Very often therapists ask me how much to focus on the sex issues in therapy, and how much to focus on the relational issues. This is a very important question, because of course the sexual and relational aspects of sex issues are intertwined. Therapists who don’t feel comfortable discussing sex in therapy will focus on the relational issues, thereby missing multiple rich opportunities to help, but focusing on the sex issues to the exclusion of relational dynamics would almost always be totally unproductive.
If you’ve watched my Will Lily workshop, you’ll know that the final question I ask on my introductory sex issues assessment is “When a sexual encounter is over, do you feel satisfied? Would you do it again?”
This question is a little broader than the others I ask in the assessment. Instead of pinpointing a specific issue, or pointing to an immediate and urgent intervention, it invites the client to take a broader view, to step back and assess the sexual encounter as a whole. Often by the time you ask this question you have a pretty good idea of the answer, but this question points to exactly where the distress is, so you know where to focus once the urgent matters are addressed.
It can also be very interesting when you get an answer that surprises you. It’s a cue to ask more questions and rethink some of your assumptions.
Your clients’ answers to the satisfaction question are also important because they open the door to looking at the relational distress. Satisfaction resides at the intersection between sex issues and relational issues. When you ask this question you have already gathered quite a bit of specific information about sex, and now you will learn how all together affects the clients and their relationship. The answer to the question about satisfaction will shape your long-term treatment plan as you help the clients understand the sex issues in the context of the relationship, and vice-versa.