There are happy endings in therapy.
I don’t mean the kind some people get at a massage parlor. No, in my practice, the happy endings last much longer: People change, are more satisfied with life, and understand how they used to undermine themselves. Most importantly, they have new tools with which to face the future.
Every case is different, of course, and not every one ends successfully. But the majority in my practice do—generally, because people learn some or all of these lessons:
- Acknowledge things as they are before trying to change anything.
- Know what’s important to you personally, not just what society values.
- Tell your partner the truth about your own experience.
- Decide that you can change, and notice how you believe you can’t.
- Don’t take your partner’s sexual functioning personally.
- Realize that a “sex problem” might not actually be about sex.
We can see these ideas at work in the following stories of people who completed therapy with me this past spring.
Marie and Josh
Marie was always a little more interested in sex than Josh and preferred more variety, too. But as long as they were having sex a couple of times a week, she was more or less content.
As Josh approached 50, his erections became less reliable. She was more than ready to increase their oral sex, although her favorite activity remained intercourse. Knowing that, Josh felt self-conscious and hated the idea that she was “settling.” He gradually wanted sex less and less often.
That’s when things headed downhill for them.
On top of that, he was orgasming with her less frequently. He didn’t mind (many middle-aged men don’t), but she couldn’t really believe that. Unfortunately, she took it all—his periodic lack of orgasm, occasionally lost erection, and reduced desire—quite personally. He tried to explain that these were just physical changes out of his control, but she wouldn’t hear that.
It didn’t help that she was having her own difficulties going through her 40s: She had always enjoyed being a very attractive youngish-looking woman and had trouble as she noticed signs of her own aging.
For her, accepting his body changes as fairly common was difficult, but once she could, we could talk more about her difficulties accepting her body changes. And when she did that, in combination with him being more verbal about his affection and desire for her, it helped them reconnect and start building a new sex life together.
They still don’t have sex as often as she would like, but she’s shifted from feeling personally rejected to occasionally feeling disappointed—a big improvement. She’s also improving at maintaining her image of being attractive as she ages.
Molly and Shannon
Molly just wanted to be taken seriously. She liked sex with her girlfriend but didn’t want to involve Shannon’s butt or her own: “Our vaginas and mouths are enough for me,” she said. “Can’t they be enough for you?”
There were other things Shannon wanted that Molly didn’t: calling her Mommy during sex, and letting their dog watch, for example—and Molly certainly was not about to get her nipples pierced.
The problem was that Shannon wouldn’t take no for an answer—and somehow, Molly couldn’t say no firmly enough so that Shannon would stop asking.
I invited Molly to list all the things they both enjoyed in bed together. There were more than just a few things, and Shannon agreed that Molly was enthusiastic about those. I proposed a 90-day moratorium on new activities, suggesting they stick to what they both enjoyed. I wanted them to experience sex without struggle, which they hadn’t had much of lately. They agreed.
During that time, we talked about other relationship dynamics. In particular, we talked about power, clear communication, and managing conflict. We cleared up a few things, and they eventually felt closer.
Shannon needed to accept that no one gets everything they want in a serious relationship. Were things like butt-playing to be a deal-breaker for her? “Not as long as we do lots of other stuff,” she said wisely. I suggested she stop asking for things she knew she wouldn’t get. Yes, grieving is often necessary in order to move forward in a relationship.
Relieved that she wasn’t constantly being asked for things she had already refused, Molly became even more enthusiastic about sex with Shannon—an outcome they hadn’t expected but gladly accepted.
Chronically afraid of disappointing his girlfriend in bed, Pratik frequently found reasons to say no to her sexual invitations.
Meanwhile, he looked at porn at night and women on the street during the day. But he felt guilty about both. He was in a terrible psychological bind: afraid to express his sexuality with his girlfriend, yet afraid to express his sexuality in any other way.
Fear of God, fear of his mother, fear of being a pervert—Pratik’s sexuality was so wrapped up in fear that, of course, he struggled with his desire.
We talked a lot about his fear. We specifically explored the idea that inhibiting his authentic desire would, of course, make it almost impossible to easily call up some enthusiastic sexual performance on demand.
I also explained that not having sex with his girlfriend was much more disappointing to her than whatever unpleasant things he might reveal about himself when he actually had sex with her—including unreliable erections or unusual preferences.
Pratik is still not done with all his fear, but he understands that keeping away from his girlfriend sexually is not a healthy way to deal with it—and he’s been taking small steps toward her with affection and erotic touching.
Veronika had an unusual challenge: For 18 months, her husband of 40 years had been sliding into dementia. They had always enjoyed sex together. Now he was interested mostly when he didn’t quite recognize her.
She wanted the sex but said it was weird to do it under those circumstances. Was she exploiting him? Doing him a favor? It was confusing.
I told her that some people would consider this a spiritual question, but she was not interested in such an approach.
I affirmed what she had said, that sex had always been a strong part of their connection. As he slipped away from her permanently, this was one of their last robust connections. I told her it was OK not to have sex when she didn’t feel she was being seen in a meaningful way. But I also gave her permission to have sex when they both wanted to, experiencing the vestiges of what they once had together.
She was grateful for the permission. On some days, her grief overrode her desire for sex and intimacy; other days, she was more than up for it. Week by week, she couldn’t predict whether she’d be interested—and I told her that was okay, too.
These cases center on a sexual issue, but the principles apply to all of our cases. As I tell therapists and would-be patients: Make sure your therapy has goals, a plan for addressing them (which may take three or four sessions), and periodic progress evaluations. That structure helps create happy endings, which is what everyone wants from therapy.
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