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Even after all these years it still feels a little dirty to type those three letters without a snicker or a smile. And in the world of psychotherapy, sex is even more problematic. It's usually tied to intimacy issues, or social functioning or, most disturbing, deviance. It might be moderately humorous to hear about the people who dress up in women's clothes, or need some sort of oddball stimuli like white socks or small animals in order to reach their full pleasure potential. But there is the darker side. A side where sex becomes completely secondary and is just a raw, untamed act of violence, simply used as a coping outlet for deep-seated emotional problems.

Our therapist has encountered these issues in his practice and, as you'll read, confronted them in his own life as well. Anyone can be a victim. Even the therapist.


Sexual deviance... Some of the stories I've seen, heard, read about, are so over the top they seemed fictitious. There must be some stories you've come across in your practice that are interesting -- or horrifying, for that matter.

I have dealt with both victims and perpetrators, but I do not specialize in sexual abuse issues and do not see the scope of issues that exist. However, I treated a 21-year-old female who was a dominatrix in a dungeon. She would tell me the stories of making men eat dog food and whipping them. There was no shortage of sexual deviance in that case. She was a victim of rape and sexual abuse. I treated an 18-year-old male voyeur who would stare into girl's windows and masturbate until he finished. I treated another male who was arrested for breaking into his neighbor's home and stealing all of her underwear.

Um, does any of this stuff ever turn you on? I mean, the dungeon thing is kind of hot. But the dog food, not so much. How about young girls with unhealthy fuck problems? I dunno, I think I'd feel kind of dirty listening to that kind of thing...

I never get turned on, because my perception of sexual interactions is far different now. There is a natural sexual attraction to certain patients in therapy, but it must maintain as that and not get in the way of treatment. Additionally, if I was to act out on an impulse with a patient, the damage I could do to them is irreparable. Not only would I perpetuate their deviance, but also betray their trust. I am supposed to be a person they can trust, someone to model appropriate behavior and get them to improve their ability to interact.

I am sure I would face a hefty lawsuit and lose my license. I also feel sorry for those people who have deviant sexual lifestyles, and the fact that they cannot derive pleasure from intimacy between two people. If there is a teenage girl with an "unhealthy fuck problem," the best thing I can do to her is treat her like a human and not perpetuate her manipulation or objectify her. My girlfriend and Christy Canyon movies give me an erection, not my patients. I do, admittedly, feel an attraction to female clients who make changes and demonstrate specific competencies.

Hmm. Well, that happens to the best of us. But the kids. How do kids deal with this sort of thing? Any particular cases you can share where you could find the roots of these types of deviant behaviors?

The case that most crystallizes the nature of sexual abuse is a patient I'd treated since he was 15. He was referred to me after making terrorist threats at his high school. He was severely picked on and a prototypical geek, which did not help matters. His biological father and mother were both drug addicts. His mother was dying because of her addiction, and his father was serving a life term of imprisonment for first-degree murder. My patient, along with his biological brother, was shuffled between two dozen different foster homes and placement facilities until he was eventually adopted, along with his brother, when he was 14.

The adoptive parents had good intentions, but were cognitively limited and had no idea what they were getting themselves into -- the intensity and myriad issues these kids were carrying. They were unable to understand the nature of their behaviors and why the kids could not stop engaging in sexual acts with each other.

My patient was unaware of who had abused him and when, probably because he was too young and blocked it out, but he did have a recollection of being both the victim and the perpetrator. Midway through therapy, his parents caught him and his brother performing oral sex on each other, but decided to work through it in therapy. Shortly after this, my patient's brother was found performing oral sex on their younger brother, who was not biological and also a foster child. The police were informed, the brother was charged and then sent to residential treatment. My patient felt a tremendous amount of guilt and shame, feeling that being the oldest he was the catalyst for his brother's troubles.

Sheesh. That's got to mess somebody up.

He was emotionally and developmentally delayed, and though 15, he often acted much younger and his peer group consisted of those much younger than him. He was not willing to engage in relations with girls, because sexual relations to him were "dirty" and were a harbinger for trouble. One of his defense mechanisms to deal with the events to create a fantasy world, a good vs. evil universe with its own characters. He became heavily involved in it as the stressors in his life increased. He worked through his sexual issues, but is still developmentally stunted and has anger issues, abandonment issues, instability and all kinds of things related to the atrocious way he grew up.

Interestingly, his father, who was his biggest critic regarding his sexual deviance, was caught by the mother masturbating in the bathroom to pornographic magazines. Dad subsequently slipped into a paralyzing, debilitating depression that caused him to lose his job and not be able to get out of bed.

Is any of this still shocking to you when you hear it or are you desensitized by now?

I cringe, but I'm desensitized to most of the stuff I hear. I have over 30 people on my caseload, and each story I hear is more upsetting, disturbing than the next. I want to clarify "desensitized." It is not that I don't care. But I am there to find solutions, better ways of functioning, not to commiserate with them and make them feel that because of specific circumstances they will never be able to improve their quality of life. I feel tremendous pain for these people. Most of them are not asking for the hand they were dealt. Sexual abuse is an issue that is somewhat close to me however, given the fact that I was twice a victim.

Wait. You were a victim of sexual abuse?

Once, when I was four, I was forced to perform oral sex on my male babysitter.

I was the kid who would get in trouble for kissing and touching the girls in elementary school, and I remember having Lando fuck Leia when I played with my Star Wars figures. Luckily, I did not perpetrate on anyone else. For the longest time, sexual interaction was an extensive turn-on for me, but something I associated with guilt and that had a negative connotation for me. When I went through my graduate programs I was forced to deal with and compartmentalize my issues, so they would not get in the way of my patient care. Now, hearing about sexual abuse gives me an enormous amount of empathy for the victim, but also for the perpetrator, because they are also damaged. No one wakes up in the morning and says that they feel like sucking off a four-year-old, or vice versa.

Jesus. Um, do you want to talk about that? The incident, that is?

I was four. I was with my babysitter, who was the son of a family friend, who was a male, and he was around 16 or 17. We were in my family room watching television side-by-side on the floor. He unzipped his pants and asked that I touch his penis. Looking back, I trusted him but was also in fear of him because he was an older male who actually seemed pretty cool. He made no threats towards me. He didn't say anything about killing me or hurting me if I told anyone, which is common among perpetrators. He simply told me not to tell my parents. That it was between us. After the touching he had then told me to "kiss" his penis, which I did a few times. I don't know why it ended at that, or if I had blocked out other acts, but that is how I remember the process. The next morning I remember feeling guilty and conspicuous, like everyone knew about it and that I had done something wrong.

So, um, what did you do?

I had told my parents in the morning, and I remember sensationalizing my story so that they would both believe me. I wanted them to make sure he never came back again. I am not sure if my parents had believed me at first, but they had contacted his parents and told him that he would either seek professional help or face criminal charges. This was told to me years later. When I was around 23 years old, I confronted my parents with this memory, and they were in shock because they had just figured that I would forget about it, that it had been erased from my conscious memory.

Two other incidents had also occurred when I was younger. One occurred when with an older, female neighbor. I climbed into bed with her and began feeling her breasts, and she shut that down real quick. I am not sure if she told my parents. The other incident occurred when I was six and a friend slept over, and we had each performed oral sex on each other.

In retrospect, he had a tumultuous upbringing, and I'm sure had acted out with others. I remember feeling the most guilty and shameful about that. I remember seeing my parents in the morning and not only suspecting that they knew but also knowing what I had done was wrong and that, at some level, I had either initiated or easily consented to the interaction.

Having gone through that, do you find yourself more sensitive to patients who have gone through similar experiences?

I feel that I am more sensitive to issues of sexual abuse because I can directly relate to the feelings that accompany the victimization. I can only attempt to empathize with physical abuse, neglect, divorce, drug addiction, etc., because those are things I was not privy to during my upbringing. I can relate to the feelings of shame, the feeling of being with another man and the subsequent questioning of oneself and one's own sexuality. I can relate to the feelings of weakness, submission and that belief that I was somewhat responsible for what happened.

There are intense feelings of confusion developmentally. Why am I getting in trouble for kissing girls repeatedly in second grade? Why was I caught in bed with a girl in second grade? Is my over-sexualized thinking natural, and why does it infiltrate every stimulus I see? In addition, it is so difficult for a male victim to divulge this to me, another male, even though I am his therapist. The idea that you were engaged in acts with another man, based on the mores of society, is threatening to the victim who is already judging himself and feels that others will judge him more harshly, even castigate him.

I am only more sensitive to the issues because I am directly in touch with them, and I make a conscious effort not to let my feelings interfere with treatment. I also have empathy for the perpetrator and want to help them stop the cycle and not hurt anyone else. No one asks for this, on both sides, it just happens.

Well, you seem to have adjusted okay. Can you look back now and see how it impacted your life?

How it impacted my life is a difficult question to answer, because I do not know what my life would have been otherwise. I know that I am an overly analytical person, and I think this helped my because I was constantly, at an older age, determining how it effected my thoughts and behaviors. I remember always thinking about sex, sexualizing everything I saw and heard, and being turned-on more so then the average kid my age.

I remember growing up that I thought of sex in a negative connotation, that it was not a component of love or lust but a by-product of wanting to hurt someone, that if you had sexual encounters with someone you did not care for them. It was dirty, and something that was secretive. I had completely detached myself of all emotional connection to a girl, and it has only been recently with my current girlfriend that I am able to mesh feelings of love and intimacy. I feel that my experiences pushed me towards a helping profession, that I was able to be compassionate and empathic and wanted to do something to help people, make them feel important, effectual and help society.

As far as getting to this point in my life, some of it is a miracle, some of it is due to perseverance and my own ability to make sense of what happened. Aside from the incidents, I've led a rather charmed life. I have great, supportive parents and family, have always felt loved more than any child ever, have a tremendous group of friends who are my second family and keep me laughing, and I have been given the opportunity to do more things and be in more positions to succeed than most kids. If it were not for these elements, I'm sure my life would have taken a more negative, hateful angle.


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The Black Table's therapist is licensed in Pennsylvania, has a private practice working with children and adults, and provides therapy to adjudicated youth.