1st Las Vegas Conference on
Integrating Therapy for Women
Las Vegas Hilton � May 19-21, 2004
The Elicitation Window: Sex is a Window Into Who We Are
Ruth Morehouse, Ph. D. (WMS24-027)
MOREHOUSE: Hello. Golly, you guys are far out there! Welcome. Sorry about the difficulties with the equipment. Moving from one room to the next and back to the same room gets a little complicated in terms of setting up the equipment. Is there anybody here who went to my first lecture? Okay. Anybody here who went to my second lecture? Okay. Good. Is there anybody here who didn't go to any of them? All right.
We'll try and accommodate everybody, but some of the things�basically what's been happening with the lectures that I've been giving is the first one was on sexual desire, the second one was looking more specifically at some approaches to use in the sexual crucible approach and how I would work with people on sexual issues, and now what we're going to do is we're going to hone in more closely and more carefully to a specific aspect of working with couples around sexual issues.
That's the idea that sex is an elicitation window. The idea about this is that sex is a window into who we are. If you're able to really get a close picture of what's going on with people in their sexual relationships, you can learn a whole lot about who they are in their general life. You can also learn a lot about what are the specific issues that are causing them to have sexual difficulties? So that's what I'm going to be working with you on today is how do you actually use the details of somebody's sexual relationship to learn more about how to help them in working on their issues of differentiation.
Is there anybody here who is a sex therapist? Okay, in sex therapy, even if you're not a certified sex therapist, if you have some familiarity with the traditional sex therapy approaches, basically you're talking about the work of Masters & Johnson and the derivatives of his work. A lot of that work is still very much a part of the way that people work with sexual issues. Bill Masters actually was a friend of mine and a friend of David's so I think he's a brilliant person and had great respect for him, but we found that there was a way for us to work with people that didn't use a traditional psychotherapy methods in sex therapy, which are things like putting bans on intercourse or sensate focus exercises or giving people prescriptions or proscriptions about what they should or shouldn't do in sexual relationships with each other. The idea of those things was, for example, if people had a lot of anxiety about sex, then telling them not to have sex for a while might be a way for them to reduce their anxiety.
We tend to use a different focus, which is using the sex that people are already having as an elicitation window. In other words, by looking into what you're doing or not doing, I can learn a lot about how you and your partner relate to each other. In fact, I might have a clearer idea about what your real level of interpersonal functioning is by looking at your sexual relationship because that's one of the areas where people's personal sense of self where the emotional charge behind sex is very powerful. You often see people who look like they're getting along very well in other aspects of their life, but in their sexual relationship their difficulties are really a reflection of what is really going on in the relationship, although they may get along well in other aspects.
Instead, we're going to focus on this elicitation window and the ideas that people always have sex in ways that reflect who they are. Even though you might often hear someone saying, �You know, I don't know what's wrong with our sexual relationship, it's just not me. I mean, I'm really an outgoing person. I'm assertive. I don't understand why I don't act that way in sex,� what you're probably seeing is that the sexual relationship is bringing out the deeper issues about sense of self and who they are.
One of the interesting things to work with people on�so the whole idea of this is, how do you really focus on sexuality and the specifics of sexuality to help people learn about what's going on in their relationship. I work a lot with therapists, actually all over the United States, who are trying to learn how to be better sex therapists or better marital therapists, who can address sexual issues. Probably the most common theme I see is that it's not that easy for people to really take a good sexual history, to really be clear about what's going on in the sexual relationship.
I can remember one time I was consulting with a man who happened to be a physician -- he was actually a psychiatrist -- and I was working with him on sex therapy issues. He didn't know anything about what was going on in their sexual relationship. I was kind of surprised because he's a very assertive guy and very aggressive in a lot of ways and a very good physician. I said, �Have you asked them anything about like, do they actually have sex? How frequently they have sex? Who initiates?� and he said, �No.� And I said, �Well why not?� And he said, �Well, you know, I thought would be too personal. I thought it would be too intimate and it would be sort of disrespectful.� Well, the people are coming to you because they're having this sexual problem. How come you're not�you wouldn't do this if somebody was coming to you with some sort of medical problem. You would feel like it was your responsibility to get the data. And yes, it's a touchy issue, and yes, people do have the right to say, I don't want to answer these questions or those questions. But your job as a clinician is to really help them understand that if they really want to work on their sexual relationship, you have to have a good picture of what's really going on.
Here's one way to kind of conceptualize what's going on with clients in their sexual relationship, and that's by talking with them about the dimensions of sexual experience. While I'm talking about this with couples, I'm doing a couple of things. I'm giving them some information that's probably somewhat new to them. Most people haven't heard about this unless they've read our books. This work comes for the work of Daniel Mosher, who is a psychological researcher. What it's basically about is really looking close in and evaluating and understanding what's actually happening when you're having sex. So when I talk to couples about this, I'm giving them information, I'm giving them a new way of understanding their sexuality, and I'm also going to learn a lot about what the sex they have is actually like.
The first thing I might do is talk with them about the dimensions of sexual experience. Basically, what this is about, and this is probably an interesting thing for you to think about in your own relationship, how does this apply to you?
When people have sex, they have sex in one of three dimensions. They either are doing sensate focus, partner engagement, or role-play. Most people don't really analyze what's actually going on in their sexual relationship. This is a way of conceptualizing what's actually happening between the sheets when the two of you get together.
Here's what sensate focus looks like. Sensate focus is when you have sex, you're primarily focusing on your own physical sensation. You're paying attention to how you feel and what feels good, and you're noticing your own arousal or your lack of arousal. You're really focusing on the sensation or the physical aspects of sexuality.
When I talk about these different dimensions of sexual experience, it's not like there's a right way or a wrong way to do this. These are all aspects of sexual experience.
A lot of people do sensate focus. In fact, many of us have learned to become orgasmic. We've learned our own sexual experiences with ourselves were probably sensate focus. Each one of these dimensions that I'm going to be talking with you about can occur on a continuum. You can do sensate focus at a low level of involvement, up the continuum to a medium level of involvement, to a very deep level of involvement. And what that means is how much do you get into it when you have sex in sensate focus?
If you're doing it at a superficial level of involvement, and that doesn't mean bad. It doesn't mean you're doing it wrong; it just means you don't get into the sensations very deeply, then people often will do sensate focus at a low level of involvement that's actually what many people are doing when they have sexual dysfunctions like losing erections or not getting aroused enough to have an orgasm. They're trying to focus on their sensations, but they may not let themselves get into it deeply enough and long enough to really feel the sensations and really get a sensation of arousal. If you do sensate focus, you don't want a lot of distractions. You probably want the lights off. You don't want your partner saying, �Do you love me?� or �How much do you love me?� or things like that because all of those things will distract you from the sensate focus that you're doing.
If you go up to a medium level of involvement, when people do sensate focus at a medium level, they can really let themselves get more deeply immersed in their own sensation. People who do it at a superficial level usually do it just enough to get turned on enough to be orgasmic. If you can really get into sensate focus, then you want to feel the experience more deeply. You want to immerse yourself in it; and if something feels good, you want to see if a harder touch or a longer touch will feel even better.
Now at a deep level of involvement in sensate focus, people will say something like, �Somebody could march into the room and I wouldn't even know that there was another person there because I'm so caught up in my own sensation.� People describe things like, �I kind of felt like I was on a trip and it was an altered state of consciousness.� So there are people who can fully immerse themselves in their physical sensation and really get into a deep experience of sexuality.
For lots of people, when they do sensate focus, the only way they can do it successfully, and that might mean that they feel it's successful because they've had an orgasmic release, is by tuning out their partner. So people who do it at sort of a superficial level, they do it by closing their eyes and focusing so much on themselves that they often seem to be tuning out their partner. You can get more skillful at sensate focus and do it at a deeper level, and you don't have to tune out your partner and you don't have to close your eyes to do it. Anyway, that's sensate focus.
The next psychological dimension of sexual experience, and by psychological dimension I'm talking about where's your head at? What's your emphasis? What's your focus? What are you really paying attention to in the overall sexual experience? That's what we mean by the psychological dimension. It's the meta-framework that you go into having a sexual activity in.
The next one is partner engagement. Now think about how much are you engaged with your partner while you're having sex? Again, you could look at this on a continuum and people can do sex and partner engagement, they might even be having the same sexual activities that they're having in sensate focus, but in partner engagement, you're focused on the connection with the person you're having sex with. At a low level of involvement, it might be that it's a casual relationship, but that's what you're paying more attention to. Or people who've been married for twenty years are still doing partner engagement at a low level of involvement. They don't get into it very deeply.
At a more medium level of involvement, people will describe experiences like, �You know, I felt so close to you that for a moment it almost felt like we were one person.� �Somebody had an orgasm. I'm not sure if it was you or me, but it didn't really seem to matter because we just felt so close.� �I just realized how much I love you. How important you've been in my life.�
An in partner engagement when people can get into it more, they really let themselves take in their partner and let themselves feel the experience of being taken in by their partner. So that's partner engagement at a moderate level of involvement.
What does it look like at a deep level of involvement? When you talk to people who really have a profound experience of partner engagement, what you're learning is that they're really connecting with the best in their partner from the best in themselves, and they're allowing themselves to really feel the vibes of the other person and also to be taken in by the other person. Often what people will say in that kind of really deep engagement is, �It really felt like a spiritual connection to me.� A spiritual connection meaning something that transcends ordinary life or everyday two sets of genitals coming together, or two people who care about each other coming together. It had more meaning attached to the sexual experience because �You're so important to me, because I thought about how much we've been through together, because I remembered what it meant to me to be the parent with you of our children.� People let themselves have these very deep senses of connection. So that's partner engagement.
A lot of people do sensate focus and a lot of people do partner engagement. The third kind of sexual dimension you can be in is role-play, and for lots of people that's kind of a scary, unpleasant thing to think about. In fact, sometimes when I talk about role-play, people think, �Well, that's not real love. That's not the way you're supposed to have sex. That's phony.� But role-play is actually a very complex aspect of sexuality.
Here's what it can look like: At a low or light level of involvement, people can do role-play where maybe they're just having a flirty repartee with each other, where maybe the woman is playing hard to get and her partner is playing the seducer who's going to get her whether she likes it or not. They're just flirting and playing around with each other, and it feels fun and it feels comfortable. It's not real serious or real deep. They can get out of it fairly quickly.
At a more moderate level of role-play, lots of interesting things can happen. For example, lots of people will do role-play where maybe they share a fantasy with their partner, and they act out the fantasy. Role-play at a moderate level of involvement involves things like costumes or props or things like that.
If you think about our ideas about sexuality, if I say to you, �the male aggressor� or �the female dominatrix,� or �the innocent young thing,� or �the physically aggressive female,� or �the sweet person who's into surrender,� you have an idea about what I'm talking about. These are sort of archetypal roles that we have where we have a picture of what the person might be doing and how they might be relating to their partner when they have sex.
People can get into playing different roles. Maybe at a moderate level of involvement, somebody who's typically the aggressor or the initiator in sex might find it kind of interesting or curious to see what it's like to take a more of a position of surrender or letting you take charge of sex.
There are different kinds of roles like this that people can act out in their sexual interactions with each other. People actually do a lot more role-play than they think. Most people would say, �Well, I don't really do that.� There are lots of relationships where people get into the role of giver and receiver. Maybe it's the guy who's the giver. His idea is that he's supposed to always make sure that his partner is satisfied. He almost always initiates sex. He focuses a lot on trying to please her. He's basically the giver, and she may be the receiver. She's passive. She doesn't initiate sex but she'll go along with it. She might not be giving him very much stimulation, and she's also bought the idea that the focus of attention should be on getting her to react.
People get into those roles a lot. One of the interesting things to take a look at is what happens if you challenge those kinds of roles that people have? Like, for example, one of the things I do is I work with couples who come to see me for a four-day intensive program. They work for three hours a day for four days in a row. Typically what I might see is a guy who says, �You know, you want to know my idea of heaven? If my wife would just take over the sex for one night and just do me, you know? And instead of me always worrying about her and me always pleasing her, she would just really try to please me. I mean, to me that's like I would have died and gone to heaven.�
So the wife might say, �Well, okay I'm going to give it a try,� and the next day they come back and it's really interesting what you hear. She says, �He couldn't do it.� I said, �What do you mean he couldn't do it? He said that's his dream come true.�
What you find out when you get them to tell you the story is she starts to be the sexual aggressor. In fact, she says, �Don't do anything. Just receive,� and within a couple of minutes, the guy is awkward and uncomfortable. He's trying to even up the playing field, and it's his turn to do something to her and he recognizes, �Man I am so caught up in this role, it's so much a part of me that I feel uncomfortable or awkward or out of sorts when I'm not giving as good as I'm getting. It doesn't feel right or it feels funny.�
Well, you can take a situation like that; and talking with your client about that, you can really help them get a clearer understanding about what's going on. For example, maybe it's just a pattern that he's not familiar with changing. That's what the difficulty is. But sometimes there's a lot of other interesting things that are going on, like, does he really feel like it's okay for him to go first in their relationship? Is he feeling like he doesn't deserve that kind of sexual attention or sexual gratification? Is he afraid that if he's not pleasing her, she won't really stick around for a sexual interaction?
You can take that one issue and get the person to look at what's the difficulty that you're having in this switching roles. You thought it would be easy. It's harder than you thought it would be. Often somebody might say, �Well, I just wasn't sure that if I wasn't turning her on and making her happy, that she really loved me enough to really have sex with me unless I was doing all the giving.� Or maybe they explore the idea that it's hard for them to ask for what they want because whenever they did that in the past as a child, they usually got the message that it wasn't okay to do that or they got disappointed. So you can use these kinds of dimensions to start bringing out data and analyzing more of what's going on in the sexual relationship.
To continue up the continuum of role-play, at a really deep level of role-play, people are able to get into different roles and it doesn't feel like they're in a role. They're not acting. They're not putting anything on. It's just, �This is a part of my sexuality. There's parts of me that are aggressive and sexually active, and there's another part of me that likes to experience surrender and likes the way that feels.�
Here's the idea of how you can use this to look into people's sexual relationship. After I talk with somebody about this, I would say something like, �Which one do you think you do? Which one does your partner do?� It's very interesting for people to have a way to actually conceptualize what their sexual style is. Usually people will do one or maybe two of these dimensions, and actually most of us are having difficulty getting into them very deeply.
The first thing I'd ask them to do is to kind of explore which dimension do you think you use? How deep do you think you get into it? What you'll often find as you explore these things is the particular dimensions of sexual experience that people use are usually a reflection of whatever their issues of differentiation and individuality are about. They're also often a reflection of their limitations.
Let me give you an example of what I mean by that. I was working with this one couple that came to see me. They were a pretty sophisticated couple, knew a lot about sex, had a good sexual relationship, but in the last couple of years something was missing in their sexual relationship. It seemed day kind of flat. The woman was complaining that it just wasn't really what she wanted in sex.
I'm trying to find out, what's really going on with this couple. What are they talking about? What's missing? They function okay. They have a certain amount of variety. They do different things. What is really missing for this woman in their sexual relationship? One of the questions I asked her was the question I ask most people: �How do you decide and who decides when it's time to go to the main event?� � sex, which for many people would be vaginal intercourse; other it might be oral sex or anal sex or something like that. �How do you decide when it's time to shift from foreplay to sex?�
She thought about it for a few moments and she said, �I don't know.� And I said, �Well, go back and see if you can put yourself back in the last time you had sex. How did you decide?� And she said, �To tell you the truth, I think I start having sex when it gets too intense.� I said, �What do you mean?� And she said, �Well, what we usually do for foreplay is oral sex, and I really like oral sex a lot. I can really get into it. But then I start to get embarrassed or uncomfortable because I realize I'm just in the throws of my own sexual eroticism and arousal, and I start worrying about what I'm going to look like. I'm uncomfortable with my partner witnessing me being in such a sexually excited state. And when I get to that place, I stop doing it, I don't have an orgasm, and I switch to intercourse.�
In other words, what this woman is doing is she's going into sensate focus and she's going into it moderately deeply; but when it gets to be too personal�see, the real issue for her was, �It's not so much that my partner is seeing me being sexual, it's that I'm witnessing him witness me, and that's the part that seems so intimate. I can see him seeing me, and I can't deal with my own eroticism. I can't validate myself enough to be able to feel comfortable with it.� So I do something like good old intercourse, which is less intimate, less erotic, and less personal to her. In her situation, she was doing sensate focus but needed to learn how to do it in a way that she could give herself permission to go the full course on that.
Other people are really good at sensate focus or they're really good at role-play. They can wear costumes and they can do wild sex and do all kinds of things, but when you get them to think about making eye contact with their partner, it scares the hell out of them. I saw a woman like that a few years ago. She was very beautiful. She was married to a very successful man. She would wear these fabulous costumes, and she would be almost like his courtesan. Then she fell in love with him and decided to get married to him. The idea of more personal sex, the idea of making eye contact while you're having sex, that was much more threatening to her than putting on a wild costume and strutting around or swinging from the chandeliers.
So people's individual issues are going to come out in the sexual dimension that they experience. One thing I do is ask people what their sexual dimension is, how deep they go, and also get them to take a look at the one's that they don't do and why it would be difficult for them to do them. That whole discussion gives me information about what their sexual relationship is like, but it also gives them a way to think about, �Gee this is kind of interesting to actually be looking at your sexual relationship in this way. I wonder what it would be like to get into role-play.� Usually one couple of the couple will say, �Oh, I think that's fun. I've always wanted to do that, but I knew he wouldn't do it� or �I knew she wouldn't do it.� Sometimes people have lots of discomfort about role-play, but it also can be a place where you have novelty and creativity. It takes a lot of self-validation to be able to show up in a costume and see whether or not your partner notices. There's always the issue about, can I carry it on? Can I pull it off? So role-play can be one of the ways that couples explore sexuality together, and many of them are equally uncomfortable with it so it's sort of a way that they can�a lot of what brings people together in relationships is shared experiences, so they might start working collaboratively. Like I've had couples say, �You know, I'm really good at sensate focus and we do a lot of role-play, but what we really need to focus our attention on is the partner engagement. So I think for a while we're not going to do the other ones as much. We're going to try and focus on, can we really make more of an emotional connection with each other.�
I've been presenting these to you, and it looks like I'm going to keep presenting them to you! This kind of discussion can really bring people to start looking at the specifics of their sexual relationship. In terms of partner engagement, most of the time when you start talking with people about what their level of a partner engagement is, you'll find that many people don't make eye contact while they're having sex. Why would you want to look at the person you're having sex with? You know, that seems kind of out of the ordinary. It's such a simple question. A lot of times I'll ask people, �Well, how satisfied are you with the emotional connection that you have during sex? Like, for example, do you make eye contact?� and the man will say, �Yeah, we do that,� and the woman will say, �No, we don't. I've never opened my eyes and looked at you.� So then you've got to get them to be clear what they mean by eye contact. When I'm talking about eyes-open sex, I'm talking about, are you looking at me while I'm looking at you? This is a very novel and scary idea for lots of people.
One of the things that it can do is get people to really start paying more attention to what they're actually doing during sex because so often you have people who are coming in complaining about �sex is boring, we don't have a connection.� They're not looking at each other; they're not talking to each other. And yet�well, you wouldn't have a conversation with somebody like that. Why are you doing the most intimate thing that's supposedly two people can do and you're not even looking at the person that you're having sex with? Just getting people to look at that issue. It's not my job to force them to do this, but just opening up that idea by going into the details of how they relate to each other is very useful.
Another thing that lots of people look at is many people have a difficult time talking during sex. They don't say anything to each other. They find that that either distracts them or they don't think it's romantic or something like that. So getting people to look at, �How do you get your partner to touch you the way you want him to touch you if you don't say anything to him? What is the reason why you're not talking?� �Well, I'm afraid I'll lose my concentration� or �It doesn't seem romantic.� Getting people to look at those issues, and maybe then they can have a more informed choice about whether or not that's the way they want to continue to have sex.
I was describing these sexual dimensions to you as if they were linear or you do one or you do the other, but in a robust sexual relationship people are able to do more than one dimension at a time and to do it at deep levels of involvement. This is where sexual possibility and sexual intimacy can really occur.
When you're having sex with your partner tonight and you're really being playful and you're Mark Anthony and she's Cleopatra and you're really getting into it and having fun and that's the same person that the next time you have sex with them, you know it's going to be a poignant, romantic, loving, emotionally connected experience, it creates more meaning for each of those sexual experiences. Sometimes it's fun to focus on one or the other, but it's also possible to have more than one thing going on at the same time.
In the book Passionate Marriage by David Schnarch, who is my husband and he and I work together, we talk about the idea of doing and being done. Doing and being done is when you can take all three dimensions and put them together in one intense sexual experience. It might look like, �Tonight I'm really going to do you. I really want you to feel good. I want to do things that really increase your sensation. I just want you to sit back and relax and enjoy yourself.� And so you're really focusing on sensation, but it means a lot to you that your partner is giving you this much attention and cares that much about you that they're willing to really focus on your pleasure. So you've got that emotional connection. Then you have the role-play aspects of giver and receiver. Intense sexuality often is a combination of two or more of these same dimensions at the same time.
That's one big way that you can start working with people and trying to get a window into what their sexual relationship is like. Let's go ahead and look at some others.
As I said, for lots of people really taking a careful sexual history is not necessarily something they've been trained to do or they've been comfortable doing. Even trained sex therapists have lots of difficulty with this. So when you're looking into, I want to learn more about what's going on with this couple, here are a couple of important points: The accuracy of the therapist's lens is very important. In order to get an accurate picture of what their sex really looks like, you have to be willing to hone in and ask some questions.
You need to get actual behaviors. A lot of times when people come in for couple's therapy and maybe they're saying they don't have a very good sex life but they've got other problems too, and then you'll ask them about their sex life and they'll say, �Oh, it's pretty good.� Then their idea is, �Well, we don't have to talk about that.� If you've got a really good sex life, I want to learn more about it because I want to figure out what you're doing in sex that you haven't been able to do with the kids or the chores around the house. Let's see if we can figure out the positive components of your sexual relationship so that we can see how you can use those same skills to transfer to other parts of your relationship.
Actually, getting a really good picture is a pretty important thing to do. Let me give you an example. I saw a case a few weeks ago with a couple who were coming to see me because they've been married for two years and they weren't having sex, and the sex that they were having, which was getting less and less frequent, was not very satisfying. The woman reported that she didn't have an orgasm with her partner and she's really starting to get dissatisfied with the sex and wondering if she's picked the wrong person.
I want to try to really figure out what's going on there. What's the actual picture of what's going on? Here is one of the things that I would ask�the question: Her husband is a really nice guy. He's a computer nerd type of guy, very bright. His idea is, �Okay, I want to be a good sex partner and I should do A, B, C, and D to try to turn her on,� and he goes through his idea of what would be sexually arousing to her. And guess what? She doesn't get aroused. She doesn't get very turned on, and often she'll just say, �Oh, why don't you go ahead and have an orgasm and let's call it quits.�
Basically, what I want to do is I want to figure out what's happening within that woman. One thing I want to find out is what kind of feeling she's having. But just as important, I want to know what she's thinking. I will say, �What are you thinking about when you're not getting aroused?�
See, I'm honing right in to getting a bird's eye view of their sexual relationship and what's actually going on. Sometimes when you ask really direct and specific questions like this, you can feel like you're being invasive, or people can be uncomfortable answering it. Basically, this is what I would tell them. I'd say, �You know, the reason I'm asking you these very specific questions is in my work I have found that people often gloss over really important details in sex, and it's in that moment of disconnection between you and your partner that we've got to figure out something different for you to do if you want.�
So I'm saying �What are you thinking about while you're NOT getting aroused?� and she says, �To tell you the truth, what I'm thinking about is, there he goes, he's going through that damn list again, and I'll be damned if I'm going to come if he doesn't stop being so concrete about this!�
She's got a picture in her head that he's just going through a list, and she digs in her heels. It's like there's a part of her that's resisting giving him what he wants, which is to please her, because she's mad at him because she doesn't want him going through a list. He doesn't make eye contact with her. He doesn't talk, and he doesn't make any sort of a visual or verbal expression that he's enjoying himself, and she feels disconnected from him. He may not be doing it right, but who knows because she's so mad and she's thinking such negative things about him that that's, at least at this point, what's getting in the way of her having sexual arousal or having more pleasure from sex. That's what I mean by really getting into the details of it.
Here are some other things that you can try to do as you're addressing looking into people's sexuality. Sometimes it might sound like I'm being a detective as I get into the details of people's sexual relationship, but people will also often gloss over very important things that you want to make sure you have a clear picture of what's going on in their sexual relationship. One of the things I suggest is you want to make sure that when somebody describes something to you about their sexual interaction, maybe you go back and make sure that you have a clear picture of it. Or if you've heard them say two things that are contradictory, you try to go back and clarify what's really going on.
You're very interested in what they do while they're having sex, so I'll ask questions like, �Who starts foreplay? What does foreplay look like? How long does it last? How do you decide when to move on? What kind of emotional connection are you having? What are you thinking about while you're having sex with each other?� I'm also interested in how they respond to the questions. So I'm getting the data from their actual sexual experience, but I'm also noticing things about how comfortable they are or how they deal with sexual experiences or the discussion of sexual experiences.
Even though you might think that this would be uncomfortable for people, if you have a calm, well-balanced approach to this and you're comfortable with the idea that learning about people's sexuality is an important part of your role, many people get very comfortable. In fact, that's part of what I'm trying to do. I'm trying to get people comfortable with the details of talking about sex. After somebody's been to see me for four days, I mean, maybe they never talk during sex, never talked about sex, often they say, �Probably one of the best things that happened was you gave us permission to talk about sex.� Well, I didn't really. But for some reason or other, they can't give themselves permission to talk about sex, but if an authority tells them it's the right thing to do, then they'll do it. Detailing some of these discussions about sex, they'll probably talk to you more about sex in your office then maybe they do with each other. That can be very helpful to people to start get more comfortable with sexual topics.
Let's see what else we have here. One of the things that I mentioned was when you're working with people on sexual issues, one of the things that you want to do is look through the lens of differentiation. For a lot of you who have been to the other lectures that I've done, you've heard a lot about differentiation. I'm just going to mention a couple of aspects to it.
It's that process of balancing out connection and separateness in a relationship. When you look at who's initiating sex or how they're initiating sex or that type of thing, you want to be looking at it through the lens of differentiation. As we mentioned before, there are four aspects to differentiation that you want to be paying attention to.
How much in the sexual specifics can you tell how much people are able to hold on to themselves and define themselves while keeping a close connection with their partner? This means: Will they speak up and ask for what they want? Will they let their partner know if the partner is doing something that's physically uncomfortable or distasteful to them? Are they willing to make eye contact during sex, which is a way of defining themselves? If their partner doesn't want to make eye contact, are they willing to confront the issue, understanding that their partner may be in a different place, but still holding on that sense of, this is who I am in the sexual relationship.
You're also going to see a lot of issues about self-soothing come up around sexuality. Self-soothing is your ability to hold on to yourself, quiet yourself down, and not let your emotions get out of control. So if your partner is suggesting something to you sexually that you're uncomfortable with, do you freak out? Or do you quiet yourself down and let yourself be open to the possibilities that maybe there is something to this sexual behavior he's interested in. Or why am I so afraid to try oral sex, for example? Or why won't I kiss my partner for more than a couple of seconds? To look at those questions and to really confront the ways that people hold back sexually, one of the things you really want to do is assess their ability to self-soothe and to try to reinforce the things that they can do to quiet themselves down, to get their anxiety under control.
I've had women come in to see me who are so anxious about initiating sex, they will literally throw up ahead of time. You know, that's not exactly the sexiest thing in the world. Teaching people how to calm themselves down and take a deep breath and try to figure out, is there a way I can do this that won't make me so anxious.
A real important aspect of looking into people's sexual lives is looking at their reactivity to their partner. A lot of times people are watching every move their partner makes during sex, trying to get some sort of picture of, does she like this, is she upset, is she turned on, is she not turned on, what's she thinking, what's she not thinking? When you're looking at people's sexuality, you're going to try to be figuring out how reactive are they to the reactions of their partner? Or do they have the ability to hold on to themselves and quiet themselves down and not let their partner's emotions control them or what they're doing sexually?
Then the last aspect of differentiation is the ability to tolerate discomfort for growth. This is something that you can look inside the sexual activities of the couple and you can get a sense of what is their capacity to take a risk? I'm not talking necessarily about doing kinky sex or something like that. The lady I was describing to you a few minutes ago, for her the biggest risk in her life was making eye contact with the man she'd been married to for four years because that level of personal intimacy made her feel very vulnerable and very exposed.
By looking at their sexual style and looking at the things that they describe, you can get a good picture about, what is their true ability to kind of hold on to themselves and how much are they willing to take a risk in order to grow sexually?
So the interesting thing is I've been talking with you a lot about the idea that sex is an elicitation window. I think the main ideas that I wanted to get across were that in order to use sex as a way of understanding people's relationships, you've got to be willing to ask specific questions, you've got to make sense out of the data that you see, and you also need to be willing to explore with them what these things might represent or mean in the broader picture of their relationship.
While you're doing this, this last point is important. It's the experience and not the therapist that's the teacher. I may work with people on the specifics of the dimensions of sexual experience because I think it's a useful piece of information for people to have, but what I'm really trying to do while I'm working with people is take the experiences that they have and let them make some meaning out of it instead of giving lectures or doing what most of us do when we get uncomfortable or feel like we're not doing a lot in therapy, you start lecturing people or giving them information. It's much more effective to take the natural things that occur in their relationship and get them to derive something from the experience rather than to just give them a lot of information.
Here's an example: Maybe I'm working with a couple who the woman hasn't been initiating sex very often. She's been uncomfortable doing it. She just happens to decide to try it one night. What I'd want her to look at is, what were you thinking about yourself while you did this? What were you thinking about your partner while you did this? Maybe what she's thinking is, �Man, I'm pretty hot stuff! I can't believe I'm finally stepping up and doing this.� Or maybe she's thinking, �Oh god, if I do it this time, he's probably going to expect me to do it every time.� She's generating that stuff from her experience and either one of those outcomes, either one of those thoughts is going to give her a whole lot of information about how she's operating with her partner.
I'm always looking for these live experiences that will help the person teach themselves what their sexuality is about and what their sexuality indicates or represents about them.
That's all I have to say. Anybody got any questions? Yes, could you speak up?
AUDIENCE: <Inaudible question.>
MOREHOUSE: There's a couple of things I would probably do about that. The first time they said it, I might say okay, and I'd talk with them about whatever it is they wanted to talk about. If I saw them again, a couple of more times, eventually if not sooner, I would always get to looking at their sexual relationship because I actually believe it's one of the most powerful ways to get effective, efficient, fast treatment. Maybe the second time they brought it up, I would say something like, �That's why I'm wanting to work with you on your sexual relationship, because I think that if you can get your sexual relationship as a place of real connection and intimacy and emotional connection, that's going to do more to help you with the fights that you're having about the kids or the dishes than focusing on those specific areas.� You can use a closer sexual connection to help you generalize that.
I mean, let's face it, you've just had great sex with somebody, you've been laid a couple of times this week, and you really feel close and intimate with your partner, you're going to be a lot more willing to talk about things like who's turn it is to do the dishes and what are we going to do about our kid, or something like that.
I would just work with them around the idea that I believe that the most effective way to deal with communication issues is through sex because all of the issues that you're going to come up with when you deal with your sexual issues are also issues that you can see in your broader relationship. How do I ask for what I get? How do I deal with rejection? How do I say no? What do I do when my partner misunderstands me? Think about how impactful those kinds of issues are and how much they come up around looking at your sexual relationship, then help them generalize them to the other aspects of their life. That's how I would work with people.
Okay, well thank you very much for staying late. I enjoyed it and I hope it was helpful to you.
AUDIENCE: <Inaudible comment.>
MOREHOUSE: For the most part, yeah, but I work with lots of sexual issues with people individually, but most of the work I do is with couples.
AUDIENCE: <Inaudible question.>
MOREHOUSE: Polyamory or?
AUDIENCE: <Inaudible question.>
MOREHOUSE: All right, well that's a great question and it's coming up for people more and more and more because there's now a new phase of polyamory, which is the idea of having sex with more than one partner, but it's often with somebody who you also have a friendship or a connection with. Other people just like threesomes with people they don't know or with the next-door neighbors or whatever.
This is the way that I handle it. I don't decide on other people's sexuality, what's right or wrong, unless I feel like it's physically dangerous or something with somebody. I would need to deal with my own feelings of, I don't think that's the way that people should have sex and recognize that this is their sexual relationship. Often issues about multiple sex partners are ways of avoiding intimacy, but I want them to figure out if that's what is going on in their relationship. I'm not going to tell them, at least not until I get whole lot of information, and it's not necessarily always true, but I can tell you the number of people I've seen who've actually been able to have multiple partners at the same time or threesomes and haven't really been coming from a solid, good place is very limited.
My job is to help them look at what's going on in their primary relationship, and often with the kinds of questions that I'm asking, they'll either realize that it is a way of avoiding connection and what do they want to do about that. A lot of times what I'll work with people on is, �I'm curious about why you're trying to have sex with more people when you haven't really mastered the sex between the two of you first. I wonder if you are having more emotionally connected sex, would you still have that desire for other partners?� and some people will and some people won't. I'm just trying to get them to look at that. �You're concerned about being prudish. I think the way you can handle that is you have to recognize your own bias, but recognize that these are separate people from you and they have a right to their own sexuality. You also have a right and an obligation to get them to explore the impact of this on their own relationship and on their own level of differentiation.�
Often what happens in those cases is there's one person who doesn't really want to be doing it, and they're kind of accommodating and going along and they're feeling angrier and angrier and more resentful. Maybe your job is to help that person find a voice to speak up about what he or she wants, but you've got to really get into the details to find out if that's going on or not.
AUDIENCE: <Inaudible question.>
MOREHOUSE: Yeah.
AUDIENCE: What do you do, or what is the reason for not wanting to kiss in lovemaking?
MOREHOUSE: That's a great question. Part of it has to do with the fact that sex often isn't as intimate as kissing. Kissing is more personal. It's more intimate. It's more kind of supposed to be representing romance, and sometimes people don't want to kiss because the romance isn't there. It's like they're forced to look at it more when they're kissing. Some people don't kiss because it gets them aroused and there's a part of them that doesn't want to feel the arousal. The general reason often has to do with it's more intimacy than some people can handle. As your partner becomes more important to you, you seem to be less able to tolerate connection sometimes than if it was a more casual relationship. Really working with people on kissing is very interesting and curious because I'll tell you probably I'd say 80 percent of couples don't really kiss in any kind of romantic way.
AUDIENCE: <Inaudible comment.>
MOREHOUSE: Okay, I guess you liked it. I guess this is the end of the workshop? |