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Interview with Kristen Lilla, MSW, LCSW, CST, one of only four certified sex therapists in Nebraska. Lilla is in private practice at Omaha Sex Therapy, where she provides therapy services to both individuals and couples. 

What books or websites would you recommend to people interested in cultivating healthy relationships and intimacy?

One that is really great is ‘Mating in Captivity’ by Esther Perel. It’s basically about how you keep the intimacy alive in a long-term relationship, and I think that’s something that a lot of relationships struggle with. 

Another one is ‘Rekindling Desire’ by Barry McCarthy and Emily McCarthy. It’s along the same lines: In a long-term relationship when you kind of lose that spark, how do you get that spark back? And what does that look like? And what are some of the steps you can take to rekindle that relationship? 

There’s ‘Intimacy and Desire’ by David Schnarch. This is a little more wordy and a little more theory-based than some of the others, a bit more intellectual. David Schnarch is great, but he is a little more like a textbook. 

Along a little bit more of a different line: ‘The Seven Principles of Making Marriage Work’ by John Gottman. A lot of people are familiar with Gottman; he’s a marriage therapist based out of Seattle and he’s been doing this for like 40 years and he really does not advise intimacy at all. I wouldn’t send someone to him for any kind of sexual issue, but a lot of his focus in his book is about communication and I really believe a lot of things come down to communication or lack thereof. He really focuses about some of the things people really need to pay attention to, such as fair fighting, where a lot of us get to know somebody and think we can treat our partner in a certain way because they’re not going anywhere. And so I think there is a lot of good advice in his book even though it’s not sexual in nature. 

Another book I love for people who aren’t already in a relationship is a book called ‘Sex Smart’ by Aline Goldbrod. It’s a really simplistic, to-the-point book about sexuality, but she traces it back to childhood and how the things we grew up with influence how we are as adults. That’s a book I recommend to quite a few clients because you can take it slow, there are exercises at the end of each chapter and people will always come back and say, ‘I learned something about myself.’ I think it’s such a good book for people who aren’t even in relationships because there is something foreign about sexuality; it is such a hot topic that we don’t always feel comfortable exploring it. 

What are the top things people should know about healthy relationships and intimacy?

Number one is communication. Everybody says that: You have to communicate. It’s so much easier said than done. People either have poor communication skills or they are communicating differently, each missing the other’s message. I think it so important to be able to communicate and I’m so cheesy, when people say, ‘We need to talk about sex’, I say, ‘You can talk about it outside of the bedroom—because that’s where everything happens—talk about it over pancakes. It’s much more difficult to be offended when you’re at a restaurant; you’re not going to have a big blowout. It’s about communication, not having a fight or criticizing, and being comfortable doing that. 

Second—in jest, sort of–‘Use it or lose it’. Couples get into that habit: I’m too tired. I have to clean the house. The kids are home. I have to get up early to go to work. Whatever; I have to do this, I have to do that. People come up with excuses and when your sex life suffers then you get in this rut where you have such a low libido, or you’re in a nonsexual relationship because you’re not putting the effort into it. So, believe it or not, habit is actually a good thing. So doing that lingering kiss in the morning kind of creates that desire, so when you get home you’re a little more excited to see your partner. And the dishes are still going to be waiting for you at the end of the night, anyway.

The third thing is—I think this one is really important; not just in relationships but I talk about this a lot in a sexual nature—When you’re in a relationship and you’re busy making your grocery list or you’re thinking about the toys in the living room that need to be cleaned up, you’re not present with your partner at all. In this case, the intimacy is not going to be enjoyable because you’re busy thinking about other things. It can create a whole slew of problems, making it more difficult to orgasm, or it can lead to erectile dysfunction. You can set yourself up when you’re not present. It’s easier said than done, so I tell people to practice breathing exercises or try some yoga. And it’s the same thing when you’re communicating, to be present and not to have your retort ready to go so you can beat your partner to the punch; it’s not about winning it’s about being present and actively partaking in your relationship. 

I have a fourth one:  Have common interests and date night and adult conversations. With so many couples, I’ll ask them what they have in common and they say, ‘We have kids together’ or ‘We have a house’. And I say, ‘I’m not so sure those are “common interests.”’ When the kids move out, there’s nothing left because (the relationship) is not built on anything sustainable, so I really encourage people find some kind of common interest, even playing a game once a week. The common interest could be one another, prioritizing that time together. And I’ll tell people that even if it’s for an hour a week, you’re not allowed to talk about your work and you’re not allowed to talk about your kids. I don’t care if you go to CNN or talk about a current news article as long as you’re engaging in something. 

What are the top misconceptions about relationships and intimacy?

Number one, that it’s easy. In the beginning of a relationship, it usually is easy. When you first start dating someone you can get three hours of sleep a night and have sex twice a day and it’s very exciting. You have all these endorphins going. But it can’t always sustain itself. I notice that when a lot of people move in together, that’s when the problems start creeping up because you have to do day-to-day life all of a sudden. I think people get excited and they rush into things and they kind of have that high, but it doesn’t sustain itself and that’s not realistic for the long-term. People are like ‘we’ll never run out of things to talk about.’ Hence adult night and adult conversation, because you need to have things to talk about. Or people will go, ‘I know everything about that person’ but I say, ‘I’ll bet you don’t. You just need to find a way to bring out a different side of them.’ How do you do that? You need to have an environment to cultivate that instead of the same old sitting on the couch and watching Netflix. 

Number two is a big one and I think people don’t view it this way, but it’s a misconception that you can control your partner. People really do think that. One example is pornography: ‘I’ve told him he’s not allowed to look at pornography.’ Let’s talk about the bigger issue—Why is he looking at it and why does it bother you?—But more importantly, you don’t have that control over someone. So a lot of times the partner says, ‘Okay, I won’t look at it because they’re going to get mad.’ But they do it anyway and then they get caught and it creates a big blowout.

We don’t talk about these things, either; nobody says, ‘You’re not allowed to have an affair.’ Esther Perel, in her book, talks about how we get jealous or how nobody’s going to want our partner, so we think we have that kind of control. Until it happens. She comments that, ‘What makes you think that you had that control, anyway? Whatever made you think you owned that person?’ And you don’t. And so, especially when things start to fall apart in relationships and suddenly we’re grasping for that control, too, when we’re trying to win them back. That goes hand in hand with having your own separate lives and some independence and trust. 

A more mundane example would be like if I told you that you had to take the trash out. I can’t make you; I don’t have that kind of control. If you don’t want to take the trash out, you’re not going to do it. So we pick an argument about it for the next 20 years or accept the fact that you’re never going to take the trash out. And that’s the choice that we get.

One more thing, and this is actually more sex-related; it happens a lot with things like erectile dysfunction: People come in and they talk about, they focus everything on, orgasm. They get really disappointed because their partner loses their erection or the person who has erectile dysfunction gets really frustrated because they lose their erection and they forget about the entire aspect of intimacy and foreplay and the entire 30 minutes they put into before that, because it’s about that end result. It’s not always erectile dysfunction, but I see a lot of couples related to this issue because I think the ingrained societal messages and the pornography industry make it all about that. It happens, too, as we age, something like menopause or having cancer or something where the body doesn’t work the same as when we were 20, so we discredit all of the other things intimacy is all about.

What do you tell teenagers about sex?

I’m actually working on my certification to be a certified sexuality educator as well. I do a lot of work with Girls Inc. and I’m going to be starting to go into some of the Omaha Public schools to do some sex education. The fight with sexuality education is time, because it’s so time-limited; there’s never enough time to do everything. That’s been a conversation with the school districts, where I say I want to talk about this and this and this, and they say, ‘Oh, we don’t want you to talk about that.’ There’s actually been some tiptoeing. We always talk about anatomy and we always talk about contraceptive and STDs, but I firmly believe sexuality education should not be shame-based and that it should be sex-positive. So what do I tell teenagers about sex? Two words: the truth. 

We certainly have programs that I do where I utilize materials and resources and models and all that good stuff, but at the end of the day, the best education I’m doing is when I’m able to have an open and candid conversation with them. Because when they’re comfortable asking questions—and I’ve heard a lot of really interesting questions—it feels really good to be able to give them accurate information. And once the ball starts rolling, usually everyone in the room feels comfortable: ‘She asked that? Well, I’m going to ask that now.’ 

One thing that I really emphasize, that is a really important thing to me, is consent. I do some activist work in the community with Slutwalk ( and I organized Vagina Monologues in Omaha ( Both of those are about stopping violence against women and girls and bringing awareness to rape culture. I think that’s important, whether we’re talking to boys or girls, to discuss consent. 

I’ve heard some really scary information from girls, too, that they think…that you can’t change your mind. No, you can change your mind. It’s so good to able to do that education and talk about things like menstruation and masturbation and help them become comfortable with their own bodies. We’ve heard the messages from the media, we get so much information about being thin and beautiful and these standards are correlated into sexual standards. I love doing sex education and I was very determined to be a sex therapist. The education piece just kind of fell into my lap and it has been a really nice balance for me. 

One of the lessons I do that is more controversial is a lesson on pornography. When I’m allowed to do it, it stirs some really great conversation, because whoever talks to our teens about porn? 

I have a lot of women who come in (to my practice) who have never masturbated or maybe never had an orgasm and they’re like, ‘I must be crazy.’ But think about it: realistically, as a woman you could go your entire life without ever touching yourself. You can use a washcloth to bathe yourself, we use toilet paper to wipe after the bathroom, we can use a menstrual pad. Where boys have to (touch their genitals) every single day. So it’s a different mentality along with the other messages about being stinky or gross. We’re just raised so differently. 

Sometimes the message for girls is ‘cross your legs and don’t ever touch’, rather than ‘it’s okay to do that but you should do that in privacy.’ They’re starting to change those messages for little kids and I think that’s a good thing, but the lesson when I was a kid was ‘good touch/bad touch’ and ‘those are your private parts’. But saying ‘that is a private part’ is implying that even I can’t touch it. It’s so confusing and I think they’re starting to get away from that a little bit, more so ‘it’s appropriate to touch yourself but not appropriate for someone else to touch you’, more about boundaries.

What do you think is the most romantic music?

My answer is sort of cheesy: your partner’s breathing or heartbeat. I know it’s cliché, but it goes back to being present rather than having that distraction in the background, really being in tune with your partner. 

You know when your relationship and intimacy are healthy when ___________?

A sex therapist will typically say ‘if you’re having good sex, then you have a good relationship,’ where marriage therapists say the opposite. So we usually say ‘fix the sex and you fix the relationship.’ When people come in and their sex life is suffering, there’s usually other stuff going on, they’re fighting frequently or they have as a lot of stress over money or they just had a baby; there’s always more to the story. When people have a good sex life, their relationship is usually pretty healthy, they’re communicating and they’re spending time together and they’re prioritizing. 

How has communication changed regarding dating, relationships and sex from past to present? 

Absolutely there are pros and cons, and in some ways technology has made it easier for people to communicate and interact with one another. There’s constant access 24/7 and there’s so many different dating websites. For couples, it can be a really good things because they can keep things interesting, send those flirty text messages or pictures or whatever. 

On the contrary, as far as dating there are almost and too many outlets, so many different dating websites, and then you have things like Tinder out there now. It accentuates this hooking-up culture rather than genuine interaction, so I think it can be difficult for people looking for a relationship who are trying to utilize and navigate the online world; there are so many people who are just in there for sex.  Or you can judge people just on a profile picture and that’s not a genuine interaction. Sure, you can weed people out really quickly, but you can be missing out on something.

I learned about this a few months about this from a client—it was a married couple and he had been caught having an affair—that here are dating websites out there for navigating an affair. We’re not talking an open relationship or polyamory or swinging; it was someone being deceitful and going behind someone’s back, and there are actually websites to help someone navigate that.   

How do legal and privacy issues affect the way people approach modern relationships? 

I think it makes people really conscious of what they’re putting out there, specifically if we’re talking about nude pictures and sexting. In some ways I think it sucks that we have to put so much forethought into sending a flirty picture to our partner and the idea that you trust that partner and it can keep things fun and flirty. 

But there are so many aspects where it does catch up with people, like revenge porn or even with celebrities’ naked photos leaking. In both of those examples, they weren’t giving anyone explicit permission to share those. I’m not a lawyer, but where does the law come into play with that? That’s pretty upsetting when you haven’t given someone permission, especially if you’re being hacked, to leak that all over the Internet. I think that’s deserving of a bigger conversation, on privacy and legal rights and where the line is drawn. The other side of that is ‘just don’t take those kinds of photos’, but I think that’s blaming-the-victim mentality. 

Are alternative lifestyles more accepted or more challenging today? 

It’s a little of both. I think it’s becoming more accepted by society, just the fact that there’s terminology. The word ‘polyamory’ suddenly has a definition behind it and people are talking about it. I think it’s certainly getting some headway and becoming a bit more accepted as people are becoming more educated and having these discussions. At the same time, we do live in a pretty conservative area—Nebraska—so I think there is absolutely still a lot of judgment. 

Most people do accept monogamy as the only form of acceptable relationship. Because monogamy is so ingrained in us, an affair or loving more than one person is leading to a divorce. I think we as humans are capable of loving more than one person, but is that for everybody? Absolutely not. I do think it’s worth a bigger discussion and less judgment. I’ve worked with a lot of poly couples who have come to me after going to other therapists who have accused them of being criminals or encouraged them to get a divorce. And that’s in the therapy field. 

There needs to be more discussion and education, so I’d say (alternative lifestyles) are extremely challenging…When we’re talking about open relationships or swinging or whatever, that’s fine if it’s not for you—don’t do it! But I think we can respect that other people are different from you.

Are LGBTQ relationships more accepted or more challenging today?

I think generally it’s more accepted, but here’s a not-so-fun fact for you: LGBTQ youth are four times more likely to commit suicide than their straight peers. More specifically, the transgender population. In Vagina Monologues—it’s March 13 and 14 this year, at Girls Inc. on the 13th and Sokol Hall on the 14th—it’s all about women, and one of the pieces this year is about trans women; I think that’s such an important inclusion. I’ll share some statistics, and some of them are so scary and staggering: 49 percent of transgender people attempt suicide and one in 12 transgender people in America is murdered. I think we accept LGBTQ relationships more than ever before, but we certainly have a lot more work to do, especially the transgender community.  

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