Isaak and Bella’s story, Why psychosexual treatment can help with loss of intimacy in relationships

Published in Counselling Stories on June 2nd 2019

How our work helps, but differs from physical sex therapy.

Important: This case study is a created narrative, composed of several separate therapy examples so does not represent any one individual or couple.

Isaak was referred to his GP to seek therapeutic help because he lost his erection whenever he attempted sexual intercourse with Bella, his first serious girlfriend, whom he had met online.

Medical tests had revealed no organic cause for this dysfunction. Isaak attended the first few sessions of therapy on his own. His therapist suggested that the work would be more productive if the couple were seen together and, after some weeks, Bella arrived, very reluctantly. Both partners explained that Bella had no problems.

Unlike Isaac, was still a virgin at 25 years of age, and while Bella was of the same age, she had a history of successful sexual relationships.

An exploration of both their family backgrounds revealed that Isaak had a powerful, dominant father and a depressed, shadowy mother. The therapist suggested that Isaak’s anxieties about getting close to his partner in intercourse related to his negative image of an internal couple, where only one person had life and presence, and a fear of identifying with his potent but destructive father. He had no access to any rage towards his father or towards his mother who had failed to stand up for him.

It was hard to get a coherent account of Bella’s history. She was angry about being ‘forced’ to come to couples therapy and insisted that her life was fine, her parents fine, her only frustration was that Isaak was impotent Her parents had both been heavily involved in competitive dog shows and as a child she had to attend events with them all over the country. In her teenage years she was often left at home alone and she started a sexual relationship with an older man when she was fourteen years old. She initially said this was not abuse, as she made the choice to have sex with him. She just came across as defensive and closed off, and the therapist wondered whether just as Isaak was unable to penetrate her sexually she too had a history of needing to protect and defend herself against emotional penetration.

Therapy was difficult at first. Isaak tried everything the therapist suggested but nothing seemed to work or make any difference to his erectile difficulties.

Everything suggested to Bella was dismissed as irrelevant. Reknowned therapist Gross (2013) write that patients tell their stories by unconsciously making the therapist feel like them. Isaak made the therapist feel what it was like to be him, helpless and resentful at never being good enough. Bella made the therapist feel shut out, unwanted. These feelings (interpreted by a therapeutic skill known as countertransference), reflected the Therapists internal worlds. And this information helped the therapists bear the negative responses by the clients to the therapy.

Eventually, through exploring their unconscious fears and the couple dynamics, and through asking them to complete some homework exercises related to the dysfunction, Isaak was able to achieve satisfactory penetration and intercourse. They were able to give a more coherent narrative about their lives, with Isaak able to see his father and mother’s relationship in more realistic terms and Bella to talk about the loneliness she suffered in her childhood. She also revealed, both to Isaak and to the therapist that she suffered from bulimia and at times felt depressed and vulnerable. When she spoke about her depression, Isaak was able to get in touch with his strong, potent side and she was able to get in touch with her neediness.

What do we learn from this story? How therapy helps intimacy via understanding roles.

Often people adopt roles in relationships related to their upbringing and life experiences. This might be as the ‘adopting parent’ ‘adult’ or ‘child’ roles in the intimate relationship. Problems can occur when each member of the couple gets rigidly stuck in one role. In this relationship, Isaak was stuck in the helpless child role and Bella the dismissive parent. As their emotional and sexual relationship changed and developed through the therapy, the couple were able to feel safe to play a little and to try out different and more creative roles.

Find out more about our psychosexual service.

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