The Ledger
Every statement that passed quotation and attribution checks. Mix any filter with any other: certainty 1/5, debate potential 5/5, or both at once.
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Iasenza: Medical Diagnoses Function as Narratives That Create Categories of Sickness
“Medical diagnoses are stories and narratives, right? And they tell us what makes us sick or what makes us well. And when they come up with a new diagnosis, now you can have a whole other family of narratives of sickness.”
Iasenza: Sexual initiation patterns are more socially constructed than biologically determined
“Yeah, I think it really, probably most sex therapists would say it's more socially constructed than biologically determined, even though, yes, Cisgendered men have more testosterone in their systems than cisgendered women, let's say.”
Iasenza: Couples' communication problems are often failures to negotiate differences
“We're having trouble with differences, so it might not even be communications really the problem. It's that they're not able or they don't have the skills to be able to hear each other out, to be able to then find compromises, which is a big skill in couples.”
Iasenza: Suppressing true needs from partners drives relationship breakdown
“Whatever way you're not saying truly what you need, or what you don't want, or whatever, is creating probably why you're in my office in the first place.”
Iasenza: Partner Acceptance Does Not Eliminate Internal Shame in Withholding Secrets
“Even if the partner really proves to be truly a loving, non-judgmental partner, that doesn't mean that the self is that understanding. So it could be more of a conflict within the self about why someone can't put words to it.”
Iasenza: Privacy does not violate relationship agreements, whereas secrecy inflicts harm
“Privacy is an area of human experience that does not impact the couple negatively, especially in terms of understood or implied truth you know, between them, or agreement.”
Iasenza: Relationship outcomes become harder for therapists to predict over time
“The longer I've practiced, the less I can really predict. How a couple's gonna turn out. I've become more humble over time, and I've been more surprised over time.”
Iasenza: Highly reactive and hostile couples can achieve profound long-term turnarounds
“If people allow themselves to unfold, it could take years, but people can turn corners, and I've seen people turn corners that if you took the video tape in the first session, you would have said, I can't believe this is the same couple.”
Iasenza: All sex is group sex involving generational trauma and attachment histories
“All sex is group sex, and they laugh, and I said, well, this is what I mean. You think you're in bed alone with your partner. You're not. You're in bed with your trauma history or attachment history, your trauma history or attachment history, your mother and f…”
Iasenza: The Clinical Desire Narrative Creates Most Dysfunction in Couples
“That desire component since the 19 eighties, I think is one of the major narratives, I believe creates problems in couples, because most couples come in with desire disorders.”
Iasenza: For most women, sexual desire follows arousal rather than preceding it
“For most women, desire follows arousal. It does not precede it.”
Iasenza: Sexual arousal can increase in long-term relationships into one's eighties
“For some people, the in a long-term relationship, they might even be more aroused by their partner in their, I work with some people in their eighties. It's so great to work with the eight-year-olds because for some people, they love, they fall in love with th…”
Iasenza: Most people define sex strictly by genitals, penetration, and orgasm
“Most people, because that's the narrative we're taught, is usually the definition of sex is genital. It has to involve the genitals, sometimes has to involve penetration, not always, and has to end an orgasm. Those three components usually are the most common …”
Iasenza: Sexual Experiences Fit Three Distinct Models Beyond Orgasm
“Look, you have at least three different models out there, narratives, what sex is. You could say desire ending in orgasm, that's the more traditional one. Ok, nothing wrong with it. If it works, you're great. If it works for both, you're great. But there are t…”
Iasenza: Expecting Reciprocal Sex Leads Many Couples to Avoid It
“You don't have to always have, be, have reciprocal sex every time you do it. That's also a burden. Many couples don't have sex because one of the partners may not want to, ah, let's say, be up for an orgasm, or even be able to experience arousal that easily, s…”
Iasenza: Lack of commitment after resolved issues signals desire to leave
“And sometimes you could see each thing gets better, but a half of the couple might not still be committed, more committed. And more happy. That can give you a clue that there could be still something about this person really doesn't want to be here.”
Iasenza: Asexual People Are Often Mislabeled as Sexually Dysfunctional
“Asexuality doesn't get enough, you know, attention in our society, because I think some people don't even know they're asexual, and they get labeled sexually dysfunctional because they don't, you know, sex isn't a major variable for them, for attraction. They …”
Iasenza: Having children helps separating couples endure difficult conversations
“In fact, that having a kid in the picture really can give them the strength to stay there and really tough out the really difficult conversations.”
Iasenza: Authentic relationships inevitably involve partners hurting each other
“So when I talk about authenticity, I say, if you're really authentic, you're gonna hurt each other. Not even intentionally, but unintentionally.”
Iasenza: Individual Sessions Help Couples Surface Secrets Safely Before Joint Therapy
“That's why with couples often whether they're, especially if they present with sexual issues, but even if not, sometimes I will do some individual sessions for history, or just for them to tell me a little bit more about a particular problem, because sometimes…”
Iasenza: Pre-1970s Sexual Health Models Excluded Psychological Desire
“Prior to 19 seventies, there was no narrative for desire in sexuality. Because prior to the seventies, we had Masters and Johnson's model of, ah, what makes everybody sexually healthy, what sexual health looks like. And in Masters and Johnson's model, desire w…”
Iasenza: DSM Removed Hypoactive Sexual Desire Disorder for Women
“In the DSM, women cannot be diagnosed with desire disorder anymore. Hypoactive sexual desire has been removed”
Iasenza: Sexually active 80-year-olds maintain intimacy by deconstructing sex beyond mechanics
“Older people usually who are still erotic and sexually together at 80 know how to deconstruct sex, because they've just had to. Over time, the body parts might not work because of illnesses or medications or things that happen, and if they're really still got …”
Iasenza: Sexual initiation does not inherently confer more relationship power
“I don't think just the person who initiates really has more power. Some people might argue it's actually the person who's seducing the other, or, Plays the other part that has power.”
Iasenza: Resistant relationship narratives typically stem from deep-seated trauma or childhood wounds
“As I begin to do narrative therapy very early on, by starting to deconstruct how they're saying a problem exists, and the stories, and so forth, some things will shift fairly rapidly, but some will be quite resistant. And those are the ones that then are usual…”
Iasenza: Fear of Failure Prevents People From Ending Relationships
“Many times, even therapists can, couple therapists can feel like the breakup is a failure, and I think that's a narrative that's really one to be dealt with as people are trying to decide, or one person wants to leave that relationship, they think it's over. T…”
Iasenza: Open relationships are a high-maintenance activity if executed well
“Well, what I often tell people is, this isn't a moral question, it's like, it's a high maintenance activity if you're gonna do it well.”
Iasenza: Initiators often leave breakup therapy due to overwhelming guilt
“Sometimes the person who is breaking up, they can't tolerate staying in the room because they feel too guilty about it.”
Iasenza: Relationship strength is defined by repair and recovery skills
“I always tell people the real strength is How do you recover from something? Not the fact that you already had the fight or the rupture, but how do you recover? How fast you recover? How well, what are your skills to recover?”
Iasenza: Almost all couples initially cite communication as their primary problem
“Almost all couples, whether it's, ah, they have sexual issues or other issues, usually will say communication. That's one of people's most favorite presenting descriptions, is they'll say, we need help with communication, which is the general catch-all kind of…”
Iasenza: Couples with kids must treat their relationship as another child
“I often say to couples with kids, the relationship's another child. You don't have one child, you have two. It's called your child named, you know, Mary, and then you have a relation, a marital relationship to still nurture, and people don't get that a relatio…”