No Shame: Real Talk With Your Kids About Sex, Self-Confidence, and Healthy Relationships

By Lea Lis

Sex-positive parenting begins before your child starts talking. In No Shame: Real Talk With Your Kids About Sex, Self-Confidence, and Healthy Relationships, New York City Psychiatrist Dr. Lea Lis offers a guide to parents as they seek to help their children through the maze of sexuality and intimate relationships in the 21st century. In clear, straightforward terms, she lays out the groundwork on which parents can help their kids grow up to enjoy positive sexual experiences, and backs up her arguments with data from the most recent surveys and studies of teen sexual behavior. Dr. Lis’ unique Mindful Kid practice in New York is well recognized as an approach that emphasizes the mental healthcare of the child, exploring underlying issues to truly help children and their families move through and beyond their concerns to a place of healing and connection. In No Shame, Dr. Lis covers the many issues that may arise as children grow: how to help young children understand personal physical boundaries; the importance of opposite-sex role models in children’s lives, what to tell—and not tell—your kids about your own sexual history; and the role of rituals to mark a girl’s first period or a boy’s passage into manhood. Dr. Lis gives practical pointers on how to help your kids when their relationships run into trouble, how to encourage them to have good relationships with themselves, and how to teach them to flirt and to deal with rejection. No Shame shows how talking to your kids about sex and encouraging them to keep a dialogue open with you will help them to have positive, joy-filled emotional and sexual relationships as they grow up. This may not always be comfortable, but as Dr. Lis shows throughout this book, talking about sex, love and relationships in a knowledgeable way is essential.

• Language: English
• Publisher: Lea Lis
• Release date: Sep 22, 2020
• ISBN: 9781989603369

Lea Lis

Lea Lis is the Shameless Psychiatrist. She is a double board certified adult and child psychiatrist who has been working with non-traditional family arrangements since the beginning of her psychiatric career. Dr Lis helps parents, children, and adolescents face challenges and develop healthy, sex-positive attitudes and practices in their lives. In her own private psychiatric practice (Mindful Kid) she has developed expertise in working with modern families of all types. She has appeared as an expert on parenting in programming by ABC, CBS, NBC, and other news outlets, as well as newspapers such as The Chicago Tribune and The Washington Post. She is active in the American Psychiatric Association, having served as a member of their National Ethics Committee and on the Board of Trustees, and her publications have appeared in the Journal of Psychiatric Practice and the Journal of Academic Psychiatry.

Book preview

1 An Introduction to Shameless Psychiatry

The what, why, & how of positive parenting

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Education is not permission

Don’t you want your children to be autonomous, sexually fulfilled adults? Don’t you want your children to have successful and loving intimate relationships? Helping them to do so means being sex-positive. The phrase sex-positive in association with parenting is sometimes misunderstood as taking a permissive or anything goes approach to sexuality… No, that’s simply not the case! It’s not permissive parenting; it’s an extension of overall positive parenting. It also means teaching them how to communicate, how to live without shame, teaching them to love their bodies, how to be vulnerable. You need to nurture your child’s sexual development, through adolescence and into adulthood, by educating them to understand not only the pleasures and the dangers of sexual activity, but also how sexual activity can enhance their relationships, and help foster intimacy. This book is not just about sexual education; it is about the roles that sex and sexuality play in the healthy development of intimate relationships.

Communication can be so hard… but you gotta do it!

Parents, here’s the most important thing to remember: developing a parent–child relationship based on mutual trust, respect, and openness sets the stage for your child to build self-esteem and develop healthy relationships throughout their life. Good communication allows you to impart your values to your child and helps them to in turn navigate an increasingly complicated world. Your communication patterns with your child should start when they are very young and will be replicated in their future relationships, so whatever your patterns are early on… that’s what your child will likely continue with into their adult life. Start setting a good example now. And if, after reading this book, you feel you’ve made mistakes in the past, now is the time to correct them.

Here are some facts to back all this up:

Parent–adolescent communication plays a protective role in adolescent sexual behavior, leading to later sexual initiation, more consistent condom use, and less risky behavior.

Teens who have regular conversations with their parents about sex also report having closer relationships with them overall.

A powerful study of the link between parent–adolescent communication and safer sex practices among youth examined 30 years of data from more than 25,000 adolescents. Researchers found parent–adolescent sexual communication influenced safer sex behavior, such as the use of contraceptives and condoms.

Communication with parents about sexual matters was also associated with increased communication with dating partners.

Unfortunately, research also shows that too few adolescents talk with anyone about sexual topics—neither parents, friends, nor dating partners—and that attempts at such conversations fail when sex is defined only as a source of disease or the possibility of conversation is silenced through authoritative proscription of having sex at all. Don’t let your child be the one left in the dark.

So, start those talks early on and keep them going!

Do you want to be the kind of parent who shuts down sex discussions, leaving it up to your child’s school, their friends, and pornography to dictate the messages they learn? No way! You know you have a unique opportunity to do better than the way you may have been raised, and that’s why you’ve come to this book. You have the opportunity to send the kind of messages that impart your values and your truth.

Sex is not something that should only be talked about once, or only in times of crisis

What is the right age to begin to talk to your child about sex? As soon as they can speak! Rather than being compressed into a single monologue, as in a one-off Talk, something that generations who came of age in the 1950s, ’60s, ’70s, and ’80s experienced, a sex-positive education should begin at birth and continue throughout a child’s life, with developmentally appropriate explanations and discussions.

Unfortunately, even parents who communicate effectively with their children in almost every other situation become tongue-tied or nervous when it comes to sex. Further, given children’s inevitable exposure to a sex-saturated media, and to a host of contemporary social debates about gender and sexuality, such discussions need to happen not only earlier but with greater frequency, and have become more challenging for parents.

Just to reiterate this important point: As a parent, you may fail to address issues around sex, gender, reproduction, and identity during your children’s earlier years because you worry about seeming overly permissive or attracting undue attention to the subject of sex. Or, you may simply not know how or when to start. Some parents may also worry that kids will be tempted to experiment if they acquire any bit of sexual knowledge. But this logic is backwards: warning your kids about a cliff doesn’t necessarily make them want to jump off!

Many parents thus leave the important job of sex education to the schools, but sex education is rarely taught early enough or well enough in the classroom. Most contemporary sexual issues are not addressed in public school sex education programs, and schools vary in terms of the content they offer. By middle school, vast differences in knowledge develop among peers due to their parents’ political, religious, and other beliefs—not to mention their fears. Don’t leave this important job to the schools. Take the matter into your own hands. I am here to help you do so with competence and ease.

Parent Public Service Announcement!

So, with all that being said, I have a Parent Public Service Announcement: knowledge protects children at each phase of their development.

Here are some recent statistics:

About 1 in 10 children will be sexually abused before their 18th birthday.

About 1 in 7 girls and 1 in 25 boys will be sexually abused before they turn 18.

44 percent of rapes with penetration occur to children under age 18.

Victims younger than 12 account for 15 percent of those raped, and another 29 percent of rape victims are between 12 and 17.

Children are most vulnerable to sexual abuse and assault at ages when many parents have not yet even broached the subject of sex.

Starting a child’s sex education early has a protective effect. Very young children who do not know the proper words for their genitals, for example, are at risk for sexual victimization because they cannot easily provide a description if something happens to them. Older children who have developed shame around their sexuality may decide to keep their victimization secret rather than share details with a trusted adult like you. Adolescents and older teenagers often turn to their friends—and, increasingly, the Internet—for advice and information rather than their parents… and we know how reliable the Internet is for information.

Rapidly changing world

Children today are growing up in a rapidly changing world. As a parent, you may be single, divorced, cohabiting, or remarried. The children that you currently have may be the result of previous partnerships, adoption, or a variety of reproductive technologies. You may be in a same-sex partnership, multiple partnerships, or outside-the-box co-parenting arrangements, which are becoming more prevalent and more visible. New understandings of sex and gender, along with a range of alternative identities, have ushered in even more possibilities for relationships and families.

As a parent, you hope to prepare your child to lead a successful, meaningful, and satisfied life, even though you may feel uncertainty about what the future looks like. The hopes and fears of parents drive an expanding literary offering on the subject of parenting: parenting after divorce, stepparenting, single parenting, same-sex parenting, parenting the adopted child, parenting the LGBTQ+ child, and so on. To further complicate matters, many family arrangements are not necessarily mutually exclusive. For example, two lesbians might form a blended family: raising one child conceived in a prior opposite-sex union and one child they adopted together. Identities are not mutually exclusive either: a parent might be single, nonmonogamous, and bisexual. And, regardless of your own family arrangement, all parents and children will undoubtedly encounter gender, sexual, and relationship diversity.

Children thrive in loving and respectful environments… period.

Whether such social changes are positive or negative, for society or for individuals, is not up for debate in this book. My goal in No Shame: Real Talk with Your Kids about Sex, Self-Confidence, and Healthy Relationships is to help parents in any type of family arrangement raise strong, secure, and resilient children who become strong, secure, and resilient adults—an aspiration that resonates across the lines of identity and sexuality. After spending more than a decade as a psychiatrist working with parents and children in almost every imaginable type of family, I believe that children thrive in loving and respectful environments. It’s that simple—and that complicated.

So now let’s talk about the how-to

My approach to the nuts and bolts of sex education is developmentally appropriate and can be adapted to work with the beliefs and values of your family. Ever since Jean Piaget, a famous psychologist, began to study the development of children, psychologists and psychiatrists have studied and refined our understanding of human cognitive development. What was once thought of as a hierarchy of discrete, identifiable developmental stages is now viewed as a continuum; human maturation from infancy to adulthood is understood as a dynamic process rather than a one-time achievement. Still, the process of learning how to think, remember, and interact with others is similar enough across time and place to serve as a map, even if some of the territory is uncharted.

Drawing on insights from cognitive psychology, No Shame presents parents with

time-tested strategies for tackling common (as well as uncommon) problems, concerns, and situations associated with each developmental stage;

emotional regulation techniques, such as mindfulness, that can be taught at each stage;

resources for further reading; and

discussion topics for parents and older children.

These techniques can be adapted and practiced over time by you and your child to enhance communication, strengthen relationships, regulate emotions, and build self-esteem.

Communicate in the NOW

Parents, here’s another important reality to keep in mind: Some of our knowledge about sexuality remains stable over time. But there will always be new research, an ever-changing social context, and the fact that beliefs about sex are always understood within the framework of our current values, which are also ever-changing. This means that we parents periodically need to revisit what we have learned. Our children may also need to tackle issues that never even occurred to us. For example, when we were young gay marriage was illegal and almost a taboo topic. Then we watched it come to the political forefront as a hot-button issue in the last couple of decades. Now, for our youngest round of children, gay marriage seems like a total non-issue, and you may be discovering their attention is on trans rights and freedom from the social construct of gender.

This book thus also prepares you to handle questions and concerns that fall outside a basic sex education but are increasingly part of growing up today: sexual identities, the composition of contemporary families, the changing world of dating, the accessibility of pornography, sex in the media, the pressures of social media on youth, and other dizzying topics. I am seeing an uptick in confusion about gender identity and sexual orientation in my practice. This leaves many teens stressed about their identity in this ever-changing societal dynamic, and they are getting very little guidance from mentors and parents, who are often just as confused themselves.

In addition, teenagers today are facing a crisis of intimacy in their relationships. Boys are pushed to have no-strings-attached sex from early on… as early as their first sexual encounters. Girls are having sex to gain attention rather than for pleasure or intimacy, and are pushed from young ages to present themselves in a sexualized manner. Sexual liberation can sometimes become confused with a lack of personal boundaries or self-respect.

Parents, you need to address pleasure as a main element in sex ed! Moms, can you imagine the impact it would have had on your own empowerment if your parents had actually told you that what matters during sex is your pleasure? I mean, WOW, what a revolutionary concept! We’ll be diving into this idea of including the importance of pleasure in your sex ed communications later in this book.

Here’s another big one: the line between consent and coercion is often debated in the media—think of the #MeToo movement—but remains fuzzy for adolescents attempting to navigate their relationships. When you were in eighth grade, you probably never had to figure out how to handle requests for naked selfies over Snapchat. You may never have processed a breakup that happened over text message. But that is all the more reason to communicate with your child about the unique challenges they are confronting.

You are about to get some awesome therapy tips

Parents, this book is not just aiming to give you advice about sexual education. This book is so much more! I am a practical therapist who uses cutting-edge therapeutic tools to make my patients well. I use these same tools to give great advice about raising a sex-positive child. I am giving you the best of all the little pearls from the evidence-based therapy I use in my medical practice. Take these pearls as a huge value-add in your parenting toolbox. I have seen the common problems faced by children, and I will teach you what you need to know both with tips and with patient stories to illuminate the important points. Please be advised these are all fictionalized accounts of patient experiences I have had over the years; names and identifying information have been changed to protect patients’ privacy, which I hold sacred.

Who is the Shameless Psychiatrist?

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So, here is my origin story. By age 15, I already knew I wanted to be a child psychiatrist. My aunt Marie, to whom I was very close, was a psychiatric social worker. She developed a unique style for treating severely mentally ill patients, such as those with schizophrenia. Rather than just recording a patient’s responses to her questions, Marie took an authoritative role and gave them instructions to follow. Her commanding presence, along with her integrative approach to treatment and rehabilitation, made for many successful cases in the facilities where she worked. I didn’t know at the time the fundamental influence her style of therapy would have on my own practice later on.

When I was 15, Marie signed me up as a volunteer and found ways to take me into the locked wards to help her interview. This was unheard of at the time, and it probably would never be allowed today. I was the only sophomore at Manhasset Secondary School ever to work on a locked psychiatric ward. It was a profoundly life-changing experience, one that set me apart from my friends. Like other kids, I worried about where I would sit at lunch and if I would be invited to the cool parties, but at the same time I also worried that a patient I was working with might have an aggressive outburst that morning. Part of me cared about what I was planning to wear to the next dance, but another part thought that dances were frivolous compared with caring for people who were mentally ill. My classmates had no idea what I did after school and on weekends, and I wouldn’t have known how to begin to explain it to them.

At a young age, I discovered that I had an intense empathy with others. I have always been the person everyone comes to with their problems and for my advice. Although it was shocking for me to work with those patients who were so severely ill, it also set me on a course to study psychology and to start thinking about what we—as humans, as members of a certain culture, and as individuals—do and do not want to talk about. I became fascinated with the human mind. I logged many hours talking with patients and the professionals who cared for them.

Discovering my calling and choosing my career so young meant that I was able to focus my energy and time on taking the most direct path to my goal: high school, undergraduate college, medical school, internship, and eventually building a private practice. I also had that ten thousand hours of experience early on, which, coupled with my innate understanding, allowed me to become an expert. I can diagnose many patients after the first sentence they utter just by the way they walk into my office, their body language, and their initial facial expressions.

It was also as a teenager that I became aware that people who did not conform to mainstream ideals of gender, sexuality, or relationship style were stigmatized and ostracized. My great-uncle Frank brought his special friend Bob with him to family gatherings. It took me years to realize that he was gay. They were both accepted as members of the family, although none of us talked about the true nature of their relationship. To Frank and Bob, adopting a child would have been unthinkable, even if it had been their dream to marry or have a family together.

Now, I am familiar with research showing that marriage and family can provide health benefits and social support networks that are important across sexual orientations or preferences. But even back then, the fact that people would be barred from fulfilling such dreams seemed unfair to me, and even destructive.

It was while I was weighing the unfairness of how society treats us based on our sexuality that I met an HIV patient named Matthew. I was 17 and volunteering on a locked ward at Hillside Hospital, and Matthew was only two years older than me, but dying of diseases related to HIV. Despite being so painfully thin, his body riddled with sores, he smiled when I entered the room. He also had dementia. When he was lucid, he sometimes told me stories about his lovers. My friendship with Matthew left an indelible impression on me, because what he was going through seemed so cruel. He would never travel or fall in love again. He wouldn’t even celebrate his 21st birthday. And because AIDS was still thought of as a gay disease then in the US, he was blamed for his own misfortune.

This experience stuck with me. I began studying psychology and neuroscience at Dartmouth College, and continued to work at Hillside as a researcher. In 1999, I entered medical school at St. Vincent’s in New York City. At the height of the AIDS panic, many hospitals were turning away homosexual men. St. Vincent’s is a Catholic hospital and, remarkably, opened its doors to a community that was being hit hard by an epidemic that was still little understood. For several years I worked on the St. Vincent’s wards dedicated to treating these patients. Later, I also worked in an HIV clinic where patients were suffering from mental illnesses that had been triggered by the disease. These ailments included cognitive impairments and depression.

The sense of loss experienced by these men overwhelmed me. Society prevented men with same-sex partners from loving each other openly, marrying, and raising children together. Sometimes their own families had deserted them out of shame or fear. And now a disease was destroying the only social ties they had left, killing their lovers, partners, and friends.

By 2003, when I started my residency at New York University School of Medicine, HIV was better understood and on its way to being controlled—at least among some groups. Gay and lesbian communities were slowly regrouping, with an enhanced emphasis on creating chosen families. Although progress was uneven, gay men and lesbians were increasingly living openly with their partners, sometimes with children. Researchers, health professionals, and politicians raised concerns that single or gay fathers would not make good parents because they were not as nurturing as women, or that alternative family arrangements would generate instability because partners could not be married. Some people even suggested that children in nontraditional families would be exposed to inappropriate sexual scenarios in addition to debilitating social stigma.

How I learned the secret sauce for raising healthy children

As a child psychiatrist, I knew that good parenting requires love, support, and setting boundaries for the child. Parents who were great role models and mentors raised successful children. Being a good role model and mentor was more important than whether the parents worked outside the home or baked homemade cookies every day.

When I began working with the children of gay parents, I realized that the basic ingredients of good parenting were the same in those homes as well. Nontraditional family structures posed some unique challenges, but overall, children traveled similar developmental routes regardless of the sexual orientation of their parents.

For the lesbians I saw in my practice, parenting was intentional rather than accidental. Pregnancy wasn’t—couldn’t be—the result of a drunken night. They attended to details that would be taken for granted by straight parents. Before gay marriage was legal, for example, same-sex partners worked out legal parenting agreements in addition to wills and other documents to protect their children. Lesbians sought out male role models for their kids, as they knew that opposite-sex attachments and interactions would be important. They consulted with me even though I often thought they did not really need my advice—their children were well-cared-for and well-adjusted. When they realized that I was accepting of their sexuality, they referred other clients to me. After I started my practice, Mindful Kid, in 2008 in the Hamptons, my practice grew and I knew I was gaining the experience I needed to write this book.

During this time, gay men were also increasingly becoming parents through surrogacy and adoption. Although I found that the lack of a mom could make parenting a bit more complicated for these families, the difficulties could be addressed. The gay male couples that I worked with, for example, did not always realize that one of them might need to take time off work during the early months of their child’s life. They wanted to rely on a baby nurse to do this work, even though research shows that developing a stable early attachment with a primary caregiver is extremely important for a child’s development. I would counsel them on choosing roles for the child’s first few months, whether that of the caregiver, who takes a lengthy paternity leave of at least three months, or that of the breadwinner, who provides the financial and other support during that period. These roles are usually gendered in heterosexual families, although they do not need to be. Once the men realized they couldn’t take the value of such early mothering lightly, they stepped up to the challenge.

I could say the same applies to modern-minded heterosexual couples where both members are breadwinners. I am finding that more and more fathers are deciding to take a step back from their career to be the primary caregiver, as their partner may have either a more lucrative career or a higher societal impact career. And the father may be more suited to the nurturing role. See the documentary about Ruth Bader Ginsberg and her husband, who supported her every step of the way with both parenting and behind-the-scenes advocacy work in the service of her rise to the US Supreme Court. Not only did RBG live an untraditional life (especially during the 1970s!), but she stressed the need for all parents to have their rights protected, regardless of gender, in her earliest Supreme Court cases.

My permanent shift away from gender bias

People like RBG have shown us that anyone can take either a traditionally masculine or a traditionally feminine role when it comes to parenting. Debates raged in the media, and sometimes the courts, over whether gay and lesbian parents could be good parents. But every day in my practice, I saw real-life examples of conscientious, loving, effective parenting by same-sex couples. And as the scientists began to weigh in with research on the question, it became clear that parenting was not the privileged domain of heterosexuals. Same-sex partners could do just as good a job as opposite-sex partners, by some measures even better. They did, however, face some unique issues as well. As I began systematically thinking about how best to help nontraditional families move through the different phases of child rearing, the initial ideas for this book began taking shape.

In 2009, while pregnant with my first daughter, I had another significant experience. I attended the Burning Man festival—an annual gathering of hippies, artists, and cultural visionaries that takes place in the desert near Reno, Nevada. For one week, Black