A Feminist Approach to Sex Therapy
posted by David Avruch, LCSW-C
on February 10, 2018
Feminism means different things to different people. I call myself a feminist psychotherapist because certain key tenets of feminist theory - in particular, examining the the distribution of power in society and in relationships - can be powerful tools in my work with clients. This is true when it comes to treating sexual problems as experienced by an individual or couple.
How does it work? First, we look at the status quo and ask what’s missing. Contemporary discussions of sexual problems privilege a biomedical perspective. For example, two of the most common reasons people seek sex therapy - erectile dysfunction and lack of sexual desire - are often viewed as exclusively medical problems, with expensive pharmacotherapies being prescribed for both conditions. While for some clients medication brings relief, the biomedical approach alone ignores other potential causes and solutions.
Traditional sex therapy examines a sexual problem from three different angles: biomedical, psychological, and relational. Often, more than one angle is in play. For example, a biomedical reason for erectile dysfunction could be hypertension, a psychological factor could be depression, and a relational factor could be a feeling of emotional distance from one’s partner. By jumping straight to medication, we ignore important - and treatable - problems underlying the sexual complaint. One possible consequence of ignoring other causes: if a client manages his ED by taking a prescription medication without treating an underlying depression, he may lack the motivation to remain adherent to the medicine. Research on the drug Viagra, for example, has documented that up to 50% of patients who are prescribed the drug will quit taking it within a few years; a significant minority never fill the prescription to begin with.
Feminist sex therapy introduces a fourth angle for examining a sexual problem: the political. It seeks to understand sexual functioning in the context of society’s expectations of women and men, as well as how we are taught to think about our bodies and sex. For example, female hypoactive sexual desire disorder (HSDD; “hypoactive” means underactive) is thought to occur in up to one third of all women in the United States. A feminist analysis would ask: is this the product of social conditions? For example, research has documented that in heterosexual relationships in which both partners work full time outside the home, a disproportionate share of housework and childcare continues to fall on women. This can create resentment and discord within a relationship. Conversely, other data has shown a positive correlation between marital satisfaction and sexual desire. A feminist psychotherapist would be curious whether the division of labor in the home is related to the female partner’s experience of sexual desire.
Sexuality is inherently complex. In my experience as a therapist, examining a problem from multiple angles and gathering as much data as possible, rather than being limited to a single model, can lead to new opportunities for improved functioning both for the individual and the couple.
Female hypoactive sexual desire disorder: epidemiology, diagnosis and treatment. Warnock JJ. CNS Drugs. 2002;16(11):745-53.
Women in the Workplace Survey 2015, LeanIn.org & McKinsey
How long do patients with erectile dysfunction continue to use sildenafil citrate? Dropout rate from treatment course as outcome in real life. Sato et. al. Int’l Journal of Urology, April 2007
The F.A.S.T. Model. Teresa L. Young. Journal of Feminist Family Therapy, 2007; 19:2
Sexual desire and relationship functioning: the effects of marital satisfaction and power. Brezsnyak M & Whisman MA. Journal of Sex and Marital Therapy. 2004 May-Jun; 30(3):199-217.
Four Tips to Improve Your Intimate Relationship
June 6, 2017
In the film ‘Eat, Pray, Love,’ the main character tells a story about her friend Deborah: “Deborah, a psychologist, was asked by the city of Philadelphia if she could offer psychological counseling to a group of Cambodian refugees, ‘boat people’ who had recently arrived in the city. Deborah was daunted by the task. These Cambodians had suffered genocide, starvation, witnessed relatives murdered before their eyes, spent years in refugee camps, and endured heroic boat trips to the west. How could she relate to their suffering? How could she help these people?” The main character who plays Elizabeth Gilbert, the author of the book ‘Eat, Pray, Love,’ went on to say that the Cambodian people wanted to talk with her friend Deborah, the psychologist, not about the trauma and suffering they had experienced as result of fleeing their country, but about their love relationships. They wanted to talk about the love they had found, the love they had lost, and the love they were missing and wanted back…all about a special guy or girl whom they couldn’t stop thinking about. Elizabeth Gilbert found herself thousands of miles away from home going to talk to a medicine man about the very same issue: her love life.
Why is it that so many people are consumed with their love relationship? These relationships touch a very deep place within us. The concerns seem to fall into three categories:
-People who have had their heart broken by someone they love and just can’t seem to recover.
-People who are in a relationship currently and are concerned that the relationship is not working.
-People who are looking to find the right person with whom to spend their lives.
In this blog posting I would like to focus on some tips for those who are in a current relationship and feel that it is not working. In future blog postings, I would like to address more tips for current relationships, as well as tips for those who are trying to get over a past relationship, and tips for those who are looking for the right person to be with.
So, here goes:
Tips for Improving Your Current Love Relationship
1. Be willing to listen. Try to hear what your partner is telling you when he/she speaks. Pause. Don’t think about what you are going to say next, just listen. Let your partner know what you think they are saying. Let them tell you if you heard it accurately or if there is something they need to clarify. Stay calm.
2. Provide safety for your partner. Remember that you are both on the same side ultimately. Your partner is not your enemy. Your partner is your friend. How can you speak to your partner in a way that allows them to feel respected and not attacked? When either of you escalate, the discussion is over for the moment and needs to resume later after a cooling off period.
3. Laugh together. Remember when you met your partner and you had countless moments together talking and making each other laugh? Where did that go? Bring the humor back into the relationship. You may have to work hard to find it again, but you will.
4. Devote time to the relationship. You two need time together and without your children or your friends. It may be very difficult if you have children, but it is essential that you make it happen on a regular basis. Get off the sofa or away from the computer. Turn off the cell phone. Think of a creative way to spend time together. Surprise your partner and ask him/her to surprise you. Make it a priority. And make a rule that you won’t talk about your problems on the date.