Case Studies, Sexual Heroin: Variant Arousal Patterns Are an Obstacle to Intimacy

By McCarthy, Barry; Cintron, Jennifer | Psychotherapy Networker, November/December 2005 | Go to article overview

Case Studies, Sexual Heroin: Variant Arousal Patterns Are an Obstacle to Intimacy


McCarthy, Barry, Cintron, Jennifer, Psychotherapy Networker


Case Studies

Sexual Heroin Variant arousal patterns are an obstacle to intimacy By Barry McCarthy and Jennifer Cintron

When a bewildered woman finally confides to friends that her husband or partner has been avoiding sex for months, or that the couple's rare liaisons are filled with awkwardness and self-doubt, the questions on many lips often are: Is he having an affair? Could he be gay? In our clinical experience, more often than not, the answer is no--homosexuality and extramarital affairs aren't, by a long shot, the only explanations for the male sexual avoidance that brings couples into marital or sex therapy. Far more frequently than most people imagine, we discover the man has another sexual secret: he's involved in a compulsive variant arousal pattern as absorbing, erotic, and hard to kick as sexual heroin.

There's a reason why pornography is the most financially successful business on the Web, with thousands of websites catering to every conceivable fetish. According to experts in the field of male sexual behavior, including Gene Abel and Michael Metz, some two to five million men have either a variant or deviant arousal pattern. Variant patterns, like fetishistic preoccupation with high-heeled shoes, or toes, or rubber, or cross-dressing, may be secret and shame filled, but they harm nobody physically. Deviant patterns, like pedophilia, exhibitionism, and frotteurism (when a person rubs against another to high arousal or orgasm, usually on public transportation), by contrast, are either illegal, or cause harm to others, or both.

Therapists working with couples in which variant arousal patterns are a problem must move on two fronts simultaneously: the intense, secret compulsion must be confronted and the couple's damaged sexual relationship must also be restored. This is urgent work; good therapy for sexual secrets and dysfunction can determine whether the marriage survives or fails. The adage in marital therapy is that good sex alone can't make a marriage, but bad sex can sink it.

A Romance Gone Sour

Take, for instance, Paula and Keith. They were in their early thirties and had been together for four years and married for nearly two when they came for their first therapy session with Barry McCarthy. They were filled with self-doubt and blame, each secretly fearing that their marriage wouldn't survive. Their relationship, they said, had begun in a bloom of romantic love and almost daily lovemaking. But after six months, Keith's passion had dimmed markedly. Despite their deep, genuine affection for each other, their bedroom had become an awkward place. Spontaneity, playfulness, and erotic charge had given way to fumbling self-consciousness. Nothing seemed to flow. Paula worried secretly that her husband didn't find her attractive because he avoided sex altogether and wouldn't say why. The last time they'd made love had been on their honeymoon 20 months earlier. The more Paula asked what was wrong and looked for reassurance, the more Keith avoided not only sex, but any discussion of sex. The decline in their mutual happiness, Keith implied during that mutually blaming first session, was at least partly Paula's fault: she'd gone from being optimistic and self-confident to pessimistic, dependent, and constantly nagging and seeking reassurance.

After our joint initial meeting, I saw Keith and Paula separately. (I find this the most efficient way of getting a client to quickly disclose sexual secrets, and to find out what meaning their mutual sexual distress holds in the narrative of their past and present lives.) Paula told me that when Keith avoided sex, she went into a spiral of self-doubt about her own attractiveness and the viability of the marriage itself. Was it her? (She had a long scar on her thigh; perhaps it turned Keith off.) Was it him? (Perhaps he was, as her friends suggested, gay.) Or was it them? (Perhaps the marriage just wasn't viable.) And Keith's failure to even acknowledge a problem was making her feel crazy in addition to self-doubting. …

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