talking sex - The Derbyshire Branch of AFT

DAFT and ASPENS Conference, Thursday 16 May, 1:45 – 3:15
Dana Mills-Powell
The context we’re in:
paradoxes at the heart of this issue
• Sex talk is everywhere but often not where it
needs to be.
• Sex is a foundational narrative about an adult
relationship, but is often not spoken.
• Sex should be brought in to couple therapy, but
how, if the couple themselves do not?
• Sex is both idealised on the one hand, and a
method of abuse or control on the other
• Is there any question why this topic is hard to talk
My own story of systemic training: does sex matter?
What is your training story?
The historical context: how did this all
come to be?
UK: Non-statutory sector took on marriage counselling in the
Relate, Marriage Care, TCCR.
Some systemic input:
• Robyn Skinner , One Flesh Separate Persons (1976) and
(1980) article, Journal of Family Therapy.
• Dallos and Draper (3rd ed.) 2010, added a chapter on couple
therapy (but it’s all drawn from the USA).
• UKCP’s systemic college adopted the new name of College
of Systemic, Family, Couple Therapy (CFCST)
• 2012 special issues of Context and JFT on couple therapy
but very little drawn from the UK.
“In the USA, when did who knock couple therapy out of
psychoanalysis and into family therapy? “(Nick Child)
Jay Haley (1963) Marriage Therapy, when with
Bateson’s original schizophrenia project in Palo Alto, CA
• Alan Gurman, professor of psychiatry and director of family
therapy training at Univ of Wisconsin. Clinical Handbook of
Couple Therapy (4th ed.) (2008) Described Haley’s work as
“undoubtedly the defining moment at which family therapy
incorporated and usurped what little was left in the stalledout marriage counselling and psychodynamic marriage
therapy domains
• James Framo, professor of psychology and family studies,
San Diego CA (1996). Journal of Marital and Family Therapy,
“Haley wanted to make sure that psychoanalytical thinking
be prevented from ruining the newly emerging field of
family therapy.”
• AAMFT (American Association of Marriage and Family
Sex therapy: UK and USA
We can summarise that early UK family therapy with its lack of focus on the couple
relationship had little interest in the emerging field of sex therapy with the
exceptions provided previously.
The study and practice of sexology and sex therapy took off in the late 1960s with
first the work of Alfred Kinsey who was first to study and publish material on the
sexual behaviour of Americans between 1938-1952.
Others followed including William Masters and Virginia Johnson who pioneered
the work on the human sexual response cycle starting in the late 1960s—still in
use today by sex therapists and in creating frameworks for sexual disorders in the
DSM: excitement/ plateau/ orgasm/ resolution.
Later on in 1970 they wrote the text, Human Sexual Inadequacy which described
sexual disorders and their treatment. Overall, research and practice of
psychosexual therapy (or PST) has been largely driven by the USA.
The emergence of Systemic Sex Therapy.
• Two texts published in 2009 (Systemic Sex Therapy and A
Clinician’s Guide to Systemic Sex Therapy) have crafted the
‘intersystems approach to sex therapy’.
• Fundamentally, it is looking at sexual difficulties and DSMdefined disorders from all of the following vantage points:
Individual and Biological
Individual and Psychological
Dyadic/Couple Relationship
Family of Origin
Society, Culture, History and Religion
Practice: facilitating sex talk in
couple therapy
Body, mind and spirit connections
• Tom Andersen: Therapy as Social Construction:
• “When life comes to me it touches my skin, my
eyes, my ears, the bulbs of my tongue, the
nostrils of my nose. As I am open and sensitive to
what I see, hear, feel, taste, and small I can also
notice ‘answers’ to those touches from myself, as
my body ‘from inside’ lets me know in various
ways how it thinks about what the outside
touches, what should be concentrated on, and
what not. “
Working with the spirit/body
• James and Melissa Griffith in their book Encountering the
Sacred in Psychotherapy speak of the body as a “door” to
the sacred or spiritual.
• “Even religions that discourage gratification of bodily
passions strive to access states of the body that are
associated with reverence, awe, and communion with God
or Spirit. This access is sought through spiritual practices—
fasting, ritual dieting, ascetic practices, or other activities
that place a check on physiological arousal from fear, anger
or shame. All this suggests that the sensations of the body
play a larger role in the perception of spiritual experience
than many of us in Western culture had supposed.” (2002,
p. 42).
Meaning as context: Coordinated
Management of Meaning (CMM)
• CMM: practical tool with a theoretical
• There can be no meaning without context.
• Human experience is embedded in levels of
context (hierarchical model)
• Every conversation is in fact a cluster of
conversations (atomic model)
• Sex as a form of communication between
• Gergen, K. & McNamee, S. (1992) Therapy as Social Construction. London:
• Griffith, J. and Griffith, M. (2002) Encountering the Sacred in
Psychotherapy. New York: Guilford.
• Gurman, A. (2008) Clinical Handbook of Couple Therapy (4th ed.).
• Haley, J. (1963) “Marriage Therapy”. Archives of General Psychiatry, Vol. 8,
March. Available from (Nick Child’s website).
• Hertlein, K., Weeks, G., & Gambescia, N. (2009) Systemic Sex Therapy.
New York, London: Routledge.
• Hertlein, K., Weeks, G., Sendak, S. (2009) A Clinician’s Guide to Systemic
Sex Therapy. New York, London: Routledge.
• Pearce. WB (1994) Interpersonal Communication: Making Social Worlds.
New York: Harper Collins.
Case example
• Case example: a Christian couple coming to me due to
difficulties in their sex life.
• The atomic model for each of them in one session,
which brought out their stories of faith (“off limits”,
“never heard a Christian speak positively about sex”),
family scripts (“taboo in my family”), gender stories
(“men want it and girls go along with it”), and specific
episodes which were influential .
• It also brought forth the woman’s issues with her body
and links to an eating disorder in her younger years: “I
should not be allowed to enjoy sex.” It is this broad,
systemic approach which this tool assists us in.
• Working with another person. Draw an
atomic model on a sheet of blank paper,
putting sex in the centre as a “speech act”.
Use this model as a framework for your
conversation—the interviewer will then use
different levels of context to shape their
questions and briefly summarise the
responses in each of the loops. The model will
show the multiple levels of meaning of sex for
your interviewee. Swap roles.