Beyond Pain: Building Healthy Relationships and Sexuality w/ Samantha Heuwagen
Understanding Chronic Pain and Its Impact on Sexuality
Samantha emphasizes that many clients who seek her help often struggle with vague issues related to their sex lives. They might not explicitly mention pain, but through deeper exploration, Samantha uncovers the root of their concerns. She explains that her role as a sex therapist is to peel back the layers of these issues, which can involve not only physical pain but also emotional and relational challenges. Samantha also points out that it's crucial to refer clients to specialists when necessary because therapists cannot prescribe medication or conduct medical tests.
The "Ghost Pain" and Its Psychological Impact
Samantha introduces the concept of "ghost pain," highlighting that even after addressing physical pain, individuals may continue to experience psychological distress related to their past experiences. This illustrates the importance of addressing the mental and emotional aspects of chronic pain alongside its physical manifestation.
Redefining Sex and Fostering Communication
The conversation takes an insightful turn as Samantha challenges the conventional notion of sex solely as penetration. She encourages clients to broaden their understanding of sex to encompass various physical and emotional forms of intimacy. Samantha underscores the importance of open communication between partners to navigate physical challenges and redefine their sexual experiences together.
The Evolution of Communication
The conversation concludes by addressing how societal changes and globalization have made communication about these topics even more necessary. Communities and relationships have become more diverse, and learning how to communicate effectively has become crucial. Samantha offers valuable insights and guidance for anyone dealing with these complex issues, emphasizing the importance of open communication, understanding, and seeking professional help when needed.
Defining "Sex" and the Pressure to Perform
Shifting the conversation toward her work as a sex therapist, Samantha mentions that clients often want to fast-track their journey to sexual satisfaction, particularly when it involves pain during sex. She touches upon the societal pressure, especially in heterosexual relationships, where there's a strong emphasis on performing for one's partner. Samantha acknowledges that some individuals may want to skip the hard work involved in addressing sexual pain and get to the reward immediately. She stresses the importance of patience, self-discovery, and the recognition that there is no one-size-fits-all solution when it comes to managing sexual pain.
The Complexity of Sexual Definitions
The discussion turns to the complexities of defining "sex." Some individuals simply want practical advice on how to enjoy sex without pain. She highlights the societal expectation that sex should involve penetration, especially in heterosexual contexts. Samantha suggests that there's a need to broaden our understanding of sex and what it means to different people, as well as to break free from rigid definitions and expectations.
The Significance of Cultural Competence in Therapy
Samantha starts by highlighting the multifaceted nature of culture, which extends beyond ethnicity. Chronic illness itself can become a significant component of one's cultural identity, influencing their experiences and challenges.
She passionately addresses this issue, given her multicultural background and experience working with clients from diverse backgrounds, including the Latinx community and people from various religions. Samantha emphasizes the heartbreak she feels when clients share stories of previous therapists who lacked cultural competence or used them as experimental cases.
The Role of Lived Experience in Therapy
Samantha acknowledges that having lived experience can provide a unique perspective, but it also comes with challenges. Therapists must be cautious not to impose their own biases or experiences on clients, as every individual's experience is unique. The importance of therapists' therapy and consultation is emphasized, regardless of whether they have lived experience in a particular area. Samantha and her host stress the significance of therapists continually striving to understand their clients and create a safe space for healing.
Conclusion
Samantha has emphasized the significance of open and effective communication when dealing with chronic pain in the context of relationships and sexuality. Her expert guidance highlights that discussing pain, desires, and boundaries with a partner is essential for building trust and intimacy. This foundational principle serves as a cornerstone for addressing the unique challenges that chronic pain can bring to one's sex life.
This enlightening discussion with Samantha Heuwagen serves as a beacon of support and guidance for anyone navigating the often complex terrain of chronic pain, online communities, and sexuality. Samantha's expertise, empathy, and ethical approach underscore the vital importance of addressing these issues with sensitivity, understanding, and the right professional guidance.
Disclaimer: Everything we discuss here is just meant to be general education and information. It's not intended as personal mental health or medical advice. If you have any questions related to your unique circumstances, please contact a licensed therapist or medical professional in your state of residence.
Destiny Davis, LPC CRC, is solely responsible for the content of this article. The views expressed herein may or may not necessarily reflect the opinions of the guest.
The content in this blog post comes directly from a real, human interview between Destiny and her guest on The Chronic Illness Therapist Podcast. This written version was formatted using AI. Listen to the full episode to hear the actual conversation.
Listen to my full conversation with Samantha Heuwagen on Ep 11: The Foundations of Sex and Chronic Pain w/ Samantha Heuwagen, MA LMFT ACS
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Episode transcribed with AI and may contain errors that are not representative of the actual word or meaning of the sentence.
Samantha Heuwagen is a licensed marriage and family therapist and bestselling author in the Metro Atlanta area. When not working with clients, she sparks discussion about mental health with the goal to spread awareness across the us and beyond by challenging the popular discourse surrounding mental illness and making it more inclusive.
Her books from the starless series, Don among the stars, fading, Starlight, Stardust emerging, and in the wake of stars are available. Now, wherever books are. Her fifth book moonlet will be available September, 2022. Discover what it means to be human in this feminist science fiction series, where her debut novel was nominated for a 2019 Georgia author of the year award.
In the first novel category, you can connect with her on Instagram or TikTok at the sci-fi therapist and @samanthaheuwagen.com. Hi Samantha. Thanks so much for coming on.
Thanks for having me. You made me sound really cool with the bio. Thank you. .
Yeah, absolutely. So I, I was realizing, I didn't actually mention that you are also a sex therapist and that is what you're here to talk about today.
Sex therapy, chronic pain, chronic illness, and some of the different intersections around
that a hundred percent. I'm really excited. Good.
So
maybe we can start with a little bit about, um, what people come to you with when they're dealing with pain. What is kind of the first thing that, that comes up for you?
When you think about that question? Yeah. I
think about the clients that come in and they're like, something's wrong with my sex life. They don't ever say it like that, but you know, they re read between the lines and the more digging you get, you realize that they're either living with pain, whether that be a physical pain or there's something up with their relationship, their relationship with sex in general, their relationship to their body.
Like something's off. Nobody usually comes in with direct. Medical or kind of like the awareness of what that looks like. So it's up to us as sex therapists to kind. Peel back the layers and understand what that is and what that isn't. And so a lot of people will say they're in pain, but I don't, I don't know what that means.
And it isn't until, you know, asking more questions, embracing the curiosity, and then most times referring them out to other specialists. Right. Cause as a therapist, I don't have the power to prescribe medication. I wish I could run tests. That would be so helpful. I wish I could figure out what was going on behind the scenes like that, but we don't have that power here in the state of Georgia.
I don't believe any the. Ever anywhere has that power, unfortunately. So then you have to refer out and kind of create this like team mentality to figure out exactly what the pain is, where is it coming from? And then I like to add, because we always think pain of physical is a physical thing and it is, but also I call it like the ghost pain.
Right. So just because you have a medication and it's helped the pain, or you try something different and it's helped the pain or you find out what the underlining thing. Doesn't mean that that pain has just magically disappeared mentally. We hold that, you know, that, that information. And so sometimes the brain takes it and goes, well, I'm feeling good right now, but it might come back.
So that's kind of what I do. That's how I visualize the whole thing. Yeah.
That's a perfect, um, answer to kind of what our role is then in the therapy room and it's managing the fear around pain.
Yes.
What do you do for people who are currently in pain still? So they either have been working with specialists or they haven't yet worked with one, and they're not, they're still dealing with this pain on a daily basis, but they're in a relationship.
Sex is really important to them and they can't engage in the way that they want to. What are some of the things that you start to navigate with those clients? One
of my favorite things that came from my, my time teaching at Kennesaw state university was defining what actual sex is. So when you say it, when I say it, you and I are thinking about two different things, I wanna say nine times outta 10, most people are thinking of just penetration.
Oh, sex is just. Some type of penetration and I'm like, that's well and good. But like, if you're in pain or it doesn't feel like your body is able to go to that space, then that just kind of ruins. If you will, air quotes, ruins the time that you want to have in this, this sexual entity, this space, this vibe, whatever you wanna define it.
So when I define it with clients, we get really specific. I don't believe that sex is just the physicality. It could be the emotional. So then we need to figure out what sex represents. Is it a connection with your partner or partners? Is it something else? Is it a release? What is it? So if you're coming to me and there there's pain associated with any kind of inter, um, intercourse, Then I wanna know what else is sex to you?
Is it handholding? Is there different levels is there's kissing is cuddling. Part of that is heavy petting part of that. I mean, I can go on and on the list is endless because everybody's definition of sex is different. I always like to say, it's like your definition, your partner's definition or partner's definitions, and then the couple's definition.
So we need to all get on the same page. So if you go to your partner and you're like, I really want to be sexual, but I'm in pain or something, doesn't feel right. Then it's up to you and that person or persons to then get creative and figure out, okay, well then what are you comfortable with? What does work for what your body is like given out right now?
And I love that because it gets it just demystifies one, what sex is, but then also puts everybody on an even playing field. So it's not just, oh, I, I want sex. And everybody's like coming up with their own image and their own scenario about what that looks like. It's literally. Already defined. There's already some knowledge there and you can use the toolbox metaphor, that metaphor that I like to use with my clients, which is that you put stuff in there.
So one day you might be like, cuddling is enough. And so you pull cuddling out of that. But then another day I might be like, well, I would like cuddling and kissing and heavy petting and out of course, and that's enough. And then of course you can always add, um, penetration. I like to use the other stuff first.
Cause everybody always thinks about that. And they're always like, that's the only way to have sex. And it's like, no, it's not, no, it's not. Y'all's you the limit. Why,
why do you think that is? Why do you think that that is the only thing that people, um, associate sex with?
Oh my gosh, girl, you live in the same world that I do.
Like it's just. That's it, that's the message. That's the message that we get in media. That's the message that we get in books. That's the message that we get, um, in pornography and any kind of that scape. Like, that's it, like you are there to have an orgasm, you're there to hit climax, whatever that looks like, whatever that feels like.
And then you're done. That's it. That's so sad. Cause it's more than one thing, but we don't, we don't live in that world. And I wish gosh, with my whole heart, I wish that comprehensive sex ed was widely used and spread because age appropriately, we would learn that it's not just about that. It can be so many different things to different people, but we have to have the tools to communicate that and the understanding of what our bodies are doing and not doing to get to that place.
I just went off on my little. Little pedestal. I'm so passionate about it. I wish we had that, but we don't.
Yes. I couldn't agree more. Our sex ed is, um, atrocious at best, so. Oh yeah. Yeah. I don't know. I don't know what the answer is there. Uh, especially given the current state of. Of our climate right now.
And the, um, anti-abortion laws that are coming out. I mean, this is where we're at right now. And so, uh, if that's where we're at, I can't even imagine then talking about, I can't even imagine our country being. More on board, we're talking about comprehensive sex education. So, which is so ironic and, and
terrible.
Um, yeah, there's so much fear associated with it. And honestly, there's nothing to fear with that with comprehensive sex ed it's it's age appropriate. And I can't stress that enough. Right. So you're not gonna be telling. A five year old about pornography. Instead, you would be telling them about the different types of families and good touch and bad touch and that they have the consent and, and all of that.
Such important messages for a five year old to know, right? Yes. A hundred
percent. And you'd be giving them words about body parts. So let's say God forbid, something happened to them. They would be able to communicate effectively to their caregiver. Like if something happened.
Or if something made them uncomfortable, or if they had a question, instead of shrouding everything in mystery and secrecy, it would be out on the table. It would be clear as day and people would feel more supported. And I think that's why we have so many issues with sex and sexuality these days is cuz it is, you know, this like hidden thing that we can't talk about.
And then we bring pain into it. Then it just adds more stigma. Right? Cause it's like, well, I'm supposed to be this sexual person. Sexual. Person's just supposed to show up pain free and the body is supposed to work as it's supposed to work. And it's like, oh, nobody come on. We're not, we're not robots. We're not perfect.
Every sexual activity. And, and, um, I was what to say, adventure. It could be adventure, I guess we'll go with that is different because your body changes a daily in your partner's bodies, change daily and, and all of that. But you.
We don't live in that world, but we're trying, no, that's such a good point about like your body changing daily that I think is really important, especially when you live with chronic pain, because yes.
So everybody's body changes daily. Mm-hmm , uh, we all feel good. Some days don't feel good other days and you're right. We have this expectation that we're supposed to feel exactly the same way. We're supposed to just be able to show up, do the thing, no matter, really, no matter how we feel, right. That's kind of the message we have with, with everything in life.
Like you go to work, no matter how you feel, you have sex, no matter how you feel like. And so there's so much here because what we were just talking about with comprehensive sex education early on like kindergarten years, uh, it sets the tone and sets the foundation for such good, healthy communication.
And if you don't have that, how are you gonna work through problems? Right? Like if you can't even do that for. Normal for lack of a better word, normal, no issues. Like you're just like no chronic pain, no, whatever.
Yeah. What do you want for dinner? That's you know that yeah, exactly. Yeah. I'll be able to communicate that I want, you know, cross stuff for dinner, like yeah.
I, and even
that's hard, right? Like that's even hard, a hundred percent. I
see a lot of couples lately and I don't know if it's because of the pandemic stay tuned. There'll be another. Another time discussion of when there's more information, but lately I've been meeting, meeting with a lot of, uh, couples that like are blowing my mind girl, because I'm, I'm there being like, yes, how can I help you?
And they're like, have never
had
any deep discussion about things. Like children, finances, um, how they're gonna set up their relationship, what are their goals in life? And I'm like, y'all have been together for a minute. And this is not just one case. This is a, this has been over the last, I wanna say definitely six months, maybe a year.
I've been working with people in this space, in this couple's realm that it's like, wait, if you're not even talking about these quote basics, How are you gonna talk about something? That's got some shame, some listen to me, a lot of shame surrounding it, and it just blows my mind. So we are not doing ourselves any favors, unfortunately.
Well,
I think one of the things that comes to mind when you talk about that is we never used to have to have these conversations because everybody, everything was there. Like the normative. So, if you think back to two, 300 years ago, communities where people lived, you know, in just their community and, and didn't really travel outside of that, mm-hmm , you didn't need to have these conversations because everybody knew what was expected and everyone fell in line.
And maybe there were a couple outcasts in that community who went against the grain and they were outcasted. And other than that, if you stayed in your community, you knew exactly what was expected of you. Mm-hmm. Come in globalization, which has its pros in so many ways also brings in. Just an overwhelming amount of different cultures and a different, um, nonverbal languages, as well as verbal languages and so much difference that we, our brains just don't know how to wrap our heads around it.
And so this should come with learning how to communicate. If I don't, if I'm not gonna automatically know about you, because you're not in my community and we didn't grow up together and all that, then I should at least have the communication skills to be able to ask you questions. Listen, reflectively.
And have these conversations, but we aren't taught how to do that. Right. So we have evolved past these kind of like small communities where we didn't have to ask these questions and we're not learning how to ask
them. Well, the idea of control pops up for me where it's like, what you were describing. It sounds like, you know, people were in line because.
What else were they gonna do? Like there was this control aspect and now we're out here. We have access to so much, but use so little it's wild and it's, and it's about like, you want to be able to follow your community, cultural, societal, whatever, but. People are smarter now kind of asterisk with that.
People have more access to different ways of being. And I also think about like how we're teaching young people, not just about sex, but, but how to be in this world. And it's all about can, I'm gonna call it the state, but I don't necessarily mean like, State states, but like, how do we control people, you know, to do be the workers that we want them to be.
Cuz humans are messy and humans are not always the nicest in the world, but like why is it now a problem? Well, because we're not embracing vulnerability, we're not being taught that it's okay to tell someone, you know, it was great meeting you. It's just not working. and we don't know what to do with the rejection.
We don't know what to do with the emotions that come up on both sides. Cuz it's both, it's hard for both individuals. Whoever's in the system to say like this isn't working, but we don't have these like fail, safe abilities, these communal abilities to, to one go to our people and be like, oh, this sucks. I got broken up with.
Um, and then even internally be able to navigate all the complexities of that.
Yeah, I think we don't have, um, The communication tools. And then oftentimes we just don't know what we want either. So we kind of spend some time like, okay, I need some time to process and to think, but then there's also so much in this world that takes our attention away.
And so while I think sometimes ghosting is extremely intentional, I think there are other times where like, you kind of like put the response on the back burner and then it just keeps going and going and going right. And before you know, it, like it's been too long, so we need to take accountability for that.
But I think that. We just don't know enough about our own needs and wants in order to actually say, this is what I like. This is what I need. And again, chronic pain and chronic illness, it's even harder because even if you've had it your whole life, so you have a whole lot of experience with it. You probably don't have a whole lot of like role models around you who are teaching you how to speak about that in that, like that particular illness or, oh
yeah.
Think about the cultural aspects of that. Like you just grin and bear it. Don't say anything. Don't, don't talk about your problems or, you know, um, think about my community and it's just like what the facade, like you need to like look and be a certain way. So everything's kind of, again, shrouded in this darkness, even though you're like, I don't know how to navigate any of this.
And it's like, no, no, no. We're not gonna talk about that. Like, no, no, no. Just keep, keep a good smile on and keep going and you'll be okay. And it does make things harder, right? Cause life is already heard, but then you add this chronic illness, chronic pain. And it's like, oh, now I'm supposed to be able to one navigate life in general.
But then I got this added situation that no one is allowing me to talk about. Cuz quote makes them uncomfortable or, you know, we just don't talk like that. It's it's super wild. It's it's. It's hard. It's frustrating. And I'm gonna be pro therapy for a hot minute. And if y'all are listening, I hope you have been pro therapy this whole time, because like therapy is a space for you to navigate that safely, without feeling whatever cultural, um, elements might be holding you back or misinformation or feel information or fear or anything like therapy.
Is that place to just be like, look, I'm dealing with. Support me through it let's walk together on this journey and figure it out together because you know, I need help.
Yeah. And culture, culture has so many different components, right? It could be your ethnicity, but it could also be just the mere fact that you have a chronic illness and the particular.
Disease that you're dealing with. Um, there's a cultural component in that way too. So how important do you think it is for the therapist to have some, some real lived experience with the culture that the, the cultural aspects that a client is bringing into session?
Well, I'm super biased. Um, Because of my, uh, multicultural background, but then also because of the clients that I do work with, I'm very honored to be working with multicultural clients as well, predominantly in the Latinx community, but I've worked with people from all over the world, um, different religions.
Um, so for me, the heartbreaking part of my job as a professional is hearing that they've gone. Clients have gone to other clinicians and. They didn't know, like they, they didn't have the cultural competency to actually support the client or they, this is a new one. They used that client as an experiment.
And I was like, bar, like that is just, Nope, that's not what we do. Therapists are required to do CEU training, which is continuing education training. Um, you know, Consult, if you need support or refer out, if it's just not your jam. Like, I don't know if I could work with, um, like evangelical Christians at this point.
Because I don't, I don't have that competency. I wouldn't know where they're coming from. I wouldn't understand. So I would refer out because that's appropriate. I don't think clinicians should be taking on clients just because they can, or they need to eat. That's a whole nother problem. Y'all let me just say that as a whole nother thing.
That's another talk for another time. I mean, that's
what we're taught, right? Like we we're taught, like we take him a. You take on, whoever comes to you and you kind of are martyr in that way. And yeah. So there are a lot of therapists right now who I think still feel really icky about like specialization.
But my experience has always been that the more specialized I am, the more I can help that particular person. I can take EU and I can at least not do harm and not just like, be asking them all the questions. And you just explain to me so I can understand that's not what therapy is about
because it's, it's different saying, like, I wanna know you, the person, the client or the clients.
I believe that a clinician should be well versed. And we kind of had this conversation before we started recording, where someone recently came to me and was like, Hey, um, I wanna do anger management. And I was like, well, person, I have done that, but it's not my specialty. It's I specialize in sex therapy.
I specialize in healthy relationships. I, I specialize in, um, exploration of kink and, identity and all of that. So when they said that I had to be very honest and I'm glad that they went in a different direction because though I could have done. It would've probably been painful for both of us. Um, cuz it would've been, I needed to go do some research and I mean, that sounds like I'm lazy and I don't want to no, no, no, you guys,
no, but is this what you were speaking to when you said like some therapist experiment with their clients?
Yes. Okay. Yes. Yeah. I would've had to like piece meal, a treatment plan. You know, rely heavily on my consultation groups and like the other clinicians that I have, um, in my life, I would have to go back to the research and like, you know, read books and like, it would basically be like go to mini school. for something that like somebody who organically does that, who already has that knowledge base could go and work with them.
And I think like bringing it back to chronic illness and pain, we were talking too, like, how does it relate to sex therapy? and it really does because a lot of the, like maybe I wanna say close to 50% of what I do with. Is because there's some pain, there's some quote dysfunction. I don't like that word, but that's what we're going with.
Quote, dysfunction, um, that we have to bring in other professionals like urologists, like dermatologists, like gynecologist, um, to help, you know, sort out the physicality to it. And then us as therapists, you know, go and, you know, support the mental aspect of whatever's going on.
Yeah, I think that,
um, Not everybody has to have like some, some ultra specific specialized niche. Um, but if you're going to work with a population that requires that, then you do have to have that. Yeah.
And you also ask the question of like, does the client, or excuse me, the, um, clinician and therapist, y'all basically the same thing.
Clinician is like you do clinical work, meaning you see the clients, um, Which is what I do. And I think that's what you do as well. Yeah. And so, um, you asked if there needed to be any like personalized experience, you know, in school they say that it helps. So you have that like empathy and like just ground level understanding, but kind of, I feel like it doesn't matter.
how, and hear me out, hear me out. I'm gonna walk this fine line because if you are doing your job as a clinician and therapist, then like you don't have to have that exact. Experience to have empathy and compassion and to guide a client through healing, you can like, I mean, it kind of helps, like it kind of is nice, but also I kind of feel like, well, you gotta be very careful then, you know, because if, if you have the experience, you don't wanna put your shit on the client's shit.
And so. I know what you mean. Yeah. You don't wanna put your biases
or your experience, your experience, and think that they're going through that same exact in the same way. There's pros and cons,
for sure. Yeah. I almost think it's a little harder, but like some people can navigate it flawlessly.
Yeah, I think that's the thing. Like if you're going to specialize in something that you have lived experience in, you have to. You still have to have that consultation. You still have to have your own therapy. It
is, you know what I always say, I'm gonna interrupt you. I'm so sorry for, I never see a therapist that doesn't see a therapist.
yes, yes. I mean, you have to be able to sit on the other end of the couch. I know what that process feels like. And I think what's more important is not so much if a client, if a therapist has a lived experience, but how comfortable they are with the topic. I think it's the discomfort. For me, I think the lived experience is what helps me then be more comfortable in the situation.
But like we just said, lived experience can also make you more uncomfortable in certain ways. So, yeah, it's, it's about knowing yourself. Like you have to be hyper aware of your own. Internal thoughts and motivations and automatic behaviors and things of that nature. Yeah. But it's about your comfort. If, because I think a lot of therapists are really scared of touching chronic illness because it's body based and it's like, well, that's outside my scope of practice.
And,
um, it's, it's not. And so interesting. You say that because as a sex therapist, I was actually just having this conversation with my sex therapy consult group. Um, and. I have always thought that sex therapists should be like doctor like medical doctors and you know, what, if they haven't changed the law or.
Therapist, you either take these courses and, and sit for this exam. I'll be the first in line to try to get my MD that way, you know, because we are already kind of specialized to use the quote medical model. Right. I need to know things about the body. I need to know about reproduction. I need to know about that stuff in order to help my client.
Um, and, and some other clinicians in other areas probably do something similar, but I've always thought. That sex therapy was one of those areas that needed to work hand in hand with the, um, medical community. Yes. And so why not give them specialized training? Like hello? Um, and so my, my consult group actually brought it up and said the same thing and I was like, oh my God, I'm not alone.
Um, so there are some clinicians that do fear that because they don't feel like that is their lane or their, um, like she's, like you said, the scope of practice, but I think for sex therapy and pain management in any way, You kind of have to use the medical model, not in the disconnect from client kind of way.
When we think, when we say that, that's what some people think, but in the way that like I have this particular set of skills and knowledge to help the people out. Yeah. I have to know that in order to help you,
it's why I, having an interdisciplinary team is so important. Although also, I mean, it can be highly inaccessible to have multiple specialists.
Um, it can get quite expensive for sure. A hundred
percent.
Yeah, it's hard. It's hard dealing with so many different intersections, but I think that's why it's important to have these conversations and, um, to have people willing to just learn. Like, we just have to be willing to learn. I think that's something I think in a world of specialists, I think that that is also an issue is like, we all feel like we have to know like everything about this particular niche or this particular
thing.
And, well, I mean, that's what school does for you, right? It kinda already sets, I don't know where you went. I went to me, uh, mercy university, school of medicine, and I feel like they definitely pushed for specialty, but it was like SP specialty light, you know, they were like, yeah, you should probably have one.
But for the most part, it was like, And I'm glad, cause I think everybody, every new clinician should have the foundation, but in school you get kind of like taught that like you should know it all. But now that I've been in private practice and out in these streets for almost a decade, that sounds like so long.
Um, I feel like, no, I don't know if I could do it all at this point. I just wanna do what I know how to do because I've, I've spent so much time doing it. does that make
sense? Oh, absolutely. Yeah. And I think the biggest thing it's like, we're not taught even as therapists. I mean, we are taught how to ask open ended questions and things of that nature, but the medical, uh, medical professionals.
Our high we're all high, Eva, everyone, everyone in this country. Like we just feel like we have to know this thing. And it stops us from asking questions when really, if you wanna become an expert, all you should be doing is asking
questions. You know, what's so funny. I went to a conference once. What was it?
I think it was am M F T American association of marriage and family therapist conference here in Atlanta. And I remember, uh, going to like, um, what do I wanna call it? A wasn't a panel. It was like somebody's presentation. And the gentleman was like, who was also a therapist?
He was like, all we do is ask questions. And I was like, what? No, I don't ask questions the whole time. That's silly. That's that's what is he talking about? And I, it stuck with me until the following week. I started doing therapy back up. I went to work obviously, and I, it must have taken like less than a half a day.
And I was like, oh my God, that guy was right. All I do is live my life, asking questions. And from that realization, flash forward to today, I just, even when somebody asks me if I want fries, do you want fries with that? I'm like, well, I'm not sure what are the fries? You know, what. Kind of fries, you know, like I just find myself as a poor example, but I find myself just like recruited more questions, like one it's part of our training.
Yeah. That's what they're supposed to do. We, we, we wanna answer you, but like, we really can't cause it's your life, but then all we do this work for long, long enough. And like you find yourself going, oh my God, all I'm doing is asking questions. But you should, it's a beautiful trait. It's a good gift to give yourself and others like learn to ask more questions.
It's okay. Yeah. The asking questions piece is so important. I mean, we were talking earlier about, um, just like knowing yourself and being able to then communicate that to your partner. And I think even within that, you can ask open-ended questions in order to further figure out. Is right for the, both of you.
I mean, you had mentioned earlier, it's like, there's, what's right for you. There's what's right. For the partner or partners. And then there's, what's right for the couple as, as one unit. Yeah. And that takes time to figure out, like, I think. You had mentioned, you know, people being together and still not even like broaching these topics.
And we kind of talked about a little bit about why that might be, but again, in the past, you know, in these, in these communities, people would've, they had their whole life to like learn. What is what is expected or what they wanted or what they didn't want. I don't
even know if we can like, understand what it would be like to not have access to the internet or books, you know, cuz so many people back then were illiterate.
They didn't have access. And now that we do, I, I think we have some kind of choice. I'm put asterisk on that. Um, y'all I'm very like, um, what do I wanna say? Rebellious. Okay. So that's why I'm putting an asterisk on it. Cuz I know there's like positionality and intersectionality with, to be aware of. But back in the day, when you just lived in these small communities, like you're saying, and you didn't have access, you didn't cultivate critical thinking.
Well you did in like your own way, a way that we probably could not comprehend in 20, 22. But like, you know, we all have our own different views and I think it's hard to kind of comprehend that back in the day.
We didn't have access. Therefore our thoughts were, I don't wanna say smaller cuz that's disrespectful, but like that kind of idea that they just kind of stayed in a general vicinity. You didn't have access to like wider pastures if you. That makes help. That makes sense. Yeah, no
disrespectful. No, I think that there's like everything.
There's a balance. And I think at one point the balance swung way too far on one end where there was like no diversity, no ability to go outside the box. And then as globalization started creeping in, I think there was more opportunity to travel and people would come back. You know, having so much being so much better for that experience.
And, um, but I do say we've swung all the way to the other side and you have to be really careful. This is why we talk so much about like things like social media detoxes and stuff like that, because it is, it is toxic to hear a hundred. You can literally scroll TikTok and hear a hundred different people talking in an hour, a hundred different opinions.
Unless your algorithm's fucked up, then they're the same. That is the same. That's right. That's right. Unless the days of dogs and funny videos and days of that, now I'm just getting like more political stuff. I, I like it, but at the same time, I have to be wary myself where it's just like, You know, it's supercharged, it's super charge in one situation or, you know, God forbid you get on what they call the wrong side, OFAC, you know, find it as you'll.
And they're like, I'm on the wrong side of help me. And you're like, that sounds scary. I don't wanna there either. I mean, I help you, but like, that sounds so scary. I don't wanna be on the wrong side of
that's so funny. Yeah, no, for sure. Like the algorithm can keep you in your own small bubble. That is also, that is also a thing.
Um,
Yeah. Oh, you know what? That I just thought about something that's on topic, but a little off topic, but I swear to God, I'm gonna make it, make sense in a minute. You, we were, we're still talking about pain and so, um, full disclosure, you guys, I not only work with it, but I have, uh, what's called interstitial Citis, which is like bladder pain syndrome.
So it's like having a UTI all the time. Thank the Lord above that. Um, I have been interested and figured it out and I'm so grateful. Made sucks, especially when there's flareups. Florida sucks. Anyway. So when I first got diagnosed, I was in Tampa, Florida, and then I moved to Atlanta, like a hot second later and met my urologist.
She kicked me out. Y'all like, she was like, you're doing so good. Like, we work together for five years. You gotta go be free, run off until the sunset. I'm like, okay, but I'm gonna call you if I got a problem, she's like, yes, please call me anyway. But when she first came on the scene, bless her. She was like, I need to tell you something.
So that sounds so dramatic when I say it like that, but she was like, I need to tell you something. And I was like, what, what, what, you know, I'm like sitting there, my, my head is spinning already. And I'm like, okay, I gotta learn how to eat again. And like what triggers me? And like, will this medicine work?
Will this situation work? Da, da, da. She's like, whatever you do, don't go online. And I was like, what? And she's like, do not go. To the community boards do not go find your people on the line because it's terrifying out there. And I was like, whoa, I'd never had a doctor talk to me like that. I had never had that kind of insight.
I didn't even know me. I had to go look . I had to, I was like, why? But I knew, I knew, I knew it was gonna be ugly. But I was like, I still wanna know, like, you know, you don't want to be alone on this chronic illness journey. You do wanna find your people, you do wanna find others like you and listen to like the, the good stories and bad and all of that.
But holy shit, she was correct. It was so sad there. It was so scary and. You just wanna cry. You just wanna go find that person saying all the things and just give 'em a hug. But I, I bring that up because as much as we are like, yay, TikTok and dances and dog videos and yay community, it can get dark real fast.
And then, then, then where are you? You know, uh, I, I don't have anything at the end of this story besides be careful use your best judgment. Know your boundaries and, you know, just be worried that like, and I'm I'm blanket statement stating this. So destiny, please let me know if, if you feel the same, that like, Humans.
Don't go online all the time to be like, gosh, life is sunshine, rainbows. Ah, look at this, look at this picture of this cake. You know, we do that on occasion, but a lot of times, especially today, I think I don't, I, I'm not, that's not my area of researcher expertise, but it feels like a little bit more heavy where people go.
To talk about the bad in life or talk about their big emotions like that. So you wanna be careful how much of that you're consuming, because God forbid it impact how you see yourself and your situation and what's going on with you. Um, I've heard some really good things about people like me with interstitial societies and I've heard some really God awful things.
Right. Um, that's. But if you get stuck in one way or another, Ooh, I just, I'm just sending you the best we don't. We wanna manage that. We wanna use our boundaries and we wanna use our, our best judgment when it comes to interacting online in those types of spaces.
I think the, um, idea of using your boundaries is a perfect.
Piece of advice because it can get really scary, really fast. And I think there are also a ton of really healthy, positive accounts, but, um, I think people also even get sucked into like the, I cured my illness with this supplement or diet thing. Yeah. And so even the positive ones can also make you feel really shitty inside.
That doesn't
work for you too. And, and not that I have like a major following online. I'm not saying that in one way or another, but like, that's why I don't personally talk about my journey. I say that I have it. Well, I haven't really openly talked about it in a hot minute and I'm gonna have to reflect on why, but there, I know there's definitely a blog post on my website, SamanthaHeuwagen.com in the show notes.
And I know that I have talked about it and like, you know, stories and like very short, what do I say? Like things that don't last forever, but I know there's definitely a blog poster too, about chronic my chronic illness. But other than that, I will not say. Well, I'll tell you the doctor that I went to, um, her name is Dr.
Janelle foot. She's amazing. She's in Midtown, Midtown, Atlanta love her, love her team. Amazing, but I will not say what worked for me or not, because I feel very fortunate and lucky that I've managed it, but I've managed it. The Samantha Heuwagen way. Not everybody should do what I do because I, no, not everybody has my body.
So be stupid. And I kind of wanna swing that concept back into sex and sex therapy. And yes, like at the beginning we, we talked about defining sex and I will say, I do know that there are gonna be some people who hear that and think, I don't wanna hear that. I just want to know how to have penetration without pain.
Oh, yeah, we just, I just, well, I don't wanna do the homework. I wanna skip a few steps. Like, come on, girl. Where's your magic wand? I'm like, oh Lord. Yeah, I
think it's just because it's so ingrained in us that like that is. And if I, if I might get a little bit, uh, I don't even know the word here, but especially in heterosexual relationships, like I just need to please, my man.
Mmm. Right. Mm-hmm . And so, like, that's a, I don't know. Is that something that comes up for you, uh, in your work with clients?
Oh yeah. All the time. I was just thinking about a case when you were saying that, where it's just like, they want to fast forward the work to get to the reward and I'm like that got nothing for you.
I like how you, I like how you're, you're calling it like work and reward. Well, I like it and I don't like it because I think, I think the work like the work actually makes maybe, especially with chronic pain and chronic illness, it's like, uh, it makes me a little bit like weary of like delving into that, but mm-hmm, like everything in life, like.
There is a process that happens yes. Before you get to this end result. And yes, truly the, if literally with every single thing, the, what my goal for my clients almost always is, is how do we help you enjoy the process? The outcome is just like, um, A little gold star that like happens, you know? And so ejaculation is just the little gold star that happens at the end.
Like how can we enjoy it? And it doesn't
even have to happen. Right. Like, yeah. So, yeah. Yeah. Thank you for clarifying that that's important or core language on my part, uh, thousand apologies. But that's the, so to answer your question, that's the vibe. However you wanna say it is, that's the vibe where it's like, I wanna pass through and just get to where I think I need to go.
And I'm like you where I'm. But like, what if that's not even where you need to go or like you get there and you're like, uhoh, there's still more to do or, you know, whatever that looks like. Let us.
Work together to find things that we can do, depending on where you're at, whether that be emotionally, mentally, or physically, like let's create this toolbox together. So you can go out and like, see what works and what doesn't work. Cause like another thing I should have said at the beginning that if I failed to mention, cause I felt so safe here was that so many people think a sex therapist is a sex worker.
We love a sex worker. Bless. , that's not it. We are literally doing therapy, but with a focus on sex and sexuality. So I don't wanna see my clients do anything. Um, that'll be very inappropriate and unethical. Um, I don't want, they don't need to send me the porn links. Oh, look at this. No, mm-hmm I find myself saying all the time.
I got a great imagination. She wrote some books. she she's proven it. Like she's got a great imagination. I don't need to see anything. I want my clients to go and experience it and enjoy themselves. Um, but I don't need to physically see anything I need. Sometimes I would need more details. Like if they're like this didn't work, I don't wanna get too vulgar, but you know, this didn't work.
Okay. Walk me through how you did it. Right. Walk me through what, what do you mean? It didn't work. I once worked way back in the day, I worked with a gal that said, um, I have pain here and she literally, this was like OG. Practicum time. Um, she put her hand over her for those who
don't know that's internships.
Oh
yeah. In intern. Yeah. Mm-hmm the clinic. Um, she put her hand over her pelvic area. Well y'all. Have you ever seen a female looking body? Uh, there's a lot going on there. So I was like, I don't know. So we had to ask questions. So I just wanna clarify that, like, you know, when I give homework to clients or, you know, we gather stuff to put in their, to toolbox it's for them to do the work outside.
And I saw this really nice thing on TikTok of all places that people were like this, this was another clinician out in the wild that was. Therapy is once a week, usually for 50 minutes, the real work is what you do outside of that 50 minutes. And that's my, my point here. It's like, I'm here with you as the guide on the side, coming up with ideas, seeing if they fit, seeing if they don't fit, what did you come up with?
And like seeing what works and what doesn't and what we can do better, you know? Anyway. I just had to say that, like, I don't wanna see nothing. Yeah. So ethical sex therapist is gonna do that. There are things called sex surrogates. Ooh, that's enough. Let's bring that up. So if you, um, Have pain illness.
There are people now I don't believe there are any currently, unfortunately in Georgia, if there are, let me know, uh, there was one, but I do not think she's working anymore. A sex surrogate can come in and help you. Um, there will be sexual activity depending on what's going on, but there are individuals out there.
I don't want to call them sex coaches because sex coaches. are not. Um, how do I wanna say that? They're not, some of them have training many do not, you know, they come from that camp. If I had sex one time, therefore I can tell all the people how to have sex. Ooh, golly. , it's very scary, but there are surrogates and, and professionals that can help you hands on.
That is not a sex therapist. We do talk. Good
distinction. Yeah. I think that's important. Is there anything else that you feel is important for people to know? I think the biggest thing I got from today's episode is continuing to make sure people always come back to the basics and the foundations, which is communication and.
Know that if that's hard for you, that's okay. And that's normal and that's what we are here to, to help. Yeah. With, um, is there anything else that you think is really important, especially around the chronic pain piece? There's
so many and like, and I know, like you said earlier, like there's so many avenues of helping professionals in this space.
It's really about finding those that you feel comfortable with and those that have your, your, um, niche. Niche niche needs. Um, that's really a paramount because if you come to a sex therapist, it's almost like I kind of consider us like the hub. Like we're the people that are like, okay, let's go find you a physical therapist.
Let's go find you a sex surrogate. Let's go find you a doctor. What kind of doctor? We need a urologist. Nope. We need a gynecologist. You know, we, you. We can be the hub, but there are other professionals. If therapy seems like too much, or it's not the right time or prob possibly not even the right issue, there are other trained professionals that do wanna help you.
I know the medical community is messy these days. I know that we all get a bad rap. We are doing the best we can. The system sucks. Let's just call what it is. The system sucks, but there are people and I always. That if you have any questions, concerns, or whatever, I'm always here to take, uh, those, those, and help you find a professional in your area.
Now I'm not gonna say this to all medical situations, but I could definitely help you find a therapist in your area, especially a sex therapist in your area. So never, ever hesitate to reach out. And you can find me all over the internet at the sci-fi therapist. So don't, I love that.
So helpful. Thank you so much, Samantha.
And I'll put all that information in the show notes and, um, people can reach out in that way. Thanks. Yeah. Awesome.
Listen to Samantha’s interview with me, Destiny Davis, on Ep 11: The Foundations of Sex and Chronic Pain w/ Samantha Heuwagen, MA LMFT ACS
Samantha Heuwagen is a licensed marriage and family therapist and bestselling author based in Metro Atlanta. Samantha's work extends far beyond her therapy practice. She is a vocal advocate for mental health awareness, challenging stereotypes, and fostering inclusivity in discussions about mental illness. Samantha is also the author of the popular "Starless" series, with her fifth book, "Moonlet," set to be released in September 2022. Her debut novel was even nominated for a 2019 Georgia Author of the Year Award.
Connect with Samantha:
Meet Destiny - The host of The Chronic Illness Therapist Podcast and a licensed mental health therapist in the states of Georgia and Florida. Destiny offers traditional 50-minute therapy sessions as well as therapy intensives and monthly online workshops for the chronic illness community.