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The American Psychological Association’s Division of Psychotherapy and Psychoanalysis met this past week in New York City. The theme of this year’s conference, “Conflict,” was explored in numerous papers and presentations that focused on conflict’s many different forms—from cultural to intergenerational, from marital to intrapsychic [the psychological processes of the individual]—and the ways in which psychotherapists and analysts can work to resolve them.
A central tenet of Freud’s original theory, developed at the dawn of the 20th century, was that conflicts between drives and defenses are the source of our neurotic misery. Since that time, much progress has been made in both expanding and revising Freud’s original ideas, as well as developing new and wider applications for psychoanalytic theory.
One of the most interesting presentations, at the conference—that of by Suzanne Iasenza, Ph.D.—concerned the use of psychoanalytic concepts in the treatment of sexual dysfunction. Dr. Iasenza, a faculty member of the Institute for Contemporary Psychotherapy and Psychoanalysis, spoke of the treatment of couples with “low sexual desire,” one of the most ubiquitous issues in sex and couples therapists’ consulting rooms. She is careful to distinguish between (a) disorders of desire, which can occur between partners with a history of attraction to each other, and (b) disorders of attraction, in which there may have not be a sufficient spark to begin with. Obviously, it is more challenging to help with the latter problem, though it is not insurmountable, she says.
Most marriage therapy in founded on the belief that if communication is improved and other sources of tension and conflict are resolved, a couple’s sexual relations will improve as a result. Often, this is the case, but Dr. Iasenza’s findings are that sexual dysfunction often has deeper roots and requires the therapist to utilize multiple theoretical perspectives—e.g., psychodynamic, systemic, and cognitive-behavioral. A couple’s sexual interaction can undergo many changes over the life of their relationship, and conflict and communication are just some of the sources of influence.
One key question that she always asks is, “What is your model of sexual behavior?”—meaning, “What is your conception of a successful sexual act?” Often this question alone can open an important discussion of pressures and preconceptions. Many people are wedded to the original Masters and Johnson model of sexuality in which sex begins with desire and ends in orgasm. This model makes assumptions that have been challenged in recent years by researchers who have discovered that the boundaries of heterosexuality are more fluid than previously believed. Educating couples about this new work can have a significant impact.
Particularly important for women clients who report themselves as having low sexual desire is the work of Rosemary Basson and her colleagues. She has identified gender differences in sexual motivation, arousal, and desire that have important implications. Basson introduced the concept of a “circular” response cycle in women, as opposed to the more “linear” one that describes male sexuality in which desire leads to arousal as a prelude to sex. Many women report “multiple reasons for initiating or agreeing to sex,” and desire may not be experienced until after arousal. A distinction can be made between “spontaneous desire” (innate drive) versus “responsive desire,” which is contextual and relational. Women, she has found, often don’t feel aroused until after having begun engaging in sex, which they may have agreed to/initiated because of a desire to feel close or connected rather than because they have experienced physical desire or arousal.
Components of Basson’s (2001) Female Sexual Response Cycle
Learning about this model can be tremendously relieving to both parties. Women can understand that they are not abnormal because they don’t think about sex as often as their partner does, or feel aroused spontaneously, as he sometimes does. Men can be reassured that simply because she does not experience desire in the same pattern as he does, this does not mean she is not attracted to him or unable to be aroused.
In other words, a woman who wants to feel a burst of desire for her partner before having sex may be in for a long wait. Instead, if she begins having sex out of a state of “willingness,” she will find that desire and/or arousal will follow, sometimes at the same time. Many couples in long-term marriages with continuous sexual activity seem to understand this intuitively and report that they sometimes have “maintenance sex,” meaning they have sex simply to keep their sex life going.
Dr. Iasenza likens sexuality in long-term relationships to food and hunger: there are times when you will go out to dinner with your partner even if you are not terribly hungry yourself. Likewise, couples are encouraged to develop sexual “menus,” consisting of different things they each find pleasurable. Continuing the restaurant metaphor, she suggests that it makes sense that sometimes you’ll want Chinese and other times your partner will prefer Italian food. Always having the same menu can lead to boredom and disinterest, yet when it comes to sex, many couples find this happening to them. The good news is that with imagination and determination, Iasenza says, improvement is possible.