EP160: A Lifelong Experiment: Exploring Intimacy and Curiosity in Relationships

Navigating Intimacy and Connection in High-Stress Professional Lives

In this episode of The Girl Doc Survival Guide, Dr. Alexandra Stockwell, a physician turned relationship expert, shares her journey and insights into nurturing passionate and fulfilling relationships for high-achieving professionals, particularly those in medicine. Dr. Stockwell discusses the challenges faced by physician couples, emphasizing the importance of transitioning from a sympathetic nervous system-driven state to a more relaxed parasympathetic state to foster intimacy. She introduces the concept of Uncompromising Intimacy, highlighting the need for honest self-expression and shared vulnerability in relationships without compromising personal truths. Practical strategies are provided for maintaining and improving emotional connections, including the significance of curiosity, setting boundaries, and effective communication techniques. The episode stresses that cultivating a healthy and fulfilling relationship is a continuous, learnable process that requires intentional effort and attention.

00:00 Introduction to Dr. Alexandra Stockwell

00:49 Personal Anecdotes and Early Marriage

02:15 The Journey to Intimacy

04:16 The Role of the Nervous System in Intimacy

08:22 Uncompromising Intimacy: A New Approach

18:56 Practical Strategies for Better Communication

27:43 Balancing Medicine and Relationships

34:24 Final Thoughts on Building Better Relationships

Transcript

Christine Ko: [00:00:00] Welcome to today's episode of The Girl Doc Survival Guide. I'm joined by Dr. Alexandra Stockwell, who brings a fascinating perspective as both a physician and relationship expert. After 12 years in medicine, she transitioned to become what she calls an "intimacy doctor", applying her scientific training to help high achieving professionals create passionate, fulfilling relationships. With 28 years of marriage and four children of her own, she offers practical wisdom for women in medicine seeking to thrive both professionally and personally. Thank you for being here. 

Alexandra Stockwell: Thank you so much. I don't think of intimacy doctor as a burgeoning specialty. It's like kind of fun branding. That was fun to hear you say that. 

Christine Ko: Yeah. Can you first share just like a little personal anecdote about yourself? 

Alexandra Stockwell: Sure. My husband and I met the first week of medical school. He is a [00:01:00] practicing physician in pain management. We were both a few years older, hadn't gone straight from college to medical school. I had my first child at the very end of third year of medical school. And then the second one just before my internship. I share all of that because basically the first eight or 10 years, we really had no time. We never took a honeymoon 'cause we got married based on the exam schedule and our rotation schedule third year. That's how we chose the date. We just didn't have time to spend the weekend in bed together or go to Paris. We really were highly compatible, totally in love, really aligned with financial decisions, parenting, career choices, and supportive about sleepless nights, all of that. The sex that we were having, I now think of it or refer to it as functional sex, meaning we were each having orgasms. Yes, it was enjoyable, [00:02:00] but it was not what the poets write about. It was not the kind of thing where afterwards I just felt that much closer to him in the way that I understood was possible and had experienced in prior relationships, quite frankly. I always thought that once we had more time together, neither of us working overnight, no diapers to change, the whole scene, that things would heat up in a way that they hadn't.

Actually with more time sleeping through the night, no diapers to change, nothing really changed in the quality of our intimacy or sex. And it was this huge kind of awareness that it's not just more time that we needed. That was really an observation that started a whole journey for me, which brings the two of us to be having this conversation. It's not just more time that [00:03:00] a physician couple with either two physicians or one physician needs. There's so much more that's required to really nurture and be passionate and fulfilled with one another beyond just being partners in life. 

Christine Ko: You mentioned that you did have a different kind of relationship with some prior people. Meanwhile, you are definitely in love with your husband. You don't think it's just chemistry? 

Alexandra Stockwell: No, I don't think that at all. When you have a life with someone, when there's real love and intimacy, when it has more depth and commitment to it, there are all kinds of other considerations that arise. So I'm not talking about a prior relationship when I thought I was gonna marry someone. I didn't have that before. That's not my situation. I just mean that when the stakes are lower, it's easier to have certain kinds of fun because we're not depending on one another for anything else.  

Christine Ko: So [00:04:00] it almost sounds like maybe for most of us, most physicians, maybe we're like too serious. 

Alexandra Stockwell: Yeah. I don't think of it specifically as too serious, but I definitely go in that direction. In very general terms, we as humans are wired with our autonomic nervous system. Much of being a competent physician requires our sympathetic nervous system to be activated. We need to be constantly vigilant to not miss a diagnosis, to keep track of the time so that we don't get delayed to make sure we've said everything we need to say in the chart, to not pee in the middle of the surgery, to .... I could go on and on. Really no matter how good a bedside manner we have or how devoted to the good of our patients, in order to be successful in [00:05:00] medicine, we need to be with a certain level of sympathetic nervous system activation all the time, be in a kind of state of stress, and also override our physical needs and desires. That's all built in.

But the nature of intimacy, whether it's emotional intimacy or sensuality, erotic vitality, pleasure, those require the ease and relaxation and kind of timelessness of parasympathetic activation. It's actually a very interesting observation that when it comes to most systems in the body, when they are aroused, it's due to sympathetic nervous system activity. But when it comes to arousal, sexually and sensually, that's all [00:06:00] parasympathetic. If a man is too stressed, he cannot maintain an erection. If a woman is concerned that the children are about to wake up or that she needs to get enough sleep in order to make lunches the next day, like I could use any example.... All of that works against the kind of ease and relaxation.

I don't know when you wanna start. It depends how super motivated somebody is in college or even high school. It's gonna differ for different people, but it's years and years of that kind of feedback and engagement with ourselves, our bodies, and our tasks and responsibilities. It really is almost like a retraining or mindfulness. There are a lot of different ways that we could describe it. 

And really, it's a very courageous, confronting journey to learn to be [00:07:00] aware of my needs and desires and honor them, and for him to do the same, because of course, being able to just override how we genuinely feel was synergistic because we both had that training and personality. 

Christine Ko: Yeah. To summarize what you so eloquently said, a pattern of medical training and practice is it's high stress, and so we have sympathetic activation, very little time for parasympathetic. We're overactivated by our sympathetic nervous systems, and so that is detrimental to really building intimacy.

Alexandra Stockwell: Yes, exactly. And the thing is that we don't necessarily feel like we're in a high stress state. There are times of more stress and less stress, but it's more that we operate with a baseline, which is far more [00:08:00] stress than we tend to appreciate, unless we're really focused on engaging in activities that require us to lower stress. And so I think all of that is really compounded for physicians. 

And then there are all the usual challenges that any couples have. I wanna bring in another concept that I think is really essential and it's definitely the driving force in my work, which is Uncompromising Intimacy, also the name of my book, which is available on Amazon and Audible. Uncompromising Intimacy. That's really based on my methods. Let me step back and say, far and away, the most common relationship advice that's given is to compromise. If you wanna have a happy marriage, you have to be good at compromise. Compromise is the way to make things work, and that is just summarily false. [00:09:00] If what you want is a bland, pleasant, safe companionship, compromise is a wonderful way to achieve that. But if you want passion and connection and aliveness and fulfillment, and to find your relationship really nourishing and maybe even adventurous, compromise just will not get you there. Being uncompromising will in the way that I mean it. And so I need to say very clearly. I don't mean uncompromising in the sense of being rigid. You always get your own way. That is no better than compromise. I think of compromise as being the phenomenon where I don't share the truth of who I am. I'm not self-expressed because if I share my desires, my dreams, my fears, my challenges, it will be too much. So I withhold it [00:10:00] in order for my partner to be more comfortable. So when I talk about uncompromising intimacy, I'm really talking about learning to feel like yourself, to be your whole self, to be real, to be true, to be transparent, to be vulnerable in a way that your partner can receive it and ideally share equivalently with you. So on the one hand, yes, it's about learning to relax, but it's also learning to be right with who you are and growing in our capacity for self-expression, because we all yearn to feel seen and received. That requires being able to share who we are.

Christine Ko: It does sound like it requires both parties though to be on board, right? 

Alexandra Stockwell: In the best of all possible worlds, yes. But there is so far [00:11:00] that someone can go. I'm assuming listeners are mostly women, so I'll use that example. It's amazing how far a relationship can evolve and improve when just the woman is working on it.  

One of the things that I teach my clients is to cultivate curiosity, because if you think back to the experience of being in love, it is fully saturated with curiosity. What did you major in college? Where is that tattoo from? Where do you wanna live? If you didn't choose this specialty, which are the other ones that would've been appealing? Like just being in love includes this kind of insatiable curiosity to get to know this other person. And then we have the beautiful experience of becoming comfortable with one another and feeling more secure in the relationship. It's a more steady foundation. We can rely on it. And invariably we dial [00:12:00] down our curiosity because it feels nice to be familiar and know what our partner's going to answer. So we stop asking questions, and that comes at a cost because as human beings, especially as physicians, we continue to grow and evolve and have formative experiences. And if we're not bringing our growth and evolution into the marriage, it restricts how connected we can feel. So that is one of the things that I teach almost all clients, to just open up and be curious. Whimsical questions, profound. Anything other than logistics and childcare, and what you're gonna have for dinner tonight, and who's gonna make it?

I am thinking of a client I had. She didn't even wanna tell him that she was coaching with me, which was fine. She really did the work to identify what she wanted and how she wanted [00:13:00] them to be interacting. She ended up getting this deck of cards with questions that she would just keep on her kitchen island. In their family, she cooked dinner, and he came home in time for dinner. She would always pull one or two cards. He never even saw them, but she would just introduce questions. They'd been married 25, 30 years, but they started having conversations that they had never had before. That was the whole purpose of asking the questions, and they both just felt closer. They became more affectionate. 

Christine Ko: Uniquely, maybe something physicians face in their relationships, a challenge, is that we're just so busy. It's a high stress profession. So just opening up to being more curious to your partner is something that can help just revitalize things instead of just talking about the daily tasks that get us through our day.

Alexandra Stockwell: Yeah, that's definitely true. And I think the [00:14:00] thing I would add is that anyone who's a physician has some amount of skill being goal oriented. They know how to make a plan and follow through and how to set priorities. You just don't get to be a successful practicing physician without those skills. When it comes to a marriage, it's unbelievable how much we're willing to tolerate before it becomes a real priority. 

If you're listening, and you take one thing away, what I would want it to be is to give your marriage the same quality of attention that you give the other things that are important in your life. Sometimes just the other things are shouting louder. So we focus on them and the marriage takes a backseat, and other times we don't really know what to do to improve things and so keep our attention away and put it into working [00:15:00] out or hanging out with friends or hobbies with whatever free time we have, because those are gonna be fulfilling. And I think one of the saddest scenarios is when someone wants to improve their marriage, but just really doesn't know how, because there really are a lot of relevant tools and perspectives. Once you really prioritize your marriage, you can have some return on whatever time and attention you invest on it. 

Christine Ko: That's great. So do you think that the caregiver mindset that physicians have, and maybe especially women have once they become mothers, affects physicians' relationships? 

Alexandra Stockwell: I definitely do. The skills that are needed to really thrive and enjoy a marriage are very different ones than the ones we cultivate to be successful in our career or as parents. And that is very confronting because the last thing we wanna feel is not [00:16:00] knowing the answers. We don't wanna feel like interns 15 years into marriage. 

Christine Ko: Yeah. What are the skills that are necessary? 

Alexandra Stockwell: I think curiosity is so important. I think we as women really don't appreciate the impact of our tone, and I'm not saying that we need to be like all soft damsels. I don't believe that at all. I don't think softness is the answer, but we often add pressure to our communications in order to make them happen. And I think just being more relational in our tone rather than directive goes very far in the other person being inspired to take action. And also one of the most important things is to know what we want, because it is very easy, it's human [00:17:00] nature, to be able to know what we don't like, to complain, to feel disappointed, but to actually identify what I want. How I wanna be kissed, how I wanna be spoken to, how I wanna spend my time, how I wanna move forward together. It's just so much easier to know what doesn't work than to actually identify what does work and feel worthy enough to say so without criticizing our partner, but in a way that makes it feel good to give you what you want.

Christine Ko: It sounds like one important practical strategy to maintain or build better connection with a partner is to make sure that you know what you want. 

Alexandra Stockwell: Absolutely. That sounds very easy, but often it's not. [00:18:00] I've had a lot of experience with women who are professionally successful, manage the household, et cetera, et cetera, and they can just rattle off what their kids need, what their office needs, all of that. But not, what do you need? So your to-do list is shorter or empty, but, what do you need that would have you feel joyful? What do you need that would have you feel great to be alive in the body you live in? What do you need that would soothe your heart and give you courage for the challenges that are so severe right now? That is just the rare person who wakes up immediately knowing that without really spending some time considering it, and typically, no one's asking those questions. 

Christine Ko: Life's too busy. 

Alexandra Stockwell: And it doesn't occur to people. 

Christine Ko: Once you figure out what you want, what are [00:19:00] some specific communication techniques that might help you talk about them?

Alexandra Stockwell: The first thing, very basic, but rarely happens, is to tell your partner that you wanna have a conversation and ask if they're available for that conversation. That first step of making the request, not the demand, not just putting it on the agenda, but, I have something vulnerable I wanna share with you, or, I have something important I really want you to know. Are you available to hear it now? And it has to be a real question. Most good men are gonna say yes, but it has to be a real question. So if they say, no, you don't crumple, you just say, okay, when will you be available? And similarly, if it goes the other way, like it's fine to say no, but ideally you make a plan for when it will happen. That's the first thing. 

The second [00:20:00] thing is that it has a much better effect if you start your conversation with why you're sharing it. Let's say, I want more affection in my marriage. If I just start in with that, chances are very high that my husband is either gonna shut down or get defensive or angry in some way. He's gonna take what I'm saying as a criticism that he has somehow failed, he's not good enough, and here she goes again, telling me what's wrong with me, which nobody really wants to hear. So the alternative is to say, I love you so much. I'm so grateful for the life we've built together. I feel really good about this area of our life and this area of our life. I love the vacations we take, and that we're so aligned with financial decisions. You could choose whatever it is, and, there's one area that I'd like to uplevel and bring to the same standard as the things I've just [00:21:00] mentioned, because I think we'll both be much happier. If you say something along those lines customized to what is actually gonna speak to your partner, they are much more likely to hear the exact same communication receptively and gratefully. My main point here is less about the content and more about how you set it up. How you deliver it so that they're inspired, thank you for telling me, rather than, you're not affectionate either.

Another thing which is very subtle, and it's not something to maintain, but from the initial conversation is not actually to ask for any change, but just to share how you feel.

To just recap, it's, I'd like to share something with you. Are you available to hear it? Then you say why you're sharing it so that [00:22:00] you're both aligned and ready to collaborate. And then the third thing is to share your experience, to share how you feel and have problem solving happen another time. It could be another time like five minutes later. It could be another time the next day. But if the two of you go into problem solving too quickly, which you're both inclined to do, then you miss the beauty in sharing how you feel in having that received. It will have you feel more emotionally connected if you're just sharing how you feel. You can even set that up and say, I just wanna tell you how I feel and I want you to hear me. I'm glad to hear if you have feelings you wanna share, and then we'll move on to problem solving. But let's not go there right away. 

Christine Ko: Feelings being, feeling emotionally intelligent enough to be able [00:23:00] to know how you feel and to be able to share it and to be able to recognize even what you feel to name it. Recognize it. Manage it. 

Alexandra Stockwell: Yeah, and what I've described is not venting, it's not dumping, it's not something you say in the heat of the moment. This is something that you really contemplate yourself. Then you give the digested version. And I wanna emphasize that I think with really any high level communication skills, you wanna start with something really benign and unimportant. So you can focus on growing your skills before using them for the thing you really care about the most.

So maybe it's, you do what I've just shared, and then the thing you wanna communicate is that your feelings were hurt about how communication about daycare pickup happened, or who was gonna pay the housekeeper. I'm just [00:24:00] thinking of random things, but..... You do it where the content is just not that big a deal, and when you've had these kinds of conversations enough, then you can bring in wanting more affection or for intimate moments to go a different way than they do. 

Christine Ko: It does sound like this takes time. Even just asking for one conversation, do you have the time to talk about this? Your story about the couple with the cards on the kitchen island, just over time, every day as she's making dinner and her partner comes home, just ask a couple questions, and you just build with time.

Alexandra Stockwell: Yes, it does take time, but I prefer to focus on it taking attention. There are things that can totally improve a marriage that take a second. We have so many [00:25:00] interactions with one another, and we can control the quality of those interactions. The example I like to give is, let's say one of you leaves for work earlier than the next. So let's say if it's me, I could just leave. Because my husband knows I'm gonna be leaving at 6:30, I don't need to communicate. Off I go. Or I could at the door say, bye, sweetheart. I'm heading out. That's fine too. I could go find him wherever he is and give him a peck. Or I could go, take a breath, be in the present moment. Give him, I don't mean like a whole make out, but like just kiss him in a way that it feels like we're connecting with one another where there's actual meaning and it feels like a husband wife moment.

That doesn't take more time. It just takes attention and then head out for the day. And if I do [00:26:00] that and then I come home and he comes home in the evening. We're reconnecting. We're not just connecting for the first time that day. And so there are so many things often in the moments of transition that we can do in a way that expresses care for one another or in a way that focuses on getting onto the next thing.

My husband and I, we staggered our training because we already had two children. So I was at home for a year when he was doing his internship, and when he would say goodbye, it was like, yes, his body was there, but his mind, his attention, he was already in the car and down the street many miles and focused on arriving at the hospital. And I would be like, he's saying goodbye to me. Why do I feel so neglected in this moment? And I started putting attention on the quality of our interactions. Which moments it's gonna be is gonna depend for different people. It could also just be how you text one [00:27:00] another through the day. In sending a practical text, do you add a sweet emoji, or do you keep it a totally practical communication? So these ways that I think of more seasoning rather than the actual dish, that those are ways that do not take more time, but do take attention and a quality of presence that result in feeling beautifully connected without adding anything to the schedule.

Christine Ko: Attention. Attention's hard. It is hard when people are under stress. Like you mentioned before, when your sympathetic nervous system is activated and you're really stressed out, it is hard to give attention to something new. Do you recommend creating boundaries to help protect a relationship from the demands of medicine?

Alexandra Stockwell: That's such an interesting question. I've never been asked that question quite like that. The answer's really gonna be different for each [00:28:00] couple. Ideally it's something they figure out at the beginning of the marriage, but that may not have happened. And so it's just time to figure it out now, and you have to be true to yourself. So if you're someone who's constantly thinking about your patients, then it's gonna be really hard to make those boundaries, but it may be especially necessary.

There are a few different ways to do it. One is to not discuss anything work related in the bedroom, or not discuss anything work related after 9:00 PM. Really this needs to be collaborative. The reason the question is so intricate when it comes to physicians is that I'm not advocating that a physician doesn't share what's impacting them during the day because if you don't share at all, if you have really outstanding boundaries and [00:29:00] protect the family life and protect the marriage, then there's so much of the doctor that can't join the marriage, and you end up feeling really split, and I don't advocate for that. That is a form of compromise as far as I'm concerned, over compartmentalization. So I think there's a dance, and it's really gonna depend on the personalities. It's gonna depend if the partner's a physician also or not.

Christine Ko: You're saying this sort of splitting off isn't really ideal either, and that's in your eyes a compromise, which shouldn't, that wouldn't probably lead to really sharing all of yourself. What would your advice to be to someone who feels that they do have to split that way? That they do have to choose between sort of career and relationship?   

Alexandra Stockwell: I think it's really interesting to think about why. Is that because you think your partner just can't handle what you would [00:30:00] share? Is it because you just don't wanna deal with how your partner responds, that it's not gonna be what you need? Is it because if I started really opening up, I would just be swallowed and I'd never be functional again. One of the most important things is to know you can titrate opening up. You don't even think you're holding it in, but when you start thinking what if I did share what it's like for me every day? That it's like the dam will burst and there's no coming back. That's actually not true. We have the capacity to titrate. 

Think about what kind of response do you want when you share. Give your partner the manual so that it can be a win-win for both of you. Think about what the purpose of sharing is. You wanna think about what kind of response do you want. So maybe [00:31:00] you say, I wanna tell you about my day and I just want you to gimme a hug. Or maybe, I wanna tell you about my day and then hear if you have any suggestions. Or, I wanna tell you about my day, and then I don't wanna discuss anything after that. And, I wanna watch Netflix and eat ice cream. There's no wrong way. Yeah. But if you don't say what you want, your partner is very unlikely to get it right. Unless you've been sharing regularly and the two of you have really learned the winning dance. 

Christine Ko: To go back to something we were talking about earlier, it might be hard for you to know what you want though, right? Whether you want to hug, whether you want some advice, whether you want to just eat ice cream after you share. It takes some reflection on your part to figure that out. 

Alexandra Stockwell: Yes. Although I [00:32:00] trust any woman physician to have the insight to say, I'm not really sure what I want, so could you give me a hug and then next time I'll know if that's what I wanted. Or, if you have an amazing partner, you could say, I'm not really sure what I'm gonna want afterwards. Do you have any idea? And maybe they don't. Yeah. More likely they don't. But they could. They could.

Christine Ko: Yeah, I think that's beautiful. I'm not really sure, maybe start with a hug or do you have ideas? That's nice. 

Alexandra Stockwell: Yeah. I think that a lot of relationship success is built on not feeling like an expert no matter how long you've been married. There's not really expertise in being married. I sometimes laugh at how so many things, when you do it over and over, you become more skilled. But when it comes to sex or communication with a spouse, we can do it, [00:33:00] 300 times and then it starts to get worse, so it's a little bit different, or 3000 times, like whatever it is. But the point is being a researcher, like really investigating, let me try this and see what happens. Let's see how I feel, let's see how my partner feels, and let's discuss it. Okay. That worked amazingly, but let's tweak this in how we do it next time. Maybe next time we each, I don't know, work out and then we have the conversation, or let's do it over a bottle of wine watching the sunset. Maybe that would be conducive to the conversation or maybe it's after the children are in bed and everything is set for the next day and we're lying in bed under the covers, that's when you have the conversation. There's no formula. It's really more flexibility, insight, and having a [00:34:00] researcher's attitude about what's gonna have you feel good and your partner and the two of you feeling good together. 

Christine Ko: Yeah. It also comes back to what you said in the very beginning. That researcher mindset is about being curious. What's gonna work for me? What's gonna work for you? What's gonna work for both of us together? And experiment and figure out was that really right? Was it what? What could be better? That was perfect or not. Do you have any final thoughts? 

Alexandra Stockwell: Yes. Having a fantastic relationship is a learnable skill. No matter how long your relationship has been, if you want it to be better, if you want to feel more nourished and fulfilled, it's not about finding a different person. I'm talking about when things are, at minimum, good enough. Or even quite good. If you want better, it's just about learning how to create that. And I think in our [00:35:00] society there's just not enough models or memes or vulnerable truth about how good it really can be if we're willing to be lifelong students in our marriages. 

Christine Ko: Yeah. I like that. Thank you so much for your time and all your insights.

Alexandra Stockwell: I appreciate your questions and conversations. Thank you.