Sex Therapy and Imago
-- Alixe Thompson interviews Sylvia Rosenfeld, LCSW

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	Sylvia Rosenfeld helps couples get the sex they want

When might a couple seek out sex therapy?
Couples who experience difficulties around sex in their relationship can find solutions working with a sex therapist. A sex therapist can help the couple to define and diagnose their sexual difficulties and can work out a treatment program to deal with those issues. These problems might include low desire.

How does sex therapy fit in with Imago?
Like Imago, sex therapy works on improving a couple’s communication, as well as dealing with underlying relationship and childhood issues. In addition, however, sex therapy can provide couples with behavioral exercises to do at home that are specific to their problems. Often, sexual issues help clarify underlying relationship issues.

Issues we explore in Imago, such as “otherness” or differentiation, are also addressed as they come up. For example, when a partner assumes to know what you like based on what he or she likes. When you feel intimate, you are inviting yourself to partake in a profound emotional relationship, and of course, fears come up such as being too connected to the other or fear of losing oneself.

How does sex therapy help?
A couple begins to learn about each other by hearing the other talk as well as by having new positive sexual experiences at home. For example, I worked with a couple where one partner got lost in his sexual experience and the other partner felt left out. Rather than react defensively, the first partner asks the second to ‘help me by making yourself noticeable; help me by asking for what you want.’ They take turns talking and mirroring. As in Imago therapy, they check in with one another. Sex brings up issues that can be worked on throughout the relationship. In the therapy, you can see how patterns and conflicts are played out sexually in their relationship.

So you start the healing with a dialogue…
Yes, but unless you do more than talk, nothing changes! Don’t wait until the relationship is perfect to work on the sex. In fact, improving your relationship doesn’t always result in better sex. Have you ever wondered why some couples have good sex despite being in conflict? Sometimes a little anxiety can help; a little tension can fuel the fire in the bedroom. While doing your relationship work in therapy, sex can be the fun activity that can enable you to re-romanticize your relationship, making your partner a source of pleasure rather than pain.

How do you help couples who are not having sex?
I start behaviorally, beginning with each person’s history, getting the background information on the couple as well as the problem. If a couple comes in who have not been sexual for a period of time, I sit down and ask detailed questions. Most people will easily talk about sex, but it is very important to create a safe space for this dialogue first. Based on my assessment of the sexual issues, I devise the at-home assignments that help them to slowly and successfully reconnect sexually.

What are some of the reasons a couple is not engaging in sexual behavior?
There are many reasons. They include: sexual pain, medical problems, performance anxiety, insufficient stimulation, age-related changes and poor communications. Through the behavioral exercises and Imago Dialogue, the couple begins exploring issues from their past, such as: sexual trauma, family messages about sex, or how their view of sex has limited the quality of their experience.

And lastly, can you give an example of a physical exercise a couple can engage in to help them be better partners?
Masters and Johnson developed an exercise called Sensate Focus. A couple takes turns pleasuring each other. The first experience is a sensual one and does not involve genital touching. If this experience goes well, the couple progressively adds genital touching, orgasm, and then intercourse, if desired. One partner touches the other from head to toe, first lying on their stomach and then on their back, experimenting with different styles of touch. The partners then switch. Couples learn to give and receive. They give feedback, allowing one to learn what the other likes. This fundamental practice can begin to expand a couple’s experience of sexuality and intimacy. Most of us experience only a fraction of the pleasure, intimacy and openness that is possible in sex. Pleasure when combined with intimacy leads to greater passion.

Sylvia Rosenfeld, LCSW, is a Certified Imago Therapist Advanced Clinician, and AASECT Certified Sex Therapist, in practice in New York City. In addition to her clinical practice, she provides consultation and training to therapists on sexual issues.