Psych Attack

In this episode, I catch up with Dr Sarah Ashton to hear about her work in the area of sexual health and intimacy. In particular, we focus on kink and paraphilias, where they come from, as well how to treat a paraphilic disorder and work with clients experiencing shame.

Dr Sarah Ashton is a registered psychologist, Board Approved Supervisor, training author, and the Director and Founder of SHIPS.

Sexual Health and Intimacy Psychological Services (SHIPS) is a progressive psychology organisation in Melbourne, Australia. They provide sex, intimacy and mental health treatment & training.

You can follow SHIPS’ work on LinkedIn, Facebook, TikTok, and their blog

Sensitive content warning
The episode focuses predominantly on the importance of understanding the whole person, including their erotic experiences and desires. We talk about a wide range of erotic experiences and the conversation covers experiences that are fulfilling and pleasurable, as well as some examples of disorders where harm is done. This episode refers to sexual assault, pedophilia and exhibitionism. Specific case examples and lived experience are not discussed. Please take care while listening and if you are feeling discomfort and think you would benefit from some support, please reach out to your GP or contact a service like Lifeline.

Cite this episode
MacDonald, J. B. & Ashton, S. (2024, June 5). Sex therapy, kink and paraphilias (No. 18) [Audio podcast episode]. In Psych Attack. www.psychattack.com

Transcript
There is a transcript available for this episode. The transcript has not yet been reviewed for accuracy.

What is Psych Attack?

Psych Attack focuses on the diversity of the domain of psychology. Join us for a relaxed conversation with experts discussing the topics they are passionate about in psychological research and/or practice. The aim is to better understand the spectrum of human experience, the methods used in psychology, and the people attracted to working within it. The conversations will be of interest and accessible to novice and experienced psychology listeners alike.

Hosted by Dr Jasmine B. MacDonald (jasminebmacdonald.com.au).

Dr Jasmine B. MacDonald (00:00):
Hello and welcome to Psych Attack. I'm Dr. Jasmine B. MacDonald. Today I'm catching up with Dr. Sarah Ashton to hear about her work in the area of sexual health and intimacy. In particular, we're gonna focus on kink and paraphilias, where they come from, as well as how to treat a paraphilic disorder and work with clients experiencing shame. Welcome, Sarah.

Dr Sarah Ashton (00:45):
Thank you. Thanks for having me. It's a pleasure.

Dr Jasmine B. MacDonald (00:48):
I'm wondering if we could start by you sharing some info of your background, uh, your journey in psychology and how you came to become a sex therapist.

Dr Sarah Ashton (00:57):
Well, I've always been interested in sex and sexuality, and when I was studying undergraduate psychology, I kept waiting for, uh, the subject of,of sex to come up. And there was a bit of a mention of Freud's Oedipus Complex, but apart from that, it was largely absent. And so when I was doing an, an internship as part of the four plus two, after I'd completed honors, I, uh, was looking for work experience and applied for, um, a job working with sex offenders. So I really had exposure early on to sort of, I guess, the extreme end of the population when it comes to where sexual function has gone, gone wrong. One of the benefits of working as part of, in the forensic field is they give you lots and lots of training. So, um, you know, we provided group therapy for offenders, and we got to work with the co-facilitator.

Dr Sarah Ashton (01:52):
And as a, you know, early career, um, provisional psychologist at that point in time, I was, I got to watch other people work. I got exposures to either, you know, the interpersonal dynamics that played a role in, in therapy, um, and also some really exceptional training that was provided as part of the role. And then I worked with juvenile offenders. And when I was working with them, I could really see how much pornography was shaping their view of, um, sex and sexuality and, and their perceptions of gender as well, particularly expectations around, uh, women. And so I decided to do a PhD focused on experiences of pornography. So in particular, I looked at young women's experience of, of pornography in terms of how they, um, how it makes 'em feel about themselves, how, uh, it influences their relationship dynamics. And as part of that research, I conducted interviews.

Dr Sarah Ashton (02:47):
Uh, so it was qualitative research. And what was most powerful about those interviews was some of the young women I spoke to had never, never had conversations with anyone about some of these topics and these experiences. Um, and it was so powerful for them to sit there and, and feel heard by me as part of the interview. I think the culmination of all of those experiences that what really inspired me to start ships. So there was no, I guess, organization that specifically focused on the treatment of sexual health issues using psychological, um, modalities. So I just decided to create it. I decided there needed to be a, a space where, um, these sorts of conversations could happen. And also there needed to be an extension on the discipline of, of psychology. Not only did I have to sort of start a psychological practice where therapy was provided, I also needed to, at the same time, um, write and develop all of the training on on, on how to treat sexual issues using psychological modalities.

Dr Sarah Ashton (03:55):
Yeah. Five years later, we have a team of, of 30, um, and we're delivering thousands of hours of, of psychological therapy across the year. Um, and we also have over 23, um, training courses and that are available online. And, you know, we also provide training for all sorts of different organizations and psychology practices yet, and I haven't stopped yet 'cause there's a, there's just such a great need for, um, for normalizing these discussions and, and, um, you know, providing healing for, um, people within our community. I think that sex represents the vulnerability and the shadow of our humanity. Um, and it can result in experiences of absolute bliss and intimacy and connection. And at the same time, it can be one of the most destructive actions if we're talking about the experience of sexual assault. I think that moving this out of the shadows and being able to understand and create healing has a huge transformative impact. And particularly for erotically marginalized communities like sex workers or lbtq plus community, or people who practice kink or non-monogamy. It's my personal and professional mission. I'm privileged to be in a position where I can set this up and, and offer this to practitioners and, and, um, and the community. And, um, I love it. .

Dr Jasmine B. MacDonald (05:24):
I can hear the, um, the passion and the motivation that you have when you do a PhD. You wanna be working in a space that is niche and novel and carve out your own space, but habit is sweet for you to sit with, um, research participants, presumably clients as well, and probably they've never had this kind of conversation before. It's, um, kind of a sad state of affairs, right?

Dr Sarah Ashton (05:47):
Yeah, definitely. So many people suffer alone for years of their life because they, well, they either think that there's nothing that they can do, do about whatever the issue is that they're experiencing or that they have too much shame about sharing it. Yeah. Or they don't know the way forward. So one of the most satisfying aspects of working with people around sex is that there's a huge amount of, um, relief and, and healing that happens simply when they get in the room. And you can, um, you can, they have full permission to speak about this. And, and I think that, you know, one of the things about ships is that because we openly advertise ourself as, you know, working with erotically marginalized communities, and also that this is what we do. You know, um, uh, we, we we treat sexual health issues. People already have that sort of signaling of safety before they even walk through the door. And, you know, it's one of our primary needs as humans, right. Safety and connection. So, um, yeah, I think that it's so important that we don't just have these isolated spaces or, you know, practices that, that signal this, but we need, um, to really think about training and, and signaling and safety across the board when we're talking about healthcare. Mm-Hmm. , because that, that is necessary for, for any kind of healing. And healing is the aim of, of, of healthcare. Yeah. Yeah.

Dr Jasmine B. MacDonald (07:18):
What are referrals like for ships? So when you don't have people who are coming straight to ships, you have people who are maybe experiencing a range of other mental health aspects or social aspects that maybe have a core or have an important link to their sexual identity or desires. Do you find that practitioners in, in the Melbourne area are supporting with referrals and, and providing that pathway for people?

Dr Sarah Ashton (07:43):
We have a number of different services and practitioners who, who will regularly refer to us. Um, and I think that it's really wonderful and it is part of a lot of people's practices. I think that some of our clients, what they talk about is perhaps working with a practitioner about particular issues, maybe mental health issues, then they reach the point where they perhaps realize a connection with a sexual health issue. Um, or that comes up in therapy. Then the therapist at that point in time says, you know, oh, this is not something I can help you with. And then refers them on, as we know, as practitioners, it's really important for us to be aware of the limits of our professional experience and capacity, and only treat what we have training to treat on the whole, what I've discovered when I've been training and working with practitioners is that a lot of the time, the reason why practitioners don't talk about sex, or they don't, um, broach these topics is because they live in as part of the broader social system that, you know, we all live, um, within, which is one that shames and stigmatizes sex and sexuality for a lot of people, you know, they might not have grown up talking about sex.

Dr Sarah Ashton (08:55):
And so, um, not only do they not raise this within their, all the relationships in their life, maybe not even their intimate relationships, they then don't feel like they can raise it within their, the therapeutic context either. Then it becomes more about perpetuation of that, that shame and stigma, rather than perhaps acting in alignment with your, you know, skills and expertise. So I, I suppose that's why I'm passionate about all practitioners learning how to have these discussions. 'cause even if you don't cont continue treating someone for a particular sexual issue, people are a system, you know, everything is interconnected and all of the sexual issues relate to people's psychology and they relate to and are influenced by mental health, um, and mental health issues. So, no, we need to understand that as, as practitioners so we can, um, adequately formulate the, the presenting issue we're working with. But also we need to make sure that we're not further perpetuating, uh, shame and stigma around sexual issues. Um, and that we create the space where people can disclose that so that they're not, yeah, they're not suffering with something unnecessarily for years of, of, of their life. Um, and they're not having, um, their internalized shame reinforced even further.

Dr Jasmine B. MacDonald (10:15):
Let's talk about kink and, um, paraphilias. Uh, where do we start, Sarah?

Dr Sarah Ashton (10:20):
Um, well, let's start with some definitions. I think that's always helpful. , definitely

Dr Sarah Ashton (10:26):
A paraphilia. Um, and, and maybe we should start off with a paraphilic disorder. So those two things are different. Um, so a paraphilic disorder is any in, um, intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically that is biologically or physically normal, physiologically mature, consenting human partners. In order for it to be a disorder, there has to be clinically significant distress. So there has to be harm that's caused to the individual or to other people. A paraphilia, on the other hand, is the same previous definition, however, it is, um, it does not cause distress to that person or to other people. It doesn't cause harm to other people. And then if we look at the term kink, it is another term that can be used to describe paraphilias. It's usually referred to as an umbrella term that encompasses basically atypical sexual behavior.

Dr Sarah Ashton (11:33):
Um, which is, I don't, you know, what is normal? There is no normal when it comes to sexual behavior. So this is all a bit kind of arbitrary, but yeah, atypical, erotic, pleasurable, fun, intimate or self-expressive sexual interests. A fetish is an arousal to an inanimate object or specific target, like a body part. Let's define as well, because we might talk about that as part of this. So that stands for, domination, sadism and ma masochism. So essentially we really wanna differentiate between, um, sexual interests that maybe fall outside the spectrum of what we consider to be quote unquote normal. And of those which ones cause distress and harm. 'cause if they don't cause distress and harm, then we actually want to approach that completely differently. We, we, that really changes what we do as therapists in, in treatment.

Dr Jasmine B. MacDonald (12:31):
In the odd training that I was working through, a range of examples were provided to kind of, I might ask you in a sector, give a couple of examples to make quite concrete for the audience. Mm-Hmm, . But what was interesting in particular, I thought, was that in going through the epidemiology and prevalence was for lots of, I think it was for disorders in particular, but perhaps more broadly, like the fun aspects as well, is like prevalence is not really known because of the nature of stigma and, um, and the extent to which these things aren't discussed. So I thought that in itself is just fascinating.

Dr Sarah Ashton (13:05):
Yeah, definitely. I mean, I'm not sure if you're familiar with, uh, kinsey's research in the 1940s and fifties, Kinsey interviewed thousands of people who identified as men, thousands of people who identified as, as women. And, uh, he and his team recorded the sexual histories and interests of, um, of all of these individuals. And then they published it in, in a book for the public. And that was a, an a kind of socially ground-breaking moment because it really smashed people's ideas of what was normal, you know, so, so we, we know that actually, um, diverse sexual experiences are, are more common than, than we think. There's really, you know, uh, very few people who fall into this kind of category of quote unquote normal or what we, we socially expect to be normal, as long as you're not hurting anyone who cares, who, who cares. You know, any, any additional reaction above and beyond that is usually, you know, internalized, you know, kink shaming and, and because of a lack of awareness around sexual experiences. So I think that, you know, that's probably one of the most helpful things to do initially with clients is to kind of, is to establish whether or not it's harmful, but, you know, um, and then, then to really normalize,

Dr Jasmine B. MacDonald (14:32):
Would you mind giving a couple of, I mean, it doesn't have to be most common, like that, that's really not what the emphasis is here at all. It's really about appreciating the diverse erotic interests that people have. But for, um, just, uh, some concrete examples for the audience of paraphilias and, um, kinks.

Dr Sarah Ashton (14:51):
Mm-Hmm, , yeah.

Dr Jasmine B. MacDonald (14:53):
Is kinks plural or kink

Dr Sarah Ashton (14:55):
depends if you have lots of them or not. Okay.

Dr Jasmine B. MacDonald (14:59):
Can be plural. Cool.

Dr Sarah Ashton (15:00):
. So some examples of kinks fall under the category of practice. So for example, um, some people enjoy, um, dominating in the bedroom, so they might enjoy, like telling people what to do or requiring them to be subservient, consensually, inflicting pain or harm in some way. And then some people enjoy being in the, the opposite position. So being submissive and receiving pain or punishment or direction in, in some way. If it's a, a kink and it's part of practice, then these are deliberate, consensual considered, um, roles that involve sometimes a contract where all these, um, aspects of consent are established. And then there's, uh, a start and a finish to, uh, the, the session of, of play of exploration. And following on from that, there'd be, you know, aftercare to kind of reestablish, um, the, the emotional and physical wellbeing and, and dynamic.

Dr Sarah Ashton (16:01):
An example of a fetish might be like, probably one of the most common ones would be like a foot fetish, right? So an interest in a, in a body part. Um, other fetishes include things like, you know, leather or, um, you know, latex, for instance, some textures. An example of a paraphilic disorder, probably one of the most common ones that people have heard of might be, um, pedophilic, um, disorder, or I think the most common one is exhibitionistic disorder. Um, so, uh, just to maybe define those in case, uh, the listeners are not aware. So exhibitionism, exhibitionism, is, um, arousal to exposing, um, genitals, pedophilic disorder is an interest in pre pubescent, uh, children.

Dr Jasmine B. MacDonald (16:47):
And what do we know about where kink and paraphilia comes from for people?

Dr Sarah Ashton (16:53):
There's a lot of different theories about this, and I think the overarching thing to say, um, is that every person is different. And the way that our sexuality and sexual preferences are, um, developed is really, um, individual to each person. So we can't overarchingly say this is how it's developed in terms of how our brain works. There's neurological reinforcement that occurs between a stimulus and orgasm and arousal. Whenever we're, uh, experiencing an orgasm or we're feeling aroused, our brain kind of creates a map between the other sensory or internal aspects of that experience and the reward. So it's a forms a reward pathway. And some of the most kind of formative, uh, foundations of this blueprint that we have for arousal, they occur when we're, we are youngest, right? And that's, that's the same for, for all the blueprints that we have for functioning in general.

Dr Sarah Ashton (17:55):
Um, the, the younger they occur, um, the more likely they're going to influence everything else that, that, um, that occurs after them. If we have an experience early on that we, um, associate, or that's paired even just through happenstance, um, with arousal, like for instance, if we experience, uh, arousal at the same time that we happen to be smelling a banana, you know, we might then find that actually that's something that prompts that arousal in future. And so we, we form that, um, that pathway, and then if we continue to or have orgasms to the smell of bananas, then we are gonna reinforce that pathway even more. And that might be, you know, a kink that we develop. So that's one explanation. Uh, another is that, you know, particularly with reference to people who one of the most common fantasies for cis women is arousal to the, um, the idea of non-consensual sex, right?

Dr Sarah Ashton (18:57):
So, um, a fantasy involving for sex really common. If you're out there and and you're, and you experience this, then just know like really, really normal. Um, and there's a few, there's a few reasons for this. So the first is that if you have some, a traumatizing experience where all of your control and agency is taken away and you have lots of fear and you know, all sorts of other really distressing, activating emotional experiences that are associated with this, if that's stored neurologically as part of the traumatic memory, and then you experience, um, you're able to reconstruct that similar scenario, either internally, so in, in terms of a fantasy or externally through perhaps a, a kink, um, play session where you are taking on or playing out this role, this dynamic through role play, but you're able to overlay that with pleasure and consent and intimacy, right?

Dr Sarah Ashton (19:54):
So you construct the whole situation differently, then you get to pair those experiences with the original traumatic memory, and it actually can be an incredibly healing process. So people can be driven to do this even, uh, subconsciously, right? It's a way of healing or resolving. Now, it really does depend on how you're experiencing that. If it is actually healing, if you are facilitating an environment where it will be safe and it will be consensual, and you will be heard, that can be sometimes very difficult for other reasons, which maybe I can go into if you want me to. The other way that, that kinks or paraphilias develop can sometimes be subconsciously driven, um, through the desire to heal or resolve traumatic experiences. That's just what I've noted clinically. There's little bits of research that might kind of draw together to sort of imply that. But yeah, that, those, that's probably, um, just something that I've noticed when it comes to working with clients.

Dr Jasmine B. MacDonald (20:54):
Hmm. That's fascinating. So then, as a practitioner, how do you work with, well, this is where I wanna be really conscious of how I'm speaking, Sarah, because we're not exclusively talking about paraphilic disorders, we're talking about some things that are really fun and some things that are, you know, on the forensic end,

Dr Sarah Ashton (21:13):
I think that this is the point that I often, that practitioners often come to me with questions, you know, um, or this is what they seek supervision around. So they're working with a client and they say, how do I know if this is harmful for this person? You know, 'cause perhaps this person is walking in and they're going, look, you know, I'm, you know, I've got this kink, or I'm practicing, um, BSM in this way. And the practitioner wants to be affirming, they wanna be supportive of diversity, but they're also wanting to make sure that they're properly evaluating what's going on for this person. And whether this behavior is actually something which is helpful or not. And some things may be going off in their radar, and they're going, I'm just not, I'm, I'm not sure how to navigate this. The simple answer is to is to ask, is there any harm being caused here?

Dr Sarah Ashton (22:06):
But the way of arriving at that answer can only be the result of, um, a really, um, thorough evaluation of that person's underlying, uh, psychological functioning. So sometimes the kink itself might be reinforcing problematic behavioral patterns. So an example of this might be perhaps someone has emotionally avoidant tendencies, and this means that they don't confront and acknowledge their emotional experiences, which means that they repress them, and it means that they, maybe they experience depression, or they experience difficulties in their relationships 'cause they're not communicating about what they need, for instance. So in interviewing and talking with this client, you notice these, these patterns, right? And maybe they've developed other sort of emotionally regulatory behaviors that are not helpful for them, like other addictive behaviors. Maybe they use alcohol to sort of numb emotional responses as another avoidant tactic. And so when they talk about their, um, their kink, maybe, um, they have an interest in, in masturbating to leather, let's just use that for example.

Dr Sarah Ashton (23:17):
In talking to them and exploring what actually happens for them in the moment when, when this is going on, you discover that they're describing the experience of avoidance, right? Yeah. They're describing, they, what prompts it beforehand is that they, um, they're experiencing stress or they're worrying about something. And so then they decide to, you know, um, move themselves away from that by, of, you know, being completely immersed in the leather in that moment. And this is one of the things about practicing kinks in particular, is that they're extremely stimulating and immersive. They can be, same with, same with porn as well, right? So it can really be quite a good tactic for, for avoidance, you know? Um, and then afterwards they sort of describe themselves as like then returning to the, the issue. And so maybe having to do it again for avoidance. So you really have to unravel the whole cycle of use.

Dr Sarah Ashton (24:12):
What's prompting it, what's their experience like it, and how does this parallel and fit into other patterns within their, you know, um, their life and their, their psychology. And then we can say, for this person, I mean, in and of itself, the behavior not causing any harm, right? Like, um, however, it is reinforcing underlying unhelpful tendencies, you know, so this person probably wouldn't meet the criteria for a paraphilic disorder, right? Um, but they, they, we can say that that behavior is, is not particularly helpful in, in the way that they're approaching and engaging it. So we can never really just make determinations about a, be a sexual behavior based on the surface level behavior itself, with the exception of behaviors that are overtly, um, harmful, like sexual acts that involve children. We can't really determine the nature of that without understanding the whole person. We can't deter determine if it's harmful without considering the broader formulation. And it can be both, right? It can and it, and more often it's both. So when a practitioner is working with a client, our aim is to help them understand how this fits into their broader psychology so that they can look at their use rather than us making any sort of us needing to deliver them that news or or kind of make any evaluation of their behavior. So that's a way of being, um, affirming, uh, but also perhaps encouraging the client to observe their own relationship with the behavior. I

Dr Jasmine B. MacDonald (25:51):
Think it's really useful, the framing of thinking about the conditioning aspects and then understanding, you know, in the same kinds of way that you might have a cigarette or a drink or put on Netflix because you're trying to completely not think about what happened, behaviors, erotic behaviors in a similar kind of way, any human behavior like potential potentially soothing human behavior.

Dr Sarah Ashton (26:15):
I think the reason why we might not automatically, you know, think about kink or practice in the same way, or why it's important to note this in this context, is because the behavior can overtly look like it's harmful, right? If someone's spanking somebody else, or they're saying things that are degradating in some way, overtly, the behavior in and of itself appears to be harmful. So that's why sort of a, a nuance signaling and understanding in this context is, is important.

Dr Jasmine B. MacDonald (26:48):
Yeah, because we're, and you talk about this in the, in the training that I worked through as well, but that the practitioners that filter of the, the assumptions that they make or their own experience or what's been reinforced for them, psychology in its simplest form is like, how do we help people not experience pain or degradation and have good self-esteem ? So like, flipping these things and saying, actually there's like a, a pleasure or a arousal that can come from these aspects that we might be trying sometimes, like, um, holistically thinking we need to minimize anything that's not positive for the clients that we work with. So I think that's, yeah, a really important, powerful thing to be thinking about. And I mean, comes back to the fundamentals of like, maybe don't be making judgment calls or decisions for what, what's best for the person you're working with. Talk to them about what they're getting out of the behavior.

Dr Sarah Ashton (27:41):
When we start to make judgements about behaviors, rather than, you know, when you talk about what's positive, where are you gonna drive that determination, the beha make you and your subjective judgment of a behavior or the client's report of their internal experience. Because making judgements about behavior through our subjective experience is discrimination, right? Like, that's, that's literally what happens when people discriminate. They're, they're making judgements just based on what they're observing and their own perception and associations with that. So we really need to consciously be very considerate about our intention around, um, how we approach, um, experiences and discussions as practitioners. That doesn't mean that we're not gonna have , we're of course we're gonna have our own experiences and our own judgements and associations, but as practitioners, it's our role to, um, observe that and to try and not insert ourselves as much as we can, right?

Dr Sarah Ashton (28:46):
You can't, we can't eliminate that entirely, of course, but we can bring a level of consciousness and intention to it. I guess we've been speaking a lot about kinks, um, but treatment for paraphilic disorders is another category of te treatment entirely. So if someone is actually causing harm through their behavior, then we take a totally different approach in treatment. Um, we wanna do the same thing in terms of understanding the function of the behavior so that, um, and the needs that it's meeting so that we can look at addressing those needs in other ways. Um, but we'd also be wanting to utilize specific interventions for changing the sexual behavior. So we'd actually want to change some of those beha patterns so that further harm is prevented. And there's all sorts of very specific and important considerations. If you are working with somebody who is, has para, um, pedophilic or hemophilic interests, or any interests that pose any threat or harm to other people, you really perhaps need to think about mandatory reporting in those contexts, get some extra supervision, um, and make sure you have some extra care for yourself, um, generally, because there's a lot of complexities and additional considerations in those, those contexts.

Dr Sarah Ashton (30:02):
Uh, having said that, it's so fantastic when somebody comes forward for treatment, you know, before they've done any harm and that they're motivated to do that. And so we really don't want to be discouraging people from doing that. But at the same time, you know, it, it, it's always up to you as a practitioner whether or not, you know, you're comfortable working with any client in, in particular, but, you know, I think psychologists have very divided attitudes towards working with, uh, clients with, uh, paraphilic disorders. So anyway, that's why the, I've created the training, so if you'd like to learn more about it, then, um, that would be a wonderful thing to do, even if you don't work specifically with, with clients with these issues.

Dr Jasmine B. MacDonald (30:42):
Hmm. Thanks, Sarah. When we're discussing paraphilic disorders, we're talking about working towards, or treatment towards changing the behaviors when we're talking about things that are fun and not causing risk to the person or to other people. Kink and fetishes or, this is where I think we shift to talking about working through shame. So

Dr Sarah Ashton (31:03):
Shame is actually, and working through shame is actually really important for both paraphilic disorders and for kink. If we talk about, um, kink and for a moment, you know, really we're working towards acceptance integration with identity, you know, being able to, you know, own this aspect of themselves, maybe explore further, um, you know, some fears that can come up around disclosing this ident identity, if this is something that, um, that wanna do, navigating relationship difficulties or different interests or different, you know, if someone's not interested in their kink, all those sorts of things that can be, can be part of working with people who have specific interests. And sometimes they also feel distressed about it because they would like to be able to connect with a partner in different ways, you know, and so the kink is getting in the way of that if we're talking about shame in the context of paraphilic disorders.

Dr Sarah Ashton (31:57):
So I think, I mean, you've, you're probably familiar with the differentiation between guilt and shame. So guilt is such an important emotion. It says, you know, this behavioral, this thing that I've done is not in alignment with the person that I wanna be. You know, it, it doesn't sit right with me. And that's a really important signal. Shame on the other hand, is saying, this behavior is who I am, you know, I'm a bad person rather than I did a bad thing. And what shame does is it stops us from having a, um, accepting and autonomous relationship with a part of ourselves. So if we feel shame, um, and the shame is prompted in relation to a sexual behavior, a lot of people ignore it. They push it out of their mind, or they, they come up with ways of disconnecting and separating from it, which actually means if you want to change a behavior, you are, you're not going to be, be able to if you, if you have, if shame is dominating your experience.

Dr Sarah Ashton (32:58):
So working with shame is actually usually the first step when we are talking about changing a sexual behavior, which is harmful, um, because we need the person to look at it, we need to look at it, they need to look at it clearly as part of themselves and really understand it. You know, when I was working with sexual offenders, that was the first part of the journey, and some people were more or less able to do that. And that really, it sort of depends on the rest of their personality construction as well. If you, if you have somebody who has more of a narcissistic personality, construction, then activation of shame, woo, you know, very difficult for them to deal with. And so then there, there's someone who might be more likely to, um, deny, you know, um, sexual offending, someone who's more likely to just completely lie about it to or to dissociate from it completely. I'd say in, in both contexts it's important, but it's different, but for important, for different reasons, you know, um, but, but essentially embracing and seeing our sexual behavior as being part of ourselves is necessary in both contexts.

Dr Jasmine B. MacDonald (34:06):
I just have a sense that we could talk for another hour just on that aspect, . Yep, yep, yep. This is such a powerful and interesting topic, and your knowledge and the way that you share insights and experiences is just really eloquent. Thank you, Sarah. I very much appreciate it. Oh,

Dr Sarah Ashton (34:27):
That's kind of it.

Dr Jasmine B. MacDonald (34:28):
I know that people will be listening and be interested and thinking about what else you have happening, what else is happening at ships? Uh, what could people be, uh, keeping an eye out for, or what, what are you working on that you're excited about at the moment?

Dr Sarah Ashton (34:42):
Well, there's lots of projects on the go at ships. always, we're always thinking about what more we can contribute to the community. I think one of the things that we do regularly is provide free resources to the public through our Instagram and other social media platforms. So we're also on LinkedIn, on Facebook, on TikTok, and we have, um, blogs and resources on our website. So our blogs are written by our psychologists, if you wanna check those out. Um, the Instagram content, uh, have lots of that that comes through every week. Um, and we've really, we're taking psychological and sexual concepts and making them consumable for the public. So, um, give us a follow on Instagram if you wanna keep up with that. We also have, uh, as, as I mentioned, 23, um, training courses. We have, um, a PARAPHILIAS training course and also a kink and training course.

Dr Sarah Ashton (35:33):
PARAPHILIAS is divided into assessment and treatment, part one and part two. If you're interested to learn more, you can, um, check those out. Uh, we also have a community membership. So basically that means that you get access to all of the training if this is an area of, um, practice that you're really interested in. And that also means that you, uh, have access to monthly group supervision. So I run group supervision with other, um, students and where you can talk about, uh, clients and case studies and any questions that, that are raised. And that membership also gives you 30% off events. So we have, um, events that run throughout the year on, we've done events in the past where, uh, we looked at, uh, sex work inclusive practice, and that included a panel of, um, sex workers and myself presenting on that topic. Um, we, heck yeah, , uh, we usually run a, an annual how to start your career in sex therapy event as well, which is a, a another panel event in person with myself and some other, um, senior psychologists. And we also run a community workshop at the end of the year where we look at clinical examples of, of sexual issues and some of the, the kind of base theories. So lots of exciting stuff. We haven't released the dates on those for, for 2024 yet. But stay tuned on our website and, um, yeah, check out the community membership, if that's something you'd be interested in.

Dr Jasmine B. MacDonald (36:59):
I'm familiar with your work and your resources broadly, and hadn't even realized how much you do. That's incredible. So I'm gonna, I'm gonna keep an eye out for that, and I'm going to put links to all, all those things that I can, um, in the show notes for, for listeners to check out. Thank you for your time, Sarah. One of the ways that I like to finish up is to kind of zoom out from the topic that we've been focusing on and ask what do you do with yourself when you're not working?

Dr Sarah Ashton (37:24):
I love to run. Um, so I run most mornings. I love getting out into, to nature and to move my body. It just puts me in a good, um, frame of mind. I have two gorgeous cats. Um, Franklin and Monica, they're a bonded pear. We adopted them. Um, Franklin is a very handsome ginger tripod, and Monica's a black and white cutie. Um, so I love hanging out with them. And, um, I love gardening and I also paint and, you know, I do all the, the usual, um, human things, like spend time with friends and my partner and my family. And, um, connection is key. So, um, yeah, that's me.

Dr Jasmine B. MacDonald (38:10):
Lovely. Animals are just the best like in, in every situation. Yeah.

Dr Sarah Ashton (38:15):
Yeah, they really are. ,

Dr Jasmine B. MacDonald (38:19):
Uh, thanks again for your time, Sarah. Um, absolute pleasure to have this conversation and thank you for sharing your expertise.

Dr Sarah Ashton (38:26):
Pleasure. Thanks for having me.