A Systems Approach to Sex Therapy with Gay Male Couples

SUMMARY

Sex therapy with gay male couples is difficult for many family and relationship therapists. Family therapists lack knowledge of the nature of sex therapy, gay male culture and sexuality, the dynamics of gay male couples, and the sexual issues gay male couples are likely to bring to sex therapy. Countertransference also makes sex therapy with gay male couples difficult for some family and relationship therapists. This paper addresses those issues and then explains a systems approach to sex therapy with gay male couples.     

Hypoactive Sexual Desire in Heterosexual Women:

The problem of hypoactive sexual desire is the most common sexual problem that heterosexual couples and individuals present to sex therapists. Often it is a woman who reports that she has the problem, or her male partner brings her to therapy believing she has hypoactive desire. The treatment literature describes a variety of causes that contribute to the disorders of sexual desire. However, most of the literature looks primarily at the causes within an individual's history of within a couple's relationship. There does not seem to be adequate consideration given to the social and cultural limitations that have defined and prescribed a sexual role for women that is primarily oriented to the service of male needs rather than female sexual pleasure. This article will analyze some of the social and cultural forces that limit female sexual expression, and are a neglected factor when causes for low sexual desire in heterosexual women are given.     

Knowledge and Attitudes About Later Life Sexuality: What Clinicians Need To Know About Helping the Elderly

In the family therapy field we have often overlooked the elderly and in particular addressing sexual concerns within the context of couples therapy with the elderly (Van Amburg, Barber, & Zimmerman, 1996). The projected life-span of the elderly has increased due to improvements in medical technology and due to a better quality of life which promotes longevity. Included in this paper are the specific age-related physical, emotional, and sexual changes common in later life as well as a clinical case vignette of an elderly couple presenting with a sexual issue. Current sexuality education programs for the elderly are reviewed as well as clinical implications for therapists who treat the elderly.     

Intercultural Therapy with Latino Immigrants and White Partners

SUMMARY

Interethnic and interracial marriages of Latinos and White Americans are on the rise and will continue to reshape the identities of individuals, couples, families, and communities. Clinicians working with these intercultural couples find no systematic training to address what is becoming a significant segment of our society. Couple therapists, however, cannot be culturally competent and effective based solely on knowledge of some dimensions of a couple's cultural backgrounds. Using clinical and theoretical ideas, the author defines clinical work with these couples as an explicit intercultural exchange. Our task as clinicians requires a rethinking of our conversations with these couples. It involves a caring therapeutic approach that is sustained on relational and systemic levels, and intercultural conversational skills inspired by clinical and other literatures that are explicitly dedicated to work with cultural difference and the “other.”     

Heterosexual, lesbian, and gay male relationships: a comparison of couples in 1975 and 2000

This study examined the differences among lesbians, gay men, and heterosexuals at two points in time (1975 and 2000) using responses of 6,864 participants from two archival data sets. Groups were compared on variables representing equality of behaviors between partners in seven realms: traditionally "feminine" housework, traditionally "masculine" housework, finances, support, communication, requesting/refusing sex, and decision-making. In addition, the current study compared monogamy agreements and monogamy behaviors reported by the two cohorts of couple types. Overall, the results indicate that on the equality variables, there have been many statistically significant behavioral shifts among the different sexual orientations across 25 years. In addition, all couple types reported substantially greater rates of monogamy in the year 2000 than in 1975. The present study has important clinical implications for therapists working with couples because it provides new baseline evidence regarding how couples now interact with one another (especially about monogamy) and how this has shifted over time. In addition, it elucidates the differences that still exist between different couple types, which could serve to inform couple therapists as they strive to become more culturally competent working with same-sex couples.     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.     

Strengthening Family Resilience

Abstract

Researchers in the field of marriage and family therapy have largely ignored the effect of gender bias on clinical decision making. The purpose of this study was to explore if patient gender influenced prognostic judgments and if male and female therapists utilized different client characteristics when formulating prognostic judgments. Prognostic judgments were based on clinical profiles of couples seeking marital therapy for inhibited sexual desire. The multidimensional scaling procedure, KYST, was utilized to analyze the data. The findings indicated that the identified patient's gender did not influence prognostic judgments. However, therapist gender did influence the client characteristics used to formulate prognostic judgments.     

Integrating Sex Therapy Interventions with Couple Therapy

This conceptual/clinical paper presents a couple, integrative, psychobiosocial model of assessment, treatment, and relapse prevention for common sexual dysfunctions. The goal is to encourage couple therapists to integrate sexual permission-giving, scientifically and clinically relevant sexual information and guidelines, and specific sexual suggestions/interventions into their couple work. The artificial barriers between couple and sex therapy is to the detriment of couples who need to address intimacy and sexuality problems.     

No Means Yes? Perpetuating Myths in the Sexological Construction of Women's Desire

The diagnosis and treatment of desire disorders are contentious issues within sexual medicine today. The issue of women's sexual desire (or rather lack of sexual desire) in particular, has highlighted a variety of problems within the current diagnostic framework for sexual dysfunctions. In an effort to rectify some of these problems, the concept of receptivity has been put forward by a number of clinicians with the suggestion that this better reflects women's experiences of desire. It is argued here, however, that he concept of receptivity presents serious problems for women in heterosexual relationships. Rather than helping women, furthering this concept may simply reinforce male sexual demands, curtail women's sexual autonomy, and promote coercive sex as an acceptable norm. It should therefore not be adopted by therapists.     

Improving Young Male Couples’ Sexual and Relationship Health in the 2GETHER Program: Intervention Techniques,Environments of Care,and Societal Considerations

Young male couples are at high risk for acquiring human immunodeficiency virus (HIV). However, few HIV prevention programs meet the needs of young male couples that express an interest in how to maintain healthy relationships. As such, we developed 2GETHER, a couple-based program that integrates HIV risk reduction and sexual health information into a relationship education program specific to young male couples. 2GETHER was guided by cognitive-behavioral theories of HIV risk reduction and relationship functioning and was informed by a social–ecological perspective to address factors within and outside the couple that can impact sexual and relationship health. As a micro-level intervention, 2GETHER intervenes directly with couples via psychoeducation and cognitive-behavioral strategies to change couples’ communication patterns, sexual health behaviors, and relationship satisfaction. Successful implementation of 2GETHER requires mezzo-level interventions that create an affirming environment of care for sexual minority individuals and facilitators who are culturally competent in working with young male couples. Although macro-level interventions to change societal acceptance of and policies germane to sexual minority couples are beyond the scope of 2GETHER, we discuss how clinicians can advocate for systemic changes to improve sexual minority couples’ health, and how 2GETHER addresses the impact of such macro-level factors on the couple’s relationship. Our experience developing and testing 2GETHER indicates that HIV prevention programs for young male couples should reflect the unique contexts shaping sexual minority individuals’ relationships and lives, and that programs should intervene within and across multiple levels when possible to improve health for sexual minority men.     

Therapists' Perspectives on Working with Interracial Couples

SUMMARY

This paper is based on interviews with seven marriage and family therapists (AAMFT Clinical Members) on their experiences of providing therapy to interracial couples in the course of their private practices. The interviews were conducted by the author as part of a masters thesis project. Interracial couples may frequently present for therapy with a variety of generic couples' issues and concerns. However, therapists often find that underlying these more generic concerns are issues related to the ethnic, racial, and cultural differences that the partners bring to the relationship. This paper focuses on the historical context of intermarriage, specific concerns and issues that interracial couples experience in their relationships, and on the experiences of therapists providing therapeutic services to this diverse and challenging client population.     

Inequalities of power and sexual problems

The proposition that sexual problems can emerge as a response to structural inequalities of power is explored by reference to a case which forms part of our current clinical work and research in this area. It is suggested that inequalities of power between heterosexual partners and societal 'discourses' which support the use of sexuality, predominantly by women, as an influence strategy, can serve to promote the development and maintenance of sexual symptoms as forms of covert power struggles. An integration is attempted of systemic and feminist theories with some practical suggestions for therapists working with couples with sexual problems.     

Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

Assessing and treating sexual dysfunctions in Orthodox Jewish couples: a summary of 41 consecutive cases

ABSTRACT

Orthodox Jews are a distinct subgroup with specific beliefs and values towards sexuality, reproduction, modesty, and openness to mental health treatment. This paper reviews the treatment of 41 Orthodox Jewish couples who presented for sex therapy. Most couples were referred by a rabbinical leader. The most common presenting problem was an unconsummated relationship; present in 27 couples. In 34 couples the initial presenting complaint was a male sexual problem yet in 20 of 41 couples both partners described having some sexual problem. Almost 50 per cent of both men and women were also diagnosed with a comorbid psychiatric disorder, which was almost always previously undiagnosed. The most common presenting problems were vaginismus, male inhibited arousal, and/or inhibited male orgasm. Two case examples illustrate some adaptations to assessment and treatment that can be helpful in treating sexual problems in Orthodox Jewish couples.     

Male Emotional Intimacy: How Therapeutic Men's Groups Can Enhance Couples Therapy

Men's difficulty with emotional intimacy is a problem that therapists regularly encounter in working with heterosexual couples in therapy. The first part of this article describes historical and cultural factors that contribute to this dilemma in men's marriages and same-sex friendships. Therapeutic men's groups can provide a corrective experience for men, helping them to develop emotional intimacy skills while augmenting their work in couples therapy. A model for such groups is presented, including guidelines for referral, screening, and collaboration with other therapists. Our therapeutic approach encourages relationship-based learning through direct emotional expression and supportive feedback. We emphasize the development of friendship skills , core attributes of friendship ( connection, communication, commitment, and cooperation ) that contribute to emotional intimacy in men's relationships. Case examples are included to illustrate how this model works in clinical practice, as well as specific suggestions for further study that could lead to a more evidence-based practice.     

Together or Apart

Psychotherapists often mistake their theories for realities that they are not and thus may operate with an overly confident sense of "knowing" what is true about a particular couple relationship. Many schools of therapy tend to "pathologize" the dynamics of couple interaction and practitioners need to guard against being too inducted into any one world view. Facility with the theories and techniques of many different couples counseling strategies (psychodynamic, behavioral, structural and strategic approaches) can increase flexibility and the "working base" of therapists. Ultimately, however, the personhood of therapists, their awareness of their own biases (about levels of connection, emotional expressivity, feminism, or power relationships) and their ability to adopt a neutral, therapeutic stance are the essential ingredients for meaningful and curative couples counseling.     

Family and Couples Therapy in a Time of War

SUMMARY

In this article the issue of professional responsibility of couples and family therapists is raised with regard to the war in the Persian Gulf. Implications are discussed for families and couples coping with the stress of war and its aftermath.     

Save the young--the elderly have lived their lives: ageism in marriage and family therapy

The paucity of literature addressing mental health issues concerning geriatric populations represents the perpetuation of ageist practices and beliefs in the field of marriage and family therapy. The purpose of this study was to assess whether client age and clinical training relate to the evaluation of couples who present for conjoint therapy. Written vignettes describing two couples, one older and one younger, who report issues involving the absence of sexual intimacy, increased frequency of arguments, and increased use of alcohol were evaluated by practicing marriage and family therapists, therapists-in-training, and individuals with no clinical background. It was hypothesized that respondents' views would vary in connection with the age of the couple and with the three levels of participant training. Results indicate that client age and participant training are associated with perceptions of individual and couple functioning. Our findings suggest that the relational and mental health concerns experienced by elder couples are not perceived as seriously as are identical concerns experienced by younger couples. Contrary to our expectations the observed differences between views of the two age conditions did not significantly differ between levels of participant training. Training and experience in marriage and family therapy may not significantly mitigate vulnerability to age-discrepant views.     

Sexual Attraction in Conjoint Therapy

Considering the magnitude of the potential repercussions concerning sexual attraction between mental health professionals and their clients, relatively little research exists in the field of marriage and family therapy (MFT). Although the topic of sexual attraction and various ethical dilemmas accompanying the issue have raised awareness of the increasing need to address sexual attraction dynamics in therapist training programs (Harris, 2001 Harris, S. M. 2001. Teaching family therapists about sexual attraction in therapy. Journal of Marriage and Family Therapy, 28(1): 123–128.  [Google Scholar]), the inherent gray nature of the topic often makes it difficult to address. Research shows that that a majority of therapists encounter feelings of sexual attraction either toward or from their clients during their careers. In light of the MFT research addressing sexual attraction in therapy, to date few studies address the phenomenon in the context of conjoint therapeutic sessions, a significant component of our profession. This paper presents the results of a study designed to assess how therapists in training think about how they would handle attraction in the context of a conjoint couple session and discusses the inherent difficulty in managing sexual attraction in such a context.     

Demand and withdraw behaviors in couples with a history of infidelity

Although relationship distress and dissolution are common consequences of sexual involvement outside a committed relationship, there is little empirical information regarding communication behaviors of couples who have experienced extradyadic involvement (EDI). This study examined male and female demand and withdraw behaviors in videotaped conflict discussions among 170 married or seriously dating couples categorized into 3 groups: those without a history of sexual EDI, those with a history of sexual EDI that was known to the other partner, and those with a history of "unknown" (undisclosed or undiscovered) sexual EDI. Both men and women in a relationship where there was at least one unknown EDI demonstrated the highest levels of demand behaviors. Furthermore, demand behaviors were higher for participating partners (those engaging in an outside sexual relationship) in relationships with an unknown EDI compared with participating partners in relationships with a known EDI. Conversely, demand behaviors were higher among nonparticipating partners in relationships with known EDI, compared to with nonparticipating partners in relationships with unknown EDI. Withdraw behaviors demonstrated a less pronounced and less consistent pattern of elevation by EDI group, and role within EDI, compared with demand behaviors. Clinical and relational implications for these findings are discussed.