Working with Sexual Problems in Intimate Relationships

Why do people come for therapy?

Sexual problems in intimate relationships?

With intimate relationships there is an assumption that they are relationships within which sex plays a part. Not all people want or need a sexual relationship and they can still have intimate elationships. For the purposes of this page I am considering those intimate relationships within which the sexual component is causing problems.

What kind of problems?

One could distinguish between individual sexual problems (like unreliable erection, or pain during penetration) which affect the relationship, and relationship issues which affect the sex (like desire discrepancy and communication). One could also consider social conditioning (like attitudes to sex and the influence of porn) or spiritual issues (like the meaning made of sex and the importance of love to the sex). In my view, in practice, it’s difficult to untangle these components which are often interdependent, hence the Bio-Psycho-Spiritual-Social frame mentioned earlier. Each relationship and its problems are unique, so rather than suggest that there are ready made solutions, I have listed some approaches that have been shown to have beneficial results and can therefore form a therapeutic start.

Redefining touching

Sex, in its many manifestations, usually involves physical touching. This is often not a subject that is freely discussed and most of us are left to figure it out from experience, media and peers. This can lead to gaps in our awareness and misunderstandings. We may be under the influence of the societal conceit that we should know all about it and the concern that our partners probably do. This can impede communication, both about what we would prefer and what our partners would prefer.
There are a number of ‘touch’ programmes that go back to the basics of sensation. These are used primarily to throw light on what is really going on in our interactions, rather than from a ‘technique teaching’ perspective. Some examples are Sensate Focus programmes and David Schnarch’s guided hugging, gazing and touching schemes.

Redefining relating

The quality of the relationship can have an impact on the quality of the sex life and how the difficulties are perceived and approached. Because of the vulnerability people can feel around exposing the complex totality of their sexual selves, communication of issues can be fraught or avoided. There are a number of useful questionnaires and workbooks which can help to throw light on people’s sexual scripts as well as open up the space to include dimensions they may not have considered. Some examples are Pat Love’s ‘Sexy Body/Sexy Brain’ questionnaire, and the workbook ‘Make your own Sex Manual’ produced by Meg-John Barker and Justin Hancock.

Redefining ‘meaning making’ around sex

The largest sex organ in the human body is the brain! As David Schnarch points out there are only so many ways to juxtapose sets of genitals, but where we can go in our minds is infinite. People may not realise the ‘meaning making’ they are doing around sex and they can almost always expand it. Sometimes the ‘meaning making’ can be restricting and simply becoming aware of it can be freeing.
There are many useful resources to assist in this area. There’s a workbook ‘Understanding your Erotic Fantasies’ again by Meg-John Barker and Justin Hancock, Gina Ogden’s Four Dimensional Wheel of Sexual Experience, and much published information on Tantra exercises

Redefining understanding about sex

Thankfully there are great educational resources to help people find out what they have not been taught and what they have been taught wrongly. Porn is not a guidebook for a long term sex life. There are wonderful explanatory concepts set out in Imago theory and David Schnarch’s theory of differentiation. A therapist can help clients become aware of their assumptions and offer new avenues of insight.

Many more resources

Here are some links to people who offer teachings and insights into this complex area: Brené Brown, David Schnarch, Diana Richardson, Esther Perel, Gay & Katie Hendricks, Gina Ogden, Harville HendrixHedy Schleifer, John and Julie Gottman, John Gray, Judith Mank, Karen Gurney, Marilyn York, Mark Gungor, Meg-John Barker, Michele Weiner Davis, Neil Sattin, Nina Dølvik Brochmann & Ellen Støkken Dahl, Patricia Love, Stan Tatkin, and Terry Real.

This is just a selection and you may like some and find others less engaging, but they all have much wisdom to share and each link is just a start. If you watch most of them then YouTube’s algorithm will help you find many more in this field.

Here’s a great example of the excellent resources available – 6 minutes

Why do people come for therapy?

And by the way, you don't need to wait for a crisis.

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