Sexual health counselling is an immensely subtle and delicate area of expertise. Even in a relatively morally permissive society such as Britain, people may still experience a certain ethical dilemma before seeking out professional help with this kind of problem. In an interview with Kommersant UK, Gulya Diyarova, the psychotherapist, sexologist and director of EFT School, discussed the implications of cultural differences, the concept of collective shame and how couples can resolve intimate problems.
Gulya, tell us how you ended up in Britain and became a psychotherapist and sexologist.
Ethnically, I’m a Tatar and I used to live in Moscow. I moved to Britain about 30 years ago, together with my family. We had three little children. We left Russia during a period of tension, the troubled times of the 1990s. My first career, in Russia, was as a paediatrician and neurologist, but over here, I gradually requalified as a psychotherapist, working with couples and individuals. At first, I worked for the NHS, Relate, (an organisation of psychotherapists working in the area of relationship support) and Tavistock Relationships, before opening a private clinic. At Relate, they suggested I qualified as a sexologist, as this was close to my training as a doctor and they needed a specialist in this field. It was quite easy for me to begin training in this area and it opened up new possibilities for my work with couples and individuals. I studied sexology for four and a half years in total; that gave me the theory, plus the time I needed to gain the practical clinical experience. In Britain, you must be a qualified psychotherapist or counsellor to become a sexologist-psychotherapist. Sexology is an extra qualification. The first step is the basic training certificate, after which study for the full qualification begins. I studied at different places in England, including Tavistock Relationships, which is the leading centre in Britain. It’s known for its in-depth training programme for couple therapists.
You specialise in the EFT approach. What does this consist of?
For therapists, the training is constant, it never ends. While studying, I developed an interest in Attachment Theory, which is a universal theory of human relationships. Its founder, John Bowlby, said that we are always attached to something, from cradle to grave. Attachment theory is one of the basic elements of Emotionally Focused Therapy (EFT). I brought this approach to England in 2010 and, since then, both in an independent capacity and together with the Canadian EFT Institute, I’ve been running themed courses and supervising and preparing other therapists for their certification. Nine years ago, I founded the first and only therapeutic society of EFT schools in the world and also an EFT clinic in London for specialised help with difficult cases featuring superseded and traumatic emotions, whether in couples, family groups or individuals.
Attachment is fundamentally important, as it represents the intimacy we all crave and strive for in our relationships. In truth, all relationships, whether romantic or friendship-based, are the cornerstone and possibly the prerequisite for our survival and growth. We all want understanding and acceptance. We also want to be heard. Everyone reacts to distress in their own way; some argue vigorously, prove points and criticise, whilst others fall silent and clam up. Patterns of behaviour within relationships depend on the attachment style we developed in our childhoods and what we have learned from our own families. Later on, they create distress in our adult relationships. The task of an EFT psychotherapist is to identify what motivates these patterns and precisely which emotions and fears lie behind them. Finding out how someone copes with fear is a fascinating process. Famously, many react with ‘fight or flight’, although perhaps a third option is to freeze in expectation of danger. One client explained it like this: ‘I expect to be shot at any moment, but I don't know where the bullet will come from as I am in the dark’. It’s very frightening to feel in constant danger and that a ‘bullet’, in the guise of pain, can come at any time. We work in the area of these emotions and we help people to speak in the language of attachment and intimacy. We find that virtually all our clients are very receptive to EFT and that helps us to do our work.
How often do clients come to you with specifically sexual problems?
It has to be understood that any couple experiencing problems and distress in their relationship suffers from sexual tensions and difficulties. As it’s a very sensitive subject, if the clients themselves initially don’t mention it, the therapist must proactively, but carefully broach the topic of sexual life and ask questions. The therapist has to create a feeling of security during the session to help the patient open up. When I work with a couple, I generally ask them about intimate contact at some point. As a psychotherapist with many years of experience, it heartens me that recently, more couples, especially younger ones, have begun to come for help at the very start of their relationships, before they have any children, rather than after 20 years of struggle and attempts to sort things out on their own. Sometimes what I hear is like something out of the Daily Mail, such as a woman who realised, in the 30th year of her marriage, that her husband had had at least 70 (!) illicit sexual encounters. They were mature people with adult children. How could this have happened? Did the woman fail to notice or did she choose not to? We work on similar issues and others with the help of Emotionally Focused Therapy.
Is it easy for modern British sexologists to find clients, or, even in the 21st century, in a relatively emancipated country, are there difficulties?
That’s a good question. We have to recognise that we can never escape our cultural differences and that, overall, Britain is a multicultural country. Yet at the same time, although the ways these problems are expressed may be different, all the troubles, suffering and fears associated with attachment and security within relationships are quite similar, irrespective of what language someone speaks. Generally, it’s easy for me to broach this topic during EFT since, as a rule, patients respond well and cooperate. Still, there is a generation barrier. For instance, young couples come to me when their problems first arise at the beginning of their relationships, while older generations undoubtedly find it hard and sometimes embarrassing to turn to a sexologist. In my experience, I've noticed that certain ethnic communities exhibit a collective sense of shame, which discourages discussing personal distress, particularly intimate issues, with outsiders. They pass on to each new generation a belief that this is not allowed as it’s shameful and a sign of weakness. It’s important to take this attitude into account and treat it with respect. This approach can help someone to feel secure, be themselves and be able to open up. It’s actually quite difficult to live with a vulnerability if you can’t share it with anyone, as it’s quite draining.
Have you noticed a difference between Russian-speaking clients and native English people?
Yes, there’s a difference. Although I don’t often work with Russian speakers in particular, more often I see people who have long been settled in Britain. However, I have observed that these clients have a sort of unrecognised barrier of shame. Their attitude implies “Leave me alone, I’ll sort it out myself”. This is especially the case with Russian men.
Is this phrase a demonstration of men’s confidence, or something else?
Self-confidence is only external, it happens on the surface. But actually, the true emotion behind this attitude is a certain degree of shame or fear. Once a man came to me with a narrative along the lines of: “I’m the leader of a large corporation, I have tens of thousands of subordinates, and I resolve conflicts proactively, but in my own family I can’t cope…this shows my vulnerability and weakness”.
In mixed marriages, differences in culture and temperament also occur. For instance, If an English husband is high-status and significantly older than his Eastern European wife, then he won’t be so inclined to discuss such a treacherous and sensitive area as problems with his intimate life. Once, amongst my clients there was an English husband and his Scandinavian wife; as is well-known, people from Northern Europe can be temperamentally cold and emotionally withdrawn. He was a professor of psychology from a prominent university and he said to me: “Name any theory and I can give a lecture on it”. But in his own relationship, he couldn’t find a common language with his wife, he couldn’t listen to her on an emotional level. All in all, for men, discussions of their sexual problems can lead to loser complexes, helplessness and a feeling of shame. But as sexologists, rather than considering these issues as shameful weaknesses, we recast them as strengths and even signs of fortitude and manliness whilst admiring patients’ ability to be open about their vulnerabilities. We understand how hard this is and we’re ready to work with it.
Have businessmen often come to you for help?
When I began my private practice, I immediately opened my office on Harley Street and many high-status, successful people came to me. Initially, they arrived with their own mindset and myths, and attachment theory helped me to take off their armour. I love the moment when the client before me’s status begins to lose its importance and they become just a suffering person living in constant fear and distress.
What about businesswomen?
A particular approach is needed for successful female clients. As a rule, business ladies have gone through a difficult journey to achieve all that they have. They are not always able to let go of their status and give themselves the chance to just be a weak woman. In other words, I’ve noticed that they’re actually less willing than successful businessmen to leave it all behind and, for a short time, become vulnerable in the therapist’s office.
Let’s talk about the combination of money, power and sex; how do they interrelate and affect each other? For instance, does the ‘small penis complex’ really stimulate a desire to earn more and acquire a large automobile or house?
Money, power and sex are emotive, intertwined areas, with money serving as a material manifestation of power. As for penis size, this is both true and more of a stereotype. This complex is actually hiding the same fear of helplessness, rejection and being ignored. I have taught myself to distinguish between what people originally tell me when describing their initial complaint and what really hides behind their words, to see its deep-down essence and their true desires. Incidentally, women can also develop small or large penis complexes.
How exactly is this expressed?
Despite our anatomical differences, women, just like men, also try to compensate for their natural human vulnerabilities. It would be fair to say that in their fundamental essence, women and men are both made from the same emotional material. Psychotherapy has long moved on from the excessively determinative understanding of sexual complexes of the time of Freud. That is, the outward expression of this type of complex may involve a woman’s more or less masculine tendency to attempt to prove her own success by acquiring external success symbols such as wealth, power and sexual triumphs, an unwillingness to accept her own vulnerability, a rejection of femininity in all its forms, including speech patterns, clothing style and even, in extreme cases, a denial of maternity. But, looking deeper, beyond the masks, which both men and women create as a defence mechanism, I can usually detect attachment vulnerabilities, sadness, the pain of loss and a passionate drive and desire for intimacy, both emotional and physical. We work on this together to help the client find, either within themselves or the person they are close to, the best ways to cope with fears, pain and emotional suffering and seek out strength and spiritual fortitude.
Could you give some advice on how to bring up a child so that they will avoid problems with their sexuality in adult life?
You know, the commonest complaint of my clients is, of course, communication difficulties with their children. But everything comes from childhood, from the attitudes the child receives during upbringing, on whether there were many prohibitions or none at all and how these prohibitions were communicated (through respectful discussion or with shame and punishment). All of this has an impact on subsequent life and the likelihood of communication problems. On the subject of advice, there is some good news; research has shown that it’s enough to be completely congruent and communicate effectively with the child for at least a third of the time that you interact with them. That isn’t really so much, and, as parents, we can do this. But there is the remaining part, the other two-thirds. If there is a gap, a certain break in attachment or a misunderstanding, we need to put it right and heal it. If balance is preserved during upbringing, the child is highly likely to grow up to be confident in themselves, their environment and the people around them, which will equip them to adapt to the world emotionally. There is a good book, Raising Parents, by Patricia Crittenden, about how to train, or ‘bring up’ parents so that they can raise psychologically healthy children.
If a couple encounters libido problems, how can a sexologist help?
Libido is a creative topic. As psycho-sexual therapists working with couples, we don’t talk about concepts such as ‘low’ or ‘high’ sex drives. Instead, we talk of a certain mismatch of libido levels or sexual needs. At the very start, we need to do some research and make sure that neither of them has a hormonal imbalance or a medical or physical anomaly such as vaginismus in women. Some couples live together long-term without sex, and it suits them; they bring up children and focus on other areas of life. The key is not how good or bad your sex is but how well you are matched and the extent of any mismatch. For instance, maybe one member of a couple can live contentedly with the status quo and the other can’t. We look at how to reduce the gap and bring the size of the mismatch to the point where it is acceptable and comfortable for both parties. I’m sometimes asked: “Is what we’re doing normal?”. I answer with my own question; “How is it for you?” If it suits you, then everything is fine.
I could also make this analogy: when you get into a car, you can’t step on the accelerator and the brakes at the same time. In exactly the same way, there are sexual brakes and accelerators, that is, what arouses and intensifies sexual desire and what puts a stop to it. The analogy is clear; we can either step off the brakes, and remove whatever was hindering things to facilitate the sexual sphere, or we can step on the gas by boosting arousal and easing sexual contact. To start with, it’s important to work out what the brakes and accelerators in your sex life are. One client told me “He goes into the room, but it’s strewn with clothes and the bed isn’t made so I don’t even feel like going in there” It may not seem to matter to him, but for her, it’s an impediment. Couples make discoveries in this area while working out what’s a turn-off and what gets them going. It’s essentially about communication. The therapist creates a safe environment where they can talk freely.
Sometimes people come and say “I don’t like sex”, but sex is a multifaceted concept. That’s why surprising emotional discoveries occur when you start to talk it all through to find out what exactly they don’t like, what exactly doesn’t work out for them and when; whether that's during foreplay, the physical act itself, or afterwards. For instance, one woman told me that she didn’t need sex, but then it turned out that for her, foreplay begins at breakfast over the cornflakes. It depends on how her husband looks at her and serves her tea and whether he talks to her or hides behind his morning newspaper…at that moment, she decides internally whether the idea of sex that evening appeals to her. For her husband, this was a great discovery.
Do you have any all-purpose tips on how to improve sexual relations?
There is a three-minute game which I invite clients to play in my office. For three minutes, one partner tells the other how they'd like to be touched by them. They only describe it, without touching, but they imagine it in their heads. Then the other does the same. They often talk about touching the most unexpected places, such as the very sensitive skin behind the ears, the back of the hand and the sides of the body…sometimes they forget about the game and talk for more than three minutes. There is a lot of room for imagination and intrigue in this game. At times people say afterwards: “Wow, we’ve been starting with the genitals every time for 20 years! That's why we’re not great at sex!”.