Trauma, Lost Desire, and ART: A Breakthrough Therapy with Brooke Bralove

kay, hey y'all, it's me, Dr. Smita Rahman, Gyno Girl. Welcome back to another episode of Gyno Girl Presents, Sex, Drugs, and Hormones. I'm Dr. Smita Rahman, sexual medicine specialist and menopause expert here in Chicago. And I'm here to remind you that if your body sometimes feels off or dismissed or disconnected, you're not the problem. We know that today, because today we're actually gonna have a wonderful conversation about what sits underneath so many of what we see in our patients.

but it doesn't get like named out loud. And that is really trauma. Trauma is something that is not, know, it's something people have one way of thinking about, but we see it in so many different ways in our lives, whether it's sexual trauma, medical trauma, know, childhood trauma, it perpetuates so many people's lives and it can show up in a variety of ways with sexual activity, with low desire, with not being able to tolerate an exam.

because as it said, the body you will always remember, right? And we're gonna, and I'm so excited today to talk to the wonderful, amazing Brooke

She specializes in helping high achieving women break free from perfectionism, trauma, emotional patterns that get them stuck in cycles of self pressure and self-adopt. Her work integrates neuroscience-based approaches, which we're going to talk about because some people haven't heard about accelerated resolution therapy, which we're going to talk about. And she's also trained in the daring way based on the research of Brene Brown, helping individuals move through shame into resilience, courage, and self-adoption.

I love her work. I love what she's doing and she's going to give people some real tools today to get to where they need and understand how to find it. So welcome, Vrook. So lovely to have you.

Brooke Bralove, LCSW-C (: 02:09

Thank you, really happy to be here.

Dr. Sameena Rahman (: 02:11

It's so exciting. I want to start with, you know, I'm a guy, no girl, so I love a good backstory. So I want to hear what your backstory is, what brought you into the world of, you know, psychotherapy, sex therapy, all the things. You know, let's hear about it.

Brooke Bralove, LCSW-C (: 02:28

So I think I've often wanted, know, off to a great start. Hold on. That's a great one.

Dr. Sameena Rahman (: 02:35

No worries. I don't know what I like. More caring for me than editing.

Brooke Bralove, LCSW-C (: 02:41

Okay. Alright.

Well, what brought me into psychotherapy is actually my own psychotherapy. So I had wonderful parents who were pro-therapy, you know, back in the late 70s, 80s. And so I was a pretty anxious kid. And so the first time I ever went to therapy was, I think, third grade. And I liked it. I liked having someone special to talk to once a week. That was just for me.

And I really found meaning in it and at different points in my life, I would go back to therapy, you know, when I needed some more work or a tune up or through a depression. And so I just love that special relationship. So for me, being a therapist is really about being able to impact people, you know, one at a time in a very intimate way through relationship, which is really how we learn trust and authenticity.

and deep connection. And then I became a sex therapist because at the age of 39, I found myself divorced and had an amazing sexual awakening that I felt like everybody should be privy to and experience in their lives. And so I was super fascinated.

Dr. Sameena Rahman (: 04:06

Yeah. Yeah.

Brooke Bralove, LCSW-C (: 04:11

by talking about sex and learning about sex and it frankly is just a lot of fun.

Dr. Sameena Rahman (: 04:18

It is. We met at Ishweshwara. I talk about Ishweshwara on this podcast all the time, so my listeners know. But we have the best conferences, Yeah, it's so interesting to say that you, because you said you grew up in the 70s and 80s. having been in that time period myself, understanding that having parents that are so really with it and advanced in some ways.

The boomer generation wasn't really the ones that were like, let's cater to what's happening to you emotionally. were just like, deal with it. We'll talk to you later. You know, that kind of thing. So the fact that you had such support is really amazing. Can you talk a little bit about like, you know, I think that's very unique. they in the background of any kind of medical psycho background or psychological background?

Brooke Bralove, LCSW-C (: 05:05

No, not at all, actually. But I think my parents were people who thought you should talk to experts when you didn't know something. And so when they got a divorce, they, you know, talked with a therapist about how to tell us and, the best way and things to do and not to do. so, again, I'm really grateful. also grew up in a family where expressing big feelings

Dr. Sameena Rahman (: 05:16

Okay.

Dr. Sameena Rahman (: 05:25

That's nice.

I'm.

Brooke Bralove, LCSW-C (: 05:35

was totally allowed, especially with my mother. So I was allowed to be in a crappy mood. I was allowed to be sad. I was allowed to cry. And I was met with presence and connection. And of course, that is not what I see in my office. I see so many people, adults, who, especially if they're men,

Dr. Sameena Rahman (: 06:00

Yeah.

Brooke Bralove, LCSW-C (: 06:02

who grew up with boys don't cry, I'll give you something to cry about, and any big feelings, including joy or squashed. And so what does that mean for their relationships, their intimate relationships? Doesn't mean really good things because they aren't able to express themselves and they don't trust that someone actually cares about their inner world and inner experience.

Dr. Sameena Rahman (: 06:05

Yeah.

Dr. Sameena Rahman (: 06:20

All right.

Brooke Bralove, LCSW-C (: 06:32

And I was with a mom who, again, just made so much accepting space for all of that. She wasn't perfect, but she made a lot of space for my big feelings, and I had a lot of them.

Dr. Sameena Rahman (: 06:46

wonderful. That's really wonderful. mean, you know, speaking of around like childhood experiences, you know, we had

We had a great session at Ishwish about childhood experiences and some of them adverse and some of them not. We don't want to label all of them, but we do know there's a lot of good data on what adverse childhood experiences do, not only to like, you know, your sex life, but also just like in general, how it manifests in your cardiovascular health and other ways. I think I had heard Sophie Bergeron for the first time from Canada talk about it years ago and it was really eye-opening. So now I make sure I sort of like really inquire about people

when we consider all the different types of trauma they experience or whatever the case may be. But I guess first I wanna ask you, can you sort of define what you see is trauma? And then let's talk a little bit about childhood and then we can go into some of the other aspects.

Brooke Bralove, LCSW-C (: 07:40

So I define trauma really as anything that happens to you that your nervous system finds overwhelming and has difficulty processing. And so, you know, some people distinguish between big T trauma and little T trauma, you know, that's a little controversial. I use that language only because I think it helps more people accept

that they did experience traumas in their life if you don't label it as a big T trauma. Because most people do not come in and maximize their trauma. They minimize their trauma.

Dr. Sameena Rahman (: 08:19

Right. Right. Right. Absolutely. Yeah.

Brooke Bralove, LCSW-C (: 08:23

And so my job is to help them see that even though it wasn't witnessing war or murder, that even if they had kind of a father who got angry every time they spilled a drink, even that a child can experience as traumatic based on what their body does in the moment.

Again, what I like to think about is that trauma really is anything that overwhelms the nervous system that puts you into fight, flight, freeze, or fawn.

Dr. Sameena Rahman (: 09:05

That's very good actually. I mean, now I'm like thinking about putting my kids through trauma. Like what kind of trauma am I? Yeah, I think, know, to your point, you know, it's so variable in terms of the different types of trauma people experience. There's childhood types of trauma that have happened. We know medical trauma is real, obviously sexual trauma, all the things. How do you think adverse childhood experiences kind of show up?

Brooke Bralove, LCSW-C (: 09:10

Little tea, little tea.

Dr. Sameena Rahman (: 09:33

in adult intimacy.

Brooke Bralove, LCSW-C (: 09:37

They show up everywhere. They really do. And again, that can be anything ranging from, you know, growing up in a single parent household to having an alcoholic parent to being, again, the victim of violence or a witness to domestic violence. And all of that creates an environment in where children

Dr. Sameena Rahman (: 09:38

Mm-hmm.

Brooke Bralove, LCSW-C (: 10:04

do not feel safe in their own bodies. It's not, children can't say to themselves, wow, it looks like mom and dad are really struggling and you know, something's wrong with them. Children are inherently narcissistic. They blame themselves. And so I think when you have kids who grow up thinking they're the problem or they're at fault, they cause bad things to happen.

Dr. Sameena Rahman (: 10:20

course.

Brooke Bralove, LCSW-C (: 10:33

I think they walk around with that and they often experience a great deal of shame and they then deal with that shame in different ways. They might act out, they might sexually act out or act out violently or they may go inward into shutdown. so relationally, that's often what you're gonna see this kind of either coming at you aggressively

or shutting down, right? So you're either fighting or you're fleeing. And so relationally, that's very, very challenging.

Dr. Sameena Rahman (: 11:11

Sure. Yeah. And to your point, think, and so some of the kids who are exposed to say like a lot of even verbal abuse, right? Not necessarily physical abuse. Do you think, and they're both bad in their own ways. I think, do you find some people then become, is that how we have so many abusers that come from abusive families? That they take that role on because that's what they see, right?

Brooke Bralove, LCSW-C (: 11:36

Yes, that's the intergenerational trauma that is so hard to undo. Although I do see people changing those generations moving forward. But again, that takes work. Exactly. Absolutely. Yeah, exactly. And it is pretty awesome to be able to provide people support, psychoeducation, and healing.

Dr. Sameena Rahman (: 11:43

Mm-hmm.

Dr. Sameena Rahman (: 11:50

That fantastic.

Brooke Bralove, LCSW-C (: 12:04

that does enable them to see that they can make different choices. But yes, I mean, what we find is if someone grows up in, you know, let's say a physically and verbally abusive household, it is very likely that they will either be victims to that again, or they will be perpetrators. And the way I like to frame it is usually when someone grows up and parents are violent,

They spend their whole lives saying, I am not going to be anything like, you know, my dad. I am not. No matter what, I won't do this to my kids. I won't do this to my kids. But the problem is the universe and the brain don't know the difference between not violent and violent. And so you actually end up creating that kind of propensity inside yourself by disavowing all of that.

So what I find is what you can help people do is say, you know, this happened to me. I might have a little propensity inside of me, and that would make sense. So how do I want to deal with that part so that it doesn't become who I am? And that is a lot more manageable. And so, you know, whether it's IFS work, internal family systems, looking at different parts of people.

Dr. Sameena Rahman (: 13:19

matching.

Right.

Brooke Bralove, LCSW-C (: 13:32

There's a part of me that can be a perpetrator. There's a part of me that was a victim and might become one again. But again, this takes support, consistency, love, and attention, and honestly, sometimes money for therapy. And that's a problem in many communities, of course.

Dr. Sameena Rahman (: 13:48

No.

Sure. Let me ask you, well, let's talk a little bit about how it physically manifests, right? So people that under, they live with this trauma or they hold this trauma. You're a kid that goes off to college, you you've been under an abusive environment. How do they physically, how is it manifesting?

Brooke Bralove, LCSW-C (: 14:10

Well, if it doesn't manifest in a really outward way, like drug addiction, sexual acting out, violence, if it doesn't go outward, it goes inward. And that's, of course, what you were alluding to at the beginning of the podcast, which is The Body Keeps the Score. And so then you're looking at things like chronic headaches, GI issues, chronic back pain, migraines.

Dr. Sameena Rahman (: 14:17

See you then.

Brooke Bralove, LCSW-C (: 14:41

Say it again. Exactly. And yeah, and I have a lot of anecdotes about pelvic floor dysfunction when we talk more in a little bit about a therapy I provide. But yeah, it shows up in the body in gripping patterns, literally. The body learns to guard. And then that creates chronic tension in the body.

Dr. Sameena Rahman (: 14:42

the floor dysfunction. Floor dysfunction. Yeah.

Dr. Sameena Rahman (: 15:00

Yeah.

Dr. Sameena Rahman (: 15:04

always come.

Brooke Bralove, LCSW-C (: 15:08

you know, TMJ, you're pointing to your jaw. I'm like, yeah, TMJ.

Dr. Sameena Rahman (: 15:15

Absolutely. And I see this happening, you know, obviously clinically. I'm wondering, you know, I've been thinking a lot because, you know, we did a session on AI and everything. I was going to ask you this later, but since we're talking about this and I want to talk about how we can deal with some of these traumas and I you to talk about some of therapy that you provide.

But tell me where you think like the intersection of the chat boxes is going to come into play. Because I think, you know, for me, I've been thinking, you know, so many people are doing chat boxes. So many people are using AI and they come to me with these preconceived notions based on what the AIs are telling them. Right. And, and I don't know if you were ever were able to stick around for the talk that I gave on AI and bias is really like who is creating these systems within the machine learning center. Right. Or if I'm a white male that's putting in all the data, like am I

than automating sexism and racism. And that's always the question mark, right? But when I had someone recently talk about how they used AI to better communicate with their clinician because AI terms to utilize. so she was someone who maybe

Brooke Bralove, LCSW-C (: 16:18

Mmm.

Dr. Sameena Rahman (: 16:25

might've been on the spectrum or something like that and couldn't really. And so then I thought, wow, is that how we should be using it? As a means to really help foster the relationship between you and your clinician or therapist. How are you seeing it manifest in your office right now? Are people coming in with their diagnosis telling you this is what I need?

Brooke Bralove, LCSW-C (: 16:28

Mm-hmm.

Brooke Bralove, LCSW-C (: 16:44

Yeah. So not exactly, because I, first of all, I want to say no one will replace an actual therapist ever because it's the relationship that matters. And I think a lot of people are going to turn to AI, of course, but I don't believe there are some therapists kind of freaking out. Like, are we going to lose our jobs? I don't feel that way. Yeah.

Dr. Sameena Rahman (: 16:56

Right.

Dr. Sameena Rahman (: 17:09

No. I'm doctors too.

Brooke Bralove, LCSW-C (: 17:13

And I don't feel that way because I truly believe at the end of the day, we want someone to profoundly see us and being in person and deeply connected is the way to do that. That's what's ultimately healing. But I love AI for homework. So when we're running out of time and a patient is talking to me about how they don't know how to

Dr. Sameena Rahman (: 17:34

Mm.

Brooke Bralove, LCSW-C (: 17:42

their sister about not bringing up their weight issue at Thanksgiving, if we don't have time to talk about that, I say that's a wonderful thing to talk to AI about. That's a great chat GPT. Because I do find that a lot of people can talk through dynamics, but finding the actual words is very difficult for people. They really want to be told

Dr. Sameena Rahman (: 17:50

Yeah.

Brooke Bralove, LCSW-C (: 18:09

you know, what do I say? And of course, that's less of what I'm going to provide. I'm going to talk about what do you want to feel with that person? And, you know, I talk about their goals, but providing them actual language. I'm like, you don't need me for that. So please go use it, you know, in between. So I actually I suggest it sometimes to people never as a replacement, but as a way to.

Dr. Sameena Rahman (: 18:10

do I say?

Dr. Sameena Rahman (: 18:25

Yeah, yeah, yeah, yeah, yeah.

Brooke Bralove, LCSW-C (: 18:36

continue their work in between psychotherapy sessions or sex therapy sessions.

Dr. Sameena Rahman (: 18:41

Right, really to give them the words they need to really, you know, get to that next level. No, I totally agree with you. I mean, speaking of some of the technology, just, I was just thinking about it. Have you seen the show Shrinking? What do you think about it as a therapist?

Brooke Bralove, LCSW-C (: 18:55

Yes.

Brooke Bralove, LCSW-C (: 18:58

I mean, look, there's not one show, you know, TV movie that ever gets it really right. But is it absolutely hysterical? And do I love it? 100%. But, you know, it's so outrageous. It's just so outrageous.

Dr. Sameena Rahman (: 19:05

Right.

Dr. Sameena Rahman (: 19:10

Yeah.

Dr. Sameena Rahman (: 19:15

It's kind of, I think it's like the crazy anatomy of, you know, whatever. Cause they have some outrageous things that they're doing and you're like, no, we don't do that. And when I was like, that actually captures a lot and I can't watch it because of the trauma that I get from watching it. It's like a retelling.

Brooke Bralove, LCSW-C (: 19:24

Yeah, mean, very f-

Brooke Bralove, LCSW-C (: 19:30

Yeah, very few times while I'm watching Shrinking, I'm like, yeah, I've said that. That kind of never happens. A lot of it is very cringy with the therapist with the worst boundaries ever. But here's what I do like about it. What I do like is that it really shows therapists being human. And I think that matters. And this is something I feel pretty deeply.

Dr. Sameena Rahman (: 19:35

Yeah. Yeah.

Yeah!

Dr. Sameena Rahman (: 19:53

Yeah. Yeah.

Brooke Bralove, LCSW-C (: 19:59

I was trained as a psychodynamic psychotherapist, which is very much blank slate, create tons of space, silence, distance, don't share one thing about yourself. And I would say the psychodynamic police is probably like on my shoulder being like, what are you doing? What are you doing? What are you doing? And what I would say is I'm being authentically myself. So I modeled to my patients how to be authentically themselves.

Dr. Sameena Rahman (: 20:06

distance.

Dr. Sameena Rahman (: 20:19

Yeah.

Dr. Sameena Rahman (: 20:28

Yeah. And I think that's sort of like even just being out there on social media showing an authentic side of yourself. I was actually having this conversation with one of my research colleagues and Dr. Janine Anderson, she was at ISHWISH and she's the great sex service researcher. We were talking about reflexivity in medicine and she was saying, you know, like, we always have to remember what part of ourselves do we bring into that exam room? Are you just

Brooke Bralove, LCSW-C (: 20:28

They want real in front of them and I'm sure you relate.

Brooke Bralove, LCSW-C (: 20:45

Yes.

Brooke Bralove, LCSW-C (: 20:55

Mm-hmm.

Dr. Sameena Rahman (: 20:57

Dr. Rahman OB-GYN, but you're putting aside mom of three, you're putting aside Muslim woman, you know, that kind of thing. But I think it's the layers that get peeled away as we talk about being on social media and showing people that we're like human beings with issues, you know, like just like anyone else.

Brooke Bralove, LCSW-C (: 21:14

Yeah, because if they only put us on a pedestal, that is not useful to them because then they just continue to see that there's a big distance. And there isn't. There's no distance other than I am here 100 % for you right now. But when I go to my, you know, when I go to my life, you know, it ain't always pretty.

Dr. Sameena Rahman (: 21:23

Yes. Yes. Yes.

Dr. Sameena Rahman (: 21:30

Right, right.

Dr. Sameena Rahman (: 21:35

Yeah, exactly. You know what the part I did like about shrinking? I lost my mom a year ago. And so I liked the 10 minute or was it 15 minutes crying? You listened to some really emotional songs. I did that a lot and I didn't even realize I was doing it. Like I would listen to her classic Indian Punjabi songs and I would sit in the shower and I would cry. I would mess up 10 to 15 minutes almost daily for a very long time. And I come out like, OK.

Brooke Bralove, LCSW-C (: 21:42

Hmm, sorry.

Brooke Bralove, LCSW-C (: 21:56

Mm-mm.

Dr. Sameena Rahman (: 22:05

I'm done with that for the day, you know?

Brooke Bralove, LCSW-C (: 22:08

Good for you. Yeah. So you're talking about basically honoring all feelings that come up, but putting a nice container around them so that they do not bleed out everywhere. And what most people do is stuff them. And then they literally come out at the worst moments in the worst ways. So I 100 % support that. And I think that's really wonderful that you that you did it that way. And you probably got through.

Dr. Sameena Rahman (: 22:18

Right.

Dr. Sameena Rahman (: 22:28

Right, right.

Brooke Bralove, LCSW-C (: 22:36

the acute phase of your grief in a pretty rapid way by honoring what was already there so that then when you needed to compartmentalize, you could actually do that.

Dr. Sameena Rahman (: 22:48

Yeah, because I think for anyone experiencing a loss, like grief isn't linear. It's not like, I'm done with grief. Like every day it could come up and I have to suppress it just to think like, OK, I have to continue to be present for the people who need me kind of thing. Let's talk about different therapies. I know I went on a tangent because I was just thinking about shrinking in my head. But let's talk about different therapies that are being used right now. I think, you know, I've heard and done some research on EMDR.

but what you're providing is something even more interesting and possibly more effective, depending on the patient. Can you talk to us a little bit about an ART and sort of trauma and what it is and how you do it really?

Brooke Bralove, LCSW-C (: 23:31

Sure. So ART or ART is a brief treatment modality that uses rapid eye movement and voluntary image replacement to change the way the brain stores distressing images, memories, and then the corresponding negative sensations that show up in the body when you're triggered. And so it does come out of EMDR.

reated by Laini Rosenzweig in: 2008

But what happens in my therapy office is literally pure magic. I have to fight back tears, certainly weekly, if not daily, when I'm doing ART, because you literally see someone change in a way that, you know, I'm a long-term talk therapist. Change is slow. And so it's both gratifying to me as a therapist.

But also, I'm changing lives. ART is changing lives rapidly. It's a terrible business model because people get better very fast. And sometimes you only work with them for a couple of weeks, and then they're gone. And of course, obviously, that's wonderful. But I always joke it's not the best business model.

Dr. Sameena Rahman (: 25:19

or can do more people in a shorter amount of time. Well, can you give me an example? Because I'm trying to figure it out in my head. If I were your client right now, talk to me how you would talk to someone. And we don't have to do a session, obviously, but just.

Brooke Bralove, LCSW-C (: 25:31

Yeah, yeah, of course. Yeah, so what I would say is, let's say you, let's keep it in the sexual realm, you know. So let's say that you had a sexual trauma in college. And what was showing up for you right now is that when...

Dr. Sameena Rahman (: 25:48

We should probably give a trigger warning or something for people. right. Yeah.

Brooke Bralove, LCSW-C (: 25:50

yes, we are gonna talk about trauma. I'm not gonna give any details that I believe would be triggering actually at all other than talking about the topic of sexual assault. So thank you for that. And so you would come in and let's say that every time your husband touched you, you flinched and you got very rigid. And that along with that meant

Dr. Sameena Rahman (: 26:01

Yeah.

Brooke Bralove, LCSW-C (: 26:19

that you were having sexual pain during intercourse. You're going to come in in a lot of current distress. It's causing problems in your marriage. Your husband feels rejected. You feel terrible because you love your husband deeply. But no matter what you do, your body has an automatic response. And you know, because you know it's from the sexual trauma.

because you flash there, it feels like that same thing is happening to your body in the moment. So I would say, let's have you come in and let's do some ART to try to get rid of that. What you would do is you'd come in and again, the idea is that you would see that sexual assault in your mind with zero talking. So what is great about ARTs, you don't have to talk about your trauma, because what we know is,

Talking about your trauma over and over again actually makes it worse in terms of the neural pathways that just keep getting kind of dug in, I like to say. Yeah. And so we're going to create new neural pathways by having a different experience. And so you'll imagine that scene while you're doing this rapid eye movement, which is simply moving your eyes back and forth, left to right.

Dr. Sameena Rahman (: 27:22

Yeah.

Dr. Sameena Rahman (: 27:38

My clothes are your open, your are open.

Brooke Bralove, LCSW-C (: 27:40

So in ART, we do it eyes open. Yeah, just not your head. You don't move your head. So you just move your eyes kind of back and forth like this. Now, we're trained to use our hand. I want to save my shoulder. And so I use a light bar. Many people use a light bar, like EMDR therapists do. And you would just follow that while you're thinking about something.

Dr. Sameena Rahman (: 27:45

No, you just, just want to go this way.

Okay.

Brooke Bralove, LCSW-C (: 28:08

When you're thinking about a sexual assault, we would imagine that you're gonna have negative sensations show up in your body. The eye movements calm those negative sensations. And so over time, when you pair negative images with negative sensations that then get calmed, you will begin to desensitize yourself to it. And then we basically have you see it again. And the second time you see it, it's often just

kind of different, less impactful. You may have more neutral sensations in your body. And then we do this thing called voluntary image replacement, which is again, where you decide how you wish that had happened. Maybe you wish you had pummeled the guy who was about to sexually assault you and it never happened.

Dr. Sameena Rahman (: 29:01

Thank

Yeah.

Brooke Bralove, LCSW-C (: 29:04

Maybe you wish you had not gone to that fraternity party that night, exactly. Maybe you wish you'd just gone out with your girlfriends and had a good night. Maybe you wish the police had come. Maybe you wish your father had come and protected you. It's whatever you need to heal that you need to give yourself the experience of seeing. And when you do that, positive sensations show up in your body.

Dr. Sameena Rahman (: 29:08

party.

Brooke Bralove, LCSW-C (: 29:32

and then we spread those all around. The brain doesn't need the truth, it needs a good story that's detailed and healing. And then the brain has no need for the images. So in ART, we say keep the knowledge, lose the pain. You will never forget the facts. You do not want to forget the facts of your life, but you have no need for the intrusive memories, feelings, or God forbid,

getting triggered by your husband in the moment when he just wants to give you a hug. And so it gets rid of current distress by going and healing images from the past. And it works on everything you would go to regular therapy for, everything.

Dr. Sameena Rahman (: 30:23

Okay, how's my next question? I was gonna ask you, because I take care of a lot of patients who have provoked vestibulotinia, sexual pain on entry, and many times they're born with too many nerve endings at the vulvar vestibule. We call that congenital neuroproliferative vestibulotinia. And so these patients really end up needing a vestibulectomy. So we remove that part of the vestibulotinia now. And then afterwards, I find that like,

they haven't convinced their body that the pain is gone, even though when I touched them on exam, it's zero out of 10. And so a lot of times I do recommend EMDR for them and really, they need physical therapy, pelvic floor therapy, and then some really rigorous therapy to help their brain understand that this is gone now. But have you done this with some of those patients or do you imagine it working even better than EMDR?

Brooke Bralove, LCSW-C (: 31:11

Again, I'm not an EMDR therapist, but I do know that it does work faster than EMDR for sure. In only one to five sessions, EMDR is usually a little bit longer. And I have the experience of working with tons of people who've done EMDR and found it somewhat helpful. And then they come and do ART and they get better. But yes, pelvic pain is, I don't want to say exciting to me. That's not exactly what I mean.

but working with it is. So I'll give you an example. I had a patient who came in with six years of pelvic pain. She could only get the tip of her fingernail into her vagina, and she wanted to become pregnant. And she could barely sit. She could barely wear pants. It was completely debilitating. This is a referral from our good friend Dr. Rachel Rubin, who refers lots of people to me who have a lot of difficulties.

Dr. Sameena Rahman (: 32:06

Was you're in Maryland,

Brooke Bralove, LCSW-C (: 32:08

Yeah, we're about five minutes down the road from each other, which is great. so she came in and we first just tried to figure out kind of where it came from. we did like one or two sessions and we weren't having a lot of luck. Then I asked her to tune into her pelvic pain in the moment. And she could say, these are the sensations in my.

Dr. Sameena Rahman (: 32:11

wonderful. OK.

Brooke Bralove, LCSW-C (: 32:34

in my pelvic floor. It's gripping, it's tight, it feels hot. I asked her to ask her brain to show her the first time she had those sensations in her life. I didn't say, when was the first time you had painful intercourse? When was the first time your vagina hurt, your vulva hurt? I said, ask your brain to show you. And immediately, her brain showed her being beaten by her mother at the age of eight.

Dr. Sameena Rahman (: 32:53

Yeah.

Brooke Bralove, LCSW-C (: 33:05

That

Dr. Sameena Rahman (: 33:05

And she had just pushed that away.

Brooke Bralove, LCSW-C (: 33:09

She didn't really process it as anything negative. She had just processed it as this is what my mom did to me. But what we learned is that the body had linked those two things together. So what happened? To protect herself at age eight, she gripped that pelvic floor as tight as she could to guard. She remembers shielding herself. Well, what happens when you are literally shielding yourself?

You're tensing every single thing inside your body, including your pelvic floor. So to stay safe, her body protected her in that moment by getting small and tight. But then she continued to do that. And when I tell you this woman's pelvic pain went away, I thought I cannot talk about ART without the goosebumps. I mean, I literally wish you could see, it's pathetic. It's literally pathetic that I can't talk about it.

Dr. Sameena Rahman (: 33:56

I'm really getting goosebumps myself. I'm like, yeah. I'm so, I'm feeling so like wow right now, wow. Yeah.

Brooke Bralove, LCSW-C (: 34:07

and I feel emotional. And she was able to get pregnant by using a turkey baster. So a little bit larger than her pinky was able to get in there and she got pregnant. So it's really profound work. I'm sorry. It's really wonderful that we can do this so quickly.

Dr. Sameena Rahman (: 34:20

No, I'm about to go to crap too.

Dr. Sameena Rahman (: 34:30

Wow. And can you just tell me how do you differentiate EMDR from ART?

Brooke Bralove, LCSW-C (: 34:36

Sure. Yeah, so there are a few major differences. One is that EMDR deals with thoughts and feelings, whereas ART deals with images and sensations. So you're actually just, now it doesn't mean that ART can't work on limiting beliefs. It works incredibly well on things like, you know, I'm not good enough and, you know, I'm ugly and I'm useless and I fail at everything.

So it does work on that, but it goes about it through imagery. And it is, again, as I said, a briefer, one to five sessions per issue versus EMDR, which is usually 10 to 20. It also, EMDR kind of meanders, and you follow wherever the patient is going. ART has a very clear protocol. It has a beginning, a middle, and an end. And you don't.

Dr. Sameena Rahman (: 35:10

Yeah.

Brooke Bralove, LCSW-C (: 35:35

end a session without resolution. That's why it's called accelerated resolution therapy. Whereas EMDR, people talk about it kind of opens you up sometimes and then it doesn't close you back down in a contained way. And it's a lot of this is to be continued. And I find that there are a lot of people who cannot manage that distress in between sessions. There's almost no distress in between sessions. In fact, people report feeling

Dr. Sameena Rahman (: 35:45

We need you.

Brooke Bralove, LCSW-C (: 36:04

much better because we gauge what they feel at the beginning on a scale of zero to 10. A lot of people, if it's a real huge trauma, are starting at a nine or 10. And sometimes they get to a zero. You know, not everyone. mean, there's not one treatment that works for everyone, but there's it's it's almost never that someone would feel worse. And in regular trauma therapy, sometimes in ENDR, they feel worse. And guess what? It's not motivating to come back.

Dr. Sameena Rahman (: 36:28

you did.

Dr. Sameena Rahman (: 36:34

back. Yeah, that's what I found is that some patients are like, I tried it and you know, it just didn't it didn't do it for me or whatever. And so I think that's really helpful to know. And are there is there a is there a way for people to find who does a RT versus like, is there a site for a RT certified?

Brooke Bralove, LCSW-C (: 36:53

Yes, yes. So we're growing. It's very exciting. More and more people are getting trained. And I now have a practice that specializes in ART. And it's the greatest thing because we can help so many more people now. And that brings me great joy. But yes, they can go to acceleratedresolutiontherapy.com. And there's a list of people by state, by country.

Dr. Sameena Rahman (: 37:08

you

Dr. Sameena Rahman (: 37:13

Okay, gotcha.

Brooke Bralove, LCSW-C (: 37:18

It is in a few countries. definitely, it's more in the US and Canada than anywhere else. But yeah, you can find somebody, I have a provider who can do it virtually. That's the other thing. It can be, it's equally effective virtually or in person, which shocked me. Absolutely shocked me. But I have worked with people with profound trauma and virtually and they do great.

Dr. Sameena Rahman (: 37:33

Yeah.

Dr. Sameena Rahman (: 37:46

Yeah.

that's wonderful. I mean, because we see it, you know, coming up in so many different ways. Like, you know, I'm sure.

I'm thinking of some patients that I have that have persistent genital arousal disorder who probably started, because when they can remember a time when they were five or six and they were doing that, to me that says it's probably region five that started it, unless they had a fall or something. And so we kind of do this region-based approach to assessing it. Have you had much experience in that capacity at all with PCAD patients? I'm sure Rachel maybe send you some patients.

Brooke Bralove, LCSW-C (: 38:19

Well, have what I, yeah, I have experienced a lot of people or with something, you know, like chronic UTIs, you know, something like that where, mean, and they have to process the trauma from when it first started. And it's usually when they're quite little. And then you have to, so you have to sort of work on maybe the first time it occurred that they remembered, but then usually there's the medical gas lighting and you've got to process that.

Dr. Sameena Rahman (: 38:25

and yeah.

Dr. Sameena Rahman (: 38:36

Mm-hmm.

Brooke Bralove, LCSW-C (: 38:47

And that's really, so I do work an unbelievable amount with medical trauma.

Dr. Sameena Rahman (: 38:47

Thanks.

Dr. Sameena Rahman (: 38:53

I was going to ask you that too because between obstetric trauma that you know we have no control over some time and medical trauma from the way our system is set up to give people a 10 minute visit and discard their pelvic pain or sexual pain or whatever I can imagine that's a huge factor.

Brooke Bralove, LCSW-C (: 39:10

Yeah, and it works really well with, you know, chronic illness. I mean, you've got, you know, a lot of people with EDS or POTS who've been told it's all in your brain and they have to work through that to begin to trust their own experience that this is real and true for them, which we we certainly know it is. And I do I have there's one experience of medical trauma that I found was sort of profound is that

Dr. Sameena Rahman (: 39:27

Yeah.

Brooke Bralove, LCSW-C (: 39:38

well, was birth trauma, actually. So Dr. Rubin referred someone to me who had come into her office and the second she was handed a mirror to look at her genitals, she had a full blown panic attack and they had to stop immediately. I mean, there was just absolutely no moving forward. And so she referred her to me. I only saw her for two sessions. We processed a birth trauma that had occurred 11 years before.

And in two sessions, she went, after two sessions, she went back to Dr. Rubin smiling, happy, relaxed, looking at the mirror, learning about her body. Gone, absolutely 100 % gone. I never saw her again. It was great.

Dr. Sameena Rahman (: 40:19

music.

Dr. Sameena Rahman (: 40:23

That's so awesome. And do you find like, you know, obviously, you know, if you pay attention around the world, people can be traumatized by things they hear. And so like, you know, with the whole Epstein files, I, you know, I find a resurgence of people coming in with pelvic pain when there's a lot of information about, you know, sexual assault or, you know, child trafficking or whatever. I have this memory of when Brett Kavanaugh got, I just remember this big uptick and like patients who were like, I didn't even know I had this issue, but my pain,

back and so and so happened at six years old. Is that, are you seeing some of that? Did you see some of that when you know the whole Epstein files came up and

Brooke Bralove, LCSW-C (: 41:01

Yes, and Kavanaugh, mean, both. But yes, with Epstein, know, people are coming in with more symptoms, you know, and also, if things had been dormant, you know, like they'd been kind of healed from something, they'll get, yeah, a little uptick in, you know, or simply disgust and helplessness. And we can walk work through that too. I mean, just because again, sexual

Dr. Sameena Rahman (: 41:21

you know.

Brooke Bralove, LCSW-C (: 41:30

you know, abuse survivors, a lot of what you are trying to help them with is that helplessness. And when we see this is happening everywhere all the time, and then, you know, there's no problem somehow, right, no accountability, nothing happening, then they're angry and they begin to feel helpless again. And so we sometimes have to work through that with ART or talk therapy.

Dr. Sameena Rahman (: 41:38

Yeah.

Dr. Sameena Rahman (: 41:45

No accountability,

Dr. Sameena Rahman (: 41:52

Yeah.

Dr. Sameena Rahman (: 41:57

Yeah, that's amazing. Okay. I've been so captivated. I forgot the question. Well, let's talk a little bit. Let's change gears from trauma and talk a little bit about sex therapy generally, know, like mismatch libido and what people get wrong and right about it. First, tell me what you think the biggest, you know, misconception is around sex therapy.

Brooke Bralove, LCSW-C (: 42:22

That's a great question. Well, the worst misconception is, of course, that I'll be doing something sexual with you in my office. And about every quarter, I get one of those phone calls, you can figure out pretty quickly is that kind of phone call.

Dr. Sameena Rahman (: 42:29

Yeah.

Yeah, Masters and Jones.

Dr. Sameena Rahman (: 42:39

Yeah.

Brooke Bralove, LCSW-C (: 42:42

Well, the biggest misconception is that they won't need to do homework.

Dr. Sameena Rahman (: 42:47

Yeah, right.

Brooke Bralove, LCSW-C (: 42:49

They don't, a lot of people come in and they just think we're gonna talk about it. Well, you know, it's an action. Sex is an action. Intimacy is an action. So, sorry guys, I'm gonna give you homework. And if you don't do it, that's fine, but it's not gonna change. So I wanna, you know, maybe you'll understand that most sex therapy involves homework, doing it differently.

Dr. Sameena Rahman (: 42:53

Yeah.

Yeah.

Dr. Sameena Rahman (: 43:11

Yeah.

That's it guys, homework is involved. So get back to it.

Brooke Bralove, LCSW-C (: 43:18

And the most important homework is always going to be masturbation. Spoiler alert, sex therapy involves a lot of masturbation for good reasons.

Dr. Sameena Rahman (: 43:25

Yeah.

Dr. Sameena Rahman (: 43:29

Yes, absolutely. Well, let's talk about when you use it and vibrators and stuff. mean, I think, you know, a lot of people, you know, don't and we should talk a little bit about sensate therapy. So where do you use sensate therapy? Where do you use, you know, directed masturbation or, you know, vibrator work?

Brooke Bralove, LCSW-C (: 43:54

Well, vibrators, yes, early, often, all the time, please have as many as you want. That's what I would say about vibrators. And I think vibrators are super exciting right now. My favorite is the Lem right now by Hello Nancy. And I have recommended it to all my patients. And they just come back in and they just kind of give a thumbs up. So that's good.

Dr. Sameena Rahman (: 43:58

I'm sorry. The more the better. The more the better. Yeah.

Dr. Sameena Rahman (: 44:12

Really?

Brooke Bralove, LCSW-C (: 44:24

In terms of homework, for people who come in with a lot of sexual shame and then anorgasmia, that's gonna be a lot of masturbation. And again, it will start wherever they are. Sometimes someone will come in, a woman will come in who's anorgasmic and she's never masturbated. She might be in her 40s or 50s. Or, you know, she...

remembers being turned on by something at a young age and then has shame about that and so therefore has kind of shut her own orgasm down. And so there we're just working on getting very comfortable with your body. But we don't start with genitals. So again, if someone's really kind of phobic, we are going to start with my simple question, which is incredibly difficult for a lot of women to answer.

What brings you pleasure?

Dr. Sameena Rahman (: 45:25

And I was like, yeah, sure.

Brooke Bralove, LCSW-C (: 45:28

Not sexually. What? Anything. And I will say it feels very sad to me that many women cannot answer that. And so.

Dr. Sameena Rahman (: 45:30

just in general.

Dr. Sameena Rahman (: 45:36

Because we don't think of our pleasure. We just say, OK, you know what? Suffering, can endure. Let's just get through it. Let's help our kids feel good. Let's help our husband feel good. Let's help our wife feel it. Whatever. We don't think about, we don't center it, honestly.

Brooke Bralove, LCSW-C (: 45:50

That's right. So we'll start there and then we'll start with totally non-sexual touch, non-erotic touch, you know? And you know, I find like something as simple as like, do you like your hair played with? Do you like your hair being brushed? And you know what? Men, women, non-binary people, people, I guess there's a lot of nerve endings in your scalp because people love that.

Dr. Sameena Rahman (: 46:14

Yeah.

Brooke Bralove, LCSW-C (: 46:17

It's also a very loving thing, right? We think about it like a parent would do. It's not necessarily erotic, but it makes people feel very safe, very calm, very held and kind of cherished. And so that's a great thing to do to yourself or to ask a partner to do if you have one. So yeah, that's where I do a lot of the masturbation kind of homework. And then the sensate focus is usually a little bit more with couples.

Dr. Sameena Rahman (: 46:22

Yeah.

Brooke Bralove, LCSW-C (: 46:47

So couples that come in and they're in sexless marriages. I see a lot of sexless marriages. So again, I usually try to just give a general idea that it's usually if you haven't had sex in the last year, and that's kind of continuing maybe, but I think that you get to define it the way you wanna define it. I don't believe in strict definitions.

Dr. Sameena Rahman (: 46:55

What's name of the song Sexless Marriage by the way?

Brooke Bralove, LCSW-C (: 47:16

But I do think occasionally it can be helpful to people to just understand what we mean by that. And so in those situations or very mismatched libidos or people who have totally non-erotic energy between them, which is a lot of middle-aged couples, let's be real, right? Just, you know, flat and they love each other and they want to be together and they, you know, find each other even attractive, but they've just lost.

Dr. Sameena Rahman (: 47:35

They do, you know? Flap.

Brooke Bralove, LCSW-C (: 47:46

all the erotic energy, I will have them just go back to basics. And what I usually say is, remember when you were 15, 16, 17, 18, 22, when you first started becoming a sexual being and making out was the greatest, you could have the most pleasure in the world from that. How many married couples, how many long-term partners are making out? Almost zero.

Dr. Sameena Rahman (: 48:19

Subtropically. I had a patient tell me just the other day, she's been married for like 20 years and was like, you he tried to kiss me and I love him, but oh, I can't stand kissing him anymore. Like his tongue, like, and she said, I used to love it. And she's like, will this testosterone make me want to kiss him again? I was like, wow, it's a little complicated.

Brooke Bralove, LCSW-C (: 48:20

Almost zero!

Brooke Bralove, LCSW-C (: 48:38

Yeah, and there I would say, well, have you told him how you're how you like to be kissed now? What you're learning about yourself now, it is never too late to teach your partner how to touch you. Never. And you can say something, you know, people do not want to do this. I don't want to ask. I don't want to ask. Well, I don't know how you get anything in life without asking, but that's just me.

Dr. Sameena Rahman (: 48:47

Mm-hmm.

Dr. Sameena Rahman (: 48:53

Yes, that's good.

Dr. Sameena Rahman (: 49:06

Yeah.

Brooke Bralove, LCSW-C (: 49:07

But so, you you got to take control of it, but you can say, you know, I was thinking something that we could do together that would be fun is why don't you teach me how to kiss you the way you really want to be kissed? So you model it and what you're really saying, you know, underneath is, my God, please, can I teach you how to kiss me? But that's not the point. You do reciprocal and that create, mean, because your partner is probably going to go,

Dr. Sameena Rahman (: 49:28

you

Brooke Bralove, LCSW-C (: 49:36

We haven't kissed at all in a while, sure. But you gotta get back to basics. Do you remember when holding hands and just feeling somebody's fingertips, you know, when you're in a movie, when you were younger felt? Do that. That feels good. You gotta get those senses activated again. But when you only do, it's nine o'clock, the kids are in bed, let's have sex, let's start with missionary.

Dr. Sameena Rahman (: 49:38

Mm-hmm. Mm-hmm.

Dr. Sameena Rahman (: 49:51

Mm-hmm.

Brooke Bralove, LCSW-C (: 50:05

Then I'm going to turn you over. Yeah, we're going to do it this way. You're not using lube. You expect things to happen. That's just not how it works anymore. And here's the part I don't think people get right. You have to grieve what is lost. You have to grieve the ripping your clothes off, you know, for somebody. You have to grieve that you don't

Dr. Sameena Rahman (: 50:06

I'm sorry.

Brooke Bralove, LCSW-C (: 50:34

You aren't dying inside to have sex with your partner. You have to grieve it. It's a loss. And I don't think that gets talked about enough.

Dr. Sameena Rahman (: 50:45

That's true, actually. just assume, mean, you I always talk to my patients about responsive desire in these long-term relationships and, this medication is not going to make you want to drop down and like, you know, do it five times a week or whatever, but you might not push them back as many times, you know, that kind of thing. But I don't think, yeah, I don't think that we talk enough about the loss of the fact that spontaneous desire or horniness is no longer part of the equation.

Brooke Bralove, LCSW-C (: 51:10

Yeah, yeah, but, or end, it doesn't mean that you can't start to refocus on how to build and make space for responsive desire. And so there are a lot of ways to do that. And the biggest thing around responsive desire, in my opinion, is the willingness to try. That means I don't feel like it in this moment, but...

I value our sexual connection. I know I always feel better afterward. I know I always feel more connected to you. I know you're less grumpy. And so I'm willing to try. Does that mean that you have to stay with it if after 20 minutes you're still like, you know, feeling absolutely nothing? No, but give it 10 minutes. And specifically the way to do that, that helps with the willingness to try.

Dr. Sameena Rahman (: 52:00

Yeah.

Brooke Bralove, LCSW-C (: 52:07

is to build in a transitional activity from paying bills, screaming at the kids to go to bed, to fine, let's get naked and have sex. People think they can just do that. And again, we aren't that simple. And especially when we're middle-aged with hormonal shifts and problems and weight gain, we're not feeling as good, whatever it is. And so,

Dr. Sameena Rahman (: 52:22

Yeah.

Dr. Sameena Rahman (: 52:35

Yeah.

Brooke Bralove, LCSW-C (: 52:36

You got to build in an activity that can be a five minute meditation that could be taking a bath or shower, going in and rubbing, you know, your favorite scented lotion all over your body. How do you get back in your body and out of your thinking, anxious brain and more into it? I also encourage people if they're not feeling it.

Go take your vibrator into your bathroom. If you know you have, let's say, a sexual date with your partner, you know, at nine, go into the bathroom at 8.45 before they come home and masturbate for five minutes. You don't need desire to come before arousal. You cannot wait for desire to hit you like a bolt of lightning. It's not happening.

Dr. Sameena Rahman (: 53:25

Yeah.

Dr. Sameena Rahman (: 53:31

Yeah. That's not happening anymore.

Brooke Bralove, LCSW-C (: 53:35

for most of us. I don't mean to say that it can't. I think it absolutely can. I'm having the best sex of my life at age 51, but it doesn't mean that I don't also have to work on the responsive thing. It is 100 % a thing. And I'm not in a long-term marriage right now, so I've got that going for me as well, right? It's an uphill battle. It's not easy. But you have to work toward acceptance of what is no longer

Dr. Sameena Rahman (: 53:54

Yeah. Yeah.

Brooke Bralove, LCSW-C (: 54:03

to create what can be.

Dr. Sameena Rahman (: 54:07

That's nice. That's actually a very good point actually. And I think that's the part that we don't emphasize enough, right? Like this whole idea of like, where we go from here, but it's okay. Like it's okay. We can go from here.

Brooke Bralove, LCSW-C (: 54:22

Yeah, and also, and then just everybody says what's wrong with me. I mean, it's just the perpetual what's wrong with me. I know I must be the only person who doesn't want to. And also, it makes them doubt their love for their partner. Because they're like, wait, I know I love my partner, but I don't want this. What does this say? Maybe not much other than you gotta bring in some mystery, imagination, and play.

Dr. Sameena Rahman (: 54:37

Yes.

Dr. Sameena Rahman (: 54:42

Yeah, yeah. Right. Yeah. Yes.

What exactly? Yeah. The date nights are important. Yeah. Well, this has been awesome, Burke. I want to be cognizant of your time. I could actually talk to you because I'm so intrigued by our conversation, especially learning more about ART. But this has been wonderful. Please tell everyone. I'll put in the show notes too. put in the show notes. But please tell everyone where they can find you, how they can get in touch with you, and what you have coming up.

Brooke Bralove, LCSW-C (: 55:15

Yeah, so you can find me at brookbralev.com and Instagram and Facebook is at brookbralevpsychotherapy. And I'm just continuing to build a practice that specializes in sex therapy and ART. And that combination, specifically my passion, the place I feel deepest is around sexual trauma of any kind and helping people heal with ART.

so that they can be these beautiful, wonderful sexual beings who feel very deserving of all kinds of pleasure in their lives.

Dr. Sameena Rahman (: 55:56

Yes. that's wonderful. Well, thank you so much. This has been really eye opening. I am very captivated by everything you said. But everyone, thanks for tuning in for another episode of Gyno Girl Presents Sex, Drugs and Hormones. I'm Dr. Samina Rahman, Gyno Girl. Remember, I'm here to educate so you can advocate for yourself. Please join me next week.

Brooke Bralove, LCSW-C (: 56:03

Thank you. It was fun to be here.