intimacy - The Milton H. Erickson Foundation

Transcription

The Couples Therapy Conference '97:
SEXUALITY &
intimacy
Friday-Sunday, March 14-16, 1997
San Francisco Airport Hilton
San Francisco, California
APPROVED FOR
20.5 HOURS OF MCEP CREDITS
I
Keynote Addresses by:
David Scharff, M.D.
"Regaining Intimacy:
Sexual Doubts, Intimate Desires"
David Schnarch, Ph.D.
''Passionate MarriageTM:
The Path of Personal Evolution
and Eyes-Open Sex"
Presenters include:
Bernard Apfelbaum, Ph.D.
Lonnie Barbach, Ph.D.
Ellyn Bader, Ph.D. & Peter Pearson, Ph.D.
Marty Klein, Ph.D.
Peter Krohn, M.A., M.F.C.C.
Sandra Leiblum, Ph.D.
Joseph LoPiccolo, Ph.D.
Ruth McClendon, M.S.W. & Les Kadis, M.D.
David Scharff, M.D.
Bennet Wong, M.D. & Jock McKeen, M.D.
Jeffrey K. Zeig, Ph.D.
Bernie Zilbergeld, Ph.D.
Sponsored by
The Milton H. Erickson Foundation
Phoenix, Arizona
with organization by
The Couples Institute
Menlo Park, California
Table of Contents
Schedule ................................. 1
The Faculty ............................... 2
About the Conference ....................... 3
The Milton H. Erickson Foundation, Inc. . ........ 5
Abstracts and Educational Objectives ............ 7
Handouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
SCHEDULE
I
FRIDAY, MARCH 14, 1997
8:30 - 8:45A.M.
8:45 - 9:45 A.M.
Opening Remarks
Keynote Address
International Ballroom
Passionate Marriage™: The Path of Personal Evolution and Eyes-Open Sex! David Schnarch, Ph.D.
10:00 A.M. - 12:30 P.M.
Workshops
Disrupting Symbiosis and Facilitating Differentiation Ellyn Bader, Ph.D. I Peter Pearson, Ph.D.
Savoy Ballroom
Passionate MarriageTM: Sex, Love and Intimacy in Emotionally Committed Relationships David Schnarch, Ph.D. Terrace Ballroom
Teaching the How-To of Sex Bernie Zilbergeld, Ph.D.
Vintage 4-5
Shame and Intimacy Ruth McClendon, M.S. W. I Les Kadis, M.D.
Vintage 1-3
2:00 - 5:00 P.M.
Workshops
Is There Such Thing as a Sexual Problem? Marty Klein, Ph.D.
Passionate Marriage TM (continued) Schnarch
Object Relations Treatment of Physical and Sexual Trauma David Scharff, M.D.
·
Demonstration Interviews
2:00-3:15 P.M. Jeffrey K. Zeig, Ph.D.
3:30- 5:00 P.M. Ruth McClendon, M.S. W. I Les Kadis, M.D.
6:00-7:00 P.M.
No-Host Hospitality Event and Authors' Hour
Vintage 4-5
Terrace Ballroom
Vintage 1-3
Savoy Ballroom
Savoy Ballroom
Vintage 1-5
I SATURDAY, MARCH 15, 1997
8:00 - 10:30 A.M.
Workshops
The Personal Growth and Development of the Couples Therapist: Developing Personal Power Jeffrey K. Zeig, Ph.D.
Savoy Ballroom
Vintage 4-5
Post-Modern Sex Therapy Joseph LoPiccolo, Ph.D.
Object Relations Couple Therapy David Scharff, M.D.
Vintage 1-3
Is It Symbiosis or Is It Intimacy? Ellyn Bader, Ph.D.
10:45- 11:45 A.M.
Keynote Address
Regaining Intimacy: Sexual Doubts, Intimate Desires David Scharff ,M.D.
1:00 - 4:00 P.M.
Workshops
Love, Sex and Infertility: The Impact of Infertility on the Couple Sandra Leiblum, Ph.D.
Post-Modern Sex Therapy (continued) LoPiccolo
Object Relations Couple Therapy (continued) Scharff
The Nature of Sex and Spirit David Schnarch, Ph.D.
4:15- 5:15 P.M.
Savoy Ballroom
Vintage 4-5
Vintage 1-3
Terrace Ballroom
Panels
Couples Working with Couples Jock McKeen, M.D. I Bennet Wong, M.D.; Ellyn Bader, Ph.D. I Peter Pearson, Ph.D.;
and Ruth McClendon, M.S. W. I Les Kadis, M.D.
Terrace Ballroom
What To Do When One Partner Has No Sexual Interest in the Other Joseph LoPiccolo, Ph.D.; David Scharff, M.D.;
David Schnarch, Ph.D.; and Bernie Zilbergeld, Ph.D. Savoy Ballroom
SUNDAY, MARCH 16, 1997
8:45 - 9:45 A.M.
Panels
Hostility and Anger in Couples Relationships ... A Conversation Bernard Apfelbaum, Ph.D.; Jock McKeen, M.D. I Bennet Wong, M.D.;
Ruth McClendon, M.S. W.; and Joseph LoPiccolo, Ph.D. Savoy Ballroom
What Leads to Sustained Change in Couples Relationships Lonnie Barbach, Ph.D.; Les Kadis, M.D.;
Ellyn Bgder, Ph.D.; and David Scharff, M.D.
Terrace Ballroom
8:45 - 9:45A.M.
Conversation Hours
Vintage 1-3
Vintage 4-5
Sex on the Internet Sandra Leiblum, Ph.D.
A Conversation on Men Bernie Zilbergeld, Ph.D.
10:00 A.M. - 12:30 P.M.
Workshops
Sex After Fifty: Changes, Challenges and Rewards for Older Couples Sandra Leiblum, Ph.D.
Menopause: Hormones, Emotions and Sexuality Lonnie Barbach, Ph.D.
Low Sexual Desire and Sexual Aversion Joseph LoPiccolo, Ph.D.
2:00 - 5:00 P.M.
Workshops
Sex After Fifty (continued) Leiblum
Counter-bypassing: A Demystifying Approach to Sex and Intimacy Bernard Apfelbaum, Ph.D.
The Relationship Garden Jock McKeen, M.D. I Bennet Wong, M.D.
Educating Rita- and Ralph ... and Practicing It in Private Practice Peter Krohn, M.A., M.F.C.C.
5:00-5:15 P.M.
Vintage 1-3
Savoy Ballroom
Vintage 4-5
Closing Remarks
1
Vintage 1-3
Vintage 4-5
Terrace Ballroom
Savoy Ballroom
Terrace Ballroom
The Faculty
Bernard Apfelbaum, Ph.D. - Berkeley, California
Lonnie Barbach, Ph.D. - Mill Valley, California
Ellyn Bader, Ph.D. & Peter Pearson, Ph.D. - Menlo Park, California
Marty Klein, Ph.D. - Palo Alto, California
Peter Krohn, M.A., M.F.C.C. - Sebastopol, California
Sandra Leiblum, Ph.D. - Piscataway, New Jersey
Joseph LoPiccolo, Ph.D. - Columbia, Missouri
Ruth McClendon, M.S.W. & Les Kadis, M.D. -Aptos, California
David Scharff, M.D. - Chevy Chase, Maryland
David Schnarch, Ph.D. - Evergreen, Colorado
Bennet Wong, M.D. & Jock McKeen, M.D. - Gabriola Island, B.C., Canada
Jeffrey K. Zeig, Ph.D. - Phoenix, Arizona
Bernie Zilbergeld, Ph.D. - Oakland, California
2
ABOUT THE CONFERENCE
THE COUPLES THERAPY
CONFERENCE '97:
SEXUALITY AND INTIMACY
With the divorce rate for all marriages in the United States
at more than 60 percent, perpetual honeymoon bliss is
rarely the outcome for most couples. What does it really
take to create and sustain relationships that are both intimate and sexual?
Therapists are continually thrust into the tension of couples' colliding goals, values, interest and sexual desires. As
couples therapists, we listen daily to conflicting demands
and grapple with competing theories and interventions.
This unique conference focuses on two prominent aspects
of couples' lives, intimacy and sexuality. From conceptualization to intervention to termination, therapists have an
extensive array of choices. Theoretical constructs are at
times incompatible and mutually exclusive: Intervention is
not merely a matter of picking and choosing from a variety
of models.
At this seminar, you will see, hear and learn from leadingedge theorists and practitioners as they define, describe and
discuss differing approaches that initially promote closeness and those that move toward managing differences and
facilitating differentiation.
Registrants will have an opportunity to learn what the latest research shows. By the end of three days, you will have
advanced and refined your own thinking about how to
approach the challenge of facilitating intimacy and sexuality.
American Medical Association. Credits will be provided
on an hour-per-hour basis.
(3) The Milton H. Erickson Foundation, Inc., is approved
by the American Psychological Association to offer continuing education for psychologists. The Milton H. Erickson
Foundation maintains responsibility for the program. No
partial credit will be awarded for APA, but provided on an
hour-per-hour basis.
(4) The Milton H. Erickson Foundation, Inc., is approved
by The National Board for Certified Counselors (Provider
No. 5056). The N.B.C.C. approval is limited to the sponsoring organization and does not necessarily imply
endorsement or approval of individual offerings.
(5) State of Florida Department of Professional Regulation.
Continuing education credit is provided by The Milton H.
Erickson Foundation, Inc., for Clinical Social Workers,
Marriage and Family Therapists, and Mental Health
Counselors through the State of Florida Department of
Professional Regulation, Board of Clinical Social Work,
Marriage and Family Therapy, and Mental Health
Counseling (Provider No. CM-275-Exp.l/99).
(6) B.R.N. The Milton H. Erickson Foundation, Inc. is
approved by the Board of Registered Nursing in California
to offer continuing education for nurses (Provider No. CEP
9376). This program is eligible for a maximum of20.5 contact hours.
(7) This program meets the requirements of the AASECT
and is approved for 18.50 hours of Continuing Education
Credits (CEs). These CEs may be applied toward AASECT
certification and renewel of certification.
PROGRAM OBJECTIVES
CONTINUING EDUCATION
(1) In. working with couples, be able to directly address
issues of sex and intimacy.
(2) To compare and contrast clinical/theoretical perspectives and translate these into specific interventions.
Participants in CE activities will be made aware of any
affiliation or financial interest that may affect the speaker's
presentation(s). Each speaker has been requested to complete a conflict of interest statement. The names of faculty
members declaring a potential conflict of interest are indicated in the program syllabus.
ACCREDITATION
(1) C.P.A.A.A. The Milton H. Erickson Foundation, Inc., is
approved by the California Psychological Association
Accrediting Agency to offer mandatory continuing education for psychologists and maintains sole responsibility for
the program (MCEP Course No. MIL015-24).
(2) The Milton H. Erickson Foundation, Inc., is accredited
by The Accreditation Council for Continuing Medical
Education to sponsor continuing medical education for
physicians.
This program meets the criteria for credit hours in
Category One of the Physician's Recognition Award of the
CONTINUING EDUCATION VALIDATION
Validation of Continuing Education forms will be from
9:00 a.m.-6 p.m. Sunday, March 16, 1997. Registrants will
be given a Certificate of Attendance after turning in the
Continuing Education Application and Evaluation Forms.
CE Validation also can be done by mail by sending materials to The Milton H. Erickson Foundation, Inc., 3606 N.
24th St., Phoenix, AZ 85016-6500. Please do not fax
materials. MCEP and AASECT CE paperwork must be
recieved NO LATER THAN March 21,1997.
3
ELIGIBILITY
tific efforts. The Board of Directors of The Milton H.
Erickson Foundation are Jeffrey K. Zeig, Ph.D.; Roxanna
Klein, R.N.; M.S., J. Charles Theisen, M.A., M.B.A., J.D.;
and Elizabeth M. Erickson, B.A. Linda Carr McThrall is
Executive Director.
The Conferenc~ is open to professionals in health-related
fields including physicians, doctoral-level psychologists
and dentists who are qualified for membership in, or are
members of, their respective professional organizations
(e.g., A.M.A., A.P.A., A.D.A.). The Conference also is
open to professionals with mental health-related graduate
degrees (e.g., M.S.W., M.A., M.S., M.S.N.) from accredited institutions. Applications will be accepted from fulltime graduate students in accredited programs in the above
fields who supply a letter from their department certifying
their full-time student status as of March 1997.
IDENTIFICATION BADGES
At the Conference, each attendee will be issued a name
badge. Please wear your badge at all times. Only persons
wearing identification badges will be admitted to any of the
scheduled programs or activities. There is a fee of $5 for
replacing lost badges.
VOLUNTEERS
SIGNS
In exchange for a waiver of registration fees, a limited
number of spaces were set aside for volunteers. They will
monitor meeting rooms, assist with registration and continuing education, help faculty, etc. They also are available to
help registrants with questions; the volunteers can be identified by their red ribbons.
All signs and posters must be approved by the Milton H.
Erickson Foundation. Notices are not permitted on hotel
walls or doors and will be routinely removed.
BOOKSFORE
Brunner/Mazel Publishers, Inc., will sell books by faculty, as well as related titles throughout the conference. The
bookstore will be located in the Bayshore 2 room of the
hotel.
Bookstore hours:
Friday, March 14, 1997.......... 11 a.m. - 7 p.m.
Saturday, March 15, 1997...... 11 a.m.- 6 p.m.
Sunday, March 16, 1997........ 11 a.m.- 6 p.m.
SITE AND ACCOMMODATIONS
Meetings will be held in the San Francisco Airport
Hilton.
The Conference hotel and meeting rooms are accessible
to people with disabilities.
PHYSICAL CHALLENGES
INFORMATION AND MESSAGE CENTER
The Conference hotel is accessible to the physically challenged. Please let us know if you have special needs.
An Information and Message Center will be located near
the Erickson Foundation's Conference Registration area.
PARKING
TAKE-ONE TABLES
Parking is free at the hotel. Valet parking is $10 per day.
No tape recording will be permitted. Professionally
reproduced audiotapes will be available for purchase.
There are take-one tables located in the Ballroom Lobby.
Please visit the Foundation office about displaying your
literature on the tables. Unauthorized materials in unauthorized locations will be routinely removed.
SMOKING POLICY
SPONSORSHIP
Smoking will be permitted only in designated areas and
not in any of the meeting rooms.
Sponsored by The Milton H. Erickson Foundation, Inc.,
a federal nonprofit corporation, formed to promote and
advance the contributions made to the health sciences by
the late Milton H. Erickson, M.D. For more information on
Foundation activities, please contact The Milton H.
Erickson Foundation, Inc.; 3606 N. 24th Street; Phoenix,
AZ 85016-6500; tel (602) 956-6196; fax: (602) 956-0519;
e-mail: [email protected].
TAPE RECORDING
HOSPITALITY EVENT AND
AUTHORS' HOUR
There will be a no-host "Welcome to SFO" reception
Friday, March 14, 6:00-7:00 p.m. in Vintage 1-5. Some of
the faculty who have written or edited books will be available to autograph their works for registrants during the
hour. All attendees are invited.
FINANCIAL DISPOSITION
Profits from the meeting will be used by The Milton H.
Erickson Foundation to support its educational and scien4
Regional workshops are held regularly in various locations.
The Phoenix Intensive Training Programs, with Fundamental,
Intermediate, and Advanced (supervision) levels, are available to
qualified professionals and are held regularly. Regional workshops and the Intensives ·programs are announced in the
Foundation's newsletter.
The Foundation provides training/supervision for professionals.
The Foundation is equipped with an observation room and
audio/video recording capabilities. Inquiries regarding services
should be made directly to the Foundation.
THE MILTON H. ERICKSON FOUNDATION, INC.
The Milton H. Erickson Foundation, Inc., is a federal nonprofit
corporation, formed to promote and advance the contributions to
the health sciences made by the late Milton H. Erickson, M.D.
In addition to organizing Congresses and workshops, the
Erickson Foundation also organized the three landmark
Evolution of Psychotherapy Conferences in 1985, 1990, and 1995
attracting an average of 7,000 professionals from around the
world at each meeting. Other Foundation activities include publishing a newsletter, books and The Brief Therapy Annual. Also
available are ongoing training programs for professionals and
independent study at the Erickson Archives. The Foundation distributes educational audio- and videocassettes. Please contact us
for further information.
The Milton H. Erickson Foundation Board of Directors are
Jeffrey K. Zeig, Ph.D.; Roxanna Erickson Klein, R.N., M.S.; J.
Charles Theisen, M.A., M.B.A., J.D.; and Elizabeth M. Erickson,
B.A. Linda Carr McThrall is Executive Director.
The Milton H. Erickson Foundation does not discriminate on
the basis of race, color, national or ethnic origin, handicap or sex.
ERICKSON ARCHIVES
In December 1980, the Foundation began collecting audiotapes, videotapes, and historical material on Dr. Erickson for the
Erickson Archives. The goal is to have a central repository of historical material on Erickson. More than 300 hours of videotape
and audiotape have been donated to the Foundation. The
Erickson Archives are available to interested and qualified professionals who wish to come to Phoenix to independently study
the audiotapes and videotapes that are housed at the Foundation.
There is a nominal charge for use of the Archives. Please call or
write for further details and to make advance arrangements to use
the Archives.
TRAINING OPPORTUNITIES
The Erickson Foundation organizes International Congresses
on Ericksonian Approaches to Hypnosis and Psychotherapy.
These meetings have been held in Phoenix in 1980, 1983, 1986,
1992, in San Francisco in 1988, and in Los Angeles in 1994.ln
1993, the Foundation sponsored the Brief Therapy Conference in
Orlando, Florida. Another Brief Therapy Conference was held in
December, 1996 in San Francisco. Each was attended by approximately 2,000 professionals.
In the intervening years, the Foundation organizes national
seminars. The four-day seminars are limited to approximately
450 attendees, and they emphasize skill development in hypnotherapy. The 1981, 1982, and 1984 seminars were held in San
Francisco, Dallas, and Los Angeles, respectively. In 1989, the
Foundation celebrated its lOth Anniversary with a training seminar in Phoenix.
The Milton H. Erickson Foundation organized The Evolution
of Psychotherapy Conference in 1985, in Phoenix. It was hailed
as a landmark conference in the history of psychotherapy.
Faculty included Beck, the late Bruno Bettelheim, the late
Murray Bowen, Ellis, M. Goulding, the late Robert Goulding,
Haley, the late Ronald D. Laing, Lazarus, Madanes, Marmor,
Masterson, the late Rollo May, Minuchin, Moreno, E. Polster, M.
Polster, the late Carl Rogers, Rossi, the late Virginia Satir, Szasz,
Watzlawick, the late Carl Whitaker, the late Lewis Wolberg,
Wolpe, and Zeig. This conference was repeated in 1990 in
Anaheim, California, with a similar faculty including Bugental,
Glasser, Hillman, the late Helen Singer Kaplan, Lowen,
Meichenbaum, and Selvini Palazzoli. Keynote addresses were
given by Viktor Frankl and Betty Friedan.
The Erickson Foundation jointly sponsored the European
Evolution of Psychotherapy Conference July 27-31, 1994, in
Hamburg, Germany. This Conference offered a faculty similar to
previous Evolution meetings with the addition of Frankl,
Gendlin, Grawe, Kernberg, Meyer, Stierlin and Yalom.
The Dec. 13-17, 1995, Evolution Conference was held in Las
Vegas, Nevada, and featured the same faculty. Gloria Steinem
offered the keynote address.
AUDIO AND VIDEO TRAINING TAPES
The Milton H. Erickson Foundation has available for purchase
professionally recorded audiotapes from its meetings.
Professionally produced videocassettes of one-hour clinical
demonstrations by members of the faculty of the 1981, 1982,
1984, and 1989 Erickson Foundation Seminars and the 1983,
1986, 1988, 1992, and 1994 Erickson Congresses also can be
purchased from the Foundation. Audiotapes and videocassettes
from the 1985, 1990, and 1995 Evolution of Psychotherapy
Conferences, and the 1993 and 1996 Brief Therapy Conferences
also are available from the Foundation.
AUDIOTAPES OF MILTON H. ERICKSON, M.D.
The Erickson Foundation distributes tapes of lectures by Milton
Erickson from the 1950s and 1960s when his voice was strong.
Releases in our audiotape series are announced in the Newsletter.
TRAINING VIDEOTAPES FEATURING HYPNOTIC
INDUCTIONS CONDUCTED BY MILTON H.
ERICKSON, M.D.
The Process of Hypnotic Induction: A Training Videotape
Featuring Inductions Conducted by Milton H. Erickson in 1964.
Jeffrey K. Zeig. Ph.D., discusses the process of hypnotic induction and describes the microdynamics of techniques that
Erickson used in his 1964 inductions.
Symbolic Hypnotherapy. Jeffrey K. Zeig, Ph.D., presents information on using symbols in psychotherapy and hypnosis.
Segments of hypnotherapy conducted by Milton Erickson with
the same subject on two consecutive days in 1978 are shown.
Zeig discusses the microdynamics of Erickson's symbolic technique.
Videotapes are available in all formats, in American and foreign standards. For information on purchasing tapes, contact the
Erickson Foundation.
5
PUBLICATIONS OF THE MILTON H.
ERICKSON FOUNDATION
What is Psychotherapy?: Contemporary Perspectives
(J. Zeig & W.M. Munion, Eds.) contains the edited commentaries of 81 eminent clinicians.
The Annual of Brief Therapy: Creative Thinking and
Research in Brief Therapy: Solutions, Strategies, and
Narratives. Evolving from The Ericksonian Monographs,
the Foundation recently established the Annual of Brief
Therapy. Only the highest quality articles on brief therapy
theory, practice and research will be published in the Brief
Therapy Annual. Contributions are encouraged.
Manuscripts should be submitted to William Matthews, Jr.,
Ph.D., Editor-in-Chief, 22 Fox Glove Lane, Amherst, MA
01002. The Associate Editor is John Edgette, Psy.D. For
subscription information, contact Brunner/Mazel
Publishers.
The following books are published by and can be ordered
through Brunner/Mazel Publishers, Inc., 19 Union Square
West, New York, NY 10003:
A Teaching Seminar with Milton H. Erickson (J. Zeig, Ed.
& Commentary) is a transcript, with commentary, of a oneweek teaching seminar held for professionals by Dr.
Erickson in his home in August 1979. (Dutch, German,
Italian, Japanese, Portuguese, and Spanish translations
available.)
Ericksonian Approaches to Hypnosis and Psychotherapy
(J. Zeig, Ed.) contains the edited. proceedings of the First
International Erickson Congress. (Out of print.)
NEWSLETTER
Ericksonian Psychotherapy, Volume 1: Structures; Volume
II: Clinical Applications (J. Zeig, Ed.) contain the edited
proceedings of the Second International Erickson
Congress. (Out of print.)
The Milton H. Erickson Foundation publishes a newsletter for professionals three times per year to inform its readers of the activities of the Foundation. Articles and notices
that relate to Ericksonian approaches to hypnosis and psychotherapy are included and should be sent to Betty Alice
Erickson, M.S., L.P.C., Editor-in-Chief, 3516 Euclid,
Dallas, TX 75205. Business and subscription matters
should be directed to the Erickson Foundation at 3606
North 24th Street, Phoenix, AZ 85016-6500.
The Evolution of Psychotherapy (J. Zeig, Ed.) contains
the edited proceedings of the 1985 Evolution of
.Psychotherapy Conference. (German and Japanese translations available.)
Developing Ericksonian Therapy: State of the Art (J. Zeig
& S. Lankton, Eds.) contains the edited proceedings of the
Third International Erickson Congress.
ERICKSON INSTITUTES
There are 65 Milton H. Erickson Institutes/Societies in
the United States and abroad that have applied to the
Foundation for permission to use Erickson's name in the
title of their organization. Institutes provide clinical services and professional training. There are institutes in
major cities in North America, South America, Europe, and
Australia. For information, contact the Foundation.
Brief Therapy: Myths, Methods & Metaphors (J. Zeig &
S. Gilligan, Eds.) contains the edited proceedings of the
Fourth International Erickson Congress.
The Evolution of Psychotherapy: The Second Conference
(J. Zeig, Ed.) contains the edited proceedings of the 1990
Evolution of Psychotherapy Conference.
STAFF OF THE ERICKSON FOUNDATION
Sylvia Cowen
Bookkeeper
Ericksonian Methods: The Essence of the Story (J. Zeig,
Ed.) contains the edited proceedings of the Fifth
International Erickson Congress.
Diane Deniger
Volunteer Coordinator
Jeannine Elder
Faculty Coordinator
Theresa Germack
Administrative Assistant
The Evolution of Psychotherapy: The Third Conference
(J. Zeig, Ed.) contains the edited proceedings of the 1995
Evolution of Psychotherapy Conference.
Karen Haviley
Registrar
Alice McAvoy
Staff Assistant
Julia Varley
Audio-Videotape Sales
Susan Velasco
Lori Weiers
The following book is published by and can be ordered
through Jossey-Bass Inc., Publishers, 350 Sansome Street,
San Francisco, CA 94104:
6
ABSTRACTS AND EDUCATIONAL OBJECTIVES
7
THE COUPLES THERAPY CONFERENCE '97:
• SEXUALITY AND INTIMACY •
FRIDAY, MARCH 14,1997
8:30 - 8:45 AM
OPENING REMARKS
••••••
8:45 - 9:45 AM
KEYNOTE ADDRESS
PASSIONATE MARRIAGE™: THE PATH OF PERSONAL EVOLUTION AND EYES-OPEN SEXI
Sexual passion and intimacy have more importance in marriage than influencing satisfaction. They are tied to the natural
process of differentiation in emotionally committed relationships. Your sexual behavior is a picture of who you are, and
a path to who you want to be. How therapists understand sex will determine what sexual-marital therapy can be.
Educational Objectives: 1) To describe how childhood roots of intimacy can lead to adult problems with intimacy and
sexuality. 2) To describe how new relationships offer opportunities for repair and growth.
••••••
10:00 AM - 12:30 PM
WORKSHOPS
Workshop 1
FRIDAY AM
Savoy Ballroom
DISRUPTING SYMBIOSIS AND FACILITATING DIFFERENTIATION
Ellyn Bader, Ph.D. and Peter Pearson, Ph.D.
Most couples have symbiotic fantasies and expectations. Dr. Pearson will conduct a live interview, which will
demonstrate multiple ways of facilitating the journey into differentiation. Dr. Bader will provide commentary on the choice
of interventions and will teach principles for building effective differentiation.
Educational Objectives: 1) To name symbiotic structures in couples relationships, and how to disrupt them. 2) To
describe and demonstrate three principles that lead to sustained change in couples relationships.
Workshop 2
Terrace Ballroom
PASSIONATE MARRIAGEw: SEX, LOVE AND INTIMACY IN EMOTIONALLY COMMITTED RELATIONSHIPS
Passion and intimacy follow predictable but little-understood patterns. Couples and therapists who don't recognize them
unwittingly do things that encourage~ divorce. The natural ebb of sex, desire and intimacy can help people and
relationships grow- if they know how to use it. Discover how foreplay is a "language• and a negotiation, and how the
process of eyes-open sex can revitalize boring marriages. Learn the psychological "style" of having sex, and how
expanding couples' sexual repertoire can enhance differentiation and capacity for intimacy and passion. In the afternoon
portion there will be experiential activities involving case deconstruction, analysis and developing interventions.
Educational Objectives: 1) To describe how one of the following is linked to differentiation: sexual foreplay is a
"language" and a negotiation process; expanding sexual repertoire or depth of connection; experimenting with eyes-open
sex; regulating cycles of stability and growth. 2) Given a couple, develop a clinical intervention around a common sexual
issue in the relationship, and critique the intervention from the standpoint of its ability to enhance differentiation.
Workshop 3
Vintage 4-5
TEACHING THE HOW-TO OF SEX
Bernie Zilbergeld, Ph.D.
Sex is one of the few acts/experiences in life that you can't go somewhere to learn No therapy actually teaches how to
do sex. Even in sex therapy, details are few and demonstrations non-existent. For the last two years, in conjunction with
several colleagues, I have experimented with being more explicit in my suggestions to clients in regard to technique and
other issues such as, how to find time for sex, using words and touch to enhance sex, making sex more intimate and more
spiritual, sharing and acting out fantasies, using toys, etc. The results have been so encouraging in terms of sexual
satisfaction and intimacy that my colleagues and I now offer seminars for the public, teaching and demonstrating the
same methods and practices. In this workshop, I discuss the pros and cons of explicitly teaching the how-to of sex, what
should be taught, and how and what might be relevant qualifications for doing the teaching.
Educational Objectives: 1) To list three reasons for teaching clients and others exactly how to go about having healthy,
relationship-enhancing sex. 2) To identify three issues that should be covered in such a teaching program.
Workshop 4
Vintage 1-3
SHAME AND INTIMACY
Ruth McClendon, M.S. W. and Les Kadis, M.D.
Healthy couples are those who understand that their intimate and sexual relationships are the most valuable and most
vulnerable areas of their lives. Individuals in healthy couples know and respond to each other while maintaining
themselves and their self-worth. This workshop outlines both •barriers to intimacy• and •paths to intimacy•, and describes
a treatment approach for successfully establishing and maintaining individual and mutual positive regard.
Educational Objectives: 1) To describe barriers to intimacy. 2) To describe paths to intimacy.
••••••
2:00 - 5:00 PM
WORKSHOPS
Workshop 5
FRIDAY PM
Vintage 4-5
IS THERE SUCH A THING AS A SEXUAL PROBLEM?
Marty Klein, Ph.D.
Sexuality is NOT love or intimacy, although the three often over1ap. Therapists need to know the difference in order to
work most effectively with each. In examining clinical issues such as desire discrepancy, power struggles, eruptive anger
and late adult virginity; we will explore the difference between sexual problems and relationship problems, when to
refocus clients toward or away from sexuality, the role of sexual technique in sexual complaints and the sexual
assumptions therapists have that interfere with treatment.
Educational Objectives: 1) To name three common assumptions clinicians have about sex. 2) To name two criteria a
clinician would use to decide whether to focus on sex or relationship/intimacy issues.
Workshop 2 (Continued)
Terrace Ballroom
PASSIONATE MARRIAGE111: SEX, LOVE AND INTIMACY IN EMOTIONALLY COMMITTED RELATIONSHIPS
Passion and intimacy follow predictable but little-understood patterns. Couples and therapists who don't recognize them
unwittingly do things that encourage divorce. The natural ebb of sex, desire and intimacy can help people and
relationships grow - if they know how to use it. Discover how foreplay is a "language• and a negotiation, and how the
process of eyes-open sex can revitalize boring marriages. Learn the psychological "style• of having sex, and how
expanding couples' sexual repertoire can enhance differentiation and capacity for intimacy and passion. In the afternoon
portion there will be experiential activities involving case deconstruction, analysis and developing interventions.
Educational Objectives: 1) To describe how one of the following is linked to differentiation: sexual foreplay is a
"language• and a negotiation process; expanding sexual repertoire or depth of connection; experimenting with eyes-open
sex; regulating cycles of stability and growth. 2) Given a couple, develop a clinical intervention around a common sexual
issu~ in the relationship, and critique the intervention from the standpoint of its ability to enhance differentiation.
WorkshopS
Vintage 1-3
OBJECT RELATIONS TREATMENT OF PHYSICAL AND SEXUAL TRAUMA
David Scharff, M.D.
Using a video case of adult physical trauma in a couple, this workshop presents. theoretical and clinical approaches to
helping couples deal with the effects of trauma on their relationships and on their families. The example traces the roots
of the couple's difficulty and explores the effects of trauma on their children.
Educational Objectives: 1) To describe the object relations theory of trauma in adulthood and childhood. 2) Given a
case, describe treatment of victims of physical and sexual trauma .
••••••
DEMONSTRATION INTERVIEWS
Educational Objective: To view styles of couple therapy and to be able to apply techniques in given clinical situations.
2:00-3:16 PM
Demonstration Interview #1
Savoy Ballroom
3:30 - 6:00 PM
Demonstration #2
Ruth McClendon, M.S.W./ Les Kadis, M.D.
Savoy Ballroom
••••••
·6:00 - 7:00 PM
HOSPITALITY EVENT &
AUTHORS' HOUR
••••••
Vintage 1-5
THE COUPLES THERAPY CONFERENCE '97:
SATURDAY, MARCH 15,1997
8:00 - 10:30 AM
SATURDAY AM
WORKSHOPS
Workshop 7
Savoy Ballroom
THE PERSONAL GROWTH AND DEVELOPMENT OF THE COUPLES THERAPIST: DEVELOPING
PERSONAL POWER
How does one master couples therapy? Should training emphasize theory, technique or research? What about the
personal growth of the clinician? In this workshop, we will identify essential characteristics or •postures• that distinguish
Milton H. Erickson and other master practitioners of brief therapy. We will realize those postures through a series of
graduated, experiential exercises Attendees will participate in growth games and group hypnosis to explore the merging
of discipline and spontaneity that occurs in the most artful and effective clinical work. This program will develop the
clinicians muscles (therapeutic power).
Educational Objectives: 1) Given a couple, devise an experimental exercise to address a clinical issue. 2) To provide
three reasons for using experiential methods.
Workshop 8
Vintage 4-5
POST-MODERN SEX THERAPY
Couples now seen for sex therapy often do not respond to the techniques that emphasize only behavior prescriptions and
education. This workshop integrates sex therapy with a systemic analysis of the sexual dysfunction, ~nd presents a more
broadly directed treatment intervention model.
Educational Objectives: 1) To describe the interaction of dynamic, behavioral and systemic factors in the etiology of
sexual dysfunction. 2) To describe the method for dealing with •resistance• to directive sex therapy.
Workshop 9
Vintage 1-3
OBJECT RELATIONS COUPLE THERAPY
David Scharff, M.D.
Object Relations Couple Therapy focuses on each partner's need for a relationship in which to find personal and shared
fulfillment. This workshop introduces the major ideas of object relations (individual psychological organization, projective
identification, the holding relationship, transference/countertransference) through lecture, video example, audience
discussion and consultation to participant cases.
Educational Objectives: 1) To describe the theoretical and clinical basis of Object Relations Couples Therapy. 2) To
describe the use of transference and countertransference in couple therapy.
Workshop 10
IS IT SYMBIOSIS OR IS IT INTIMACY?
Ellyn Bader, Ph.D.
Individuals with borderline and narcissistic issues frequently demand that their partner provide intimacy. However, they
cannot create the conditions for intimacy to occur or be sustained. Through video and clinical transcripts, I will
demonstrate how to help these individuals develop self capacities to sustain intimate moments while decreasing fruitless
demands.
Educational Objectives: 1) To describe the difference between symbiosis and intimacy. 2) Given a couple, demonstrate
two roles which enable partners to confront and re-own their own projections. 3) To describe how to move couples along
the continuum from symbiosis to greater intimacy.
1 0:45 - 11 :45AM
KEYNOTE ADDRESS
REGAINING INTIMACY: SEXUAL DOUBTS, INTIMATE DESIRES
David Scharff, M.D.
This keynote explores the childhood roots of intimacy which lead to adult deficits in intimacy and sexuality which the
couple hopes to correct, and the way new relationships offer opportunities for repair and growth.
Educational Objectives: 1) To describe how childhood roots of intimacy can lead to adult problems with intimacy and
sexuality. 2) To describe how new relationships offer opportunities for repair and growth .
••••••
1 :00 - 4:00 PM
WORKSHOPS
Workshop 11
SATURDAY PM
Savoy Ballroom
LOVE, SEX AND INFERTILITY: THE IMPACT OF INFERTILITY ON THE COUPLE
Infertility can create considerable stress on couple relationships. Common issues during infertility diagnosis and
treatment include problems of coercion, communication, allocation of finances and empathic failure. AddHionally, marital
and sexual tensions may escalate during the months (years) of infertility intervention and subsequent to leaving infertility
treatment. This workshop will identify how infertiiHy affects •love•, •sex• and •relationships• during infertility treatment as
well as how •sex• can affect infertility.
Educational Objectives: 1) To list six ways in which infertility can stress couple relationships. 2) To list four basic
considerations when working with infertile couples.
Vintage 4-6
POST-MODERN SEX THERAPY
Couples now seen for sex therapy often do not respond to the techniques that emphasize only behavior prescriptions and
education. This workshop integrates sex therapy with a systemic analysis of the sexual dysfunction, and presents a more
broadly directed treatment intervention model.
Educational Objectives: 1) To describe the interaction of dynamic, behavioral and systemic factors in the etiology of
sexual dysfunction. 2) To describe the method for dealing wHh •resistance• to directive sex therapy.
Vintage 1-3
OBJECT RELATIONS COUPLE THERAPY
David Scharff, M.D.
Object Relations Couple Therapy focuses on each partner's need for a relationship in which to find personal and shared
fulfillment. This workshop introduces the major ideas of object relations (Individual psychological organization, projective
identification, the holding relationship, transference/countertransference) through lecture, video example, audience
discussion and consultation to participant cases.
Educational Objectives: 1) To describe the theoretical and clinical basis of Object Relations Couples Therapy. 2) To
describe the use of transference and countertransference in couple therapy.
Terrace Ballroom
Workshop 12
THE NATURE OF SEX AND SPIRIT
Sexual desire is a source of guilt, fear and condemnation for many people. It also can be a pathway to humanity and
spirituality for couples, and for therapists who work with them. By integrating sex, spirituality and differentiation on
theoretical and practical levels, this workshop offers a clinical framework, and case examples of facilitating
personaVspiritual growth through common sexual crucibles of marriage. This approach demands not only personal and
professional maturity and courage, but a fundamental redefinition of the meaning of relationships, and the purpose of
therapy.
Educational Objectives: 1) To state the difference between type •A• and the •B• religions in regard to sexuality. 2) To
describe how or why resolving common sexual issues in marriage can enhance spirituality and differentiation in mutually
facilitative ways.
••••••
4:16- 6:16PM
PANELS
Educational Objective: To compare and contrast clinical and philosophical perspectives of experts.
Terrace Ballroom
Panel1
COUPLES WORKING WITH COUPLES
Jock McKeen, M.D./Bennet Wong, M.D., Ellyn Bader, Ph.D./Peter Pearson, Ph.D. and
Ruth McClendon, M.S.W./ Les Kadis, M.D.
Savoy Ballroom
Panel2
WHAT TO DO WHEN ONE PARTNER HAS NO SEXUAL INTEREST IN THE OTHER
Joseph LoPiccolo, Ph.D., David Scharff, M.D., David Schnarch, Ph.D., Bernie Zilbergeld, Ph.D.
••••••
THE COUPLES THERAPY CONFERENCE 197:
SUNDAY, MARCH 16, 1997
8:45 • 9:45 AM
PANELS
Educational Objective: To compare and contrast clinical and philosophical perspectives of experts.
Savoy Ballroom
Panel3
HOSTILITY AND ANGER IN COUPLES RELATIONSHIPS •••A CONVERSATION
Bernard Apfelbaum, Ph.D., Jock McKeen, M.D./Bennet Wong, M.D., Ruth McClendon, M.S.W. and
Terrace Ballroom
Panel4
WHAT LEADS TO SUSTAINED CHANGE IN COUPLES RELATIONSHIPS
Ellyn Bader, Ph.D .• Lonnie Barbach, Ph.D., Les Kadis, M.D., David Scharff, M.D.
••••••
8:45 - 9:45 AM
qONVERSATION HOURS
Educational Objective: To learn philosophies of various practitioners and theorists.
Conversation Hour 1
Vintage 1-3
SEX ON THE INTERNET Sandra Leiblum, Ph.D.
Conversation Hour 2
Vintage 4-5
A CONVERSATION ON MEN Bernie Zilbergeld, Ph.D.
••••••
10:00 AM • 12:30 PM
WORKSHOPS
Workshop 13
SUNDAY AM
Vintage 1-3
SEX AFTER FIFTY: CHANGES, CHALLENGES AND REWARDS FOR OLDER COUPLES
Sandra Leiblum. Ph.D.
Despite the tendency to view older adults as asexual, many middle-aged (& older) individuals remain interested in
maintaining an active, romantic and fulfilling sexual life. Nevertheless. there are a number of fActors which impinge on
both the quantity and quality of sexual life as couples age. This workshop will focus on the changes, challenges and
therapeutic issues characteristic of sex/relationship therapy with folks over 50.
Educational Objectives: 1) To describe changes in sexual response and sexual exchange in single and coupled mature
adults, as a function of biological, intrapsychic and interpersonal factors. 2) To list factors affecting menopausal and
post-menopausal sexual desire and sexual response. 3) To describe hormonal and psychotherapeutic intervention
possibilities.
Workshop 14
Savoy Ballroom
MENOPAUSE: HORMONES, EMOTIONS AND SEXUALITY
The transition to menopause can have a major impact on a couple's relationship. Armed with the newest research, Dr.
Barbach will describe how changing hormones can cause irritability, depression, anxiety, other emotional symptoms and
sexual problems in mid-life women. A range of solutions for these symptoms will be outlined.
Educational Objectives: 1) To describe three common symptoms of changing hormones. 2) To list three approaches for
treating sexual problems that occur as the result of changing hormones.
Workshop 15
LOW SEXUAL DESIRE AND SEXUAL AVERSION
Disorders of desire and sexual aversion are now the most commonly seen problems in sex therapy. This workshop will
present a model for evaluation and treatment of these problems.
Educational Objectives: 1) To describe the causes and symptomatic manifestations of low desire and aversion. 2) To
describe the treatment of these disorders.
• •••••
2:00 - 5:00 PM
WORKSHOPS
Workshop 13 (continued)
SUNDAY PM
Vintage 1-3
SEX AFTER FIFTY: CHANGES, CHALLENGES AND REWARDS FOR OLDER COUPLES
Despite the tendency to view older adults as asexual, many middle-aged (& older) individuals remain interested in
maintaining an active, romantic and fulfilling sexual life. Nevertheless, there are a number of factors which impinge on
both the quantity and quality of sexual life as couples age. This workshop will focus on the changes, challenges and
therapeutic issues characteristic of sex/relationship therapy with folks over 50.
Educational Objectives: 1) To describe changes in sexual response and sexual exchange in single and coupled mature
adults, as a function of biological, intrapsychic and Interpersonal factors. 2) To list factors affecting menopausal and
post-menopausal sexual desire and sexual response. 3) To describe hormonal and psychotherapeutic intervention
possibilities.
Workshop 16
Vintage 4-5
COUNTER-BYPASSING: A DEMYSTIFYING APPROACH TO SEX AND INTIMACY
Bernard Apfelbaum, Ph.D.
The Counter-bypassing strategy reveals how much everyone depends on creating the illusion of intimacy in sex through
narrowing awareness to sensation and fantasy, bypassing conflict and unresolved issues. Even the limited introduction
of intimacy through the expression and acceptance/validation of tensions and insecurities in sex makes possible the brief
treatment of desire problems.
Educational Objectives: 1) To name the precipitating stress that potentate~ the secondary causes of sex problems (often
misidentified as primary). 2) To describe how to treat desire disorders through facilitating and validating the expression
of seemingly counter sexual experiences in sex.
Wortshop 17
Terrace Ballroom
THE RELATIONSHIP GARDEN
Jock McKeen, M.D. and Bennet Wong, M.D.
Based upon power and control for security and comfort, most relationships become prison-like. In the vulnerability of
•The Relationship Garden, • individual resources are shared to facilitate the individuation of both parties. This engaging
presentation will feature live demonstrations, music and poetry- addressing romance, sexuality, commitment, jealousy,
intimacy and love .. in a frank exchange of ideas and experience.
Educational Objectives: 1) To describe issues of sexuality and intimacy in ongoing relationships. 2) To describe the
stages of a deepening intimacy. 3) To name ways to overcome obstacles to intimacy.
Wortshop 18
Savoy Ballroom
EDUCATING RITA- AND RALPH ••• AND PRACTICING IT IN PRIVATE PRACTICE
Peter Krohn, M.A., MFCC
The capacity to manage oneself effectively under Interpersonal stress is vital to the heaHh of Individuals in a relationship.
This process can be fostered by psycho-education in private practice. This workshop explores specific methods and
opportunities of developing self-capacities such as self-soothing and cognitive inner guidance during intense couple
interactions.
Educational Objectives: 1) To list five areas of self-capacity development that can enhance intimacy in a relationship. 2)
Given a hostile , dependent couple, name the primary areas of self-capacity development that need to be addressed
initially. 3) Given a conflict-avoidant couple, Indicate the primary areas that would apply.
••••••
6:00-6:16 PM
CLOSING REMARKS
••••••
Terrace Ballroom
Couples Therapy conference, March 1997
Workshop: Counterbyassing; A Demystifying Approach to Sex and Intimacy.
Presenter: B. Apfelbaum PhD
1) Audiotape excerpts from couple sex therapy session following home
assignment using counterbypassing script lines.
2) First stroking assignment.
3) Script Lines Checklist.
Excerpts from a couple sex therapy tape.
[10 minutes.]
These are four excerpts from one 60 minute session. It was the second session
with a couple whose presenting problem was an unconsummated marriage of six
years. They report on their experiences with the first assignment, which
was to be done three times. They were given written instructions and were
told to bring their notes for each of the three times, to be read aloud in
the next visit. They also were given the counterbypassing Script Lines
Checklist, which as you will see, played a significant role in this case.
I. This first excerpt begins with his reading his notes for the second time
they did it (she has just finished reading her notes for that time).
M: ... uh, my notes which are not in four parts [that is, not separated into
active and passive fronts and backs, as in the instructions] say:
Went into the episode with great trepidation, bitched about having
to do it, got Jeanne upset, but then by and large really enjoyed
stroking her and being stroked by her. I feel that she did the
better and less mechanical job on me than I did on her. Nevertheless,
after my initial bitching we approached it with more of a sense of
fun. In all cases, whether I was stroking or being stroked, I called
for an end to it. I tried to get, uh ... I tend to get impatient even
with pleasure. Jeanne I think could do this endlessly.
T: Well, you didn't actually report the impatience except just mentioning
it at the end. How did you experience that?
M: Uh, well, I experience anything when I can't smoke for let's say an hour
or, anything that seems to be a sort of mechanistic kind of assignment, I
respond to that with a certain degree of impatience.
T: It was the mechanistic aspect of the assignment rather than just the task
itself ...
M: Right, and getting into it. Once I get into it I don't mind it.
same time, as Jeanne was saying, I called time all the time.
T: ... and then you said that's because you felt impatient.
you were into it ...
M:
Urn, yeah, I didn't want it to go on for --
F:
Endlessly.
17
At the
So even though
Counterbypassing, p. 2
M:
No, I mean, ten, fifteen minutes was enough.
T:
Mm-hm.
M:
And, uh ...
T:
I see.
So it wasn't that impatient.
M: No, I mean it wasn't ... you know ... it didn't ... ! wasn't ... uh ... totally
displeased with it or anything like that. It was an impatience ... .
T:
No, that wasn't the word you ... were saying ...
M: Maybe impatience isn't quite the right word there, but at least it's
keeping track of time up to the point where I know that ten or fifteen minutes
has passed, and that's enough as far as I'm concerned.
She :
How much ...
T:
Well, why don't you finish what you have ... first ...
M:
No, that's it.
T:
Oh.
M:
Yeah.
T:
Yeah, why don't you do that?
That's all I have.
Was that the fronts, or the backs?
It's everything?
Maybe I oughta go through my little check marks and see what I have.
M: Let's see for #1: "I don't know why we're doing this" ... uh ... "I wish I
felt more like stroking you."
T:
Mm.
M: "This is a chore for me," "I'm afraid you're going to feel rejected if I
don't enjoy this more," "I want something but I don't know what it is," "I
think I'm mostly doing this because I'm supposed to," "I feel like there's
something else I want to say but it's not in any of the scripts," "I'm afraid
you're going to be disappointed," "I wish we could play hookey from this,"
"I feel obliged to do as much for you as you've done for me," "I feel like
we both have to succeed at this," "I'm feeling lazy but like I'm not allowed
to," "I'd like to take a break," "I wish this wasn't so important," "I feel
like there's something more you want but · I don't know what it is."
T: Well, now, that's interesting. It's there in what you checked off but it
wasn't in your notes. Maybe you were ... Well, how do you account for that?
Rather than speculate here, why don't we ask you?
M:
I don't know.
I don't know that I do account for it.
T:
Well, it sounds like you're in touch with ... maybe it's more you just
weren't thinking that's something to write down. You see, I don't know how
much it's that and how much you are actually insulated from ... and then maybe
the lines reminded you but you're sort of keeping some distance ... you not
wanting ...
M: Well, I'm not sure that ... well, I think I know what you're getting at.
In a way I think you're right. I don't think it is something that I
particularly would write down, myself -- .
II. She then reads her notes for the third time they did the assignment,
and the therapist then turns to him:
T:
So what did you have down for that?
M:
Let's see, it says:
As usual I postponed doing this but enjoyed it and felt relaxed once
we began. I still think that Jeanne enjoys this more than I do but
I think I'm getting better. Throughout the entire time I felt that
we were close emotionally and psychologically. As before, I ended
each stroking session --
I ended each stroking session, meaning I was the one who called time
but I do not expect that to change. I think that both of us are
becoming progressively more aware of each other's bodies as we continue
to do this.
And as far as the things I checked off, it was: "I don't know why we're doing
this," "I'm afraid you're going to feel rejected if I don't enjoy this more,"
"I feel like there's something else I want to say but it's not in this,"
"I'm afraid I'm not going to do a good enough job," "I wish I could play
hookey from it," "I feel like we both have to succeed," "I'm feeling lazy
but like I'm not allowed to," "Wish this wasn't so important," and "I feel
like there's something you want but I don't know what it is."
T: Again there's a sharp discrepancy between what you write and what you check
off, but it isn't influencing what you write.
III.
T: Maybe one way of capturing what I'm thinking is that this reluctance you
felt again-- there's no clue to that in your notes. It's only in what you
checked off. In other words, your notes don't reveal anything about ...
When you read your notes I was going to say, "Well, I don't understand where
the reluctance comes from." Then when you checked the lines, I could sort
of get more of a feeling for it. So there's something left out of your
notes --
F:
It seemed like his opening statement --
M:
It was just that as usual I wanted to postpone doing this.
T: Yes, that's in there. But what I'm saying is that I was going to have
to ask him, well why, because from what you describe about the experience
there's nothing in there would-Then when you checked the lines I could
see, but if the lines hadn't been available there wouldn't be any clue.
Now, why is that? Why wouldn't there be more of a clue in your notes about
that? Is that some way you tend not to think about -- You do tend not to
think about negative stuff?
M: Uh, I probably don't tend not to think about it, I probably tend not to
express it.
Now, why is that?
T:
Not to express it.
M:
I don't know
T:
Style?
M:
Well, if I tend to be negative I tend to be --
T:
Real negative?
It's your style?
M: Really negative. So that if I'm only mildly negative it doesn't seem like
something worth expressing.
T: That might be an important aspect of things, though, because I could see
how, if that's the case, you might be more likely, let's say, about your
sexuality, that -- you know, there might be things that you're critical of
or don't like or dissatisfactions you have about Jeanne, but your tendency
might be just to withdraw and keep things okay rather than to get into them.
M:
Well, I think that's true.
T: That's helpful. So that if our job, the three of us here, is to see
what we can do to ... bridge the gap here, between you, then what we bump into
I think would be dissatisfactions, because that's what's causing you to back
off, rather than you would just start feeling wonderful, or whatever. So I
wouldn't look for that, in other words, in terms of this hypothesis, or this
model we're just conjuring up here at the moment.
In other words, it's like saying that the distance is a way of keeping it
positive. To get closer would mean having to actually deal with some negative
feelings which you'd rather not have to deal with, or constitutionally don't
unless they get real strong.
I'm more inclined to think that I don't want to see whatever is there if
I did look at it more closely.
M:
T: Well, how would you say that? Like because ... not that you know explicitly,
but what would be the best way of saying why that is?
M: I'm afraid that if I look at it more closely there might not be anything
there.
T: Okay. Well, that's kind of what I mean about the feeling of futility or
hopelessness or something. I mean, one way that seems obvious. You know,
once you say it, sure, that's how you feel. But to get to it or get it said
gives us a more secure feeling of --because, see, that, that's like the
first level of the problem, as I was saying a minute ago. It's backing off
for fear that you're going to be turned off. To treat it just as if you're
turned off, good or bad, whatever that means, would be a mistake. Because
right now you're not there yet. You're backed off even from that.
IV.
T: Where one is more easily able to get lost in sensation and the other one
still needs contact but then the contact's broken, that's kind of a problem.
So whatever else is true, that may be a factor.
I don't say it's the whole thing, but it looks like maybe a factor that you
would not have been able to notice because you're totally ... At least that's
what I get out of what we've done so far. Something to think about. The
effect would be, I guess, for you always to feel und~r some kind of pressure
even though I don't know if you feel it because you will withdraw before the
pressure ...
M:
No, no no, in fact I'm not, that is true.
T:
Oh, it is true.
M:
Yeah, I do feel I'm under a certain degree of pressure.
T:
Mm.
M:
And then I withdraw.
T:
I see.
M: Or sometimes I withdraw in advance so I don't feel under so much pressure,
you know.
T:
I see.
M:
Both ways.
For published applications of this approach, see especially:
An ego-analytic perspective on desire disorders. In Sexual Desire Disorders, Leiblum &
Rosen (Eds). Guilford, 1988 (75-104).
Masters and Johnson revisited: A case of desire disparity. In Case Studies in Sex
Therapy, Rosen & Leiblum (Eds). Guilford, 1995 (23-45).
BSTG Stroking Assignment
The purpose of this assignment is to set up a simple standardized situation
to collect impressions about what goes on between you when you are touching
one another: what you experience and what you imagine that your partner
experiences. We are interested in the discomforts that arise, because tensions
and insecurities are easier to relieve when they can be brought out in the
assignment and the~ discussed in the office.
Read over these instructions at least once before you do the assignment, and
also have this sheet at hand to refer to when doing it.
The idea is to do a structured stroking assignment, meaning that you will be
taking clear turns and will be following a methodical procedure. One partner
gets stroked for half the time and the other for the other half. There will
be enough time to see what it is like to touch and to be touched, to collect
clear impressions of what each experience is like with your partner.
You will be doing a light fingertip stroke all over your partner's body.
Ideally, the one being stroked will say what feels good and where it feels
good, and how the touch could be improved, but don't expect to ·be able to do
this right away.
This assignment is
least enough light
be done unless the
sensations. Don't
the idea is to get
done without clothes, using a bed. There should be at
to see what you are doing, and the assignment should not
room is comfortably warm, since any chill blocks other
try to create a special mood with wine or music, since
a kind of baseline impression.
To make your strokes glide smoothly, rub a small amount of baby powder between
the hands (be careful to avoid breathing it) and renew it periodically.
Cornstarch can be used as a substitute.
Stroking movements should blend into one another in a slow continuous motion
without losing contact with your partner's body. The idea is to do a teasing touch, especially in sensitive areas: · lips, ears, anus, breasts,
genitals. These should be included without special attention, although patterns of goose bumps should be attended to further since, if the room is not
cold, this is a sign of successful stroking. If you hit areas of ticklishness use a heavier touch and then progress to a lighter one.
First you do both backs, then both fronts. Each turn should last 10-15
minutes. It is important to keep things simple and, as much as possible, to
not to vary the assignment in any way. All other sexual activity should be
avoided on the day the assignment is done.
SCRIPT LINES CHECKLIST
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
I feel uncomfortable.
I think your stroking feels mechanical.
I feel I'm supposed to like everything you are doing.
I'm worried about what you're thinking.
That doesn't feel good but I don't know what would.
It feels like you're being too careful.
It feels like you're trying too hard.
I resent that you're not enjoying this more.
I don't know why we're doing this.
I wish it was OK to ignore you.
I feel hopeless about ever turning you on.
Right now my mind is a blank.
I wish I felt more like stroking you.
I wish I could enjoy your stroking.
This is a chore for me.
I'm not feeling anything.
I don't feel like talking.
I feel a million miles away.
This seems difficult and complicated.
I feel turned off.
I'm afraid you're going to feel rejected if I don't enjoy this more.
I feel like you need me to be more involved.
I want something, but I don't know what it is.
I don't think I'm going to like anything we're doing today.
I think I'm mostly doing this because I'm supposed to.
I'm beginning to feel impatient.
You seem preoccupied (or far away).
I feel like there's something else I want to say, but it's not here.
I'm afraid I'm not going to do a good enough job.
I'm afraid you're going to be disappointed.
I keep getting distracted.
I wish we could play hookey from this.
My mind keeps going off into fantasies.
I feel obliged to do as much for you as you've done for me.
I'm afraid you're getting bored.
I'm afraid you won't tell me if you don't like something.
I feel like we both have to succeed at this.
I'm feeling lazy, but like I'm not allowed to.
I'm feeling that there's too much I don't like.
I'm afraid of discouraging you.
I'm feeling too finicky.
I'd feel like a pest if I said everything I wanted.
I'd like to take a break.
I'm afraid you'd get mad if I stopped doing this.
I wish this wasn't so important.
I feel like there's something you want, but I don't know what it is.
I feel like I should appreciate what you are doing more.
It feels like something just went wrong, but I don't know what it is.
I can't seem to concentrate on what I'm doing.
I hate these script lines.
BSTG
[stroking assignment, continued]
BACKS:
partner
an arm,
down on
The passive partner lies face down on the bed. Preferably the active
sits on the edge, but some people will need back support, leaning on
pillow, or against a wall or headboard. If possible, avoid lying
your side and try to use both hands.
Begin with the back above the waist, using a light fingertip stroke. Spend
a few minutes covering this area, lightly dragging your fingers in long
sweeping motions or in slow circular ones. Then move up to the neck and
shoulder area, and along the sides of the arms. At the buttocks add a kneading
motion, spreading and moving the muscles. Then go down the backs of the
legs and back up the outside and down the inside of the legs. Feet can be
done with the flat of the hand or gently kneaded.
FRONTS: The partner whose back was done first now lies facing upward with
eyes generally closed. The active one then does the chest and stomach area,
then neck, head and face, arms, and down over the pubic area and the hips to
the legs.
NOTES: Since the purpose of this assignment is to collect impressions and
experiences, try to notice what you are thinking and feeling and what, if
anything, is said. Write down as much of this as you can.
NOTES ARE ESSENTIAL, even though you may think you will remember what went
on. Make a point of having pads or paper available for this. Write your
notes as soon as possible after the assignment is done, and include as much
detail as you can.
WHAT YOUR NOTES SHOULD COVER: Label the four parts: active and passive
backs; active and passive fronts. Your reports should cover both what you
felt, both physically and emotionally, and what thoughts you were having, in
each of the four parts, as well as your impressions of what was going on in
your partner. Be sure to include the date, as well as who initiated the
assignment and how you felt about doing it.
Feel free to talk over your experiences doing the assignment, but we recommend that you do not read each other's notes, since that may inhibit you in
writing them.
74't74V'.A..'V'4'\"7'.4.tr.4.\74\'7.4.\"'7A'\'7A.'77'.4.\74'\"'i.4."VA..tr.A.\7'4't74V'.A.\"7'.4.\'7.4.\"7'.4.~/·\"7·!'7·\'i'·\1
The Development Of Self:
Crucial To Greater
Intimacy And Satisfaction
In Relationships
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445 Burgess Drive, Menlo Park, CA 94025
Telephone (415) 327·5915. Fax (415) 327-Q738
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Overview of Symbiosis
In our culture we combine expectations for sex, love, idealization,
and intimacy all into one person. Individuals then look to their
primary relationship to meet all, or nearly all of their emotional,
sexual and intimate needs. They feel angry when this is not forthcoming
and then attempt to change their partner's behavior or bounce into an affair
with the hope of finding it with someone else. As a result in our culture,
we end up with relationship problems in epidemic proportion.
By the time couples show up in our office they are usually painfully
disillusioned. These expectations have not been met. Most of these individuals
started their relationships with spoken and unspoken fantasies of union,
closeness and desire to make up for past hurts.
These couples then structure their relationships symbiotically.
When this doesn't work they become distressed.
They want you, as the therapist to:
• Become the fairy Godmother/father; Change the partner;
• Improve the symbiotic functioning of the relationship.
They don't want you, as the therapist to:
+ Confront the underlying s~biotic expectation;
+ Address the symbtotic behavior.
e£A'yn Bader Ph.D., & ,._, PNr.on Ph.D., ~ ~ Dmw, Menlo Parle, CA H025. Tel (4151
327-515
••• Overview of Symbiosis continued•••
Symbiosis Defined: It is an attempted solution for existential anxiety
about being alone and an attempted way to maintain attachment.
It occurs when there is excessive emotional dependency on partner.
This results from: Individual's limited capacity to:
• Be alone and maintain their own self-esteem;
• Calm or comfort themselves during disagreement;
• Encourage themselves in self-directed activities;
• Do their own thinking.
This results in: Emotional reactivity to the partner.
Symbiotic Behavior: Is the individual's attempted solution to:
• Maintain attachment;
• Be taken care of;
• Manage separation anxiety;
• Handle the anxiety of standing alone by avoiding
defining self/disagreeing/voicing differences.
Ci:lyn 8adw Ph.D., &
,..,,...,_Ph.D~
44$
s...,... Drive. Menlo l'arlc, CA 0«125. Tal (..151 327...15
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Evolution of Differentiation
1. Internal self reflecting and identifying own thoughts,
feelings, values, wants and desires.
2. Developing the increasing ability to express congruently
one's own thoughts, feelings, wants and desires To expose," who I am".
3. Developing awareness of the partner as
separate and different
4. Developing an increasing ability to listen, hear and
then respond effectively to these differences with clear boundaries.
5. Developing the ability to create an environment
in the relationship that supports desired changes.
CUyrt 8«»r Ptr.D. & ,.._,...,_, Ptr.D., 445 Bwven OtM, AIMio ,._rl!, CA H025. Tel (4151 J27-M15
The Borderline Continuum In Couples Therapy
Overview: Early secure attachment has failed- they look to relationship to meet
this need but do it indirectly and as a result run into each others defenses.
Characteristics:
Do not have libidinal object constancy
Self is not coherent
Separation Anxiety - Often high
- have problems being alone
Use splitting - black/white thinking
Can't manage ambiguity - can't love and hate
same person
Often will dominate the relationship with
regression or helplessness
Are self critical
Are other-directed
Have boundacy confusion
Undermine own autonomy
Are emotionally unpredictable
Relationship Features:
Attachment is maintained at expense of
self-development
Couples Thernpy Issues:
Couples therapy can be vecy powerful when it
actively addresses the issues described above:
Use affect, helplessness, and regression to try and
maintain control in the couples relationship
Borderline must know you are on their side
Expect the "WE" to dominate
Get permission to give feedback
Will have excessive dependency on partner
Early on change fear of abandonment to:
~~You feel alone and scared and aren't sure
you'll cope... "
Are dependent on validation from other to maintain
equilibrium
Be explicit about partner's contribution
Dread loss of other and may perceive it even when it
isn't happening
Define boundaries
Don't believe that their own differentiation will lead
to positive responses from the partner.
Strengthen boundaries - Hold other as a separate
self -and maintain own boundaries when other is
distressed
Efforts at building self/asserting self are met with
internal criticism - this serves to maintain symbiotic
structure of relationship and to inhibit the
differentiation that would lead to healthy movement
for both the individual and the couple.
Be self activating in the room - Be able to
express self fully to partner while managing own
~etyaboutabandonmentorengulfment
What to Confront:
Balance always between confrontation &support
confrontation of the regression and helplessness
Support for self-differentiation and for staying
effectively separate from the partner
Teach partner how to confront using adult ego
state
Summary of Borderline: "If I am me, (grown-up and self-activated),
I'll be abandoned... ! want to be loved so badly that I'll give up me to be loved by you...
then I'll be angry that you won~ meet my dependency needs."
The Narcissistic Continuum In Couples
Overview: The narcissist expects to be adored and seen as perfect without having to give much
in return. They do not want to be challenged and instead desire to be admired Often want to
be loved unconditionally (feel entitled) or to be the one and only.
Characteristics:
Relationship Features:
Couples Therapy Issues:
Preoccupied with status, prestige, power,
adequacy, money thrive on power, in context
of fragile self-esteem
Wants to be adored without doing much
Couples therapy can be very powerful when they
have the motivation to maintain the relationship.
Self and self-esteem are looked for in the
other
Need constant attention & mirroring and
perfect stroking - use others to prop up self
and become outraged when not understood
Feels entitled to unconditional love "I deserve
it"
Being irresponsible is justified by
rationalizations, indifference and a sense of
special status for self
Lack empathy - unable to experience how
others feel
Like to be in control
Will respond to criticism with shame or
humiliation - and often attack back
Individuation may be over-emphasized
Relationships are to be used not enjoyed
Will put major emphasis into career to protect selfesteem
Will give little to partner
Easily sees partner as disapproving
Feels rejected easily
Can go on for long periods of time in symbiotic
relationship and this may only break down when
adoration is not available.
Relationship failures show up when empathy is
required. Problem in couple often becomes evident
when life circumstance or therapy requires
individual to function autonomously or empathically
towards partner.
Lack of genuine committed attachment enables this
partner to rapidly change partners to another
symbiotic relationship rather than face world alone.
Address the insecurity, low self-esteem, inability
to soothe-self and the resulting inability to give.
In therapy, narcissist may not want to be there
keep distant from therapist, resist insight, and be
indignant about having problems. Will often
attempt to outwit therapist and stay dominant.
Therapist precipitates a crisis and then holds and
contains through the crisis
You must be erepared for their anger - when you
confront Don t let it stop you BUT: Don't enter into control struggles
Confrontations are often about their internal
process and pain - What they do to themselves
Help partner talk their feelings and reactions
Indirect confrontation comes from partner as
partner asks for more from the Narcissist.
Describe inability to manage differences because
they are often felt as narcissistic injury (leading
to despair)
Label inability to have empathy
Summary of Narcissist: "I don't need anyone (I'm great, special etc.) but I need you to tell me (show
me) I'm okay, but I won't let on how important you are to me".
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Initiator
Revealing one's self
Focus On
One Issue Only
Before you b~gin, get clear
on your mam concern.
Check your partner's readiness.
Stay on tracK: with this one issue.
Describe what you want.
~xpress Your
Avoid Blaming,
Accusing or
N arne Calling
Blaming stops you from knowing yourself.
You liave a role to play in being beard.
You may wish to acknowledge some
positive aspects of the situation.
Feehngs & Thoughts
Be Open To
Self-Discovery
contradictory. Go beyond simply expressing
one feeling. Look for the vuhierability
that may be underneath your initial feeling
... e.g. sadness, fear, jealousy, hurt, guilt, etc.
Explore y-our personal, inner experience.
Keep gomg deeper into how you feel What aoes this tell you about yourself...
how you respond ...how you thiiik and feel?
This Is my problem -It's an expression
This process Is about my willingness to
of who I am -It's about me
revealing myself and being willing
take a risk to speak or discover my truth,
and about lnaeaslng my ability to
to express my own thoughts andfeelings.
tolerate the expression of our differences.
-----------. -. . ------- ·---------------------------
~·
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-·~·~·~·~·~·~ ~~·~~·~~·~·~~.--~~·~·~....-~~·~·~·~~.--.!11
0 ~ 11t1M1 Ph.D. 8 Ptffl A1nor1 Ph.D• .USI!Irgm ~ Mm1o An. CA 94025. Ttl (41 51 327·591 5
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Inquirer
The Effective Listener
Listen Calmly
Don't defend yourself,
argue or cross-complain.
Remind yourself that you don't have
to take what's said so personally.
Hold onto uThe Big Picture".
Empathize
Do your best to put yourself in
your partner's shoes. Respond with empathy.
Keep making empathic statements until
a soothing moment occurs. You can hold
onto yourself and still be able to imagine
what it's like for the other person.
Ask Questions
Recap
Develop an interested and curious
state of mind. The questions you ask
are designed to understand
your partner's e~erience.
Can you come up with any examples
on your own that will let your partner
know you really understand?
Repeat back to your partner,
as accurately and completely as
you are able, what you've understood.
Check it out with your partner
to see if it's complete and accurate.
Reminder to self:
Am I in a place to listen with openness?
1do not own this problem.
I do not need to get upset.
It's up to me to manage my reactions.
Reminder to self:
My partner Is a separate person
with their own feelings, thoughts,
personality andfamily history.
I only need to listen, not lookfor soluUons.
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C SVft BtJdfr Pfi.O. II,_, l'fDnDn Pfi.D. US IUgttSS ~ Mflllo I'M. G4 94025. Tel (41 Sl 127·5915
Empathy In The Inquirer.
0 Is able to be less reactive at
times to partner's defming self.
As Inquirer can recap capably.
0 Treats other people
as extension of self
~
,
/
0 Manages anxiety &reactivity
skillfully, without personalizing.
Self-soothes and maintains thinking.
f.i Asks questions aimed
at understanding
Initiators experience.
I@ Demand for fusion.•
0@ Experiences and expresses
compassionate understanding for
divergent and paradoxical points
of view without compromising
personal integrity.
•
,
00 Can listen openly
understand other-self assess
see options-self validate.
~
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Less D~erentiated
The Continuum Of Empathy
More Differentiated~
~~~--~--~~~--~-~--'T"7~.--"T7~~--"T7~~ ~~..!f
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~
As Inquirer can contain
self to listen, but has very
limited ability to recap;
High degree self-reference.
@)
~
0 Same as 0 but catches
self and recovers on own.
~-J
0 Is able to experience
shift within self as under standing of other increases.
1
0 Is mostly able to stay in roleoccasionally slips out- able to get
back with reminder from therapist.
® Actively and curiously interested
in greater understanding of partner,
able to ask questions that further
Initiator's discovery of themselves.
c-.pt .... N.IN& MlCC
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L"A\"Z'.A.'S"ZA.ti~-z;.;..'S"ZA.VA~-z;.;..v;;...,,
Breakdowns In Roles:
Initiator
Inquirer
+ Blaming. Focusing
• Start problem
solving or fixing.
• Getting defensive,
self-referencing
and not holding role.
• Asking questions that have more
to do with the Inquirer than with
the Initiator.
+ Projecting an_d OJ?erating from
proJection.
• Low ability to access empathy.
• Under-developed ability to
self-evaluate/validate/soothe.
on other rather than
exploration of self.
+ Bring~g up too
many Issues.
+ Under-developed ability to
identify or ·
articulate feelings.
• Demanding a
merged response.
• Not connecting the event
or situation at hand with a
deeper understanding
CEIIyns.derPti.D., &,....,PNraonPti.D., <US8Utfleuarw., MenloParlt. CA H025. T.,(415}327-6115
Self Capacities that are developed and
strengthened by using
the "ito i" roles:
+ Increased anxiety tolerance
+ Ability to delay gratification
+ Increased ability to internally self reflect
and self define
+ Increased capacity to self-soothe
+ Clearer boundary definition
+ Increased capacity to experience empathy
+ Increased ability to self validate
CE/Iyn B.wr Ph.D., I. P.w P'Nr.«J Ph.D., 445 8urgNa om., lltlenlo P8rlt, CA 1«125. T_, (41$1327-5115
~~~-zA~!74.trA..V:...V:...\"2'.A.v.A.!'74.v•~VAa..tr~L.A.v.A.'J
~
Principles for Developing Intimacy in Couples'~
Relationships
~
1. The foundation for ongoing, sustained intimacy comes from exploring,
appreciating and persevering in managing differences.
2. Progressive levels of self disclosure stimulate
increasing levels of anxiety/fear.
3. Moments of greatest defense/defensiveness provide some of the best
opportunities for intimacy with self and inttmacy with the
partner... therefore they are not to be avoided.
4. Core beliefs/decisions about self/other inhibit the ability to receive
intimate communication or to exl?ress anxiety laden or controversial material.
Shifting these core orientations opens new potential for the partners.
5. Deepest intimacy is arrived at by repetitively countering natural
instincts for self-protection and self-preservation.
CE/tyrl s.der Ph.D., & ,.._,,._,_,Ph.D., 445 Burveu Drive, Menlo ,._rlc, CA 14025. Tel (4151327-5815
The Couples Institute was founded in 1984 by Dr. Ellyn Bader and Dr. Peter Pearson to
help couples develop effective, satisfying relationships. We wanted "to focus on
helping couples bring out the best in themselves and their partners. "
We believe that couples relationships can progress through normal developmental
stages. When couples get stuck in this process, they develop impasses and
symptoms. Sometimes these impasses last for many years. However, when partners
learn the stages and develop skills and capacities to progress through these stages,
they can move on to having relationships that enrich them. We believe that the energy
for change rests with the couple and that we can be catalysts to help unblock normal
impasses. Partners then can progress from Symbiosis to Synergy. In this process,
differences and disagreements become stepping stones to greater Intimacy.
At the Couples Institute we use classes, workshops, couples groups or psychotherapy
tailored to the couples unique circumstances and developmental stage. We also offer
training for therapists and a special intensive workshop designed only for therapists
and their partners.
Training Opportunities for Therapists
We offer 2 day and 4 day workshops for therapists to understand our theoretical model and
develop initial comfort using it with couples in their own practice. We also offer ongoing
consultation groups which meet monthly each year between September and May. These are
designed to focus on your own cases and on developing refined diagnostic and intervention
skills.
Perhaps our most unique training opportunities occur when therapists participate as
trainee/assistants in our 2 day and 5 day couples workshops.
Upcoming Couples Workshops
July 5-9, 1997
This relationship workshop is reserved only for therapists and their partners. It is
designed to be an intense, powerful opportunity to challenge, stretch, inspire and revision your relationship. In these jam-packed days you- can literally reorganize your
relationship to a higher level. You work shoulder to shoulder with a small group of likeminded couples to generate new and more effective, involved and satisfying ways of
being with your partner.
What can you expect from this stimulating week? You increase your ability to manage
unruly emotions during tense discussions. Increase your capacity to persist in the face
of disappointment. Hold firm to your values, integrity and interests while making room
to really understand your partner. By strengthening your individuality, you enhance
intimacy and can more easily discuss, dream and imagine the next chapter of your
relationship.
The Couples Institute 445 Burgess Drive, Menlo Park, CA 94025 (415) 327-59.15 fax: (415) 327-0738
July 12-13, 1997
~~coming from your Heart"- a weekend workshop for couples to learn about
differentiation. This workshop is an artful blend of theory, demonstrations and
practicing new skills. This workshop focuses on helping couples manage their
emotional and verbal reactivity during tension discussions.
July 14 -16, 1997
This workshop is only open to couples who have previously attended a 2 day
workshop. It is kept small to give maximum opportunity for couples to work on their
own unique situatiohs. Having learned the foundational knowledge from a prior retreat
they now apply this information and these skills for deeper clarification and working
through specific impasses.
Upcoming Training Workshops
October 14-17, 1997
4 Day Advanced Training - This small group training with Ellyn Bader is designed to
give therapists an opportunity to exponentially further their understanding and skills in
the developmental model as well as to present their own cases. Ample time is
available for role play, video examples, lecture and case consultation.
Books, Audio and Video Training Tapes
We have available professionally recorded audio and video tapes on different aspects
of the developmental model. They are:
Establishing Goals in Couples Therapy- Video, Dr. Ellyn Bader
Disrupting Couples Conflictual Communication - Video, Dr. Ellyn Bader
In Quest of the Mythical Mate - audio of 2 day workshop, Drs. Ellyn Bader and
Peter Pearson
Surviving and Thriving with Difficult Couples - audio of 1 day workshop, Drs. Ellyn
Bader and Peter Pearson
Initiator/Inquirer Tent Cards - set of 10 for couples to take home
Book: In Quest of the Mythical Mate by Ellyn Bader, Ph.D. and Peter T. Pearson,
Ph.D., 1988, New York: Brunner/Mazel Publishers.
From Symbiosis to Synergy: Stepping Stones to Intimacy. A visual aid for therapists to
assist in teaching the developmental stages to couples.
The Couples Institute 445 Burgess Drive, Menlo Park, CA 94025 (41?) 327-5915 fax: (415) 327-0738
APPENDIX
A
the
pause
Positive Approaches
to Menopause
NEWLY REVISED AND UPDATED
Foreword by John Arpels, M.D.
@
A PLUME BOOK
Summary of
Symptoms and Solutions
0\
~
Premeustraal syndrome, mood swings, irritability,
depresllioa
Diet-Avoid alcohol, sugar, dairy products, salt
Exe~Daily
Behavior--Relax whenever necessary
Prepare family members and colleagues
Undergo psychotherapy when needed
Don't smoke
Supplements-Vitamin B-6: SG-300 milligrams per day
Magnesium: ISo-400 milligrams per day
Homeopathy-Individual remedies
Acupuncture and Chinese herbs-Individual treattnent
Herbs-Chastebeny (Vitex)
Skullcap for irritability
Saint~ohn's-wort for depression
Honnones-Esttogen is particularly effective
Natural progesterone
Appendix A
Appendix A
Fatigue
Exercise-Daily
Acupuncture and Chinese herbs-Individual treatment
Herbs-Chasteberry (Vitex)
Hormones-Estrogen (sometimes testosterone)
Gastric upset, coDStipation, diarrhea
Homeopathy-Individual remedies are particularly effective
Herbs-chamomile tea, peppermint tea, bitter herbs
for gastric upset, psyllium husks for constipation
Hormones-Estrogen
248
Sleep disturbance
Diet-Avoid caffeinated and alcoholic beverages
Avoid large evening meals
Drink warm milk before bedtime
Exercise-Daily
Behavior--White noise, very hot baths, reading, relaxation exercises
Herbs-Motherwort, passionflower, valerian
Hormones-Estrogen
Meatal fuzziness
Behavior--Increase organization, use notes and lists
Herbs-chasteberry (Vitex)
Hormones-Estrogen is particularly effective
249
Nausea and dizziness
Headaches
Homeopathy-Individual remedies are particularly effective
Herbs-chasteberry (Vitex), peppermint oil, feverfew
Hormones-Estrogen
Skin se...itivity
Hormones-Estrogen
Joint and muscle pain
Behavior--Massage
Exercise-Daily
Acupuncture and Chinese herbs-Particularly helpful
Herbs-Burdock, black cohosh, blue cohosh, nettles,
cleavers for joint pain
Hormones-Estrogen
Breast tenderness
Supplements-Vitamin E: I OD-800 international units
per day
Hormones-Progesterone or testosterone
Appendix A
250
Frequent urination
Homeopathr-lndividual remedies
Hormones-Estrogen-Estrogen cream may be sufficient
Urinary incontinence
Behavior-Kegel exercises, relaxing while voiding
Homeopathr-Individual remedies
Hormones-Estrogen for urge incontinence
Medical-Surgery
Hot flashes
Supplements-Vitamin E: 60~800 international units
per day
Hesperidin: I ,000 milligrams per day
Vitamin C: 50~ I ,OOQ milligrams three times per day
Diet-Avoid coffee, chocolate, alcohol, spicy foods, and
fruits high ~ acid
Keep cold liquids nearby
Exercise-Daily
Behavior-Dress in layers, carry a fan, have sex weekly
Homeopathr-Individual remedies
Herbs-Chasteberry (Vitex), black cohosh, Dong Quai,
Siberian ginseng
Hormones-Estrogen is particularly effective (sometimes
progesterone or teStosterone)
Medical-Glonicline, Aldomet
Appendix A
251
Heart palpitatioiUJ
Herbs-Chasteberry (Vitex), black cohosh, Dong Quai
Hormones-Estrogen
Behavior--R~tion
Heavy bleeding
Acupuncture and Chinese herbs-particularly effective
Herbs-Chasteberry (Vitex), shepherd's purse, blessed
thisde
Hormones-Progesterone
Medical-D&C, ablation or laser burning of the uterine
lining, hysterectomy
Weight pill
Exercise-Aerobic, daily
Diet-Reduce intake of fats
Drink lots of water
Hair loss
Hormones--Estrogen
Medicai-Antitestosterone medication plus Rogain
Increased hair growth
Behavior--Bleaching, electrolysis
Hormone--Estrogen or natural progesterone
Medical-Antitestosterone medication
252
Appendix A
SkiD problems
Behavior-Quit smoking
Use sunscreen
Diet-Drink lots of water
Hormones-Estrogen for dry skin
Natural progesterone cream for acne
Medical-Retin-A or antitestosterone medication for
acne
Lack of sexual desire
Behavior-Psychotherapy when appropriate
Hormones-Estrogen and/ or testosterone
Painful intercourse
Behavior-Additional lubrication with sex
Vitamin E or Replens on regular basis
Masturbation and stretching vagina
Psychotherapy when appropriate
Hormones-Estrogen-cream or pills-is particularly
effective
Natural progesterone cream
Testosterone cream
Supplements-Zinc: 15 milligrams per day
Appendix A
253
Heart disease prevention
Exercise--Aerobic, minimum three times per week
Diet--nonfat or low-fat, low-cholesterol, moderate fiber
Hormones-Estrogen
Supplements-Vitamin C: 500-3,000 milligrams per
day
Vitamin E: over 100 international units per day
Miscellaneous-Baby aspirin: one per day
Osteoporosis
Exercise--Weight-bearing: three hours per week minimum
Diet-consume adequate dairy products; increase other
foods high in calcium
Drink calcium-fortified juices
Decrease animal flesh significantly
SQpplements-Total intake from food plus supplements:
Calcium (elemental): 800 milligrams per day with estrogen
Calcium (elemental): I ,20D-l ,500 milligrams per day
without estrogen
Vitamin D: 400 international units per day
Magnesium: 15o-400 milligrams per day
Malic acid, boric acid, manganese, silicon, copper,
zinc
Hormones-Estrogen and testosterone
Reasons That People Have Sex
feel powerful
nurture other
control partner
feel close
prove they're OK
pleasure
feel they have to
self-expression
relieve tension
avoid conflict
feel nurtured
prove they're normal
prevent infidelity
placate partner
reinforce gender identity
display moral superiority
avoid intimacy
self-exploration
create dependence in partner
How Clients Really Feel About Sex
Many people are afraid of being sexually inadequate
Many people are afraid of being sexually abnormal
Many people overestimate the amount that others have sex
Many people are embarrassed to talk about sex with their partner
Many people don't have a language for talking about sex
Many people don't think that fun is part of sex
Many people don't feel close during or after sex
Many people think they should become aroused without touching
Many people feel guilty about their fantasies or desires
Many people use sex for power or to express emotion
Most people don't know how male & female bodies work
c. Marty Klein, Ph.D (800) 584-Slll;[email protected]
43
Myths About Sex
Monogamy is natural or normal
Sexual problems always reflect personal or relationship problems
Affairs are rarely about sex/Affairs are only about sex
Intimacy is the most important part of sex
Fantasies about others are a form of infidelity
There's something wrong with people who want sex "too much"
Adults sexually exploited as children can't expect to have satisfying sex
Sex becomes less important as relationships age
Sex equals intercourse
Sexual fantasy predicts sexual behavior
Dealing with stds or contraception is disruptive
It's important to have "normal" sex
Myths About Love and Intimacy
Intimacy= entwinement
You must like someone in order to love him/her
Love is a sufficient reason to marry someone
Affairs always destroy marriages
Excellent relationships have little or no conflict
True love typically leads to good sex
Monogamy is more mature than non-monogamy
The most important thing in a relationship is how much the partners love each
other
c. Marty Klein, Ph.D (800) S84-S 111; [email protected]
Presenting Problems are Typically a Solution. To What?
Anger
Grudges
Guilt
Power imbalance
Lack of self
Trust issues
Fear of own power
Prior exploitation
Fear of intimacy
Wanting out of a relationship
Ambiguous relationship contract
Unrealistic expectations or beliefs
Guidelines for Assessing Patients and Situations
See power dynamics as separate from their content
Think system, not individuals
See sexual symptoms as solutions--to what?
See people as bigger than, and not, their symptoms
Note how people disempower themselves
Listen for how people describe why they can't trust themselves,
their bodies, or sex
Although dysfunctional or low desire partners typically control
much of the sexual relationship, they rarely feel that way
The myth of the high desire/low desire couple
Help patients understand that feeling powerless
is not the same as being powerless
Encourage messages of entitlement
When people avoid sex to avoid being controlled,
don't see this as "low desire"
Assess non-sexual power dynamics
c. Marty Klein, Ph.D (800) 584-S 111; [email protected]
Evaluating Clients' Sexual Experience
What language do you use to discuss sex?
Can you or your partner decline sex without creating bad feelings?
What does "real sex" have to contain?
How often do you masturbate? Do you enjoy it? How do you feel about it?
Does your partner know you masturbate?
How do you feel about initiating sex?
What kind of contraception do you use? STD protection? How often?
Do you know how .to have orgasms? In what way? Do you enjoy them?
Is sex ever physically painful?
Do you like to kiss? How do you like the way your partner kisses?
Sexually, does your body work the way you'd like?
Do you know what you need in order to create satisfying sex?
Do you notice men/women on the street? Do you fantasize about sex with
them?
How often do you use drugs or alcohol before or during sex?
How often do you have sex when you don't want to?
How do you feel about your sexual fantasies?
Features of Sexual Functioning That May Indicate Non-sexual Issues
Having sex· despite pain
Having unwanted sex
Forcing partner to have sex
Repeated requests for predictably rejected activity
Refusal to believe that partner is satisfied
Ignorance of partner's desires or (dis)satisfaction
Assumption that partner should always be in the mood
Despite his/her obvious sexual frustration
Deferring to partner's alleged sexual expertise in the face of contrary evidence
Deferring to partner's inappropriate demands about contraception or STDs
Agreeing to an unwanted sexual contract desired by partner
Therapists' (&Psychotherapy's) Sexual Issues That Affect Treatment
Anger at men/women/sex
Willingness to help clients defme what's sexually "normal"
Discomfort/unwillingness to accept certain variations
Desire to prove sexual liberalism or morality
Political agendas
Fear of sexuality
Discomfort with sexual ambiguity
Confusion & anxiety regarding power and surrender
Misinformation about biology, psychology, sociology, & anthropology of
sexuality
Beliefs:
about the appropriate role of sex in a relationship
about proper sex roles
about sexual fantasy
about the use of erotica and sex toys
that monogamy is mature, & disinterest in monogamy=fear of intimacy
that more sex is better than less sex
that all sexual issues really express relationship issues
that this is normal, that isn't
about the relationship between love and desire
about the relationship between masturbation and desire
about what constitutes infidelity
about what constitutes sexual exploitation
All Sexual Relationships Involve Power Dynamics
Sex involves the tension between desire and fulfillment,
which are poles on a power continuum
People typically want things from sex that they can't have without
a partner's cooperation
Sexuality has a dark/lusty side with few restraints on desire
Our sexual instincts include the desire to permeate boundaries
Our sexual intelligence includes desires to dominate/submit
Many people are taught that sex is something one person takes from another
The power dynamic is a primary carrier of sexual intimacy
Sex takes place in the body, which is the seat of primary process
The Importance of Power Dynamics in Sexuality
The power dynamics of sex make people feel vulnerable, anxious, or angry
Being clear on power dynamics facilitates sexual intimacy
People and relationships often express power problems sexually
People often experience or distort intimacy problems into power issues
Our culture, including the therapy and recovery industries, confuses surrender
and powerlessness
Entitlement issues are often experienced/expressed sexually
When direct communication is discouraged, sex is often the communication
vehicle for feelings
Intrapsychic Pain About Power and Sexuality Include:
Fear of letting go
Fear of being judged
Fear of caring too much
Fear of losing oneself in passion
Fear of becoming dependent
Fear of harming self, others
Anger about not being taken seriously
Anger about not being desired enough
Anger about desiring too much
Anger about not being seen clearly
Anger about the inability to create fulfillment
Feeling trapped in a power struggle
Self-talk: Ways People Disempower Themselves Around Sex
I'm no good at sex
My sexual preferences aren't normal
My body isn't attractive enough for good sex
I'm too self-conscious about my body to enjoy sex
I'm too easily distracted during sex
My partner is better at sex than I am
My partner is hard to please
My contraceptive or sexual health concerns are a problem
I'm less comfortable with sex than most other people
I can't forget my emotions, the recent past, or the distant past
I can't enjoy sex unless I have no conflicts about it
How Therapists Collude With Clients' Sexual Self-victimization
Not understanding how the media, religion, and government conspire to
disempower people sexually
Not confronting clients' beliefs about others' sex lives
Not (appropriately) talking about your own sexual feelings
Believing that sexual trauma dooms clients' sexuality
Letting clients identify themselves primarily as sexual victims
Not confronting clients' sex role stereotypes
Not asking for definitions of sexual terms
Not confronting clients' self-diagnoses
Getting caught up in the sexual content of what clients say
Behaving inappropriately with clients
Not recognizing own value judgements
Messages of Sexual Empowerment
Everyone deserves sexual pleasure
Imperfect bodies can have full sexual pleasure and intimacy
However your body likes (consenting) sex is OK
Sexuality is a wonderful, divine gift
Your fantasies cannot hurt you or anyone else
Sexual curiosity is normal
If someone is embarrassed about your sexuality it doesn't necessarily mean you
did something wrong
If you are honest and respectful, your pleasure won't hurt others
You have the right to control your own body at all times
You are entitled to experiment
You are entitled to change your mind after sex begins
You are entitled to decline things you have previously agreed to
You are entitled to initiate at times
You are entitled to not initiate at times
You are entitled to masturbate at any time for any reason
You are entitled to touch yourself during sex with a partner
You can put the past behind you
c. Marty Klein, Ph.D (800) 584-5111; [email protected]
r.;.~
~~~
•
......
FRoM SYMBIOSIS To SYNERGY
STEPPING STONES To INTIMAcr ..FoR CoUPLES
NoRMAL ANo N~RAL CHALLENGES .AloNG THE WAY
THIIIMBPIAII:!Illl~.u.Mooa • 'nll<:o..Ns~MIMDPAII.CA
• c.z..m,Cac:l7r :1!. SAna, P. PwDc AIGP.Ka!Ht
00
-5
2
8
3
STAGBS oP CouPus RIILATIONSHIP BaOCHURB: BADBR, PBAilooN &: KRoHN
PlrrBR M. KRoHN, MFCC
51
Maxl•u•
Curreat Level
of Awallable
Self CaJIKIUes
AtOiiUmal
FuncUoalag
N~~~---l
Residual
level of
"RtStJnl
Trauma
j
II ::_- _ .___ .._.J
Intrapersonal depiction shows a desirable ratio:
A greater level of Self Capacities, (Self/Other differentiation)
is available relative to the level of residual "resting trauma. "•
f)
Restimulation of early trauma; ~
stimulation of anxiety·
threat to couple's bond
~~ttttt
llonaal
Residual
MuliiUII
Curreat Level
of Aflllale
Self ~aciUes
At Oitllllll
Functioalag
Level of
"Rest1a1,
Trau111
Restimulation/Stimulation results in inverted ratio where trauma exceeds
Self Capacities. The efforts of individuals are directed towards tension
reduction, (e.g., demands for fusion), rather than anxiety tolerance .
@)
The "ito i" proc:as with
its C1Jll!hasis on empathJ. &:
differentiation pruvfdes
1 strudwe that ~ts~
e of restimulation and
anTthe demand for fusion.
.e
Facilitation of
differentiation
fi:!!!!!ii;;;;;;;;;;i;;;;;;;;!I!!J!iii;;~ leads to
strell2thened
Self Capacities
ttltt
lllll
Mul•llll
IermaI
Resldu11
CUI'I'IIItlntl
of Aallalllt
Self l:__lp1c1Ua
AI DiU...
fuacU11111
Lnelot
"Restlna
Trauma''
Illustration of how the reduction of traumatic restimulationl
stimulation & facilitation of self/other differentiation work together
to develop and strengthen Self Capacities.
RssriMULATJON Or TRAuMA As APPLIBD To CouPtBs- AoAPrBD FRoM JoHN BRmRB's PH.D. TRAuMA MoDBL
P!TBRM.KloHN,MF()C
.
~
t+l
The ·a· to ·a· Process
For The Development Of Self Capacities.
·No More Cold Shoul~
This dlalotnJe Is an example which Illustrates how positive
"self-talk' can help you as the ln!Uatgr to stand-up for
~O::fC:.'::l~l~that :re ~ru~nsobe~.
A5 !be 11111u1rer positive-~~can help you to calm
and comfOrt yourself In limes of stress. whRe you remain
present. able to hear and understand ypur partner
without taking what's said so personaDy.
,....,.._. rmsocs.mrnacl...
"*
~
rw gat 10 !ld c:111 my mnc1
It ....aes me lleMll41D bmg II up
bull)lllanlteepltnsleleany longer•..
..____. "Charrle, there's something that's been bothering me
that I want to talk to you about. .. is this ail okay tfme?"
Self-Capacity Development In Relationship
+ Identitv
SIC to define self. 1b know fee(mgs and thoughts.
SIC to ~ress, rMil seU appropriately - u the moment unfolds.
SIC to express desires, (without denland), and activate oneaelf
.
toward the achievement of these.
Desire to know oneseU deeply. 1b e:rperience inner conflicts,
contradictions and panidOJeS. Th be capable of seeing oneself IS a
whole being with recognition and responsibility for one's flaws.
+ Affect Recognition, Regulation, and Modulation
SIC to calm and comfort oneseU under stress.
SIC to k>lerate pain and anxiety; delay gratification and urgency;
Willingness to explore unknown and unresol\'ed interrmtra personal issues.
SIC to move from one affective slate to another.
SIC to be resilient and recover from injury, feelinp of rejection,
perception of threat etc.
--.-.Boundary
-+-
SIC to see other as a separate ~n.
1b be interested, curious in gettins 1o know other.
SIC lo attach to other and rel\llate degree lnd distance IS desired.
SIC to hold onto oneself - feelings, thoughts, beliefs and values
in the face of interpersoilal pressure or stress.
SIC lo discriminate ancf not take projections personally.
SIC to manage inner distress maintaining clial~ u well as outer.
SIC to set limits for others and fOr seU.
• Cognitive and Perceptual Skillfulness
• SIC to integrate thinking with feelinp.
.
Ability to consider a broader picture. to senerate positiw self·talk, guidance ek:.
SIC to affirm positiw aspedi, make repairs appropriately.
and generate new options.
......
=
~-,::~
5 P~erequisites For Developing
· Greater Self-capacities:
+ Self-Mastery
(Incorporates aspects of all of the above.)
SIC to idf·usess, be accountable to seU based on deeply held
goalldesire ID live consruently with beliefs, values and guiding principles.
1b observe oneself, and to hear and assess observations that others make of
you and to be capable of freely choosing to make changes, or noL
SIC to gruw in self-sufficiency, i.e., to be dedicated to the acquisition
of ewr·more inner strength to rely on one's own inner processes
to provide oneseU with validation, direction and ene!JY for a meaninsfullife.
1b do this in the context of an intimate relationship.
~!
I
1) Focus on yourself instead of your partner
2) Develop a sporting attitude
3) Know thyself - to thine own self be true
4) Plan Ahead
5) Practice, practice, practice
SBLP-CAPACDY DBVBLOPMBNT IN RBLATIONSHIPS
PB'I'BR M. KaoHN, MFCC
Calming md Comforting Jbursdf Under Stress
Developing The Skill, Art and Benefits of Self-Management:
/kgiiJ by P/8111Jing Ahud md tb~ Pmctia:, Pnctict:, Practice!
Plans are best 1111de when you are calm and relaxed. Despite this fact, people usually wait
to fipre out how to resolve conflicts in the beat and stress of the moment in which it's oc·
cuning. However, at the same time your body iagoing in another direction - it has ·
sounded the alums for an all-station alert, and is preparing you for a light or a night. When
we are in a state of high physiological arousal, most of us, are not at our best in terms of
clear thinkins. understanding of one another andlor liodins compusionate
resolutions.
Self-Management will revitalize your relationship
The goal of this worksheet is to plan in advance effective strategies that focus on
developing sreater abilities to 11111111e yourself dwins I stressful interaction with your
partner. The goal of Self·MUIIsement is to avoid becoming emotiooally reactive.
People can become reactive in different ways; enppna in instantly escalati111 fi&hts, or
stormin&·off Rights, pusive agreasive actina-out, resentfully complyins. isauina threats and
ulti011turns etc., etc. Self-Maoasement mea111 developina the skilla to tolerate pain and
anxiety, to think productively, and to be willinato focus on developins yourself rather lhan
holdins your partner entirely raponsible for the difficulties in the relationship. Deepenins
these skilla will mean lhat you will be able to remain true to yourself, your values, belief•
etc., while you support your partner' a eq111l right to do the same -despite any differences!
AJ. in any sport or hobby, practice is required in order to succeed.
First and Foremost...
Gettina oneself calmed down takes precedence over anythin& else. Research has shown lhat
when your pulse ia 10~. or 100re, above of your nonoal baseline' your ability to respond
other lhan wilh the liptiRipt reaction is seriously compromised. Your ability to listen,
think and undentand has pretty much sone by lhe wayside once you're at this point.
Beyond Ibis, you DIIJ weU do serious damaae to the relationship by continuiq to enpse in
cycles or neptive escalation. Task one is to dilensage. Announce it - •rm soinato lake I
break so I can calm down•. Set a time to talk apin. Take a few slow deep breaths from
your lower abdomen. Concentrate on exhalina fully. Slow yourself down.
• .... M. c.a..I'Ul., WIIJ ManioP'I Soooceoll Or Pail, Si.-lSclloWr, New Yn
Living Up Th Our Potential...
Even When Our Buttons Get Pushed
What stops you from beins your best and responding in the way you want to?
Well, surprisingly enough, in many cases, it can come from 'Doin' what comes nat'rally'.
When something creates anxiety our gut instinct is to avoid it. When we !eel hurt,
we want to hurt back, or run. When someone criticiz.ea us, we want stup them. II'$ only
natural. We wouldn't dream of encourasing them to tell us more- let alone ask them
questions that are an invitation to heap on 'further abuse.'
And yet if we look at the results of 'Doin' what comes nat'rally' - it's easy In see that trying
to stop your partner from criticizing you doesn't really work; nor does an eloquent defense;
nor does criticizing them back.
So maybe, what does work is all about "Dolo' what comes unNat'raJiy•
Many or the skills that lead to greater intillllcy and lasting satisfaction in relationship are
•counter intuitive• . (Ibis is psydJ~blbbk for ~pinsl our instincts.} Although we are
applyina it in this illllance to calming down when your body is all geared-up for a lisht or a
Risbt, it is true in sreat many iwnces.
Beins at out best also has to do with thinking about relationship in ways that are contrary to
conventional wisdom, HoUywood and from our families.
Here are some other coaslderations of what may be contributing to your getting
thrown-off center and keeplns you from fuactloalnc at your best:
t If your response il quite intense chances are lhat you are perceiving the situation in a
way that hu restimulated an old wound, hurt etc. This may intensify your reaction to the
current situation and explain why it feels disproportionately upsetting.
t The inability to see andlor treat your partner u a separate person, with their different
feelinp, thoughts, beliefs and vllues-and yetlhe npectation lhat lhey validate, reflect
and approve of youn. {RIIller dun ftdirll secUR lh~tlhere is ITJOI1J for botJJ ofyou with
your dilfereDca.J
•
t Takinc thiqs very pCrsoDIUy. Believins that when your partner expresses compl•ints
about you lhat it's all about you. {RIIher IJun burirJ8 it 6S m indiation ofb11W upset
llley're kdm, iD Ibis momeDI.J
t Believing lhat the more you hear about your partner's upset feelinp- the worse it will
be. That you have to protect yourself _by stoppina your partner from buildin& up a case
against you - 'nippina it in the bud.' (lnstud ofruliziDa lh~t bylislenif11 almly, I.Slios
quulions, beiJ11 iDterested IDd curious, you wiU lum mort ~bout your pvtDer; mil .s
you do you wiD see bow tbe issue beJDDp to yourputrle.J
t Difficulty puttin& yourself in your partner's shoes. (It's ru/ly possible to do IDd s/iiJ bold
ooto your own poiDI of view -.syou become successlulfOU wiD tDhmce iDI.iriJicy.J
+ Are there any words. thoapts, lmqes or adlou you cu think of lhat mlpt
A Wli-Ruilrling 8rr:rr;i.se
help you to feel a little calmer, perhaps see thiAp In a different Ucbt, and resala a brl&hter penpedive? Please jot dowa .. muy u you CID think of.
Self-soothing W¥ler Interpersmal Stress.
The purpose of this worbheet is to help you to find some new ways to resolve conflicts, or
to take sreater riska in order to have lhe posaibility of increased inti011cy in your relation·
lhip.
t Think of a typical, reasrrlnc stresafullateractlon between you ud your partner.
(It may help if you close your eyes, and allow yourself to relax for a moment.
This will help you to slow down and focus. Be open and see what cornea up.)
t Keeplns the orlsfaal altuaUoa In miDd are there aome positive waya yoa cu
think of that will help you to see yoar partner iD a different llsht7 Please jot
tbese down.
AJ. you observe youraelf in this situation, focus on your feelinp, lhoupts and behavior then check any item& from the list below that apply:
Under stre11, It' a mostly true that I:
a
a
a
a
a
a
a
a
a
a
a
Think neptive thou&bll, blame, crilicire or condeinn my partner.
Think neplive thoupll, blame, crilicix or CODdemn myself.
Peelanpy and upresa it inappropriltely and instantly without lhinkin&Peel threateoed, overwhelmed and leave lhe scene u quickly u posaible.
Say thinp lhat are unfair and inapproprilte lhstllater wish I hadn't.
Do lhinp lhst I later resret or feel ashamed ol.
Re-eoact I behavior that seem& like I scene from my family when I wu P'OwinB up.
Get depreased, feel hopeless and stuck and do nothins.
Resentfully comply to keep the peace.
React quickly and intensely in the moment.
Try not to show how hurt, or angry I feel.
t When you look ba~ at ~he situaUoa, at a later Ume, do you wbll you had re·
aponded uy differe.atly7 How?
On the followinc paae you will find a list ol ideaa that olhu couples found helpful.
Are there 'any that mipt be helpful to you? If 10, Include them, or reword them 10 they
suit you and lhen write lhem down aiDD& with the others on your list.
Now, aelect one or two of tlteae that aeaa to be the mCIIl useful.
Bxpress these u a &oallhat you wish to wed toward&. Goals are best when they are very
specific, so they can be Wllluestioaably observed u lhey are achieved.
(B.s. - btber tJun 1iviJv bim tbe siltDitrutmeJJJ wileD I'm upset. I VD toinlto Jet bim
bJow eactly bow I ltd IDd IbM I WIIJito Wi}.
Goela are bat when lhey are not reliant on pleuin& someone else or geHiq somethina in
exchan&e from anyone else - it Dllkes a real difference when they come from an inner
personal motivation.
fB.I· -I doo't Dlt mpdf wbeD I sUrt yeJ/iDt uti flliiJI, so I'm soirJito !Ut ~ lirDe out,
10 for • walk IDd lint aim mpdldoWD lllfilbtD tUt my tiDJt to ru/ly tbiJJ! .bout lbt
sitU6tiOD IDfl wlnt olber opliDDS I luw.J
SetUDI I soalla II easy U ruHas·ln the blaak to thia statement -
•what I want to start dolns, or stop dolo..__ _ _ __
t What would be the moil helpful thing for you to bear that could help you to
atay more calm and centered if the situation were to happen acain?
Or, "What I want \o do more of, or leu of, is:._ _ _ __
SB~MANAGBMBNI'I SBLP-SooniJNG UNDBR INTBRPBROONAL ST'RB$
PBTBR M. KRoHN, MFCC
" ....When somethingIS. bothenng
. me. .."
SlllllllllriJie wbcre you Jee younelf ill the IDiliator role.
Slllllllllrize where you see yourself ill the lnquiRr role.
lde~~lifr pb for yaunelf ill each role. Wbal ue re&IOIIIble milUiloeiiD aim for?
It is best wbell pb Clll be clearly defined iD o~Jxnoable actioDs.
It IUf belp ID express them u thillp you wish ID Slut, slop or . . doills, or do less.
A"athc Iqjtiabc
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llllcuW.-~. .., ..... Idr&.loolioplllloo_.._ .. l
.W.!a
....
·~'lllc-J.-..........,~...,··
=-.:.~
~~,.:::'!.':'.=;.~:r...~.=-~
SBLP-bssMBNr~GoALS.ANt> NHXT STBPS
Pll'rBR M. KRoHN, MFCC
....... •hr-•llcd..,....Siot
~l.':IL!anprtllr~. l- ..
When something is bothering me in my
relationship, I typically...
When my partner is bothered by something
and lets me know, I typically.....
1see attached for some ideu of normal and typical ways people respond)
Is there a goal I wish to set for myself
based on my automatic, usual response ?
Is there a goal I wish to ;:;et for mys~lf
based on my automatic, usual response ?
~--
: ~ Basic Principles of Effective Goals: ~ '
Relationship Goals:
1) What I want to understand/learn about my relationship:
1) They are describable and observable
and contain either action, behavior or facts
2) What I want to do more ol or start doing:
21 Individual has own personal benefit from
accomplishing goal v.s. accomodation to partner
3) What I want to do less ol or stop ~oing:
3) Therapist and client both know when it is complete.
4) Some things I'll do that will let me know
GoALSNARRATIVB ~NT
PirrBR M. KRoHN, MFCC
Love, Sex, and Infertility: The Impact
of Infertility on the Couple
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
SANDRA RJSA LEIBLUM
UMDN]-Robert Woodjohnson Medical School
Infertility can slgnlflcantly stress a couple
relationship in a myrltul of ways. Men and
women bave different ways of coping witb
infertility and, at times, one or tbe other
partner feels lnsu./fldently understood
or supported. Issues of coercion,
communication, financial t~llocation, and
empatbk failure are common. Furthermore,
marital and sexual constriction often
occurs, botb during tbe months (or years)
of Infertility intervention, and wben tbe
Infertility crisis bas apparently been
successfully resolved. Tbls article addresses
these Issues and illustrates them wltb a
case example Involving botb primary and
second Infertility. It Is noted tbat empatbk,
effective indlvi4U111 and couple therapy can
be an Important resource In dealing with
botb tbe immediate and long-term
aftermath of infertility on sexual and
marital functioning.
© 1996 )obn Wiley & Sons, Inc.
• infertility • couple
adjustment
IN
• marital and sexual
SESsioN: PsYcHOTHERAPY IN PRAcncE
2/2:29-39, 1996
I
deally, love, sex, and fertility go together as
naturally as the proverbial horse and carriage.
For t~e. one i~ ~ix couples who have difficulty
conc.etvm~, this 1s not the case. Despite a loving
relat10nsh1p and sexual enthusiasm, conception
does not occur even after months of "doing the
right thing in the right place at the right time."
When months of unsuccessful procreational atte~pts become. years of frustration and disappomtment, mantal and sexual satisfaction are often compromised. Infertility can pose a real
challenge for even the strongest of relationships.
It is not uncommon for couples to seek counseling during the years spent actively dealing with
the infertility crisis, as well as after it has apparently been resolved.
For many couples, procreation represents a
• Corresponden.ce and requests for reprints should be sent to Sandra R. Leiblum, UMDN]-Robert Wood
Johnson Medzcal School, Department of Psychiatry, 675 Hoes Lane, Piscataway, N] 08854.
In Session: Psychotherapy in Practice. Vol. 2. No. 2. pp. 29-39 (1996)
© I 996 John Wiley & Sons. Inc.
57
CCC I 077-2413/96/020029-11
30
LEIBLUM
highly significant and emotional symbolic bond-a joining and synthesis of both
their genes and their love-and a public declaration of their "coupledom." To be
frustrated or thwarted in the enterprise of making a baby together is a major insult
as well as, potentially, a major loss.
This article will consider the impact of infertility on marital and sexual relations. Common sources of marital tension will be identified and therapeutic interventions will be illustrated with a case example in which a couple must deal with
both primary and secondary infertility.
INFERTILITY AND MARITAL STRESS
By virtue of the fact that infertility diagnosis and treatment is usually a long-term
stressor, which is often experienced as an insult to an individual's sense of personal
efficacy and reproductive adequacy, marital and sexual satisfaction may be challenged in a myriad of ways.
Male and Female Reactions
to Infertility Diagnosis
Although both infertile men and infertile women experience infertility as a threat
to their self-concept and self-esteem and as a loss of personal control, infertile
women tend to experience greater feelings of sadness, guilt, depression, and anxiety than do men in coping with infertility (Link & Darling, 1986; McEwan,
Costello, & Taylor, 1987; J. Platt, Fieber, & Silver, 1973; L. Platt & Leiblum,
1995). Additionally, women tend to blame themselves for infertility, even when
the etiology is primarily due to their partner or is shared. Such self-attribution
increases their sense of sadness and depression as well as feelings of unworthiness.
Obsessive self-reflection, self-blame, guilt, and anxiety on the part of either
spouse obviously interferes with marital vitality and engagement. When one partner is distressed and preoccupied for months or even years, marital tensions
and/ or resentment is not uncommon.
In extreme instances, feelings of self-blame and guilt may be so strong that an
infertile individual feels unworthy of marriage or their partner's love and devotion. Such feelings, if unexpressed and undiscussed, can contaminate couple communication. In this capacity, it is important to note that men typically have greater
difficulties in emotional expressiveness, in general, than do women, and particularly, in discussing their reactions to the diagnosis and stress of infertility. At
times, this increases feelings of alienation and emotional estrangement between
husbands and wives.
Couples often need assistance in identifying and expressing their thoughts
about the impact-both positive and negative-of infertility on their relationship.
They often need permission to discuss feelings that they think may be unacceptable or hurtful to their spouse. For instance, it sometimes happens that conception
attempts are postponed until the career of one or the other partner is successfully
launched. Then, when infertility surfaces, the spouse who has been eager to start a
family feels resentful and angry at his or her mate: "If you hadn't insisted on
finishing medical school (or passing the bar, or buying a house, etc.), we could
Love. Sex. and Infertility
31
have had a baby by now!" Although second-guessing one's decisions is not helpful, unexpressed feelings do not vanish. It is important to deal with such sentiments in order to get them out of the way, rather than have them percolate below
the surface. Eventually, couples can be helped to acknowledge that infertility is an
unjust and frustrating insult to both of them.
Sometimes, the intensity and sharing of feelings that occur with infertility can
help cement the bond between spouses, but only if each partner feels understood
and supported.
Overt and Covert Coercion to Comply
with Infertility Treatment
Two partners rarely share the same motivation or commitment to having a biological child. In fact, it is not uncommon for the partner who is more invested in
having a baby to place considerable pressure either subtly or overtly on the less
enthusiastic partner. This may take the form of insisting on continuing infertility
treatment when the odds of success seem remote, or to participate in infertility
treatments that may be unacceptable to one of the partners. For instance, in a
recent case, when a wife learned that her husband's sperm count was too low for
conception (although it was sufficient when they conceived their first child), she
insisted that he immediately agree to the use of donor semen. He was reeling from
the news of his infertility and could not agree to the use of another man's semen.
After months of pressure from his wife, they eventually decided that they needed
to go for conjoint sessions because he felt threatened by his wife about an infertility option that he was not ready for and was ambivalent about.
Different degrees of motivation about having a child need not be a problem if
both partners are invested in achieving a pregnancy. However, when one partner
already has a biological child by a previous marriage, or is more ambivalent about
parenthood, a power struggle may ensue. The partner desperate for a baby feels
resentful and alone in his or her quest for parenthood, and can become overtly
insistent or quietly manipulative in eliciting his or her partner's cooperation in
infertility treatments. For instance, in another recent case, a husband with two
biological children by a former marriage reluctantly agreed to participate in his
wife's attempts to get pregnant, despite advanced maternal age and a missing
ovary. Secretly, he counted on the fact that she would miscarry if a pregnancy
occurred. When, after two miscarriages, she successfully delivered a baby boy, he
left because he did not want to be a father again!
Financial Conflicts
Infertility treatment is expensive. Conflicts often arise over how much money to
allocate for medical treatment, given the low success rate associated with many of
the newer reproductive options. Sometimes couples disagree on whether to spend
scarce financial resources on an outcome that is more likely to result in a child, for
example, adoption, or to pursue medical attempts to achieve a pregnancy. Disagreements arise over how many trials of in vitro fertilization or ovum donation to
undertake given the costliness of each attempt and the relative likelihood of success. Tension over finances and monetary allocations can become heated, indeed,
and can disrupt marital intimacy.
32
LEIBLUM
Empathic Failure
For the woman or man who desperately wants a biological child, the failure to
conceive or to successfully carry a pregnancy to term can be devastating. Moreover, recovery from an unsuccessful reproductive attempt or a miscarriage is often
slow, and the feelings of despair, anger, and hopelessness may be profound. When
one partner seems to be "taking too long" to "snap back" from an unsuccessful
reproductive attempt, the other partner may become impatient and unempathic:
"Why doesn't she (he) get over this already? It's been three months. What about
me and our relationship? Doesn't she (he) value what we have together?" At the
same time, the grief-stricken partner feels isolated and unsupported. When infertility treatments continue for many years, couples often need assistance in coping
with their sense of frustration and estrangement from each other.
Marital Constriction
Marriages flourish when couples share joy as well as sorrow together. Although
the stress of infertility can, indeed, bring couples closer together in fighting a
common "enemy," if. infertility treatment is extended, the lack of fun and lightheartedness in the relationship can take its toll. Life may seem bleak and pleasureless. Couples often need permission and encouragement to take vacations from
infertility treatment and to spend time nourishing their relationship.
Sexual Constriction
Finally, infertility may negatively impact on sexual frequency and satisfaction, and
may create sexual difficulties for both husband and wife. The loss of sexual spontaneity, the scheduling of intercourse at ovulation, the scrutiny by outsiders of
various sexual parameters, and the pressure to procreate can induce considerable
anxiety, avoidance, and frustration. Although initially the thought of having sex in
order to create a baby is associated with passion and promise, the frustration and
disappointment of un~uccessful procreative attempts may cast a shadow over
sexual exchange. What was initially sexy and passionate becomes work.
Sexual interactions may be affected in a variety of ways. For example, the sexual
script (Gagnon, Rosen, & Leiblum, 1982) may be abbreviated. Time devoted to
sensual foreplay may be shortened as well as efforts to increase arousal. Whereas
male ejaculation is necessary for conception, female orgasm is not, and hence,
sometimes attention devoted to stimulating female orgasm is abandoned. Rather,
the thrust of sexual encounters is for prompt and reliable ejaculation in conjunction with ovulation or the cessation of ovulation-induction medication. In fact, it
is not uncommon for couples to undertake sex only when ovulation is expected
and to dispense with sexual intimacy at other times of the month.
Men and women feel a variety of sexual demands in connection with procreative, rather than recreational sex. Men may feel the demand to get an erection
despite a lack of sexual desire. The pressure to ejaculate can be very great, even
when arousal is minimal. For women, some of the especially gratifying aspects of
sex, such as sensual caressing and kissing, may be abandoned altogether in the
pressure to induce male ejaculation.
For couples whose sexual adjustment was tenuous to begin with, long-standing
infertility treatment can negatively impact on sexual response and pleasure. Men
Love. Sex. and Infertility
•
33
with unreliable erections may experience erectile failure and sexual avoidance.
Women with a history of inhibited sexual desire may find themselves becoming
sexually avoidant at times other than ovulation.
Not all couples experience all of these problems, but most infertile couples
experience some of them. If the changes in their sexual script are ignored and the
lack of sexual satisfaction is minimized, couples may pay a significant price in
terms of their sense of closeness and marital happiness.
The following case example illustrates how marital and sexual satisfaction was
significantly compromised by a decade of infertility treatment. Although the wife,
a nursery school teacher and mother of one daughter was the identified client,
individual therapy was followed by couple therapy with the goal of relieving the
sexual problems that had developed for each of them.
CASE ILLUSTRATION
Presenting Problem/Client Description
Susan, a consultant in child development, was first seen in psychotherapy in 1989,
a year following her father's death and 2% years of frustrating and unsuccessful
attempts to conceive a second child. At the time of her first contact, she was 38
years old and felt that "time was running out." Compounding her distress and
depression was the absence of emotional and sexual intimacy between Susan and
her husband. It had long since been eroded by a 3-year struggle to become
pregnant with their first child. Their sexual life, which had never been carefree and
spontaneous, suffered greatly during the years of scheduled sex, and for the past 2
years, sexual contact at times other than ovulation, had totally ceased. Sex was a
mechanical and pleasureless activity dictated by Susan's ovulation-induction regimen.
Susan was the oldest of three daughters of Roman Catholic parents. As a young
child, she was close to her mother and suffered separation anxiety when the time
came for her to attend kindergarten. Although her current anxiety about separation was not incapacitating, Susan experienced distress at the thought of loved
ones leaving, or of leaving a loved one. Her daughter beginning kindergarten was
stressful for her, as well as her husband's business trips.
As a child, Susan was the "over-responsible daughter." Her middle sister was
regarded as volatile and high-strung, and consequently, few demands were placed
on her, whereas her youngest sister was the family "pet," pretty and adored with
minimal domestic or academic expectations. As a teenager, Susan was considered
overly moody and introspective; she was often teased and criticized when she was
silent or sought to be alone.
Susan's father was a critical, depressed, and intellectual man who confided in
Susan and made her feel special, although guilty about being his favorite child. His
oft-repeated expression, "smile in the morning, cry at night," was a sentiment that
Susan felt poignantly characterized her life.
Always a superior student, Susan was accepted to an outstanding college where
she met her future husband, Paul. He was quiet, gentle, and loving, and they
quickly developed a strong emotional attachment. At school, they were inseparable, although they refrained from having sexual intercourse for 2 years. Finally,
after a beer bash at a local fraternity, they consummated their relationship. Sexual
34
LEIBLUM
relations thereafter were loving but infrequent because of their lack of privacy and
Paul's tentative sexual approach. When sex did occur, it was gratifying.
Upon graduation from college, Susan and Paul were married, and 6 years later
began attempts to conceive. After 18 months of unsuccessful attempts, they consulted an infertility specialist who performed a variety of tests. The scheduling of
their sexual encounters began in earnest, and Susan charted her basal body temperature upon awakening each morning for 3 years.
The impact of medical scrutiny and scheduled sex took its toll. Paul began to
experience occasional difficulty achieving or maintaining erections. Susan said:
"We really had to work at it." She remembers experiencing little pleasure or sexual
satisfaction. Rather, she recalls lying in bed with "my tush on a pillow and my legs
in the air. I always worried that the semen would roll out when I stood up."
After several years of this, Susan became "really depressed, so depressed that I
would not talk. I withdrew from Paul and blamed myself." Even though the
infertility tests were inconclusive in identifying the cause of infertility, Susan felt
responsible because "my menstrual cycles had always been irregular." The irony
of the comment that had humiliated her as an adolescent, "your big hips are
perfect for childbearing," haunted her.
She began to feel and behave like an asexual woman. Her sense of self-confidence in both her appearance and skills diminished. She had always been vulnerable in terms of her physical self-esteem, viewing herself as a "brain without a
body." Her lack of sexual enthusiasm and physical self-confidence further exacerbated Paul's sexual insecurity and tenuous sexual adjustment.
Susan recalls one huge fight at this time with Paul. Although lacking in sexual
desire, she had long petitioned Paul to seek therapy for dealing with his premature
ejaculation and lack of imaginative foreplay. He denied that there was a problem.
On this particular evening, Susan became insistent and begged him to ~o for help.
He became furious and shouted: "Maybe you should take a lover." Ironically,
following this blow-up, they went on to have sex several times that week-end and
Susan believes this was when she successfully conceived her daughter.
Pregnancy was not stress-free. Susan began bleeding 1 month after her pregnancy was confirmed and was treated with hormones to maintain the pregnancy.
Sex was discontinued because they were fearful of "dislodging or disrupting the
fetus." Susan's amniotic fluid broke at 28 weeks and her daughter was born 7
weeks prematurely, weighing 4 pounds, 5 ounces (1,956 g). The delivery was
difficult and necessitated a "huge episotomy."
Not surprisingly, sex was infrequent in the 1st year of their daughter's life.
Susan and Paul were fatigued and exhausted; the presence of their daughter in
their bedroom did little to encourage sexual spontaneity.
As their child got older, sex remained infrequent, about once a month. Although Paul had always been a rapid ejaculator, he now developed erectile problems. In fact, in order for sex to be successful at all, Susan needed to awaken him in
the middle of the night and stimulate him. "I guess his performance anxiety is less
when he's been sleeping," she said, "but I really resented having to do all the
initiating and waiting until the middle of the night to do it."
When their daughter was 4, they initiated attempts to have a second child.
Susan desperately wanted to "create new life" following her father's death. It was 2
years into her struggle with secondary infertility that Susan requested individual
therapy.
Love, Sex, and Infertility
35
Observations About Secondary Infertility
Although primary infertility, the inability to conceive or carry a pregnancy to
successful delivery of a live child, is widely acknowledged as a source of stress,
frustration, and depression, secondary infertility tends to receive less attention and
commiseration. Yet, the woman who longs for a second child but is unable to
conceive experiences feelings similar to that of the primary infertile woman: denial, disbelief, anger, guilt, and grief. The attitude of both family and friends, though,
is less sympathic. The general feeling is that she should be grateful for having a
child at all, especially a bright, healthy one.
In sessions, Susan talked about her struggle and obsession with her infertility.
Feelings of punishment and inadequacy jostled with feelings of sadness and indignation: "Why should I be denied this child when I've suffered so much already?"
Susan wondered if she was being punished for her fantasies about taking a lover,
for her resentful feelings toward her mother and sisters, for her lack of "goodness." She talked about how, as a child, she tried to be "saintly," and now, she
merely felt "spiteful."
Her grief over her inability to conceive again was exacerbated by her implacable belief that it required at least two children to constitute a real family. Moreover, although she was considered an expert in child development by virtue of her
training and position, she felt fraudulent: "What do I know about children?" She
believed that being a mother of an only child invalidated her as an expert on child
development.
·
Therapeutic interventions were directed to challenging her erroneous cognitive
beliefs. For example, her belief that a "normal" family consisted of two children
was confronted with gentle teasing and persuasive statistics. Susan was eventually
able to expand her definition of family to include those headed by single mothers
and lesbians, gay men, and grandmothers. Similarly, her beliefs that one needed to
have more than one child in order to be an expert in child development, or that
having siblings necessarily enhances a child's life, were closely examined and
confronted. As Susan was able to relinquish her erroneous and obsessive ruminations, she was better able to become involved with her husband and daughter.
Only after several months of individual therapy was Susan ready to tackle her
marital problems. It is well documented that depression stifles sexual desire and
Susan's long-standing feelings of guilt, anxiety, and incompetence contributed to
her chronic dysphoria and indirectly to her lack of sexual interest.
Individual treatment was terminated when Susan was able to accept the likelihood that she would not be having a second child, but that she could have a full
happy life. Marital tensions had eased and Susan was more receptive to sexual
intimacy with her husband, who had independently sought individual therapy for
what he insisted was a work-related depression (denying the impact that infertility
treatment and its consequences had had on his own feelings of self-esteem and
marital satisfaction).
Conjoint Couples Therapy: Marital
and Sexual Treatment
Susan recontacted me 3 years later. At that time, she announced that she felt good
about herself and her daughter, but not about her marriage. She was actively
36
LEIBLUM
involved in teaching and community outreach; she had cultivated a large circle of
friends to provide an "extended family," but there was little physical or emotional
intimacy with her husband. Sexual relations occurred fewer than a dozen times a
year and only when Susan awakened her husband in the middle of night. Paul was
unable to attain an erection without considerable genital touching. Susan felt that
as a couple in their early 40s, they were too young to "sexually retire."
During our first conjoint session, it was agreed that the goal of sex therapy was
to increase both the quality and quantity of their sexual encounters. Both Susan
and Paul concurred in acknowledging the disastrous impact that both the primary
and secondary infertility had on their marriage.
Paul was seen for an individual session to obtain a psychosocial history and to
secure his view of their sexual and relationship problems. He talked at length
about the impact of infertility interventions on his sexual functioning: "I used to
like sex a lot, but then, what had been a 'game' turned into work." Although he
indicated that he had always had worries about performing well sexually, his
anxieties were exacerbated by the intrusive infertility evaluations and sex on demand. "I just wanted to get it over with," he said, and speculated that this feeling
probably contributed to his early ejaculation. Compounding his problem was his
awareness of Susan's lack of pleasure and desire. Sex seemed mechanical and
emotionally sterile.
Paul did wryly acknowledge that the necessity of sex during ovulation meant
that their sexual frequency increased and that although he often was "not in the
mood before we started, I would enjoy it once we got going."
When asked how their sexual life had changed after the birth of their daughter,
he said that it got worse. Having a baby meant that scheduling sex was even more
imperative: "We had to wait until she was asleep and we could not afford to have a
headache because of the ovulation-induction medicine Susan was taking." Paul
recalled that his wife's obsessive preoccupation with getting pregnant coupled
with her lack of genuine sexual enthusiasm led to his total loss of sexual desire.
"Whereas I used to ejaculate rapidly, I couldn't even get an erection when we were
trying to conceive. Susan would become angry and withdraw; I would become
frustrated and depressed. I lost all sexual interest."
Course of Ti'eatment
In most respects, sex therapy with Susan and Paul resembled traditional sex therapy for couples complaining of inhibited sexual desire and erectile difficulties
(Leiblum & Rosen, 1989; Rosen & Leiblum, 1992).
In order to remove the pressure to perform and reinstate attention to sensual
pleasure, a ban on intercourse was declared. Sensual massage sessions were suggested, in which Susan and Paul could take their time to rediscover each other's
bodies. With their daughter at an age where sleepovers were possible, privacy was
ri:ow available. Because their bedroom was associated with negative expectations
of frustration and failure, massage sessions were held in the den.
Time devoted to self-stimulation was recommended for each of them. Paul
needed an opportunity to reassure himself about his ability to reliably achieve an
erection. As it turned out, although he was able to get an erection during masturbation, he often lost erections during interactions with Susan. It was decided that
pharmacological assistance would be helpful and he was referred to a urologist
37
who prescribed injections of papaverine and phentolamine.t He readily learned
how to self-inject and felt much more inclined to initiate sex knowing that he no
longer had to worry about getting or keeping erections.
For her part, Susan reacted positively to permission and encouragement to
masturbate. Her first experience in self-stimulation was an "eye-opener," and she
reported that she experienced the "most intense orgasm of my life." Subsequently,
she felt more comfortable about engaging in self-stimulation and used it as a
pleasurable and reliable respite from stress. In fact, she was intrigued by the
creative and colorful sexual fantasies she experienced when she masturbated.
As the sexual intimacy between Paul and Susan improved, so did their satisfaction
and delight in their relationship. Marital tensions ebbed and they expressed genuine
pleasure in being together. Susan admitted privately that, whereas she used to have
many fantasies about having an extramarital affair, she now felt grateful that she had
not acted on those fantasies. She was genuinely able to appreciate Paul's devotion,
support, and gentleness. Whereas formerly they avoided affection for fear that it
would lead to sexual intimacy, they now both felt more sexually confident.
In sessions, they reminisced about their 20 years together and how their sexual
and emotional adjustment was associated with old family messages and expectations. Paul realized that his family's emphasis on achievement-in all areas of
life-added to his sexual anxiety. Sex had became yet another domain in which
"performance counted." His confidence about his masculinity and sexuality had
been assaulted by the years of infertility evaluation and treatment. When he
developed erectile problems, he felt further humiliated and inadequate; sexual
avoidance seemed the only sensible option. Gradually, he reported developing a
greater sense of personal efficacy and sexual self-confidence.
As Paul became more loving and expressive, Susan felt an increase in sexual
desire. Sexual initiation was now viewed as a joint responsibility. Emphasis was
placed on quality of interaction, rather than frequency.
Outcome
At the end of 4 months of couple therapy, it was mutually agreed that their
treatment goals had been achieved. Although Paul was still dependent on pharmacotherapy for erections, he was satisfied. He liked having the security of knowing he could count on erections during sex with Susan. For her part, Susan still
wished that Paul was a more inventive and creative lover. Nevertheless, she truly
appreciated his warmth and daily declarations of love. They celebrated their 20th
wedding anniversary feeling that they had come a long way along a circuitous
route, but that, at last, they had arrived at a destination worth reaching.
Commentary
This case illustrates a variety of issues characteristic of sex and marital therapy
with individuals and couples who have coped with (or are continuing to cope
with) infertility.
1In the last decade, pharmacological stimulation of erection has become popular by injecting vasodilating drugs into the corpora cavernosa of the penis. For a complete account of both medical and
psychological treatment approaches to erectile failure, see Rosen and Leiblum (1992).
38
LEIBLUM
1. Individual therapy may need to precede or occur concomitantly with sexual/marital
therapy. Because infertility triggers so many individual as well as couple issues,
individual sessions are often necessary. Spouses often need to express angry or
resentful feelings about their partner, their past marital history, or their families (or
in-laws) in the safety of individual therapy before they can open up to a partner.
In this case, Susan had long-standing feelings of insecurity and anxiety well
before her difficulties dealing with infertility surfaced. The unexpected blow that
infertility represented to her sense of personal efficacy and reproductive adequacy
acted as the catalyst for a clinical depression in a "psychologically vulnerable"
woman. Once we were able to reduce some of her guilt and anxiety, conjoint
counseling could begin. Similarly, Paul needed individual therapy before he could
admit that his depression was due, in part, to the long-standing marital and sexual
problems he was experiencing: His depression was not simply a result of work
stress. Sexual therapy was successful, in part, because Susan and Paul had resolved
many of their individual issues and ambivalence toward each other. When they
started treatment, they were both highly motivated to recapture what had once
been a loving relationship.
2. Although the majority of couples coping with infertility report a decrease in sexual
satisfaction, this does not imply that most couples will develop sexual dysfunction(s) as a
consequence of infertility. Infertility may be the final straw that triggers sexual
performance problems in sexually vulnerable individuals, but the vast majority of
couples react to the intrusiveness of infertility treatment with only a decrease in
sexual frequency and a narrowing of the sexual script (Fagan et al., 1986; Gagnon
et al., 1982; Leiblum, 1994; Reading, 1993 ). Sexual encounters may be relegated to
coincide with ovulation and diminish during the luteal phase. There is often less
variety in sexual positions. The achievement of female orgasm becomes less important when sex is for procreation. Less time and creativity may be given to
stimulating sexual arousal. These changes may make sex less satisfying overall, but
do not necessarily create actual sexual dysfunction. However, for individuals who
are already sexually insecure or inhibited, infertility can lead to significant problems in sexual desire, arousal, and orgasm, as it did for Susan and Paul.
3. Although sexual initiation and orchestration is often the province of the male partner
in heterosexual couples, for couples dealing with infertility, female initiation of sexual
relations becomes more commonplace. Women know when they are likely to be
fertile; they are aware of where they are in their ovulation-stimulation regimen
and they are painfully cognizant of when ovulation is expected. Typically, women
determine when sex will occur and are likely to announce, "Tonight's the night!"
to spouses who may or may not be in the mood for sexual intimacy.
In this case, Paul was never confident about sexual initiation. Their sexual script
cast Susan in the role of sexual initiator. She had to awaken Paul in the middle of
the night when his sexual performance anxiety was at its lowest level. Over time,
she came to resent this role. She believed that she was already doing too much to
maintain intimacy in the relationship and was overwhelmed at being the constant
target of infertility evaluation and intervention. Already turned off by her husband's sexual passivity and lack of initiative, the sexual demands of infertility
treatment only exacerbated an already noxious situation.
4. Finally, it is obvious from this case that, even after the infertility crisis is apparently
resolved in a seemingly successful fashion, sexual and marital problems can continue to
exist. Sometimes, years after the couple has terminated infertility treatment and/ or
psychological counseling, they appear for sex or marital therapy. Although they
39
may not identify the role that infertility played in the development of their sexual
or marital difficulties, it is apparent to the clinician that there is unfinished business with respect to the infertility diagnosis and/ or treatment. The feelings of
grief, loss, or injury that infertility can create rarely subside completely, although
they can be tamed with time and therapy.
CONCLUSION
This article highlights how infertility can have a negative impact on marital satisfaction and sexual intimacy. It is worth noting, however, that the majority of
research studies indicate that infertile couples typically report satisfactory marital
adjustment and adequate sexual function. Whether this is an accurate reflection of
the impact of infertility on marital and sexual satisfaction, an example of "faking
good" in research studies, or a testimony to the fact that couples who elect to stay
together and work on overcoming their infertility are a select population, it is
nonetheless true that infertility can stress a couple's resources and can trigger a
variety of marital and sexual problems. Empathic, effective individual and couple
therapy can be an· important resource in dealing with the immediate and long-term
aftermath of infertility.
SELECT REFERENCES/RECOMMENDED READINGS
Fagan, P., Schmidt, C., Rock, J., Damewood, M., Halle, E., & Wise, T. (1986). Sexual
functioning and psychologic evaluation of in vitro fertilization couples. Fertility and
Sterility, 46, 668-672.
Gagnon, J., Rosen, R., & Leiblum, S. (1982). Cognitive and social aspects of sexual dysfunction: Sexual scripts in sex therapy. Journal of Sex and Marital Therapy, 8, 44-56.
Leiblum, S. (1994). The impact of infertility on sexual and marital satisfaction. Annual
Rev.iew of Sex Research, 4, 99-120.
Leiblum, S., & Rosen, R. (1989). Principles and practice of sex therapy: An update for the
1990s. New York: Guilford Press.
Link, P., & Darling, C. (1986). Couples undergoing treatment for infertility: Dimensions of
life satisfaction. Journal of Sex and Marital Therapy, 12, 46-58.
McEwan, K., Costello, C., & Taylor, P. (1987). Adjustment to infertility. Journal of Abnormal Psychology, 96, 108-117.
Platt, J., Picher, 1., & Silver, M. (1973). Infertile couples: Personality traits and self-ideal
concept discrepancies. Fertility and Sterility, 24, 968-972.
Platt, L., & Leiblum, S. (1995). Infertile men and infertile women: A psychosocial comparison. Poster session presented at the annual meeting of the Association for Psychosomatic
Obstetrics and Gynecology, Crystal City, VA.
Reading, A. (1993). Sexual aspects of infertility and its treatment. In M. Diamond, A. DeCherney, & D. Greenfeld (Eds), Infertility and reproductive medicine clinics of North
America (pp. 559-567). Philadelphia: W. B. Saunders.
Rosen, R., & Leiblum, S. (1992). Erectile disorders: Assessment and treatment. New York:
Guilford Press.
sax after
so: Changes, Challenges and Rewards for Older couples
Sandra Risa Leiblum, Ph.D.
Professor of Clinical Psychiatry
Co-director, Center for Sexual and Marital Health
UMDNJ-Robert Wood Johnson Medical School
Piscataway, New Jersey 08854
There is significant variability in the sexual behavior of
older men and women (Leiblum & Segraves, 1995). While some remain
sexually interested and active, others show a significant reduction
in sexual desire and frequency as well as changes in sexual
response. Nevertheless, recent research with both older men and
older women suggests that overall sexual satisfaction and enjoyment
is not related to age and considerable pleasure from intimate
sexual contact can continue even in the face of sexual performance
problems.
There are changes with aging, however. In healthy, married
older men, there tends to be a negative relationship between age
and sexual desire, sexual arousal and activity and an increasinq
prevalence of sexual dysfunction (Schiavi, Mandeli and SchrinerEngel,
1994).
The
incidence
considerably in the decades past
Aging
Study
(1994),
for
of
erectile
problems
increases
so. The recent Massachusetts Male
example,
reported that
the
combined
prevalence of minimal, moderate and complete impotence in men
between the ages of 40-70 was 52%. Age was the variable most
strongly associated with erectile failure. In older men, erectile
problems are correlated with heart disease, hypertension, diabetes,
medication and indexes of anger and depression, as well as many
psychological variables. Nevertheless, when sexual desire exists,
most older men can continue to enjoy an on-going sexual life, with
or without reliable erections (but with a modicum of imagination
and devotion!). Moreover, there are a number of pharmacological
treatments that are effective in facilitating erection.
In women,
the impact of age on sexual response tends to be
less dramatic. The impact of hormones on female sexuality is more
muted than it is for men.
Estrogen is obviously important
in
maintaining vaginal elasticity and lubrication in peri- and postmenopausal woman but testosterone appears to be the significant
"libido" hormone.
While for many women,
the years following menopause,
sexual desire declines in
a significant minority
of women
continue to be quite sexually active. In a large-scale telephone
survey of Australian women,
aged 45-55,
the majority of those
surveyed (62%) reported no change in sexual desire·with menopause
(Dennerstein,
•al,
et.
1994).
Recent
research
with
elderly
hypertensive women found that among the sexually active women with
partners, more than half rated their level of sexual interest as
moderate or high.
Nevertheless,
a host of psychological issues can adversely
affect the sexual lives of older couples, including the indirect
impact of
chronic disease,
marital discord,
loss,
rigid and
inapproprpiate sexual "scripts" and plain old boredom.
workshop
will
address
the
psychological,
Today's
biological
and
interpersonal contributions to sex after 50! Case vignettes will be
given to facilitate group problem solving.
References
Dennerstein,
L.,
Smith,
A.M.,
Morse,
c.
&
Burger,
H.
( 1994).
Sexuality and the menopause. Journal of Psychosomatic Obstetrics
and Gynecology, 15, 1, 59-66.
Feldman,
H.,
McKinlay, J.
Goldstein,
I.,
Hatzichristouo,
D.,
Krane,
R.,
&
(1994). Impotence and its medical and psychosocial
correlates: Results of the Massachusetts Male Aging study.
The
Journal of Urology, 151, 54-61.
Leiblum, s., Baume, R. and Croog, B. (1995). The sexual functioning
of elderly hypertensive women. Journal of Sex and Marital Therapy,
20, 4, 259-270.
Leiblum, S.R. & Segraves, R. T.
(1996). Sex and aging. In J. M.
Oldham and M.B. Riba (Eds.) American Psychiatric Press Review of
Psychiatry, 14. Washington, D.C.ss.
Schiavi,
R.,
Mandeli,
J.,
Schreiner-Engel,
satisfaction in healthy aging men.
therapy, 20: 3-13.'
P.
(1994).
• Journal of Sex
&
sexual
Marital
SEX AFTER FIFTY: CHANGES, CHALLENGES AND
REWARDS FOR OLDER COUPLES
Case Studies
Sandra R. Leiblum, Ph.D.
Department of Psychiatry
UMDNJ-Robert Wood Johnson Medical School
Piscataway, NJ
(Do not reprint without permission.)
Erectile Failure in a long-married traditional couple
The patient is a 61 year old married executive presenting
with the complaint of erectile failure. He has already consulted
the company physician who prescribed a course of intracavanosal
injections. The patient is loathe to take these, suspecting that
the problem is more psychological than physical since he awakens
with sturdy morning erections. He is not taking any medications
that might interfere with erectile failure.
The patient describes a stable, but "boring" relationship
with his wife of 33 years. While he is intellectually curious and
physically active (golf, jogging, swimming), she is rather shy
and socially reticent; she does volunteer work at their Church.
Her only interest is shopping. Over the years, she has gained
weight, but she remains a devoted and loving wife with
traditional sexual attitudes.
Their sexual script tends to be predictable and
circumscribed with the patient as the sexual initiator who must
"arouse" his wife into action. Any activity other than missionary
position coitus is rejected.
His wife views her husband's erectile problem as belonging
to him alone and is reluctant to appear for treatment. The
patient is distraught and depressed about his erectile failure
which he views as proof of "aging".
A lackluster sex life in a devoted couple
The couple, Mr. and Mrs. B., aged 55 and 53, respectively,
consult you because their sex life lacks spark and passion. Mrs.
B. who suffers from dysthmia and multiple medical complaints
(oack problems, migraines and occasional panic attacks) initiates
the request for therapy. She is an attractive, but non-assertive
and non-complaining woman who is always kind and supportive of
her husband. Eighteen months ago, she became seriously depressed
and was hospitalized. Her depression was precipitated, in part,
by her chronic disappointment in her sexual life with her
husband. Although she knew he was devoted to her and eager to
meet her needs and requests, he was sexually passive and somewhat
inhibited. Often, he ejaculated before she could reach orgasm.
She was alternately bombarded by strong sexual feelings for which
she had no outlet and sexual apathy herself.
In the intake questionnaire, to the questions inquiring
about the ch.ief complaint, the husband writes "There is lack of
spontaneity; my wife does not achieve sexual fulfillment." She
writes, "I am very inhibited and have many suppressed sexual
emotions. I have many puritanical beliefs and also feel that I
~"
not thin enough to be wanted. I do not feel I deseerve more and
do not want to hurt my husband by sharing my sexual frustration.
I am embarrassed to ask for anything. I have become explosive
with the need for sexual release in the last few years."
A Case of Widower's Syndrome: Problems of a Blended Family
Mr. F., a fit, youthful and financially successful 61 year
attorney, lost his wife suddenly and traumatically following a
six week struggle with brain cancer. He was left with his 13 year
old son and feelings of devastation and grief. Most of all, he
felt lonely.
Within a period of 3 months,
he found himself a sought
after bachelor. Dating was a defense against feelings of grief
and loneliness and within a matter of months, he became
passionately involved with a 41 year old divorced mother of
three. He was completely "swept away" but worried that his new
girlfriend would not agree to a committed relatinship with a man
of his age. Consequently, he deducted 10 years from his age,
telling her he was 51 rather than 61.
Sexually, he found himself having difficulty getting and
keeping erections. Although he could occasionally be orally
stimulated into achieving an erection, more often sex was
disappointing and humilitating for him. Nevertheless, she enjoyed
the intense oral orgasms and the lavish gifts and attention he
provided. They were married following less than one year of
courtship.
Mr. T. sought sex therapy six months after the marriage. He
was devastated by his sexual "impotence", depressed by the
failure of their two families to bond, and plagued by occasional
regrets about his decision to remarry. The sexual problems were
worse than ever.
Loss of Desire after breast cancer and an extramarital affair
The patient is an extremely attractive 50 year old married
woman who has survived breast cancer and chemotherapy. During the
cours~
of her cancer treatment, one of her physicians became
erotically attracted to her; she succumbed to his advances, fell
in love, and was sexually active with him, despite her moral
reservations.
She had never experienced such passionate,
uninhibited and gratifying sexual activity prior to this
relationship. However, when her lover decided to terminate the
affair because it was threatening his marriage and · because the
patient was becoming overly committed to him, she was catapaulted
into a suicidal depression. Her depression has lifted and she is
maintained on prozac; she is also in analytical psychotherapy
with a psychiatrist she respects.
Now, one year later, she is consulting you because she wants
to "reawaken" sexual interest for her husband. Although he is
physically attractive, totally devoted, and
physically non-
demanding, she lacks all sexual desire for him and has been
unable to become sexually aroused or orgasmic for over two years
(since her breast surgery and the affair). She "wants" to want to
have sex with him, but recoils at his approach.
Ill but sexually interested husband; resentful wife
Mrs. T., 56, initiated therapy because she felt guilty about
denying her 62 y.o. husband sex, but felt unable to subdue her
feelings of anger and resentment.
Throughout their 30 year marriage, her husband had been
dominant and often tyrannical. Although as a young bride she
"worshiped" his intelligence and certitude, she had become unable
to tolerate his critical and often demeaning attitude toward her.
Although his fits of rage passed quickly, and were followed by
contrite apologies and declarations of love, she was unmoved. His
physical touch was revolting to her. She did not want a divorce,
though, but rather wanted to find a way to live with him.
Their relationship had changed dramatically 10 years
earlier, when he became ill with serious intestinal problems,
resulting in multiple surgeries, weight loss and dependence on
her to nurse and care for him. She rose to the occasion, even
obtaining a nursing degree so that she could be more effective.
As .his dependence grew, so did her feelings of independence -nd
self-sufficiency.
Although she had enjoyed her sexual relationship with her
husband when he was well, when he became a "patient", she ceased
viewing him as an attractive sexual object. She could be a nurse,
but not a lover. He became depressed and angry; she felt guilty
and avoidant. This was the situation when she finally decided to
seek therapy- for herself. She wanted to know how and whether it
was possible to resume a sexual life with her husband.
Mismatched sexual interest in a sexagenarian couple
The R's are an older couple. He is 73, she is 69. Both are
in good health. They are referred by their marital therapist with
whom they have been in treatment for 6 months. Their discrepant
sexual appetites have been a problem throughout their marriage,
but has reached crisis proportions. He wants sex often, 4-5 times
a week, with access to her body for fondling and carressing
daily.
She wants to be lef·t alone but she knows, based on past
experience, that if she totally avoids her husband sexually, he
will find many interested and available female partners.
Throughout their marriage, sex has been a source of
contention. Although they both are orgasmic and do not have any
sexual performance problems, she has never been physically
attracted to her husband. Now, after 40 years of marriage, he
continues to pursue her sexually. She respects and admires his
intellect, but finds it hard to capitulate sexually. She is both
angry and depressed by the current state of affairs.
Upon interviewing each partner individually, it turns out
that she has experienced some early childhood sexual insults and
that he was arrested several times for sexual exhibitionism. Both
these events were in tqe distant past and have not been discussed
or explored in the last 30 years.
Chronic Disease and its effects on Spouses
Mrs. T ., a "southern" lady of 75 years, was referred by her internist because of
complaints of chronic insomnia. She would awaken frequently during the night with
uncomfortable genital sensations. She did not know what was causing her nocturnal
"tension" or how to relieve it, but it was seriously interfering with her sleep and she
was distressed.
A careful assessment revealed that her husband of 38 years was ill with
prostate cancer and had been sleeping in an adjacent bedroom for the past 5 years.
Although they had been sexually intimate and physically affectionate throughout
their long marriage, physical exchange had all but ceased with his illness. Mrs. T.
missed the intimacy as well as the genital release coital activities provided. She asks
whether there is any solution to her current distress.
Ruth McClendon, M.S.W.
Leslie B. Kadis, M.D.
Redecision Relationship Therapy Model
Shame and Intimacy
Current research shows that relationship therapy works, people change
and people are cured. Current research also outlines elements that need to be present
in psychotherapy for change to occur; for change to occur in a reasonable period; and
for change to endure. These elements are: (1) a definite focus for the therapy, and (2)
a clear connection between presenting problems and the associated feelings, childhood
experiences and cognitive processing. Furthermore, research suggess that insight or
understanding alone is not sufficient to promote lasting change, and that the availability
of affect or emotion is essential. However, emotions alone, in and of themselves, are
not sufficient either. What is necessary for success in psychotherapy is to: (1) mobilize
present affect, (2) link that affect to the dynamics of the past, and (3) make the whole
package relevant to the present.
The Redecision Relationship Therapy Model (RRTM) presented in this
workshop is an integrated model for doing marital and family therapy. RRTM
delineates a focus, utilizes contracts, and, combines systems and individual work with
insight and affect in a unified structure. The model can be used in many different
therapeutic structures, from long-term treatment or intensive multiple-family groups to
brief and even single session interventions. The model gives direction and structure to
the treatment process. It encourages many forms of psychotherapeutic intervention,
and allows for interventions to be suitability determined by the situation or the
relationship. The model addresses the ongoing, continuous and dynamic interaction of
the system and the individuals who make up the system. We first described this threestage model as Redecision Family Therapy in 1977. We observed that current
behavior, in the form of interactional patterns, and personal history, in the form of early
decisions, operate in a reciprocal relationship. As a result, our model works first on one
aspect and then the other, dealing with both as essential to relationship therapy.
Although the RRTM three-stage model is presented as a linear
progression, in real life it is more of a shifting entity that flexibly accommodates
relationships and circumstances as they are. As with any form of therapy both the
presenting circumstances and the depth of the patt;lology drive the model. In other
words, although we describe the three stages as distinct entities they are rarely clearly
demarcate. For example, while a family is involved directly in the work of one stage,
P.O. Box 190, Aptos CA 95001
phone: (408) 688-7167
Fax: (408) 688-2656
E-mail: [email protected]
79
1
the work on other stages may be going on as well. Movement back and forth among the
three stages is continual. A progression through the stages can occur within one
interview and, over the entire treatment process. In addition, research on the model
has proved that doing the intrapsychic work of stage two is not necessary for each
individual in the relationship. Systems and relationships can change with the change of
only one person.
With any form of therapy or any move in life destinations define the
journey. In relationship therapy the patients' vision of what is "healthy" for them is used
to define the overall direction of the work. In this model we combine this vision with
research work on healthy relationships which has clearly delineated many elements of
healthy systems. RRTM incorporates the idea of what is a healthy family into its
framework in that it focuses on the family's ability to address and manage whatever life
brings to them. Nevertheless, there is more to life than the executive functions, there is
the need for intimacy, and this too is incorporated into RRTM. The healthy relationship
has been described as one in which people know about each other, care about each
other, respond to each other, and respect each other. These are the essential
elements. The RRTM targets the developm~nt of solid executive functions and a
healthy emotional tone.
Finally, an important challenge for relationship therapy is to create the
environment in which system members will reveal themselves. This is sometimes quite
a task, since people usually restrict or distort their behaviors, thoughts, and feelings
when outsiders, even other family members, are present. Much of RRTM is devoted to
creating this safe environment in which the family can be itself and show itself, not only
to the therapist but even more importantly to each other. These are some guidelines
that facilitate this process:
1. Know where you are going and keep it positive.
2. Focus on current interactions and how they impede relationship health.
3. Help each person learn how his or her behavior impacts others.
4. Motivate people to take responsibility for their own decisions and
change.
5. Create new relationship dynamics by teaching new skills, behaviors and
guidelines for relationships.
Stage One: Systems
Stage One is a systems stage with the focus on symptom or problem
phone: (408) 688-7167
Fax: (408) 688-2656
2
resolution through changes in both the structure and function of the system. The
purpose of Stage One is the emancipation of the individual from the emotional tangle
and problems that dominate the relationship. Stage One examines, and then interrupts
the ongoing and continuous interactional patterns that negatively affect problem solving
behavior, positive coping skills, task mastery, social competence and intimacy. In Stage
One the interface of defenses, mental models or early decisions, and how they manifest
themselves in the present is defined.
Stage Two: Individuals
Stage Two is the intrapersonal or intrapsychic stage. In Stage Two the
main focus shifts to the transformation of internal models. This involves helping the
individual confront his or her past to gain the confidence to master the present and
decide upon the future. The focal point for changing internal models or making
redecisions is derived from the individual's process and participation with other system
members.
Stage Three: Reintegration
Stage Three is focused on the prevention of future disablement, both
individual and systemic, through teaching new effective and healthy ways to function
within the interpersonal system. Psychoeducational and specific behavioral
interventions that provide information and teach new skills are particularly valuable in
the third stage when the emotional temperature has been lowered.
Redecision Relationship Therapy is a model that integrates an
interpersonal and intrapersonal perspective. It stresses the dignity of each person and
their ability to change. As a treatment approach, it brings action, vitality and humor to
the process, emphasizes the positive and utilizes the strengths the relationship brings
to the therapeutic situation.
phone: (408) 688-7167
Fax: (408) 688-2656
3
I
\
\
\
I
Workshop Bibliography
Basch M: Understanding Psychotherapy: The Art Behind the Science. New York, Basic
Books, 1988
Suber M: I and Thou (2"d ed.). New York, Scribners, 1958
Cook D: Measuring shame: The internalized shame scale. Alcoholism treatment
Quarterly. 4: 197-215, 1987
Jourard S: The Transparent Self. New York, Van Nos Rheinhold, 1971
Goulding R, Goulding M: Changing Lives Through Redecision Therapy (2nd. ed.).
New York, Brunner/Mazel, 1978
Kelly V: Affect and the redefinition of intimacy, In Knowing Feeling: Affect, Script and
Psychotherapy. Edited by Nathanson D: New York, W.W. Norton, 1996
Malone T; Malone P: The Art of Intimacy. New York, Prentice-Hall, 1987
McClendon R, Kadis L. Chocolate Pudding and Other Approaches to Intensive Multiple
Family Therapy. Palo Alto, Science and Behavior Books, 1983
McClendon R, Kadis L.: A model of integrating individual and family therapy: The
contract is the key. In Brief Therapy: Myths, Methods and Metaphors. Edited by Zeig
J, Munion W. New York Brunner/Mazel, 1990, pp 135-150
phone: (408) 688-7167
Fax: (408) 688-2656
4
SHAME AND INTIMACY
RELATIONSHIP QUESTIONNAIRE
Name:
------------------------
Age:_
Date:_ __
Type of Relationship (circle one): Single, living alone; Single, living with partner;
Married; Divorced; Widowed; Looking;
1. Briefly give your definition of Intimacy:
2. How do sex and intimacy relate:
3. List and explain the top five values you hold that help you attain and maintain intimacy:
4. List and explain the top three things that you see about yourself that are obstacles to intimacy
in your current relationship:
5. With respect to your childhood, what experiences helped you learn how to be intimate?
6. With respect to your childhood, what experiences have interfered with your ability to be
intimate?
7. What else do you think is important in your ability to have the relationship you want?
phone: (408) 688-7167
Fax: (408) 688-2656
5
DEVELOPMENTAL STAGES
OF RELATIONSHIPS
TRANSCENDENCE
dis~mbodi~nt
APAlliY
SEPARAUON
Indifference, Boredom, Despair,
Brealdn& up the relationship;
possibk resen1men1s and ~e,
mulency to repeat the rnlstakes
Passive-A&gressive,
ResiBnation,
Rational, •Realistic ~ Roles,
Remaining IOgetber "for tbe Jnds•
,,
wUb
new parm.n, new romances
//
Submission
Abandonment
~"'~n-Engagement ~
~"'~/7
POWER STRUGGLE
Expectalions, c~ Blame,
Knowing
Walls, Obligations. Coercion,
/
Resentmenls, lletJen&e, Rules,
Guilt, Exdlemenl, Trust/Mistrust
Entitlement
II
ROMANCE
INTEGRADON
Acceptance, Respect, Sharing,
'
VISion, Hopes, Dreams,
Mystery, EJccilemenl
Boundaries, Recognition,
Vulnerabilly, Self-responsibiJUy
\
Clarity of Intention
Renewal of Imagination
I
\
CO-CREATION
COMMITMENT
A spirllual sense of union of Self
More realistic apeaations ofSelf
and Other, wbik beiJ18 in.spirlJ18
to others, leading to tbe creation
and Other, smse of .scu~
belorfBin&rwss In relatkmsbip,
faUb In life
of new romances.
Action
From McKeen, J. And Wong, B.R.,
84
Th~
Relationship Garden, PO Publishing, 1996.
DEVELOPMENTAL STAGES
OF RELATIONSHIPS
TRANSCENDENCE
disembodi~nt
APA1HY
SEPARATION
Indifference, Boredom, Despair,
Passive-Aggressive, Resignation,
RAtional, •Realistic•, Roles,
Remaining together "for tbe Jdds•
Breald118 up the relalionship;
possible resentmenls and ~e,
tendency I{) repeat the mistakes
with new partners, new rcmaances
,,
//
Submission
Abandonment
~M~n-Engagement ~
~"''~/7
POWER SIRUGGLE
Expectalions, c~ Blame,
Walls, Obligations, Coemon,
Knowing
Resentmenls, RerJe111le, Rules,
Guilt, Excilemenl, Trust/Mistrust
Entitlement
II
ROMANCE
INTEGRATION
.Acceptance, Respect, Sharing.
Hopes, Dreanu,
Mystery, ExcUemenl
V"ulon,
Boundaries, Recognition,
Vulnerabllty, Self-responsibility
\
Clarity of Intention
Renewal of Imagination
I
\
CO-CREATION
COMMITMENT
A spirllual sense of union of~
More realistic expectations ofSelf
and Other, while bel118 insJXrl118
kJ albers, leading to tbe creation
of new romances.
and Other, senu ofsecurity,
belongi118ness In relationship,
faUh In life
Action
From McKeen, J. And Wong, B.R., 1he Relationship Garden, PD Publishing, 1996.
Stages of Loving
Loving is Supportive
Loving is Enstrengthening
Loving is Enlightening
Loving is Valuing The Person
Loving is Pleasuring
Loving is Recognition
Loving is Being Vulnerable
and Intimate
Loving is Accepting
Loving is Sharing
Loving is Co-Creating
Loving is Eternal
0
from McKeen, J. & Wong, B.R., The Relationship Garden, PD Publishing, 1996
Stages of Loving
Loving is Supportive
Loving is Enstrengthening
Loving is Enlightening
Loving is Valuing The Person
Loving is Pleasuring
Loving is Recognition
Loving is Being Vulnerable
and Intimate
Loving is Accepting
Loving is Sharing
Loving is Co-Creating
Loving is Eternal
o from McKeen, J. & Wong, B.R., The Relationship Garden, PD Publishing, 1996
THE SELF & OBJECTIFICATION
A.
Stages of development of the Self:
1. Omnipotence: feeling at one with all (merge).
2. Objectification: making objects of the self, all experiences and things for the purpose of control,
self-reliance and self-definition (emerge).
3. Person-making: becoming a person through the vulnerable act of revealing and being revealed (contact),
for the purpose of self-expression and autonomv.
B.
Advantages of objectification:
1. It serves to separate the self from others.
2. It helps to define predictable roles, providing a sense of security.
3. Objects are more controllable than are persons.
4. Condensation and fetish-making simplify experience, conserving time, energy and consideration
5. The creation of objects provides a sense of power and excitement, overcoming underlying feelings of
helplessness.
6. Warring nations depend upon objectification in order to subjugate and kill. No person would be able to
kill another person until he or she has been made into an object such as "the enemy" or "the
foreigner" or "the savage." Such a process helps us maintain dominion over one another, often with a
resulting sense of security or peace.
6. It provides a defense against being revealed and vulnerable to the control of others.
C.
Becoming a person:
1. Early training provides objectified role models for security-making in an obligating-expectation society
that demands conformity.
2. Early relationships are all objectified in roles (eg. mother, father, sibling, teacher, etc.) which are
projected upon all new relationships which provide the opportunity to move beyond into intimate
relationships.
3. Objectified relationships are exciting and frightening, providing security /insecurity and self-esteem;
intimate relationships are fulfilling and informative, providing for self-acceptance and autonomy.
4. Most societies are based upon the achievement of power (eg. money, postion) through role-creatirig
hierarchies that encourage individuals to objectify the self and others and to become field dependent.
Becoming self-reliant and sensitive to the needs of the self and others encourages the building of
strength.
5. Dependence upon the rights of the individual within society encourages the development of victims with
issues of power and helplessness. Victories in this arena offer a sense of triumph and revenge, which
mitigates against personal growth.
6. Through mutual revelation and vulnerability, the self and other stand revealed as persons. All
objectifying behavior needs to be recognized, acknowledged and accepted before reaching a mutual
agreement on what expression is acceptable to both.
7. Loving as "taking care of" one another objectifies the other as relatively helpless, giving rise to feelings
of hope, sympathy and charity, fostering dependency and more helplessness. Loving as "recognition"
and "empathy" encourages self-responsibility and autonomy.
8. Responsibility involves the capability to respond (ability to remain sensitive and in contact) with the
other, free from the obligations and prejudices of the fixed patterns of reaction which are
characteristic of objectifying people.
9. The autonomous person is not afraid to objectify the self or other because he or she remains aware of the
process, enjoying the games without believing them. Honesty to the self and to other(s) is an essential
ingredient of a healthy way for the self to grow.
D.
Spirituality:
1. Throughout its development, the self yearns for a reunion with an other and the universe -a spiritual
quest. Too often, that quest is objectified into gods and religions to which the self submits and
enthralls. Ecstasy, the state of moving beyond the self through surrender, is only possible for the
autonomous self.
2. In relationship, the self can develop spiritual bonds that are possessive if objectified or freeing if
authentic. In the former, the self is diminished; in the latter, the self grows and becomes more of
itself.
o McKeen, J. And Wong, B.R
THE SELF & OBJECTIFICATION
~.
Stages of development of the Self:
1. Omnipotence: feeling at one with all (merge).
2. Objectification: making objects of the self, all experiences and things for the purpose of control,
self-reliance and self-definition (emerge).
3. Person-making: becoming a person through the vulnerable act of revealing and being revealed (contact),
for the purpose of self-expression and autonomy.
~.
Advantages of objectification:
1. It serves to separate the self from others.
2. It helps to define predictable roles, providing a sense of security.
3. Objects are more controllable than are persons.
4. Condensation and fetish-making simplify experience, conserving time, energy and consideration
5. The creation of objects provides a sense of power and excitement, overcoming underlying feelings of
helplessness.
6. Warring nations depend upon objectification in order to subjugate and kill. No person would be able to
kill another person until he or she has been made into an object such as "the enemy" or "the
foreigner" or "the savage." Such a process helps us maintain dominion over one another, often with a
resulting sense of security or peace.
6. It provides a defense against being revealed and vulnerable to the control of others.
Becoming a person:
1. Early training provides objectified role models for security-making in an obligating-expectation society
that demands conformity.
2. Early relationships are all objectified in roles (eg. mother, father, sibling, teacher, etc.) which are
projected upon all new relationships which provide the opportunity to move beyond into intimate
relationships.
3. Objectified relationships are exciting andfrightening, providing security/insecurity and self-esteem;
intimate relationships are fulfilling and informative, providing for self-acceptance and autonomy.
4. Most societies are based upon the achievement of power (eg. money, postion) through role-creating
hierarchies that encourage individuals to objectify the self and others and to become field dependent.
Becoming self-reliant and sensitive to the needs of the self and others encourages the building of
strength.
5. Dependence upon the rights of the individual within society encourages the development of victims with
issues of power and helplessness. Victories in this arena offer a sense of triumph and revenge, which
mitigates against personal growth.
6. Through mutual revelation and vulnerability, the self and other stand revealed as persons. All
objectifying behavior needs to be recognized, acknowledged and accepted before reaching a mutual
agreement on what expression is acceptable to both.
7. Loving as "taking care of" one another objectifies the other as relatively helpless, giving rise to feelings
of hope, sympathy and charity, fostering dependency and more helplessness. Loving as "recognition"
and "empathy" encourages self-responsibility and autonomy.
8. Responsibility involves the capability to respond (ability to remain sensitive and in contact) with the
other, free from the obligations and prejudices of the fixed patterns of reaction which are
characteristic of objectifying people.
9. The autonomous person is not afraid to objectify the self or other because he or she remains aware of the
process, enjoying the games without believing them. Honesty to the self and to other(s) is an essential
ingredient of a healthy way for the self to grow.
D.
Spirituality:
1. Throughout its development, the self yearns for a reunion with an other and the universe -a spiritual
quest. Too often, that quest is objectified into gods and religions to which the self submits and
enthralls. Ecstasy, the state of moving beyond the self through surrender, is only possible for the
autonomous self.
2. In relationship, the self can develop spiritual bonds that are possessive if objectified or freeing if
authentic. In the former, the self is diminished; in the latter, the self grows and becomes more of
itself.
o McKeen, J. And Wong, B.R.
David E. Scharff, M.D., Co-Director
International Institute of Object Relations Therapy
6612 Kennedy Drive
Chevy Chase, MD 20815
301-215-7377
Object Relations Therapy of the Traumatized
Couple and Family
Presenter: David E. Scharff, M.D.
I.
II.
Fairbairn
1)
Need for Relationships
2)
Multiple Subunits of Self and Object
Klein
1)
Projective and Introjective Identification
2)
Aggression originates in the child
90
III.
IV.
Problems in Klein's Theory
1)
The absence of a theory of trauma
2)
Interpersonal origin of the death instinct as a result of the inner closed
system
Winnicott
1)
Psycho-Somatic Partnership
2)
Object Mother and Environment Mother
Area of Focused Object Relating
and Relational Holding
Originating In l·to-1 Relationship.
V.
VI.
Zone of
Traditional Relatedness
Bion
1)
Group Theory
2)
Valency
3)
Conudner/Conudned
The Family as a Group Container
XV.
Effects of Physical and Sexual Trauma on Personality Development
Encapsulation of traumatic nuclei
Dissociation and gaps in the psyche
Splits in the self with awareness
Splits into multiple selves with separate memory banks and noncommunicating consciousness
Impaired capacity for fantasy elaboration and symbolization
Thinking that is literal, concrete, and sometimes non-verbal
Defensive preoccupation with the mundane
Preoccupation with bodily symptoms
Implicit memory behaviors that repeat the trauma
XVI. Technique of Object Relations Therapy for Trauma
Welcome going-on-being
Relate to splits
Recreate the transitional zone of fantasy
Monitor the holding environment
Move between context and focus
Translate body communications
Hold a neutral position equidistant between trauma and going-on-being
Recover images in the transference-countertransference
Put images into narrative form
Refind the self as its own object
Be there as both object and absence
Transmute trauma to genera
References:
1. Scharff, J. S. and Scharff, D. E. (1994). Object Relations Iheragy of
Physical and Sexual Tmuma. Northvale, NJ: Jason Aronson.
2. Scharff, J. S. and Scharff, D. E. (1992). The Primer of Object Relations
Theragy. Northvale, NJ: Jason Aronson
3. Scharff, D. E. and Scharff, J. S. (1987). Object Relations Family
Thera.gy. Northvale, NJ: Jason Aronson.
4. Scharff, D. E. and Scharff, J. S. (1991). Object Relations Cougle
Ihera.gy. Northvale, NJ: Jason Aronson.
5. Scharff, D. E. (1992). Refindin~ the Object and Reclaimin~ the Self.
Northvale, NJ: Jason Aronson.
~BJE<..l'
~
RELATIONS COUPLE THERAPY
David ·E. Scharff, M.D.
Jill Savege Scharff, M.D.
Copyright @ 1997
Object Relations Couple Thenpy
The couple is not a pair of individuals. It is a system of conscious and unconscious intrapsychic object relationships.
• which are experienceci in the interpersonal area.
• whic:h function in ways unique .to that couple.
• which can be noted by the couple therapis.t who attends to the marital system as the spouses
relate to each other and to the therapist.
• which repeat patterns of interaction embodying old ways of feeling and behaving rooted in
earlier experiences with families of origm
B. A Theory of Object Relations and. Couples
Object relaticm.s theorists:
F~AIRN: The infant is driven by the need for attachment. As the infant develops a relationship I
intolerable features need to be repressed, because they are too rejecting or too exciting to bear.
The splitting and repression of rejecting and exciting objects, parts of the self in relation to them,
and apptoptiate affects of rage and longing lead to unconscious psychic structure. Fig. 1
Anti libidinal
ega
Figure L
Fairbaim1S model of ~chic orpni%3don~ by
D. E. Scilarff. from Tit~ Se:r.,:aJ Relatior.sltip: An Objet:: ..'l.elatiar..: VF~N
of Sc and the Family. Reprinted courtesy of Routledge and Kepn ?au!.
~:
Reconstructed infantile fantasy about the earliest relationship. Suggested the infant
imagines parts of ~ts own feelings to reside in the other person so as to protect itself, the loved ~Ld
needed other pe.'"Son, and the relationship. This projection is the basis of projective identification.
Fig. 2
lntrojectlve lden~catlon
2. The mechanism here lJ the interaction of the chlld•a ~Jectlve and introjective identifications with the puent
u the child meets fruatration unrequited yeunina or traU)IlL·. The dJqram depicts the child longing to have his needs
met and identifylna with ~ trends in the parent via projective identification. If he meets with rejection, he
identifies with tho frustration of the pUfnt's own anti.Ubidlnal q•tem via introjective identification. In an internal
reaction to the frustration, the Ubldlnalsyatem ii further repreae'cl.-by tho renewed force of the child's anti-libidinal
system.
Figure
WINNICOTI: 1> The psychosomatic partnership behveen mother and infant organizes the
infant's psyche and the woman psychologically as a mother of that infant.
2) In the transitional space betWeen mother and infant, internal structure and
interpersonal interaction aeate each other.
3) The mother has two basic func:tions: to saieguard or hold the environment as
a context fer growth (the amtextual mother) and to be the object of the child's
love and hate (the object mother). Figs. 3 and 4
1. Mother with fetua
inside physically &
psychologically penetrating
her inner apace. Arma·around
holding already in place.
2. Birth u the moment
of establiabing the
peycboeomatic partnership
within the anna-around
holding environment.
3. Within the arms-around holding,
the mother Corms the psychosomatic
partnership with the infant across
a zone of transitional relating.
The zone or transitional phenomena
ia supported by contact with the
mother's holding capacity.
Figure :l3 . The movement from the pre-birth somatic putnenhip to the utabllahment of the psychosomatic partnership
at birth. The transitional zone, across which the psychosomatic partnership occurs, is mediated and supported by its
intimate contact with the arms-around holding of the mother.
Somatic partnership
between mother & infant
begins to organize the
infant psychologically
Psychosomatic
interface and
zone of
transitional
relatedness
As psychosomatic
relationship becomes
less physical, zone of
transitional relatedness
increases.
Infant's interior
shows initial
organization under
influence of
relationship with
mother
Figure 4 . The earliest psychosomatic: partnership between mother and infant. This begins the organization of the
infant's psyche and of the mother-as-mother. J.. the phyaic:al c:omponent of the relationship wanes, the area of transitional relatedness and transitional phenomena takes prominence, inheriting the core issues of the psychosomatic partnership. It is still closely connected to the functions of iU'JD&ooaround holding.
!JICKS: Applied Fmbairn. and Klein to marriage. Each partner projects unwanted or endange.~ par:
of self into the spouse, leading to mutual projective identification. Protection of the self and tl'-.
!'e!ationship is intended, but deterioration often results. The projective identificatory system leads to
discernible '1marital joint personality".
BION: Applied Klein to groups. Projective identification oa:urs between group and leader, and amor..
individuals to create an unacknowledged basic assumption group of unconscious assumptions. Ir..C.:
viduals take leadership for one or another basic assumption because of their valency to do so. Simila:::
we find that in marriage spouses are chosen because of.their valencies to accept the particular projectividentifications of their spouses.
AND ZINNER: Applied projective identification to families by noticing adolescents wer·.
identified as harboring unwanted or longed for parts of the parents. Also desaibed shan!d unconscioQ
family assumptions: unacknowledged but tacitly agreed-on views which organize the family. Zinne:
applied Dicks' concept of mutual projective ·identification to the marital interaction of the parents in ~- ·
families he studied.
~0
VVhat bl Object Relations Couple Theapy?
,
:om
It is a ::te~..od. that derives
psyc:hoanalytic:prindples of listening, responding to unccr..scot:.
~ •
•
1
•
•
•
""-•
•
...:
. the transrerence
.
.:
:r.a___ a.!, ~ev~cF.=g :rs.g:..., :.nte:rpret:ng,
.a nd warkin g m.
an d ccunter=ans.e:
e-Y1c:e :award· unde!"Standing and growth.
T'.ne thenpeutic relationship offexs: an environment similar enough for tb.ese parter.ts to eme-~
b..:: ...:;~: ::lou~ :Or :c:ientiiicaticn and reworking because the therapist ~r.angs :.~e capaC.:y ~:
holding, fo~ sharing the couple's experience, for tolerating anxiety and loss, arid for providing space
for understanding.
3.
Transference and countertransference in couple thenpy
SCHARFF AND SGiARFP:.Projective identification also occurs between couple and therapist. L~
countertransference;we.mceive an image of ~e couple transference to us when there is resonance
between the object relations '1 set'' of the couple and our own inner objects, including our 11internal
couple". The couple's .shared transference stems from difficulties in.providing holding to spouses
and is elicited. in respense to expectations of the therapist. This contextual transference expresses
attitudes towards the. therapist's responsibility for the therapeutic context. Individual focused
object transferences (stexnming from the internal objects of husband or wife) may attempt to
substitute for the contextual transference when the couple cannot sustain confidence in the
therapeutic: context. In couple therapy, we expect osdllation between focused and contextual
transference.
I
4. Models of thenpy
Figmc S.lDdividual Therapy
Azea or centered
relateduea and origin
or iDdividual traaafermcea
and projective idmtif~eatiou
Ar. of lbued boldiq
ad oriciD olllwed
Cllllt.atul tnDferiDce
Figure 6. Family Thc:apy
of boldiq prcMdecl by the
tberapi.lt for the family therapy
e..,~dll1
t'1H'ltJH''IId..IPro,ldlrY!
aro,iet~tm
holding
and
identiftcations
of holding tor the therapy:
leadership provided by therapist
but supponed by couple. too.
Figure 7. Couple Therapy
?!gt.!te 8. The T.lc:apist's Intcmal Couple
·:~Jte 9. The Rejecting Transference in Couple Therapy
Therapist's lntcmal couple
felt as beckoning to
compensate ror tbcir
mutual rcjcctfon.
::~~ !0. The Exciting Transference in Couple Therapy.
Table 1. Tasks of Object Relations Couple Therapy
Setting the frame
Maintaining a neutraJ position of involved impartiaiity
Creating a psychological space
Use of the therapisrs seM: Negative capabiUty
5. Transference and Countemnsference
6. Interpretation ot defense, anxiety, fantasy and inner oqect relations: The Because Ctause
7. Wortdng hough
1.
2.
3.
4.
).
Integration of Therapies
)ccurs through a theoretical model in which the individual's psychology is made up of internal objects
'lhich represent his/her experience with the family. Parts of self or object are projected into si~cant
1thers .. spouse, therapist, family members- in a stuck cycle or in anew way that allows reworking. Thi~
Lappens in therapy, in marriage, or at another developmental stage. Because each is built on the same
'asic theory, individual, couple, sex and family therapy are theoretically and practically compatible
vith each other. Treatment decisions must be made about the fit of a suitable approach or of a mixture
>f modalities.
-..
The Goals of Object Relations Couple Therapy
'l'otsymptomresolutionbutl)retumtoappropriatedevelopmentalphaseoffamilylife,withimproved
:apa_d ty to master developmental stress; 2) improved ability for work as a team; 3) improved ability to
lliferentiate and to meet the needs of husband and wife.
Table 2. Criteria far Termination
1. The couple has intlmalized the therapludc space and now has a reasonably sean hoking capacity.
2. lJnaxasdaus projedive identiftcatians have been I8Q)QIIized, owred and taken bade by each spouse.
3. The capacity to wen togatiW u 11a parUWS is~
4. Retati1g i1timaraty and saxuaUy is mUIUally gratifying.
5. The c:oupe can envision its futln devek)pnent and provide a vital holding envirorment for its family.
a. The ccupl~ can difterentiata among and meet 1he needs of each pal1ner.
7. Alternatively, tne coupe recoguizss the failure of tne marital choice, understands the unconscious object
retationsincampatlbiity, and the panners separate wilh same griefwortcdane andwitn acapacity to continue
tD mourn the loss of 1he
indlvidualy.
rnamaoa
References:
1. Scharff, O.E. and Scharff, J.S. (1991). Object Relations Couple Therapy.
No:-:hvale, !'JJ: Jason ..~--anson.
2. Sc...1tarff, D. and Sc..l-wff, J.S. Couples and Couple 71\era.py i:-t. Object Relations
Family Thenpy. Northvale, New Jerser- Aronson: 1987.
3. Scharff, D. An Object Relations Approac.~ to Sexuality in FarJly Liie. Ir~ j.
Scharff (ed) Foundations of Object Relations Family r.nerapy. Northvale,
New Jersev: .Aronson: 1989.
4.. Sc.'Larii, o.' T.ne Sexual Relationship. Roudedge: Lor.cion: :982.
c:/Wattiaf}e & 9-ami[!J
dfeaftfz Centet (~)
~uitE.. 310, 2922 CaE..'t:J'tE..E..n YJa'tkway, CaE..'t:J'tE..E..n, Cofo'tado 80439
{ 303) 670-2630 (ax { 303) 670-2392 www.paHionatE..maniagE...com
Passionate Marriage ™
The Path of Personal Evolution
and Eyes-Open Sexl
David Schnarch, Ph. D.
Sexual passion and intimacy have more importance in marriage than just influencing
satisfaction. They are tied to the natural process of differentiation in emotionally committed
relationships. Your sexual behavior is a window into who you are, and a path to who you want
to be. Therapists' understandings of sex determine what sexual-marital therapy can be.
I. Part-whole errors: confusing a part for the whole.
Common part-whole errors:
1. the nature of human desire
2. other-validated & self-validated intimacy.
3. attachment theory & differentiation theory.
4. sexual function & sexual development.
5. mistaking conceptualization as intervention.
II. The nature of human sexual desire.
III. Sex is a language.
IV. Passionate Marriage:
"Passionate Marriage is about
resilience rather than damage,
health rather than old wounds, and
human potential rather than trauma."
.(from Chapter One)
Copyright 1997 by David Schnarch, Ph. D. All rights reserved.
102
cJl!1.attia;-& 9amJy
d/-eaLth Centet (~)
c:Euite 310, 2922
Cr:rE.'Lfj'LE.E.n. rPa'Lkway, Cr:rE.'Lfj'LE.E./2.1 CoLo'Lado
80439
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The Nature of Sex & Spirit
Sexual desire is a source of guilt, fear, and condemnation for many people, It can also be
a pathway to humanity and spirituality for couples, and for therapists who work with them. By
integrating sex and spirit on theoretical and practical levels, this workshop offers both clinical
framework and case examples of facilitating differentiation through common sexual crucibles of
marriage. This approach demands not only personal and professional maturity and courage, but a
fundamental redefinition of the meaning of relationships and the purpose of therapy.
I.
The necessity of considering spirituality within marriage & family therapy.
II.
All religious traditions attempt to integrate sexuality and spirituality one way or another:
type "A" and type "B" religions.
III.
The roots of sexual theology in Western culture.
IV.
Difficulty integrating sex and spirituality within sexual-marital therapies.
V.
VI.
The spontaneous surfacing of spirituality in pursuing sexual potential.
Spiritual and sexual desire occur at different levels of enlightenment and differentiation.
VII. Resolving common sexual issues in marriage can enhance spirituality and differentiation
in mutually facilitative ways.
VIII. Spirituality is marked, not by the absence of desire, but by fullness of desire.
Self-Transcendence
(self-transformation)
Self-Preservatio~n
...~----+----Self-Adaptation
(agency)
(communion)
(Male)
(Female)
Self-Dissolution
Adapted from Ken Wilber's Sex, Ecology, & Spirituality (1995)
Copyright 1996-7 by David Schnarch, Ph. D. All rights reserved.
dl/{an.iaye & 'Jami[J
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Passionate Marriage TM
Sex, Love, & Intimacy in
Emotionally Committed Relationships
One-Day Workshop
Morning: Passion and intimacy follow predictable but little-understood patterns. The natural ebb of sex, desire, and intimacy can help people and relationships grow-if they know how to
use it. Expanding couples' sexual repertoire can enhance their differentiation and capacity for
intimacy and passion. Afternoon: Case analysis and developing interventions.
Foreplay: negotiating the intimacy, eroticism, and meaning of what follows.
Sex is a language: kissing styles
Sex is a window
Spontaneous behavior vs. prescribed "exercises"
Eyes open sex and orgasms
The process is the purpose
Intense intimacy: tolerating being known
Psychological dimensions of sexual experience
Sexual trance
Partner engagement
Role play
An ecological perspective:
Sex, intimacy and differentiation in emotionally committed relationships
reciprocally stimulate each other.
Diagram (over): Regulating growth and stability in marriage.
Passionate MarriageTM...-Harnessing the natural processes of differentiation
in emotionally committed relationships.
Copyright 1997 by David Schnarch, Ph. D. All rights reserved.
Regulating Growth and Stabili1y
for Individuals/ Marriages/ Families/ and Groups
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Application of The Sexual Crucible Approach developed by Barbara & Don Fairfield. A.C.M.E. leader couple
From: Passionate Marriage: Sex, Love, & Intimacy in Emotionally Committed Relationships
by Dr. David Schnarch. Copyri ht 1997.
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facing the anxiety of defining yourself while getting closer to your partner, a process called differentiation. In his approach, you don't have to compromise or give up your desires; instead, you have to stand
on your own, stay close to your partner, and be prepared to soothe yourself when you don't get what you
want. Sexual encounters provide perfect opportunities to differentiate and develop the strength to love
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Mixing humor and compassion, Dr. Schnarch describes couples' explicit sexual encounters and
dramatic therapy sessions to demonstrate how they went beyond simply curing sexual dysfunctions to
achieve their sexual potential. In this respectful, erotic, uplifting, and spiritual guide to sexual and
emotional fulfillment, David Schnarch seeks to bring out the best in each of us, to help us love on life's
terms, and to develop an invigorating adult sexuality. (Published April, 1997 by W. W. Norton.)
Constructing
Constructing the Sexual Crucible: An Integration of Sexual & Marital Therapy
was published in 1991 by W. W. Norton & Co. This extraordinary book challenges the
fundamental paradigms in which sexual-marital therapy is currently conducted. It conceptually integrates individual, sexual, and marital therapies, providing a fresh look at the nature of intimacy and the diverse barriers to intense eroticism in many marriages.
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The Milton H. Erickson Foundation, Inc., presents
A SEMINAR ON ERICKSONIAN
APPROACHES TO HYPNOSIS &
PSYCHOIHERAPY
December 11-14, 1997 • Phoenix, Arizona
Featuring:
Joseph Barber, Ph.D., Betty Alice Erickson, M.S., L.P.C.,
Stephen Gilligan, Ph.D., Stephen Lankton, M.S.W.,
Ernest Rossi, Ph.D., Kay Thompson, D.D.S.,
Michael Yapko, Ph.D., Jeffrey K. Zeig, Ph.D.
SM
Call or Write for brochure
The Milton H. Erickson Foundation, Inc.
3606 North 24th St.
Phoenix AZ. 85016-6500
(602) 956-6196 • FAX (602) 956-0519
email: [email protected]
Special for Couples Attendees
until Aprill5-Save $100 on registration fees!
Fees are $300 professionals/$200 for full-time graduate students*, senior citizens (55 & older*) and foreign registrations
YOU PAY ONLY $200/$100 with this coupon
NAME: ________________________________
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*Graduate students must provide a letter from their department on letterhead stationery certifying their full-time student status. Senior citizens
must submit a copy of their driver's license as proof of age.
107

intimacy - The Milton H. Erickson Foundation

Transcription

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