Monthly Archives: June 2011

Sexual Fantasies

Some people get very freaked out by sexual fantasies and worry that having fantasies makes them “bad.” 

When I was in private practice, I did a lot of sex counseling, and one thing I would ask a couple individually is “what are your sexual fantasies?”  Here’s the typical answers I would get:

1.  “Oh, I don’t have them.  That would be rude.”
2. “I can’t talk about them.  They’re really sick.”
3. “What difference does it make?  He or she would never do them.”

There’s a lot of angst surrounding sexual fantasies.  They’re basically erotic thoughts that make you feel sexier.  They’re arousing and add to the “moment.” Research shows most people wish to fantasize, but have sex in the context of the person they love and feel most comfortable with. – in other words, they use fantasy as an aphrodisiac.  The people who report the highest sexual satisfaction tend to be those who have fantasies, because they fuel arousal, particularly when things start to get a little “everydayish.” 

Things are very exciting when they’re new, and when they get to be functional, things lose their appeal.  That’s when people stop playing with each other, stop being each other’s girlfriend or boyfriend, and stop using sexual fantasy. 

If you’re a tennis player, all things you do before a game are like foreplay.  You imagine hitting the ball well today, and what you’re doing is fantasizing about how the game is going to be.  So fantasy provides a very important function. Fantasy takes your mind totally away from distractions and allows you to enjoy the “moment,” helping you to focus and maintain arousal.  When women say they have trouble with orgasms, the number one thing therapists try to get them to do is fantasize and masturbate.  It’s like jump-starting the whole mechanism.

In general, the most common fantasies for both men and women are those that relive an exciting sexual experience, or those that imagine sex with a current or different partner.  It doesn’t mean you don’t love your spouse, but it means sometimes you need a jumpstart to make yourself feel sexy and not make sex feel so mundane.

The next most common fantasies involve oral sex, sex in a romantic location, heightened sexual power or irresistibility, and (believe it or not), for most women, forced sex.  When women fantasize about forced sex, it’s not about being beaten, stabbed, or shot.  Instead, it’s about being swept off their feet, being held down and totally enjoying the abdication of responsibility for anything happening.  Male fantasies tend to focus more on visual imagery and explicit anatomic detail.  Women’s fantasies tend to be about emotion and affection.

And consider telling your partner your fantasy, but not if it’s that your neighbor’s body is so hot you can hardly hold your breath, or that you think of him or her while having sex with your spouse.  But if you have a fantasy about the two of you, and you know your spouse well enough to know this would not be crossing a line, then you can tell them.  Things that won’t hurt your spouse’s feelings can be shared.  Otherwise, keep your mouth shut, because there is nothing UNsexier than telling your spouse “I have to go to an entirely different place to do it with you, but I love you.”  THAT just doesn’t fly.

Quote of the Week

It’s easy to play any musical instrument:  all you have to do is touch the right key at the right time and the instrument will play itself.

               – Johann Sebastian Bach


                 German composer, organist, harpsichordist, violist and violinist

How To Say You’re Sorry

There is an effective way to apologize and an ineffective way. 

Here are some ineffective ways:

1. I’m sorry.

That’s it.  That’s it?  It’s kind of shallow and superficial.  If you say “I’m sorry you felt upset,” that puts the blame on the injured party.  If you say “I’m sorry YOU felt upset,” that means you aren’t taking responsibility for your actions.  That just says you got upset and I’m sorry that you got upset, but it’s not my problem!

2.  I’m sorry if I did something to offend you.

Ouch.  The “if” word is a stab in the heart.  It’s pretty defensive, and not “owning” it.  It’s qualifying the apology.  Any apology with a qualifier in it is not really an apology.

I particularly remember this one, because I was in a situation where I used this and blew it.  I made a terrible mistake early on in my psychotherapy practice.  I used this line with a patient.  She didn’t say anything, but the next week, she came back furious.  I guess I was being defensive and didn’t realize it.  So, even the pros do it.

3.  If it will make you feel better, I’m sorry.

Whoa!  This one is so insincere that it literally drips insincerity.  What you’re really saying is “If it will make you feel better (you stupid, weak, annoying idiot), then I’m sorry.  Yikes!

4.  I’m sorry for whatever I did.

This is one that too many husbands try to use, but then too many wives don’t communicate particulars!  This one is a bit vague and non-specific.

5. Any and all apologies followed by the word “but…”

This apology reminds me of a funny thing that happened in a psychotherapy session.  I sometimes get a little playful with words and images, so when I had a husband and wife in therapy, and every time the wife opened her mouth, she said “but, but, but, but,” I said back “you’re a ‘but’ with feet!”  She went through the roof, because she thought I called her an ass.  I guess I should have watched the way I worded that comment.  I wasn’t sensitive and got a little too playful at the wrong time.

That example segues into how to apologize correctly.

First of all, you personalize your apology.  “I am sorry I hurt you.”  Anything that is personal is felt more deeply.  That needs to grow into “I’m sorry I hurt you by breaking my promise….” or whatever you did.

The third part of the apology occurs when you show you really understand why this was upsetting – you’re not only acknowledging that it was upsetting but also why it was upsetting.  “I’m sorry I hurt you by breaking my promise to call.”  You are justifying their being upset.  You elaborate on all the hurtful aspects of what you said that you’re aware of, and then you again express regret and remorse.  “I am so sorry  I have hurt you.  I take full responsibility.  I did this and I regret it.  I have remorse.  I was being selfish and flighty.  I was insensitive.”

It’s really then important to express some desire to make amends.  Discuss what you are going to do inside your heart, soul, life, mind, and habits to make sure it doesn’t happen again.  And repeat your apology as often as needed, especially for bigger wounds. 

After things have settled down, and some time has gone by, you might want to talk about some mitigating circumstances, but in general, I wouldn’t suggest you go in that direction until the pain has subsided to a much lower level.  And don’t use the excuse “I had a few too many drinks.”  You still did what you did. 

If you are going to apologize, make it sincere or don’t bother.

Quote of the Week

A proverb is a short sentence based on long experience.

               - Miguel de Cervantes Saavedra


                 Spanish writer, adventurer and soldier

                 Author of Don Quixote de la Mancha

Some Doctors Turn Away Obese Patients

Here’s a subject that’s going to make a lot of people mad, but that’s probably every subject I talk about. I’m going to give you my opinion. You can debate it, you can agree with it, you can disagree with it, you can think about it. It’s all okay with me.

Some ob-gyn doctors in South Florida turn away obese women. Not chubby. Not fat. Obese women. Some names were given out in a news article, and some doctors got in trouble. One said, “Oh, no. I do see obese women.” In a nation with 93 million obese people, you get a few doctors in South Florida (my guess is that they’re everywhere) who refuse to see otherwise healthy women solely because they are obese and all hell breaks loose.

Some of the doctors said the main reason was their exam tables or other equipment couldn’t handle people over a certain weight, but at least six said they were trying to avoid obese patients because they have a higher risk of complications. Keep in mind the malpractice problems for ob-gyn doctors is huge. People have floated away from that specialty because everyone wants a perfect baby and they sue the doctor when it doesn’t happen. It’s a really difficult specialty at this point.

“People don’t realize the risk we’re taking by taking care of these patients,” said Dr. Albert Triana, whose two-physician practice in South Miami declines patients classified as obese.[Dr. Triana later said his practice does accept obese patients] “There’s more risk of something going wrong and more risk of getting sued. Everything is more complicated with an obese patient in GYN surgeries and in [pregnancies].” (

A couple of doctors said the cross-over point was if the women weighed over 250 pounds. Two of the doctors who were interviewed stated they didn’t want to begin seeing obese women and then have to send them to specialists if they later developed problems. The office manager at one place said “This is just not a high risk practice.” The doctors there are not experts in obesity.

Turning down overweight people is not illegal for doctors, but the policy worried leaders of physician groups, medical ethics experts and advocates for the obese — how can you advocate for obesity? It’s like advocating for slow suicide. That’s bizarre to me — all of whom said it violates the spirit of the medical profession.

One doctor stated that if they had that policy, they wouldn’t have a practice, because they’d lose half their patients. And do you know why that’s true? Because statistics don’t lie: Americans are fat! According to, Americans are fatter than Mexicans, Australians, Greeks, New Zealanders, the British, and more. We’re fat! American’s ate more than twice as much high fructose corn syrup (sugar) per person in 2004 than we did in 1980. We’re eating more and more crap and we’re moving less and less, so we have more and more obese people.

I went to a website that advocates for obese people and found an article about obesity discrimination in the doctor’s office:

Perhaps a more unsettling type of obesity discrimination occurs in a place where caring, trust and unbiased treatment should be guaranteed…your doctor’s office. Unfortunately, on average, doctors are not immune from obesity discrimination tendencies. (

I read that and I got angry. Doctors are not discriminating because they find the patient offensive, they’re discriminating because obese people walking in clearly indicate that they’re not responsible; they don’t have self-discipline; and they probably won’t follow the protocol. They are also more likely to have side complications and not do what it takes to get the fat off so they will be healthier and be less at risk. All the risk now goes to the doctor. How many of you think that is fair?

What I’ve learned is that it’s okay for you to be totally out of control, but someone else has to accommodate you anyway. That’s personal responsibility? That’s a bratty kid.