Handling Unexpected Intimacy Issues

Not a Sex Therapist? No Problem

Stephen Snyder

It’s a shame that so many therapists shy away from talking about sex in the consulting room, believing that they don’t have sufficient expertise. The reality is that any well-trained therapist can help clients understand, and in many cases even resolve, sexual problems—simply by using their natural curiosity, some common sense, and a few key tools.

Let’s say, for example, you’ve been treating a young woman, Carmen, in counseling for issues related to managing stress in her life. After several months, Carmen tells you she’s begun a relationship with a new man, Scott, whom she likes very much. Several weeks into their relationship, Carmen comes into your office looking upset. She takes a deep breath and surprises you by saying, “When Scott and I have sex, I just don’t feel anything at all.”

What do you do? You could refer her to a sex therapist, but right now it’s just the two of you, and she’s just trusted you with something very intimate. Like it or not, for the rest of this session you’re her accidental sex therapist. Here’s how to make the most of the opportunity.

First Steps

At this point, you have absolutely no idea what Carmen’s talking about when she says she doesn’t “feel anything” during sex. Don’t worry. Neither do I. That’s typical. People don’t usually express themselves very clearly when it comes to sex. They tend to get vague.

But let’s see if we can figure it out. There are roughly three parts to sex: desire, arousal, and orgasm. You’ll want to make sure to ask her about all three.

Beginning with desire, you ask, “Are you attracted to him?”

“Sure,” she says, though her desire is starting to diminish since she can’t feel anything when they have sex.

“Do you have orgasms?” you ask.

“Yes,” she says, she’s had plenty of orgasms. Not with him yet, but she knows that can take some time. So no, she explains, she’s not referring to orgasms when she says, “I don’t feel anything.” By process of elimination, that leaves arousal as the likely issue.

Asking about arousal can be tricky, since arousal has both a physical aspect and a psychological one. You ask her if she gets wet. Yes, she tells you, she gets fully wet, and physical intercourse isn’t a problem.

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Again, by process of elimination, she seems to be describing a problem with psychological arousal. That’s not surprising. Psychological arousal tends to be at the heart of most good sex. Ask someone to recall the best sex of their lives, and they’ll usually tell you about a time when they felt very psychologically aroused. Conversely, when someone refers to bad sex, it typically means they just went through the motions without feeling psychologically aroused at all.

Finding the Words

Most clients lack a vocabulary for describing how arousal feels. Masters and Johnson spent many years studying what happens to people’s bodies when they get aroused, but few investigators have tried to understand the psychological aspect of it. For years, I’ve been asking clients to examine it in their own lives. Given their answers, here’s my short list of what ideally happens when you get aroused:

     - You get absorbed in the moment. You stop thinking about bills, worries, responsibilities—your entire portfolio of ordinary concerns slips away. Your time sense gets distorted. If someone gave you an IQ test during peak arousal, you wouldn’t do all that well on it. In fact, they might have a hard time getting you to pay attention to the questions!

     - You regress to a more infantile state of mind. You become more selfish, less patient. If the phone rings during lovemaking, you don’t care who’s calling or what they want. You may feel very close to your partner, but you’re not really interested in hearing about their day. You just want them to give you their complete attention and tell you how wonderful you are.

     - You feel great about yourself. When you’re highly aroused, you have a feeling of “yes, that’s me!” You feel in touch with your deepest, most authentic self. It’s a grateful feeling. “Thank you for finding me. The me of me. Thank you for bringing me home to where I really live.”

The best way I’ve found to express these three things in a language most clients can easily understand is to ask them whether during sex they manage to get “really dumb and happy.” Most clients will tell you they never thought of sex that way before, but that it makes sense and helps them more easily describe what’s going on in their heads—or not—during lovemaking.

Let’s get back to Carmen, who doesn’t “feel anything” when she and Scott have sex. “Is there any time you do feel something with Scott?” you ask.

“Oh, yes,” she says. “I love it when Scott and I kiss on the couch in the living room.”

“Does it make you feel kind of dumb and happy?” you ask.

“Yeah, I never thought about it, but I guess it does,” she replies. “But then I start thinking about what’s going to happen next.”

“Like what?” you press gently.

“Like he’s going to take me into the bedroom, and it’s going to be a disaster. That’s when I don’t feel anything.”

Now we’re getting somewhere, right? The picture is starting to come into focus: something good starts in the living room, then goes bad in the bedroom. Let’s see if we can fill in more details.

To read the full version of this article, click here...

Stephen Snyder, MD, is a sex and relationship therapist in Manhattan. Parts of this article have been adapted from his book Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship, copyright © 2018 by the author and reprinted with permission of St. Martin’s Press, LLC.

Photo © iStock/GeorgeRudy

Topic: Couples | Sex & Sexuality

Tags: Challenging Cases & Treatment Populations | couples | Couples & Family | couples choreography | couples conflict | couples therapist | Couples Therapy | love | love and relationships | sex | Sex & Sexuality | sex life | sex therapist | sex therapy

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1 Comment

Saturday, February 9, 2019 4:19:20 PM | posted by Francois Renaud
I find this article dangerous to consider that any therapist with common sense and no training to deal with sexual issues is being told they can resolve sexuality in complex relationship dynamics. It also reduces the professionals who have actually gotten proper training to resolve sexual issues. There are definitely connections any therapist can make, but that is like saying to an architect that they can be an engineer by reading a couple of books. Helping people with sexual issues is not just a matter of having knowledge about sex, but being comfortable with the subject (which most therapists aren't #lackofpropertraining) and knowing the intricacies of doing sex therapy as it requires years of training to distinguish your own values from therapy