal and unique sexuality is that we may have a certain level of sensitivity to pressure to the gas and pressure to the brakes. So, generally speaking, someone who comes in feeling like they don't experience as much desire as they would like to tend to fall into one of three categories Either they have a fairly moderate, normal brake and a low sensitivity accelerator. They have pretty normal accelerator, pretty normal brakes and just aren't getting a lot of pressure on the accelerator and are getting too much pressure on the brakes. Or they have a pretty moderately sensitive accelerator and very sensitive brakes.
Heather Caballero:And you know, all of those are kind of different contexts for what we, how we approach that language of learning what your sexuality looks like and how do we navigate with that context, but also in that sense of like maybe having too much sex, someone who has a particularly excitable gas pedal and then not particularly sensitive breaks. You know they might be considered hypersexual and I've encountered it before that because their breaks or in this case, all the good reasons sometimes to turn off our arousal not being as prevalent in our lives can lead to this sense of them feeling really out of control of their sexuality and their ability to have sex in a way that is comfortable. Because those things that tell us sex is uncomfortable aren't as loud, they aren't as much of a get out of this situation break pedal as they are for other people. There have been times that that's been encountered and particularly if that is different from their partner, then that may be a factor to discuss and that is also normal.
Laurie Poole:No, exactly, I think what I was. You know, and your point's really well taken. I think it's when someone wants sex more frequently than the other one does and the person who doesn't feels very you know that fear of failure and letting their partner down and so on comes into play, and the person who wants more sex feels rejected, not desired, etc. And that is certainly creates discord in the relationship. I was just saying from a point of view of a happy couple saying, oh, we have sexist many times a week and it's a real problem.
Laurie Poole:We just, you know we have time for nothing else, but I hear what you're saying, heather.
Laurie Poole:There's just so many elements, dynamic experiences that contribute to how we show up in our sexual intimacy with a partner, and it's a fascinating field to work in and I am so glad that we have you at the Montfort Group, because many therapists are not comfortable working in this realm and we need therapists who can shed light and provide couples, partners, with language and greater understanding of self right, how I, as an individual, experience my sexuality in this unique way and expression.
Laurie Poole:I say over and over again, it all starts from within In any kind of relationship. It starts with you. So thank you so much for your time today and I really look forward to further additions of this conversation, because we've only just touched the top of the iceberg, absolutely, you know. I think that there's just so much more to discuss and educate people and to share. So thank you very much, heather. Anyone interested in booking an appointment to see Heather can go over to our website at themontfordgroupcom. You can schedule an appointment with Heather and other therapists online and, heather, I look forward to chatting with you again about this really important topic.
Heather Caballero:I look forward to it too. Thank you for having me.
Laurie Poole:Okay, super. Thank you so much, Heather.
