Tag Archives: Sexual Wellness

Helping female clients reclaim sexual desire

By Alicia Muñoz October 2, 2017

If you see women in your counseling practice, it will be hard to ignore the issue of female sexual desire in your work together, even if the focus of treatment is something that appears unrelated to sexuality. In fact, a woman’s relationship with her own experience of sexual desire is often inextricably linked to her sense of identity, self-esteem, personal agency, energy levels, self-care habits and interpersonal relationships. Her desire issues and how she feels about them will weave their way, often implicitly, into your sessions.

The more that counselors can increase their awareness of the nuanced issues related to female sexual desire, the easier it will be to create a space in which clients can explore these issues safely and productively. Working with women more explicitly on understanding, experiencing and sustaining sexual desire can empower them to proactively regulate their moods, reduce stress levels and decrease symptoms of anxiety and depression. Furthermore, reconnecting with the motivation to feel sexual desire has the potential to help transition trauma survivors from “survival to revival” (in the words of couples therapist Esther Perel) as they access the enlivening energy of their own erotic life force.

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), female sexual interest/arousal disorder is characterized by a lack of sexual interest or sexual arousal for at least six months. Whether a woman is upset or distressed by her lack of interest or arousal is a crucial criterion for the diagnosis. The disturbance can be moderate, mild or severe, lifelong or acquired, generalized or situational. Furthermore, according to the DSM-5, “Women in relationships of longer duration are more likely to report engaging in sex despite no obvious feelings of sexual desire at the outset of a sexual encounter compared with women in shorter-duration relationships.”

Rosemary Basson, director of the University of British Columbia’s sexual medicine program, has noted that other than in the early stages of a new relationship, women’s arousal doesn’t always follow the traditional model of spontaneous sexual desire. Rather, women’s desire tends to be more responsive, with a deliberate choice to experience sexual stimulation required before an actual experience of arousal.

Estimates on how many women suffer from female sexual interest/arousal disorder vary widely, in part because there is so much complexity, variability and subjectivity to how sexual desire issues and arousal problems are measured and experienced. According to an article by Sharon J. Parish and Steven R. Hahn in the April 2016 issue of Sexual Medicine Reviews, issues with sexual desire or arousal are present in 8.9 percent of women ages 18 to 44, 12.3 percent of women ages 45 to 64 and 7.4 percent of women 65 and older. These percentages translate into a significant portion of the female population. It is hard not to wonder what sociocultural circumstances are contributing to making problems with desire so pervasive and systemic for women.

In Standard E.5.c. of the 2014 ACA Code of Ethics, counselors are reminded to “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others.” This ethical consideration comes into play when counselors treat women with desire issues.

With the work of Helen Singer Kaplan’s triphasic sexual response cycle and an ever-expanding body of nuanced research on women’s sexuality, studies have come a long way from the male-centric, Freudian view of women’s sexual and psychological functioning and even from Masters and Johnson’s linear model of spontaneous sexual response. Researchers today strive to be more objective and aware of the physiological and psychological reality of women.

Even so, systemic prejudices related to gender and gender identity continue to saturate every area of girls’ and women’s lives, creating unique challenges in female clients in the areas of desire and sex. Fostering the safety and trust necessary to explore your clients’ desire issues can move issues of female sexuality and desire from an implicit undercurrent in your work to an explicit focus of therapy. This can help clients separate the wheat of their erotic potential from the chaff of limiting, destructive or shame-based gender and sexual conditioning.

Take Louisa, a 30-year-old client who has been married for two years. (Note: Louisa isn’t an actual client; however, her situation illustrates common sexual desire issues experienced by clients who seek counseling.) Although Louisa initially seeks treatment for depression and anxiety, a few sessions into treatment she begins referring in passing to life stressors that are “TMI” (too much information). Following these TMI comments, Louisa deflects the conversation to other topics with a shrug and a laugh.

Counselors can be attuned to these “throwaway” comments and to dismissive humor, gently inviting clients to elaborate by expressing interest in the information the client is editing out. When the counselor gently points out Louisa’s “TMI” reference and explores what she thinks might be too much information for the therapist, the issue of Louisa’s sex life begins to surface. Counselors may need to reassure clients who experience shame around sexual desire and sexuality that it can be of great benefit to focus on and explore heretofore off-limit topics and the memories, beliefs, thoughts and feelings connected to those topics.

Interventions

The following interventions may provide springboards for exploring desire issues in counseling sessions with female clients.

1) Provide psychoeducation on the connection between relaxation and sexual arousal, and work with your client to identify ways she can relax. Maureen Ryan, a sexual health coach in Amherst, New York, says, “The first step to a great sexual experience is to relax. Pleasurable touch helps facilitate this process. The body becomes aroused, and then the desire follows. For most women, sexual intimacy precedes desire.”

Explore the thoughts, fears and behavioral patterns that inhibit relaxation. Work on helping your client identify how she might create an external environment that would facilitate her transition into a sexually receptive or erotically engaged state. This might include activities that allow her to feel present or “in the flow” or connect more with pleasurable sensory input (tastes, sounds, smells, visual stimuli, touch).

2) Invite your client to create a body map. Sex therapist Aline Zoldbrod suggests using this technique with couples to facilitate a dialogue about current preferences. However, it can also be used one-on-one with female clients who may struggle with shame issues related to their bodies and their experiences of sexual desire.

Your client draws a body shape, back and front, and then uses red, yellow and green crayons to color the shapes in. Green means “I like to be touched here always,” yellow means “I like to be touched here sometimes,” and red means “I never like to be touched here.” This map can serve as one starting point for a deeper exploration of a client’s relationship to her body and her history with touch.

3) Introduce the “prop” of a velvet vulva into your arsenal of psychoeducational tools and use it to help clients understand the anatomy of the vulva, the clitoris and what movements and sensations typically stimulate arousal. This prop can also be used to instruct women on arousal as counselors model a clear, sex-positive language for expressing needs and preferences to a partner.

4) Introduce your client to the concept of “sexual blueprints.” You may want to provide a client with a handout summarizing sexologist Jaiya’s five erotic blueprints: energetic, sensual, sexual, kinky and shapeshifter. Reading about and discussing these blueprints can reduce shame, normalize a client’s experience of her own sexual predilections and help her consider new possibilities. Jaiya’s website (missjaiya.com) has a quiz to help women and men identify their blueprints.

5) Explore the meaning of pleasure for your client. What turns her on? What charges her up and connects her to her own sense of flow or aliveness? A counselor can coach a client to say, “I feed my own desire when …” and then complete the sentence with different activities, thoughts and behaviors that enliven her. Encourage your client to begin developing a running list of whatever it is she can proactively do to power herself up, delight herself and revitalize herself.

Also be sure to have an extensive list of your own desire-feeding activities. This will help you menu ideas for your clients.

6) Help clients develop awareness about the sex-negative and body-negative influences that have shaped how they see and experience themselves and their bodies. Encourage them to limit the sex- and body-negative influences in their lives. This may mean avoiding certain magazines, being mindful about television shows and choosing not to watch certain movies or videos. It may mean setting clearer boundaries with select people in their lives.

Also help clients explore ways that they can take in more sex- and body-positive messages, either through reading different magazines, limiting their exposure to narrow standards of beauty, increasing their vigilance of the kinds of advertising or body imagery they expose themselves to, or regularly and intentionally appreciating their own bodies through pleasurable body rituals and experiences.

A shift in attitude

Over time, Louisa begins to understand that the lack of sex in her marriage underlies her anxiety and depressive symptoms. She fears it means that she and her husband are on their way to divorce and that it’s “all her fault.” Here, the counselor helps Louisa increase her awareness of this critical inner voice and develop greater self-compassion.

Louisa’s husband has become more vocal about their sexual problems and grown increasingly more irritable and withdrawn in their day-to-day life. As a result, Louisa is no longer able to continue pretending the problem is just situational, temporary or unimportant.

In therapy, she examines her sexual misconceptions and beliefs and the influence of her family’s cultural and gender-based expectations of her. To her surprise, she realizes she has limited awareness of her actual bodily sensations. She often “lives in her head” and ignores the signals her body sends her. As a result, she has never really tuned in to what she feels leading up a to sexual encounter. Her low sexual desire is just the tip of an iceberg of denial related to sensations and emotions.

Part of Louisa’s work in therapy becomes learning how to “listen” to her body. She practices doing this in session and also sets aside time outside of sessions to sit quietly and observe her own sensory experience.

In the past, when Louisa lost her motivation to have sex with one of her boyfriends and couldn’t recreate the feeling of strong, active arousal with him, she would interpret it as “falling out of love” or the boyfriend “not being right for her.” It wasn’t until Louisa married her husband that she was faced with the stark truth of her own sexual experience: She had a hard time experiencing spontaneous, robust arousal once the novelty of a relationship wore off. Mostly, later in a relationship, she simply responded to her partner’s desire for her.

This insight signaled a shift in Louisa’s attitude toward sex and herself. She started to mourn her lack of erotic engagement with her past partners and current husband and to commit to cultivating a relationship with her own erotic experience. She began recognizing her own inhibitions, her lack of erotic accountability and the expectation she had always carried that her partner should know what pleased her without her assistance, guidance or willingness to explore the ways that their needs and desires met or diverged.

Because Louisa loved her partner and wanted to make their marriage work, she committed to learning how to experience her own desire and arousal more regularly. Her motivation to feel desire for her own pleasure and sense of wholeness shifted her approach to the sexual disconnection in her marriage from that of a burdensome problem to an adventure.

Untapped potential

When it comes to working effectively with female sexuality and desire, remaining neutral about larger cultural biases can stall your work as a counselor. In a culture saturated with narrow and distorted models and templates of beauty, it is nearly impossible for human beings who emerge from their mothers as female babies to grow up free of misconceptions about their core selves, their bodies, their sensuality and their eroticism.

Some women may manage to stay intuitively connected to their erotic core throughout childhood and adolescence despite the social, relational and societal risks involved, perhaps even making it into adulthood relishing the full range of their sexual experiences on their own terms. A great number of women, however, wouldn’t have survived physically, much less psychically, without shutting off their sexual circuit boards.

Usually, this shutdown isn’t a conscious choice. It is something that girls learn to do within the context of their relationships as a way of maintaining caregivers’ and others’ love and approval. Even for girls growing up in progressive, supportive families, fitting in with peer groups or feeling socially rooted can sometimes cost them some important piece of connection to their core sexual selves. Girls may grow up lacking erotically vibrant, powerful female role models. Sometimes their families and circumstances don’t allow them the luxury of maintaining a strong, healthy, intact relationship with their bodies.

When girls suppress aspects of their deepest erotic impulses and experiences, layers of judgment and shame encase not only what and how they feel, but also who they are. Like a seed trapped in amber, a woman’s erotic potential can remain untapped even as she develops and grows in other areas. It waits for the right conditions to emerge.

Counselors can provide those conditions in therapy. Here are some key ways that counselors can help women reclaim their erotic selves.

1) Take continuing education courses on sexuality.

2) Read progressive, inclusive books on women’s sexuality and women’s sexual empowerment, such as Getting the Sex You Want by Tammy Nelson, She Comes First by Ian Kerner, Mating in Captivity by Esther Perel, Woman on Fire by Amy Jo Goddard, Pussy: A Reclamation by Regena Thomashauer, Come as You Are by Emily Nagoski and Women’s Anatomy of Arousal by Sheri Winston.

3) Familiarize yourself with the facts regarding the unique challenges that women continue to face today locally, nationally and globally, particularly as they relate to physical safety, fiscal equality, political representation and reproductive issues and rights.

4) Learn to talk about all of the parts of women’s bodies with ease. Practice with your children, spouses, colleagues and friends. Learn the exact locations of women’s body parts, study how they interact and learn to identify a woman’s body parts by their correct names (e.g., distinguishing between a woman’s visible genitals — her vulva — and the internal, muscular tube that leads from her vaginal opening to her cervix — her vagina). Learn to discuss sex, sexuality and sexual acts correctly and comfortably.

5) When you pick up on a client’s reactivity, defensiveness, shame or self-consciousness related to a sexual topic, bring warmth and compassion to the moment through attuned interventions. For example: “I noticed that you covered your eyes just now as you mentioned having sex with your boyfriend. Can we be curious about what just came up for you?”

It is important to keep in mind that low desire and lack of sexual interest are issues that many women won’t openly admit to, even when these experiences are their daily reality. There is a lot at stake. Just as a man’s sexual identity and sense of competence can get tied up with his ability to pleasure his partner to orgasm or to maintain an erection, a woman’s sense of sexual self-worth can be intricately connected with her ability to both stimulate and quench her partner’s sexual desire.

When the impetus or the drive to engage in sex with her partner or spouse wanes, a woman’s sense of sexual self-confidence can waver. It can feel as if she is failing at an essential aspect of her being: loving and being loved sexually. It can also inspire terror. Will she lose connection to this person she depends on and loves? How will this affect her family relationships? Is this a prelude to something worse? What changes lie around the corner as a result of her inability to match her partner’s sexual needs with her own authentic responses and initiatives?

Counselors are in a privileged and important position with their female clients at this particular historical juncture. Women are feeling pulled to take up leadership positions and exert influence in spheres of power previously dominated by men, from political offices to corporate headquarters to influencing the ecological trajectory of the planet. To experience the fullness of their emotional range, the force of their uniquely feminine values, priorities and principles, and the vitality of their full aliveness, many women need help developing a healthier relationship with their erotic selves. Because many women have adapted and suppressed aspects of themselves to function in a world that prioritizes the more traditionally masculine values of strength, dominance, competition and self-protection, they need to find ways to access the more traditionally feminine priorities of sustainability, vulnerability, connection and empathy to feel truly like themselves again.

Counselors can safely, warmly and sincerely support the exploration of women’s low sexual desire or inhibited arousal by first prioritizing a woman’s desire as an essential energy source in her life. They can help their female clients navigate the unique, nuanced challenges of low desire and the ways it manifests in a woman’s relationship to her own self, her body and those she loves. Once this issue is prioritized in treatment, it can be made explicit and explored. From there, it becomes easier to disentangle the negative beliefs that women harbor about their bodies and themselves from their inalienable, noncontingent worth as women.

Because many women have come to experience their own desire as beyond their control, they may fear that they are the problem — outliers on the graph of normative human sexual desire doomed to disappoint and frustrate the people they love and need most. Helping women take control of their own experience of sexual desire through explicit counseling interventions has the potential to shift clients’ views of what’s possible for them erotically and, in so doing, what’s possible for them as vibrant, entitled human beings with desires that matter. This shift is seismic and can transform all aspects of women’s lives.

 

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Alicia Muñoz is a licensed marriage counselor and desire expert in private practice in Falls Church, Virginia. She is also a speaker, author, blogger and frequent contributor to various print and online publications. Visit marriedtodesire.com for more of her writing on desire, or sign up for her weekly Relational Growth Challenge at aliciamunoz.com.

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The relationship as client

By Laurie Meyers September 22, 2016

Among the most common difficulties that bring couples to counseling are infidelity, financial problems, sex and intimacy issues, parenting challenges and ongoing tensions with the in-laws. Each of these problems has its own unique characteristics, but according to couples counselors, they tend to share a similar root cause — namely, lack of communication. The challenge for couples counselors (and their clients) is to identify how communication went awry — or if it ever truly existed in the first place — and then work to reestablish it.

Couples counseling is fundamentally different from individual counseling, says Paul Peluso, past president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

“Too often, counselors think that couples counseling is ‘individual counseling times two,’ and they conduct individual counseling with each person, while the other partner observes,” Peluso says. “That really isn’t couples counseling. Instead, with couples counseling, you have not just branding-images_inkhearttwo perspectives in the room that you have to balance, but you have the … relationship that you are working with. In fact, it is the couple’s relationship that technically is your client, not the individuals in the couple.”

Having a relationship as the client instead of an individual makes it much more challenging to build a therapeutic alliance, says Barbara Mahaffey, a licensed professional clinical counselor and ACA member who practices in Chillicothe, Ohio. The relationship is not just an entity, but rather two separate people who have different thresholds for opening up and trusting, she explains. Couples also come in with different goals and expectations. Mahaffey, who specializes in counseling couples and families, says her task as a counselor is not just to address these goals and expectations, but to help the couple discover how they can reconcile their personal expectations and establish new goals that will allow them to move forward as partners.

“Couples will come in and want to fight over who is right and who is wrong in the relationship,” Peluso says. “It is the couples therapist who has to sell the idea that no one is wholly ‘right’ or wholly ‘wrong.’ Paradoxically, neither is to blame and both are to blame — in the technical sense — for the state of the relationship at the same time. Both have played a role in setting up the conditions for the relationship. So the focus is on how each person’s behavior and reactions to [the] other affect the couple’s relationship. If each person wants to be in the relationship, then they have to take responsibility for how their behavior impacts the health of the relationship. And this is very different than individual counseling.”

Confronting infidelity

Unfortunately, the catalyst that most often pushes couples into a counselor’s office is also one of the most difficult issues to move past.

“The single most common issue that brings couples into therapy is infidelity,” says Peluso, a licensed marriage and family therapist (LMFT) who has written several books about both infidelity and couples counseling. “Over the last 20 years, researchers have demonstrated that this is the most common presenting concern, and if it is not revealed initially, it is often disclosed in the course of couples therapy. Infidelity can take many forms, from sexual to nonphysical intimacy, and it now includes relationships online.”

“In terms of who cheats, researchers have found that women are just as likely as men to participate in infidelity,” Peluso continues. “As a result, practitioners have to know how to deal with the complex and often devastating issues that accompany infidelity. Unfortunately, when couples counselors are asked about it, they overwhelmingly say that it is the topic they feel least prepared to treat.”

Amber Lange, a licensed professional counselor who owns and practices at Bedford Health, a group practice in Lambertville, Michigan, can attest to the high demand for infidelity counseling. Her practice has become known for specializing in issues surrounding infidelity and betrayal. Initially, the sheer need for counselors knowledgeable about and willing to tackle this particular relationship threat astounded her. “I’ll never be out of a job [as an infidelity specialist],” she says ruefully.

Among couples for whom the act of infidelity is fresh, the nonoffending partner is typically experiencing acute stress and may even have symptoms that resemble posttraumatic stress disorder, Lange says. The offending partner, on the other hand, is typically feeling beaten down because he or she has repeatedly been asked blunt questions that shine a direct light on his or her indiscretions: What did you do? Where? How much money did you spend?

In cases in which the infidelity is years in the past, the core counseling issue more often involves a lingering lack of trust, Lange says. “The nonoffending partner [may have] forgiven the offending partner, but they have never rebuilt trust,” she explains. “So the nonoffending partner is hypervigilant about trust and the [possibility of the] offending partner reoffending.”

If the act of infidelity is recent, Lange helps the couple work through their “why, who, where, how” stage. “I talk about the idea of how you can’t ‘unknow’ something once you know it,” says Lange, a professor of counseling at Capella University. “There’s a lot of knowledge that you can gain that may further traumatize you, such as the sexual positions that your partner was in with someone else.”

Clients may also wonder if their partner did things with another person that the nonoffending partner refused to do. If this information is disclosed, Lange explains, it can lead the nonoffending partner to do things he or she is uncomfortable with in an attempt to please the offending partner.

Instead of attempting to get answers to questions that can further damage the relationship, Lange encourages the nonoffending partner to ask structured questions such as: When did you start having sex? When did you stop? Did you have unprotected sex? These types of questions provide information that the nonoffending partner needs to know, Lange says.

The next phase of Lange’s therapeutic approach involves narrative therapy. As part of this stage, Lange might ask couples who delayed getting therapy after the infidelity to briefly touch on information about the affair as a way to see if there are lingering questions. This process also helps Lange to assess the strength of the couple’s bond.

The story of ‘us’

Regardless of whether the couple is confronting a recent infidelity or the infidelity happened years in the past, constructing the story of their relationship represents the core of the healing process, according to Lange. Couples build the narrative to gain a clearer understanding of how and when the cracks in their relationship developed, she explains. They talk about the beginning of their relationship and explore how they interacted. Were they friends and true partners? What happened that started pulling them apart?

“Life” — deaths, births, work, money and so on — is usually the answer to that second question, Lange says. In addition, people typically change over time, which further alters the nature of the relationship, she notes. All of these factors in combination can make a relationship vulnerable to disruption. Add in misperceptions and unmet expectations, and once tiny relationship fissures can turn into large cracks that cause couples to drift apart.

Among the most common life events that can start to pull some relationships apart is the birth of a child, Lange says. “Before the birth, couples were able to spend all their time and energy and money on each other. After the birth of a child, ideally, you love that child and invest all of that [time, energy and money] in parenting and child rearing — which is not bad, but [couples] come into my office, and they haven’t been on a date in three years.”

In addition to not making time for the romantic relationship, the couple may be trapped in patterns that are actively pulling them apart, Lange says. “You’ve been great parents, but the mother is staying home or working and raising kids at the same time, the father is working and overworking to pay for the mortgage and save for retirement — those kinds of things can hurt a relationship,” she says.

When a couple stops talking to each other, it creates a gap, and it is tempting to fill that gap with other people or activities, Lange notes. Partners may begin to betray each other in different ways, whether it is spending time on social media instead of with each other, watching pornography or working long hours, she says. “In the process, we’ve let the relationship go awry,” Lange observes.

But this risk of unraveling is not exclusive to couples with children. Those who get married or enter into domestic partnerships too quickly upon meeting or when they are very young are also particularly vulnerable, Lange says. For example, those who form romantic relationships in their teens or early 20s are in the midst of experiencing significant personal development. This may not happen at the same rate for both partners, eventually leaving them feeling as if they don’t know each other, Lange explains. Likewise, people who get married or form a domestic partnership in the matter of a few weeks have not typically had enough time to establish a strong base of friendship. Over time, it’s not uncommon for them to realize that they don’t even like each other, Lange says.

Lange asks clients not to make a decision about whether to stay together until after they have gone through the process of identifying what went wrong. Then, if they choose to stay together, Lange helps them start to discuss how to protect the relationship going forward. This typically includes setting aside time to talk with each other more frequently, being intentional about making time for dates and even going on vacations without the kids. But it also involves each partner identifying the behaviors in which he or she engages that play a role in pulling the relationship apart.

For example, Lange recounts something that a client recently shared. “One of the things that I have recognized about myself over the past six months is that I tend to withdraw,” the client told her. “When my partner and I got into an argument, I went away, slept in the kids’ room and wouldn’t talk. I would work 85 hours a week. Even when I wasn’t in the office, I was checking my email.”

In essence, Lange says, the client just wasn’t “there” in the relationship. Other people do the same thing by burying themselves in hobbies such as sports or scrapbooking. As a result, they end up spending more time with friends or with hobbies than they do with their partner and family, Lange says.

The process of building the couple’s story in counseling and finding the cracks and vulnerabilities is a long one. For the first four to six weeks, when a couple is still going through the initial trauma phase of the infidelity, Lange has them come to counseling every week. Once a couple moves on to the storytelling stage, she has them come to counseling only about once per month, in part because she feels that much of the processing and healing needs to take place between sessions as the couple slowly rebuilds the relationship.

“They have to have time to figure out things … how to be in relationship, how to recreate their friendship and how to build [new] good memories,” Lange says. During the process of rebuilding the relationship, trust is also being reestablished and forgiveness is being granted. Then the couple can move forward, she explains.

Ideally, the couple will also identify potential problem areas and reach compromises on how to address those issues. For example: “You say I can’t work 90 hours a week, but we need money, so how are we going to figure that out? … This is [our] story. Here’s the way we go forward. Here’s what we need to do.”

Symptom vs. problem

Brian Canfield, a past president of ACA, also says that infidelity is the event that most commonly brings couples into his office. But he believes infidelity is always indicative of other underlying problems in the marriage or relationship.

“I view an affair not as the problem but as a symptom,” he says. “An affair is like malarial fever. It’s uncomfortable, but it’s not the fever itself that’s going to kill you — it’s the disease.”

Canfield believes that if a counselor addresses the underlying issue first, it will help to stabilize the couple, which will then allow them to deal with the ramifications of the infidelity. “You [the counselor] have to assess if there is a commitment and desire to save the relationship,” says Canfield, an LMFT whose practice has offices in Louisiana, Arkansas and Florida. “Trust and betrayal, that’s not where you put the spotlight. The trust will return once you stabilize the relationship.”

Canfield starts by asking the couple what they want out of the counseling process and their relationship as a whole. “What would you like to see happen? If it is possible to salvage the marriage, would you be willing?” Canfield asks. “A lot of people want to know why [the affair happened], but here is where we are. Where do you want to be? If you were going to redesign marriage, how would it look?”

Canfield says financial difficulties are the most common underlying issue that couples bring into his office. In his experience, there is so much shame surrounding finances that most couples would rather talk about the details of their sex lives than money. He frequently encounters situations with couples in which one partner has been maintaining a hidden bank account or run up the balance on their credit cards without the other partner knowing. He tells couples that part of the counseling process involves full disclosure.

“A lot of couples are in tremendous denial,” Canfield says. “They don’t know how much debt they are in, what their bills are or have a good picture of how much income they are bringing in.”

Sometimes people feel entitled or convince themselves that it’s OK to buy what they want regardless of how it affects their spouse or partner. They tell themselves that they work hard and that they deserve it. Canfield sees part of his role as helping to bring clarity to these situations to encourage better choices.

“The other spouse may say that if this doesn’t change, I will exit the marriage for my own survival. Which circumstances are more important? Keeping the marriage or continuing to spend?” he asks.

Canfield doesn’t try to play the part of financial adviser to couples (although he does recommend that couples seek professional financial advice elsewhere if needed). Instead, he helps couples recognize their need to possess a clear picture of their financial situation and to develop a reasonable budget.

“It’s a matter of priorities and trade-offs,” he says. “The key as a couples counselor is to have the couple work together as a team. Most couples, when they work as a team, can find common ground.”

Canfield emphasizes that as a couples counselor, it’s not up to him to dictate how much a couple will spend on their priorities. Instead, his focus is simply on making sure that they have agreed on a plan going forward.

Once the underlying issues have been addressed, Canfield helps the couple deal with what he calls the “moral disparity” in a relationship in which infidelity has occurred. The nonoffending partner may feel like he or she has the higher moral ground, but to move forward, the couple must try to reach a “mutual amnesty,” Canfield says.

This involves a delicate balance. Canfield tries to make the couple aware that the infidelity occurred because of the underlying problems — to which they both contributed — that were straining the relationship. However, he always makes it clear that it is not the fault of the nonoffending partner that the other partner cheated. Yes, they both contributed to the relationship’s problems, but the offending partner chose to act out by having an affair.

Matters of miscommunication

Mahaffey, an associate professor of human services technology at Ohio University–Chillicothe, finds that relationship difficulties usually involve a significant degree of miscommunication, which is exacerbated by a number of factors. She helps couples understand how communication can get mixed up by explaining the pieces of a “miscommunication model” that she has devised.

Mahaffey starts by asking both partners to list all of the traits they possess that are different from their partner’s traits. She then takes these lists and draws two people facing each other. This represents two people talking, whereas the lists represent their different — and sometimes conflicting — points of view. Mahaffey often also draws a “family rule book” between the two figures. This represents how a person’s family of origin can affect the way he or she interprets interactions with a partner. Mahaffey often asks couples about their family backgrounds and experiences to illustrate the influence of the family of origin.

Mahaffey will then ask both partners to think about all the times they asked for something and didn’t receive what they wanted from their partner. As they voice these details, it’s not unusual for one partner to exclaim, “You never said that!” Typically, the case is not that either partner is lying, Mahaffey says. Rather, it’s that one of the partners has not been phrasing the requests in a way that effectively communicates what he or she needs, Mahaffey explains. She also informs the couple that humans think at about 500 words per minute but cannot speak more than 125 words per minute, meaning there is ample opportunity for the intended message to get lost.

Other complicating factors in communication include different coping styles (such as one member of the couple shutting down verbally or retreating physically or emotionally during times of stress), the fact that women often process information differently than men and the daily anxieties of life, Mahaffey says. For example, it’s hard for a couple to communicate effectively when one or both partners are stressed about finances, work or the car breaking down.

The last part of Mahaffey’s model entails explaining how words themselves — or how people define them — can get in the way. For example, Mahaffey might ask a couple, “What’s the definition of love? Is it that supper is on the table when I come home? Or liking to snuggle? Or texting 60 times a day?”

At this point, Mahaffey has the couple use “I” statements and talk about what needs they feel are being unmet. One partner might say, “I like to have help with housework.” The other partner might note that the request usually comes during a football game or while engaged in something else that he or she enjoys doing. At this point, Mahaffey might ask if the partner would be willing to provide help either before or after the game. This exercise highlights just one example of an area of possible compromise. The larger point is that the couple needs to sit down and talk about what they need from each other and how those needs can be met, Mahaffey says.

Intimate partner violence 

All counselors, but couples counselors in particular, should be looking for signs of intimate partner violence (IPV) among their clients, asserts Ryan Carlson, an ACA member and couples counselor who has done research on screening methods for IPV.

Because IPV is such a prevalent societal problem, all counselors — knowingly or unknowingly — will encounter clients who have experienced or are currently experiencing violence at the hands of their partners, Carlson says. According to data gathered in 2011 and published in 2014 by the Centers for Disease Control and Prevention, more than 1 in 4 women and more than 1 in 10 men in the United States have in their lifetime experienced sexual violence, physical violence or stalking by an intimate partner.

Providing counseling in the presence of such interpersonal violence can be dangerous, not just to the victim but also to the counselor, says Carlson, a licensed mental health counselor practicing in Columbia, South Carolina. That is a primary reason it is important for counselors to be alert to the signs of IPV and to have a protocol to follow should a client be a victim.

Perhaps the most beneficial thing counselors can do is to get connected to the people Carlson calls the “real experts” on this issue — those who work at local domestic violence shelters. “Most of what I have learned [about IPV] has come from domestic violence advocates,” he acknowledges.

Not only can these advocates help counselors assess whether it is safe to work with a couple in which IPV is a reality, but they also stand ready to assist clients who are looking for help, says Carlson, an assistant professor of counselor education at the University of South Carolina.

Carlson says he uses the term IPV because it is more inclusive than domestic violence. There is an IPV continuum, and domestic violence is on the extreme end of the spectrum, representing the most severe cases that involve, as Carlson puts it, “power and control,” as opposed to nonlethal violence or verbal abuse. From Carlson’s perspective, it is not safe to try to conduct counseling in those cases involving power and control.

Carlson advises counselors to use a formal screening tool for IPV at intake but says there are other red flags to look for, including a client’s unwillingness to take responsibility for actions. “Control over finances or transportation is [also a] red flag,” he continues. “Is one partner restricting access to cell phones, finances, the car, who the other partner can interact with? … Look for body language. Does one partner consistently look to the other when they answer questions? Is it permission seeking? Is there inconsistency in their answers? For example, as part of a meeting to determine whether or not a couple would want to participate in a research study I was doing, I asked about income. The husband gave me an answer, but when I met with the wife separately, she said the husband wasn’t really working and that she wasn’t allowed to talk about that.”

This one disparity turned out to be an indication of severe domestic violence. Carlson followed his protocol and was able to get help for the victim.

What does a protocol look like? Carlson says he has a formal memorandum of understanding with the local domestic violence shelter saying he can call at certain hours when he has a need for consultation. The memorandum also states that he will not provide identifying information about the client, only basic relevant information. This includes the presenting problem and any context he feels is important. The consultant can then advise him on whether the couple’s case might be a power-and-control situation. In those instances, Carlson must find a way to offer help to the victim without tipping off the partner who is engaging in the abuse.

With all of the couples Carlson counsels, his regular practice is to meet briefly with each individual separately at the beginning of each session. This is primarily so that he can get each partner’s point of view independently on the difficulties the couple is experiencing, but it also provides him with a chance to provide contact information for the domestic violence shelter if circumstances warrant. Carlson and the partner who is the target of the abuse may even call the shelter together.

In some cases, however, the victim of the abuse is not ready to leave the relationship. Carlson say many counselors may have a hard time relating to that. “We think we need to get the person out of the relationship immediately, but [we] need to do it safely,” he cautions

The victim has typically been living under abusive circumstances for years and may not yet have reached a crisis point, Carlson explains. Again, he uses consultation with his domestic violence resources to help him navigate this terrain. Regardless of whether the victim is ready to leave, Carlson says the average counselor should not try to continue providing services in these power-and-control cases. Telling the couple that he feels this particular modality will not work for them has proved to be a successful way of terminating treatment without escalating the problem of abuse, he says.

Lynn Linde, senior director of the ACA Center for Counseling Practice, Policy and Research, adds the caveat that counselors should make sure their states do not require them to report suspected cases of IPV under mandated reporting laws.

There are IPV cases for which Carlson thinks couples counselors are qualified to help. These involve lower lethality or “situational couple violence” (as opposed to one partner begin generally aggressive outside of the relationship as well). In such instances, a couple’s arguments may get out of hand and they may engage in behaviors such as pushing or throwing things at each other. “This can be dangerous, but it’s not as dangerous as choking or using a weapon,” Carlson says. However, he says, it is important for the couple to acknowledge that this behavior is unhealthy and to show a willingness to learn more appropriate ways to interact. It’s also essential that neither partner is afraid of the other, Carlson stresses.

In contrast, partners who engage in power-and-control tactics usually show little or no remorse and may exhibit antisocial-type behavior, Carlson explains. In fact, he says, studies have shown that when engaging in the abuse, these types of offenders typically experience a drop in heart rate rather than an escalating heart rate that is typically associated with anxiety over one’s situation or actions. Carlson also notes that whereas research indicates that men are almost always the perpetrators of power-and-control types of IPV, situational IPV is gender neutral.

None of this information constitutes a foolproof method for deciding whether it is safe for a counselor to work with a couple with a history of IPV. That’s why Carlson continues to do research on screening methods that are better at identifying the presence of violence among couples and where on the spectrum of severity that violence falls.

“Getting it wrong can be very dangerous,” Carlson concludes.

Counseling LGBTQ couples

Although the issues that bring lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) couples into counseling are generally the same as those that affect heterosexual couples, the legalization of same-sex marriage has raised some issues unique to LGBTQ relationships, say counselors who work with this population.

“There is a tremendous validation both from the legal system and from society upon their relationships,” says John T. Super, an LMFT who is also a clinical assistant professor of counselor education at the University of Florida. “This validation can provide an emotional confidence or boost surrounding a same-sex relationship that lessens the perceived stigmatization that has occurred. Additionally, since the Supreme Court decision [legalizing same-sex marriage], we have seen a large number of those in long-term relationships choosing to marry and report feeling equality to traditional marriages.”

Although the Supreme Court’s decision is a huge advancement for the LGBTQ community and has given many couples the opportunity for which they have long waited, actually getting married has not been absent of negative consequences for some couples, says Super, a member of ACA. “Clients have explained [that] when they announced their marriage … it was in many ways similar to the coming-out process in that those who are choosing to marry and are in same-sex relationships may face resistance from friends and family as they legalize the relationship,” he explains. “I have heard clients say that their friends and family accepted their relationship, but when they choose to marry, the thought of the same-sex couple entering into a legal marriage is a line the friends or family are not comfortable crossing.”

Counselors have an important role in helping same-sex couples navigate the resistance they may face when they decide to get married, agrees Joy Whitman, a past president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. Amidst the joy of getting married, there may be feelings of hurt and loss from being rejected all over again by certain individuals or segments of society, she says. Counselors can help couples grieve and process this loss.

According to Whitman, who previously worked as a couples counselor, marriage can also exacerbate a common problem in same-sex relationships: unequal comfort levels with being “out.” Marriage can make the partner who is less “out” feel especially vulnerable, she explains.

Counselors should also be aware that for the first time, LGBTQ couples are facing divorce, Whitman says. Not only is this a new experience, but the need in many cases to stand up in court and disclose intimate relationship details can be particularly disconcerting for clients in same-sex relationships, she says.

Super and Whitman also note that counselors need to be aware of the generation gap among different LGBTQ couples. “Couples who are in their 20s experienced a very different level of social acceptance than couples in their 50s or older,” Super points out. “This generational difference can be important to understand when determining the levels of internalized oppression the individual or couple has experienced.”

Despite these issues and other issues that are specific to the LGBTQ community, Super and Whitman emphasize that couples counseling is couples counseling. Peluso, an associate professor of counselor education at Florida Atlantic University, agrees.

“In many respects, the practice of couples counseling shouldn’t change that much,” he says. “Focusing on the relationship means taking the relationship as it is created by the partners involved. The only judgment that the couples counselor is making is, ‘Is this healthy for you right now?’ and then seeing how the couple can change that. That is fairly universal.”

 

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Additional resources

To learn more about the topics addressed in this article, see the following select resources offered by the American Counseling Association.

 

Books (counseling.org/bookstore)

Podcasts (counseling.org/continuing-education/podcasts)

  • “Love and Sex and Relationships” with Erica Goodstone

Webinars (counseling.org/continuing-education/webinars)

  • “Crazy Love: Dealing With Your Partner’s Problem Personality” with W. Brad Johnson
  • “The Secrets to Surviving Infidelity” with Scott Halzman

VISTAS Online articles (counseling.org/continuing-education/vistas)

  • “Five Counseling Techniques for Increasing Attachment, Intimacy and Sexual Functioning in Couples” by Elisabeth D. Bennett, Jaleh Davari, Jeanette Perales, Annette Perales, Brock Sumner, Gurpreet Gill & Tin Weng Mak
  • “Helping Couples Reconnect: Developing Relational Competencies and Expanding Worldviews Using the Enneagram Personality Typology” by Thelma Duffey & Shane Haberstroh
  • “Loving Kindness Meditation and Couples Therapy: Healing After an Infidelity” by Laura Cunningham & Yuleisy Cardoso
  • “Supporting Same-Sex Couples in the Decision to Start a Family” by Debbie C. Sturm, Erika Metzler Sawin & Anne L. Metz
  • “Working With Intercultural Couples and Families: Exploring Cultural Dissonance to Identify Transformative Opportunities” by Cheryl L. Crippen
  • “Working With Sexual Addictions in Couples Therapy” by Sara L. Wood

Practice Briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling Couples With a Trauma History” by Catherine J. Brack & Greg Brack

ACA Divisions

  • The International Association of Marriage and Family Counselors helps develop healthy family systems through prevention, education and therapy (see iamfconline.org).
  • The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling seeks to promote greater awareness and understanding of LGBT issues and improve standards and delivery of counseling services provided to LGBT clients and communities (see algbtic.org).

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Addressing children’s curiosity of private parts

By Ashley Wroton May 16, 2016

Damion’s (*) grandmother walked into the office, eyes reluctant to connect. Sitting on the sofa, she slowly began to explain her reason for coming in.

“I made this appointment for my grandson. He’s 3. The day care has threatened to suspend him. He pulled his pants down while in line to go outside, and last week wasn’t the first time.”

Chloe’s (*) dad, with mixed emotions of anger and worry, stated, “She’s only 5. She has all brothers. I’m afraid that someone has hurt her. She’s pulling her dress up at the bus stop and laughing about it, even after we tell her to stop.”

As a registered play therapist and licensed professional counselor who works with children as young as 3, these scenarios represent common conversations that I have with worried and confused parents. When children display behaviors that adults consider sexualized, it is a natural reaction to begin fearing that abuse has taken place. However, for preschool-aged children, it is a common and developmentally appropriate exploratory behavior.

In fact, research studies support that many children who engage in sexualized play or behaviors have not experienced sexual abuse. In a 2009 article published in Clinical Psychology Review (see digitalcommons.unl.edu/psychfacpub/403/), Natasha Elkovitch of the University of Nebraska-Lincoln and her co-authors also outlined that typical, “high-frequency” behaviors reported by parents of preschoolers include:

  • Touching private parts at home or in public
  • Exposing private parts to others
  • Trying to look at others’ private parts
  • Standing too close to others
  • Touching female breasts

While knowing that this curiosity and naïve exploration of their bodies and the bodies of others is a normal, developmentally appropriate stage, however, it does not lessen the often awkward feelings and uncertainty of how to handle it.

This feeling is only compounded by the dreaded anticipation of the teen years. As children grow, their knowledge and awareness of sex also grows through exposure to caregiver relationships, peer interactions and the media (i.e., TV, Internet, social media).

The statistics related to sexualized behaviors and the adolescent stage of development add to many caregivers’ fears. According to a 2008 adolescent survey report conducted by the Centers for Disease Control and Prevention, 50 percent of U.S. adolescents (grades 9-12) were sexually active, 7.1 percent had their first sexual experience before age 13, nearly 15 percent had already had “four or more partners,” and 38.5 percent did not utilize contraception.

When caregivers observe or learn about their child’s play involving private parts and respond with alarm, sternness, isolation of the child or avoidance of the topic, the caregiver may inadvertently be shaming the child. This makes the mental connection for the child that private parts are bad and that their caregiver is not someone to talk to about their curiosity.

Research conducted by William Pithers and colleagues in 1998 indicated that children exhibiting sexualized behavior problems were more likely to have parents who viewed their children as attention seeking, considered time with them as unrewarding, were emotionally distant and engaged in more conflict-dominated interactions. Children who grow up under this parenting style tend not to view their caregivers as reliable role models of interpersonal relationships, confidants or valuable resources on awkward topics. These children are more likely to seek answers, nurturing and a semblance of love from others, taking their cues from online information and peer pressure.

Damion’s grandmother was part of the generation that did not talk about such behaviors. Such behaviors were not just kept private; they were left a mystery. Damion’s grandmother was also really overwhelmed. She had a job, teenagers of her own she was still raising, a husband, friends and a very busy 3-year-old grandson who was missing his mother. She was exhausted and admitted to often thinking that Damion was a burden and too needy. She just wanted his problem behaviors to stop.

Chloe’s dad was raising four children on his own, with Chloe being the only girl. He was at a loss and thought that he had failed as a father. He admitted that conflict was a major part of daily life in their home. He was stretched thin for time, money, patience and ways to relate to his daughter.

So, what can caregivers do to help their children bridge the expanse from developmentally appropriate curiosity of the world around them in preschool to healthy decision-making and boundaries?

Thankfully, many researchers have been asking versions of this question for decades. The answer consistently comes that the relationship that children have with their caregivers is the key to positive outcomes — specifically, the authoritative parenting style of balancing warmth and support with Underwater photo of happy family swimming in the blue poolmonitoring and control. This is supported across socioeconomic and ethnic groups.

Beginning in the first year of life, children are learning how and whether to trust their caregivers. Erik Erikson’s stages of psychosocial development also states that during the preschool years, children are attempting to gain a sense of autonomy. They want and need to feel emotionally safe enough both to explore the world around them (including their bodies and others’ bodies) and to seek out caregivers when confusion or “storms of life” arise. This time of a preschooler seeking refuge in a caregiver is the most valuable and opportune time to start the lessons of interpersonal boundaries, social etiquette, family morals and values, and decision-making skills.

With preschoolers, it is best to engage in these conversations and lessons through play. When children are engrossed in their toys and own imaginations, they are much more likely to talk. Garry Landreth, a pioneer in the world of play therapy, has said, “Play is a child’s language, and toys are their words.”

Entering a child’s world through play is the best way to speak his or her language about tricky topics. Watching children’s play and keeping track of the themes in their play can provide great insight into what they are trying to gain mastery over or what is troubling their hearts and minds. Playful lessons may seem counterintuitive. However, they make the most lasting memories and connections for children. Entering a child’s world through play also builds bonds that help the child feel the emotional security to seek caregivers out when troubles come.

In working with Damion and Chloe, it was vital to include their caregivers. With both families, we decided to set aside certain times at home during the week for a special, uninterrupted time with each child and caregiver. It started out as 15 minutes of imaginative play of the child’s choosing. All behavior concerns started to decrease.

We also used our therapy session to begin talking about private parts and why they are private. This conversation was transitioned into the home as the caregivers became more confident in their preferred way of talking about the subject with the child. The caregivers and I also worked to increase the balance of warmth and support with monitoring and control. Through therapy, we confirmed that no abuse had occurred; the children’s behaviors were a combination of developmentally appropriate curiosity and negative attention-seeking behavior.

Through my work, I have found that many caregivers, when trying to teach their children about private parts, are uncomfortable with many of the books that describe reproduction or sexual abuse. A colleague and I decided to write a book that approaches this topic from a normal, developmentally appropriate perspective in a way that helps caregivers start the conversation and normalizes talking to caregivers. It’s … Just Private will be available at booksellers in the upcoming months.

 

 

*All identifying details of these stories have been altered to protect the identities of the individuals referred to in this article.

 

 

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Ashley Wroton is a licensed professional ItsPrivatecounselor and registered play therapist in Hampton, Virginia. She received her master’s degree in education and her education specialist degree in mental health and school counseling from Old Dominion University. She is the co-author, with Shelby Debause, a licensed marriage and family therapist, of It’s … Just Private, a children’s book that helps young children understand the need for setting boundaries with their bodies and gives caregivers strategies for communicating those boundaries. Ashley and Shelby can be reached through Facebook at Ashby Consulting LLC or through the genesiscounselingcenter.com website.

 

Ten intimate relationship research findings every counselor should know

By Sara Polanchek and Sidney Shaw November 23, 2015

“Follow your heart but take your brain with you.” Relationship science has come a long way since Alfred Adler shared those words of wisdom, but they remain just as applicable today as when he Doveswrote them in the 1920s.

Modern scientific studies, ranging from smelling T-shirts (seriously) to connecting couples to skin and heart monitors while they discuss a topic of conflict, have changed our understanding of the scientific underpinnings of relationships. These studies have also informed improved approaches to bringing “your brain with you” as you follow your heart.

Our professional experience, both as relationship counselors and as instructors of undergraduate courses on intimate relationships, has cemented our belief in using the science of relationship to help both educators and individuals heed Adler’s words. In this article, we present 10 intimate relationship research findings that (we think) every counselor should know.

 

10) Health: Connection and intimacy improve health. Romantic relationships are correlated with overall well-being. More and more studies are showing that maintaining an intimate relationship provides protective factors in both emotional and physical health. Specifically, individuals who are engaged in a romantic relationship tend to report lower responses to pain, elevated immune responses, increased longevity and a greater ability to moderate their brain’s response to threat. A broader societal focus on enhancing the potential for individuals to form and maintain
healthy connections with others could improve general health and life satisfaction for a significant portion of the adult population.

9) Changing trends and times: Culture matters in relationship. Relationship-related norms have changed dramatically during the past five decades. No longer is marriage the presupposed path of a relationship, nor does marriage generally have the staying power of previous years. Increased rates of cohabitation before marriage (60 percent today compared with 5 percent in 1960) and advanced age at time of first marriage are two more signs that times have changed. Furthermore, 41 percent of babies are now born out of wedlock, compared with 5 percent in the 1960s. The fluidity of many of today’s relationships can create complex co-parenting landscapes that have consequences for the individuals involved and their children.

As counselors, our beliefs may be textured by demographic patterns of a prior generation. How might our beliefs and values influence our work? What are our attitudes toward the institution of marriage? Cohabitation? Divorce? What does the term traditional family currently mean?

Our awareness of changing relationship trends and the contemporary influences that have resulted in these changes provide an essential backdrop to our practice as counselors. Of the many influences that have led to the ongoing shift in modern norms concerning relationships, three stand out.

  • Economics: In industrialized societies, individuals are better able to support themselves without relying on a partner to fill in the gaps. Women in particular are less financially dependent than in previous generations and, therefore, less tied to marriage as a fundamental need.
  •  Individualism: Western cultures have a stronger focus on self. In part, this means that individuals want more out of their relationships — more excitement, more passion, more devotion — and feel justified in seeking new partners if these needs aren’t being met.
  • Technology: Technology has opened up the dating world, expanding potential partner choice from a very limited geographical proximity to a literally global “market.” Via social media and online dating sites, individuals can compare their partners’ perceived shortcomings with an infinite number of alternatives. In addition, a long-distance romance ignited through Skype is easily snuffed out when one partner returns to “single status” on Facebook or other media. In such instances, the ease of technology can deny individuals the growth opportunities that result from the discomfort of breaking up in a sensitive fashion.

8) Growth beliefs: The downside of a soul mate. The belief in a one-and-only soul mate is a very enticing notion. The prospect of finding that one person who is “perfect” for us or whom we were “meant” to be with seems embedded in our cultural lexicon. According to some scholars, the notion of the soul mate dates back to ancient Egypt some 5,000 years ago, but it is a belief that still largely persists in our culture today. A 2011 Marist poll found that 73 percent of Americans believed that destiny would lead them to their soul mate; the percentages of women (71 percent) and men (74 percent) who held this belief were roughly the same.

Belief in a soul mate is closely aligned with what modern researchers refer to as “destiny beliefs.” In contrast, people who hold “growth beliefs” adhere to the outlook that relationships naturally involve conflict and that challenges in the relationship can be overcome. It is easy to see how growth beliefs can translate into an approach that embraces conflict and struggle as inherent elements of relationships. People who are higher in their growth beliefs about relationships tend to deliberately engage in more relationship-maintaining behaviors and actively plan ways to resolve conflict in relationships than do those who are lower in their growth beliefs. Individuals with strong growth beliefs tend to view relationship conflict as normal and often interpret this conflict as an opportunity for growth and expansion.

Counselors who understand these differences are better poised to support their clients as they struggle to identify well-suited partners and to help ground their clients with a more realistic view of long-term relationships.

7) Perpetual problems: Not all problems should be fixed. Conflict makes frequent and unavoidable appearances in every relationship. Commonly, couples view the sources of conflict as problems to be fixed or solved. However, well-known relationship researchers Julie and John Gottman report that an astounding 69 percent of relationship problems are perpetual. These problems don’t have a solution and are therefore not going to get “fixed.”

Couples who approach all problems with a “solve it” mentality will find themselves in gridlock — terrain that is wrought with frustration and angst. It is critical that counselors reframe this gridlock and shift the focus away from resolution. In other words, help clients stop trying to fix every problem. Instead, focus on dialogue around the problem through a lens of compassion and understanding. Counselors can coach their couples as they develop the skills necessary to soften the edges of conflict and elicit the emotional security necessary for each partner to feel safe inside this process.

6) The magic ratio: Bad is stronger than good. Although negative interactions play an important role in relationships (for example, challenging an unfulfilling status quo or shining light on unproductive communication patterns), couples and families attending counseling are often there because they lack a healthy balance of positive and negative interactions. They are in a state that Robert Weiss referred to as “negative sentiment override.” For a healthy balance of positives and negatives, the “magic ratio” is 5 positives (minimum) for every 1 negative.

According to the Gottman Institute, the 5-to-1 ratio is typical of conflicted couples that are at relatively low risk for divorce. Among happy couples, however, that ratio is about 20-to-1. Thus, when working with couples and families, aim for positive sentiment override and assist clients with understanding their partners’ perception of negatives and positives. One partner may think that he or she is engaging in a positive interaction, but the other partner may not experience it as such. In a way, strength-based counseling is a modeling of this balance of negatives and positives. A helpful exercise for counselors is aiming to keep track of their own perceived positive-negative ratio in interactions with clients.

Acknowledging the need to increase positive interactions does not diminish the need to thoughtfully address the important role of negativity in relationships. As counselors know, all negative interactions are not created equal. A few guidelines for navigating negative interactions can provide clients with concrete tools.

First, when introducing a topic that may be perceived as negative, it helps to use a “softened startup.” Basics of this approach include beginning slowly and neutrally, using I statements, choosing an appropriate time to bring the topic up and placing emphasis on making a request as opposed to an accusation.

Even with these softened techniques in mind, negative feelings in the aftermath of conflict can still arise, but repair attempts can re-establish the healthy balance of negatives and positives. Repair attempts refer to acts that lower tension from a negative interaction. These may include suggesting a timeout, offering an apology, using a gentle demeanor or engaging in a kind act. Whatever the case, repair attempts, softened startups and a focus on increasing positive interactions are all aimed at nudging a couple into positive sentiment override and reaching that magic ratio.

5) Psychophysiology: A calm brain is more thoughtful and compassionate. In the context of love, an alarmed brain is a brain that is not at its best. Relationship researchers now have sophisticated tools to study the neurological and autonomic underpinnings of emotion. Diffuse physiological arousal occurs when emotional triggers elevate an individual’s heart rate approximately 20 beats per minute above typical. In this state, an individual’s ability to access compassion and empathy, laugh, listen or express affection is severely limited. Each of these actions is known to diffuse, or at least soften, hostile conflict.

Counselors can provide clients with important relationship tools by helping them understand their idiosyncratic triggers and teaching them how to moderate the impact of these triggers on their physiology. Individuals can learn myriad mind-body techniques that moderate physiological arousal and activate the body’s natural relaxation response.

4) Androgyny: Traditional gender roles can be detrimental to couples. Gender roles in society serve the function of defining roles based on sex. However, the simplistic, dichotomous view commonly reinforced by societal norms can be quite limiting and can negatively affect intimate relationships. Historically, the terms masculine traits and feminine traits have been used, but today’s researchers predominantly apply the terms instrumental and expressive to refer to different traits. Instrumental traits refer to task-oriented behaviors — for example, assertiveness, ambition, decisiveness, rationality and self-reliance. Expressive traits refer to traits involving emotional and social skills, including characteristics such as tenderness, compassion, empathy, warmth and sensitivity to others.

Stereotyped gender roles have generally reinforced either instrumental traits or expressive traits based on a person’s sex identification. However, research continues to demonstrate the untoward effects of such narrow, stereotyped roles. For example, numerous studies have found that adherence to traditional stereotyped gender roles is significantly associated with relationship violence and justification of violence. Additionally, in a 2006 study, Heather Helms and colleagues found that spouses who follow stereotyped gender roles tend to have marriages that are less satisfying and happy than do couples that have more nontraditional gender roles.

There may be a tendency, because of socialization, to think of instrumental and expressive traits as opposite ends of a continuum. More accurately, these traits are essentially sets of skills, and a person can be low or high in these skills. The ability to utilize instrumental and expressive traits fluidly as dictated by the situation has been shown to be associated with more contented relationships. For numerous reasons, holding tightly to traditional gender roles can be detrimental for individuals and society. By teaching and cultivating awareness of the benefits of androgyny (embodying both instrumental and expressive traits), counselors can help couples build more satisfying relationships and become more well-adjusted individuals.

3) Passion paradox: Passion can have a downside. The novelty that accompanies young romantic love quickens our hearts and fills us with renewed vigor and passion. Some individuals report feeling superhuman and, indeed, many can tolerate pain at levels that would be quite unpleasant absent the vision of their new lover’s face to stimulate the release of pain-muting hormones.

However exciting and fun these passionate feelings may be though, they can also cloud our judgment and push our behaviors in directions that may not serve our best interests. For example, the flood of feel-good hormones that accompany a new relationship can mask the evidence of traits that are unhealthy for long-term relationships, such as reactive jealousy, possessiveness, dependency and so on. Similarly, in the early stages of a relationship, a couple may make choices (cohabiting, becoming pregnant, etc.) that the partners might avoid or delay if they were viewing each other with more clarity. In other words, commitment decisions might best be made after the novelty of a new relationship has waned and the realities of the partners’ true characteristics have had a chance to surface.

By addressing the common confusion between passion and intimacy, and discussing the normative processes of passion, counselors can help clients understand and respond thoughtfully to the developmental progression of most relationships.

2) Conflict and dialectics: Conflict and dialectics are ubiquitous. One of the most basic rules of conflict is that it is unavoidable. However, clients and counselors alike sometimes approach conflict as something to be snuffed out or avoided at all costs. Counselors can help improve intimate relationships by encouraging clients to approach conflict as an important thread woven into the fabric of relationships and teaching them to develop relationship skills to navigate conflict in a way that promotes personal and relational growth.

Research into relational dialectics — meaning the opposing tensions, motivations or philosophies that exist in intimate relationships — informs our approaches to dealing with conflict. Examples of these dialectics include autonomy/connection, openness/closedness, stability/change and integration/separation. According to dialectical theory, each of these domains contains a tension that can never fully be resolved. For example, working toward stability and predictability in a relationship can jeopardize the needs of one partner (or both partners) for change and unpredictability, which may result in a mundane relationship that lacks excitement. Providing psychoeducation about the inevitability of dialectics can soften its energy inside a relationship and open pathways for intimacy that may otherwise be thwarted.

1) Sexuality: “Good enough sex” is good enough. With few exceptions, cultures all over the world continue to accept a double standard inside the sexual relationship. Particular to Western culture, males are expected to want sex all the time, and success is determined primarily by the occurrence of orgasm. Females are expected to be sexually quiet and to fall in line with the whims of their husbands or boyfriends, and success is a secondary consideration reflecting male technique and his ability to “deliver” an orgasm to the female.

Ubiquitous messages from media serve to reinforce these roles. Although not a simple task, proponents of egalitarian sexuality encourage couples to avoid falling prey to the gender stereotypes that can inhibit sexual freedom. An expanded (and, sexual researchers might say, superior) version of sexuality emphasizes a focus on multiple facets beyond orgasm — nongenital touch, emotional intimacy, fun and stress release, to name a few — that can be cultivated in any relationship.

This “Good-Enough Sex” model, first introduced by Michael Metz and Barry McCarthy, challenges aforementioned stereotypes and instead emphasizes flexibility (with regard to expectation and prescribed roles), egalitarian desire and pleasure. A major premise of this model is a focus on realistic expectations. According to Metz and McCarthy, the couple that understands and accepts that up to 15 percent of sexual encounters will be dissatisfying is more likely to persevere and reconnect than is the couple that erroneously expects all sex to be “successful.”

Given that dysfunctional sexuality can erode couple intimacy, it is worthwhile to assess and explore this domain of the couple relationship with clients. Counselors can help clients untangle the embedded socialized behaviors that disrupt the pleasure processes and provide information regarding realistic sexual expectations.

Conclusion

As highlighted in this article, recent advances in relationship science provide counselors with new tools, techniques and insights to apply to their practice. As scientific study deepens our understanding of the mechanisms, motives and context of relationships, we are better equipped to help individuals and couples come to a better understanding of healthy relationships, their partners and themselves.

Relationships are inseparable from human history, yet the cultural context of relationships is ever changing — perhaps seldom more so than in recent decades. Cognizance of the drivers and impacts of these changing norms, as well as the cultural proclivities we inherit from the idiosyncratic nature of our own upbringing, can further empower our work. Staying abreast of the burgeoning field of relationship-related research is a daunting task, yet never have counselors been better equipped to help others take their brain with them as they follow their heart.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Polancheck

 

Sara Polanchek is the clinical director in the Department of Counselor Education and Supervision at the University of Montana in Missoula. Contact her at sara.polanchek@mso.umt.edu.

 

 

Shaw

 

Sidney Shaw is core faculty in the clinical mental health counseling program at Walden University and a certified trainer for the International Center for Clinical Excellence. Contact him at sidney.shaw@waldenu.edu

 

 

 

Letters to the editor: ct@counseling.org

 

 

Entering the danger zone

By John Sommers-Flanagan October 28, 2014

For the most part, the United States lacks a coherent and systematic approach to sexual education. Instead, as lampooned in an online issue of The Onion, sex education is typically informal, unorganized and inaccurate. The Onion article describes a scene in which a 10-year-old boy takes his 8-year-old cousin behind his parents’ garage with a page ripped out of a magazine and shares “the vast misguided knowledge of human sexuality he had gleaned from classmates’ hearsay as well as 12 minutes of a Real Sex episode he watched in a hotel room once.” The older boy recounts his rationale: “Every time people have sex the woman has a baby, and I just want [my younger cousin] to be completely prepared before getting naked with a girl.”

The good news is that The Onion deals in news satire. The bad news is that the current state of sex education in our country isn’t much better than the fictional version portrayed in The Onion.

Image of youth looking at laptop computerConsider that a report this past April from the Centers for Disease Control and Prevention indicated that more than 80 percent of adolescents between the ages of 15 and 17 have no formal sexual education before actually having sex. If teenagers have no formal sex education, then what informal sex education do you suppose they take with them into their first sexual experiences?

One such source of informal sex education is pornography. In 2009, University of Montreal professor Simon Louis Lajeunesse designed a study to evaluate how pornography use affects male sexual development. He planned to interview 20 males who had viewed pornography, then compare their responses with those of 20 males who had never viewed porn. Remarkably, Lajeunesse had to abandon his project because he couldn’t find any college-aged males who hadn’t already viewed porn.

Other researchers report similar experiences. It appears that most boys, rather than learning about sex from a well-meaning, albeit uninformed cousin, get their information from the pornography industry … and my best guess is that the porn industry isn’t focusing on the best interests of American youth. This is one way in which reality may be worse than The Onion’s satiric version of events.

The absence of formal and accurate sexual education is a particularly American problem that may find its way into the offices of professional counselors. Many young males probably have little basic knowledge about sex and sexuality, or hold unhelpful ideas. Some will have porn addictions. Others will want to talk about how pornography may be affecting their real sex lives. You may also have clients who are concerned about their partner’s or potential partner’s porn viewing behaviors. Working with young (and older) males (and females) who want to talk about their sexual knowledge, beliefs and behaviors, including watching pornography, is both a challenge and an opportunity for professional counselors.

Counselors have an ethical mandate to strive toward competence. As articulated in the multicultural counseling literature, this requires cultivating personal awareness, gathering knowledge and developing skills.

Awareness: Expanding your comfort zone

Talking about sex, sexuality and sexual attraction can be difficult at every level. Think about yourself: How easy is it to talk about sex with your supervisor, colleagues, students or clients? Your own experience may give you a glimpse into how challenging it can be to broach the topic of sex — even for professionals.

In comparison, it’s probably an understatement to say that it is especially difficult for boys to initiate a conversation about sex or sexuality with a professional counselor. This is why counselors who work with boys should become comfortable initiating conversations about sex. If you don’t ask at least a few gentle, polite, yet direct questions, you may be waiting a long time for the boy in your office to bring up the subject.

On the opposite extreme, some young clients will jump right into talking about sexuality and push us straight out of our comfort zones. Recently, I was working with a 16-year-old boy who described himself as a polyamorous “furry” (which I later learned involved sexualized role-playing as various animals). Admittedly, it was a challenge to maintain a nonjudgmental attitude. But without such an attitude, we wouldn’t have been able to have repeated open and useful conversations about his sexuality and sexual identity development.

Knowledge: The effects of pornography on boys and men

Many potential areas related to sexuality deserve attention, focus and discussion in counseling. But because pornography and mixed messages about pornography are everywhere, it can be an especially important subject.

Most counselors probably believe that repeated exposure to pornography has a negative impact on male sexual development. This negative impact is likely exacerbated by the fact that most boys aren’t getting any organized, balanced and scientific sexual information. Nevertheless, within the dominant American culture, there remains strong resistance to both sex education and pornography regulation. Even in a recent issue of Monitor on Psychology, the authors of an article questioned whether porn is addictive and blithely noted that “people like porn.”

It’s not surprising that porn has advocates. After all, it’s estimated to be a $6 billion-plus industry. In addition, media outlets explicitly and implicitly use pornlike sexuality to attract an audience and sell products. Recently we’ve seen the increased use of hypermasculine male body types in the media, but most of the rampant sexual objectification still focuses on young female bodies.

Given that sexual development includes a complex mix of culture, biology and life experience, it’s not surprising that researchers have had difficulty isolating pornography as a single causal factor in male sexual developmental outcomes. However, a summary of the research indicates that as the viewing of pornography increases, so does an array of negative attitudes, behaviors and symptoms. Generally, increased exposure to pornography is correlated with:

  • More positive attitudes toward sexual aggression, increases in sexual aggression, multiple sexual partners and engaging in paid sex
  • Increased depression, anxiety and stress, and poorer social functioning
  • Positive attitudes toward teen sex, adult premarital sex and extramarital sex
  • More positive attitudes toward pornography and more viewing of violent or hypersexual pornography
  • Higher alcohol consumption, greater self-reported sexual desire and increased rates of boys selling sexual acts

In contrast to these findings, a 2002 Kinsey Institute survey indicated that 72 percent of respondents considered pornography to be a relatively harmless outlet. This might be true for adults. I recall listening to B.F. Skinner talk about how older adults could use pornography as a sexual stimulant in ways similar to how they use hearing aids and glasses.

But the point isn’t whether people like porn or whether porn can be relatively harmless for some adults. The point is that pornography is a bad primary source of sexual information for developing boys and young men. As a consequence, it’s crucial for counselors who work with males to be knowledgeable about the potential negative effects of pornography.

Skills: How can counselors help?

A big responsibility for professional counselors who work with boys is to consistently keep sex and sexuality issues on the educational and therapeutic radar. This doesn’t mean counselors should be preoccupied with asking about sex. Rather, we should be open to asking about it, as needed, in a matter-of-fact and respectful manner.

As with most skills, asking about sex and talking comfortably about sexuality requires practice and supervision. But as Carl Rogers often emphasized, having an accepting attitude may be even more important than using specific skills. This implies that finding your own way to listen respectfully to boys (and all clients) about their sexual views and practices is essential. It also requires openness to listening respectfully even when our clients’ sexual views and practices are inconsistent with our personal values. As with other topics, if we ask about it, we should be ready to skillfully listen to whatever our clients are inclined to say next.

Case example

Some years ago, I had a young client named Ben who was in foster care. We started working together when he was 10 and continued doing so intermittently until he was 17.

When Ben was approximately 13, I routinely started asking him about possible romance in his life. He typically redirected the conversation. Occasionally he gave me a few hints that he wanted a girlfriend, but he mostly still seemed frightened of girls. As my counseling with Ben continued, I became aware that I had been conspiring with him to avoid talking directly about sex, possibly because I was afraid to bring it up.

I finally faced the issue when I realized (far too slowly) that Ben had no father figure in his life and, thus, I was one of his best chances at having a positive male role model. With encouragement from my supervision group, I was able to face my anxieties, do some reading about male sexual development and finally broach the subject of having a sex talk with Ben.

Toward the end of a session I said, “Hey, I’ve been thinking. We’ve never really talked directly about sex. And I realized that maybe you don’t have any men in your life who have talked with you about sex. So, here’s my plan. Next week we’re going to have the sex talk. OK?”

Ben’s face reddened and his eyes widened. He mumbled, “OK, fine with me.”

The next session I plowed right in, starting with a nervous monologue about why talking directly about sex was important. I then asked Ben where he’d learned whatever he knew about sex. He answered, “Sex ed at school, some magazines, a little Internet porn and my friends.”

I felt a sense of gratitude that he was listening and being open, even if we were both feeling awkward. We talked about homosexuality, pornography, sexually transmitted diseases, pregnancy, contraception and emotions. I tried to gently warn him that too much porn could become way too much porn. He agreed. He told me that he didn’t feel like he was gay but that he didn’t have anything against gays and lesbians. At the end of the conversation, we were both flushed. We had stared down our mutual discomfort and navigated our way through a difficult topic.

Professional sex educators emphasize that parents shouldn’t have just one sex talk with their kids; they should have many sex talks. What I thought was THE talk with Ben turned into something we could revisit. Over the next two years, Ben and I kept talking — off and on, here and there — about sex, sexuality and pornography.

Final thoughts

Boys are a unique counseling population, and sex is a hot topic. Together, the two provide both challenge and opportunity for professional counselors. As counselors, we should work to develop our awareness, knowledge and skills for talking with boys about sex and sexuality. You may not be the perfect sex educator, but when the alternatives for accurate information are pornography or someone’s uninformed older cousin, it becomes obvious that having open conversations about sex with boys is an excellent role for counselors to embrace.

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Readings and resources for working with boys and men

  • A Counselor’s Guide to Working With Men, edited by Matt Englar-Carlson, Marcheta P. Evans & Thelma Duffey, 2014, American Counseling Association
  • “Addressing sexual attraction in supervision,” by Kirsten W. Murray & John Sommers-Flanagan, in Sexual Attraction in Therapy: Clinical Perspectives on Moving Beyond the Taboo — A Guide for Training and Practice, edited by Maria Luca, 2014, Wiley-Blackwell
  • Guyland: The Perilous World Where Boys Become Men, by Michael Kimmel, 2010, Harper Perennial
  • Tough Kids, Cool Counseling: User-Friendly Approaches With Challenging Youth, second edition, by John Sommers-Flanagan & Rita Sommers-Flanagan, 2007, American Counseling Association
  • The Macho Paradox: Why Some Men Hurt Women and How All Men Can Help, by Jackson Katz, 2006, Sourcebooks
  • The Good Men Project: goodmenproject.com

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John Sommers-Flanagan is a counselor educator at the University of Montana and the author of nine books. Get more information on this and other topics related to counseling and parenting at johnsommersflanagan.com.

Letters to the editor: ct@counseling.org

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.