Sex on the Therapy Couch: Working with Sex in the Therapeutic Relationship

SEX ON THE THERAPY COUCH:
Working with sex in the therapeutic
relationship
© Stephanie Jeans 2013
www.indabacounselling.co.uk

“The study of sex is
the study of the
beginning of all life,
and science holds
the key, and yet we
sit huddled in the
dark like prudish
cavemen filled with
shame and guilt,
and the truth is,
nobody
understands sex.”
Masters, 1956

“It’s a pity that sex is such a dirty little word.”
- D. H. Lawrence
• Whether we love it or loathe it, we can’t escape
fact that we were created by it, came out of it,
indulge in it and it’s on our minds, for better or
worse.
• Sex is a topic of conversation between the sexes
for titillation, entertainment, for something
seriously educational and for something personally
intimate.
• It may be overtly public or deeply private, but sex
is always on and in the mind.

• Despite a seemingly liberated culture, there is still
much shame, stereotyping and ignorance
surrounding sexual issues.
• This can be true of the counsellor as not all training
exposes trainees to sexual issues and to exploring
their own sexuality and prejudices.
• As therapists we must notice our values and
assumptions; develop an understanding and
perspective of our sexuality as a vital force in ours
and clients lives.

• We cannot easily apply the label ‘normal’ to
sexuality. Does that mean ‘usual’, ‘ordinary’,
‘natural’, as it ‘ought to be’ or what an expert claims
it ‘should be?’
• Perhaps it’s what someone thinks or feels is normal
and anything different is a perversion, deviation, or
abnormal.
• Sexologists may see some things as ‘abnormal’ e.g.
obsessive cleansing of genitals.

• Mind-sets inherited
from family, both
spoken and
unconscious
• Culture, incorporating
myths & taboos
• Peers
Our Attitude to Sex is Influenced By:

• Attitudes inherited from childhood, or out of
ignorance can cause unnecessary misery.
• When you are bringing up a child, you are
potentially raising a future husband/wife/partner.
• We take responsibility for bodies (food etc.) &
minds (education etc.), why not sexual
development too?

• Theorised that the ability to give or receive intimacy
& to desire ‘the other’ has basis in early attachment
with primary caregiver.
• Early experiences of closeness, touch, and learning
emotional regulation come from interaction with a
significant caregiver.
• Adult relationships are impacted by, & reflective of,
those formed in childhood. An insecure child
becomes an insecure adult.
John Bowlby and Attachment Theory:

• Each partner brings their own individual working
models of attachment & projects their own needs,
wants, senses of selves & structural defences, onto
one another.
• Avoidant: impersonal sex
• Ambivalent: prioritises emotional over sexual relating
• This can create discrepancies in desires for relational
intimacy & sexual encounters.
John Bowlby and Attachment Theory:

• Early experiences will impact
intimacy and sex as
attachment anxieties will
reflect in sexual relationships.
• Our ‘sexual script’ will be
learnt, either positively or
negatively, and be
incorporated into our
childhood experience and
continue to affect us as adults.
“Tell me how you were loved &
I will tell you how you make love.” Esther Perel

Our ‘Sexual Script’ incorporates biological and
cultural factors.
There are three main strands:
• Development of gender identity as male or female
• Sexual responsiveness
• The capacity for close, dyadic relationships
(Bancroft, 2009)
A sexual ‘script’:

(Bancroft, 2009)
1. Pre-natal stage
2. Childhood
3. Adolescence & Early Adulthood
4. Marriage (or establishment of a stable,
sexual relationship)
5. Early and late parenthood
6. Mid-life
Six Basic Stages:

SHAME
The main source of failure to achieve
adult sexual satisfaction is an
interference early in life with a child’s
discovery of his/her own body as a
source of pleasure.
Shame is a wound made from the
inside, dividing us from ourselves
and others

Shame leads us to:
• Withdraw
• Attack self
• Attack another
• Avoid

• Self-abuse to self-love; taboo to
some, celebrated by others
• Maligned and mythologised
• Noted in utero from 17 weeks
• Scientifically regarded as normal
and harmless
• When faulted, children may develop
sense of shame and fear which can
impact anything to do with sex
AND THEN YOU GO BLIND…

• Sex therapists see it as part of human sexual
development, as a source of pleasure without
risk.
• It is used in sex therapy to help men and
women deal with sexual problems.
• Can play a specific role in sexual evolution as
getting to know self intimately is a rehearsal
for getting to know another similarly.

Teens and sexual health in an online world
Perils of Pornography

60% of teens face
sexting pressure
How teens ‘sexting’
photos end up on
paedophile websites
Brain scans prove porn
is as addictive as drink
and drugs
Vast majority of UK
teens have seen
sexual imagery
online, or
pornographic films
In 2012 there were
19,000 reports
relating to child sex
abuse online (CEOP)

Wrecking
Ball
Grappling with sexuality: Precocious in acting
out, but vulnerable and immature in relating
Yet want love and intimacy,
so what else can they do?
But wreck it…

Tasks of growth for a child would be to gain
independence, without rejection, of parents i.e.
to be able to present selves in adult world
To develop a strong identity, a sense of who
and what they are, which includes their sexual
identity

• Exploring sexual conditions of worth.
• Formulating a positive sexual identity.
“To know and love oneself ‘as is’ is a
prerequisite to know and love another.”
Jacques Lacan
Sexual satisfaction starts with self:

Remove the taboos and shame:

• Factors that can derail sexual development &
detract from adult enjoyment include:
- trauma
- abuse
- difficult early sexual experiences
- unusual developmental pathways
e.g. early/late puberty
- high degree of family guilt &
inhibition around sex
• It is not unusual for clients with low libido to have
history of abuse, flashbacks, dissociation & aversion
to sexual experience.

• For reproduction
• To boost or to maintain self-esteem
• To relieve tension
• For material gain
• To connect intimately with another
• For excitement and to take a risk
• For pleasure and to feel good
• A hostile assertion of control or dominance
Functions of sex are complex:

• Physical e.g. illness, alcohol, drugs
• Pregnancy
• Ageing
• Loss of self-esteem
• Anxieties and stress
• Loss of status or change in circumstances
• Betrayal of trust
• Sexual boredom
Causes of Sexual Issues:

• Withdrawal of sex when there is no alternative way
to express anger or disappointment.
• It can be way of unconsciously exerting power and
control in response to the lack thereof outside of the
bedroom.
• It can be done in a mechanical way so as to maintain
a ‘safe’ emotional distance.
Sex can be used in potentially
destructive ways:

• The result of conflicting needs and motivations can
be a partner who mourns the lack of intimacy and
trust which impedes feeling safe & thus enjoying
sex. Instead sex becomes associated with negative
feelings such as fear, jealousy, guilt and anger.
• Problems may thus arise when two people are
using sex to fulfil different functions at any one
time.

Sexuality of the Middle-
Class, Midlife Woman
Related research to be found on
The Sexuality of the Middle-Class, Midlife Woman:
Research on the Nature and Significance of Sexual
Satisfaction Within a Long-Term Relationship

Male gender stereotypes:
• If a sexually functional man has a willing
partner he is attracted to, he will engage in
sex whenever the opportunity is offered.
• All a man needs to achieve & sustain an
erection is to think about or to ‘want to have’
sex. Women on the other hand, need
sufficient foreplay including, but not limited
to, direct genital stimulation.
• When there is a mismatch in libido, invariably
it is the man who has higher sex drive & the
woman needs cajoling.

Male gender stereotypes:
• What men enjoy most is the thrill of the
chase, & if a woman wants a man to
commit she should play hard to get & for
him to ‘win’ her.
• Men & women play distinctive, gender
defined roles within the relationship. The
man is the provider, protector & leader. He
woman is the nurturer, home maker &
supportive partner.
(Monique Viljoen-Platts, 2013)

• Therapeutic space gives room for self
understanding & self development, a space to
transition through changes with the self
structure.
• It allows one to develop an authentic ability to
give and receive verbal, physical & sexual
intimacy, & understand meaning behind needs
you hope to be met by your partner.
• If one changes self, one can change
relationships & intimate encounters.

Perel believes the key to sustaining desire is
reconciliation of 2 fundamental human needs:
The need for
security,
safety,
predictability
The need for
adventure, risk,
the unexpected,
surprise, journey
A paradox as these very things that nurture love
can be the very ingredients that stifle desire
Esther Perel: The Secret to Desire in a Long Term Relationship - Full video

People are drawn to their partner when:
• They are separated, allowing each to get back in
touch with the imagination of desire and longing.
• When they see the other in the spotlight, thus
radiant, confident and somewhat elusive, mysterious.
• In this space lies the erotic & the move to that other.
• The mystery is not so much about travelling to new
places but instead looking with new eyes.
We need to reconcile love and
desire in order to maintain eroticism

Ask questions of self as opposed to the other:
• I turn myself off when …
• I turn myself on when…
Use erotic intelligence as more than animalistic
biology.
(Esther Perel, 2013)

Health Benefits of Sex:
• Sex relieves stress
• Sex boosts immunity
• Sex burns calories
• Sex improved cardiovascular health
• Sex boosts self-esteem

• Sex improves intimacy
• Sex reduces pain
• Sex reduces prostate cancer risk
• Sex strengthens pelvic floor
muscles
• Sex helps you sleep better
(Boots WebMD, 2013 www.webmed.boots.com)
Health Benefits of Sex:

“We consider sexual intimacy as primarily relational,
secondly physical. Bodies rarely have problems
finding sexual pleasure if the confusion in the mind is
laid to rest.
Being sexually alive has little to do with the right
body shape, or the right partner. It is about one’s
self-concept, self-embodiment and attitude to life,
and the ability to reprogram internal messages from
the image-makers of the past.”
(Duffel & Lovendal, 2002, p. 222)

• Develop respect for a range of lifestyles & an
ability to observe & reflect on gender roles in
our world.
• We may be uncomfortable learning about
clients’ intimate lives, feeling an intruder or
voyeur.
• We may feel naïve, lacking basic knowledge, so
CPD is necessary.
Therapeutic Considerations:

The therapist’s value is not in ‘the fund of
information, rather as a source of attuned
curiosity.’
(Anne Power, 2013, Therapy Today)

References:
Bancroft, J., 2009. Human sexuality & its problems (3rd Ed.). London: Longman Group Ltd.
Bowlby, J., 1997. Attachment. London: Pimlico.
Duffell, N., & Lovendal, H., 2002. Sex, love & the dangers of intimacy: A guide to passionate relationships
when the ‘honeymoon’ is over. London: HarperCollins Publishers.
Hakim, C., 2012. The new rules: internet dating, playfairs and erotic power. London: Gibson Square Books
Ltd.
Jeans, S. J., 2012. Sexuality of the middle-class, midlife woman: research on the nature and significance of
sexual satisfaction within a long-term relationship. http://www.indabacounselling.co.uk/resources/Sexuality
Kahr, B., 2007. Sex and the psyche. London: Penguin Group.
O’Leary, C. J., 2012. The practise of person-centred couple and family therapy. New York: Palgrave McMillan.
Orbach, S., 1999. The impossibility of sex. London: Penguin Group.
Perel, E. http://www.ted.com/talks/esther_perel_the_secret_to_desire_in_a_long_term_relationship.html
Power, A. 2013. When passion cools. www.therapytoday.net
Schnarch, D., 2003. Resurrecting sex: Solving sexual problems & revolutionizing your relationship. New York:
HarperCollins Publishers.

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Nottingham
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(+44) 7772696598
info@indabacounselling.co.uk
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Contact:

Sex on the Therapy Couch: Working with Sex in the Therapeutic Relationship

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