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Sexual Problems Can Be Complex

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Sexual Problems Can Be Complex

An example of bullying as the underlying cause of a couple’s sexual symptoms

Sally yelled for her husband Jim to hurry into the bathroom—water was everywhere. Sally had decided to wash her hands and all hell broke loose. Apparently, a seal in a pipe under the sink had rotted and water came gushing out like a fire hydrant turned on to cool off urban dwellers. Enter Jim in a rage: “What the hell did you do?” Angered by the injustice of Jim’s reaction, Sally threatened to leave: “Screw you,” she yelled back, “maybe I should just get a divorce.”

In couple’s treatment, Jim told me that he knew he was wrong as soon as the angry, blaming words left his mouth. “I was being stupid. Sally didn’t do anything wrong. I’m so ashamed of myself.” After watching Jim beat himself up for a couple of minutes I asked him what he thought about Sally’s threat to divorce. He thought for a moment and answered: “I was clearly wrong, but I think she overreacted; actually, she always does. There’s no reason to threaten divorce over something like this. In the past, she used to shun me for weeks for something pretty minor.”

Sally and Jim’s exchange was not so uncommon one, particularly so for partners who have experienced being bullied or “picked on” as children. While Jim was conscious of the fact that he was severely bullied by his tyrannical father and by his peers as a child, he wasn’t aware that he had repressed a substantial amount of rage, and of the real-time consequences of a dynamic that have been eroding his marriage. As treatment progressed, it became apparent that Jim sadistically picked on Sally to release his pent up anger. Paradoxically, the bullying also supported his masochistic tendencies by producing shame, and by putting himself in Sally’s line of fire.

Sally, having had bullying parents and a particularly sadistic grandmother, was quite sensitive to being picked on. Her sensitivity often culminated with a reflexive threat to divorce, or what I referred to as a tendency to: “bring a gun to a knife fight.” It is said that inside every sadist is a little masochist, and vice versa.

The multi-generational transmission of bullying notwithstanding, what was most fascinating about Jim and Sally is that they only sought treatment because Jim was suffering from Premature Ejaculation (PE). Barring their sexual difficulty, the couple admitted that their interactional issues wouldn’t have been enough to get them to therapy.

Todd constantly ridiculed his wife Sue about her dress; Sue often countered with slurs about his intelligence (Sue held a master’s degree; Tom was a High School graduate). Both partners grew up in homes where they were severely picked on. Todd had a sadistic, alcoholic father who physically and emotionally tortured him; Sue suffered from the hands of a tyrannical, mentally ill sister who—out of misguided empathy—her parents let rule the house. Anytime Sue complained, her parents would dismiss her with the mantra: “Stop whining, at least you’re normal.”

Despite Todd and Sue’s dynamic, treatment was sought only because Sue had developed vaginismus (i.e., a tightening of muscles surrounding the vagina that prohibited sexual intercourse)—something that gave Tom even more ammunition to attack her.

My point: Both couples were primarily concerned about their sexual symptoms, but they couldn’t—for the life of them—see the connection between their torturous histories, their bullying interactions, and their sexual symptoms. When they were able to do so, their symptoms dissipated and their relationships improved. Hence, my treatment focused heavily on putting an end to the bullying. Sexual exercises—most common for treating sexual problems—played only a small role in both therapies.

Oftentimes sex therapists focus too heavily on alleviating sexual symptoms and miss how influential the past and the present relational dynamics are in the lives of couples. Balancing, and seamlessly integrating content and process is the true art of couple’s therapy.

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Dr. Stephen J. Betchen is a licensed marriage and family therapist and certified sex therapist, as well as a critically acclaimed author and regular contributor to the popular Ladies’ Home Journal column, “Can This Marriage Be Saved?” He currently serves as Clinical Assistant Professor at Thomas Jefferson University. For more than 25 years, Dr. Betchen has helped couples repair their relationships and reach new levels of happiness, whether they’re battling about in-laws, sex, parenting, infidelity, money, careers—or anything in between. (Case in point: He once treated folks who were at odds over the wife’s weight and the husband’s constant criticisms!) Dr. Betchen’s approach to couples therapy is refreshingly simple: He offers no gimmicks, slogans or quick fixes to nagging problems. Instead, Dr. Betchen believes that individuals change only when they discover what’s really driving their behavior—and that relationships change only when couples develop empathy for their partners and understand what really drew them together. (Turns out that physical attraction is just part of it.) Dr. Betchen provides in-depth analysis of couples’ attitudes and behavior, enabling them to see themselves and each other in a new light. And from there, he delivers real-world advice that teaches couples how to change themselves—and their relationship. Dr. Betchen is the author of numerous professional articles on relationships and makes frequent media appearances. His expert opinions often appear in national publications, including Family Circle and Men’s Health. In addition to Magnetic Partners, Dr. Betchen is the author of Intrusive Partners-Elusive Mates.

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