Working With Undisclosed Sex Pain: Vivian’s Story

In my last post, I told you about one of my experiences working with sex pain and desire discrepancy in therapy. Today’s story from the therapy room comes from Vivian, who lives and practices in Sydney, Australia. Vivian recently took my 16-week online course “Assessing and Treating Sex Issues in Psychotherapy.”  Vivian writes:

I would describe my skill level with sex issues before I took your class as intermediate. I was comfortable asking about sex issues and I could help couples use those discussions to support more intimacy and healing of wounds. And I still got so much out of your course!

Since taking your course, I use your script to open the topic of sex with every new client, both couples and individuals. What an easy way to introduce this topic right in the first session! In the majority of cases, clients tell me there is something about sex they want to discuss, and then I use your brief assessment tool as a non-threatening, normalizing way to delve into the issues. This usually opens up a conversation between us, which in itself is diagnostic in that I get a good sense of their comfort with the topic and their interactional patterns.

It’s been surprising to me to see how often sex pain is an issue, and has so often never been revealed let alone discussed. For example, a young woman I saw last week said that pain happens “sometimes” during penetration and that she’d never told her partner. After unpacking this a bit, I was able to give them some psychoeducation, make a recommendation about how to proceed, and ask them to stop any activities that resulted in pain until it could be resolved; I was able to let them know that continuing to have painful sex can cause other problems both physically and emotionally.

With the same couple, I used several other tools and techniques I learned in your course and was able to help her be able to tell him that there were things she’d like him to do which she hadn’t been able to say. Although those were difficult conversations, and they both had to stretch to have them, I had the tools, knowledge, and the confidence to help them get there.

I am still exploring the wealth of information included in your course, and reveling in all the resources too. Thank you so much!

Kind regards,

Vivian.

www.vivianbaruch.com

How to Build a Long-Term Relationship With Courage and Compassion

This part three of a three-part series on sex and differentiation of self in relationships. If you missed the previous part, about symbiosis in the early stages of a relationship, you can check it out here.

At some point in a relationship things start to change. Partners begin to notice that all is not completely rosy, and there have been some disappointments and disillusionments. They shake off the super bonded and immersed-in-other mindset,  look around, and realize they are two unique individuals, with very different thoughts, feelings, beliefs, perceptions, and preferences. How annoying! As the fog clears, you realize you’re not all that happy they cook and eat meat in what used to be your pristine vegan kitchen. Or you feel a little cranky about how you actually never DO have an orgasm, you just fake them. How could your partner not know that? This step from the first stage, symbiosis (rose colored glasses), to the second stage, differentiation (showing up more completely and uniquely), is where many relationships get stuck.

Depending in part in how lost we got in the symbiotic stage, and how secure and grounded we are generally, this new awareness of self can be challenging and messy. Probably your clients have had a very difficult time with this transition, or are still stuck in it, maybe for many years. Some couples never get through this. Some fight, some shut down, but if you look closely, at the root of things is discomfort with our differences of opinions, preferences, and beliefs. How clean is clean? Who decides when sex is finished? Is porn ok? These are real differences. I don’t know about you, but I don’t get my way multiple times EVERY DAY. Becoming able to come to terms with the idea that the differences are interesting and healthy sure makes life easier.

Why is this so hard? Because here’s the thing about differentiation: it’s scary as hell. If you figure out what you think, feel, believe, and prefer and then share it with your partner, they might not agree with you. They might be offended or angry, or collapse in hurt. If your tentative first foray into vulnerable disclosure was met with an extreme or distressing reaction, how can you steel yourself to try again, and again, and again? If you aren’t willing to risk the relationship, it is mighty hard to say something uncomfortable, however true it may be.

That’s when you have the Big Choice: differentiate or assimilate. Rock the boat, or capitulate and stabilize. Just to clarify: rocking the boat, or differentiating, is NOT the same thing as stonewalling, digging in, having a debate, or proving you’re right. What if you were to choose to get curious about your partner’s perspective, and why they see it differently than you do, rather than hammering your point in an effort to change your partner’s mind? What if you remained calm as you explained why you believe what you believe, and allowed your partner to ask questions about that in order to better understand you, with neither of you getting defensive, shutting down, or going on the attack?

Let’s make this less abstract and more specific to sex:

Do you know what you want sexually? Can you tell your partner? Under what circumstances? How about right in the middle of sex? How about if you think your partner won’t like what you want to say–for instance, that you would prefer to go back to snuggling on the couch watching Netflix? What if you lose your erection? Can both of you stay connected, sexy, and loving? Or do you make a lot of problematic meaning of the situation and pull away? Think of an opinion you have about sex–for instance, what is your opinion about crossdressing? Or polyamory? Or how about condom use? Can you share that with someone you love who might have a strongly-held opinion that doesn’t agree with yours?

A healthy sexual relationship requires differentiation–or else sex becomes an empty, anxiety-ridden performance, in which each partner plays the part they imagine their partner wants from them. The strong foundation you built in the symbiotic stage ideally should create safety for you to take some risks now.

It takes courage to ease through the vulnerability of self-disclosure and the fear of losing a relationship in order to reveal your true feelings and desires to your partner. It takes compassion to open your heart to your partner’s true feelings and desires, even if you are afraid of what they might mean. A strong relationship calls for both courage and compassion, and a therapist’s role is to help each partner discover those resources within themselves.