Zeroing In: How a Therapist Can Help Identify the Source of Sexual Disfunction

Couple standing on bridge with city lights in backgroundWhat does a sex therapist do? People often ask me what type of problems show up most often in my office. As most readers of my blog already know, I don’t like to put lots of focus on “disorders”. Most clients call because they are experiencing sex addiction in some form, or because they’re having difficulties with desire or lack of desire.

One caller said, ”My partner wants sex twice a week and I’m more interested in once per month.”  Are you figuring that the speaker is probably a woman?  Uh-uh. This person is male, 28 years old, healthy and in great shape, and married to a woman he loves for 4 years. He didn’t have problems getting and keeping erections, and had no other physiological problems, and claimed that he loves sex and had a “really active” sex life when he was single and dating “lots of gorgeous women.”  His wife is also extremely attractive and she claimed that she was unhappy with his “rejection” and that she was tired of having to always initiate to get her own sexual needs met. As you can imagine, it’s usually the other way around with heterosexual couples; men are usually looking for sex more often, so they initiate more often.

Since Joe had boasted about his earlier “notches on the bedpost”, I guessed early on that he was avoiding genuine intimacy with Maria, with whom he’s now “mating in domesticity.” Marriage has a way of bringing up a million opportunities to let our spouse see who we really are. For folks who are scared of closeness, matrimony can feel extremely threatening – conjugal anti-bliss!  Fortunately, both Joe and Maria were willing to continue with therapy and learn what they could do to repair and strengthen their marriage.

So how do I help a couple like this? First I zero in to understand exactly what is going on for each of them during the infrequent sexual encounters that they do have. Often I will ask them to describe, in detail, what transpired the last time they were sexual, beginning with which one initiated and HOW they did that. For example, I asked Joe when he knows it’s time to initiate and why he picks the particular day and time. What does he do first to signal that he’s interested and why does he choose the particular move?

As I listen to Joe describe the experience I’m also watching Maria, and gauging her response to his description. If we’re in my office I’m watching how connected they are, or if we’re working by phone I listen carefully for her reactions. My guess with Joe was that he was somewhat disconnected, nervous about closeness, and focused primarily on getting his sexual needs met. If he’s concentrating solely on the sensations in his genitals, he’s not going to be connecting with Maria.

Since they have difficulty making eye contact when they speak to one another in my office, I can safely assume that in bed they will not be truly “seeing” one another or making any genuine erotic connection. I’m trying as best I can to slow down and understand what they are feeling. As I do this I’m forming a clearer picture of HOW Joe is avoiding intimacy, his level of anxiety (which is quite high) and his sense of sexual shame about being truly seen sexually.

And that’s just the beginning. Most of us don’t really share with our partners what turns us on and how we react to the challenges of being naked – both literally and figuratively- with each other. As I coach Joe and Maria to talk to each other, they are learning new communication skills and what brings them pleasure. This starts haltingly in my office, but most couples will continue the conversation in the car driving home, and later in bed.

Earlier trauma may play a role in what’s disturbing the relationship and when this is true I’ll work with the individual separately, or if they prefer, refer them to a colleague. Most couples have the ability to work through their problems, whether these are financial, family-related, or sexual. My job is to help them learn how to talk about their feelings and sometimes embarrassing experience of sexual intimacy.

© Copyright 2010 by Jill Denton, LMFT, CSAT, CCS. All Rights Reserved. Permission to publish granted to

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  • Leave a Comment
  • Nan

    December 23rd, 2010 at 3:10 PM

    This has to be a tough job, but certainly a fascinating one!

  • shane watson

    December 24th, 2010 at 2:31 AM

    some people just don’t enjoy intimacy with their partner in marriage even though they did with the same person before marriage.yes,there will be a lot of changes after marriage and you will see your partner in a new light but this always intrigues me.

  • Ellen

    December 24th, 2010 at 7:59 AM

    It is hard for me to grasp that sex is such a huge issue for so many married couples. I mean, it is so wonderful when it is with someone that you love and care about, why all of the hangups?

  • J-Son

    December 24th, 2010 at 12:43 PM

    Sex-it has created problems in many a marriage,sue to lack of it and even due to too much of it.It’s also caused problems when done by one of the partners with a third person,whether in a heterosexual relationship or a homosexual one.Sex-the bone of contention after all!!! ;)

  • Luke T

    December 24th, 2010 at 11:58 PM

    Sexual incompatibility is something that is often overlooked by people before tying the knot. Even for those who involve in pre marital sex they do not pay much attention if there have been problems in their sex life if and when they do decide to go ahead with the marriage.

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