On sex, love and intimacy
The term “psychosexual” may sound odd, redundant. Ever since Freud’s seminal work on the human mind, relationships between psychological and sexual have been established and remain broadly accepted. What makes that therapeutic school a distinct one is that here it deals centrally with the psychosexual and the relationial.
Freud himself coined the terms “psychosexual” to describe the key evolutionary stages of the human mind in Freudian development. Freudian psychodynamic school may have been scrutinised for decades along many critical lenses (some with reason) but that psycho/sexual relation has proven unchallenged. So why coin that term?
Well the simple answer is that there was a “space” yet largely unchartered, between psychology and psychotherapy at large and clinical sexology. Psychosexual and couple therapies aim right in the middle, for couples or individuals experiencing issues and challenges that are typically psychosexual. It talks of sexuality as a central field, and addresses all related emotions, boundaries and dynamics. It is primarily focused not on the sexual organ as a clinical object, but the whole person as a sexual and intimate actor.
Couples therapy can provide a highly effective way of helping couples with a huge range of difficulties. It can be very enlightening to work together with your partner to examine what blocks you have been experiencing either in your communication or in your sex life, how they have arisen and how they may be resolved. It is then often tremendously helpful and encouraging to be working purposely together through the problems rather than alone.
Psychosexual vs. Traditional sex therapy
Psychosexual Therapy as it is often called in short can be easier to explain contrasted to traditional sex therapy, which aims to:
- Improve sexual functioning
- Improve / remove symptoms of dysfunction
But what about intimacy? Erotic Connection? The meaning and experience of sex rather than the successful performance? How essential is penetration or orgasm?
Psychosexual therapies posit that sexual difficulties are too often seen as symptoms or dysfunctions. That this lens also focuses too much too often on the perceived dysfunction in isolation, at the expense of the holistic person/patient (the meaning they ascribe to sex, to relationships, to desire, to arousal, etc.)
Psychosexual: Key indications and concepts
‘We have to face the contradictory images two or more partners hold about themselves and about each other, find the truth in each and come to a joint narrative, making sense of the whole story, in such a way that each has the freedom to be who they chose to become and to do so in a way that is caring of the self and loving of the other. If we succeed in this, even in a modest way, this is no mean feat.’
Examples of typical presentations for couples therapy:
- Psychosexual problems, either both or individual
- Conflict with partner – difficulty coping with intensity or frequency of conflict
- Assertiveness/communication difficulties
- Lack of emotional intimacy
- Trust issues
- Unresolved issues, for example, re children, finances, other people in past
Sexuality as a whole is also (unsurprisingly) examined and understood under a variety of finer, granular lenses:
- Organic: What are the organic traits of the patient? Attractiveness and self-image. Medical history. Libido.
- Non-Organic: What are the non-organic traits of the patient? Status and self-worth.
- Primary: Our own, inherent sexuality. What touch excites us, personal preferences, the physical processes of reaching orgasm. Primary sexual organs and erogenous zones. Primary validation of sexual marker, and fundamental sexual act.
- Secondary: Secondary sense and attributes of sexuality. Relationship specific sexuality (chemistry, the give and take between each partner’s inherent sexuality, what’s happening in the wider relationship.) Performance standards (perceived, imagined or reasonably expected).
- Situational: Describes the sexual being inherently in his/her context: Age, personal events and issues, position in a biopsychosocial model, family relationships and status, health levels, etc.
- Total: The complete psychosexuality of the client/patient
Besides from the primary or secondary sexual ID and factors, psychological factors (depression, anxiety, phobias, addictions etc) are also considered, as well as the thoughts, memories, and fantasies they may have originated.
- Relationship
- Intimacy, Conflict, Relationship History, Communication
- Context
- Family, Friendships, Work, Religion, Class etc. Sex education and taboos
Psychosexual & Couples therapies vs. Sociology
A large part of the psychosexual family of therapies hinges on a sociological analysis of the client/patient. Of prime importance to this sub-set of practitioners are concepts such as diversity and difference (alterity), power balance and acceptance. Other common themes and lenses include:
- Gender
- Sexuality
- Age
- Ability
- Race
- Religion
- Colour
- Class
- Wealth
- Education/ intelligence
- Attractiveness
- Assertiveness
- Other?
Sexual Diversity
- Identity and Practice
- LGBTQIA
- BDSM
LGBTQIA
- Lesbian
- Gay
- Bisexual
- Trans
- Queer
- Intersex
- Asexual
BDSM / Kink
- Bondage and discipline
- Dominance and submission
- Sadomasochism
- PIV
How to start a conversation about sex
- Start positive
- Be transparent and ‘locate’ your questions
- Be matter of fact
- Stay curious and open-minded about lifestyle choices, gender of partner, sexual choices of clients, etc.
- Stay aware and reflective about any cultural factors
- Think about timing
- Be on the lookout for openings and invitations
- Use questionnaires and other assessment tools
- Normalise sex as a topic
- Choose language that is comfortable for you and your client
Psychosexual & Couples counselling: A critical view
How about individual Therapy?
That is a question you will often hear associated to psychosexual and couples therapy. If most of the concepts, frames and lenses adopted have to do with socilogy, psychology, trauma, communications, etc. aren’t these better explored in an individual focused therapy?
The simple answer is that it depends, and that there are no cookie-cutting answer to this. It is entirely true that many of these issues could also be worked with in individual therapy by non psychosexual and relationship therapists. In the end it may come down to the individual’s choice e.g.
- Preference for working psychotherapeutically in a particular approach e.g. psychodynamic or Gestalt
- Preference to deal with the problem in the context of wider set of issues in life e.g. anxiety in general, not just in sexual scenario
- Wanting to have time alone with a therapist to explore from the individual’s past history and current feelings at leisure, rather than also having it explored from the couple and the partner’s perspective.
There are also situations when couples therapy may be contra-indicated. If so, the couple therapist should be able to refer the couple to an appropriate alternative.
Another possibility is that one of the couple is referred for individual therapy with someone else but the couple undertake couple therapy at the same time. This could be the case for example, if one of the couple is needing help to work on specific personal trauma like sex abuse or severe depression.
We need to consider whether we are able to work within our competence and whether the couple are in a position to embark on couple therapy, given the other problems experienced. As always context is key, and custom therapeutic protocols must best accommodate a variety of important context (personality disorders, sex addiction, substance abuse, risk of domestic violence, etc.)
