Sex and Love in Intimate Relationships


Buy It Now!

Book is ‘model of clarity’
(June 2009 Issue)

“Sex and Love in Intimate Relationships”
By Robert W. Firestone, Lisa A. Firestone, &
Joyce Catlett
American Psychological Association
Washington, D.C., 2008

By Paul Efthim, Ph.D.

Sexual problems rank among the top reasons psychologists refer their own patients for consultations. When sex matters arise in the course of treatment, even seasoned couples therapists may doubt their ability to help. This pattern is reflected in the high volume of referral requests for "sex therapists" on psychologist email lists.

Although some of these referrals relate to specific sexual dysfunctions requiring medical or subspecialty assessment, it appears that most involve couples or individuals in which sex has died. Having attempted some behavioral treatment to revive the sex, the exasperated therapist seeks out a "sexpert" colleague who can take over.

It is unfortunate that many psychologists apparently don't feel comfortable in this domain because, in most cases, patients would be better served by addressing sexual problems in the context of regular couple therapy rather than splitting off sex to a separate treatment.

Fortunately, publishers have recognized gaps in the clinical literature on sexuality and have responded. A superb book by Firestone and colleagues recently released in paperback, "Sex and Love in Intimate Relationships" is a model of clarity that will appeal equally to therapists and educated readers.

Rather than focus on the technical aspects of 'good sex,' the authors take aim at the central problem of intimacy. They make a sobering argument: although most adults profess a desire for closeness, relatively few can tolerate loving or being loved.

The authors, affiliated with the Glendon group in Santa Barbara, integrate decades of clinical experience and longitudinal research with a broad review of the literature to argue their case. They document the subtle and not-so-subtle ways that sexuality can be damaged during development, leading to entrenched defenses that block emotional vulnerability and inhibit sexual relatedness.

The key defense, termed the "fantasy bond," takes the form of a once-useful but now destructive form of self-sufficiency and pseudo independence. Similar to Kohut's concept of the selfobject, the fantasy bond involves a self-parenting process that the child (and later the adult) uses to both nourish and punish the self internally. In the face of overwhelming frustration and separation anxiety, the child merges with the idealized parent in an attempt to maintain internal coherence.

An internal thought process referred to as the "voice" regulates the self-parenting process via intrapsychic communication that ranges from minor self-criticism to major attacks on the self. The voice functions as "the language of defensive process" and supports self-soothing via internal sources of gratification such as fantasy, substance abuse, and isolation.

In clear terms, the authors describe how negative attitudes that arise from defensive self-parenting lead to serious distortions of oneself and one's partner that get introduced into the sexual situation. An adjunctive treatment technique labeled "voice therapy" is described that seeks to bring out subconscious thoughts and emotions related to patients' core defenses. Later chapters of the book illustrate how this approach can be integrated into a wide variety of therapeutic models.

One of the strengths of this volume is its description of psychodynamic processes without resorting to jargon and theoretical abstractions. Another asset - the book's clear definition of "healthy" sexuality - also works in the opposite direction by offering a normative view of sexuality which may feel overly narrow to some. In a glaring omission, the book's numerous case examples do not feature any gay or lesbian persons. As troubling as this is, the book's central points maintain broad applicability to intimate relationships of all kinds.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds faculty appointments at the Massachusetts School of Professional Psychology and the Boston Institute for Psychotherapy.