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Sex Therapy Through a Narrative Lens

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Lindsey Davis

on 14 November 2013

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Transcript of Sex Therapy Through a Narrative Lens

Sex Therapy Through a Narrative Lens
"Change our sexual stories, and we change our erotic lives."

Brief Background on Narrative Therapy
What do you Remember?
Common Issues Seen in Sex Therapy
1) Sex Therapy after a Serious Illness
2) Sexual Abuse
3) Fertility Issues
4) LGBT Issues
When a Man Loves a Woman

Case Study
Please watch the following clips from the movie
When a Man Loves a Woman
about a couple struggling to reintegrate intimacy into their lives after one partner's struggle with alcoholism.
After watching the clips, split into groups of 3 and role-play the scenario of the couple coming into your office seeking sex therapy. Use narrative techniques to help the couple. Class discussion will follow.

This presentation provides suggestions on how to integrate sex therapy with narrative therapy for an alternative approach to working with couples from a variety of backgrounds and varying issues.

Remember to:
1) Deconstruct
2) Externalize the problem
3) Find Unique/Sparkling Events
4) Amplify their preferred narrative
5) Find support networks that can assist clients with amplifying their preferred narrative.

• Michael White and David Epson
"the therapist adopts a position of consultant to those experiencing oppression at a personal level from their problems and at a political level from a mental-health discourse and set of practices which permeate western culture" (Carr, 1998, p. 487).
Narratives create identity and identity creates narrative
"Clients live the stories they are told or come to tell about themselves." (Yarhouse, 2008, p. 197)

Sex Therapy after a Serious Illness
Sexual Abuse
LGBTQ Clients
McCoy, Stinson, Bermudez and Gladney study on increasing intimacy after prostate cancer.
Study can be extrapolated to most illnesses or diseases that cause sexual dysfunction.
5 major themes were identified that described ways in which couples are affected by prostate cancer
Goals of Therapy
(from Estrada, 2012)
Deconstruction of oppressive stories
Empowering alternative stories
Separate person from internalized problem saturated stories and disempowering cultural themes
Open space for new alternative empowering stories
Basic Techniques (Estrada, cont)
Listening through the "not knowing position"
Deconstructive Listening
Unique Outcomes/Sparkling Moments
Preference Questions
How to tie it into sex-therapy (basic ideas)

Can be used to re-write a couples sexual history narrative
Deconstruct the ideals and messages you have received about sex throughout your life or your partner's life.
Challenge diagnostic labels (Barry, 1997)
Work with couples to rebuild intimacy in their life through challenging their previously held belief systems.
Fertility Issues in Couples
• "Infertility is related to depression, anxiety, sexual dysfunction, and identity difficulties” (Peterson, Gold, & Feingold, 2007)
• Inability to become pregnant after 1 year of sexual intercourse
• One in six couples have difficulties; 10% of couples are infertile in the US
• Treatments for infertility change the lifestyle of the couple and may strain “emotional and financial resources”
• Women-decreased self-esteem, decreased sexual functioning, changes in mood, depression, anger, anxiety, social isolation, guilt, identity issues, jealousy of pregnant friends/family which leads to more guilt/shame, motherhood = womanhood.
• Men-pain, sorrow, disappointment, inadequacy, guilt, shame, low self-esteem, anger, isolation, loss, personal failure, depression, lower relational satisfaction, higher levels of sexual dissatisfaction, anxiety, “useless, failure, defective,” doubt masculinity, unable to “fix” the problem, less likely to confide in friends and family members

:Long-lasting love
: Equality
: Sex
: Balance
: Intimacy
: Achievement
: Never again
Alternative stories that help clients go beyond the conventional happily-ever-after scenario.
Narrative therapy views the client within a sociocultural context, therefore researchers have found it valuable to use narrative therapy with cross-cultural populations. (Cooper & Lesser, 2008; Phipps & Vorster, 2009)
Narrative therapy validates LGBT clients and serves as a social change movement (Galarza, 2005)
Narrative therapy with LGBT clients can provide specific strategies to rehabilitate widely discredited identities. (Hall, 2012)
Interpretation about what same-sex attraction means for a person has a powerful influence on one's life. Problems may be viewed as internalizing dominant discourses. (Yarhouse, 2008)

Taken from (Hall, 201
1) Self-Esteem
Sexual dysfunction causes a loss of self-esteem in both partners.
Men feel inadequate
Women feel unattractive and unwanted.
2) Sexual Intimacy
Satisfaction with sexual life is an important predictor of satisfaction with life
3) Masculinity/Femininity
Sexual fantasies can be impacted
Decreased pleasure in thoughts about sex
Hormonal changes
4) Role Change
Becoming ones caregiver
If traditional gender roles exist, they can become reversed causing a shift in the balance of the relationship
5) Communication
Stress and major adjustments following treatment
Desire to return to a normal life quickly can lead to couples not discussing the illness or communicating feelings
Barry, D. (1997). Telling changes: From narrative family therapy to organizational change and development.
Journal of
Organizational Change Management, 10
(1) 30-46).

Carr, A. (1998). Michael White's Narrative Therapy. Contemporary Family Therapy,
20(4), 485-503.

Cooper, M.G., & Lesser, J.G. (2008).
Clinical social work practice: An integrated approach
(3rd ed.). Boston, MA: Pearson

Galarza, J. (2013). Borderland queer: Narrative approaches in clinical work with latina women who have sex with women.
Journal of LGBT Issues in Counseling,
7, 274-291. doi: 10.1080/15538605.2013.812931

Hall, M. (2012). The honeymoon is over: Narrative sex therapy for long-term lesbian partners. In P.J. Kleinplatz (2nd ed.)
New directions in sex therapy
(285-302). New York, NY: Routledge.

Kerner, J., Avnet, J. & Mandoki, L. (1994).
When a Man Loves a Woman.
United States: Touchstone Pictures.

McCoy, M., Stinson, M. A., Bermudez, J. M., & Gladney, L. A. (2013). Utilizing a
narrative approach to increase intimacy after prostate cancer. J
ournal of Creativity in Mental Health
, 8, 48-69. doi: 10.1080/15401383.2013.763684

Miller, B., Parra Cardona, J., Hardin, M. (2006) The use of narrative therapy and
internal family systems with survivors of childhood sexual abuse: Examining issues related to loss and oppression.
Journal of Feminist Family Therapy, 18
. 1-27.

Peterson, B. D., Gold, L., & Feingold, T. (2007). The experience and influence of
infertility: Considerations for couple counselors. The Family Journal, 15(3), 251-257.

Phipps, W.D., & Vorster, C. (2009). Narrative therapy: A return to the intrapsychic perspective?
South African Journal of
Psychology, 39
(1), 32-45.

Stark, M. D., Keathley, R. S., & Nelson, J. A. (2011). A developmental model for
counseling infertile couples. The Family Journal, 19(2), 225-230.

Yarhouse, M.A. (2008). Narrative sexual identity therapy.
The American Journal of Family Therapy, 36,
196-210. doi:

Mistakes made by well meaning family and friends
“God never gives you more than you can handle”
• Failure to recognize the severity of the experience
• Failure to recognize the experience of loss
• Invalidation of couple’s experience
• Focusing on the person’s symptoms rather than the infertility as the center of the pain that creates the symptoms
(Peterson, et al., 2007)
Counselors role is to help:
• Identify and express their feelings about infertility
• Externalize the experience and related difficulties instead of focusing on clt characteristics
• Develop strategies to deal with the stressors and pain
(Peterson, et al., 2007)

Narrative Therapy
• Psychosocial and grief issues such as miscarriages
• Clients who see infertility issue as only one way to define themselves cope better with infertility
• Externalization of the fertility issue
• Couples are encouraged to find new meaning in their experiences with infertility through telling and retelling of their story
• Encourage rituals that honor their struggles with loss-give permission to grieve
• Each person within the couple tells his/her story to their partner to develop their own narrative
o Relief at telling story, different perspective of story, appreciation for partner’s unique experience
(Stark, Keathley, & Nelson, 2011)
Deconstruction Questions
What messages did you receive about femininity? masculinity? womanhood? manhood?
Where did you receive messages about being a woman? man?
Who in your life supports this way of being feminine? masculine?
What are the effects of this belief on your life?
How has infertility effected your relationship with yourself?
What has infertility talked you into doing in your relationships with friends? family?
How does infertility worm its way between you and your partner?
Are there other problems that infertility teams up with?

Paper on Narrative therapy for childhood sexual abuse. (Miller, Cardona, & Hardin, 2006)
Sexual abuse survivors typically have inner critic messages of self-blame, self-hatred, and self-doubt.
Self-blame leads to poor adjustment in three areas: self-esteem, relationship anxiety, and comfortableness with closeness.
Victims develop doormat effect
Woman childhood sexual abuse survivors may experience cognitive distortions around five areas: safety, trust, power, self-esteem, and intimacy.
Male sex abuse survivors may struggle with issues of masculinity, abuse, and homosexuality.
Survivors may avoid sex or act out sexually. They struggle to develop healthy, intimate relationships.
Narrative therapy helps sexual abuse victims re-story their experience according to their own preferred story, rather than the one that has been imposed on them.
In order to be liberated from an experience of sexual abuse, it is essential to give voice to the internal struggles caused by such abuse. Giving voice to the abuse allows the victim to grieve.
Narrative therapy interventions
Deconstruct dominant cultural narrative
Externalizing the problem
Re-authoring the story
Providing a context for the story
Deconstructing dominant cultural narrative
Sexual abuse victims have trouble conceptualizing how sex can be a positive, healthy experience. Survivors are often more concerned about their partner's sexual gratification than their own.
Current culture normalizes sexually abusive behavior by glamorizing violence and coercion.
Sexual abuse is about one person exercising control and power over another.
Narrative Therapy
Externalizing the problem
Allows for separation from the trauma
Naming the problem/incident
"If the incident of sexual abuse that is stealing your sense of self-worth, security, and self-esteem had a name, what would it be?"
Re-authoring the story
Once clients have externalized the sexual abuse, they can begin re-authoring their story in a way that allows for healthy sexual attitudes and experiences.
This process may have to begin with a concentration on sexual activities unlike the ones experienced during the abuse.
New stories will build confidence and a more empowered way of thinking.
Providing a context for the story
Client's new narratives gain power when they are presented and accepted in front of an audience. In the case of sex therapy, the audience would often be one's partner.
Bringing a safe partner into therapy can help educate the partner, while also providing support for the survivor.
The telling and re-telling of narratives allows for future possibilities.
These linguistic and performative strategies may help:
Context-Shifting Questions
Untangling Story Snarls
Inflection Strategies
Resisting Narrative Pulls
Disrupting Narratives
Multiplying Narrative Links
Performance Strategies
Taken from (Hall, 2012)
Helping LGBT clients change narratives may increase sexual connection
or simply legitimize non-erotic partnerships.
Full transcript