Case Study

Sexual Fantasies in Couples Therapy

The Art of Encouraging Erotic Imagination

Magazine Issue
July/August 2024
Sexual Fantasies in Couples Therapy

As adults, we tend to focus on managing our work schedules, running our homes, and caring for others. In the process, it’s easy to get stuck in a rut and lose our sense of fun and adventure, especially when it comes to sex. As every couples therapist knows, this rut has the potential to unravel our romantic relationships. Luckily, we don’t have to ditch our daily roles and responsibilities to reenergize our partnerships.

“Fantasy and friction make for a great sex life,” sexual health pioneer Helen Singer Kaplan famously said. But when therapists address couples’ sex lives, we sometimes overfocus on everyday realities—Who initiates sex? How often? Could you establish a date night? What do you need to feel receptive to one another? Are there underlying resentments we need to look at? These questions are worth discussing, but so is another, less talked about, more internal and creative source of erotic energy: partners’ sexual imaginations.

Through my own experiences as an Imago Relationship and AASECT-certified therapist, I’ve learned to explore sexual fantasies to unlock partners’ imaginations and help them cultivate intimacy. I’ve stumbled many times as a therapist navigating my clients’ sensitivities and misconceptions about sexual fantasies, which are often shrouded in guilt and shame—making them relational land mines. Each clinical gaffe I’ve made has helped me adjust my approach and work to understand my clients’ perspectives better, even as I seek new ways to transform potential land mines into sources of creativity and intimacy. This was the case with Juan and Estella, a distressed couple I saw recently, for whom sexual fantasy was a taboo subject.

Dreams We Have While Awake

The atmosphere in my Santa Monica therapy office sizzles with electricity—and not the good kind. Juan, a former Navy Seal in his mid-40s, sits across from his wife, Estella, a past beauty pageant winner, who currently works as a broadcaster on a local news channel. Like many couples, Juan and Estella sought counseling because they struggled to connect emotionally and physically. Juan’s recent erectile dysfunction had intensified their challenges. The physical closeness they’d once shared had become awkward, leaving them frustrated and bristly. This isn’t uncommon: once the romantic phase of a relationship ends, many couples struggle with desire.

Earlier in the session, we’d spoken about what their sex life had been like before Juan’s challenges keeping an erection. Juan had explained that he gets anxious right before he comes because he doesn’t want to fantasize about anyone other than Estella in those moments.

“It’s okay to have sexual fantasies about someone else,” I say nonchalantly.

“Wait, what? How can you say that?” Juan asserts emphatically, furrowing his brow. “That’s cheating!”

I notice that Estella reacts, too, frowning as her cheeks and neck redden.

“Are you saying Juan should think about other women while having sex with me?” Her voice is chilly. Despite her diminutive physical size, her presence is formidable, and my chest tightens. The truth is their reaction surprises me. I’ve never considered extradyadic fantasies as constituting unfaithfulness, but I can see that by inadvertently offending one of their relationship values, I’ve elicited defensiveness. But I’ve learned something, too. Is this part of what’s at the root of their sexual difficulties? Do Juan and Estella fear and misunderstand the nature of sexual fantasies, which can be a potent driver of desire and arousal?

“Estella made me promise to think only about her during sex,” Juan continues, his gaze shifting toward his wife. “So now I only think of her.”

“If Juan thinks about someone else during sex,” Estella interjects, with a mixture of sadness and anger, “it means I’m not enough.”

“First of all, your feelings and perspectives are valid,” I assure them both. “But thinking of someone other than your partner during sex isn’t just common: it’s natural. It doesn’t necessarily reflect a lack of commitment or desire in the relationship. Many people imagine others during foreplay or sex with their partner.”

“That’s a relief to hear,” Juan says. “I guess you’d know. Thing is, I become so preoccupied with the fear of thinking about someone else that I actually end up losing my erection with Estella. We both get frustrated and give up. And I feel like I’ve failed her.”

“When he loses his erection,” Estella says, “I can’t help but take it personally. I begin telling myself, ‘He no longer finds me attractive. If he did, he’d stay hard.’”

From the beginning of my work with any couple, I make a point of addressing sexuality directly. I want to convey my own comfort level discussing desire, the body, and arousal, to help them share their sex life openly with each other. Throughout my sessions with Juan and Estella, I gauge the level of their anxiety. Anxiety dampens sex drive and arousal. Hopefully our conversation serves as a bridge—a channel through which their unspoken fears and struggles can begin to surface, creating an opportunity for deeper understanding, connection, and pleasure.

Juan, would you judge yourself for the dreams you have while sleeping?I ask.

Of course not,” he responds, looking puzzled. “I can’t really control my dreams.”

Sexual fantasies are kind of like dreams we have while we’re awake,” I explain. Often, they arise involuntarily, particularly during sex. Fantasies reside in the realm of imagination. Attempting to control this part of your psyche with judgment can stifle joy and pleasure. What if, instead of feeling threatened by fantasies, you were curious about them? What if you shared your fantasies with one another? Or even cultivated them together?”

“I don’t know.” Estella shifts backward in her chair and crosses her arms over her chest, forming a literal barricade against the conversation we’re having.

“His commitment and attraction center on you,” I say, hoping to reassure her that it’s okay to imagine and explore possibilities; her attachment to Juan is safe. But it’s clear she feels uneasy and skeptical. “You and Juan have chosen each other as lovers. Remember, many of the fantasies we have aren’t about things we plan to do in reality. Sexual fantasies don’t have to diminish your bond. What if they actually enhanced it by infusing your relationship with novelty and intimacy?”

I’m aware that I’m talking a lot, probably because I’m a little anxious myself, but something must have landed with Estella, because she uncrosses her arms and sighs.

I’d like to feel more relaxed in bed,” Juan says. He scans Estella’s face, and exhales.

They both seem to be recalibrating and taking in what I’ve said. Many people need reassurance that there’s nothing wrong or abnormal about them simply because they have sexual fantasies. Learning that sexual fantasies are a healthy aspect of sexual functioning can help lower a couple’s anxiety.

“I’ll try my best not to worry so much about what you’re thinking,” Estella says.

“Here’s my recommendation,” I say. “Over the next week, would you be willing to set aside three minutes each day to cultivate a sexual fantasy about each other? Let it be naughty, kinky—whatever. Don’t judge it; just allow it to unfold in your imagination.”

Estella shrugs and looks at Juan, who shrugs back.

“You game?” I ask.

“What do we have to lose?” Juan says in a voice that offers me a glimpse into his former Navy Seal persona—he sounds focused and determined.

“Okay,” Estella responds, though her response is far more hesitant.

Erotic Overlap

As Juan and Estella settle into their seats at the start of our next therapy session, I can see they’re more relaxed—which makes me hopeful.

What did you think of the homework?” I inquire.

Shoot!” Estella exclaims. “I forgot we had homework. Remind me what it was?”

“You were going to fantasize on purpose,” I say. “How about we do it now? Take a moment and either recall an erotic fantasy you’ve had or come up with one.”

Nothing comes to mind.” Estella crosses her arms over her chest, a stance I’m familiar with from our last session. Should I pivot? I wonder. Am I moving too fast for them? I want to challenge Estella to think outside of the box, but at the same time, I don’t want to trigger her. Sometimes, it’s not an easy line to walk.

“Can you think of a sexual fantasy that involves Juan?” I prod with a smile. Estella’s silence reinforces my fear that I’m going down the wrong path.

“I’ll start,” Juan says. “I keep remembering that time we had sex outside when we were camping up in the Sierras. In the afternoon. Do you remember, Elle?”

That was fun,” Estella agrees, her body relaxing slightly.

“It was hot,” Juan continues, his voice dropping an octave.

What made that fantasy alluring for you, Juan?” I ask, relieved that he’s sharing.

My intention is to help them focus on pleasurable and exciting sexual moments by highlighting sex-positive experiences. Couples who can talk openly about sex in non-shaming and nonjudgmental ways tend to have more sex. Talking about pleasure and sensuality enables partners to collaborate in creating more mutually satisfying sexual experiences.

The possibility of someone seeing us,” Juan recalls with a slight smile playing on his lips. “The thought of being caught was a turn-on.”

I definitely felt close to you,” Estella murmurs shyly.

Talking about this is a great way to understand your desires better,” I say.

“What if I don’t have fantasies?” Estella blurts. “I never seem to want to have sex.”

“Do you enjoy sex once you start having it?” I ask.

“Sure, once we get going, I do,” she says. “But I hardly ever want sex out of the blue.”

“That’s very common,” I say. “It’s called responsive desire. It’s different from spontaneous desire, which emerges instantly. You can activate responsive desire by creating moments and situations that boost arousal. Is there a time that you really enjoyed having sex with Juan?” I ask Estella. The less ashamed she feels about her wants and needs, the more likely she is to share them. If she doesn’t want to share, I’ll change my tact and explore what’s getting in the way of her sense of safety around going deeper into this topic.

I guess I like it when Juan takes control,” Estella says quietly. “But I don’t want to like that. I’m generally not a passive person.”

Submission fantasies are very common, especially among women,” I say. “Having them doesn’t mean you’re submissive. It can be exciting for couples to experiment with role-playing scenarios. Through erotic play you can act out fantasies while still feeling in control.”

“I don’t know. We haven’t ever tried anything like that,” Estella says. I take her participation to mean she’s adjusting her perspective, however slightly.

“Could you talk to each other about what you might be okay exploring?” I ask.

She rubs her palm along her skirt as though smoothing a stubborn wrinkle.

“We could pretend we’re back in the Sierras having sex outside and that we might be caught at any moment,” Juan interjects, his voice sounding both mischievous and hesitant. “Maybe I could be a park ranger, and you could be a lost geologist.”

Estella bursts out laughing. Juan looks hurt, but quickly regains his composure.

“It might seem silly initially, but the novelty could add to the sexiness,” I say.

“I did theater in college,” Estella says “I loved pretending to be other people. I wasn’t laughing at you, Juan, I just feel nervous. I like your idea.”

I’m hearing a willingness to bring more creativity to lovemaking,” I say. Estella nods, straightening in her chair. “What about you, Juan?”

“If it means recreating our experience in the Sierras, I’m in,” Juan says.

When one partner introduces a sexual fantasy that elicits discomfort in the other partner, I encourage open, nonjudgmental communication. Sometimes I guide couples in going deeper into specific elements that render a fantasy erotic, which can lead to insight and even action steps for novel experiments. We explore details where there’s a shared erotic overlap, as there is with Juan and Estelle with the Sierras fantasy.

Some sexual fantasies can be actualized because it’s safe to do so, and both partners are on board with the plan. At the same time, others can simply be enjoyed as imaginative, unfulfilled scenarios. Either way, we can equip couples with tools to navigate the spectrum of their desires with respect and curiosity.

Silly but Sexy

A week later, Juan and Estella walk into my office holding hands.

“You both seem very affectionate today,” I note with a smile.

“We’ve been having a lot of fun,” Juan says as he sits down.

“Tell me more,” I encourage.

“We’ve been doing some new things,” he begins. “Kind of mind blowing, actually. I get self-conscious about it sometimes, but we’re doing it anyway.”

“That’s wonderful. Whatever’s happening seems to be revitalizing you both.”

This sounds odd,” Estella admits, “but I like role playing Aphrodite, the Greek goddess of love.” She’s beaming as she lets go of Juan’s hand and lifts one arm, her thumb and index fingers touching as though she’s holding a toga or a flower.

I play Ares, the god of war,” Juan says sheepishly. “It’s cool to connect my military training to something sexy and fun. We pretend Aphrodite’s husband, Hephaestus, might catch us.”

Juan even surprised me the other day by dressing the part,” Estella laughs. “I got home from work, and he opened the door wearing nothing but a sheet. It was silly, but sexy.”

“I love the creativity and playfulness of what you’re doing!” I say. I’m impressed at how Juan and Estella are delving into different sexual scripts and embodying a range of sexual archetypes. If they can keep it up, I believe their intimacy will grow.

I’ve learned to tread carefully as I guide couples through the labyrinth of buried or withheld sexual fantasies, mindful of partners’ sensitivities and misconceptions. Many individuals need reassurance that their fantasies are a healthy and vital part of sexuality. When partners feel safe, they can release the shame and guilt surrounding their fantasies and share their unspoken desires and secret yearnings, cultivating a profound sense of intimacy.

Far too often, the erotic imagination slumbers and behavioral suggestions alone fail to reawaken sexual arousal and connection. As therapists, by challenging judgments and assumptions, cultivating trust, and guiding clients toward playing more with the rich, alchemical material of sexual fantasies, couples can tap into a wellspring of creativity and reignite passion.

Case Commentary

By Holly Richmond

Theodora Harvey’s ability to recognize—and immediately pivot—when she felt she pushed her clients into shame-laden territory is commendable. Taking our clients a bridge too far can happen in a hair’s breadth in sex therapy, and Juan’s erectile dysfunction and Estella’s feelings of not being enough were primed for exposure and the consequential reactions that followed. Sex therapists are trained to be sex-positive, meaning that all sex is good sex as long as it’s consensual and pleasurable. There isn’t much that can shock us, and if we’re following our sex-positive tenet, there’s certainly no judgment.

Harvey showed up in pitch-perfect, sex-positive form, ready to diffuse the weightiness of the rupture by assuring Estella that fantasizing cultivates a landscape for having better sex, not worse, and it doesn’t constitute cheating. Unfortunately, she quickly learned that Estella didn’t share her beliefs. I’m assuming, like most of us, Harvey didn’t have Estella’s full relational and sexual history for this first session. Had Estella been cheated on previously? Had a parent left because of infidelity? Did she have self-confidence issues surrounding her looks and body? It was evident that the issues present in the room had little to do with fantasies or genitals, and everything to do with insecurities stirring up self-criticism and shame.

I appreciate Harvey’s ability to connect the customarily innocent world of dreams to the presumedly forbidden world of fantasies. They both come from the same construct, imagination. Imagination is what makes sex erotic—vital and creative, the heart of our life force—rather than primal. Imagination elevates sex to an art, a place where cocreation can flourish. Imaginative sex makes us feel deeply alive, just like Juan and Estella’s experience in the Sierras, with the thrill of being caught and having a secret that’s only theirs to share. Estella’s beliefs about sex, fantasies, and her own desirability unintentionally put Juan in a freeze state by trying to control his imagination, which in turn constrained his sense of aliveness, and then, patently, muted his penis. There was nothing wrong with his penis; it was his mind—his biggest sex organ—that had shut down.

Harvey did a commendable job of weaving elements of sex education and sex positivity into these sessions, especially by having Juan and Estella start by fantasizing about each other, rather than others. As she stated, the most effective route into this sensitive territory is by centering respect and curiosity.


Couples Therapy Intensive Course

Theodora Harvey

Theodora Harvey, PhD, is a licensed marriage and family therapist, certified AASECT and Imago Relationship Therapist, and Kundalini yoga and meditation teacher with a private practice in Santa Monica. She specializes in couples counseling and clinical sexology.