Academic journal article Journal of Marital and Family Therapy

Integrating Sex and Attachment in Emotionally Focused Couple Therapy

Academic journal article Journal of Marital and Family Therapy

Integrating Sex and Attachment in Emotionally Focused Couple Therapy

Article excerpt

In this article, sexual functioning is placed in the context of love as an attachment bond. Attachment theory offers the most coherent and empirically validated theory of adult love and is summarized together with the implications of this theory for the practice of couple therapy in which sexual issues are often addressed. Recent research on attachment and sexuality is outlined and a model of healthy sexuality where attachment and sexuality are integrated is offered. The principles of an attachment-oriented approach to sex issues are set out and illustrated with reference to the process of emotionally focused couple therapy. Case descriptions and brief in-session transcripts are included.

In the introduction to the fourth edition of the classic text Principles and Practice of Sex Therapy, Leiblum (2007) notes that there has been increasing recognition of the need for an integrated approach to the treatment of sexual disorders and complaints. The advent of oral medications has paradoxically made it apparent that "treating the genitals alone is unlikely to lead to long-term success" (p. 7). A focus on relationship context is essential. The success of psychological interventions focused on individual partners is clearly associated with relationship factors. In a British study for erectile dysfunction (Hawton, Catalan, & Fagg, 1992), the success of sensate focus and graduated sexual stimulation techniques was determined largely by the couples' ratings of communication prior to treatment. As Masters and Johnson (1970) noted, there is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy.

Just as the field of sex therapy is once again recognizing the power of the relationship in which sex occurs, so couple therapists are recognizing the power of sexual responses to define the quality of love relationships. While contented partners attribute only between 15% and 20% of their happiness to a pleasing sex life, unhappy mates ascribe 50-70% of their distress to sexual problems (McCarthy & McCarthy, 2003). Sexual problems most often reflect and then actively exacerbate relationship conflict. They also exacerbate distance. Once sexual contact ceases, often sensual and affectionate touch follows. Couple therapists almost inevitably find that sexual anxieties, conflicts, and deprivation are part of relationship distress. While some therapists focus on relationship issues and trust that if partners get along better, sexual issues will resolve themselves, many couple therapists find themselves actively helping couples to specifically address sexual difficulties as part of the process of relationship repair and relapse prevention, especially when it is clear that the relationship is contributing to partners' sexual functioning difficulties, and these difficulties are not solely caused by organic or physical health problems. The line between sex and couple therapy is becoming finer and finer.

However, in the area of sexuality, couple interventions still tend to be narrow or "problem-oriented" (Heiman, 2007), perhaps because there is little clarification on what general relationship factors are important in defining sexual disorders or satisfaction. In terms of a general explanatory framework, sexual problems have often been seen as arising either from an individual partner's anxiety that is exacerbated by negative interactional patterns or from too much "emotional fusion" or "enmeshment" within a couple relationship that is then presumed to dampen eroticism and desire (Schnarch, 1997). Neither of these frameworks has placed sexual responses in the context of a systematic and well-researched theory of adult love that offers a couple therapist a map to a couple's sexual and relationship problems and a clear guide to resolving these problems.

In this article, sexual functioning is placed in the context of attachment theory and the process of emotionally focused couple therapy (EFT), an empirically validated approach to repair distressed relationships that focuses on adult relationships as attachment bonds (Johnson, 2004, 2008, 2009). …

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