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Section 8: Addressing the Unconscious Sexual Saboteurs

To this point, we have addressed several components of a person’s psychological make-up that may interfere with the enjoyment of and engagement in sexual activity, including the presence of performance anxiety, spectatoring, and depression. This discussion, until now, has not addressed some of the complex psychological - and cultural - forces that may enter into and interfere with the expression of a person’s sexuality. This section will enter into some study of the complex world of unconscious sexual saboteurs.

To be clear, this section is concerned with couples who present with a reasonably good degree of emotional attachment and commitment to one another - hence not exhibiting the kinds of serious attachment or personality disorders that can create such powerful psychological challenges to healthy sexual expression.

Clients bring into their relationships - and their therapy - both a history and a complete personal culture, shaped from the summation of the lifetime of experiences that inform their perceptions, values, memories, ideas and beliefs. Until they encounter problems from this cultural material, for instance when it interferes with their sexual life, this material may be hidden in plain sight; it is just how they have come to engage with the world. This is to say that clients frequently have a lack of awareness about “old” beliefs, values, worries and fears that they are bringing into their relationships, and this material can undermine progress in therapy.

If this were not enough, they also engage in their relationship within the context of one or more cultural milieus that generate powerful forces encouraging certain ways of thinking, behaving and being, and discouraging other ways of thinking, behaving and being. These forces are often pervasively presented through television and other media that disseminate information. This person-milieu interaction can create two almost exactly opposite kinds of problems in addressing sexual concerns.

On the one hand, the forces from these cultural milieus can support and strengthen the material that already exists within the client’s personal culture, in which case any problem areas are more difficult to address. On the other hand, these forces can exist in conflict with the client’s personal culture, in which case the client may be torn between competing demands.

While sexuality is not the only area in which these forces are seeking influence, it is often one of the more emotionally laden areas. An important part of the work of sex therapy lies in the untangling of these many factors. Let’s examine a case study to demonstrate how this works.

Dr. Joseph LoPiccolo tells of a young couple who came to see him - the wife was anorgasmic and the husband had rapid ejaculation. With some sex therapy types of interventions, the wife became orgasmic. At the next session with Dr. LoPiccolo, the husband said to his wife, “Oh my gosh, last night you were just like a German Shepherd in heat.” As you might imagine, the wife was a bit upset by this response.

When Dr. LoPiccolo explored the husband’s reaction, what surfaced was that the husband had grown up with the message, “Good girls don’t like sex.” In his conscious mind he wanted his wife to enjoy sex, but his deeply held long-term belief was sabotaging the couple’s progress. He was getting a secondary gain from her remaining anorgasmic - he could still see her as a “good” girl.

The wife was also getting a secondary gain from her husband’s rapid ejaculation - she was getting attention and empathy from close friends about having to deal with this problem. (LoPiccolo, personal communication, 1990).

The most complex clinical work in this case would likely not be concerned with medical approaches to sexual performance concerns. The work would more likely involve the untangling of internalized cultural messages, intrapsychic conflicts, fears and worries, and guilt and shame.

This is a sexual problem, in that there is a conflict being expressed in the sexual arena, but pulled away from the sexual overlay, it is really just one of many areas in which conflicts arise from internalized cultural messages. The process of addressing this concern would transpire much as it would if the couple’s conflict was concerned with other problems in the relationship where powerful cultural and intrapsychic material is present, such as money or child-rearing practices.

This is to say that a reasonably experienced mental health clinician would likely be qualified to help this couple sort through their concerns without the kind of specialized training that a certified sex therapist would need for cases with more complex sexual concerns occurring. This couple might profit from the use of Sensate Focus in combination with some supportive work uncovering and restructuring the beliefs and values contained within the unconscious saboteurs.

Now, consider this example:

The prevailing and pervasive myth that endless intercourse will produce the elusive female orgasm results in unrealistic expectations, disappointment, and often finger pointing and blame or self-deprecation.

One therapist reported the following case:

“I just received a letter yesterday from a couple in their early twenties who are struggling because the young woman hadn't had an orgasm by oral or manual means, and when they began to have what she called "regular sex" the boyfriend was sure she would come. When she didn't, he lost interest in being sexual at all because he felt like a failure.

There's no question that the issues are muddy as a riverbank, and people need so much more detailed, comprehensive information than they have. Remarkable that with all the books and advice columns people in our field write, the amount of misinformation and disinformation is still so rampant.”

This scenario offers a good representation of what was described in an earlier chapter, where we discussed the importance of a safe and secure, non-thinking flow state, as opposed to sexuality that is being disrupted by fears, worries, anxieties, disappointments and other emotions. In this case, the male partner’s sexual desire is being interrupted by worries about his partner’s anorgasmia being related to his performance.

This is a perfect scenario in which to describe the combination of approaches that will be utilized in cases of sexual problems within relationships. It will begin with accurate assessment, looking to determine whether the female partner’s anorgasmia can be attributed to physical factors and/or unconscious saboteurs that inhibit her sexual response.

Physical problems would be determined by a thorough medical examination with a specialist who is both familiar with sexual concerns and who can be counted on to handle the concerns delicately and sympathetically. Unconscious saboteurs would need to be uncovered - both for the man and the woman – and addressed with care and sensitivity.

In either instance, education, normalizing, and removing blame would be in order, followed by Sensate Focus or other approaches that would enhance overall efforts towards increasing intimacy and bringing the couple together in a search for mutually acceptable solutions.

Finally, consider another example of an unconscious saboteur(s):

A young woman described herself as very shy. She had rarely dated in high school or college. Shortly before graduating from college, she met a young man and quickly fell in love.

She stated, “Before I knew it, we were in bed. I was shocked at myself. We didn’t have intercourse, but we did other things.” The couple got married, and for the next two years they were unable to have intercourse because the wife had vaginismus.

In therapy she acknowledged that her inability to have intercourse might indeed have something to do with her fears about her sexual potential if she allowed herself to “let go.” Also she had been raised in a sexually repressive household where she got the message that having sex was bad. Now that she was married, she could not just “flip a switch.” She was still tied into her family of origin, and having intercourse may have broken a family taboo and been viewed as an entry into adulthood.

The treatment protocol for vaginismus can include psychotherapy, but may also require the use of vaginal dilators combined with a program of muscle relaxation and biofeedback to increase vaginal dilation. While an experienced mental health clinician may be able to work through - over time - the psychological obstacles presented by the unconscious saboteurs, this may be an instance where at least a portion of the work must be done by a provider who is trained and experienced in work with this specific problem.

A conscientious clinician would need to be very clear about his/her area of competence in deciding whether to hold on to this case or make a well thought through referral.

There are many different approaches that may need to be used in order to ferret out and confront unconscious saboteurs. Just as an aside, one way of addressing the saboteurs is to say to clients something like,

“This is going to sound really crazy, but there is almost always something positive that’s coming out of having this kind of problem. Think of what’s happening as perhaps 90% negative with a 10% positive component. It’s really important to know what the 10% might be, because it can interfere with what you want to accomplish. What can you think of that might be a positive of having the problem?”

If the couple is unable to respond to this question during the session, you can give this as an assignment for them to consider prior to your next session. Initially they may deny there is “a positive,” but the author has found that after some time to “mull it over,” most people will acknowledge specific experiences and/or beliefs that could hamper their progress.