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Helping Couples Deal with Intimacy and Sexuality

Cognitive and Rational-Emotive Behavior Therapy with Couples:

Love and sex are universal themes in almost every aspect of art and culture. Unfortunately, many couples have a great deal of difficulties living up to the ideal portrayed in art and literature. Indeed, sex frequently fails to live up to its romantic apotheosis and couples often end up disappointed or distressed. In literary depictions of romance, couples in love fall into each other’s arms and make effortless love and they go on loving and making love until the end of their days. Sadly, the ideal of the synchrony of love and sex is not as common as one may hope. And when love and sex are indeed coalesced the bond between the two is often short lived. Why does this happen? In examining this question we can turn to both Albert Ellis and Aaron Beck. Beck (1989) predicated much of his couples therapy techniques on his observation that romantic passions that begin with the intensity of drug intoxication frequently wear off, as do drug induced highs. He noted that this fading leads to changes in the partner’s perceptions of each other. As romance begins to fade, the partners begin to suffer an increase in cognitive distortions about each other. His prescription is quick and appropriate. He details a range of cognitive changes and exercises to give the couple tools to attenuate the conflict that ensue from these distorted cognitions. However, what he fails to adequately address is why after a few years of bonding, do couples that saw each with blurry-eyed passion suddenly become overwhelmed with distorted cognitions.

There is a theoretical drawback with most counseling for sex and intimacy problems. In essence, they all help couples make changes to address a degrading bond but none clearly explain that why this so frequently occurs. This includes Cognitive Couples Therapy, Emotionally Focused Couples Therapy (Johnson, 2004), Acceptance and Commitment Therapy (Jacobson & Christenensen, 1996) and other approaches. However, as far back as the early 1940s, Albert Ellis recognized that a significant portion of couples’ conflict has to do with waning sexuality. Importantly, he noted that sexuality is derived for evolutionary and biological reasons (Ellis, 1957) and the contributing factors to the experience of sexuality are not static. Consequently, he counseled counselors to treat sexual issues with an understanding of psychology, sexology and anthropology (Ellis, 1954). Early in the development of sex therapy, Ellis recognized that sexual desire and choice are both malleable and ephemeral. It is for this reason that he saw sexual compatibility as often requiring outside sources of stimulation (Ellis, 1972). He did so in recognition of the problem discussed above—sexual passion and romantic love are often fleeting. This is the fundamental problem faced by counselors treating couples for sexual difficulties.

Relationships and Passion

Why do couples suddenly notice the flaws and blemishes that they have not seen in the early stages of the relationship? Why are they often exasperated by their lover’s personality that they had once found charming and engaging? The answer is found in very old brain circuits that alter perception when in passionate states. Sexual arousal can subvert many limbic survival defenses. Disgust is attenuated when one is sexually aroused (Stevenson, Case, & Oaten, 2011). For example, think about your typical reaction to finding saliva on the rim of a soda bottle offered to you by a stranger—it most likely is handed back with haste and a grimace. Yet when sexually aroused we greedily suck the saliva of our paramour—this popularly known as French kissing. Also, when aroused we will orally stimulate portions of the body immediately adjacent to the sources of urine and feces. The same people who passionately make oral love will stop taking mints offered near the restaurant cashier when they are told that most restaurant patrons don’t wash their hands. Sexual arousal even attenuates rational caution. The most sociopathic outlaw appears caring and loving when a woman is strongly attracted to him.

These biological predicates of love and sex need to be understood by counselors treating couples with sexual and physical intimacy problems. Too often sexual problems are viewed as primarily social, cultural or learned. In contrast, the overwhelming evidence presented by sex researchers indicates that love is a biological phenomenon that bonds couples only long enough to mate and rear a child (Fisher, 2004). Studies have shown that romantic love is a result of activation of brain reward circuits such as the right ventral tegmental area, the right postero-dorsal body and the medial caudate nucleus (Aron et al., 2005) , primitive brain regions that regulate motivation and pleasure. Importantly, romantic or sexual love is a cross-cultural universal constant that can best be explained by innate neuropsychological systems. These systems evolved to produce intense sexual yearnings and subsequent bonding. These cravings emanate from the reward centers of the brain and lead to intense withdrawal-like cravings for the absent lover. In addition, they tend to attenuate all negative judgments about the lover. Sadly, for many couples these love bonds fade in a year or two (Fisher, Brown, Aron, Strong, & Mashek, 2010). Love scientist Helen Fisher pointed out those early prehumans in tribal groups began to lose interest in their mates after a child was old enough to integrate into the tribe.

Sometimes love lasts just long enough for sex, sometimes long enough to wean a child and in rare and very romantic cases. Love and sex remain intimately connected for a lifetime. Sadly, the third case is rare. The dismal reality, based on the high rate of divorce and relationship dissolution is that the transition from romantic love to an enduring conjugal love commonly fails to evolve. Although, divorce rates remained fairly constant in the last two decades, there has been a trend towards fewer couples marrying (Kreider & Ellis, 2011). For example, approximately 85% of people born from 1940 to 1944 were married by the age of 30 in contrast to the 65% of people born from 1970 to 1974. Estimated divorce and separation rates range from 40% to higher rates as those found by Martin and Bumpass (1985) who concluded that when allowing for under reporting the actual rate is closer to 66%. Whatever the precise rate of divorce, it likely understates the rate of relationship dissolution as many relationships fail before marriage is achieved.

It is difficult to precisely measure the proportion of non-conjugal relationships that dissolve but it is reasonable to assume that it is no better than for married couples. Studies that did manage to yield some estimates found the prospect of successful ongoing relationships to be somewhat bleak. In an Internet survey of 3,000 people, 35% reported having had a relationship breakup in the past 10 years. And of those between 18 and 34, 59% reported recently having had a recent relationship breakup (Fetto, 2003). This is concordant with the finding of Simpson (1987) who surveyed 234 non-married individuals with an average age just under 20. In a follow-up just 3 months later, 42% of those surveyed had broken up.

Irrespective of marital status, it seems that the strength of the coupling bond is enhanced by time spent together, personal commitment to the relationship, level of love, degree of social support and assessment of availability of better mates (Felmlee, Sprecher, & Bassin, 1990). This last variable is one that is often ignored. That is, on some level, partners are always vigilant for mates who can offer more. This was illustrated in a study of lesbian couples in relationships in which partners who perceived few alternatives to their mate tended to be more committed (Beals, Impett, & Peplau, 2002). The social exchange perspective of relationships appears to be supported by the high rates of relationship dissolution and in fidelity (Byers & Wang, 2004). In short, it posits that relationships, irrespective of love, are founded on an exchange of perceived value. In the starkest terms, most members of loving relationships remain vigilant for a better mate. Couples’ counselors often overlook this unfortunate reality.

Most relationships traverse several phases: the first is the initial excitement of romance, then a fading of passion, followed by a change in the way a partner perceives his or her mate. This perceptual change is such that physical and character flaws that were obscured by passion now become visible. Romantic attraction tends to mask the defects, blemishes and idiosyncrasies of the partners. With the imperfections more salient, there is often a surge in complaints and criticisms that typically leads to conflict. In order to apply rational emotive/cognitive behavioral solutions to the problems of marriage and love, it is first important to understand the essential nature of these two fundamental components of social interplay. As Nobel laureate Daniel Kahneman pointed out, we are prone to like or feel we have knowledge with things that are familiar (Tversky & Kahneman, 1973, 1974). Love relationships, coupling and marriage are so ubiquitous that they seem quite scripted. In fact, couples are bound together by a complex of none conscious, social, cognitive and personality factors that take a bit of analysis to fully grasp. A therapist who fails to address the hidden forces contributing to difficulties in relationships will undermine his or her best efforts to help.

Sexual Relationships and the Evolution of Human Sexuality

In 1895 Breuer and Freud published a book titled Studies in Hysteria that paved the way for a century of psychoanalytic explanations of human behavior. The theme of the explanations is that expressed or repressed sexuality and aggression underlie and direct all human behavior. Indeed, even the most creative acts are viewed as resulting from disguised sexual intentions in the form of sublimation. Although, psychoanalytic theory has largely failed to meet research support (e.g., Ellis & Abrams, 2008), it seems to have stumbled onto a key principle of today’s zeitgeist evolutionary psychology. Evolutionary psychology supports the idea that sex does permeate most every aspect of our lives. A man does not buy the expensive sports car only because he wants to drive fast. A woman does not dye her hair or buy a snug fitting dress because she wants to look good for herself. Even someone cramming for college entrance exams might be trying to bring his or her grades up for reasons other than college admissions. Entrance into a better school leads to increase income and consequently better access to a mate.

Supporting this perspective, psychologist David Buss (2005) theorized that virtually all male violence has a sexual basis. This point was compellingly detailed by authors Malcolm Potts and Thomas Hayden (2008) who cogently argue that most wars can be traced to innate sexual competition. This evolutionary perspective of violence is based on both direct and indirect sexual jealousy. Direct sexual jealousy usually involves a male guarding his mate, whereas indirect jealousy extends to encounters that are tangential to the love relationship. For example, the rage a man feels when slighted is abstractly sexual as it may result in his losing prestige or social standing. Since all men are potential sexual competitors, loss of face typically leads to a diminution in a man’s access to females. Indeed, many evolutionary psychologists opine that homicidal jealousy is an evolutionary adaption since killing a direct or indirect sexual competitor was an efficient solution during human evolution. Why not? There were no jails, lawsuits or any consequences save for revenge by the slain man’s kin. Killing one’s sexual competitor smoothed the path towards passing one’s genes to future generations. In short, evolution may have made it more adaptive to kill than be cuckolded.

The need to take an evolutionary view of sex is emphasized by Dobzhansky (1973), who said “nothing in biology makes sense except in the light of evolution.” By logical extension it follows that nothing in sexuality makes sense except in light of evolution. Psychologists who attempt to understand and treat couples in distress must at least make an attempt to understand human social behavior in terms of our evolutionary past. Usually one can infer the underlying meaning of human behavior by looking at how that behavior would have been adaptive during our early evolution. Human sexuality during our distant past was unlikely to follow the Western ideal of long-term monogamous relationships. Indeed, sexual monogamy in nature is quite rare. Birds that are often cited as forming pair bonds for life often do so, but they rarely maintain sexual monogamy. Extra pair copulations (EPC’s) or what married couples would denote as adultery, seems to be remarkably common among birds in pair bonds. Birds like the passerine and the cockatiel, which are known to be socially monogamous have a substantial number of their offspring fathered by males outside the pair bond (Fossøy, Johnsen, & Lifjeld, 2006 ; Spoon, Millam, & Owings, 2007). Why do birds “cheat” on their mates? It seems that a pair bond is beneficial for raising the hatchlings that includes protection and procuring food. It is also beneficial for the female’s genetic legacy to obtain genes from males that offer the best genes possible. It seems that female birds have developed the ability to discern good genes in males and in turn male birds work very hard at trying to highlight their genetic endowments. This is accomplished through extravagant displays such as that of the peacock (Loyau, Jalme, & Sorci, 2005), the ability to acquire prime territory as in the case of the bowerbird (Pruett-Jones & Pruett-Jones, 1994) and the ability to fight (Edler & Friedl, 2010). In short, sexual behaviour in almost all species includes a strong tendency for females to seek males with the best genetic endowment. There is little doubt among evolutionary psychologists that this is case for humans.

This pattern is also observed in apes, animals that are quite genetically similar to humans. The most similar, Bonobos and chimpanzees are both none monogamous and highly sexually competitive. When a female chimpanzee is in estrus, she will mate with numerous males in short order. If there is ever a semblance of monogamy, a chimp pair will go off for a few days on what primatologists label consort relationships (Fisher, 1992; McGinnis, 1979). However, upon their return the pair bond tends to rapidly dissolve. It is more common for chimpanzee sexuality to involve what amounts to mating frenzies with multiple male-female pairings. During these encounters there is rarely internal aggression so long as the dominant male’s access to females is not impeded. Despite the restrictions of the male hierarchy, females in estrus will mate with eight or more different males per day. Like their larger cousins, Bonobos also are quite promiscuous with virtually no sexual pair bonding. These close human relatives are not only extremely promiscuous but also seem to include both heterosexual and homosexual sex in all their social interactions (Parish & De Waal, 2000 ; Ryan & Jethá, 2010).

Primates who don’t form pair bonds use a vicarious method of sexual rivalry; they let their sperm compete for them. A chimpanzee produces approximately 223 times more sperm than a gorilla (Fujii-Hanamoto, Matsubayashi, Nakano, Kusunoki & Enomoto, 2011). Why is this the case? Gorillas live in small groups in which one male mates with multiple females—no sperm competition, hence their small testicles. Chimpanzees are much smaller animals, tipping the scales at around 120 pounds but they have large testicles that together weigh about four ounces (Kenagy & Trombulak, 1986). Since female chimpanzees in estrus mate with several males a day, the male chimpanzees have evolved to be large and to produce a large number of sperm cells in order to increase the chance of fertilization. Humans have a testicular size that falls between gorillas and chimpanzees. This suggests that humans have evolved a mating system that is neither as promiscuous as that of the chimpanzee, nor as exclusive as that of the gorilla. Nevertheless, all indicators denote that humans are a promiscuous species whose sexual impulsiveness can be briefly held in check by romantic love.

In their book the Myth of Monogamy, Barash and Lipton (2001) compellingly argue for the innate human tendency for polygamy. They point out that virtually no animals are monogamous, including birds - the genus most often cited as emblematic of monogamy. This is also the disillusioning case for the paradigm of pair bonding, the prairie vole. These mate-for-life rodents do indeed stay together for life but the female very often finds the time to mate with other males (Ledford, 2008). What about human cultures? C.S. Ford and psychologist Frank A. Beach studied 185 human societies (1951) and found 39% approved of extramarital sexual relationships. More recently, Helen Fisher and her coworkers observed that 84% of human societies permit some form of polygyny (Tsapelas, Fisher & Aron, 2011).

What does all this mean? In distilled form, it means that monogamy, especially sexual monogamy, is not the norm for primates—and every bit of social data demonstrate that this strongly applies to human primates. Indeed, the evidence points to the fact that serial monogamy with a substantial degree of infidelity is something that we are evolutionarily primed for. This being the case, couples are likely to confront many sexual challenges that are expressions of a biological rather than a psychodynamic unconscious. This fact is particularly important for the counselor working with sexual problems. The evolutionary tendency to lose sexual passion is just one of the problems couples face. Some of the more vexing ones will be subsequently discussed.

Paraphilias, Fetishes, and Problems of Preference

Just as humans seem to be evolutionarily primed for sexual interpersonal diversity, we need to be primed to be aroused by other people. However, for men there seems to be far more variety in this priming than in women. This greater variation in sexual arousal cues is in part due to the male’s reliance on visual signals for sexual arousal. Ideally, the source of arousal would be the shape and form of another person’s face and body. For a heterosexual man it will be the face and body of a woman for a homosexual it will be that of a man. However, men are extraordinarily more prone to paraphilias than women. That is, some men are not aroused by a person’s attributes but by peripheral aspects, by social situations, or other cues that make the other individual largely irrelevant.

In contrast to animals, in which the mechanics of sex vary very little, with humans the range of sexual expression is far more diverse. Indeed, sometimes it is hard to recognize certain lustful behaviors as sexual at all. Some sexual acts are so far from the archetypal theme of physical intimacy that misses the target completely. Hence the term paraphilia, which is derived from Greek words meaning beside or to the side of love. Thus, the individual who has a paraphilic sexual focus is often denied the intimacy that sex can bestow. And for some, sexual arousal cues are so inconsistent with affection or tenderness that they serve to alienate potential lovers. It is this manner of paraphilic sex that is most often categorized as a disorder (American Psychiatric Association, 2000) . Here the paraphilic individual is so focused on a sexual arousal cue that it is nearly completely divorced from the person who possesses it. Interestingly, as divorced as a paraphile may be from intimacy, he or she will almost always require a person consistent with his or her gender choice for the paraphilic act. For example, if a heterosexual man requires degradation for arousal, he will always want that degradation to come from a woman. For most people with paraphilias, the need for the fetish object or the paraphilic act is linked to no shame, distress or social impairment. This fact is the basis for those who argue that paraphilias should not be categorized as sexual disorders. A cogent proponent of this position is Charles Moser (Moser, 2009 ; Shindel & Moser, 2011). In a study conducted prior to common access to the Internet, Moser and his colleagues (Moser & Levitt, 1987) took a survey of 178 men recruited at a sadomasochism support group, through an ad placed in a sadomasochism magazine. A portion of the findings are presented in Table 7.1 below.

Table 7.1 details the type of paraphilic interests found in those who were active in a fetish lifestyle. It shows that people who are active in a paraphilic lifestyle tend to be aroused by acts that are commonly considered shocking or offensive. Moser surveyed people who led active paraphilic lifestyles. An estimate of the prevalence in the general population was found in an informal ongoing Internet sex survey in which more than 70,000 anonymously responded (http://www.survey.net/sv-sex.html). The check list has three levels for each arousal cue—curious, mild, and heavy. Respondents were permitted to make multiple choices so that someone aroused by mild pain could also select both curious and heavy pain. The results set forth in Table 7.2 indicate that paraphilic interests are quite common and therefore normal. However, like any sexual proclivity, when taken to an extreme, it becomes an acute barrier to sexual intimacy.

Normal or not, paraphilias present a particularly difficult problem to heterosexual couples, due to the fact that the great preponderance of women do not find most paraphilias arousing or even acceptable. In some cases an accommodating lover will indulge the paraphile, but more often the paraphilia becomes a shameful secret that is exercised outside the relationship or is relegated to fantasy. In either case it creates a sexual distance in the relationship. Interestingly, it appears that sadomasochistic sexuality or other paraphilias are far more accepted among gay men. In lesbians they are both less common or tend to be attenuated in intensity. This is in contrast to many male paraphiles who absolutely require the paraphilic cue for arousal or orgasm.

Counseling for a Paraphilic Partner

Paraphilia, an almost exclusively male disorder may allow for a relationship with genuine love but typically has little in the way of sexual communication and intimacy. As noted earlier, the paraphile’s lover will virtually never directly arouse him. Instead, the lover becomes one of several “props” that are necessary for sexual arousal. It is important for the counselor to be aware that paraphilias are as refractory to change as one’s sexuality. That is, it is no easier for a man with a foot fetish to change to become aroused by a whole woman than it is for a straight man to become visually aroused by a penis.

Since more paraphiles have learned to keep their propensities secret, they will typically be exposed in a relationship when their guard is down. A man is caught masturbating to fetishistic pornography; his wife discovers sexual implements, women’s undergarments or membership on a fetish site like FetLife. When exposed, fear and shame often lead to denial, explanations of experimentation or if inescapable vows to change. The essential fact that the shocked partner must be guided to accept is that her partner will not change. Counseling for this couple with this problem must include an assessment of the severity of the paraphilia. In the more severe forms it tends to exclude all traditional sexual intimacy and be obsessively consuming. In such cases the relationship is in great peril unless the non-paraphilic partner is extraordinarily accommodating. In less severe forms, if both members are willing, the couple needs to be helped to build a sex life that includes the fetish. Common beliefs among women who discover their mate is a paraphile are “He is a pervert and a terrible person for having these desires,” “He completely deceived me about his love, and our relationship is a total lie,” “He should be able to be turned on by me without his fetishes” or “If he really loved me, he would be attracted to me without needing his sex games.”

The response of the male lover when his mate discovers his predilection is often shame, guilt and denial. Counseling for a couple facing this difficulty needs to address this aspect of the problem. Men “outed” as paraphiles will suffer beliefs like: “I am a pervert and terrible person for having these desires,” “I am not a real man if I need to be aroused in such a sick way” or “I can never be happy with these desires.” The counselor should help the client challenge these irrational beliefs. Counseling for the woman must address beliefs about shame, rebuke and betrayal. The woman needs to be helped to challenge beliefs that the paraphilia is a volitional betrayal of the relationship or that her lover’s sexual desires denote a lack of love. If this can be successfully conveyed, then the next phase of counseling can commence.

This second phase of the counseling must involve strategies to help the couple develop a sexual compromise that permits limited expression of the paraphilia. For example, if the man has a lingerie fetish such that he is aroused by wearing women’s undergarments, his spouse must find her comfort range with his dressing this way prior to or during sex. If she finds it offensive or distracting, a compromise can be reached in which he uses the lingerie for arousal prior to coitus. The therapist can facilitate the process by helping the paraphile’s spouse explore the basis for her aversion to his arousal cues.

Problems with Arousal

The most common source of failure of sexual arousal is the fundamental gender difference in arousal cues. Men are visually aroused and tend to be less discriminating in that arouses them and when. Women typically require displays of emotional commitment, affection, stability and quality from those who would arouse them. Both of these general rules have exceptions, but they are important starting points for inquiry in counseling couples with arousal difficulties.

One arousal problem that is particularly dreaded yet easy to treat is erectile dysfunction. Studies have shown that this is more common a problem than most afflicted men may think. And this fact is something that needs to be conveyed in couples’ counseling. For example, in one study which surveyed the top sexual problems in men, these were listed as follows: problem getting an erection, problem maintaining an erection, premature ejaculation, and inhibited enjoyment (Dunn, Croft, & Hackett, 1999) . The high prevalence of erectile dysfunction, especially among older men, was measured in a study of men over 40 by Laumann et al. (2007) . The authors found that the prevalence of moderate to severe erectile dysfunction was 8.8% for men 40–49, 15.2% for men 50–59 and 29.2% for men 60–69. These rates among older men may not be surprising. However similar prevalence was found in a survey of younger men (Heruti, Shochat, Tekes-Manova, Ashkenazi, & Justo, 2004) in which 19% of men 25–28 reported mild erectile dysfunction and 5% reported a moderate to severe condition. Prior to the advent of the phosphodiesterase inhibitor (PDE5) medications, which include Viagra, Levitra, and Cialis, the predominant problem addressed in sex therapy for men was erectile dysfunction. Clearly, this is no longer the case.

For many couples, the problem is more complex than erectile dysfunction. One or both partners have ceased to find the other sexually interesting. This problem needs to be addressed by seeking sources of anger, resentment, and other negative emotions that may be barriers to finding new ways for the couple to excite each other again. As noted earlier, the waning of romantic love is usually linked to a decline in sexual arousal. Of course with all sexual problems, especially those with recent onset, organic bases must be ruled out. These can include endocrine problems—especially reduced free testosterone levels. Having ruled out organic bases for the problem, psychotherapeutic interventions can proceed.

Counseling for Loss of Arousal

Any therapeutic intervention must take into consideration the natural tendency to habituate to one’s lover over time. As suggested above, men tend to habituate to lovers relatively rapidly, and women, although a bit slower in losing interest, will tend to do so when romance fades. When romantic love fades, arguments increase, the idiosyncrasies of one’s lover become more vexing, and a partner may begin to attend to other possibilities. These tendencies conspire to make sex with one’s mate less exciting. It is important that a couple’s counselor ascertain whether problems like erectile dysfunction or anorgasmia result from a fundamental loss of attraction rather than organic problems. If attraction has indeed faded, the counselor then needs to determine if both members of the couple are committed to their partner. A relationship can survive a diminution of passion if there is a conjugal love and friendship. If such bonds have developed, then the counselor can help by exploring irrational beliefs that will invariably make the problem worse, such as: “It is a terrible affront that my lover does not get excited by me!” “I can’t stand that she doesn’t excite me anymore,” “I am a terrible person for fantasizing about other men,” or “This relationship is a complete failure because he/she doesn’t want sex.”

The first approach in counseling for loss of sexual interest in a relationship is to explore the beliefs and emotions consequent to the change in sexual response. Then each partner needs to be helped to see the tacit rigidity, demanding, and damning nature of their irrational beliefs. Ideally, each partner is guided to disavow the belief in front of his or her paramour. This will reduce much of anxiety, hurt, and guilt associated with loss of sexual interest. When this has been accomplished, the couple then benefits from tools that enhance the sexual response.

The Case of Hillary and Mark: Loss of Passion

Hillary and Mark had a romantic wedding, which was appropriate because they were very much in love. Hillary was senior administrator for a pharmaceutical company and Mark was a structural engineer with both a full time job and a part-time consulting practice. According to Hillary, sex in the first two years of their marriage was frequent and intensely pleasurable. It resulted in a daughter, Sara, and all remained well as they became increasing affluent and close as a family. Unfortunately, by the fourth year of the marriage, Hillary began to complain about Mark’s assertiveness, his masculinity, and his ability to discipline their daughter. Mark said he was frustrated and hurt, as he felt that he had not changed in any way. Exacerbating the problem, Hillary had completely withdrawn from Mark sexually. She initially denied that this was the case, citing a single sexual encounter a month earlier. However, when questioned further, she responded with complaints about Mark’s annoying behavior at home—especially his inconsistent parenting of Sara. Mark was articulate and clearly intelligent; but he was also quite shy and passive. He was frustrated and angry with Hillary’s constant complaining and her sexual withdrawal. Yet he never expressed these feelings to her. Instead, he became sullen and passive aggressive.

Initially in counseling, Hillary insisted on enumerating Mark’s flaws and failings avoided the topic of sex, which was very important to Mark. In an individual session Hillary acknowledged that Mark did not arouse her anymore, but insisted it was a result of his behavior. In Mark’s individual session he repeatedly insisted he could see no changes in the relationship that would account for Hillary’s complaints about him, nor her sexual withdrawal. His tacit belief was “Hillary should act lovingly and be attracted to me because she is my wife.” In response to this, the counselor suggested that he change his demeanor with Hillary. He asked Mark to be direct when distressed about relationship and parenting issues instead of avoiding conflict. Mark had also acknowledged that he felt that he could no longer be open with Hillary about his anxieties and life stressors. The therapist told him that this was indeed unfortunate, but the nature of the relationship had changed. Hillary had begun to see his frequent requests for succor and consolation as unattractive weakness. When together, Hillary acknowledged this and stated that in the past Mark’s need for emotional support and reassurance evoked maternal feelings, but now it was sexually alienating. Hillary’s irrational demand was that Mark should know that she found his behavior a turn-off and should change without her having to ask. The therapist helped Hillary see that both she and Mark had changed in the relationship and that acceptance was required for growth. Mark was still not happy that he had to maintain a façade of machismo to keep Hillary sexually attracted. And Hillary continued to feel that she was compromising by staying with Mark. Nevertheless, the relationship continued and sex improved once the couple dealt with their irrational beliefs.


When one is emotionally and sexually committed to another person, there are few life events that are as traumatic as discovering that the loved one has been intimate with someone else. This intimacy is usually sexual, but it can be romantic sans sex. The latter is more common with a woman who might develop a deep romantic bond with a man (on occasion with a woman) without ever having sex. Although husbands and lovers tend to find this disturbing, it does not approach the emotional firestorm that ensues when the infidelity is indeed sexual. David Buss’ contention that violent jealousy in the face of sexual infidelity is a male adaption is supported by the fact that a negative relationship between the length of the second finger to the fourth finger and increased anger at sexual jealousy (Fussell, Rowe, & Park, 2011). The second digit to fourth digit ratio is a correlate of prenatal testosterone levels such that men or women with ring fingers being longer than their index fingers were usually exposed to higher levels of testosterone. Thus, a masculinized brain is one that experiences greater distress at sexual infidelity.

Counseling Couples Facing Infidelity

As with all couples’ therapy, treatment for a couple with an unfaithful partner should begin with an individual session with each partner. Very often one or both members of the dyad will use the couples’ therapy as an exit strategy. It is painful to leave a relationship for reasons that include guilt, inertia, social responsibility, or feelings obligation. Thus, the difficulty in leaving is not based on a sincere desire to remain with the paramour. In this case the counselor is placed in a no win situation in which the partner who secretly desires a way out can claim that he or she has tried everything to make it work. Failing that rationale, the therapist’s interventions can be blamed for pulling the relationship asunder. A requisite of doing couple counseling is being thick skinned, but the job does not include billing for wasted time. Thus, it is essential that the counselor make a determination if both partners are really committed to continuing the relationship. The research previously presented is important in that a great deal of sexual motivation is innate, evolutionarily old, and not immediately accessible to the individual. As Beck (1989) emphasized, couples radically change their judgments when romantic passion attenuates. The role of the couples’ counselor is to accurately assess the factors that led the one of the partners to seek sexual satisfaction from another.

A brief history of the sexual trajectory of the relationship needs to be compiled. This is to ascertain whether the infidelity is a result of problems such as: Diminished attraction on the part of one or both partners. Pairing for reasons other than sexual attraction such that one or both were never compellingly sexually attracted to each other. Succumbing to a brief intense temptation. Anger at the lover or spouse leading retribution through infidelity. Undisclosed sexual performance issues. Undisclosed sexual pathology.

When and if a change has taken place and becomes evident in counseling, the counselor must assist each partner to understand and accept the change. Such changes can include loss of sexual passion, the development of anger or resentment, or the introduction of a third party. When a change such as loss of passion leads to infidelity, the counselor must insist that the offended partner understand his or her hurt, anger, and vengefulness in terms of his or her demands and other irrational beliefs. The offended partner must be helped to see that retribution and rage are not compatible with restoring the relationship. To accomplish this, irrational beliefs must be elicited and collaboratively challenged, as illustrated in the following case study. Similarly, the irrational beliefs that led the unfaithful partner to stray must be identified. If the unfaithful partner hopes to remain in the relationship, the irrationality of his or her actions needs to be explored and challenged. Both partners must be helped to see that creating a new relationship without the ruminations about the past is the best path to resolution. If both can view the infidelity act as bad, but not terrible or unredeemable, it can eventually become no more relevant than the sexual encounters that took place prior to the relationship.

The Case of Donna and Sal’s Marital Infidelity

Sal is a Latino who takes great pride in his physical prowess and his ability to manage tough laborers. His hobby is martial arts and he notes that he is quite proficient in self-defense and fighting when necessary. His manner and mien convey that this is not bluster. At the time of treatment he was cohabitating with Donna, an administrative secretary in the main office of a national corporation. Her job requires her to work late on many nights as well as attend corporate functions. Despite not being married, Donna and Sal have three children under age ten who are cared for by Donna’s mother when both parents are at work. The couple sought treatment as a result of an increasing number of arguments about Donna’s late hours at work and Sal’s growing discomfort with her socializing with men at corporate functions.

When asked if he was jealous of any specific coworker, he said no, but he was not comfortable with her being away from home for several hours during the evenings. Donna insisted that attending these functions was essential for her career, but Sal angrily argued that her job was secretarial, not social. She responded, a bit dismissively, that he didn’t understand the corporate world.

In employing Rational Emotive behavior Therapy with this couple, the therapist helped each partner understand the irrationality or in flexibility of his or her demands. For example, Donna would insist that late work was necessary, but would make no offers of compromise about setting some limits. Her tacit irrational beliefs were to the effect “he has absolutely no right to restrict my behavior; he doesn’t work in a corporate setting and is making completely unfair demands based on ignorance.” Consequently, Donna was shown that her rigid stance only provoked Sal to become more demanding and hostile. Sal labored under beliefs to the effect, “she is the mother of my children and absolutely should make being with them a priority. Her failure to compromise is an absolutely unacceptable affront to my masculine role in this relationship.” Sal was helped to see that although he had a strong desire to be in control of the relationship; Donna did not have to completely accept his standards for female behavior. In addition, Sal was helped to see that being less angry and demanding might yield more room for compromise. There was moderate success with this approach and treatment ended after five sessions, with both Sal and Donna agreeing to work on several homework assignments. The respite in conflict, along with helping the couple identify and dispute irrational beliefs such as those cited above did not completely attenuate Sal’s suspicions about his partner’s activities.

Sal continued to complain that Donna seemed indifferent and unaffectionate. She increasingly avoided sex and any forms of physical intimacy. She became quite dismissive of Sal’s interest in sports and would criticize him for being unsophisticated and excessively machismo—some of the very qualities that had initially attracted her to him. In counseling sessions he would complain that she was pulling away from him and always putting him down, something Donna would consistently deny. So in spite of the reduction in conflict that counseling had accomplished, Sal continued to feeling increasingly frustrated with Donna. He insisted that these changes in the way she related to him were making him increasingly suspicious about the times she insisted she was working late. He hired a private detective who did his job, showing Sal a series of photos that stunned and enraged him—photos of the woman he loved entering hotels and restaurants with an executive in her company. Not only that, but she was very affectionate towards this man in the photos… the type of man Sal feared and resented.

Sal called this author in a state of agitated rage. He was hurt and very angry, criticizing the therapy and ranting about how all the work on communication, anger control, and irrational demands was worthless because all the while Donna was having sex with an executive coworker. The object of Donna’s passions was almost as vexing as the infidelity. Sal, although a manager, managed labor. Although earning a respectable salary, he was very jealous of the educated high status male coworkers with whom Donna worked. This jealousy was frequently stoked when she would discuss these men with admiring adulation. Now the men he had been covertly competing with had won, and in his eyes had humiliated him.

Sal’s Irrational Beliefs

“I have been completely humiliated and must retaliate to save my honor.”
“Donna is a completely worthless slut and I must punish her.”
“I can never trust a woman again.”
“I must punish Donna by fighting her for the kids.”
“I cannot stand the idea that people will know she cheated on me.”
“I absolutely must get the guy that stole my wife.”
“I am a worthless lover and cannot satisfy a woman.”
“Donna is tainted and I cannot be with her.”
“My marriage is a total failure.”
“Donna deceived me and everything she ever said must be a lie.”

After meeting with Sal, this author requested that Donna come in for a solo session. She agreed, if for no other reason than that she wanted a means to communicate with Sal who had already confronted her in an angry and menacing way. During the session, she insisted that she still loved Sal but “not in the same way.” She stated that he had changed and had become more demanding, “primitive,” and suspicious. Donna insisted that it was Sal’s behavior that drove her into someone else’s arms. Her explanation was no doubt visceral, but might very well have reflected a change in perspective brought about by the type of change in romantic love discussed previously. Specifically, as the passion for Sal faded, flaws that to that point were tempered by passion became far more noticeable, leading to an increasing loss of sexual attraction.

Donna’s Irrational Beliefs

“I have an absolute right to pursue sexual gratification if Sal refuses to meet my needs.”
“It is completely Sal’s fault that he let himself deteriorate. He has forced me into • arms of someone else.”
“My new lover completely understands me and loves me far more than Sal, so I am doing absolutely nothing wrong in seeking his affections.”
“He is not the man I married. I had to find someone like Sal used to be.”
“I shouldn’t have to be with man this bad, when there are nice men who like me.”
“Sal should understand that I needed to do this.”
“Sal made me lonely and dissatisfied, I have an absolute right to be happy.”
“It is very common to have an affair, I’m sure Sal wouldn’t mind that much.”

Even though these irrational or demanding beliefs are likely to arise due to innate factors, they can nevertheless be addressed through a Rational Emotive approach. Donna has to learn that her alienation from Sal is in part a result of a change in her perception. This can be accomplished by encouraging her to specify the exact nature of his change that is troubling her and to explore the reality of his alleged change.

A significant percentage of those suffering from infidelity will never forgive the offense (Cann & Baucom, 2004; Shackelford, Buss, & Bennett, 2002 ) . This needs to be explored early in treatment. If indeed it seems that infidelity represents an unforgivable transgression, then the couple needs to be counseled accordingly. Specifically, the unfaithful partner needs to be warned that staying in the relationship will tend to be associated with ongoing hostility and resentment.

As the therapy proceeded, Donna accused Sal of changing for the worse, but she was unable to specify the exact nature of these changes. The therapist helped to see that it was her change in perception, not a change in Sal that led to the disaffection. The irrational or demanding beliefs set forth above were elicited over several sessions of counseling. One by one they were directly challenged by the counselor or by the counselor guiding Donna or Sal to challenge the beliefs themselves. This is illustrated with a session excerpt with Donna; her irrational beliefs are identified in italics.

Therapist: “Donna, I guess if you weren’t happy with Sal’s behavior you had no choice but to find someone else?”
Donna: “Of course I had a choice, but…”
Therapist: “Oh, so you had other options; can you give me an idea what some were?”
Donna: “I guess I could have told Sal that I was unhappy.”
Therapist: “But you were unable to do this?”
Donna: “No, I could have. I could have spoken to him, but he made it too hard.”
Therapist: “I see. He made it too hard to talk to him; how did he do this?”
Donna: “Well, he’s not the type of man you can talk to; he also gave me the impression that he didn’t want to talk about things.”
Therapist: “So because you had this impression, you thought you needed to someone else?”
Donna: “I didn’t have to…. He just pushed me away and I needed to.”
Therapist: “You needed to have an affair?”
Donna: “I guess it’s something I wanted because he always turned me off with his macho behavior and his anger. I just didn’t think he was into me anymore.”
Therapist: “But it he wasn’t “into” you, why do you think he agreed to come to counseling? Didn’t that indicate that he cared to some degree?”
Donna: “Well, maybe he cares, but he’s very angry. He’s just so hard to deal with and I can’t stand it when he acts so macho and ignorant.”
Therapist: “It appears as if you could stand it during the early part of the relationship. Did he change so much that now you can’t bear it at all?”
Donna: “I guess I can bear it; I think we’ve both changed.”

In this session segment, Donna exhibited some irrational demands and low frustration tolerance. She was helped to see that although she still loved Sal, she had become less attracted to him and took the easy way out by finding another lover. Consequently, some of Sal’s actions that were either acceptable or even attractive had now become off-putting, resulting in more negative judgments from Donna towards Sal. When made aware of this, she realized that Sal’s change was largely based on her perceptions.

Helping Sal was considerably more problematic as he was very angry and ambivalent about continuing the relationship. In fact, he stated that he hated the fact that he still loved Donna. He felt trapped by a desire to stay with her and a vengeful anger. His anger alternately was directed at Donna and the man with whom she had strayed. The therapist initially focused on the pragmatics of staying with Donna and his children. He helped Sal challenge his irrational beliefs to the effect “I must hurt Donna or the man she cheated with or I am not a man. I absolutely cannot stay with Donna because a man who stays with an unfaithful wife is worthless. She must be punished and contrite or I would be a fool to stay with her.” Over several individual sessions Sal was helped to identify these demanding, irrational beliefs and was taught how to challenge them. At this writing Sal is still with Donna, but remains somewhat suspicious and bitter. The maintenance of the relationship requires some behavioral changes on both of their parts. Sal needs to become more attentive and less exaggeratedly masculine. Donna needs to be more attentive to Sal and reassure him that her infidelity does not negate her love for him. At this point the relationship is showing some gradual improvement.


Sexual intimacy in relationships is comprised of a complex interaction of ancient biological drives, unique personalities, and cultural forces. Treatment of couples with sexual problems must always begin with a cognizance of the range and complexity of the many expressions of sexuality. It is particularly important that the counselor eschew his or her own values of sexual propriety. Instead, the goal is to perform a differential evaluation of the couple’s unique approach to sexuality and the basis of its malfunction. It is also important to be cognizant of the fact that a couple consists of two unique individuals, each of whom may have very different values and desires than his or her partner. The counselor needs to explore how these differences initially coalesced and how they began to unfold. This understanding is best accomplished by eliciting the beliefs each partner has about him or herself, the partner, and relationships in general. When the demanding, rigid, in flexible, or other irrational beliefs are exposed, disputing them collaboratively offers the best hope for the couple with sexual and intimacy problems.


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