Mary Ann Leff, LMFT
Healing Through Relationship
Licensed Marriage, Family Therapist
Areas of focus and specialization:
Grief and Loss
Creativity and Creative Blocks
Mixed Culture Couples
Women, Aging and Menopause
Psychotherapy is meant to be a healing process that can bring about relief, increased understanding, and can lead to change. People ask how therapy “works.”
Talking through areas of personal concern with an empathic, perceptive and non-judgmental professional can help us feel seen and understood in a validating way. It can help us identify ways we have learned to cope with or survive difficult times in the past, and we can examine which of those have been successful strategies, and which have held us back. In a safe and confidential space, it can allow for emotional release and a place to gain new perspective and insight.
Psychotherapy is useful in times of transition or loss, and can help us make difficult decisions related to relationships and work. At times, it is specific and problem-focused. At others, it is a more long-term and deeper journey.
Our sense of self, or of who we are, develops through our earliest relationships. Within our early relationships we can learn to trust, or we are betrayed; we can feel valued and see ourselves as unique, capable and competent, or we can be shamed and feel inadequate; we can learn to empathically connect with and care for others, or we are not mirrored and live with disconnection. Just as we can be hurt in relationships, we can be healed through the intimacy and safety of therapeutic relationships.
I believe that all of this work needs to be done with an awareness of the effects of the cultural and social context in which we live and are raised, and that racial, gender and other marginalizing stereotypes and assumptions can cause the most severe wounding of all.
Relationships, like individuals, go through stages of development, and at each stage there can be times of readjustment when a skilled couples therapist can help.
Some couples come to see me in the midst of a crisis, and some come to fine tune an already good relationship to make it better. Some come at the beginning of a new relationship to clarify goals and values, to learn to improve communication, or to focus on one problematic area of their relationship. Others come as a last attempt to save a relationship that has felt disconnected for a long time. And some come to get help to separate in a respectful, mutual way that can minimize pain and blame.
I meet a couple wherever they are, believing that each couple has to set their own objectives and goals, and that each partner has to take responsibility for change. The key to a healthy relationship is sharing a vision of the kind of life you want to be living and consciously working toward making that vision a reality. Each partner can do this by identifying the kind of partner they aspire to be and working towards that. Relationships need two strong and differentiated partners who together co-create a third entity—an intimate, connected and committed relationship.
About Sexual Desire
Many of my clients come to see me presenting with what they call a “lack of sexual desire,” usually seeking therapy because this has negatively impacted their couple relationship. They want to either return to a previously experienced level of desire or to feel, for the first time, the desire they believe is an inherent aspect of a good, healthy sexual relationship and that is missing for them.
What is Sexual Desire? It is difficult to define something as elusive and personal as “desire” because each of us can experience it so differently. (It might be one of those questions like: “What is art? I don’t know, but I know it when I see it.” “What is desire? I don’t know, but I know it when I feel it.”)
We often think of desire as a feeling of being horny, lusty, or having a high libido--a sense of needing it, wanting it, feeling turned on. People tend to think of it as a need, an impulse, an urge, perhaps an instinct,. It is something that is stirred in the moment, but seems necessary for the moment to take place. We know it’s there because of how our bodies feel or where our thoughts and fantasies lead us. It is the psychobiological energy that we think precedes and accompanies arousal and can lead to sexual behavior. It is energy that fluctuates, and its sources are variable and often can be personally baffling.
This concept of sexual desire---desire as a hunger---seems more driven by hormones and biology, and may be more commonly experienced by men, and by some younger women; it tends to be influenced for women by their menstrual cycles, by people in the early stages of love, or after a long separation from a lover.
Rosemary Basso (http://www.cmaj.ca/cgi/content/full/172/10/1327 and http://www.arhp.org/publications-and-resources/clinical-fact-sheets/female-sexual-response) has described another type of sexual desire that is not spontaneous and is not experienced as a drive or a hunger. It is more responsive rather than innate, and may be experienced more as a willingness to engage in and be receptive to sex and sexual stimuli. This way of thinking about desire---that it is something that can be created and enhanced or, alternately, can be inhibited and extinguished---takes into account relational, emotional, social, cultural, and economic factors as well as the behavioral, biological and physical ones.
Since desire can be influenced by such a range of factors, there can be no one way to “treat” a “lack of desire,” and (though the pharmaceutical companies are spending a fortune looking for it), there is, as of yet, no magic pill. As I work with clients, I look closely at each individual. I first want to differentiate between a lack of sexual interest or feeling and an aversive reaction to sex or sexual touch. It’s important to know whether, once engaged in sexual activity, they can find pleasure and arousal. I look closely at history: their socio-economic and cultural background and the early messages they received about sex; their past experiences and relationships, whether they’ve had any unwanted or traumatic experiences; and at their current situation: their stage of life, their age, their health, current stressors including young children or aging parents; and at the effects of medications they might be taking.
I determine whether individual or couple, or a combination of both individual and couple therapy will be most effective. I want to discover if a person is identified as having low desire just because their desire is lower than their partner’s, and if the issue might be more of a discrepancy in desire than an individual issue. I look at relationship dynamics, and see how frequently sexual dynamics are played out in other aspects of a couple’s relationship--sometimes obviously, and sometimes subtly. I look at the interaction of cause and effect that a difficult sexual relationship has on a couple, and I combine education and coaching with an uncovering process. Sometimes, reframing expectations and getting in touch with the willingness to be sexual can make dramatic and swift change. Sometimes it takes deeper and more long-term work to become attuned to the sexual life force that exists within us all.
About Sex Therapy
Sex Therapy is talk therapy that helps individuals and couples resolve sexual difficulties. It was born, as a field, in the 1970’s after William Masters and Virginia Johnson published their ground breaking works Human Sexual Response and Human Sexual Inadequacy. They described and defined what they referred to as “the sexual response cycle” (critique to follow in another article). They categorized sexual problems into discrete diagnostic categories of “sexual dysfunction”--including difficulties with arousal and orgasm, and sexual pain. They then devised a behavioral treatment to focus on the relief of these symptoms without needing to uncover underlying conflict. The approach assumed that if the anxiety and the pressure to “perform” (critique to follow in another article) that accompanies or precedes most sexual dysfunctions could be eliminated, then normal healthy sexual functioning would return. (Normal, healthy sexual functioning was defined within a relatively narrow range.)
Prior to this, most problems with sexual functioning were characterizes as the result of underlying unresolved conflicts and were treated with psychoanalysis. Patients remained in analysis for years, often gaining insight, but with little change in their sexual functioning. “Sex Therapy” brought about more immediate and concrete results.
Sex Therapy became something very specific, and sex therapists were specialists, like myself, who were trained to work in this way. Missing from this perspective, however, was not only any consideration of intrapsychic dynamics, but it also failed to look at a broader context which might account for the contribution of relationship dynamics or life circumstances. It left out the impact of culture, gender, and power. It failed to allow for the broad range of what we now know is part of the normal human sexual response.
In the more than 30 years that I have been seeing clients, both the presenting problems of my clients and my thinking about them has become more complex. Due to increased self-help information available on the internet, clients are more sophisticated and have more access to education and resources. It is rare, these days, that I see problems as simply “fixed” as I did in 1979. As a result, my understanding and work with sexual problems integrates basic sex therapy techniques with all I know about individual psychodynamics, and couple and system theory. I work directly and relationally, and draw from attachment and developmental theories. I try to consider all of this in the culture and context of my clients’ lives, and think of the Sex Therapy I practice as Integrated Sex Therapy. (See the tab labeled “interview” to get more insight into how I work with and think about sexuality and therapy.)
I have had a private practice in North Berkeley seeing individuals and couples since 1980. I have taught, supervised, and offered consultation to therapists for many years. My clients include people from diverse racial and ethnic backgrounds and people of all sexual orientations.
I see both individuals and couples, and I work from a relational model of psychotherapy, believing an empathic psychotherapeutic relationship (that includes humor and a good dose of common sense) can be a powerful path toward healing.
Early in my career I developed a specialization working with a range of issues related to sexuality, and I continue to hone my thinking about the connections between sexuality and overall identity and well-being.
My teaching experience includes graduate courses at Santa Clara University, California State University East Bay, California Institute of Integral Studies, New College of California, JFK University, and St. Mary’s College. My classes included Human Sexuality, Ethics and the Law, Couples Counseling, Psychopathology, and Counseling Women.
For many years, I was a member of the Women’s Therapy Center faculty, supervising, teaching and serving on the Board of Directors. I was prominent in their Continuing Education Series, taught “Feminist Ethics and the Law,” and organized and presented at the “On Desire” conference and the “More About Sex” workshop series.
My undergraduate training was in Fine Arts, and I have been a life-long working artist. I was once enormously gratified when a formerly depressed client thanked me by saying: “You brought color back into my life.” The older I’ve gotten, and the more mature I’ve become--both as a therapist and as an artist--I’ve developed an appreciation for the importance and depth that texture brings to both life and art.