When is psychosexual therapy an appropriate route for a couple?

Published in Blog by Linsey Blair on March 8th 2017

A question that is often put to me as one of the trainers for our MA in Couple and Individual Psychotherapy and the Psychosexual MSC is ‘when is psychosexual therapy the most appropriate referral pathway for a couple?’ This is a question that our clients also ask me in my role as an assessor for Tavistock Relationships. Many couples that come to Tavistock Relationships present with sexual issues along with other issues; this makes sense. If a couple are struggling emotionally than it is likely that the physical relationship is also suffering. How do we therefore distinguish between the couples who go down the psychosexual pathway and those who into the psychodynamic or psychoanalytic model of working? And how do our clients know what is suitable?

One way to consider this is to think about whether the sexual issues are the primary or secondary presenting problem i.e. are the couples difficulties causing the sexual problem or is the sexual problem causing the couples difficulties? If the answer is the latter than psychosexual therapy, which puts the couples sexual relationship at the forefront of the work, would probably be appropriate. However this question is very rarely easy to answer especially as both partners may have different views on the matter. For example in a couple who are arguing frequently and have not had sex since the birth of their first child one partner might say that if they had more sex they would argue less and the other partner might say if they argued less they would have more sex; both these are probably true. The chicken or the egg question is an unsolvable one.

A clearer way to answer the question is to say that psychosexual work is appropriate where there is a diagnosable dysfunction. Problems that we work with frequently are vaginismus, erectile disorder, premature ejaculation, low sexual desire, inorgasmia, delayed ejaculation and pain on intercourse. Sometimes individual and/or couples come to us having already visited their GP who diagnosed the issue and recommended psychosexual therapy. Some couples self-diagnosis and a consultation with a psychosexual therapist at Tavistock Relationships is an excellent space in which to think about whether the diagnosis is correct and what treatment options might be available. It is important for both couples and therapists to be aware that the diagnosis are complicated as often an individual may have more than one diagnosis and it is common for both partners in a relationship to have differing diagnoses. For example if a woman experiences pain on penetration it is not uncommon for her partner (if male) to develop erectile disorder as he empathises with her pain and unconsciously or consciously does not wish to penetrate. Psychosexual therapy is a very good way to unravel the meaning behind sexual difficulties as well as to overcome them via working on creating different and new ways to be together intimately.

Overall I think that that best way however for a couple and a referring therapist to know whether or not psychosexual therapy is the most appropriate treatment pathway is for them to know what the therapy actually entails.

What is Psychosexual Therapy?

If a couple were to come to a psychosexual therapist they would typically be asked to engage in a behavioural programme aimed to increase physical and emotional intimacy. The first step of this programme is that penetrative sex is off the menu and the couple are asked to carry out a gentle touching exercise. The focus here is on sensuality and the purpose of a sex and genital touching ban is that this reduces performance pressure and allows the couple to just be together without thinking about ‘what next’. The therapist would normally ask for the exercises to be carried out 2-3 times per week and they are approximately an hour in length. Psychosexual therapy therefore would be difficult for couples currently in a long distance relationship or for couples who feel it is impossible to have 3 hours a week of interrupted time together. However it is worth considering that the impossibility of spending time together is likely to be the issue in itself. Couples often find that by working together to find the time for the exercises their sense of intimacy increases because they are both prioritising the relationship in a way that they might not have done for a long time. The behavioural programme that the couple will work through is called the Sensate Programme and it would be tailored to their needs with their therapist. This programme is not goal orientated it is simply about increasing intimacy and it will have techniques for managing particular dysfunctions worked into it.

Inevitably this behavioural programme will stir up emotions; some couples find the exercises surprisingly moving and are shocked by the intensity of feeling that they stir up while others might struggle to even do the exercises, whatever emotions occur as a result of the programme can be thought about within the therapy. The wonderful thing about psychosexual therapists within Tavistock Relationships is that they all have a basis in couple therapy and so we move in and out of working with the physical and emotional aspects of the couple relationship to provide a holistic approach to relationship functioning.

What next?

If the idea of psychosexual therapy feels right for you then come and have a chat to us. Within the consultation session you can think about the varying different types of therapy we have to offer and your consultation therapist will help you decide what the best route is for you.

All therapy that we offer at Tavistock Relationships will provide a space to think about sex in a safe and non-judgemental environment; the difference with psychosexual therapy is that the couple are set physical exercises as part of the therapeutic process. When there are sexual problems within a relationship the partners often resort to avoiding any physical intimacy for fear it might lead to sex and avoid talking about sex for fear it might lead to an argument. For many couples just sitting and thinking about the physical relationship alongside a therapist can release so much of this built up pressure. Couples and individuals who are experiencing sexual difficulties can feel very isolated because sex can also be a taboo topic between families and friends; it can be a huge relief not only to share their story, but also to have a therapist who is able to work with them to build the intimacy back into the relationship in a way the keeps in mind both partner’s needs and desires.