Intimacy and Sex

Sexual problems are a leading case of marriage breakups. The most common issues today are “hyposexuality” (low sexual desire) or “hypersexuality” (impulse-driven sexual desire).

In recent years, we’ve worked with countless couples where one individual spends two to three of their workday chatting on the Internet sexually or looking at pornography, while at the other end, they are part of a couple who has not had sex or 10 years. The result is often anger, feelings of being unloved, over-involvement with the children that is detrimental, and eventually they end up in divorce.

Relational and Sexual Therapies

​Statistically, committed relationships are no easier to maintain now than in bygone days. The specific nature of the problems may have change, but the complexity remains. Relational issues, historically, often focused around: roles, child-rearing decisions, extended family, fidelity and how to allocate time and resources.
Today’s couples still struggle in these areas. Additionally, modern life seems to generate both new opportunities and new challenges. Some of the common dilemmas presented by couples today revolve around: lack of shared enjoyment, chronic conflict, problems that never fully resolve, pervasive negativity, power struggles, and lack of shared interests or vision.

These culminate in an overall lack of fulfillment, generalized dissatisfaction and a subsequent turning away from the relationship as a source of comfort or inspiration. Sometimes, people become resigned. Others leave, only to find similar stumbling blocks resurfacing in the next relationship. Some attempt to apply wisdom from other arenas of life – where they have been given quite successful — to the relational sphere, only to find it creates even greater discord. Likewise, relative to sexuality, old issues remain relevant, but are eclipsed by some originally less frequent that now permeate culture.

Forty years ago, the most commonly presented issues were erectile or ejaculatory problems in males, and pain with intercourse or lack of orgasm in females. These issues have not disappeared. Currently though, with (1) the availability of Viagra and Viagra-like drugs, and; (2) the more extensive use of prescription medications which, while rectifying one medical problem create the unfortunate side effects of dampening or eliminating sexual desire or arousal, and; (3) the ever-present accessibility of the Internet, inhibited sexual desire (ISD) now competes with compulsive sexual behaviors for predominance in presentation.

  • For local couples, MTI recommends that therapy is once or twice a week, and we recommend a contract for 10 sessions. We request that the couple spend three hours of alone together between sessions. A second 10 sessions is sometimes necessary.
  • For out o-f-town couples, we recommend 90-minutes daily, and then we work with one individual (with their partner in the room) for a second 90-minutes each day, for seven days.
  • If sex therapy is adjunctive, we give the clients daily suggestions that they incorporate into their time together.
  • MTI utilizes a co-therapy team, one with 30 years of experience working together with couples. In this format, each client feels supported and there is less of a risk of bias.
  • Therapy is typically “directive” meaning the therapists are active and provide guidance for change as well as homework suggestions to practice the new skills.
  • Blocks to intimacy, from previous relational distress and prior relationships or childhood trauma or neglect are dealt with directly.
  • Skills include dealing with anger, depression, anxiety, problem-solving, communication, boundaries, unsolvable problems, intimacy maintenance, social and recreational management, deeper levels of intimacy, child rearing and co-parenting.


Treatment Format

When a relationship is already generating a high degree of stress and distress, one session a week can be insufficient.

With one weekly session, too often, whatever is initially learned and applied unravels in the course of the ensuing week. Each week can feel like starting over. This cycle can create heightened hopelessness and lessened motivation, even when a couple starts out highly committed to a change process.

We have found, over the last 25+ years of working with couples, a more intensive format has the potential to generate greater momentum towards change. At a minimum, two sessions per week is preferable.

Ideally, depending on what couples’ schedule affords; a week-long Marriage Counseling Intensive Retreat can offer great potential for making crucial needed progress. These initial shifts can facilitate the foundation required for implementing further change – often with a greater sense of teamwork, even where previously lacking.

During the intensive retreat, the couple create a vacation from as many other commitments as possible, are seen daily, with “homework assignments” done together between sessions. Alternatively, given the nature of the problems to be addressed, a 4-day weekend intensive, followed by continuing outpatient sessions, may help to jump-start the process of change, creating greater clarity about what is likely to be possible or desirable going forward.

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