Lack of sexual intimacy invites a back-to-back relationship.
A recent study asked marriage therapists how often they asked the couples with whom they worked about their sex lives, and how extensively they encouraged to couple to focus on sexual issues in their treatment sessions.
Surprisingly few therapists inquired in detail about the frequency and satisfaction levels of sexual intercourse, or focused routinely on sexual issues during treatment. That fact in itself is problematic, particularly given the results of the 2011 report from the National Marriage Project in which happily married couples ranked sex right up there with communication, commitment and generosity as top factors in their marital satisfaction.
Even more problematic was the revelation of gender differences among therapists. Male marriage counselors more often encouraged discussion of sexual issues. Women marriage counselors focused on sexual functioning significantly less. Since the majority of marriage therapists are women, that means that most couples’ therapists do not sufficiently explore this essential aspect of marital functioning.
The relevance of this trend hit me personally when I recently published a blogpost on how to determine the effectiveness of a marriage therapy. A woman named Cynthia wrote a Comment asking why I had not included the therapist’s encouragement of discussion about sexual issues in my set of questions.
“Woops!” I realized regretfully. “I’m personally making the mistake on this questionaire that women therapists in general seem to make with clients.”
Adding to my blogpost a question on how much a therapist attends to sexual issues in the marriage treatment was easy. The harder part for me in responding to Cynthia’s question was answering the Why. Why had I omitted a question on sexual issues in my initial posting?
For sure the omission was inadvertent, not on purpose. I totally endorse the importance addressing sexual functioning in marriage therapy. The omission was an error.
In my own clinical work I include questions about sexual functioning in the initial paperwork couples fill out prior to their first session. If there are any indications of sexual difficulties, my routine is to ask for more details and address the difficulties early in treatment.
So here’s some speculations on possible sources of my inadvertent omission.
Embarrassment Discomfort about talking publicly about a private issue like sex could hold a therapist back from detailed questioning.
Personally, I’m long past that. Having been a therapist for over thirty-five years, married for over forty years, and a gramma many times over I feel pretty immune from discomfort about discussing sexual issues with clients.
Actually, talking about deeply personal issues with clients is what a therapist does all day every working day. In this regard sexual topics are not all that different, though perhaps more conventionally regarded as private, than much of what we routinely discuss in treatment. Again, the squeamishness dimension, for me at least, is not the cause of my not having included a question on talking about sex in my therapist evaluation suggestions.
Sex-therapy skill-set insufficiencies Uncertainty about what to do to ameliorate sexual difficulties could be a second reason why marriage therapists tend to give sexual issues short shrift.
I’m sure that for many therapists this is a very real factor. Sexual therapy tends to be regarded as a therapy specialty area. Sex and marriage therapist Barry McCarthy notes this reality in his excellent 2008 Journal of Contemporary Psychotherapy article on this subject called “Integrating Sex Therapy Interventions with Couple Therapy.”
McCarthy explains that the couple counseling and sexual counseling fields have grown up as separate disciplines, each with their own techniques, their own training programs, and their own conferences and journals for sharing new developments in the field. It’s no wonder therefore that many marriage therapists may feel insecure addressing sexual problems because of feeling insufficiently equipped with the necessary skill sets.
In addition, too few therapists have been trained in the kinds of EMDR and energy therapy treatment techniques that can undo the impacts of earlier sexual trauma. In fact, I’m not so sure that sex therapists have these skills either.
Thinking back on recent cases of low or zero desire that I’ve treated, these newer energy therapy methods have been key to the successful outcomes. In one case, for instance, one husband felt unable to interact sexually with his wife. He needed to be able to track back to the incident that long ago had occurred between them for which he was subconsciously punishing her by withholding sexual attention. In addition, the energy psychology intervention called The Emotion Code identified and released the trapped negative emotion from an earlier incident in his life that had undermined his sexual confidence.
Conflict resolution skill-set deficits The most common cause of sexual difficulties in the couples I’ve treated in my clincial practice have been practical conflicts, usually about sexual frequency.
Left untreated frequency conflicts can, over time, yield ever-wider rifts between the couple, posing a risk for all-or-nothing polarization. When one spouse begins feeling that their partner wants sex all the time, he or she may eliminate touching or hugging and even smiles for fear that any [positive contact will release the partner’s perpetual urge for copulation. Meanwhile the other spouse begins to believe that his or her partner never is willing to participate in sex.
Yet if, for instance, one spouse prefers daily intercourse and the other’s preference is something closer to weekly, this is a resolvable conflict. Most couples, with a therapist’s help, can explore their underlying concerns and end up with an action plan that works for both of them.
Unfortunately, too few therapists are skilled in win-win conflict resolution strategies. Many marriage therapists, alas, lack sufficient conflict resolution skills training to succeed in helping couples talk cooperatively until they find mutually agreeable solutions to their sexual differences.
Therapist training programs probably need to shoulder at least a piece of the responsibility for insufficient therapist attention to sexual matters. Treatment of sexual difficulties needs to be moved up further toward the top of the list of skills that graduate schools teach counselors-in-training. More explicit training in dealing with sexual difficulties could add to changes in how regularly therapists address sexual issues in marriage treatments.
Assessment techniques Barry McCarthy suggests particularly helpful questions that it would behoove therapists to ask in their initial assessment sessions with a new couple. In what ways do you view your sexual relationship as a strength in your relationship? As a source of disappointment or difficulties? When in your marriage has your sexual acitivity been the most positive? When has it been problematic?
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