Q: I’m working with a couple where one partner wants sex much more than the other, but I’m not a sex therapist. Should I refer them out?
A: Good news: if you’re a couples therapist, you’re also a sex therapist! Therapists have been taught that working with sexuality is a specialty, but it’s not. It can’t be. Why? For most couples, sexual attachment is as critical to their stability as emotional attachment. Unfortunately, most couples therapists get little training in how to work with sexual attachment.
That’s why we’ve been trying to normalize discussions about sex in therapy through our writing (Laurie is the author of Wanting Sex Again: How to Rediscover Desire and Heal a Sexless Marriage) and on our podcast, Foreplay, where we use our expertise to help couples resolve sexual difficulties and highlight how important it is for therapists to talk openly about sex. We believe it’s therapists’ responsibility to initiate conversations around sexuality, rather than burdening couples with this potentially anxiety-provoking task.
Attachment theory shows that a romantic relationship has three behavioral cycles: emotional, sexual, and caretaking. Together, they form the bond between partners. Sex comprises a large part of the excitement and vitality in a romantic relationship. Without it, the relationship can easily fall into jeopardy. In fact, according to a 2013 study from the journal Couple and Family Psychology, 59 percent of divorces are attributed to sexual difficulties. Partners who experience sexual difficulties may wonder if they’re loved or in love, or may be tempted to seek affairs. The power of sex in a relationship isn’t simply body parts and physiology: it’s a force of attachment.
Pursuit & Withdrawal Cycles
Most therapists are familiar with the negative emotional attachment cycle where one partner seeks more talking, support, and emotional closeness while the other seems to back further away. One partner fears being abandoned; the other fears being judged as not good enough. The emotional pursuer expresses increasing frustration, while the emotional withdrawer seems to shut down further to avoid criticism. Sometimes the withdrawer’s apparent obliviousness to the relational problems triggers anger in the pursuing partner.
Likewise, in the sexual cycle, one partner might push for more sexual intensity, variety, or frequency. Unfortunately, they often inadvertently send their partner the message that they’re failing or not good enough in bed. In response to the perceived criticism, the withdrawing sexual partner may inhibit their sexual desire. With less sexual availability, the pursuer becomes anxiously preoccupied with sex and vigilant about signs of rejection. Insecurities about their own attractiveness might fuel a need for proof of their value. Meanwhile, as the tension grows, the withdrawer tries to avoid conflict by downplaying their partner’s requests. They might even disparage their partner’s sexual needs by saying something like, “All you want is sex!” Sexual joy, pleasure, and intimacy, strangled in this tug-of-war, is lost.
What should therapists do? First, they need to bring up the sexual cycle—as soon as the first session. This acknowledges the importance of intimate connection and affirms the sexual motive as positive. Next, therapists should deescalate conflict by validating the reasons the partners criticize, defend, and withdraw. Make explicit how the pursue–withdraw defenses are part of a cycle. When our protective strategies begin to make sense to us and our partner, it becomes safer to reveal the inner fears behind them. Finally, the goal in each session should be uncovering each partner’s need for connection, reassurance, and being desired; that’s what lies beneath these protective behaviors. As partners’ longings become apparent to each other, it increases their mutual empathy and brings them closer.
Working with the Cycles
It’s important to recognize the emotional and sexual cycles as important, separate, and interdependent.
“Marc and I just aren’t communicating,” Belinda said in her first session with George. “Last Wednesday, he agreed to talk about some of our issues, but within minutes, he blew up and left the room.” She shared that she thought Marc worked too much, and that there was tension between them about money, with Marc wanting to save for the kids’ college fund and Belinda wanting to spend it on fun activities.
George turned to Marc. “What about you, Marc? Where are the sticking points in the relationship for you?”
“The kids and money disagreements cause us stress,” he agreed. “But what’s the point in talking about it when it always ends in a fight? It’s gotten so bad that we don’t even touch anymore. Most days it feels like we’re just business partners.”
With just a little feedback from each partner, we can see multiple ways to proceed. According to Rosemary Basson, a clinical professor at the University of British Columbia’s sexual medicine program and one of the foremost researchers on women’s sexuality, women often need to feel emotional safety to feel sexual desire. You might think the natural next step is to help Belinda and Marc develop that safety, which could work. The problem with this strategy, though, is it sidelines the sexual pursuer’s primary way of finding connection: through sex. If this isn’t acknowledged in therapy, some sexual pursuers won’t engage in the emotional work, which leads to gridlock.
Whichever cycle the therapist decides to focus on first will inevitably trigger a reaction from the partner who has a priority in the other cycle—which is exactly what happened when George began by focusing on Belinda’s emotional cycle. “Marc, what happens when Belinda complains to you about being cheap?” George asked.
“It’s no big deal,” Marc replied. “I just tune out her criticism.”
“I imagine being criticized must hurt your feelings,” George responded, trying to help Marc put language to his emotions.
“Not really,” Marc replied. “I try to stay upbeat.” It was clear that Marc was trying to put on a brave face, as if his positivity would protect him from hurting.
George had run into a block from Marc in the emotional cycle. This is common: getting someone who’s emotionally withdrawn to enter the process and start talking about their feelings can be difficult, even in the safe space of therapy. But one thing stood out to George: the hint of Marc being a sexual pursuer in his complaint that he and Belinda “didn’t even touch anymore.”
George switched his focus to the sexual cycle. “Marc, tell me about the amount of touch, affection, and sex you have.”
“We haven’t had sex in two months,” Marc said, looking dismayed. “I never imagined things would get this bad.” Marc’s answer was very different from his previous comment (“It’s no big deal”). Now, he was emotionally present.
“Wow. That sounds tough. I can see some disappointment in your face as you say that,” George replied. “How do you make sense of not having sex for two months?” Here, George was using exploration of the negative sexual cycle to deepen Marc’s engagement in the cycle that mattered more to him.
Marc looked down at the floor. “I guess Belinda isn’t really attracted to me anymore.”
By revealing the fear that he’d become undesirable, Marc was showing more vulnerability than he had in expressing his anger at Belinda for her lack of sexual response. “That must be difficult,” George said. “Have you told Belinda that you think she isn’t attracted to you anymore?” Taking an emotionally focused approach here, George began to wonder whether Marc sharing his vulnerability had started to break the cycle of blaming and defending.
“No,” Marc replied. “I guess I just get mad at her when she’s not in the mood.”
“Okay, so Belinda usually sees you getting mad and feels criticized. Correct me if I’m wrong, but your anger is your way of bringing attention to the lack of sex. You want Belinda to see she needs to do something different, like initiating more, or at least responding to you.”
Here, George had validated Marc’s protective strategy as a motive for change, and was beginning to show the overlap in the emotional and sexual cycles. The hope was that by building Marc’s emotional intelligence, he’d eventually be able to ask for what he wanted more directly, but in a softer, more engaging way.
Marc nodded. “I think that’s right.”
“It sounds like you and Belinda switch positions in your fights about money and sex,” George continued. “In the money conversations, Belinda is frustrated that you don’t understand why it’s so important to her to spend money now and wants you to see something different. In the sex conversations, you’re frustrated because she doesn’t understand how sex connects you to her, and you want her to see something different. You’re both pushing for change. What’s it like to hear that although you’re both pushing for different things—Belinda for emotional understanding and you for physical intimacy—you both take the position of pursuer and withdrawer?”
“That’s interesting,” Marc said, looking contemplative. “I never realized it before, but it makes some sense. We’re both pushing each other away over the issues that are most important to us.”
Belinda rolled her eyes. “We don’t take the same positions at all!” she interrupted. “Trying to have conversations about how our family functions is much more important than having sex. I don’t appreciate it, George, when you encourage Marc to see the two as equal.” She shook her head. “As long as Marc won’t engage and talk, we’re not going to be having any sex.”
“Right,” George responded. “To you, these two cycles are not equal. I appreciate you jumping in and letting me know you think I’m off base. Your interruption is a healthy way of trying to ensure your point is heard. I hear you. Help me understand, what do you think would happen if we did see them as equal?”
Belinda shook her head again. “That’s not an option. If I give in here, then he’ll get the sex he wants and I won’t get the support I need. It’ll be a disaster for our relationship.”
“Wow,” George responded. “So it seems like not engaging sexually is your way of protecting the relationship from turning into a disaster—a he-wins-I-lose disaster?” George had homed in on the reason for Belinda’s defense, and used her fear of not getting support in the emotional cycle to justify her protective withdrawal in the sexual cycle.
Belinda nodded. “Maybe.”
Bringing both partners on board to do the work is a matter of engaging with both the emotional and sexual cycles. Why limit ourselves to just one area? When George validated Marc’s sexual needs and recognized how he feels when he’s rejected, Marc began to open up and show more vulnerability instead of blowing up. Hinting to Belinda that her sexual withdrawal had an underlying positive meaning reduced her defensiveness. Each partner began to see how their good intentions (what we call in Emotionally Focused Therapy their “protective moves”) often trigger defensiveness in their partner and creates a stuck cycle.
“I’m impressed with how both of you gave each other space to explore your typical protective strategies,” George told Marc and Belinda as the session came to a close. “You may disagree on which issue is more important, but you’re both starting to understand how the result is the same: you both lose in this negative cycle. Belinda, you pull back from sex, afraid Marc won’t care about what’s important to you; and Marc, you pursue sex for connection but don’t engage with Belinda when it comes to her need for support and understanding in the financial discussion.”
Marc and Belinda still had more work to do, but we were off to a strong start. Once the negative cycle is brought into awareness, partners can begin to find new ways of relating, instead of defaulting to their pursue or withdraw responses. Asking directly about partners’ emotional and sexual needs and encouraging them to respond to their partner with curiosity greases the wheels for better communication between them.
By ignoring, delaying, or overlooking the sexual cycle, therapists can miss a valuable opportunity to facilitate engagement, especially when working with tough-to-engage, emotionally withdrawn partners. Connecting in body and heart forms the strongest bond, and therapists need to be ready and flexible enough to harness the power of both the emotional and sexual cycles to bring about lasting change.
Laurie Watson, PhD, LMFT, is a certified EFT therapist and an AASECT-certified sex therapist who’s spent the last 30 years focusing on sexual attachment in her couples therapy and in training therapists. She’s the author of Wanting Sex Again: How to Rediscover Your Desire and Heal a Sexless Marriage and cohosts the podcast Foreplay—Couples and Sex Therapy.
George Faller, LMFT, is a certified EFT trainer, supervisor and therapist as well as the coauthor of Sacred Stress: A Radically Different Approach to Using Life’s Challenges for Positive Change and True Connection: Using the NAME IT Model to Heal Relationships. He’s cohost of the podcast Foreplay.
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