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What Happens in Sex Therapy?

by | Apr 17, 2023 | Blog, Communication, Connection, Love, Relationships, Sex Therapy

 Feeling ambivalent about sex therapy? 

When a couple comes in for sex therapy, I can feel their combined energy of eagerness and hesitation. On the one hand, you’ve finally decided to get help for a sexual concern. You did your research to find a qualified therapist, scheduled the appointment, and have arrived at your first session.

Time to find solutions, right?

On the other hand, your sex life is often a private topic. You’re meeting with a stranger. You’re about to talk about deeply personal issues. “Putting it all out there” can feel uncomfortable, risky, and difficult. You may not want to hurt your partner’s feelings or perhaps you don’t want to be seen as “the problem” partner. 

In the early stages of sex therapy, I like to focus on building a relationship with the couple and with each partner individually. Sure, I ask questions about your sex life, but I also step beyond that to learn about you as a whole person. Our conversations touch on a wide variety of life experiences, not just sex.

Why? Sex doesn’t sit in a vacuum by itself. Many of your life experiences influence your sexual expression or lack of expression. All of your life domains intersect and influence each other.

What Do We Talk About First?

Within the first four or five sessions, we typically cover an overview of your current relationship story, including a full relationship history to help clarify how you’ve arrived at where you are today. 

We also talk about your career, parenting (if applicable), your medical history, mental health struggles, stress management and how you handle your emotions, the family you grew up with, physical health, traumas, losses, adjustments, and of course, your sex life. 

The Early Sessions

When we focus on your sex life, we’ll explore the quality and frequency of sex, any dysfunctions, anxieties, worries or pain associated with sex, along with your history of sexual desire, arousal, and pleasure. We’ll explore when in life you feel most relaxed and how you feel when you take time to focus on your body. 

Some of this conversation happens within a couples therapy format. I also schedule a few individual sessions with each person to help me connect with each partner separately and apart from the context of the relationship. 

Ultimately, while one partner may become the designated “patient”, the relationship as a whole is my client. Any suggestions or feedback that I offer, even when it’s directed toward one partner or the other, is in support of creating a healthy, vibrant relationship. 

Laying the Groundwork for Deeper Conversations

While you may want to jump right in to find quick solutions to your problems, sex therapy doesn’t typically unfold that way. 

According to John Gottman, Ph.D., couples will sit with their problem for an average of five years before they decide to reach out for help through couples therapy. While I don’t have the research on how long it takes couples to reach out specifically for sex therapy, I imagine it would be even longer due to the sensitivity of the topic. 

Since the problems don’t typically just arrive overnight but build over time, the process of healing or finding resolve takes at least 10 sessions to feel a shift. Even if a breakthrough happens quickly, sustaining sexual health and wellness takes time and repeated practice.

Creating the Right Pace

Since most couples experience both an eagerness and a hesitation to resolve their sexual issues, the pace of the work matters. Move too fast, and it will overwhelm you. Move too slowly, and you’ll feel like you’re not making progress. A good, productive sex therapy experience requires us to find the sweet spot that generates progress but also feels manageable. 

Important Questions in Sex Therapy

Early on, I love to explore what may seem like “basic” questions/answers about sex with couples. These questions often give couples pause because they’re the types of questions most folks don’t really think about when it comes to sex.

The first question is: What is sex?

Seems obvious, I know. But seriously, when you say, “We had sex” or “We’re not having sex,” what exactly are you referring to? Think about how you might answer that question before reading further.

Most heterosexual, cisgender couples say that sex is intercourse. 

Then I ask, does that include orgasm?

Most people say yes.

Then I ask, for both partners? One partner? If the other partner didn’t orgasm during intercourse, did sex happen?

Now the conversation gets more interesting. The pause and the uncertainty set in. 

These questions open up an interesting conversation about sex, how you define it, what qualifies as sex, and how that definition shapes your sexual desire and experience.

My Favorite Follow-Up Question in Sex Therapy

After we explore what sex is, how each partner defines it, and consider how their definitions influence each partner’s desire for sex, we then deepen the conversation. 

My follow-up question is: Why do you have sex? 

Again, this may seem obvious, but I guarantee that most people have never actually thought about it. Most partners default into the action of having sex (according to their definition) without considering why they do it. 

Some answers might include: 

  • Because it feels good
  • For closeness
  • For a release
  • Because I’m supposed to

Why do people, in general, have sex?

Then we look beyond the couple’s reason, and I’ll ask: Why do people, in general, have sex? What are the many reasons someone might have sex?

Some couples will list the very same reasons as their own and not move beyond that. In that case, I help them out by offering some ideas. Other couples may add reasons for having sex that go beyond their own motives.

Some of these can include:

  • Stress relief
  • For fun
  • To feel powerful
  • To feel desired

I might add some additional ideas, such as:

  • For revenge
  • To feel loved
  • To feel attractive
  • For spiritual enlightenment
  • For money
  • To feel valuable
  • To manipulate
  • For comfort
  • Out of boredom

This exercise helps couples learn and understand that sex with another person is a complex experience. It has many sides, outcomes, and functions. One partner’s definition of sex may not match the other’s. One partner’s “why” may be different from their beloved’s. 

When Your Sexual Motives Differ

If one partner uses sex as a stress release, but the other partner uses sex to feel connected, the mismatched energy and motive is felt. The partner who uses sex as a stress release may not be very focused on making the kind of connection their partner wants. This difference can shut sex down completely in a relationship.

In sex therapy, the solution is not a matter of finding a way to “just do it”. Sex is an existential experience. Meaning-making is an important part of the work to help create healthy, consensual sexual expression and engagement. 

Setting the Stage for Deeper Work

These preliminary conversations create a backdrop for you to explore your own motives, values, and reasons for wanting or not wanting sex. 

It creates the foundation to address longstanding concerns such as sexual desire differences, sex after having a baby, sex after a diagnosis, performance issues, or sexual pain.

As sex therapy unfolds over several weeks, I’ll often refer back to your “what” and “why”. These ideas may evolve as therapy progresses, with their “what” and “why” changing.

Your sex life is not a static experience.  It’s dynamic and changes over the relationship lifespan. That means that your “what,” and your “why” needs to have some flexibility to support change, as well as room to grow. 

In Summary

These seemingly “basic” conversations create a gentle entry into the private lives of a couple’s sex life. It helps establish a safe environment to explore the complex and nuanced topic of sex. 

The work focuses on a combination of therapeutic conversations, sexual re-education, sexual communication practices, healing of erotic wounds, and exercises for home practice. This combination focuses specifically on the couple’s unique goals. 

Over time, the hesitation that once accompanied the eagerness lessens as the couple begins to develop a richer understanding of their sexual selves and their sexual relationship. 

They typically gain confidence in themselves as sexual beings and clarity in their sexual and relational needs. They strengthen sexual communication and find a way to honor each other and the relationship as a whole. 

 

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Why Couples Can’t Communicate

by | Feb 10, 2023 | Blog, Communication, Connection, Love, Marriage Survival, Relationships, Soulful and Mindful

We Can’t Communicate

No matter what issue couples present in therapy, 97% of them will cite communication as a core problem in their relationship.

In a recent post, I shared that the #1 predictor of divorce is a lack of love.

When the “in love” phase of your new relationship energy slows down and brain chemicals like norepinephrine, dopamine, and endorphins decrease, you can find yourselves suddenly bickering or not seeing eye to eye on issues that never bothered you before.

Your communication styles break down.

You react instead of respond, lose sight of the good in your mate and create emotional wounds.

When you stop caring, stop expressing your feelings, and no longer hold each other in high regard, you live in a love-less state.

You literally love less.

Your Intimacy Dance

This often shows up in what you say or don’t say, in your eye contact or lack of, facial expressions, breath patterns and tone of voice.

In couples therapy, we help couples see their unique intimacy dance and how it affects their ability to love.

This includes learning about who tends to lead, follow, control, be aggressive or passive, pursue or distance, shut down, withdraw and so much more.

In fact, this chart highlights skills we help couples avoid along with teaching them what they can do instead to help make their intimacy dance more fluid, connected, and loving.

10 Communication Skills for Couples

Conduct an honest assessment on yourself.

Mark the behaviors on the left-hand side that you know you might do and practice the suggested behavioral changes on the right.

10 Communication Skills for Couples 

Healthy intimacy requires strong communication skills.

As you can see from the chart above, the skills are not mysterious or complicated.

They’re not vague or abstract.

They are concrete, tangible, do-able behaviors that you can start to practice right away.

Remember, a series of small right actions can heal emotional wounds and course-correct most relationships.

Far too many couples fail to learn basic skills that can transform their relationship.

With simple behavioral changes, you can stop hurting each other and start to feel alive and happy again.

Good communication skills help you create high levels of relationship clarity, connection and satisfaction.

What resources do you use to help you be a strong, clear communicator? What skills do you use to tune in and listen well?

How do you remember to practice “loving”, consistently?

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#connection

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#understanding partner differences

What to do if You and Your Partner Have Different Sex Drives

by | Feb 8, 2023 | Blog, Communication, Connection, Love, Marriage Survival, Relationships, Soulful and Mindful

Different Sex Drives

Have you ever said any of the following? 🗣
  • I have no desire
  • My partner has a low sex drive
  • My partner’s drive is much higher than mine
  • I never want to have sex
Unfortunately, today’s media pigeonholes the partner with the “lower” sex drive as dysfunctional. Couples seek out therapy wanting to “fix” the person with the “lower” drive. But the idea of “fixing” can actually further that person’s sense of feeling like a non-sexual person.

Mismatched Desire

What if I told you that when it comes to mismatched desire, no one needs to be “fixed”? Let me break down the latest research on understanding libido to help you better understand your personal sex drive and that of your partner.

What We Used to Believe 📖

For many decades, we thought that you needed desire to have sex.

The model looked something like this:

Desire → Arousal → Climax → Rest

Desire leads to arousal, which leads to climax. Then the body returns to a state of rest. So, according to this model, if you don’t have desire, you can’t become aroused, yadayadayada… And thanks to the pioneering work and research of Emily Nagoski, Ph.D. who wrote the book Come As You Are, we now have research that helps us better understand how desires differ and why. As I break this down for you, think about how desire shows up for you. Think about your partner. Think about the areas that you feel stuck, hurt, confused and frustrated with desire and sex.

What We Believe Now 🧠

Nagoski’s work shows us that there isn’t just one kind of desire. It’s not a situation where you either have it or you don’t. Desire varies from men to women and it varies within gender as well. In her research, she identified 3 types of desire: Spontaneous, Responsive and Contextual. Let’s look at each one and see which applies to you.

Three Types of Sexual Desire ⭐️

Spontaneous desire means that desire shows up instantaneously. Seventy-five percent of men experience spontaneous desire, 25% of men don’t. Only 15% of women experience instant desire, whereas 85% of women don’t. Look at those statistics again. They’re important. In this description, spontaneous = instant. Sex is merely mentioned or initiated, and desire instantly shows up, ready to go. Responsive Desire means exactly how it sounds. This refers to desire that grows in response to some form of stimulation. When something sexy happens, desire grows. Five percent of men and 30% of women experience responsive desire. So, if you don’t necessarily initiate sex or think much about it, but tend to respond to your partner’s advances, you may have responsive desire. Contextual Desire means that sexual desire is dependent on the circumstances and the environment. Even if you feel stimulated, if the circumstances and the environment don’t work for you, your desire cannot fully show up. This might help explain why you lack desire when the kids are sleeping in the next room, you had a hard day at work or you feel tired. For you, context is everything. Nagoski found that most people, regardless of gender, fall within a blend of responsive and contextual desire, but for some, desire can feel spontaneous, even though it may not be. They may not realize that the other factors all fell into place in order for their desire to show up “instantaneously”.

Sexual Desire and You 💫

We typically love sharing this information in our couples therapy sessions because it generates so many A-HA! reactions. Finally, couples can begin to make sense of their experience and better understand each other. Information like this helps the “lower desire” partner remember that they are capable of desire, lust and erotic expression. It also helps the “spontaneous” desire partner depersonalize the perceived lack of desire in that partner. It makes room for us to consider that there is no “right” or “wrong” way to experience desire.

It’s just different for everybody.

So often, as we’ve evolved from being pre-adolescents to teens to adults, we didn’t get the right information about sex. No one really taught us. We grew into our adult bodies and entered adult romantic relationships lacking critical information! One of the joys of being a relationship and sex therapist is that we get to set the record straight. You’re never too old and it’s never too late to get solid, clear, accurate sex education. So which types of desire do you and your partner experience? Love starts with you. ❤️

Are You at Risk of a Spiritual Divorce?

by | Feb 6, 2023 | Blog, Communication, Connection, Love, Marriage Survival, Relationships, Soulful and Mindful

 The Spiritual Divorce

Unfortunately, many couples experience divorce before they actually formally divorce.  

Divorce is often the result of a silent separation that happens over many years. It creeps in slowly and quietly. No specific trauma required. 

In fact, it can happen when couples don’t practice the most fundamental aspects of loving:

  • Intimacy – genuine care for the welfare of the other, mutually sharing thoughts and feelings, being supportive, practicing empathy
  • Passion – demonstrating attraction, desire and physical connection through affection and sexual exchanges
  • Commitment – attending to the relationship in a conscious, mindful way on a consistent basis

It all comes back to this article where we learned about Sternberg’s Triangular Theory of Love. 

Sternberg Theory of Love

Are You in a Spiritual Divorce?

In her book, Learning to Love Yourself, author Sharon Wegscheider-Cruse offers the following symptoms as signs that you may be in a spiritual divorce:

  • Habitual sadness in the couple – low energy
  • Mutual sentiments of boredom and emptiness
  • Indifference to each other’s problems or dreams
  • Frequent coldness or avoidance in sexual encounters
  • Lack of small courtesies and politeness
  • Climate of mutual distrust
  • More confidence in someone outside the relationship than with each other
  • Communication routine and superficial
  • Frequent feelings of being alone or misunderstood
  • Insults and sarcasm and a discomfort with healthy anger
  • Much avoidance and little confrontation
  • Overbusy and chaotic social or professional life
  • Loss of capacity for play and joy
  • An atmosphere of the “violence of silence” in the home

Notice how many behaviors from this list tie right back to the Triangular Theory of Love.

Passivity, Disengagement and Loss of Interest

What stands out to me in the spiritual divorce is not so much what’s done but what’s not done. This list reflects a couple that has lost interest in each other, who engage passively, lack meaningful dialogue or experiences, live parallel lives, avoid each other and feel lonely even though they share a life together.

In modern love, it’s easy for this to happen, even to couples that were once incredibly close.

Modern-day couples live with unprecedented demands, especially in today’s climate of managing life during a global pandemic along with our charged political climate.

Even in moments where you might feel like you can relax, these issues sit beneath the surface. They’re with you on every shopping trip, school drop-off, family event, work engagement and social media feed.

It’s hard for our bodies and minds to drop into real relaxation. It’s hard to have the energy to be interested in your partner’s day. Life feels hard right now.

If You Find Yourself in a Spiritual Divorce

If you’ve read the list above and can check many of the statements, please don’t panic. You can find your way back to a more connected, loving relationship. It’s not too late. 

Here’s a great exercise to try with your partner.

Time Machine

  • Set aside an hour on a Friday or Saturday night
  • Make tea or cocktails with a snack
  • Start to go back in time and remember when you first met
  • Talk about that day/night
    • Who approached who?
    • What attracted you to each other?
    • What was your first date like? First kiss?
    • What felt fun and light back then?
    • What individual hobbies were you into? 
    • How did you like to spend your time as a couple?
  • As you go back in time, notice how it feels to remember. What do you miss?
  • What are the qualities that you want to bring back to your life now?
  • What matters to you most?
  • How can you make some changes?
  • What are you both willing to commit to?
  • Hug often as the night unfolds

You Can Reset and Restart

Finding your groove again as a couple doesn’t always have to require grand gestures. You don’t have to take a vacation somewhere to find each other, although vacations are certainly nice.

Sometimes, a few meaningful conversations can get the ball rolling. But talk isn’t enough. 

You have to follow through with action. 

What actions can you put into place (remember, small and meaningful go a long way) to start to bridge a divide that might have been growing between you?

What behaviors are you willing to shift to prevent a spiritual divorce?

 

What to do if You’re Falling Out of Love with Your Partner

by | Feb 5, 2023 | Blog, Communication, Connection, Love, Marriage Survival, Relationships

Have you ever worried about falling “out of love”?

Partners will tell us, “I’m just not ‘in love’ anymore”. 

In love. Out of love.

Do these phrases simplify our complex human experience? Do they influence our perspective of love to be all or nothing? You either feel it or you don’t, and by the way, it’s temporary…?

Current research tells us that a predictor for divorce is not infidelity, lack of romance, financial stress, or co-parenting differences.

It’s a lack of love. 

Yes, life happens. But conflict between partners arises when they decrease their emotional expression and intimacy, positive regard for each other and demonstrations of caring. Couples can live in that love-less state for years.

Research from the Gottman Institute shows us that on average, couples will wait at least five years before they reach out to a relationship therapist for help. 

In the words of playwright Jean Giraudoux, “If two people who love each other let a single instant wedge itself between them, it grows – it becomes a month, a year, a century; it becomes too late.”

So what does it take for a couple to achieve and sustain love for the long haul?

Lucky for us, research shows us specific ways we can make our love sustainable.

“In Love” vs. “Loving”

On our website, we refer to, what most couples call “in love”, as, “the honeymoon phase” of your relationship.

It refers to a common experience during the early dating process where you may have felt lots of excitement about your partner. Sex may have happened often and felt passionate. 

In the book, A General Theory of Love, authors, Lewis, Amini and Lannon, distinguish between the honeymoon experience of being “in love” and the experience of “loving”. 

graphic of a suitcase and the honeymoon phase

They note that being “in love” conjures up the memory of the energy and excitement of a couple’s first meeting and early courtship. In that phase, two people achieve instant attraction and passionate sex, often while barely knowing each other. 

They also highlight that our culture values an “in love” status. Books, magazines, movies and media cast images of being “in love” without acknowledging the work involved to maintain that high state of arousal. 

The authors show us that the “in love” state shown in the media is merely an entry point to the long-term experience of “loving”… if one chooses. 

Further, they explain that “loving” involves “synchronous attunement and modulation”, and requires the investment of time to really know each other. Synchronous means “in person, in real-time”. Modulation refers to adjustment and regulation.

In our take-a-pill, fast-food, high-speed internet, instant messaging culture, “in person, in real-time” experiences become less prioritized. Instant reactivity seems to supercede self-regulation and adjustment.

We expect connection and intimacy to happen quickly or through digital emoji hearts. We are not encouraged to “make time for and attune” to our partners. As the authors put it, we’re encouraged to “achieve, not attach”. 

Lewis Amini and Lannon added, “If somebody must jettison a part of life, time with a mate should be last on the list…”

So we know that being “in love” captures an entry point and that loving occurs over time, in multiple, real-time, in person, interactions. It requires us to know the depths of our partners and ourselves. 

But what about the sex? 

Graphic of Sternberg's Triangular Theory of Love

Sternberg’s Triangular Theory of Love

Now that we can distinguish between being “in love” and “loving”, let’s explore how to actually achieve a “loving” state in relationships. 

Some of the foundational work that we do in couples and sex therapy is based upon the research of Robert Sternberg. As a psychologist and social scientist, Sternberg gave us the model of the Triangular Theory of Love.

It is based on the image of a triangle and each corner includes one of the core components of loving relationships. 

In fact, our Intimacy Breakthrough course for couples weaves these principles throughout the lesson modules, focused on strengthening your emotional, physical and sexual intimacy.

Let’s explore Sternberg’s three components and how you can apply them. 

Three Components to Sternberg’s Triangular Theory of Love

Sternberg helped us understand that a relationship’s success is not based on one aspect of relating. It’s the combination of different components that make up the whole of how we love. 

There may be times when one component feels stronger than another. His work helps us understand that love fluctuates. He also showed us there are different types of love shared between couples throughout the course of their relationship. 

Intimacy

Sternberg placed intimacy at the top of the triangle. To Sternberg, intimacy meant the close bonds partners might share with each other. It reflects how interested they are in each other, how they show respect to each other, caring for the welfare of the other and in general, contributing to their partner’s happiness.

Consider your own relationship: How do you and your partner practice intimacy as defined above? How well do you communicate your ideas and feelings? Do you hold each other in high regard? Do you value each other? How warm do you feel around each other? 

Passion

To the left of the triangle, Sternberg placed passion. He said that passion is an important component in the beginning of relationships because it reflects strong feelings of desire, attraction and love. Initially, it contributes to the motivation for loving. It combines romance, physical attraction and sex.

Consider your own relationship: How do you and your partner demonstrate romance? How special does your partner make you feel? How might you rate the quality of your sex life on a scale of 1-10, 10 being full satisfaction? How sexy and desired do you feel?

Commitment

To the right side of the triangle is commitment. Commitment refers to a couple’s decision to be together, and in the long term, to the maintenance of their love. It refers to choice. Choice is not limited to a one-time decision in the beginning. It’s a daily exercise of not only choosing your partner, but also of maintaining your love, through thick and thin. 

Consider your own relationship: What do you do on a daily, weekly or monthly basis that helps you maintain the love of your relationship? Be careful not to only name the ways you manage life together. Focus on how you behaviorally show your partner that you commit to your love.

Apply This to Your Relationship

The experience of life-long loving, as shown in the Triangular Theory of Love, helps us understand that a healthy relationship cannot succeed on just any one component of the triangle. Even further, we can see that when all areas are strong, the whole is greater than the sum of it’s parts. 

Naturally, as you ride the ebb and flow of your relationship, there will be times when some components feel stronger than others. There will also be times when the strength of one component will increase the strength of another. And vice versa. They’re interconnected.

Sternberg wrote that when all three components are strong, couples achieve, what he calls consummate love. In consummate love, couples feel happier together than apart, work through conflict with grace, delight in each other’s stories and enjoy a healthy sex life. 

We believe that many couples can experience consummate love throughout the lifetime of their relationship but not as a constant state of existence. All relationships ebb and flow. For those couples who worry about any component of the triangle, well, there’s resources that can help greatly improve all three areas. 

When couples take our Intimacy Breakthrough course for couples, they get closer to consummate love. They learn to make time for their relationship (commitment), strengthen communication, positive regard, empathy, affection (intimacy) and find their spark through sexual connection (passion). 

Consider the questions above, below each component of the triangle. Check-in with yourself. Be honest.

Where can you improve on your loving? What tools do you need to help you do it?

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