The psychosexual elements of our work as psychosexual and relationship therapists can seem, at times, to be very straightforward and even risk becoming formulaic. We regularly use homework CBT exercises, relationship rekindling, communication work etc. More often than not, though, I find myself engrossed and excited by the way our clients bring out, not just the psychotherapeutic skills and understanding we have but the philosophical.
This philosophical enquiry is, more commonly, expected in relationship work. We might, for example, be helping them to think about major life decisions they are making or exploring existential angst they may have about whether they and their partner are living according to their individual and joint values. Similarly, when the issue brought is purely about their sex life, this, too, can so often bring out the need to engage in a tentative, philosophical enquiry.
Let’s take, for example, the common dilemma of one wants more sex, the other less or even none. Why is this the case? Once we have ruled out the usual suspects of lack of desire, relationship conflict, pain, dysfunction, history of abuse, on the one hand and lack of love or affection or sexual compulsivity on the other, what is left? What is left is often much discussion on the nature of their sex life and whether it meets their needs. This discussion can then turn into, before we know it, an exploration of what sex means to them and what it could mean to them.
So, typically, for the one who says they don’t like sex, if we discuss what sex means to them, they might say that sex ideally means tenderness, romance, and underpinning this, real emotional connectedness. This, however, isn’t being experienced within the current sexual relationship with a partner who seems cut-off during sex, demanding more and more of the apparently disconnected sex. On the other hand, sex could mean, for the other partner, an expression of themselves as an individual, their masculinity or femininity, or just their self – their vitality or life-force. It could be that they, although not showing tenderness, do see their sex as an expression of their love, just a more passionate expression. This is a common male/ female divide, but I find this dynamic can often play out the other way around. It is as often expressed in same-sex as in heterosexual couples.
Without ever sharing it, how could either person know what the other one is feeling, let alone what they value and aspire to? It is vital that we, as therapists, remain open to the many possibilities, of what the meaning of sex is for each individual. We can then help them not just to communicate their needs and values to the other partner, but in the first place, work out for themselves what their own sexual values are! They may never have thought about sex this way before. Often, they are just aware that they are not happy with how things are, but don’t know why and so they can’t express it. Just moving the couple to a place where they have space to explore their values and choices, without judgement from the other, can be a huge achievement that promotes mutual trust and affection.
Even if there isn’t a particularly deep meaning: “Sex is fun and I want lots of it and to experiment,” we can lead the way by accepting that this is how they see it and that it is OK for them to express themselves so honestly. Similarly, their partner’s: “Sex is unimportant to me, I prefer it when we go out more together” is also OK. The problem then becomes, how can they make this work together when their needs seem so far apart? This is usually easier to deal with, as it is more responsible than “Which one of us is right and which one is wrong?” Sometimes the deeper exploration alone can shift these polarities by adding acceptance and understanding to the mix. It is more than simply being empathetic or non-judgemental, what is required, here, is a genuine curiosity and embracing of each client’s sexual values to help them make authentic choices.
We can encourage them to consider whether, for them, sex maybe, for example, both fun and emotionally connected. We can use our skills and experience to help them work on this shift away from their polarised positions whilst staying true to their own needs. This can seem paradoxical but, strangely, it happens.
In the same way, where there are specific sexual difficulties, such as pain or erectile dysfunction, exploring the meaning of these for each partner can help understanding in a way that just understanding their feelings doesn’t. We will probably also explore whether the meanings that they seek in sex can be found in the rest of the relationship, integrating, as we do in our way of working, the psychosexual and the relational.
Sometimes the difficulties aren’t going to be resolved within their current relationship. After all, no-one needs to shift if they don’t want to, but if they fail to shift a little, the relationship might be sacrificed. At least by discussing the meanings that they attribute to sex, blame can be removed, and each one can feel a greater sense of self-esteem.