Last weekend Tom had a bit too much to drink and that created a problem. He and his wife, Sarah, tried to make love a few hours later and Tom couldn't just quite make it work. This had never happened before. He felt bad, she was disappointed but understanding, but now he is having a hard time, worrying that this lack of performance could happen again.
Ellen is in her first really serious relationship in a long time. She enjoys the lovemaking she has with her boyfriend, Jake, but there are times when he touches her in the certain way and either completely she completely zones out or mentally over-reacts. She knows where it is coming from - rough sexual experiences with a abusive boyfriend of long ago. She hasn't talked to Jake about it, but finds herself beginning to brace herself when they have sex.
While couples can come to therapy concerned about a number of sexual issues, two of the most common, in my experience, are those like Tom and Ellen. Tom's problem is that he's fallen into a downward spiral of performance pressure. One night of subpar activity sets off a running anxiety that it can happen again; the worrying itself creates the self-fulfilling prophesy that can quickly get worse. Ellen, on the other hand, is reacting to something else, namely, the triggering of old negative physical and emotional sensations inadvertently brought on by Jake's innocent touch. Like Tom, this, too, can set of downward spiral for her as well.
As a way of breaking these cycles, I often suggest that couples try a variation of the sensate focus exercises created by those famous sexologists Masters and Johnson almost 40 years ago. There are 2 versions, creatively termed Sensate 1 and Sensate 2. Sensate 1 is essentially mutual massages. Couple undresses (or not) and take turns giving it other slow massages. It differs, however, from the standard massage in that the person who is receiving the massage is in total control. She tells the massager where and how to touch, giving constant feedback.
It is absolutely essential that the massager do exactly what the other says. After the one person has had enough, they switch. If sensate focus one goes well (the person massaged is able to relax and appreciate the experience), the couple can move onto Sensate 2 where the massage can now include touching of sexual parts, but no intercourse; again the same rules apply.
This exercise is great because it builds both trust and communication. For someone like Tom it breaks the cycle of performance pressure. He is able to focus on himself and his sensations without worrying about outcome, while Sarah learns what he likes and doesn't like. For Ellen the results are similar. She too helps Jake know what she likes, can practice staying focused on her sensations rather than spacing out, and most importantly, perhaps, can begin to create trust and relax by experiencing control, all helping to offset the feeling of anxiety and pain that she associated with the past. After doing this a few times and with this foundation in place, the couple is then able to move towards intercourse, with each more sensitive to their partner's likes and dislikes.
Obviously, this exercise isn't only helpful to couples like Tom and Ellen. It's great for any couple as a way to increase communication, intimacy, and knowledge of each other.
So give it a try and see what happens.