Andrew Burdette 00:00:00  The growing Group practice podcast is part of the practice of the Practice Network, a network of podcasts to help you grow, manage and promote your business and yourself. To hear the other podcasts like The Practice of the Practice Podcast, go to practice at the practice.com backslash network. You're listening to the grow a Group Practice podcast, a podcast focused on helping people start, grow, and scale a group practice. Each week you'll hear topics that are relevant to group practice owners. I'm Andrew Burdette, a practice owner, and I love to hear from people, their stories, and real life experiences. Let's get started. Hello and thanks again for tuning in to the grow a Group practice podcast. Today I am here with Gary Katz, who is the founder and director of the center for Intimacy and Recovery. Thanks for joining me. Hope you're having a good day.

Gary Katz 00:00:58  Yeah, thanks for having me. I'm really excited to be here.

Andrew Burdette 00:01:00  Yeah. I usually ask people to just give a little backstory on how they got to be really are, and what led them to this point in their careers.

Andrew Burdette 00:01:08  Yeah, sure.

Gary Katz 00:01:09  I this is a second career for me. The first 20 something years of my career were combined both as a middle school teacher, teaching primarily seventh grade and also working as a rabbi. And, I felt called to those as a way to help people, really kind of you grow into what I thought, you know, felt was to be most connected to themselves and live a life that felt best for them and this kind of career, second career as a therapist grew out of that. It was like I didn't feel I had the tools I needed to really do that. I had the tools to teach the curriculum. But when I saw kids in my class who looked the way I felt as a kid, like you could just see on their face that they weren't able to learn the way they needed to because of emotional stuff. I didn't have those tools to help them. So, that combined with 20 years of seventh graders who I loved and love. But it was just time. I didn't want to go out.

Gary Katz 00:02:05  Being that teacher that was burned out, led me to a different career, and it was really the same calling of helping people to be the most connected with themselves and through the lens of therapy. And that's really why the name of the practice is center for Intimacy Recovery. It's about intimacy here doesn't necessarily mean sex. It means the ability to be connected to myself and to look at all the parts of myself, even the ones that sometimes I wish weren't there or I. They make me cringe, you know? and because if I'm not able to look at them myself, I'm not going to let you see them. And so if I can't be intimate with myself, how can I get intimate emotionally, mentally, spiritually, physically with you as well? So we look at all forms of intimacy, and then we also help people kind of unravel the things that block their ability to have intimacy with themselves and internal partner.

Andrew Burdette 00:02:58  I'm remembering back to grad school and something that five years post grad school and realizing I don't know when I'm going to fit in, but I'm just thinking of like, Murray Bowen and differentiation and just that being such a cool thing about you have an internal constellation and kind of the way the professor described things was he literally drew out like a mobile, out on screen and made or illustrated of your internal self and then your internal self and the context of relationships and both of those developed simultaneously.

Andrew Burdette 00:03:27  And are you tending to both aspects of things and. Yeah. yeah, I think many people, especially outside of therapy, hear intimacy and just think sex life. And that's as far as it goes. And it's really not true.

Gary Katz 00:03:42  Apparently. Apparently not. Yeah. So, you know, I would say that although it is not limited to intimacy, the majority, I would probably 80% of our clients that come to us, are coming with something sex related. And I would say it's either, some type of problematic sexual behavior that is causing them to not be themselves and probably impacting their intimacy with a significant other or partner or sex therapy. and so, I don't know, maybe it'd be worth while. We were chatting before to really explain the difference between those. Is that helpful?

Andrew Burdette 00:04:21  Yeah. So so I have a I have a substance use background for working with substance use and have the, the EDC equivalent in North Carolina, which is the advanced one for master's level. And, I can remember in all my addictions classes and even just a regular kind of classes in general about like what's not a problem unless it's a problem, right? So like where's where does sexual behavior become problematic? And especially in our current climate, political and otherwise, like there's problematic for others directly.

Andrew Burdette 00:04:52  And I think some of your work is probably in that category, but also like problematic for the individual themselves. And that seems like probably where I'm guessing more of your work lies. So yes, it'd be helpful to.

Gary Katz 00:05:04  So yeah, there's like first of all, I think that even just there's so much energy around sex in general. Right. Just in the world, that it carries as much as energy and shame. We know people struggling with substance use disorders feel with sex is ten times more. and so, that's part of what when we look at what's the problematic thing, we want to help someone determine what does that mean for them. And so one of the issues, because of the level of shame around it, is they can't even agree on what's the correct term and diagnosis. So there's words like problematic sexual behavior, compulsive sexual behavior, impulsive sexual behaviors, sex addiction out of control sexual behavior in our practice, I don't get caught on the term. I want to help the person. And with that.

Gary Katz 00:05:55  So the way we look at it is, is this causing distress? You know, years ago, he'll probably kill me for sharing this, but I was, my son was was then probably in his 20s. We got he had been out all night before he was visiting New York, and we had a race we were going to run together in Brooklyn. so we got up early to take the train, and I heard that he the door, he came in around 3 a.m.. He had been out to visit friends and on the train on the way there, like 630 in the morning, taking the train to the race, he said, how do you know if sex is a problem? This is kind of what you're asking. And I was like, this is like one of those moments where you pray and ask God to give you something smart to say. And I just said, well, I think the sex is supposed to feel good, not just physically, but also internally, like integrated into myself.

Gary Katz 00:06:47  And so if I don't feel good about it, I want to get curious why it shouldn't cause me shame. Everyone has some type of shame around sex, like a mistake they made and their whatever level of their sexual evolution. And they didn't make the best judgment because of the intensity of arousal, but like it shouldn't be causing you pain, emotional pain. So that's the first thing I would look at like and help a client explores, you know, if some is something problematic and why do you feel pain about it? Is it coming from yourself or is it coming from someone else's expectations? Is it coming from societal expectations? You know, let's say women, right? Like there's such a double bind for many women, either they're not sexual enough, they're prude, or they're too sexual and they're a slut. Right? Like so. There's such a bind for them. That's all societal that gets internalized. So really helping someone start to discover what is healthy sexuality mean to them literally feel like? They don't have to worry about everyone else's judgment and they could be true to themselves.

Gary Katz 00:07:50  How would they live their life sexually? and are they struggling to do that and why? Many people, you know, have everybody has an opinion about sex. So many people actually don't speak about it to others because it's, again, that level of shame, even if it's not a therapy issue, but just socially, a lot of people feel discomfort about it. So, identifying what their healthy sex life will look like or who their ideal would be, and then what's getting in the way for them to doing it. In addition, that could be things like my morals and my values, whether they're based on how I was raised by my parents, it might be based on my community, it might be based on religious community. Right. They're going to have a different level, especially around sex, probably, the culture that I live in and the country I live in. So someone, you know, you get a lot of first Generation clients who their parents have values from the country they immigrated from.

Gary Katz 00:08:49  And they're trying to bridge the gap between their values in their house and the values in the society. They're growing up in the United States. Those are prime cases of like, let's figure this out. Yeah, it's not bad. It's not. We don't want to. There's no shame, but let's figure it out. But, and then it could also be on how is it impacting others like you mentioned. So if I have a spouse or a partner, you know, am I impacting them through my sexual behaviors with them? Like, am I selfish or am I am I using it as a weapon? Am I withholding affection and sexual attention because I'm angry about what was served for dinner? I'm just, you know, as an example? Or am I also maybe hiding things from them because of other things I'm doing secretly, which is a form, you know, like, especially if they feel it, it can be it's harming them even though they don't know what it is. But they're there like something feels off with us and they let's fix the relationship.

Gary Katz 00:09:45  And often the person in an attempt to keep something secret, misdirected what's going on. And then it gets blamed on the other person or other things. And so they're they're like not even knowing their own reality. So like looking at all these different forms of like, is this my ideal or not? And, it can be challenging for people because it really requires a level of self honesty, I think, and a comfort level for a topic that even though almost everybody is being sexual, many people are uncomfortable to talk about.

Andrew Burdette 00:10:18  I mean, there's a lot of layers to when you touched on them, to where there's our family system, there's our family systems community we grow up in, which is often involves some degree of like religious exposure, even if you're not a religious practicing household. And I just I always think of, there's a the opening scene of Burn After Reading, where, like, John Malkovich's character is like getting kind of canned off of, like, the beat for the CIA. You know what I'm talking about? Cause you're laughing.

Andrew Burdette 00:10:47  But his partners, like, breaks the news of, like, you're an alcoholic. And John Malkovich says you're a mormon, too. You everybody's an alcoholic, and it's a little more colorful, but, like, that's the gist. And it is relative, right? So I think one of the fears of discussing something like sex is if I were to just think of my family like there's people in my family that would be very okay to have a conversation about it. And there's other people that would their ears would fall off, right. Like just because and they're all great people. It's just this is a topic that's really difficult. And I would imagine working with people around that, especially since it ties into these really deeply rooted like existential type beliefs, is really takes a particular nuance to kind of get people to open up with.

Gary Katz 00:11:33  100%, 100% and like money. I think sex and money are things that families may not talk a lot about, and it's impacted by their culture and their background. yeah.

Gary Katz 00:11:46  I mean, I don't know if you've ever done I often do what we run a lot of groups at the practice, and I often ask the people to share what how is sex discussed growing up? And almost every time the majority, not all, but the majority is like it wasn't. Or I got a condom or something like that, you know what I mean? Like, it's very it's not. And so even the avoidance of discussing already is a message to a kid. Something's up with this, right? Well, why why are we, not talking about such a thing? So. And if I can't learn it from my parents, I have to learn it secretly from my buddies. Or nowadays, the internet. Why can't I talk about with my parents? So already there's some kind of intrinsic messaging going on to a child or whatever age, that there's something taboo and secretive or private about this, and it can be confusing to children, especially the distinction between private and secret, I think is also they don't have the ability to necessarily tease that out.

Gary Katz 00:12:46  So yeah. And then also if you have a couple they're bringing in what, what that is like for them. So culturally religiously like the example in the movie right. One guy has this background, the other guy has another background. Boom. There's a, there's a, you know, a judgment that comes out because of their, their upbringings.

Andrew Burdette 00:13:06  where it's again, I think some of it's probably going to be somewhat relative because even working with like substance use addictions, there's, there's the criteria and then there's really where it's problematic. Right. And where does something like addiction get paired up with sex. And so where would like a sex addict, like how would one know. And or like, you know, nymphomaniac I think, comes to mind as part of this, too, as one of the paraphilia and other things. And for listeners out there, there's a whole that's a whole rabbit hole to go down. So I'll let you all Wikipedia paraphilia and check that out. But, yeah. Like where as a clinician, where's maybe the criteria about, you know, someone having a very high sex drive and expressing that and finding a way to express it, hopefully in a healthy way with healthy partners, to somebody that's maybe like a once or twice a month person, like once a week could seem like an, you know, like where where does this come into? How do you ask this question?

Gary Katz 00:14:07  So it kind of dovetails the the difference between sex therapy and I'll say sex addiction or problematic sexual behavior.

Gary Katz 00:14:15  So therapy focused on problematic sexual behavior or sex addiction, is focused on when the behavior is creating a crisis in someone's life based on their value system or harming themselves or harming someone else. this other sex therapy is more about things like and it can include that, but it's also things that are about function. So like erectile issues, orgasm issues, vaginismus, painful sex. And for some couples like discrepancy of desire where, like you said, one person might want to have sex multiple times a week and another person wants to have sex twice a month. And so, for example, someone comes into me and says, I'm not having enough sex or we're not having enough sex, or I want to know what that means, because that could mean completely different things to two different or five different people. so but that's also the difference between sex therapy and, and sex addiction, just in case anybody was wondering if they read that. At our practice we do both because ultimately if someone has a problematic sexual behavior, the goal is to have healthy sex, which is where sex therapy also leads to.

Gary Katz 00:15:25  and I just want to also say that there's a chasm between those two worlds. That's probably as broad and wide as the chasm between our two political parties in our country. And at least as it feels now, both politically and with these two groups, never the twain shall meet, or rarely the twain shall meet the moderates. The middle of the line is rare, because, for the reason that in the sex therapy world, they really that world really grew out of the sex positivity movement. And really trying to reclaim that sex shouldn't be a thing that's shameful and bad. And so that's such a important, principle in sex therapy that sex is not shameful. So when they hear people saying, oh, sex addiction, you have a problem with sex, they're hearing you're shaming those people. So there's a really it's not complete, but there's a the most part, there's a broad chasm. And so you're going to get people in one group on, you know, an element of each group putting down the other side.

Gary Katz 00:16:31  That's basically unfortunately, what happens, just like we see in our political thing and not really listening. And they make the other, the other, the other sides of such a ridiculous extreme. Unfortunately, that happens here too, but they're both very compatible. we have both. We, you know, we have trained sex therapists and train people to deal with sex addiction, and they're all non shaming. You know, the ones that are going to come to our practice or hopefully any practice and be like, you did what. Oh you know like it's not going to happen. So that's just an important understanding. And as you read the literature is people listening may be reading literature about each group. They're going to probably read critiques of the other school of thought. And I think it's just important to know that. But, yeah. So I think the case with that you quoted from that movie is a good example. So someone who's brought up, you know, we see clients that range from very religious upbringing, let's say Hasidic Orthodox Jews.

Gary Katz 00:17:27  Mormons like. Like the case you said, you know, Baptists, very fundamental Christians, Muslims like a whole range of very you know, more. I see traditional observant, practices on a religious level to and dealing with those clients. And we also deal with clients who are sex workers, who are in open relationships, who have some constellation of relationships that is non-traditional, not, you know, not the traditional thing you'd expect. So as you were trained and probably, you know, most of the guests you've had on, we're trained to work with each person in the world that they come from and the world that they exist. So I'm not going to be pushing a religious value on someone who doesn't have that. I'm probably not going to push the religious value on anyone, but I'm going to work with a client who's having that religious upbringing or did and is in that world. I'm going to work with them within the value system around sex. and so somebody who grows up in that world where maybe it's a sin to masturbate or look at pornography, they're going to be identified by someone else, like that couple in that movie faster than a 20 year old kid in a fraternity at a college where maybe they're all, it's all about like, let's, you know, let's get laid and let's watch porn.

Gary Katz 00:18:51  So that's not going to even be identified as a problematic behavior where this, you know, I'm thinking of one client. I had a young Mormon man, a Swedish guy who, because of a certain ritual that he had to deal with every week, felt identified as a problem. Was it a problem? You know, not necessarily, but it was being identified as one. So we have to, like, work with them in their system. And that can, you know, for everybody in a way like, is this feel healthy to you but keep them in their system. You can't you don't tell someone to leave their system. That's not going to be helpful for them either.

Andrew Burdette 00:19:24  I was thinking about, though, as you're talking there is that part of what we do is therapist like, if we really are doing that deep work is inviting people to evaluate their beliefs and especially around sexuality. I would imagine this comes up often, and I would guess it probably comes off often a little more, given the population you work with than maybe your general population, like most people aren't usually like looking to the system they're in as being the source of their anxiety.

Andrew Burdette 00:19:54  Maybe. so how does that come up? Like how what if you have somebody that you know, is realizing, this is my authentic self and the system I'm in is in conflict with who I am? Yeah. How does that work?

Gary Katz 00:20:09  Very, very tenderly. You know, the same way I would think, if someone was looking at their family system separate from religion and seeing like, oh, I've been an identified patient, or they identified a problem. And really, I was calling out truth. You know, I wasn't playing the game. You have to be very gentle and tender as they explore it and be with them and walk with them and even let them lead sometimes, most of the time. Because if you if you put that information in front of someone that isn't ready to handle it, it's going to not work. But it's also going to be so painful for them. And they're probably going, if they're not ready, they're going to retreat. Similar to like someone dealing with their sexuality.

Gary Katz 00:20:55  If you say to I early in my career, I just asked a client, you know, who is around sex. He was having sex with men, but he dated women. And I asked, and he was having dates with some of the men. And I brought up the question about like, same sex attraction. And he walked out of my office, you know, like he couldn't it was just it was too early. I didn't I didn't know that. I didn't expect that reaction. And I But so I think the same thing with cultural or religious places. I and I think it's important for therapists to be careful to not let their own personal biases like, yes, we have to have best practices. And there exists, I think, sometimes a certain arrogance that we know what's best for a client. And while we may be living, many therapists are living in a world of greater understanding about authenticity or sexual needs or all these things. But who says that that's better than what the client systems teaches about connection and community and support? So I think we have to be humble and be with the client where they're at.

Gary Katz 00:22:04  And it's a very and be careful not to let our own biases. and that's the thing I work with new therapists on all the time like that, who have strong beliefs about sexuality and, you know, and then they're working with a client who's in a, who is repressed or like in a family that's repressed or a community that might feel more repressed. And to be careful not to, just because we think it's better put that on them, could be very damaging and painful.

Andrew Burdette 00:22:29  I'm kind of just thinking of kind of waiting until it's invited to where, like the client kind of says, hey, exactly how does this say or do you have a perspective, and if so, what might it be? And you can kind of introduce that different perspective when there's a signal of openness versus by the way, yeah.

Gary Katz 00:22:50  This comes up a lot. The place that I see it quote the most is with young men in either family systems or community systems, where masturbation, let's say, is frowned upon or pornography is frown upon.

Gary Katz 00:23:04  And so they are believing that they are sinners because, or they're bad, or they're going to die even because they're masturbating and they've tried to stop, maybe. And like, they're teenagers, they're not stopping. I mean, you know, come on. And so if I would say to someone that's just normal, like, don't like, that's ridiculous. That's a sin. They're, they're not going to probably listen to me or come back because they're going to feel I'm not respecting their value system. and so what I try to do is exactly what you said. Either they have questions or I actually encourage them to find a mentor or a clergy member in their community that they can talk to about that and like that, they feel that they can relate to about that so that they can get support within their system. and then process that. But also, you know, at the same time, without contradicting and being very respectful of their background, trying to take some of the shame out of it. You know, it's hard.

Gary Katz 00:24:08  It's a really fine line to walk on because if you go too far you lost them or you've insulted and hurt them.

Andrew Burdette 00:24:15  for listeners out there that are kind of thinking about, is this an avenue I want to maybe explore or develop or kind of move into? I know from like, the substance abuse world, there's, there's a range of perspectives and not all of them get along harmoniously. And the handful of people locally that are therapists that work with sex just in general in different ways, kind of, like you said, seem like there's a big chasm between them. And I'm sure there's chasms within the sex therapy world. There's a spectrum, I'm sure there. And then also spectrum within the sex addiction world are there. I just also want to be mindful about how I'm going to ask this, because I don't want to throw systems under the bus. Right? But like, I guess, are there some more modern perspectives around this that make it easier to work with people struggling around sexuality?

Gary Katz 00:25:01  I think so, and even some non modern ones.

Gary Katz 00:25:04  I the sex therapy world I found has two primary approaches. One's a CBT oriented approach. you know, do this homework, work on this. So, for example, I don't know if, you know, there's an exercise called sensate focus. I don't know if you're right. So that's a CBT type thing where a couple wanting to reconnect sexually will lie naked next to each other, and slowly one will touch the other and it will be, you know, you let your body just observe and it's not going to be sexual. You're not going to have intercourse or anything, but it's just about the body itself will create arousal if we're present in our body. So it's about mindfulness. That's a CBT approach with many things like erectile issues or other things. There's a lot of CBT approaches and same thing with relationship stuff. But another approach within the sex therapy world is a more psychodynamic like what was what was modeled for you, what were you taught looking at those things and working through them? Maybe like more old fashioned? I still like to work that way.

Gary Katz 00:26:06  So that's old fashioned, but probably predated the CBT world. and so I think someone coming in to want to get help for sex therapy wants to think about what they're looking for. And they could I would recommend asking a sex therapist like, are you more practical focus? Or you're more like analyzing and looking at the things that led into this? I think that would be very important and important for the client to know what they want, right? Like obviously the client should the client if the client wants action steps to fix it, great. If the client wants to have a deeper understanding, that's where they're drawn to, then I would encourage them to do that. If.

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Andrew Burdette 00:27:41  Just thinking of like different books I've read in this realm. there's a book which is great content is horribly written. It's the passionate marriage. I know from time to time I'll have people come in and kind of ask around intimacy with their partner and how to be better partners to their partners, and that's a book I will kind of disclaim about. Could have benefited from different editors and other things. Is there something that maybe hits those that book? Are you familiar with it and if so, like is there a book that can kind of.

Gary Katz 00:28:12  I'm not familiar with it. Sorry.

Andrew Burdette 00:28:14  Yeah, okay.

Gary Katz 00:28:15  trying to like, non-existent. Trying to remember, but I don't remember it, so. Not that it's not a good book, but I don't remember it.

Andrew Burdette 00:28:21  No, it would be worth checking out. It really is the heart of intimacy and trying to, like, I guess, do more of the psychodynamic kind of things about, I can't remember if it was my professor for human sexuality or if it was one of the other MFT courses in school that was like, it's it's about the dishes, but it's never really actually the dishes, right, kind of thing. And you kind of had alluded to that too, and a lot of, a lot of this book, kind of in the examples of the work that he's done, kind of has gives these couple that come in and stuff's broken down and it turns out someone's stressed or is going through menopause and stuff suddenly very uncomfortable and wasn't previously. And it has nothing to do with the actual real connection with the partner. But because discussing those types of things is quite challenging.

Gary Katz 00:29:07  Yeah. And so I think and also and that's kind of how we work also and I think it's very valuable is like we all have just like we talked about the talk about sex, but we all have living models that we grew up around who have modeled to us how to be in a relationship just by living. So whether I'm raised with one parent or two parents or a larger family unit, how they're affectionate with each other, I'm as a little kid, I'm taking that in. I'm drinking it in, as you know, how they talk to each other. I had multiple over years. I had different partners that I was with who commented on my sarcasm, that how they didn't appreciate it. And I was like, what are you talking about? You know, like, I don't I'm just making a joke. And one day I was at home with my parents home, and I heard one of my parents be sarcastic to the other one in a really binding way. I was like, oh, that's right.

Gary Katz 00:30:05  So like what we are modeled, is going to probably show up in how we show up in a relationship. And so those are the psychodynamic things. Also I want to look at. And also if we have a family that every night we have dinner together and we go out with our cousins, we go on vacation with our cousins. And we do all these things as a huge family unit. And my partner grows up in a family that like people get what they need and they sit in front of the TV or they go, they do individual things. There's less communication. And I always think of it like, the episode on Seinfeld with the close talker where the guy who talks stands so close and it's like everybody walks like, leans back. So if I'm used to this social distance for intimacy, I'm holding my hands up about, I don't know, six inches apart. But my partner grew up in a family where they're used to this. So when I come to them and I'm like, hey sweetie, speak, they feel smothered.

Gary Katz 00:31:02  What do you mean? Why are you all over me? Or. And I feel like. Why are they there? Trying to adjust to create what felt comfortable for them in their nervous system. And I feel like they're moving away from me. So I'm gonna take oh, you don't love me. You don't want to be with me. Even if I'm securely attached, it's going to activate something. So that's, I think, a good example of looking at that. It's not about like, oh, my partner didn't respond to the text on time or didn't do the dishes. Like you said, it's about what are the things that were modeled for us that we may not even be aware of, that we're bringing into our relationship that are impacting how we relate, how close we are and how we relate sexually to. Another question I'll often ask clients is how do you as a couple? Or if it's the individual in your relationship, how do you initiate sex? It's a while. It's a simple question.

Gary Katz 00:31:54  Everyone's got to do it somehow, right? Like, but I would say 60% of the time it's not. Hi. Do you wanna have sex with me? Right. It's like, oh, yeah, we're a certain shirt and then they know. Or I cuddle backwards into them in the bed, or I make some silly. All the words we have for sex that are not about sex, right? Like you want to get it on. I mean, like, like really eloquent people who say the silliest. I had a couple, a really sweet couple that said, well, we did have sexual Congress yesterday. I want you to know that that's what it is. I don't want, you know.

Andrew Burdette 00:32:32  Did you ask if they follow parliamentary procedure with that?

Speaker 4 00:32:37  Right.

Gary Katz 00:32:37  Did you recognize each other from the floor? You know, like. Yeah, I mean, I didn't I didn't have an issue with the image of them being sexual. I just want to clarify. But like the word Congress and sex just didn't do it for me.

Gary Katz 00:32:48  Yeah. so but and I was playful with them when I was like, what do you mean, sexual? Because I, I saw there was this discomfort in saying it so that all is not about the dishes, it's about so much other stuff.

Andrew Burdette 00:33:03  As you're working with people, and we were kind of talking a little bit about this at the start, like there's probably times where having somebody that's like a specialist in like physical medicine with pelvic floor is just as relevant as a therapist who can talk through sex therapy with somebody. And yeah, as you're working with people, how do you start to recognize that or suggested is it just a de facto like you start with us and kind of like, you know, if you've got somebody that's bipolar, you're working with their psychiatrist in conjunction, is it kind of an automatic thing or are there indicators?

Gary Katz 00:33:35  Yeah. I would say it's the opposite. I would send someone first to a medical expert. Let's rule out the physical issue. So let's say whether it's a pelvic floor issue, vaginismus or erectile issues for a man.

Gary Katz 00:33:51  Let's make sure that anatomically Everything is as it's supposed to be. Because as long. Because if that's it, we could do therapy for years. We're not going to solve the problem. and so I send them there first, even the consult, before they have a first session, I'll suggest to them if they will ask them. But if they haven't seen a doctor yet or, or a pelvic floor specialist or, you know, gynecologist, depending on the person or what it is, I'll really recommend go do that. And if you're still if you know, they'll tell you if there's a physical, or anatomic issue and if there's not, come back and we'll help it 90% come back. Yeah. because so much, you know, there's definitely obviously physical issues, but those people usually kind of sense it and they go right away to a doctor. So and most of the people have come after I've gone going to a doctor, or a pelvic floor specialist. But once we're working with the person, it does take a while for them sometimes to take this very kind of like somatic, experienced struggle of pain or dysfunction in some level and acknowledge that it's psychological or emotional because they're having a physical, embodied experience of it.

Gary Katz 00:35:10  So it's like, what do you mean? and so we often, if they haven't been able to get the results they wanted, and that makes it easier for them to be more open, but they still don't understand it. So we really have to explain that to them. And then if they are working with someone 100% like, we want to be in communication with any physical therapist or pelvic floor specialists or anything like that urologist that they're working with. I would say it's probably not done enough in the field because, as you know, like everything in our fields are bifurcated, even though it's all the same person, like even the fact of medical physical doctor and PT and or an exercise trainer and a therapist. Like my mental well-being is impacted by what I eat, how I sleep. What kind of exercise I get. But yet it's rarely discussed in therapy. Let's talk about your mom and dad instead. Yeah, we have to look at these things too, because they impact how I feel every day.

Andrew Burdette 00:36:12  Yeah, it is difficult being in a position to where I can kind of ask, you know, like, I mean, you and I can both ask, like, so are the meds kind of giving you the results you're looking for? I'm still going to tell you only talk to your doctor that prescribed them, like, you know, like, or even just, you know, things like anxiety shows up a lot and there's, there's some supplements that are really helpful, but you kind of have to just say, I've, I found for myself in grad school that L-theanine was really helpful to fall asleep. Right. Like, I can say that, but I can't say you go down and for ten bucks, you know, buy some magnesium and maybe fall asleep easier. Kind of thing, even though it's there's a lot to back it up. It's just out of our scope and it makes it really difficult.

Speaker 4 00:36:55  Yeah.

Gary Katz 00:36:56  And it's one of the things that our practice that I've been starting to really push the staff to do is like, we should be checking on their relationship to sleep.

Gary Katz 00:37:03  Relationship to food, not in a disordered eating way, but just like, do they eat in a way that makes them feel good? Because if when I know when I eat in a way and happens, that doesn't make me feel good, I don't feel good, and then that affects my mental health. Why did you do that, Carrie? What are you, an idiot? Like, whatever the narrative or just. I physically feel like, so heavy and and, and exercise too. Like, it's it's actually, like, incredulous to me that I haven't been doing this the whole time. Yeah.

Andrew Burdette 00:37:34  Have you, as you worked with somebody, like, maybe over long term, when you're kind of sleuthing out what's really maybe the root of things is there. Does anything stick out as being really surprising about the why that someone found themselves struggling.

Gary Katz 00:37:53  That's a very interesting question. I don't get surprised by a lot anymore. I wish I did. I'm always curious, and I. I want to still be learning.

Gary Katz 00:38:02  I don't assume to know it a person, but you see enough types of cases that it's there's a variety of things that are probably contributing factors. It may be different amounts of each, whether, you know, neglect relational trauma, like, let's say, out-of-control sexual behavior, neglect, relational trauma, the need to disconnect for some reason, it feels good. And I keep doing it until, like, I have a dependency on the feeling good or, you know, with erectile issues not being connected to myself emotionally, being in my head, you know, trauma. Same thing with many vaginal issues too. So I don't get surprised often anymore. So I don't know. I can't think of something off the top of my head.

Speaker 4 00:38:50  Sorry.

Andrew Burdette 00:38:51  Do you. How much does the fear of intimacy with a partner play a role in?

Gary Katz 00:38:58  Well, I think that like that, to me, that plays the role like, you know, because, we've all been hurt. This sounds so.

Speaker 4 00:39:06  Depressing. We've all been hurt.

Andrew Burdette 00:39:09  So true though. I mean, it's right.

Gary Katz 00:39:11  Like, I feel there's, in New York, in New York City, there's somebody. I don't know who it is, but they've gone around all over and they've taken a stencil and they spray painted, and it's a picture of a heart. And sometimes I actually have a slightly like and send it to you and there's sometimes an arrow through it. But over the top it says protect your heart. Like, who does that? I've never seen it. I mean, I've seen someone doing it, but I see it all over. I just saw one the other day again. I think that's what we're all trying to do, because whether it's some type of relational impact from a parent or, you know, some mean kid on the bus or getting turned down by the first person. I try to ask to the school dance in middle school or like life has hurt and rejection. And it also helps us as we know, but makes us resilient. But there's a wound, you know, I think of our hearts is like having nicks and cuts and bruises and bandages all over them.

Gary Katz 00:40:10  So we all develop strategies to try to be safe, safer, protect ourselves. And in our intimacy groups, for example, I'll put the whole range of intimacy avoidant behaviors ranging from the person who you know is at home every night with 32 cats and watching Netflix and never socializing or going on dates to the person who's having sex with every person they meet. Those are two sides, extreme sides of the same coin. They're both.

Speaker 4 00:40:41  Avoiding.

Gary Katz 00:40:41  Deeper intimacy, just in different ways. So we put them in the same group, even though you think like it wouldn't fit, because we want to drive the focus to that. Exactly what you said, intimacy avoidance versus like the behavior. And what's at the root of intimacy avoidance, the fear that all of us have of getting hurt. And it shows up differently for men and women because of societal expectations and, you know, laws of, you know, not laws but beliefs about masculinity. And we can't show weakness. And women need to make themselves smaller or be pleasing or be good.

Gary Katz 00:41:15  And all the ways that society, unfortunately pressures men and women. it shows up through there. And, when we meet someone, we, you know, it's scary to take a risk to say you want to go out. I like you, I love you. or the first time you're naked with someone like all of these are very, very we're getting judged. It's vulnerable. And so and I think that's really the root I think of a lot of what we do. So I look at that, that's how I the lens, I look at people who are acting out some form of sexually that's harmful to themselves. Like, if I have all these secrets over here, you can't really hurt me if you're my partner fully. Like, I have 12 eggs, you have eight, but I put the other four elsewhere. You can't crush my heart. Other people might use control, you know, or busyness in there. Like, let's make sure we have the cleanest house and we're doing this. And that's a way to avoid intimacy, too.

Gary Katz 00:42:15  Or, you know, work or there's a million ways and they're not, not they're not pathological and they're not bad. They're just ways. We're all trying to protect ourselves. even therapy, even recovery, even religion can be used as a way to avoid intimacy. If I make it as a right like. And so can sex. Sex can be a way to connect with myself or someone else. But it can also be a way to disconnect from myself in someone else. So it's all about how we're using it. And, that's exactly what this entire our entire entire practice is about.

Andrew Burdette 00:42:51  So for listeners out there, if there's an interest in working more with intimacy and then around sexuality, do you have a desire? Like how would you like if you were mentoring like an intern or something like that? Where would you kind of steer them to like pursue more knowledge and education about this?

Speaker 4 00:43:07  That's a.

Gary Katz 00:43:07  Great question. do you mean like, well, I would pursue them to slow down and connect to themselves.

Gary Katz 00:43:15  I, you know, when I get the the new hires of the interns who are like quoting modalities and books and things like that, I'm like, that's great. But the biggest tool that I was taught by my supervisors was my body to listen to, like, notice what happens in a session, you know, and I can I feel that from you. Like I have a sense that's how you work to like. I'm not going to be like CBT ADP sensory like I'm like whoa. So let me just happen in my body. What went on. Let's what was going on with the client and things like that. And it draws me and I sometimes even feel pulled in towards the client when something happens. So that's really to me, slow down. And what are the practices that you can learn for yourself by experimenting? It's a learning process that helps you stay as connected as possible to yourself. You know, there are books on intimacy. but that's what I think would be the best thing to do.

Gary Katz 00:44:10  And there are, you know, I'm about to get on a soapbox, but there are intimacy practices or practices to help couples or help people learn how to be more intimate that give you a workbook. That's not where you're going to learn how to be more intimate in a workbook. Go out and be intimate. You know, like go out and have friendships. That's why we have 12 groups in our practice, because we're trying to create environments in a bubble that people have less skin in the game, less risk. They can take risks emotionally in their group and say, hey, I don't like it that you said that. Hey, I really appreciate that you said that. And then take them back to the ones where they have more intimacy avoidance because there's more risk with their partner or their kids or their parents or their best friend, or their boss, and they can have those muscles built up. So I don't I think intimacy is an experiential thing, not a book.

Andrew Burdette 00:45:03  Yeah. It's the difference between reading about riding a bike and then going to do it.

Speaker 4 00:45:07  Correct? Yeah. Correct.

Gary Katz 00:45:09  100%. And I, I get, you know, a lot of male clients who come in and they want an assignment on how to learn to be more intimate. They want to work. And there are because I'm on a million listeners, there are practices that do groups that use workbooks to learn intimacy. And my hope is that they're using the workbooks as a starting place to then have the discussion and the relational piece, but it's changed how I work as a therapist, too. I'm not going to just sit and take notes and ask questions. I. The relationship we're having is intimate. It's within the structures of a therapeutic relationship. But I'm going to upset my client. I'm going to hurt their feelings. I'm going to start the session late and the wrong time. Make a joke that doesn't land right, whatever it is. Because I'm a human. And if we have a relationship, like we said before, people get hurt. The goal is to help them to be able to say it to me and have maybe the first place ever in their lives where they could say, you know what? That didn't feel good.

Gary Katz 00:46:07  Or, hey, it did rub me the wrong way when you made that comment and I interpreted it this way. And then we can have repair, which then deepens the relationship. So if they can do it here between them and me, they can then maybe take it into their more important relationships.

Speaker 4 00:46:23  Got it.

Andrew Burdette 00:46:25  are there any key takeaways for listeners you want to make sure that they take away from this conversation?

Gary Katz 00:46:30  Yeah, I kind of want to also talk on the business piece quickly about this. Okay. If you're thinking about like, the business side of this population of clientele or this type of practice, I think there's a huge benefits. You know, sexuality is a central part of who we are. Those who are younger, newer therapists and the different like layers of the way they teach, you know, coexisting levels. Sexuality is a primary level of all of us. So you really can get to some really core stuff with people. but if you're doing sex therapy, typically, it's very rewarding.

Gary Katz 00:47:09  It's very, you know, you have to you have to have your relationship with sex mostly worked out because if you're not comfortable, they're not going to feel comfortable. And that's why also from a business perspective, we get many referrals from other therapists. That's why someone might say go to a sex therapist. Partly because of their training, but also because many therapists are uncomfortable talking about sex. It happens every week. We get new clients are like, we never discussed this in couples therapy before, or we never talked about sex, or my therapist that I should come talk to you about sex. So and I wonder, like, why isn't there therapist talk? So you have to work out your own stuff, like just with everything as a therapist, but especially about sex. sex therapy clients don't stay so long, especially if it's the CBT approach. So you just have to know that business wise that you're going to have to be generating new clients. But it's very fulfilling. It's really beautiful. the problematic sexual behavior clients and their partners who are impacted, what's called betrayal trauma, being betrayed, having trauma by an intimate partner.

Gary Katz 00:48:16  they're a good business niche also, because they're coming in on fire. Unfortunately, like, I'm not trying to capitalize on someone's pain. I really want to be The explicit, but they don't. They're not coming in with like, I'm having some slight anxiety and I wake up for an hour and a half every night and I don't sleep well, like their life is on fire. The person who's been caught having a secret sexual life feels immense shame they're being asked by their partner, usually if it's been that dynamic or they're either in immense pain that they came in on their own or they came in, it was generated by being discovered. They're being asked to give up something that was probably a coping mechanism for them, that which means that they don't know how to function. Just like you say, stop drinking, live life like, what do I do? So they're they're they've lost their coping mechanism. And right now they've, they've lost their attachment partner because they're mad and hurt. And the person who did the discovery who was, discovers that they were betrayed.

Gary Katz 00:49:13  They're living through I don't know who my person is. So they've lost their partner too. So they're reeling and they're both in shame. They're not. It's one thing to go to your girlfriends or your your friends and say, my partner has a substance abuse issue or is drinking too much. There's nothing to say. My partner's been sleeping around all the time, honey. Right. Because then you have to deal with their judgment. Kick them to the curb. What if you don't want to? Who says you should? I mean, you're right. Like, every person has to walk in those shoes and decide what's best. So they often stay in secrecy because of the shame and the shame around the sex. So we automatically the couple needs support because they're trying to like 50 minutes a week is not going to be enough for them when they're trying to live their life, and then they need individual support and often to help reduce the shame and get normalized somewhat, put them in group. So it's really a population.

Gary Katz 00:50:06  It has challenges because they come in hot. If you can handle that, if you can handle the crisis of how do I live without my attachment person? it's a place where you can really, you know, build a huge support system for them, which gives you a huge practice. So if we get a couple that comes in, they see a couples therapist if they're willing to do it. Sometimes they're not two individual therapists and two groups, you know, and then you're also not competing with the general, like you and I were discussing earlier, the general market. One of the reasons I had a background of working with substance abuse. Also, I didn't go into it because it was the height of the opiate addiction, maybe a little before the hype, but it was already escalating. Everybody was advertising. Everybody is presenting this. Right. So the same reason probably like right now I wouldn't go into ketamine, like everybody's doing certain other things. Like if that's the hot if it's saturated market wise, it's not the I don't think unless it's my passion, a person's passion obviously, but so I'm not.

Gary Katz 00:51:07  What we advertise is a very niche advertising. Or when we get a reputation with other therapists who refer to us, it's like, oh, they handled these issues versus like a generalized practice. So we're going to talk about generalized anxiety or a little substance abuse disorder or some self-care needs or perfectionism. So it's a very niche thing. it's both, you know, sex in both of these areas, the sex therapy area, the problematic sexual behavior area there. It's a huge segment of the population either way. and I think the reward is really powerful because to see people with such a key, because sex means everything but sex, like, was it Oscar Wilde or. It's like, I forgot, I always mess up that quote, but it means so many other things. Self desirability, value, power, all these other things. So you're going to get to those things with someone when you're dealing with sex. And while they come in, like all cases of the presenting issue, the depth of the work becomes so much bigger.

Gary Katz 00:52:09  And it I think it's really beautiful and rewarding work.

Speaker 4 00:52:13  Cool.

Andrew Burdette 00:52:14  If people do want to work with you, how can they find you?

Speaker 4 00:52:16  Yeah.

Gary Katz 00:52:18  Intimacy. Recovery. Com is our website. There's ways to contact us through there. and, you know, my name is Gary Katz. You can Google me. You'll probably find an episode of me or this podcast, like, start there. but yeah, intimacy recovery.com is the easiest way. You can read more about our practice, and there's a way to sign up for a consultation for free. And you know, anyone? Interestingly enough, anytime I've ever done a training on this for therapists, like 5% of all therapists reach out because these issues are so pervasive. So, and I would encourage that, you know, I don't know your demographic. I would imagine it's primarily mental health professionals. Like, you know, there's a lot of shame in struggling with something like this while you're trying to help other people. And you don't have to sit in that shame.

Andrew Burdette 00:53:09  Well, thank you so much for for coming on. we'll have your description and link and other stuff in the show description and stuff for anybody interested that didn't catch it. But now this has been really interesting. And it's a I think it's a like you said, this is something that everybody deals with and very few people are talking about. And I think the more we can remove the stigma and taboo ness of it, I think we'll probably all have better relationships across the board.

Gary Katz 00:53:34  That's the hope, I agree.

Speaker 4 00:53:36  Yeah. Well, thanks.

Andrew Burdette 00:53:37  So much for coming on and thanks.

Speaker 4 00:53:38  For having me. Yeah.

Speaker UU 00:53:39  I appreciate it.

Andrew Burdette 00:53:46  If you love this podcast, please be sure to rate and review. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guest are rendering legal, accounting, clinical or any other professional information. If you want professional, you should find one.