Dear Reader,

We've recently subscribed to Showtime again, and are finally able to catch up with one of my favorite TV shows, ​Couples Therapy​. In case you're unfamiliar, it's where a real psychoanalyst (Dr. Orna Guralnik) talks to real couples (so many) about their issues.

In Season 3b, there's a particular one that caught my interest, Josh and Natasha. I may have started watching this show purely for infotainment, but the more training I've been receiving, the more I pay attention to Orna's process.

And before I get into how and why I would have chosen a different way to work with this couple on their intimacy issues, let me just say that I know Orna is an analyst so her approach is different by definition. I also know the show has been heavily edited so I definitely do not have all information. I haven’t watched the last episode yet, so I don’t know how it all works out in the end, but they seem to have made progress in other areas, and all roads lead to Rome, as they say. So really, this is just a way for me to practice what I’ve learned in my ​ATSIP​ certification, and what I’d do if they were my clients. :-)

Clip from the show - Here's what happened

Natasha and Josh are a couple who've been together for four years, and they work with individual therapists as well. They just had a baby, and she has an older daughter from another relationship. They come in due to their mismatched libidos where he is the highly frustrated higher-desire partner, and she is experiencing lower desire due to low self-esteem and postpartum body image issues.

I generally got the sense that Orna sided with Josh in making the goal of the sessions to get Natasha's libido up in some way, and I had a strong reaction to this particular clip (transcribed and edited for clarity):

Josh: This week has been really unhappy with rejection for me 'cause I've been making a lot of efforts to try to initiate both like sexual situations and just intimate situations with Natasha and she's rejecting every single time. It's just taking a lot out of me to just keep trying and just feeling undesired. I'm just trying to figure out what'll work. You know, like, I don't know. 'cause my partner doesn't talk to me about a preference and I've asked, but right now…

Orna: ask

Josh: (to Natasha) what is your preference? How would you like me to initiate sex?

Natasha: (to Orna) Josh has these moments where his desire is driving the interaction. And when he comes on to me, I'm like, yes, but I'm just not feeling aroused.

Josh: I don't want her to jump my bones. I'm just talking about just enjoying something, right? I don't even feel liked. I feel tolerated. I feel like a pervert.

That's the energy that I'm getting. It makes me feel sometimes like, is this intentional? Are you trying to minimize me? But because I'm starting to feel that way, my emotional self is hunching, and it's like, that's not me. My natural self is confident, boisterous, and it just feels like I'm being fucking suppressed.

Let's be real. As much as I deal with rejection, I'm handling it pretty fucking well. I'm frustrated, and then I'm dealing with a partner who's making me feel like my frustration is oppressing them or making them feel bad themselves. So now I have to uproot my feelings, forget about them, and then worry about her.

And that happens even in conversation. So I just ask her, how do I initiate? She didn't say anything.

Orna: Mm-hmm.

Josh: She didn't answer that question.

Orna: But let's go back to the original question. First of all, (to Natasha) you said that the problem for you is that it's on Josh's, I dunno what to call it, clock.

Natasha: It feels like I don't know, whether it be my body, my hormones or whatever, that feeling for me is very few and far between. So I don't get to experience or reciprocate that.

Orna: You don't get to experience your own desire.

Natasha: Yeah. Just spontaneous, “I would like to have sex right now”, and then being able to direct that at my man.

Orna: Even on your own; do you pleasure yourself?

Natasha: It's like, no; not never. Extremely rarely. I'm talking about I just physically don't have the desire with him, without him. Like it's not him.

Orna:. Your libido is low or you're disconnected from it.

Natasha: Exactly. But I'm not rejecting him. It's just that I feel like I'm, oh, the word betraying feels bad, but like I'm betraying myself.

Orna: What would be okay for you to do together as far as any kind of intimacy that wouldn't feel like it's an act of betrayal?

Natasha: touching, making out that sort of thing.

Orna: do you have any suggestions?.

Josh: I'm trying not to be frustrated right now. That's what I'm trying to do.

Orna: Yeah. I think part of what's going on is you're so overwhelmed by the feelings that this is bringing up in you, which I understand. Rejection, frustration and I guess some form of humiliation or feeling bad about yourself that those feelings get so overwhelming for you that you're not actually grasping what Natasha is saying about her experience at this moment

Josh:. No. I'm not gonna lie to you. I'm not.

Orna: Okay. Well, I heard Natasha say that her own libido feels very elusive to her.

Josh: Yeah. Okay.

Orna: So that's part of what you were meeting when you are trying to engage her sexually. Yeah. What I'm asking is what area can you meet at? Somewhat in the middle between the two of you.

Can we take sex off the table?

Josh: I have no problem with that. Okay. You know, so it's not been an issue…

Orna:. Let's agree to that. And Natasha, your job is to try to find some place within yourself to initiate from. Initiate contact, initiate conversation. Okay, and let's see what happens.

Comments

These are the main issues I noticed:

1. The conversation starts with Josh venting his considerable frustration, and Orna doesn’t correct or re-direct him when he reveals that it is based on the assumption that Natasha wants him to initiate sex, and he’s just not been doing it the right way.
2. When Natasha reveals she is not experiencing “spontaneous desire”, there is a missed opportunity for a little bit of psycho-education around desire in general, e.g., how it lives in the parasympathetic nervous system, so it cannot bloom under stress or pressure. But also a differentiation between spontaneous and responsive desire, where people with responsive desire, as the name suggests, can start feeling desire once the mood is right and a slow, non-pressuring beginning of connection has been made.
3. Orna treats desire like a spectrum where the partners should find somewhere to meet in the middle. This may yield short-term results, but it is binary thinking that will most likely leave the higher desire partner unfulfilled, and the lower desire partner stressed, because one is getting less and the other has to supply more than they actually want. Instead, changing the mindset to creating a new paradigm (see below) would probably be more helpful. She does a great job translating Natasha’s experience to Josh though, so he can begin to see things from his partner’s perspective.
4. Orna suggests taking sex off the table, but she doesn’t ask the couple how they define “sex”. We can assume that it’s probably penis-in-vagina (PIV) intercourse, because that is the common definition. There’s an opportunity for some more psycho-education about
   1. how the usual thinking of a linear “kissing-touching-intercourse-orgasm” is severely limiting the couples options (most likely blocking even the kisses Natasha would like, because they’re considered foreplay that have to lead to something),
   2. how a more circular and improvisational approach to sex would be more flexible (kissing, touching, cuddling can all happen on their own and create closeness and connection without any further agenda),
   3. how postpartum bodies for many people need at least a year to recover, and
   4. how there are many other ways for bodies to experience pleasure that don’t involve PIV.

Re-Conceptualizing Mismatched Libidos

If Josh and Natasha were my clients, I would have started in the same way by inviting them to tell me what's going on, and what they would like to work on. Then, to get a better idea of where the work will be headed, I would have asked both partners, starting with Natasha, the following questions:

• When your partner initiates a sexual interaction, do you feel willing?
  • This is to rule out coercion, violence, or pressure, which would add another level to the relational interventions I'd have to consider. I’d also normalize that feeling external and internal pressure for sex usually kills desire. It is no wonder she feels less and less inclined the more he asks for it.
  • On the topic of pressure, Josh is clear in how badly he feels about himself in that space. That’s a great indicator that experimenting with easing off the pressure would yield benefits for him as well, as it would allow him to show up more aligned with his values of being a considerate partner.
• Are you interested in sex, think about it, experience desire?
  • I want to get a sense if they have the mental headspace, or psychic energy for sex. Josh clearly does, Natasha clearly less so. I would explain that there is no “right” amount of desire to have, every person is different.
  • If they don't now, never did, and don't think they ever will, they might be asexual. In this case, the work would be supporting the partners in figuring out how to navigate that impasse. It doesn’t sound like this would apply to Natasha.
  • If they don't think about sex now, but used to, and want to get back to it, then the work becomes figuring out what is getting in the way now, and how to overcome that.
• Do you feel unwanted pain with any kind of touch or sexual interaction?
  • Many people think painful sex is just something they have to endure, so it's no wonder that desire will lessen over time. The good news is, most pain can be treated. We don’t know if this is the case for Natasha.
• Do you experience your body responding to arousal? I.e., flushing, increased heart rate, do you get wet / do you get hard?
  • This is to gauge any physiological issues that might be getting in the way of desire, once a sexual interaction has been initiated. Again, not sure if this is the case for Natasha.
• Are you able to reach orgasm when you want to, with or without your partner?
  • Orgasms are a reflex response to sustained high levels of arousal. (Yes, kinda like sneezing.)
  • This helps to identify the level of self-awareness about pleasurable touch, knowledge of anatomy, and the level of differentiation between Self and partner, including can they communicate what it is they like and dislike, and can they stand being in pleasure and arousal as long as it might take. Again, not sure if this is the case for Natasha.
• At the end of the interaction, do you feel satisfied?
  • The answer to this one probably won't be a surprise at this point, but it's still helpful to name and verbalize.

Thank you again to ​Martha Kauppi​ for teaching me (and many others!) this approach.

So, what do you think? Happy to hear any questions or comments you might have. And if you’d like to go through these questions for your own mismatched desires, let’s talk.

Cheers,

PS: Interested in something more tailored to you and your relationship, but not ready for coaching? I'd still love to support you! Here are some resources you might find helpful (links):