Training Therapists About Intimacy

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After speaking on pornography in Toronto and Alberta, I’ve just returned from lecturing on intimacy in Vancouver, my third Canadian city this year.

As always, the British Columbia Psychological Association was gracious and well-organized. About half of those in attendance had heard me speak there last year on infidelity and cybersex, which of course is a lovely compliment.

Therapists are as interested in “intimacy” as everyone else. What exactly does it mean? How do we create it? Why is it so hard to maintain? Our patients have trouble talking about this magical thing—and so do professionals. So I wanted to give people a useful description, a vocabulary, and a way of working with people that empowers them, too.

The elements of intimacy that I discussed include:

~ Communications infrastructure
Do people feel understood way more than they don’t? Do people know how to get each other’s attention without creating drama?

~ Explicit values consensus
Do people believe they want compatible things from their relationship, and from life?

~ Reliable commitments
Do people keep their promises, both small and large?

~ Ability & willingness to self-soothe & self-discipline
Do people manage themselves in adult fashion even when they feel disappointed, lonely, jealous, sick, or desperately need a shower?

~ Insights about power dynamics
Can people ask for what they want in a straightforward, understandable way?

~ Ability to manage conflict
Can people disagree as partners rather than adversaries? Is the goal of conflict to win, or to understand?

~ Acknowledgement of existential issues
Can people admit that they have the normal fears and challenges of being human?
* * * * * *
Notice that sexuality itself isn’t on this list. Many psychologists in attendance were surprised, especially as I’m known as a sex therapist.

Sex is NOT necessary for intimacy. And there’s plenty of sex that isn’t intimate. That’s why when my patients use intimacy as a synonym for sex (“We’d like to be intimate more often”; “We’d like to have more variety in our intimacy”), I gently guide them to the word “sex.” And I suggest that “We use the word intimacy primarily to describe an aspect of our emotions or a quality of the relationship.”

Of course, many people desire sex in their couple or their relationship. I talk about that in the office every week, hour after hour. But whereas people typically want to talk about desire and orgasms, positions and erections, I usually think that stuff can wait. First, I want to talk about those elements of intimacy I listed above.

And so before I ask detailed questions about lubrication and masturbation and clitorises and fantasies, I usually ask about other things:

Can people talk to each other? Do they feel valued by their partner? Is there general agreement about the kind of relationship they want to have? Can they manage conflict without being mean or keeping grudges? Can they admit when they’ve made a mistake? Do they accept how the other person feels even if it seems confusing or foolish? Does each person accept genuinely gentle criticism? And can they talk about their fear of growing older, their fear of trusting, their fear of—well, intimacy?

When people have that kind of relationship, we can talk about oral sex and period sex and BDSM sex and every other kind of sex. Without it, of course we can talk about sex—but enjoyable sex in a long-term relationship that’s filled with mistrust, selfishness, and manipulation just isn’t sustainable.

After lunch, we did talk about a few other things: the stories we tell ourselves about ourselves (“I’m just no good at this communication thing;” “Since my awful first marriage, I’ll probably never trust women ever again”); the categories we construct (Clueless engineer; drama queen; oversexed), and then conveniently forget we made up those categories that are suffocating us; and the rules of “fair fighting.”

In my 39 years as a therapist, almost every couple has told me they have “communication problems.” My answer is usually some version of “Well, we’ll see about that.” Because in my experience, most couples communicate clearly—they just don’t like what they hear.

In troubled relationships, people communicate their disrespect, their desperation for attention, their lack of trust, and their greed all the time. They communicate clearly by being chronically late, by forgetting things their partner has said are important, by changing the subject when they’re being criticized, by doing exactly what they said they wouldn’t do, and by making apologies that are obviously perfunctory.

Then these same people want to know how they can be “more intimate.” Whether they mean “more sex” or “getting along better,” I’d love to tell them. But you’d be surprised how many people ask for that—and then reject my answers.
If you liked this, you’ll enjoy my post at

And check out my Architecture of Intimacy webinar, at

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