Confessions of a sex therapist

Confessions of a sex therapist: The middle-aged woman who’s gone off sex and the depressed husband who can’t make love

Counselling organisation Relate has seen a two-fold increase in the number of couples turning to sex therapy in the past five years.

Here, we look at a week in the life of a busy sex therapist. Denise Knowles, 54, from the East Midlands, has a thriving private practice as well as working with Relate clients. This is her eye-opening week:

MONDAY

11AM: My first clients of the week walk hesitantly into my counselling room at Relate in the East Midlands. The walls are painted a soothing cream and everything is designed to make people feel at ease.

But smartly-dressed Sam and Fiona perch on the edge of their chairs opposite me and do not make eye contact with each other.

Fiona, 33, busies herself by arranging her handbag at her feet and Sam, 34, leans towards me, pressing his hands together in front of him. 

Marriage counselling: Relate has seen a two-fold increase in the number of couples turning to sex therapy in the past five years

Marriage counselling: Relate has seen a two-fold increase in the number of couples turning to sex therapy in the past five years

He is a business development manager and Fiona works in PR. They don’t have children and to look at them you would imagine they were the perfect couple.

Yet there’s a complete absence of affectionate body language or mutual touching. After a long pause, I ask how I can help. This is their first visit  –  I always try to see couples together for their 50-minute introductory session.

Sam glances nervously at his wife, then blurts out: ‘We don’t make love often enough.’

Fiona is bright red. ‘How often do you feel you should make love?’ I ask.

‘At least three or four times a week,’ he replies. ‘But we only make love two or three times a month.’ 

‘Do you agree this is a concern?’ I ask the clearly uncomfortable Fiona.

‘It isn’t such an issue for me,’ she replies, quietly.

I know that Sam made the initial phone call to us and I wonder if he had to coerce her into coming along.

‘Perhaps we don’t have sex as much as we used to,’ she adds. ‘But that’s normal, isn’t it?’

She looks at me for reassurance. They have been married for four years and are thinking about trying for a baby. Both have very busy working lives, earning about the same amount of money and, as they talk more about their daily lives, I am beginning to get the impression Fiona is feeling under pressure.

The subtext seems to be that she feels she has to do everything: run the home, do the shopping and arrange their social lives, as well as hold down a full-time job  –  and is concerned how she will manage a baby as well.

He, meanwhile, like many of us, is fed on a diet of the supposedly non-stop fantasy sex enjoyed by celebrities, and feels that in these early years of their marriage they should still be swinging from the chandeliers.

Slowly, we begin to explore these issues. I suggest they both come for the next stage, which are about three sessions on their own, in which I will explore the history of their relationship.

To many men, sex represents love and reassurance. If Fiona doesn’t want to make love, he thinks she is falling out of love

Then they will come to see me together, for anything up to 12 sessions, and I will give them ‘tasks’ to practise at home.

Right at the end of the session we have a revelation. Sam has seemed increasingly agitated and suddenly he says: ‘You don’t even want to make love to me!’

Fiona looks at him, shocked.

‘I don’t think you love me any more,’ he says, and then looks about to cry.

I am not surprised. To many men, sex represents love and reassurance. If Fiona doesn’t want to make love, he thinks she is falling out of love. In fact, this is not the case at all, but he cannot see it. I do think their relationship can be saved, but thank goodness they came to see me before real damage was done.

They agree to come back and explore these problems much more fully with me, so that is an initial breakthrough. 

TUESDAY

9AM: A private consultation in the clinic at my home. Barbara and John are in their mid-50s, a very dignified, middle-class couple whom I have been seeing for three months. They are in the middle of the joint sessions.

Married for 30 years, they clearly love each other, but over the past two years John has said that Barbara seems to ‘freeze’ whenever he tries to touch her and their sex life has dwindled to nothing.

Their children have grown up and left home, and John had been looking forward to bringing the honeymoon romance back into their marriage.

No sexual feelings: Barbara and John's sex life has dwindled to nothing (posed by models)

No sexual feelings: Barbara and John’s sex life has dwindled to nothing (posed by models)

But Barbara does not want to make love to him at all and admitted in her first interview that she has no sexual feelings whatsoever any more  –  towards John or anyone.

Through the individual history sessions, I discovered Barbara has a lot of residual anger towards John. She felt he left the upbringing of the children entirely to her and neglected her emotional needs as he pressed forward with his career. 

She feels he has been controlling, insensitive and does not appreciate that she gave up a career as an artist to raise his children.

Not being good at expressing this anger, she has internalised it and convinced herself she no longer feels anything for him. He is oblivious to this. At one session, they both sat in my consulting room in floods of tears. She realises she has lost her ability to relax and allow herself to feel sensations.

I have set them a series of home tasks. The first was to sit on the sofa and hold hands. They haven’t done this for years. Next, they had to lie together in bed, naked.

Again, they have not been naked in front of each other for years, wearing pyjamas and a nightie and sleeping on opposite sides of the bed.

Barbara admits the tasks have been really hard for her  –  she felt extremely vulnerable. But she has been touched at how gentle and caring John has been.

With a giggle, she tells me that last night they had a cuddle and kiss. I don’t want them to try anything sexual yet  –  they need to re-establish their intimacy first.

Barbara admits she likes John stroking her hand and that the skin-on-skin contact was reassuring. I end the session by telling them to sleep naked, cuddle and kiss, read books together or share a bath. Silly, fun things to make them feel relaxed and intimate, without the pressure of full sex.

At lunchtime, I sit and think about them. I see so many couples who say they have ‘gone off’ sex. There is either a loss of desire or ‘inhibited sexual desire’ in that the desire is there, but the performance is not. 

Many people do not realise the effect age has on us as sexual beings. It is perfectly normal in women over 40 to find sex more problematic physically and for men to find they cannot perform as they used to.

Often, they either blame themselves or each other, thinking it is indicative of a relationship problem, which is wrong. These problems can easily be overcome, with therapeutic support, medical help, time, and an absence of stress.

We live in an age where so many people have a distorted fantasy about sex. Women’s magazines are full of articles about multiple orgasms and everyone, via the internet, has easy access to pornography. Older couples think they should be having much more sex.

WHO KNEW?

Up to 50 per cent of adults report having sexual problems

 

2PM: Nina and Joe bounce into my office, with a big smile on their faces. I am delighted, as this young couple have been through so much. They are in their 20s and have been living together for three years.

Joe has a problem in that he can make love, but not finish. They want to start a family and Nina thinks the problem is her fault.

But she tells me love-making had become mechanical before this difficulty emerged. This is their three-month ‘follow-up’ meeting to check that their relationship is still on course, and I can tell by their faces that it is!

They have had money worries, Joe had been feeling anxious about different aspects of his life and he couldn’t relax in his love-making. The less success he had, the more he worried it would happen again.

Nina, meanwhile, was trying to reassure him, while thinking that it must be partly her fault. But through a series of intimate exercises, they have discovered a trigger  –  something physical Nina can do  –  which seems to release him. They have learnt that touching, kissing and stroking does not have to lead to sex, so the pressure is not always there. 

THURSDAY

After a day off on Wednesday, in which I have done some research, I feel fresh and ready to go.

11AM: Alexandra is 47 and has been divorced for seven years. She’s a successful career woman and runs her own finance business. She has a good relationship with her ex and her two teenage children are both at private school.

This is her third session and at first I found it hard to understand why she wanted to see me. Then, halfway into our first session, she admitted: ‘I don’t know what to do!’

She hasn’t had a sexual relationship for five years and the one she had after her divorce was a disaster.

Many couples feel under pressure if one of them 'goes off sex'

Let down: Many couples feel under pressure if one of them ‘goes off sex’ (posed by models)

She tells me she had very little sexual experience before she married, her parents were strict Catholics and she is terrified of the dating game.

She’s had three dates, but the men were either odd or made it very clear they expected sex at the end of the evening.

This totally threw her. She is looking for a long-term partner, but is worried about the whole business of middle-aged sex and mortified at the thought of taking her clothes off in front of a man.

Now, she tells me, she has been emailing a 46-year-old man who sounds respectable, looks lovely from his photograph and seems to share her interests.

He lives a long way away and she wants to invite him to stay, but has got herself in a state at the thought of sex. As we talk, she reveals her love life with her ex-husband was not fulfilling. She hadn’t felt able to tell him what she liked and thought of love-making as being for his pleasure, not hers.

Now she wants more, but is extremely naive. She needs to get to know her body and find out what she enjoys, focusing on her wants, so she can share these sensations with another man. At first she felt extremely shy, but is now more relaxed with her own body.

I suggest she should not leap straight into a sexual relationship with this man, but take it very slowly. For her, I think it is all about confidence. She needs to feel sexy, desirable and in control.

At the end of the session, she gives me a happy smile and says she is going shopping for clothes. I am delighted to see the increasing confidence in her body language and in the way she regards herself.

FRIDAY

1PM: A Relate session in the East Midlands. Mary and Nick have both been married before and are now married with two children each, so they have a step-family of four.

Mary’s children live with them all the time, Nick’s stay every Wednesday night and every other weekend. They are in their late 40s.

Mary is here alone. ‘Everything should be fine,’ she says, twisting a handkerchief between her hands. She looks up at me. ‘There are lots of cuddles and touching, the kids are all getting on great, but. ..’ she tails off and I think she is about to cry.

‘But I could sit next to him naked on the sofa and he’d say: “Shall we have a cup of tea?” There’s no spark. He wonders why we aren’t getting on in bed, but I feel no real enthusiasm from him. We’ve been through so much, and I am terrified of failing at yet another relationship. It must be me.’ I reassure her that it is not just ‘her’.

Gradually, she tells me that Nick felt very put down by his first wife. She was always telling him he was useless, as a dad  –  and in bed. Nick has confirmed this to me, too. Mary says: ‘I don’t think he has a sexual bone in his body.’ Then she cries.

It’s very distressing for her, as she loves him, he’s a great father to her children and she’s really worried she has rushed into a relationship without thinking it through.

But she can’t live with such a patchy and unsatisfying love life. I have suggested to Nick that he improve his very poor body image and he has lost weight, been to the gym and is much more energetic.

Couples have to realise that sex will change in a long-term relationship. You are likely to have sex less as you get older, but that doesn’t mean it will be less pleasurable

But he was made redundant last year, which didn’t help his self-image. Mary feels they are becoming detached, and she says, tellingly: ‘I just want someone to make me feel I am a very desirable woman.’

I suggest that they need, first of all, to re-establish their confidence in each other. They need to praise and compliment each other, in a non-sexual manner. They need to make time for each other, away from the children, and go out on dates.

I suggest they practise touching in a non-sexual way, hugging and holding hands.

They need to re-establish what attracted them to each other and work back from there.
Nick needs to feel he is loved and valued. He’s ‘switched off ‘ his sex drive, as a defence mechanism. Mary agrees and says she can now see how vulnerable he is. This is the start of their journey to rebuild their relationship.

You cannot over-estimate how important sex is in a long-term relationship. It’s the private bond between couples, the unspoken intimacy which makes their relationship sustainable and successful.

But it doesn’t have to be swinging-from-the-chandeliers amazing, nor does it have to be every night. What it has to be is fulfilling for both partners, without one feeling under pressure.

Couples have to realise that sex will change in a long-term relationship. You are likely to have sex less as you get older, but that doesn’t mean it will be less pleasurable. Do not let that intimacy go.

In nearly all marriages that fail, the sex has ended or it has become a selfish act for one partner. Sex isn’t just the act itself, it is touching, hugging, giggling and holding hands.

My parents have been married for 57 years and they still hold hands. People have to have realistic expectations of a long-term relationship, in which sex is a part of the total intimacy.

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