Research to date pertaining to sexual difficulties within relationships has predominantly focused on the physiology of sexual behaviours at the expense of the emotional and relational aspects. However, analytic theorists and practitioners at The Tavistock Clinic in London are making significant contributions to our psychological understandings.
Arguably, physiological aspects attained primacy after Masters & Johnson proposed their rational, medicalized, concepts of sexuality in the Human Sexual Response Cycle Model in 1966. This model objectified the biological contingents of sexual relating (making biological factors primary in desire) and ignored the subjective and intra-psychic aspects of desire for sexual intimacy.
One can explore the desire for intimacy on a number of theoretical levels, with Freud (1905) for example framing it as a ‘lack’ or need for ‘wish fulfillment’, set at a structural level of personality, in recompense for psychosexual developmental gaps or fixation (oral, anal, phallic) at specific developmental points in childhood. Erikson (1968) continues this predominantly individualistic perspective, indicating that the ability to embrace intimacy with another is dependent upon the psychosocial development of a strong sense of self and identity. An existential and humanistic perspective would couch the desire for intimacy in the basket of “ultimate concerns” (Tillich, 1952) or basic human needs which drive action and response, and generate meaning and a sense of belongingness throughout life.
Attachment theorists such as Bowlby (1980) and Fonagy (2001) determine that the desire for intimacy is a self sustaining, intra-psychic human need; whilst also accepting the biological. They theorize that one’s ability to give or receive intimacy and to have desire for ‘the other’ has a basis in early attachment relationships with primary caregivers. Their basic premise is that relationships throughout the lifespan are impacted by, and are reflective of, those formed in childhood. Therefore, an insecurely attached child will become an insecurely attached adult, a securely attached child will become a securely attached adult, and so forth. These internal working models of dynamic relational behavior will thus have an impact upon adult desires for intimacy both at a relationship level and at a sexual one.
This particular conceptualization of desire envelops affective, cognitive, behavioural and ‘meaning making’ needs alongside communication and connection needs; whilst also addressing the intrinsic ability to both meet these needs (or not) and offer oneself as generative in the fulfillment of one’s partners needs (or not).
Intimacy becomes more complex when one moves from monadic, individual considerations to the dyadic, dual pair or couple. Both parties bring their own individual internal working models and models of attachment into the relationship, and project their own contingent needs, wants, senses of selves, and structural defensive psychological aspects onto and into one another. This often creates, understandably, discrepant desires for relational intimacy and sexual encounters. Not only that, but in effect the couple creates its own monadic system – the couple as a single unit – which is a mixture of all of the above contingencies formed into one intricate unit of collusion. Hence, from a systemic or ‘bigger picture’ perspective, it is often difficult to isolate cause and effect in a situation of desire discrepancy – where one, or other, or both, experience a problem in their intimate and/or sexual relating – due to the feedback loops which inform, feed and maintain the system.
According to statistics, 96% of British men & women aged between 16-44 considered happy (?) sexual relationships within marriage to be either a “very” or “quite” important contributor to a successful marriage (Johnson, Mercer & Cassell, 2006). However, psychosexual problems including desire, arousal, orgasm and sex related pain is prevalent in 10% to 20% of men and women (Carr, 2005).
Whilst direct sex therapy is still adopted whereby couples receive advice, directives and psycho-education based primarily on the Master’s & Johnston model and its adjuncts; therapists are becoming increasingly aware that therapy must also address the intra-psychic and the interpersonal (see Russell & Russell, 1992). This need has primarily arisen out of the problems of circularity within the systemic relationship, as indicated above, in conjunction with the circularity of additional symptoms. It is becoming increasingly discovered and understood, that marital distress, depression and anxiety is an extremely common result of psychosexual problems; however the reverse also holds true with psychosexual problems arising out of situations where the particular individuals involved are depressed and anxious.
It is likely that the French psychotherapist Jacques Lacan was on firm ground when he said that the ideal sexual relationship does not exist. He believed that only those who have awareness of the ‘lack’ which they bring to their relationships are even capable of loving. Effectively he was saying that to know and love oneself ‘as is’, is a prerequisite to know and love another. This is why it is important to aim towards the Delphic Motto of “Know Thyself” in a process of personal development such as individual psychotherapy, if one is to ever change the mix of interpersonal and sexual relationships being currently experienced.
An individual who accepts and embraces a sense of incompleteness, imperfection or ‘lack’ within the self and likewise within ‘the other’ can reduce fusion and enmeshment in the intimate pair, and generate autonomy and self responsibility. This awareness will not only positively impact the couple but will also reverberate throughout all areas of relating (friends, colleagues, siblings for example). One expense (?) is of course the giving up of the defensive projective ‘wish’ of perfection in others to ‘shore up’ an incomplete self.
Sexual satisfaction begins with the self. If sexual desires are entrenched in a quagmire of projections then ‘the other’ not only becomes minimized in a power imbalance but also becomes objectified in an unfolding Buberian “I-It” relationship. Such a relationship embraces a narcissistic set of self needs (neediness), disconnection (distance) and a lack of self responsibility and authenticity (truthfulness). This displaces the giving, the connectivity and the authentic union and intimacy of the “I-Thou” where two people truly meet (Buber, 1958).
Should an individual decide to attend therapy to deal with relationship, intimacy or sexual concerns there must necessarily be room within the therapeutic space to reflect upon the self which the individual takes to their relationships. Discrepant/different desires can possibly be resolved by working through power imbalances and struggles, communication issues (which impact upon verbal intimacy) and issues of trust – most situations of jealousy are actually resultant of perceived but unconsciously repressed flaws in the self! One must develop the ability to give and receive verbal, physical and sexual intimacy, and understand the meaning behind the needs one hopes to be met by the partner. The therapeutic space gives room for self understanding and self development and a space to transition through changes within the self and self-other structure. If you change your self, you can change your relationships, your intimate encounters, your sex life, and, incidentally, your life!
Bowlby, J. (1980). Loss Sadness and Depression. New York: Basic Books.
Buber, M. (1958). I and Thou. Edinburgh: T&T Clark.
Carr, A. (2005). Family Therapy: Concepts, Process & Practice. Chichester, England: John Wiley & Sons Ltd.
Erikson, E. (1968). Identity: Youth & Crisis. New York: Norton.
Fonagy, P. (2001). Attachment Theory & Psychoanalysis. New York: Other Press.
Freud, S. (1905). Three Essays on the Theory of Sexuality. The Standard Edition of the Complete Psychological Works of Sigmund Freud (J.Strachey, Trans.), Vol.7,pp.125-245. London: Hogarth
Johnson, A.M., Mercer, C.H. & Cassell, J.A. (2006). Social Determinants, Sexual Behaviour, & Sexual Health. In M.Marmot & R.G.Wilkinson (Eds.), Social Determinants Of Health (2006). (2nd ed.). (pp.318-340). Oxford: Oxford University Press.
Russell, A. & Russell, L. (1992). Integrating Sex Therapy & Couple Therapy. The Canadian Journal of Human Sexuality, Vol. 1.(2), Summer 1992.
Tillich, P. (1952). The Courage To Be. Glasgow: William Collins & Co Ltd.