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Sex on the Therapy Couch: Working with Sex in the Therapeutic Relationship


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Counsellors can sometimes feel ill-equipped to engage with clients in this area, owing to a lack of training or their own unclear feelings around sex. This can inadvertently undermine clients feeling safe to openly discuss sexual concerns. The workshop addresses this and will encourage participants to explore how their own attitudes may impact a Person-Centred therapeutic relationship.

There can be many variations of this theme, so some clarification is offered below:
In counselling training, we are encouraged to examine our views and to raise our self-awareness around all manner of issues, such as loss, race, disability, difference and diversity, so as to be effective therapists. Much of sexual training focuses on sexuality and GLBT, and sexual abuse, while more general feelings about the act of sex itself is often neglected. This can leave counsellors less equipped to engage comfortably with client concerns, e.g. owing to personal embarrassment or shame, such that a client might then feel unsafe to openly discuss sexual apprehensions in their relationship or anxiety about having sex, not liking it, wanting it too much, being influenced by pornography, to name but a few areas of potential worry.

The presentation is thus intended to address theses issues by an examination of societies' views of sex, our own feelings about it, and finally we will link these to how all of this may subtly impact our client work.

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Sex on the Therapy Couch: Working with Sex in the Therapeutic Relationship

  1. 1. SEX ON THE THERAPY COUCH: Working with sex in the therapeutic relationship © Stephanie Jeans 2013
  2. 2. “The study of sex is the study of the beginning of all life, and science holds the key, and yet we sit huddled in the dark like prudish cavemen filled with shame and guilt, and the truth is, nobody understands sex.” Masters, 1956 © Stephanie Jeans 2013
  3. 3. “It‟s a pity that sex is such a dirty little word.” - D. H. Lawrence • Whether we love it or loathe it, we can‟t escape fact that we were created by it, came out of it, indulge in it and it‟s on our minds, for better or worse. • Sex is a topic of conversation between the sexes for titillation, entertainment, for something seriously educational and for something personally intimate. • It may be overtly public or deeply private, but sex is always on and in the mind. © Stephanie Jeans 2013
  4. 4. • Despite a seemingly liberated culture, there is still much shame, stereotyping and ignorance surrounding sexual issues. • This can be true of the counsellor as not all training exposes trainees to sexual issues and to exploring their own sexuality and prejudices. • As therapists we must notice our values and assumptions; develop an understanding and perspective of our sexuality as a vital force in ours and clients lives. © Stephanie Jeans 2013
  5. 5. • We cannot easily apply the label „normal‟ to sexuality. Does that mean „usual‟, „ordinary‟, „natural‟, as it „ought to be‟ or what an expert claims it „should be?‟ • Perhaps it‟s what someone thinks or feels is normal and anything different is a perversion, deviation, or abnormal. • Sexologists may see some things as „abnormal‟ e.g. obsessive cleansing of genitals. © Stephanie Jeans 2013
  6. 6. Our Attitude to Sex is Influenced By: • Mind-sets inherited from family, both spoken and unconscious • Culture, incorporating myths & taboos • Peers © Stephanie Jeans 2013
  7. 7. • Attitudes inherited from childhood, or out of ignorance can cause unnecessary misery. • When you are bringing up a child, you are potentially raising a future husband/wife/partner. • We take responsibility for bodies (food etc.) & minds (education etc.), why not sexual development too? © Stephanie Jeans 2013
  8. 8. John Bowlby and Attachment Theory: • Theorised that the ability to give or receive intimacy & to desire „the other‟ has basis in early attachment with primary caregiver. • Early experiences of closeness, touch, and learning emotional regulation come from interaction with a significant caregiver. • Adult relationships are impacted by, & reflective of, those formed in childhood. An insecure child becomes an insecure adult. © Stephanie Jeans 2013
  9. 9. John Bowlby and Attachment Theory: • Each partner brings their own individual working models of attachment & projects their own needs, wants, senses of selves & structural defences, onto one another. • Avoidant: impersonal sex • Ambivalent: prioritises emotional over sexual relating • This can create discrepancies in desires for relational intimacy & sexual encounters. © Stephanie Jeans 2013
  10. 10. “Tell me how you were loved & I will tell you how you make love.” • Early experiences will impact intimacy and sex as attachment anxieties will reflect in sexual relationships. • Our „sexual script‟ will be learnt, either positively or negatively, and be incorporated into our childhood experience and continue to affect us as adults. © Stephanie Jeans 2013 Esther Perel
  11. 11. A sexual ‘script’: Our „Sexual Script‟ incorporates biological and cultural factors. There are three main strands: • Development of gender identity as male or female • Sexual responsiveness • The capacity for close, dyadic relationships (Bancroft, 2009) © Stephanie Jeans 2013
  12. 12. Six Basic Stages: 1. Pre-natal stage 2. Childhood 3. Adolescence & Early Adulthood 4. Marriage (or establishment of a stable, sexual relationship) 5. Early and late parenthood 6. Mid-life (Bancroft, 2009) © Stephanie Jeans 2013
  13. 13. The main source of failure to achieve adult sexual satisfaction is an interference early in life with a child‟s discovery of his/her own body as a source of pleasure. SHAME Shame is a wound made from the inside, dividing us from ourselves and others © Stephanie Jeans 2013
  14. 14. Shame leads us to: • Withdraw • Attack self • Attack another • Avoid © Stephanie Jeans 2013
  15. 15. AND THEN YOU GO BLIND… • Self-abuse to self-love; taboo to some, celebrated by others • Maligned and mythologised • Noted in utero from 17 weeks • Scientifically regarded as normal and harmless • When faulted, children may develop sense of shame and fear which can impact anything to do with sex © Stephanie Jeans 2013
  16. 16. • Sex therapists see it as part of human sexual development, as a source of pleasure without risk. • It is used in sex therapy to help men and women deal with sexual problems. • Can play a specific role in sexual evolution as getting to know self intimately is a rehearsal for getting to know another similarly. © Stephanie Jeans 2013
  17. 17. Perils of Pornography Teens and sexual health in an online world © Stephanie Jeans 2013
  18. 18. How teens „sexting‟ photos end up on paedophile websites 60% of teens face sexting pressure Brain scans prove porn is as addictive as drink and drugs Vast majority of UK teens have seen sexual imagery online, or pornographic films In 2012 there were 19,000 reports relating to child sex abuse online (CEOP) © Stephanie Jeans 2013
  19. 19. Grappling with sexuality: Precocious in acting out, but vulnerable and immature in relating Yet want love and intimacy, so what else can they do? Wrecking Ball But wreck it… © Stephanie Jeans 2013
  20. 20. Tasks of growth for a child would be to gain independence, without rejection, of parents i.e. to be able to present selves in adult world To develop a strong identity, a sense of who and what they are, which includes their sexual identity © Stephanie Jeans 2013
  21. 21. Sexual satisfaction starts with self: • Exploring sexual conditions of worth. • Formulating a positive sexual identity. “To know and love oneself „as is‟ is a prerequisite to know and love another.” Jacques Lacan © Stephanie Jeans 2013
  22. 22. Remove the taboos and shame: © Stephanie Jeans 2013
  23. 23. • Factors that can derail sexual development & detract from adult enjoyment include: - trauma - abuse - difficult early sexual experiences - unusual developmental pathways e.g. early/late puberty - high degree of family guilt & inhibition around sex • It is not unusual for clients with low libido to have history of abuse, flashbacks, dissociation & aversion to sexual experience. © Stephanie Jeans 2013
  24. 24. Functions of sex are complex: • For reproduction • To boost or to maintain self-esteem • To relieve tension • For material gain • To connect intimately with another • For excitement and to take a risk • For pleasure and to feel good • A hostile assertion of control or dominance © Stephanie Jeans 2013
  25. 25. © Stephanie Jeans 2013
  26. 26. Sex can be used in potentially destructive ways: • Withdrawal of sex when there is no alternative way to express anger or disappointment. • It can be way of unconsciously exerting power and control in response to the lack thereof outside of the bedroom. • It can be done in a mechanical way so as to maintain a „safe‟ emotional distance. © Stephanie Jeans 2013
  27. 27. • The result of conflicting needs and motivations can be a partner who mourns the lack of intimacy and trust which impedes feeling safe & thus enjoying sex. Instead sex becomes associated with negative feelings such as fear, jealousy, guilt and anger. • Problems may thus arise when two people are using sex to fulfil different functions at any one time. © Stephanie Jeans 2013
  28. 28. Sexuality of the MiddleClass, Midlife Woman Related research to be found on The Sexuality of the Middle-Class, Midlife Woman: Research on the Nature and Significance of Sexual Satisfaction Within a Long-Term Relationship © Stephanie Jeans 2013
  29. 29. Male gender stereotypes: • If a sexually functional man has a willing partner he is attracted to, he will engage in sex whenever the opportunity is offered. • All a man needs to achieve & sustain an erection is to think about or to „want to have‟ sex. Women on the other hand, need sufficient foreplay including, but not limited to, direct genital stimulation. • When there is a mismatch in libido, invariably it is the man who has higher sex drive & the woman needs cajoling. © Stephanie Jeans 2013
  30. 30. Male gender stereotypes: • What men enjoy most is the thrill of the chase, & if a woman wants a man to commit she should play hard to get & for him to „win‟ her. • Men & women play distinctive, gender defined roles within the relationship. The man is the provider, protector & leader. He woman is the nurturer, home maker & supportive partner. (Monique Viljoen-Platts, 2013) © Stephanie Jeans 2013
  31. 31. • Therapeutic space gives room for self understanding & self development, a space to transition through changes with the self structure. • It allows one to develop an authentic ability to give and receive verbal, physical & sexual intimacy, & understand meaning behind needs you hope to be met by your partner. • If one changes self, one can change relationships & intimate encounters. © Stephanie Jeans 2013
  32. 32. Esther Perel: The Secret to Desire in a Long Term Relationship - Full video Perel believes the key to sustaining desire is reconciliation of 2 fundamental human needs: The need for security, safety, predictability The need for adventure, risk, the unexpected, surprise, journey A paradox as these very things that nurture love can be the very ingredients that stifle desire © Stephanie Jeans 2013
  33. 33. We need to reconcile love and desire in order to maintain eroticism People are drawn to their partner when: • They are separated, allowing each to get back in touch with the imagination of desire and longing. • When they see the other in the spotlight, thus radiant, confident and somewhat elusive, mysterious. • In this space lies the erotic & the move to that other. • The mystery is not so much about travelling to new places but instead looking with new eyes. © Stephanie Jeans 2013
  34. 34. Ask questions of self as opposed to the other: • I turn myself off when … • I turn myself on when… Use erotic intelligence as more than animalistic biology. (Esther Perel, 2013) © Stephanie Jeans 2013
  35. 35. Health Benefits of Sex: • Sex relieves stress • Sex boosts immunity • Sex burns calories • Sex improved cardiovascular health • Sex boosts self-esteem © Stephanie Jeans 2013
  36. 36. Health Benefits of Sex: • Sex improves intimacy • Sex reduces pain • Sex reduces prostate cancer risk • Sex strengthens pelvic floor muscles • Sex helps you sleep better (Boots WebMD, 2013 © Stephanie Jeans 2013
  37. 37. “We consider sexual intimacy as primarily relational, secondly physical. Bodies rarely have problems finding sexual pleasure if the confusion in the mind is laid to rest. Being sexually alive has little to do with the right body shape, or the right partner. It is about one‟s self-concept, self-embodiment and attitude to life, and the ability to reprogram internal messages from the image-makers of the past.” (Duffel &Lovendal, 2002, p. 222) © Stephanie Jeans 2013
  38. 38. Therapeutic Considerations: • Develop respect for a range of lifestyles & an ability to observe & reflect on gender roles in our world. • We may be uncomfortable learning about clients‟ intimate lives, feeling an intruder or voyeur. • We may feel naïve, lacking basic knowledge, so CPD is necessary. © Stephanie Jeans 2013
  39. 39. © Stephanie Jeans 2013
  40. 40. The therapist‟s value is not in „the fund of information, rather as a source of attuned curiosity.‟ (Anne Power, 2013, Therapy Today) © Stephanie Jeans 2013
  41. 41. References: Bancroft, J., 2009. Human sexuality & its problems (3rd Ed.). London: Longman Group Ltd. Bowlby, J., 1997. Attachment. London: Pimlico. Duffell, N., &Lovendal, H., 2002. Sex, love & the dangers of intimacy: A guide to passionate relationships when the „honeymoon‟ is over. London: HarperCollins Publishers. Hakim, C., 2012. The new rules: internet dating, playfairs and erotic power. London: Gibson Square Books Ltd. Jeans, S. J., 2012. Sexuality of the middle-class, midlife woman: research on the nature and significance of sexual satisfaction within a long-term relationship. Kahr, B., 2007. Sex and the psyche. London: Penguin Group. O‟Leary, C. J., 2012. The practise of person-centred couple and family therapy. New York: Palgrave McMillan. Orbach, S., 1999. The impossibility of sex. London: Penguin Group. Perel, E. Power, A. 2013. When passion cools. Schnarch, D., 2003. Resurrecting sex: Solving sexual problems & revolutionizing your relationship. New York: HarperCollins Publishers. © Stephanie Jeans 2013
  42. 42. Contact: 35 Manor House Close Wilford Nottingham NG11 7BR (+44) 7772696598 Facebook: LinkedIn: Twitter: @stefjeans © Stephanie Jeans 2013