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Eros and Aging - Page 11

Case Commentary

By Gina Ogden

Michael Metz and Barry McCarthy's carefully crafted "Good Enough" program offers a range of skills crucial to helping couples like Bill and Cynthia move through midlife sexual performance crises. The program is based on several precepts invaluable for both clients and therapists: that sexual intimacy is an integral part of relationships throughout life; that it's normal for couples to experience difficulties with intercourse as they grow older; and that Viagra and other performance-propping drugs aren't the panacea pharmaceutical companies would have us believe. When Bill loses erectile confidence and consults his internist, he's following a path traveled by countless midlife men (and women) who seek sexual help. Unfortunately, few physicians are trained to treat patients beyond writing a prescription.

The purpose of GES therapy is to help couples embrace relational complexity, introduce nondemand sensual pleasure, and teach a kind of "mature" teamwork to help open up erotic flow. Metz and McCarthy's sequence of taking a sex history, education, and home-play reads like the best of Masters and Johnson, updated for the 21st century. Through this approach, Bill and Cynthia ultimately learn to value a new intimacy over their old routines, and to appreciate each other's unique and changing arousal styles.

One strength of this gentle approach is that it demystifies sex therapy for both clients and clinicians. Yet embedded in it are assumptions that might undermine a couple less motivated than Bill and Cynthia. For instance, the program centers on the notion that a man's changed consciousness will revive a couple's flagging sex life. I believe the program would be strengthened by including a psychoeducational component on the sexual complexities specific to midlife women, such as body image, shame, guilt, and the hormonal anomalies of low libido. There's the stated premise that "health" means heterosexual and committedly coupled. However, single adults constitute a growing percentage of midlife Americans, with many forming new and socially diverse relationships: gay, lesbian, and polyamorous, for starters. Finally, I'd welcome hearing how the authors might adapt their program to introduce flexibility and pleasure in resistant couples with messy histories of disappointment, abuse, clandestine affairs, ongoing fights about money, teenagers, aging parents, and on and on. These are the ones most likely to appear in our therapy offices.

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