Working with Intimacy Fears

It is common to encounter intimacy fears when working with absent or low sexual desire. Underlying intimacy fears can contribute to lack of desire and avoidance of sex resulting in relationship distress. These fears include but are not limited to such phenomena as fear of exposure, loss of control or being controlled, fear of anger emanating from the partner or losing control over one’s own anger, and fears of rejection or abandonment (as described in Weeks & Fife, 2014). The therapist will need to spend a considerable amount of time identifying each underlying fear and then help the client understand its origin and function, and how to move past the fear. Unfortunately, the fears are often unconscious and must be inferred from the behavior, the man’s history in prior relationships and genogram work.

Uncovering Secrets

When the man who has been avoiding sex with his intimate partner has been carrying one or more sexual secrets, he might be willing to share his secret. The therapist must be prepared to help the couple deconstruct this new information and find ways to deal with the intense emotions that destabilize the couple during and after disclosure.

In cases of infidelity, the man will be helped to decide what to do with this information. We believe the man must be encouraged to cease the activity immediately, decide how and when to share the truth with his partner, and be helped to explore the possible reasons for his behavior. A rule of thumb is that the therapist cannot hold a secret involving infidelity; keeping this information from the unknowing partner creates a difficult or impossible situation for doing therapy. It is not the therapist’s responsibility, however, to disclose the sexual secret. Instead, we often use a strategy that suggests the man is “ambivalent about his commitment to the marriage.” For him to explore his indecision, and to support the partner, the conjoint treatment will be stopped and replaced by concurrent individual sessions. Sometimes this intervention is significant enough to create suspicion in the unknowing partner and begin conversations about his ambivalence. There are numerous approaches to dealing with secrets in therapy, and the reader is advised to review Weeks, Gambescia, and Jenkins (2003) for more information.

We have had success in helping couples process secrets involving undisclosed sexual abuse during childhood or adolescence. Fantasies about sex with the abuser can become intrusive in sex with one’s intimate partner and the person who has been abused might avoid sex in order to escape the intrusive thoughts. Sometimes uncovering the secret is a relief to the partner as they often blame themselves for the symptomatic partner’s lack of interest in sex. Recovering from sex abuse will take significant time in both individual and couple therapies but this work can be very rewarding. Psychoeducation, distress reduction, communications skills, and mindfulness skills described in the chapter on sensate focus can be used in couples work.

Revealing fetishes in the man with HSDD is another challenging situation for the therapist. We have seen this situation turn out well and end in disaster. In one case, the wife was willing to go along with his fetishistic activities and the couple incorporated them into sex. In other situations, the outcome was not as favorable. For example, a newly married couple divorced after the wife discovered evidence of his cross-dressing. Another older heterosexual couple divorced after several attempts to accept his preference for several fetishes. The higher desire partner is frequently relieved to find a reason for the man’s HSDD and can be willing to work with their partner around this challenging issue. Psychoeducation, communication work, and conjoint treatment are recommended.

One of the most difficult situations we have seen is when the man truly has a sexual orientation that is not consistent with the life he is living and has stopped having sex because of it. The sessions can be very painful for the man and his partner. Some couples find a way of continuing to live together in a committed relationship, while others separate or find new arrangements such as consensual non-monogamy. Even when the presentation is an individual one, the couple struggles together and will need to work together to heal or find another solution.