Case Study

Fantasy in Couples Therapy

Is Encouraging Sexual Fantasies Playing with Fire?

A young couple in bed about to kiss | Photo by cottonbro studio/pexels

This article first appeared in the November/December 2008 issue.

Couples who are satisfied with their sex lives are happier than those who aren’t, and are likelier to stay together. They describe their relationships as connected, intimate, safe, fun, and affectionate. Conversely, as I’ve found over 20 years of practice, partners who aren’t having good sex are usually more dissatisfied with their relationships overall—more frustrated with each other, more discouraged about their joint future, and likelier to split.

Many therapists assume that if they help couples improve their relationships, the improvement will naturally lead to a rewarding erotic life. But what if helping couples create a satisfying erotic life is the key to increasing their feelings of companionship and mutual connection, not the other way around?

The age-old question is: how can couples maintain a strong, vital sex life over many years without having boredom undermine eroticism? Sexual boredom often results from the assumption by each partner that there’s no longer anything new to discover about the other, or about their sex life together. I’ve found that a therapist can alleviate such sexual ennui by helping each partner reveal previously undisclosed erotic fantasies. This apparently simple step can lead to new ways of seeing and experiencing the partner and the self. In a short time, it can have an invigorating erotic impact.

Sheila and Johan were both in their early fifties. They were physically active, with no psychiatric histories, and had been in therapy for three months. Johan reported that he felt bored in the marriage and was thinking of straying. “I crave adventure,” he said. “I’ve been thinking of having an affair, just to do something different.”

Sheila reported that she felt distant from Johan and that they’d drifted apart. They rarely shared meals anymore, often worked late into the night in their separate home offices, and sometimes didn’t even spend much time together on weekends. Sheila complained that she no longer felt Johan was interested in her, and wondered whether he still found her attractive. They hadn’t been physically affectionate for many months, rarely holding hands or touching casually, and seemed to be living parallel lives. She feared they were on the verge of separating.

In addition to hearing about their general marital unhappiness, I took a history of their sex life together, asking if they enjoyed their sex, whether each had orgasms, and if they knew their partner’s sexual fantasies. Johan thought he knew exactly what Sheila liked and didn’t like in bed. This was comforting to him and helped him feel confident that he could please her, yet it led to a high level of sexual boredom. He felt her needs were predictable and that they didn’t venture far from the things that had been “working” over the years.

Sheila longed for the times when Johan had been excited and turned on by her, describing what they had now as “maintenance” sex. They each knew how to touch each other, but they’d been doing it the same way for so long that it felt as though they were stuck in a rut. Neither Johan nor Sheila said anything about feeling an intimate connection during sex.

At this point, many therapists might focus on helping the couple get along better in their day-to-day connection by teaching them what might be called “companionship skills,” including better ways of communicating, resolving conflicts, changing behaviors, and, when appropriate, becoming more effective parents. Clearly, these skills determine how well we coexist with our partner, and, theoretically, once the nonsexual relationship is back on track, the sexual connection should follow.

But I thought we should focus on how Sheila and Johan could create connection and add adventure and excitement to their sex life while keeping their relationship safe. It’s been my experience that unless couples are satisfied with feeling like nonsexual roommates (and I have yet to see such a couple), they won’t connect in a deeply intimate and meaningful way unless their erotic relationship improves. As I’ve suggested, sexuality is the fuel that fires feelings of connection and intimacy.

The erotic aspect of a relationship includes all the partners’ needs for intimacy, erotic release, sensual contact, touch, affection, attention, and physical and emotional connection. When the erotic side works, couples feel less conflict, negotiate their needs more fluidly, and feel deeper connection and commitment to each other. By contrast, sexual dissatisfaction can itself cause conflict, tension, and stress. Desire discrepancy, sexual dysfunction, affairs, sex addiction, and other sex-related issues may be underlying many of the “companionship” issues that present for treatment in a couple.

Deciding which couples are appropriate for this fantasy-evoking approach is determined by assessing their capacity for empathy in the early sessions. Part of this determination comes from seeing how the couple presents in the initial stages of therapy, and how they respond to questions about their sex life. Some couples visibly relax in the session when the topic of their sexual relationship is raised. They sink into their chairs, move closer to each other, making more eye contact, and engage each other more. Other couples seem to freeze up.

Simple assessment questions can include “How is your sex life currently? How many times per month are you having sex? When you do have sex, how satisfying is the experience? Do you both have orgasms? What’s your vision of how your erotic life might look differently if you could make changes together?” Such questions will trigger a response in the couple ranging from resentment and conflict to a more in-depth exploration of a shared passionate relationship.

To help clients feel more connected within their relationships, therapists must become more comfortable talking about sex in their sessions, providing a model for their clients to follow in engaging in more open and frank discussions, in the office or at home. Even more important, clients need to be encouraged to explore and discuss fantasies as a way of opening a dialogue and focusing on the erotic.

Before having a couple share their fantasies, it’s important to explain how they can validate each other’s experience. When one partner talks about his or her vision of an ideal erotic sex life, the listener should simply mirror back what the experience sounds like, and acknowledge that this is their partner’s experience, even if he or she doesn’t understand it, or experiences it differently. When a partner can see that the other can have his own personal response to the erotic experience, and listen without judgment or defensiveness, the couple is ready to move into a dialogue about erotic fantasies.

Sexual Fantasy Research

Why focus on fantasy rather than sexual skills? There’s good evidence that sexual fantasy plays a vital, though often underestimated and underground, role in people’s daily activities and has a powerful impact on their sex lives. One study, released by UCLA, reported that 64 percent of women had ravishment fantasies. These fantasies weren’t rape images, but erotic scenarios in which the women took a submissive role to a dominant male partner (think Pirates of the Caribbean). More research is needed to determine how this or many other fantasies affect women’s sexual expression.

In my psychotherapy practice, women report a wide range of sexual fantasies, including sex with strangers, friends, neighbors, and other women. For a comprehensive study of women’s fantasies, see Nancy Friday’s book The Secret Garden. Women’s fantasy images of men include many body types, from well-built muscular physiques to physically unattractive ones and sometimes “repulsive” strangers, the repulsion being the erotic turn-on.

Research shows that men are aroused by fantasies and internal imagery before they become physically aroused. An article in New Scientist in June 2008 by Alison Motluk reports a study in which researchers tested male brains by measuring erection response to visual erotic stimuli, including photos of naked women and couples having intercourse. The researchers found that the men’s mirror neurons for sexual intercourse were activated by the images before the penis became erect. In other words, the men’s brains got “turned on” before their bodies.

Both men and women respond to auditory sexual stimulation. Erotically charged sounds and words might include descriptions of sex acts, words describing body parts, sounds made during lovemaking—sighs, groans, and whispers—sexual talk, and sexual sounds. A study by J. M. Dabbs measuring sexual response through pupil dilation found that men and women alike become aroused when exposed to auditory sexual stimulation.

Beyond arousing sexual feelings, sharing sexual fantasies can increase intimacy and connection. Through imagination, we connect to our desires. By sharing images of desire with our partners, we can spark attention, interest, affection, and excitement. In short, sexual fantasies can play a vital role in improving couples’ sex lives.

The Need for Honesty

To help Johan and Sheila create more sexually rewarding experiences for themselves, I suggested a structured dialogue approach. Using a worksheet I’d developed, consisting of four questions intended to provoke thoughts and statements about sexual fantasy, one would answer each question aloud in session while the other would mirror back what had been heard, without discussion. This structure encourages empathic listening and offers a sense of safety for the listener, who’s relieved of the pressure to respond in a positive or negative way to each fantasy and doesn’t have to agree or disagree to “living out” the partner’s vision.

The worksheet questions start with appreciation and move into sexual appreciation, desire, and finally fantasy. This progression gives the listener time and space to comprehend the fantasy. The four questions are as follows:

“One thing I really appreciate about you is . . . . .”

“One thing I really appreciate about sex with you is. . . . .”

“One thing I really like and want more if is. . . . .”

“One thing I would like to try is. . . . .”

Because the partner hearing the fantasy responds by repeating what’s been said, there’s no room for discussion about whether the fantasy will be acted upon. This process gives the couple time to talk and listen without judging or planning.

This worksheet format slows down the stimulation process and provides time for sexual arousal. Researchers Skyler Hawk, Ryan Tolman, and Charles Mueller report that arousal must occur more slowly than with visual stimulation for auditory erotic fantasy to be stimulating.

Sheila used the worksheet to tell Johan that she’d always fantasized about having sex in the shower. As she shared these images with him, he described a rush of hope and possibility; he felt that she was participating in the erotic aspect of their life together. Afterward, he realized that they didn’t actually have to act on the fantasy: it was the telling of the fantasy, the verbalization and empathic listening, that excited him. In this new way of talking about sex, they both discovered a new surge of desire.

The risk is, of course, that sharing fantasies in therapy will initiate deeper longings and unmet needs. Take Laura and Paul, partners for 14 years, parents of two young children, who’d entered treatment to resolve conflicts around financial stress. They also wanted to work on their almost nonexistent sex life.

I led Laura through the fantasy dialogue, which began with an appreciation and moved into more of what she wanted in bed. She shared with Paul that she had a secret desire to dress up in leather. He listened, obviously trying to be empathetic. But as I watched his face, I saw him struggling to hold in some strong emotion and becoming more and more agitated as she went into greater detail about the sexy outfit she wanted to wear for him. Finally, unable to contain his thoughts, he stood up and yelled at her, “Well where are we going to get the money for that kind of outfit!?”

Laura was shocked, hurt, and angry. At that moment, I realized that, for them to share sexual intimacy, they needed first to be able to feel empathy. Sharing one’s fantasies and desires creates transparency and an opportunity to discover the other; however, hearing a partner’s fantasy can trigger fear and uncertainty when a difference of viewpoint between the self and other becomes apparent. This reaction in turn can create the unpleasant experience of feeling separated and not totally merged with the partner, which can be hard to handle. My mistake in their therapy was that I’d brought them into the fantasy dialogue without giving them the skills to process the emotions connected to their sexual shutdown. This experience is what made me realize that I needed to change my approach to this work and determine whether a couple had the skills to empathize with each other before having them share their fantasies.

Talking about Sex Honestly

The beginning of this journey to increased erotic pleasure and connection starts with learning how to talk about sex. Most couples are less than honest with their partners about it. For example, almost 70 percent of women fake orgasms, according to studies. More and more men are faking it, too, or are perhaps being more open about admitting that they do.

It’s sometimes difficult for partners to talk about their deepest, hidden fantasies, usually from fear of how the other partner will respond. We’re afraid our partner will judge us, or challenge us about not having mentioned this desire before, or wonder where we “learned” the newly revealed information. We’re also afraid that our partner will actually want to act out our fantasy—a thought that can be quite threatening.

Studies have found that 33 percent of men and 10 percent of women have fantasized about a threesome, but sharing this fantasy with a partner can bring up insecurity and tension. For some couples, it may create arousal and connection; for others, it may trigger suspicion and jealousy. To reduce anxiety, the divulging partner needs to clarify the extent to which an unexpected fantasy amounts to a proposal for action.

To help reduce anxiety, I describe fantasy as falling on an “erotic curiosity spectrum.” Erotic curiosity arises from things a partner has read or seen or wondered about, but perhaps doesn’t need to act out. In the lower ranges of the erotic curiosity spectrum are the thoughts and images that make up a person’s internal fantasy life—ideas and experiences that have some erotic impact on the imagination. At the far end of the spectrum are the fantasies that he or she may want to act on. Perhaps a catalyst is needed to make this happen, but these fantasies are ones the person would like to experience with his or her partner. When we encourage couples to describe their fantasies, it’s important to ask them to be clear about whether they’re talking about a curiosity, a fantasy, or something they’d like to act on, as a means of reducing the anxiety level.

The Role of Psychotherapy

Making questions about sex part of the intake of a couples session, or simply asking “When was the last time you had sex, and how was it?” may give the couple permission to respond openly, knowing that the therapist is comfortable talking about sex. Openly and directly expressing desires and fantasies doesn’t have to lead to specific actions, but can be a means of growing closer and more intimate.

Couples describe the experience of sharing fantasies as being able to be more “themselves” with their partner, bringing more of who they are to the relationship, and being truly “seen,” giving them a greater sense of connection with their partner. Fantasy talk can provide clear ways to meet each other’s needs, creating a deeper level of communication and adding excitement to a union.

Most couples say they want passion in their relationship. If they already have it, they want to keep it; if they don’t have it, they want to create it. But couples have to work at it, just
as they do other parts of a relationship. One way to begin is by learning intimate, erotic communication. Counseling can help couples create this type of rewarding and passionate partnership by providing a safe space and structured way of sharing their deepest fantasies.

Case Commentary

By Don-David Lusterman

I applaud Tammy Nelson’s concern with the importance of sexual fantasy. Her intervention was effective for Sheila and Johan, and, I’m sure, with many others. She’s concluded that when couples believe there’s nothing new to experience in their sex life together, the relationship is likely to sink into a state of mutual boredom and dissatisfaction, and that the way out is for the couple to relieve the boredom through sharing their fantasies. Many of her examples of fantasy are really statements about what one partner feels is either absent or insufficient in their connection with the other, and very much wanted or desired. Of course, as Nelson mentions, fantasy may also be much darker, not so much representing a want, but a picture of a dark and exciting inner adventure without any need for it to be translated into action.

But there’s a danger of seeing sharing fantasy as a “one size fits all” intervention. In 35 years of practice, I’ve found that sexual fantasy plays a varied and complex role in people’s lives. We all know that when some couples go to a romantic movie, they’re very likely to come home feeling erotically charged. To give a dated example, who knows how many men of my era went home imagining themselves Charles Boyer while their wives fancied themselves Ingrid Bergman. They didn’t talk about it. Verbalizing it would have broken the spell.

Fantasy has enormous erotic potential, but sharing it may be dangerous. I’ve treated a number of men who believed that they were bisexual. One of them, a clergyman who loved his wife, his family, and his profession, described the positive effects of keeping his fantasies private. He often fantasized about a man (or boy) to whom he was attracted for. As he and his wife made love, he sometimes imagined that she was that man or boy, and it was a powerful sexual experience for him—and for his wife, who loved his passion and felt a part of it. Encouraging fantasy sharing with this couple might have yielded disastrous results.

Age, culture, ethnicity, religious beliefs and traditions are a few of the many elements that define our patients’ contexts. The couple who enjoy Sex in the City may respond quite comfortably to the question “What are your favorite sex fantasies?” For people who grew up in a different context, the question may seem bizarre or deeply insulting. Orthodox Jews, people who grew up in Asian cultures, and devout Catholics are but a few who might react poorly to that degree of directness. Encouraging sexual fantasies is fine—as long as therapists remember that the sharing of sexual fantasies is fine with some couples, but can be destructive for others.

Finally, I’d take some issue with Nelson’s broad assertion that “couples who are satisfied with their sex lives are happier than those who aren’t.” In some marriages, people have great sex but little emotional connection, and in others, it’s the reverse.

Authors’ Response

British sexologist Havelock Ellis said that modesty is one thing that people of all cultures and ages have in common, and he defined one aspect of modesty as the fear that others would be “disgusted” by one’s fantasies. So it’s understandable that couples hesitate sometimes to share their inner desires directly with their partner, for fear that their partner won’t show empathy or understanding.

The intense intimacy that’s developed from sharing fantasies is different than “true confessions”—when one shares fantasies with a partner in an attempt to create animosity, distance, or jealousy. Sharing sexual fantasies in the context I develop here has more to do with the idea that a romantic, committed relationship includes the erotic, regardless of whether people experience that aspect of their relationship as satisfying at the moment. Without it, they may feel like roommates and report less passion and connection.

The question for people of all cultures isn’t “What’s your favorite sex fantasy?” as this implies that they have sex fantasies. The question for all couples is more about “What do you desire?” Shared desires can be acted out, or simply used as a way to explore the other.

Sexuality is something we all share. What separates from other mammals, whose sexuality is merely biologically driven, is our capacity to be erotic and to use our imaginations.

What I imagine is that couples can learn to share their desires without creating pain in the relationship, and—this is a fantasy of mine—and that these techniques will create emotional connection, and not be merely a way to alleviate sexual boredom.

Tammy Nelson

Tammy Nelson, PhD, is an internationally acclaimed psychotherapist, Board Certified Sexologist, Certified Sex Therapist and Certified Imago Relationship Therapist.  She has been a therapist for 35 years and is the executive director of the Integrative Sex Therapy Institute.  She started the institute to develop courses for psychotherapists as the need grew for certified, integrated postgraduate sex and couple’s therapists in a growing field of mental health consumers who need more complex interventions for their relationship needs. On her podcast The Trouble with Sex, she talks with experts about hot topics and answers her listeners’ most forbidden questions about relationships. Dr. Tammy is a TEDx speaker, Psychotherapy Networker Symposium speaker and the author of several books, including Open Monogamy: A Guide to Co-Creating Your Ideal Relationship Agreement (Sounds True, 2022),  Getting the Sex You Want: Shed Your Inhibitions and Reach New Heights of Passion Together (Quiver, 2008), the best-selling The New Monogamy: Redefining Your Relationship After Infidelity (New Harbinger, 2013), When You’re the One Who Cheats: Ten Things You Need to Know (RL Publishing Corp., 2019), and Integrative Sex and Couples Therapy (PESI, 2020). Learn more about her at

Don-David Lusterman

Don-David Lusterman, PhD, is adjunct clinical supervisor at the Ferkaug Graduate School of Psychology of Yeshiva University and has taught at Hofstra University. He’s the author of Infidelity: A Survival Guide and Bridging Separate Gender Worlds.