Sex Therapy for Building Intimacy

A Therapeutic Approach to Common Sexual Problems

Katy Butler

Twenty years after the sexual revolution, in the most sexually explicit culture in the world, a surprisingly large number of people continue to experience sexual problems that have a significant impact on the overall health of their romantic relationships.

Before the 1950s, people with sexual problems were given pejorative labels like “impotent” and “frigid.” Psychoanalytic therapy had little to offer them beyond symbolic explorations of their upbringings and “Oedipal” conflicts. Things got slightly better in the 1950s, when Joseph Wolpe and other behaviorists taught people to reduce their fear with deep breathing exercises and relaxation techniques while they imagined sexual situations that had made them tense. This was of some help, but things only really changed in the 1970s, after gynecologist William Masters and his research associate Virginia Johnson began studying the physiology of human sexual response in the laboratory.

Today, sex therapy consists mainly of counseling and “homework” in which new experiences are tried and new skills practiced. If clients are too tense or reluctant to try something new, systems approaches, couples therapy, prescription drugs and psychodynamic therapy may be tried as well.

Modern sex therapy often begins with instruction in “sensate focus.” The pressure to have an orgasm, keep a firm erection or prolong intercourse is taken away. Instead, individuals or partners are told to set aside time to caress themselves or each other in a relaxed environment, without trying to achieve any sexual goal. Once anxiety is lowered, sex therapy often proceeds successfully, especially in treating the following common problems:

Premature ejaculation in men.
Treatment involves lowering anxiety and teaching the man to become aware of his arousal during lovemaking, until he recognizes the sensations that precede his “point of no return.” Then he practices what sex therapist Barbara Keesling, author of Sexual Healing, calls “peaking”–pausing before the point of no return and relaxing, breathing and stopping movement until his arousal subsides. After a few minutes’ rest, the man returns to movement, stimulation and arousal. The “peak and pause” routine is repeated five or six times per homework session. The exercise can be done by a man masturbating alone, while his partner is giving him oral sex or during intercourse. Men can squeeze their pubococcygeal or PC muscles during the pause to dampen arousal, or the man’s partner can squeeze on the coronal ridge just below the head of the penis.

Orgasmic difficulties in women. Therapy with “pre-orgasmic” women was pioneered by psychologists Lonnie Barbach of San Francisco, author of For Yourself: The Fulfillment of Female Sexuality, and Joseph LoPiccolo, a coauthor with Julia Heiman, of Becoming Orgasmic. It has extraordinarily high success rates with women once written off as frigid. In group and individual programs lasting 6 to 10 weeks, women are given basic information about female sexual response and are encouraged to spend one hour a day on self-pleasure “homework,” familiarizing themselves with their own anatomies and sexual responses, examining their vulvas with a mirror and speculum, massaging themselves, perhaps reading Nancy Friday’s collections of sexual fantasies and masturbating. Most of the women soon learn to give themselves orgasms, and then gradually transfer their new skills to lovemaking.

Even if you or your partner doesn't experience one of the aforementioned sexual problems, here are a few modern tantric techniques that can be used by any couple:

Create intimacy through gentle contact. Modern Tantrism focuses strongly on the subtle physical harmony between partners. In Tantra: the Art of Conscious Loving, yoga teachers Charles and Caroline Muir of the Source School of Tantra in Maui, Hawaii, recommend spoon meditation. Lovers lie together spoon-fashion on their left sides and gently synchronize their breathing. The outer person, the nurturer, rests his right hand on the heart of his partner. Placing his left hand on her forehead, he visualizes sending love and energy from his heart down his arm and into her heart on his out-breath. On the in-breath, he draws energy back from her forehead and into his body in an endless circle.

Focus on connection rather than orgasm. Much of conventional sex therapy has focused on orgasm. Many previously unsatisfied women were liberated in the process, but it also turned intercourse into a big project, made orgasm the be-all and end-all of being together sexually, and defined any other sexual interaction as “the failure to achieve orgasm.” Tantrism extols the joys of brief sexual connections without orgasm. In The Tao of Sexology, for example, Taoist teacher Stephen Chang recommends that couples practice the “Morning and Evening Prayer” for at least 2 to 10 minutes, twice a day. Every morning and evening, partners are to lie together in the missionary position, lips touching, with arms and legs wrapped around each others’ bodies and the man inside the woman. The couple breathes together in a peaceful, relaxed state, with the man moving only enough to maintain his erection. “The couple enjoys and shares the feelings derived from such closeness or stillness for as long as they desire,” writes Chang, who notes that orgasm sometimes follows without any movement. “Man and woman melt together, laying aside their egos to exchange energies to heal each other.”

“When sex is good,” Charles Muir said at a recent workshop, “It’s 10 percent of the relationship. When it’s bad, it’s 90 percent.”

This blog is excerpted from “The Evolution of Modern Sex Therapy.” Read the full article here. >>

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Topic: Couples | Aging | Anxiety/Depression

Tags: counseling | drugs | EFT | HEAL | intimacy | male sexuality | meditation | premature ejaculation | psychoanalytic therapy | psychodynamic therapy | psychologist | psychologists | relaxation techniques | sex therapist | sex therapy | sexual fantasies | SPECT | TED | therapist | yoga

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Sunday, October 18, 2020 3:58:01 PM | posted by Sam Elcor
I beg to differ when it comes to using sensate focus as a treatment for sexual dysfunction. In my experience the technique has exactly the opposite effect of what it is meant to do \(lower anxiety) Instead after going to a number of Sex Therapists practicing both sensate focus and CBT my wife and I, especially my wife couldn't stand the stress, anxiety and frustration sensate focus therapy caused while attempting "homework exercises" with the treatment focus on me who suffers from severe intimacy anxiety caused by a Dismissive Avoidant Attachment disorder (Due to family of origin trauma) which in turn causes me to suffer from sexual dysfunction like Anorgasmia (Inhibited Ejaculation and the inability to get and keep an erection) while in an emotionally close relationship. There was so much pressure for me to perform during the SF homework and so much pressure on my wife to try and arouse me (without any luck) that she finally had had enough and quit therapy. I have suffered from these sexual dysfunctions for decades. Thankfully my wife and I are still together despite our marriage being sexless from the beginning. But others may not have such an understanding spouse and I would recommend you go easy when treating anxiety related sexual dysfunctions in men with Sensate Focus. Like many of Masters and Johnson's ideas about treating sexual dysfunctions the concept is now old and outdated.

Thursday, March 15, 2018 8:08:09 AM | posted by Renee
I believe my husband was abused as a child, hence the reason his therapist suggested he suffered with PTSD. He hasn’t admitted all of his trauma, however I see it in how he functions in our marriage. He did explain he had issues with intimacy. While I see a very selfish man who don’t know how to connect with anyone. We need help. We finally talked about it again, but he doesn’t know how to make progress and address the issue. Can someone refer us to a sex Therapist, before the worst happens?😔