Happy Endings in Sex Therapy

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There ARE happy endings in therapy.

I don’t mean the kind you get at a massage parlor. No, in my therapy the happy endings last way longer. People change, they’re more satisfied with life, they understand how they used to undermine themselves. Most importantly, they have new tools with which to face the future.

Every case is different, of course, and not every case ends successfully. But the majority of cases in my practice do—generally, by learning some or all of these lessons:

~ Accept things as they are before trying to change anything
~ Know what’s important to you personally, not just what society values
~ Tell your partner the truth about your own experience
~ Decide that you can change, and notice the ways in which you believe you can’t
~ Don’t take your partner’s sexual functioning personally
~ Realize that a “sex problem” might not actually be about sex

We can see these ideas at work in the following stories of people who completed therapy with me this past spring.

Chronically afraid of disappointing his wife in bed, Pratik frequently found reasons to say no to her sexual invitations.

Meanwhile, he looked at porn at night and at women on the street by day. But he felt guilty about both. He was in a terrible psychological bind: afraid to express his sexuality with his wife, afraid to express his sexuality in any other way.

Fear of God, fear of his mother, fear of being a pervert—Pratik’s sexuality was so wrapped up in fear that of course he struggled with his desire.

We talked a lot about his fear. We specifically explored the idea that inhibiting his authentic desire would of course make it almost impossible to easily call up some enthusiastic sexual performance on demand.

I also explained that not having sex with his wife was much more disappointing to her than whatever unpleasant things he might reveal about himself when he actually had sex with her—including unreliable erections or unusual preferences.

Pratik is still not done with all his fear, but he does understand that keeping away from his wife sexually is not a healthy way to deal with it—and he’s been taking small steps toward her with affection and various kinds of erotic touching.

Marie & Josh
Marie was always a little more interested in sex than Josh was, and preferred more variety, too. But as long as they were having sex a couple of times a week, she was more or less content.

As Josh approached 50, his erections became less reliable. She was more than ready to increase their oral sex, although her favorite activity remained intercourse. Knowing that, Josh felt self-conscious, and hated the idea that she was “settling.” He gradually wanted sex less and less often.

That’s when things headed downhill for them.

On top of that, he was orgasming with her less frequently. He didn’t mind (most middle-aged men don’t), but she couldn’t really believe that. Unfortunately, she took it all—his periodic lack of orgasm, occasional lost erection, and reduced desire—quite personally. He tried to explain these were just physical changes out of his control, but she couldn’t hear it.

It didn’t help that she was having her own difficulties going through her 40s: she had always enjoyed being a very attractive youngish-looking woman, and had trouble as she noticed signs of her own aging.

For her, accepting his body changes as fairly common was difficult, but once she could do that, we could talk more about her difficulties accepting her own body changes. And when she did that, in combination with him being more verbal about his affection and desire for her, it helped them reconnect and start building a new sex life together.

They still don’t have sex as often as she would like, but she’s shifted from frequently feeling personally rejected to occasionally feeling disappointed—a big improvement. She’s also getting better at maintaining her image of herself as attractive as she gradually ages.

Molly & Shannon
Molly just wanted to be taken seriously. She liked sex with her girlfriend, but didn’t want to involve Shannon’s butt or her own: no fingers, no toys, nothing. “Our vaginas and mouths are enough for me, can’t they be enough for you?”

There were other things Shannon wanted that Molly didn’t: calling her Mommy during sex; letting their dog watch; and she certainly was not about to get her nipples pierced.

The problem was that Shannon wouldn’t take no for an answer—and somehow Molly couldn’t say no firmly enough so that Shannon would stop asking.

I invited Molly to make a list of all the things they both enjoyed in bed together. There were more than just a few things, and Shannon agreed that Molly was enthusiastic about those. I proposed a 90-day moratorium on new activities, suggesting they stick to what they both enjoyed. I wanted them to have the experience of sex without struggle, which they hadn’t had much of lately. They agreed.

During that time, we talked about other relationship dynamics. In particular, we talked about power dynamics, clear communication, and managing conflict. We cleared up a few things and they eventually felt closer.

Shannon needed to accept that no one gets everything they want in a serious relationship. Were things like butt-play going to be a dealbreaker for her? “Not as long as we do lots of other stuff,” she wisely said. I suggested she stopped asking for things that she knew she wouldn’t get. Yes, grieving is often necessary in order to move forward in a relationship.

Relieved that she wasn’t constantly being asked for things she had already refused, Molly became even more enthusiastic about sex with Shannon—an outcome they hadn’t expected, but which they gladly accepted.

Veronika had an unusual challenge: for 18 months now, her husband of 40 years was sliding into dementia. They had always enjoyed sex together. Now he was interested mostly when he didn’t quite recognize her.

She wanted the sex, but said it was weird to do it under those circumstances. Was she exploiting him? Doing him a favor? It was confusing.

I told her that some people would consider this a spiritual question, but she was not interested in such an approach.

I certainly sympathized.

I affirmed what she herself had said, that sex had always been a strong part of their connection. As he slipped away from her permanently, this was one of their last robust connections. I gave her permission to not have sex when she didn’t feel she was being seen in a meaningful way. But I also gave her permission to have sex when they both wanted to, experiencing the vestiges of what they once had together.

She was grateful for the permission. On some days her grief overrode her desire for sex and intimacy; on other days, she was more than up for it. Week by week, she couldn’t predict whether she’d be interested—and I told her that was okay, too.

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