in Intimate

Relationships

Robert W. Firestone
Lisa A. Firestone
Joyce Catlett

American Psychological Association • Washington, DC

Copyright © 2006 by the American Psychological Association. All rights reserved.
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Library of Congress Cataloging-in-Publication Data

Firestone, Robert.
Sex and love in intimate relationships / Robert W. Firestone, Lisa A. Firestone, Joyce
Catlett.
p.cm.
Includes bibliographical references and index.
ISBN 1-59147-286-5
1. Sex. 2. Love. 3. Intimacy (Psychology) 1. Catlett, Joyce. II. Title.

HQ801.F553 2005
306.7-dc22 2005003228

British Library Cataloguing-in-Publication Data

A CIP record is available from the British Library.

Printed in the United States of America

First Edition
 CONTENTS

Acknowledgments Vll

Introduction 3

I. Exploring Sexuality and Love 9

Chapter 1. What Is Healthy Sexuality? 11

Chapter 2. What Is Love? 29

II. Factors Influencing Sexual Development and

Adult Sexual Functioning 41
Chapter 3. Factors That Affect an Individual's Sexuality 43
Chapter 4. Men, Women, and Sexual Stereotypes 75
Chapter 5. Approaches to the Etiology of Sexual
Dysfunctions and Problems in Sexual Relating ......... 111

III. The Defensive Process and Sexuality................................. 133

Chapter 6. The Role of the Fantasy Bond, the Voice
Process, and Death Anxiety in
Sexual Relationships :........................... 135

Chapter 7. Sexual Withholding 171

Chapter 8. Couple Relationships: Jealousy and

Sexual Rivals 197

v
IV. Therapeutic Approaches to Problems in Sexual Relating 227
Chapter 9. Voice Therapy Applied to Problems in
Sexual Relating 229
Chapter 10. Suggestions for Enhancing Sexual Intimacy 263
Epilogue 281

References 289
Author Index 321
Subject Index 329
About the Authors 337

vi CONTENTS
 ACKNOWLEDGMENTS

We wish to express our appreciation to Tamsen Firestone, [o Barring-

ton, Susan Short, and [o Linder-Crow for their brilliant editing of the
manuscript. Weare grateful to Susana Buckett for her efforts in researching
the vast literature on sexuality, intimate relationships, and gender issues
and for her help in producing the final manuscript. We also wish to thank
Anne Baker, who worked closely with us to complete the manuscript;
Margaret McMurtrey, for her help in copy editing the final draft; and [ina
Carvalho, who, assisted by [oni Kelly, is responsible for disseminating an
expanding body of written and filmed works through the Glendon Associ-
ation.
We want to thank Gary VandenBos and Jon Carlson for producing
the American Psychological Association (APA) video on Sexual Health
with coauthor Lisa A. Firestone, which provided the initial impetus for
writing this book. We also wish to acknowledge our indebtedness to Susan
Reynolds, acquisitions editor at APA Books, for her continued encourage-
ment and support and to Judy Nemes, development editor, for her insightful
suggestions regarding stylistic, organizational, and editorial changes.
We express our gratitude to the people whose stories are recounted
throughout this book. We thank them for their openness and honesty in
describing their feelings, thoughts, and opinions about their sexual lives and
intimate relationships in interviews, psychotherapy sessions, and discussion
groups. These individuals were strongly motivated to make the insights they
gained available so that others might benefit from their experiences.
The names, places, and other identifying facts contained herein have
been fictionalized, and no similarity to any persons, living or dead, is intended.

VI!
s x
ove
in lntlrnote
Relationships
 INTRODUCTION

Although sexuality can be one of the greatest pleasures in life, and a

very special opportunity for gratification and fulfillment, it also represents
an aspect of life that is complex and difficult and sometimes even traumatic.
In this regard, the renowned psychiatrist Laing quipped in a number of his
workshops that "the bedroom is the most dangerous place on earth." Both
men and women are confused about themselves as sexual beings and are
vulnerable to destructive internal "voices"] or self-attacks that have been
incorporated during their developmental years. Furthermore, because of a
generalized suppression of communication on the subject, people receive
little feedback about the subject of their sexuality. Cultural influences rein-
force negative attitudes toward the body, nudity, and sexuality, giving sex
a "dirty" connotation. The unnecessary and unnatural suppression and distor-
tion of sexuality in Western society lead to an exaggerated, prurient interest
in sexuality, dirty jokes, perverse attitudes and actions, and a general increase
in aggressive acting out behavior (Prescott, 1975).
The so-called sexual revolution of the 1960s was replaced with a
conservative backlash that served to compound the problems in sexual
relationships. Over the years, sex has been used in marketing commercial
products, as well as other manipulations of public opinion. Sex on the
Internet, allowing for arousal separate from human contact, has become a
profitable commodity. In modern society, there is often more sex, but less
feeling. Young people refer to "hooking up" (Brooks, 2003), a term that

3
suggests the lack of feeling in sexual relating. Men and women today are
suspicious and distrustful of one another, which negatively affects their
sexual relationships and prohibits real intimacy. Most find it difficult to
combine sex and love and sustain genuine closeness.
Human sexuality is a simple and pleasurable combination of attitudes
and actions that involves giving and receiving for both parties. If not
corrupted by ignorance, prejudice, childhood trauma, or outright sexual
abuses, people can enjoy this natural function. The main thesis of this
volume is that sexuality is often limited or damaged in an individual's
upbringing, and the resultant unresolved emotional pain gives rise to long-
standing psychological defenses. These defenses, both self-protective and
self-nurturing, preclude personal vulnerability and interfere with full and
uninhibited participation in sexual relating.
Most men and women profess that they desire a close, loving sexual
relationship that is active and long-lasting. We have found that, in actuality,
relatively few can tolerate loving or being loved. For those who have been
damaged as children, living defensively, maintaining distance, and warding
off closeness can become lifelong behavior patterns that seriously affect
their relationships and sexual lives.
Our purpose in writing this book is to shed light on the often trouble-
some subject of sexuality, sharing knowledge gained from more than 40
years of combined clinical experience and a unique longitudinal study of
three generations of individuals, couples, and families.' Based on our work,
we will describe the developmental issues that affect a child's sexual identity,
point out the problems in establishing intimacy, define a healthy sexual
relationship, enumerate the factors involved in developing oneself and in
selecting a mate, and describe a treatment modality for sexual problems and
conflicts that is effective in improving sexual relationships. In short, we
wish to provide information that clinicians can use to help their clients
become more fully loving and sexual.
Sex and Love in Intimate Relationships is different from the large majority
of books on sex, which tend to focus on the technical aspects of sexual
relationships. Currently there is a dearth of information regarding the impor-
tant emotional or psychological dimensions of human sexuality. This book
does not focus on evaluating or perfecting sexual performance. Instead, it
deals with sex in a much broader sense by focusing on how people feel
about themselves as men and women and how they interact in their
close relationships.
We view sex as a physical and emotional exchange and describe sexual-
ity as a form of intimate communication. This book delineates both the
psychological factors that contribute to satisfying sexual experiences and
those that interfere with the ability to achieve sexual and emotional inti-
macy. It provides an in-depth understanding of why the unique combination

4 SEX AND LOVE IN INTIMATE RELATIONSHIPS

of love and sex, although challenging, offers the most fulfillment. This work
is based on a theoretical model that integrates psychodynamic and existential
systems of thought, that points out the relationship between psychological
defenses and sexual difficulties. We provide numerous case studies and
personal accounts to illustrate this perspective.
This book offers information gathered from a large number of individu-
als, both in and out of couple relationships, in both clinical and nonclinical
settings. The diverse population represents a broad mental health spectrum,
ranging from healthy individuals and those with minor emotional problems,
to people with more serious disturbances. They recounted their experiences
in a variety of situations, including psychotherapy sessions, individual and
couple interviews, formal and informal discussions, and specialized seminars
organized for the purpose of gathering data on such issues as subjects' feelings,
opinions, attitudes toward sex, and sexual practices.

ORGANIZATION OF THE BOOK

Sex and Love in Intimate Relationships is divided into four sections. Part I,
"Exploring Sexuality and Love," addresses fundamental questions such as
what is healthy sexuality and what is the meaning of the word "love."
The chapters also deal with components of a "healthy" sexual relationship,
qualities to further develop in oneself and to look for in an "ideal" partner,
and characteristics of an "ideal" sexual experience. We offer our conceptual-
ization of love and its manifestations in a close, personal relationship.
Part II, "Factors Influencing Sexual Development and Adult Sexual
Functioning," delineates crucial interpersonal factors that affect children's
sexual development. The topics under discussion include parents' emotional
hunger and its effect on the child's emerging sexuality and other parental
attitudes and behaviors that can generate a sense of shame in children.
Many of the case studies in this section recount painful experiences people
endured in their early lives. In some cases, these incidents may appear to
be relatively mild; nevertheless, they had a serious impact on the sexual
development and adult sexual functioning of the individuals involved. Other
cases describe experiences that were, in fact, traumatic and that had severe
and long-lasting effects on the sexual lives of the people involved.
We argue that the hurt and fear resulting from such experiences may
lead to a defensive posture and a tendency to depersonalize that often have
a profound adverse effect on the willingness to remain vulnerable and close
during intimate moments. We propose that problems in sexuality are closely
related to overall defenses; for example, children who have been emotionally
deprived or rejected early in life tend to experience problems forming attach-
ments and difficulties in combining love and sex as adults.

INTRODUCTION 5
 This section also addresses issues of sexual stereotyping and its effect
on couple relationships and describes differences as well as similarities be-
tween men and women. We offer our views regarding the psychodynamics
involved in the development of sexual dysfunctions and review a number
of other theoretical approaches to the etiology of these dysfunctions and
problems in sexual relating.
Part III, "The Defensive Process and Sexuality," describes the key
element of our theoretical approach-the fantasy bond-an illusion of
connection to the mother or primary caregiver. This primary defense or
illusion of fusion leads to a pseudoindependent posture that later interferes
with closeness with others. We show how an awareness of the existential
issues of aloneness and death reinforce the primary defense or fantasy bond.
This section also introduces the concept of the voice-a secondary defense-
that supports the fantasy bond and self-parenting process. We describe how
debilitating critical voices are introjected during early family interactions
and discuss the role that these negative views of self and others play in a
variety of sexual problems.
Another chapter discusses the relationship between psychological de-
fenses, sexual withholding, and symptoms of low sexual desire, a disorder
that is prevalent in Western society. Also we explore the ways that men
and women experience painful feelings of sexual jealousy. Lastly, we provide
an in-depth discussion of our views regarding the advantages and disadvan-
tages of exclusive versus nonexclusive sexual relationships.
Part IV, "Therapeutic Approaches to Problems in Sexual Relating,"
describes the therapeutic methodology called voice therapy. We delineate
the five steps in voice therapy as they have been applied in the context of
couples therapy and provide case studies to illustrate assessment, treatment
strategy, and outcome. We describe corrective suggestions, journaling exer-
cises, and other homework assignments that can help partners learn to
tolerate more intimacy in their relationship. The epilogue summarizes our
approach and briefly reviews the major concepts and methods elucidated
throughout this work.
To conclude, in both the clinical and nonclinical populations we
studied, many people reported being confused and insecure about their
sexuality. Often they believed they were the only ones struggling with
this issue. In this book, we explore in depth the experiences that damage
individuals in their sexuality and provide methods for understanding and
coping with the problems that result from these early experiences. We have
found that by identifying and challenging destructive thought processes or
"voices" that interfere with closeness and optimal sexual functioning, people
can learn to combine love and sexuality and achieve that special combina-
tion that is so desirable in their intimate relationships.

6 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 NOTES

1. The concept of the "voice" (Firestone, 1988) refers to a system of thoughts,

beliefs, and attitudes, antithetical to self and hostile toward others, that is at
the core of all forms of maladaptive behavior. When verbalized in the second
person format, the contents of this destructive thought process are generally
accompanied by varying degrees of anger and sadness.
2. For a description of participants in the longitudinal study, see Firestone, Firestone,
and Catlett (2003) and Firestone and Catlett (1999).

INTRODUCTION 7
 I
EXPLORING SEXUALITY
AND LOVE
 1
WHAT IS HEALTHY SEXUALITY?

Sexual health is the integration of the somatic, emotional, intellectual,

and social aspects of sexual well-being, in ways that are positively
enriching and that enhance personality, communication, and love.
- World Health Organization
(1975; cited in Slowinski, 2001, p. 273)

A healthy sex life is central to one's sense of well-being and a potential

source of pleasure, happiness, and fulfillment. The enjoyment of passion,
eroticism, and sexual intimacy and the giving and receiving of affection are
fundamental aspects of being human. The special combination of loving
sexual contact and genuine friendship that can be achieved in an intimate
relationship is conducive to good mental and physical health and is a highly
regarded goal for most people.
On the other hand, sexual relationships can be risky emotional invest-
ments because they also have the potential for causing distress and grief.
Indeed, a good deal of human misery centers around sexuality and the
difficulties that most people encounter in attempting to achieve and sustain
satisfying sexual relationships. Disturbances in sexual relating have serious
consequences, affecting every aspect of a person's life, including activities
and pursuits far removed from the sexual domain.

DEFINING "NORMAL" SEXUALITY

In contemporary discourse about sex, the terms "normal," "natural,"

and "healthy" have all been used to describe sexual behavior in human

11
beings. It is important to draw some distinctions between these terms.
"Normal" is a word generally used to indicate the statistical norm, that is,
what most people do, whereas the terms "natural" and "healthy" are more
likely to be used as value judgments regarding the moral dimensions of a
given sexual behavior or practice (Strong, DeVault, & Sayad, 1999).
Sex researchers have stressed the enormous diversity ofsexual behaviors
and practices across different cultures (Suggs & Miracle, 1993). Obviously,
what is considered "normal," "natural," or "moral" in one society may well
be considered "abnormal," "unnatural," or "deviant" in another. Further-
more, what was considered abnormal in the past may be considered normal
and acceptable today. Indeed, during the past several decades, the frequency
with which people engage in certain sexual activities has changed sub-
stantially. For example, Laumann, Gagnon, Michael, and Michaels (1994)
reported that

The emergence of oral sex as a widespread technique practiced by

opposite-gender sex partners probably began in the 1920s and over the
past seventy years it has become more common in varioussocialcontexts
and among most social groups. (p. 102)

Similarly, people's evaluations of the "morality" of these sexual practices

have significantly changed (Stone, 1985).1According to Marty Klein (1992),
"What was considered abnormal only forty years ago: vibrators; touching
oneself during intercourse; couples masturbating together; women enjoying
oral sex ... are now considered fairly routine in many parts of the country"
(p. 163).
In discussing how to evaluate the morality of a specific sexual practice,
Klein (1992) cited three criteria as a basis for making a responsible choice:
"Is it consenting (and is the other person really in a position to give consent)?
Is it exploitative? Is it self-destructive?" (p. 5). In Sex: A Philosophical Primer,
Singer (2001) also addressed the subject of morality and sexual ethics,
asserting that

All means of satisfying one's sexual urges should be considered equally

moral, equally permissible, provided that they entail no harm to any
one else.... Nevertheless, society has an undeniable obligation to
protect minors against sexual molestation, and the same applies as well
to adults who have or wouldhave withheld their free consent in relation
to activities abhorrent to them. (p. 119)

Our views regarding "moral" and "natural" sexuality are congenial in

many respects to the sentiments expressed by Klein and Singer. In the
following pages, we expand on Klein and Singer's definitions and describe
our views regarding healthy sexuality.

12 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 OUR PERSPECTIVE ON HEALTHY SEXUALITY

We define healthy sexuality as a mode of sexual relating that represents

a natural extension of affection, tenderness, and companionship between
two people (Firestone, 1990c; Firestone & Catlett, 1999). When both part-
ners are fully present, in close emotional contact with each other, and
enjoying the spontaneous giving and receiving of affection and sexual plea-
sure, their lovemaking contributes significantly to their emotional well-
being and overall satisfaction in life.
In our work, we focus on the psychological factors that tend to give
sexuality its depth and meaning. From this perspective, healthy sexual
relating involves two individuals who have mature attitudes toward sex and
do not view it as an activity isolated from other aspects of their relationship.
They see sex as a fulfilling part of life and lovemaking as an opportunity
to offer pleasure to each other and to experience pleasure themselves. They
are sexually aware and informed, relatively uninhibited, and largely unself-
conscious in their emotional and sexual responses, and they are therefore
free to enjoy the physical contact, excitement, and passion of the sexual
encounter. Both partners have an active desire for sex, a positive body
image, and congenial attitudes about themselves and their partner that are
relatively free of distortion or bias.
Healthy sexuality also implies incorporating sexuality into one's daily
life, rather than consigning it solely to the sex act itself. In an ongoing
sexual relationship, both partners would be aware of the important role that
sex plays in their lives, not as an exaggerated area of focus but as a simple
human experience.
In our work with individuals and couples, we observed that an individu-
al's attitude toward sex is usually reflected in his or her level of vitality,
overall appearance, and expressions of tenderness and affection. Sexual
desire adds zest to people's lives, whereas diminished or inhibited sexual
desire can detract from their enthusiasm for living and make life seem flat
and uninteresting. Indications of sexual desire and a lively interest in sex
can be observed in a person's facial expression, smile, friendly manner, sense
of humor, playfulness, spontaneity, and enthusiasm. People who enjoy an
active sex life seem more energetic and vivacious and are generally more
appealing than those who are inhibited sexually or have little interest in sex.
We believe that "natural" or "healthy" sexuality includes an acceptance
of our animal nature and a positive attitude toward our bodies, our nudity,
and our sexual urges. It implies seeing sex as a simple and pleasurable act
and giving it a high priority in our lives. In a culture or society that viewed
sex as a natural, pleasurable activity, the subject would be openly talked about
and personal feelings and preferences would be discussed in an adult fashion.

WHAT IS HEALTHY SEXUALITY? 13

 OTHER DESCRIPTIONS OF THE SEXUALLY
HEALTHY INDIVIDUAL

Mental health professionals, sex therapists, and sex educators have

attempted to conceptualize the sexually healthy individual in terms that
encompass many personal qualities, attitudes, behaviors, and lifestyles
(LoPiccolo, 1994; Zilbergeld, 1999). Schnarch (1991) has described healthy
sexual functioning as being closely related to an individual's "capacity for
intimacy" and his or her ability to attach "profound emotional meaning to
sexual experience" (p. 19). The Sexuality Information and Education Coun-
cil of the United States (2002) recently published a broad definition of
healthy sexuality. The council delineated a wide range of characteristics of
the sexually healthy adult individual, who would
Appreciate one's own body. Seek further information about reproduc-
tion as needed. Affirm that human development includes sexual devel-
opment that mayor may not include reproduction or genital sexual
experience. Interact with both genders in respectful and appropriate
ways. Affirm one's own sexual orientation and respect the sexual orienta-
tion of others. Express love and intimacy in appropriate ways. Develop
and maintain meaningful relationships. Avoid exploitative or manipula-
tive relationships. (p. 7)1

Another definition of healthy sexuality can be found on the University

of Illinois Web site (University of Illinois Board of Trustees, 2004) that
cited sex therapist Maltz's definition of healthy sexuality as
Positive, enriching, and about how we communicate and accept and
give love. It means having the ability to enjoy and control our sexual and
reproductive behavior without guilt, fear or shame. Sexual expression is
a form of communication through which we give and receive pleasure
and emotion.... Healthy sex requires that these conditions be met:
Consent, Equality, Respect, Trust, and Safety. (p. 1)

CRITERIA COMMONLY USED TO EVALUATE SEXUALITY

The frequency of sexual relations is often considered to be a criterion

for healthy sexuality or an indicator of "normality." Indeed, many men and
women are curious about how often the average person makes love. There
are a multitude of sex surveys that report the frequency of sexual relations
for single, cohabiting, and married people.
Stritof and Stritof (2004) reported highlights of one recent survey (the
2003 Durex Survey), which found that the average American couple has
sex about once a week. The survey also showed that unmarried couples

14 SEX AND LOVE IN INTIMATE RELATIONSHIPS

living together have sex 146 times a year, while married couples make love
98 times a year on average. Results from another survey (Laumann et al.,
1994) showed 13% of married couples having sex a few times per year, 45%
reported making love a few times per month, 34%, 2 to 3 times per week,
and 7%, 4 or more times per week.'
The types of sexual activities that couples engage in are often used as
criteria for normality. The survey conducted by Laumann et aL (1994) found
that the large majority of men and women (95% and 97% respectively)
engaged in vaginal intercourse; approximately three quarters of both men
and women practiced oral sex; and one quarter of men and one fifth of
women reported engaging in anal sex. Among men and women who reported
having sex with a sarne-gendered partner in the past 5 years, active and
receptive oral sex were practiced by between 72% and 82% of respondents.
Active and receptive anal sex were practiced by between 62% and 64% of
the male respondents. For women in same-gendered partnerships, "the rates
and pattern of oral sex are quite similar" (p. 319) to those reported by male
respondents in same-gendered partnerships.
Many individuals evaluate the "success" of their sexual performance
in terms of whether or not their lovemaking culminates in orgasm for both
partners. In the study cited above, Laumann et aL (1994) found that "Three-
quarters of the men report that they always have orgasm during sex" (p. 114).
The survey also uncovered an interesting discrepancy: 29% of women said
they always have an orgasm with this specific partner. This rate was "46
percentage points lower than that of men" (p. 114). In commenting on this
discrepancy, Laumann et aL, stated, "To the extent that female orgasm is
now considered both a right (for women) and a responsibility (for men), this
discrepancy undoubtedly constitutes a source of considerable intergender/
interpersonal tension" (p. 114). These findings raise another important
question: do most men and women consider orgasm to be the ultimate goal
or criteria for a "healthy" or an ideal sexual experience?

DIMENSIONS OF AN IDEAL SEXUAL EXPERIENCE

In describing the dimensions of healthy sexuality, researchers have

recently turned their focus to evaluating emotional satisfaction or dissatisfac-
tion attained by adult individuals during a sexual experience rather than
focusing solely on physical satisfaction as in previous surveys. One extensive
survey (Laumann et al., 1994), for example, assessed the degree of physical
and emotional satisfaction. Results from interviews with 3,432 men and
women showed that 47% of men and 41% of women reported that their
"specific partnerships could be accurately characterized as 'extremely' physi-
cally pleasurable" (p. 118), while only 41% of the men and 37% of women

WHAT IS HEALTHY SEXUALITY? 15

reported the partnership as emotionally satisfying. What dimensions of a
sexual experience or relationship contribute to its being satisfying both
physically and emotionally?
In the following pages, we offer material from ongoing specialized
seminars about sexuality and from interviews in which people discussed
their opinions, feelings, and experiences. During these interviews and semi-
nars, men and women were asked, "How would you describe the ideal sexual
relationship or experience?"

Elliott: I think a sexual experience is ideal when it's part of

sharing the day and then being affectionate, then there's
more affection, and then you're sexual. Afterwards, you're
affectionate, and you're friends; it's a smooth continuum
like that.
Diana: I think that an ideal sexual experience would be one
where both partners would feel appreciative to one an-
other for being given something that made them happy
and made them feel good.
Brad: For me, the ideal sex experience would include feelings
of friendliness and closeness, combined with passionate
lovemaking, and talking freely and directly to your sexual
partner about your personal feelings, both positive and
negative, as they arise.
Andy: I think that for me the thing that makes sex an ideal
experience is if my girlfriend is really interested and really
lets me make her feel good.
Renee: An ideal sexual experience has an even deeper meaning,
because to be fully sexual makes you feel so alive. You
feel it everywhere in your life. When I'm sexual, I really
feel my body. I love that feeling, I love feeling the other
person. I love feeling my own body, just physically, my
skin against his skin and the physical sensations. But also
it makes me feel alive and very sensitive to everything
around me, to my life. If I'm not motivated to be sexual,
I become dull, my senses become dulled.
Vivian: I feel like the most important thing is just being there
and not being inside my head, being with my husband
and feeling really close. Those times feel really special.
Christopher: [to his girlfriend] When it's nice between us, it is so
wonderful for me and I feel both excited and close, and
I also feel very free. It's interesting that what comes with
the really gratifying sexual experience is a sense of feeling
really free afterwards too. I feel happy to see you through-

16 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 out the day and my feelings of affection and closeness
continue for quite a while.
Maria: Sex would be a simple part of life. It's not separate, it's
not serious, it's not in a dark room, it's a fun, easy,
close experience.
Jason: For me to have a really, really satisfying sexual experience,
I need intimacy, whether it's physical or verbal, outside
of the bedroom first. I think sex is better when there's a
connection there. It might be more aggressive and physi-
cal, or more calm and tender, depending on the situation.
Also I feel satisfied when I get some acknowledgment
that my boyfriend was pleased.
Kevin: I feel that the ideal sexual relationship is made up of
friendship, continuity, and affection. And spontaneity is
a key part of it. Anything that routinizes the relationship,
I feel, kills the sexuality.
The general consensus obtained from these interviews and discussions
seemed to indicate that to be a fully satisfying experience, the sexual relating
had to include emotional closeness. Healthy sexual experiences appear to
be characterized by an uninterrupted flow of pleasurable sensations and
feelings throughout the act. There is a notable absence of inhibition at any
time during the process, beginning with the initial expressions of physical
affection, and continuing through foreplay, intercourse, and the time imme-
diately following the experience. Partners feel free in undressing, being
looked at, and being touched. They are not worried about making sounds
indicating their pleasure, nor are they fastidious about smells or focused
exclusively on having an orgasm.
In an "ideal" sexual encounter, partners would proceed naturally from
one plateau of arousal to the next undisturbed by negative thoughts about
their bodies, their sexuality, their performance, or their partner. Both part-
ners would tend to be spontaneous in their sexual responses, and neither
person would try to inhibit or control any aspect of the sex act. Because
both individuals would take responsibility for their own sexual desires and
needs and indicate their wants, there would be a feeling of equality inherent
in their interaction that would contribute to their overall sense of well-
being and individuality. Ideally, there would be an absence of guilt, self-
critical ruminations, or hostile attacks on one's partner about the experience.
Following a gratifying sexual encounter, partners would tend to experience
a mixture of happiness, sadness, relaxation, and fulfillment, and they would
probably express their mutual appreciation, verbally and nonverbally, for
the pleasure they received.
A satisfying sexual encounter can be playful, carefree, sensuous, affec-
tionate, serious, sad, or a combination of these qualities and emotions.

WHAT IS HEALTHY SEXUALITY? 17

Although there is a wide range of sexual experience that men and women
enjoy, many have described their ideal experience as one that combines
tenderness, warmth, friendship, and sexual satisfaction. For example, in one
group discussion, Maria talked about aspects of her sexual relationship with
her husband that she found especially gratifying and meaningful.
In our lovemaking, there is such an absolute lack of control. It's almost
a magical experience, because going into it, I never know what's going
to happen. There's no timing, there's no order of anything; we're simply
two people together, and I never know ahead of time exactly how it's
going to work. But if we're both close, really there in the situation, it
really does feel to me like something magical happens.
Satisfying, mature sexual relations are not necessarily limited to long-
term relationships. For example, a sexual encounter between two people
who have just met can be satisfying on both an emotional and physical
level. In general, a positive or healthy sexual experience, whether casual
or not, includes close emotional contact with one's partner, a sense of
mutual give and take, and feelings of fulfillment and well-being following
the experience. In the same discussion, Jeremy expressed his ideas about
what he considered to be the "ideal" sexual experience.
The "ideal" sexual experience can go from being fun and playful to
being a very deep emotional experience. I've had a few "ideal" sexual
experiences with a woman who I didn't develop a long-term relationship
with. But in that moment there was an intimacy, there was a together-
ness, and you lose a self-consciousness in that intimate moment with
someone like that. You're two people equally sharing that experience.
But, at the same time, you have a tremendous awareness of the other
person's vulnerability, and their being soopen and receptive to you.There
is something so touching about that awareness and that experience-
that's what makes it ideal.
Another participant, Cliff, described the contrast between what he
considers an "ideal" and a less-than-ideal sexual experience:
When sex is simple and easy, I feel very happy with my girlfriend, and
I don't have a lot of thoughts in my head about being able to satisfy
her. But then there are times when it's not like that, and it feels like
there are six of us in the bedroom, like in that movie, The Story of Us,
when Bruce Willis and Michelle Pfeiffer's "parents" suddenly appear
and interrupt an intimate moment with their hostile messages. When
that happens to me, there's so much going on in my head, it's confusing
and I get muddled.
As is obvious from Cliffs description, obstacles can arise during sex
that interfere with sexual fulfillment. For example, at those times when
people get into their heads (thinking negative thoughts or just worrying),

18 SEX AND LOVE IN INTIMATE RELATIONSHIPS

lovemaking can come to a complete standstill, leaving partners frustrated
and confused.
In listening to individuals talk about their sexual experiences, we
learned a great deal about what interrupts the smooth flow of feelings and
sensations during lovemaking. For example, people described the kinds of
negative thoughts that often intruded into their thinking at various points,
distracting them from the full enjoyment of the experience. In many cases,
these critical thoughts were directed toward their sexual performance and
increased any anxieties they might have had regarding having an orgasm
and/or satisfying their partner.
Satisfying sex and emotional intimacy may elicit a myriad of emotions-
feelings of tenderness, excitement, pleasure in satisfying the wants and needs
of the other, and joy in sharing a meaningful experience. An especially
close sexual interaction, one that combines "eyes-open" emotional intimacy
with passionate sex, may approach a spiritual level (Chessick, 1992; Schn-
arch, 1991). We believe that during those moments when ecstasy and
exhilaration combine with poignant feelings of sorrow and existential pain,
lovers never feel more together and more alone. Indeed, this unique blending
of eroticism and love represents a powerful antidote to the existential despair
inherent in the human condition.

ESSENTIAL PERSONAL QUALITIES FOR

HEALTHY SEXUAL RELATING

Any attempt to synthesize the information gathered through years of

discussions and interviews with couples can sound prescriptive and simplistic,
an attitude that is personally offensive to us and incongruent with our
perspective and purpose. Nevertheless, it is valuable to delineate the factors
that we have found to be the most significant in contributing to positive
or healthy sexual relating. It is obvious that the success or failure of an
intimate relationship is strongly influenced by the personal qualities one
brings to the relationship as well as by one's choice of a partner. Taking
both of these perspectives into account, there are a number of personality
characteristics that each partner might strive to further develop within him-
or herself.

N ondefensiveness and Openness

In our work with couples, we have found that two qualities essential
in achieving a satisfying and fulfilling relationship are openness and a lack of
defensiveness. Nondefensiveness may be defined as a receptivity to feedback
without being guarded or hypersensitive about any topic. The negative

WHAT IS HEALTHY SEXUALITY? 19

impact of making certain subjects taboo and excluding them from one's
communications in a close sexual relationship cannot be overstated. Because
most people are self-critical in the area of their sexuality, they often overreact
to any negative feedback, mild or harsh, from an intimate partner, whether
it is related to their appearance, body, sexual practices, or performance.
Therefore, they tend to exclude these subjects from their communications.
The resulting censorship in the partners' dialogue leads to increased tension
and tends to reverberate through other areas of the relationship.
Studies by Gottman and Krokoff ( 1989) have shown that many couples
find it uncomfortable to communicate about sex. In some cases, one partner's
defensiveness about sex predisposes the withdrawal of the other person,
while in other instances defensiveness leads to an escalation of conflict
between partners. Defensiveness may be expressed through refusal to talk
about the subject, anger, tears, "falling apart," and victimized pleas for more
understanding. There may be expressions of defeat and hopelessness through
statements such as, "Well, if that's how you really feel about me," "Why
do you have to be so picky? You're always finding fault with me," or other
statements that make a partner regret ever having broached the subject.
Openness includes the ability to be forthright in expressing feelings,
thoughts, dreams, and desires. Individuals who are direct in stating their
sexual wants and needs have a good effect on their partner and the relation-
ship. Men and women who are motivated to develop beyond their defenses
against intimacy, especially in their communications, are generally not secre-
tive or self-protective, nor are they embarrassed or ashamed to disclose their
fears or doubts about sexual matters to their partner. However, people who
are resistant to change may be more secretive and less open to feedback
when communicating with their partner. In terms of their sexuality, these
men and women may develop habitual or routinized modes of interacting
sexually because they are afraid of being vulnerable and emotionally close
to their partner.

Honesty and Integrity

Dishonesty and deception are perhaps the most hurtful qualities mani-
fested by sexual partners. Because deception fractures another person's sense
of reality-the belief in the veracity of his or her perceptions-the personal
qualities of honesty and integrity are fundamental to the emotional well-
being and mental health of both partners and vital to the quality of their
relationship. For example, deception about the other's sexual alliances can
destroy the betrayed partner's basic sense of trust in him- or herself and
other people.
Real honesty requires considerable self-knowledge and an intolerance
of any falseness or insincerity in oneself. It is manifested in a nonduplicitous

20 SEX AND LOVE IN INTIMATE RELATIONSHIPS

style of communication. People who have achieved a high level of integrity
in their lives also have a realistic evaluation regarding the extent to which
they are capable of accepting loving sexuality in their relationships. They
represent themselves accurately and do not condone discrepancies between
their words and actions.
Double messages such as proclamations of love that are not congruent
with loving behaviors are confusing and ultimately destructive to the trust
between sexual partners. Studies of communication within couples (Canary,
Cupach, & Messman, 1995; Gottman, 1979; Gottman & Krokoff, 1989;
Keeley & Hart, 1994) have found that the greater the discrepancy between
the manifest content (seemingly positive verbal messages) and their underly-
ing or latent meaning (in particular, body language indicating negativity),
the greater the potential for disturbance. In the area of sexuality, as in other
areas of the relationship, partners may have implicitly agreed not to notice
the discrepancy between statements of love and behaviors that express
underlying hostility. This further confuses the issue and creates additional
problems in the sexual interaction. As Bach and Deutsch ( 1979) said, "There
is a tendency of both parties to disavow the crazymaking experience, to
deny it and smooth over its ill effects" (p. 23).

Respect for One's Partner as a Separate Individual

In an ideal relationship, each partner values the other person, separate

from his or her own interest, and places the other's wants, desires, and
satisfaction on an equal basis with his or her own. Furthermore, each partner
feels congenial toward the other's overall goals in life. In relating sexually,
neither attempts to manipulate or control the other's responses. In seeking
a potential partner, one would be well advised to seek out someone who is
independent and self-reliant, because these qualities are needed to develop
this type of mature perspective on relationships. The ideal partner would
be aware that feeling his or her separateness is an integral part of having
a sensitive, tender feeling toward his or her partner.
Individuals who have developed a high level of self-differentiation
show, through words and actions, a genuine respect for the boundaries,
wants, and priorities of their mate. They take pleasure in seeing their partner
flourish in areas of his or her life that are separate from them. There is an
awareness that to be close to another person, one must have a sense of
one's separateness and autonomy.
To develop the ability to maintain independence and autonomy while
relating closely with another, a person would first need to achieve insight
regarding important events in his or her childhood, for example, in relation
to any losses, separations, or trauma experiences that may have occurred.
The resolution of past trauma entails gradually developing a coherent

WHAT IS HEALTHY SEXUALITY? 21

narrative about experiences with significant attachment figures and making
sense of aversive childhood events. Findings from recent research (Karr-
Morse & Wiley, 1997; Main & Goldwyn, 1984; Main & Solomon, 1986;
Siegel, 1999) have shown the necessity for retrieving painful childhood
memories as well as the emotions associated with these memories to achieve
maturity in one's attitudes and behaviors in an adult relationship." In addi-
tion, individuals need to challenge defensive attitudes and sexual biases
formed early in life that may still influence their ways of relating to their
partner.
In discussing problems encountered by many individuals who are strug-
gling to preserve their autonomy and sense of themselves in their relation-
ships or marriages, Wallerstein and Blakeslee (995) proposed that the first
task of intimate partners is separating emotionally from the family of origin.
In explaining what this entails, they wrote: "Psychological separation means
gradually detaching from your family's emotional ties.... This emotional
shift from being a son or daughter to being a wife or husband is accomplished
by internally reworking your attachments to and conflicts with your parents"
(p. 53) [italics added]. In other words, even though a person is physically
distant from parents and other family members, unless he or she has achieved
a certain degree of emotional emancipation from the family, there will
inevitably be limitations on his or her sexual life. Bowen (1978) and Kerr
and Bowen (1988) have also called attention to this important factor in
personal development, emphasizing that emotional emancipation from the
parental family is an important step toward becoming a more differentiated
self or autonomous human being.

Empathy, Compassion, and Understanding

Empathy, compassion, and understanding are related concepts; how-

ever, some authors have discriminated between these terms. Empathy is
defined by Siegel and Hartzell (2003) as

Understanding the internal experience of another person; the imagina-

tive projection of one's consciousness into the feelings of another person
or object; sympathetic understanding. This is a cognitively complex
process that involves mental capacities to imagine the mind of another.
Empathy may depend on the capacity for rnindsight, mediated by the
integrative right hemisphere and prefrontal regions of the brain. (p. 224)

Siegel and Hartzell define compassion as

The ability to feel with another. ... Compassion is a caring stance

toward the distressful emotional experience of another person. Compas-
sion may depend on mirror neuron systems, which evoke an emotional

22 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 state in us that mirrors that of another person, enabling us to feel
another person's pain. (p. 224)
Understanding involves an awareness and appreciation of the common-
alities and differences that exist between two people. According to Duck
(1994),
The more one comprehends another person, the more one learns not
only about the person's mind but also about the range of social actions
that the person finds acceptable. In turn one can modify one's style of
behavior in order to respond more appropriately to the person in the
extended interactions of a relationship. (p. 131)
Duck's description of the elements that make up understanding is
similar in many respects to Siegel and Hartzell's (2003) concept of
"Mindsight-the capacity to 'see' or image, the mind of oneself or another,
enabling an understanding of behavior in terms of mental processes" (p.
224). In expanding the concept of empathy, Eagle and Wolitzky (1997)
contended that "there are different components and aspects of empathy,
including the empathic experience of the listener, received empathy, em-
pathic communication, and so on" (pp. 241-242).
When both partners are empathic and capable of communicating with
compassion and respect for the other person's wants, attitudes, and values,
each partner feels understood and validated. In an ongoing sexual relation-
ship, they are able to candidly discuss their differences as well as their
commonalities. As a result, their communications, both during sex and in
other parts of their life together, have the positive effect of making each
person feel acknowledged and unique.

The Capacity to Give and Receive Love, Affection, and Sex

Ideally, personal growth and increased self-differentiation would facili-

tate an increase in a tolerance for closeness and an enhanced potential for
enjoying sexual intimacy in one's relationship. The act of making love
involves a particularly close physical and emotional exchange between two
people. To be fully engaged in this powerful transaction, an individual needs
to develop his or her capacity to both give and receive physical affection
and to enjoy the emotional exchange that occurs during a sexual experience.
The ability to love-to feel empathy and to express kindness, generos-
ity, and tenderness toward another person-requires first learning to value
oneself and one's experiences. This can be a difficult task because the ability
to see oneself as having worth and one's life as having value is often damaged
early in life. Thus, the process of learning to love is an ongoing endeavor
directed toward transforming negative attitudes toward oneself and one's
sexuality into a more compassionate, less restrictive view.

WHAT IS HEALTHY SEXUALITY? 23

 In our opinion, this process of expanding one's capacity to love another
is a skill that must be developed, just as one develops any other skill.
However, learning to love can be difficult and complicated for men and
women who, as children, may have been damaged in their feelings about
themselves. For example, it may be difficult to accept tenderness and sexual
responses from another person because such affection causes a resurgence
of painful feelings from the past. We believe that to preserve a loving, sexual
relationship, both partners must be willing to face the threat to their defense
system that being loved and appreciated poses. Both must be willing to
change negative images of themselves formed in the family and to give up
defenses they once may have felt were necessary for their psychological
survival.

The Capacity for Being Vulnerable

It is important to develop the capacity to be vulnerable in close sexual

experiences rather than trying to protect oneself against the possibility of
being hurt or rejected. Individuals who have been damaged early in life and
who lack trust in others are often afraid to take a chance on being close
emotionally and sexually in a relationship. They may be especially intolerant
of combining love, affection, and satisfying sex in an intimate relationship.
The ability to maintain emotional contact with one's partner while
making love presupposes a willingness to experience poignant feelings that
invariably arise during a meaningful sexual encounter. We have found that
the special combination of sexuality, affection, and emotional closeness can
serve to remind people that they are truly alive, that they really do exist.
Giving value to their existence tends to make them acutely aware of the
fragility of life and the ultimate separation, through death, from loved ones
and from the self. Frightened by these issues of death and dying, people
often turn their backs on their sexuality and retreat emotionally, rather
than embrace life to its fullest.

CONCLUSION

In answering the question, what is "normal" or "natural" sexuality, it

is well to remember that these definitions have changed during the past
century, as they have in every period of history. As historian Stone (1985)
rightly observed: "What is absolutely certain ... is that over the long history
of Western civilization, there has been no such thing as 'normal sexuality.'
Sexuality is a cultural artifact that has undergone constant and sometimes
dramatic changes over time" (p. 42). Normality or abnormality in relation
to sexuality is embedded in people's beliefs about the morality or immorality

24 SEX AND LOVE IN INTIMATE RELATIONSHIPS

of certain sexual practices, and these beliefs can vary tremendously across
cultures, social classes, ethnic groups, and historical eras.
In describing our conceptualization of "healthy sexuality," we ex-
panded on definitions of healthy sexuality previously adopted by several
organizations and public health officials and included other important psy-
chological and relational dimensions. An understanding of healthy sexuality
enables one to visualize personal qualities and behaviors in each partner
that would contribute to a loving and sexually fulfilling relationship. In an
ongoing intimate relationship, healthy sexual experiences based on love,
affection, and friendship have an overall positive effect on both partners.
In addition, mature loving sexuality is manifested in an appreciation and
respect for the true nature of the other person and support for his or her
personal freedom pursuant to his or her personal goals in life. Individuals
who strive to develop themselves and their full potential and who seek
partners with strength and independence are more likely to succeed in their
quest for love and sexual intimacy.
A combination of sexuality, close emotional contact, and personal
communication is an ideal in couple relationships. However, relationships
that combine genuine love and sexuality are difficult to find and even more
difficult to tolerate or accept. Although people feel especially gratified when
a sexual experience has also been emotionally satisfying, they have a good
deal of resistance to that combination. This resistance arises in part because
genuinely loving sexuality represents a significant intrusion into people's
psychological defenses. Lovers frequently feel uniquely vulnerable to the
possibility of future loss or rejection when they remain close to each other
during sex. They are deeply touched to be gratified by another, yet are
painfully aware of how much they stand to lose.
As men and women become more aware of these seemingly paradoxical
reactions to love and sex, they expand their boundaries and experience
more satisfaction in life. For example, during the course of our clinical study,
we observed that many clients altered their attitudes toward sex in a positive
direction. In challenging their defenses against closeness and intimacy, they
gradually changed many ways they had limited or controlled expressions of
love and sexuality in their intimate relationships. They increasingly came
to value love and sexual intimacy and viewed these aspects of their relation-
ship as a fundamental part of life. In essence, they came to perceive sexual
love as "a way of being together" as Keen (1997) described it, that is, "not
having (mutual possession) or doing (exercising skills), but being present and
vulnerable in the fullness of [one's] being" (p. 207) [italics added].
Moreover, we found that, in general, as individuals develop and work
through childhood conflicts and trauma, they become less fearful of physical
and emotional closeness. As they mature emotionally and modify defensive
behaviors, they tend to make better choices and progressively develop more

WHAT IS HEALTHY SEXUALITY? 25

fulfilling sexual relationships. As their potential for eroticism and emotional
closeness increases, they are likely to seek partners who manifest strength and
independence and who can also tolerate relatively high levels of intimacy.
It has been our experience that people can learn to tolerate the anxiety
evoked by passionate, loving sexual experiences and maintain a real closeness
with their partner and a natural, healthy desire for sex. In differentiating
themselves from their families-of-origin and strengthening their point of
view in relation to their sexuality, they can develop and sustain more deeply
fulfilling sexual relationships than they previously thought possible.

NOTES

1. According to historian Stone (1985),

To a young male citizen of Athens in the fifth and fourth centuries

B.C., it was perfectly proper and moral to use the body of a male or
female slave for any sexual pleasure that took his fancy-whether it be
sodomy, fellatio, or whatever. ... [From the 4th to the 18th century]
it was generally held that passionate sexual love between spouses within
marriage was not only indecent but positively sinful. (p. 35)

2. The other characteristics listed by the Sexuality Information and Education

Council of the United States (2002) are

Make informed choices about family options and lifestyles. Exhibit skills
that enhance personal relationships. Identify and live according to one's
values. Take responsibility for one's own behavior. Practice effective
decision-making. Communicate effectively with family, peers, and part-
ners. Enjoy and express one's sexuality throughout life. Express one's
sexuality in ways congruent with one's values. Discriminate between
life-enhancing sexual behaviors and those that are harmful to self and/
or others. Express one's sexuality while respecting the rights of others.
Seek new information to enhance one's sexuality. Use contraception
effectively to avoid unintended pregnancy. Prevent sexual abuse. Seek
early prenatal care. Avoid contracting or transmitting a sexually trans-
mitted disease, including HIY. Practice health-promoting behaviors,
such as regular check-ups, breast and testicular self-exam, and early
identification of potential problems. Demonstrate tolerance for people
with different sexual values and lifestyles. Exercise democratic responsi-
bility to influence legislation dealing with sexual issues. Assess the
impact of family, cultural, religious, media, and societal messages on
one's thoughts, feelings, values, and behaviors related to sexuality. Pro-
mote the rights of all people to accurate sexuality information. Avoid
behaviors that exhibit prejudice and bigotry. Reject stereotypes about
the sexuality of diverse populations. (p. 7)

26 SEX AND LOVE IN INTIMATE RELATraNSHIPS

 Also see "Defining Sexual Health: A Descriptive Overview" (Edwards & Cole-
man, 2004).
3. Laumann et al. (1994) reported results from a comprehensive survey of the
sexual habits of people in the United States. They conducted 90-minute, face-
to-face interviews with 3,432 Americans between the ages of 17 and 59, asking
them about their sexual practices and beliefs. The University of Chicago Harris
School (1994), in a summary of Laumann's results, reported that "Approxi-
mately one third have sex a few times a year or not at all, a third have sex
once or several times a month, and another third have sex at least two or more
times a week" (p. 2).
4. See Main and Solomon (1986) and Siegel (1999) regarding the relationship
between the ability to construct a coherent narrative of one's attachment
history, the elicitation of deep feeling, and the resolution of early trauma and
loss. In discussing ongoing attachment research conducted with the Adult
Attachment Interview, Siegel (2001) stated,
The finding that the coherence of the adult's autobiographical narrative
is the most robust predictor of the child's attachment with the parent
can help us shed light on the importance of neural integration for
both mental health and nurturing interpersonal relationships. Coherent
narratives can be seen to reflect the ability of the "interpreting" left
hemisphere to utilize the autobiographical, mentalizing, and primary
emotional processes of the right hemisphere in the production of "co-
herent" autonoesis, or self-knowledge. (p. 89)

WHAT IS HEALTHY SEXUALITY? 27

 2
WHAT IS LOVE?

The great aim of every human being is to understand the meaning of

total love. Love is not to be found in someone else, but in ourselves;
we simply awaken it. But in order to do that, we need the other person.
The universe only makes sense when we have someone to share our
feelings with.
-Coelho (2004, p. 116)

For centuries, philosophers, poets, novelists, and social scientists have

attempted to define the meaning of the word "love," describe the emotions
accompanying the subjective experience of falling in love, and elucidate
how love is manifested in human relationships of every kind. Reik (1941)
called attention to the problem of defining love in his book Of Love andLust:
Love is one of the most overworked words in our vocabulary. There is
hardly a field of human activity in which the word is not worked to
death.... There is no doubt as to which science is qualified to give us the
desired informarion and insight, but psychology seems to be extremely
reticent on the subject. (pp. 9-10)

Writing about love in his personal journal, Laing (personal communica-

tion, July 1989) expressed sentiments similar to those of Reik:
Psychology.... No where within the network of its assumptions and
terminology is there any possibility of even conceptualising mutual love .
. . . Freud stated his position perfectly clearly: "Simple human love is
impossible" (Future of an Illusion). Most of his followers are too cow-
ardly, dull, and dishonest to be so candid.

Two brief quotations from Paulo Coelho's Eleven Minutes were reprinted in this chapter. From Eleven
Minutes by Paulo Coelho. Copyright © 2004 Paulo Coelho. Reprinted by permission of
HarperCollins Publishers Inc.

29
 Let us move on. Let's take a few breaths of fresher air. Let's start
with the belief, hope, wish, that mutual love is possible.

PHENOMENOLOGICAL DESCRIPTIONS OF LOVE

Volumes have been written about the nature of love and how love is
manifested in an intimate relationship. The philosopher Singer (2001), in
Sex: A Philosophical Primer, asserted that
There is no single entity, no discernible sensation or emotion, that is
love .... There is no feeling, no unique and explicit datum, such that
love exists if and only if it is present. Love is a form of life, though
often short-lived, a disposition, a tendency to respond in a great variety
of ways, many overlapping but none that is necessary and sufficient. It
is a propensity to have affirmative and corroborative responses, thoughts,
and inclinations to act without being limited to anyone paradigmati-
cally. (pp. 84-85)

In The Four Loves, Lewis (1960) wrote about Eros (or what many refer
to as passion), describing it as "that state which we call 'being in love'"
(p. 91). He observed that "the lover desires the Beloved herself, not the
pleasure she can give" (p. 94).
Without Eros sexual desire, like every other desire, is a fact about
ourselves. Within Eros it is rather about the Beloved.... [It is] entirely
a mode of expression. It ... [is] something outside us, in the real world.
. . . One of the first things Eros does is to obliterate the distinction
between giving and receiving. (pp. 95-96)1

In You Can't Go Home Again, Wolfe (1934) gave "love" great signifi-
cance when he eloquently described the basic nature of human beings:
Man loves life, and loving life, hates death, and because of this he is
great, he is glorious, he is beautiful, and his beauty is everlasting. He
lives below the senseless stars and writes his meanings in them....
Thus it is impossible to scorn this creature. For out of his strong belief
in life, this puny man made love. At his best, he is love. Without him
there can be no love ... no desire. (p. 411)2

In a conversation with Arnold Toynbee (Gage, 1976), Daisaku Ikeda,

former president of Soka Gakkai International, a Buddhist organization,
described a version of the Buddhist conception of love:
The word love has been highly conceptualized and made very abstract.
Just as charitable works without love can do harm, so abstracted love
without practical application can be meaningless. I believe that the

30 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Buddhist concept of compassion ... defined as removing sorrow and
bringing happiness to others ... gives love substantial meaning....
Yoraku-the second component of compassion in the Buddhist
sense-means the giving of pleasure.... It is the joy of living ... the
ecstacy of life. It includes both material and spiritual pleasure. Without
the deep feelings of fulfillment and the ecstacy generated by the emotions
of life, pleasure in the truest sense is impossible. (pp. 357-358)

There are also many judeo-Chrisrian conceptualizations of love. Per-

haps the most familiar are the statements attributed to the apostle Paul in
I Corinthians 13 (World English Bible):
Love is patient and is kind; love doesn't envy. Love doesn't brag, is not
proud, doesn't behave itself inappropriately, doesn't seek its own way,
is not provoked, takes no account of evil; doesn't rejoice in unrighteous-
ness, but rejoices with the truth; bears all things, believes all things,
hopes all things, endures all things. Love never fails.... But now faith,
hope, and love remain-these three. The greatest of these is love.
(vv.4-13)

OUR VIEW OF LOVE

But what is love, really? What does it mean to love someone? Defining
love in operational or behavioral terms is a challenging undertaking. In
Altruismand Altruistic Love, Post, Underwood, Schloss, and Hurlbut (2002)
raised an important question: "What is at the very core of human altruistic
love?" Their answer was that love might be conceptualized as "affirmative
affection."
We all know what it feels like to be valued in this way, and we remember
loving persons who conveyed this affective affirmation through tone of
voice, facial expression, a hand on the shoulder in time of grief, and a
desire to be with us.... Love implies benevolence, care, compassion,
and action. (p. 4) [italics added]

In our view, actions that fit the description of a loving relationship

are expressions of affection, both physical and emotional; a wish to offer
pleasure and satisfaction to one's mate; tenderness, compassion, and sensitiv-
ity to the needs of the other; a desire for shared activities and pursuits; an
appropriate level of sharing of one's possessions; an ongoing, honest exchange
of personal feelings; and the process of offering concern, comfort, and out-
ward assistance for the love object's aspirations.
Love includes feeling for the other that goes beyond a selfish or self-
centered interest in the object. As such, love nurtures and has a positive
effect on each person's self-esteem and sense of well-being. Love is truth

WHAT IS LOVE? 31
and never involves deception, because misleading another person fractures
his or her sense of reality and is therefore a serious human rights violation
that adversely affects mental health.
Our thinking regarding the nature of love is congenial with the words
written by Fromm (1956) in The Art of Loving. Fromm observed that "There
is only one proof for the presence of love: the depth of the relationship,
and the aliveness and strength in each person concerned; this is the fruit
by which love is recognized" (p. 87). These manifestations of love can best
be personified in the following description of one man's feelings for his wife
after 25 years of marriage:

When I first met Annette, I thought that she was attractive and she
appeared to be a very nice person. At the time, however, I wasn't
especially drawn to her; in fact, she seemed a little boring. Yet for some
bizarre reason, a crazy thought came into my mind and it came up
repeatedly: "You're going to marry this girl." It was so odd and out of
character to the way I usually think that I told my friends about it and
we all laughed. For one thing, my life was stable, I felt content, and I
was already involved in a romantic relationship at the time. Besides, I
considered the words that came to me to be rather corny.
Nothing came of this incident, but later on, Annette became in-
volved in my social circle and we actually became friends. One day, on
our way to meet friends for a day sail, Annette and I found ourselves
alone together, an unusual circumstance. While we were driving to the
marina, I suggested that we stop for a moment to look at the ocean
conditions. Parked by the breakwater, I leaned toward her and we kissed.
From that moment on we were in love.
In our love, a remarkable transformation took place in both of our
lives. For one thing, her looks changed radically; indeed, in love, she
developed into an exceptionally beautiful woman and I wasn't the only
one who noticed the difference. All of our friends commented on it.
Now it's close to thirty years later since we first met and she's still
beautiful, but it's not just her physical beauty.
For me, my life changed radically. We did get married, my friendships
expanded, and I was inspired in my work. I had the courage to forge
ahead in many new and creative endeavors.
Annette is an incredibly sensitive, psychologically sophisticated and
sweet person, very affectionate and naturally responsive sexually. She
has an unusual capacity for pleasure in being touched and is easily
orgasmic. I love her body and her responsiveness. I know that it's hard
to believe, but after all of these years, I'm still as sexually attracted as
I was originally.
There are many other qualities in Annette that I discovered as
our relationship unfolded. Annette is exceptionally intelligent, free-
thinking, creative, and has an incredible sense of humor. She can turn

32 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 an unfortunate or embarrassing situation into something poignant and
special. She has a unique feeling and respect for people's sexual nature
and it has a powerful effect on both women and men. She has the
knack of making women feel more feminine and men feel manly.
In our relationship there has always been a sense of equality and
mutual respect. We fully believe in the personal freedom of each other
and pose no limits on each other's development. This has been a guiding
principle for us even when it caused us inconvenience or pain. I think
that's why our relationship is still fresh and exciting. In that respect,
we feel different from what we see in so many other couples. They
appear to be so much more possessive and intrusive on each other and
act different in each other's company than otherwise. I find the company
of most couples to be boring. They seem to cancel out each other's
sexuality and appear deadened in each other's presence.
From what I have said, you might think that life for us has always
been happy. It has certainly been good overall, but we have had our bad
times. When I first suggested that we have children together, Annette
became emotionally distraught, even hostile. I had never seen her like
that before and it shocked her as well. She had never been defensive
and caught on that something was radically wrong with her response.
But that didn't change things. We had trouble for months after that.
Her feelings were all over the place and it practically ruined us. Luckily
she got help and worked out her fears about having children. The result
was that we now have four grown daughters who have turned out well.
And the trouble about having children wasn't our only problem.
Whenever the issue of death came up-a movie, something on the
news or information about the tragedy of someone we knew-she would
become cold and unaffectionate. I would be hurt at those times and it
was difficult for both of us.
Even at other times she would shy away from being romantic and
back away from closeness, and this caused me a lot of pain. She was
shy about showing our relationship in public, especially if her women
friends were around. She didn't want to stand out exactly. She even
said that she felt like she didn't want to be too important to anyone
or too valued. At those times, she would pull inward to protect herself.
There were occasions when I was shaken up, too, because I had
never been so vulnerable in a relationship. But eventually we sweated
out these difficult times together because we really cared deeply for one
another. To this day, we are lovers and the best of friends, rely on each
other for support and companionship, and are a vital part of each other's
lives. I know that she knows me and loves me and that I make her
happy. She says that her life would be impossibly dull without me. I
can barely imagine the horror of living life without her.

The relationship between this man and woman was inspirational to

all of their friends and acquaintances and was illustrative of what we conceive

WHAT IS LOVE? 33
to be the essence of a loving style of relating. Both parties were kind,
generous with one another, independent, self-reliant, warm, respectful, sexu-
ally responsive, not restrictive or intrusive, and nondefensive. Although
this example illustrates love between a couple, many of the same qualities
apply to love between friends and family members and can be extended to
a love for humanity.

WHAT GENUINE LOVE IS NOT

To better understand what genuine love is, perhaps we should also

describe what it is not. Love is not what we mean when one is told by a
family member that "mommy or daddy really loves you but he/she just
doesn't know how to show it." Love is not selfish, possessive, or demanding,
or a proprietary right over the other. Love is never submission or dominance,
emotional coercion, or manipulation. Love is not the desperate attempt to
deny aloneness or the search for security that many couples manifest in
their desire for a fused identity.
Lawrence (1920) stressed this theme in his work:

Why should we consider ourselves, men and women, as broken frag-

ments of one whole? It is not true. We are not broken fragments of
one whole. (p. 271)

Fusion, fusion, this horrible fusion of two beings, which every woman
and most men insisted on, was it not nauseous and horrible anyhow,
whether it was a fusion of the spirit or of the emotional body? Why
could they not remain individuals, limited by their own limits? Why
this dreadful all-comprehensiveness, this hateful tyranny? Why not leave
the other being free, why try to absorb, or melt, or merge? One might
abandon oneself utterly to the moments, but not to any other being.
(p. 391)

Love is not to be confused with emotional hunger, that is, a desperate,

immature need for dependence on another that drains the other person's
vitality. Nor is it to be confused with a deep longing to find total confirmation
of oneself in the other. In The Denial of Death, Becker (1973/1997) described
the results of finding such an "ideal" love:

If you find the ideal love and try to make it the sale judge of good and
bad in yourself, the measure of your strivings, you become simply the
reflex of another person. You lose yourself in the other, just as obedient
children lose themselves in the family .... When you confuse personal
love and cosmic heroism you are bound to fail in both spheres. . ..
How can a human being be a god-like "everything" to another? (p. 166)

34 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 In "Projecting Our Other Half," Sanford (1980/1985) discussed the
other side of the coin of "ideal love." He argued that
To the extent that a relationship is founded on projection, the element
of human love is lacking. To be in love with someone we do not know
as a person, but are attracted to because they reflect back to us the
image of the god or goddess in our souls, is, in a sense, to be in love
with oneself, not with the other person. Real love begins only when
one person comes to know another for who he or she really is as a
human being, and begins to like and care for that human being. (p. 88)

Love is not a word to be bandied about as in a couple's collusive

attempt to maintain control of one another. It does not relate to an inner
state of mind that has no recognizable outward manifestations.
In our experience, we have found that many people fail to reach a
level of emotional maturity that would allow them to be capable of offering
love, and they are also afraid of accepting or receiving love. In working
with couples in initial intake sessions, we have observed that one or the
other will outline a number of objections that amount to a fairly extensive
annihilation of the other's character, only to be followed by an equally
denigrating attack by the other partner. As the session progresses, we often
notice their mistreatment of one another firsthand and tend to agree with
both parties' assessment of each other, as these negative behaviors become
more obvious. In other words, they have described each other fairly accu-
rately, as it turns out, and manifest considerable hostility. Yet when we ask
these warring couples why they stay together when they find each other so
objectionable, they typically respond by saying, "Because we love each
other." However, the destructive behaviors these people manifest toward
one another do not fit any acceptable definition of the word love. Why call
it "love" when the behavior toward the love object is neither affectionate nor
respectful, lacks communication and companionship, violates the personal
boundaries of the other, and is often insensitive or outright hostile or abusive?
However, our views also resonate with those of Laing (1967), who
expressed cautious optimism when describing couples who lived their lives
based primarily on illusions of love. In The Politics of Experience, he wrote,
"Perhaps men and women were born to love one another, simply and
genuinely, rather than to this travesty that we call love" (p. 76).

OTHER CONTEMPORARY VIEWS ON PSYCHOLOGICAL

AND BIOLOGICAL COMPONENTS OF LOVE

The subjective experience of being in love involves a multitude of

biological, environmental, and social factors. Love encompasses both an

WHAT IS LOVE? 35
emotional experience and behavioral responses. Feelings of love, as with
other feelings, arise involuntarily and are experienced as sensations in the
body (Firestone, Firestone, & Catlett, 2003). As Greenberg (2002) suc-
cinctly put it: "Emotions go coursing through people's bodies whether they
like it or not" (p. 14). The various components that impact the experience
of emotions, including love, have been studied by researchers, including
bodily (physical) components (Fosha, 2000; Valliant, 1997) and components
involving evaluation, perception, sensation, and feeling (Greenberg &
Safran, 1987).
In their work, Hatfield and Rapson (1993) make a distinction between
two basic types of love. They defined passionate love as a "hot," intense
emotion: "A state of intense longing for union with another. Passionate
love is a complex functional whole including appraisals or appreciations,
subjective feelings, expressions, patterned physiological processes, action
tendencies, and instrumental behaviors" (p. 5). In contrast, these researchers
defined companionate love as a "warm" emotion, "the affection and tender-
ness we feel for those with whom our lives are deeply entwined" (p. 9).
Attachment researchers who focus on the role of love in caregiving
and attachment behavioral systems have proposed several hypotheses about
the behavioral responses associated with love. For example, Kirkpatrick
(1998) observed that "Many behaviors exhibited by adult lovers resemble
behaviors of infants interacting with their primary caregivers. Adult lovers
engage in kissing, cuddling, nuzzling, 'baby talk,' holding hands, and a variety
of other behavior patterns commonly observed in mother-infant dyads" (pp.
362-363). However, Kirkpatrick also noted that adult romantic attachments
may be qualitatively different from infant-parent attachments. "Romantic
relationships might involve neither the caregiving system nor the attach-
ment system per se, but rather are organized around a single component
shared by those systems: the emotional bond of love" (p. 361).
Research into specific physiological and neurological underpinnings
oflove has only recently been undertaken by the scientific world.' According
to Insel (2002) despite "nearly 50 years of research on the neuroendocrinol-
ogy of sex," there is a dearth of studies regarding "where or how the brain
mediates love" (p. 254). Insel also noted that

Love, whether considered as attachment, such as a pair bond, or viewed

as a form of self-sacrificing altruism, is difficult to define operationally.
. .. Although most of us may recognize love as the most powerful
psychological and biological experience of our lives, how do we quantify
this experience? (pp. 254-255)

In spite of these obvious difficulties, several researchers have attempted

to identify the physical or neurological correlates of love as manifested both
in attachment behaviors between parent and child and in adult romantic

36 SEX AND LOVE IN INTIMATE RELATIONSHIPS

attachments (Fisher, 1992,2000,2004; Fisher, Aron, Mashek, Li, & Brown,
2002; Lewis, Amini, & Lannon, 2000; Love, 2001; Pines, 1999). In a review
of these studies, Lewis and colleagues (2000) offered a thoughtful account
of how physiological and psychological factors may interact to create not
only the experience of love, but also an individual's core sexual identity:
From birth to death, love is not just the focus of human experience
but also the life force of the mind, determining our moods, stabilizing
our bodily rhythms, and changing the structure of our brains. The body's
physiology ensures that relationships determine and fix our identities.
Love makes us who we are, and who we can become. (p. viii)

Being in love and falling in love may involve different biochemical

processes. Research studies have focused on determining biological compo-
nents underlying emotions that people experience during the "falling in
love" phase. For example, Pines (1999) noted that the process of "falling
in love" involves two basic components, arousal and labeling.
All strong emotions [including love] have two components, one is
physiological and has to do with the body, the other is cognitive and
has to do with the mind. The physiological component is a state of
arousal. The cognitive component is a label that explains the
arousal. (p. 14)

Pines cited a series of studies conducted by Aron (role-play experiments

in a natural setting and in the laboratory) that investigated the cognitive
components of arousal and the important role played by labeling in partner
selection, attraction, and the subjective experience of falling in love. In
one such experiment, called the "creaky bridge" experiment, Dutton and
Aron (1974) asked one group of men to cross either a "flimsy suspension
bridge" five feet wide and some 250 feet above jagged boulders and river
rapids of the Capilano Canyon in Vancouver, British Columbia, or a broad,
low bridge farther upstream. Fisher (2004) described the experiment as
follows:
In the middle of each bridge stood a beautiful young woman (part of
their research team) who asked each passing man to fill out a question-
naire. After each man completed the survey queries, she casually told
him that if he had any further questions about the study, he should
call her at her home. She gave each her telephone number. None knew
the woman was part of the experiment. Nine out of thirty-two men
who walked the narrow, wobbly high bridge were attracted enough to
call the woman in her home. Only two of those who met her on the
low, solid bridge contacted her. (p. 193)

Fisher conjectured that the attraction was linked to a physical change

in the body that is associated with danger: "Danger stimulates the production

WHAT IS LOVE? 37
of adrenaline, a bodily stimulant closely related to dopamine and norepineph-
rine" (p. 193),4 As psychologist Hatfield (1988) stated, "Adrenaline makes
the heart grow fonder" (p. 204). In other words, the sense of danger created
a sense of excitement similar to the experience of "falling in love."
In discussing brain chemicals or neurotransmitters that may contribute
to the rapid heartbeat associated with this type of arousal, Liebowitz (1983)
hypothesized that the euphoric state of falling in love or infatuation may
be induced by phenylethylamine (PEA). According to Liebowitz,
Drugs that raise norepinephrine, dopamine, and PEA levels at times
cause overstimulation, in which people need only a few hours' sleep,
tend to feel very optimistic about the future.... Interestingly, this is
similar to what happens to people when they get promoted, win a
lottery, or fall in love. (pp. 37-38)

In her book, Why We Love, Fisher (2004) stressed the fact that
We still know so little about this madness of the gods.... But of one
thing I am convinced: no matter how well scientists map the brain and
uncover the biology of romantic love, they will never destroy the mystery
or ecstasy of this passion. I say this from my own experience. (p. 218-
219)

CONCLUSION

Learning to love wholeheartedly is a most worthwhile endeavor but

requires considerable devotion, time, and energy. As Rilke (1908/1984)
observed,
It is also good to love: because love is difficult. For one human being
to love another human being: that is perhaps the most difficult task
that has been entrusted to us, the ultimate task, the final test and proof,
the work for which all other work is merely preparation. (p. 68)

Serious resistance will be encountered as clients strive to learn how

to love and be loved more fully because when people have been hurt in
the past, they are reluctant to trust and be open to being hurt again. They
feel self-protective and fear being vulnerable and open to emotional pain.
In describing this learning process, Coelho (2004) wrote
Everyone knows how to love, because we are all born with that gift.
Some people have a natural talent for it, but the majority of us have
to re-learn, to remember how to love, and everyone, without exception,
needs to burn on the bonfire of past emotions, to relive certain joys
and griefs, certain ups and downs, until they can see the connecting
thread that exists behind each new encounter; because there is a con-
necting thread. (p. 139)

38 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 A person who overcomes self-limiting defenses and learns to give and
receive love experiences the most satisfaction in life. Indeed, as we noted
in the previous chapter, love is the antidote to existential pain and aloneness.
When love is sincere and real, it reaches spiritual proportions that give
value and meaning to life.

NOTES

1. Excerpt from The Four Loves, Copyright © 1960 by C. S. Lewis, renewed 1988
by Arthur Owen Barfield, reprinted by permission of Harcourt, Inc.
2. Quotation from chapter 27, p. 411, from You Can't Go Home Again. Copyright
1934, 1937, 1938, 1939, 1940 by Maxwell Perkins as Executor of the Thomas
Wolfe estate. Copyright renewed © 1968 by Paul Gitlin. Reprinted by permis-
sion of HarperCollins Publishers, Inc.
3. To some people, these investigations are unwelcome because they threaten to
destroy the "mystery of love." In their book Brain Sex, Moir and Jessel (1989)
called attention to the fact that
Senator Proxmire ... in opposing a grant request from the National
Science Foundation into the nature of love ... said: "200 million
Americans want to leave some things a mystery, and right at the top
of those things we don't want to know is why a man falls in love with
a woman and vice versa." (p. 101)

4. Fisher (2000) found that these parallels suggest that "levels of CNS dopamine
are rising in the infatuated individual as their beloved takes on special meaning"
(p. 99). In a functional magnetic resonance imaging (fMRI) experiment, Fisher
found that the caudate nucleus, which intensifies the experience of romance,
"became active as our lovesick subjects gazed at the photos of their beloveds"
(p. 149). Fisher (2000) also reported studies showing that "increased concentra-
tions of dopamine in the central nervous system (CNS) are associated with
exposure to a novel environment ... as well as with heightened attention,
motivation, and goal-directed behaviors" (p. 99). Two hormones, oxytocin and
vasopressin, have also been shown to be activated during sexual intercourse
and are also assoc~ted with feelings of attachment. According to Love (2001),
"Oxytocin is largely responsible for why you feel closer to your partner and
more 'in love' when you have regular sex" (p. 115).

WHAT IS LOVE? 39
 3
FACTORS THAT AFFECT AN
INDIVIDUAL'S SEXUALITY

Sexuality teaches us, more than any other human experience, about
self-who am I and why do I exist?
-Harvey and Weber (2002, p. 55)

What is sexuality? What precisely does the word refer to? A certain
ambiguity seems to be associated with its meaning and common usage.
According to Zoldbrod (1998) "Sexuality means a dimension of personality
instead of referring to a person's capacity for erotic response alone" (p. 2).
Aanstoos (200l) defined sexuality as being "like an atmosphere, in the sense
that it is an ever-present background-a horizon of existence.... Just as
we are, we are sexual" (p. 78).
Human sexual development and sexuality are topics far broader in
scope than the act of sexual intercourse per se. Sexuality encompasses an
individual's basic identity as well as the dimensions of healthy sexuality
delineated in chapter 1. Indeed, the ways that people express themselves
sexually play a significant role in all relationships, including those be-
tween women and men, women and women, and men and men. As Harding
(2001) cogently noted, "Whenever two people find themselves together
they have to negotiate the hetero-erotic or the homo-erotic potential of

Portions of Helen Singer Kaplan's The Sexual Desire Disorders were reprinred in this chapter.
Copyright © 1995 from The Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation by
Helen Singer Kaplan, MD, PhD. Reproduced by permission of Routledge/Taylor & Francis Books,
Inc.

43
their relationship in some way" (p. 1). In the discussions of sexual relating
throughout this book, we refer to all interpersonal relationships and all types
of sexual encounters between adults. Our goal is to examine psychological
and social factors that influence the wide range of sexual experiences and
intimate associations that human beings are involved in.
In our work, we have found that the fundamental issues in disturbed
sexual relationships are closely related to an intolerance of intimacy based
on each partner's psychological defenses and his or her negative attitudes
toward self and others. Fears of aloneness, abandonment, rejection, and
potential loss manifested by both partners are significant factors at the
core of the problems they encounter in relating sexually. In particular, the
combination of love and sex is a difficult goal for most people to achieve
because it revives painful memories and feelings from childhood. It also
arouses the dread of potential loss through rejection and ultimately, through
death. In addition, an intimate sexual relationship, in which the lover sees
the other in a realistic, positive light, threatens the defense system by
interrupting negative fantasies about the self and disrupting psychological
equilibrium (Firestone & Catlett, 1999).
When one constructs a powerful defense system, which often happens
when there has been anxiety and emotional deprivation in one's early years,
there is a compelling need to hold on to and protect that system of defenses.
Fears, anxieties, and insecurities also drive individuals to reenact their par-
ents' defensive style of interacting and destructive, stereotypical attitudes
toward each other in their closest relationships. The tendency to emulate
negative parental attitudes and behaviors, together with the process of
retreating to a defensive, self-protective posture, interferes with the ability
to develop and sustain fulfilling sexual relationships characterized by feelings
of compassion and equality.
In this chapter, we explore the factors that contribute to the difficulties
that many individuals encounter in developing and maintaining, or even
tolerating, intimate, loving sexuality. The chapter begins with a brief descrip-
tion of some biological factors that may contribute to the development of
gender identity and other aspects of adult sexual functioning. Next we
describe how painful childhood experiences and interpersonal attitudes in
the family impact the sexual development of children and predispose the
formation of psychological defenses. From a developmental perspective, we
describe how identification and imitation processes operating within the
family can influence gender role expectations and boys' and girls' sexual
identities and sexuality. We also explain how sexual abuse affects children's
emerging sexuality. The chapter ends with a discussion of the diverse cultural
and societal influences on people's sexuality and sexual lives, including the
impact of the media and popular culture.

44 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 SOME BIOLOGICAL FACTORS THAT AFFECT
HUMAN SEXUALITY

Sexual behavior is based on an innate biologically determined drive.

As with any other animal, human beings have a natural drive to be sexual
and reproduce (Fisher, 1992, 2000, 2004; S. Freud, 1905/1953; Hazan &
Shaver, 1987). In addition, a person's sexual behavior, sexual desires, and
gender identity are psychosomatic, that is, they encompass aspects of the
mind as well as the body (Fausto-Sterling, 2000).
In their attempts to explain the course of a child's sexual development
and its culmination in an adult's sexual functioning, philosophers, psycholo-
gists, and others have focused on the mind or the body, or on an interaction
between the two (Everaerd, Laan, & Spiering, 2000). For example, philoso-
pher Giddens (1992) proposed that "The body, plainly enough, is in some
sense-yet to be determined-the domain of sexuality" (p. 31), while psy-
chologist Michael Bader (2002) argued that "Sex begins in the mind and
then travels downward.... It is the imaginative power of the mind that
transforms our biological imperatives into the actual experience of sexual
pleasure" (p. 5).
Even though human beings have evolved beyond estrus (which drives
sexual behavior in other species), "the biological imperative to reproduce
and to multiply still gives shape to our sexual desires" (H. Kaplan, 1995,
p. 24). For example, testosterone is recognized as the libidinal hormone for
both men and women. According to Moir and Jessel (1989), "The more
testosterone, the greater the sexual urges already present, be they homosexual
or heterosexual, orthodox or deviant" (pp. 103-104). Neuroendocrinologist
Olsen (1992) noted that "Hormones secreted by the testes during a critical
developmental period have masculinizing and defeminizing effects on sexual
behaviors" (p. 1).
According to Fisher (2004), dopamine and norepinephrine are brain
chemicals that initiate sexual desire, probably through increasing testoster-
one levels. As noted in the previous chapter, oxytocin and vasopressin also
appear to be involved in sexual responses as well as tendencies to form an
intimate attachment. H. Kaplan (1995) asserted, for example, that oxytocin
in particular is probably the "'glue' that attaches babies and mothers as well
as lovers to each other" (p. 31).
As is true with other innate human capacities, the diverse manifesta-
tions of an individual's sexuality are multidetermined; they are powerfully
influenced or controlled by a wide range of genetic, environmental, and
social factors. These factors interact with each other to determine the ways
in which each person expresses his or her sexuality. As sex researcher
Bancroft (1999) correctly observed, "We cannot expect to understand

FACTORS THAT AFFECT SEXUALITY 45

human sexuality unless we consider both biology and culture (and it is
important to stress culture, not just environment) and the interface between
them as it affects the individual, the dyad, and the group" (p. 226).

INTERPERSONAL FACTORS THAT AFFECT

CHILDREN'S EMERGING SEXUALITY

During their formative years, children are faced with pain and anxiety
from two major sources: (a) negative experiences in the family and
(b) fundamental human issues such as the evolving awareness of aloneness,
aging, and death as inevitable processes in life (Firestone, 1997a). A major
source of the problems that plague adult sexual relationships can be traced
to adaptations that children necessarily make to early interpersonal pain,
separation experiences, and other losses. Later in the developmental se-
quence, children learn about death, the ultimate separation. At this point,
the defenses they formed originally in relation to interpersonal stress are
powerfully reinforced. Thereafter, disturbances in emotional and sexual func-
tioning, resulting from the process of defending oneself against interpersonal
and existential pain, are retained throughout life, predisposing serious prob-
lems in one's intimate relationships.

The Effects of Parental Attitudes and Behaviors

Emotional damage to children is a complex phenomenon (Belsky,

1980) and no single pattern of parent-child interaction is fully explanatory
in relation to adult sexual functioning. However, there are a number of
interpersonal factors that cause children to form defenses that affect their
body image, emerging sexuality, and future choice of partners.
It is important to recognize the fact that parents have a fundamental
ambivalence in relation to their offspring. Parents' feelings and attitudes
toward their children, like their feelings and attitudes toward themselves,
are both positive and negative (Chen & Kaplan, 2001; Firestone, 1990b;
R. Parker (1995); Rohner, 1986, 1991). On the basis of cross-cultural studies
encompassing 35 cultures, Rohner (1991) found that parents' attitudes could
be assessed along a continuum ranging from parental warmth and accept-
ance to indifference, rejection, and hostility. He concluded that parental
rejection has a universal effect on children and that it can be measured
intergenerationally.
The fact that parents have strong desires to nurture and care for their
children does not negate the hostility or indifference they feel at times
toward them (Firestone & Catlett, 1999). In the process of growing up, all
children experience varying degrees of emotional pain in their early family

46 SEX AND LOVE IN INTIMATE RELATIONSHIPS

relationships. Even in "ideal" families there is unavoidable frustration and
pain, for example, in reaction to inevitable separation experiences and
existential concerns, and most family constellations are less than ideal
(Beavers & Hampson, 1990; Tedeschi & Felson, 1994).
Children's hurt or angry response to their parents becomes transformed
into defensive behaviors that are later elaborated in many areas of their
adult lives, including their sexuality. This defensive incorporation of parental
characteristics and behaviors is heightened during times of unusual stress
and emotional pain. The dynamics underlying the child's strong tendencies
to imitate a parent's more negative traits and behaviors can be understood
in terms of the defense of identifying with the aggressor (Ferenczi, 1933/
1955; A. Freud, 1966). Under stressful or abusive conditions, the small child
ceases identifying with him- or herself as the weak, vulnerable child and
instead identifies with the powerful parent. In the process, the child incorpo-
rates the parent's aggression and hostility and takes on the parent's defenses,
behaviors, and traits as his or her own.

Parental Rejection and Hostility

Obviously, parents vary widely in their responses to their infants and

children. At times parents are warm and affectionate toward their child,
while at other times they may be unresponsive or even cruel. When parents
are consistently warm and accepting in their interactions with family mem-
bers, children generally grow up with a sense of well-being and healthy self-
esteem, and they are likely to feel accepting of their bodies and sexuality.
However, when parents are inconsistent and erratic in their responses,
children learn to expect rejection or punishment and tend to withdraw so
they will not be hurt. This anticipation of being hurt or rejected persists
into adulthood, influencing individuals' responses in close interpersonal
relationships.
Parental attitudes of rejection, indifference, and/or hostility toward a
child can result in feelings of being unlovable. These feelings are later often
manifested in negative feelings toward various body parts that lead to critical
thoughts about these specific areas. Subsequently, when these parts are
touched or otherwise stimulated, a state of anxiety or tension, or even
physical pain may be aroused rather than feelings of pleasure (Orbach,
2004 ).1
James: My girlfriend is a very affectionate person, but sometimes I can
hardly stand her touch, especially when she touches my face.
When I started exploring the reasons for this, I remembered
that when I was a little kid, I really wanted to be close to my
mother and wanted to show her affection. When she would
be watching TV, I'd want to lay my head in her lap, but she

FACTORS THAT AFFECT SEXUALITY 47

 was so tense that she couldn't just relax and sit there. She'd
tell me to move over, to get away from her. When I thought
about those times, I had more understanding about why I feel
uncomfortable with my girlfriend's touch.

There are a number of reasons why many well-intentioned parents

hold back affection from their children. Parents who were deprived of
affection and love during their childhood often lack the emotional resources
to provide affection, love, direction, and control for their children. In
addition, the aliveness and spontaneity of infants and children threaten
their parents' defenses by reawakening suppressed feelings from the past. In
an attempt to avoid these painful emotions, many parents unintentionally
maintain a certain distance from their children by being indifferent, reject-
ing, critical, or even hostile toward them. In fact, frequently parents find
themselves treating their offspring with many of the same destructive behav-
iors they experienced during their formative years. There is also evidence
that parents experience discomfort when their child passes through stages
of development that were particularly painful or traumatic for the parents
themselves. During this time period, they can become unusually insensitive
or punishing to the child (Gerson, 1995).
In addition, many parents experience feelings of discomfort and pain
when their children express physical affection toward them. To cope with
these feelings, they may pull away or even become punitive in their responses.
Children who experience this type of response gradually learn to inhibit
the expression of their positive feelings. Many children come to believe
that there is something wrong with their loving feelings or that their affection
or their physical nature or bodies are somehow unacceptable.
Parents' discomfort and anxiety are transmitted to their infant through
physical touch, facial expressions, and other behavioral cues. Observers have
noted a form of withdrawal in mothers who appear to be unaffected or
unmoved by the emotional experience of feeding or caring for a child, and
who avoid eye contact with their infants (Bolton, 1983; Welldon, 1988).
Other studies have investigated the ways that a mother's feeling state is
transmitted to her infant (Beebe & Lachmann, 2002; LeDoux, 1996; D. Lott,
1998; Schore, 1994; Siegel, 1999; Siegel & Hartzell, 2003; Stern, 1985,
1995).2
A number of theorists and researchers (Fosha, 2000; Gewirtz & Hol-
lenbeck, 1990; Harlow, 1958; Harlow, Harlow, & Suomi, 1971; Montagu,
1986; Orbach, 2004; Stern, 1985, 1994, 1995) have emphasized the impor-
tance of bodily touch as well as parental acceptance of the infant's body.
According to Orbach (2004), "We therapists know how absolutely critical
benign and loving touch is in both early development and in life in general"

48 SEX AND LOVE IN INTIMATE RELATIONSHIPS

(p. 37). She also emphasized that "The body that is not received, the body
that has no body to meet in its development becomes a body that is as
precarious, fractured, defended, and unstable as a precarious psyche" (p. 27).
Inhibitions resulting from a "precarious" body image and a sense of being
unlovable often cause people to hold back their love, affection, and sexual
responses in their closest, most intimate associations.

Harsh Attitudes Toward a Child's Body and Developing Sexuality

Early experiences with diapering and toilet training playa significant

role in an individual's image of his or her body. Negative attitudes or overt
disgust expressed by parents contribute to a sense of shame that persists
into adult life. The genital area becomes imbued with an anal connotation,
confused with excretory functions, and is therefore considered dirty. Shame-
ful feelings are extended to anything below the waist.
Melissa: Recently, I found a photograph of myself as a baby, strapped
to the toilet. I couldn't have been more than a few months
old. My mother used to brag to her friends that I was toilet-
trained before I was a year old. Later, when I was older, there
was a bottle of some kind of liquid, it smelled like peroxide,
on the back of the toilet. She told me I had to thoroughly
cleanse myself with it every time I went to the bathroom.
After I was married, I continued to worry about cleanliness.
I used douches daily, or sometimes more often, because I had
a basic feeling that I was dirty "down there."
We have found that excessive control or domination, as well as an
overconcern with cleanliness and orderliness, can damage children's sense
of autonomy and their feelings that their bodies belong to them (Firestone,
199Gb). Other clinicians have described tendencies on the part of some
parents to take over the child's body and bodily functions in this manner.
For example, according to Fisher and Fisher (1986), "Such parents may
express their anger and suspicion by imposing unreasonable body controls.
What is terribly confusing to the child is that such controls are invariably
disguised as something that is being done 'for your own good'" (p. 79). In
his extensive studies of shame, M. Lewis (1992) called attention to the fact
that parents often express disgust or contempt when socializing their chil-
dren, especially during toilet training. He explained that if parents are unable
to reason with their children or feel it is unacceptable to express anger,
they may employ disgusted or contemptuous facial expressions, usually un-
consciously, as a solution to disciplinary problems. The child incorporates
these negative parental attitudes that often generalize to an overall feeling
that he or she is basically bad, undesirable, and unlovable.

FACTORS THAT AFFECT SEXUALITY 49

Imitation of Parents' Distorted Views
of Sexuality and the Human Body

Parental attitudes toward nudity, masturbation, and sex play have a

powerful impact on children's ongoing sexual development. Developmental
psychologists have stressed the fact that during early childhood, masturbation
and sex play are normal and typically not problematic (Bonner, 2001;
Martinson, 1994; Zoldbrod, 1998). However, on an emotional level, many
parents still find it difficult to think of masturbation and sex playas normal,
as not harmful to children, and they tend to respond accordingly. Other
parents find nudity in young children to be problematic and by their attitudes,
convey the message to their child that his or her body is shameful. When
parents have repressive attitudes and rigid dogmatic religious beliefs, these
attitudes, together with their sexual tensions, are covertly or overtly con-
veyed to the child, usually with negative consequences (Firestone, 1990b;
Davidson & Darling, 1993; Gagnon, 1985; Kelsey & Kelsey, 1991; Zold-
brod,1998).3

Carlos: Once when I was about 12 years old, I walked into my parents'
bedroom and my mother was taking a shower in the bathroom.
I didn't know she was in there, and when she came out, she
yelled at me for being in their bedroom and ran past me very
quickly to get a robe to cover herself with. For the whole time
I was growing up, there was always a big fuss being made about
me getting dressed quick, to cover up my body. So even now
to this day, if I'm in the locker room at the gym, or if it's the
first time that I'm with a woman and we're getting undressed,
my first thought is that they're going to see that there's some-
thing weird about me, and it leaves me feeling really awkward
and shy, especially in a sexual situation.

Attitudes Toward Sex

Virtually every individual, to some degree, has developed a negative

point of view about sexuality and the body, especially the sexual areas.
Children witness their parents' distorted attitudes, which they assimilate.
These attitudes take sex out of the realm of a natural human function and
relegate it to a separate and distinct area of life. Within many families,
there is little or no indication that the parents enjoy an affectionate, active
sexual relationship. In the extreme, some parents are reluctant to express
physical affection in front of their children. Many parents feel that children
should learn healthy attitudes about sex, but few discuss sex openly and
personally with their children (Firestone, 1990b; Friday, 1977; Galinsky,
1981; Schiffer, 2004).

50 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 We have noted that, in some families, parents go to the opposite
extreme and overemphasize sex, which can be as damaging as the more
repressive attitudes of more rigid families. Parents who have a distorted
focus on sexuality and an overly sexualized style of relating extend those
attitudes to their children. For example, an adolescent girl recalled that
when she was five, her "open-minded" parents provided her with detailed
information about sex that was inappropriate for her age. Although they
subscribed to the view that sex is simply a natural function of the human
body, their sexual attitudes and activities were promiscuous. Later, the young
woman revealed that she had grown up thinking that all interactions between
a man and a woman were sexual and had no idea that friendship or affection
could exist without a sexual component being present.

Attitudes Toward One's Body

Negative views held by parents in relation to the human body and

nudity predispose the development of a sense of shame and guilt in children.
In turn, this formation of a negative body image significantly affects sexual
attitudes and feelings in one's adult life. Theorists have emphasized that
sexual identity and self-esteem have their foundations in one's image of
one's body (Orbach, 2004; Storr, 1968; Whitaker & Malone, 1953). Accord-
ing to Storr (1968), an individual's self-esteem is chiefly rooted in sexuality.
"We cannot escape our physical natures; and a proper pride in oneself as a
human being is rooted in the body through which love is given and taken"
(p. 69).
When observing infants and toddlers, one can see that they enjoy a
sense of freedom and a lack of self-consciousness about being naked. Yet
by the time they are five or six, many children are embarrassed to be seen
without clothes. The effects of children imitating their parents' attitudes
and internalizing shameful feelings about their own bodies can be observed
in the negative thoughts and feelings many men and women have about
themselves. We have found that most people have critical thoughts about
various parts of their bodies. These internal attacks often impair their ability
to feel sensations in certain areas of their body or complicate a potentially
gratifying sexual experience.
When parents dislike themselves, have a negative view of their bodies,
and are ashamed of their productions, they will inadvertently pass on the
shame they feel about themselves and their physical nature to their children.
It is natural for a person to extend his or her subjective views about him-
or herself to his or her creations. In addition, many parents tend to disown
negative attitudes toward their bodies and project them onto their offspring.
As a result of assimilating these distorted views early in life, many
men and women still suffer from feelings of sexual inferiority and inadequacy.

FACTORS THAT AFFECT SEXUALITY 51

Most have secret doubts about their sexuality and countless criticisms about
their bodies.
Jonathan: I have critical thoughts about myself, about practically every-
thing about me, my shoulders, chest, legs, and especially my
penis. The attacks [inner voices] are like, You're so small,
you're not like other men. Just look how small your penis is. It
doesn't look like a man's penis, and everything else about you
is wrong, everything else about you is like a little boy. How can
you possibly expect to attract women if you look like this? I'm
constantly looking at other men and thinking to myself that
every man looks more masculine than me or more attractive
to women than me.
I remember that my father had a low opinion of himself
as a man. I think he extended the feelings he had about
himself to me because he always seemed embarrassed by me,
especially by the way I looked. Actually 1was a really skinny
kid. One summer when I was about 10 years old, we were
at the beach, and my father humiliated me by ridiculing me
in front of all my friends, pointing out how "skinny and
scrawny" I was. So today many times 1 feel like hiding. 1
literally don't want to be recognized, because I'm afraid in
that recognition and in any comparison with any other man,
I have to lose.

Similarly, many women have serious doubts about their appearance,

their ability to attract a sexual partner, and the size and shape of their body.
For example, Rosa revealed negative thoughts she experiences during love-
making:
I start having picky, critical thoughts about my breasts, like You're so
strange-looking. You don't have breasts like normal women, there's really
something wrong with your breasts, they're not big enough, they're so small
and they're not the right shape. I think this stuff a lot, but it feels hard
to say. I feel ashamed to say it.
Also I'm really critical of myself about being short. I think I use it
to feel like I'm not like a real woman or that I don't really have a real
woman's body. The thoughts go like this, You're deformed in some way
because you're small, and it makes you different. You don't look the same
as other women.

Men and women who have negative attitudes toward their bodies and
sexuality feel confused and lack confidence. Any criticism of how men are
sexually, any sign of sexual dissatisfaction on the part of their partner, or
any hint of rejection reinforces men's inner doubts about their manhood.
Men's concerns appear to center on the theme of sexual inadequacy, which
in some cases may be related to their fathers' views of their own bodies and

52 SEX AND LOVE IN INTIMATE RELATIONSHIPS

their attitudes toward sex. Many women have similar doubts about their
femininity. Based on the strong identification with the mother, the female
child internalizes her mother's critical attitudes toward her body and toward
sexuality. As an adult, she often experiences these attitudes as derogatory
thoughts about her weight, breast size and shape, genitals, and overall sexual
performance (Fenchel, 1998; Friday, 1977; Rheingold, 1964).
To summarize, many men and women have grown up in families where
they were taught distorted views about the human body and sex. In turn, they
pass these views on to their offspring. Thus, for many men and women, the
simple act of sex is often contaminated by a harmful socialization process that
inhibits spontaneity and fosters feelings of self-consciousness and shame.

Identification With and Imitation of Same Sex Parent

Parents' importance as role models for their children has long been
emphasized in the literature (Bandura, 1986; Maccoby & Jacklin, 1974).
Both the strengths and weaknesses of mothers and fathers are transmitted
through the generations within the family context, with parents serving as
positive and negative role models for the sexual attitudes and behavior of
their children. Parents' positive traits and behaviors are readily imitated by
children and assimilated without conflict into their personalities and behav-
ior repertoires. However, the most pervasive influences on the sexual func-
tioning of both women and men may lie in their identification with, and
imitation of, the negative characteristics and behaviors of the parent of the
same sex (Bandura, Ross, & Ross, 1961).
Children closely observe and incorporate the ways in which their
parent of the same sex relates to his or her mate. If interactions between
the parents are generally hostile, sons tend to identify with and imitate
their father's negative attitudes and behaviors in relation to the mother and
other women, whereas daughters take on their mother's negative views and
behaviors toward the father and men in general.

Mothers and Daughters

The relationship between mothers and daughters is based on an identi-
fication that is intense and powerful (Firestone, 199Gb; Mendell, 1998).
According to Mendell (1998), "The mother-daughter tie is the most archaic,
difficult, and in some ways the most important and lasting relationship in
a woman's psychic life" (p. 227). This strong identification can have positive
as well as negative consequences in a woman's life, especially in her relation-
ships with men (Fenchel, 1998; Welldon, 1988). Girls learn by observation
and imitation to be like the mother and feel strange or uncomfortable when
they are different from their role model.

FACTORS THAT AFFECT SEXUALITY 53

 In addition, girls who suffer maternal deprivation carry elements of
exaggerated need into subsequent relationships with men. The anger, resent-
ment, and search for nurturance continue to complicate friendships and
relationships with women as well. Paradoxically, the more painful and
frustrating the interactions with a rejecting or withholding mother, the
more the daughter tends to incorporate her mother's toxic attitudes and
behaviors. Left unchallenged over time, the distinction between the daugh-
ter's personality and the incorporated negative traits becomes less and less
obvious until the defended posture of the mother becomes dominant and
the pattern is repeated with her children.
The effects of this imitative process can be observed in couple and
family relationships. For example, when a mother represents herself as an
asexual woman and allows herself to deteriorate physically, it has a destruc-
tive effect on her daughter's sexuality. During a discussion group, several
women reported that as they were growing up they were bothered by their
mother's lack of attention to appearance and apparent disinterest in sex.
An awareness of these negative attitudes, traits, and behaviors in their
mothers caused these women considerable guilt and self-recriminations that
often took the form of self-critical thoughts.
Allison: I remember that my sister and I used to think of ways to try
to get my mother to care more about herself. We used to
actually talk about what we could do to try to get her to bathe
more often because we were aware of her body odors. It was
actually a topic of conversation between my sister and me,
because we knew she never cared about herself and it made
us feel terrible.
Joan: I was angry that my mother didn't just lose weight, that she
didn't take care of herself. I remember being repelled by the
way she looked. But at the same time, it made me really
critical of myself. I'm reallycritical of my body becauseI think
I look like her a lot and I feel heavy like her, even though
I'm not that overweight.
Repercussions of the destructive elements in the mother-daughter bond
have a negative effect on a woman's relationship with men and later, with
her children. However, it is more important to emphasize the powerful
limitation this bond may impose on each woman's sense of self. Its stultifying
impact on a daughter's sexuality and feelings of self-worth and competency
is far greater than many people realize (Firestone, 1990b).

Fathers and Sons

Fathers play an influential role in their son's sexual development,
just as mothers do with their daughters. Boys who experience their father

54 SEX AND LOVE IN INTIMATE RELATIONSHIPS

as angry and abusive in relation to their mother are often fearful of
becoming like him. As adults, they may inhibit their natural assertiveness
and attempt to hold back their angry reactions to provocations from
their partners on the one hand; on the other hand, they may find them-
selves acting out abusive behavior in relation to their partners, just as their
fathers did.
A boy may observe his father's hostile, patronizing, and defensive
attitudes toward women and may identify with him when he is in conflict
with his wife. Some men have a paternalistic or judgmental style of
relating to their wives, which their sons imitate and later reenact in their
relationships with women. For example, David recalled that while he was
growing up, his father was punitive and harsh toward him and his
mother.
David: I remember how my father related to my mother. He was
condescending and super-critical of her. He yelled at her at
lot, telling her she had no right as a woman to do thus and
so, or implying that she had no right to speak her mind or
have opinions. So it's been painful for me to recognize that
that was the way I treated my wife when I was married. I always
acted superior to her and ordered her around and directed her,
telling her, in effect, what she could and could not do. Also
I never listened to her or thought she had anything worthwhile
to say.
One day after she had been seeing a therapist for a while,
she was telling me what she would like to do that evening,
and I got very angry at her, I guess simply for having an opinion
of her own. I yelled at her and insisted that she had no right
to say what she was saying. In fact, I told her in no uncertain
terms that I didn't want to hear another word out of her.
Instead of cowering like she usually did, she just looked puzzled,
and, actually slightly amused. She said, "David, you're talking
to me like I'm a child." I realized then that my being a parent
in relation to her being like a child was over.

If the father is passive or subordinate to the mother, boys closely

observe and incorporate his style of relating to her; boys are acutely aware
of the times when their father caters to their mother, is intimidated by
her tears, or surrenders to her control. In families where this dynamic
predominates, the son may imitate his father's subservient role.

Competition and Oedipal Issues

Parents' unresolved feelings about competition are often acted out in

relation to their offspring. Intense covert feelings of rivalry, resentment, or

FACTORS THAT AFFECT SEXUALITY 55

hatred toward a child on the part of the parent of the same gender, the
parents' overall retreat from competitiveness and sexuality, and their lack
of sexual fulfillment, are debilitating forces affecting the child's attitude
toward competing and his or her sexuality as an adult.
S. Freud (1909/1957) observed that children exhibit competitive and
sexually rivalrous feelings toward parents of the same sex as they strive for
the attention of the opposite sex parent and noted that these rivalrous
feelings engender a fear of retaliation in children. However, parents' rival-
rous, competitive feelings toward their children have been seen as less
acceptable and are less documented in the literature. Clearly, there are some
exceptions, including Bloch (1985), Firestone (1990b, 1997a), Kestenberg
and Kestenberg (1987), A. Miller (1979/1981), Rheingold (1964, 1967),
and Shengold (1989) among others.
Historically, the incest taboo came into existence as an attempt to
suppress rivalry within the family system (DeMause, 1991; Fox, 1983/1993;
Levi-Strauss, 1969/1993).4 Yet these highly charged competitive feelings
are not eliminated by restrictive codes and continue to exist within families.
In couple relationships where the quality of the sexual relating has decreased
or there is excessive dependency or possessiveness, the partners often experi-
ence considerable jealousy in relation to rivals or competitors (Bloch, 1978;
Firestone, 1994a). The birth of a child brings a third party into the situation,
which can disturb the sense of equilibrium and security of one or both
parents. In addition, immature and narcissistic parents are threatened by
the child's demands for attention from the other partner as well as the
partner's response to such demands.
Most parents find it difficult to admit feelings of anger, jealousy, and
rivalry in relation to their children. Therefore, parents generally attempt
to suppress their negative wishes or urges to rid themselves of the unwanted
rival. Nevertheless, children sense this covert aggression, and it has a detri-
mental effect (Bloch, 1978; A. Miller, 1979/1981, 1980/1984a; Rheingold,
1964, 1967; Welldon, 1988). Later, as adults, when they are involved in
competitive situations, these individuals may experience irrational fears
and self-attacks. Because of this, many people pull back from competing,
especially in sexually rivalrous situations. For example, in a 12-year study
involving more than 2,500 women, Rheingold (1964) found that many
recalled childhood fears of parental aggression, especially fears of retaliation
on the part of a jealous, vindictive mother. In explaining these fears and
their consequences in the lives of adult women, Rheingold noted that "the
child's greater dependency upon the mother causes her attitudes and acts
bespeaking rejection to be the more threatening" (p. 19). "The threat of
retaliation ... forces her [the daughter] to abandon her aspirations and
surrounds all woman-roles with danger" (p. 267).

56 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 A mother who is insecure may experience feelings of jealousy and
envy in observing her husband's attentiveness to the daughter. In this
situation, when she senses her mother's anger, the daughter becomes fearful
of her mother's envy and her potential for acting out vindictive behaviors.
Later, as an adult, she may fear retaliation from other women who represent
symbolic substitutes for the mother.
Tina: I can clearly recall the hatred that my mother directed toward
me. She knew I was my father's favorite. She was always telling
me that I was too old to sit on his lap or give him a hug. I also
know how my father felt toward me, so I can imagine that she
waseven more resentful than I wasaware of at the time. I know
that I felt afraid of her a lot of the time. Now, whenever I walk
into a room where there's that kind of competition going on,
or if I sense another woman watching in the background, I feel
the same fear and panic, and I feel like running.
We have found that many women take their cues from other women
in the interpersonal environment in terms of their emotional state. There-
fore, when women observe other women being self-denying, unattractive,
or distant from the men in their lives, they are more likely to imitate those
types of behaviors.
Similar dynamics may be operating in the male child who is regarded
as a competitor by the father. As adults, these men often project the aggres-
sion that was originally directed toward them from their fathers onto other
men in their present-day life. Therefore, they have an exaggerated fear of
retribution and tend to retreat from competitive situations (Firestone,
1994a). For example, a father, who was insecure and jealous of the attention
his wife paid to their son (Sam), constantly criticized his son and ridiculed
any qualities that his wife responded to. At times, the father became explo-
sively angry, threatened punishment, and on occasion was physically abusive
toward Sam. Later, the son projected fears of his father's wrath onto other
men.
Sam: Recently I began to realize that there are reasons why I don't
actively compete in my everyday life. My fear of my father has
followed me ever since childhood and it still affects me now. I
can see how I've transferred my fear onto every other man in
my adult life and onto every situation, especially in relation to
my girlfriend. I have a gut level feeling of not being able to
successfully compete for her especially if there's another guy in
the picture. I have an irrational fear that he's going to kill me,
or at the very least, deeply humiliate me. But I'm beginning to
realize that these fears have nothing to do with my real life now,
they have to do with the past.

FACTORS THAT AFFECT SEXUALITY 57

Parents' Exploitive Use of the Child to Fulfill
Their Emotional and/or Sexual Needs

Parents' or other adults' exploitive use of children for emotional and/

or sexual satisfaction can be particularly damaging to a child's sexual develop-
ment. Even in the absence of actual sexual abuse, a parent's seductive
behavior or exaggerated focus on a child also leads to feelings of inadequacy
or fears of being depleted later in life. Numerous sexual dysfunctions and
disorders of sexual desire have been correlated with childhood sexual abuse
and emotional incest. This type of abuse is especially devastating when the
parent, the person most responsible for the safety of the child, is the person
who has betrayed the child's trust (Courtois, 1999; Dorais, 2002; Freyd,
1996; Herman, 1981, 1992; Sarwer & Durlak, 1996).

Emotional Hunger
Many children suffer from the debilitating effects of a parent's emo-
tional hunger, desperation, and intrusiveness. Emotional hunger is a desper-
ate longing, based on parents' unmet needs from the past, to demand love
from their child rather than offer love and affection. Generally speaking,
immature or emotionally hungry parents exert a strong pull on their offspring
to try to meet their (the parents') dependency needs (Firestone, 1990b;
G. Parker, 1983; Tronick, Cohn, & Shea, 1986; West & Keller, 1991).
Psychoanalysts (Masterson, 1985; A. Miller, 1979/1981) have stressed the
fact that children who are "used" or exploited in this manner feel compelled
to gratify their parents' unconscious primal needs at their expense. In describ-
ing this important dynamic of family life, Fenchel (1998) contended that
"Any infant is an enigma at birth, but the infant is a total object for the
parents' needs. The narcissistic investment of the loving parent represents
a demand on the child for support of the parents' self-esteem" (p. 152).
Emotional hunger may be manifested in a wide range of behaviors.
Parents may try to live through their child, have a proprietary interest in
the child, or exhibit anxious overconcern and overprotection, intrusiveness,
and affectionateless control. A needy parent may also exclude the other
parent from the mother-child or father-child dyad, as will be described in
chapter 4. In some cases, as children develop, parents may portray a need
for their child to actually take care of them-"parentification" (G. Parker,
1983).
The detrimental effects of parents' emotional hunger that have been
observed in adolescents and adults can include feelings of insecurity and of
being suffocated, drained, or depleted (Firestone, 1990b). Immature and
emotionally hungry parenting can result in sexual problems for both men
and women. One of the most significant outcomes in adulthood related to

58 SEX AND LOVE IN INTIMATE RELATIONSHIPS

experiencing a parent's emotional hunger is an intolerance of physical and
emotional closeness. Individuals with this intolerance will often uncon-
sciously distance themselves by withholding or inhibiting their responses.
There is a difference between genuine affection and the kind of af-
fection and physical touch that reflects a parent's underlying feelings of
emotional hunger (Firestone, 1985, 1990b; Firestone & Catlett, 1999). The
child being caressed by an emotionally hungry, needy parent who is sexually
or emotionally immature does not feel loved, cared for, or secure. Such a
child may become refractory to physical touch and may feel trapped by close
relationships later in life. These feelings of claustrophobia in combination
with guilt are also common in children who have been made to fill the role
of confidante to a parent.
For example, Neil began experiencing problems in his relationship
with Elizabeth as the couple became closer. Evidently, their sexual relation-
ship had been exciting initially, but Neil reported feeling increasingly awk-
ward and self-conscious as time went on. In a session, he revealed that it
was becoming difficult for him to respond to Elizabeth as she became more
demonstrative and wanting sexually.
Neil: I've never felt uncomfortable in any sexual situation until the
last few months as Elizabeth and I started getting closer. Even
the specifics are embarrassing. ] ust everything, her touching me
feels like it's wrong, and I feel shaken up by it.

As Neil explored the problem further, he experienced deep feelings of sadness

and anger as he traced his feelings of self-consciousness to interactions with
his mother.
Neil: I think that I know where this comes from. I felt that kind of
self-consciousness with my mother, even recently. It's a very
uncomfortable kind of feeling. I can't have a normal conversation
with her, and our hugs are always very intense. I'll kind of pull
away and then she'll kind of pull me back and then I don't know
what to do.

In recalling the ways in which his mother was emotionally hungry toward
him, Neil began to achieve insight into some of the reasons why he was
having problems in his sexual relationship with Elizabeth.

Emotional Incest
Covert incest or "emotional incest" (Love, 1990) is closely related to
emotional hunger. An emotionally incestuous relationship is basically a
sexualized relationship, "even when there is no clear-cut, explicit sexual
activity between the individuals" (Gartner, 1999, p. 26). Manifestations of
emotional incest in a parent or parents include flirtatiousness, sexualized

FACTORS THAT AFFECT SEXUALITY 59

affection, inappropriate touching and handling of the child's body and
clothing, sexual innuendos, possessiveness, jealousy of other people in the
child's life, a strong preference for and focus on the child, and sexualized
excitement when close to the child. According to Love (1990), emotional
incest has two defining features "The parent is using the child to satisfy
needs that should be satisfied by other adults" (p. 9), and "The parent is
ignoring many of the child's needs" (p. 10). In their writing, Bolton, Morris,
and MacEahron (1989); A. Miller (1979/1981); Love (1990); and Shengold
(1989) have shed considerable light on the subject of enmeshed families
and emotionally incestuous relationships.
Hannah's parents divorced when she was 10, and she would visit
her father on holidays. When she was 13, her father became blatantly
inappropriate in relating to her.
Hannah: When I was 13, I stayed at my father's apartment in London
for two weeks during the summer. The first night I was there,
he said that as a treat, he was taking me out to dinner at
his favorite restaurant. He told me I could even wear make-
up. The day before I arrived, he had bought me a really
stylish black dress and beautiful earrings, which he insisted
I wear. I remember being really excited. I felt like I was being
treated as special by him. He even put up my hair himself.
His favorite restaurant turned out to be the corner pub.
That was the first disappointment. Then as soon as we sat
down in a booth, some guys came over, friends of his, and
he introduced me as his "new girlfriend." At first I thought
he was just joking around, but then I saw that he wanted
his friends to think I was his girlfriend. I was horrified! I felt
so uncomfortable, but I could not say a word. I just smiled
and kept quiet, afraid of making him mad and of losing his
attention. At the time, I could see that he was using me in
a way that seemed kind of weird. I felt so nervous and self-
conscious I could barely eat. But we went out practically
every night of those two weeks to the same pub and the
same scene was repeated. I couldn't wait until the holiday
was up and I could return to boarding school. I never told
anybody about this, it was too embarrassing.
Today I realize how those "dinners out" with my father
must have affected me. It's clear to me now that he was
totally insensitive to my feelings. It's obvious that there were
sexual overtones to what he did. I really came to believe
that my looks were the most valuable thing I had. I was a
nobody, except for how I looked.
Today I feel that I'm always focused on how I look and try
to figure out new waysto dress to attract men. But whenever a

60 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 man seems to fall for me, for my looks, I soon became bored
with him. I start to pick him apart. It's sad, because the man
I broke up with recently wanted to get married and have a
baby with me. He really liked me, for me. We enjoyed activi-
ties together, like skiing, taking walks. I became extremely
critical of him. I became disgusted with him. I could not
stand his looking at me, his touching me. Eventually the
relationship ended and I lost a chance to have something
valuable in my life because I can't accept real love from a
man. My father's perverted use of me left me unable to accept
real love and closeness. I protect myself by getting rid of any
man who gets too close to me.

Emotionally incestuous parents injure the child's capacity for wanting

and his or her desire to seek satisfaction in a mature sexual relationship.
Individuals who were damaged in this way may unconsciously inhibit their
sexual responses in their adult relationships. In particular, as a sexual rela-
tionship becomes emotionally closer and more meaningful to them, they
may experience a diminution in sexual desire or an increasing aversion to
making love. In discussing sexual problems that are common among victims
of emotional incest, Love (1990) argued that in some cases, these children
later become involved in "brief, clandestine affairs with relative strangers."
Others tend to repress their sexuality. "The man may be impotent or disinter-
ested in sex. The woman may be afraid of sex or have difficulty achieving
an orgasm" (p. 54).
Gabrielle: To me, my father's attentions seemed competitive, especially
when I started to date. He always told me that my skirts
were too short and would measure the distance from my
knees to the hem of my skirts before I left on a date. Once
when I was in my late teens, our family went on vacation
together. An older family friend asked me to take a walk
with him into town. This was in broad daylight and as we
turned the corner some blocks from our hotel, I noticed my
father walking half a block behind, stalking us. I tried to
pretend nothing unusual was going on, but the friend I was
with finally noticed. He was outraged at my father's behavior
and his suspicious nature and actually confronted him when
we got back to the hotel. Of course, that led to a completely
humiliating scene.
Even before I got married, I had a lot of sexual problems.
It was difficult for me to feel very much sexually, especially
after my boyfriend and I started living together. Then after
we were married, it got even worse. On the rare occasions
that I was sexually responsive, I would feel guilty, but I

FACTORS THAT AFFECT SEXUALITY 61

 didn't know why. Then the next time, I wouldbe completely
unresponsive. After that, I wouldfeel guiltyfor pulling away
from him. Much later, I realized that my sexual inhibitions
were related to the way my father had felt about sex and
especially the way he viewed my sexuality. It was like it
somehow belonged to him.

Overreactions to Natural Feelings of Attraction

That Occur Within the Family

There are feelings of attraction that naturally accompany the close

contact that parents have with their children (Dix, 1985; Firestone, 1990b,
Friday, 1977). The feelings of love and affection that we are describing here
are different from sexual feelings. Obviously, behaviors based on sexual
feelings, including inappropriate touching or handling of a child and overt
sexual child abuse, are destructive to children.
Emotionally healthy parents who have satisfying adult sexual relation-
ships are comfortable with these feelings and can express loving affection
to their children. In spite of the fact that these feelings naturally occur,
some parents may still feel discomfort when such feelings arise. For example,
some mothers report feeling uncomfortable with physical sensations they
experience when their baby is nursing (Dix, 1985). Other mothers and
fathers avoid expressing physical affection to an older child because they
are confused or alarmed at any indications of sexual attraction. We have
observed some children who were punished as though they are to blame
for arousing these "forbidden" emotions in parents. Parents need to become
more aware that fears associated with taboos against physical closeness
between family members can effectively limit them in their ability to accept
the child's expressions of love and affection. As noted earlier, in such
situations, the child internalizes a feeling that there is something unlovable
or unacceptable about him or her and learns to hold back or inhibit love,
affection, and other positive responses.
Physical affection and contact are vital and valuable for a child's
development. There is, of course, an obvious distinction between warmth,
affection, and tenderness and sexualized attention to a child. In this context,
it is important to mention that the focus on incidents of sexual child abuse,
while leading to necessary identification of cases, treatment, and prevention,
has also had an inhibiting effect on people who work closely with children.
Acting on this self-consciousness and fear may be detrimental to psychother-
apy with children and can often pose a problem for child psychologists,
teachers, day-care providers, and other professionals who have close contact
with young children (Orbach, 2004). In many cases, children who grow up

62 SEX AND LOVE IN INTIMATE RELATIONSHIPS

in conditions of neglect and abuse turn to a favorite teacher or mentor as
their only source of affection and positive role-modeling. If these adults
hold back their natural warmth and affection out of a fear of being misinter-
preted, they inadvertently inflict further damage on those children most
in need; indeed, they may well harm every child they would otherwise
positively influence.

Child Sexual Abuse and Incest

Child sexual abuse is the sexual exploitation or victimization of a child .
by an adult, adolescent, or older child. The difference in age and sexual
knowledge between a child and an older person makes informed consent
to sexual activity impossible. Child sexual abuse was defined by Steele and
Alexander (1981) as "the misuse of the immature child by the adult for the
solving of problems and satisfying of adult needs, while disregarding the
appropriate needs and developmental state of the child" (p. 233). Incest is
child sexual abuse that takes place within the family context. Incidents of
child sexual abuse and incest are far more prevalent than previously recog-
nized. Faller ( 1999) reported, "Estimates are that one in three or four women
is sexually abused during the course of her childhood and one in six to 10
men" (p. 4).
Child sexual abuse can involve both fathers and mothers as well as
other adults and parental substitutes and includes abuses toward same-sex
children. According to Whealin (2004),
Men are found to be perpetrators in most cases, regardless of whether
the victim is a boy or a girl. However, women are found to be perpetrators
in about 14% of cases reported against boys and about 6% of cases
reported against girls. (Who Are the Perpetrators of Child Sexual Abuse
section, 9T 5)

In some industrialized countries, people do not report child sexual abuse,

and it is believed by many clinicians and researchers that sexual abuse is
under-reported in the United States as well.

Sexual Abuse of Female Children

In her descriptions of incest involving female children, Freyd (1996)

proposed that profound amnesia for sexual abuse and related events may
occur when there has been a betrayal of trust in cases where the perpetrator
is an attachment figure, such as a parent or caregiver: Zurbriggen and Freyd
(2004) also noted, "According to betrayal trauma theory, survivors of child-
hood abuse by a caretaker have learned to cope with social conflicts they

FACTORS THAT AFFECT SEXUALITY 63

cannot escape by being disconnected internally" (p. 145). Wilsnack, Won-
derlich, Kristjanson, Vogeltanz-Holm, and Wilsnack (2002) found that
"Among women who report [child sexual abuse], forgetting and subsequently
remembering abuse experiences is not uncommon" (p. 139). Similarly,
Courtois (1999) called attention to the fact that sexually abused children
often forget the incidents of maltreatment.?
Ogilvie (2004) reported that "Estimates of female-perpetrated child
sexual abuse based on a variety of surveys of the general population ...
place the percentage of sexual contact by females at .. , approximately
5 percent ... for female children" (pp. 3-4). With respect to female sexual
abuse of girls, she also noted that "Recent research suggests that mother-
daughter incest is not rare; it is underestimated and underreported because
its occurrence involves the breaking of two taboos, incest and homosexual-
ity" (p. 4).

Sexual Abuse of Male Children

The problem of estimating the prevalence of child sexual abuse among

boys is compounded by the fact that these cases are likely to be under-
reported (Purcell, Malow, Dolezal, & Carballo-Dieguez, 2004). In fact, ac-
cording to Dorais (2002) "For a long time, it was thought that sexual abuse
of boys was still a marginal phenomenon. This is not so.... [Burl boys are
more reluctant than girls to disclose the fact that they have been abused"
(pp. 16-17). Gartner (1999) also observed that "the sexual victimization
of boys ... is even more universally minimized, underestimated, and ridiculed
than the abuse of girls" (p. 3). Gartner further noted that "Boys are socialized
to believe that men want sex whenever it is offered to them. The sexual
behavior of adults with boys has often been misunderstood and underreported
because it is not considered abusive or even unwelcome" (p. 42). Being
abused by an adult male presents special problems for boys. According to
Gartner, "Molestation by a man is likely to undermine a boy's sense of his
gender identity and orientation, whether he is predominantly heterosexual
or homosexual" (p. 96).
Sexual abuse by a woman may be even more problematic for young
males. "The traumatic impact of abuse of boys by women is particularly
minimized in our culture" (Gartner, 1999, p. 46). When the perpetrator is
the boy's mother, the damage to the boy's psyche and sexuality is especially
destructive (Miletski, 1995). According to Gartner (1999), "Maternal sexual
betrayal of a son often occurs covertly, in the guise of some aspect of
caretaking and nurturing, as when a mother gives her son unneeded enemas
or spends too much time washing his genitals" (p. 52).

64 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 IMPLICATIONS OF CHILD SEXUAL ABUSE FOR ADULT
FUNCTIONING AND SEXUAL RELATING

The implications and long-term effects of incest and child sexual abuse
are pervasive, far-reaching, and extend beyond the sexual sphere. Significant
correlations have been found between child sexual abuse and higher rates in
adult life of depressive symptoms, anxiety symptoms, dissociation, substance
abuse disorders, eating disorders, posttraumatic stress disorders, bipolar dis-
orders, and suicide (Bergen, Martin, Richardson, Allison, & Roeger, 2003;
Fergusson, Horwood, & Lynskey, 1996; Gold, Lucenko, Elhai, Swingle,
& Sellers, 1999; Hvun, Friedman, & Dunner, 2000; Mullen & Fleming,
1998; Oates, 2004; Romans, Martin, Anderson, Herbison, & Mullen, 1995;
Safran, Gershuny, Marzol, Otto, & Pollack, 2002; Spak, Spak, & Allebeck,
1998; Thakkar, Gutierrez, Kuczen, & McCanne, 2000; Twomey, Kaslow,
& Croft, 2000).
Studies have shown that female adolescents who were sexually abused
as children tend to develop secondary sexual characteristics (breasts and
pubic hair) earlier and begin menstruating at an earlier age than their
nonabused peers (van der Kolk, personal communication, April 2004). They
experience themselves as different, in the negative sense, from other girls,
and as a result have very few or no female friends. Instead they gravitate
toward friendships with boys who they relate to in a sexualized way. Mullen
and Fleming (1998) also reported evidence showing that in "those whose
abuse has been particularly gross (in terms of physical intrusiveness, fre-
quency, duration or closeness of relationship to abuser), there is an increased
risk of precocious sexual activity with its attendant risks of teenage pregnancy
and social ostracism" (p. 8).
Specific outcomes in terms of adult sexual functioning and problems
in intimate relationships have been delineated by several clinicians and
researchers (Doll, Koenig, & Purcell, 2004; Heiman & Heard-Davison,
2004; Kirschner & Kirschner, 1996; Meston, Heiman, & Trapnell, 1999;
Purcell et al., 2004; Roberts, O'Connor, Dunn, & Golding, 2004).6 These
effects include "sexual aversion or avoidance, decreased sexual desire or
sexual self-esteem, inhibited sexual arousal or orgasm, vaginismus, dyspareu-
nia, and negative attitudes toward sexuality and intimate relationships in
general" (Meston & Heiman, 2000, p. 399). Kirschner and Kirschner (1996)
found that "86 percent [of child sexual abuse survivors] had difficulties
dealing with close relationships" (p. 408).7 Other studies cited by Kirschner
and Kirschner found that "67 percent of female survivors experienced an
aversion to sex. Briere (1992) reported that 42 percent of his sample experi-
enced low sexual desire" (p. 409).

FACTORS THAT AFFECT SEXUALITY 65

 Herman (1981) has found that the ongoing effects in adolescent and
adult women's lives from sexual abuse and incest range from feelings of being
set apart from other people, isolation due to the incest secret, promiscuity,
revictimization by other relatives and adults, rape, deep feelings of shame,
depression, and suicide attempts. In Herman's sample, "Many oscillated
between periods of compulsive sexual activity and periods of asceticism and
abstinence" (p. 100). Incest, in particular, interferes with the child's ability to
form a secure attachment either with the abusing parent and the "enabling"
nonabusing parent, preventing the development of a basic trust in other
people. Both limitations clearly have negative consequences in the exploited
child's adult relationships. Mullen and Fleming (1998) asserted that "In
those abused by someone with whom they had a close relationship, the
impact is likely to be all the more profound" (p. 9). These researchers also
noted that the consequences of this breach in basic trust can often be
observed in the types of attachments people develop in their adult sexual
relationships.
The long-term effects of childhood sexual abuse on the lives of boys
and men have recently become the target of research. Purcell et al. (2004)
reported that "The effects of CSA [child sexual abuse] on diverse emotional
and social domains are pervasive and long-lasting" (p. 94). Cross-sectional
studies of sexually abused men show elevated levels of hypersexuality and
high-risk sexual behavior, including prostitution, unprotected sex, and hav-
ing many sexual partners. According to Purcell et al., gay men and bisexual
males are "more likely to have been abused than heterosexual men, and
... are particularly likely to have been abused by men" (p. 97). In an in-
depth study of 26 male survivors of childhood sexual abuse, Lisak (1994)
found that the men expressed a "basic sense of badness in myriad forms:
As a feeling of inferiority, of insignificance, of being unacceptable and
unlovable.... For some men, sexual intimacy was frightening because it
re-evoked feelings related to the abuse" (pp. 541-542).
Research studies have been conducted to explore the long-term cumu-
lative effects of experiencing physical, emotional, and sexual abuse, as well
as exposure to family and community violence (Briere, 1992; Briere &
Elliott, 2003; Cole & Putman, 1992; Mullen & Fleming, 1998). These three
forms of child maltreatment frequently occur together. For example, Felitti
et al. (1998) found that the probabilities that children who were exposed
to child sexual abuse were also exposed to psychological abuse and physical
abuse were 24% and 22%, respectively.f
We believe that any kind of sexual abuse is clearly damaging psychologi-
cally to both boys and girls; however, the effects are compounded by the
secrecy that surrounds incestuous relationships (Conte, 1988; Firestone,
199Gb; A. Miller, 1981/1984b; Newberger & deVos, 1988). The consequences

66 SEX AND LOVE IN INTIMATE RELATIONSHIPS

of these acts are exacerbated when denial and dishonesty within the family
take precedence over concern for the child. In an interview, Melanie, 45,
described the secrecy that surrounded the ongoing incestuous relationship
she had with her father that began when she was 9 years old. When she
entered therapy at 29, Melanie was suffering from feelings of emptiness,
diminished sexual desire, and compartmentalized feelings about her sexuality
and her body. Melanie explores the shame and guilt that had led to her
secrecy.

I had been in therapy several months when I brought up the subject

of my sexual relationship with my father. My therapist was the first
person I had ever told since I left home. In all the years of silence, it
was like I had been keeping my sexual life a secret even from myself.
My father would take me to his workshop behind the garage, and
the whole thing was very secretive. We pretended to everyone and
even to ourselves, I think, that we were engaged in practical work that
had to be done and that I was his helper. I didn't tell my mother for
years. Then when I finally told her, there was a big family upheaval: I
could hear them yelling and talking about divorce and about him going
to prison. I thought I had ruined the whole family. The next day, my
mother took me aside and said "Just don't tell anybody. Don't tell
anybody ever. Not even your best friend."
For about two weeks after that, my mother didn't let me out of her
sight, so I wasn't exposed to my father. But then one night, we were
in the kitchen doing dishes and she said that he wanted some help in
the workshop, so I should go and see if I could help him. I was so
confused, I couldn't believe she said that, but I went anyway. And the
sexual thing started up all over again. When I was in therapy and
looking back on that time, I had to face the fact that she essentially
gave me over to him. So it made sense to me that I never brought up
the subject again to her.
I tried to rationalize away my guilt by reminding myself that my
father never had actual intercourse with me, and so I was able to preserve
my "virgin" status. But I worried endlessly that the relationship had
damaged me sexually and that I would never be sexually "all right."
After I left home, I was involved with lots of guys. Sex was very
exciting for me. I felt really passionate and it seemed like everything
was fine. But then I met a man I really was drawn to, and we fell in
love. At first, things were okay, but as we got closer, I started having
a lot of trouble feeling any sexual sensations. Then after we married, I
started avoiding situations where we would ordinarily be sexual. When
we did make love, I sometimes would feel like pushing him away,
especially when he was saying loving, tender things to me. That's when
I decided I had to go to therapy.

FACTORS THAT AFFECT SEXUALITY 67

 Distorted cultural and familial attitudes toward sex also contribute to
and complicate the resultant psychological and sexual problems (Firestone,
1990b; Herman, 1992; Spiegel, 2003). As Miller (1980/1984) put it,
It is not the trauma itself that is the source of illness but the unconscious,
repressed, hopeless despair over not being allowed to give expression
to what one has suffered and the fact that one is not allowed to show
and is unable to experience feelings of rage, anger, humiliation, despair,
helplessness, and sadness. (p. 259)

The optimal response in terms of ameliorating the impact of child

sexual abuse would be for parents to show empathy and understanding
toward the child rather than maintaining secrecy through denial or by
invalidating the child's experience. Lieberman (2004), in describing her
"relational diathesis model," emphasized that one condition necessary to
achieve resolution of sexual abuse trauma and resume developmental mo-
mentum is "the caregiver's capacity to provide comfort and assuage fear"
(p. 345).

CULTURAL AND SOCIETAL INFLUENCES ON SEXUALITY

In the process of evolving groups and societies, individual patterns of

defense are pooled and combine to form specific world views, cultural atti-
tudes, and social mores. Cultural prerogatives and social mores based on
defense formation then reflect back on each member of society, further
reinforcing people's defenses and depriving them of vital experiences neces-
sary for achieving their true potential (Billig, 1987; Billig et al., 1988;
Firestone, 1985, 1997a).
These types of institutionalized attitudes and conventions act on people
in the form of negative social pressure and support their distorted views of
sex and their defenses against being close sexually and emotionally in a
personal relationship (Francoeur, 2001; Shea, 1992). Commenting on the
impact of culture on sexuality, Bancroft (2002) stated, "Here we can assume
that learning plays a crucial mediating role; the culture provides guidelines
or scripts for appropriate sexual responses, and the individual learns them
accordingly" (p. 19).9
It appears that societies in the Western world (with few exceptions)
perceive sex in ways that sensationalize it and imbue it with a "dirty"
connotation. At the same time, numerous social sanctions function to
suppress honest, realistic discourse regarding sex, place serious prohibitions
on sex education for young people and discourage an open discussion of
sexual abuse and incest (Herman, 1981). We agree with Prescott (1975)
and A. Miller (1980/1984a) who argued that a suppressive society leads to

68 SEX AND LOVE IN INTIMATE RELATIONSHIPS

an increase rather than a decrease in the pervasiveness of problems in
sexual relating, perversion, child abuse, and rape, the very effects it attempts
to avoid.
On a societal level, there is still considerable support for the point of
view that sex is inherently bad (Francoeur, 2001). This concept of sexuality
continues to influence conventional secular thinking despite the sexual
revolution and scientific, social, and medical advances regarding sexuality
during the past 50 years (Tiefer, 2001). In some traditional religious belief
systems, for example, sex is perceived as an expression of the baser or sinful
nature of human beings. Regarding these negative views of sex, Shea (1992)
called attention to the historical fact that, in contrast to ancient Babylonian,
Egyptian, Greek, and Roman cultures, "The Christian era, influenced by
pagan philosophies, brought the Western world a negativity to sex that is
unique among the great cultures of history" (p. 72). For generations, this
negativity, combined with inaccurate, distorted views of human sexuality,
has functioned to alienate people from their bodily sensations and feelings
(Pagels, 1988, 1995; Vergote, 1978/1988).
In our opinion, religious teachings originally meant to enhance spiritual
and human qualities have been misinterpreted in a way that has contributed
to people's tendencies to lead a self-denying, self-sacrificing life. Theologians
have used St. Augustine's revision of the creation myth, in which he postu-
lated that death was the punishment for Adam's act of disobedience, to
hold out the promise that if one denies sexual desire and bodily pleasures,
one's soul will triumph over the body and survive death (Pagels, 1988).
Goldenberg, Cox, Pyszczynski, Greenberg, and Solomon's (2002) approach
is congenial to our point of view stated above: "Although virtually all
cultures restrict and disguise sexual behavior in some ways, some seem more
restrictive than others. Similarly, some cultures seem to go to great lengths
to distance humans from other animals, whereas others do not" (Cultural
Variability section, qr 1). Goldenberg, Pyszczynski, Greenberg, and Solomon
(2000) concluded,

Thus we may be in a catch-22 in which we must control anxiety to be

able to embrace the potential for pleasure that our bodies provide, but
we must largely forsake our bodies and cling to the world of cultural
symbols and standards [religious belief] to control that anxiety. (p. 215)

Anthropologist Manson (1994) observed that "With the exception of

the moral conservatism of the Victorian era, Western culture has generally
experienced a gradual relaxation of sexual mores since the Renaissance"
(p. 86). However, in spite of this positive evolution, restrictive attitudes
toward a wide range of sexual behaviors still exert considerable influence
in contemporary society. These social mores obviously have destructive
effects on an individual's sexual development. For example, negative views

FACTORS THAT AFFECT SEXUALITY 69

of sex often have the effect of suppressing natural curiosity and aliveness
about sexuality and increasing guilt about sex (Calderone & Johnson, 1989;
Gunderson & McCary, 1979). In general, repressive social mores in relation
to nudity, the human body, and sexuality continue to playa crucial role in
each child's sexual development in spite of an accumulated body of knowl-
edge regarding biological aspects of sex. As a result, nearly every individual
in our culture has learned to feel shame regarding his or her body, body
parts, and sexuality, and these imposed views have generated a variety of
sexual problems and fears related to sexual performance (Calderone &
Johnson, 1989; Firestone, 1990b, 1990c).

PERCEPTIONS OF SEXUALITY REPRESENTED IN THE MEDIA

AND OTHER FORMS OF POPULAR CULTURE

Each person growing up today is affected by repressive and exploitative

attitudes toward sexuality. Distorted beliefs about sex and prejudicial, sexist
views of men and women are widely disseminated through books, magazines,
popular music, radio, television, the internet, and other areas of popular
culture. For example, Kernberg (1995) has suggested that in the mass media,
there was a substantial increase in "mutual distrust between male and female
groups" (p. 187) during the 1990s.
Sex as presented in numerous film and television productions is all
too often sensationalized and trivialized and is at times presented in conjunc-
tion with scenes of violence. This combination desensitizes viewers and
blurs the distinction between appearance and reality. In a policy statement,
the American Academy of Pediatrics (2001) announced that "In film, tele-
vision, and music, sexual messages are becoming more explicit in dialogue,
lyrics, and behavior. In addition, these messages contain unrealistic, in-
accurate, and misleading information that young people accept as fact"
(Abstract). "The average American adolescent will view nearly 14,000
sexual references per year, yet only 165 of these references deal with birth
control, self-control, abstinence, or the risk of pregnancy or STDs" (Ameri-
can Academy of Pediatrics, 2001, Media and Sexual Learning section).
Pornography in the United States is now a $8 billion a year business.
According to He (2001), in this country pornography is accepted as part
of the adult culture and is legally and morally tolerated. "Pornographic
material is legally available to anybody over eighteen in bookstores, news-
stands, video stores, X-rated movie theaters, adult cable channels, pay TV
and even international computer networks such as the Internet and World
Wide Web" (p. 132).
There have been mixed reviews and opinions concerning the effects
of pornography and other nonpornographic print media on adolescent and

70 SEX AND LOVE IN INTIMATE RELATIONSHIPS

adult attitudes and sexual behavior. Historically, the sexual content in
literary works has consistently elicited concern and censorship throughout
the 20th century in the United States. For example, Fanny Hill was banned
in the United States until 1966, and James Joyce's Ulysses was subject to
censorship on national and local levels (Stern & Handel, 200l).
In recent years, the Internet has evoked similar concern, providing
the impetus for studies to determine its positive and negative effects on
Web surfers. For example, Stern and Handel (2001) reported that
Researchers are divided on whether or not this [the interactive feature
of the Internet] isa blessing or a problem.... Some researchers, however,
warn that the combination of anonymity and rewarding intimacy can
lead to deviant sexual misconduct (Durkin & Bryant, 1995) and disrup-
tions in marital relations (Young, 1998). (p. 289)
The above analysis is not meant to convey the impression that most,
if not all, electronic and print media contain negative or distorted messages
about sex. To the contrary, many literary works, films, television programs,
and Web sites convey accurate information and positive messages about
sexuality to readers and media consumers. For example, Anderson-Fye
(2003) reported a longitudinal study of adolescent girls in Belize that revealed
how they were positively affected by viewing American television talk shows,
especially Oprah. Several girls in the study, after viewing Oprah, were able
for the first time to accurately identify some of their experiences with male
relatives as sexual abuse. They were then able to work through the resulting
symptoms of posttraumatic stress disorder that emerged and help change
their families for the better. They also felt empowered to not accept abuse
from men. In the print media, hundreds of poems, novels and essays
depict the potential emotional richness and meaning of people's sexual lives.
Unfortunately, because of their wide audience appeal, films and TV programs
that distort or trivialize sex may have far more influence on individual
members of society than do more realistic, positive views set forth in many
literary works.

CONCLUSION

An individual's sexuality and his or her sexual development are deter-

mined through the complex interaction of many biological, psychological,
and social factors. Sexual behavior is based on a biologically determined
drive; similarly, sexual desire and sexual arousal contain physical and cogni-
tive components and are experienced in the body as well as the mind.
Sexual feelings, as with all feelings "arise involuntarily and are experienced
as sensations in the body" (Firestone, Firestone, & Catlett, 2003, p. 107).

FACTORS THAT AFFECT SEXUALITY 71

In this regard, we believe that people who are close to their feelings are
better able to respond positively to loving and being loved in an intimate
relationship than those who have less access to their feelings. Furthermore,
research (Oatley, 1996; Parrott & Harre, 1996) has shown that feelings are
closely related to people's motivations, that is, to their wants, needs, and
desires. When children are hurt early in life, they develop defenses to protect
themselves against painful emotions. However, the defenses that function
to reduce painful emotions also cut people off from experiencing other
feelings as well. In other words, one cannot selectively defend oneself against
feelings of pain and frustration without diminishing one's capacity for experi-
encing the whole gamut of emotions. Thus, remaining connected to one's
feelings is crucial to pursuing the satisfaction of one's wants and needs in
a sexual relationship.
In working with patients and in observing individuals and families
in their everyday lives, we have become increasingly impressed with the
prevalence of sexually related disturbances in our culture. These disturbances
are related to a variety of factors that influence children's development as
sexual beings. For example, in socializing their children, parents may feel
under pressure from society to teach restrictive, negative views of sexuality.
On an intellectual level, most people recognize that negative attitudes
toward the human body, nudity, masturbation, and sex play between children
are the results of social learning. Yet these views continue to be transmitted
to children and exert a powerful influence on their emerging sexuality.
Moreover, the majority of adults in Western society have grown up
in families where they assimilated negative perceptions of sexuality and
distorted views about sex. These attitudes persist, generally on the uncon-
scious level, and interfere with the achievement and maintenance of sexually
and emotionally fulfilling relationships.
In addition, many children endure sexual abuse at the hands of imma-
ture adults who themselves may have been victims of destructive sexual
attitudes and sexual maltreatment. This form of abuse contributes to a wide
range of sexual dysfunctions and emotional disturbances in adults. Sexual
abuse also interferes with children developing a healthy, secure attachment
to their caregivers. Their insecure attachment patterns are often manifested
in their adult relationships and cause problems in their sexual relating.
Many problems in adult sexuality and in couple relationships are related
to even more fundamental disturbances in parent-child relationships. These
sexual problems and disturbances might never arise if parents, because of
their limitations, did not need to defend themselves in their interactions
with their children. For example, children whose parents love and accept
them for who they are and allow them to freely express their love and
affection toward them are unlikely to develop sexual problems as adults or
feel confused about their sexuality. Children whose parents do not exploit

72 SEX AND LOVE IN INTIMATE RELATIONSHIPS

or use them to fulfill their (the parents') emotional or sexual needs will be
unlikely to grow up with persistent fears of love and sexual intimacy. Parental
defenses, including emotional hunger and an intolerance of being loved,
are perhaps the most powerful factors impacting their children's emerging
sexuality. Children react to the resultant hurt and frustration by forming
defenses, which in turn, predispose disturbances in their sexual functioning
that can persist into adulthood.

NOTES

1. For example, Orbach (2004) has addressed this dynamic in reporting a case of
vaginismus, or painful intercourse.
2. When examining and coding an infant's behavioral and feeling reactions during
selected close interactions with its mother, Stern (1985) noted that the mother's
internal emotional state had a powerful influence on her baby's state of arousal
and emotional responses. Overstimulation from an intrusive mother, understim-
ulation from a depressed mother, or chaotic, inconsistent stimulation from an
anxious mother tended to disrupt the relaxed, alert state in the infant, referred
to as a state of "going on being" by Winnicott (1958).
3. Regarding parents' views of sex, Zoldbrod (1998) described a continuum of
family attitudes toward sex, ranging from an ideal environment through a
predominantly nurturing environment, evasive environment, permissive envi-
ronment, negative environment, seductive environment, to an overtly sexual
environment and outlined several outcomes in terms of potential disturbances
in adult sexual functioning.
4. See theories on the evolution of the incest taboo in Suggs and Miracle (1993),
in particular the papers by Fox (1983/1993) and Levi-Strauss (1969/1993).
According to Levi-Strauss (1969/1993), "The prohibition of incest is less a
rule prohibiting marriage with the mother, sister or daughter, than a rule
obliging the mother, sister or daughter to be given to others" (p. 229). The
rule or taboo functioned as a kind of "alliance assurance" to cement cooperative
ties with other members of the tribe and incidentally increased gene variability.
5. There is still considerable controversy regarding the veracity of recovered
memories and the concept of "repression" as the defense mechanism responsible
for periods of "forgetting" traumatic childhood events, including incidents of
child sexual abuse. See Loftus and Ketcham (1994) and Pope and Brown (1996).
6. Spiegel (2003) found that more than 50% of outpatients and from 50% to
70% of inpatients have histories of child sexual abuse. A study conducted by
Kinzl, Traweger, and Biebl (1995) with 202 female university students found
that victims of multiple child sexual abuse reported sexual desire disorders
and orgasmic disorders more frequently than did single-incident victims and
nonvictims. In addition, Mullen and Fleming (1998) found that
Significantly more child sexual abuse victims believed their attitudes
and feelings about sex caused problems or disrupted their satisfaction

FACTORS THAT AFFECT SEXUALITY 73

 in sexual relationships.... There was also a significant increase in the
frequency with which the victims complained of what they perceived
as negative and disruptive attitudes in their partners that caused sexual
difficulties. (pp. 7-8)

7. See Doll et al. (2004), who asserted that

An emerging body of literature suggests that children who are [sexually]
abused also face increased risk of physical health problems in adulthood,
including negative sexual and reproductive health consequences such
as unwanted pregnancy, sexually transmitted diseases including HIV
infection, and adult sexual violence. (p. 3)

Cobia, Sobansky, and Ingram (2004), in their study of female survivors of child
sexual abuse, found that "Many women internalize the psychological coercion
from the abuse, overgeneralizing the abusive experience to other potential sex
partners and to a general aversion or avoidance of sexual activity" (p. 314).
See also Reissing, Binik, Khalife, Cohen, and Amsel (2003), who cited a study
involving three groups of women showing physical distress related to sexual
functioning. "More women in the vaginismus group reported a history of child-
hood sexual interference and held less positive attitudes about their sexuality"
(p. 55).
8. The Adverse Childhood Experiences (ACE) Study conducted by Felitti et al.
(1998) found "a strong dose response relationship between the breadth of
exposure to abuse or household dysfunction during childhood and multiple risk
factors for several of the leading causes of death in adults" (p. 251). "The
prevalence and risk [of] ... ~50 intercourse partners, and history of a sexually
transmitted disease increased as the number of childhood exposures increased"
(p. 250).
9. With respect to other societal influences on an individual's sexuality, Herdt
(2004) noted that
Less obvious are the forces of poverty, racism, or heterosexism that
disproportionately impact upon minorities or certain social classes or
sexual cultures not in the majority, creating conflict, turmoil, uncer-
tainty, and anxiety that inflect sexual development. Among the out-
comes of such conditions in contemporary society are sexual abuse,
sexual risk taking that introduces unintentional pregnancy early in
development, and exposure to major STDs. (p. 53)

74 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 MEN, WOMEN, AND
4
SEXUAL STEREOTYPES

At this contentious moment in the history of male-female relationships,

it is important for us to note that there is not one set of elements for
men and another for women. Society has wounded and rewarded men
and women differently. But when it comes to practicing the art and
discipline of love, we are equally challenged.
-Keen (1997, p. 32)

During the past 50 years, a significant transformation has taken place in

the way men and women relate sexually (Hyde & Oliver, 2000; Schoenewolf,
1989; Solomon & Levy, 1982; Walsh, 1997; Young, 1999). Numerous cul-
tural developments have contributed to these changes, among them the
feminist movement, the men's movement, and women's ongoing and increas-
ing involvement in the workplace (Bly, 1990; Sheehy, 1998). Since the
1960s, surveys indicate that many men have become more sensitive and
less detached while many women have become more self-assertive and less
dependent than their predecessors (Rubin, 1990). Commenting on the many
real gains for both men and women that may be attributed to the "sexual
revolution" Rubin stated,
For the first time in our history, women were not just permitted but
exhorted to experience the full force of their sexuality, to take pleasure
in its expression, to celebrate it publicly rather than to conceal it as
some private shame. '" [For men] there was the possibility for sex
among equals, sex with a "good" woman who made a free choice, a
woman who was neither guilt-ridden nor shamed by the expression of
her sexuality, a sexual connection that was also a freely given emotional
exchange. (p. 93)

However, as social critic Young (1999) observed, these gains are far
from complete: "Too many countries around the world still deny women

75
the basic rights of adult members of society (though it's worth remembering
that men's lot in these countries usually is not too enviable either)" (pp. 265-
266).
Despite the movement toward gender equality, many people still lack
a fully developed sense of self and the autonomy necessary to sustain a
loving and sexually fulfilling relationship. Men and women are currently
living within a society that is in transition between a traditional patriarchal
social structure and a system that reflects more equality between the sexes
(Silverstein, Auerbach, & Levant, 2002). As a result, many are confused
about their gender roles, relationships, and sexuality.
It is beyond the scope of this book to examine the multitude of recent
societal changes with respect to gender roles and expectations or to comment
on their implications for sexual relationships. However, in this chapter, we
describe an overall view of sexual stereotyping in our society and show how
these distorted views create animosity between men and women. We provide
a brief review of findings from gender studies and a critique of gender studies
that we believe may perpetuate stereotypic attitudes. We offer our views
regarding similarities and differences between the sexes. Our focus is on
exploring these similarities and differences in terms of men's and women's
psychosexual development, adult sexual functioning, and ways of expressing
their sexuality in relationships. In addition, we explore how boys and girls
learn their parents' defensive styles of relating with each other through the
process of imitation. Also we examine conflicting hypotheses about how
children are socialized into their respective gender roles and the differential
developmental tasks they encounter during their formative years. Lastly, we
briefly review several conjectures proposed by evolutionary psychologists
regarding differences in male and female sexual strategies and preferences
in mate selection.

SEXUAL STEREOTYPES: AN OVERVIEW

As described in chapter 3, psychological defenses established early in

life later combine with the defenses of other individuals to produce cultural
attitudes and social mores that shape a society. Once established, cultural
prerogatives and social institutions reflect back on each member of society
(Billig, 1987; Billig et al., 1988; G. Mead, 1934/1967). Sexist attitudes and
sexual stereotypes are a significant part of this defensive apparatus and are
transmitted through succeeding generations within the family context. If
parents have sexist attitudes, their children assimilate these views, both
explicitly through verbal communications and implicitly through the pro-
cesses of identification and imitation. These defensive views are then pro-
jected into the social mores and institutions of the larger society. Sexism

76 SEX AND LOVE IN INTIMATE RELATIONSHIPS

essentially represents the extension of each individual's biased, hostile atti-
tudes toward the opposite sex into a social framework. Negative attitudes
toward lesbian, gay, bisexual, or transsexual orientations are also still com-
monplace in our culture (Friedman & Downey, 2002).
Although changes have occurred in the roles of men and women in
our society, there are still remnants of sexist views that portray men as
masterful and powerful yet paternalistic and uncommunicative, and women
as emotionally responsive and communicative yet childlike, helpless, and
incompetent (Aries, 1997; Beyer & Finnegan, 1997; Kupers, 1997).1 Sexual
stereotypes are confusing because they assign men and women to artificial
categories. Clearly, some stereotypes do correspond to research findings
regarding specific differences between men and women. However, when
these findings are exaggerated or overgeneralized in the popular media
(Tiefer, 2000); and when perceptions of men and women take on a connota-
tion of cynicism and denigration, they generate hostility between people
and undermine their relationships.
According to Lott (1997), some gender research has perpetuated biased
attitudes toward women and men. She commented that, in general "Catalog-
ing sameness and differences does not serve the interests of a science of psy-
chology, first, because we well know that behavior always occurs in a context
and that the situation or circumstance makes a significant difference" (p. 19).
Lott went on to note that societies that encourage beliefs "in gender-related
traits (regardless of whether they are said to be learned or innate)" tend to
justify the continuation of "separate spheres for women and men" (p. 22).
The majority of adults have been raised in families in which they
learned inaccurate information about themselves and about the opposite sex.
Social psychologist Geis (1993) noted that people hold numerous implicit
hypotheses and beliefs about men and women that they use to "interpret
perceptions of males and females from the time they are born" (p. 14).
Moreover, these beliefs about gender differences influence people's behavior
in ways that are limiting or restrictive (Deaux, 1999). For example, Fiske,
Bersoff, Borgida, Deaux, and Heilman (1997) have pointed out that "prescrip-
tive or normative sex stereotypes (e.g., women should be nice and passive;
men should be strong and aggressive)" (p. 322) are harmful for both women
and men.
Despite changes in family life because of increased equality between
the sexes, the ways that many boys and girls are socialized into their respective
gender roles may still adversely affect the quality of their relating in adult
associations. For example, Ickes (1993) has reported "a growing body of
research evidence indicating that the relationships of men and women with
traditional gender roles are far from optimal" (p. 71).
In general, sexist attitudes tend to foster a "us/them" polarization and
reflect an underlying negativity and hostility that can be as damaging to

MEN, WOMEN, AND STEREOTYPES 77

human relations as racial prejudice. In a recent interview (American Associ-
ation of Marriage and Family Therapy Staff, 2002), Keen strongly criticized
sexist attitudes and traditional gender role expectations of men and women
that remain in popular thought today: "I would no longer use words like
masculinity and femininity. They are very deceptive" (p. 33).
People go into therapy asking the questions they've been taught to ask,
so you get these simplistic things, like "men are from Mars and women
are from Venus." Come on! I have 2 daughters and 2 ex-wives-don't
tell me that women are always from Venus. In some of the groups I've
worked with, I've met good, assertive women, making their place in
the world and after a while they say, "I don't feel feminine." And there
are the men who are very sensitive and tell me that they don't feel
masculine.... They have all these stereotypes. I try to lead them to
their own stories-to own their own autobiography, rather than think
in terms of these archetypes. (p.35)

DISTORTED VIEWS OF MEN AND WOMEN

In exploring the sources of stereotypic views of men and women, it is

worthwhile to briefly summarize recent social and economic trends.

A Historical Perspective on Men

During the late 1960s, a number of social forces converged to set into
motion a cultural movement that has come to be known as the "men's
movement." The movement evolved in part as a response to the women's
liberation movement and was also inspired by the youth movement's opposi-
tion to the status quo and the Vietnam War. Currently, the men's movement
is divided among several major organizations that promote differing ideolo-
gies and have diverse psychological underpinnings and political agendas.

Distorted Views of Men

Despite the efforts of many factions in the men's movement to promote

gender equality and challenge sexual stereotypes, there are still strong tend-
encies to malign and depreciate men in contemporary society. Glick and
Fiske (200l) have cited findings showing that men and women alike have
more positive views of women than of men. Some early proponents of the
feminist movement also expressed hostile attitudes toward men. As femin-
ist bell hooks [sic] (1984/2001) observed, many women liberationists origi-
nally insisted on a "'woman only' feminist movement and a virulent
anti-male stance" (p. 527). "Men, they argued, were all-powerful, misogynist

78 SEX AND LOVE IN INTIMATE RELATIONSHIPS

oppressors-the enemy. Women were the oppressed-the victims" (p. 527).
According to Young (1999), "The new feminism [beginning in the 1980s]
... focuses on the evil that men do to women" (p. 5).
Many people still view men as powerful, aggressive, insensitive, non-
communicative, and misogynous and as being interested only in sex, not
in intimacy or close relationships (Allen, 1997; Aries, 1997; Felson, 2002;
Kupers, 1997; Rubin, 1983). It is not uncommon to see gender issues dis-
cussed, in both the professional and popular literature, from a biased point
of view that perceives men as being less sensitive, feelingful, communicative,
and empathic than women. For example, in attempting to make people
more aware of the ways that commonly accepted stereotypes about men
affect the raising of boys, Levant (1992) delineated the "seven traditional
male role norms" (p. 380). Among the characteristics he described that fit
these male role norms are "restrictive emotionality" and "nonrelational
attitudes toward sexuality" (p. 380).
Linguist Tannen (1990), who bases her work on findings from selected
gender studies, has argued that women feel that men do not communicate.
Tannen (1997) attributes the problem to differences in conversational style.
Her use of the terms "reporHalk and rapport-talk" to depict these differences
may have the effect of supporting stereotypic views. She contended that
"For most men, talk is primarily a means to preserve independence and
negotiate and maintain status in a hierarchical social order. ... For most
women ... conversation is primarily a ... way of establishing connections
and negotiating relationships" (p. 88).
Such discussions also tend to portray men as generally being less willing
than women to commit to a relationship. This same bias depicts men as
being primarily interested in their careers, sporting activities, and practical
matters and as being less interested than women in marriage and parenthood.
We believe that these sexist attitudes prevent people from developing a
genuine understanding or a realistic picture of men's personal qualities.
Moreover, many men accept these generalizations as foregone conclusions
and have internalized the associated negative emotional loading or bias.
As a result, they subscribe to society's stereotypical and negative views
of themselves, which causes them to turn against themselves and other
men.
For example, in comparing men and women in terms of self-esteem,
it is interesting to note that a study by Rudman and Goodwin (2004) showed
that "women strongly implicitly prefer their own gender, whereas men do
not" (p. 508). In an interview, Rudman further explained, '''A clear pattern
shown in all four studies is that men do not like themselves automatically
as much as women like themselves'.... 'This contradicts a lot of theoretical
thinking .. , [and suggests] that negative male stereotypes can promote
greater liking for women'" (quoted in Dittmann, 2004, p. 11).

MEN, WOMEN, AND STEREOTYPES 79

 During the developmental years and throughout their lives, boys and
men attempt to adjust their behavior according to these negative stereotypes
about men (Pleck, 1995).2 For example, Silverstein et al. (2002) have
emphasized that men develop gender role identity as a result of strong social
pressure to conform to cultural norms and stereotypes.' According to Pollack
(1998), the myth that boys are "toxic" includes a perception of men as
"psychologically unaware, emotionally unsocialized creatures" (p. 62). In his
work, Pollack stresses the fact that men and women alike are damaged by
accepting these stereotypes as real representations of boys and men.
There are also numerous stereotypes about men pertaining to their
sexuality. In our society, men are generally perceived as being more sexually
oriented than women, having more sexual experiences and fantasies than
women, being more sexually aggressive, more random, more impersonal in
their sexual encounters than women, and relating to women as sex objects
(Levant, 1992; Pleck, 1995). Although research does tend to support the
premise that men indicate more interest in sex than women," the information
is often misinterpreted or exaggerated. The same is true when people over-
generalize or exaggerate research findings suggesting that men have more
sexual experience and more sexual fantasies than their female counterparts,
are more random in selecting partners, and desire more variety (Buss &
Schmitt, 1993).
In relation to child-rearing, many men who believe that they are less
nurturing or loving toward children than women may retreat from the
paternal role and leave most of child-rearing functions to women. Some
women reinforce this stereotype by subtly conveying that women understand
better than men how best to raise a child (Pollack, 1998).5 In describing how
traditional gender roles based on cultural stereotypes have been manifested in
fathering, Silverstein et al. (2002) commented, "Because a 'real' man must
avoid 'sissy stuff,' a traditional father limits his involvement in child care.
He might 'baby-sit' if his wife has to be away, but he does not actively
manage the children" (p. 362).
Although family life has changed in recent years, partly as a result of
women's increasing involvement in the workplace, internalized stereotypes
and behaviors based on these biased views are difficult to overcome because
they are deeply entrenched in people's thinking. In a series of interviews
and discussion groups, several men and women revealed the ways in which
distorted views of men were transmitted to them in the context of early
interactions within their family-of-origin.
Colin: I've been thinking lately about how my mother's attitude
toward men affected me while I was growing up and how
I'm still struggling with that in my adult life. I had a view
of my father through my mother's eyes, and it was not a
very good view. She really saw him as a critical, angry man.

80 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 So I grew up seeing him, and almost all men, through her
eyes. I didn't even know what a strong man was. To me,
viewed through her eyes, strong men were mean. Strength
was meanness.

Evan: I can identify totally with what Colin said. Anything that
I do that feels male, I identify as being mean. I grew up in
a household in which my father was at work all the time.
When I was 8 years old, my father died and from then on
I was surrounded by women who saw men as lechers. I
picked up their point of view, and I've got that point of
view toward other men. I've taken on that point of view
toward myself, and it really restricts me. If I have a sexual
urge that I feel like acting on, not even necessarily the
physical act of sex per se, but just talking with a woman
that I'm attracted to sexually, I feel totally constrained. I
feel like if I make a move that I'm infringing on someone
else's territory. I feel that it's wrong for me to do, it's mean
for me to do and that I just don't belong there.

Kimberly: Whenever I feel interested in meeting a man or pursuing a

relationship, I have a lot of cynicism about my prospects. I
remember my mother lecturing me about men. I never
thought much about her lectures at that point and I thought
they had no effect on me whatsoever. But now I find myself
thinking things like: "You're never going to find any man
who is nice because there are no men who are like that.
They're all horrible. They all want to make a fool out of
you. They all do. They're all just going to drop you and toss
you aside for somebody else. They all are."

Jennifer: My father didn't have any sexual experience before he mar-

ried my mother when he was 23. He really believed the
stereotype that men were out of control sexually. He was
always telling me "You have to be really careful with men,
because the least little thing you do to them is going to
trigger them and they're going to be out of control and they
won't be able to stop themselves."

Eric: Up until I was about six or seven, my sisters and I slept in

the same room, and then we were separated. At that time,
my younger sister was my best friend. I remember I could
not understand what was going on. Also I remember I had
a feeling I was being separated because I was changing into
a person that could not control himself and I was going to
do something bad. There was this unspoken feeling in my
family that "Men get to a stage where once they become a
sexual person it's something they can't control. They become

MEN, WOMEN, AND STEREOTYPES 81

 like an animal, and you have to separate them from girls
really early so that nothing happens in the family." And I
know that as I grew older, I kept on waiting for this mysteri-
ous thing to happen to me that I was going to turn into an
animal in terms of being sexual and not be able to hold
myself back.

A Historical Perspective on Women

The feminist movement (a revival of the original 19th century women's

movement) has lobbied for better child care, abortion rights, and ratification
of the Equal Rights Amendment and has taken an aggressive stand against
patriarchism (Yanak, 2004). 6 On the socioeconomic level, feminists have
contributed significantly to women's goals of achieving personal freedom
and equal status with men (Showalter, 2001).
Living within a patriarchal society has indeed had a significant impact
on women's lives (Bigler, 1999; Gilligan, 1982, 1996). For many centuries,
women were denied access to power and influence in many important spheres
of life and therefore many adopted indirect or passive means in attempting
to fulfill their human potentialities (Chesler, 2001). As Rubin (1983) noted
more than twenty years ago, "Not only are women economically and socially
disadvantaged when compared to men, but social definitions insist that
passivity and dependency are the core of femininity while aggressiveness
and independence are the central features of masculinity" (p. 141). Today,
many women still find it difficult to break out of this stereotypic mold, often
for reasons that are more psychological than social (Gilligan, 1991).7

Distorted Views of Women

Women are continually being shaped and directed by stereotypes in

destructive ways that cause alienation between the sexes. For example, in
Western society, attitudes that portray females as helpless and unstable are
still commonplace and have both a direct and indirect influence on economic
as well as sexual equality between the sexes. Many feminists predict that it
will take considerably more time to alter basic attitudes about being a woman
in a patriarchal society (Chodorow, 1978; ]. Miller, 1976; Spence, 1999;
Young, 1999).
Admittedly, it is difficult to alter, within one or two generations, deeply
held sexist beliefs based on a centuries-old patriarchal social order. One
reason for this difficulty lies in the fact that many sexist attitudes are implicit
and exist on an unconscious level. As noted previously, unconscious, implicit
beliefs held by parents are internalized by their children and, in turn, are

82 SEX AND LOVE IN INTIMATE RELATIONSHIPS

reinforced by stereotypic views still prevalent in most modern societies. In
fact, some theorists argue that sexist views against women based on patriarch-
ism have changed little during the past 100 years. For example, according
to Rosenberger (1998), "Freud's ... [1905/1953] evaluation of women as
possessing weaker superego development reflected the prevailing social con-
text of womanhood.... This paradigm is little changed today and little
varied across cultures" (p. 66).
In terms of physical strength and overall body size, women are clearly
the weaker sex. Originally, these biological factors undoubtedly contributed
to the formation of an unequal power structure based on the division of
labor by sex difference. However, women who exhibit overly passive or
compliant traits and behaviors have probably been influenced more by
suppression, social prejudice, and stereotypic views than by these biological
determinants. Fiske et al. (1997) described the effects on women of trying
to follow "prescriptive" stereotypes or "female role norms"; "[Women's]
competence is undervalued if they behave in traditionally feminine ways,
while their interpersonal skills are derogated and their mental health is
questioned if they behave in traditionally masculine ways" (p.322).
In the area of sexuality, women are invariably thought of as having
less sexual desire and fewer sexual fantasies, and as being more passive
sexually than men. They are viewed as having little interest in casual sexual
encounters and as only wanting sex if they are in love or involved on a
deep level (Buss & Schmitt, 1993; Daly & Wilson, 1983; Ridley, 1993). In
their relationships, they are believed to be more loving and faithful than
men. Society views with criticism and suspicion those women whose sexual
preferences and behaviors fail to conform to these stereotypes. According
to Reid and Bing (2000), most people still rely on these stereotypes when
defining women's roles:

Women have been represented on one polarity as asexual madonnas,

and at the other end as highly sexual, alluring sirens .... They are
either good or evil. The good woman will be represented biologically
as virginal (i.e., pure, innocent, and naive) and psychologically as a
self-effacing, self-denying earth mother. The evil woman is seen as a
whore; she is a scheming, ambitious, and a clever seductress. (pp. 141-
144)

Clearly, not all of the social prejudice that women face is hostile;
some paternalistic attitudes toward women as the weaker sex are seemingly
positive. For example, although women are typically perceived as more
childish, melodramatic, scatterbrained, or irrational than men, on the posi-
tive side, they are seen as sensitive, empathic, and intuitive, as easily forming
deep emotional attachments, and as primarily interested in a long-term

MEN, WOMEN, AND STEREOTYPES 83

relationship and parenthood. As Glick and Fiske (2001) pointed out,
"Benevolent sexism (a subjectively favorable, chivalrous ideology that offers
protection and affection to women who embrace conventional roles) coexists
with hostile sexism (antipathy toward women who are viewed as usurping
men's power)" (p. 109). (Views of men as strong, masterful, and rational
are also "benevolent.")
According to Glick and Fiske, many women willingly accept this
stereotypic view of themselves. "Benevolent sexism, after all, has its rewards;
chivalrous men are willing to sacrifice their own well-being to provide for
and to protect women" (p. 115). Indeed, both men and women tend to
endorse "benevolent" sexist beliefs that perceive women as basically weaker
than men in areas that go beyond size and strength and as needing special
protection and care."
We have found that although most women believe on a conscious
level that they are as competent and as intelligent as their male counterparts,
on an unconscious level, many still hold internalized stereotypic beliefs that
are diametrically opposed to their conscious attitudes. Despite the fact that
women are increasingly assuming leadership positions in the business and
professional world, in their personal lives and in their intimate relationships,
some women continue to relate to men as "ultimate rescuers" and feel they
need to be taken care of on some level. In a meta-analysis that investigated
gender differences in helping behaviors, Eagly and Crowley (1986) found
indications of this tendency. "In general men helped more than women
and women received more help than men" (p. 283).
In calling attention to traditional stereotypes and conventional views
of gender roles that alienate men and women, Keen (1997) argued that
"Women, we are told, want to talk about their feelings and problems, and
men just want to solve them. Women want relationship, and men need to
maintain autonomy. We suffer from different communication strategies,
tongues, languages" (p. 12). Keen went on to say that

There is widespread resentment about the ways we [are] wounded by

the gender roles we inherited. Men were taught that they could earn
love only by providing, taking charge, being in control, and protecting
women and children. Women were taught that they could earn love
only by being nurturing, sexy, submissive, and passive. (p. 26)

In a similar vein, Marmor (2004) has criticized the negative sexist

views of women still promulgated in society, many of which were based on
findings in previous research: "The degree of cultural and/or intellectual
accomplishment on the part of women as compared to men is not dependent
on any presumptive inherent biological or psychosexual inferiority, nor has
it ever been" (p. 19).

84 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 A BRIEF CRITIQUE OF GENDER RESEARCH

In recent years, a number of researchers have critiqued many of the

widely publicized findings obtained from gender studies. We suggest that
the ways in which some studies were designed probably contributed to the
contradictory and inaccurate findings previously reported in the literature.
For example, Grossman and Wood (1993) manipulated instructions to sub-
jects in two experiments. They discovered that any gender differences in
emotional expressivity were largely related to subjects' endorsement of
gender-role expectations. In other words, subjects in the two experiments
responded as they believed they were "supposed" to respond, according to
the popular gender stereotypes.
In addition, Burn (1996) reported that measures of empathy used in
some studies found larger sex differences on self-report questionnaires than
on physiological measures. Her finding suggested that males may "be unwill-
ing to portray themselves as empathic on a self-report measure, because
doing so is inconsistent with the male gender role" (p. 57). We contend
that this finding could also be explained by the fact that men may be
reluctant to reveal feelings of empathy or be emotionally expressive because
they have come to accept without question the stereotypical view of them-
selves as being less empathic and emotionally expressive than women.
Other recent gender studies have shown that many stereotypes nega-
tively comparing men with women in terms of their ability to express
emotion are blatantly inaccurate, while others have interpreted inconclusive
findings as being definitive (Barrett, Robin, Pietromonaco, & Eyssell, 1998;
Carpenter & Addis, 2000; Conway, 2000).
In studies that examined men's and women's communication styles,
Burleson, Kunkel, Samter, and Werking (1996) found few differences in
key aspects of communication. In particular, Dindia and Allen (1992), in
their meta-analysis of 205 studies involving 23,702 subjects, found that
"sex differences in self-disclosure are small" (pp. 117-118). These findings
contradicted Tannen's (1990) hypotheses regarding differences between
men and women in their communications styles as described in the previous
section. Hook, Gerstein, Detterich, and Gridley (2003) concluded that
"Men and women were similar in their level of comfort with both giving
and receiving emotional support in relationships" (p. 471). In relation to
men's and women's views of love, Fehr and Broughton (2001) found that
"Unexpectedly, both women and men embraced companionate kinds of
love as representing their view of love" (p. 134).
In terms of sexuality, it does not appear that women are innately less
interested in sex or more sexually inhibited than men. In fact, when men and
women are surveyed, there is tremendous overlap in their sexual propensities

MEN, WOMEN, AND STEREOTYPES 85

and preferences. For example, contrary to the popular stereotype that men
have far more sexual experiences than women, a recent survey (Smith,
1998) showed that since the early 1900s, women have gradually become
more experienced sexually. In 1998, 51.5% of women between the ages of
15 and 19 had engaged in premarital sex, as compared with 60% of the
men in the same age group.
In a meta-analysis of research in this area, Hyde and Oliver (2000)
concluded that "The bottom line is that the theories reviewed ... do not
make strong differential predictions regarding patterns of gender differences
in sexuality. Rather, they yield similar if not identical predictions" (p. 73 ).9
In other words, there appear to be more similarities than differences between
men and women in areas pertaining to sexual interest and sexual behavior.
Attachment research has provided conflicting findings regarding differ-
ences between men and women in their attachment patterns in adult roman-
tic relationships. For example, Shaver, Papalia, et al. (1996) found some
gender differences in attachment styles, particularly in individuals catego-
rized as being insecurely attached, while others (Gentzler & Kerns, 2004;
Schmitt, Alcalay, et al., 2003) found no gender differences in individuals
categorized as avoidantly attached.
Lastly, in terms of child-rearing, Silverman (2003) reported findings
from numerous studies, including research conducted by Lamb, showing no
differences between fathers' and mothers' desire and ability to parent their
children. For example, in summarizing their research, Lamb and Lewis (2004)
reported, "Most men in a variety of cultural settings clearly adapt positively
to parenting" (p. 278).
We believe that it is important to explore the differences that do exist
between the genders, separate from the stereotypic biases, overgeneraliza-
tions, and frequently politicized interpretations of research findings regarding
such differences.

OUR VIEWS

Our observations of men and women have led to the conclusion that
many gender stereotypes are exaggerated and destructive. Our interviews
and discussions with individuals, couples, and family members resulted in
information that often contradicted widely accepted generalizations about
how women and men view emotions, sex, relationships, and child-rearing,
and how they relate in an intimate association. For example, we found that
although most males traditionally have been taught to mask their emotions,
including feelings of empathy, compassion, and sadness, they are as emotion-
ally expressive as females in settings where such feelings are acceptable. In
spite of this, some of the men we interviewed still tended to underestimate

86 SEX AND LOVE IN INTIMATE RELATIONSHIPS

their sensitivity and their capacity for experiencing emotion and, to some
extent, they idealized women with respect to these qualities.
In terms of committing to a relationship, the large majority of men
reported that they desired a long-term association with another person, were
as interested in marriage and raising children as their female counterparts,
and wanted to share the responsibilities of child-rearing with their partner.
We also found that, contrary to stereotypic thinking, men were not indiffer-
ent to women's feelings and moods. In fact, most of the men we interviewed
showed a consistent concern for their partner's well-being and reported
feeling the most happy and contented when their partners were feeling
strong and self-confident.
In relation to child-rearing, both men and women indicated a strong
interest in and feeling for children. Moreover, many women reported having
the same anxieties about handling newborns as men did. They did not feel
that they possessed an inherent maternal quality that made them more
sensitive or attuned to their infants and children than their mates. In fact,
there tended to be wide variation among mothers as well as fathers in their
capability to care for their offspring. We also noted that many men gave
child-rearing functions a high priority and tried to spend as much time as
possible with their children. Our findings with respect to men's involvement
in child-rearing functions are supported in part by Pleck's (1997) findings
that there have been "Clear increases in paternal engagement and responsi-
bility, especially over the past three decades" (p. 75).
We also found that in general, both men and women reported feeling
guilty and were self-critical when they felt they were not living up to popular
societal stereotypes. Moreover, many said that they felt resentful and angry
when a partner failed to conform to certain gender role expectations.
We suggest that there may be differences between men and women
with respect to the ways that they express themselves in a sexual situation. For
example, a sexually healthy, emotionally mature man would be comfortably
assertive and responsive during sex. This term refers to the capacity to
respond spontaneously and sensitively to indications of the woman's increas-
ing excitement and ro an ability to remain emotionally close throughout
the experience and afterward. This emotional contact can be preserved
through verbal and/or nonverbal communication.
Being comfortably active indicates an absence of self-doubts, feelings
of inadequacy, and anxieties related to feeling completely responsible for
satisfying one's partner. It also implies a freedom from the fear that some
men experience in the presence of a passionate, wanting woman.
In fact, many men report experiencing the highest levels of sexual
arousal when their partner becomes excited or aroused. At the same time
they enjoy receiving physical affection, touching, and sexual caressing from
their partner.

MEN, WOMEN, AND STEREOTYPES 87

 A sexually healthy, emotionally mature woman would tend to be
actively receptive during lovemaking. This implies a willingness to remain
fully open to her partner during sex and the ability to stay in touch with
one's bodily sensations and feelings rather than to retreat into one's mind.
Women who are self-possessed and able to remain emotionally close to
their partner during sex can be described as being actively receptive.
During lovemaking, they are neither overly aggressive nor passive. Active
receptivity as described here is representative of an internal state of wanting
and the desire to enter into an equal physical and emotional transaction
with another person. It is important to emphasize here that receptivity
does not mean passivity. As Marmor (2004) noted, "Receptivity and
passivity are not synonymous. It is a striking commentary on the power
of a cultural prejudice that both male and female classical Freudians have
always assumed that the vagina, as a hollow organ, had to be a passive
receptacle" (p. 16).
If a woman is in this receptive state, that is, allowing herself to com-
pletely experience feelings of sexual desire, she tends to elicit a strong sexual
response from her partner. Ideally, this receptivity and openness are part of
her overall style of relating to her partner. In other words, these behaviors
and traits of openness and vulnerability would extend beyond the bedroom
into the couple's daily life and significantly contribute to harmony in their
relationship. When making love, ideally both partners, if emotionally mature
and sexually healthy, would be fully engaged in an equal transaction in
terms of both giving and receiving affection and sexual pleasure, and each
would be responsible for asking for what he or she wanted sexually.
In a discussion group, Ken talked about feeling that his girlfriend,
Lauren, was not open to receiving pleasure from him.

Ken: The one thing I've had a hard time saying is that I don't see
our sex life as being as exciting as I would like it to be. I don't
feel excited when I think about making love. I feel that some
of the things you do make me not want to be with you.
When I thought more about it, I realized that it seems difficult
for you to receive pleasure from me during the sexual act. I
haven't been able to explain it very well or talk about it with
you until now.
I don't feel critical of you, or critical about the reasons why
I don't feel attracted to you. I have an idea of what it is. I think
it's difficult for you to let me make you feel good, to have an
orgasm. It's hard for me to feel like I can give you an orgasm. I
feel like you take it from me [sad]. Then I feel gypped out of
being able to make you feel good. I feel upset, different than
how I like to feel with you. Instead, what I end up doing is
avoiding being sexual with you.

88 SEX AND LOVE IN INTIMATE RELATraNSHIPS

We also learned that a man's emotional and sexual responses appeared to
be strongly related to the woman's genuine sexual desire. A woman may
act interested or aggressively pursue sex, but without feeling and genuine
desire for the man, her partner will have difficulty responding sexually. Most
men blame themselves for sexual failures and tend to deny their partner's
influence, even when intellectually aware of her potential effect. We also
found that the way women feel about themselves and their physical appear-
ance has considerable impact on their partner's sexual desire. Women also
revealed that they experienced less sexual desire and often found it difficult
to feel excited or aroused when their partner was cold or withdrawn, became
overly dependent, seemed to value work over personal and family life, or
felt victimized.
Therefore, there are several definitive differences between men and
women and these differential behaviors and propensities are influenced by
a multitude of biological, environmental, and cultural factors. As Chiland
(2004) argued,
Mead [Mead, 1948] shows that every society has a concept of how males
and females should feel and behave and how, through the educative
and other child-rearing procedures it sets up, it shapes children in such
a way that they become the men and women that society expects. (p. 86)

The socialization process within the family, differential developmental

tasks, and social learning through identification with and imitation of paren-
tal role-models are all formative influences that interact to generate different
sexual attitudes and behaviors in men and women.

PARENTAL IMPACT ON ADULT SEXUALITY

In this section, we focus on the dynamics operating in the earliest

relationships of both male and female children that impact their later devel-
opment as sexual beings. It is important to note that social learning in
relation to sexuality and differential sexual behavior takes place in the
context of role modeling and imitation, especially of the traits, attitudes,
and behaviors manifested by the same-sex parent. Hogben and Byrne (1998)
stressed the fact that "As children are more likely to be reinforced for same-
sex imitation, they tend to pick up same-sex behaviors, which leads to
the cognitive association of particular behaviors with male versus female
sexuality" (Hogben & Byrne, 1998, Theoretical Models and Research Out-
comes section, 9f 9). According to learning theory, "children imitate same-
gender adults more than other-gender adults, so that the gender-role behavior
of the previous generation perpetuates itself in the next generation" (Hyde
& Oliver, 2000, p. 61). Thus, an exploration of parent-child relations can

MEN, WOMEN, AND STEREOTYPES 89

facilitate a better understanding of same-sex identification and imitation
processes that contribute to adult sexual functioning of individuals of
both genders.

Fathers and Sons

In attempting to establish a relationship with their father, many boys

experience serious inner conflicts: they long for tenderness, love, and nurtur-
ance from their fathers, yet in some families, there may be a taboo against
fathers being physically affectionate to their sons. According to Pollack
(1998), "Because of the way we as a society view boys and men ... many
fathers, especially in public settings, may feel inhibited about showing the
empathy they naturally feel for their sons" (p. 116).10
Competitive feelings between family members can have a negative
effect on boys' sexual development. Boys may experience envy, hostility,
and feelings of rivalry directed toward them from their fathers and may
have competitive feelings toward their fathers as well (Firestone, 1994a).
We have found that both sets of feelings can contribute to the sense of
alienation that many boys feel in relation to their fathers. As adults, their
friendships and associations with other men are often influenced by emo-
tional residuals of this conflict. For example, a son's awareness that as an
adult he is now enjoying a more satisfying intimate relationship than his
father had can lead to guilt and anxiety about surpassing his father. Men's
achievements in their professional and personal lives and in their relation-
ships can activate powerful feelings of fear and guilt, as well as a sense of loss.
In addition, fathers serve as role models for their sons in terms of both
positive and negative behaviors they exhibit. For example, in a study of
more than 80 adolescent boys, D'Angelo, Weinberger, and Feldman (1995)
found that sons of fathers who were aggressive and who lacked self-control
exhibited numerous problems as adolescents and adults. Included in these
problematic behaviors were "poor peer relations ... at-risk behaviors ...
multiple sexual partners ... [and] poor conflict resolution skills" (p. 883).
Boys observe and identify with a father's hostile and defensive attitudes
toward their mother and other women, as noted in chapter 3. A father's
weakness as a role model poses a serious limitation on the son's ability to
develop a strong sense of male identity. Moreover, many fathers unknowingly
support the mother's stereotypic views of men as uncommunicative, harsh,
and unfeeling. Many women reinforce this sexist attitude when they use
their husbands as agents of punishment. As a result, many children, boys
and girls alike, learn to view male strength in a negative light. With respect
to these conflicting views of masculinity that boys are presented with, Park
(1995) emphasized that

90 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 What the boy needs is a father's help in dealing with the emotional
pressures that come from his mother. He needs to learn that there are
other views of masculinity than those which she propounds, and that
what she says to him has more to do with her own past experiences
than with him. (p. 23)
Some fathers manifest intrusive child-rearing practices when relating
to their sons. Barber and Harmon (2002) have described a form of "psycho-
logical control" that they observed in many family constellations. According
to Barber and Harmon, psychological control includes such parental behav-
iors as possessiveness, protectiveness, love withdrawal, control of the child's
personal life, and erratic emotional behavior. Barber and Harmon reported
preliminary findings from a number of studies that investigated the negative
effects of paternal psychological control on male adolescent behaviors, par-
ticularly tendencies to be aggressive in peer relationships. Although their
results are still inconclusive because of the limited number of samples studied
thus far, there are indications that this type of control on the part of fathers
is detrimental to the psychosocial development of their male offspring.
Other fathers exert harsher forms of behavioral control in interactions
with their sons. For example, in his work, G. Parker (1983) observed a
number of fathers who exerted "affectionateless control" over their sons."
Parker defined affectionless control as a harsh parenting style that appears
to represent a diminished caring on the part of fathers. For example, Jain,
Belsky, and Crnic (1996) reported a group of fathers who they described
as traditional in their child-rearing practices. "The traditional men were
those classified as disciplinarians and as uninvolved.... [They were] over-
reactive to typical toddler behavior, resulting in almost exclusively disciplin-
ary interactions or avoidance of their sons altogether" (p. 440).
As a result of these influences, many men feel isolated and alone in
their suffering and may try to mask their pain with a tough, defensive
exterior (Jolliff & Horne, 1999; Pollack, 1998; Silverstein et a1., 2002).
They are convinced that other men do not experience the same feelings of
inadequacy, desperation, and fear that torment them. Because they feel
alienated, they often find it difficult to relate to other men on more than
a superficial level.
Pollack (1998) delineated several negative consequences in male devel-
opment stemming from absent or uninvolved fathers. He noted that "Father
absence has been correctly linked to a host of ills for boys ... [including]
difficulties with emotional commitments" (pp. 124-125). As noted, interac-
tions between parents can have both positive and negative effects on their
male offspring. Alienation between parents, argumentative interactions, and
marital distress in general can interfere significantly with a boy's relationship
with his father. For example, one study reported by Cummings, Goeke-

MEN, WOMEN, AND STEREOTYPES 91

Morey, and Raymond (2004) showed that "Marital conflict predicted more
disruptions in father-son than in mother-son interactions" (p. 200).
In general, the anxiety and insecurity from these early childhood
experiences with their fathers are perpetuated in men's adult relationships.
The defenses that they formed to cope with this pain and hurt interfere
with their achieving real intimacy and adult sexual relating.

Mothers and Daughters

In the traditional family constellation, the mother still has the role
of primary caregiver and therefore exerts the greater influence on children
(Mendell, 1998). Mothers' strengths as well as their weaknesses are transmit-
ted intergenerationally to their daughters through the processes of identifica-
tion and imitation. In general, girls tend to form a stronger identification
with their mothers than do boys (Chodorow, 1978; Fenchel, 1998; Hudson
& Jacot, 1995). According to Genevie and Margolies (1987), mothers "form
this primary relationship more readily with their daughters whom they view
as extensions of themselves" (p. 291). This phenomenon has the potential
for perpetuating mature, positive personality characteristics through succeed-
ing generations of women. However, the negative effects of this identifica-
tion process often outweigh the positive (Fenchel, 1998; Firestone, 199Gb;
Welldon, 1988).
Mothers who are intrusive and violate the boundaries of their children
damage their daughters' ability to develop independence and autonomy as
adult women. For example, an emotionally immature mother may attempt
to merge her identity with her daughter and overstep the boundaries between
them (Fenchel, 1998; Rubin, 1983; Westkott, 1997).12 If a mother seeks to
fulfill herself through her children, her daughter often feels drained of her
emotional resources and angry at the mother's intrusiveness and control.
Many girls react to their mother's exaggerated focus by repressing their
anger and becoming more passive and compliant. As adults, they tend to
unconsciously hold back their affection and sexual responses in intimate
relationships, with little or no understanding of the underlying reasons.
Emily: Recently I started thinking about my relationship with my
mother and how I was always her baby and I was her best
friend and I was her everything. I remember going to the store
in high school and crossing the street and her holding my hand
and feeling totally humiliated and being so afraid my friends
were going to see me holding my mother's hand crossing the
street. And she'd always make a big deal about it. Anything I
did, she was tight there.
One time my boyfriend and I-we were totally in love-
we were at my Mom's house and we laid down on the floor to

92 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 watch TV, and my mother came and laid right between us.
Then she laughed and said, "Oh silly me. What have I done?"
Today I feel still guilty about falling in love. Getting to
know a man is okay, but once the relationship deepens, then
I feel guilty and I want to step back. Each time this happens,
it's hard for me to maintain the closeness. Something comes
between us. It sounds strange, but it's almost like she gets in
the way. It's like somehow she possesses me or something like
that. I feel like she's still here, she's still getting in my way,
and she still wants me. She doesn't want me to have anything,
except for her.

Paradoxically, the more the daughter resents the mother and suffers
in interactions with her, the more she tends to imitate her behavior. Her
attempts to remain close to the mother lead to the formation of a fantasy
bond or imagined connection with her (Firestone, I990b). As a result of
this negative identification, the daughter tends to incorporate and compul-
sively act out her mother's most negative characteristics, traits that were
not necessarily representative of her mother's personality as a whole. This
alliance or imagined fusion with the mother can playa significant part in
limiting the daughter's ability to assume the role of an adult sexual woman.
For example, some women experience profound separation anxiety when
they symbolically or literally move away from the mother as they reach
higher levels of self-differentiation and become more individuated.
In other cases, a daughter may fear her mother's feelings of hostility,
jealousy, and envy as she moves toward sexual maturity. She may actually
be afraid of retaliation from the mother for seeking adult sexual fulfillment.
In our experience, we have found that both separation anxiety and fear of
the mother's envy or vindictiveness are often experienced by women at
crucial points in their sexual development. Caplan (1981) has described
how a daughter may adjust to her mother's envy: "Often, she does one of
two things (or tries both at different times): she reduces her efforts to achieve
(or at least begins to conceal them from her mother), and she puts emotional
or physical distance between herself and her mother" (p. 120).
Guilt reactions may also become more evident as young women take
tentative steps toward independence or move away from emotional ties with
the family. In the case of adolescent girls, the guilt involved in breaking
away or "leaving her mother behind" is often intense and debilitating,
especially when the mother is depressed, self-denying, self-destructive, or
immature in her orientation (Richman, 1986).
Thus, each step in the daughter's movement toward self-differentiation
and separation from the mother, entering into a sexual relationship with a
man, getting married, starting a family of her own, can create varying degrees
of guilt, fear, and separation anxiety. During such critical periods, these

MEN, WOMEN, AND STEREOTYPES 93

powerful emotions often cause women to retreat to a sameness with the
mother. Similarly, each step that women take toward sexual maturity is
filled with conflict. Most women are necessarily ambivalent; they are torn
between expressing their love and sexual desire in relation to a man, which
represents a symbolic separation from the mother, and holding back their
loving responses, which affirms the imaginary connection with her (Fire-
stone, 1990b; Rubin, 1983). In reporting data from interviews with pregnant
women, Rheingold (1964) described the consequences of preserving the
imagined connection with one's mother:
A woman may bring any number of assets to marriage-compassion,
wisdom, intelligence, skills, an imaginative spirit, delight-giving femi-
ninity, good humor, friendliness, pride in a job well done-but if she
does not bring emancipation from her mother, the assets may wither
or may be overbalanced by the liability of the fear of being a woman.
(p.451)

Over many generations, women have tended to internalize compliant,

yet inwardly defiant, behavior patterns that have been as detrimental to
their personal development as the social forces that made their use necessary.
These passive-aggressive tendencies often give rise to withholding patterns
that may only be partially conscious; yet these behaviors act as barriers to
harmonious relations between men and women. Although many women
still feel restricted or oppressed by the inequities that continue to exist
within society, we believe that much of the damage to their initiative and
sexuality can be traced to limitations imposed by identification with negative
traits in the mother and fears of separating from the imagined connection
or fantasy bond with her (Firestone, 1990b).

Mothers and Sons

A significant aspect of maternal influence on male offspring is the

propensity of some mothers to be overprotective, overly involved, intrusive,
or nervously focused on their children, and on their sons in particular. This
overprotective stance may originate from benevolent maternal attitudes,
however, it can also arise because of a mother's lack of involvement in
other parts of her life. As French psychoanalyst and social critic Kristeva
(Oliver, 2002) commented,
Nobody knows what the geed-enough mother is ... but I would try to
suggest that maybe the good-enough mother is the mother who has
something else to love besides her child; it could be her work, her
husband, her lovers, etc. If for a mother the child is the meaning of
her life, it's too heavy. (p.336)

94 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Investigations into the long-term effects on boys of maternal overpro-
tection and control have shown that "psychological control was positively
related to both depression and antisocial behavior" in older boys (Barber
& Harmon, 2002, p. 19). As adults, men who were affected by their mothers'
anxious concern, intrusiveness, and exaggerated focus may exhibit a wide
range of defensive reactions. To varying degrees, they may experience painful
feelings of inadequacy or have a fear of being smothered or dominated by
a woman. They may even become critical of sexually responsive women
and unconsciously averse to forming relationships with them.
We have found that men tend to experience feelings of sexual inferior-
ity when the mother has been inappropriate or seductive in her behavior
during the formative years. It has been shown that a seductive relationship
with the mother often stimulates intense oedipal rivalry and leads to in-
creased fear of competing and powerful feelings of inadequacy in the growing
boy (Love, 1990; A. Miller, 1979/1981; Park, 1995). This type of provocative
relationship on the part of some mothers can predispose sexual problems
in adult males, including either an avoidance of sex, or a tendency to be
overly compliant or submissive in relationships with women. In general,
these family dynamics lead to considerable hostility between men and women
and can seriously undermine their sexual relationships. On the basis of 150
in-depth interviews with men during a period of two years, Park (1995)
found that for many men, "The experience of being truly close to someone
else, whether man or woman, puts him at risk of experiencing again the
same bewildering emotions that he knew in infancy" (p. 3). Specifically,
with respect to overly solicitous and emotionally seductive mothers, Park
noted that

Men [from these enmeshed families]' who generally have so much of

mother, tend to experience her presence as sometimes smothering,
stifling and demanding. In their later relationships, the pull towards
intimacy and sexual union is powerfully countered by the fear of being
submerged or swallowed up. They cannot get close because they do not
think they will survive the experience. (p. 125)

In some families where the mother tends to form an exclusive relation-

ship with her son, the father is often pushed into the periphery of the boy's
life. We have found that although the father may feel distressed and angry
at the way his son is being overprotected or indulged, he also feels excluded
from the relationship and finds it difficult to intervene, and he may develop
resentment toward both his wife and son (Firestone, 1990b).
A mother who is intrusive in this way exerts a strong pull on the son
that leaves him feeling empty. The same person that a son would naturally
turn to for love and care is instead seeking nurturance, care, and love from

MEN, WOMEN, AND STEREOTYPES 95

him (Love, 1990). Therefore, as an adult, he may self-protectively pull back
from women and turn away from potential sources of gratification in close
relationships (Firestone & Catlett, 1999). Men who have been damaged in
this way may develop habitual patterns of holding back their affection and
sexual responses because they perceive their partner's sexual interest as
a demand.
Emotional unavailability, rejection, or withholding on the part of
mothers also have detrimental consequences for male children (Fenchel,
1986; Park, 1995; Pollack, 1998; Pollack & Levant, 1998). For example, if
a mother withholds her affection and love from her son, his hurt and angry
response may cause him to suppress his affectionate feelings for her. In other
cases, he may become clingy, desperate, and overly dependent on her.
Subsequently, as an adult, he may be uncomfortable with dependent feelings
in himself.
Many men continue to search for gratification of their unfulfilled
longings for affection, tenderness, and love. The desperation and dependency
they felt toward their mother is now directed toward the primary woman
in their lives. In their adult associations, these men seek symbolic safety
and reassurance in an imagined connection or fantasy bond with women
(maternal substitutes) to their own detriment and that of their sexual rela-
tionship (Firestone, 1985). According to Rubin (1983), the man's sexual
involvement with a woman
Calls up the memory of the infantile attachment to mother along
with the old ambivalence about separation and unity, about emotional
connection and separateness. It's likely therefore that it will elicit an
intense emotional response-a response that's threatening even while
it's gratifying.... It's also what they fear. For it threatens their defenses
against the return of those long-repressed feelings for that other
woman-the first connection in their lives. So they hold on to the
separation between the sexual and emotional and thereby keep the
repression safe. (pp. 105-106)

Fathers and Daughters

Fathers also playa significant role in their daughters' development. It

has been found that paternal warmth and involvement in the family are
important factors influencing the development of femininity in young girls
(Cramer, 1997). In explaining the importance of fathers in the lives of their
female offspring, Rubin (1983) stresses that fathers are crucial in helping
their daughters successfully differentiate from the mother. She noted that
In childhood, a girl handles the threat [of separation from the mother]
by turning to father to help her make and maintain the necessary
separation.... It's this difference, and the importance it holds in her

96 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 separation struggle, that helps to define a girl's sexual orientation....
A father affirms the femaleness of his daughter. (pp. 147-148)

There is also some evidence showing that paternal neglect, emotional

unavailability, or indifference are hurtful to female children. One study
(Manlove & Vernon-Feagans, 2002) of fathers and infant sons and daughters
found that fathers were available to their sons significantly more than to
their daughters. The fathers in this sample were also much more involved in
caregiving or child-rearing tasks in relation to their sons than their daughters.
In a seminal article, Ellis et al. (2003) posed the question: "Does father
absence place daughters at special risk for early sexual activity and teenage
pregnancy?" These researchers conducted longitudinal studies in the United
States and New Zealand in which community samples of girls were followed
prospectively from early in life (5 years) to approximately age 18. It was
found that the answer to this question is yes. "First, in both the U.S. and
New Zealand samples, there was a dose-response relationship between timing
of onset of father absence and early sexual outcomes," (p. 815), including
teenage pregnancy. Cramer (1997) also emphasized that "fathers contribute
heavily to their daughter's representations of gender identity and of relations
between the sexes," but she qualified her statement as follows: "The degree
of cohesion [agreement] or of conflict between female images carried by
mother and father will in great part determine the future woman's fate"
(p.388).
In many areas of female psychosexual development, it appears that on
the one hand, fathers can provide confirmation of their daughter's feminine
characteristics, while on the other, they can denigrate these same potentiali-
ties. For example, several women participants in our seminars reported
feeling humiliated by fathers who depreciated or ridiculed them. Often these
humiliating events occurred early in the girl's life:
Jacqueline: When I was about five years old, my sister and I were
arguing in our bedroom while we were getting dressed and
my father was yelling for me to come into the living room.
I didn't have any clothes on yet, but I was so afraid to not
respond right away when he called that I went out into
the living room. I was naked when I walked in there, and
when he saw me, he started laughing. I remember feeling
humiliated and there was nothing I could do to cover
myself up either.
Paula: My father teased me all the time about my body, especially
when I got to be a teenager. If I got dressed up to go to a
party and was wearing a padded bra, he would notice and
invariably say "Hey, it looks like you're getting help today."
I was always very embarrassed about my breasts being small
anyway, so I would feel totally humiliated when he said

MEN, WOMEN, AND STEREOTYPES 97

 that. His teasing made me feel terrible about myself and I
thought I was so inadequate, that something was really
wrong with me, that my body wasn't right somehow.

Obviously, in families where the father has an overly sexualized

involvement or actually acts out incestuous feelings, he has a profoundly
harmful effect on his daughter's developing sexuality. In relation to father-
daughter incest, Herman (1981) suggested that: "The actual sexual encoun-
ter may be brutal or tender, painful or pleasurable; but it is always, inevitably,
destructive to the child. The father, in effect, forces the daughter to pay
with her body for affection and care which should be freely given" (p. 4).
In summarizing this section, we suggest that the psychodynamics opera-
ting in the father-daughter and father-son dyads described above are compli-
cated and often difficult to untangle. As Lamb and Lewis (2004) commented,
"Because the two parents' behaviors, attributions, and attitudes are com-
plexly interrelated, it is hard to identify paternal effects" (p. 290). However,
these researchers also stressed the fact that "The evidence to date suggests
that ... earlier paternal involvement predicts their adult children's feelings
of satisfaction in spousal relationships" (p. 290).

GENDER-ROLE SOCIALIZATION AND DEVELOPMENTAL TASKS

The ways that children learn to conform to their gender roles are
largely determined by familial and cultural influences; however, there is
considerable controversy regarding how male and female children are social-
ized into their respective gender roles. Some theorists suggest that society's
patriarchal influences still direct the socialization of boys and girls (Nealer,
2002; Pollack, 1998), whereas others claim there is little difference in how
male and female offspring are being raised in today's families (Geary, 1998).
In addition, social learning theorists have hypothesized that differences in
mothers' and fathers' styles of relating to each other must "somehow help
boys and girls acquire gender-appropriate behavioral repertoires" (Lamb &
Lewis, 2004, p. 287).
A number of research studies have been conducted addressing the
question of whether or not remnants of patriarchism have differential effects
on boys and girls. In particular, many researchers have focused their attention
on how society and families influence young children's development of
emotional expressiveness and empathy. These personal qualities and/or be-
haviors are important because they affect one's ability to establish and
maintain intimacy in an adult romantic relationship as well as influencing
one's style of sexual relating.

98 SEX AND LOVE IN INTIMATE RELATIONSHIPS

Male Psychosexual Development and Gender-Role Socialization

Research findings related to the ways that boys are raised in our culture
are contradictory. There are at least three competing theories that attempt
to explicate the socialization of a male child into the masculine gender role.
For example, in a review of research into child-rearing practices in the
traditional family, Pollack (1998) asserted, "Studies show that boys at a
very early age are pushed to suppress their vulnerable and sad feelings, they
also demonstrate that boys are pressured to express the one strong feeling
allowed them-anger" (p. 44). In other words, Pollack's findings showed
that in more traditional families, boys are taught to act brave, strong, and
tough and to not show weakness, and therefore to stay away from tender
feelings. In Pollack's opinion, our patriarchal society also places a strong
emphasis on male children separating emotionally from the mother at an
early age. Other research (Levant, 1998) has indicated that male infants may
be more emotionally expressive than female infants before this separation.P
According to Levant, this research also showed that "Despite this initial
advantage in emotional expressivity, males learn to tune out, suppress, and
channel their emotions" (p. 39).
In contrast, Kiselica (2001) has criticized Pollack's and Levant's find-
ings and their interpretations of such findings. According to Kiselica, boys
and girls differ only in how they express feelings of empathy. In his work,
Kiselica observed that "boys are just as likely as girls to help a crying peer"
and concluded that male children and adolescents are "quite capable of
responding prosocially when their fellow human beings are in some kind
of trouble" (p. 15).
Geary's (1998) findings also contradict Pollack's and Levant's position.
Geary discovered no differences between male and female infants and tod-
dlers in their expressions of empathy in situations where they had caused
the distress in another baby. In addition, he reported studies showing that
the ways boys and girls are socialized to their gender roles are becoming
increasingly similar, and that in general, parents "treat boys and girls in
very similar ways" (p. 252).
Thus, it appears that many of the findings regarding socialization prac-
tices briefly reviewed here are ambiguous and largely inconclusive. We
suggest that there is a need for further, carefully designed, observational
studies of emotional expressiveness and empathy in adult males and their
proposed antecedents in infants, toddlers, and young boys.
Psychoanalytic and object relations theorists have suggested that the
different developmental pathways by which boys and girls attain sexual
maturity may contribute to gender differences with respect to emotional
responsiveness, attitudes toward sex, and sexual behavior (Benjamin, 1995;

MEN, WOMEN, AND STEREOTYPES 99

Chodorow, 1978, 1989; Kernberg, 1995).14 For example, Kernberg (1995)
contended that the developmental tasks faced by boys (resolving the oedipal
conflict) are substantially different from those that girls encounter. However,
Kernberg also noted that all children, regardless of gender, face a similar
developmental task-that of emancipating themselves from the effects of
their parents' attitudes toward the opposite sex and their prohibitions regard-
ing sexuality: "In short, overcoming fear and envy of the other gender
represents, for both men and women, the exhilarating experience of over-
coming the prohibitions against sexuality" (p. 54).
Mendell (1998) also stressed similarities between male and female
development: "Both girls and boys must grapple with the issue of separating
from the mother, first in order to attain object constancy and its associated
autonomy and then in the service of becoming separate, differentiated,
genital sexual beings" (pp. 231-232). The son, in differentiating himself
from the mother, gradually shifts his identification to the father.

Female Psychosexual Development and Gender-Role Socialization

In contrast to theoretical approaches to male development, there is

considerable agreement about the important social and cultural factors that
continue to affect girls and women through the life span. Hyde and Oliver
(2000) observed that "Central to the message conveyed to girls and women
is that sex for them is legitimate only in the context of a committed
relationship, whereas men are allowed more sexual freedom" (p. 71).
The results of this differential socialization would indicate that "women
are punished for sexual activities such as having numerous partners or
engaging in casual sex, whereas men are less likely to be punished, or perhaps
are positively reinforced (through admiration or increased social status), for
such behaviors" (p. 61). Hyde and Oliver (2000) noted, however, that this
"double standard" has eased in recent years, being replaced by a more relaxed
standard in which premarital or extramarital sex is tolerated for both men
and women, yet these sexual involvements are acceptable for women only
if they are in love or engaged." Social role theory proposes that throughout
childhood and beyond, girls learn implicitly and explicitly what will be
expected of them as sexual women, including expectations based on the
double standard described above (Bussey & Bandura, 1984; Fagot & Hagan,
1991). In addition, according to Reid and Bing (2000), girls are taught that
they need to be cared for and protected because they are the "weaker" sex.
Attachment researchers have also explored gender differences in studies
comparing the personality traits and behaviors in infants who are securely
attached to their mothers with those of infants categorized as insecurely
attached. One study found that at age 4, insecurely attached girls showed
greater compliance and less assertive behavior than insecurely attached boys

100 SEX AND LOVE IN INTIMATE RELATIONSHIPS

(Turner, 1991). However, Gilligan (1982) found that compliant behavior
is manifested at a later stage in girls' development than was suggested
by Turuer."
Psychoanalytic and psychodynamic theorists have approached the issue
of female psychosexual development from a number of different perspectives.
Early psychoanalysts proposed that girls needed to maintain their original
identification with the mother in order to attain a decisive female identity
and appropriate feminine gender role. At the same time, they also needed
to make "libidinal connections to the father and-unlike boys-[girls need]
... to overcome the rivalry with the mother" (Fenchel, 1998, p. xvi ).
In contrast to classical psychoanalytic perspectives, early revisionists
and critics of Freud's male-oriented theories (Chodorow, 1978; Horney,
1967) asserted that the most significant factor is not how girls resolve the
triangular situation of the oedipal complex but rather how they respond to
events and experiences that occur much earlier, during the pre-oedipal
phase. Recently, Benjamin (1999) who endorses Horney's revisionist views,
argued that "The girl reaches the [oedipal] complex by way of her libidinal
strivings toward the father rather than through the narcissistic injury of not
having a penis" (p. 88). Benjamin also noted that the anxiety of separating
from the mother is more important than castration anxiety as a formative
influence in female sexual development."
French psychoanalyst Chodorow (1978, 1989) concluded that boys
and girls have different gender-related experiences because women care for
children. She contended that,
As a result of being parented by a woman, both sexes are looking for
a return to this emotional and physical union. A man achieves this
directly through the heterosexual bond which replicates for him emo-
tionally the early mother-infant exclusivity which he seeks to recreate.
. . . Women have different and a more complex set of relational needs,
in which exclusive relationship to a man is not enough. This is because
women experience themselves as part of a relational triangle in which
their father and men are emotionally secondary, or at most equal, in
importance to their mother and women. Women, therefore, need pri-
mary relationships to women as well as to men. (1989, p. 77)
Chodorow further asserted that, in contrast to boys, it is not necessary
for girls to sever the attachment to the mother in order to develop a feminine
identity; instead they need to preserve the attachment to the mother. 18
We agree, albeit only in part, with Chodorow's analysis of the differen-
tial outcomes of early developmental tasks for boys and girls. We contend
that because male and female children face differential developmental tasks
during their formative years, as adults they tend to have a conflict of interest
when they enter into a sexual relationship with one another. As Chodorow
asserted, for a man, a close sexual relationship can symbolize the fulfillment

MEN, WOMEN, AND STEREOTYPES 101

of his desire for close, affectionate contact with the mother that he has
longed for since early childhood. However, this illusion that he is achieving
a reunion with the mother is often based more on a childlike fixation than
on a healthy, adult desire for companionship. We emphasize that for a
woman, a mature sexual relationship with a man can symbolize separation
and a loss of fantasized connection with the mother, which arouses consider-
able fear, guilt, and anxiety. In such instances, men and women are at odds
with each other in forming a committed sexual relationship, especially one
that includes emotional closeness and satisfying sexuality. To avoid the
blending of love and sexuality, one or both partners may withdraw either
sexually or emotionally from the other person.

EVOLUTIONARY PSYCHOLOGISTS' CONJECTURES

ABOUT DIFFERENTIAL MATING STRATEGIES

One difference between men and women suggested by evolutionary

psychologists is that men and women employ different strategies in selecting
mates (Buss & Barnes, 1996; Buss & Schmitt, 1993; Kriegman, 1999). These
psychologists propose that prehistoric men and women needed to solve
different types of adaptive problems (Buss, 1994; G. Miller, 2000). Describing
the reasoning behind their conjectures, Buss and Schmitt (1993) explain
that for more than two million years, our ancestors' choices evolved through
a process of natural selection. During evolutionary history, both women and
men have pursued short- and long-term mating strategies necessary for
solving problems of adaptation. Their preferences for desirable qualities in
a potential mate evolved from those strategies that best solved problems
related to each gender's reproductive constraints, that is, strategies that
essentially favor gene survival.
For example, Buss and Schmitt (1993) reported that men's tendencies
to be more random and women's tendencies to be more selective have been
observed to be universal across human societies. They conjectured that men
tend to seek sexual variety and pursue a larger number of sexual relationships
to ensure the replication of their genes in future generations. In attempting
to identify which women were fertile, primitive man had to rely on cues
indicating youth and physical health: "full lips, clear skin, smooth skin,
clear eyes, lustrous hair, symmetry [breasts, waist and hips in proper propor-
tions], good muscle tone, an absence of lesions ... sprightly, youthful gait
and high activity level" (p. 208).
In order to allocate their limited resources to the offspring that carried
their genes, our male ancestors also needed assurance that they were the
rightful parent. According to Buunk, Angleitner, Oubaid, and Buss (1996),
"Over human evolutionary history, men have faced a profound adaptive

102 SEX AND LOVE IN INTIMATE RELATIONSHIPS

problem that has not been faced by women: uncertainty in their parenthood
of children" (p. 359). In modern times, men still tend to prefer "women
who are young and physically attractive as indicators of reproductive value
(see Buss, 1989b) and who are sexually loyal and likely to be faithful as
indicators of paternity certainty" (Buss & Schmitt, 1993, p. 226).
These theorists (Buss & Schmitt, 1993) found that for the most part
women are highly selective in choosing a mate. Their selectivity is partly
a function of a biological imperative to find both the best genes for their
children (Wilson, 1981) as well as the resources and parental interest neces-
sary for assisting in the rearing of offspring to reproductive age. According
to Buss and Schmitt, "women in long-term mating contexts, more than men,
willdesire cues to a potential mate's ability toacquire resources, including ambition,
good earning capacity, professional degrees) and wealth. This prediction has
been confirmed extensively across cultures" (p. 223). Although different
groups value different characteristics, this general pattern appears to hold
up across cultures.'? According to evolutionary psychologists, men and
women also have different strategies in relation to short-term partner selec-
tion and casual sex (Schmitt et al., 2003). For example, in "choosing partners
for a sexual liaison, men reliably indicated lower criteria than did women"
(Kenrick & Trost, 1993, p. 154).
The hypotheses set forth by evolutionary theorists are not without
their critics, especially when the theory is applied to assumed differences
in male and female mating strategies. Moore and Travis (2000) argued
that,

As applied to human culture, this view [that males benefit by mating

with as many females as possible] supports the notion of promiscuous
behavior in men as being adaptive, when in reality there is no evidence
that promiscuous men have more offspring than men who invest heavily
in the nurturing of their children. (p. 48)20

In our opinion, although certain evolved sexual or reproductive strate-

gies and tendencies may still persist in individuals of both genders, other
factors including cultural and psychological factors and the availability of
potential partners probably have more influence in shaping people's sexual
behavior and preferences (Hazan & Diamond, 2000). Gender researchers
Eagly and Wood (1999) tend to agree with our point of view. They found
that "a re-analysis of Buss's [1989] ... study of sex differences in the attributes
valued in potential mates in 37 cultures yielded cross-cultural variation that
supports the social structural account of sex differences in male preferences"
(p. 408). In a more general sense, rather than attributing sex differences in
human behavior primarily to evolved dispositions that differ by sex, it may
well be that these differences lie "mainly in the differing placement of
women and men in the social structure" (p. 408).

MEN, WOMEN, AND STEREOTYPES 103

 More importantly, human beings are far from being passive recipients
of certain inclinations that may have helped their ancestors survive. In
other words, we have some choice in the matter, our destiny is not predeter-
mined, and our behavior and propensities are continually being influenced
by a myriad of other factors.

CONCLUSION

In most aspects of their psychological makeup, men and women cannot

be easily categorized according to their gender identity. Their behavior
should not be evaluated or judged by conventional criteria that stress gender
differences. Clinically, it is important to work with clients to facilitate an
understanding that they do not have to comply with these gender expecta-
tions and stereotypes. It is helpful to explore with them the similarities
between women and men, describe their mutual strengths, and to demon-
strate through attitude and action that it is possible to change destructive,
traditional sexist attitudes.
Although considerable effort has gone into attempts to delineate early
environmental influences on gender-role behaviors and different sexual
attitudes and behaviors observed in men and women, it appears that many
findings from gender research are ambiguous or inconclusive. In any case,
these findings and popular interpretations of such findings should not be
used to support destructive stereotypes that still exist in our culture.
On a social level, proponents in the men's and women's movements
have contributed to the struggle to achieve personal freedom while develop-
ing a sense of kinship with members of the opposite sex. Yet, because sexist
attitudes are internalized so early in the developmental sequence, people
still face a difficult task in challenging and transcending sexual stereotyping,
traditional gender roles, and the defensive behaviors embedded in these
roles. This struggle requires boldness and determination when confronting
internal conflicts and external social pressures that support conformity to
rigidly defined sex roles.
We believe that women and men can develop themselves personally
and become equal partners in all aspects of their relationships, including
sexually. Women can take responsibility for their sexual desire and fulfillment
and ask more directly for what they want sexually. Men can view their
partners as equal and not take a paternalistic attitude toward them. Men
can challenge their idealization of women especially in their role as mothers.
Women can challenge their idealization of men as "rescuers" who should
protect and take care of them. Women can break the negative aspects of
their identification with their mothers and face the anxiety of living as

104 SEX AND LOVE IN INTIMATE RELATIONSHIPS

separate individuals. Men can break the negative aspects of their identifica-
tion with their fathers and overcome fears of achieving intimacy in their
relationships, even if their fathers did not.
By becoming more aware of the sexism and the distortions of men
and women still prevalent in Western culture, people can gradually move
beyond these views and develop closer, more congenial relationships. As
they relinquish defensive attitudes about themselves and their sexuality,
they can achieve higher levels of self-differentiation and experience more
fulfillment in their sexual lives.

NOTES

1. Aries (1997) noted that "Decades of research has shown widespread agreement
among people about the characteristics of men and women" (p. 96).

Men are characterized by a cluster of instrumental traits: they are seen

to be leaders, to be dominant, aggressive, independent, objective, and
competitive. Women, in contrast, are characterized by a cluster of
affective traits: they are seen to be emotional, subjective, tactful, and
aware of the feelings of others. Gender stereotypes have changed rela-
tively little over the past twenty years despite considerable changes in
women's status in society. (p. 96)

2. Pleck (1995) and Levant (1992) have discussed the effects of "gender-role
strain" on males, that is, the inconsistent and contradictory roles they are
supposed to fill. According to Walsh's (1997) description of this concept, "For
example, men are expected to be independent and competitive at work and
caring and cooperative at home. Failure to fulfill male role expectations can
lead to 'low self-esteem and other negative consequences'" (pp. 399-400).
3. Silverstein et al. (2002) commented that

Gender roles were seen as culturally defined on the basis of cultural

stereotypes rather than as emanating from an intrinsic biological femi-
nine or masculine essence .... Attempts to conform to these role norms,
therefore, inevitably lead to psychological stress rather than to psycho-
logical well-being. (p. 362)

4. Although differences between men's and women's levels of sexual desire have
been reported by a number of researchers and clinicians (H. Kaplan, 1995;
Love & Robinson, 1994), it has also been shown that these differences appear
to be a matter of degree and are influenced by a wide range of factors, including
social, psychological, and biological influences.
5. Observing this pattern in the families he studied, Pollack (1998) attributed
some of the father's difficulties to what he termed "gatekeeper mothers":

MEN, WOMEN, AND STEREOTYPES 105

 Gatekeeping is what happens when mothers, despite their very best
intentions, unwittingly maintain so close a bond with their sons that
there is simply little room left for the father to playa meaningful role-
the emotional "gate" has been kept closed. (p. 125)

6. Currently, many feminists continue to focus on inequities between the sexes,

both politically and economically. Others, particularly feminists in academia,
have concentrated their efforts on altering stereotypic attitudes and beliefs
about women, as well as developing a "relational" therapy approach. Notable
among these are a group of clinicians and researchers at the Stone Center for
Developmental Studies at Wellesley College (Jordan, Kaplan, Miller, Stiver,
& Surrey, 1991; J. Miller & Stiver, 1994; Rogers, 1994).
7. According to Gilligan (1991), women's struggle to resist complying with restric-
tive, traditional patriarchal prescriptions is a psychological battle that begins
in preadolescence. "Girls are pressed at adolescence to take on images of
perfection as the model of the pure or perfectly good woman: the woman whom
everyone will promote and value and want to be with" (p. 24).
8. In recent years there have been concerted efforts on the part of many women
to move past "benevolent" stereotypic views. For example, Dowling (2000)
documented a significant countertrend where women are refusing to accept
these paternalistic, condescending views of themselves. In her book The Frailty
Myth, she emphasized the strides made by many women to correct these sexist
views of women as inherently weak, frail, or helpless in relation to men. Drawing
on various studies in the sports world, including statistics from Women's Olym-
pics, Dowling no red that "Women of all ages have begun trading in the crimped
'femininity' of the past for a bold new female bravado" (p, xxxi).
9. However, there are a few gender differences in other areas of sexual functioning.
Smith (1998) found that 54% of men think about or fantasize about sex every
day or several times a day, whereas only 19% of women think about sex with
this same frequency. Results from the Laumann et at. (1994) large-scale survey
indicated that 26.7% of men, compared with 7.6% of women, reported that
they had masturbated at least once a week during the past year. According to
Hyde and Oliver (2000), "Many other gender differences were moderate in
magnitude ... Males were more sexually permissive ... and females reported
more anxiety, fear, and guilt about sex.... Still other behaviors showed no
gender difference" (p. 68).
10. Kindlon and Thompson (1999) have emphasized how important it is for fathers
to be able to make an "emotional connection" with their sons. They noted
that
Even though fathers in two-parent families today tend to be slightly
more involved in child care than they were twenty years ago (a gain
of about 15 percent), their involvement doesn't always translate into
the kind of emotional connection that boys want.... We find that
boys feel shortchanged, not only in terms of time but also in terms of
affection, and this loss remains with them into adulthood. (p. 100)

106 SEX AND LOVE IN INTIMATE RELATraNSHIPS

11. According to G. Parker (1983),
There are two broad rypes of overprotecrion: a caring form labeled
"affectionate constraint," which is not clearly associared with psychiatric
disorder; and a form in which there is an associated decrement in care,
labeled "affectionateless control" which appears to be strongly associated
with several psychiatric disorders and with several anomalies in psycho-
social development. (pp. ix-x)

See also the study by Jain, Belsky, and Crnic (1996), in which four groups
of fathers were identified by cluster analysis: caretakers, playmates-teachers,
disciplinarians, and disengaged fathers.
12. See Westkott's (1997) critique of Stone Center's New Psychology of Women:
The Stone Center writers do not question what they describe as "the
mother's interest in being understood and cared for" by her daughter.
... Instead, they accept it as a given ... implying that it is "natural"
or unproblematic. However, by doing so, they close off the possibility
for interpreting it as a parent's use of her child, a practice which others
... have argued has harmful developmental consequences. (p.367)

13. Findings from a number of infant studies tend to support Levant's (1998)
observations and hypotheses regarding emotional expressiveness in male infants.
For example, Tronick (1980) reported that "When mothers held a frozen
posture and a still face while looking toward their [2-month-old] infants, the
babies looked away and eventually slumped away with a hopeless facial expres-
sion" (p. 7). According to Tronick and Weinberg (1997),
Infant boys are more emotionally reactive than girls. They display more
positive as well as negative affect, focus more on the mother, and display
more signals expressing escape and distress and demand for contact
than do girls. Girls show more interest in objects. (p. 61)

See also Lyons-Ruth and Zeanah (1993). However, in other observational

studies, female infants and toddlers tended to surpass male infants and toddlers
in maintaining eye contact with caregivers and peers, recognizing (aces, and
reacting with empathy to another infant's crying (Zahn-Waxler, Radke-Yarrow,
Wagner, & Chapman, 1992; Zahn-Waxler, Robinson, & Emde, 1992).
14. Critics have argued that "outdated" psychoanalytic theories generally "ignore
individual circumstances and assume an essentialist position (Le., the belief
that there exists a basic female nature that remains relatively impervious to
contextual factors)" (Reid & Bing, 2000, p. 145). In particular, these critiques
strongly disagree with approaches suggesting that daughters have "difficulty
identifying with their mothers because they held sexual desires for their fathers"
(p. 145). For example, Reid and Bing claimed that "In light of current incidents
of family sexual abuse and reexaminations of Freud's notes, researchers now
give less credence to the notion of female gender emanating from penis envy
or childhood feelings of female inferiority" (p. 145). Similarly, in relation to

MEN, WOMEN, AND STEREOTYPES 107

 male development, Silverstein and Auerbach (1999), in criticizing the essential-
ist assumption "that boys need a heterosexual male parent to establish a mascu-
line gender identity" (p. 403), noted that "a significant amount of research on
the children of lesbian and gay parents has shown that children raised by
lesbian mothers (and gay fathers) are as likely as children raised in heterosexual,
two-parent families to achieve a heterosexual gender orientation" (p. 403).
15. From a cross-cultural perspective, Morokoff (2000) has asserted that "women's
sexual behavior is subject to social control in most if not all societies" (p. 308).
Morokoff noted, however, that recent social changes have reduced the power
exerted by some of these techniques, for example, "The advent of effective
contraception has [led to] ... a steadily increasing percentage of adolescent
women [who] become sexually active with each new survey conducted" (p. 309).
16. According to Gilligan, only when girls reach preadolescence (sometime be-
tween the ages of 9 through 13) do they become compliant, give up their
opinions, and lose a sense of who they are and what they know. In comparing
the different developmental crises that boys and girls must navigate, Gilligan
(1991) emphasized that "The relational crisis of boys' early childhood and of
girl's adolescence is marked by a struggle to stay in relationship-a healthy
resistance to disconnections which are psychologically wounding (from the
body, from feelings, from relationships, from reality)" (p. 24).
17. Benjamin (1995) further explained that
Once core gender identity is established in the first twelve to eighteen
months of life, the child proceeds to elaborate gender role identity in
conjunction with separation-individuation issues, hence in a contlictual
and variable context. ... Children continue throughout the second and
third years to identify with both parents, even though their roles are some-
what differentiated and the father may assume special importance.
(p.l27)

18. Classical psychoanalytic theories of male psychosexual development and the

oedipal conflict have been articulated for more than 100 years; whereas theories
of female psychosexual development were not explicated until the latter half
of the 20th century.
19. Buss (1994) also asserted that "In evolutionary terms, men and women are
identical in many or most domains, differing only in the limited areas in
which they have faced recurrently different adaptive problems over human
evolutionary history" (p. 18). Thus, men and women also evolved a number
of similar personality characteristics and behaviors that they prefer in potential
partners, such as intelligence, affection, generosity, and altruism. These traits
can also be hypothesized to have evolved through the process of sexual selection,
because in modern times these traits are among those that appear to be equally
distributed statistically between the two genders. As Ridley (1993) put it, "Not
everything is different; most things, in fact, are identical between the sexes.
Much of the folklore about differences is merely convenient sexism" (p. 248).
20. Moore and Travis (2000) cite numerous examples of media "hype" surrounding
supposedly scientific findings based on sociobiological or evolutionary prine i-

108 SEX AND LOVE IN INTIMATE RELATIONSHIPS

pies. For example, in describing an ABC television news program on the reality
of sex differences, they commented: "The message of the program was that men
and women are 'just biologically hard-wired to be different,' and, accordingly,
expectations of gender specific behaviors and attitudes should be different as
well" (p. 49).

MEN, WOMEN, AND STEREOTYPES 109

 5
APPROACHES TO THE ETIOLOGY
OF SEXUAL DYSFUNCTIONS AND
PROBLEMS IN SEXUAL RELATING

In contrast to normal lovers, dysfunctional individuals focus on and

expect unpleasant sensory input, which effectively decreases the experi-
ence of pleasurable, erotic sensations. In short, these patients engage
in innumerable ploys and maneuvers to down-regulate their desire for
sex, including such tactics as "turning off" their sexual partners by
putting their "worst foot forward."
-H. Kaplan (1995, p. 23)

Since the publication of S. Freud's (1905/1953) Three Essays on the

Theory of Sexuality, psychoanalytic approaches to the origins of sexual
dysfunctions have gone through many transformations, and new conceptual
models are continually being developed. Psychoanalytic theories regarding
factors that predispose the development and maintenance of sexual disorders
have decreased in popularity. At the same time, other approaches based
on object-relations, attachment, cognitive-behavioral, and family systems
theories, along with biomedical models explaining the etiology of these
disorders, have become increasingly prominent.
Many mental health professionals attribute the current biomedical
focus on dysfunctional sexual relating to the widespread acceptance of
Masters and Johnson's models of sexual health and inadequacy set forth
in Human Sexual Response (1966) and Human Sexual Inadequacy (1970).
The work of these sex researchers has been criticized for its neglect of
the emotional, relational, and spiritual aspects of sexuality. For example,

Portions of Helen Singer Kaplan's The Sexual Desire Disorders were reprinted in this chapter.
Copyright © 1995 from The Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation by
Helen Singer Kaplan, MD, PhD. Reproduced by permission of Routledge/Tayler & Francis Books,
Inc.

111
although H. Kaplan (1995) acknowledged Masters and Johnson's contribu-
tions to changes that have occurred in treating sexual dysfunctions, she also
emphasized that "The oversight of sexual desire disorders created problems
in that this left large numbers of patients and couples whose complaints
center around inadequate sexual motivation out in the cold" (p. 2).
In this chapter, we discuss the definitions of the various sexual dysfunc-
tions as delineated in the Diagnostic andStatistical Manual of Mental Disorders,
Fourth Edition (DSM-IV; American Psychiatric Association, 1994). Biomedi-
cal factors clearly contribute to the development of sexual dysfunctions. How-
ever, our focus is primarily on the psychological factors involved in the
etiology of disturbances in sexual relating. We first discuss our views regarding
the origins of sexual dysfunctions and other sexual problems in intimate
relationships. Next we briefly review several object-relations, attachment
theory, social learning, cognitive-behavioral, and family systems approaches
to the etiology of sexual dysfunctions. We discuss similarities between these
approaches and our approach to the psychodynamics involved in the devel-
opment of these dysfunctions and other problems in intimate relating.

DEFINITIONS OF SEXUAL DYSFUNCTIONS

Sexual disturbances and problems in sexual relating are widespread in

Western society. According to the 1992 National Health and Social Life
Survey conducted by Laumann, Paik, and Rosen (1999), 43% of women
and 31 % of men suffer from some form of sexual dysfunction. According
to the DSM-IV (American Psychiatric Association, 1994): "A Sexual
Dysfunction is characterized by a disturbance in the processes that character-
ize the sexual response cycle or by pain associated with sexual inter-
course" (p. 493).
According to Rosen and Leiblum (1995), "Sexual desire disorders are
among the most prevalent and challenging problems encountered in current
sex therapy" (p. 19). Sexual desire disorders include hypoactive sexual desire
disorder (HSP) and sexual aversion disorder. The other sexual dysfunctions,
corresponding to the other three phases in the sexual response cycle, are
the sexual arousal disorders, which include female sexual arousal disorder
and male erectile disorder; the orgasmic disorders, which include female
and male orgasmic disorders and premature ejaculation; and the sexual pain
disorders, which include dyspareunia (pain during or after intercourse in
both males and females) and vaginismus ("recurrent or persistent involuntary
contraction of the perineal muscles ... when vaginal penetration . . . is
attempted") (American Psychiatric Association, 1994, p. 513).1
The diagnostic categories have been criticized by some clinicians and
theorists (McConaghy, 2003; Weeks & Gambescia, 2002) who argued that

112 SEX AND LOVE IN INTIMATE RELATIONSHIPS

the definitions of various sexual dysfunctions are confusing and "perplexing."
For example, Weeks and Gambescia noted that the DSM-IV's definition
of hyposexual desire disorder "raises a number of clinical and theoretical
issues" (p. 2). Clinicians are left to determine whether the problem lies in
one partner's subjective perception of low sexual desire in the other, which
partner is experiencing interpersonal distress, and whether the problem is
acquired, situational, or generalized.
As is the case with most emotional disturbances, the sexual dysfunc-
tions delineated above are multidetermined. Genetic predispositions, bio-
chemical factors, and environmental influences combine to contribute to
the development and maintenance of various sexual dysfunctions in adult
individuals. In some cases, biological predispositions may exert a greater
influence, whereas in other cases, family, social and cultural factors are more
important. For example, in certain cases, the cause of a specific sexual
dysfunction may be traced to the direct effects of a general medical condition.
"If psychological factors also playa role in the onset, severity, exacerbation,
or maintenance of a sexual dysfunction, the diagnosis is the primary Sexual
Dysfunction (with the subtype Due to Combined Factors)" (American Psy-
chiatric Association, 1994, p. 517). In addition, a wide variety of pharmaceu-
ticals have been found to be associated with the development of sexual
dysfunctions or an intensification of their symptoms (Segraves & Balon,
2003).

OUR VIEWS ON THE ETIOLOGY OF SEXUAL DYSFUNCTIONS

All people exist in conflict between tendencies to pursue real gratifica-

tion in their closest relationships, and tendencies to depend on internal
sources of gratification, including fantasy, excessive use of substances, and
inward, routinized behavior patterns. The major threat to physically and
emotionally fulfilling sexual relations can be traced to the developmental
history of each partner and to experiences that necessitated the formation
of psychological defenses, as described in chapter 3.

The Oral Basis of Sexuality

We propose that an individual's sexuality may be represented on a

continuum, ranging from total fantasized self-sufficiency, as in seriously
disturbed or psychotic patients, to a healthy interdependence with another
person in meeting one's needs (Firestone, 1985). This continuum can be
conceptualized as ranging from the oral phase to mature genital sexuality.
To understand where clients are on this continuum, it is valuable to examine

ETIOLOGY OF SEXUAL DYSFUNCTIONS 113

their sexual life and sexual fantasies because they symbolically express atti-
tudes toward the giving and receiving of love in relation to other people.'
Basic attitudes toward the giving and receiving inherent in sexual
intercourse are closely related to feelings associated with early oral experi-
ences and other reciprocal interactions with the mother or primary parenting
figure that take place during the preverbal stage of development (Stern,
1985). Studies of early sexual development have also emphasized the preoedi-
pal stage as being a critical period for establishing one's sexual identity
as well as basic feelings of trust in attachment figures (H. Kaplan, 1979;
Schoenewolf, 1989). Indeed, many problems in sexual relating may have
their origins in the mother-infant dyad (Caplan, 1981; Chodorow, 1978;
Genevie & Margolies, 1987; L. Kaplan, 1984; Park, 1995; Rheingold, 1967).
It is interesting that the only two direct exchanges of bodily fluids
between human beings are breast-feeding in infancy and ejaculation in
adulthood. In this conceptualization, sexual attitudes relate to the underlying
oral symbolism, in that the penis symbolizes the breast, the vagina symbolizes
the mouth, the semen symbolizes the milk, and the pregnancy the full belly
(Firestone, 1957). The oral basis of sexuality and the symbolic confusion
of sexual and feeding symbols are not restricted to serious psychopathological
syndromes. We suggest that this conceptualization contributes to under-
standing sexuality in normal individuals.
People who avoid sex and closeness are, in effect, turning away from
seeking gratification from the external world-from someone outside them-
selves. When there has been considerable anxiety and deprivation related
to early feeding experiences, sexual relationships, physical touch, and bodily
contact with other persons may become threatening. Sexual dysfunctions
such as premature ejaculation, retarded ejaculation, or erectile difficulties
in the male and hypoactive sexual desire disorders and arousal and orgasmic
problems in the female may reflect a movement away from sex and a close,
emotional exchange between two people and a movement toward relying
on sex more as a means for self-gratification.
The prevalence of obesity and addictions in Western society may be
indicative of a movement away from or an avoidance of sex on the part of
many individuals (Brody, 2004). The compulsive eater, drug abuser, and
alcoholic are all denying dependency needs and the natural drive to affiliate
with other people. Through their addictive habit patterns, they appear to
be expressing a belief that they are completely self-sufficient-a defiant,
pseudo independent attitude: "I can take care of myself. I don't need anything
from anybody else."
In general, the way people relate in their intimate relationships reveals
a great deal about where they are in their development psychologically.
Their attitudes toward sex as well as their mode of sexual relating indicate
the extent to which they are defending themselves against becoming fully

114 SEX AND LOVE IN INTIMATE RELATIONSHIPS

autonomous adults. It has been our experience that healthy, mature sexual
relating, in combination with feelings of friendship in an intimate relation-
ship, tends to arouse anxiety because it represents a powerful intrusion
into people's defensive posture and their illusions of self-sufficiency and
pseudoindependence.

Developmental Factors That Interfere With Adult Sexual Functioning

We contend that the child's natural attraction to the mother grows

out of the satisfaction of his or her need for proximity to the parent or care-
giving adult. The drive to be physically close to the mother is one of the
earliest determinants of an appropriate gender identification for both male
and female offspring. However, if the child's natural attraction to the mother
or primary caregiver is frustrated, healthy sexual functioning may be compro-
mised in any number of ways.
As described in chapter 3, sexual abuse, incest, or inappropriate behav-
iors on the part of a seductive adult or adults are harmful to children's
emerging sexuality and can also contribute to the development of sexual
dysfunctions. The authors have found that the child's defensive reactions
to these painful impingements may take one of two different forms: (a) sexual
sensations may be heightened in parts of the body that were violated or
inappropriately touched, that is, those parts become sexualized; or (b) those
parts of the body may become deadened to sensation. As noted earlier, child
sexual abuse can predispose either condition in adult males and females.
(Herman, 1981; Purcell et al., 2004).
In the former cases, where sexual sensations have been intensified,
pleasurable sex is often accompanied by intense guilt reactions. Even when
the sexuality in a relationship is initially passionate, guilt reactions (in some
cases, the guilt is associated with the emergence of long-forgotten memories
of child sexual abuse or incest) are often eventually triggered in the abuse
survivor, especially as he or she becomes more emotionally close to the
partner. The stage is thus set for possible development of a hyposexual desire
disorder or, in more severe cases, a sexual aversion disorder.
In cases of orgasmic disorders, a combination of painful affects and
defenses, including those described above, may be operating in individual
partners and in turn can have a detrimental effect on the couple's sexual
interaction. For example, we found that in some cases, retarded ejaculation
appears to be influenced by the man's awareness of his partner's escalating
tension as she approaches orgasm or when he attempts penetration. In
this case, the antecedents of the problem of retarded ejaculation may be
complicated. On the one hand, it may be that the man was abused sexually
as a child, or on the other, his partner may have been traumatized by
such events and be selectively phobic in relation to penetration. In these

ETIOLOGY OF SEXUAL DYSFUNCTIONS 115

instances, the intervening variables linking the original trauma experienced
by the symptomatic partner to his or her current sexual problem need to
be explored through extensive history-taking and depth psychotherapy. In
addition, the therapist needs to examine the ways that the symptomatic
partner's sexual disturbance affects the other's ability to respond sexually
and to understand how the couple's sex life is affecting the relationship as
a whole (Johnson, 2002).
Orgasmic disorders in women may be directly or indirectly related to
environmental factors from childhood. Defensive behaviors developed in
the aftermath of child sexual abuse are some of the mediating factors that
contribute to an inability to experience orgasm in both males and females,
although studies have shown that females are more at risk for this specific
outcome (H. Kaplan, 1995).3
We have also described the role of shame and guilt in the development
of disturbances in sexual relating (Firestone, 1990b). Shame and guilt repre-
sent the internalization of parental rejecting attitudes in relation to the
body, to simple bodily needs and desires, as well as the need for affectionate
contact and love. In many of the individuals we interviewed, it appeared
that if they had developed feelings of shame about a particular part of their
body as children, they often experienced destructive thoughts about that
area in their present-day relationships. In some cases, they reported that
this specific part became insensitive to physical touch or sexual caresses.
Others appeared to have invested a certain symbolic meaning in one area
of their body such that being touched sexually in this area often triggered
feelings of shame. In addition, many people seemed to be able to pick up
their partner's feelings of shame about the affected part or area (probably
through projective identification) and felt hesitant about touching or caress-
ing those areas.
Lastly, in considering the psychodynamics involved in other forms of
sexual disturbances, we suggest that patients who manifest sadomasochistic
fantasies or behaviors (jureidini, 2001; Stoller, 1975) have strongly identified
with an abusive, sadistic, or aggressive parent as a child, a defense first
described by Ferenczi (1933/1955) and later by A. Freud (1966). Sexual
activities can be accompanied by feelings of hostility toward oneself or one's
partner, by aggressive, sadistic fantasies, or the feelings may be expressed
through the acting out of behaviors that function to humiliate or degrade
oneself and/or one's partner. The underlying dynamics are often a result of
an internalization of parental sadism and aggression under conditions of
extreme stress. In examining possible origins of sadomasochistic fantasies
and behaviors, it is interesting to note that Ferenczi's original paper (1933/
1955) dealt specifically with the consequences of incest or sexual child
abuse. Ferenczi began his analysis of such cases as follows:

116 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 The real rape of girls who have hardly grown out of the age of infants,
similar sexual acts of mature women with boys, and also enforced homo-
sexual acts, are more frequent occurrences than has hitherto been
assumed.
It is difficult to imagine the behaviour and the emotions of children
after such violence. . .. These children feel physically and morally
helpless, their personalities are not sufficiently consolidated in order to
be able to protest.... The same anxiety, however, if it reaches a certain
maximum, compels them to subordinate themselves like automata to the will
of theaggressor, to divineeachone of his desires and to gratifythese; completely
oblivious of themselves they identify with the aggressor.
The most important change, produced in the mind of the child
by the anxiety-fear-ridden identification with the adult partner, is the
introjection of the guilt feelings of the adult. . . . The misused child changes
into a mechanical, obedient automaton or becomes defiant, but is unable
to account for the reasons of his defiance. His sexual life remains
undeveloped or assumes perverted forms. (pp. 161-163)

Ferenczi's germinal paper opened up the way for an alternative interpre-

tation of Freud's oedipal complex. In other works, the first author (Fitestone,
1994a, 1997a) has described this alternative perspective on the oedipal
complex, which often predisposes a powerful identification with the aggres-
sive parent. In more severe or pathological cases, the internalized hostility
and sadism are often manifested in sexual fantasies containing aggressive
or sadistic components or they may be expressed through the acting out of
aggression toward self and partner. Silverstein (1994) identified still another
costly consequence of this defense mechanism: "The child, identifying with
the aggressor, satisfies his or her superego and fear of retaliation by channeling
aggression into fantasy and/or by blocking sexual desire from consciousness"
(p.37). It is important to note here that less aggressive or less severe
sadomasochistic behaviors are not considered pathological by many mental
health professionals or by individuals who engage in these practices and
find them enjoyable and pleasurable.
In other less severely disturbed individuals, such as a man who has
an exclusive interest in young, postpubescent girls (as distinguished from
pedophilia), the causative factors may include fears of being engulfed by an
overly involved, seductive mother, avoidance of incestuous attraction to
female siblings, or oedipal fears of retaliation from other males. Men who
are attracted to adolescent girls often believe that being sexually involved
with a younger, inexperienced woman rather than a mature, sexually experi-
enced woman is essential to avoid feelings of humiliation and sexual inade-
quacy. Similarly, women who are exclusively attracted to adolescent boys
may avoid full sexual relations with adult males for a variety of reasons:

ETIOLOGY OF SEXUAL DYSFUNCTIONS 117

they may fear penetration or they may have unresolved oedipal issues in
relation to the father and thus fear retaliation from the mother.

A BRIEF REVIEW OF OTHER THEORETICAL APPROACHES

TO SEXUAL DYSFUNCTIONS

A number of theories have evolved to explain the etiology of the

various sexual disorders. Each conceptual model mirrored the social and
political climate, the economic conditions, and the scientific and philosophi-
cal thinking of its particular era." These distinctive theoretical approaches
have different implications for how clinicians intervene with clients who
are suffering from symptoms of a sexual dysfunction.

Psychoanalytic Perspectives

Briefly stated, in his theory of sexuality, S. Freud (1940/1964) proposed

that disturbances in "normal" sexual functioning are largely caused by the
failure to resolve the oedipal conflict. Remnants of the conflict are repressed,
maintained in the unconscious, and continue to have an effect on an
individual's sexual functioning throughout his or her life. S. Freud (1912/
1957) hypothesized that in many cases, male erectile dysfunction or impo-
tence was related to an inability to integrate sexual desire and love. In
describing these patients, he commented that "Where they love, they have
no desire, where they desire, they cannot love" (p. 183).
Other theorists (Fairbairn, 1952; Guntrip, 1971; Melanie Klein, 1975;
Sulli van, 1953) place the origin of sexual conflicts in the preoedipal phase
and in the relationship to the mother. For example, in a recent reworking
of classical psychoanalytic views regarding the etiology of hysteria, Bollas
(2000) emphasized the importance of the child's early love and attraction
to the mother as well as the mother's acceptance of her infant, including
his or her body and emerging sexuality.
The clinical work of psychoanalyst Kernberg ( 1980) supports our think-
ing regarding adult versus regressed modes of sexual expression. For example,
Kernberg (1980, 1995) stressed the importance of individuation and self-
differentiation in suggesting that mature or "genital" sex requires a leaving
behind of the parental figure of the same sex. In addition, Kernberg (1980)
conceptualized a continuum of sexual love that is largely determined by "the
capacity-or rather, the incapacity-to fall and remain in love" (p. 278). At
one extreme on Kernberg's continuum are "narcissistic personalities who
are socially isolated and who express their sexual urges only in polymorphous
perverse masturbatory fantasies" (p. 278; Level 1). At the other extreme

118 SEX AND LOVE IN INTIMATE RELATIONSHIPS

(Level 5) is "the normal person who has the capacity to integrate genitality
with tenderness and a stable, mature object relation" (p. 278).
According to Kernberg (1980,1995), Fromm (1956), and others, "im-
mature" sexuality and love relations also reflect an individual's failure to
extend "self-love" (primary narcissism) to the love object. In our terms,
the criteria for "mature" sexuality and intimate relating would imply a
transformation from self-gratifying forms of sexuality into a reliance on
others for satisfaction in interpersonal relations.

Object Relations Perspectives

During the past five decades, a number of object relations therapists

have begun to employ Fairbairn's (1952) and Guntrip's (1969) concept of
split ego-the libidinal and antilibidinal ego-as a basis for understanding
the etiology of patients' sexual problems. Object relations theorists emphasize
the importance of experiences that occur during the preoedipal phases as
formative influences on later sexual dysfunctions. According to Guntrip
(1961), who interpreted Fairbairn's work, disturbances in libidinal (sexual)
development begin in infancy:
When the mother does not succeed in making the child feel she loves
him for his own sake and as a person in his own right.... That is the
factor that dominates all other and more detailed, particular issues such
as oral deprivation, anal frustration, genital disapproval, negative and
over-critical discipline and so on. (p. 284)

In a similar vein, we propose that when children suffer excessive

frustration, deprivation, parental intrusiveness or rejection during the preoe-
dipal stage of development, they develop defenses that may be often mani-
fested in their adult lives in the form of sexual dysfunctions, aberrations,
or other sexual inhibitions.
From Fairbairn's perspective, an individual is motivated from the begin-
ning of life by the need to affiliate with other people, not as a means of
reducing tension (related to hunger, sex, etc.), but for purposes of survival
from an evolutionary standpoint. In describing his theoretical approach,
Fairbairn (1952) asserted that when "the child comes to feel (a) that he is
not really loved for himself as a person by his mother, and (b) that his own
love for his mother is not really valued and accepted by her" (p. 17), there
may be a regression to an earlier stage of development. The child tends to
internalize the rejecting object (the mother) and repress the emotional pain
of rejection.
Of particular note is Guntrip's (1969) interpretation of Fairbairn's
view of the resultant split self: "We view the libidinal ego as in bondage
to guilt or fear, that is imposed by an antilibidinal ego which in part represents

ETIOLOGY OF SEXUAL DYSFUNCTIONS 119

the frightening or accusing parents who have themselves disturbed the child"
(p. 202). According to Guntrip (1971), "Fairbairn treated sexual problems
as ... internal bad-object relationships with either the exciting object or
the rejecting object" (p. 95).
Fairbairn's and Guntrip's theory is comparable to our concept of the
self and the antiself systems described in chapter 6. In fact, there is a close
relationship between the two theoretical positions. In our theory, the self
system is composed, in part, of identification with and imitation of parents'
positive traits and behaviors and is constructive and goal-directed. The
antiself system is made up of identification with and incorporation of negative
aspects of parents' personalities and behaviors. These "negative parental
introjects" are manifested in the form of a destructive thought process or
internal voice that is alien to an individual's aspirations and desires. How-
ever, from our perspective, the split ego is not only a function of parental
abuses but is also a result of the child's defensive adaptation to existential
concerns. Both interpersonal trauma and ontological issues foster the "anti-
libidinal ego" or, in our terms, the antiself system that leads to self-limiting
aspects of the personality and predisposes inhibitions and disturbances in
sexual relating.
Fairbairn's and Guntrip's theories are important because they represent
significant contributions to contemporary models explaining the ways that
individuals relate sexually in their intimate associations. For example, Gun-
trip (1971) emphasized the fact that, "Of all the appetites, sex is the only
one that cannot be wholly divorced from object-relations" (p. 36). Guntrip
also stressed the importance of using an object-relations perspective when
treating individuals with sexual problems: "I have never yet met any patient
whose overintense sexuality and/or aggression could not be understood in
object-relational terms, as resulting from too great and too early deprivations
of mothering and general frustration of healthy development in his child-
hood" (p. 40).
British psychoanalyst and family systems theorist Dicks (1967) ex-
panded Fairbairn's (1952) concept of the "antilibidinal ego" in investigating
the effects of aversive childhood experiences on adult sexual relationships.
Dicks first outlined the inevitable conflicts that arise even during a healthy
or "ideal" developmental sequence and went on to describe how defenses
and ego-splitting can occur in less-than-ideal environments, with less-than-
ideal objects (parents). According to Dicks, the effects of this defensive
splitting can be observed in people who, although they are "intellectually
and socially competent adults," remain "impoverished in their intimate
object relations" (p.42).
Dicks's clinical and theoretical work helps explain one phenomenon
under consideration in this book-why sexual relating often becomes trou-

120 SEX AND LOVE IN INTIMATE RELATIONSHIPS

blesome as a relationship matures and partners become emotionally closer
and reach deeper, more profound levels of sexual intimacy. Dicks argued that
[Fairbairn's theory] alsoexplainswhy,when biological sexualmaturation
and cultural pressures stimulate the need ofsuch a "well-adjusted" person
for total sexual loving commitment and spontaneity, the result can be
so inadequate; infantilely demanding, crude and ambivalent, hence
sabotaged by the anti-libidinal ego. (p.42)

Another major contribution of object relations theory, as articulated

by Melanie Klein (1975), Fairbairn (1952), and Guntrip (1971) lies in its
elucidation of the concept of "projective identification," which has added
substantially to the pool of knowledge about mature sexual love. In Dicks's
(1967) conceptualization of a "collusive marriage," each partner has pro-
jected elements of the "split-off, guilt-laden libidinal and anti-libidinal egos"
(p, 118) into the other through projective identification, an unconscious
process that adversely affects the couple's love relations. Scharff and Scharff
(1991) explained the role of projective identification in marital relationships
and applied the concept to treating couples' problems in sexual relating.
These clinicians proposed that the medium for projection in the sexual
encounter is the body rather than the mind. "Any body part of self or other
can become identified with the disclaimed projection, but the erotic zones
are particularly likely targets.... Penis, vagina, and the woman's breasts
become the physical locus of the repressed rejecting and exciting object
systems" (p. 55). Scharff and Scharff as well as Zinner (1976) suggested that
through the process of projective identification, feelings of sexual inadequacy
in one partner can be defensively and unconsciously transferred to the other. 5
Kernberg (1991) has also emphasized that both unresolved preoedipal
and oedipal conflicts are core issues that affect the couple's sexual relation-
ship, especially as partners become closer emotionally and sexually: "With
sexual intimacy comes further emotional intimacy, and with emotional
intimacy, the unavoidable ambivalence of oedipal and pre-oedipal relations"
(p. 156). Kernberg traced this ambivalence to the differential developmental
tasks faced by men and women and the ways in which healthy sexual
development may be compromised by faulty parent-child relations.

The man's ambivalence toward the exciting and frustrating mother

from early childhood on and his deep suspicion of the teasing and
withholding nature of mother's sexuality become issues interfering with
his erotic attachment, idealization, and dependency on the woman he
loves. His unconscious oedipal guilt, his sense of inferiority to the
idealized oedipal mother may result in sexual inhibition with or intoler-
ance of a woman who becomes sexually free and is no longer a little
girl-woman toward whom he may feel reassuringly protective....

ETIOLOGY OF SEXUAL DYSFUNCTIONS 121

 In the case of a woman who did not have an early satisfactory
relationship with a mother who tolerated the little girl's sexuality, the
unconscious experience of a hostile and rejecting mother who interfered
with her early development of bodily sensuality and, later on, with her
positive relationship to father may result in exaggerated unconscious
guilt about sexual intimacy in conjunction with commitment in depth
to a relationship with a man. Under these circumstances, the little
girl's normal shift in object from mother to father is unconsciously
distorted. (p. 156)

Kernberg's explanation of the dynamics underlying many types of

sexual disturbance within the couple agree to a certain extent with our
understanding of family influences on the sexual development of male and
female offspring, as described in chapter 4. We also found that many women
who had an unsatisfactory relationship with a hostile, rejecting mother not
only suffer exaggerated unconscious guilt about sexual intimacy, but they
are also fearful of disrupting the imagined connection (fantasy bond) with
the mother. We further suggested that, in these cases, entering into a
satisfying sexual relationship with a man symbolizes emotional separation
from the mother and loss of the imagined safety and security provided by the
fantasized fusion with her, which constitutes an anxiety-provoking situation.

Attachment Perspectives

According to Bowlby (1973), the tendency to seek proximity to the

caregiving figure originally served to protect the infant from predators; it is
not a secondary drive derived from hunger or sensual needs as Freud believed.
Fear of potential danger or brief separations from the mother or parenting
figure activate a built-in behavioral control system in the infant or toddler
and stimulate actions (sucking, smiling, clinging, crying, and following)
that (ideally) elicit appropriate maternal responses. Since the time Bowlby
first introduced his ethnologically based theory, attachment researchers have
investigated the relationship between an individual's early attachment his-
tory and his or her style of relating in an adult romantic relationship (Fraley
& Shaver, 2000; Hazan & Shaver, 1987; Shaver & Clark, 1994; Shaver,
Collins, & Clark, 1996; Shaver & Hazan, 1993). Others have studied pro-
posed links between attachment styles and types of sexual behavior (Brennan
& Shaver, 1995; Feeney, Noller, & Patty, 1993; Schachner & Shaver, 2004;
Stephan & Bachman, 1999).
According to Shaver and Hazan (1993), approximately 55% of the
people involved in romantic relationships have a secure attachment style.
As children, these individuals were likely to have formed a secure attachment
pattern with one or both parents. According to Schachner and Shaver

122 SEX AND LOVE IN INTIMATE RELATIONSHIPS

(2004), people who are categorized as securely attached "are open to sexual
exploration and enjoy a variety of sexual activities, including mutual initia-
tion of sexual activity and enjoyment of physical contact, usually in the
context of a long-term relationship" (p. 180). In contrast, people who are
categorized as "anxious/ambivalent" or "preoccupied" lovers (approximately
20%) "show a greater preference for the affectionate and intimate aspects
of sexuality than for the genital aspects (e.g., vaginal or anal intercourse)"
(p. 180). Avoidant or dismissing lovers, who make up approximately 25%
of couples "are less likely than their less avoidant counterparts to fall in
love ... and their love style is characterized by game playing (Shaver &
Hazan, 1988) .... Avoidant adults express dislike for much of sexuality,
especially its affectionate and intimate aspects" (p. 181).
In describing how these attachment types might play out in a relation-
ship, Schachner and Shaver (2004) asserted that sexual encounters between
"anxious and avoidant individuals seem especially troublesome, given that
one partner may be inclined to seek approval and lasting affection [through
sex] while the other is inclined to have short-term sex without intimacy or
commitment" (p. 193).6
Attachment theorists Shaver, Collins, and Clark (1996) have provided
descriptions of how "internal working models" mediate partners' styles of
relating in adult romantic attachments. Internal working models are de-
scribed by many theorists as representing children's beliefs about self,
others, and relationship, and as mediating partners' styles of relating in an
adult romantic attachment (Batgos & Leadbeater, 1994; Bretherton, 1996;
Bretherton & Munholland, 1999; Fischer & Ayoub, 1996). According to
Bretherton (1996) "insecure individuals develop working models of self and
attachment figure in which some schemas or schema networks [cognitive
processes] may be dissociated from others" (p. 14). Shaver and Clark (1994)
suggested that children who grow up with a negative internal model of
themselves and their attachment figure often become adults who have rela-
tively low self-esteem and distrust relationship partners.
There are important similarities between the above descriptions of
negative aspects of internal working models and our concept of the destruc-
tive thought process or the internalized "voice." We conceptualize the
"voice" as a basic part of internal working models that can help explain
the complex dynamics involved in interpersonal relationships (Firestone &
Catlett, 1999). The voice is hypothesized as an intrapsychic mechanism
that is primarily responsible for the perpetuation of negative parental atti-
tudes, beliefs, and defenses in succeeding generations. It also influences the
type and quality of attachments formed by adult individuals in their couple
relationships. In describing Robert Firestone's theoretical model, Van Horn
(1999)7 noted

ETIOLOGY OF SEXUAL DYSFUNCTIONS 123

 Firestone has made a convincing case that difficulties in intimate adult
relationships can be traced to internal working models of self and other
and to the thoughts about self and other that are inspired by those
models. [His] clinical material ... demonstrates clearly the ways that
both positive and negative modelsof the selfare transmitted fromparent
to child and the ways that the negative models are incorporated into
defensive patterns that prevent true intimacy in adult relationships.

Attachment theory has also contributed substantially to the under-

standing, evaluation, and treatment of sexual dysfunctions in intimate part-
ners and of marital distress in general (Johnson & Whiffen, 1999; Shaver
& Hazan, 1993). According to Johnson and Whiffin (1999), in situations
where an individual believes the partner is unavailable or unresponsive,
anger and anxiety are aroused which, in turn, trigger that individual's internal
working models of self in relation to the other person. These working models,
which are derived from his or her past experiences in early attachment
relationships, shape how the partner's "responses will be appraised and
interpreted, and how an individual will then communicate and respond"
(p.369).
We would add to the above statement by stressing that even the way
that a partner's personal qualities and behaviors are perceived is often
strongly influenced or distorted by internal working models or destructive
thought processes, which represent the internalization of negative aspects
of one's early attachment relationship(s). As Johnson and Whiffen noted,
the purpose of working models is to make predictions in attachment relation-
ships. "Insecure models may predispose people to selectively attend to and
defensively distort information.... An anxious partner [may think] ... 'He
is distant. He doesn't love me and I am unlovable'" (p. 373).
Johnson and Greenberg (1995) and Bader and Pearson (1988) have
used aspects of attachment theory, in conjunction with some concepts from
family systems theory, to formulate treatment strategies for couples with
sexual dysfunctions and other problems. (See chap. 9.) According to Bader
and Pearson (1988), one type of troubled sexual relationship, the "en-
meshed" type,
Is characterized by merger, avoidance of conflict and the minimization
of differences. The other type is almost the behavioral opposite. The
hostile-dependent system is dominated by anger and conflict. Too terri-
fied to end the relationship and not mature enough to end the battles, the
couple remain locked in endlessrounds ofmutually inflictedpain. (p. 10)

This dynamic is similar in many respects to our descriptions of partners

who form a fantasy bond or imagined connection with each other as the
relationship evolves, who suffer from a deterioration in the quality of their

124 SEX AND LOVE IN INTIMATE RELATIONSHIPS

sexual relating as a consequence and who may develop a secondary sex-
ual dysfunction.

Social Learning and Cognitive-Behavioral Perspectives

Early social learning theorists, Bandura (1986) and Maccoby and

Jacklin (1974), proposed that sexual attitudes and sexual behaviors, like all
attitudes and behaviors, are learned both explicitly and implicitly through
the processes of identification and imitation. A major tenet of social learning
theory states that individuals tend to imitate the actions of a role model,
that is, a person with whom they closely identify. In the process of assimilat-
ing attitudes about sex, children use as role models not only actual persons,
especially parents, but also symbolic models, including people portrayed in
the media.
Several clinicians and theorists have employed an integrated social-
cognitive-behavioral approach in an effort to delineate familial and societal
factors influencing the development of heterosexual, lesbian, gay, and bi-
sexual gender identity (Crosbie-Burnett, Foster, Murray, & Bowen, 1996;
Hogben & Byrne, 1998; Hyde & Oliver, 2000). H. Kaplan (1995), who
expanded her original behavioral approach to include interpersonal and
psychodynamic perspectives, joins Beck (1988; Beck, Rush, Shaw, & Emery,
1979) and other cognitive therapists in hypothesizing that sexual preferences,
idiosyncratic sexual desires, and fantasies are also determined by the interac-
tion of individual histories, learning, and experience. Based on clinical work
with more than 7,000 patients, Kaplan (1995) concluded
In terms of learning theory ... it may be speculated that any and all
experiences that are sexually arousing to the child and occur during a
critical period of development . . . may become permanently and indelibly
programmed into his or her "erotic software." ...
It may be further speculated that the continuous and repeated mutu-
ally pleasurable intimate physical and emotional contact that small
children normally enjoy with their mothers, fathers, and other family
members ... are inadvertently mildly erotically arousing to infantsand young
children, and sensuously pleasurable for their parents ... and that these
experiences form the psychologic origins of normal sexual fantasies and de-
sires. (p. 40-41)

Kaplan did not imply that these mutually pleasurable experiences harm
children in the way that sexually abusive or incestuous experiences do. She
did contend, however, that "this hypothetical normal sexual 'imprinting'
process can go awry and result in linking sex with fear and/or in the acquisi-
tion of and fixation on atypical and possibly disadvantageous sexual fantasies
and desires" (p.42). In other words, sexual responses may be genetically

ETIOLOGY OF SEXUAL DYSFUNCTIONS 125

"hardwired" into the brain before birth, yet learning and experience interact
with predispositions to shape adult sexual desires, fantasies, and behaviors,
and many of these experiences can interfere with this process.
In exploring the more complex causes of inhibited sexual desire (ISD),
Kaplan (1979) described theories derived from learning theory and interper-
sonal orientations. Expanding on these systems of thought, Kaplan noted,
"The child may learn to inhibit his sexuality, to sabotage his romantic
success, and to be guilty about pleasure, if the emotional nonverbal and
verbal responses of his family are destructive and not encouraging in these
respects" (p. 89). In a subsequent work, The Sexual Desire Disorders, Kaplan
(1995) emphasized the critical role played by "selectively negative cognitive
and perceptual processes . . . in the pathogenesis of HSD [hypoactive sexual
desire] disorders" (p. 117). She also called attention to specific negative
thoughts her patients had reported:

The sexual symptom protects against the evil eye of the harsh and
irrational conscience which is evoked by this success [a gratifyingsexual
experience]. The unconscious injunction-s-t'vou are not entitled,"
"something will happen if things get too good," "who do you think you
are?" "you can't have everything"-may be the underlying cause of
sexual difficulties in such cases. (1979, p. 171)

Kaplan also observed that such negative beliefs caused many patients to
be fearful about experiencing pleasure and finding fulfillment in an intimate
relationship. Paradoxically, anticipating success in a sexual experience
seemed to bring many of these negative cognitions to the surface. Many of
Kaplan's patients reported that these destructive thoughts became more
intense and were experienced more frequently as their relationship became
more meaningful or after they made a commitment to the partner.
In exploring family dynamics that might be linked to inhibited (or
hyposexual) desire disorders, Kaplan asserted that "I have come to believe
that a good relationship with the same-sex parent confers considerable
immunity against subsequent sexual psychopathology" (1995, p. 134). In
describing the mother-daughter relationships of many of her female patients,
Kaplan wrote,

In our patient population, the great majority of women with HSD and
sexual aversion disorders had not received proper encouragement from
their mothers, and they had for the most part been unable to form
healthy female identifications. The mother-daughter relationships of
our female patients were poor for a variety of reasons, including the
mother's unavailability, cruelty, alcoholism, narcissism, or her own emo-
tional problems.... On the other side of the coin, the key to much of
male sexual pathology lies in faulty father -son relationships. (pp. 134-135)

126 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Kaplan's views regarding the etiological factors involved in these types
of sexual dysfunction agree in substance with our perspective on negative
aspects of the mother-daughter and father-son relationships, as described
in chapter 4. Kaplan's focus on "negatively charged emotions and cognitions"
is similar to our focus on destructive thought patterns and the associated
anger that can block sexual desire and interfere with sexual arousal.
Kaplan (1995) has also suggested that the fear and emotional pain
associated with sexual abuse or other trauma experienced in childhood may
become sexualized and have a negative effect on adult sexual functioning.
"On a psychological level the erotization of trauma and pain, which is
especially devastating to a child when this occurs at the hands of parents,
makes this psychic wound less overwhelming and easier to bear" (p.45).
However, the defense of identifying with the abusing parent and eroticizing
the painful interactions with that parent can have additional costs in terms
of the child's later adjustment. For example, Kaplan has pointed out that
"As is true of all mechanisms of defense, the process of eroticizing the
aggressor can backfire; when this happens, the person may have to pay a
heavy price" (p. 45). One price, according to Kaplan, is that the individual
may develop deviant sexual fantasies and behaviors. She noted that

It is common for men who werehurr by rejecting, withholding, demand-

ing, controlling, cruel, elusive, or sadistic mothers to eroticize the very
same destructive qualities that caused them so much pain when they
were children. When they grow up these men may feel attracted only
to women who hurt them in similar ways, but they are unable to form
attachments to decent women. (p. 137)

As noted earlier, a number of theorists have suggested that a direct

relationship exists between shame, dysfunctional beliefs, and sexual dysfunc-
tions, especially in cases of inhibited sexual desire (Goldberg, 1996; Kaufman,
1980; M. Lewis, 1992; Morrison, 1989). For example, in his treatment of
symptoms of pathological shame in both neurotic and narcissistic patients,
Goldberg (1996) noted, "If [the child] ... is unable to express clearly her
feelings of hurt and anguish, she develops a disparaging inner 'narrative
voice' that constantly warns her away from situations in which she might
again be hurt or painfully exposed" (p.38).
Beck (1976), cognitive therapy, Ellis and Harper (1975), rational-
emotive therapy, and Elliott (1999), anthetic therapy, among others, have
discussed concepts such as "automatic thoughts," "irrational beliefs," and the
"inner critic" hypothesized to contribute to depression, anxiety, and sexual
disturbances. Others, including Kaufman (1980), Guidano and Liotti ( 1983 ),
and Kaplan (1979,1995) have investigated the psychodynamics underlying
clients' negative beliefs about sex, men, women, and relationships.

ETIOLOGY OF SEXUAL DYSFUNCTIONS 127

Family Systems Theory

Schnarch's (1991) approach to the etiology of sexual dysfunctions (or

problems in achieving one's sexual potential, as he would put it) integrates
Bowenian family systems theory with aspects of existential psychology. In
working with couples, Schnarch uses various techniques from sex and marital
therapy to help individual partners increase their level of self-differentiation
(Bowen, 1978; Kerr & Bowen, 1988).8
In explaining the basic tenets of family systems theory, Bowen (1978)
argued that "In the average nuclear family ... the spouses are emotionally
'fused' with each other and with the children, and it is difficult to get far
beyond the fusion or to do more than react and counterreact emotionally"
(p. 545). Bowen indicated that the degree of "emotional fusion" varied
tremendously among families. Kerr and Bowen (1988) defined a major
concept of family systems theory-"self-differentiation"-as

The degree to which [people] . . . are able to distinguish between the feeling
process andthe intellectual process. Associated with the capacity to distin-
guish between feelings and thoughts is the ability to choose between
having one's functioning guided by feeling or by thoughts.... People
who have achieved the least amount of emotional separation from their
families (the most entangled child in a poorly differentiated family)
have the least ability to differentiate thinking from feeling. (pp. 97-98)

Bowen's treatment, based on his family systems theory, was primarily

focused on helping patients differentiate from the "external" family, whereas
the goal of our therapeutic approach is to achieve insight into the sources
of low levels of self-differentiation and assist patients in the differentiation
of self from the "internal" family, that is, separation from negative parental
introjects or the voice process.
We suggest that Schnarch's (1991) adaptation of Bowen's approach
neglects important contributions consolidated from findings in attachment
research that have expanded our understanding of the diverse factors influ-
encing the development of problems in sexual intimacy. In publications
and lectures, Schnarch has overlooked important findings from these studies
that explain how early attachment to caregivers can affect the quality of
sexual relating in adult romantic attachments. Schnarch (1991) quoted a
number of writers who tend to dismiss, to a certain extent, closeness as an
important factor in intimate relationships. For example, Schnarch cited
Malone and Malone (1987), who said "Closeness is certainly important and
necessary, but it has become a neurotic, obsessive preoccupation, and a

128 SEX AND LOVE IN INTIMATE RELATIONSHIPS

destructive overconcern in current human societies" (p. 3). In contrast, we
contend that "Intimacy and mutual regard can only be achieved when
couples struggle through the anxiety aroused in movement toward closeness
and individuation" (Firestone & Firestone, 2004, p. 393 ).9
Overall, Schnarch (1991) appears to believe that raising individual
partners' levels of self-differentiation is the only viable pathway to sexual
intimacy, while ignoring other formative influences and aspects of part-
ners' psychosexual development and attachment history. His view of
"closeness" noted above, is in sharp contrast to Bowen's original thinking,
exemplified by Bowen's statement that "Giving up some togetherness does
not mean giving up emotional closeness" (Kerr & Bowen, 1988, p. 107).
Schnarch's theoretical approach fails to take into account the fact that
developing a secure attachment (earned security in an adult romantic
attachment) and emotional closeness with an intimate partner is, in fact,
a major aim of psychotherapy with couples. Movement toward that goal
would of course be contingent on each partner achieving a higher level
of self-differentiation.
Schnarch (1991) views the couple as a system and perceives sexual
problems as reflecting interactional processes within the couple system rather
than intrapsychic processes within the individual partners. Thus, the term
"inhibited sexual desire" has a certain relativity to its meaning because "The
actual level of the 'low sex drive' partner's desire might increase with a
different partner and might well have been higher with the current partner
at a prior time" (p. 225).
Schnarch emphasizes that low levels of self-differentiation in each
partner contribute to a couple's troubled sex life. He asserts that partners
involved in committed relationships have sexual difficulties because they
are operating at relatively low levels of self-differentiation. We tend to
agree with Schnarch's observation that partners with low levels of self-
differentiation cling to a conventional form of "other-validated" intimacy,
based on the need for fusion, rather than "self-validated" intimacy based
on the ability to tolerate separateness and existential aloneness. Schnarch
also argues that a committed sexual relationship provides the crucible in
which partners can "grow up" by differentiating themselves emotionally
from their family of origin. In treatment, Schnarch uses techniques aimed
at eliciting "profound intimacy," acknowledging that anxiety will be aroused
by an increase in intimacy during sex. We concur with Schnarch's emphasis
on existential anxiety and his explanations regarding why partners with low
levels of self-differentiation have boring, routine sex: "People have boring,
monotonous sex because intense sex and intimacy (and change itself) are more
threatening than many people realize" (Schnarch, 1991, p. 143).

ETIOLOGY OF SEXUAL DYSFUNCTIONS 129

 CONCLUSION

In this chapter, we provided a brief summary of several theoretical

perspectives, including our own, related to the etiology of sexual dysfunc-
tions. According to these perspectives, there are many environmental factors
that contribute to the development of disturbed sexual functioning in adults.
Sexual dysfunctions and other problems in sexual relating have serious
consequences in that they affect every aspect of the couple's relationship,
including activities and pursuits far removed from sexual relating.
We propose that sexual dysfunctions, particularly inhibited sexual de-
sire disorders, represent a denial of one's needs, whether these needs are
oral or sexual or for love. The majority of problems in sexual relating clearly
indicate a defensive posture in relation to the giving and receiving of products
in an equal exchange with an intimate partner. To better understand this
defensive posture as it is manifested in an individual's style of expressing
his or her sexuality, it is necessary to develop a conceptual model of healthy
sexual relating and to characterize the elements that enter into disturbed
or dysfunctional modes of sexual relating.
We have concluded that people have a basic conflict between strong
tendencies to pursue real sexual gratification in an intimate relationship,
and powerful propensities to rely more on internal sources of gratification,
including fantasy, substance abuse, inward habit patterns and impersonal
modes of sexual relating. Most people, however, are unaware that they are
trying to avoid love and sexual fulfillment. Their withdrawal from these
experiences may become habitual and eventually lead to symptoms of a
clinically diagnosable sexual dysfunction. The challenge for therapists is to
help clients resolve this conflict by encouraging them to move toward a
less defended, more vulnerable posture in relation to their loved ones.
An understanding of defense formation in early childhood, specifically
the core defense-the fantasy bond (described in chap. 6 )-is crucial to
understanding why people find it difficult to move beyond low levels of self-
differentiation, establish a secure base in their relationship, and achieve
"profound intimate sex" as described by Schnarch (1991). In this regard,
Bowen commented that "the concept of the fantasy bond provides an
understanding of the intrapsychic processes operating within each individual
that predispose the development of the 'emotional ego mass,' characterizing
families in which members have low levels of self-differentiation" (personal
communication, November 1986).
In our view, difficulties that arise during the course of a long-term
sexual relationship clearly indicate each partner's respective levels of self-
differentiation as well as reflecting the type of attachment they have formed
with their partner, that is, preoccupied, dismissing, or fearfully avoidant.

130 SEX AND LOVE IN INTIMATE RELATIONSHIPS

Progress in therapy will be largely determined by the degree to which the
individual can break free from destructive family ties on an external level,
and from negative parental introjects (destructive thought processes or inter-
nalized voices) on an internal level, to form a secure attachment with his
or her mate. The way people relate sexually reveals the extent to which
they are still defending themselves against becoming separate, autonomous
individuals capable of enjoying emotional closeness and sexual intimacy
with a relationship partner. Mature, genital sexuality, combined with feelings
of companionship in a long-lasting relationship, does indeed precipitate
anxiety states because it represents a powerful intrusion into the fantasy
bond-the imagined fusion with one's parent or parents.

NOTES

1. Other categories of sexual disturbance include the Paraphilias or sexual perver-

sions, which are defined as being characterized by "recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman
objects, 2) the suffering or humiliation of oneself or one's partner, or 3) children
or other nonconsenting persons" (American Psychiatric Association, 1994, pp.
522-523). According to the DSM-IV, when perverse fantasies or behaviors
lead to "clinically significant distress or impairment," for example, if they are
compulsive and "require the participation of nonconsenting individuals, lead
to legal complications, [or] interfere with social relationships" (p. 525), they
may be defined as perversion. Stoller (1991) included the term "perversion"
in his original definition of sexual aberration. "Sexual aberrations can be divided
into two classes: variants (deviations) and perversions" (p. 37). Perversion is
"a habitual, preferred aberration necessary for one's full satisfaction, primarily
motivated by [unconscious] hostility" (p. 37).
2. Silverstein (1994) also suggested studying a client's sexual fantasies. She pro-
posed a continuum of "eroticism that includes varying degrees of dominance
and power. ... The more powerless and helpless the child feels, the more likely
he or she will develop dominance and control fantasies" (p. 34). "Both men
and women channel power needs into sexual fantasies; both men and women
wish to control the love object" (p. 36).
3. Research has shown that in some women, the physiological response indicates
orgasm has occurred, yet they report having experiencing no orgasm (Basson,
2003). The subjective experience of orgasm appears to be damaged in these
women; the underlying mechanisms for this phenomenon have yet to be deter-
mined (Everaerd, Laan, Both, & van der Velde, 2000).
4. The social and political conditions of each era, specifically the conservative
"antisex" bias that has existed in America since the 1970s obviously influenced
theory formation, treatment, and the direction of sex research (Melby, 2001;
Richard, 2003). Also see feminist perspectives and critiques of S. Freud's

ETIOLOGY OF SEXUAL DYSFUNCTIONS 131

 hypotheses regarding the ongms of sexual dysfunctions in the female
(Chodorow, 1999; Everaerd et al., 2000).
5. Zinner (1976) has also noted that many sexual disorders and distorted sexual
attitudes have a historical basis in childhood. He found that the unconscious
material that is projected onto the other person during sex contains "highly
conflicted elements of the spouse's object relationships with his or her own
family of origin" (p. 297).
6. In a related study, Feeney (1999) reported that "In a 6-week diary study ...
we ... found that female avoidant and male ambivalent subjects were the least
likely to report engaging in sexual intercourse. This finding suggests that gender
and attachment style interact in their effects on sexual behavior" (p. 371).
However, Bogaert and Sadava (2002) found that correlations between attach-
ment style and variations in sexual behavior were less than .20. They proposed
that "Perhaps attachment processes may strongly predict sexuality (e.g., fre-
quency of sexual behavior, number of partners or' affairs) only when a relation-
ship is threatened, such as when a partner has an affair" (p. 201), that is, when
the attachment behavioral system is activated by threat of loss.
7. Van Horn's work includes Lieberman, Compton, Van Horn, and lppen (2003)
and Lieberman and Van Horn (2004).
8. There are major differences between family systems theory and psychodynamic
perspectives in terms of conceptualizing "causality" of emotional and sexual
disturbances. Psychodynamic theories deal with unconscious motivations and
cause-and-effect, linear explanations to understand their origins, which to
Bowen and Schnarch's are generally inaccurate. According to Kerr and Bowen
(1988), "Systems theory links all symptoms [of neurosis] to the emotional
system, a system that is not equivalent to the psychoanalytic 'unconscious'"
(p. 230).
9. We also agree with Bray's (1991) definition of intimacy "as voluntary closeness
with distinct boundaries.... Closeness that lacks boundaries and is not per-
ceived as voluntary reflects emotional fusion rather than intimacy" (p. 275).

132 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 6
THE ROLE OF THE FANTASY BOND,
THE VOICE PROCESS, AND DEATH
ANXIETY IN SEXUAL RELATIONSHIPS

Man is subject to a basic need that conceptually transcends and cannot

be reduced to libido or aggression, the primary drives of psychoanalytic
theory.... The individual is impelled throughout his life by [a] dual
psychological phenomenon: the need for contact and the aversion to
awareness of separateness.... The universal psychopathology is defined
as the attempt to create in real life by behavior and communication
the illusion of fusion.
-Fierman (1965, pp. 208-209)

The decline in sexual passion and quality of intimate relating that is

so common in long-term relationships and marriages cannot be attributed
to the reasons usually given: familiarity, gender differences, economic hard-
ship, or other stressors. As a relationship matures, there is often a shift in
its dynamics, fears of potential loss or rejection may surface, and painful
feelings from childhood may emerge, which can cause partners to retreat
to a more defended posture. Disturbances in sexual relating arise primarily
because at a certain point the defensive processes that both individuals
bring to the relationship come into play and limit their ability to continue
to enjoy sexual intimacy.
Many men and women encounter difficulty in trying to maintain
relationships that are both emotionally and sexually satisfying, because in
their earliest relationships, hurt and frustration caused them to turn away
from love and closeness and to become suspicious and self-protective. To
varying degrees, children are forced to rely on a fantasy of connection
and self-nourishing, self-soothing behaviors because of less than adequate
parenting. As adults, they still seek to gratify themselves internally rather
than trust or depend on external relationships. For example, some people
replace emotional gratification with overeating, excessive drinking, using

135
drugs, working compulsively, or masturbating rather than depending on
another person to gratify their wants or needs for affection and sex (Fire-
stone, 1985).
During childhood, people internalize negative as well as positive views
of themselves during the socialization process. Positive self-attitudes are
easily assimilated into the personality while those that are negative are
incorporated in the form of an alien aspect of the personality that cannot
be fully integrated. These negative attitudes and fantasies eventually became
a basic part of people's feelings toward themselves and adversely affect their
lives. By the time they reach adulthood, most have developed a strong
defense system, incorporated a critical view of themselves in the form of
an internal thought process (the "voice"; Firestone, 1988) and achieved a
psychological equilibrium compatible with this destructive view. The reality
of being genuinely acknowledged or loved threatens to disturb this equilib-
rium, and people usually refuse to allow it to affect their basic defensive
structure and negative self-concept (Firestone & Catlett, 1999).
Fears of sexual intimacy are not only related to the anxiety associated
with closeness on an interpersonal level, they are also based on existential
fears. Being intimate with another person in a loving sexual encounter
makes one aware that life is precious, but must ultimately be surrendered.
If one embraces life and love, one must also face death's inevitability (Fire-
stone & Catlett, 1999).
Although we have touched on these concepts in previous chapters,
in the following pages we will elaborate on the underlying psychological
defenses that originate in childhood and that ultimately interfere with close
sexual relating. We provide an in-depth perspective on the fantasy bond (the
primary defense) and voice process (the secondary defense) and elucidate a
conceptual model of sexuality that helps clarify why people retreat from
sexual and emotional intimacy. In discussing this theoretical approach to
sexual problems in the context of an intimate relationship, we show how
defenses formed by each partner early in life in relation to interpersonal
pain and death anxiety can have detrimental effects on his or her sexual
functioning as an adult.
We delineate two modes of sexual expression that may be manifested
by intimate partners and elucidate how manifestations of the fantasy bond,
initially formed with a parent or parents, contribute to inward, self-gratifying
modes of sexual relating as contrasted with genuine feelings and relating
during the sex act. In exploring the factors that lead to disharmony in sexual
relationships, we show how destructive thought processes or internalized
"voices" of both partners interfere with achieving and sustaining a loving
sexual relationship. Lastly, we describe how death anxiety and a heightened
awareness of one's essential separateness are often precipitated as partners
become closer and more intimate in their sexual relating.

136 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 PSYCHODYNAMICS

In this section, we explore the environmental factors that predispose

defense formation and show how these defenses act as barriers to healthy
sexuality.

The Formation of the Primary Defense-The Fantasy Bond

Early in the developmental sequence, the infant compensates for emo-

tional deprivation and defends against separation anxiety by forming a
primary defense, which we refer to as the fantasy bond. The fantasy bond
is an imagined fusion with the mother or primary caregiver. It is an effective
defense because a human being's capacity for imagination provides partial
gratification of needs and reduces separation anxiety. For example, research
has shown that fantasy processes are satisfying for people exposed to con-
ditions of physical deprivation. In one study (Keys, Brozek, Henschel,
Mickelsen, & Taylor, 1950), volunteer subjects deprived of food and kept
on a minimum sustenance diet reported that they spent hours daydreaming
about food, which partly alleviated their tension and reduced their physical
pangs of hunger.
The fantasy bond helps individuals cope with the intolerable pain and
anxiety that arise when the infant is faced with excessive separation anxiety
or frustration. This type of anxiety can be far more devastating to the infant
than the frustration itself, at times representing for the infant "a threat of
annihilation. This ... is a very real primitive anxiety" (Winnicott, 1958,
p.303).
Infants have a natural ability to comfort themselves by using images
and memories of past feeding experiences to ward off the anxiety caused
by excessive frustration. When parents are generally unavailable or inconsis-
tent in meeting their infant's needs, the infant increasingly relies on fantasies
of imagined fusion with his or her parents. The fantasy bond now becomes
a substitute for real gratification, and the child becomes progressively more
dependent on this process as a means of comfort and security.
No child has the ideal environment. There are inevitable frustrations
and separation experiences in the lives of all children (Briere, 1992; Felitti,
2002). 1 To varying degrees, all people depend on internal gratification from
an imagined connection with the introjected parent or primary caregiver.
However, the greater the frustration, pain, and anxiety and the greater the
degree of reliance on this imagined connection, the more maladaptive
the individual may become in his or her adult relationships (Firestone,
1984, 1985).
A number of theorists, beginning with Kaiser (Fierman, 1965) have
described modes of relating based on fantasy processes or a delusion of fusion

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 137

(Karpel, 1976, 1994; Wexler & Steidl, 1978). In a discussion of Kaiser's work,
Fierman (1965) noted that Kaiser focused on duplicitousness or indirect
communication, which he identified as a major manifestation of the illusion
of fusion. "To engage in indirect communication, the individual blunts and
distorts his own awareness of separateness, creates the illusion of fusion,
and is precariously gratified on an imaginary basis in a fusion relationship
with the other person" (p. 209). Kaiser's hypothesis that this "delusion of
fusion" is the universal psychopathology is analogous to Firestone's (1984)
conceptualization of the fantasy bond as the primary defense mechanism
in neurosis.
The development of the fantasy bond leads to a pseudoindependent
posture, that is, an illusion that one can take care of oneself and needs
nothing from the outside world. The more an individual comes to rely on
fantasy, the less he or she will seek or be able to accept gratification from
other people in real relationships (Firestone, 1985; Firestone & Catlett,
1999). Once a fantasy bond is formed, it predisposes inward behavior pat-
terns, including a preference for fantasy gratification over real satisfaction,
a reliance on substances as painkillers, asceticism or self-denial, patterns of
holding back affection and sexual responses from one's partner (withhold-
ing), tendencies toward isolation and passivity, self-critical attitudes, and
cynical, hostile views of self and others. All of these reflect negatively on
a person's development and later sexual satisfaction.

The Self-Parenting Process

The core defense or fantasy bond takes the form of a self-parenting

process that the child (and later the adult) uses to both nurture and punish
him- or herself internally. The process involves self-nourishing thoughts
and habit patterns as well as self-punishing ideation and behaviors. The
fantasy of being merged with a parent, and the use of self-nourishing, self-
soothing behaviors such as thumb-sucking or rubbing a favorite blanket,
combine to alleviate the emotional pain of rejection and the fear of separa-
tion and aloneness.' The self-parenting process is maintained throughout
one's childhood and persists into adult life, and in many people, it may
come to be preferred to real relationships as a source of comfort and safety.
In parenting themselves, children experience a false sense of being
totally self-sufficient because they have introjected or taken into themselves,
the image of the "good and powerful" parent. The more pain and frustration
the child experiences, the more that child will need to introject this positive
parental image.' In describing the process of introjection, Erikson (1963)
noted that "In introjection we feel and act as if an outer goodness had
become an inner certainty" (pp. 248-249). Unfortunately, in so doing, the
child also takes on the parent's hostile, rejecting attitudes toward him or

138 SEX AND LOVE IN INTIMATE RELATIONSHIPS

her (Firestone, 1985). These internalized parental attitudes or negative
parental introjects form the basis of his or her negative self-image (Gun-
trip, 1969).
In defending themselves against overwhelming frustration and emo-
tional pain, children tend to depersonalize, fragment, lose feeling for them-
selves, and become hostile and suspicious of others. In denying their needs
and wants in relation to other people, they become a complete system unto
themselves. In an attempt to maintain some sense of ego intactness under
stressful circumstances, the child merges with the powerful parent in fantasy,
incorporates hostile parental attitudes, and, at the same time, retains painful,
"primal" feelings of being the helpless "bad" child. This fragmentation leads
to a confused self-concept in which one sees oneself as better or worse than
others, and accounts for significant variations of mood (Firestone, 1997a).
Clearly, the degree of fragmentation and the subsequent effects on
adult functioning exist along a continuum. The extent to which children
defend themselves by becoming fragmented into elements of the parent-
child system is generally proportional to the amount of damage they incur
while growing up." The more deprived, rejected, or exploited the child, the
more he or she comes to rely on the fantasy bond as a compensation and
then goes on to reject genuine closeness and affection in adult romantic
attachments.
As adults, individuals continue to parent themselves-nurturing,
soothing, and punishing themselves-in much the same way they were
treated as children. Bollas (1987) has described his concept of the "self as
object" in similar terms in his work: "Each person transfers elements of the
parents' child care to his own handling of himself as an object" (p.59).
Kohut's (1977) concept of the "selfobject" is similar in some respects to the
concept of the fantasy bond or self-parenting process, in particular the self-
nurturing component. According to Elson's (1987) summary of Kohut's
theoretical approach, Kohut proposed that

With every denial from the parents, with every delay, which is a kind
of denial, something is set up internally. The ego performs internally
something that formerly was performed externally by the mother or
father. ... If the loss is traumatic, beyond what the psyche at a specific
developmental moment can actually perform, or if it is done in too
great a measure, then there will be a gross identification with the lost
parent. (p. 103)

Self-nourishing tendencies are subsequently elaborated into more so-

phisticated means of self-gratification, such as praising and comforting one-
self; vanity; eating disorders; addiction to cigarette smoking, alcohol, and
other drugs; compulsive masturbation; and an impersonal, self-soothing style
of sexual relating. Self-critical thoughts, guilt reactions, attacks on the self,

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 139

and cynical views of other people are examples of the punitive element of
the self-parenting process.
At some point in the developmental sequence, children gradually come
to realize that the life they perceived as permanent is in fact temporary
(Anthony, 1971/1973; Kastenbaum, 1974, 1995; Lester, 1970; Nagy, 1948/
1959; Rochlin, 1967). Their secure world is turned upside down by the
dawning awareness of first their parent's future death and then their own.
After they develop an awareness of death, separation experiences, whether
real or symbolic, tend to arouse death anxiety. The defenses that the child
developed to deal with early interpersonal distress are then used and rein-
forced as he or she attempts to alleviate this existential pain. Thereafter,
the fantasy bond of fusion with parents and other family members becomes
the child's basic defense against the dread of separation and death.
Individuals who form a fantasy bond in an intimate relationship tend
to externalize aspects of the internalized parent-child fused image or system
into their sexual relating, and may alternatively act out either aspect in
relation to their partner. 5 In general, people who are operating from the
parent or child ego state tend to manifest self-gratifying modes of sexual
relating. In particular, maintaining the stance of a child symbolizes the
refusal to become an adult and grow older. In this way, the imagined fusion
with the partner provides an illusion of immortality on an unconscious level.

The Formation of the Secondary Defense-The Voice Process

Self-nurturing and self-punishing behaviors are regulated by an internal

thought process, antithetical toward self and cynical toward others, that we
refer to as the "voice" (Firestone, 1988). All people suffer, to varying degrees,
from internal conflict and a sense of alienation from themselves-dynamics
that extend beyond such descriptive terms as ambivalence or dissonance.
On the one hand, each individual has a point of view that reflects his or
her natural wants, aspirations, and desires for affiliation with others, as well
as the drive to be sexual, to reproduce, and to be creative. On the other
hand, each individual has another point of view that reflects tendencies for
self-limitation, self-destruction, and hostility toward other persons.
The voice can be defined as a systematized pattern of destructive
thoughts and attitudes, accompanied by varying degrees of angry affect, that
is at the core of an individual's maladaptive behavior (Firestone, 1988). It
is an overlay on the personality that is not natural or harmonious but
represents the incorporation of destructive parental thoughts, attitudes, and
defenses. In essence, the voice can be conceptualized as the language of the
defensive process. It functions as a secondary defense that supports the
primary defense, the fantasy bond, and strongly influences self-parenting,
inward behavior patterns. It takes the form of intrapsychic communication

140 SEX AND LOVE IN INTIMATE RELATIONSHIPS

that ranges along a continuum from minor self-criticisms to major self-
attacks. In addition, the voice supports self-soothing habit patterns, isolation,
self-denial, self-destructive lifestyles, suicidal ideation, and, at the extreme
end, actual suicide.
The conditions in childhood that predispose formation of negative
thought processes that govern self-limiting, self-destructive behaviors in-
clude neglect, emotional deprivation, overt and/or covert rejection, and
physical, emotional, and sexual abuse (Firestone, 1997a). To maintain the
illusion of connection to the parent under these harsh circumstances, chil-
dren idealize their parents at their own expense. At the same time children
imitate the personality traits and behaviors of their parents, even if they
perceive these traits as negative or undesirable. Imitation involves two other
important psychological processes, identification and introjection, which are
vital in the developmental sequence (Rapaport, 1951).
When children feel the most threatened and fearful, they generally
identify with the aggressor (the person causing their suffering) in an attempt
to possess that person's strength or power. Through this process of identifica-
tion, children assume the qualities of the parents and, at the same time,
assimilate or introject the hostile, critical attitudes their parents are express-
ing toward them (Bettelheim, 1943/1979; Ferenczi, 1933/1955; A. Freud,
1966). Unfortunately, children tend to incorporate the attitudes of the
parent at his or her worst, that is, at times of extreme tension and abuse.
Therefore, negative parental introjects (the voice process) may not be truly
representative of parental attitudes on the whole.
In those moments of extreme distress or abuse, children disconnect
from themselves and cease to exist as a real self, a separate entity. In
this way, the process of introjection is responsible for the inclusion of a
systematized "parental" point of view within the self (Firestone, 1988). This
introjected view militates against the individual's unique personal aspirations
and opposes his or her motivations to fulfill basic wants and needs, including
desires for sexual gratification.
In previous works, Firestone (1988, 1997a, 1997b) described how nega-
tive parental introjects or "voices" internalized during the formative years
lead to an essential dualism within the personality. He emphasized that a
primary split exists within every individual between forces that are construc-
tive and goal-directed (the self system) and a destructive thought process
alien to his or her best interests (the antiself system).
The division of the psyche into the self and antiself systems occurs
early in life, often during the preverbal stage of development. Both systems
are dynamic and continually evolve and change over time (Firestone, 1984,
1985, 1988, 1997a, 1997b). (See Exhibit 6.1.)
Negative attitudes toward self and others based on this split can have
a devastating effect on intimate relationships. This insight is crucial in

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 141

 EXHIBIT 6.1
Division of the Mind
Parental Ambivalence
Parents both love and hate themselves and
extend both reactions to their productions, that is, their children

/ <,

Parental Nurturance
"'
Parental Rejection, Neglect, Hostility

I Other factors: ~
accidents, illnesses, death anxiety

Self System Antiself System

Unique makeup of the individual- The fantasy bond (core defense) is a self-parenting
physical, temperamental, genetic process made up of two elements: the helpless, needy
structure; harmonious identification child and the self-punishing, self-nurturing parent. Either
and incorporation of parent's aspect may be extended to relationships. The degree of
positive attitudes and traits; and the defense is proportional to the amount of damage
effect of experience and education sustained while growing up.
on the maturing self-system.

The self mediates between (1), The antiself is composed of three primary
(2), and (3) the reality principle. factors or stages of self-attack.

(1) Personal goals: primary and Voice Process Behaviors Source

secondary-primary goals (1) Critical Verbal self-attacks-a Critical parental
include food, water, sex; thoughts generally negative attitudes,
secondary goals include toward self. attitude toward self projections, and
affiliation with others, search and others predisposing unreasonable
for meaning, and compassion alienation. expectations.
for others.
(2) Micro- Addictive patterns. Identification
(2) Personal conscience: made up suicidal Self-defeating and self- with parents'
of individual's ego-ideal and injunctions. limiting behaviors. defenses.
value system (inner-directed).
(3) Suicidal Actions that Parents' covert
(3) Reality principle: actions are injunctions- jeopardize, such as and overt
evaluated in regard to positive suicidal carelessness with one's aggression
or negative consequences in ideation. body, physical attacks (identification
relation to personal goals. on the self, and actual with the
suicide. aggressor).

Copyright © 2004, The Glendon Association. Used with permission.

understanding the psychodynamics underlying the way individuals relate to

each other sexually, because destructive thought processes directed both
toward self and a significant other predispose alienation in an intimate
relationship (Firestone, 1990c). During those times when thoughts based
on the internalization of parents' harmful attitudes and defenses predominate
in one's thinking, serious distortions of oneself and one's partner are often
introduced into the sexual situation.

142 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 When people are under stress, there is a breakdown in the self system.
When an individual is "not him- or herself," the self is fractured into parental
and childlike behaviors that fit the model of transactional analysis." These
parental and childish elements (within the antiself system) are part of the
self-parenting process. Paradoxically, the child's struggle to maintain some
sense of intactness and ego integrity under conditions of extreme stress
produces fragmentation and disintegration (Noyes, Hoenk, Kuperman, &
Slymen, 1977). In forming an imagined fusion with his or her parents, the
child becomes divided into being at once the weak, bad child and the
nurturing/punishing parent (Firestone, 1997b).
These destructive thought processes (negative parental introjects) can
be brought to the surface and identified through voice therapy, and when
expressed, they reveal an unusual amount of aggression toward self. Writers
from other disciplines have long been aware that people harbor considerable
aggression toward themselves and have described destructive forces within
the personality that create most of the misery in life. In 1621, Burton (1621/
2001), in The Anatomy of Melancholy, captured the essence of the antiself
system or internal enemy and its destructive effects on people's lives when
he wrote,

Every man [is] the greatest enemy unto himself. We study many times
to undo ourselves, abusing those good gifts which God hath bestowed
upon us, health, wealth, strength, wit, learning, art, memory to our own
destruction: Perditio tua ex te (thy destruction is from thyself) .... We
arm ourselves to our own overthrows; and use reason, art, judgment,
all that should help. us, as so many instruments to undo us. (p. 136)

Most people tend to underestimate the depth of this division within

themselves as well as the pervasiveness of their tendencies to make self-
limiting, self-destructive choices. They try to deny this fracture by identifying
negative traits predisposed by the antiself system as their own. "That's just
the way I am; I've always been like rhat." Unable to tolerate the lack of
integration within themselves, they tend to compromise their wants and
desires, which are a fundamental part of their identity, and move in the
direction of the prescriptions of the voice. Freud's realization that uncon-
scious motives determine much of human behavior was a threat to people's
illusions of omnipotence, yet discoveries made in the course of investigating
the voice are even more threatening because they make people painfully
aware of the aggression toward themselves (Firestone, 1997b).
Several theorists and clinicians have described irrational beliefs, mal-
adaptive core schemata, automatic thoughts, and other aspects of destructive
thinking that are similar in some respects to our concept of the voice process.
(A Beck, Rush, Shaw, & Emery, 1979; Ellis, 1973; Epstein, 1973, 1993,
1994; Epstein, Lipson, Holstein, & Huh, 1992; Stiles, 1999). For example,

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 143

according to cognitive-experiential self-theory, developed by Epstein et al.
(1992), "individuals have 2 systems for processing information, a rational
system and an experiential system" (p.328). In Epstein's model, people
develop basic schemata or implicit beliefs in the experiential system rather
than the rational system. In addition, these beliefs "consist primarily of
generalizations derived from emotionally significant past experience"
(Epstein, 1994, p. 715).
Epstein (1994) further argued that
The main sources of maladjustment ... are disharmony (including
dissociation) within the experiential system and a failure in need ful-
fillment, not a discrepancy between conscious and unconscious thinking.
. . . The task of therapy is to change the maladaptive schemata in the
experiential system and to promote synergistic (rather than conflictual)
need fulfillment. (p. 717)

In his approach, Stiles (1999) suggested that people can be "considered

to be psychologically composed of multiple internal voices" (p, 268). One
implication based on Stiles's conceptual model is that "the occurrence of
dysphoric emotion reveals the presence of ... two discrepant voices within
the person" (p. 270). According to Stiles, one voice represents "continuity-
benevolence assumptions" or CBA voices that "arise from early positive experi-
ences of nurturing and care" (p. 269) while other "voices" may be "derived
from problematic (traumatic or threatening) experiences [which] are some-
times warded off or cast out" (p. 268).

TWO MODES OF SEXUAL RELATING

The fantasy bond plays a fundamental role in how people relate sexu-
ally. The way children learn to cope with pain in their earliest relationships,
and the kind of defenses they adopt to deal first with separation anxiety
and later with the awareness of death, are preserved intact within their
personalities as adults. In particular, as one begins to invest meaning in an
intimate relationship or becomes more committed to one's partner, the self-
parenting process is seriously threatened and there is a strong tendency to
revert to a more self-protective or defended style of sexual relating.
In general, one can conceptualize two distinct modes of sexual relating:
(a) a personal, outward style of interaction that is a natural extension of
affection, tenderness, and companionship between two people; and (b) an
impersonal, self-gratifying expression in which sex is used primarily as a drug
or painkiller. Sexual experiences can be viewed as existing on a continuum
between the two modes of sexual expression, one in which there is a personal
exchange between two people and the other in which sex is being used

144 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 EXHIBIT 6.2
The Continuum of Sexual Relating
Inward Outward
Less personal, more "mechanical" style Close emotional contact and personal
of sexual relating. relating, not focused on techniques.
More masturbatory: use of partner as a Relating to partner as a real person,
means to gratify oneself, one's own not a sex object, concern for partner's
needs for security, relief from stress, well-being and satisfaction as well as
and to enhance self-esteem. for one's own. The sex act is viewed as
an equal exchange, physically and
emotionally.
Sexual withholding: holding back or Spontaneous expression of affection,
inhibiting sexual desire, physical free flow of feelings of excitement in
affection, attractiveness, sexual which the sex act naturally proceeds to
responsiveness. completion uninterrupted by inhibitions.
Control: attempts to control or Both partners allow the sex act to
manipulate aspects of the sexual naturally flow from one phase to the
relationship, for example, the next.
frequency, time, place, and positions of
the sex act.
Relying on fantasy to increase Minimal use of fantasy: sexual fantasies
excitement: fantasies are kept a secret shared with partner.
from the partner.
Voice attacks experienced before, If voice attacks arise, they are shared
during, and following the sex act are with the partner.
kept to oneself.
Feelings of emptiness, irritability, and Feelings of happiness, pleasure,
dissatisfaction are often experienced satisfaction, and emotional closeness
after the sex act. are often experienced after the sex act.
Copyright © 2004, The Glendon Association. Used with permission.

primarily to relieve tension, or feelings of emptiness and insecurity. (See

Exhibit 6.2.)
We have proposed that the sex act may be conceptualized as a real,
but temporary, physical connection or union followed by a sharp separation
(Firestone, 1984). Thus, a satisfying sexual experience is capable of arousing
separation anxiety in many individuals, who then attempt to protect them-
selves by retreating to a more inward, defended mode of sexual expression.
At the same time, they revert to acting out parental or childish behaviors
in relation to each other rather than continuing to maintain an adult ego
state. It is important to emphasize that in most cases, people distance
themselves emotionally from their sexual partner before their anxiety reaches
the level of conscious awareness.
In our experience, we have found that most people are resistant to
maintaining an adult ego state and often regress to childish or parental

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 145

modes of interacting in the face of anxiety. It appears that any interaction
symbolizing separateness, individuation, or lack of fusion is capable of arous-
ing anxiety and can lead to a regressive trend. For some people, a defended
or impersonal style of sexual relating is manifested in most or even all of
their sexual encounters, and rarely, if ever, do they experience genuine
sexual intimacy in their relationships. In other words, in contrast to many
people who may regress to self-gratifying modes of sexual relating as a defense
against intimacy, these individuals, who have been damaged in their ability
to relate closely, are characteristically inward and self-gratifying in their
style of relating. In fact, it could be said that the adult mode represents an
ideal state of adjustment that most individuals are incapable of achieving
to varying degrees. The ability to remain in an "adult ego state" (Berne,
1961; Firestone, 1988) appears to depend primarily on an individual's level
of self-differentiation (separation from the fantasy bond with the family-of-
origin; Bowen, 1978; Hellinger, 1998; Karpel, 1994; Kerr & Bowen, 1988;
Schnarch, 1991; Willi, 1978/1984, 1999).

THE EXTENSION OF SELF-PARENTING INTO

SELF-GRATIFYING MODES OF SEXUAL RELATING

As described earlier, children who parent themselves develop an illu-

sion that they do not need to be gratified by another person. As they develop
through adolescence and into adulthood, they extend this illusion and the
self-parenting behaviors that support this fantasy process into self-gratifying
modes of sexual relating. They also use other elaborate methods to comfort
and soothe themselves, including promiscuous sexual relating, compulsive
masturbation, or other addictive, repetitive sexual practices that relieve
tension. The use of sex as a narcotic is directly analogous to addictions
such as alcoholism and other forms of substance abuse, in that the sexual
experience acts as a painkilling drug to cut off or inhibit feeling reactions.
It represents a movement away from real sexual intimacy and emotional
exchange between two people, and toward reliance on sex as a mechanism
for self-gratification that may actually place a limitation on a mature, healthy,
or loving relationship. In some cases, these disturbances in sexual relating
can reach a clinical level and be manifested in symptoms of a specific
sexual dysfunction.
Symptoms of a self-gratifying mode of sexual relating can be present,
to varying degrees, in any sex act. One or both partners can revert to this
mode of sexuality at any point before, during, or following lovemaking.
After an especially satisfying sexual experience, many people become distant,
preoccupied, or argumentative, or they become childlike, dependent, and/
or punishing in expressing elements of the internalized parent-child system.

146 SEX AND LOVE IN INTIMATE RELATraNSHIPS

Understandably, this regressive process may be difficult to identify because
people tend to retreat to an inward, defensive posture or revert to parental
or childlike behaviors before the anxiety, sadness, and other painful emotions
evoked by the experience reach the level of conscious awareness.
A shift during lovemaking from close emotional contact to a more
self-gratifying style of relating is damaging to the well-being of the individuals
involved. Many people report feelings of emptiness, a sense of dissatisfaction,
boredom, and irritability following sexual experiences in which an inward
or less personal mode of relating predominates. For example, in a discussion
group, Grant talks about his reactions to this impersonal style of sexual
relating.
Grant: Some of the women I dated when I was in my early twenties
were very seductive. They seemed really interested in being
sexual with me, which intrigued me. They definitely pursued
me, which was more comfortable for me. I would describe them
as being very sexually energetic. Making love with them was
usually fast, breathless, kind of a frenzied sexuality, like in
some movie love scenes. But lots of times being sexual in this
way didn't make me feel good even while it was going on.
Afterwards I usually felt sort of let down and kind of empty
because it wasn't personal in any way.

In another discussion group, Chuck reveals the difficulties he has being

personal in a sexual relationship.
Chuck: I always anticipate having a really passionate experience when
I make love with my girlfriend. But I usually end up feeling
empty and disappointed afterwards, even though everything
works out fine technically. She always has an orgasm, or several
of them, and I have no trouble coming, so things seem really
okay. Yet the whole act is somehow unsatisfying to me. This
one night, she even complained that she didn't feel very close
to me when we made love, that it seemed more like a perfor-
mance than like an exchange between us. This upset me even
more and I thought about our typical sexual experience. I'm
constantly planning different techniques and positions to use
that I think will turn her on. Sometimes I visualize erotic
pictures I've seen, so I can feel more excited. I realize I'm in
my head thinking about sex a lot, but I feel I'm not very much
in contact with her most of the time.

For both men and women, a pseudo independent posture is central as

they attempt to defend against the threats to their defense system that are
inherent in intimacy. The quality of a couple's sexual relating is strongly
influenced by each partner's mode of sexual expression, that is, whether it
is based on a core defense of fantasized self-sufficiency or on the pursuit of

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 147

a healthy interdependence with another person. Similarly, both partners'
modes of sexual expression are largely determined by whether they are "being
themselves," that is, operating from the adult ego state, or whether they
have regressed to a more defended, parent-child state. Often as the relation-
ship evolves and a fantasy bond develops, each partner tends to externalize
the parental or childish ego state and, through the process of projective
identification, relates to the other from this defended posture.
When threatened by the unique combination of an emotionally close
and sexually fulfilling experience, people may unconsciously hold back one
or the other aspect during lovemaking. As Hellinger (1998) pointed out,
"The sexual expression of love is also our most humble action. Nowhere else
do we expose ourselves so completely, uncovering our deepest vulnerability"
(p. 32). Some people are more prone to retreating from being emotionally
close to their partner, while others inhibit or withhold their physical sexual
responses. Withdrawing from emotional contact with one's partner and
dissociating one's feelings during the sex act itself can become habitual or can
occur intermittently, leading to a more impersonal style of sexual expression.

DEFENSES AGAINST INTIMACY THAT ENCOURAGE

THE FORMATION OF A FANTASY BOND

We use the term fantasy bond to describe both the original imaginary
connection formed during childhood and the repetitive efforts of adult
individuals to make fantasized connections in their intimate associations
(Firestone, 1984 ).In their adult relationships, people unconsciously attempt
to recapture the more familiar conditions within the family, the conditions
under which they formed their defenses. Individuals accomplish this in three
ways: through selection, distortion, and provocation. They tend to select
partners who are similar in appearance, behavior, and defenses to one or
another family member; they distort their perceptions of their partner in a
direction that corresponds more closely to this family member; or, if these
defensive maneuvers fail to recreate the past, they tend to manipulate their
partner to elicit familiar parental responses. Through these three methods,
individuals are able to externalize the fantasy bond and repeat the negative
circumstances of the original family in their intimate relationships.

Selection

Selection is a defense mechanism whereby individuals choose their

partners to replicate the early family situation. People are usually drawn to
someone who is similar to a person who was a significant figure in their
early life. They are attracted to a person whose style of relating feels comfort-

148 SEX AND LOVE IN INTIMATE RELATIONSHIPS

able and familiar. They select someone whose defenses mesh with their
own. Initially, there is a great deal of sexual chemistry in these relationships.
Linda grew up with a domineering, punitive mother. Leaving home
at an early age, she met and was drawn to Tom, who dominated and criticized
her, treating her in a way that was negative, yet familiar, to her. Several
years later, after breaking up with Tom, she moved to another state where
she met Anthony, an attractive, seemingly gentle man, and immediately
fell in love. However, as the relationship developed, Linda realized that she
had once again chosen a man who expressed the same patronizing, yet
judgmental attitudes toward her as Tom and her mother had. Linda's typical
response to Anthony's disapproval and condescension was to feel victimized
and sullen, as she had felt as a child when her mother criticized her. She
found herself passively accepting his criticisms. In this way, she maintained
the image of being unlovable and worthless that she had developed in her
family. Yet these powerful, negative feelings about herself felt comfortable
and familiar to her.
In other cases, people may select a partner with complementary per-
sonal qualities and behaviors in an attempt to compensate for perceived
deficits in themselves. For example, a quiet, somewhat passive person will
tend to be attracted to a gregarious, active person. These relationships are
also often characterized, initially at least, by strong "sexual chemistry."
Partners may experience a sense of wholeness from this union, when in
reality, both partners are weakened as they come to depend on each other
for these complementary functions and traits. Many people who form this
type of relationship eventually come to resent or even hate the traits in
the other person that they initially sought out. This sense of a merged identity
in those relationships eventually leads to a decline in sexual attraction to
one another.

Distortion

Individuals who use distortion as a defense modify their perceptions

of a partner so as to see them as more similar to a parent or family member
than they are in reality. When people choose a partner who is different
from a parent or other family member, someone who loves or values them
for who they really are, they often become self-conscious or anxious. In
particular, at points where their partner's responses challenge the basic
image of themselves formed within the family, individuals begin to distort
their partner to relieve their anxiety and to recreate conditions that are
more familiar, albeit negative. Both positive and negative qualities of one's
partner may be exaggerated, but the distortion usually functions to make
the new person more closely approximate an important person from the
past.

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 149

 When Tim fell in love with Barbara, one thing that particularly ap-
pealed to him was her excitement in sharing activities and projects with
him. The couple spent hours playing tennis and working together on land-
scaping projects.
One day Barbara needed to run errands and was unavailable for a
tennis match with Tim. Finding himself resentful and angry, but reluctant
to express directly what seemed to him to be irrational feelings, Tim became
sullen and silent. From that point on, whenever Barbara made plans with
her friends that did not include him, Tim made subtle comments implying
that she was self-centered and was neglecting their relationship. Sometimes,
he went so far as to question her regarding her whereabouts. Over a period
of time, Tim's complaints and suspicions began to affect Barbara negatively.
They interfered with the closeness they had shared and their sexual relation-
ship suffered. The deterioration continued and they eventually went their
separate ways.
Much later in therapy, Tim recognized that he had seriously distorted
Barbara's behavior and had come to attribute qualities to her that were
more characteristic of his mother, who was narcissistic, emotionally unavail-
able, and indifferent to his wants and needs as a child. He realized that his
mistreatment of Barbara, based on his distorted attributions, began when
she expressed a desire for them to begin living together. Her desire to be
with him in a more committed relationship challenged his basic image of
himself as a burden, an identity he had formed as a result of his mother's
neglect.

Provocation

If the first two defensive maneuvers fail to recreate the past and main-
tain the defense system, people tend to manipulate their partner to elicit
familiar parental responses. They may behave in ways that provoke angry,
critical, or harsh reactions from a mate. In the example above, Tim's sullen
complaints and suspicious questioning served the purpose of dampening
Barbara's excitement for sharing activities with him, including lovemaking.
He was finally able to evoke the same response from Barbara that was
familiar to him, the indifference and emotional unavailability that had
characterized his mother's interactions with him throughout his childhood.
As previously noted, when a relationship challenges a person's essential
image of him- or herself, the person often becomes anxious. Before develop-
ing a conscious awareness of this anxiety, one may begin to act in a way
that changes the relationship in a manner that replicates one's early life
experiences. Partners may begin to hold back their affectionate, loving, and
sexual responses, which originally were so appealing to the other person.
They may incite anger in each other with forgetfulness, intrusiveness, silence,

150 SEX AND LOVE IN INTIMATE RELATIONSHIPS

and other insensitive behaviors that indicate an underlying hostility. Fre-
quently, one or both partners are provoked to the point where they actually
verbalize the internalized self-critical thoughts of the other person. Most
people who provoke their partner are unaware that their actions are inducing
aggression, hostility, or withdrawal in the other person. They feel innocent
because they do not recognize that their behaviors have changed, only that
their partner is changing. Many relationships fail because each partner is
protecting him- or herself, maintaining a "safe" distance, thereby holding
on to his or her primary fantasy bond with the parent.
All three maneuvers-selection, distortion, and provocation-operate
to recapitulate the type of relationship people had originally with a parent
or family member. In this way, partners transform the new relationship
into one that more closely corresponds to the environment in which they
developed their defenses, and they are thus able to reestablish their psycho-
logical equilibrium.

MANIFESTATIONS OF THE FANTASY BOND

IN COUPLE RELATIONSHIPS

Men and women are most likely to become romantically involved at

a time in their lives when they are breaking dependency ties and experiencing
a sense of separateness and independence. In this state, they tend to attract
others with their vitality and aliveness. They tend to lower their defenses
to varying degrees and are more open and vulnerable than usual. The new
lovers often report experiencing an enhanced sense of well-being and a
heightened sense of joy and closeness.
Falling in love is an exciting time in people's lives. Being passionately
in love brings out powerful emotions, such as elation and joy, that the lovers
may never have experienced before. At the point where the partners begin to
feel anxious, they often subtly withdraw or create distance in the relationship
without being aware of altering their behavior, as noted earlier (Karpel,
1994 ).7 They gradually give up the most valued aspects of their relationship,
especially the eroticism and sexuality. They may also retreat from being
close emotionally. These partners often substitute a fantasy bond for genuine
personal contact. Conflict often develops as both individuals strive to pre-
serve their defenses while at the same time they try to hold on to their
initial feelings of sexual attraction, affection, and friendship. The two condi-
tions tend to be mutually exclusive.
Following the initial phase of falling in love, many couples form a
fantasy bond, particularly after making a significant commitment-to living
together, to marriage, or to starting a family. They may revert to a more
routinized, mechanical style oflovemaking, experience a diminution in their

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 151

feelings of attraction for each other, or find themselves making love less
often (Firestone, 1987; Orbach, 1999).8 These are all signs that a fantasy
bond has been formed. However, most people are unaware that the quality
of their sexual relating has been adversely affected by this unconscious
attempt to merge with their partner for purposes of security. Fenchel (2000)
described this phenomenon as follows:
Sustained intimacy requires that both partners are capable of giving
and receiving love. Where intense unconscious wishes for merger and
primitive omnipotence prevail, the ensuing discomfort can become
unbearable and lead to withdrawal, frustrating the need for intimacy.
(p. 172)

Clients in couples therapy commonly attribute the loss of attraction

and diminished frequency of lovemaking to familiarity; yet, when they
develop more independence or self-differentiation, they frequently recover
many of their original feelings of attraction and sexual desire.

INDICATIONS OF THE FANTASY BOND IN

COUPLE RELATIONSHIPS: A CASE EXAMPLE

Rick and Cecelia had been married for ten years. Their sexual relation-
ship, passionate and loving during the early phases, had gradually deterio-
rated, particularly during the past five years. Both partners were dissatisfied
with the quality and frequency of their lovemaking and the overall relation-
ship as well. In the following sections, we discuss this couple's relationship
and describe their sexual relating, examining specific behaviors that indicate
how they formed a fantasy bond as their relationship evolved.

Background

Rick and Cecelia met when they were in their late twenties. At the
time, Rick had recently finished college, received his architectural license,
and was working in a well-respected firm as part of a team that designed
low-income housing for the elderly and the poor. After years of schooling,
he was gratified to finally be working in the field of architecture. Cecelia,
who had grown up working in her family's drugstore, was managing a trendy
restaurant. She was happy that she had broken away from the family busi-
ness a few years earlier and was now her own boss in a business that she
loved.
When they first became involved, Rick and Cecelia were strongly
attracted to each other. Rick found Cecelia's optimistic, energetic personality

152 SEX AND LOVE IN INTIMATE RELATIONSHIPS

especially appealing. In addition, he perceived her as being "very pretty"
and especially enjoyed looking at her while making love. Cecelia perceived
Rick as highly intelligent and responsible and was drawn to his fun-loving,
spontaneous manner. The couple discovered that they were highly compati-
ble and shared many common interests, values, and goals in life.
As children, Rick and Cecelia had both felt lonely and isolated. During
the depression, Rick's father had struggled to make a living and the family had
to make frequent moves. At each successive move, Rick found it increasingly
difficult to make new friends and eventually gave up. Cecelia's parents had
divorced when she was 5 years old, and her mother remarried. Cecelia spent
the rest of her childhood feeling like an outsider in the new blended family
and felt ostracized by her stepfather and step-siblings. Both Rick and Cecilia
had led very inward, self-protective lives, and even though they were gener-
ally friendly and outgoing, neither had many close and meaningful relation-
ships before they met each other.

Routinized, Impersonal Sexuality or a Decline in Sexual Relating

Shortly after they fell in love, Rick and Cecelia decided to move in
together. At the time, they were thoroughly enjoying the sexual part of
their relationship, which was free-wheeling, playful, and spontaneous. Soon
they began to talk about getting married. During this period of time, Cecelia
gradually stopped seeing her old friends and began to spend most of her
time with Rick. Also, their sexual relationship seemed to "sort of flatten
out," as Rick described it. Both partners revealed that they made love
somewhat less frequently, and when they did, it was not as passionate or
spontaneous as before. They still enjoyed being sexual; however, their sexual
relations had become predictable: the same behaviors, same position, at the
same time, in the same location.
In many couples, when one or both partners sacrifice their individuality
to fuse with the other, their basic attraction to each other is jeopardized.
People in a fantasy bond often treat each other as an appendage, which
causes their feelings of sexual attraction to wane. The quality of their
sexual relating continues deteriorating because of deadening habit patterns,
exaggerated dependency, negative projections, and loss of independence.
Moreover, to maintain a comfortable distance, when they feel vulnera-
ble, many people begin to withhold the desirable qualities in themselves
that attracted the partner to them in the first place. This withholding leads
to a sense of guilt and remorse in the person who is withholding. Many
times, couples whose sexual feelings have decreased because of a fantasy
bond find themselves making love out of a sense of obligation and responsibil-
ity rather than out of a genuine desire to be together.

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 153

Form Versus Substance

People who form a fantasy bond usually resist accepting the fact that
they have lost much of their feelings of sexual attraction and friendship for
each other and have, to some extent, become alienated. They attempt to
cover up this reality with a fantasy of enduring love, substituting form for
the substance of the relationship. The conventional form of relating consists
of the convenient habits and superficial conversation that many partners
come to rely on to preserve their fantasy of being in love. Everyday routines,
customs, and role-determined behaviors provide the structure and form of
the relationship, replacing the warmth, sexual attraction, affection, and
companionship that characterized its early phases.
After their wedding, Rick and Cecelia threw themselves into "making
a life together." They bought a new car and a house that they carefully
decorated. Rick left his architectural firm and started his own company.
Cecelia left her job to begin a part-time catering business from their home.
For fun, she enjoyed throwing elaborate parties for family and friends, the
highlight being an annual birthday celebration for Rick.
However, in spite of trying to set up a perfect life together, Rick and
Cecelia's sexual relationship continued to deteriorate. They were making
love less and less frequently, and when they did, the thrill and excitement
were gone. On the evening of their fifth anniversary, Cecelia invited family
and friends to their home for a dinner party. During the evening, Cecelia
and Rick overate and drank too much wine. Afterward, when they went
to bed, they were not affectionate and did not make love; they just climbed
into bed and fell asleep.
Recognizing that people are able to use elements of reality to support
their fantasies is crucial to understanding how the fantasy bond operates in
many couple relationships. In a previous work (Firestone, 1993), we described
a continuum of fantasy involvement arbitrarily divided into three categories:
"( 1) the person with extreme propensities for fantasy and isolation ... ;
(2) the person who utilizes elements of reality primarily to reinforce and
support an ongoing fantasy process rather than really investing in relation-
ships ... and (3) the person who lives a realistic committed life whose
actions match aspirations and capabilities" (p. 341).

Individuals in Category Two merely give the impression or illusion of

seeking satisfaction in reality. They use real events as a means of reinforc-
ing or "feeding" their most prized fantasies, and value form over sub-
stance in interpersonal relationships. (p. 341)
It is difficult to try to convince people who are trying desperately to
preserve a fantasy of love that they are not in a loving relationship.
They know that they feel love and attraction, they spend considerable

154 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 time thinking about it, yet their outward expressions of affection may be
very limited or even contradicted by hostile or rejecting behavior toward
their mates. (p, 342)

In couples who have formed a fantasy bond, partners use the conven-
tional symbols of love to maintain the form of the relationship. They depend
on certain routines and rituals to strengthen the illusion that they are still
in love. For example, anniversary celebrations, the traditional Saturday
night dinner out, family reunions, and other rituals become symbols of
togetherness and romance, and these are used to reinforce the couple's
mutual fantasy of closeness and love (Firestone & Catlett, 1999).
At the same time, any event that arouses an awareness of separateness
threatens the partners' fantasies of fusion, precipitating anxiety states that
predispose anger, hostility, and self-destructive tendencies, as well as a
regression to childish, overly dependent, or parental, domineering behaviors.
Sensing this threat on some level, most couples negotiate agreements regard-
ing a wide range of rules and implicit contracts to reassure themselves that
they are still in love. When analyzed, these rules can be seen to represent
the "form" of a relationship; they include unspoken rules governing conven-
tional and obligatory behaviors that replace partners' spontaneous acts of
generosity and kindness that characterized the initial phases of their relation-
ship (Boszormenyi-Nagy & Spark, 1984; Hellinger, 1998; Sager et aL, 1971 ).9
A common pattern that we have observed is one derived from tradi-
tional gender role expectations and based on stereotypic views of women
as weak, dependent, and helpless and men as strong, masterful, and dominant.
For example, the implicit contract of a more traditional couple in which
both partners hold such internalized stereotypes might contain the following
unspoken rules: The man's rule, if made explicit, would be: "I'll take care
of you because you need to be taken care of," and the woman's would be:
"I'll continue to need to be taken care of, that is, I'll be dependent and
will defer to your wishes and decisions."
In a chapter appropriately titled "Domestic Gulags" Kipnis (2003) lists
a hundred (or more) of these rules, restrictions, or "interdictions," as she
labels them. Her essay includes nine pages filled with examples of the implicit
rules of "coupledom" that regulate each partner's behaviors in relation to
the other. These interdictions, based on people's expectations regarding
love and marriage, are automatically accepted because they provide protec-
tion against perceived threats to a couple's illusion of love and closeness.

Sexual interdictions are, needless to say, standard. But it is the panoply

of other interdictions that is actually far more revealing about the
conditions of modern couplehood. From bathroom to bedroom, car to
kitchen, no aspect of coupled life is not subject to scrutiny, negotiation,
and rule formation ... and love means voluntary adherence to them....

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 155

 What follows is a brief sample of answers to the simple question:
"What can't you do because you're in a couple?"
You can't leave the house without saying where you're going. You
can't not say what time you'll return.... You can't go to parties alone.
You can't go out just to go out, because you can't not be considerate
of the other person's worries about where you are, or their natural
insecurities that you're not where you should be, or about where you
could be instead....
You can't sleep apart, you can't go to bed at different times, you
can't fall asleep on the couch without getting woken up to go to bed.
. . . You can't get out of bed right away after sex....
You can't have friends who like one of you more than the other, or
friends one of you likes more than the other. ... You can't be too
charming in public, especially to persons of the opposite sex (or same
sex, where applicable). You can't spend more than X amount of time
talking to such persons, with X measured in nanoseconds....
Thus is love obtained.... What matters is the form.... Exchanging
obedience for love comes naturally-we were all once children after
all, whose survival depended on the caprices of love. And thus you
have the template for future intimacies: If you love me, you'll do what
I want or need or demand to make me feel secure and complete and
I'll love you back. (pp. 82-94)

In a similar vein, Willi (1978/1984) pointed out that in many marriages

and couple relationships, each partner adjusts his or her behaviors in adapting
to the demands of the partnership. According to Willi (1999), unspoken
rules representing such demands are part of "a collusion-an unconscious
interplay between two partners based on corresponding relationship fears
and deficits" (p. 94). Willi emphasized that collusions become destructive or
"pathological when they commit the partners to restricting their interactive
effectiveness to a particular form" (p. 94).

This leads them to infringe upon each other's personal integrity and
autonomy. The partners become unacknowledged accomplices in main-
taining the collusion by accepting the destructive demands of the other
without resistance, and by accepting behavior which hinders their per-
sonal development. (p. 94)

Karpel (1994) noted that relationships organized around these destruc-

tive rules may often lead to a pattern of distance and pursuit, which is only
one among many patterns that emerge when couples adhere to relational
rules learned in their family of origin. Hellinger (1998) emphasized that
couples need to become aware of these types of unspoken rules before they
can move past them, and then they need to face the resulting guilt:

156 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 When two people join in a partnership, each brings a model of partner-
ship and (or the roles and functions of men and women based on the
values of his or her family of origin, and they both follow these rules,
patterns, and norms out of habit.... For love to succeed, it is often
necessary for partners to rise above the dictates of the conscience binding
them to their reference groups. Thus, the price of love is often guilt.
(p.47)

Mutual Self-Deception

In addition to implicit contracts that support the form of a relationship,

the capacity of human beings for self-deception enables partners to maintain
an internal image of closeness and intimacy, often while the frequency and
quality of their sexual relating is steadily decreasing. Yet eroticism, passion,
and the enjoyment of sex are important aspects of a loving relationship.
Genuine love includes affection, companionship, sexuality, honest commu-
nication, and shared activities; otherwise, love can become merely an ab-
straction in one's mind.
Over the years, Rick and Cecelia rationalized the decline in the quality
and frequency of their lovemaking. Rick believed that it was because he
was so distracted and stressed by starting his own business. Even though he
missed being sexual with Cecelia, Rick still enjoyed the feeling that there
was somebody to come home to at the end of a long day. Cecelia reasoned
that her low sexual drive was based on hormonal changes and probably had
something to do with her approaching age 40. Even though she could recall
the passion of their earlier lovemaking and enjoyed the memories, she also
felt that there was something comforting about just cuddling with Rick
at night.
For several years, they said nothing to each other about any concerns
they had regarding the deterioration in their sexual relationship. When
they finally talked about this change, they came to the conclusion that
nothing was really wrong. Articles in popular magazines, as well as what
they surmised from observing their friends' relationships, convinced them
that all sexual relationships naturally deteriorate with time, familiarity,
and maturity.

Polarization of Parental and Childish Ego States

As noted previously, when a couple forms a fantasy bond, each partner

tends to retreat to a defended posture and alternatively acts out either
parental or childish behaviors. During the sex act, both people may be
operating from the childish mode, and at the same time, projecting the

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 157

voice (the introjected parent) onto the other person. When they are in
this defended state, both partners are subject to voice attacks regarding their
sexual performance and their partner's and are fearful of losing control or
surrendering themselves fully to the experience.
When Rick and Cecelia fell in love, they were two independent, highly
competent adults. Each was attracted to the other's strength and maturity,
and both participated in their sexual relationship as equal and active partners.
However, after they were married, they began to polarize: Cecelia reverted
to the role of child and Rick to that of parent. This dynamic became
apparent in nearly every area of their relationship.
In particular, in their sexual relationship, Cecelia became more and
more childish and passive. She no longer took an active role in pursuing
sex and instead acted as though sex was something that Rick wanted. Rick
became more and more parental, vacillating between "caretaking" (tending
to Cecelia, coaxing, and helping her to feel sexual) and "scolding" (being
patronizing, condescending, and at the same time angry at her for not
wanting to be sexual).
In relationships characterized by a fantasy bond, the partners may
polarize into a parental or childish posture, as Rick and Cecelia did. By
regressing to childish styles of relating, people are capable of manipulating
their partners into taking care of them. Behaviors that provoke parental
reactions-worry, fear, anger-act to cement this externalization of the
self-parenting process (Willi, 1975/1982, 1978/1984, 1999). In describing
this polarization in Couples in Collusion, Willi (1975/1982) asserted: "In the
disturbed partner relationship we often observe that one partner has a need for
over-compensatory progression while the other seeks satisfaction in regression.
They reinforce this one-sided behavior in each other because they need each other
as complements" (p. 24).
The process of reverting ro a childish mode of experience can also
function as a defense against an awareness of death. Observing how people
tend to seek a sense of immortality, albeit on an unconscious level, from a
partner who is acting out the role of parent, expert, or "ultimate rescuer,"
Rank (1941) stated,
As a rule, we find ... in modern relationships ... one person is made the
god-like judge over good and bad in the other person. In the long run,
such symbiotic relationship becomes demoralizing to both parties, for it
is just as unbearable to be a God as it is to remain an utter slave. (p. 196)

In most relationships, this type of interaction persists with occasional

role reversals, and so it is rare that either or both partners are relating from
an adult ego-state, either sexually or in other areas of the relationship.
Indeed, only those individuals who exist primarily in an adult ego state are

158 SEX AND LOVE IN INTIMATE RELATIONSHIPS

capable of consistently enjoying a mature sexual experience or relationship-
one that combines affection, love, and sex.

Idealization of the Partner

In order to preserve the fantasy bond, each partner must maintain a

positive idealized image of the other. The most effective way to prevent
reality from tarnishing that image is to exaggerate the other person's real
strengths or admirable qualities. These are the same dynamics that existed
in the original fantasy bond in which the child idealized his or her parents
at his or her own expense.
Moreover, many people enter marriage with the expectation that all
their needs will be met by the other, which places a heavy burden on their
partner. Obviously, no one person can fulfill such unrealistic expectations
or live up to such an idealized image of power and goodness. Often when
a partner is made aware of the weaknesses, shortcomings, or simple human
foibles of the other, he or she becomes angry and resentful because this
idealization is threatened. Many people alternate between the extremes of
distortion. At times they exaggerate their partner's strengths and desirable
qualities, while at other times they severely criticize or focus on his or her
perceived undesirable qualities or weaknesses.
When Rick fell in love with Cecelia, he was especially drawn to her
looks and captivated by her liveliness and generosity. As the years went by,
Cecelia gained 40 pounds. She complained of being tired and often went
to bed early. Rick found himself taking over tasks and responsibilities that
Cecelia had previously performed. However, Rick still referred to Cecelia
as beautiful and spoke of how attractive she was to him. He thought of her
as tireless, always ready to lend a hand, and generous to a fault. At the
same time, he was angry at the money she spent on gifts for friends, for
him, and for herself, and he continuously nagged her about living beyond
their means and felt victimized by her spending habits.
When Cecelia first met Rick, she was especially drawn to him because
he was competent and responsible. However, when Rick went into business
on his own, his company did not do well, and the couple's finances suffered.
Over time, he became withdrawn and irritable. It is ironic that Cecelia
deferred to Rick about practical and financial matters because she was always
able to successfully manage her own business. She told friends that she was
lucky to have a man like Rick because he understood so much more than
she did about such things. Her anger at him for putting them into financial
straits was saved for private moments. At those times, she would lash out
at Rick with nasty, sarcastic reminders about his lack of business sense and
his "stupidity."

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 159

Loss of Independence and a Sense of Separate Identity

A significant sign that a fantasy bond has been formed is when one or
both partners relinquish important areas of personal interest, their opinions,
unique points of view, and their individuality, to become an imagined unit,
a whole entity. Attempting to find security in an illusion of fusion with
another person contributes to a progressive loss of identity in each person.
The people involved increasingly depend on habitual contact, with less
personal feeling and emotional closeness, and find life somewhat superficial
or empty as they give up more aspects of their personalities.
After Rick and Cecelia were married, Cecelia quit her job managing
the restaurant and started a part-time at-home business. Before making this
change, Cecelia had enjoyed the challenge of running a full-time business,
and she had especially liked meeting people and developing relationships
with her clientele. She would talk to Rick about all the different experiences
she encountered in her day. Cecelia thought that she would enjoy working
at home but she found that it left her feeling understimulated. She realized
that she did not have much to talk to Rick about.
When Cecelia spoke to Rick about these feelings, he suggested that
she work for him. He told her that he could use someone to organize the
office and keep his books. Cecelia readily accepted the offer. However, in
working with Rick, Cecelia was unable to reexperience the excitement that
had made her happy when she was working on her own. Instead Cecelia
and Rick's identities became more fused and the negative behaviors that
were symptomatic of their fantasy bond became more pronounced.
With less and less awareness of each other as separate people, Cecelia
and Rick no longer felt sexually attracted to one another. To overcome
this obstacle in their sexual relationship, they turned to an external source
for sexual stimulation. They began to watch pornography to become aroused.
Rick said, "It was strange-we were together but we were not really together."
Unfortunately, conventional beliefs and the myth of eternal love rein-
force people's tendencies to give up their independence and individuality.
Society's belief in unconditional, everlasting love supports people's resistance
to understanding the sources of deterioration in their sexual relating. The
false assumption that true love is unconditional reinforces both partners'
tendencies to cling to illusions of connection and oneness, while remaining
unaware that the real closeness and sexual intimacy between them have
declined to a significant degree.
More often than not, when a couple has formed a fantasy bond, the
individuals involved are following the dictates of their respective voices.
Their communications are being filtered through a biased or alien point of
view that distorts their partner's real image. Both parties tend to withdraw

160 SEX AND LOVE IN INTIMATE RELATIONSHIPS

from expressing affection or sexual responses to the other and use various
rationalizations promoted by the voice to justify their anger, provocations,
and withdrawal. In addition, as described earlier, anything that arouses an
awareness of separateness or an independent existence is anxiety-provoking
and often leads to hostility. This anger is frequently experienced in the
form of self-critical thoughts: You're so boring, how could he(she) still want
to be sexual with you? and voice attacks against one's partner: He's not really
responding to you. She's not that attractive. He's (She's) not interested in sex-
he(she) doesn't really care about you. Or: He's (She's) only interested in sex,
he (she) doesn't really care about you.

MANIFESTATIONS OF THE VOICE PROCESS

IN SEXUAL RELATING

In this section, we explain how negative thoughts, internalized voices,

or self-attacks and hostile attitudes toward one's partner can intrude into
the sex act at any point, before, during, or after the experience, disrupting
or seriously interfering with the natural flow of feelings of excitement
and passion.
Problems in sexual relating and many symptoms of sexual dysfunctions
are strongly influenced or controlled by negative thought processes that
take away from the bodily experience and feelings before, during, or following
a sexual encounter. Similarly, experiencing a sexual problem predisposes an
increase in one's negative thinking, resulting in a kind of feedback loop.
Although the voice exists primarily on an unconscious level, many
people are partially aware of its manifestations in the form of a running
commentary or internal dialogue that criticizes and attacks them. During
a sexual experience, these attacks often come to the foreground in one's
thinking, reinforcing negative attitudes toward one's body, nudity, and sexu-
ality. For example, You're too fat. You should keep your body covered up and
hidden. You'd better have an orgasm. The voice also influences self-denying
tendencies and causes many men and women to give up their natural sexual
desires and wants by conforming to early programming and conditioning.
You don't need sex that often. You're just not a sexual person. You're too old
for sex.
Destructive thought processes or voices support the defense mecha-
nisms of distortion and provocation described earlier. Tim's distortion of
Barbara, in a previous example, was promoted and reinforced by destructive
thoughts such as You'd better watch out! She's really changed. She used to love
doing things with you. But now she's more excited about having lunch with her
friends than being with you. She's so selfish, all she thinks about is herself. His

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 161

pattern of distorting Barbara led to behaviors that eventually provoked
distance in the relationship. In therapy, Tim reported that his complaints
and accusations were influenced by increasingly intense voice attacks: You'd
better let her know that she's no fun to be with anymore. Show her how miserable
you are, how she's hurting you. His suspicions regarding her other activities
were instigated by thoughts such as Look, you just can't trust her. You can't
trust women. They act interested, then they drop you. You'd better find out where
she's really going. She's probably seeing someone else. That's why she doesn't
want to be sexual with you anymore.
Patterns of chronic misunderstanding often develop in a couple's sexual
relating and can be traced to distorted perceptions of one's partner as well
as critical thoughts about oneself. This type of distorted thinking may be
manifested in two ways: (a) in negative attitudes toward oneself, one's body,
and one's sexuality that often lead to feelings of being criticized or misjudged
by one's sexual partner; or (b) in negative expectations, perceptions, or
distortions of one's partner that can be used to feel misunderstood, unappreci-
ated, or exploited sexually. Both types of attitudes, toward oneself or one's
partner, lead to behaviors that create emotional distance between partners
during lovemaking.
Marcia identifies negative thoughts she experiences while making love.
(The contents of her self-attacks appear in italics.)

When things start to get close sexually between Cody and me, I
start to feel sad. But then I start thinking things about myself like,
You're not like other women. You don't feel things the way other women
feel things, you don't feel anything. Then things start to feel mechanical
to me.
When I'm feeling mechanical like that, and Cody touches me, I am
actually thinking about my response, like, You don't really feel right.
You're not going to be able to relax and feel this. You're not going to be able
to respond and really enjoy this, and then it affects the way I am in the
situation. It seems like the only way I can stop thinking these things
is if I feel sad. That helps me. The thoughts quiet and then I feel like
I'm able to be there, present in the situation.

It is worthwhile for individuals to identify and challenge their negative

views of self and others in the context of a psychotherapy that exposes
the core issues underlying sexual problems. Partners need to learn to free
themselves of distortions and provoking or self-defeating behaviors that
cause distress in their sexual relationships (Foley Kope, & Sugrue, 2002).10
I

Recognizing the restrictions imposed by the introjected parent or voice

process enables them to improve the quality of their lovemaking and main-
tain real closeness with their partner during the sex act.

162 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 THE ROLE OF DEATH ANXIETY IN THE DEVELOPMENT
OF SEXUAL PROBLEMS

Disturbances in sexual functioning are not solely due to a client's

residual fears related to painful experiences or trauma in childhood; they
are also based on existential fears (Firestone & Catlett, 1999). In previous
works (Firestone, 1994b; 1997a; Firestone, Firestone, & Catlett, 2003), we
have delineated a number of defenses that individuals employ in an attempt
to deny existential realities and their personal mortality. Observing how
human beings are remarkably capable of denying death on an unconscious
level, Zilboorg (1943) pointed out that, "In normal times we move about
actually without ever believing in our own death, as if we fully believed in
our own corporeal immortality" (p. 468).
The basic framework for denying death can be found in the system of
defenses that children construct at a stage in the developmental sequence
that precedes their understanding of death. As described earlier, when chil-
dren become aware of death, they tend to regress to an earlier stage of
nonawareness and strengthen the fantasy bond. Thereafter, individuals
adapt, to varying degrees, to death anxiety through a process of depersonaliza-
tion, self-denial, and withdrawal of libido (emotional investment) from other
people and life-affirming activities. The denial of death often generalizes to
an antifeeling, antisexual existence and supports the choice of addictive
attachments over involvement in genuinely loving and sexually satisfying
relationships.
Viewing problems in sexual relating from an existential perspective
both challenges and expands on Freudian theoretical considerations. For
example, empirical research from existentially based terror management
theorists (TMT) has suggested a different way of looking at people's ambiva-
lence toward sex. In discussing the theoretical implications of terror manage-
ment research, Goldenberg et al. (2002) noted that

Although social scientists from Freud on have viewed ambivalence

about sex as a byproduct of cultural mores, the present research supports
an opposite causal sequence. The findings suggest rather that rules and
restrictions for sexual behavior protect individuals from confrontation
with their underlying animal nature that frightens us because of our
knowledge that all creatures must someday die. (Implications Regarding
Sexual Regulation section, 9f 1)

An understanding of how defenses function in relation to painful

experiences within the family as well as to death anxiety helps explain
many puzzling phenomena about human sexual behavior, including people's
tendencies to retreat from loving sexual experiences and intimate relating

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 163

in their adult associations. We have noted that when people have the
closest, most intimate experiences, they frequently become acutely aware
of their mortality and the pain and loss associated with it, and as a result,
many retreat from such experiences. Indeed, in extreme cases, they may
avoid sexual gratification altogether. On an unconscious level, they prefer
not to be loved and valued because it makes them more vulnerable and
aware of their own death. They often experience negative thoughts toward
themselves and/or their partner that they believe represent their point of
view. For example, many individuals have reported experiencing voice at-
tacks such as Why do you need anyone, anyway? You'll just be disappointed
and hurt if you really get involved. You can't trust him or her. Even if you find
someone who loves you, relationships don't last forever.
Loving sexual contact in combination with feelings of friendship in a
committed relationship arouses anxiety because it represents a powerful
intrusion into one's sense of safety and security, albeit false, achieved by
forming a fantasy bond. Moreover, experiencing the unique combination
of love and sex often reminds people of the fragility of the physical body
and of life itself.
We (Firestone et al., 2003) have called attention to people's tendencies
to renounce sexual pleasure and deny themselves happiness in close sexual
relationships because of the fact that sexual experiences are inextricably
linked to the body, which is subject to deterioration and eventually, death.
We have noted that "some individuals may become sexually withholding
to escape an awareness of being connected to their body" (p.194). As Becker
(1973/1997) put it, "The sexual conflict is thus a universal one because the
body is a universal problem to a creature who must die. One feels guilty
toward the body because the body is a bind, it overshadows our freedom"
(p. 164). "Sex is of the body, and the body is of death" (p. 162).
Recent findings from research based on terror management theory
have confirmed our views as well as Becker's hypotheses. Proponents of
TMT (Goldenberg, Pyszczynski, McCoy, Greenberg, & Solomon, 1999;
Solomon, Greenberg, & Pyszczynski, 1991) have argued that "sexual behav-
ior is affected by mortality concerns, because sex is an activity that reminds
us of our core animal nature" (Goldenberg et al., 1999, p. 1175).
Goldenberg et al. (1999) conducted empirical studies to test the follow-
ing basic tenets of TMT theorists, which stated that "Sex is a ubiquitous
human problem because the creaturely aspects of sex make apparent our
animal nature, which reminds us of our vulnerability and mortality. People
minimize this threat by investing in the symbolic meaning offered by the
cultural worldview" (p. 1173).
One experimental study demonstrated that anxious individuals who
ranked high in neuroticism "who are especially likely to find sex threatening,
rated the physical aspects of sex [on a scale] as less appealing when reminded

164 SEX AND LOVE IN INTIMATE RELATIONSHIPS

of their mortality" (Goldenberg et al., 2002, Introduction), Goldenberg
et al. (1999) concluded that "high-neuroticism individuals are conflicted by
sex and that the conflict is rooted in mortality concerns" (p. 1184). Because
the human body is vulnerable to illness, deterioration, and death, many
people also have a tendency to feel shame about their bodies and the pleasure
potentially available through bodily sensations and feelings. There is a sense
of betrayal in knowing that one is trapped in a body that will eventually
deteriorate and die.
Involvement in a close, loving sexual relationship would mean, in
effect, becoming reconnected to one's body, to one's deepest emotions, to
one's sense of self as a unique individual. It would entail the reexperiencing
of feelings of aloneness, separateness, and existential anxiety that may have
been successfully repressed. We have found that often in therapy, when
clients are relieved of a sexual symptom or problem (for example, a woman
becomes orgasmic for the first time, or a man overcomes an habitual pattern of
premature ejaculation), there is usually increased apprehension about death.
Existential psychologist May (1969) reported his observations of this
phenomenon in his patients, He proposed that "The relationship between
death and love is surely clear in the sex act" (p. 103). In a case analysis,
he discussed a patient who illustrated this hypothesis:

A patient, whose problem was sexual frigidity and who had never
experiencedan orgasm in intercourse, told me ofa dream which dramati-
cally illustratesthis sex and death theme. In her dream, she experienced
herself for the first time in her own identity as a woman. Then, still in
the dream, she had the strange conviction that she wouldhave to jump
into the river and drown. The dream ended in great anxiety. That
night, in sexualintercourse, she had an orgasm for the first time. (p. 103)

These dynamics can also be manifested in other sexual problems as

in this personal account revealed by Simone during a seminar on sexuality:

Simone: (to husband) When you and I first met, I so much enjoyed
getting to know you, and I really fell in love with you. You
were a different person from anyone I had ever known. I felt
like it was an amazing time in my life. Being with you, I
felt different sexually from the way I had felt before in any
relationship. You really wanted to know me on a deep level,
you wanted to know my body, my sexuality, and me, my
personality. I learned so much about myself in being close to
you in that way, whereas in previous relationships, I had
mainly focused on the sex, on whether I was going to have
an orgasm or not. But I think that in getting to know myself,
I became aware of the amount I had to lose. I began to have
thoughts and dreams about death.

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 165

 I remember a recurring dream I had around that time. In
the dream I'm on a train speeding across a long trestle bridge
high over a bottomless canyon. The train is headed straight
for a mountain, where the track abruptly comes to an end.
Everybody knows the fate of the train and we're all running
frantically through the cars, trying to get to the last car.
I'm running fast, trying desperately to stay alive a few more
minutes. I want to get to the last car before the engine crashes
into the mountainside. While I'm running, I realize it's futile,
that the situation is hopeless, there is really no escape. But
I keep running anyway, frantically trying to reach the last car.
Usually I would wake up screaming. Obviously, in the
dream, the train represents my body, which I can't escape
and the train ride is my life. The mountainside we're crashing
into is my death which I have no control over, no matter
how hard I try.
Looking back, I realize that after a while, I turned our
relationship into a source of comfort and I somehow stopped
relating to you personally. My nightmares disappeared. At
the same time, I was using you in that way to think you could
save me somehow. Our relationship became very connected
and I lost sight of what it really was in the first place.

In general, the more individuals become reconnected to the body and

the more they become emotionally invested in a sexual partner or mate,
the more anxiety and sadness they experience and the more they have to
lose. People often respond to the resulting rise in anxiety and emotional
pain on a preconscious or unconscious level by reverting to a defended
posture with little or no awareness of any alteration in their behavior.
Therapists can find it difficult to identify specific defenses against death
anxiety for this reason: defense mechanisms are instituted before clients
become aware of their anxiety on a conscious level.
Thus, it appears that the resistance, manifested by many individuals,
to a biological drive and a desire for activities that provide so much pleasure
is partly rooted in a powerful fear-the fear of deterioration, and death of
the body. Becker (1973/1997) stressed the fact that most people "chafe at
sex ... [because] they resent being reduced to the body ... sex to some
degree terrifies them: it represents two levels of the negation of oneself.
Resistance to sex is a resistance to fatality" (pp. 163-164).
The sexual act represents a double negation: by physical death and of
distinctive personal gifts. This point is crucial because it explains why
sexual taboos have been at the heart of human society since the very
beginning. They affirm the triumph of human personality over animal
sameness. (p. 163)

166 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 The implications of this point of view for understanding and treating
problems in sexual functioning are impressive. As Goldenberg et aL (2002)
noted in their conclusion, "Recognizing the conflict between our animal
and symbolic natures in the domain of human sexuality may shed light on
a myriad of problems associated with this most pleasurable aspect of human
existence" (Conclusion section, 91" 1).

CONCLUSION

To sustain a loving sexual relationship, individuals must be willing to

face the threats to the defense system that loving another person and being
loved for oneself evoke. To be able to accept genuine affection, tenderness,
love, and fulfilling sexual experiences as a part of an ongoing relationship,
they must be willing to challenge their negative voices, modify the image
of themselves formed in the family, and give up well-entrenched defenses,
which would cause them a great deal of anxiety.
Many people come to prefer a fantasy bond or illusion of connection,
where their psychological equilibrium is maintained, over genuine compan-
ionship and actual love. In forming a fantasy bond with their partner,
each person recreates painful experiences from childhood in present-day
relationships while maintaining an illusion of merged identity to cope with
the anxiety of existing as a separate, distinct individual. Essentially, individu-
als face a fundamental dilemma when entering into an intimate relationship:
whether to invest fully in the relationship and remain vulnerable to possible
rejection and loss, or to attempt to protect themselves by retreating to a
more inward, defensive posture and impersonal, self-gratifying modes of
sexual relating.
People could choose to go against their voice attacks and retain their
feelings of affection for each other. A couple could learn to share their
feelings about existential realities inherent to the human condition. In
recognizing that all human beings face the same existential crisis, they could
approach each other with a sense of genuine compassion and empathy.
Embracing life fully with minimal defenses would enable individuals to
remain open and vulnerable to experiencing love and sexual intimacy in
their relationships. As Coelho (2004) declared, "Profound desire, true desire
is the desire to be close to someone. . . . When desire is still in this pure state,
the man and the woman fall in love with life, they live each moment reverently,
consciously" (p. 133 ).11 People who have the courage and determination to
achieve these goals are better able to maintain an equal adult relationship,
personal closeness, and sexual fulfillment.

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 167

 NOTES

1. These effects of cumulative Averse Childhood Experiences (ACE) on the

physical and mental health of adults have been documented in a large popula-
tion study by Felitti (2002). Briere (1992) also has asserted that "the majority
of adults raised in North America regardless of gender, age, race, or social class,
probably experienced some level of maltreatment as children" (p. xvii).
2. See Silverman, Lachmann, and Milich (1982) and Keys et al. (1950). See also
Orbach, Shopen-Koffman, and Mikulincer (1994).
3. The idealization of the parents at the child's expense acts as a survival mecha-
nism for the helpless, dependent child because recognizing the full impact of
the negative characteristics of one's parents predisposes severe anxiety states
and a sense of hopelessness in the child. In Bloch's (1978) book So The Witch
Won't Eat Me, she asserted "That a distorted parental image may be essential
to the psyche's defensive system has emerged with great clarity from both my
work with children and my psychoanalytic treatment of adults" (p. 162).
4. Empirical studies conducted by Bocknek and Perna (1994) demonstrated how
childhood trauma is internalized. In his research, Bornstein (1993) also investi-
gated hypotheses stating that dysfunctional parental introjects predict an indi-
vidual's risk for psychopathology.
5. The formation of the fantasy bond or self-parenting process leads to a split
within the antiself system itself. The three ego states described in this chapter
are similar in some respects to those depicted by transactional analysis (T A;
Berne, 1961, 1964). Our analysis differs from TA analysts in terms of emphasis.
"We tend to stress the underlying defensive processes determining the move-
ment between the ego states, whereas T A clinicians generally concentrate
more on phenomenological aspects" (Firestone, 1988, p. 127). Obviously, adult
individuals do not exist exclusively in a childish or regressed state; rather they
vacillate between the parental and the child mode of experience. As a result,
they may spend only a small proportion of their time in the adult ego mode.
6. In Voice Therapy, Firestone (1988) described three modes of experience as
described in transactional analysis, the parental, the childish or regressive, and
the adult mode:

These modes of experience refer to internal ego states as well as to

behaviors and feelings expressed outwardly. Each person is in transition
between these modes, but he or she may become stabilized in one mode
or another in relation to other people. (p. 113)

The parental mode is reflected in self-attacks and other critical, superior atti-
tudes toward others, whereas the childish mode is reflected in regressive trends
and often in overly dramatic reactions to present-day events that are similar
to painful experiences in childhood.
7. Karpel (1994) described how people often remain unaware that their interac-
tions are defensive or negative when each partner's early attachments have
not been "good-enough":

168 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 When early relationships have not been good-enough, these longings
are likely to be intensified, by virtue of having been unmet, and to be
accompanied by fears and defenses which have developed to cope with
a range of negative feeling-states (such as frustration, rage, shame and
guilt, fear of abandonment, grief, and despair) and which interfere
with the natural development of the individual's capacity for intimacy.
However, because these feeling-states are so distressing, they are likely
to be repressed by the individual so that he or she has little conscious
awareness of them, but instead expresses them unconsciously in the
give-and-take of close relationship. (pp. 48-49)

8. Orbach (1999), in The Impossibility of Sex, described this process of deterioration

in sexual relating as follows:
Sexual intimacy, once irresistible and exciting-the way to connect and
communicate-turns humdrum. Sex becomes less frequent, less urgent,
and moves from being an opening up and exploration by two people
of one another to becoming a block between them, an act surrounded
by expectations, disappointment, worry or routine. (pp. 153-154)

9. The notion of implicit rules or contracts ("marriage contracts") was initially

described by Sager et al. (1971) as unconscious elements in each partner that
have an adverse effect on marital relationships. Other clinicians (Boszormenyi-
Nagy & Spark, 1984; Hellinger, 1998; Karpel, 1994) have delineated various
role expectations, family-of-origin "process" rules, and cultural prescriptions
that partners bring to the relationship. Harper, Anderson, and Stevens (2004)
investigated these rules in developing the Couple Implicit Rule Profile. They
cited both positive and negative unspoken rules: "facilitative (e.g., 'Share your
feelings,' 'Play, have fun together') and constraining rules (e.g., 'Don't feel or
talk about feelings,' 'You are responsible for how your partner feels,' 'Rely on
yourself, not your partner')" (p. 1).
10. See Foley, Kope, and Sugrue (2002, pp. 257-261) about challenging negative
thoughts that affect sexuality.
11. Quotation from Eleven Minutes by Paulo Coelho. Copyright © 2004 by Paulo
Coelho. Reprinted by permission of HarperCollins Publishers Inc.

FANTASY BOND, VOICE PROCESS, DEATH ANXIETY 169

 SEXUAL WITHHOLDING
7
If the sexual desires of one of the partners aren't reciprocated, he or
she isin a weakposition becausethe other has the powerto reject. (p. 34)

The fundamental balance of giving and taking that love requires is

threatened when one partner habitually gives or takes more, or when
what is given in love is not taken in love.
-Hellinger (1998, p. 46)

The phenomenon of sex-deprived marriages has become the focus of

the popular media and mental health professionals as well (H. Kaplan, 1995;
McCarthy, 1997a, 1999; Weiner-Davis, 2003). McCarthy (l997a) defined
a nonsexual relationship as one in which partners have sex less than ten
times a year. According to this definition, "approximately 20% of married
couples and 40% of nonmarried couples who have been involved more than
2 years have a nonsexual relationship. This is a major mental health problem
that poses a threat to marital satisfaction and viability" (p. 231).
Sex therapists tend to agree that the complaint of a majority of couples
who seek professional help is that of low or inhibited sexual desire
(H. Kaplan, 1995; McCarthy & McCarthy, 1998, 2003). McCarthy and
McCarthy (2003) noted that "Research studies ... find that 1 in 3 women
and 1 in 7 men report inhibited sexual desire. Sometime in marriage more
than 50 percent of couples experience inhibited desire or a desire discrep-
ancy" (p. 5). H. Kaplan (1995) also emphasized that "The majority of our
patients with sexual desire disorders reported that their problem was acquired,
that is, that they lost their sexual desire after some period of normal function-
ing" (p. 56).1

Portions of Helen Singer Kaplan's The Sexual Desire Disorders were reprinted in this chapter.
Copyright © 1995 from The Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation by
Helen Singer Kaplan, MD, PhD. Reproduced by permission of Routledge/Taylor & Francis Books,
Inc.

171
 There is confusion about the factors that are responsible for this trend.
We propose that the decline that many couples experience in sexual desire
and activity as their relationship matures is largely attributable to the tenden-
cies of individuals to form a fantasy bond with their partner. Once a fantasy
bond is formed, a person withdraws from intimacy to a self-protective illusion
of being fused with the other. Underlying this withdrawal is a fear of needing
anything from others and of having to give anything of oneself. These
feelings manifest themselves in withholding behaviors.
In this chapter, we describe how sexual withholding-a major dimen-
sion of the defensive process-blocks the subjective experience of sexual
desire, thereby contributing to the deterioration in sexual relating that
many couples experience as their relationship matures. Next we delineate
environmental factors that predispose the development of self-denying and
withholding tendencies. These include parental withholding in relation to
children's wants, fears of competing because of covert or overt sexual rivalry
within the family, or parents who were unable to offer or accept affection
in relation to each other or to their children. In addition, we discuss how
the experience of incest and sexual abuse during childhood can lead to
inhibited sexual desire in adulthood. Case studies illustrate how destructive
thought processes or internalized voices regulate or control the withholding
of affectionate and sexual responses.
Sexual withholding is one form of a more general pattern of withholding
and self-denial that has not been fully explored in the psychological litera-
ture, with some exceptions (Bach & Deutsch, 1979; Carnes, 1997; Love &
Shulkin, 1997; Mitchell, 2002). Holding back one's positive qualities and
goal-directed behaviors represents a major dimension of an inward, defensive
process that intrudes into all areas of one's life. Withholding is part of a
self-destructive process that represents an attempt to gain control over
potential hurt, loss, or separation. Such tendencies to avoid fear and pain
are understandable and yet the very act of holding back to avoid being
hurt can paradoxically exacerbate an individual's misery (Firestone, 1985;
Firestone & Catlett, 1999).
Sexual withholding can be defined as an inhibition of expressions of
sexual desire and interest, including physical affection, touching, attractive-
ness, and other aspects of healthy sexuality. People tend to withhold loving
feelings and sexual responses from their partners as part of a basic defense
against genuine closeness and sexual intimacy. This reduction of emotional
transactions with one's partner is characterized by the reluctance to exchange
psychonutritional products.' Thus, the withholding partner is able to main-
tain a comfortable distance in the relationship and keep his or her defenses
intact.
Sexual withholding and denying oneself sexual pleasure, referred to
by some clinicians as "sexual anorexia" (Carnes, 1997), can lead to a wide

172 SEX AND LOVE IN INTIMATE RELATIONSHIPS

range of sexual disturbances in an intimate relationship.' Individuals who
tend to be sexually withholding or chronically self-denying may have sex
infrequently or not at all, experience discomfort in sexual situations, with-
draw from being close emotionally to their partner during sex, or experience
difficulties during the arousal phase, foreplay, or penetration. Clinically, they
may manifest symptoms of inhibited sexual desire, psychogenic impotence, or
female orgasmic disorder. Many individuals suffering from low sexual desire
are hesitant about entering into intimate transactions because of their resis-
tance to offering love and affection outwardly or to taking love in from an
outside source.
We are not referring here to people who intentionally or consciously
withhold as a calculated manipulation that is meant to be hurtful. Instead,
the focus is on individuals for whom sexual withholding is largely uncon-
scious and causes both partners pain and distress. Much of the suffering and
conflict within relationships is due to one or both partners taking back the
love, affection, and sexual responses they once felt and expressed.

WITHHOLDING BASED ON SELF-DENIAL

In an intimate relationship, sexual withholding may involve (a) a

holding back from or distancing of oneself from one's partner, or (b) a
holding back of pleasure from oneself, which incidentally hurts the other
person as well. On some level, the partner who denies him- or herself sexual
pleasure becomes increasingly more self-hating and guilty, which in turn
leads to more self-denial, sexual inhibition, and avoidance of sexual situa-
tions. The individual who is being withheld from experiences considerable
frustration and anger, which he or she often attempts to suppress.
The process of denying oneself sexual pleasure and fulfillment often
becomes automatic and involuntary over time. Many cases of low sexual
desire and lack of sexual responsiveness can be directly or indirectly attrib-
uted to habitual self-denial (Carnes, 1997; Firestone, 1985). Individuals who
deny themselves gratification may also have strong needs to control other
aspects of the sexual relationship. In terms of our theoretical approach,
these individuals are attempting to regulate an inner world of fantasy and
maintain psychological equilibrium. They tend to perceive spontaneous
sexual responses and free-flowing sexual experiences as risky and potentially
painful. In his book, Can Love Last?, psychoanalyst Mitchell (2002) provided
a cogent explanation for people's need to control sexual passion in a long-
term relationship:
Erotic passion destabilizes one's sense of self. When we find someone
intensely arousing who makes possible unfamiliar experiences of our-
selves and an otherness we find captivating, we are drawn into the

SEXUAL WITHHOLDING 173

 disorienting loopiness of self/other. We tend to want to control these
experiences and the others who inspire them. Thus, emotional connec-
tion tends to degrade into strategies for false security that suffocate
desire. (p.92)

Lori grew up feeling that she did not deserve much out of life. Whenever
she hesitantly expressed a desire for something, her parents automatically
denied her requests and told her she was selfish, needy, and demanding. As
an adult, she gradually lost interest in sex and began working compulsively
in her career in real estate. In her midtwenties, she met Scott and their
relationship was fun and romantic for a brief period of time. However,
troubled by her decreasing interest in being sexual, Lori entered psychother-
apy. In the first session, she revealed that she had a self-denying approach
to life:

Lori: I rarely allow myself to have fun, to go out to movies or dinner.

But the main thing that bothers me is I'm not as excited or as
interested in making love as I was, and things have started to
feel bad between Scott and me.
In fact, anytime I start to feel happy, I feel incredibly guilty,
like I shouldn't be having fun. I find myself thinking, Just wait
until the ax falls. Things can't stay this good forever. I even
start wondering why Scott still likes me, especially since I've
been so rejecting of him. Why would he like me? I really get
myself into a down mood thinking like that, and then I find
myself wanting to avoid him even more.
I remember when I left home for college, my mother told
me that I was going to regret going away and leaving them.
My mother and father didn't get along, and I think she resented
the fact that I was getting away and leaving her with him. She
was so sarcastic and nasty the day I left: She practically yelled
at me as I went out the door. I remember her exact words:
"So you think you can just go off and have your own life, do
you? Well, don't be so sure of yourself, Lori. You're nothing
special. What have you ever done for your father and me?
You're so ungrateful for all we've done for you. You don't
deserve anything!"
Just remembering those words makes me realize more than
ever before why I deny myself pleasure and hold back from Scott.
Why I have to control myself and him so much. Why I won't
simply be happy. Why I only let myself have little dibs and dabs
of fun and happiness. It's pretty clear how I learned to deny
myself everything, It's exactly like the way my parents denied
me anything I wanted when I was a kid.

174 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 PASSIVE-AGGRESSIVE WITHHOLDING BASED
ON SUPPRESSED ANGER

One common form of withholding is passive-aggression, which can

be attributed to suppressed anger. H. Kaplan (1995) has noted that "anger
at the partner is the most common and serious underlying cause of partner-
specific loss of desire" (p. 142). Withholding behaviors based on hostility
have the effect of provoking angry responses in a partner, thereby creating
alienation and distance in the relationship." In a sexual situation, hostility
may be acted out in a disguised form in a number of ways. The partner who
has suppressed hostile feelings toward his or her mate often pulls back
unconsciously from being emotionally close during the sex act.
According to McCarthy and McCarthy (1998), one cause of inhibited
sexual desire is "negative emotions, especially anxiety, depression, or anger.
... Anxiety is the problem easiest to treat.... Anger is the most difficult
emotion to deal with.... Anger usually involves nonsexual issues, but it
poisons the sexual relationship" (p. 179).5 H. Kaplan (1995) also emphasized
that most patients have little awareness of the underlying anger and anxiety
that fuel their avoidance of sexual relations with their mate: "It should be
noted once again that patients with sexual motivation dysfunctions typically
have no insight into the self-induced elements in their lack of sexual interest
in the partners; they tend to blame this on 'poor chemistry'" (p. 117).
In a long-term relationship, if partners become withholding, they tend
to perceive sexual intimacy as threatening to their defended, inward state
and so try to avoid spontaneous sexual interactions. In some cases, one
partner may attempt to control certain dimensions of the sexual encounter,
including how often the couple makes love, the conditions under which
they make love, as well as the techniques and positions they use. In general,
by reducing both their responses of giving to and taking from a sexual partner,
men and women effectively limit or control the emotional transactions in
the relationship, which in turn contributes to a deterioration in the quality
of their sexual relating.

WITHHOLDING AND MIXED MESSAGES

In relationships characterized by a fantasy bond, mixed messages play

an important role in supporting the form of the relationship while negating
the fact that love and sexual passion have declined. If partners are made
aware of their withholding patterns and reveal the underlying hostility or
grudges, this admission necessarily disrupts their illusion of closeness and

SEXUAL WITHHOLDING 175

connection. Mixed messages, combined with withdrawal and withholding,
have been observed in videotaped interactions between partners as part of
a research study conducted by Gottman and Krokoff (1989). Their studies
demonstrated that when double messages are part of partners' customary
ways of interacting, their negative emotions tend to be communicated
nonverbally through their posture, tone of voice, and other bodily cues. A
preponderance of negative nonverbal or latent messages, in conjunction
with positive verbal messages, between partners more often than not is
predictive of the eventual dissolution of the relationship.
Other clinicians have described mixed messages, communication styles,
and actions that are used to cover over anger. Keeley and Hart (1994)
asserted,

Mixed messages may lead to uncertainty about the relationship or part-

ner and very often are communicated with nonverbal cues.... These
cues (e.g., eye blinking, increased self-touching, more speech hesita-
tions) may send messages of distraction and reticence, which would be
detrimental to the intimacy process. (pp. 156-157)

Passive-aggressive, withholding behaviors, together with positive ver-

bal messages, create considerable confusion and conflict in intimate relation-
ships. Bach and Deutsch's (1979) book, Stop! You're Driving Me Crazy,
examines the myriad ways that people in everyday life attempt to disguise
their aggression through double messages, resulting in what they termed
"crazymaking" (CM). Citing cases from their clinical research, Bach and
Deutsch reported, "From thousands of stress reports during individual and
group psychotherapy sessions, a linkage emerged between pathogenic com-
munication patterns and indirect, so-called passive aggression" (p. v).
According to Bach and Deutsch, CM "derives from the obscure portion
of a double message" (p. 20).

The open half of the message is always clear and understandable....

It is invariably a message of goodwill, acceptance, agreement, love,
concern, loyalty. But the second half of the double message is always
foggy. It is indirect. And it is always especially hard for us to hear and
understand, because it is something we don't want to hear. In many
cases, it suggests a conflict in the relationship.... That contradiction
is what is so maddening. (p. 20)

Bach and Deutsch suggested that double messages and passive-aggres-

sive or withholding behaviors are particularly detrimental to a couple's
sexual life. "Sexuality can encompass CM behaviors at their most impactful"
(p. 270). One CM pattern they described ("your wish is my wish") represents
a "false kind of accommodation" (p. 152).

176 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 He: Gee, it feels good to be close to you. I know you've had a tough
day, with the kids being sick and all. But wouldn't you like to
roll over and come closer?
She: [Exhausted but accommodating even though shefeels little or no sexual
interest} You know I always like to be close to you. [And she rolls
over. But note that she does not answer his question about what
she wants.]
He: [Touching] Does this feel good?
She: [Again not really answering] You know I always like it when you
touch me.
He: [After some minutes of touching] I want to be inside you. Do you
want me inside you?
She: Have I ever said no, dear?
But there comes a time when the accommodator's partner realizes that
yes did not really mean genuine and willing assent-only submission.
When he tries to enter her, he finds that she is really not prepared for
him to do so. (p. 153)
Withholding behaviors are the nonverbal manifestations of anger that
partners are afraid to expr~ss through direct communication. Often this
anger has been suppressed and exists on an unconscious level. For example,
a man told his fiancee that he loved her long hair; the next day she had
it cut short and permed and could not understand his shock and angry
reaction. A woman who repeatedly asked her husband to leave the keys to
the family car for her whenever he went on a business trip felt provoked
each time he "forgot" and took the keys with him. In both cases, the eM
partner was "innocent" in one sense, in that the anger driving the withhold-
ing behavior was mostly unconscious.
In many cases, individuals use subtle patterns of withdrawal and with-
holding to disguise rejection. Intimate partners may not wish to acknowledge,
either to themselves or to the other, the fact that they are rejecting the
other person. For example, Joshua and Lynn had been dating for several
months. From the beginning of their relationship, Joshua had been open
in expressing his love for Lynn. Lynn, who was somewhat reserved, was
more cautious in communicating her feelings toward Joshua. Although he
was satisfied for the most part with the way the relationship was evolving,
Joshua told Lynn that his fantasy was for her to fall in love with him as he
had with her. Specifically, he longed for her to verbally state her love for him.
One evening, after their lovemaking had been especially passionate
and close, Lynn found herself spontaneously saying the words of love that
Joshua had been waiting to hear. She realized that she valued the relationship

SEXUAL WITHHOLDING 177

and was willing to take a chance and invest more emotionally than before.
After she shared her feelings with Joshua, the couple talked at length about
themselves and their relationship. Then Lynn fell asleep in Joshua's arms.
Waking several times during the night, she continued to be physically
affectionate and close to him.
The next morning, Joshua woke up irritable and sullen. He accused
Lynn of keeping him awake all night and complained of being "sleep-
deprived" because her affectionate embraces had disturbed his sleep. During
the next several weeks, Joshua became less affectionate and avoided opportu-
nities to be sexual, while continuing to tell Lynn that he loved her. In an
interview six months later, Lynn revealed that she and Joshua had ended
their relationship. After the breakup, Joshua entered individual psychother-
apy. In his sessions, he identified the negative attitudes he had toward
women and his belief that no woman would ever love him. Desperate to
hold on to Lynn, he had tried to deny the anger and anxiety that were
aroused when her statement that she loved him contradicted his negative
attitudes and expectations. Unable to face his angry feelings, Joshua had
struggled to suppress them, yet his underlying hostility had been expressed
in his behavior toward Lynn.

PREDISPOSING FACTORS IN
FAMILY RELATIONSHIPS

In growing up, children experience a number of events and circum-

stances that predispose the development of withholding behaviors. Examples
of these are parents who are disrespectful of the boundaries of their children
and continually intrude on their lives; immature parents who use their
children's achievements to enhance their own self-image or to live through
them; parents who are withholding themselves and therefore are incapable
of accepting or offering love and affection to each other or to their children;
or an environment that is characterized by neglect, rejection, or outright
abuse.
In his work, Barber (2002) called attention to a particular form of
parental intrusiveness that some research has shown to be detrimental to
the developing autonomy of children and adolescents. He referred to this type
of negative parental behavior as "psychological control" and has explored
the correlations between this type of parental control and outcomes in
adolescence, in particular in teens who are aggressive in their peer
relationships.
In a series of research studies investigating the components of psycho-
logical control, Nelson and Crick (2002) elaborated on Barber's (1996)
earlier conceptualization. Their findings tended to support Barber's initial

178 SEX AND LOVE IN INTIMATE RELATIONSHIPS

construct and his descriptions of the types of parental behaviors that make
up psychological control, including parental withdrawal of love, guilt and
shame induction, criticism, and excessive control of a child's life through
possessiveness and overprotection. Nelson and Crick conducted studies to
explore their hypothesis that "relationallv aggressive children, within the
context of exclusive, enmeshed relationships with parents, may learn that
close, intimate relationships are highly valued and, perhaps, that the manipu-
lation of such relationships is an effective means for achieving one's
goals" (p, 168).
Our descriptions of parental intrusiveness, possessiveness, and emo-
tional hunger are similar in many respects to Barber's concept of psychologi-
cal control. We have observed that children growing up in an environment
in which their feelings are manipulated through guilt and shame, where
their wants and needs are invalidated or disappointed, and where there is
no respect for personal boundaries, often begin to withhold from their
parents to protect themselves. Unfortunately, this protective behavior on
the child's part can persist into adult life.
When children suffer emotional pain and frustration in family interac-
tions, they tend to withdraw their emotional investment in parents or other
caretakers, that is, a process of decathexis occurs. They learn to stop wanting
real affection and become self-denying. At the same time, they give up their
natural feelings of love and affection toward others and learn to withhold.
They restrict the expression of their natural feelings and gradually substitute
fantasy and a defensive, inward posture toward life that keeps real experiences
manageable and helps maintain psychological equilibrium. In addition, as
described in chapter 3, emotionally hungry parents exert a pull on children
that leaves them drained of their own resources. Later, as adults, they may
self-protectively turn away from potential sources of gratification, including
being fulfilled in an intimate sexual relationship. Many adults who were
hurt as children also indicate fears of being drained that persist into adult
life, and interfere with relationship satisfaction.

Factors Predisposing Withholding Based on Self-Denial

One environmental factor strongly related to the child's developing

a posture of self-denial is the parents' inability to accept expressions of love
and affection from their offspring. Many well-meaning parents unconsciously
discourage loving responses from their infant or young child because these
responses threaten their defenses and emotional equilibrium. When parents
find it difficult to accept expressions of love from their offspring, their
children learn to gradually disengage from themselves and suppress their
positive feelings." Many come to believe that there is something wrong with
their loving feelings and that their affection or their physical nature is

SEXUAL WITHHOLDING 179

somehow unacceptable. The resultant shame they experience causes them
to unconsciously resolve to hold back their warmth, tenderness, and affection
in future interactions.
Children are also injured psychologically when parents vacillate be-
tween being self-protective or inward and being in a more emotionally
responsive state. When parents are in a feeling state, they are more sensitive
to their offspring and may be able to feel and express the love they character-
istically withhold. The child, in tum, naturally responds to his or her parents
with love and affection. However, when parents revert to a more defended
state and a more impersonal mode of relating, they are blocked in their
sensitivity and concern for their child. Their withdrawal causes considerable
hurt particularly when it occurs following unusually close times with their
offspring (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1973; Wein-
field, Sroufe, Egeland, & Carlson, 1999).
As the child matures, other parental behaviors contribute to the ten-
dency to be self-denying. Parents encourage this self-denial by responding
with rejection to their children's wants and by humiliating them for express-
ing their wants and needs, as Lori's parents did. Parental withholding of
affection instills a deep sense of shame in the child, which later in life is
transformed into feelings of embarrassment, self-consciousness, and a sense
of degradation about having sexual wants and desires. In addition, mothers
and fathers who are self-denying and hold back affection from each other
serve as poor role models for their daughters and sons. Children observe,
and later imitate in their adult relationships, the withholding behaviors
they saw acted out between their parents.

Fears of Competition

In some cases, sexual withholding can be motivated by a fear of compet-

ing because of covert or overt sexual rivalry within the family. As noted in
chapter 3, children of both genders often feel threatened by retribution
from their parent of the same sex. As adults they tend to retreat from
expressions of mature sexuality and hold back their natural responses of
affection and love. In many cases, they project onto their present-day rivals
the fears of retaliation they originally experienced in relation to a parent.
We suggest that many men and women retreat from competitive situations
because they anticipate that either winning or losing will arouse destructive
thoughts and angry self-attacks. The dynamics discussed here contribute to
an understanding of one important outcome resulting from unresolved oedi-
pal issues (Firestone, 1997a; Firestone & Catlett, 1999).
Other clinicians have noted this phenomenon. For example, in summa-
rizing her clinical work, H. Kaplan (1995) concluded that the etiology of

180 SEX AND LOVE IN INTIMATE RELATIONSHIPS

inhibited sexual desire lay in early childhood experiences. She asserted that
"The family histories of patients with intimacy-passion splits often reveal
one of two types of 'deeper' causes: 1) the reawakening of the incest taboo, and
2) painful early emotional attachments" (p. 146). In describing these patients,
Kaplan noted that they "find nice partners, but always manage to destroy
their relationships" (p. 146). Kaplan observed that these patients manifested
"the inability to sustain passionate feelings within a close committed relation-
shiP" (p. 146).
These men and women experience normal feelings of desire and passion
in the early stages of a relationship. However, if the partner looks for
more of a commitment or a greater degree of intimacy, at a certain
point, a point that exceeds these individuals' psychic "safety zones,"
they shift into a critical, countersexual mode, and lose their erotic
interest in the partner. (p. 146)
From our perspective, at this point people's defense systems ("safety
zones") are threatened by the experience of being loved and especially
valued, and they may begin to act out patterns of sexual withholding with
little or no conscious awareness.

Factors Predisposing Withholding Based on Passive-Aggression

Children have limited outlets for expressing pain and frustration in

the family. They find it safer and more acceptable to express their anger
indirectly by holding back behaviors and responses that their parents request
or demand from them. They also learn that they have some leverage over
their parents by acting out passive-aggressive behaviors, including noncom-
pliance, incompetence, and dawdling. The acting out of anger indirectly is
an attempt to avert the retaliation they imagine they would receive for
more direct acts of anger and provides a measure of release. Some children
eventually become so accustomed to withholding that they come to believe
that they are unable to perform certain tasks that are, in reality, within
their capabilities.
Men and women who have grown up with the automatic response of
saying "no" to themselves and others are resistant to changing these patterns.
Because this form of holding back is largely an unconscious process and is
manifested primarily in passive behaviors, it is difficult to confront this
defense directly or to pinpoint which specific behaviors are being withheld.
The person who is made aware of his or her negativism or hostility tends
to act wounded and misunderstood and becomes defensive when passive-
aggressive techniques are exposed. This is particularly evident in intimate
relationships where people are often the most angry and defensive when
their withholding patterns are pointed out by a mate or therapist.

SEXUAL WITHHOLDING 181

Child Sexual Abuse

The effects of child sexual abuse are often manifested in symptoms of

inhibited sexual desire disorders in adult individuals. In their work, M. Lewis
(1992) and Fried (1960) have also suggested a direct link between shame
and the inhibition of sexual responses. Moving in and out of physical
closeness is intolerable to individuals who have acquired a sense of shame
about their bodies or their sexuality during their formative years or who
have become cut off or removed, to varying degrees, from themselves and
their feelings. As adults, these individuals may unconsciously hold back a
full sexual response to avoid reawakening these painful feelings or memories
and reconnecting with their authentic self.
Findings by Kinzl et al. (1995) have shown that "Women who experi-
enced multiple sexual abuse often reported intimacy disturbances (i.e., im-
pairment of shame and a sense of guilt, disgust, anxiety), and impairment
of sexual pleasure" (p. 790). 7 In many cases of child sexual abuse, dissociation
is the basic defensive response (Courtois, 2000). During a close sexual
experience, women with histories of child sexual abuse may become anxious,
which can precipitate a number of defensive reactions, including the defense
of dissociation. M. Lewis (1992) conjectured that "dissociation occurs as a
consequence of early and severe childhood trauma, usually of a sexual
nature" (p. 172).

It appears reasonable to conclude that abuse, sexual or otherwise, leads

to shame. The shame produced is too powerful and painful and needs
to be transformed. During the shame-avoidance process the dissociation
occurs .... When shamed, the self attempts to remove itself from the
shamed self. One can remove oneself in a variety of ways.... The most
intense way may be the splitting of the self. (p. 172)

Rothschild (2000) noted that for many people who suffer from posttrau-
matic stress disorder as a result of childhood sexual abuse, their symptoms-
"accelerated heart rate, cold sweating, rapid breathing, heart palpitations,
hypervigilance, and hyperstartle response (jumpinessj-i-jmav become
chronic]. When chronic, these symptoms can lead to sleep disturbances,
loss of appetite, sexual dysfunction, and difficulties in concentrating" (p. 7).
Andrews (2002) also emphasized the fact that child sexual abuse has
a profound effect on a woman's body image. She noted that "At a cognitive
and emotional level, abuse survivors often report a deep shame and hatred
of their bodies that goes far beyond the normative discontent experienced
by the majority of women in Western societies" (p. 257).
In her clinical work, H. Kaplan (1974, 1995) described many cases of
inhibited sexual desire and sexual aversion disorders that were related to
child sexual abuse and trauma. Kaplan (1995) suggested one reason why

182 SEX AND LOVE IN INTIMATE RELATIONSHIPS

feelings associated with child sexual abuse might be reawakened as partners
became closer emotionally:
The inability to meld emotional closeness with sexual passion is hardly
surprising in persons who sustained substantial emotional damage in
early life. These individuals simply feel safer reserving their erotic feel-
ings and desires for strangers who cannot get close enough to hurt
them. (p. 147)

We are familiar with many cases similar to those described by Kaplan

(1995). In one case, Olivia, 25, found herself holding back her affection
and sexual responses at times during sex. Olivia and Greg had been married
a year when these problems began to surface. In one session, Olivia described
the tumultuous emotions she experienced while making love. According to
Olivia, these emotions usually emerged just as she was beginning to relax
and enjoy Greg's affection and sexual caresses.
Olivia: I don't feel like there are any words exactly when Greg and
I are being sexual. It's more like a very strong feeling that
I want him to stop.

Therapist: If you could say something at the time, what would you say!

Olivia: Well, in that situation, I really feel like saying to him,

"Don't touch me there. It hurts. Leave me alone. Don't
push my face like that. Leave me alone! I don't want to be
with you. Don't touch me like that. I hate the way you
touch me. Don't put your face on my face. Oh, I can't
breathe, I can't breathe. Don't put your face there. I hate
your face. I hate your breath in my face. Oh, it makes me
not be able to breath. Don't come to me. I don't want to
be with you. It hurts. [crying] You're so big and so heavy.
It just hurts too much." [crying]
Therapist: What are some of your thoughts about this!

Olivia: I have clear thoughts about it, and it definitely relates to

my father. I feel like I have flashes, like little pictures in
my head of things that happened. I remember hearing him
knock on my mother's door and then she would reject him
and not want to be with him. Then for some reason, I
remember him coming to me and that's when I felt those
feelings. I feel like a kid sometimes now in the sexual
situation. I feel like a small child. I feel like things hurt
that wouldn't hurt if I could just relax and be myself, but
I can't. It hurts in a way where it doesn't feel like I'm a
woman. It feels old to me. It feels more like memories.

Therapist: A repetition?

SEXUAL WITHHOLDING 183

 Olivia: Exactly. I think it was about three weeks ago that Greg and
I were starting to make love and his face at one point was
very close to mine. It felt like it was almost pushing a little
bit and fury just overwhelmed me. I tried not to act it out
or anything, but the feelings overwhelmed me. The feelings
that I felt were that same thing, "Don't push on my face.
It hurts. Don't push on my face!" But the feeling was that
this huge face, this big face was near my face and the breath
was on my face and I didn't want to be there. That was
the feeling. All of a sudden this one little thing, his face
being close to mine, reminded me of something from the
past, and I completely lost any desire I might have had for
making love. I just wanted to get away. And now it's been
weeks since we last made love.

In other cases, where the sexual contact between adult and child was
nonaggressive, the perpetrator may have been the only source of affectionate
contact available in the family. Many clients, both men and women, have
revealed that they found certain aspects of the sexual contact pleasurable,
yet experienced considerable guilt regarding these reactions. For example,
during the course of therapy, a woman remembered that as a child of five,
she eagerly anticipated weekend visits with her father. Her parents were
divorced, and the young girl lived with a cold, punishing mother. The
affection and attention she received from her father on these occasions
made her feel cared for, despite the fact that the affection included sexual
fondling. On some level, she knew these activities were wrong and felt
guilty for keeping them secret from her mother. Later, she revealed that
she was resistant to telling her husband about what she liked to do sexually.
On an intellectual level, she knew that her reluctance to talk with her
husband about sexual issues was irrational, yet she found it impossible to
break her silence and became increasingly more inhibited in her ability to
experience pleasure during sex. As her therapy progressed, she was able
to trace the origins of this withholding pattern to the guilt and secretiveness
she had felt as a child in relation to the sexual activities with her father.
In cases of males who had been sexually abused as children, Gartner
(1999) found that "Sexual dysfunctions are common among these men,
including lowered or excessive sexual desire, sexual aversion, erectile disor-
der, inhibited orgasm, and premature ejaculation" (p. 201). H. Kaplan (1995)
has noted that boys who are victims of childhood sexual abuse and incest
often manifest symptoms of sexual dysfunctions as adults: "When they grew
up, men who had been abused ... developed a variety of severe and disabling
sexual, as well as post-traumatic, emotional symptoms" (p. 125).
Alex, 26, grew up in an extremely dysfunctional family. Throughout
his childhood, Alex, his father, mother, and five siblings had lived in his

184 SEX AND LOVE IN INTIMATE RELATIONSHIPS

grandfather's home, where his uncle had been a frequent visitor. Both his
grandfather and his uncle sexually abused Alex from the time he was nine
until he left home at 17. Alex reported that his brothers and sisters had
also been sexually abused by the two men.
During therapy, Alex had to face the fact that his parents could be
considered criminally neglectful in that they had failed to notice the abuse
that was "going on right under their noses," as Alex put it. He revealed
that his mother, who was addicted to prescription drugs, was "totally out
of it," while his father, who was rarely at home, was generally indifferent
to his wife and children and, at times, explosive and violent.
Alex disclosed that in his relationships with women, he craved affection
and tenderness. He enjoyed "cuddling," saying that he simply wanted to
sleep with a woman, have her hold him in her arms, but was not drawn to
being sexual. He tended to pursue women who were highly sexualized but
then felt used by them and tended to withdraw and feel depressed after
these encounters. Meanwhile, Alex had a fantasy of meeting the "perfect
woman and settling down in a house with a white picket fence," where he
would feel comforted, soothed and safe. It was understandable that Alex
had intense fears of men and strong homophobic feelings, which he tried
to disguise with a tough, macho facade.
The incident that motivated Alex to come to therapy occurred when
his girlfriend had an affair. According to Alex, their relationship was going
well until she began really liking him and indicated that she wanted to be
with him more often. Frightened by what he perceived to be a demand for
more frequent sexual relations, Alex pulled away sharply and did not contact
her for two weeks. In the meantime, she began the affair out of hurt and
anger. Alex felt devastated, even though he recognized that his rejection
had precipitated the infidelity.
It became clear in the course of therapy that Alex's feelings and
attitudes toward sex were closely related to the sexual abuse he suffered
during his formative years. The connection between his current sexual
inhibitions and his early abuse was particularly evident when he described
the ways he felt sexually with women. For example, in one session, he said,
"Whenever a woman has sex with me, I feel so empty and used afterward.
I absolutely can't stand those feelings."

DESTRUCTIVE THOUGHT PROCESSES

UNDERLYING SEXUAL WITHHOLDING

The voice process regulates patterns of sexual withholding and self-

denial that are at the core of inhibited sexual desire disorders and many
other sexual dysfunctions. Self-critical attitudes as well as thoughts reflecting

SEXUAL WITHHOLDING 185

animosity toward one's partner can erupt into consciousness at any time
during a sexual experience, decreasing feelings of sexual desire and increasing
performance anxiety and feelings of self-consciousness. In responding to
these negative prescriptions, men and women may inhibit their spontaneous,
natural responses before, during, and/or following a sexual experience. As
a result, they often shift their focus to concerns about performance and
concentrate on the technical aspects of sex in an effort to circumvent these
inhibitions and complete the act of sexual intercourse.
Self-attacks and the accompanying angry affect relate to people's basic
feelings about themselves, their bodies, their sexual identity, and their ability
to both give and receive sexual pleasure and gratification. Even the mildest
voice attack can interfere with an individual's ability to take pleasure in
making love (Firestone, 1990c). Internalized voices also reinforce feelings
of shame and guilt that, in turn, effectively tone down or dampen sexual
desire and arousal (Firestone, 1988, 1997a).
Other clinicians have called attention to dysfunctional attitudes and
beliefs that are experienced by self-denying men and women. For example,
in Sexual Anorexia, Carnes (1997) delineated a number of core beliefs
subscribed to by men and women who deny themselves sexual pleasure and
fulfillment; dysfunctional beliefs that can be translated into the form of
voice attacks:

Anorexics believe: that they are unworthy and unloveable, that they
cannot depend on others, that they will have to take care of themselves;
that relationships make them vulnerable to abuse and exploitation, that
sex is terrifying, that sex must be controlled and repressed, [and] that
intimacy and sex cannot be combined. (p. 92)

On the basis of extensive clinical and empirical research with 2,109

patients and couples "with chief complaints of deficient sexual desire,"
H. Kaplan (1995) concluded that

The pathological decrease of these patients' libido is essentially an expression

of the normal regulation of sexual motivation gone awry. . . .
Further, my observations of patients with "sexual anorexia" or HSD
indicate that the psychogenic form of this syndrome is caused by
their active, albeit unconscious selectively negative cognitions and per-
ceptual processes by means of which they literally "turn themselves
off." (p. 3)

Before a sexual encounter, these negative cognitions may take the

form of self-protective warnings against becoming involved sexually and
emotionally with another person, which can effectively destroy one's sexual
interest, excitement, and desire. According to Kaplan, "The negative feelings
of desire disorder patients typically surface before they enter the bedroom,

186 SEX AND LOVE IN INTIMATE RELATIONSHIPS

thereby destroying any possibility of a normal build-up of their sexual desires"
(p. 118). For example,

You've had such a stressful day. You're too tired to have sex.
He (She) was such a creep at dinner. Why would you want to make
love to him (her)?
Why all the fuss about sex? There are other, more important things
to think about in life.

Men and women who are seeking a new partner or relationship often
experience cynical attitudes and thoughts that take away from the excite-
ment of a first date or meeting with a potential partner, thoughts such as,

Why would he (she) like you, anyway?

He (She) has no real interest in you.
What are you so excited about? He (she) is only interested in what
he (she) can get.
Keep it casual. Don't get too attached.
What do you needa relationship foranyway? You're okayon yourown.
To add to these original difficulties, the acquired immune deficiency
syndrome (AIDS) epidemic has become a destructive issue in people's sexual
lives; those contemplating a new sexual involvement often experience voices
warning them about the possibility of contracting AIDS or other sexually
transmitted diseases. These thoughts contribute to feelings of distrust and
hostility toward a potential partner. Clearly, these voice attacks are capable
of extinguishing erotic feelings and sexual desire at a critical juncture prior
to having sex.

What if he (she) isn't telling the truth about being tested?

How do you know he (she) is telling you the truth about his (her)
sexual history?
When people fail to subject these pessimistic injunctions to reality-
testing, their feelings of sexual desire are considerably diminished. This
line of thinking can also contribute to hesitancy and nervousness during
subsequent phases of the sex act.
People's angry, cynical attitudes toward their sexual partners have been
identified as crucial factors in the development and maintenance of HSD
in one or both partners. H. Kaplan (1995) has stressed this causative factor
in her work:
The major HSD theme ... [is] the selective focus on the negative aspects
of the partner, with simultaneous denial of positive qualities. To put it more
graphically, when they are with the right person in the right place,
instead of getting into gear and stepping on the gas, patients with HSD

SEXUAL WITHHOLDING 187

 keep their foot on the brake or shift into reverse, so that they never
get anywhere, sexually speaking. (pp. 115-117)

Sexual withholding is prevalent in many long-term relationships and

obviously contributes to the phenomena of "sex-deprived" marriages. Mar-
ried couples often find themselves drifting into a pattern of habitually avoid-
ing sex. A decrease in the frequency of having sex and deterioration in the
quality of sexual relating may occur at certain points in the marriage. At
each of these crucial periods of time, the voice can provide seemingly
rational reasons for partners' gradual loss of interest in sex or it can effectively
stifle erotic feelings that may still arise.
For example, after being married for a while,
The honeymoon is over. You should just settle down to the responsibili-
ties of marriage.
He (She) is so familiar by now, there's nothing new or exciting to
look forward to in making love.
After having a baby,
He's (She's) so unrealistic to want sex when he/she knows that you've
been up aU night with the baby.
She's (He's) so involved with the new baby. She (He) never wants
to make love with you anymore.
When both partners are focused on their careers and/or children,
She's (He's) always distracted by work. She (He) never wants to
make love.
All he (she) thinks about is the kids. He's (She's) never as interested
in sex as you are.
As a person ages,
You won't be able to get an erection and you won't be able to feel as
much anyway.
You'll just be dry and tum him off. Besides, people your age don't
need sex.

Personal Examples

The following excerpts from a women's group exemplify the issues

that contribute to withholding. The participants focused on identifying,
revealing, and challenging behaviors that they believed were causing distress
in their sexual lives and in their intimate relationships.
Carla: A few weeks ago, I told Ross that I really loved it when he
was affectionate, touching my hair or coming up behind

188 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 me and hugging me, and I wished he would do more. I also
wanted to act in a way that would make him feel affectionate
toward me. After that, he was really affectionate for the
next couple of days in the way I wanted, but then I noticed
I didn't like it. After a couple of days like that, I felt like
it was too much, which was stupid because it was what I
really wanted. He noticed it too-like sitting together, he
would touch my leg and I didn't respond, and he would
feel hurt.

Therapist: You found it difficult to tolerate getting what you wanted?

Carla: I feel like I can't stand it. Such a small thing would make
me pull away. So that went on for a while, and I noticed
I started thinking things like I used to think about him
like. Maybe he doesn't like being affectionate. Maybe he just
wants sex, or about myself, When was the last time you show-
ered? I don't think those ways as much as I used to, but
right at the moment we started kissing, I was thinking "Oh
my God, can I do this?" [sad, cries] "I don't know if I can
do this, if I can stand him touching me."
So that time I said to myself, "Just let yourself enjoy it,
just let go." I did, and I really felt different. I felt turned
on, I felt the kissing was nice. I wasn't thinking Oh, this is
gross. But it was a struggle before we got fully into it. It felt
good, but it's been a long time since we made love.
Therapist: So you avoided it for a while.

Carla: Yes, it's been a problem for about a year. Otherwise Ross
feels good with me; our friendship is nice, and all the other
things that were problems aren't anymore. So it's a painful
thing because I'd feel better for a while sexually and felt I
was making progress, but he still feels bad when things
are off.
Therapist: What made you cry?
Carla: Picturing him touching me and my not liking it. The actual
physical contact.
Therapist: How does it connect to just being touched? What agony is
in that cry?
Carla: The feeling is that I'm doing it with a stranger, like this
nasty man. That's the feeling, like I'm some thing that's
being used by a stranger.

Therapist: By a dirty, ugly, nasty person?

Carla: Yes, that's the feeling.

SEXUAL WITHHOLDING 189

 Therapist: How do you turn someone that you're attracted to into that?
Carla: I distort him into that sort of a person.
Therapist: But how do you make him look that disgusting to you?
Carla: It's almost like a voice telling me, He's repulsive, or He's
disgusting right now. What does he want from you?" It's like
somebody talking to me, telling me things.
Therapist: It's worthwhile to recognize it as a voice.
Carla: I feel that I could go out with another person and it would
probably be fine.
Therapist: Why would it be different?
Carla: I don't know, because there's no promise or guarantee [cry-
ing] because I could walk away and not worry about being
with him again. I could drop him if I wanted to.
Ashley: (another participant) I know what you mean. As soon as
I feel that my boyfriend is expecting something from me,
I start feeling trapped. So I don't want to be touched because
it was like he was expecting something from me. I don't
want to give that to him. It's like you're giving yourself
away. It was like a voice telling me bad stuff about him.
Therapist: So the thing that alters the situation from what would
naturally be sexual is what the voice is telling you.
Rose: With me, it's like all of a sudden, I'm not feeling right, but
there's no real reason for me not to feel good. With me, I
think there's such a projection of my father onto my husband
in the way I think he's critical of me, in the way I think
he picks me apart, in the way I'm critical of him. It's very
much like the relationship with my father. And then all of
a sudden, in the sexual situation, it's my father. I'm distort-
ing him, like you said, you're distorting even his looks.
Carla: How do you stop distorting?
Therapist: By recognizing that these voices are distorting your partner.
That you're seeing your father, not your boyfriend or hus-
band. And by recognizing all the elements that go into it:
what you owe him-what he owes you, and placing the
hatred, the anger, the disappointment, all these feelings
from your childhood, where they belong, and not letting
anything spill over into the current relationship.

Excerpts from a therapy session with a young man who was experiencing
sexual problems in relation to his girlfriend illustrate the dynamics involved
in emotional incest and the important link to patterns of sexual withholding

190 SEX AND LOVE IN INTIMATE RELATIONSHIPS

in many adults. As a young adult, Luke was popular and had many girlfriends,
yet he rarely stayed involved with a woman for longer than a few months.
Before this session, Luke had felt humiliated when he was unable to complete
the sex act with his new girlfriend.
Luke: I've been thinking about this woman I started seeing re-
cently. I've only seen her for about three weeks or so, but
in the beginning, I really liked her and I liked being sexual
with her, which was a huge thing for me because I had felt
really bad about my sexuality until very recently.
Then we had a conversation where she said I was a really
nice guy and she thought I was really special. The next
couple of days she kept asking if I was okay because I wasn't
as friendly as I had been, or as she wanted me to be. I got
really uncomfortable. It was the night before I left to go
skiing-this is very embarrassing-I actually couldn't be
sexual with her. It was something about that wanting on
her part that made me feel suffocated. I felt like she wanted
too much from me. Also she likes being on top when we're
sexual and there's something about that that's so uncomfort-
able. I mean, I had almost a panic attack while we were
being sexual. I felt suffocated.
Finally I was able to leave town and get away from her.
I actually was happy and relieved to be going on the ski
trip, because I wouldn't have to see her. {long pause] I feel
more relaxed from saying this.

Therapist: It's sad what happened in the story you told about shying
away from your girlfriend when she was really liking you.

Luke: I was looking forward to going skiing anyway, but part of

why I wanted to go was so I could get away from her. She
wanted too much. It was okay when it was on my terms
more. [sad, tearful] I feel embarrassed to say this, but I
feel really screwed up. I feel very confused about my own
reactions to her because they feel physical and I don't have
a clear thought about what's happening. I feel so creepy. I
hate to say this, but there are very few sexual situations
where I come away feeling closer or better. I only feel that
I'm screwed up, like I'm insensitive, or I'm a little boy, and
I can't satisfy a woman. Like I should just be alone.

Therapist: Can you say those as voices?

Luke: I don't know. They feel so angry. They'd go something like

this: You're right. You should just be alone. You are a creep!
You're weird, You don't belong in a man's world. You're small.
You're incompetent. You can't satisfy a woman. Why is she so

SEXUAL WITHHOLDING 191

 interested in you anyway? There's probably something weird
about her.
Why go after her? You'd be betteroff alone. Stay away from
her! [angrier] You can't have her! She can't have you! You
belong to me! You're mine! You'd better stay with me. You're
my special boy, she can't have you! [tearful]
God, that's my mother's voice. It feels so embarrassing
to hear those words coming out of my mouth. But she was
so clinging, sticky, and so dependent on me, even though
she was neglectful. I remember that she always kept me at
her side. By the time 1 was a teenager, I couldn't stand
being in the same room with her.
Since she died, other people, even some of her friends,
have said that they couldn't stand being alone with her for
very long becauseshe was so all-consuming. They said that
they felt drained after being with her, and I felt exactly the
same way. I'm starting to understand more about this from
saying these voices. It makes sense that I'm afraid when I
feel a woman wanting to be closer to me. I immediately
think that she wants more from me, that she's going to
drain me dry.

THE DYNAMICS OF SEXUAL WITHHOLDING

IN ONGOING COUPLE RELATIONSHIPS

The dynamics underlying the patterns of sexual withholding that are

operating within each member of the couple create a feedback system of
reaction and counterreaction that is often difficult to interrupt. McCarthy
and McCarthy (1998) contended that "More than any other sexual difficulty,
ISO [inhibited sexual desire] involves the couple's relationship" (p. 183).
People who have been hurt emotionally become increasingly intolerant of
closeness, affection, and passion as their relationship becomes more meaning-
ful. They begin to hold back their responses either sexually or emotionally,
trying to avoid the special combination of love, sexuality, and tenderness
that can be the most satisfying.
Withholding patterns also are acted out in areas of a couple's relation-
ship that are far removed from their sexual relating. In addition to withhold-
ing in the sexual situation, people may gradually start holding back the very
qualities that originally attracted their mates, their unique way of expressing
themselves, their looks, friendliness, simple acts of consideration and kind-
ness, and their enjoyment in each other's company. Feelings of anger,
resentment, or disappointment stemming from everyday interactions can
have a detrimental effect on the couple's lovemaking. Both parties become

192 SEX AND LOVE IN INTIMATE RELATIONSHIPS

more inward and defended against each other as the withholding patterns
become well established.
In the first stages of a romance, people usually feel sexually attracted
to each other, but later, one or the other may withdraw sexually and lose
enthusiasm for sex. The process of first being responded to sexually, then
having it held back, bewilders the other person, at which point he or she
begins to lose self-confidence and the sex act starts to feel less natural or
spontaneous. This withholding makes the person being withheld from feel
increasingly inadequate and inferior and often reawakens suppressed anger
from childhood experiences of being withheld from or rejected (Firestone,
1985). H. Kaplan's (1995) analysis of the course that many long-term couple
relationships take is congenial with our understanding of the ways in which
sexual withholding (in one or both partners) leads to anger and guilt, which
in turn, contributes to diminished sexual desire or motivation in each partner
with the consequent avoidance of sexual relations. Kaplan asserted that,
Rather than assuming that a couple's lust for each other normally
disappears after a while, one can make a case that the erotic bond may
simply lie dormant ... Thus, while some decrease of passion is normal,
I regard a marked or complete loss of sexual desire in a long-term
relationship as pathological. Such declines are often due to the corrosive
effect of marital hostility and disillusionment, and not to familiarity.
(p.38)

CONCLUSION

Sexual withholding is a defense characterized by holding back positive

responses from one's partner and denying oneself pleasure and fulfillment.
It plays a significant role in the development of many sexual problems,
particularly disorders of low sexual desire. Sexual withholding is often mani-
fested in passive-aggressive behaviors and in duplicitous communications
and mixed messages.
Patterns of sexual withholding are predisposed by experiences during
an individual's formative years. Parental behaviors such as intrusiveness,
possessiveness, and attempts to live through their offspring lead children to
hold back from others and to deny their own wants and desires. These
patterns are often carried into adult relationships and interfere with the
achievement of real intimacy. Sexual withholding may also stem from fears
of competing with the same-sex parent as a child, especially when that
parent was jealous of the attention shown by the opposite-sex parent. Child
sexual abuse can also be a contributing factor in that adult sexual relations
come to be feared, avoided, or defended against. Feelings of being exploited
as a child tend to be projected on to one's adult partner, leading to a holding

SEXUAL WITHHOLDING 193

back of warmth, affection, and sexual responses. In addition, feeling close
emotionally and sexually to one's partner may trigger memories of the
earlier abuse, which in turn can interfere with one's ability to enjoy the
sexual experience.
Destructive thoughts playa major role in sexual withholding. Self-
critical thoughts as well as thoughts reflecting animosity and anger toward
one's partner can erupt into consciousness at any time during a sexual
encounter. Voice attacks often function to increase performance anxiety
and feelings of self-consciousness in sexual situations. Thoughts that one
doesn't deserve to be happy or to be close to a partner may lead to self-
denial. Depreciating thoughts about one's partner or thoughts exacerbating
feelings of distrust can predispose holding back from one's partner.
When withholding patterns become well-established they can contrib-
ute to the development of symptoms of hyposexual desire disorders, or in
some cases, they may lead to a complete shutting down of alHeelings of sexual
desire. On a broader level, holding back personal qualities and behaviors that
are especially loved and admired by a loved one also interferes with the
achievement of sexual and emotional intimacy in couple relationships.
Progress in therapy requires that clients become more aware of their
customary methods of manipulating their partner through withholding their
positive responses. They need to further develop their ability to be loving
and sexually responsive, as well as increase their tolerance for accepting
love. Therapeutic interventions that are directed toward the personal devel-
opment and increased individuation of each partner can help break patterns
of sexual withholding, enabling both individuals to restore the intimacy,
sexual passion, and companionship that characterized the early stages of
their relationship.

NOTES

1. Schmidt and Arentewicz (1983) asserted that "[sexual] dysfunctions are the
expression of sexual inhibition, whether they manifest themselves as lack of
desire, erectile, ejaculatory, arousal, or orgasmic disturbances or as vaginismus"
(p. 40). Regarding inhibited sexual desire, McCarthy and McCarthy (1998)
raised an important question:
But isn't sexual desire a problem solely for women? ... The reality is
ISD occurs on occasion for almost every man. For ten to fifteen percent
of men it is a chronic problem, becoming more frequent and severe
with age.... In fact, one of the most thought-provoking statistics is
when couples stop having sex, in over ninety percent of the cases it
is the man's decision. This is conveyed indirectly and nonverbally.
(pp. 177-178)

194 SEX AND LOVE IN INTIMATE RELATIONSHIPS

2. Psychonutritional products include expressions of affection and sexuality; acts
of kindness, generosity, and empathy; open communication and self-disclosure,
interest in one's partner, eye contact, making an effort to be physically attrac-
tive, having a pleasant facial expression, smiling, humor, and numerous other
positive behaviors.
3. H. Kaplan (1995) noted that
Patients with the global form of HSD [Hypoactive Sexual Desire] may
be described as sexually anorexic because they have simply lost their
appetite for sex under any circumstances; in the language of the "dys-
functional control" model, their sexual motivation is down-regulated
across the board. (p.67)

4. Passive-aggression is related to "pseudoaggression," which is different from

genuine anger because it is not necessarily a response to frustration; instead it
is often a reaction to positive gratification or acknowledgment. Unusually
positive experiences frequently arouse painful feelings of deep sadness as well
as anger, which people try to shut off by manipulating or pushing away the
person offering acknowledgment, affection, or love (Firestone et al., 2003).
5. McCarthy and McCarthy (1998, 2003) also suggested that inhibited sexual
desire has numerous causes, especially "sexual secrets and hidden agendas"
(2003, p. 13). In their book Rekindling Desire (2003), they posed an important
question regarding the psychodynamics in inhibited sexual desire: "Do desire
problems cause sexual dysfunction, or does sexual dysfunction cause desire
problems?" They found that for the majority of their male patients, it appeared
that "the causation is clear-sexual dysfunction results in desire problems"
(p.51).
6. See Schore (1994), Beebe (1986), and Tronick and Weinberg (1997). Also
see Mitchell (2002) who emphasized
Because clinicians see the problems and can easily trace them back to
developmental causes, they tend to imagine a healthy child-parent love
that would only facilitate adult love and leave no problems. But it may
be that childhood love is always fraught with areas of overst.imular ion
and areas of understimulation, too much in some ways and too little
in others. It may be that "just right" is found only in fairy tales. (p. 102)
7. Kaufman (1980), Morrison (1989), Goldberg (1996), and M. Lewis (1992)
identified guilt as self-critical feelings experienced in relation to one's actions,
whereas shame is a primary affect. Both shame and guilt are mediated or
controlled by the voice.

SEXUAL WITHHOLDING 195

 8
COUPLE RELATIONSHIPS:
JEALOUSY AND SEXUAL RIVALS

Jealousy is a complex reaction to a perceivedthreat to a valued relation-

ship or to its quality.
-Pines (1998, p.3)

In all of us there still lives the child's unregarding possessiveness-the

longing for an absolute, certain, and exclusive love.
-Downing (1977, p. 74)

Jealousy, sexual rivalry, and competitiveness arise naturally in interper-

sonal relationships. In fact, one of the primary reasons people seek therapy
is because of the extreme distress they experience upon discovering that
their mate is sexually involved with another person (Glass, 2003; Glass &
Wright, 1997). The feelings aroused by this crisis are often even more
distressful and emotionally painful than those experienced by people facing
rejection or loss when a third party is not involved.
There are a number of reasons why feelings of jealousy are among
the most disturbing emotions that people can experience in an intimate
relationship. Even the suspicion that a mate is sexually involved with some-
one else disrupts the illusion that one is exclusively chosen and preferred
above all others. Also, in relationships characterized by a fantasy bond,
infidelity jeopardizes the delusion of fusion that has functioned as a symbol
of safety, security, and eternal happiness for each partner. The threat oflosing
one's mate or lover to a rival often precipitates self-destructive thoughts and
profound feelings of shame and humiliation that, under extreme conditions,

Portions of David M. Buss's The Dangerous Passion were reprinted in this chapter. Reprinted with
permission of The Free Press, a Division of Simon & Schuster Adult Publishing Group, from The
Dangerous Passion: Why Jealousy is as Necessary as Love and Sex by Dr. David M. Buss. Copyright
© 2000 by David M. Buss and Bloomsbury Publishing. All rights reserved.

197
can lead to thoughts of self-harm or suicide. On occasion, sexual infidelity
can trigger vicious thoughts against one's mate and/or rival including a
strong desire for revenge that may lead to violent acting-out behavior or
even homicide (Felson, 2002).
In this chapter, we address the many facets of jealousy as it occurs in
couple relationships, including (a) distinctions between competitiveness
and jealousy; (b) the subjective experience of jealousy; (c) psychoanalytic,
attachment, and evolutionary psychological perspectives on jealousy;
(d) manifestations of jealousy in relationships characterized by a fantasy
bond; (e) destructive thoughts or voices that intensify feelings of sexual
jealousy and contribute to self-defeating responses; and (f) the relationship
between sexual withholding and jealousy. In addition, we discuss the role
that deception plays in exacerbating jealous reactions and explore social
factors that influence jealous reactions in different cultures. Lastly, we offer
their views regarding advantages and disadvantages of open, nonexclusive
relationships versus the benefits and costs of closed or exclusive sexual
relationships.

COMPETITIVENESS AND JEALOUSY

Competition and jealousy are both dimensions of sexual rivalry in

intimate relationships. Competitive feelings are based on a natural desire
for attention, affection, love, and sex. On the one hand, competitive feelings
may be considered "irrational" in the sense that everyone has unrealistic
fantasies and desires to be the center of attention, to always be admired,
chosen, preferred, or unconditionally loved. On the other hand, competitive
feelings can be conceptualized as "rational" in situations where two people
are pursuing the same goal, because the outcome has actual consequences
for both winner and loser. For example, when two people are applying for
the same job or position or pursuing the same love object, there are obviously
real issues involved, and winning becomes vitally important to both individu-
als. As people achieve more of their career and personal goals, and especially
as they feel increasingly fulfilled in an intimate relationship, their competi-
tive feelings tend to diminish in intensity.
Feelings of competitiveness, like the other primary emotions of sadness,
anger, fear, envy, shame, joy, happiness, and exhilaration, are inextricably
tied to one's wants, needs, and desires (Firestone et al., 2003). Competitive-
ness involves the desire to triumph over one's rival as well as to denigrate
or bring one's rival down. Both of these motives can function to increase
feelings of competitiveness and intensify efforts to win the competition.
People who accept these motives and desires as natural are more likely to
be straightforward in pursuing their goals in life. In a sexually rivalrous

198 SEX AND LOVE IN INTIMATE RELATIONSHIPS

situation, for example, they attempt to "put their best foot forward" and
expend considerable effort trying to defeat their rival. In these cases, the
competition is secondary; the people involved are not competitive merely
for the sake of "winning" in itself, but for the sake of achieving a real goal-
achieving, maintaining, or regaining closeness and sexual intimacy with the
person they love.
It is important to recognize and uncritically accept competitive feelings
as simply being a part of our psychological makeup, just as anger is a natural
response to frustration. However, if people are not accepting of anger or
"irrational" feelings in themselves, or if they are afraid of competing, they
tend to avoid rivalrous situations and feel ashamed and guilty about their
competitive thoughts and feelings.
Important distinctions can be made between feelings of jealousy and
competitiveness. According to Webster's Dictionary (Random House, 1998),
jealousy is defined as

1. jealous resentment against a rival, a person enjoying success or advan-

tage .... 2. mental uneasiness from suspicion or fear of rivalry, unfaith-
fulness, etc., as in love ... , 3. vigilance in maintaining or guarding
something.... 4. a jealous feeling, disposition, state, or mood. (p. 1025)

Whereas competitiveness or competition is defined as

1. Rivalry for supremacy, a prize, etc.... 2. a contest for some prize,

honor, or advantage.... 3. the rivalry offered by a competitor. ... 4. a
competitor or competitors.... 5. '" rivalry between two or more
persons or groups for an object desired in common, usually resulting in
a victor and a loser but not necessarily involving the destruction of the
latter. 6. The struggle among organisms, both of the same and of different
species, for food, space, and other vital requirements. (p. 417)

One significant difference between these two feelings or moods is that

jealousy is fueled by self-critical thoughts and hostile attitudes toward the
love object and rival, whereas competitiveness is generally characterized by
the relative absence of voice attacks.'
A certain amount of jealousy is normal in everyday life simply because
if people are unable to achieve their goals, they are jealous and envious of
those who achieve more than they do (Pines, 1998).2 Jealousy is inevitable
to the extent that someone else has attained what one desires for oneself-
love, attention, affection, or a love object. The fact that jealousy necessarily
involves a rival is self-evident. In defining jealousy, DeSteno and Salovey
(1996) stated, "Concern over the possible termination of a relationship, in
and of itself, is not a sufficient condition to evoke jealousy; rather, the
presence of a rival is a necessary and defining condition for this emotion"
(p. 920).

JEALOUSY AND SEXUAL RIVALS 199

 The primary problem in sexual rivalries does not lie in people's competi-
tiveness or even in their jealous reactions; rather the problem lies in the
fear and guilt that cause many men and women to deny their competitive
feelings and retreat from pursuing their goals in rivalrous situations. It is
important to emphasize that feelings of jealousy are intensified when one
retreats from one's natural competitiveness. People who experienced a par-
ent's rivalrous feelings during their formative years often retreat from compet-
ing as adults in a rivalrous situation. As noted in chapter 3, rivalrous feelings
exist in many families and are particularly strong in parents who are overly
possessive and jealous. Individuals who have been raised in such a family
constellation often experience considerable fear and guilt when faced with
either winning or losing in competing with a sexual rival.

THE SUBJECTIVE EXPERIENCE OF JEALOUSY

When men and women describe their subjective experience of sexual

jealousy, they usually indicate feelings of fear, anger, or depression. Often
they tend to imagine or compare themselves unfavorably with their rivals
to their own detriment, especially when their rivals are unknown. The
various ways in which jealousy is experienced and the myriad behavioral
expressions associated with feelings of jealousy have been described by a
number of researchers (Buunk et a1., 1996; Buunk & Hupka, 1987; Pines
& Aronson, 1983; Salovey, 1991).
According to Pines and Aronson (1983), intense jealousy is an ex-
tremely painful emotional state that is associated with physical sensations,
such as "feeling hot, nervous, and shaky; and experiencing fast heartbeat,
and emptiness in the stomach" (p. 131). Pines and Aronson noted that
participants in her study on jealousy reported that "the emotional reactions
felt most strongly were anxiety, fear of loss, pain, anger, vulnerability, and
hopelessness" (p. 131). In summarizing findings from a phenomenological
study of the ways that people experience jealousy, White and Mullen
( 1989) concluded,
When studying large samples of jealous people, we may find that
thoughts about personal inferiority, feelings of sadness and despair, and
demands on the beloved for commitment are inter-correlated. Another
cluster of reactions may consist of thoughts of revenge and comparison
to the rival, feelings of anger and rage, and behaviors intended to
damage the rival. (p. 13)

Another distinction between jealousy and competitiveness lies in the

consequences of behaviors based on these emotions. Feelings of jealousy are
natural, yet behaviors based on jealous feelings (acting out anger, resentment,

200 SEX AND LOVE IN INTIMATE RELATIONSHIPS

and suspiciousness toward the love object or rival, and even violent behavior)
are often unacceptable. These behaviors must be subject to a moral consider-
ation with respect to the harmful effects these actions could have on oneself
and others. Feelings of competitiveness are also natural but, in contrast, it
is acceptable to behave competitively in a rivalrous situation, that is, to
attempt to win the competition.
In investigating jealousy and competitiveness, we interviewed men
and women about the ways they experienced these emotions in sexually
rivalrous situations. Several of their responses are listed below:
Trish: For me jealousy is a threatened feeling. A very threatened,
insecure feeling. Competitiveness is different, it comes up in
situations where I still can feel confident. When I feel jealous,
it's from a very scared, desperate, hurt place, like something
very precious is being taken away from me, or I'm being
rejected for someone much better than I am.

Jack: Last week, my girlfriend told me that she was thinking of

going out to dinner with an old friend of hers who was in
town. He's a guy she used to date in college. Even though
both of us had decided not to have an exclusive relationship,
and I've dated other women sometimes, when she told me
she was considering going out with someone else, I was furious
and blew up at her. But underneath my anger, I felt like a
nobody, completely worthless, like a little kid having a temper
tantrum, not like a man.

Darlene: If I even picture the man I'm involved with being in another
relationship, I have a totally panicked feeling, which makes
me want to drop him and run. It's almost a physical feeling
of coming apart. I feel that I would be nothing, I would
be forgotten and it would change completely what exists
between us.
Dustin: If I notice my wife paying attention to another man at a
party, I feel desperate and angry at the same time. I start
thinking, is she more interested in him than in me? Should
I try to join in their conversation? But I feel that would be
too obvious. Such a paralyzing feeling comes over me that I
can't move. I just stand there and sweat and look awkward,
but I rarely take any action on my own behalf. The things
I'm thinking in that situation are really irrational because
we've been married for five years and she's been totally faith-
ful, but I still feel insecure and jealous.

Anita: I used to feel that if I even thought "my guy" was with
somebody else, I would die. Many years ago, I suspected my
boyfriend of having another girlfriend, and I tried to figure

JEALOUSY AND SEXUAL RIVALS 201

 out the times when they might be together, like when he
said he was going out with friends to a football game or
bowling. During those times, I felt like I was going to explode
out of my own skin. I felt I couldn't control my feelings. I'd
go out to a bar and have some drinks, smoke cigarettes, I
would do anything to contain that feeling of being totally
out of control.
Kristen: 1 used to have so much self-hatred that I felt like I couldn't
compete. I remember one time in college. I was with my
boyfriend and this girl was walking across the street from us
and he looked at her and I could tell he thought she was
pretty, and 1 was so jealous. I remember it crossed my mind
that this was so absurd. If I was going to be jealous on this
level, about somebody across the street, it was insane. That's
the first time it occurred to me that I could ruin my life
over this.
Jared: When I'm jealous, I get really angry. 1 feel very insecure and
anxious and stirred up inside. The feelings are very specific
to the situation, and lots of questions come up in my mind:
Is this someone who's a real threat? Is this a rival I'm going
to lose to? How attractive am 1 to my partner? Sometimes I
try to think about the situation more philosophically. Even
if she rejects me, what would it really mean? Would it mean
that I'm less attractive or less desirable than he is? Then I
answer my own questions: Not necessarily. He might not be
the better man. Or she might be making a bad choice because
maybe she's afraid of being close to me. There could be lots
of reasons. I find that I usually feel less anxious when I think
about the situation more objectively. But I have to admit
that it's really hard to talk myself out of feeling threatened
and like I'm going to lose her.

Generally speaking, people rarely know why they are rejected for
someone else. In these painful circumstances, they tend to feel confused,
experience intense self-attacks, and ruminate about the reasons they were
rejected. In most cases, their conclusions or explanations are not based on
reality, nor are their self-criticisms necessarily valid for the reasons noted
above. In other instances, men and women desperately search for answers
by interrogating the rejecting mate. However, the reasons a mate prefers
someone else are often unconscious and thus unavailable, even if he or she
has a sincere desire to provide an explanation.
Researchers studying the phenomenon of jealousy have noted the
similarity between acute jealous reactions and the symptoms of posttraumatic
stress disorder (PTSD; Glass, 2003; Glass & Wright, 1997; Lusterman,
1995). When jealousy is extreme, people tend to have exaggerated, dramatic

202 SEX AND LOVE IN INTIMATE RELATIONSHIPS

emotional responses, which they themselves often perceive as abnormal.
They may feel overwhelmed by torturous images of their mate and their
rival in a sexual situation; or they may obsessively ruminate about the
whereabouts of their mate, suffer severe constriction of thought and emotion,
avoid situations where their jealousy might be intensified, lose interest in
other people and activities, become hypervigilant, or suffer from insomnia,
all of which are symptoms of PTSD as described in Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IVj American Psychiatric
Association, 1994).
Lastly, feelings of jealousy can sometimes serve a positive function in
an intimate relationship. For example, an individual's jealousy in relation
to the threat of a partner's infidelity may act as an incentive, providing the
impetus to develop oneself, change negative characteristics and be more
attractive, interesting, and sexually appealing than a rival (Person, 1988).
Jealousy can also make a person more aware and appreciative of the value
their partner has for them.

PSYCHOANALYTIC AND ATTACHMENT THEORISTS'

PERSPECTIVES ON JEALOUSY

Jealousy appears to be a universal phenomenon. According to White

and Mullen (1989) "Although cultures differ in the frequency and forms of
their jealousy, there are no reports of jealousy-free societies" (p. 1). It is
noteworthy that in spite of the apparent ubiquity of this profoundly troubling
emotion, many researchers who in the past studied emotional processes in
interpersonal relationships (P1utchik, 2000) considered jealousy to be a
secondary emotion, derived from the more basic, central, primary emotions
(Buunk et al., 1996).
In recent years, however, a number of clinicians and researchers have
turned their attention to the emotions associated with jealousy, envy, and
competitiveness as manifested in interpersonal relationships. Taking note
of this trend, Salovey (1991) declared, "After decades of banishment to
popular magazines and advice columns, jealousy and envy, as complex inter-
personal emotions, have certainly emerged as legitimate topics of scientific
inquiry" (p. xi). Social psychologist Shaver (1989) has argued that "Far
from being expunged, jealousy-along with love, loneliness, caring, and
sympathy-is as prevalent and insistent as ever" (p. v). In fact, in contempo-
rary society, jealousy appears to be on the increase as social and economic
changes "continue to have profound impacts on the nature of romantic
relationships and marriage" in every culture (White & Mullen, 1989, p. vii).
Theorists, clinicians, and researchers have employed a number of ap-
proaches in attempting to explicate the complicated emotional state that

JEALOUSY AND SEXUAL RIVALS 203

we refer to as jealousy. Psychoanalysts view jealousy as closely related to
earlier triangles within the nuclear family, to specific childhood events, and
to the way that the child resolved the Oedipal or Electra conflict. S. Freud
(1922/1955) conceptualized jealousy as being either "normal" or pathological
and included projected and delusional forms of jealousy in the pathological
category. According to Freud,
Although we may call it normal, this jealousy is by no means completely
rational, that is, derived from the actual situation, proportionate to the
real circumstances and under the complete control of the conscious
ego; for it is rooted deep in the unconscious, it is a continuation of the
earliest stirrings of the child's affective life, and it originates in the
Oedipus or brother-and-sister complex of the first sexual period. (p. 223)

Ellis (1996) clarified and expanded on S. Freud's distinction between

"normal" and "abnormal" jealousy:
Jealousy can be seen as rational or undisturbed when people strongly de-
sire love and affection from others but do not dogmatically insist that
they absolutely must have it. When they are irrationally or self-defeatingly
jealous, they usually have a number of irrational beliefs leading to their
feelings of insecurity, rage, and low frustration tolerance. (p. 23)

S. Freud proposed that jealousy originates sometime between the ages

of 2 and 3, when children direct their emerging sexual urges toward the
parent of the opposite sex. Obviously, boys and girls face competitors who
have all the advantages; boys inevitably lose out to the father, while girls
are defeated by the mother. Later, as adults, whenever a rival presents a
threat to a valued romantic relationship, they reexperience abandonment
anxiety as well as the painful longing, despair, hopelessness, rage, and grief
they felt at the time of the original loss.
In a discussion of "morbid jealousy," Dutton (1995a) described "cyclical!
emotionally volatile abusers [who] experience a constellation of feelings
involving rage and jealousy" (p. 34). These feelings are characteristic of the
men in Dutton's study who had assaulted their partners or wives. In assessing
symptoms manifested by these men, Dutton found a strong relationship
between behaviors manifested by patients with Borderline Personality Dis-
order and "scores and the associated features of cyclical abusiveness. Those
strongly related to borderline scores included anger, jealousy, and tendencies
to blame women for negative events in the relationship" (p. 153). In another
work, Dutton (1995b) stressed that abandonment anxiety played a promi-
nent role in the reactions of these men to perceived threats of losing
their partner.
Abandonment anxiety could be produced by ... sexual threat or any
other instance of the female moving emotionally further away (or re-

204 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 investing her energy outside the primary relationship).... Sexual jeal-
ousy, especially to the extent that it involves delusions or distortions,
may represent a form of chronic abandonment anxiety. Jealousy is
mentioned frequently by battered women as an issue that incited vio-
lence.... Jealousy produces a range of behavioral responses (including
aggression and increased vigilance) and affective reactions (including
rage and depression). (pp. 67-68)

Attachment theorists have suggested that jealousy varies in intensity

and chronicity according to the type of attachment pattern that one origi-
nally formed with the parent or caregiver during the formative years. In an
adult relationship, this pattern of attachment, whether secure, anxious/
avoidant (dismissing), or anxious/ambivalent (preoccupied), is replicated in
the form of a particular style of relating to one's romantic partner. Holtzworth-
Munroe, Stuart, and Hutchinson (1997) cited a study that found that
securely attached participants "reported more positive beliefs about relation-
ships, longer romantic relationships, and less jealousy in romantic relation-
ships" (p. 315) than adults classified as insecurely attached. They also noted
that individuals with anxious or preoccupied attachment patterns have been
described as "emotionally dependent, 'clinging,' romantically obsessive, and
jealous" (p. 316). In their research, Sharpsteen and Kirkpatrick (1997) noted
that avoidantly attached individuals
Were relatively more likely to tum their anger and blame against the
interloper [rather than the partner; whereas] ... anxiously attached
[preoccupied] people focused on the implications of the situation for
themselves.... Despite this, though, they were relatively unlikely to
take steps to maintain their self-esteem. (pp. 636-637)

In extending attachment theory to other aspects of romantic relation-

ships, Downey, Feldman, and Ayduk (2000) suggested that rejection sen-
sitivity, which they define as "the disposition to anxiously expect, readily
perceive, and intensely react to rejection by significant others" (p. 45) is a
factor to be considered in attempting to understand individuals' differential
reactions to sexual rivalry.
Other approaches have viewed jealousy as a "learned response that
when inappropriate can be unlearned" (Pines, 1998, p. X).3 In describing
her findings from an extensive study on jealousy, Pines concluded that
"jealousy is both a social phenomenon and a product of an individual's
mind" (p. 131). In working with couples, we have focused on the thought
processes in "an individual's mind," self-depreciating thoughts that intensify
jealous reactions. In coping with feelings of jealousy, it is helpful for individu-
als to identify the underlying self-critical thoughts and cynical, distrustful
attitudes toward their mates, to develop insight as to the sources of these
thoughts, and to counter them by learning to pursue their goals more directly.

JEALOUSY AND SEXUAL RIVALS 205

 EVOLUTIONARY FACTORS THAT INFLUENCE JEALOUSY

Evolutionary psychologists propose that jealousy is an innate emotion

and the result of evolutionary forces that endowed "our jealous ancestors"
with a selective advantage over their less jealous or more tolerant peers and
rivals. Buss (2000), in delineating many of the adaptive benefits of sexual
jealousy, stated
Jealousy [is] ... a supremely important passionthat helped our ancestors,
and most likely continues to help us today, to cope with a host of real
reproductive threats. Jealousy, for example, motivates us to ward off
rivals with verbal threats and cold primate stares. It drives us to keep
partnersfromstrayingwith tactics such asescalatingvigilanceor shower-
ing a partner with affection. And it communicates commitment to a
partner who may be wavering, serving an important purpose in the
maintenance of love. Sexual jealousy is often a successful, although
sometimes explosive, solution to persistent predicaments that each one
of our ancestors was forced to confront. (pp. 5-6)

It is interesting to note that women tend to feel more threatened if

their mate develops a close, emotionally intimate relation with another
woman than if he becomes involved in a sexual liaison. On the other
hand, men appear to feel more threatened when their partners are sexually
unfaithful (Glass & Wright, 1997; Pines, 1998).4 Evolutionary psychologists
have conjectured that these gender-specific threatening scenarios have their
basis in the differential sexual strategies developed by men and women
throughout the centuries (Buss, 1994, 2000; Daly & Wilson, 1983).
According to Buss (2000), during the course of evolutionary history,
women risked the loss of a mate's time, energy, resources, and commitment
if he invested these attentions in a rival. "The most reliable indicator that
a man would divert his investment was not in having sex with another
woman per se, but rather in becoming emotionally involved with another
woman" (p. 53).
On the other hand, males who were betrayed by their partners risked
expending their energy and resources on a rival's genetic children in the
mistaken belief that they were his own. Therefore a "sexual infidelity by
the woman, more than any other form of infidelity, imposed the greatest
costs on ancestral men" (pp. 52-53). In addition, in the past and in the
present, a man's reputation can be seriously damaged by his mate's sex-
ual infidelity, because "cuckolds are universally ridiculed in the eyes of
others" (p.52).
Buss also documented the more dire behavioral consequences of the
jealousy, humiliation and ridicule experienced by "cuckolded" males: "Jeal-
ousy can be emotional acid that corrodes marriages, undermines self-esteem,
triggers battering, and leads to the ultimate crime of murder. ... A full 13

206 SEX AND LOVE IN INTIMATE RELATIONSHIPS

percent of all homicides are spousal murders, and jealousy is overwhelmingly
the leading cause" (pp. 7-8). According to Felson (2002), for women who
are murdered, more than 50% are killed by an intimate partner or friend
or acquaintance. Felson identified

192 cases in which a male offender killed his female partner and 115
cases in which a female offender killed her male partner. The percentage
of incidents in which the homicide stemmed from jealousy or love
triangles was about the same for male and female offenders (19.3% for
men vs. 18.3% for women). (p. 110)

However, Barash and Lipton (200l) observed significant gender differ-

ences related to whether or not sexual infidelity leads to retribution against
the unfaithful partner. They noted, "Compared with the high probability
of male retribution after female infidelity, it is quite rare for male infidelity
to trigger female retribution" (p. 159).
Buss (2000) has conducted numerous studies using self-report question-
naires, hypothetical situations, and physiological measures to test his evolu-
tionary hypotheses about gender differences in the experience of jealousy.
One study showed that

63 percent of the men, but only 13 percent of the women, found the
sexual aspect of the infidelity to be most upsetting; in contrast, 87
percent of the women, but only 37 percent of the men, found the
emotional aspect of the infidelity to be most upsetting. (p.59)

In a number of related studies with gay and lesbian participants, Buss

found that "Homosexual men appear to express less sexual jealousy than
heterosexual men.... Lesbians appear to be more sexually jealous than
their heterosexual counterparts, who overwhelmingly express more distress
at emotional infidelity" (p. 65).
Terror management theorists (Goldenberg et al., 2003) proposed that
gender differences with respect to sexual and emotional infidelity can be
further explicated by considering the role played by self-esteem as a defense
against the terror aroused by an acute awareness of one's personal mortality.
These researchers found that "Mortality salience (MS) [being made acutely
aware of one's personal mortality] increased distress in response to sexual
infidelity for men and emotional infidelity for women" (p. 1585). Goldenberg
et aL (2003) explained their findings as follows: "Men derive relatively
more self-esteem from their sex lives, whereas women's self-esteem is more
contingent on romantic commitment" (p. 1585). Becoming more aware
of death through the experimenters' manipulation of mortality salience
threatened both men's and women's self-esteem in different domains, that
is, in the specific areas that each gender tends to rely on to enhance
(defensive) self-esteem.

JEALOUSY AND SEXUAL RlVALS 207

 The personality characteristics of a rival that trigger the most intense
feelings of jealousy are also determined by evolutionary forces, according
to Buss (2000), who has noted that "Jealousy in each sex has evolved to
mirror the mate preferences of the other sex" (p. 67). Historically, women
prefer men who have resources that they can invest in protecting the woman
and helping her raise her children to a reproductive age. "Since women
desire professionally successful men, for example, men's jealousy should have
evolved in tandem to be activated by a rival who excels professionally"
(p. 67). Men prefer women who have a youthful and healthy physical appear-
ance because these attributes signify fertility, the ability to bear children
carrying his genes. Therefore, "women's jealousy should have evolved to be
especially sensitive to rivals who are younger [because they are at a child-
bearing age] or more physically alluring" (p. 67).

JEALOUSY AND THE FANTASY BOND

The way in which jealously is experienced by individuals is affected

by several factors, including their personal qualities, the defenses they devel-
oped to cope with early interpersonal rivalries, and the quality of relating
in their intimate associations. As noted in chapter 6, in a relationship
characterized by a fantasy bond, partners have generally surrendered their
autonomy, become overly dependent on each other, and are not necessarily
kind or loving in their actions. The imaginary fusion functions to perpetuate
feelings of distrust, self-hating thought processes, and the inward, defensive
behavior patterns that each individual brings to the relationship. This illu-
sory merger, while providing a certain sense of safety and security, nonethe-
less leads to an unconscious belief in both partners that they could not exist
without each other. If one partner breaks this fantasized connection by
becoming sexually involved with a third party, powerful feelings of anger,
fear, and anxiety are likely to be aroused in the other.
Although initially pledges of fidelity may be based on a real desire or
mutual agreement, these vows can become part of a destructive bond in a
couple. This is most likely when the vows are based on the false premise
that people have proprietary rights over each other, particularly over each
other's bodies and sexuality. Within a relationship, monogamy imposed by
external social mores routinely assumed or expected by partners is different
from sexual fidelity based on freedom of choice, genuine personal commit-
ment, and the desire to share one's life with another person (Firestone, 1985).
Feelings of jealousy experienced by partners who have developed a
fantasy bond in their relationship are often intense and can become chronic.
The "betrayed" partner may experience a resurgence of painful emotions
repressed during childhood, as well as feelings of aloneness and vulnerability.

208 SEX AND LOVE IN INTIMATE RELATIONSHIPS

As a result of relinquishing certain areas of independent functioning to
maintain this illusion of fusion, partners feel increasingly inadequate and
insecure as well as more dependent on the other for their sense of self-
worth. The degree of dependency may be closely related to the intensity
and duration of jealousy experienced by partners when there is a threat to
the imagined connection brought about by sexual infidelity. In describing
their studies on infidelity, Glass and Wright (1988) observed that feelings
of jealousy tend to be more intense in someone who has depended on a
mate for their feelings of self-worth or "positive self-regard" (p.341). In
other words, the degree of dependency rather than the degree of love felt
by the rejected partner is the more significant determinant of the intensity
of his or her jealous reactions.
In relationships characterized by a fantasy bond, each partner has an
exaggerated need for reassurance that he or she is always the first and only
choice of the other. As one or both partners sacrifices their individuality,
their basic attraction to each other is diminished. The quality of the couple's
sexual relating often deteriorates and sex becomes routine and unexciting.
These conditions can lead to sexual dissatisfaction and contribute to a
partner seeking gratification in another relationship.
In general, one partner's sexual involvement with a third party disrupts
the illusion of fusion operating within the couple and shatters the false
sense of security both partners derived from their merged identity. We
suggest that the feelings of anxiety, anger, and grief experienced by the
betrayed party are often due more to the destruction of the fantasy bond
with the partner than to the threat of the relationship actually ending or
the loss of the partner to the rival. Person (1988) emphasized this point
when discussing people's profoundly debilitating reactions to rejection and
betrayal by an intimate partner:
Not only is the love object lost, and the "I" (previously valued so highly
by the beloved) cheapened, but also the "we." To the extent that the
lover defines his identity through being part of a couple, he will be
denuded of an identity when he is forced back upon a single state.
(p.305)

Personal Example

Alexis and Todd had been living together for two years when Alexis
became involved with Peter. Before her affair with Peter, both Todd and
Alexis had gradually slipped into routine, habitual ways of treating each
other. As a result, the passion and excitement that had characterized the
first months of their relationship had diminished to a considerable extent.
Alexis had begun to exert more and more control over Todd's activities
and at times made cutting, depreciating remarks about him in front of

JEALOUSY AND SEXUAL RIVALS 209

friends. However, Todd had seemed oblivious to these remarks and submitted
to Alexis's control.
When Alexis admitted to Todd that she was having an affair, he felt
as if his world had been turned upside down. After several arguments filled
with anger and mutual recriminations, Todd and Alexis went their separate
ways, and Alexis continued to date Peter. Within two months of the breakup,
Todd began dating another woman. The sadness, anger, and rage that he
had felt seemed to dissipate overnight and he appeared happier than he
had been in years.
One evening, Alexis and Peter were having dinner at a nightclub
when Alexis spotted Todd on the dance floor with his new girlfriend. Alexis's
immediate reaction was one of shock, then anger and disbelief. Humiliated,
she quickly left the club without speaking to Todd. The next few nights
were torturous for her. Suffering from panic attacks, Alexis was unable to
sleep and tormented herself with images of Todd and his new girlfriend.
She could not understand why she felt so distraught, anxious, and hopeless.
After all, she thought, "I am the one who left him!" Finally, Alexis decided
to record her thoughts and feelings.

"Shattered Illusions"

When I saw this woman dancing with Todd, running her hand through
his hair, looking into his eyes, I thought That used to be me-the
woman of his dreams, the center of his world. I was the one, the one
he wanted to have a deep relationship with, the one he courted, treated
well, idealized, never criticized, the one he shared all of his thoughts,
feelings, and life with. The only special one.
What I had thought was real love was shattered that night because
I saw it being re-created before my very eyes. Then I understood what
lies I had been living. Back then, I was the one who made him feel
saved, made him feel like a whole man. And now she does that for
him. She'll go home with him tonight and make love to him and she
will think she is saved too, and maybe she is, saved from a life of
emptiness, like me.
I believed and I still believe that a man gives me value, gives me
safety in a world of the unknown. Even though I had survived alone
before I met Todd, he felt like a savior because I became again a woman
in a man's life. I was the one and he was only thinking of me. As long
as he was wanting me, I didn't have to worry.
Todd said that he would always love me, and now he is offering all
of that to her. I see it more clearly than ever, so much so that it keeps
me up at night, so much so that the anxiety makes my stomach turn,
a nausea in my throat, I feel crazy.

210 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Then my thoughts turn to Peter-maybe I could be his special one.
I can make him feel like a man, but he isn't consistent the way that
Todd was. Or maybe I could even try to be friends with Todd again,
just be with him every once in a while, just to keep that safe feeling
alive, or else I might end up alone and without anyone.
I feel the fear and anxiety lessen when I realize what my anxiety is
truly about: aloneness and death. But that's not all of it. Why do I
wake up in the night these past days, startled, anxious, with images of
them gazing into each other's eyes being played before me? Why is this
happening? Logically I know it is not Todd who I want gazing at me,
really. I left the relationship months ago.
Then it hits me, in the middle of my chest, in my heart! It's my
mother who I once wanted that gaze from, who I still somehow want
it from, even when I think I don't, and act like I don't. I still imagine
and fantasize her looking at me, today, and saying she is proud to have
me as her child, that I am beautiful and lovable. It is that bond with
her that I grieve, that loss that I truly fear-the loss brought about by
the realization that I am not her and that she is not me, that I became
my own person a long time ago and now it's time to grow up.

VOICES THAT INTENSIFY FEELINGS OF JEALOUSY

In relationships characterized by a fantasy bond, indications of infidelity

in one partner generally evoke a barrage of self-destructive attacks and
vindictive attitudes toward the other. For some, it triggers deep-seated feel-
ings of insecurity, low self-worth, shame, and unlovability. Losing a valued
partner can give rise to extremely self-destructive thinking and rage toward
self, the partner, and the rival. The process of identifying and challenging
destructive thought processes underlying intense jealous reactions is valuable
in learning how to better cope with these disturbing affects.
Negative voices range along a continuum of intensity from mild self-
criticism to angry self-attacks and suicidal ideation. Voices at each level of
intensity can be triggered in rivalrous situations whenever there is a threat
(real or imagined) of losing a valued person to a rival. Destructive thoughts
against the self and others can be brought into conscious awareness by
asking clients to put their thoughts in the second person "you," as though
another person were addressing them. In this way, clients are able to identify
the contents of their voice attacks, separate them from a more realistic and
congenial view of themselves and others, and challenge those thoughts that
are creating irrational feelings of rage, despair, and hopelessness. Methods
to elicit and counter these destructive thoughts and attitudes are described
in depth in chapter 9.

JEALOUSY AND SEXUAL RIVALS 211

Voices Promoting Low Self-Esteem and Feelings of Being Unlovable

Feelings of sexual jealousy are especially prevalent in individuals who

perceive themselves as inadequate or deficient. These men and women have
strong tendencies to compare themselves negatively with potential or actual
rivals. Their negative self-evaluations are often based on deep-seated beliefs
of being unlovable and undeserving of love. In competitive situations, their
lack of self-esteem triggers feelings of desperation, panic, and depression.
Their possessiveness and fear over a potential loss can be traced to an
overwhelming sense of insecurity and low self-worth. Individuals with poor
self-esteem may experience some of the following self-attacks in relation to
perceived threats from a sexual rival:
You're not a real man (woman)!
You're unlovable. No one could love you!
You're so ugly; men (women) are repulsed by you.
You can't compete with him (her). You'll lose for sure.
You're so boring and uninteresting.
What makes you think you can attract him (her)?
He (She) is more sexy, more attractive, more interesting than you.
You better hangon to him (her). You'll neverhaveanother relationship.

Voices That Evoke Feelings of Shame and Humiliation

One of the more painful aspects of jealousy involves the feelings of

humiliation and shame that sexual infidelity evokes in the "betrayed" party.
These feelings may be traced to early childhood experiences of humiliation.'
Many people develop a compensatory image of exaggerated self-importance
to ward off these painful feelings. This adaptation leaves them especially
vulnerable in rivalrous situations. Their shame and humiliation are intensi-
fied in relation to others finding out about their partner's affair. They may
experience negative thoughts such as the following:
Now everyone knows that no one wants you.
You're a shameful, pitiful person.
Your friends think you're a pathetic loser.
People have lost all respect for you.
Now everyone willknow thatyoucan't satisfy a man (woman) sexually.

Voice Attacks Triggered by Potential Loss

or by Winning Over a Sexual Rival

The anticipation of potentially losing a partner to a rival can trigger

self-destructive voices, feelings of intense anxiety, and antagonism toward

212 SEX AND LOVE IN INTIMATE RELATIONSHIPS

oneself and one's partner. Often the mere thought of losing to a potential
competitor evokes powerful voice attacks.
You'd better watch out! You're going to lose him (her).
What is he (she) doing! Where is he (she) going? You'd better find out.
What if he (she) meets someone else there?
You can't compete with that man/woman.
You won't be able to stand it!
You won't ever be able to meet anyone else.
Your life will be over.
It is important to note that fears of losing to a rival do not preclude
fears of winning. Men and women fear both potential outcomes, that of
being rejected and, paradoxically, that of being preferred. Winning may
arouse an anticipation of attack from competitors or may arouse guilt feelings
because the fact of winning causes real or symbolic pain or hurt to one's rival:
Look at all the heartache you caused!
You ruined their marriage! How can you live with yourself?
Her husband (His wife) is going to get even, just wait and see.
You don't deserve to be happy. How can you be happy now in
your new relationship, knowing that you destroyed someone
else's happiness?
One of these days you're going to get yours! He (She) will dump you
for somebody else.
Both situations may precipitate intense voice attacks, causing people
to retreat from actively pursuing relationships and eventually to progressively
give up their individuality and sense of identity (Firestone, 1990a). As
noted earlier, these self-destructive thoughts are internal representations of
parental aggression that was directed toward them in rivalrous situations.
Later, as adults, when they find themselves in competitive situations, their
self-attacks tend to surface causing them to retreat or withdraw from compe-
tition.

Voices Promoting a Victimized Orientation

In a rivalrous situation, people who fear their anger and are unable
to acknowledge their aggression often descend into feelings of being victim-
ized or treated unjustly. Victimized feelings are an appropriate response for
the child who actually does lack power, but for the adult focusing on these
feelings is maladaptive.
People who have a victimized orientation toward life tend to be self-
righteous and believe that they are entitled to good treatment from others.
They issue judgments and evaluations of others, insist on authoritarian

JEALOUSY AND SEXUAL RIVALS 213

methods of punishment for those who make mistakes, and disclaim any
personal responsibility for events not going right (Firestone & Catlett, 1989).
In competitive situations, they focus on the unfairness of the situation and
the injustices perpetuated on them and feel morally justified in their dramatic
reactions to imagined or actual acts of infidelity on the part of a partner.
The negative thoughts they experience may take the following form:

How could he (she) do this to you?

Doesn't he (she) care about how much you love him (her)?
You don't deserve to be treated like this!
After all you've done for him (her), this is what you get in return!
He (She) said that he (she) loved you! He (She) lied!
This isn't fair!
This always happens to you!
Men (Women) are no damn good!
It is detrimental to one's mental health to perceive oneself as a helpless
victim of circumstances, even when faced with the infidelity of a partner.
Rather than focusing on the injustice of the other's infidelity and what
should or should not be happening, it is more adaptive to deal with the
reality of the painful situation, feel the appropriate anger or sadness, and
decide what constructive action one wishes to take in one's self-interest.

Voices Instigating Interpersonal Hostility

or Violence in Response to Perceived Infidelity

Sexual jealousy is one of the major factors associated with interpersonal

violence. Although angry feelings are often directed toward one's rival, in
many cases the betrayed lover's anger is translated into aggressive behaviors
directed toward the unfaithful spouse. Daly and Wilson (1988) asserted that
"Sexual jealousy and rivalry have been prominent in virtually every study
of homicide motives" (p. 186). According to Person (1988),
If the lover has been rejected in favor of another, he may be consumed
by a jealous frenzy, tortured by the image of his lover and the rival
together, causing him to focus his rage primarily on the rivaL By venting
all rage at the rival, the lover exonerates the beloved. Part of the
mechanism involved here is Oedipal: The rival parent is deemed the
villain. This allows rage to be discharged while preserving the goodness
of the beloved. (p. 304)

The factors that determine a violent outcome for jealousy include an

individual's personality characteristics, attachment history, belief system,
and societal influences." For example, attachment researchers have com-
pared the tendencies toward violent behaviors in men who have secure

214 SEX AND LOVE IN INTIMATE RELATIONSHIPS

versus insecure attachment styles. Findings from one comprehensive study
(Holtzworth-Munroe et al., 1997) showed that "violent husbands are more
likely to be classified as having preoccupied, ambivalent-anxious and disorga-
nized attachment strategies and as being more jealous and less trusting"
(p. 327) than nonviolent husbands. In one of the few studies of jealousy
and female aggression, deWeerth and Kalma (1993) found that males re-
ported that they would most likely get drunk, demand an explanation, or
feign indifference in a hypothetical competitive situation, whereas females
reported that they would most likely cry, verbally and physically abuse their
mates, or try to look attractive and unruffled. In competitive situations,
these individuals may experience the following hostile thoughts toward
themselves and their partner.
How couldshe (he) do that to you? You'd better put her (him) in her
(his) place!
You should get even with that bitch(bastard). She (He) thought she
(he) could get away with it. Maybe next time she'll (he'll) think
twice before she (he) fools around.
You can never trust a woman (man).
Everybody knows he (she) cheated on you, and they're not telling you.
Just look at what he (she) did to you!
He (She) deserves everything he's (she's) going to get from you!.
You idiot! You were faithful to him (her). Now look at what he's
(she's) done to you.
You're a fool! You trusted him (her) and he (she) doesn't care about
you at all.
Why don't you just fix things once and for all?
These self-destructive thoughts and aggressive attitudes toward an
intimate partner or rival are often exacerbated by other factors, including
anxieties about abandonment, panic related to the potential loss of the
partner, and narcissistic rage resulting from public exposure with the associ-
ated shame and humiliation.

THE RELATIONSHIP BETWEEN SEXUAL WITHHOLDING

AND JEALOUSY

Fear of being close to another person in an intimate relationship

predisposes provocative negative behaviors and withholding of one's positive
qualities to ward off closeness. Sexual withholding in particular heightens
feelings of possessiveness as well as jealousy. It leads to self-critical thoughts
and cynical, distrustful attitudes toward one's partner. When men and
women unconsciously inhibit their sexual desires or hold back sexual

JEALOUSY AND SEXUAL RIVALS 215

responses, they come to feel that they are at a disadvantage as competitors.
Their sense of being unable to compete causes them to focus on their
rival's advantages and they feel victimized and cheated. Sexual withholding
exacerbates people's feelings of envy and jealousy. In pulling back from a
competitive situation, they imagine their rivals as more attractive, powerful,
better than they are. Individuals who are sexually withholding tend to
experience vicious self-attacks, such as
Just look at him (her)! He's (She's) much more sexy, good-looking,
interesting, and lively than you.
You're not interested in sex much anymore. No wonder he (she)
enjoys being with someone else.
You don't stand a chance. You'd just as well give up.
In general, people who are self-denying and withholding are inclined
toward morbid, jealous brooding over imagined losses instead of actively
competing (Firestone & Catlett, 1999). When these emotions are examined,
it often becomes evident that the jealousy merely disguised the fact that it
was the person's withholding that prevented him or her from succeeding
in a romantic relationship, not the presence of a rival or competitor. In
this sense, the person arranged for his or her own disappointment and defeat.

DECEPTION AND JEALOUSY

Deception may be the most damaging aspect of infidelity. Deception

and lies shatter the reality of others, eroding their belief in the veracity of
their perceptions and subjective experience (Bader & Pearson, 2000). The
betrayal of trust brought about by a partner's secret involvement with another
person leads to a shocking and painful realization on the part of the deceived
party that the person he or she has been involved with has a secret life and
that there is an aspect of his or her partner that he or she had no knowledge of.
Many men and women who originally commit to a monogamous rela-
tionship later violate the agreement. In these cases, the violation of trust
can have a more damaging effect on the relationship than the "sexual
infidelity" itself (Glass & Wright, 1997). In her book, Not "Just Friends,"
Glass (2003) emphasized the point that lies, dishonesty, and deception in
personal relationships invariably destroy the trust between partners. She
asserted that
relationships are contingent on honesty and openness. They are built
and maintained through our faith that we can believe what we are
being told. However painful it is for a betrayed spouse to discover a
trail of sexual encounters or emotional attachments, the lying and
deception are the most appalling violations. (p.60)

216 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 In light of the damage to a person's feelings and sense of reality caused
by lies and deception, honesty in personal relationships becomes a moral
imperative. Therefore it is essential for partners who claim to love and
respect one another to agree to maintain an open and honest dialogue about
their feelings and behaviors in relation to sexual fidelity.

CULTURAL INFLUENCES ON JEALOUSY

Social scientists have proposed that the ways in which jealousy is

experienced are determined largely by cultural forces operating within a
given society (Daly & Wilson, 1983; Davis, 1977). Buunk and Hupka (1987)
have suggested that "cultures differ in the behaviors that are viewed as a
violation of the exclusivity of intimate relationships" (p. 21). According to
Barash and Lipton (2001), "about 75 percent of societies permit male infidel-
ity, whereas only about 10 percent permit female infidelity-and even in
these cases, it is not guaranteed that males will actually be tolerant of such
behavior" (p. 159).
In an essay entitled, "Jealousy and Sexual Property," Davis (1977)
declared that, "A popular fallacy has been to conceive the jealousy situation
as a 'triangle.' Actually it is a quadrangle because the public, or community,
is always an interested element in the situation" (p. 129). Indeed, as noted
in chapter 3, the pooled beliefs and defenses of each member of a society
combine to form social mores, societal institutions, and community stan-
dards. In turn, conventional attitudes regarding the exclusivity of marriage
and sanctions regulating the proprietary rights of one partner over the other
tend to exacerbate the "normal" feelings of jealousy that individuals usually
experience in a competitive setting.
In writing about manifestations of jealousy observed in diverse societies,
Sluzki (1989) stressed the fact that
Both the linguistic practice we call jealousy as well as its subjective
experience are culture bound. Some cultures lend themselves better
than others to creating a narrative of jealousy, contingent upon whether
they value individual or collective rights, favor proprietary or non-
proprietary relationships, or emphasize the differences in rights and
privileges attached to gender. (p. 54)

Sluzki concluded that within couples living in a society that focuses on

Proprietary rights, mistrust, and belief that the other is violating mutual
agreements about intimacy ... even denial or argument [about infidelity]
implies consensual behavior patterns of jealousy. There is no escape
from this closed circle, except perhaps, through an escalation severe
enough to destroy the relationship. (p. 54)

JEALOUSY AND SEXUAL RIVALS 217

 In a relationship such as the one portrayed by Sluzki, each partner
experiences powerful feelings of jealousy whenever there is a breach or even
an imagined breach in the couple's mutually agreed-on contract about sexual
fidelity. As Sluzki stressed, a society that affirms proprietary rights of one
person over another and that supports the exclusivity of the dyad or marriage
contributes to both partners' feelings of possessiveness and distrust. This
type of social order reinforces anticipatory fears of being betrayed or rejected
in favor of the rival and supports destructive self-attacks, cynicism toward
loved ones, victimized feelings of rage, and justifications for retaliating
against a rival. For individuals living in this type of social order, these
disturbing thoughts and feelings add a negative loading to feelings that
might well be considered as natural competitiveness by individuals living
in a different social order. In commenting on the meaning assigned to
extramarital sex throughout most industrialized and primitive societies,
Gilmartin (1977) argued that "As long as jealousy is justified by our cultural
norms, as long as the 'wronged party' is seen as a 'cuckold,' as long as
individuals are excused for 'crimes of passion,' we may expect jealousy to
pervade our interpersonal relations" (p. 158).
However, there have been a few exceptions to this seemingly universal
prohibition against "infidelity." For example, according to Mazur (1973/
2000), a small Quaker group in England published an essay (Toward a Quaker
View of Sex) in 1964 in which they proposed that extramarital relationships
might be a constructive force in the lives of some men and women:
"We recognize," the group maintains, "that while most examples of the
'eternal triangle' are produced by boredom and primitive misconduct,
others may arise from the fact that the very experience of loving one
person with depth and perception may sensitize a man or a woman to
the lovable qualities in others.... The man who swallows the words,
'1 love you,' when he meets another woman, may in that moment and
for that reason begin to resent his wife's existence." (cited in Mazur,
1973/1000, p. 5)

Adding his comments to the Quakers' declaration, Mazur wrote, "We

assume also that the wife has the capacity to resent her husband's existence
when she is constrained from acknowledging or confessing love for another
man" (p. 5).

OUR POINT OF VIEW IN RELATION TO

EXCLUSIVE VERSUS NONEXCLUSIVE RELATIONSHIPS

In Western societies, monogamous relationships are seen as providing

more security, certainty, and a greater possibility for long-lasting love than

218 SEX AND LOVE IN INTIMATE RELATrONSHIPS

nonexclusive relationships. In their style of coupling, many men and women
take a proprietary interest in each other's activities and are overly possessive
and controlling in their efforts to compensate for feelings of inadequacy
and fears of competition. They subscribe to the conventional belief that
married couples or people who are committed to a long-term relationship
essentially belong to each other. As children, they were taught that they
"belonged" to their families, and as adults they lack a sense of belonging
to themselves. In failing to view themselves or their mates as autonomous
human beings, they make themselves vulnerable to manipulations that play
on their guilt and sense of obligation.
People who have formed a fantasy bond are often unaware that by
limiting their partner's freedom, they are essentially limiting or entrapping
themselves. When one's partner is not free to pursue other relationships,
one never knows for certain if one has really been chosen or is really
preferred. There is always the possibility that if one were not imposing
restrictions on a partner's freedom, one would lose out in an openly competi-
tive situation.
In previous works, we have given this question of open versus closed
relationships considerable attention (Firestone & Catlett, 1999; Firestone
et al., 2003). In general, we feel that it is unwise for people to place
restrictions on each other in an intimate relationship, because eventually
one or both partners may come to resent such limitations. At the same
time, we have observed that most people are unable to cope with a partner's
sexual freedom without suffering considerable distress As Buss (2000) noted
in his study of jealousy, "Few marriages can endure third-party intruders"
(p.221).
Many couples struggle with the dilemma of whether to have an exclu-
sive or nonexclusive sexual relationship. The issue is complicated, although
not necessarily in the early stages of a relationship, when a person initially
falls in love and tends to be focused exclusively on the other. As the
relationship matures, some partners begin to question what type of arrange-
ment they wish to have during the long term-open or monogamous. In
trying to resolve this dilemma, it is beneficial for partners to fully discuss
their attitudes, thoughts, beliefs, and feelings about the type of commitment
they wish to make to each other. A primary goal of these communications
would be to come to an agreement that would respect each other's feelings
and desires. This agreement should not be violated or, at least, the partners
should enter into new negotiations with each other before making any
changes in the conditions.
One potential negative effect of pledging fidelity is that a person can
come to feel that he or she has assigned his or her sexuality to another. As
this person loses a sense of owning his or her sexuality, he or she often
experiences a decrease in sexual desire and a declination in the quality of

JEALOUSY AND SEXUAL RIVALS 219

his or her sexual relationship. In addition, in many marriages, partners
begin to take each other for granted and stop seeing each other as separate
individuals, whereas in an affair, the lovers usually see each other as two
separate people. They tend to have a more equalitarian relationship, that
is, they relate to each other as equal participants with equal value and
responsibilities. For example, Glass (2003) has observed that "Unfaithful
spouses perceived more equity in their affairs than in their marriages. Under-
standing was considered to be equal in 47 percent of marriages and in 70
percent of affairs" (p. 226). However, when an affair replaces the marriage
or the primary relationship, these patterns-for example, feeling obligated,
taking each other for granted-gradually come to be manifested in the new
relationship as well.
Within a society where serial monogamy is practically the norm, people
often feel little motivation to develop themselves personally or to "work"
on their relationship. They seem less interested in changing behaviors in
themselves that are hurtful to the other person or that are causing distress
in the relationship. Instead, they often blame their partner for their unhappi-
ness and move on to an ostensibly "better choice," only to repeat the pattern
with their new partner.
In addition, many people have an unconscious belief that love is
available only in limited quantities, that it is impossible to love more than
one person at a time, and that one can find everything one needs in one
relationship. They tend to live by these beliefs rather than to subject them
to scrutiny or reality-testing. In terms of honesty, it is psychologically impos-
sible for people to commit their feelings of love or sexual attraction to a
certain person for a lifetime, whereas individuals are perfectly capable of
controlling their actions in this regard. There is a basic dishonesty involved
when one attempts to block out or deny feelings of love or attraction for
a person other than one's mate.
We have observed that as people achieve more emotional maturity in
their relationships, they tend to evolve to higher levels of self-differentiation,
which in tum enables them to better cope with primal elements inherent in
jealous reactions and to handle competitive situations more constructively.
Often there is a concomitant maturation in people's views of conventional
marital arrangements, and they may choose to be more inclusive in relating,
both emotionally and sexually, to other people outside the relationship or
marriage. They come to recognize the impossibility and impracticality of
gratifying all of their wants and needs in a relationship with one person.
This evolved attitude toward love and marriage has been described by Person
(1988) in her book Dreams of Love and Fateful Encounters:

We must learn both to acknowledge the centrality of romantic love to

our lives, and to maintain other relationships, other avenues to meaning.

220 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 For, perhaps most important of all for the survival of love, we must not
ask it to bear the weight of all meaning. (p.321)

As Kernberg (1995) wrote in Love Relations,

I think there is an irreducible conflict between conventional morality

and the private morality that each couple has to construct as part of
its total sexual life and that always implies a nonconventional degree
of freedom the couple has to achieve for itself. The delicate balance of
sexual freedom, emotional depth, and a value system reflecting mature
superego functioning is a complex human achievement that provides
the basis for a relation that is deep, passionate, conflicted, and satisfying
and potentially lasting. (pp. 187-188)

In his book, The New Intimacy, Mazur (1973/2000) described a woman,

a 30-year-old librarian, who had a nonexclusive relationship with her hus-
band. In her interview, she spoke about her sense of accomplishment as
well as about her doubts and fears:

I didn't plan on having an open-ended marriage. It simply began to

develop that way when I discovered that my husband loves other women
besides me; that he's not monogamous in a traditional way. This realiza-
tion freed me from the obscenity of possessiveness. Some of my extramar-
ital relationships have been fruitful to me.... I do wonder about the
future-there's a measure of risk and uncertainty in the way we've now
chosen, but I'm learning not to be afraid to be a person, a woman with
worthwhile contributions to make to human society. As a matter of
fact, there is a continual excitement about our marital relationship and
mutual growing-anything else would be emotional death for us.
(p. 10)

In Eleven Minutes, Paulo Coelho (2004) declared: "I am convinced

that no one loses anyone, because no one owns anyone. That is the true
experience of freedom: having the most important thing in the world without
owning it" (p.90).7
Our views regarding sexual freedom are similar to those expressed by
the woman that Mazur interviewed, as well as the sentiments articulated
by Person, Kernberg, and Coelho. We feel that the best situation for individu-
als in a couple relationship is to sustain each partner's freedom of choice
and not limit the other by imposing unnecessary rules and restrictions.
When partners agree to respect and support each other's freedom, it extends
to every aspect of their lives and would logically apply to their sexual
freedom. It is our point of view that attitudes of possessiveness and ownership
of another human being, whether friend, mate, or child, combined with
actions of manipulation and control, constitute a form of human rights
violation. Intimate relationships tend to be the most meaningful and

JEALOUSY AND SEXUAL RIVALS 221

satisfying when they are not based on imposing limitation and restrictions
on one another.
However, we recognize that many people find it difficult to develop
the trust necessary to have an emotionally close relationship without a
guarantee of monogamy. For example, Rob and Cathy had lived together
for several years, and although they did not date other people, each believed
in sexual freedom as an ideal. Yet when they faced the issue in reality, it
turned out to be more difficult to live up to than either of them realized.
When Rob communicated that he was interested in another woman,
Cathy became extremely upset. She experienced intense anxiety and emo-
tional distress and found herself ruminating about and visualizing Rob be-
coming sexually involved with this other woman. In the weeks that followed,
she withdrew from Rob and lost interest in being sexual with him. Sensitive
to Cathy's struggle and the impact this was having on his relationship with
her, Rob reassured her that their relationship was far more important to
him than his sexual freedom. The couple talked at length about how much
they valued each other and about the type of relationship they really wanted
to have. Both agreed to be monogamous. After the conversation, Cathy
felt relieved and was appreciative to Rob for taking her feelings seriously.
The couple's relationship improved significantly, and both partners felt an
increased emotional intimacy.
When personal contracts concerning exclusive relationships, such as
the one described in the example above, are agreed on, it is essential to
honor that commitment; otherwise, the deception often takes a tragic toll
on the relationship. Thus, although giving up any personal freedom, by
definition, constitutes a restriction, in some cases this sacrifice may be worth
the price. If people are aware that having another sexual relationship would
be excessively painful for their mate, they might want to remain monogamous
out of consideration for the other's feelings.

CONCLUSION

Individuals' jealous responses, whether to sexual or emotional infideli-

ties, are wide-ranging and vary according to their childhood experiences,
the degree to which they have formed a fantasy bond with their partner,
and the culture in which they live. Jealousy has been conceptualized by
many theorists and researchers as a powerful emotion that can have both
negative and positive consequences. Jealousy has been portrayed as the
"dangerous passion," as a triggering mechanism for domestic violence, as a
defense to safeguard love and help partners not take each other for granted,
and as the predictable outcome of the oedipal triangle of early life, among

222 SEX AND LOVE IN INTIMATE RELATIONSHIPS

many others. In elucidating the defensive function that jealousy has served
throughout the ages, Buss (2000) argued that
It's unlikely that love, with the tremendous psychological investment
it entails, could have evolved without a defense that shielded it from
the constant threat from rivals and the possibility of betrayal from a
partner. Jealousy evolved to fill that void, motivating vigilance as the
first line of defense and violence as the last. (p. 223)

Progress can be made in overcoming those aspects of jealousy that are

damaging to couple relationships. In conceptualizing intense or chronic
jealousy as a defense, we suggest challenging destructive thought processes
that govern self-defeating, self-destructive behavioral responses in competi-
tive settings. We encourage an exploration of residual feelings from child-
hood that are evoked in competitive settings as well as an identification of
the self-attacks and hostile attitudes toward a rival that magnify natural
feelings of jealousy, competitiveness, and envy.
In giving up illusions of connection, individuals would necessarily
relinquish their sense of ownership over their respective partners. In becom-
ing less withholding or self-denying in pursuing their love interests, they
would find the intensity of their jealous reactions diminished to a consider-
able extent. By challenging the patriarchal assumption that women are
the property of men, they might find the incidence of domestic violence
significantly reduced. In disputing the false conventional assumption that
love is constant and invariant, they would understand the ebb and flow of
loving feelings that naturally occur in relationships and would feel less
threatened by indications of a partner's interest in another person.
Being aware of and challenging any discrepancy between words and
actions when communicating about these issues enables partners to build
a sense of trust in each other. In attempting to establish and preserve trust
in each other, partners need to learn how to communicate their desires and
wishes more directly. They need to understand how important it is not
to give double messages, particularly regarding competitive situations that
inevitably arise during the course of a relationship.
Our goal in working with couples is to inspire the development of
more mature forms of love that allow for ambiguity and uncertainty, and
to help individuals remain open and vulnerable to all of inevitable vicissi-
tudes of love. Mature love involves an appreciation and respect for the
uniqueness of the other person. It goes beyond having an interest in the
other person only as he or she fulfills one's own wants and needs. It entails
seeing the other person as a separate individual with rights to an independent
and free existence.
Ideally, society would encourage the development of intimate couple
relationships where each partner would allow the other to live and flourish.

JEALOUSY AND SEXUAL RIVALS 223

The goal would not be to reject or depreciate marriage as an institution,
but to develop constructive long-term associations that would meet the
needs of each individual and support his or her personal development.

NOTES

1. Sometimes partners are competitive with each other in the absence of sexual
rivals. For example, Mazur (1973/2000) described this form of competitiveness
within the couple: "Negative forms of competition stem from a lack of self-
confidence or self-esteem leading to jealousy of the partner's achievements,
attractiveness, friends, or sexual performance" (p. 107).
2. The terms "jealousy" and "envy" are sometimes confused in terms of describing
the ways in which the two emotions are experienced and the behaviors they
inspire. According to Friday (1985), jealousy is an emotional state based on a
fear of losing what one already has, whereas envy is based on a condition of
not having. One reason for the confusion is because, as Pines (1998) put it,
The jealous response includes, in many cases, a component of envy. A
man who is jealous because his wife is having an affair with his best
friend, for example, is likely to feel envious of his friend's success with
his wife. (p.9)
3. Regarding other approaches to jealousy, social psychologists DeSteno and
Salovey (1996) proposed that the intensity of jealous feelings experienced by
an individual is related to efforts to maintain positive self-esteem, a perspective
that is based on self-evaluation maintenance (SEM) theory. Therefore, accord-
ing to the SEM approach, the characteristics and attributes of one's rival "may
be one variable that moderates the intensity of experienced jealousy" (p. 921).
Also see Mathes (1991) who applied Lazarus's cognitive-phenomenological
theory of emotions in his research on jealousy.
4. More recent studies (Becker, Sagarin, Guadagno, Millevoi, & Nicastle, 2004)
found that the degree of commitment to the relationship tended to confound
these gender differences between reactions to sexual infidelity and emotional
infidelity. When emotions other than jealousy were considered, "Both women
and men reported more anger and disgust to the sexual aspect of the infidelity.
And both sexes reported more hurt to the emotional aspect of the infidelity"
(p.537).
5. Individuals whose voice attacks tended to arouse feelings of shame endorsed
many items on the English version of the Swedish EMBU (Swedish acronym
for Egna Minnen Betraffande Uppfostran, "Our Memories of Parental Rearing
Experiences in Childhood") inventory (Perris, [acobsson, Lindstrom, van Knor-
ring, & Perris, 1980) that assesses, among other parental behaviors, those that
generate shame and guilt in children.
6. In developing a scale to assess violence potential, the Firestone Assessment of
Violent Thoughts (FAVT), we were able to identify four factors associated
with criminal violence in our preliminary study: Factor 1, Social Mistrust-

224 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Stereotypic Characteristics; Factor 2, Thoughts of Being Disregarded/
Disrespected by Others; Factor 3, Negative Critical Thoughts about Self and
Others; and Factor 4, Thoughts/Expressions of Overt Aggression. In applying
this model to domestic or interpersonal violence, we hypothesized that specific
thoughts are triggered by infidelity and provide rationalizations for taking vio-
lent action against a spouse.
7. Quotation from Eleven Minutes by Paulo Coelho. Copyright © 2004 Paulo
Coelho. Reprinted by permission of HarperCollins Publishers Inc.

JEALOUSY AND SEXUAL RIVALS 225

 9
VOICE THERAPY APPLIED TO
PROBLEMS IN SEXUAL RELATING

[In sex therapy] much therapy time is spent in attempts to change

negative attitudes toward sexuality. These attitudes are usually the result
of societal or parental injunctions against sexuality, which are internal-
ized during childhood and adolescence. Although the patient often has
intellectually rejected these prohibitions, their emotional components
are not so easily changed.
-LoPiccolo (1978, pp. 513-514)

Voice therapy is a cognitive-affective-behavioral methodology. It is

cognitive because it helps clients access and identify destructive thoughts
and attitudes toward themselves as well as hostile and cynical attitudes
toward others. It is affective because it brings these thoughts into conscious-
ness together with the associated feelings of anger and sadness. It is behavioral
because there is a focus on modifying behaviors based on the voice that
predispose alienation in personal relationships.
This chapter explains the methodology used to elicit and identify the
self-critical thought process or voice. We have found that the techniques
of voice therapy are effective for gaining access to people's core defenses
and for facilitating changes in their maladaptive behaviors. Voice therapy
helps individuals achieve insight into the origins of their distress and assists
them in gradually altering behaviors in the direction of their stated goals.
The overall purpose of the therapeutic approach is to identify and separate
out those elements in the personality that are opposed to the self and that
predispose hostility toward others (Firestone, 1997a).

Portions of Helen Singer Kaplan's The Sexual Desire Disorders were reprinted in this chapter.
Copyright © 1995 from The Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation by
Helen Singer Kaplan, MD, PhD. Reproduced by permission of Routledge/Taylor & Francis Books,
Inc.

229
 When using voice therapy techniques as a treatment approach for
sexual problems, we suggest that clinicians develop a case conceptualization
regarding factors that affect the overall functioning of the client, taking into
consideration the relevant biomedical, environmental, social, and cultural
components. In all cases, the focus of therapy should be directed toward
(a) helping clients identify their therapeutic goals and (b) helping facilitate
their movement toward achieving these goals. As always, the therapist must
approach the therapeutic relationship from a position free of bias and value
judgments. In working with members of sexual minorities, the American
Psychological Association Guidelines for Psychotherapy With Lesbian, Gay,
and Bisexual Clients (American Psychological Association, 2000) provide a
valuable resource. The guidelines recommend that clinicians familiarize
themselves with the various ways that social prejudice "may affect the client's
presentation in treatment and the therapeutic process" (p. 1). They also
encourage clinicians to explore the ways that their attitudes toward sexual
minorities might impact their work with these clients, and to "seek consulta-
tion or make appropriate referrals when indicated" (p. 4 ).1
In this chapter, we first describe how voice therapy is used as a psycho-
therapeutic technique to help clients overcome problems in their intimate
relationships and improve the quality of their sexual relating. Next, we delin-
eate the five steps involved in the application of the technique to problems
with sexual desire and for other sexual dysfunctions in the context of couples
therapy. We provide two case studies to illustrate the steps and discuss the
impact of voice therapy. Lastly, we review methods that a number of sex and
marital therapists have developed that are congenial with our approach.
As noted in chapter 3, there are a number of biological, psychological,
and social factors that interact to interfere with an individual's ability to
achieve emotional and sexual fulfillment in a close, personal association.
In Western society, the extent of dissatisfaction experienced by people in
their sexual relationships is noteworthy. For example, in a survey of more
than 7,000 couples, 53% of the men and 59% of the women interviewed
said they were not physically satisfied in their sexual relationship, while
59% of the men and 63% of the women said they were not emotionally
satisfied (Laumann et al., 1994). A major barrier to a healthy or satisfying
sexual relationship can be found in the psychological defenses and negative
thought processes that the partners bring to the relationship and that support
distorted views of sexuality.

VOICES THAT DISRUPT SEXUAL RELATIONS

The goal of voice therapy with couples is to help each partner access
and identify the destructive thoughts that interrupt the smooth progression

230 SEX AND LOVE IN INTIMATE RELATIONSHIPS

of feelings that naturally occur during a fulfilling sexual experience. The
intrusion of these negative thoughts and attitudes can lead to a number of
sexual symptoms. When clients learn to talk openly about their relationships
and disclose specific voice attacks that they experience regarding sex, there
are often significant positive changes in their sexual relations.
Voice therapy procedures have been used to identify a wide range of
self-attacks in individuals who reported a variety of difficulties in achieving
sexually fulfilling relationships. The presence of negative thoughts during
sex has an adverse effect on people's physiological responses and, at times,
on their ability to complete the sex act. For example, one man revealed
that as soon as he begins making love, he often finds himself thinking,
You're not going to be able to keep your erection. At that point, he usually
does have difficulty and his nervousness increases with each subsequent
failure. A woman reported thinking to herself, You're not going to be able to
have an orgasm, and she experienced considerable tension and a correspond-
ing diminution in feelings of excitement. The process of anticipating a
negative sexual experience takes lovemaking out of the realm of affectionate
and pleasurable feelings and transforms it into an anxiety-provoking activity
in which men and women continually evaluate their performance.

Voices Prior to Sex

Voice attacks occur not only during sexual intercourse, but they can
also be triggered far in advance of a sexual experience, as noted in chapter 7.
Self-attacks are activated in relation to men's and women's basic feelings
about themselves, their sexual identity, and their ability to both give and
receive sexual gratification and pleasure. Self-protective thoughts warning
against becoming involved with another person, both sexually and emotion-
ally, are among the most common voices reported. Other negative, anticipa-
tory thoughts emphasize the "dangers" of being hurt or taken advantage of
in sexual situations.
Both men and women often have cynical thoughts that stifle their
excitement upon first meeting a potential sexual partner, such as

Why should he like you?

Why would she want to go out with you?
He has no real interest in you. Why get so excited?
He is just interested in what he can get.
She's going to pressure you for some kind of a commitment.

Today, with the threat of AIDS and other STDs, many people have voices
discouraging them from pursuing sexual relationships at all: This whole safe
sex thing is such a hassle. Why even bother to get involved?

VOICE THERAPY APPLIED TO SEXUAL RELATING 231

 People often feel anxious and experience voice attacks when a relation-
ship transitions from a flirtation to a fully sexual relationship:
What makes you think she's interested in more?
Why do you think he wants to be with you?
How do you know you're reading the signals right?

Voices During Sex

Individuals often experience intrusive thoughts during sex that can

detract from their feeling of excitement.

Negative Thoughts About One's Body

Self-depreciating thoughts about one's physical appearance and body,
especially the sexual areas, can interrupt the progression of sexual feelings.
Many men and women have negative views about nudity and critical feelings
about their bodies that cause them considerable embarrassment in sexual
situations.
Many women have self-conscious thoughts about their breasts:

Your breasts are sma!!, they're not like other women's, and so forth.

Or about the genital area:

Your vagina is too large, or You're too tight.

Don't let him touch you there! You might not be dean.
Don't have oral sex, he'll be repulsed.

Similarly, many men feel inadequate in relation to the size of their

penis:
Your penis is too small.
You won't be able to satisfy her.
You're not going to last.
You're not like other men.

Negative Evaluations of One's Sexual Performance

Feelings of affection and attraction that lead to a couple's mutual desire
to express their feelings sexually are easily dispelled by negative thoughts
about their sexual performance. Often, when the transition has been made
from an affectionate embrace to a sexual caress, people's voices gain in
ascendancy and can ultimately obliterate sexual desire. Both men and women
have a tendency to find fault with every aspect of their lovemaking, including
their level of excitement:

232 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 You're not excited enough.
You're not wet enough.
You're not erect enough.
You're not going to be able to come.
They criticize their movements:
You're moving too much.
He'll think you're a slut.
You're hurting her.
You're entering her too soon.
She's not ready.
They doubt their ability to please their partner:
You're not touching her right.
You're not sensitive about what he (she) likes.

Critical Voices About One's Partner

People often anticipate rejection based not only on their self-critical
thoughts, but also on hostile, critical views they have of their partner. In
voice therapy sessions, clients often verbalize negative attitudes toward their
partner, such as
She's too needy.
He just doesn't understand you.
She's not reliable.
You can't trust him.
Voice attacks against one's partner often include many of the sexist
attitudes and stereotypes described in chapter 4. Many women have negative
attitudes toward men: All men want is sex. They don't want commitment or
marriage. They are afraid of getting emotionally involved. Similarly, many men
hold cynical attitudes toward women that act to cut off their feelings of
sexual attraction and emotional closeness during sex: Women are unreliable,
jealous, erratic, and overemotional. They'll trap you into marriage.

Negative Thoughts Following Sex

Many people have negative thoughts after a sexual experience. Some

people even appear to change character immediately afterward, for example,
becoming cool and aloof or argumentative. When a sexual experience has
been particularly gratifying and emotionally meaningful, self-protective
voices predicting negative outcomes may come into play. These thoughts
are degrading to both partners and tend to devalue the sexual act. People
have reported thoughts such as

VOICE THERAPY APPLIED TO SEXUAL RELATING 233

 What did you really get from this?
You think you felt really good. So what? He doesn't really care
about you.
You always give in-you have no dignity.
She didn't look happy afterward.
How do you know she had an orgasm?
You'd better make sure she's happy. That's your responsibility.

APPLICATION OF VOICE THERAPY PROCEDURES

TO COUPLES THERAPY

Voice therapy involves an individual verbalizing his or her self-critical

thoughts in the second-person format, that is, in the form of statements
toward him- or herself. For example, "You're unattractive. You're unlovable,"
rather than "I'm unattractive. I'm unlovable." When asked to verbalize their
negative thoughts in the second person, people often spontaneously begin
to speak louder and with more intensity of feeling. With this release of
emotions, valuable material that the client was previously unaware of comes
to the surface.
Hostile, cynical thoughts toward one's partner are verbalized in the
third-person format, as though someone else were imparting negative infor-
mation to the individual about his or her partner. For example, "She's so
cold and rejecting. She doesn't really care about you." "He's so immature and
clingy. Why would you want to get involved with him?" rather than "She's really
cold and rejecting toward me," or "I wouldn't want to get seriously involved with
him because he's so immature."
The therapist who wants to deepen the level of emotion that the
client is experiencing while verbalizing voice attacks encourages the client
to "say it louder" or "say it how you're hearing it in your head." If the
therapist observes that the client is holding back feeling or is on the brink
of feeling, he or she may encourage the client to "really feel that," or "let
go and say anything that comes to mind."
In the context of couples therapy, in sessions where both partners are
present, each reveals the negative thoughts and attitudes toward him- or
herself and the other. Clients are encouraged to understand that their voices
are the cause of their overreactions, dramatic hostile thoughts, and grudges,
even when these critical views have some basis in reality. When verbalizing
hostile attitudes toward the other, partners often express the critical accusa-
tions their voices are making about traits and behaviors in the other person.
During this process, they often become aware that their voice has taken on
a sarcastic, snide tone and that these attacks are exaggerating their partner's
characteristics. Disclosing their angry, judgmental views in the form of

234 SEX AND LOVE IN INTIMATE RELATIONSHIPS

the voice helps people separate these views from a more realistic view of
their mate.
In tracing the source of their self-attacks and hostile attitudes to early
family interactions, the partners gain perspective into each other's problems
and feel more compassion for their mates as well as for themselves. In this
sense, they are sharing each other's individual psychotherapy. Recognizing
that the effect of voice attacks is to create distance and alienation within
the relationship has a powerful effect on improving partners' attitudes toward
each other as well as on enhancing each individual's personal growth. Each
partner learns to accommodate to the anxiety associated with breaking
inward, self-protective defenses and is gradually able to tolerate more love
and intimacy in his or her life.
Lastly, it is important to emphasize that voice therapy techniques are
not used as a rigid system of psychotherapy but are applied as necessary to
the specific client or couple. In using these techniques, people can begin
to counteract the dictates of the voice and achieve greater emotional and
sexual fulfillment in their closest associations.

Steps in the Therapeutic Process

In individual as well as conjoint and couples group sessions, clients

generally progress through the following steps during the course of treatment:

1. Each partner formulates the problem that he or she believes is

limiting the sexual relationship, while learning not to attribute
blame to the other. It is important for therapists to identify
any medical condition that could also be contributing to sexual
dysfunction in one or both of the partners. They should consult
the appropriate medical experts-in urology, gynecology, in-
ternal medicine, psychiatry, and pharmacology-to determine
whether organic factors or certain medications (e.g., anti-
depressants, selective serotonin re-uptake inhibitors, anxiety-
reducing drugs) are involved in a couple's problem and to
refer for treatment physical components that could be contrib-
uting to the sexual dysfunction (H. Kaplan, 1995; Kellett,
2000; Phillips, 2000). Moreover, in cases where there is a
physical component, clients often feel ashamed or critical of
themselves for what they perceive as a disability. In these
cases, the therapy needs to address the destructive thoughts
and attitudes that clients experience regarding medication or
a physical illness.
2. Partners learn to verbalize self-critical thoughts and negative
perceptions of the other, in the form of the voice.' They release

VOICE THERAPY APPLIED TO SEXUAL RELATING 235

 the deep anger and sadness associated with the verbalization of
the voice. It is important for the therapist not only to encour-
age the expression of these emotions but also to remain silent
during any pause in the client's verbalizations. Following these
pauses, deeper material in the form of core negative beliefs
about self as well as intense feelings of rage and grief often
emerge.
Each partner strives to "give away" the specific content of
his or her cynical thoughts and beliefs toward the other. Both
attempt to relinquish these hypercritical views and give up
their grudges even when these views have some basis in reality.
Partners are rarely surprised by their mate's voices about them.
Rather than feeling hurt, victimized, angry or defensive, the
partner frequently feels relieved because the other person has
usually been acting out specific behaviors based on these voices
in the couple's interactions.
3. Partners develop insight into the origins of negative cognitions
that interrupt their feelings during sex and relate past experi-
ences to present conflicts. In addition, they attempt to under-
stand the relationship between their voice attacks and their
self-limiting, self-destructive behavior patterns. The therapist
encourages clients to make this connection by asking questions
such as "Where do you think these attitudes come from?" or
"Where have you heard them before?" Clients develop an
awareness of the limitations they impose on themselves in
their everyday life and in their relationships. In becoming
aware that much of their distress is caused by restrictions they
place on themselves, people tend to attribute less blame to
their partner.
4. In collaboration with the therapist, clients plan ways to change
behaviors and communications in a direction that counteracts
the dictates of their voice and that helps them move in the
direction of their stated goals. The therapist alerts clients to
the possibility that anxiety and increased voice attacks may
accompany positive changes in one's behavior or self-image.
The new circumstances, including increased feelings of close-
ness and more fulfilling sex, although more positive, are unfa-
miliar and may initially cause anxiety as well. Many clients
have reported that, although there often were strong voice
attacks after taking action based on a corrective suggestion,
these self-attacks gradually diminished after the new behavior
had been maintained over a period of time.

236 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 5. After couples have learned the process of saying their voices
in the therapy setting, they are encouraged to reveal their
negative thoughts to each other when they occur during the
sex act. They can discuss the results in subsequent sessions
and deal with the emotions that arise. Steps 4 and 5 will be
described in more detail in chapter 10.

The example that follows illustrates the application of the five steps
in a session with a couple who had been in therapy for 6 weeks.

CASE EXAMPLE NUMBER ONE

Valerie and Mark had been married two years when they began to
experience problems in their sexual relationship. Valerie revealed that she
usually had difficulties during foreplay; she would start to worry about having
an orgasm or feel distracted by thoughts that had nothing to do with the
sexual situation. As a result, her level of arousal would immediately diminish
and she would no longer feel excited. Mark disclosed that each time Valerie
experienced any difficulty in becoming excited or if she failed to have an
orgasm, he would blame himself. Often he had trouble getting an erection
or completing the sex act. Afterward, he would feel confused, torn between
hating himself and feeling angry and resentful toward Valerie. Believing
that his anger was irrational in the situation, he would attempt to suppress
it. After this pattern had repeated itself a number of times, he felt hesitant
to approach Valerie even when he felt sexually drawn to her because he
anticipated a negative experience. As a result, the frequency of the couple's
lovemaking had decreased significantly. Both partners were strongly moti-
vated to seek professional help. They hoped to recapture the initial feelings
of attraction and passion that they had experienced throughout their court-
ship and in the early months of their marriage.

1. Formulating the Problem

Mark: When we first got together, it was really great. It was like
a fantasy come true for me. And I remember that when
we were first married, we had a very, very active sexual
relationship. I felt very experimental with you. I felt very
active with you. I enjoyed just doing whatever I felt like,
and I got a great deal of pleasure out of that. And then as
time went on, it seemed like I began to feel less that way,
less experimental, less active-sex sort of became more

VOICE THERAPY APPLIED TO SEXUAL RELATING 237

 routine-stylized, almost, and it lost a lot of the feeling for
me that I had enjoyed so much.
Valerie: That's how it seemed to me, too. I know even recently
what's happened is that I've been reluctant to show my
excitement or embarrassed to do certain things sexually.
And I think what I've done is to slowly stop doing every-
thing. Once I got self-conscious, I think I gradually dulled
my excitement down and then I would start wondering if
I was going to be able to have an orgasm.

2. Verbalizing the Voice and Releasing the Associated Affect

In the first part of the session, Valerie articulated her voice attacks:
Therapist: What kinds of things make you feel embarrassed? What are
you thinking at the time?
Valerie: It's hard to say, but one thing I noticed about myself is that
very often before we start to make love I have an affectionate
feeling toward you, Mark, but it doesn't last into the sexual
situation. If I were really myself at the time, I'd be really
affectionate and really sweet and responsive, but these days
I rarely am. It's rare.
Therapist: What are you telling yourself at the time? Try to say it in
the form of a voice.
Valerie: It's a little hard for me to put a voice to that, but as we
start to be sexual it's like, Don't touch him there. That's
disgusting! [pauses for a few seconds] I'm really embarrassed
by what I'm thinking right now.
Therapist: It's okay. Just try to say what you're feeling.
Valerie: I know I feel critical of myself for being excited or making
sounds. I start thinking things like, You're moving too much.
You're too excited. You're making too much noise. You're acting
like a slut! It seems like it's an attack on me for simply
wanting to be sexual.
Therapist: Try to say that attack. Say it in the tone of voice that
you're hearing inside your head.
Valerie: It's confusing. But I know that it makes me more passive.
It's really angry.
Therapist: Let the anger out.
Valerie: It's like, You slut, you dirty disgusting slut. What do you want
to do, eat him uP? Girls don't do that, girls don't do that, you
slut! [angry tone, then long pause followed by sobbing]

238 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 [to Mark] Then it doesn't feel equal any more, the af-
fection isn't equal. It's like you're being loving to me and
I'm kind of holding back. You know, last night it started out
sweet. I started off feeling like myself and feeling affectionate
toward you and it made me feel great. It made me feel like
I was a nice person. I felt like a sweet person. It's so rare.
Therapist: Do you have any voices about being a sweet person?
Valerie: [cries] It made me sad when you asked that.
Therapist: What are the voices about being sweet?
Valerie: The voice would be something like, There's nothing sweet
about you! Who wouldsee you as sweet? I know who you really
are! [saq]
Therapist: Try to really get into it.
Valerie: [louder, angry] This isn't you, this isn't you! This isn't how
you are. You're not a sweet person.

3. Developing Insights

Therapist: Does this voice sound familiar to you? Have you heard
it before?
Valerie: It sounds just like my mother. That's how she really saw
me. Somehow the way she saw me made me feel that if
other people saw me as sweet or attractive, it was because
I had been manipulative or seductive. Also the way she
acted toward my father, so cold, there was no affection
toward him. That really stood out to me as a child. I know
they didn't make love, they slept in separate beds. So now
if I start to feel excited or good sexually, I feel very different
from how she was and I start to get anxious. The next thing
I know, I'm attacking myself for feeling excited.

Next Mark identified what he considered to be a major problem in

the relationship and responded to the voice attacks expressed by Valerie.

1. Formulating the Problem

Mark: When I first came here this morning, I wanted to urge

you to talk, Valerie. I thought you should talk about our
relationship, because in talking to you last night, I could
see that you were sort of panicked. You saw that we were
growing distant, especially sexually, and then I was going
to be away on a business trip and you blew it up into a
really dramatic thing in your head. But after you said your

VOICE THERAPY APPLIED TO SEXUAL RELATING 239

 voices just now, I felt differently, I had a lot of feeling for
you. And I wanted to try to say what my own thoughts
were about our relationship.
There are a number of things I was thinking about along
these lines. I'm aware that I've been defended in my rela-
tionships with women. With you, in the beginning I felt
very open and I wanted to approach our relationship differ-
ently than any other relationship I had been in. But at
some point, I know I started to have some of the same kinds
of feelings that I'd had before. I felt quiet, held back, and
sort of self-protective.

Therapist: [to Mark] How have you felt recently, over the past few
weeks?

Mark: [to Valerie] I felt you pushing me away, like you said. For
example, I came home the other night and you were happy
to see me, you were sweet and appealing to me. I felt really
good toward you. Then we went into the bedroom and I
thought we were going to make love, but you started talking
about how you had been feeling at work and I felt very
pushed away by the change of your mood. Instead of being
angry, I started sort of analyzing you. I know that when
I don't admit that I'm angry, I get parental or I try to
be helpful.

Therapist: What were you telling yourself in that situation?

2. Verbalizing the Voice and Releasing the Associated Affect

Mark: I don't know exactly, that's why I wanted to explore that

here, but it's hard to get any feeling about it. I think the
biggest problem that I have in my life is that I'm quiet. I'm
kept quiet by my voices in some way. I'm kept under control
by these voices.

Therapist: What would those voices be?

Mark: Be quiet. I can't get any emotion behind it. You know that
saying about not waking the sleeping giant? I feel like that's
what I'm avoiding, crossing that border that will wake that
sleeping giant. That gives me a feeling of what those attacks
are. I started to have an image of me as a little kid-[pauses]

Therapist: [waits a moment then responds] What kind of image?

Mark: It's sort of like a memory. I'm standing in front of my mother

and she's yelling at me, "Look, just stay out of the fucking
way. [snide, angry tone] Get out of my way. Don't make

240 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 any noise. Do not call attention to yourself. Keep quiet!"
[pauses for several seconds]
Therapist: [leans forward waiting, then says] Try saying that louder.
You don't have to hold anything back.
Mark: It's just like, but there's shaking, you know-[loud voice,
gesturing with his hands] "Stop crying. Shut the fuck up.
God damn you! Keep quiet. You're bothering me. You
bother me, you little shit! Don't make a sound. I don't want
to hear a peep out of you. Get the fuck out of my way!
[rapid, loud yelling] You little piece of shit. Do not touch
anything. Stay still. God damn you! Do not make any
sound, do you understand? Keep quiet. Stop crying. Do you
understand?" [long pause] God, I had no idea that I would
say anything like that. [sad]
Therapist: [after a few moments] What voices do you have about your
sexual relationship?
Mark: I think I have a lot of voices about being sexual. They
distract me sometimes when we're making love. They're
like: You'd better make her feel good. You're not a real man.
Can't you see she doesn't want you!
Therapist: Really get into those voices.
Mark: Don't bother her. You're a creep. Why would she love you?
Why would she want you? You're so pathetic. You're so little
and disgusting! [snide, angry tone of voice] Of course nobody
loves you. Of course, nobody wants you to touchthem. Nobody
wants that from you!
It's funny, those voices are related to the first things I
said. It all goes back to those old feelings of being pathetic
and a bother for wanting anything.
Valerie: I felt so much when you were talking. I felt so sad for you
and for the way you were treated and I felt like I love you
a lot. I can really see that you're a sweet person, and I felt
a lot of pain for you. I felt good to look at you and to love
you. I wanted to be sweet to you. I really just wanted to
hold you or just kiss your face. That was how I felt.

3. Developing Insight

Mark: I've had a mental block against seeing how I've been in
the relationship. I've sort of understood it intellectually,
but I haven't been able to see it operating until just now.
It's being afraid to confront any of my issues directly and
instead seeing you as the only one who has shortcomings,

VOICE THERAPY APPLIED TO SEXUAL RELATING 241

 and then trying to help you out of whatever problems you're
having. But it's so condescending.
Therapist: So you focus on her problems instead.
Mark: Yeah, if I see problems in you and tend to them, I avoid
looking at my own problems and feelings.
Therapist: It's valuable to identify these negative thoughts and the
emotions. If both of you challenge the prescriptions of your
voices, you will be able to have more in your life. So you
have to go against the old defensive patterns and the behav-
iors that are influenced by the voice. That's the biggest part
of the therapy, in a sense, to actually counteract the effects
of the voice by taking risks, being more vulnerable to each
other, and hanging in there until you can tolerate more
closeness. This is the more difficult part and it takes a
certain amount of self-discipline to maintain the corrective
experience of taking a chance again on loving and being
loved.

4. Changing Behaviors to Counteract the Voice

In later sessions, Mark and Valerie, in collaboration with their thera-

pist, formulated plans to change specific behaviors that were based on their
respective voices. To counter his voices about being quiet, Mark set a goal
for himself to be more direct and forthright in communicating with Valerie.
He described his plans for speaking up on his behalf, which involved directly
expressing his wants to Valerie and avoiding authoritarian or condescending
pronouncements.
In a similar spirit, Valerie made a concerted effort to outwardly express
the loving feelings she had for Mark by being more affectionate, tender,
and generous in her interactions with him. These actions went against the
specific voices telling her that she was not a sweet person, that she was
seductive or a "slut." In addition, in order to overcome the voices that
inhibited them during the sex act, they decided to reveal any negative or
destructive thoughts toward each other.

5. Revealing the Voice During Lovemaking

In the intervals between sessions, Valerie and Mark revealed their

negative voices or self-critical thoughts if either felt cut off emotionally or
distracted during sex. They learned to describe their self-doubts and negative
thoughts to each other while maintaining affectionate contact. It helped
them to stay close and often they were able to recover their sexual feelings
in the situation.

242 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 A few weeks later
Valerie: I've felt so different since we started talking about this subject.
When we make love, if I start having voices about getting
too excited or if I notice that I'm not feeling very much, the
most important thing is to talk with you about what's going
on. This past week, I haven't had as many voices as I used
to have, especially the really critical ones. Sex doesn't feel
like something I want to avoid anymore. When we run into
trouble, we'll stop and talk. That's made me feel good and
also much closer to you.
Mark: About two weeks ago when I said my voices about feeling
pathetic and not like a real man, I felt such a relief from
letting out the anger I was feeling against myself. Since then
I think I've been more open and vulnerable to you. When I
stoppedfocusing on youand on problemsyoumight be having,
I was more relaxed and could feel my own feelings. After I
talked with you more honestly about my own doubts, I think
I was able to express more of my affectionate feelings toward
you while we were making love. And that's what makes me
the happiest, when I'm able to express those feelings.

CASE EXAMPLE NUMBER TWO

In the following case, voice therapy was a helpful adjunct for a couple
who had recently started psychotherapy. This was a difficult case in that
both partners were involved in an escalating cycle of conflict and hostility.
Early in the therapy, the couple's ongoing therapist requested a consultation
with a clinician who had experience with voice therapy methodology and
was familiar with the theoretical approach on which it is based.
Owen (53) and Corinne (46) sought marital therapy because of serious
communication problems and lack of satisfaction in their relationship. This
was the second marriage for both partners. The couple met 8 years prior to
entering therapy and had been married for 6 years. Their mutual complaint
was the lack of closeness in the relationship. In the intake interview, they
revealed that it had been nearly a year since they had been sexuaL According
to Corinne, her husband simply refused to talk to her and would only
answer her questions with a perfunctory yes or no. She expressed feelings
of hopelessness about the possibility that their relationship could be im-
proved by psychotherapy. Owen had recently sought treatment for depression
and had begun a course of antidepressants.
Before this consultation, the clinician gave both partners the Firestone
Voice Scale for Couples (FVSC; see Exhibit 9.1), the Behavioral Checklist

VOICE THERAPY APPLIED TO SEXUAL RELATING 243

 EXHIBIT 9.1
Page 1 of Firestone Voice Scale for Couples
FVSC
Instructions
All people experience thoughts that are critical toward themselves and others. For example,
when a person is worried about his (her) relationship, he (she) might think:
"You'd better hang on to him (her). This may be your last chance. vou may never
get anybody again:'

Or a person might have critical thoughts about a potential partner:

"Don't get involved. You might get hurt because he (she) is so unreliable."

Negative thoughts are a part of everyone's thinking process. Please indicate the frequency
with which you experience the following thoughts by circling the corresponding number.

1 - Never 2 - Rarely 3 - Once in a while 4 - Frequently 5 - Most of the time

For example, you think or say to yourself:

20 4 5 "Vou're unattractive. Why should she (he) want to go out with you?"

1. You'd better put on a good front. Put your best foot forward or he 2 3 4 5
(she) won't be interested.

2. You'dbe bsner off on your own. 2 3 4 5

3. He (she) doesn't give a damn about you. If he (she) did he (she) 2 3 4 5
would remember to do what he (she) promised.
4. He ~She) never spends time with you. He (she) is always with his 2 3 4 5
(her friends.
5. He (she) doesn't want to hear your opinions, so keep them to yourself. 2 3 4 5

6. You'vegot to be careful of what you say to a man (woman). 2 3 4 5

7. What you feel and think isn't important to him (her). 2 3 4 5

8. Even if your marriage Isn't romantic anymore, it's better than most 2 3 4 5
couples have.
9. You'vegot to keep him (her) interested. 2 3 4 5

10. He (she) can be Sucha jerk (bitch)! 2 3 4 5

Copyright © 2004, The Glendon Association. Used with permission.

for Partners (BCP; Firestone & Catletrt, 1999; see Exhibit 9.2), and the
Experiences in Close Relationships Inventory (ECR-R; Fraley, Waller, &
Brennan, 2000).3 (See Exhibit 9.3 for an analysis of scores from the BCP.)
The results showed that Owen and Corinne disagreed about his being
satisfied with their sex life. (She thought he was satisfied, he expressed that
he was not.) Owen perceived both Corinne and himself as deficient in terms
of the positive qualities delineated on the Behavioral Checklist. Corinne
saw herself in a more positive light and her husband as being deficient in
most of the positive qualities. In other words, for the most part, the partners
disagreed in their perceptions of themselves and of each other.

244 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 EXHIBIT 9.2
Behavioral Checklist for Partners (BCP)
How would you describe yourself and your partner along these dimensions (on a
scale of 1 to 5)?
1. Does not describe me/does not describe partner at this time.
2. Describes me on infrequent occasions/describes partner on infrequent
occasions.
3. Describes how I am some of the time/describes how my partner is some of the
time.
4. Describes how I frequently am/describes how my partner frequently is.
5. Describes me most or all of the time/describes my partner most or all of the
time.
Nondefensive and open (able to listen to feedback without overreacting/open to
new experiences):
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Respectful of other's boundaries:
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Vulnerable (willing to feel sad, acknowledge hurt feelings, etc.):
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Honest (straightforward, nondeceptive):
Self 1 2 3 4 5 / Partner 1 23 4 5
Physically affectionate:
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Sexuality (satisfied with sexual relationship):
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Empathic and understanding (lack of distortion of the other):
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Communicative (sense of shared meaning, feel understood):
Self 1 2 3 4 5 / Partner 1 2 3 4 5
Noncontrolling, nonmanipulative, and nonthreatening:
Self 1 2 3 4 5 / Partner 1 2 3 4 5

How would you rate yourself along these dimensions?

Sense of well-being 1 2 3 4 5
Self-confident 1 2 3 4 5
Optimistic 1 2 3 4 5

Copyright © 2004, The Glendon Association. Used with permission.

VOICE THERAPY APPLIED TO SEXUAL RELATING 245

 EXHIBIT 9.3
Corinne's and Owen's scores on the Behavioral Checklist
for Partners (BCP)
Corinne Owen
Rating Owen's rating Rating Corinne's rating
herself of Corinne himself of Owen
Nondefensive 5 2 2 1
Respectful 5 3 3 3
Vulnerable 5 3 3 4
Honest 5 5 5 3
Affectionate 5 1 1 1
Sexually satisfied 1 1 1 5
Empathic 4 1 1 1
Communicative 1 1
Noncontrolling 4 2 2 2

On the FVSC, Corinne endorsed a number of seemingly positive

thoughts indicating vanity or feelings of exaggerated self-importance:

"You can do anything you set your mind to."

"You're strong."
"You deserve better."

She also endorsed a number of hostile thoughts regarding her hus-

band, including

"He doesn't give a damn about you."

"He's a jerk, embarrassing, critical, cold, insensitive."
In addition, she endorsed thoughts indicating a pseudoindependent
orientation:
"You don't need anyone."
"You're better off on your own."

In general, Corinne reported thoughts about needing to protect herself

against being hurt by her husband and beliefs that her husband was solely
responsible for their sexual problems.
Owen endorsed a number of critical thoughts about his wife, although
there were considerably fewer than she endorsed in relation to him, for
example

"She's not practical."

"She's insensitive and critical."
"She doesn't pay attention to you."
"She always has to be right."

246 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Owen also reported beliefs that his wife was better, smarter, friendlier,
and had more knowledge than he. In relation to himself, Owen endorsed
such thoughts as
"Hang on to her, you need her."
"Treat her special or she'll leave you."
"You need to take care of a woman and make her feel special."
"You're not a real man."

He also endorsed thoughts indicating low self-esteem, dissatisfaction

with his performance at work, and frustration in relating and communicating
with his wife. On the ECR-R, Owen's attachment pattern fell in the avoid-
ant or dismissing quadrant, whereas Corinne scored as being anxiously
attached or preoccupied with relationship issues.

The Consultation

Therapist: What are some of the things that create distance

between you two?
Corinne: He never wants to socialize or go out with our
friends, he just wants to sit at home and watch
TV. We used to have a good time doing things
together, but during the last few months, he
doesn't want to do anything. He won't even talk
to me. He acts like he doesn't hear me. I can't
get him to talk to me.
Therapist: Was there a time in your relationship where you
talked more?
Owen and Corinne: Oh, yes.
Therapist: How long ago was that?
Corinne: About 3 or 4 years ago.
Owen: I remember that when we first got together and
before we got married, we used to talk a lot. We'd
go for long drives in the country. We didn't care
where we were going, we just went different places,
and we'd stop and have lunch or go walking in
the woods or along the beach.

Corinne: We were very adventuresome. It was fun. We

would joke a lot-he was very funny.

Owen: We'd hold hands-we don't do that any more.

Therapist: How would you like it to be now?

VOICE THERAPY APPLIED TO SEXUAL RELATING 247

 Owen: I'd like it to be the way it was.
Therapist: So there was a lot of hand-holding? Was there
affection?
Owen: Oh, yes. I used to show her a lot of affection.
Corinne: I was always a very affectionate person. But then
everything just stopped dead.
Therapist: When did it stop?
Owen: It seems like a long time ago.
Therapist: One year, two years?
Corinne: As far as sex is concerned, it's been at least a year,
or more.
Therapist: But when you started out how was the sex?
Owen and Corinne: [in unison] It was great!
Therapist: So you both were really happy with that; you were
having fun, you were joking around, talking more
and you were having sex. Did you like being
sexual?
Corinne: Yes. But even before we got married, it slowed
down a little, and I would do anything to get it
going again. I'd wear sexy nightgowns. But he
was less interested than me. We'd talk about that
because I wanted more and he didn't want
anything.
Therapist: This was a long time ago, you're talking about
now?
Corinne: As time went on it got less and less. First it was
down to once a month, then once every six
months, then nothing lately.
Therapist: What do you think happened?
Owen: My desire just went away for whatever reason, I
don't know why.
Therapist: You don't know where it went. Do you want it
back?
Owen: I'd like to have it back.
Therapist: You'd like to feel that way again?
Owen: Yes, I would. I miss it.
Corinne: That's surprising! [angry tone]

248 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Owen: I'd like it more.
Corinne: Yeah, but you can't rely on magic or wishes.
Therapist: But he said he missed it, that was a good first
thing to admit. That's a good first thing because
that means he wants it.
Owen: Yes, I do.
Therapist: You'd like to have that back. Did it go completely?
I mean, it just doesn't occur to you at all?
Owen: Well, it occurs to me every once in a while, but
it just seems like the desire is not there.
Therapist: So you've thought about it, but the desire that
gets you from point A to point B doesn't happen.
Owen: Yes, that's right. I don't know what it is. It's frus-
trating for me. When I'm depressed, I end up
thinking what's the use? I'm going to fail anyway.
Therapist: I'm going to ask you to do something that may
feel odd at first, but take those thoughts that you
just said about failing and put them in the second
person, like another person was saying them to
you.
Owen: Okay. What's the use? You're going to fail anyway.
Therapist: Yes, that's right. What else are you telling yourself?
Owen: It's never going to be the way it was. You're old and
not attractive any more. You're lucky to have her.
[angry, long pause]
Therapist: [waits for several seconds, then says] Try to say
more. Don't hold back.
Owen: It goes something like this, When you're depressed
you're so needy and dependent, no wonder she doesn't
like you any more. You're not very much fun when
you're depressed. You never have anything to talk
about. You're so boring. No one could be attracted
to you! [pause]
Therapist: With all these voices about yourself, no wonder
you've found it hard to feel sexual.
Owen: Yeah, yeah, but now I feel more interested in
trying to deal with that situation.
Corinne: Yeah, but I'd still like him to initiate something.

VOICE THERAPY APPLIED TO SEXUAL RELATING 249

 Therapist: One interesting dynamic I've noticed is that he
starts to reach out a little bit, but you attack.
That's counterproductive. You're missing an op-
portunity to fulfill your real goal to get closer,
especially closer sexually. It's like this little open-
ing, and there haven't been this many openings.

Corinne: Not any!

Therapist: Well, you've got to decide whether you want to
take those openings. You could leave it just the
way it is. But it doesn't sound like you're happy
with it the way it is.

Corinne: This sounds funny, but I'm almost afraid.

Therapist: It doesn't sound strange and I'm not surprised.
You've gotten used to it the way it is.

Corinne: I'm afraid for him to just come and say, "Here I
am, everything is okay." Do I trust him again, do
I believe him?

Therapist: When he makes one of these offerings, what goes

on in your mind? What are your thoughts when
you hear that? Your fears or whatever is on your
mind.

Corinne: I'm afraid to trust him. I'm afraid he's going to

disappoint me again.

Therapist: Say your thoughts about not trusting him the way
your husband expressed his thoughts earlier. How
do the thoughts go? What are you telling yourself
in your mind?

Corinne: I don't know. Something like, How can you trust

him again? Watch out, you're just going to get put in
your place. You're going to be disappointed all over
again. Why get your hopes uP? Besides, he really
doesn't give a damn about you. If he did, he would
want to have sex with you.
Therapist: I thought it was important for you to admit that
you were afraid, that you had fear, because as
much as you want it, you're kind of afraid to take
a chance on it too.

Corinne: I've never really talked to anybody about this. It's

even hard to talk to him about it, so I feel I have
no one to talk to.

250 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 Therapist: So you two haven't been talking about sex for a
long time?
Both: No.
Therapist: So this makes it kind of a hot topic. You even
started feeling a little bit open to having those
kinds of feelings again.
Corinne: Yes, I did, a little.
Owen: It's just that we need to sit down and open up
and talk about it.
Corinne: I tried. You have to do your part, too.
Therapist: He's talking to you right now.
Owen: See! I do move my lips every now and then. [both
laugh; Owen reaches out to hold Corinne's hand,
and she responds in kind]

The consulting therapist, aware of Corinne's resistance to the possibil-

ity of making changes in the relationship, attempted to elicit the feelings
of fear and trepidation that the therapist sensed might be responsible for
much of the resistance. As Corinne verbalized the voices associated with
her distrust and anger toward Owen, she uncovered fears about being hurt
again if she were to make herself vulnerable.
Listening to Owen articulate his self-critical thoughts aroused empathic
feelings in Corinne. It had the positive effect of dispelling a good deal of
her anger and softening her feelings of bitterness regarding her husband's
sexual rejection of her. Because this session was a consultation, follow-up
data was difficult to obtain. However, at the end of the session, both partners
expressed optimism about their future together. They indicated a determina-
tion to work closely with their ongoing therapist to recapture a part of their
life that they had previously enjoyed.

IMPACT OF VOICE THERAPY

Partners using the procedures of voice therapy have found that it

facilitates the separation of the hostile attacking part of the self from a more
rational or realistic view of self and others. We have observed that during
voice therapy sessions, clients tend to become more aware of the voice as
an alien, antagonistic part of the personality. Furthermore, the techniques
expose the important link between negative thought processes, repressed
childhood pain, and negative parental attitudes, as in the case of Mark and
Valerie. Articulating self-attacks as though they were coming from another

VOICE THERAPY APPLIED TO SEXUAL RELATING 251

person recapitulates those moment in childhood when clients incorporated
hostile parental attitudes, whether spoken or unspoken, in the form of the
voice. The techniques function to reconnect clients with the real self, and
they are able to experience themselves again as separate individuals with
their own motives, wants, and priorities (Firestone & Catlett, 1999). By
regaining a sense of themselves and their desires, and by developing an
understanding of the sources of their sexual problems, they can free them-
selves of many self-defeating sexual inhibitions and significantly improve
their sexual relationships.
Individuals in voice therapy also become cognizant of the way they
negatively perceive or distort events and significant people in their lives.
They learn that it is not the negative or unpleasant event itself that is the
primary cause of their distress, misery, and depression, but rather the way
they are internally processing these events or perceiving other people. Clients
are able to generalize the understanding they develop in voice therapy
sessions to their everyday lives and relationships. They learn to deduce from
their behavior or change in mood the fact that, on some level, they must
be experiencing self-attacks or hostile thoughts about their partner. Sub-
sequently, they are able to identify the specific voices motivating their
behavior. The process of challenging the dictates of the voice by changing
behaviors based on its negative prescriptions helps people overcome powerful
defenses that had limited their sexual lives and relationships.

VOICE THERAPY METHODS AS AN ADJUNCT

TO COUPLES AND SEX THERAPY

Voice therapy procedures can be of significant value to psychotherapists

whose treatment is based on other theoretical approaches. It is possible
to use the techniques as an adjunct to cognitive-behavioral approaches,
emotionally focused couples therapy, family systems interventions, and psy-
chodynamic couples therapy, which are described later in this chapter.
Even for clinicians using these other treatment modalities, the theory and
methodology contribute to understanding the core of resistance to construc-
tive behavioral change.
We suggest that voice therapy procedures can help prevent the reliving
and reenactment of the same dynamics that existed in the client's family-
of-origin. Because the techniques gain access to significant unconscious
processes in the personality, they have the added potential for becoming
a valuable research tool for elucidating the causal relationship between
destructive cognitive processes, their associated affect, and each partner's
problems in sexual functioning. Moreover, the methods facilitate an under-
standing of the origins of the voice in early family interactions.

252 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 THE PERSONALITY OF THE THERAPIST

The therapist's personality sets the tone and the emotional quality of
the therapy process and therefore cannot be divorced from interactions or
techniques (Beutler, 1997; Horvath & Luborsky, 1993). Clients' neuroses
and disturbances in their sexuality have developed within the context of a
faulty family relationship and can only be changed or ameliorated within
the context of another, more constructive relationship. According to
Strupp (1989),
The cumulative effects of interpersonal relationships ... typically in
childhood-has made the patient "ill" and ... another human relation-
ship, with a professionally trained person and under particularly benign
circumstances, can provide corrections in the patient's self-esteem and
in the quality of his or her interpersonal relationships with significant
others. (pp. 717-718)

The characteristics and responses of the therapist are crucial in creating

the "benign circumstances" to which Strupp referred and the type of relation-
ship that could achieve this end (Firestone, 2002). For example, therapists
using voice therapy techniques must be comfortable with the release of
intense emotions and encourage their full expression rather than making
interpretations that would cause the client to withdraw from feeling. In
addition, because voice therapy methods deal with core defenses, it is vital
that therapists have a complete understanding of the underlying theory of
defense formation in order to effectively help clients through crucial phases
in the therapy process."

A BRIEF REVIEW OF APPROACHES TO SEXUAL PROBLEMS

IN COUPLES THERAPY

Despite the fact that today many sex therapists remain technique-
oriented in their interventions, others have integrated concepts from specific
theoretical models (psychoanalytic, attachment, interpersonal, object rela-
tions, family systems) to help clients achieve insight into possible origins
of their sexual difficulties.' During the 1980s, for example, Bishay (1988),
Araoz (1982), and Segraves (1982) suggested integrating cognitive-
behavioral techniques with an exploration of family dynamics assumed to
be correlated with specific sexual disturbances or dysfunctions. In his review
of the state of the art in sex therapy during this period, Bishay (1988)
emphasized the need for further research "to identify the [distorted] cogni-
tions present in different psychosexual dysfunctions ... in order to establish
a manual of practice for cognitive therapy in psychosexual problems" (p. 89).

VOICE THERAPY APPLIED TO SEXUAL RELATING 253

 Currently, there are a wide array of treatment approaches to couples
who are experiencing sexual problems in their relationships. Bader and
Pearson (1988) have employed aspects of Mahler's (Mahler, Pine, & Berg-
man, 1975) developmental model (symbiotic, separation/differentiation,
rapprochement) to delineate types as well as stages of couple relationships
and to formulate treatment strategies. In their work, they begin by using struc-
tured diagnostic tools, including questionnaires about self-differentiation,
attunement, relationship history, and individual histories to determine the
particular "stage" of the couple relationship. One technique they have
employed in their therapy is the "short script" exercise derived from Gestalt
therapy. This exercise identifies "the chronic negative feelings underlying
the problem" and traces them "back to the original childhood traumas that
spawned them" (p. 37).
Bader and Pearson have also emphasized the importance of identifying
intrapsychic conflicts and making partners responsible for autonomous
change. In cases where there is conflict caused, for example, by a discrepancy
in sexual desire, they may teach partners "a technique in which one partner is
the initiator and the other is the responder" (p. 130) in their communications
within the session. "As partners alternate back and forth between each role
in different sessions, a situation is created that enhances the development
of object relations" (p. 133).
Cognitive-behavioral therapists (A. Beck, 1976; Ellis & Harper, 1975)
have stressed the importance of accessing "automatic thoughts" and
"dysfunctional beliefs" in their treatment of couples. These concepts are
similar to our concept of the voice. However, their focus is primarily on
refuting the illogic of the client's dysfunctional beliefs while neglecting to
explore the origins of destructive thought processes in negative interactions
within the family, parental abuses, or other environmental conditions (Fire-
stone, 1990b).
Cognitive therapist J. Beck (1995) has emphasized that gaining access
to emotions helps in identifying the "hot cognitions"-the core schema or
previously unconscious beliefs about self, others, and the world. Because
the techniques of voice therapy bring destructive thoughts to the surface
together with their associated feelings of anger and sadness, the methodology
can be useful as an adjunct in many of the therapies described below." In
his book, Love Is Never Enough, A. Beck (1988) attempted to convey to
couples with sexual problems that "A first step in reducing the mutual anger
in your relationship ... [is to] determine to what degree your own mental
workings contribute to the problem" (p. 261). He suggested that partners
should then look at their automatic thoughts, note their response, and look
for errors in their thinking. Next he recommends that partners reframe their
image of the other person and attempt to see the other person from his or
her perspective.

254 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 In treating patients presenting with inhibited sexual desire, H. Kaplan
(1979, 1995) found that behavioral therapies aimed at simply reducing the
level of sexual anxieties failed to ameliorate the problems for many couples.
As noted in chapter 5, she suggested an in-depth approach in which partners
could "attain insight into the immediate antecedent of the symptom. For
many of these patients this is the involuntary and automatic focus on
negatively charged thoughts, which produces a suppression of sexual feelings"
(1979, p. 103). H. Kaplan (1995) used both individual and conjoint sessions
in working with couples. She recommended sex education, sexual skills
training, including masturbation, communication skills training, and "very
gradual exposure" for highly anxious clients. In dealing with a couple's or
client's resistance to homework assignments, Kaplan suggested
An orderlyand systematic sequenceof gradually intensifying behavioral
and cognitive interventions that are aimed at progressively "deeper"
psychic levels. These progress from simple repetition of the assignment,
to reduction of its intensity, to the cognitive reframing of the problem, to
confrontation, and finally to insight into the patient's underlying conflicts.
(p.179)

During the past three decades, clinicians have increasingly employed

techniques that help facilitate the release of feelings (Bianchi-Demicheli
& Zutter, 2005; Greenberg, 2002; Johnson, 1999; Johnson & Denton, 2002;
Solomon, 200l). In a chapter titled "Coaching for Emotional Wisdom in
Couples," Greenberg (2002) provided examples of negative "voices" that
support cycles of escalating anger and hurt in many couple relationships.
He asserted that "closeness can occur only when people overcome their fear
and shame and change the negative beliefs that appear to protect them but
in reality prevent them from achieving intimacy" (p. 261). In his work, he
tries to "help partners present their feelings and needs as honestly and
openly as possible, in such a way that their partners are most likely to hear
and see them" (p. 271).
Emotionally focused therapy (EFT) is based in part on attachment
theory and has been effectively used to treat distressed couples and partners
reporting low sexual desire and sexual arousal disorders (Johnson, 2002;
Johnson & Greenberg, 1995). Two important goals of EFT, similar to those
of voice therapy, are (a) accessing "negative" emotions, such as fear, anxiety,
and anger, that trigger defensive maneuvers, and (b) exploring their possible
sources in a person's developmental history.
Johnson, Hunsley, Greenberg, and Schindler (1999) delineated the
nine steps of EFT as follows:
Step 1. Assessment-creating an alliance and explicating the core issues
in the couple'sconflictusingan attachment perspective. Step 2. Identify-
ing the probleminteractional cyclethat maintains attachment insecurity

VOICE THERAPY APPLIED TO SEXUAL RELATING 255

 and relationship distress. Step 3. Accessing the unacknowledged emo-
tions.... Step 4. Reframing the problem in terms of the cycle, the
underlying emotions, and attachment needs.. ,. Step 5. Promoting
identification with disowned needs and aspects of self and integrating
these into relationship interactions. Step 6. Promoting acceptance of
the partner's new construction of experience.... Step 7. Facilitating
the expression of specific needs and wants and creating emotional en-
gagement.... Step 8. Facilitating the emergence of new solutions....
Step 9. Consolidating new positions and new cycles of attachment
behavior. (p. 70)

Johnson (2004) also makes extensive use of what she terms "enact-
ments," in which partners, in turn, are encouraged through the therapist's
evocative, yet gentle questioning, to directly communicate their fears,
anxieties, hurts, disappointments, desires, and requests to the other person.
Johnson (2004) elaborated on the major change that occurs during the
therapeutic process:

In the process of EFT, emotions are processed and regulated differently,

resulting in more adaptive responses.... For example, when a partner
can acknowledge to self and other the panic that arises during close
physical contact, this often evokescompassion and comforting behavior
from the other spouse, allowing new healing emotional experiences to
occur. (p. 69)

In her work with survivors of child sexual abuse and relationship

trauma, Johnson (2002) follows many of the steps described above. She
begins by creating a safe context-a "secure base" in the sessions "where
partners can confront the ways in which trauma has defined their relationship
and, often, their sense of self" (p. 87). To create such an alliance and sense
of safety, Johnson emphasizes the importance of the survivor having "a sense
of control over the pace and direction of therapy.... The therapist must
be prepared ... to help clients deal with traumatic experiences that emerge
in therapy sessions and must know how to help clients manage and contain
their distress" (p. 83).
In describing the complex tasks required of therapists working with
survivors of child sexual abuse and their partners, Johnson (2002) emphasized
that, "In particular, incest survivors and their partners usually have to craft
their own detailed concept of pleasurable touch and safe sexuality to a much
greater extent than nontraumatized couples" (p. 198).
Object-relations theory has been applied by Scharff and Scharff (1991)
in their treatment of couples with sexual problems. In their clinical work,
the Scharffs found that the conflicts and sexual difficulties experienced by
couples may be functioning to exacerbate or magnify "the object relations

256 SEX AND LOVE IN INTIMATE RELATIONSHIPS

difficulties in their internal worlds" (p. 34). According to the Scharffs, in
these cases, the process of projective identification operates to maintain
and intensify the problem.
The goal of object relations therapy with couples is similar in some
respects to that of voice therapy, that is, to encourage the reinternalization
of projected material, or, in our terms, encourage the taking back of negative
projections based on the voice.
In Object Relations Couple Therapy, the Scharffs describe the use of
sex therapy in conjunction with object relations marital therapy.

The partners are assigned the first of the series of graded home exercises
that have the aim of reducing their sexual interaction, beginning with
a nonthreatening, nongenital level. When they have mastered each
step, a new component isadded.... Unlike more behavioral approaches,
sex therapy from an object relations perspective tends not to shortcut
the program, because of its focus on the totality of the couple's interac-
tion, not only on the physical parts of their sexual life. (1991, p. 167)1

Willi's (1975/1982,1999) approach to couples has changed during the

past 20 years from a psychodynamic focus on "collusive" couples to an
approach that incorporates some features of family systems thinking. Willi
(1999) himself has noted that "I see couples less as a unitary system and
more as a coevolutive process which raises questions that focus on the
individual" (p. 50). His ecological brief therapy helps "improve patients'
interactive effectiveness" (p. 236) in three spheres, including their "intraper-
sonal spheres: the constructs (schemata, beliefs, and 'internal objects') that
form the basis of their intentions, plans, and actions" (p. 236), and "the
intrapersonal spheres of the people they interact with" (p. 236), as well as
"the interactional sphere: the interactions between patients and the people
in their niches, the real effects patients produce, and the real responses they
provoke from their partners" (p. 236).
There are similarities between several aspects of voice therapy and
Willi's (1975/1982; 1999) coevolution approach to couple therapy, described
by Berg-Cross (1997) as the "Willi Model." According to Berg-Cross' depic-
tion of Willi's treatment approach, at a certain point in the therapeutic
process, the therapist may intervene by asking a client to verbalize his or
her thoughts and feelings in terms of "inner voices" and then may encourage
an answer back by asking the client to verbalize any "different or competing
thoughts." In describing this process, Berg-Cross explained that the therapist
encourages the client to articulate what his or her feelings are as if the
feelings could talk. Next, the therapist encourages the client to "expand
on the inner voices and themes ... not only the first thought or verbalization
that he chose to share" (pp. 219-220).

VOICE THERAPY APPLIED TO SEXUAL RELATING 257

 In concluding his discussion of his goals for therapy with couples,
Willi (1975/1982) asserted: "[Therapy] should enable ... [people] to find a
dialectical equilibrium between the need to develop their own person-
alities and the yearning for a way of life together, as a balance between
'self-realization within marriage' and 'self-realization through marriage'"
(p. 253).
In his practice of the "sexual crucible" model, Schnarch (1991) com-
bines a variety of sex and marital therapy techniques with helping partners
attain higher levels of self-differentiation and increased tolerance for eroti-
cism and intimate sexuality. (See chap. 5.) Perhaps the most important part
of Schnarch's overall approach ro treatment is contained in the following
statement:

The orientation of the sexual crucible is contained in the phrase "rela-

tionship with self in the context of relationship with partner." The
therapist aligns with each spouse as a separate individual, reinforcing
development of self-control and obviating the need to control the part-
ner to control one's emotionality. (p. 404)

One aspect of the "sexual crucible" treatment model is described by

Schnarch as "wall-socket" sex, which he states "is a distinctly adult-only event"
(p. 465). According to Schnarch, when couples progress through treatment
and reach higher levels of self-differentiation, they may begin ro have "wall-
socket" sex. This term refers to the shock that partners may experience
after having a passionate, erotic sexual encounter following years of boring,
mediocre sex, that is, "The shock of an intense erotic and intimate personal
experience that seemly arises out of 'nowhere'" (p.464). Another shock
that partners often experience is "The shock of observing one's own intoler-
ance and spontaneous withdrawal from such experiences" (p.464).
In treating couples who have "no-sex" marriages, McCarthy (1997a,
1997b) uses bibliotherapy, psychosexual skills training, relaxation, pleasuring
exercises, and relapse prevention strategies. In addition, he addresses the
cognitive dimensions underlying sexual dysfunctions in the context of couple
therapy (McCarthy, 1997a, 1997b; Metz & McCarthy, 2004). For example,
in treating men who have problems with premature ejaculation, McCarthy
assesses the patient's beliefs and expectations, which helps "identify distor-
tions (e.g., 'sex should be unregulated and spontaneous' ... )" or "unrealistic
beliefs such as the need to bring the partner to orgasm by intercourse alone"
(Metz & McCarthy, 2004, p. iv). McCarthy's (1995) therapy approach also
incorporates exercises to help clients relax and enjoy nondemand pleasuring.
As McCarthy (1995) puts it, "This is an active therapy that emphasizes in
vivo learning 'homework assignments.' Reading and cognitive restructuring
are important, but the crucial element is sexual exercises organized in a
semistructured manner to build comfort and skill" (p. 150).8

258 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 CONCLUSION

Voice therapy procedures uncover major defenses against closeness

and intimacy. In analyzing material gathered in voice therapy sessions, we
found that most people have voices attacks, and these thoughts are often
manifested during lovemaking. When expressed in voice therapy sessions,
these attacks are usually accompanied by considerable sadness and rage
toward self and others.
We also observed that clients, especially those who have formed a
fantasy bond in their relationship, are "listening to" or following the dictates
of their respective voices. In a sense, they filter their communications
through a biased, alien point of view that distorts the other's real image.
Both partners ward offloving, sexual responses from the other, using rational-
izations promoted by the voice to justify their anger and withholding behav-
ior. In many couples, fault-finding, hypercritical thoughts and misperceptions
of the other person were often more intense following times when the
partners had been especially close, both sexually and emotionally.
The goal of voice therapy with couples who have sexual difficulties is
to help individual partners identify voice attacks that diminish sexual desire
or interfere with sexual fulfillment and emotional intimacy in the relation-
ship. By first eliciting and then challenging specific self-attacks as well as
judgmental, cynical thoughts about the other, each partner is able to relate
more closely during sex. Releasing the affect underlying voice attacks allows
clients to again experience feelings of sexual desire and pleasurable sensations
and increases sexual satisfaction and fulfillment.
Our approach to eliciting and identifying the contents of the voice is
not didactic; that is, we do not directly persuade clients to think or behave
rationally or point out the illogic of their thinking. Instead, we help them
discover what they are telling themselves, in a negative sense, about their
body, their sexual performance, their sexuality as a whole, and about their
partner and their relationship, and attempt to assist them in moving away
from these negative attitudes and prohibitions.
In an effort to achieve a sense of internal integration, many clients
side with the alien point of view represented by the voice and come to
accept this negative point of view as their own. Helping clients externalize
their negative thoughts enables them to separate from these destructive
elements of the antiself system, thereby strengthening the self system and
their point of view. This process, in turn, enables them to cope more
effectively with self-defeating, self-limiting sexual inhibitions and withhold-
ing tendencies.
Finally, by identifying the destructive effects of internalized voices,
discovering their source, and understanding the role they play in restricting
sexual fulfillment, an individual can separate from the dictates of the voice

VOICE THERAPY APPLIED TO SEXUAL RELATING 259

and move on to Step 4, planning and carrying out corrective suggestions
for behavioral change. Before this phase in the therapeutic process, members
of a couple have generally identified the voice attacks that operate to inhibit
their expressions of affection and sexual responses. The first three steps in
voice therapy facilitate changes in attitudes that allow them to challenge
the fears underlying these inhibitions. By understanding the origins of their
fears, individuals can develop the courage to initiate corrective suggestions
that move them toward situations that they previously found too threatening.

NOTES

1. Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients can be
found at http://www.apa.org. The first four guidelines delineate suggestions for
developing nonbiased attitudes toward homosexuality and bisexuality. The
second four encourage the acquisition of knowledge about relationships and
families of sexual minority clients. The next five guidelines encourage therapists
to understand the specific problems faced by sexual minorities from diverse
ethnic groups, age groups, and those with cognitive challenges. The last three
guidelines encourage education and training in relevant mental health resources
available for these populations.
See also Ritter and Temdrup (2002).
2. It should be noted that, at times, clients may feel moved to directly challenge
the voice during a conjoint session. In attempting to counteract the effect of
the destructive thoughts and voices on their sexual relating, they may elect to
answer the voice dramatically with strong anger. "Yelling back," even at sym-
bolic parental figures, unleashes feelings of rage and hatred for which people
may feel considerable guilt. We have observed that some clients in couples
therapy, after responding angrily to their voice attacks and differentiating
themselves from their parents, for example, saying "I'm not like you," or "I'm
different," later reverted to the very behaviors they were challenging.
In other cases, it is important for clients to answer back to their voice attacks
and assert their point of view regarding their sexuality, their partners, and their
relationships. When clients feel so motivated during the session, it is valuable
to set aside some portions of subsequent sessions for the client to further
verbalize his or her "answers" to the voice. The process of repeatedly "standing
up for oneself" against voice attacks habituates the client to the guilt and
anxiety precipitated during the process of answering the voice. Eventually,
these feelings of guilt and anxiety are diminished to a considerable degree.
3. The Behavioral Checklist for Partners (Firestone & Catlett, 1999) was com-
posed of items derived from dimensions of "Interactions in the Ideal Couple"
(Figure 4 in Firestone & Catlett, 1999).
The Firestone Voice Scale for Couples (FVSC) assesses the frequency of
destructive thoughts the subject is currently experiencing toward self, toward
his or her partner, and about relationships in general. The initial version of

260 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 the FVSC consists of 96 items reflecting destructive thought patterns that are
associated with intimate interpersonal relationships. These items were derived
from clinical material, discussion groups with couples, and from graduate stu-
dents studying psychology. (See Exhibit 9.1.)
Each partner endorsed the frequency with which he or she currently
experienced destructive thoughts on a Likert-type scale ranging from 0 to 4
(0 = never, 1 = rarely, 2 = once in a while, 3 = frequently, and 4 = most of the
time). Mean scores were calculated for the three item groupings: toward self,
toward partner, and toward relationships. The mean is used because there are
different numbers of items in each grouping, and additive scores would attribute
more weight to those groups with more items and make comparisons between
the different categories difficult. Reliability and validity have not yet been
established for this instrument.
The ECR-R (Fraley et al., 2000) is a 36-item self-report attachment measure
and is derived from four categories or regions (secure, preoccupied, dismissing,
and fearful) represented in a two-dimensional (low anxiety to high anxiety and
low avoidance to high avoidance).
4. It is recommended that therapists wishing to incorporate the techniques of
voice therapy into their practice seek training in the concepts and methodology.
A basic resource for more information about voice therapy can be found in
Firestone (1988).
5. In discussing current trends in the field of sex therapy, Leiblum and Rosen
(2000) noted there were four major trends: "( 1) a trend toward greater 'medicali-
zation,' (2) increasing emphasis on pharmacological intervention, (3) greater
attention to desire disorders, and (4) more treatment uti lizing interpersonal and
object-relations theories" (p. 5). They also observed that constraints imposed by
managed care (HMOs) have necessitated increasingly briefer interventions
focused on ameliorating specific sexual problems. As a result, there has been
an increasing use of short-term treatments, for example, behavioral techniques
and pharmaceuticals (Kleinplatz, 2001; Segraves & Balon, 2003).
Goren (2003) also observed that during the 1990s, "sex therapists jumped
on the medication bandwagon" (p. 496). This trend was precipitated in part
by the introduction of sildenafil citrate (Viagra) in 1998 as a treatment for
erectile dysfunction. Leiblum and Rosen (2000) warn that "With the success
of new pharmacological agents, there is an inevitable focus on biological causes
for sexual dysfunction and a tendency to seek simple medical solutions for
more complex individual or couples' problems" (p. 11). Bancroft (1999) and
Kleinplatz (2001) contend that for the most part, contemporary sexual science
and sex therapy is essentially atheoretical, noting that "Until recently, in the
more traditional field of sexual science, theory has been notable by its absence"
(Bancroft, 1999, p.226). Kleinplatz argued that "Few sex therapists ... are
known to struggle with these basic theoretical questions," such as "What is
sexuality? What turns on people and why? ... What is the basis/origin of sexual
desire?" (pp. xv-xvi).
6. As one example, in emotionally focused rherapy (EFT), asking clients to put
their negative, angry thoughts about the partner into the third person: He

VOICE THERAPY APPLIED TO SEXUAL RELATING 261

 won't let you be close to him. She doesn't understand you, can help them separate
the destructive point of view from a more rational or congenial point of view.
As noted, saying one's hostile thoughts toward oneself and one's partner elicits
strong emotions and leads to insights regarding their origins. We suggest that
voice therapy techniques could be used to enhance emotional expression and
understanding of the sources of partners' fears and distress, specifically during
Steps 5 and 6 in EFT (Johnson, 2004). According to Johnson, these steps "also
involve the accessing of core self-concepts or models, which are associated
with the intense emotions that arise here" (p. 164). In a case example, Johnson's
client explained how he negatively defines himself: "So I say to myself, what
do you expect? You're not good at this love stuff. I feel about this big (making a
small space between thumb and forefinger). I can't even ask her anymore"
(p.l64).
Johnson noted that this reprocessing of primary emotions related to the
client's perception of him- or herself in relation to the other allows key wishes
and longings inherent in the emotions to "emerge and to be articulated"
(p.l64).
7. Scharff and Scharff (1991) described the treatment strategy used with a couple
in which both partners had histories of child sexual abuse and dysfunctional
family relations. They delineated the steps in the sequence of sex therapy
exercises including nongenital sensate focus, self-pleasuring and masturbation
and genital sensate focus but not to orgasm, among others. The Scharffs empha-
sized that this last exercise "allows full intimacy and expanded cooperative
object relating, still without the threats of penetration and interpenetration.
Safety and lowered anxiety are maintained" (p, 171). They provided an ex-
tended case example of this couple, allowing readers to "examine the process
of an unusually extensive and integrated treatment, from which we can learn
about the interlocking of individual, couple, and family processes, and the
mutual influence of the three treatment approaches" (p. 179).
8. Other therapeutic methodologies dealing with negative thought processes as
well as accessing negative affects which are hypothesized to be contributing
factors in the development of sexual dysfunctions and other sexual disturbances
are described in Beck (1988); Johnson (1999, 2002, 2004); H. Kaplan (1979,
1995); Wile (1995); and Waring (1988). Several psychoanalytically oriented
clinicians have focused, to some extent, on destructive thoughts influencing
sexual difficulties. See Scharff and Scharff (1991) and Scharff (1995). Also see
Solomon's (1997) chapter, "On Love and Lust in Therapeutic Treatment,"
and Johnson's (2003) report on the effectiveness of couple therapy, including
therapies dealing with couples' sexual problems. Emotionally focused couple
therapy, behavioral approaches, and the restructuring of attributions were
among the approaches found to be effective by empirical research studies.

262 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 10
SUGGESTIONS FOR ENHANCING
SEXUAL INTIMACY

The challenge of the conscious or mature person is to live through the

terror of being loved and touched and held.
-Love and Brown (1999, p. 64)

Corrective suggestions that initiate change in an individual's behavior

and affect his or her everyday life are a vital part of an effective therapy.
Therapeutic progress involves more than identifying destructive thoughts,
releasing repressed feelings, and achieving insight; it also requires changing
specific behaviors that will create a new interpersonal environment.
The suggestions and methods described in this chapter are focused on
helping individuals develop personally in the context of their most intimate
associations. They are an integral part of voice therapy and act as catalysts
to move people toward new, unfamiliar situations that will challenge their
customary defenses. The ideas and recommendations often lead directly to
a corrective emotional experience.' For instance, when one stops engaging
in withholding behaviors that have provoked distance in the relationship,
a new set of circumstances is generated, which in turn creates an unfamiliar,
albeit more positive, emotional climate. At this point, the dynamics of the
relationship shift to a certain extent, which necessitates a different response
from the other.
Some suggestions are directed toward helping people alter negative
attitudes and core beliefs about themselves and their partner that have
interfered with their sustaining a fulfilling sexual relationship. Others are
focused more directly on behavioral change. The rationale underlying these
suggestions is that each person gradually modifies his or her behavior toward

263
his or her stated goals in opposition to the dictates of critical inner voices.
The process also involves breaking habitual ways of relating sexually and
disrupting routines that support a fantasy bond.
Corrective experiences are directly related to maladaptive behavior
patterns that are influenced or controlled by destructive thought processes.
As noted in the previous chapter, these negative thoughts and attitudes
affect people's feelings about themselves as men and women, restrict their
ability to both give and receive sexual gratification and pleasure, and create
tension in the sexual situation. Thus, recognizing their irrationality, under-
standing their sources, and changing the actions they dictate are worthwhile
steps in helping couples achieve a more satisfying sexual relationship.

TEACHING CORE ATTITUDES ABOUT LOVE AND SEXUALITY

Ideally, in working with couples and individuals, the clinician strives

to inspire a better understanding of a tender, respectful, and empathic way of
being with another person. Clients are encouraged to develop a noncritical,
accepting attitude toward themselves and their partner and to be sensitive
to the heightened vulnerability associated with experiencing more closeness
and sexual intimacy in their relationship. They learn to develop a more
empathic understanding of the other person, particularly in situations where
they encounter roadblocks in striving to develop their capacity to give and
receive love. The following are several attributes that a therapist could
inspire.

Compassion and Empathy

It is valuable for men and women to develop a compassionate under-

standing of themselves and how they function in an intimate relationship.
It also is important that they come to realize that their problems in relating
sexually and being close emotionally are not unusual in our culture. Clients
can benefit from learning that much of the hurt that people in general
experience in close relationships is due to an unwillingness to allow the
reality of being loved to affect their basic defensive structure.
Both men and women have a tendency to punish others who love
them in order to preserve their negative self-image, which is a fundamental
part of their defense system. The man who perceives himself as cold or
harsh is likely to be cynical toward a woman who indicates an interest in
him and eventually he may push her away. Similarly, the woman who sees
herself as unattractive or unlovable is likely to find fault with the man who
offers her love. Because most people are defended to varying degrees, their

264 SEX AND LOVE IN INTIMATE RELATIONSHIPS

intimate relationships, which offer the most potential for happiness and
joy, also have the potential for generating considerable pain and distress.
In a sexual relationship, both individuals are often functioning in ways
that prohibit the free exchange of psychonutritional products. In other
words, they find it difficult to express their feelings of love, affection, and
sexuality and to accept loving responses from the other. The intolerance
of eroticism and love represents a basic dynamic in couple relationships and
is far more common than most believe. Facing the truth about the sources
of the emotional pain inherent in being close allows clients to develop more
compassion for themselves, empathy for the other person, and a sense of
kinship based on an awareness of the hurt that both of them experienced
in their formative years.

Generosity

As people become more compassionate and understanding toward one

another on a feeling level, they begin to spontaneously express these emo-
tions in numerous acts of kindness. They seek opportunities where they can
extend themselves to the other person through sensitive acts of generosity.
They discover that giving more freely of themselves, their time and their
energy, counteracts self-protective defenses, increases feelings of self-esteem,
and makes them feel worthwhile.
The generous acts described here are different in some sense from
"exchange agreements" or "contracts" that couples may negotiate in some
forms of marital therapy. They are not performed quid pro quo, nor are they
performed to gain points, to soothe a nagging spouse, to elevate one's status,
or to make one feel superior to one's mate. Acts of this nature are not
representative of a genuine giving attitude and can be damaging to both
the giver and the receiver. Generosity, in this context, is a sensitive, feeling
response to another person's wants and needs. Acts of generosity and altruism
that are an outgrowth of a partner's understanding of the other's uniqueness
are the most appreciated by the recipient and bring the most satisfaction
to the giver.
Essentially, there are three aspects of a healthy response to a generous
act on the part of one's mate. The first involves being open to accepting
what is offered, allowing the other to meet one's needs; the second involves
verbally expressing appreciation; and the third entails reciprocal actions-
offering generosity and kindness in return. These actions would not necessar-
ily be the same as what was given. The recipient would simply return the
favor by offering something of him- or herself in a way that is sensitive to
the other's unique wants, preferences, and needs.
A therapist's philosophical approach in conveying these attitudes helps
clients learn that personal happiness and sexual fulfillment are by-products

ENHANCING INTIMACY 265

of extending themselves in love and generosity. Sexual intimacy is an
outgrowth of each placing the other's well-being and happiness on an equal
level with his or her own desires, wants, and priorities.

Individuality

Another attitude to convey to couples is the importance of acknowledg-

ing each other as separate individuals and of developing respect for the other's
boundaries, wants, and goals. Sustaining a satisfying sexual relationship
presupposes a nonintrusive posture in relation to the other's values, interests,
and behaviors. Ideally, the individuals become more willing to feel their
own emotional pain without implicating the other in their inner conflicts
and they relinquish efforts to fix or change the other person.
In being sensitive to each other's wants and needs, it is also important
that people do not compromise their integrity in an attempt to maintain
harmony. Each person needs to be cautious about demanding fundamental
concessions from the other through complaints or other efforts to control
the relationship. These compromises often lead to a sense of obligation,
resentment, and disharmony. It is also important for each to strive to attain
a higher level of self-differentiation, which involves freeing oneself from
destructive ties or fantasy bonds with members of one's family-of-origin.

Overcoming Stereotypes

The development of mature sexual attitudes involves challenging and

overcoming conventional stereotypes that define men and women as essen-
tially different and basically enemies or, at the very least, as alien to each
other. It is important for couples to recognize that much of the tension and
pain that has contaminated their sexual relating stems from stereotypes
learned throughout life. By becoming more aware of the sexism and distor-
tions of men and women typical in Western society, both people can gradu-
ally move beyond these biases to develop empathy for the other, based on
a sense of kinship and commonality with members of the opposite sex.
During the course of an effective couple therapy, individuals gradually alter
the distorted attitudes toward sexuality that they acquired during the process
of socialization. They learn to conceptualize sex as a shared pleasure rather
than as a conquest, obligation, or submission to a domineering partner.

OVERVIEW OF CORRECTIVE SUGGESTIONS

The fourth step in voice therapy involves formulating corrective sugges-

tions for behavioral change. By the time a couple has reached this phase

266 SEX AND LOVE IN INTIMATE RELATIONSHIPS

of therapy, each partner's personal goals for the relationship have become
clear and self-evident. Both individuals have developed an awareness of
behaviors that limit the relationship and alienate the other person, have
developed more compassion for each other and themselves, and have made
a concerted effort to focus on constructive behavioral changes.
Both work closely with the therapist and collaborate to interrupt
maladaptive behavior patterns by planning corrective experiences that are
in accord with each individual's personal goals. Plans for changing behavior
tend to fall into two categories: corrective suggestions that help control or
interrupt self-nurturing habit patterns and other defensive behaviors; and
those that expand people's boundaries by helping them overcome fears.
The first category includes suggestions for challenging and disrupting
manifestations of the fantasy bond, which encompass giving up destructive
behaviors that predispose alienation as well as altering role-determined habit
patterns that support the form rather than the substance of the relationship.
The second category includes suggestions for expanding personal
boundaries and enhancing sexual relations, learning to set goals for the rela-
tionship, revealing voice attacks while making love, journaling, and compos-
ing an imaginary dialogue with one's parent regarding one's sexuality.

Corrective Suggestions for Challenging the Fantasy Bond

Suggestions challenging habitual routines that cut off feeling are impor-
tant for partners who have become alienated or impersonal in their interac-
tions. Seemingly innocuous alterations in routines and schedules can be a
first step in effecting change in an individual's overall defensive posture.
Even minor modifications can break into a person's inward, self-protective
state and increase his or her energy level and vitality.
One way to break into a habitual behavior pattern is to encourage
clients to step out of the traditional roles they have become accustomed
to enacting in their relationships. For example, in one couple, the wife
characteristically made the decisions, and her husband tended to passively
follow her lead. The suggestion was made to switch roles for a certain time
period. He was to decide where to go to dinner and which movie they
would see, while she was encouraged to avoid giving her opinions regarding
his decisions.
Implementing a suggestion that breaks an addictive or compulsive
behavior also allows feelings to reemerge that often have been suppressed
for years. The use of addictive substances numbs people's feelings of pain,
anxiety, and sadness, and unfortunately functions to dull other, more positive
emotions as well. There are other self-nurturing activities that are not
associated with substance abuse that serve to cut people off from their
feelings and isolate them from other people. For example, compulsive work,

ENHANCING INTIMACY 267

excessive reading, computer game-playing, television watching, and
Internet-surfing are painkillers in that they dull a person's sensitivity to
experiences in the interpersonal environment. Even sexuality can be used
to cut off feeling. For example, compulsive masturbation, sexual addiction,
and routine, mechanical sex without emotional contact can serve the same
function as any other addiction.
In one case, a male client indicated that he wanted to have a closer
sexual relationship with his wife. When describing this goal to the therapist,
he realized that he habitually watched television late at night in spite of
his wife's entreaties to come to bed. After identifying the contents of a
voice that supported his avoidant behavior, he developed a plan that he
hoped would interrupt this pattern. He decided that each night he would
turn off the television by 10 p.m. However, he was surprised by the internal
resistance he encountered when trying to carry out a plan that he himself
had initiated.
In the course of investigating his resistance, the client first remarked
that he never would have known that his wife would be so responsive to
what he considered to be a slight change in his schedule. On the one hand,
he said that he was grateful for the opportunity to compare his wife's positive
response to her previous complaints and irritability. On the other hand, he
revealed that he felt extremely anxious. He expressed uncertainty about
changing other habitual patterns that he knew were interfering with the
couple's sexual relationship.
In a subsequent session, the client disclosed that he was now engaging
in other compulsive activities such as checking and responding to his e-rnails
late at night. He recognized that this new activity had taken the edge off
his anxiety. He also realized that the feelings of anxiety he had experienced
indicated that a strong defense was being disrupted. This understanding
motivated him to redouble his efforts to adhere to the schedule he had set
and to drop other compulsive activities. The following week, he reported
feeling "the best I've felt in years." He attributed his sense of well-being
and happiness to the renewed closeness he felt with his wife.
In another case, a woman who was self-centered and domineering
provoked her husband by constantly talking. As a result, he felt progressively
more distant from her and guilty for feeling angry. In their conjoint sessions,
the therapist observed that she attempted to manipulate the conversation
to her advantage and interrupted her husband whenever he spoke. After
identifying these toxic behaviors and the underlying voices, she and her
therapist together formulated a plan to counteract them. She decided to
listen to her husband when he spoke without interrupting him. In addition,
she would monitor how much time she spent talking as opposed to listening.
Initially, the woman found this plan difficult to follow because it made
her anxious and she experienced voice attacks warning her that she was

268 SEX AND LOVE IN INTIMATE RELATIONSHIPS

giving up a basic part of her "naturally outgoing" identity. At the same
time, she felt relieved as her husband gradually became more relaxed and
opened up to her. Describing her reactions in a subsequent session, she
reported that she now knew that by talking constantly she had been cutting
off a multitude of feelings, both for herself and her husband. She said,
"When I'm quiet, just listening to him talk, and really looking at him, I
see him as a person separate from me, as vulnerable and lovable. I think it
also takes my focus off myself in some way to stop talking and just experience
the moment. It also makes me deeply sad. It's interesting though that during
those quiet times, I don't have any voice attacks."
There are a number of ways that therapists and clients can plan correc-
tive experiences to disrupt the fantasy bond. People can recognize that
their actions are no longer loving, reveal feelings of anger and withholding
patterns, and face the pain and sadness involved in trying to resume intimacy.
Both partners can expose their fears of individuation, separation, loss, and
death, move toward a more independent existence, and develop genuine
respect for each other's goals and priorities. They can strive to develop a
nondefensive posture toward feedback and work toward establishing an
open, honest style of communication. We have found that as manifestations
of the fantasy bond are understood and relinquished, partners experience
new energy and self-confidence and feel closer to each other, both sexually
and emotionally.

Corrective Suggestions for Expanding Personal Boundaries

Suggestions for expanding personal boundaries are valuable for couples

who want to enhance their sexual relating. First, they discuss goals for the
relationship that each partner feels would enhance the quality of their sexual
relating; second, they plan, with the therapist, means of supporting or
moving toward these goals; and, then as they move toward a new level of
vulnerability, they learn to tolerate the anxiety involved in making positive
changes in the relationship. The overall process has an experimental flavor
and is undertaken in a cooperative spirit.
Clients may plan suggestions that would increase their tolerance for
giving and accepting tender expressions of affection during lovemaking. For
example, if one partner realizes that he or she wards off the other person,
who typically initiates sexual contact, the couple might plan for that partner
to take the initiative in terms of expressing affection, touching, kissing, and
sexual caressing. The other person might agree to be the recipient of his
or her caresses during lovemaking instead of feeling pressured or expected
to always take the initiative.
Couples are encouraged to carry out these types of exercises slowly,
with tenderness and sensitivity. Those whose love life has become routine

ENHANCING INTIMACY 269

can plan to be more experimental during sex, make arrangements to spend
a romantic evening together, or set aside a special time to devote to lovemak-
ing. Many have reported that as a result of participating in these exercises,
they have felt a sense of permission that allowed them to go further in their
sexual expressiveness and spontaneity.
If clients put into practice the corrective suggestions they plan with
the therapist, there will be substantial changes in the overall emotional
climate within the couple. As a person modifies behaviors that have created
distance during lovemaking or in other areas of the relationship, he or she
is generally responded to with more warmth and affection. For example, a
female client who engaged in the corrective suggestion to be more expressive
of her affectionate feelings to her husband was gratified as he became more
communicative and open to her in their daily interactions. As a result, she
found herself responding more spontaneously during their lovemaking.

Learning to Set Goals for One's Sexual Relationship

When partners are planning behavioral changes they want to make

in their sexual relationship, it is important for each person to focus on
setting goals and identifying specific actions that move him or her closer
to these goals. Next, the client examines his or her behaviors to deter-
mine whether or not they correspond to his or her stated goals. Although
people have no power to change another person, they do have the power
and ability to change themselves. Changing undesirable behaviors in them-
selves has the effect of modifying the dynamics and interactions in their
relationship.
For example, in therapy, William had decided that a major goal for
him was to be closer to his wife, Monica, both during lovemaking and in
their daily interactions. In an earlier session, Monica had told William that
she wished he would talk with her more about the things he was interested
in. In response, William began to spend some time each evening talking
with Monica about the events of her day as well as sharing his thoughts
and feelings about various aspects of his life.
Returning to his office from a week-long business trip, William received
a phone call from Monica who suggested that they go out to dinner to
celebrate his homecoming. Feeling that his wife was being inconsiderate of
the fact that he was exhausted from traveling and wanted to get home, he
started to respond angrily to her request, but quickly stopped himself. As
they continued to talk on the phone, William was aware of a series of
hostile thoughts about Monica: If she really cared about you, she would know
how you feel. If she was sensitive, she would know that you don't want to go
out after spending a week away from home. She's so inconsiderate!

270 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 William realized that if he followed his first impulse to be angry, he
would be acting according to the dictates of his hostile voices and against
his goal to be closer emotionally to his wife. He decided to make a conscious
effort to change his mood of irritation and resentment and to be more open
about his feelings based on his real point of view. As the conversation went
on, William first admitted that he was tired from traveling. He then told
Monica how much he had missed her and said he preferred to spend a
romantic evening at home. She responded enthusiastically and that evening,
the couple enjoyed dinner and conversation at home, and their lovemaking
was especially tender. William was struck by the realization that had he
not chosen to directly communicate his real feelings and preferences to
Monica, their evening might have been very different.
Clients in individual therapy who wish to become involved in a roman-
tic relationship can also use corrective suggestions. In these instances, clients
often think of ideas that will move them in the direction of meeting a
potential partner or initiating a conversation with someone they are inter-
ested in. Individuals need to identify the voices underlying their hesitancy
and awkwardness in approaching others and set reasonable goals toward
which they can steadily move.

Encouraging Partners to Reveal Voice Attacks During Sex

As described in chapter 9, partners can use the techniques they have

learned during sessions to share or "give away" their destructive thoughts
and attitudes while making love. This fifth step in voice therapy is particularly
important if partners begin to notice a decrease in sexual desire or arousal
or become more involved in thinking rather than feeling. The term "giving
away" implies revealing that one is experiencing negative thoughts about
oneself or one's partner, taking responsibility for these thoughts, acknowledg-
ing that they are not being "caused" by the other, and reassuring the other
that these thoughts do not represent one's real point of view.
Instead of trying to ignore intrusive thoughts while concentrating on
completing the sex act, people are encouraged to stop and talk about their
thoughts and feelings. Even though the couple has actively stopped making
love for the moment, it is important that they maintain physical contact
while revealing their critical thoughts to each other.
The person experiencing the voice attacks expresses his or her nega-
tive thoughts in the second person, as in a therapy session. The other
person listens, allowing the partner sufficient time to verbalize all of the
voices and express the feelings that accompany them. The focus of
this exercise is on maintaining emotional contact and not on necessarily
completing the sex act. Couples who have done this exercise report that

ENHANCING INTIMACY 271

they experienced a resurgence of affectionate feelings and felt closer rather
than more distant.

Case Example

Elaine and Donald were married for 10 years when they began experi-
encing difficulties in their sexual relating. In couples therapy, they had
learned to give away their self-critical thoughts and cynical attitudes to
each other. One night while being sexual, Elaine noticed that she had
started to feel cut off from her feelings of excitement during foreplay. After
some initial hesitation, she decided to apply what she had learned in voice
therapy and disclosed her concerns to Donald.
Elaine: It's so strange, but until a minute ago I was feeling really
excited and very sexual when you were touching me, but
suddenly I started feeling distracted. Then I noticed I wasn't
feeling any sensations or feelings. I was thinking of other
things, like all the things I have to do tomorrow. So I wanted
to stop a minute and talk.
As soon as I became aware of being distracted, I got very
critical of myself, thinking, What's the matter with you? Why
can't you just relax? See, now you're not feeling anything. He's
going to notice.
Then I started thinking things about you. I know this sounds
weird but I was asking myself if you really wanted to make
love with me tonight. I know I'm probably crazy to think
something like that, but I wanted to be honest and give it
away. As soon as I got cut off, I started thinking, He doesn't
really want to be sexualtonight. You're the one who suggested going
to bed early. He just went along with it because he didn't want to
hurt your feelings. Can't you see he's preoccupied with other things
and doesn't feel that close to you anyway. That last thought is
so much the opposite of how I believe you really feel that it's
uncomfortable to say it out loud. [sad]
After listening to Elaine, Donald told her that he was grateful that
she had suggested talking because he had started to feel cut off himself.
Donald: It did seem like you started to pull away from me. I hardly
noticed it. But then I got nervous and started thinking things
like: What's going on here? She seems excited, She reaHy wanted
to be sexual. It must be you. You should touch her more gently,
more sensitively, You don't know how to touch a woman. Don't
let her know that something's wrong.

After Donald and Elaine had disclosed their respective voices and
shared their feelings, they felt closer to each other and resumed their love-

272 SEX AND LOVE IN INTIMATE RELATIONSHIPS

making. By taking time to share their thoughts and express their fears, they
were able to regain a level of feeling and closeness rather than remaining
cut off from their feelings.

Journaling Exercises
As an adjunct to voice therapy sessions, clients can maintain a
journal to help them recognize events that precipitate self-attacks and hostile
attitudes toward each other as well as to identify the content of such
thoughts. Writing down destructive thoughts and attitudes that interfere
with the expression of sexual feelings and desires helps individuals chal-
lenge their fears of sexual intimacy and make constructive changes in
their relationship.
In this journaling process, individuals record their destructive thoughts
and attitudes in a specific format: On the left-hand side of the page, they
write down self-critical thoughts they have experienced during the day
about their sexuality, their partner, and the relationship. They record these
thoughts in the second person "you"-the way they verbalize the voices in
their sessions. They attempt to allow the thoughts to flow freely, to not
censor them, and to write them down as they are "hearing" them in their
minds. In other words, they try to capture in writing the snide, sarcastic,
or vicious tone of the thoughts they have experienced that day. Next, on
the right-hand side of the page, they try to generate a more realistic view
of themselves. (See example in Exhibit 10.1.)
Clients then repeat the journaling process, using the same format to
write down critical thoughts they have about their mate. These voices may
be irrational distortions, but they generally reflect exaggerations of real
objectionable traits in their partner. On the left-hand side of the page, they
record their negative thoughts in the third person, "he/she" format. Next,
they write down a more realistic or rational view on the right side of the
paper. (See example in Exhibit 10.2.)

Composing an Imaginary Dialogue With One's Parent

The authors have found it helpful for couples to describe in writing

what they believe to be their parents' point of view toward them, their
sexuality, their partner, and their relationships. Next, they describe their
own point of view on the same subjects. (See Exhibit 10.3.) The purpose
of this exercise is to facilitate separation from negative parental introjects
and to strengthen aspects of the self system. Afterward, many people seem
to be better able to make a clear distinction between attitudes that reflect
their parent's point of view and those that represent their own wants, desires,
and aspirations.

ENHANCING INTIMACY 273

 EXHIBIT 10.1
Negative Thoughts Toward Oneself in a Relationship
Self-critical thoughts Rational thoughts
Examples: Examples:
You're not as sexy as other women. I have a lot of features that are
Your breasts are too small. Your hips attractive to men. I'm also an
are too large. You're too fat, too thin. interesting person with a good sense
You're not going to feel anything. of humor. My figure is OK the way it is.
You're not going to be able to feel When I'm relaxed, I'm vel}'
excited. passionate.
You're not good-looking like the other Women are attracted to a lot of other
guys. You're not athletic looking. qualities in me besides my looks.
Your penis is too small. Most men think their penises are too
You can't satisfy a woman. small.
You're insensitive and unfeeling. I'm sensitive to women, I feel a lot
making love to my girlfriend, and she
seems to feel a lot, too.

274 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 EXHIBIT 10.2
Negative Thoughts Toward One's Partner
Hostile attitudes toward partner Rational attitudes toward partner
Example: All he/she is interested in is Example: Of course he/she is attracted
sex. to me, but he/she is interested in me in
many other ways, too.

ENHANCING INTIMACY 275

 EXHIBIT 10.3
An Imaginary Conversation About Sex
What would your mother/father say about your sexuality, your partner, and your
sexual relationship?

What my mother/father would say:

What I would say back to my mother/father:

276 SEX AND LOVE IN INTIMATE RELATIONSHIPS

Case Example

Glenn and Claire met at a college dance, started dating, and had been
together for six months. They spent nearly every available night making
love and were very affectionate. For both, it was the best relationship they
had ever experienced. One night, Glenn spoke lightly of the possibility of
getting married some day. Soon after, Claire became increasingly critical
of Glenn, was preoccupied during sex, and the relationship started to deterio-
rate. Claire was upset that she was ruining this relationship in much the same
way as she had ruined several others, and she was experiencing considerable
anxiety. As a result, she sought counseling.
After a few sessions of voice therapy, Claire was asked to say her
critical thoughts toward herself and Glenn. As a result of verbalizing her
voice and releasing her feelings, she began to recognize her pattern in
relationships. In addition, it was suggested that she write an account of her
mother's point of view toward her relationship, followed by her own point
of view. This was her imaginary dialogue:
My mother's point of view:
I agree that Glenn is a nice boy, good-looking and fun to be with.
And I can understand that you like sex with him, but darling, think
of your future. He has no money, his family is nothing, and besides,
he's Jewish. That alone makes it impossible. You know how your father
feels about that sort of thing. You know, you were always the rebel,
always causing trouble. It's about time you outgrow it. Why can't you
be like me, do the right things and live a good and decent life? I stayed
with your father even though he was boring. At least he came from a
good family.
My point of view:
I really love Glenn and I like being with him more than anything
I ever did before. I don't give a damn if he has money or not, or where
he comes from. He's strong and sensitive and affectionate and we have
fun together. You've always been critical of my boyfriends. You don't
want me to be happy. You only want things to look right.

After writing her imaginary dialogue, Claire had a clearer understand-

ing and insight about why her relationship had changed when Glenn had
talked of marriage and why she felt so anxious. She realized that a serious
commitment to Glenn would lead to conflict with her family and, in par-
ticular, with her mother. She felt alone and like an outcast, a feeling that
was all too familiar. In addition, she recognized that she was very angry at
her mother and had always felt hurt and rejected by her. These insights
helped her to improve the relationship with Glenn and reduced her level
of anxiety.

ENHANCING INTIMACY 277

Resistance to Corrective Suggestions

Resistance occurs in all forms of psychotherapy and is indicative of

an underlying fear of and aversion to change (Blatt & Erlich, 1982; Ghent,
1990/1999; Leahy, 2001; Neborskv & Solomon, 2001; Rank, 1941, quoted
in Kramer, 1996; Wachtel, 1982). Many couples who seek professional
help because they are dissatisfied with their sexual relationship are strongly
invested in an inward, defended mode of relating that precludes sexual
intimacy. Movement toward fulfilling their sexual potential and increasing
their capacity for giving and receiving love is threatening and arouses
considerable guilt and anxiety.
Resistance to corrective suggestions can take numerous forms: individu-
als can continue to act out hostile behaviors while blaming the other for
their dissatisfaction, they may be reluctant to carry out a previously agreed-
on exercise, or they may be resistant to changing negative perceptions of
themselves and cynical views of the other person. When resistance is viewed
in terms of protecting the primary defense or fantasy bond from intrusion,
it is easier to predict the points at which anxiety will be aroused. Negative
reactions can be anticipated whenever there is any change in an individual's
cognitive, behavioral, or affective state that threatens either the self-
nourishing process or object dependency.
People who engage in corrective suggestions often report that initially
they experience increased voice attacks; however, if they maintain the
new behavior over an extended period of time, these destructive thoughts
gradually diminish. In fact, the anticipatory anxiety aroused prior to institut-
ing changes is often more intense than the actual emotional responses to
changing the target behavior. Only by dealing with the anxiety created by
positive changes can people hold on to the psychological territory they
have gained. Through corrective suggestions individuals realize, on a deep
emotional level, that they can gradually increase their tolerance for intimate
sexuality without being overwhelmed by primitive fears and anxiety states.

CONCLUSION

Voice therapy techniques, used in conjunction with corrective sugges-

tions in the context of couple or sex therapy, help people challenge negative
thought processes, establish important personal goals for their relationship,
and develop core attitudes of empathy, compassion, and respect for one
another. Corrective suggestions act to challenge the voice process and help
clients expand their boundaries. They stimulate changes in each person's
actions that are consistent with changes in his or her self-concept. The
process of carrying out corrective suggestions teaches people on a deep

278 SEX AND LOVE IN INTIMATE RELATIONSHIPS

emotional level that they can apply rational thought and insight to control
their distancing behaviors in an intimate relationship.
The suggestions described in this chapter are based on our views
about how people could ideally affiliate with one another and express their
affection, sexuality, and love.
These recommendations are not based on authoritarian prescriptions
from the therapist, nor are they imposed on clients on the basis of a predeter-
mined plan. Just as clients are encouraged to take a strong role in separating
the alien point of view represented by the voice from their own point of
view, they are encouraged to explore alternatives and possibilities as equal
participants in the therapy process. Through candid discussions about aspects
of their sexuality and intimate relating that disturb them, each individual,
together with the therapist, contributes ideas that apply to his or her unique
circumstances. The suggestions and ideas are in accord with an individual's
personal goals and focus on the areas of the relationship he or she wishes
to change.
Proper timing, rapport, and a strong therapeutic alliance are essential
in this phase of therapy. It is important to be aware that these suggestions
can lead to serious anxiety states and even regression. Movement toward
individuation in a direction away from fantasy bonds and negative parental
introjects (the voice) needs to be undertaken with care and diligence and
a deep understanding of personality dynamics (Firestone, 1988).
By using self-discipline to overcome defensive behaviors, each person
is moving away from compulsively repeating painful experiences from the
past. In order to move in that direction, people must take risks at certain
crucial points, risks that arouse anxiety. When clients manage to sweat
through the anxiety that is inherent in positive change, it gradually dimin-
ishes and there is generally substantial therapeutic progress.

NOTE

1. The term "corrective emotional experience" was suggested by Alexander (cited

in Arlow, 1989). Alexander believed that the patient needed to have a "correc-
tive emotional experience" to overcome the effects of his or her original trau-
matic experience.

ENHANCING INTIMACY 279

 EPILOGUE

This epilogue reflects our summary views regarding sex and love. As
noted throughout the book, people's sexual identity, their love life and
sexual practices, are at the core of their existence. Indeed, life is the most
satisfying when one's sexuality is combined with love in a close personal
relationship. Yet one must not exclude the importance of sexuality, even
when it fails to meet these criteria.
The tragedy is that for many people, their sense of self and their sex
lives have been damaged in their earliest associations. This interpersonal
damage, combined with destructive cultural influences, acts to prevent most
people from fulfilling their true potential for sexual comfort and gratification.
The following are excerpts from interviews with each of the authors
about their views on sexuality:
Interviewer: As a clinician dealing with the manifestations in
adults of what happens to them as children, what's
your opinion of the institutionalized, societal atti-
tudes that we have concerning sex, nudity, and the
human body?

Robert Firestone: Attitudes toward sex, if you really look at them with
any intelligence or perspective, are totally bizarre as
people experience them in our culture. Sex is a natu-
ral human function, as natural as eating. It's not a
separate function. It is not a bizarre activity that
people need to do secretly and hide. There's nothing
essentially ugly or sinful or bad about a human being,
about their body, about their genitals. When a man
and a woman are together and they are holding each
other and feeling loving, they touch and caress each

281
 other. It is a tender moment. The sexual touching
is a natural extension of those feelings. It's a natural
extension to go from caressing an arm, holding hands,
to touching a breast or a vagina or a penis. The sexual
touching is no different than any other touching. But
you learn early in life to suppress the impulse to
touch a penis, to look at it. You're taught that it's
bad or wrong to touch a vagina or that you will hurt
a woman if you do.
Why are these actions singled out? Why are these
parts of the body wrong? They are no different from
any other parts of the human body. A strange feeling
is attached to them and they come to take on a
shame and secrecy. Anything below the waist is bad.
Often the genitals are confused with anal functions
because both regions are located in the same area.
It is just as natural to touch a penis as to touch a
hand or a face. It is natural to touch a breast and to
hold it. These are not actions to be ashamed of. Why
wouldn't people feel easy touching each other? There
is nothing wrong with this.
On a simpler level, many women in Europe go
topless on the beaches. They feel wonderful, they
feel fine. No one is leaping on anybody or attacking
anybody. There is no increase in rape. Men are not
walking around with giant erections and desperately
longing and lurching. There is no chaos. It's just part
of a pretty scene, a natural scene. It feels good, it
looks good, it's natural.

Interviewer: The socialization process that goes on in every family

with their children seems to have inherent within
that process the concept that the body is dirty.

Robert Firestone: Within most families, a complete socialization pro-

cess is imposed on a natural system, foolishly and
stupidly. And in a way that damages people seriously.
This is why we are concerned with this subject in
this book. We see people who are seriously damaged
in their attitudes toward their bodies and their sexual-
ity, and it affects them in other areas of their func-
tioning. In fact, the crazy limitations and perverse
attitudes against sexuality which make it unclean or
peculiar or different from other natural functions
lead to serious states of hostility. These states often
culminate in vicious acts, such as man against man,

282 SEX AND LOVE IN INTIMATE RELATIONSHIPS

 which are totally unnecessary. And they are primarily
based on this bizarre frustration of a very natural and
simple human function.

Interviewer: That being the case, I wonder why it started and

why it's maintained.

Robert Firestone: What I think is really operating here is related to

death anxiety. In some sense, death can be viewed,
or may have been viewed, as a punishment. Because
each person who is born is living with a death sen-
tence, we view death as a punishment. There are a
lot of powerful emotions surrounding death: fear,
anxiety, guilt, shame, fear of the unknown. I think
that these negative emotions turned us against our
basic nature, our physical nature, which we know
cannot ultimately survive.
So we postulate and pray for a soul, a future, an
afterlife potential. We hope for something more in
us than the body. Unfortunately, along with the pos-
tulation of a soul, we tum against life, against the
body, and against natural activities and sexual activi-
ties. It is a trade-off-the body for the soul. The
historical roots for this no-win situation lie in the
desperation to avoid death anxiety and the terror of
the unknown.

Interviewer: What can be done about this?

Robert Firestone: It is important to bring the subject of sexuality out

in to the open, as we have done in this book. I think
an open discussion of all the feelings and attitudes
and dynamics involved in sexuality help bring the
subject out in the open, allowing people to be less
ashamed of their sexual nature. I think this type of
education is important. The possibility of this educa-
tion in the public schools would be important. More
books, articles, and educational films should be dis-
seminated on this subject. This is why we have writ-
ten this book.
It is often clear that certain restrictions and taboos
about sexuality are unnecessary or destructive or
damaging to people. There is an obvious implication
that different actions should be taken. People can
learn not to act on these negative attitudes. Parents
can be educated to not be reactive to behaviors that
children engage in, such as masturbation or sex play

EPILOGUE 283
 with peers. Parents can't learn not to have an emo-
tional reaction that has been ingrained in them and
has been part of their upbringing, but they can learn
to control the destructive urge to suppress or even
attack the innocent behavior of children in regard
to their sexuality.
Interviewer: It is your opinion that nearly every individual in our
society suffers personally in some aspect of his or her
sexuality. Why is this so?
Joyce Catlett: Everyone is damaged in his or her sexuality, whether
it takes the form of excessive guilt or inhibited sexual
drive or perversion or shame about the body or perfor-
mance anxiety or feelings about themselves as men
and women. Weare all hurt. As we have discussed
in this book, these symptoms are the result of destruc-
tive attitudes that are expressed as critical voices that
are directed toward both one's self and one's partner.
The effects of these attitudes and attacks on a person's
sexuality go beyond the sexual area of one's life.
In addition, restrictive societal influences on natu-
ral sexuality, such as fanatical religious beliefs, pro-
mote shameful attitudes about the body and negative
attitudes about sexuality and masturbation and sex
play among children. These restrictive teachings can
contribute to an increase in adult aggression and
hostile behaviors. It is our contention that the imma-
ture and puritanical and sexist and suppressive atti-
tudes toward sex that permeate our culture could
actually be considered a form of sexual abuse because
they cause so much harm.
We contend that beliefs that postulate a soul and
an afterlife to counter death anxiety and assure salva-
tion involve a trade-off that requires turning against
the body and the core of a person's sexuality. Our
work agrees with Terror Management theorists in
their understanding that the fear of death causes
humans to emphasize differentiation from their ani-
mal heritage. In other words, knowing that animals
die, people divorce themselves from their animal
nature. This defensive reaction has far-reaching con-
sequences for people's sexual development. Many
sexual problems reflect this defended adaptation to
death anxiety.
Interviewer: Then how can a person have a healthy attitude
about sex?

284 SEX AND LOVE IN INTIMATE RELATIONSHIPS

Joyce Catlett: To have a healthy and natural attitude toward sexual-
ity, a person would have to accept their animal nature
and have a positive attitude toward his or her body
and nudity and sexual urges. Sex would be seen as
a simple and pleasurable act. It would be a high level
priority in life. Unfortunately, for many people today
sex is a low priority in their lives. Many couples
have severely impoverished sexual lives. While many
people are avoiding sex and starving themselves sexu-
ally, they are finding other sources of gratification.
They are substituting addictive behaviors for sex:
eating, drinking, smoking, TV watching, internet
surfing. You just have to look around you to see
examples of these types of behaviors. When a person's
sexuality is restricted, it not only has a damaging
effect on their personal relationships but it negatively
impacts every aspect of their being.

Interviewer: What would your advice be to people?

Joyce Catlett: A healthy principle would be to embrace sex as an

important aspect of life, to give value to one's sexual-
ity, and strive to improve one's capability to give
and receive sexual pleasures. Erich Fromm has de-
scribed the art of loving, and there is an art to making
love as well. There is much that a person can learn.
A person can actually benefit from viewing sexuality
as a continuous learning process. It is necessary for
people to develop the capacity to be sensitive and
tender and loving to one another in order to touch
someone, and feel for them, and sense what they
want, and remain close and compatible. It is impor-
tant to be comfortable and easy in the sexual situation
rather than agitated or hurried. 1t is important to
enjoy each other, and to know each other, and really
be with the person you are with. Performance anxiety
and self-consciousness have a negative effect on sex-
ual feelings and cause people to lose their focus and
disconnect from their partner and can actually dis-
rupt the sex act.

Interviewer: Sexual attraction is so indefinable and obscure. What

would you say makes a person sexually attractive?

Lisa Firestone: True wanting is at the core of a person being sexually

attractive. When you are truly wanting, you are ask-
ing an implicit question of the person you are inter-
ested in to be responsive to you. Everyone, men

EPILOGUE 285
 and women alike, benefits from being acknowledged
sexually. This is true even when they don't necessar-
ily feel attracted to the other person or they don't
plan on being sexual. On the other hand, when peo-
ple retreat from their sexuality, they do not look as
alive or vital. An essential part of sexuality is looking
attractive. Ideally, a person's sexuality should be ap-
parent in their everyday life apart from the bedroom.
Sex should be openly talked about, and personal
feelings and preferences should be discussed in an
adult fashion.
Interviewer: How do you think people can develop sexually?
Lisa Firestone: In order to develop sexually, a person must first over-
come emotional problems stemming from childhood.
These limitations pertain to the early interpersonal
environment-to the way people were treated as
children. If they grew up in an environment that
was not loving or trusting or open to feelings, they
necessarily shut down and defended themselves.
When children are damaged and hurt they pull in-
ward to cut themselves off from their feelings. Feel-
ings are in the body, not in the head. Therefore, in
defending themselves, these children cut themselves
off from their bodies. They are subject to self-attacks
and destructive voices. They turn away from wanting
as a basic defensive reaction and become emotionally
and physically deadened.
People who are defended need to maintain control
of their feelings and of their expression. Being in
control is the enemy of healthy sexuality. Fear of
being vulnerable and of being out of control are
serious impediments to enjoying sex. Many people
are afraid of sex or frightened of being fully responsive
because they fear that painful emotions or memories
might surface. These people are often more respon-
sive in sexual situations that are distant or more
anonymous. Often, after a close and personal and
successful sexual experience with someone they love,
they defend themselves even more. This explains
why some people are so resistant to developing
sexually.
People can overcome basic limitations in their
sexual lives even though there are powerful resist-
ances, but they must have the courage and persis-

286 SEX AND LOVE IN INTIMATE RELATraNSHIPS

tence to break with core defenses. In order to be free
themselves, they must cope with painful emotions
and sometimes revive traumatic memories from the
past. Accepting the challenge allows for increased
sexual pleasure and fulfillment in life.

EPILOGUE 287
 REFERENCES

Aanstoos, C. M. (200l). Phenomenology of sexuality. In P.]. Kleinplatz (Ed.), New

directions in sex therapy: Innovations and alternatives (pp. 69-90). Philadelphia:
Brunner- Routledge.
Ainsworth, M. D. S., Blehar, M. c., Waters, E., & Wall, S. (1978). Patterns of
attachment: A psychological study of the Strange situation. Hillsdale, NJ: Erlbaum.
Allen, M. (1997). We've come a long way, too, baby: And we've still got a ways
to go: So give us a break! In M. R. Walsh (Ed.), Women, men, and gender:
Ongoing debates (pp. 402-405). New Haven, CT: Yale University Press.
American Academy of Pediatrics. (2001). Sexuality, contraception, and the media
[Electronic version]. Pediatrics, 107, 191-194.
American Association of Marriage and Family Therapy Staff. (2002, July/August).
The men's movement and beyond: Thoughts from Sam Keen. Family Therapy
Magazine, 1(4),32-35.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: Author.
American Psychological Association. (2000). Guidelines for psychotherapy with les-
bian, gay, and bisexual clients. Washington, DC: Author.
Anderson-Fye, E. P. (2003). Never leave yourself: Ethnopsychology as mediator of
psychological globalization among Belizean schoolgirls. Ethos, 31, 59-94.
Andrews, B. (2002). Body shame and abuse in childhood. In P. Gilbert &]. Miles
(Eds.), Body shame: Conceptualisation, research and treatment (pp. 256-266).
Have, England: Brunner-Routledge.
Anthony, S. (1973). The discovery of death in childhood and after. Harmondsworth,
England: Penguin Education. (Original work published 1971)
Araoz, D. L. (1982). Hypnosis and sex therapy. New York: Brunner/Mazel.
Aries, E. (1997). Women and men talking: Are they worlds apart! In M. R. Walsh
(Ed.), Women, men, and gender: Ongoing debates (pp. 91-100). New Haven,
CT: Yale University Press.
Arlow,]. A. (1989). Psychoanalysis. In R.]. Corsini & D. Wedding (Eds.), Current
psychotherapies (4th ed., pp. 19-62). Itasca, IL: Peacock.
Bach, G. R., & Deutsch, R. M. (1979). StoP! You're driving me crazy. New York:
Berkley Books.
Bader, E., & Pearson, P. T. (1988). In search of the mythical mate: A developmental
approach to diagnosis and treatment in couples therapy. New York: Brunner/Mazel.
Bader, E., & Pearson, P. T. (with]. D. Schwartz). (2000). Tell me no lies: How to
face the truth and build a loving marriage. New York: St. Martin's Press.
Bader, M. ]. (2002). Arousal: The secret logic of sexual fantasies. New York: St.
Martin's Press.

289
Bancroft,]. (1999). Sexual science in 21st century: Where are we going? A personal
note. Journal of Sex Research, 36, 226-229.
Bancroft, ]. (2002). Biological factors in human sexuality. Journal of Sex Research,
39,15-21.
Bandura, A (1986). Social foundations of thought and action: A social cognitive theory.
Englewood Cliffs, N]: Prentice-Hall.
Bandura, A, Ross, D., & Ross, S. A (1961). Transmission of aggression through
imitation of aggressive models. Journal of Abnormal and Social Psychology, 63,
575-582.
Barash, D. P., & Lipton,]. E. (200l). The myth of monogamy: Fidelity and infidelity
in animals and people. New York: Freeman.
Barber, B. K. (1996). Parental psychological control: Revisiting a neglected con-
struct. Child Development, 67, 3296-3319.
Barber, B. K. (2002). Reintroducing parental psychological control. In B. K. Barber
(Ed.), Intrusive parenting: How psychological control affects children andadolescents
(pp. 3-13). Washington, DC: American Psychological Association.
Barber, B. K., & Harmon, E. L. (2002). Violating the self: Parental psychological
control of children and adolescents. In B. K. Barber (Ed.), Intrusive parenting:
How psychological control affects children and adolescents (pp. 15-52). Washing-
ton, DC: American Psychological Association.
Barrett, L. F., Robin, L., Pietromonaco, P. R., & Eyssell, K. M. (1998). Are women
the "more emotional" sex? Evidence from emotional experiences in social
context. Cognition and Emotion, 12,555-578.
Basson, R. (2003). Women's difficulties with low sexual desire and sexual avoidance.
In S. B. Levine, C. B. Risen, & S. E. Althof (Eds.), Handbook of clinical sexuality
for mental health professionals (pp. 111-130). New York: Brunner-Routledge.
Barges, ]., & Leadbeater, B. ]. (1994). Parental attachment, peer relations, and
dysphoria in adolescence. In M. B. Sperling & W. H. Berman (Eds.), Attachment
in adults: Clinical and developmental perspectives (pp. 155-178). New York:
Guilford Press.
Beavers, W. R., & Hampson, R. B. (1990). Successful families: Assessment and
intervention. New York: Norton.
Beck, A T. (1976). Cognitive therapy and the emotional disorders. New York: New
American Library.
Beck, A T. (1988). Love is neverenough: How couples canovercome misunderstandings,
resolve conflicts, and solve relationship problems through cognitive therapy. New
York: Harper & Row.
Beck, A T., Rush, A J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of
depression. New York: Guilford Press.
Beck, ]. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.
Becker, D. V., Sagarin, B. ]., Guadagno, R. E., Millevoi, A., & Nicastle, L. D.
(2004). When the sexes need not differ: Emotional responses to the sexual
and emotional aspects of infidelity. Personal Relationships, 11, 529-538.

290 REFERENCES
Becker, E. (1997). The denial of death. New York: Free Press. (Original work pub-
lished 1973)
Beebe, B. (1986). Mother-infant mutual influence and precursors of self and object
representations. In ]. Masling (Ed.), Empirical studies of psychoanalytic theories
(Vol. 2, pp. 27-48). Hillsdale, NJ: Analytic Press.
Beebe, B., & Lachmann, L. M. (2002). Infant research and adult treatment: Co-
constructing interactions. Hillsdale, NJ: Analytic Press.
Belsky.]. (1980). Child maltreatment: An ecological integration. AmericanPsycholo-
gist, 35, 320-335.
Benjamin, ]. (1995). Like subjects, love objects: Essays on recognition and sexual
difference. New Haven, CT: Yale University Press.
Benjamin, ]. (1999). Women's Oedipal conflicts and boys' Oedipal ideology. In
D. Bassin (Ed.), Female sexuality: Contemporary engagements (pp. 87-95).
Northvale, N]: Jason Aronson.
Berg-Cross, L. (1997). Couples therapy. Thousand Oaks, CA: Sage.
Bergen, H. A, Martin, G., Richardson, A S., Allison, S., & Roeger, L. (2003).
Sexual abuse and suicidal behavior: A model constructed from a large commu-
nity sample of adolescents. Journal of the AmericanAcademy of Child and Adoles-
cent Psychiatry, 42, 1301-1309.
Berne, E. (1961). Transactional analysis in psychotherapy: A systematic individual and
social psychiatry. New York: Grove Press.
Berne, E. (1964). Games people play: The psychology of human relationships. New
York: Grove Press.
Bettelheim, B. (1979). Individual and mass behavior in extreme situations. In
Surviving and other essays (pp, 48-83). New York: Knopf. (Original work pub-
lished 1943)
Beutler, L. E. (1997). The psychotherapist as a neglected variable in psychotherapy:
An illustration by reference to the role of therapist experience and training.
Clinical Psychology: Science and Practice, 4, 44-52.
Beyer, S., & Finnegan, A (1997, August). The accuracy of gender stereotypes regarding
occupations. Paper presented at the 105th annual meeting of the American
Psychological Association, Chicago.
Bianchi-Dernicheli, F., & Zutter, A (2005). Intensive short-term dynamic sex
therapy: A proposal. Journal of Sex and Marital Therapy, 31, 57-72.
Bigler, R. S. (1999). Psychological interventions designed to counter sexism in
children: Empirical limitations and theoretical foundations. In W. B. Swann,
[r., ]. H. Langlois, & L. A Gilbert (Eds.), Sexism and stereotypes in modern
society: The gender science of Janet Taylor Spence (pp. 129-151). Washington,
DC: American Psychological Association.
Billig, M. (1987). Arguing and thinking: A rhetorical approach to social psychology.
Cambridge, England: Cambridge University Press.
Billig, M., Condor, S., Edwards, D., Gane, M., Middleton, D., & Radley, A (1988).
Ideological dilemmas: A social psychology of everyday thinking. London: Sage.

REFERENCES 291
Bishay, N. R. (1988). Cognitive therapy in psychosexual dysfunctions: A preliminary
report. Sex and Marital Therapy, 3, 83-90.
Blatt, S. J., & Erlich, H. S. (1982). Levels of resistance in the psychotherapeutic
process. In P. L. Wachtel (Ed.), Resistance: Psychodynamic and behavioral ap-
proaches (pp. 69-91). New York: Plenum Press.
Bloch, D. (1978). "So thewitchwon't eat me": Fantasy and thechild's fear of infanticide.
New York: Grove.
Bloch, D. (1985). The child's fear of infanticide and the primary motive force of
defense. Psychoanalytic Review, 72, 573-588.
Bly, R. (1990). Iron John: A book about men. Reading, MA: Addison-Wesley.
Bocknek, G., & Perna, F. (1994). Studies in self-representation beyond childhood.
In J. M. Masling & R. F. Bornstein (Eds.), Empirical perspectives on object relations
theory (pp. 29-58). Washington, DC: American Psychological Association.
Bogaert, A F., & Sadava, S. (2002). Adult attachment and sexual behavior. Personal
Relationships, 9, 191-204.
Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known.
New York: Columbia University Press.
Bollas, C. (2000). Hysteria. New York: Routledge.
Bolton, F. G., Jr. (1983). When bonding fails: Clinical assessment of high-risk families.
Beverly Hills, CA: Sage.
Bolton, F. G., Jr., Morris, L. A, & MacEahron, A E. (1989). Males at risk: The
other side of child sexual abuse. Newbury Park, CA: Sage.
Bonner, B. L. (2001). Normal and abnormal sexual behavior in children. Psycho-
therapy Bulletin, 36(4), 16-19.
Bornstein, R. F. (1993). Parental representations and psychopathology: A critical
review of the empirical literature. In J. M. Masling & R. F. Bornstein (Eds.),
Psychoanalytic perspectives on psychopathology (pp. 1-41). Washington, DC:
American Psychological Association.
Boszormenyi-Nagy, 1., & Spark, G. M. (1984). Invisible loyalties: Reciprocity in inter-
generational family therapy. New York: Brunner/Maze!'
Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson.
Bowlby, J. (1973). Attachment and loss: Vol. II. Separation: Anxiety and anger. New
York: Basic Books.
Bray, J. H. (1991). The Personal Authority in the Family System Questionnaire:
Assessment of intergenerational family relationships. In D. S. Williamson
(Ed.), The intimacy paradox: Personal authority in thefamily system (pp. 273-286).
New York: GUilford Press.
Brennan, K. A, & Shaver, P. R. (1995). Dimensions of adult attachment, affect
regulation, and romantic relationship functioning. Personality and Social Psy-
chology Bulletin, 21, 267-283.
Bretherton,1. (1996). Internal working models of attachment relationships as related
to resilient coping. In G. G. Noam & K. W. Fischer (Eds.), Development and
vulnerability in close relationships (pp. 3-27). Mahwah, NJ: Erlbaum.

292 REFERENCES
Bretherton, 1.,& Munholland, K. A (1999). Internal working models in attachment
relationships: A construct revisited. In J. Cassidy & P. R. Shaver (Eds.),
Handbook of attachment: Theory, research, and clinical applications (pp. 89-111).
New York: Guilford Press.
Briere, J. N. (1992). Child abuse trauma: Theory and treatment of the lasting effects.
Newbury Park, CA: Sage.
Briere, J., & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-
reported childhood physical and sexual abuse in a general population sample
of men and women. Child Abuse and Neglect, 27, 1205-1222.
Brody, S. (2004). Slimness is associated with greater intercourse and lesser masturba-
tion frequency. Journal of Sex and Marital Therapy, 30, 251-261.
Brooks, D. (2003, November 8). Love, internet style. New York Times [Electronic
version]. Retrieved November 8, 2003, from http://www.nytimes.com/2003/
11/08/opinion/08Broo.html
Burleson, B. R., Kunkel, A W., Samter, W., & Werking, J. (1996). Men's and
women's evaluations of communication skills in personal relationships: When
sex differences make a difference-and when they don't. Journal of Social and
Personal Relationships, 13,201-224.
Burn, S. M. (1996). The social psychology of gender. New York: McGraw-Hill.
Burton, R. (2001). The anatomy of melancholy. New York: New York Review Books.
(Original work published 1621)
Buss, D. M. (1994). The evolution of desire: Strategies of human mating. New York:
Basic Books.
Buss, D. M. (2000). The dangerous passion: Why jealousy is as necessary as love and
sex. New York: Free Press.
Buss, D. M., & Barnes, M. (1996). Preferences in human mate selection. Journal
of Personality and Social Psychology, 50, 559-570.
Buss, D. M., & Schmitt, D. P. (1993). Sexual strategies theory: An evolutionary
perspective on human mating. Psychological Review, 100, 204-232.
Bussey, K., & Bandura, A. (1984). Influence of gender constancy and social power on
sex-linked modeling. Journal of Personality andSocial Psychology, 47, 1292-1302.
Buunk, B. P., Angleitner, A, Oubaid, V., & Buss, D. M. (1996). Sex differences in
jealousy in evolutionary and cultural perspective: Tests from the Netherlands,
Germany, and the United States. Psychological Science, 7, 359-363.
Buunk, B., & Hupka, R. B. (1987). Cross-cultural differences in the elicitation of
sexual jealousy. Journal of Sex Research, 23, 12-22.
Calderone, M. S., & Johnson, E. W. (1989). The family book about sexuality (Rev.
ed.). New York: Harper & Row.
Canary, D. J., Cupach, W. R., & Messman, S. J. (1995). Relationship conflict: Conflict
in parent-child, friendship, and romantic relationships. Thousand Oaks, CA: Sage.
Caplan, P. J. (1981). Between women: Lowering the barriers. Toronto, Canada:
Personal Library.

REFERENCES 293
Carnes, P. (1997). Sexual anorexia: Overcoming sexual self-hatred. Center City,
MN: Hazelden.
Carpenter, K. M., & Addis, M. E. (2000). Alexithymia, gender, and responses to
depressive symptoms. Sex Roles, 43, 629-644.
Chen, Z., & Kaplan, H. B. (200l). Intergenerational transmission of constructive
parenting. Journal of Marriage and Family, 63, 17-3l.
Chesler, P. (200l). Woman's inhumanity to woman. New York: Thunder's Mouth
Press/Nation Books.
Chessick, R. D. (1992). On falling in love and creativity. Journal of the American
Academy of Psychoanalysis, 20, 347-373.
Chiland, C. (2004). Gender and sexual difference. In 1. Matthis (Ed.), Dialogues
on sexuality, gender, and psychoanalysis (pp. 79-91). London: Karnac.
Chodorow, N. (1978). The reproduction of mothering: Psychoanalysis and the sociology
of gender. Berkeley: University of California Press.
Chodorow, N. J. (1989). Feminism and psychoanalytic theory. New Haven, CT: Yale
University Press.
Chodorow, N. J. (1999). The power of feelings: Personal meaning in psychoanalysis,
gender, and culture. New Haven, CT: Yale University Press.
Cobia, D. c., Sobanskv, R. R., & Ingram, M. (2004). Female survivors of childhood
sexual abuse: Implications for couples' therapists. Family Journal, 12, 312-318.
Coelho, P. (2004). Eleven minutes (M. J. Costa, Trans.). New York: HarperCollins.
Cole, P. M., & Putnam, F. W. (1992). Effect of incest on self and social functioning:
A developmental psychopathology perspective. Journal of Consulting and Clini-
cal Psychology, 60, 174-184.
Conte, J. R. (1988). The effects of sexual abuse on children: Results of a research
project. In R. A. Prentky & V. L. Quinsey (Eds.), Human sexual aggression:
Current perspectives (pp. 310-326). New York: New York Academy of Sciences.
Conway, M. (2000). On sex roles and representations of emotional experience:
Masculinity, femininity, and emotional awareness. Sex Roles, 43, 687-698.
Courtois, C. A. (1999). Recollections of sexual abuse: Treatment principles and guide-
lines. New York: Norton.
Courtois, C. A. (2000). The aftermath of child sexual abuse: The treatment of
complex posttraumatic stress reactions. In L. T. Szuchman & F. Muscarella
(Eds.), Psychological perspectives on human sexuality (pp. 549-572). New
York: Wiley.
Cramer, B. (1997). The transmission of womanhood from mother to daughter. In
B. S. Mark & J. A. Incorvaia (Eds.), The handbook of infant, child, and adolescent
psychotherapy: Vo!' 2. New directions in integrative treatment (pp. 373-391).
Northvale, NJ: Jason Aronson.
Crosbie-Bumett, M., Foster, T. L., Murray, C. L., & Bowen, G. L. (1996). Gays'
and lesbians' families-of-origin: A social-cognitive-behavioral model of adjust-
ment. Family Relations, 45, 397-403.

294 REFERENCES
Cummings, E. M., Goeke-Morey, M. c., & Raymond, J. (2004). Fathers in family
context: Effects of marital quality and marital conflict. In M. E. Lamb (Ed.), The
role of the father in chikl development (4th ed., pp. 196-221). New York: Wiley.
Daly, M., & Wilson, M. (1983). Sex, evolution, and behavior (2nd ed.). Belmont,
CA: Wadsworth.
Daly, M., & Wilson, M. (1988). Homicide. New York: A1dine De Gruyter.
D'Angelo, L. L., Weinberger, D. A., & Feldman, S. S. (1995). Like father, like
son? Predicting male adolescents' adjustment from parents' distress and self-
restraint. Developmental Psychology, 31, 883-896.
Davidson, J. K., & Darling, C. A (1993). Masturbatory guilt and sexual responsive-
ness among post-college-age women: Sexual satisfaction revisited. Journal of
Sex and Marital Therapy, 19,289-300.
Davis, K. (1977). Jealousy and sexual property. In G. Clanton & L. G. Smith
(Eds.), Jealousy (pp. 129-134). New York: Lanham.
Deaux, K. (1999). An overview of research on gender: Four themes from 3 decades.
In W. B. Swann jr., J. H. Langlois, & L. A Gilbert (Eds.), Sexism and stereotypes
in modern society: The gender science ofJanetTaylorSpence (pp. 11-33). Washing-
ton, DC: American Psychological Association.
DeMause, L. (1991). The universality of incest. Journal of Psychohistory, 19, 123-164.
DeSteno, D. A, & Salovey, P. (1996). Jealousy and the characteristics of one's rival:
A self-evaluation maintenance perspective. Personality and Social Psychology
Bulletin, 22, 920-932.
deWeerth, c., & Kalma, A P. (1993). Female aggression as a response to sexual
jealousy: A sex role perversion? Aggressive Behavior, 19, 265-279.
Dicks, H. V. (1967). Marital tensions: Clinical studies towards a psychological theory
of interaction. London: Karnac Books.
Dindia, K., & Allen, M. (1992). Sex differences in self-disclosure: A meta-analysis.
Psychological Bulletin, 112, 106-124.
Dittmann, M. (2004). Women like women more than men like men. Monitor on
Psychology, 35(11),11.
Dix, C. (1985). The new mother syndrome: Coping withpostpartum stress anddepression.
New York: Pocket Books.
Doll, L. S., Koenig, L. j., & Purcell, D. W. (2004). Child sexual abuse and adult
sexual risk: Where are we now? In L. J. Koenig, L. S. Doll, A O'Leary, &
W. Pequegnat (Eds.), From chikl sexual abuse to adult sexual risk: Trauma,
revictimization, andintervention (pp. 3-10). Washington, DC: American Psycho-
logical Association.
Dorais, M. (2002). Don't tell: The sexual abuse of boys (1. D. Meyer, Trans.). Montreal,
Canada: McGill-Queen's University Press.
Dowling, C. (2000). The frailty myth: Redefining the physical potential of women and
girls. New York: Random House.
Downey, G., Feldman, S., & Ayduk, O. (2000). Rejection sensitivity and male
violence in romantic relationships. Personal RelationshiPs, 7, 45-61.

REFERENCES 295
Downing, C. (1977). Jealousy: A depth-psychological perspective. In G. Clanton
& L. G. Smith (Eds.), Jealousy (pp. 72-79). New York: Lanham.
Duck, S. (I 994). Meaningful relationships : Talking, sense, and relating. Thousand
Oaks, CA: Sage.
Dutton, D. G. (I 995a). The batterer: A psychological profile. New York: Basic Books.
Dutton, D. G. (1995b). The domestic assault of women: Psychological and criminal
justice perspectives (Rev. ed.). Vancouver, Canada: UBC Press.
Dutton, D. G., & Aron, A P. (1974). Some evidence for heightened sexual
attraction under conditions of high anxiety. Journal of Personality and Social
Psychology, 30, 51O-5l7.
Eagle, M., & Wolitzky, D. L. (1997). Empathy: A psychoanalytic perspective. In
A C. Bohart & L. S. Greenberg (Eds.), Empathy reconsidered: New directions
in psychotherapy (pp. 217-244). Washington, DC: American Psychological
Association.
Eagly, A H., & Crowley, M. (1986). Gender and helping behavior: A meta-
analytic review of the social psychological literature. Psychological Bulletin,
100, 283-308.
Eaglv, A H., & Wood, W. (1999). The origins of sex differences in human behavior:
Evolved dispositions versus social roles. American Psychologist, 54, 408-423.
Edwards, W. M., & Coleman, E. (2004). Defining sexual health: A descriptive
overview. Archives of Sexual Behavior, 33, 189-195.
Elliott, K. J. (1999). The "inner critic" as a key element in working with adults
who have experienced childhood sexual abuse. Bulletin of the Menninger Clinic,
63, 240-253.
Ellis, A (1973). Humanistic psychotherapy: The rational-emotive approach. New
York: Julian.
Ellis, A (1996). The treatment of morbid jealousy: A rational-emotive behavior
therapy approach. Journal of Cognitive Psychotherapy, 10, 23-33.
Ellis, A, & Harper, R. A (1975). A new guide to rational living. North Hollywood,
CA: Wilshire Books.
Ellis, B. J., Bates, J. E., Dodge, K. A, Fergusson, D. M., Horwood, L. J., Pettit,
G. S., et al. (2003). Does father absence place daughters at special risk for
early sexual activity and teenage pregnancy? Child Development, 74, 801-821.
Elson, M. (Ed.). (1987). The Kohut seminars on selfpsychology and psychotherapy with
adolescents and young adults. New York: Norton.
Epstein, S. (1973). The self-concept revisited or a theory of a theory. American
Psychologist, 28, 404-416.
Epstein, S. (1993). Implications of cognitive-experiential self-theory for personality
and developmental psychology. In D. C. Funder, R. D. Parke, C. Tom linson-
Keasey, & K. Widaman (Eds.), Studying lives through time: Personality and
development (pp. 399-438). Washington, DC: American Psychological
Association.

296 REFERENCES
Epstein, S. (1994). Integration of the cognitive and the psychodynamic unconscious.
American Psychologist, 49, 709-724.
Epstein, S., Lipson, A, Holstein, c., & Huh, E. (1992). Irrational reactions to
negative outcomes: Evidence for two conceptual systems. Journal of Personality
and Social Psychology, 62, 328-339.
Erikson, E. H. (1963). Childhood and society (2nd ed.). New York: Norton.
Everaerd, W., Laan, E. T. M., Both, S., & van der Velde, J. (2000). Female sexuality.
In L. T. Szuchman & F. Muscarella (Eds.), Psychological perspectives on human
sexuality (pp. 101-146). New York: Wiley.
Everaerd, W., Laan, E. T. M., & Spiering, M. (2000). Male sexuality. In L. T.
Szuchman & F. Muscarella (Eds.), Psychological perspectives on human sexuality
(pp, 60-100). New York: Wiley.
Fagot, B. 1., & Hagan, R. (1991). Observations of parent reactions to sex-stereotyped
behaviors: Age and sex effects. Child Development, 62, 617-628.
Fairbairn, W. R. D. (1952). Psychoanalytic studies of the personality. London:
Routledge & Kegan Paul.
Faller, K. C. (1999). Child maltreatment and protection in the United States. In
K. C. Faller (Ed.), Maltreatment in early childhood: Tools for research-based
intervention (pp. 1-12). New York: Haworth Press.
Fausto-Sterling, A (2000). Sexing the body: Gender politics and the construction of
sexuality. New York: Basic Books.
Feeney, J. A (1999). Adult romantic attachment and couple relationships. In
J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research,
and clinical applications (pp. 355-377). New York: GUilford Press.
Feeney, J. A, Noller, P., & Patty, J. (1993). Adolescents' interactions with the
opposite sex: Influence of attachment style and gender. Journal of Adolescence,
16, 169-186.
Fehr, B., & Broughton, R. (2001). Gender and personality differences in conceptions
of love: An interpersonal theory analysis. Personal Relationships, 8, 115-136.
Felitti, V. J. (2002). The relation between adverse childhood experiences and adult
health: Turning gold into lead. Permanente Journal, 6(1), 44-47.
Felitti, V. J., Anda, R. F., Nordenberg, D, Williamson, D. F., Spitz, AM.,
Edwards, V., et al. (1998). Relationship of childhood abuse and household
dysfunction to many of the leading causes of death in adults: The Adverse
Childhood Experiences (ACE) study. American Journal of Preventive Medicine,
14, 245-258.
Felson, R. B. (2002). Violence and gender reexamined. Washington, DC: American
Psychological Association.
Fenchel, G. H. (1986). Maternal unavailability as intergenerational trauma. Issues
in Ego Psychology, 9, 25-31.
Fenchel, G. H. (Ed.). (1998). The mother-daughter relationship: Echoes through time.
Northvale, NJ: Jason Aronson.

REFERENCES 297
Fenchel, G. H. (2000). Eroticism and the conventional. Journal of the American
Academy of Psychoanalysis, 28, 163-173.
Ferenczi, S. (1955). Confusion of tongues between adults and the child. In M. Balint
(Ed.), Final contributions to theproblems and methods of psycho-analysis (M. Balint
& E. Mosbacher, Trans., pp. 156-167). New York: Basic Books. (Original
work published 1933)
Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1996). Childhood sexual
abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of
childhood sexual abuse. Journal of theAmerican Academy of Child and Adolescent
Psychiatry, 10, 1365-1374.
Fierman, L. B. (Ed.). (1965). Effective psychotherapy: The contribution of Hellmuth
Kaiser. New York: Free Press.
Firestone, R. W. (1957). A concept of the schizophrenic process. Unpublished doctoral
dissertation, University of Denver, CO.
Firestone, R. W. (1984). A concept of the primary fantasy bond: A developmental
perspective. Psychotherapy, 21, 218-225.
Firestone, R. W. (1985). The fantasy bond: Structure of psychological defenses. Santa
Barbara, CA: Glendon Association.
Firestone, R. W. (1987). Destructive effects of the fantasy bond in couple and
family relationships. Psychotherapy, 24, 233-239.
Firestone, R. W. (1988). Voice therapy: A psychotherapeutic approach to self-destructive
behavior. Santa Barbara, CA: Glendon Association.
Firestone, R. W. (1990a). The bipolar causality of regression. American Journal of
Psychoanalysis, 50, 121-135.
Firestone, R. W. (1990b). Compassionate child-rearing: An in-depth approach to optimal
parenting. Santa Barbara, CA: Glendon Association.
Firestone, R. W. (1990c). Voices during sex: Application of voice therapy to
sexuality. Journal of Sex and Marital Therapy, 16,258-274.
Firestone, R. W. (1993). The psychodynamics of fantasy, addiction, and addictive
attachments. American Journal of Psychoanalysis, 53, 335-352.
Firestone, R. W. (1994a). A new perspective on the Oedipal complex: A voice
therapy session. Psychotherapy, 31, 342-351.
Firestone, R. W. (1994b). Psychological defenses against death anxiety. In R. A.
Neimeyer (Ed.), Death anxiety handbook: Research, instrumentation, and applica-
tion (pp. 217-240. Washington, DC: Taylor & Francis.
Firestone, R. W. (1997a). Combatingdestructive thought processes: Voice therapy and
separation theory. Thousand Oaks, CA: Sage.
Firestone, R. W. (1997b). Suicide and the inner voice: Risk assessment, treatment, and
case management. Thousand Oaks, CA: Sage.
Firestone, R. W. (2002). The death of psychoanalysis and depth therapy. Psychother-
apy, 39, 223-232.
Firestone, R. W., & Catlett, J. (1989). Psychological defenses in everyday life. Santa
Barbara, CA: Glendon Association.

298 REFERENCES
Firestone, R. W., & Catlett, J. (1999). Fear of intimacy. Washington, DC: American
Psychological Association.
Firestone, R. W., & Firestone, L. (2004). Methods for overcoming the fear of
intimacy. In D. J. Mashek & A. Aron (Eds.), Handbook of closeness andintimacy
(pp. 375-395). Mahwah, NJ: Erlbaum.
Firestone, R. W., Firestone, L., & Catlett, J. (2003). Creating a life of meaning and
compassion: The wisdom of psychotherapy. Washington, DC: American Psycho-
logical Association.
Fischer, K. W., & Ayoub, C. (1996). Analyzing development of working models
of close relationships: Illustration with a case of vulnerability and violence.
In G. G. Noam & K. W. Fischer (Eds.), Development and vulnerability in close
relationships (pp. 173-199). Mahwah, NJ: Erlbaum.
Fisher, H. (1992). Anatomy of love: A natural history of mating, marriage, and why
we stray. New York: Fawcett Columbine.
Fisher, H. (2000). Lust, attraction, attachment: Biology and evolution of the three
primary emotion systems for mating, reproduction, and parenting. Journal of
Sex Education and Therapy, 25, 96-104.
Fisher, H. (2004). Why we love: The natureand chemistry of romantic love. New York:
Henry Holt.
Fisher, H. E., Aron, A., Mashek, D., Li, H., & Brown, L. L. (2002). Defining the
brain systems of lust, romantic attraction, and attachment. Archives of Sexual
Behavior, 31, 413-419.
Fisher, S., & Fisher, R. L. (1986). What we really know about child-rearing: Science
in support of effective parenting. Northvale, NJ: Jason Aronson.
Fiske, S. T., Bersoff, D. N., Borgida, E., Deaux, K., & Heilman, M. E. (1997). What
constitutes a scientific review? A majority retort to Barrett and Morris. In
M. R. Walsh (Ed.), Women, men, and gender: Ongoing debates (pp. 321-333).
New Haven, CT: Yale University Press.
Foley, S., Kope, S. A., & Sugrue, D. P. (2002). Sex matters for women: A complete
guide to taking care of your sexual self. New York: Guilford Press.
Fosha, D. (2000). The transforming power of affect: A model for accelerated change.
New York: Basic Books.
Fox, R. (1993). The lamp at the end of the tunnel. In D. N. Suggs & A. W.
Miracle (Eds.), Culture and human sexuality: A reader (pp. 213-216). Pacific
Grove, CA: Brooks/Cole. (Original work published 1983)
Fraley, R. c., & Shaver, P. R. (2000). Adult romantic attachment: Theoretical
developments, emerging controversies, and unanswered questions. Review of
General Psychology, 4, 132-154.
Fraley, R. c., Waller, N. G., & Brennan, K. A. (2000). An item-response theory
analysis of self-report measures of adult attachment. Journal of Personality and
Social Psychology, 78, 350-365.
Francoeur, R. T. (2001). Challenging collective religious/social beliefs about sex,
marriage, and family. Journal of Sex Education and Therapy, 26, 281-290.

REFERENCES 299
Freud, A. (1966). The ego and the mechanisms of defense (Rev. ed.). Madison, CT:
International Universities Press.
Freud, S. (1953). Three essays on the theory of sexuality. In ]. Strachey (Ed. &
Trans.), The standard edition of the complete psychological works of Sigmund Freud
(Vol. 7, pp. 125-243). London: Hogarth Press. (Original work published 1905)
Freud, S. (1955). Some neurotic mechanisms in jealousy, paranoia and homosexual-
ity. In]. Strachey (Ed. & Trans.), The standard edition of the complete psychological
works of Sigmund Freud (Vol. 8, pp. 221-232). London: Hogarth Press. (Original
work published 1922)
Freud, S. (1957). Five lectures on psycho-analysis. In]. Strachey (Ed. & Trans.),
The standard edition of the complete psychological works of Sigmund Freud (Vol.
11, pp. 1-56). London: Hogarth Press. (Original work published 1909)
Freud, S. (1957). On the universal tendency to debasement in the sphere in love:
Contributions to the psychology of love II. In]. Strachey (Ed. & Trans.), The
standard edition of the complete psychological works of Sigmund Freud (Vol. 11,
pp. 179-190). London: Hogarth Press. (Original work published 1912)
Freud, S. (1964). An outline of psycho-analysis. In ]. Strachey (Ed. & Trans.), The
standard edition of the complete psychological works of Sigmund Freud (Vol. 23,
pp. 144-207). London: Hogarth Press. (Original work published 1940)
Freyd, ]. ]. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge,
MA: Harvard University Press.
Friday, N. (1977). My mother/my self: The daughter's search for identity. New York:
Delacorte Press.
Friday, N. (1985). Jealousy. New York: William Morrow.
Fried, E. (1960). The ego in love and sexuality. New York: Grune & Stratton.
Friedman, R. c., & Downey,]. I. (2002). Sexualorientation and psychoanalysis: Sexual
science and clinical practice. New York: Columbia University Press.
Fromm, E. (1956). The art ofloving. New York: Bantam Books.
Gage, R. L. (Ed.). (1976). Choose life: A dialogue: Arnold Toynbee and Daisaku Ikeda.
Oxford, England: Oxford University Press.
Gagnon,]. H. (1985). Attitudes and responses of parents to pre-adolescent masturba-
tion. Archives of Sexual Behavior, 14,451-466.
Galinsky, E. (1981). Between generations. New York: Times Books.
Gartner, R. B. (1999). Betrayed as boys: Psychodynamic treatment of sexuaHy abused
men. New York: Guilford Press.
Geary, D. C. (1998). Male, female: The evolution of human sex differences. Washing-
ton, DC: American Psychological Association.
Geis, F. L. (1993). Self-fulfilling prophecies: A social psychological view of gender.
In A. E. Beall & R. j. Sternberg (Eds.), The psychology of gender (pp. 9-54).
New York: Guilford Press.
Genevie, L., & Margolies, E. (1987). The motherhood report: How women feel about
being mothers. New York: Macmillan.

300 REFERENCES
Gentzler, A. L., & Kerns, K. A. (2004). Associations between insecure attachment
and sexual experiences. Personal Relationships, 11, 249-265.
Gerson, R. (1995). The family life cycle: Phases, stages, and crises. In R. H. Mikesell,
D. Lusterman, & S. H. McDaniel (Eds.), Integrating family therapy: Handbook
offamily psychology and systems theory (pp. 91-111). Washington, DC: American
Psychological Association.
Gewirtz,]. L., & Hollenbeck, A R. (1990). Effects on parents of contact/touch in
the first postpartum hour. In N. Gunzenhauser (Ed.), Advances in touch: New
implications in human development (pp. 62-71). Skillman, N]: Johnson & [ohn-
son Consumer Products.
Ghent, E. (1999). Masochism, submission, surrender: Masochism as a perversion
of surrender. In S. A Mitchell & L. Aron (Eds.), Relational psychoanalysis: The
emergence of a tradition (pp. 211-242). Hillsdale, N]: Analytic Press. (Original
work published 1990)
Giddens, A (1992). The transformation of intimacy: Sexuality, love and eroticism in
modern societies. Stanford, CA: Stanford University Press.
Gilligan, C. (1982). In a different voice: Psychological theory and women's development.
Cambridge, MA: Harvard University Press.
Gilligan, C. (1991). Women's psychological development: Implications for psycho-
therapy. In C. Gilligan, A G. Rogers, & D. L. Tolman (Eds.), Women, girls
and psychotherapy: Reframing resistance (pp. 5-31). New York: Haworth Press.
Gilligan, C. (1996). The centrality of relationship in human development: A
puzzle, some evidence, and a theory. In G. G. Noam & K. W. Fischer (Eds.),
Development and vulnerability in close relationships (pp. 237-261). Mahwah,
N]: Erlbaum.
Gilmartin, B. F. (1977). Jealousy among the swingers. In G. Clanton & L G. Smith
(Eds.), Jealousy (pp. 152-158). New York: Lanham.
Glass, S. P. (with]. C. Staeheli). (2003). Not "just friends:" Protect your relationship
from infidelity and heal the trauma of betrayal. New York: Free Press.
Glass, S. P., & Wright, T. L. (1988). Clinical implications of research on extramari-
tal involvement. In R. A Brown & ]. R. Field (Eds.), Treatment of sexual
problems in individual and couples therapy (pp. 301-346). Costa Mesa, CA: PMA
Glass, S. P., & Wright, T. L. (1997). Reconstructing marriages after the trauma of
infidelity. In W. K. Halford & H. ]. Markman (Eds.), Clinical handbook of
marriage and couples interventions (pp. 471-507). New York: Wiley.
Glick, P., & Fiske, S. T. (2001). An ambivalent alliance: Hostile and benevolent
sexism as complementary justifications for gender inequality. American Psychol-
ogist, 56, 109-11 8.
Gold, S. N., Lucenko, B. A, Elhai,]. D., Swingle,]. M., & Sellers, A H. (1999).
A comparison of psychological/psychiatric symptomatology of women and men
sexually abused as children. Child Abuse and Neglect, 23, 683-692.
Goldberg, C. (1996). Speaking with the devil: A dialogue with evil. New York: Viking.

REFERENCES 301
Goldenberg,]. L., Cox, C. R., Pyszczynski, T, Greenberg, j., & Solomon, S. (2002).
Understanding human ambivalence about sex: The effects of stripping sex of
meaning [Electronic version]. Journal of Sex Research, 39, 310-320.
Goldenberg, ]. L., Landau, M. j., Pyszczynski, T, Cox, C. R., Greenberg, ].,
Solomon, S., et al. (2003). Gender-typical responses to sexual and emotional
infidelity as a function of mortality salience induced self-esteem striving. Person-
ality and Social Psychology Bulletin, 29, 1585-1595.
Goldenberg,]. L., Pyszczynski, T, Greenberg, ]., & Solomon, S. (2000). Fleeing the
body: A terror management perspective on the problem of human corporeality.
Personality and Social Psychology Review, 4, 200-218.
Goldenberg, ]. L., Pyszczynski, T, McCoy, S. K., Greenberg, ]., & Solomon, S.
(1999). Death, sex, love, and neuroticism: Why is sex such a problem? Journal
of Personality and Social Psychology, 77, 1173-1187.
Goren, E. (2003). America's love affair with technology: The transformation of
sexuality and the self over the 20th century. Psychoanalytic Psychology, 20, 487-
508.
Gottman, ]. M. (1979). Marital interaction: Experimental investigations. New York:
Academic Press.
Gottman, J. M., & Krokoff, L. ]. (1989). Marital interaction and satisfaction: A
longitudinal view. Journal of Consulting and Clinical Psychology, 57, 47-52.
Greenberg, L. S. (2002). Emotion-focused therapy: Coaching clients to work through
their feelings. Washington, DC: American Psychological Association.
Greenberg, L. S., & Safran,]. D. (1987). Emotion in psychotherapy: Affect, cognition,
and the process of change. New York: Guilford Press.
Grossman, M., & Wood, W. (1993). Sex differences in intensity of emotional
experience: A social role interpretation. Journal of Personality and Social Psychol-
ogy, 65, 1010-1022.
Guidano, V. F., & Liotti, G. (1983). Cognitive processes and emotional disorders: A
structural approach to psychotherapy. New York: Guilford Press.
Gunderson, M. P., & McCary, J. L. (1979). Sexual guilt and religion. Family
Coordinator, 28, 353-357.
Guntrip, H. (1961). Personality structure and human interaction: The developing synthe-
sis of psycho-dynamic theory. New York: International Universities Press.
Guntrip, H. (1969). Schizoid phenomena: Object relations and the self. New York:
International Universities Press.
Guntrip, H. (197l). Psychoanalytic theory, therapy, and the self: A basic guide to
the human personality in Freud, Erikson, Klein, Sullivan, Fairbairn, Hartmann,
Jacobson, and Winnicott. New York: Basic Books.
Harding, C. (200l). Introduction. In C. Harding (Ed.), Sexuality: Psychoanalytic
perspectives (pp. 1-17). East Sussex, England: Brunner-Routledge.
Harlow, H. F. (1958). The nature of love. American Psychologist, 13,673-685.
Harlow, H. F., Harlow, M. K., & Suomi, S. J. (197l). From thought to therapy:
Lessons from a primate laboratory. American Scientist, 59, 538-549.

302 REFERENCES
Harper, J. M., Anderson, R., & Stevens, N. A (2004, September 10). Development of
theCouple Implicit RuleProfile (CIRP). Poster session presented at the American
Association for Marriage and Family Therapy Conference, Atlanta, GA.
Harvey, J. H., & Weber, A L. (2002). Odyssey of the heart: Close relationships in
the 21st century (2nd ed.). Mahwah, NJ: Erlbaum.
Hatfield, E. (1988). Passionate and companionate love. In R. J. Sternberg & M. L.
Barnes (Eds.), The psychology of love (pp. 191-217). New Haven, CT: Yale
University Press.
Hatfield, E., & Rapson, R. L. (1993). Love, sex, and intimacy: Their psychology,
biology, and history. New York: HarperCollins.
Hazan, c., & Diamond, L. M. (2000). The place of attachment in human mating.
Review of General Psychology, 4, 186-204.
Hazan, c., & Shaver, P. R. (1987). Romantic love conceptualized as an attachment
process. Journal of Personality and Social Psychology, 52,511-524.
He, Z. (2001). Pornography, perceptions of sex, and sexual callousness: A cross-
cultural comparison. In Y. R. Kamalipour & K. R. Rampal (Eds.), Media, sex,
violence, and drugs in the global village (pp. 131-152). Lanham, MD: Rowman
& Littlefield.
Heiman, J. R., & Heard-Davison, A R. (2004). Child sexual abuse and adult sexual
relationships: Review and perspective. In L. J. Koenig, L. S. Doll, A O'Leary,
& W. Pequegnat (Eds.), From child sexWlI abuse to adult sexWlI risk: Trauma,
revictimization, and intervention (pp. 13-47). Washington, DC: American Psy-
chological Association.
Hellinger, B. (with G. Weber & H. Beaumont). (1998). Love's hidden symmetry:
What makes love work in relationships. Phoenix, AZ: Zeig, Tucker.
Herdt, G. (2004). Sexual development, social oppression, and local culture. SexWllity
Research and Social Policy, 1, 39-62.
Herman, J. (with L. Hirschman). (1981). Father-daughter incest. Cambridge, MA:
Harvard University Press.
Herman, J. (1992). Trauma and recovery. New York: Basic Books.
Hogben, M., & Byrne, D. (1998). Using social learning theory to explain individual
differences in human sexuality [Electronic version]. Journal of Sex Research,
35,58-71.
Holtzworth-Munroe, A, Stuart, G. L., & Hutchinson, G. (1997). Violent versus
nonviolent husbands: Differences in attachment patterns, dependency, and
jealousy. Journal of Family Psychology, 11,314-331.
Hook, M. K., Gerstein, L. H., Detterich, L., & Gridley, B. (2003). How close are
we? Measuring intimacy and examining gender differences. Journal ofCounseling
and Development, 81, 462-472.
hooks, b. (2001). Men: Comrades in struggle. In M. S. Kimmel & M. A Messner
(Eds.), Men's lives (5th ed., pp. 527-535). Boston: Allyn & Bacon. (Original
work published 1984)
Horney, K. (1967). Feminine psychology, New York: Norton.

REFERENCES 303
Horvath, A 0., & Luborsky, L. (1993). The role of the therapeutic alliance in
psychotherapy. Journal of Consulting and Clinical Psychology, 61,561-573.
Hudson, L., & Jacot, B. (1995). Intimate relations: The natural history of desire. New
Haven, CT: Yale University Press.
Hyde, J. S., & Oliver, M. B. (2000). Gender differences in sexuality: Results from
meta-analysis. In C. B. Travis & J. W. White (Eds.), Sexuality, society, and
feminism (pp. 57-77). Washington, DC: American Psychological Association.
Hyun, M., Friedman, S. D., & Dunner, D. L. (2000). Relationship of childhood
physical and sexual abuse to adult bipolar disorder. Bipolar Disorders, 2, 131-
135.
Ickes, W. (1993). Traditional gender roles: Do they make, and then break, our
relationships? Journal of Social Issues, 49, 71-85.
Insel, T. R. (2002). Implications for the neurobiology of love. In S. G. Post, L. G.
Underwood, J. P. Schloss, & W. B. Hurlbut (Eds.), Altruism and altruistic love:
Science, philosophy, and religion in dialogue (pp. 254-263). New York: Oxford
University Press.
Jain, A, Belsky, J., & Crnic, K. (1996). Beyond fathering behaviors: Types of dads.
Journal of Family Psychology, 10,431-442.
Johnson, S. M. (1999). Emotionally focused couple therapy: Straight to the heart.
In J. M. Donovan (Ed.), Short-term couple therapy (pp. 13-42). New York:
Guilford Press.
Johnson, S. M. (2002). Emotionally focused couple therapy with trauma survivors:
Strengthening attachment bonds. New York: Guilford Press.
Johnson, S. M. (2003). The revolution in couple therapy: A practitioner-scientist
perspective. Journal of Marital and Family Therapy, 29, 365-384.
Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating
connection (2nd ed.). New York: Brunner-Routledge.
Johnson, S. M., & Denton, W. (2002). Emotionally focused couple therapy: Creating
secure connections. In AS. Gurman & N. S. Jacobson (Eds.), Clinical handbook
of couple therapy (3rd ed., pp. 221-250). New York: Guilford Press.
Johnson, S. M., & Greenberg, L. S. (1995). The emotionally focused approach to
problems in adult attachment. In N. S. Jacobson & A S. Gurman (Eds.),
Clinical handbook of couple therapy (pp. 121-141). New York: Guilford Press.
Johnson, S. M., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally
focused couples therapy: Status and challenges. Clinical Psychology: Science and
Practice, 6, 67-79.
Johnson, S. M., & Whiffen, V. E. (1999). Made to measure: Adapting emotionally-
focused couple therapy to partners' attachment styles. Clinical Psychology: Sci-
ence and Practice, 6,366-381.
Jolliff, D., & Horne, AM. (1999). Growing up male: The development of mature
masculinity. In A M. Horne & M. S. Kiselica (Eds.), Handbook of counseling
boys and adolescent males: A practitioner's guide (pp. 3-23). Thousand Oaks,
CA: Sage.

304 REFERENCES
[ordan.]. V., Kaplan, A. G., Miller, J. B., Stiver, 1. P., & Surrey, J. L. (1991). Women's
growth in connection: Writing from the Stone Center. New York: Guilford Press.
[ureidini, R. (2001). Perversion: Erotic form of hatred or exciting avoidance of
reality? Journal of the American Academy of Psychoanalysis, 29, 195-211.
Kaplan, H. S. (1974). The new sex therapy: Active treatment of sexual dysfunctions.
New York: Brunner/Mazel.
Kaplan, H. S. (1979). Disorders of sexual desire and othernew concepts and techniques
in sex therapy. New York: Brunner/Mazel.
Kaplan, H. S. (1995). The sexual desire disorders: Dysfunctional regulation of sexual
motivation. Levittown, PA: Brunner/Mazel.
Kaplan, L. J. (1984). Adolescence: The farewell to childhood. New York: Simon
& Schuster.
Karpel, M. (1976). Individuation: From fusion to dialogue. Family Process, 15(1),
65-82.
Karpel, M. A. (1994). Evaluating couples: A handbook for practitioners. New York:
Norton.
Kart-Morse, R., & Wiley, M. S. (1997). Ghosts from the nursery: Tracing the roots
of 'violence. New York: Oxford University Press.
Kastenbaum, R. (1974). Childhood: The kingdom where creatures die. Journal of
Clinical Child Psychology, 3(2), 11-14.
Kastenbaum, R. (1995). Death, society, and human experience (5th ed.). Boston:
Allyn & Bacon.
Kaufman, G. (1980). Shame: The power of caring. Cambridge, MA: Schenkman.
Keeley, M. P., & Hart, A. J. (1994). Nonverbal behavior in dyadic interactions.
In S. Duck (Ed.), Dynamics of relationships (pp. 135-162). Thousand Oaks,
CA: Sage.
Keen, S. (1997). To love and be loved. New York: Bantam Books.
Kellett, J. M. (2000). Older adult sexuality. In L. T. Szuchman & F. Muscarella
(Eds.), Psychological perspectives on human sexuality (pp. 355-379). New
York: Wiley.
Kelsey, M., & Kelsey, B. (1991). Sex and religion [Electronic version]. Retrieved
November 9, 2004, from http://innerself.com/Sex_T alk/Sex_And_Religion.
htm
Kenrick, D. T., & Trost, M. R. (1993). The evolutionary perspective. In A. E.
Beall & R. J. Sterling (Eds.), The psychology of gender (pp. 148-172). New
York: Guilford Press.
Kernberg, O. F. (1980). Internal world and external reality: Object relations theory
applied. Northvale, NJ: Jason Aronson.
Kernberg, O. F. (1991). Aggression and love in the relationship of the couple. In
G. 1. Fogel & W. A. Myers (Eds.), Perversions and near-perversions in clinical
practice: New psychoanalytic perspectives (pp. 153-175). New Haven, CT: Yale
University Press.

REFERENCES 305
Kernberg, O. F. (1995). Love relations: Normality and pathology. New Haven, CT:
Yale University Press.
Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen
theory. New York: Norton.
Kestenberg, ]. S., & Kestenberg, M. (1987). Child killing and child rescuing. In
G. G. Neuman (Ed.), Origins of human aggression: Dynamics and etiology (pp.
139-154). New York: Human Sciences Press.
Keys, A., Brozek, ]., Henschel, A., Mickelsen, 0., & Taylor, H. L. (1950). The
biology of human starvation (Vol. 2). Minneapolis: University of Minnesota Press.
Kindlon, D., & Thompson, M. (1999). Raising Cain: Protecting the emotional life of
boys. New York: Ballantine Books.
Kinzl, ]. F., Traweger, c., & Biebl, W. (1995). Sexual dysfunctions: Relationship
to childhood sexual abuse and early family experiences in a nonclinical sample.
Child Abuse and Neglect, 19, 785-792.
Kipnis, L. (2003). Against love: A polemic. New York: Pantheon Books.
Kirkpatrick, L. A. (1998). Evolution, pair-bonding, and reproductive strategies: A
reconceptualization of adult attachment. In ]. A. Simpson & W. S. Rholes
(Eds.), Attachment theory and close relationships (pp. 353-393). New York:
Guilford Press.
Kirschner, S., & Kirschner, D. A. (1996). Relational components of the incest
survivor syndrome. In F. W. Kaslow (Ed.), Handbook of relational diagnosis and
dysfunctional family patterns (pp. 407-419). New York: Wiley.
Kiselica, M. S. (2001, August). Are attachment disorders and alexithvmia character-
istic of males? In M. S. Kiselica (Chair), Are males really emotional dummies?
What do the data indicate? Symposium conducted at the annual meeting of the
American Psychological Association, San Francisco, CA.
Klein, Marty. (1992). Ask me anything: A sex therapist answers the most important
questions for the '90s. New York: Simon & Schuster.
Klein, Melanie. (1975). The writings of Melanie Klein: VoL III. Envy and gratitude
and other works 1946-1963. New York: Free Press.
Kleinplatz, P. ]. (2001). A critical evaluation of sex therapy: Room for improvement.
In P. ]. Kleinplatz (Ed.), New directions in sex therapy: Innovations and alternatives
(pp. xi-xxxiii). Philadelphia: Brunner-Routledge.
Kohut, H. (1977). The restoration of the self. New York: International Universi-
ties Press.
Kramer, R. (Ed.). (1996). Otto Rank: A Psychology of Difference: The American
Lectures. Princeton, N]: Princeton University Press.
Kriegman, D. (1999). Parental investment, sexual selection, and evolved mating
strategies: Implications for psychoanalysis. Psychoanalytic Psychology, 16,528-
533.
Kupers, T. A. (1997). The politics of psychiatry: Gender and sexual preference in
DSM-IV. In M. R. Walsh (Ed.), Women, men, and gender: Ongoing debates
(pp. 340-347). New Haven, CT: Yale University Press.

306 REFERENCES
Laing, R. D. (1967). The politics of experience. New York: Ballantine Books.
Lamb, M. E., & Lewis, C. (2004). The development and significance of father-child
relationships in two-parent families. In M. E. Lamb (Ed.), The role of the father
in child development (4th ed., pp. 272-306). New York: Wiley.
Laumann, E. 0., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social
organization of sexuality: Sexualpractices in the United States. Chicago: University
of Chicago Press.
Laumann, E. 0., Paik, A, & Rosen, R. C. (1999). Sexual dysfunction in the United
States: Prevalence and predictors. Journal of the American Medical Association,
281,537-544.
Lawrence, D. H. (1920). Women in love. London: Penguin Books.
Leahy, R. L. (2001). Overcoming resistance in cognitive therapy. New York: Guil-
ford Press.
LeDoux, J. (1996). The emotional brain: The mysterious underpinnings of emotional
life. New York: Simon & Schuster.
Leiblum, S. R., & Rosen, R. C. (2000). Introduction: Sex therapy in the age of
Viagra. In S. R. Leiblum & R. C. Rosen (Eds.), Principles and practice of sex
therapy (3rd ed., pp. 1-13). New York: Guilford Press.
Lester, D. (1970). Relation of fear of death in subjects to fear of death in their
parents. Psychological Record, 20, 541-543.
Levant, R. F. (1992). Toward the reconstruction of masculinity. Journal of Family
Psychology, 5, 379-402.
Levant, R. F. (1998). Desperately seeking language: Understanding, assessing, and
treating normative male alexithymia. In W. S. Pollack & R. F. Levant (Eds.),
New psychotherapy for men (pp. 35-56). New York: Wiley.
Levi-Strauss, C. (1993). The incest prohibition. In D. N. Suggs & A W. Miracle
(Eds.), Culture and human sexuality: A reader (pp. 229-236). Pacific Grove,
CA: Brooks/Cole. (Original work published 1969)
Lewis, C. S. (1960). The four loves. New York: Harcourt Brace.
Lewis, M. (1992). Shame: The exposed self. New York: Free Press.
Lewis, T., Amini, F., & Lannon, R. (2000). A general theory of love. New York:
Vintage Books.
Lieberman, A F. (2004). Traumatic stress and quality of attachment: Reality and
internalization in disorders of infant mental health. Infant Mental Health Journal,
25,336-351.
Lieberman, A F., Compton, N. c., Van Hom, P., & Ippen, C. G. (2003). Losing
a parent to death in the early years: Guidelines for the treatment of traumatic
bereavement in infancy and early childhood. Washington, DC: Zero to Three.
Lieberman, A F., & Van Hom, P. (2004). Don't hit my mommy: A manual for
child-parent psychotherapy with young witnesses of family violence. Washington,
DC: Zero to Three.
Liebowitz, M. R. (1983). The chemistry of love. Boston: Little, Brown.

REFERENCES 307
Lisak, D. (1994). The psychological impact of sexual abuse: Content analysis of
interviews with male survivors. Journal of Traumatic Stress, 7, 525-548.
Loftus, E., & Ketcham, K. (1994). The myth of repressed memory: False memories
and allegations of sexual abuse. New York: St. Martin's Griffin.
LoPiccolo, J. (1978). The professionalization of sex therapy: Issues and problems.
In J. LoPiccolo & L. LoPiccolo (Eds.), Handbook of sex therapy (pp. 511-526).
New York: Plenum.
LoPiccolo, J. (1994). The evolution of sex therapy. Sexual and Marital Therapy, 9,
5-7.
Lott, B. (1997). Cataloging gender differences: Science or politics? In M. R. Walsh
(Ed.), Women, men, and gender: Ongoing debates (pp. 19-23). New Haven,
CT: Yale University Press.
Lott, D. A. (1998). Brain development, attachment and impact on psychic vulnera-
bility. Psychiatric Times, XV(5). Retrieved September 26, 2004, from http://
www.psychiatrictimes.com/p980547.html
Love, P. (with J. Robinson). (1990). The emotional incest syndrome: What to do when
a parent's love rules your life. New York: Bantam Books.
Love, P. (200l).The truth about love: The highs, the lows, and how you can make it
last forever. New York: Simon & Schuster.
Love, P., & Brown, J. T. (1999). Creating passion and intimacy. In J. Carlson &
L. Sperry (Eds.), The intimate couple (pp. 55-65). Philadelphia: Brunner/Maze!.
Love, P., & Robinson, J. (1994). Hot monogamy: Essential steps to more passionate,
intimate lovemaking. New York: Penguin Books.
Love, P., & Shulkin, S. (1997). How to ruin a perfectly good relationship. Austin,
TX: Authors.
Lusterman, D. (1995). Treating marital infidelity. In R. H. Mikesell, D. Lusterman,
& S. H. McDaniel (Eds.), Integrating family therapy: Handbook of family psychol-
ogy and systems theory (pp. 259-269). Washington, DC: American Psychologi-
cal Association.
Lyons-Ruth, K., & Zeanah, C. H., Jr. (1993). The family context of infant mental
health: 1. Affective development in the primary caregiving relationship. In
C. H. Zeanah, Jr. (Ed.), Handbook of infant mental health (pp. 14-37). New
York: Guilford Press.
Maccoby, E. E., & Jacklin, c. N. (1974). The psychology of sex differences. Stanford,
CA: Stanford University Press.
Mahler, M. S., Pine, F., & Bergman, A. (1975). The psychological birth of the human
infant: Symbiosis and individuation. New York: Basic Books.
Main, M., & Goldwyn, R. (1984). Predicting rejection of her infant from mother's
representation of her own experience: Implications for the abuse-abusing
intergenerational cycle. Child Abuse and Neglect, 8, 203-217.
Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented
attachment pattern. In T. B. Brazelton & M. W. Yogman (Eds.), Affective
development in infancy (pp. 95-124). Norwood, NJ: Ablex.

308 REFERENCES
Malone, T. P., & Malone, P. T. (1987). The artof intimacy. New York: Prentice-Hall.
Manlove, E. E., & Vernon-Feagans, L (2002). Caring for infant daughters and
sons in dual-earner households: Maternal reports of father involvement in
weekday time and tasks. Infant and Child Development, 11, 305-320.
Manson, W. (1994). Riddles of eros: Exploring sex, psyche and culture. Lanham, MD:
University Press of America.
Marmor, J. (2004). Changing patterns of femininity: Psychoanalytic implications.
Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry,
32,7-20.
Martinson, F. M. (1994). The sexual life of children. Westport, CT: Bergin & Garvey.
Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Boston: Little,
Brown.
Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Boston:
Little, Brown.
Masterson, J. F. (1985). The real self: A developmental, self, and object relations
approach. New York: Brunner/Mazel.
Mathes, E. W. (1991). A cognitive theory of jealousy. In P. Salovey (Ed.), The
psychology of jealousy and envy (pp. 52-78). New York: Guilford Press.
May, R. (1969). Love and will. New York: Dell.
Mazur, R. (2000). The new intimacy: Open-ended marriage and alternative lifestyles.
San Jose, CA: toExcel Press. (Original work published 1973)
McCarthy, B. W. (1995). Childhood sexual trauma and adult sexual desire: A
cognitive-behavioral perspective. In R. C. Rosen & S. R. Leiblum (Eds.),
Case studies in sex therapy (pp, 148-160). New York: Guilford Press.
McCarthy, B. W. (1997a). Strategies and techniques for revitalizing a nonsexual
marriage. Journal of Sex and Marital Therapy, 23, 231-240.
McCarthy, B. W. (1997b). Therapeutic and iatrogenic interventions with adults
who were sexually abused as children. Journal of Sex and Marital Therapy,
23, 118-125.
McCarthy, B. W. (1999). Relapse prevention strategies and techniques for inhibited
sexual desire. Journal of Sex and Marital Therapy, 25, 297-303.
McCarthy, B., & McCarthy, E. (1998). Male sexual awareness: Increasing sexual
satisfaction (Rev. ed.). New York: Carroll & Graf.
McCarthy, B., & McCarthy, E. (2003). Rekindling desire: A step-by-step program to
help low-sex and no-sex marriages. New York: Brunner-Routledge.
McConaghy, N. (2003). Sexual and gender identity disorders. In M. Hersen &
S. M. Turner (Eds.), Adult psychopathology anddiagnosis (4th ed., pp. 506-554).
New York: Wiley.
Mead, G. H. (1967). Mind, self, andsociety: From the standpoint of a social behaviorist.
Chicago: University of Chicago Press. (Original work published 1934)
Mead, M. (1948). Male and female: A study of sexes in a changing world. New York:
William Morrow.

REFERENCES 309
Melby, T. (200l). Telling the truth in schools about sex. Contemporary Sexuality,
35(5), 1,4-5.
Mendell, D. (1998). The impact of the mother-daughter relationship on women's
relationships with men: The two-man phenomenon. In G. H. Fenchel (Ed.),
The mother-daughter relationship: Echoes through time (pp. 227-240). Northvale,
NJ: Jason Aronson.
Meston, C. M., & Heiman, J. R. (2000). Sexual abuse and sexual function: An
examination of sexually relevant cognitive processes. Journal of Consulting and
Clinical Psychology, 68, 399-406.
Meston, C. M., Heiman, J. R., & Trapnell, P. D. (1999). The relation between
early abuse and adult sexuality. Journal of Sex Research, 36, 385-395.
Metz, M. E., & McCarthy, B. (2004). A biopsychosocial approach to evaluating
and treating premature ejaculation. Contemporary Sexuality, 38(5), i-vii.
Miletski, H. (1995). Mother-son incest: The unthinkable broken taboo: An overview
of findings. Brandon, VT: Safer Society Press.
Miller, A. (1981). Prisoners of childhood: The drama of the gifted child and the search
for the true self (R. Ward, Trans.). New York: Basic Books. (Original work
published 1979)
Miller, A. (1984a). For your own good: Hidden cruelty in child-rearing and the roots
of violence (2nd ed., H. Hannum & H. Hannum, Trans.). New York: Farrar,
Straus, & Giroux. (Original work published 1980)
Miller, A. (1984b). Thou shalt not beaware: Society's betrayal of thechild (H. Hannum
& H. Hannum, Trans.). New York: Farrar, Straus & Giroux. (Original work
published 1981)
Miller, G. (2000). The mating mind: How sexual choice shaped the evolution of human
nature. New York: Anchor Books.
Miller, J. B. (1976). Toward a new psychology of women. Boston: Beacon Press.
Miller, J. B., & Stiver, I. P. (1994). Movement in therapy: Honoring the "strategies
disconnection." (Stone Center Work in Progress #65; pp. 1-13). Wellesley,
MA: Wellesley College.
Mitchell, S. A. (2002). Can love last? The fate of romance over time. New York:
Norton.
Moir, A., & [essel, D. (1989). Brainsex: The realdifference between men and women.
London: Mandarin.
Montagu, A. (1986). Touching: The human significance of the skin (3rd ed.). New
York: Harper & Row.
Moore, D. S., & Travis, C. B. (2000). Biological models and sexual politics. In
C. B. Travis &J. W. White (Eds.), Sexuality, society, and feminism (pp. 35-56).
Washington, DC: American Psychological Association.
Morokoff, P. J. (2000). A cultural context for sexual assertiveness in women. In C. B.
Travis & J. W. White (Eds.), Sexuality, society, and feminism (pp. 299-319).
Washington, DC: American Psychological Association.

310 REFERENCES
Morrison, A. P. (1989). Shame: The underside of narcissism. Hillsdale, N]: Analytic
Press.
Mullen, P. E., & Fleming, ]. (1998, Autumn). Long-term effects of child abuse
[Electronic version]. Issues in Child Abuse Prevention, 9. Retrieved March 3,
2004, from the National Child Protection Clearinghouse Web site (Melbourne,
Australia): http://aifs.org.au/nch/issues9.html
Nagy, M. H. (1959). The child's view of death. In H. Feifel (Ed.), The meaning of
death (pp. 79-98). New York: McGraw-Hill. (Original work published 1948)
Nealer, ]. (2002). Children's gender identity development: A closer look. Family
Therapy Magazine, 24-27.
Neborsky, R. ]., & Solomon, M. F. (200l). Attachment bonds and intimacy:
Can the primary imprint of love change? In M. F. Solomon, R. ]. Neborsky,
L. McCullough, M. Alpert, F. Shapiro, & D. Malan (Eds.), Short-term therapy
for long-term change (pp. 155-185). New York: Norton.
Nelson, D. A., & Crick, N. R. (2002). Parental psychological control: Implications
for childhood physical and relational aggression. In B. K. Barber (Ed.), Intrusive
parenting: How psychological control affects children andadolescents (pp. 161-189).
Washington, DC: American Psychological Association.
Newberger, C. M., & deVos, E. (1988). Abuse and victimization: A life-span
developmental perspective. American Journal of Orthopsychiatry, 58, 505-511.
Noyes, R., Hoenk, P. R., Kuperman, S., & Slymen, D.]. (1977). Depersonalization
in accident victims and psychiatric patients. Journal of Nervous and Mental
Disease, 164,401-407.
Oates, R. K. (2004). Sexual abuse and suicidal behavior. Child Abuse and Neglect,
28, 487-489.
Oatley, K. (1996). Emotions: Communications to the self and others. In R. Harre
& W. G. Parrott (Eds.), The emotions: Social, cultural and biological dimensions
(pp. 312-316). London: Sage.
Ogilvie, B. A. (2004). Mother-daughter incest: A guide for helping professionals. New
York: Haworth Press.
Oliver, K. (Ed.). (2002). The portable Kristeva (Updated ed.). New York: Columbia
University Press.
Olsen, K. L. (1992). Genetic influences on sexual behavior differentiation. In A. A.
Gerall, H. Moltz, & 1. L. Ward (Eds.), Handbook of behavioral neurobiology:
Vol. 11. Sexual differentiation (pp, 1-38). New York: Plenum Press.
Orbach, 1.,Shopen-Koffman, R., & Mikulincer, M. (1994). The impact of subliminal
symbiotic vs. identification messages in reducing anxiety. Journal of Research
in Personality, 28, 492-504.
Orbach, S. (1999). The impossibility of sex. New York: Penguin.
Orbach, S. (2004). The body in clinical practice. In K. White (Ed.), Touch: Attach-
ment and the body: The John Bowlby memorial conference monograph 2003 (pp.
17-4 7). London: Karnac.
Pagels, E. (1988). Adam, Eve, and the serpent. New York: Random House.

REFERENCES 311
Pagels, E. (1995). The origin of Satan. New York: Random House.
Park, ]. (1995). Sons, mothers arul other lovers. London: Abacus.
Parker, G. (1983). Parental overprotection: A risk factor in psychosocial development.
New York: Grune & Stratton.
Parker, R. (1995). Mother love/mother hate: The power of maternalambivalence. New
York: Basic Books.
Parrott, W. G., & Harre, R. (1996). Overview. In R. Harre & W. G. Parrott (Eds.),
The emotions: Social, cultural and biological dimensions (pp. 1-20). London: Sage.
Perris, c., [acobsson, L., Lindstrom, H., von Knorring, L., & Perris, H. (1980).
Development of a new inventory for assessing memories of parental rearing
behaviour. Acta Psychiatrica Scandinavica, 61, 265-274.
Person, E. S. (1988). Dreams of love and fateful encounters: The power of romantic
passion. New York: Penguin Books.
Phillips, N. A. (2000). Female sexual dysfunction: Evaluation and treatment. Ameri-
can Family Physician, 62, 127-136, 141-142.
Pines, A. M. (1998). Romantic jealousy: Causes, symptoms, cures. New York:
Routledge.
Pines, A. M. (1999). Falling in love: Why we choose the lovers we choose. New
York: Routledge.
Pines, A., & Aronson, E. (1983). Antecedents, correlates, and consequences of
sexual jealousy. Journal of Personality, 51, 108-136.
Pleck, J. H. (1995). The gender role strain paradigm: An update. In R. F. Levant
& W. S. Pollack (Eds.), A new psychology of men (pp. 11-32). New York:
Basic Books.
Pleck, ]. H. (1997). Paternal involvement: Levels, sources, and consequences. In
M. E. Lamb (Ed.), The role of thefather in child development (3rd ed., pp. 66-103).
New York: Wiley.
Plutchik, R. (2000). Emotions in the practice of psychotherapy: Clinical implications of
affect theories. Washington, DC: American Psychological Association.
Pollack, W. (1998). Real boys: Rescuing our sons from the myths of boyhood. New
York: Henry Holt.
Pollack, W., S., & Levant, R. F. (Eds.). (1998). New psychotherapy for men. New
York: Wiley.
Pope, K. S., & Brown, L. S. (1996). Recovered memories of abuse: Assessment, therapy,
forensics. Washington, DC: American Psychological Association.
Post, S. G., Underwood, L. G., Schloss, ]. P., & Hurlbut, W. B. (2002). General
introduction. In S. G. Post, L. G. Underwood,]. P. Schloss, & W. B. Hurlbut
(Eds.), Altruism and altruistic love: Science, philosophy, and religion in dialogue
(pp. 3-12). New York: Oxford University Press.
Prescott, ]. W. (1975, November). Body pleasure and the origins of violence. The
Bulletin of the Atomic Scientists, 10-20. Retrieved February 27, 2004, from
http://www.violence.de/prescott/bulletin/article.h tml

312 REFERENCES
Purcell, D. W., Malow, R. M., Dolezal, c., & Carballo-Dieguez, A. (2004). Sexual
abuse of boys: Short- and long-term associations and implications for HIV
prevention. In L. J. Koenig, L. S. Doll, A. O'Leary, & W. Pequegnat (Eds.),
From child sexual abuse to adultsexual risk: Trauma, revictimization, and interven-
tion (pp. 93-114). Washington, DC: American Psychological Association.
Random House. (1998). Random House Webster's unabridged dictionary (2nd ed.).
New York: Author.
Rank, O. (1941). Beyond psychology. New York: Dover.
Rapaport, D. (1951). Toward a theory of thinking. In D. Rapaport (Ed. & Trans.),
Organization and pathology of thought: Selected sources (pp. 689-730). New York:
Columbia University Press.
Reid, P. T., & Bing, V. M. (2000). Sexual roles of girls and women: An ethnocultural
lifespan perspective. In C. B. Travis & J. W. White (Eds.), Sexuality, society,
and feminism (pp. 141-166). Washington, DC: American Psychological
Association.
Reik, T. (1941). Of love and lust: On thepsychoanalysis of romantic and sexual emotions.
New York: Farrar-Straus-Giroux.
Reissing, E. D., Binik, Y. M., Khalif, S., Cohen, D., & Amsel, R. (2003). Etiological
correlates of vaginismus: Sexual and physical abuse, sexual knowledge, sexual
self-schema, and relationship adjustment. Journal of Sex and Marital Therapy,
29,47-59.
Rheingold, J. C. (1964). The fearof being a woman:A theory of maternal destructiveness.
New York: Grune & Stratton.
Rheingold, J. C. (1967). The mother, anxiety, and death: The catastrophic death
complex. Boston: Little, Brown.
Richard, D. (2003). 108th: SOS: Sexual health advocates vow to stand tough against
the Republican-led 108th Congress. Contemporary Sexuality, 37(1),1, 4-7.
Richman, J. (1986). Family therapy for suicidal people. New York: Springer.
Ridley, M. (1993). The red queen: Sex and the evolution of human nature. New York:
Penguin Books.
Rilke, R. M. (1984). Letters to a youngpoet (S. Mitchell, Trans.). New York: Vintage
Books. (Original work published 1908)
Ritter, K. Y., & Terndrup, A. 1. (2002). Handbook of affirmative psychotherapy with
lesbians and gay men. New York: Guilford Press.
Roberts, R., O'Connor, T., Dunn, J., & Golding, J. (2004). The effects of child
sexual abuse in later family life; mental health, parenting and adjustment of
offspring. Child Abuse and Neglect, 28, 525-545.
Rochlin, G. (1967). How younger children view death and themselves. In E. A.
Grollman (Ed.), Explaining death to children (pp. 51-85). Boston: Beacon Press.
Rogers, A. G. (1994). Exiled voices: Dissociation and the "return of the repressed" in
women's narratives. (Stone Center Work in Progress #67). Wellesley, MA:
W cllesley College.

REFERENCES 313
Rohner, R. P. (1986). The warmth dimension: Foundations of parental acceptance-
rejection theory. Beverly Hills, CA: Sage.
Rohner, R. P. (1991). Handbook for the study of parental acceptance and rejection.
Storrs: University of Connecticut.
Romans, S. E., Martin, J. L., Anderson, J. c., Herbison, G. P., & Mullen, P. E.
(1995). Sexual abuse in childhood and deliberate self-harm. American Journal
of Psychiatry, 152, 1336-1342.
Rosen, R. c., & Leiblum, S. R. (1995). Part I: Sexual desire disorders. In R. C.
Rosen & S. R. Leiblum (Eds.), Case studies in sex therapy (pp. 19-21). New
York: Guilford Press.
Rosenberger, J. B. (1998). Female kin: Functions of the meta-identification of
womanhood. In G. H. Fenchel (Ed.), The mother-daughter relationship: Echoes
through time (pp. 63-78). Northvale, NJ: Jason Aronson.
Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and
trauma treatment. New York: Norton.
Rubin, L. B. (1983). Intimate strangers: Men and women together. New York: Harper
& Row.
Rubin, L. B. (1990). Erotic wars: What happened to the sexual revolution? New York:
Farrar, Straus & Giroux.
Rudman, L. A, & Goodwin, S. A. (2004). Gender differences in automatic in-
group bias: Why do women like women more than men like men? Journal of
Personality and Social Psychology, 87, 494-509.
Safran, S. A, Gershuny, B. S., Marzol, P., Otto, M. W., & Pollack, M. H. (2002).
History of childhood abuse in panic disorder, social phobia, and generalized
anxiety disorder. Journal of Nervous and Mental Disease, 190,453-456.
Sager, C. J., Kaplan, H. S., Gundlach, R. H., Kremer, M., Lenz, R., & Royce, J. R.
(1971). The marriage contract. Family Process, 8, 311-326.
Salovey, P. (Ed.). (1991). The psychology of jealousy and envy. New York: Guil-
ford Press.
Sanford, J. (1985). Projecting our other half. In J. Welwood (Ed.), Challenge of the
heart: Love, sex, andintimacy in changing times (pp. 82-89). Boston: Shambhala.
(Original work published 1980)
Sarwer, D. B., & Durlak, J. A. (1996). Childhood sexual abuse as a predictor of
adult female sexual dysfunction: A study of couples seeking sex therapy. Child
Abuse and Neglect, 20, 963-972.
Schachner, D. A, & Shaver, P. R. (2004). Attachment dimensions and sexual
motives. Personal Relationships, 11, 179-195.
Scharff, D. E., & Scharff, J. S. (1991). Object relations couple therapy. Northvale,
NJ: Jason Aronson.
Scharff, J. S. (1995). Psychoanalytic marital therapy. In N. S. Jacobson & A S.
Gurman (Eds.), Clinical handbook of couple therapy (pp. 164-193). New York:
Guilford Press.

3I4 REFERENCES
Schiffer, H. B. (2004). First love: Remembrances. Santa Barbara, CA: Heartful
Loving Press.
Schmidt, G., & Arentewicz, G. (1983). Etiology. In G. Arentewicz & G. Schmidt
(Eds.), The treatment of sexual disorders: Concepts and techniques of couple therapy
(pp. 34-58, T. Todd, Trans.). New York: Basic Books.
Schmitt, D. P., and 118 members of the International Sexuality Description Project.
(2003). Universal sex differences in the desire for sexual variety: Tests from
52 nations, 6 continents, and 13 islands. Journal of Personality andSocial Psychol-
ogy, 85, 85-104.
Schmitt, D. P., Alcalay, L., Allensworth, M., Allik, J., Aulr, L., Austers, 1., et a!.
(2003). Are men universally more dismissing than women? Gender differences
in romantic attachment across 62 cultural regions. Personal Relationships, 10,
307-331.
Schnarch, D. M. (1991). Constructing the sexual crucible: An integration of sexual and
marital therapy. New York: Norton.
Schoenewolf, G. (1989). Sexual animosity between men and women. Northvale, NJ:
Jason Aronson.
Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of
emotional development. Hillsdale, NJ: Erlbaum.
Segraves. R. T. (1982). Marital therapy: A combined psychodynamic-behavioral
approach. New York: Plenum Press.
Segraves, R. T., & Balon, R. (2003). Sexual pharmacology: Fast facts. New York:
Norton.
Sexuality Information and Education Council of the United States. (2002). SIECUS
list of life behaviors of a sexually healthy adult. Contemporary Sexuality, 36(8), 7.
Sharpsteen, D. J., & Kirkpatrick, L. A. (1997). Romantic jealousy and adult romantic
attachment. Journal of Personality and Social Psychology, 72, 627-640.
Shaver, P. (1989). Foreword. In G. L. White & P. E. Mullen (Eds.), Jealousy:
Theory, research, and clinical strategies (pp. v-vi). New York: Guilford Press.
Shaver, P. R., & Clark, C. L. (1994). The psychodynamics of adult romantic
attachment. In J. M. Masling & R. F. Bornstein (Eds.), Empirical perspectives
on object relations theory (pp. 105-156). Washington, DC: American Psycholog-
ical Association.
Shaver, P. R., Collins, N., & Clark, C. L. (1996). Attachment styles and internal
working models of self and relationship partners. In G. J. O. Fletcher &
J. Fitness (Eds.), Knowledge structures in close relationships: A social psychological
approach (pp. 25-61). Mahwah, NJ: Erlbaum.
Shaver, P. R., & Hazan, C. (1993). Adult romantic attachment: Theory and
evidence. In D. Perlman & W. Jones (Eds.), Advances in personal relationships
(Vol. 4, pp. 29-70). London: Jessica Kingsley.
Shaver, P. R., Papalia, D., Clark, C. L., Koski, L. R., Tidwell, M. c., & Nalbone, D.
(1996). Androgyny and attachment security: Two related models of optimal
personality. Personality and Social Psychology Bulletin, 22, 582-597.

REFERENCES 315
Shea, J. D. (1992). Religion and sexual adjustment. In J. F. Schumaker (Ed.),
Religion and mental health (pp. 70-84). New York: Oxford University Press.
Sheehy, G. (1998). Understanding men's passages: Discovering the new map of men's
lives. New York: Random House.
Shengold, L. (1989). Soul murder: The effects of childhood abuse and deprivation. New
Haven, CT: Yale University Press.
Showalter, E. (2001). Inventing herself: Claiming a feminist intellectual heritage. New
York: Scribner.
Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal
experience. New York: Guilford Press.
Siegel, D. J. (2001). Toward an interpersonal neurobiology of the developing mind:
Attachment relationships, "mindsight," and neural integration. Infant Mental
Health Journal, 22, 67-94.
Siegel, D. J., & Hartzell, M. (2003). Parenting from the inside out: How a deeper self-
understanding canhelp you raise children whothrive. New York:Jeremy P. Tarcher.
Silverman, D. K. (2003). Mommy nearest: Revisiting the idea of infantile symbiosis
and its implication for females. Psychoanalytic Psychology, 20, 261-270.
Silverman, L. H., Lachmann, F. M., & Milich, R. H. (1982). The search for oneness.
New York: International Universities Press.
Silverstein, J. L. (1994). Power and sexuality: Influence of early object relations.
Psychoanalytic Psychology, 11, 33-46.
Silverstein, L. B., & Auerbach, C. F. (1999). Deconstructing the essential father.
American Psychologist, 54, 397-407.
Silverstein, L. B., Auerbach, C. F., & Levant, R. F. (2002). Contemporary fathers
reconstructing masculinity: Clinical implications of gender role strain. Profes-
sional Psychology: Research and Practice, 33, 361-369.
Singer,1. (2001). Sex: A philosophical primer. Lanham, MD: Rowman & Littlefield.
Slowinski, J. W. (200l). Therapeutic dilemmas: Solving sexual difficulties in the
context of religion. Journal of Sex Education and Therapy, 26, 272-280.
Sluzki, C. (1989, May/June). Jealousy. Family Therapy Networker, 53-55,78.
Smith, T. W. (1998). American sexual behavior: Trends, socio-demographic differ-
ences, and risk behavior. GSS Topical Report No. 25. Retrieved January 21,
2004, from the National Opinion Research Center, University of Chicago
Web site: http://cloud9.norc/uchicago.edu/dlib/t-25.htm
Solomon, K., & Levy, N. B. (Eds.). (1982). Men in transition: Theory and therapy.
New York: Plenum Press.
Solomon, M. F. (1997). On love and lust in therapeutic treatment. In M. F. Solomon
& J. P. Siegel (Eds.), Countertransference in couples therapy (pp. 136-154). New
York: Norton.
Solomon, M. F. (2001). Breaking the deadlock of marital collusion. In M. F.
Solomon, R. J. Neborskv, L. McCullough, M. Alpert, F. Shapiro, & D. Malan,
Short-term therapy for long-term change (pp. 130-154). New York: Norton.

316 REFERENCES
Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). A terror management theory
of social behavior: The psychological functions of self-esteem and cultural
worldviews. Advances in Experimental Social Psychology, 24, 93-159.
Spak, L., Spak, F., & Allebeck, P. (1998). Sexual abuse and alcoholism in a female
population. Addiction, 93, 1365-1373.
Spence, J. T. (1999). Thirty years of gender research: A personal chronicle. In
W. B. Swann, [r., J. H. Langlois, & L. A. Gilbert (Eds.), Sexism and stereotypes
in modern society: The gender science of Janet Taylor Spence (pp. 255-289).
Washington, DC: American Psychological Association.
Spiegel, J. (2003). Sexualabuse of males: The SAM model of theory and practice. New
York: Brunner-Routledge.
Steele, B., & Alexander, H. (1981). Long-term effects of sexual abuse in childhood.
In P. Mrazek & C. Kempe (Eds.), Sexually abused children and their families (pp.
223-234). Oxford, England: Pergamon Press.
Stephan, C. W., & Bachman, G. F. (1999). What's sex got to do with it? Attach-
ment, love schemas, and sexuality. Personal Relationships, 6,111-123.
Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis
and developmental psychology. New York: Basic Books.
Stern, D. N. (1994). One way to build a clinically relevant baby. Infant Mental
Health Journal, 15,9-25.
Stern, D. N. (1995). The motherhood constellation: A unified view of parent-infant
psychotherapy. New York: Basic Books.
Stern, S. E., & Handel, A. D. (200l). Sexuality and mass media: The historical
context of psychology's reaction to sexuality on the internet [Electronic
version]. Journal of Sex Research, 38, 283-29L
Stiles, W. B. (1999). Suppression of continuity-benevolence assumptions (CBA)
voices: A theoretical note on the psychology and psychotherapy of depression.
Psychotherapy, 36, 268-273.
Stoller, R. J. (1975). Perversion: The erotic form of hatred. New York: Dell.
Stoller, R. J. (1991). The term perversion. In G. 1. Fogel & W. A. Myers (Eds.),
Perversions andnear-perversions in clinical practice: New psychoanalytic perspectives
(pp. 36-56). New Haven, CT: Yale University Press.
Stone, L. (1985, October/November). The strange, secret history of sex. Utne
Reader, 34-42.
Storr, A. (1968) . Human aggression. London: Allen Lane/Penguin Press.
Storr, A. (1988). Solitude. New York: Ballantine Books.
Stritof, S., & Stritof, B. (2004). Marital sex statistics: Who's doing it and how
often? Retrieved January 12, 2004, from http://marriage.about.com/cs/sexual
statistics/a/sexstatistics.htm
Strong, B., DeVault, c., & Sayad, B. W. (1999). Human sexuality: Diversity in
contemporary America (3rd ed.). Mountain View, CA: Mayfield.
Strupp, H. H. (1989). Can the practitioner learn from the researcher? American
Psychologist, 44, 717-724.

REFERENCES 317
Suggs, D. N., & Miracle, A. W. (1993). Culture and human sexuality: A reader.
Pacific Grove, CA: Brooks/Cole.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.
Tannen, D. (1990). You just don't understand: Women and men in conversation.
London: Virago Books.
Tannen, D. (1997). Women and men talking: An interactional sociolinguistic
approach. In M. R. Walsh, Women, men, and gender: Ongoing debates (pp.
82-90). New Haven, CT: Yale University Press.
Tedeschi, J. T., & Felson, R. B. (1994). Violence, aggression, and coercive actions.
Washington, DC: American Psychological Association.
Thakkar, R. R., Gutierrez, P. M., Kuczen, C. L., & McCanne, T. R. (2000). History
of physical and/or sexual abuse and current suicidality in college women. Child
Abuse and Neglect, 24, 1345-1354.
Tiefer, L. (2000). The social construction and social effects of sex research: The
sexological model of sexuality. In C. B. Travis & J. W. White (Eds.), Sexuality,
society, and feminism (pp. 79-107). Washington, DC: American Psychologi-
cal Association.
Tiefer, L. (2001). Feminist critique of sex therapy: Foregrounding the politics of
sex. In P. J. Kleinplatz (Ed.), New directions in sex therapy: Innovations and
alternatives (pp. 29-49). Philadelphia: Brunner-Routledge.
Tronick, E. (1980). Infant communicative intent. In A. P. Reilly (Ed.), The commu-
nication game: Perspectives on the development of speech, language and non-verbal
communication skills (pp. 4-9). Skillman, NJ: Johnson & Johnson Baby Products.
Tronick, E. Z., Cohn, J., & Shea, E. (1986). The transfer of affect between mothers
and infants. In T. B. Brazelton & M. W. Yogman (Eds.), Affective development
in infancy (pp. 11-25). Norwood, NJ: Ablex.
Tronick, E. Z., & Weinberg, M. K. (1997). Depressed mothers and infants: Failure
to form dyadic states of consciousness. In L. Murray & P. J. Cooper (Eds.),
Postpartum depression and child development (pp. 54-81). New York: Guilford
Press.
Turner, P. J. (1991). Relations between attachment, gender, and behavior with
peers in preschool. Child Development, 62, 1475-1488.
Twomey, H. B., Kaslow, N. J., & Croft, S. (2000). Childhood maltreatment,
object relations, and suicidal behavior in women. Psychoanalytic Psychology,
17, 313-335.
University of Chicago Harris School. (1994, October 13). University of Chicago
study disputes myths about American sexual habits. Retrieved October 8, 2002,
from the University of Chicago Web site: http://www.harrisschool.uchicago.
edu/news/pressreleases/pr_american_sex_stdy.htm
University of Illinois Board of Trustees. (2004). Healthy sexuality. Retrieved Octo-
ber 9,2004, from the University of Illinois site: http://www.mckinley.uiuc.edu/
health-info/sexual/intro/healthse.html

318 REFERENCES
Valliant, L. M. (1997). Changing character: Short-term anxiety-regulating psychotherapy
for restructuring defenses, affects, and attachment. New York: Basic Books.
Van Horn, P. (1999). [Review of the book Fear of Intimacy (back cover)]. Washing-
ton, DC: American Psychological Association.
Vergote, A. (1988). Guilt anddesire: Religious attitudes and their pathological derivatives
(M. H. Wood, Trans.). New Haven, CT: Yale University Press. (Original work
published 1978)
Wachtel, P. L. (Ed.). (1982). Resistance: Psychodynamic and behavioral approaches.
New York: Plenum Press.
Wallerstein, ]. S., & Blakeslee, S. (1995). The good marriage: How and why love
lasts. Boston: Houghton-Mifflin.
Walsh, M. R. (Ed.). (1997). Women, men, and gender: Ongoing debates. New Haven,
CT: Yale University Press.
Waring, E. M. (1988). Enhancing marital intimacy through facilitating cognitive self-
disclosure. New York: Brunner/Mazel.
Weeks, G. R., & Gambescia, N. (2002). Hypoactive sexual desire: Integrating sex and
couple therapy. New York: Norton.
Weiner-Davis, M. (2003). The sex-starved marriage. New York: Simon & Schuster.
Weinfield, N. S., Sroufe, L. A., Egeland, B., & Carlson, E. A. (1999). The nature
of individual differences in infant-caregiver attachment. In J. Cassidy & P. R.
Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications
(pp. 68-88). New York: Guilford Press.
Welldon, E. V. (1988). Mother, Madonna, whore: The idealization and denigration of
motherhood. London: Free Association Books.
West, M. L., & Keller, A. E. R. (1991). Parentification of the child: A case study
of Bowlby's compulsive care-giving attachment pattern. American Journal of
Psychotherapy, 45, 425-431.
Westkott, M. C. (1997). On the new psychology of women: A cautionary view.
In M. R. Walsh (Ed.), Women, men, andgender: Ongoing debates (pp. 362-372).
New Haven, CT: Yale University Press.
Wexler, J., & Steidl, J. (1978). Marriage and the capacity to be alone. Psychiatry,
41, 72-82.
Whealin, J. (2004). Child sexual abuse: A National Center for PTSD fact sheet.
Retrieved March 3,2004, from the National Center for PTSD Web site: http://
www.ncptsd.org/facts/specific/fs_child_sexual_abuse.html
Whitaker, C. A., & Malone, T. P. (1953). The roots of psychotherapy. New York:
Brunner/Mazel.
White, G. L., & Mullen, P. E. (1989). Jealousy: Theory, research, andclinical strategies.
New York: Guilford Press.
Wile, D. B. (1995). The ego-analytic approach to couple therapy. In N. S. Jacobson
& A. S. Gurman (Eds.), Clinical handbook of couple therapy (pp. 91-120). New
York: Guilford Press.

REFERENCES 319
Willi, J. (1982). Couples in collusion: The unconscious dimensionin partner relationships
(W. Inayat-Khan & M. Tchorek, Trans.). Claremont, CA: Hunter House.
(Original work published 1975)
Willi, J. (1984). Dynamics of couples therapy (]. Van Heurck, Trans.). Claremont,
CA: Hunter House. (Original work published 1978)
Willi, J. (1999). Ecological psychotherapy: Developing by shaping the personal niche.
Seattle, WA: Hogrefe & Huber.
Wilsnack, S. c., Wonderlich, S. A, Kristjanson, A F., Vogeltanz-Holm, N. D., &
Wilsnack, R. W. (2002). Self-reports of forgetting and remembering childhood
sexual abuse in a nationally representative sample of US women. Child Abuse
and Neglect, 26, 139-147.
Wilson, G. (1981). The Coolidge effect: An evolutionary account of human sexuality.
New York: William Morrow.
Winnicott, D. W. (1958). Collected papers: Through paediatrics to psycho-analysis.
London: T avistock.
Wolfe, T. (1934). You can't go home again. New York: Harper & Row.
World Health Organization. (1975). Education and treatment in human sexuality:
The training of health professionals (World Health Organization Technical Re-
ports Series 55-33, No. 572). Geneva, Switzerland: Author.
Yanak, T. (2004). The great American history fact-finder: Feminist movement. Retrieved
February 12, 2004, from the Houghton-Mifflin Web site: http://college.hmco.
com/history/readerscomp/gahff/htmljfe 066300_ feministmove.htm
Young, C. (1999). Ceasefire: Why women and men must join forces to achieve true
equality. New York: Free Press.
Zahn-Waxler, c., Radke-Yarrow, M., Wagner, E., & Chapman, M. (1992). Develop-
ment of concern for others. Developmental Psychology, 28, 126-136.
Zahn-Waxler, c., Robinson, J. L., & Emde, R. N. (1992). The development of
empathy in twins. Developmental Psychology, 28, 1038-1047.
Zilbergeld, B. (1999). The new male sexuality (Rev. ed.). New York: Bantam Books.
Zilboorg, G. (1943). Fear of death. Psychoanalytic Quarterly, 12,465-475.
Zinner, J. (1976). The implications of projective identification for marital interac-
tion. In H. Grunebaum & J. Christ (Eds.), Contemporary marriage: Structure,
dynamics, and therapy (pp. 293-308). Boston: Little, Brown.
Zoldbrod, A P. (1998). Sex smart: How your childhood shaped your sexual life and
what to do about it. Oakland, CA: New Harbinger.
Zurbriggen, E. L., & Freyd, J. J. (2004). The link between child sexual abuse
and risky sexual behavior: The role of dissociative tendencies, information-
processing effects, and consensual sex decision mechanisms. In L. J. Koenig,
L. S. Doll, A O'Leary, & W. Pequegnat (Eds.), From child sexual abuse to adult
sexual risk: Trauma, revictimization, andintervention (pp. 135-15 7). Washington,
DC: American Psychological Association.

320 REFERENCES
 AUTHOR INDEX

Aanstoos, C. M., 43 Becker, E., 34, 164, 166

Addis, M. E., 85 Beebe, B., 48, 195
Ainsworth, M. D. 5., 180 Belsky, j., 46, 91, 107
Alcalay, L., 86 Benjamin, j., 99, 101, 108
Alexander, H., 63 Berg-Cross, L., 257
Allebeck, P., 65 Bergen, H. A, 65
Allen, M., 79, 85 Bergman, A, 254
Allison,S., 65 Berne, E., 146, 168
Amini, E, 37 Bersoff, D. N., 77
Amsel, R., 74 Bettelheim, B., 141
Anderson, ]. c, 65 Beutler, L. E., 253
Anderson, R., 169 Beyer,S., 77
Anderson-Fye, E. P., 71 Bianchi-Demicheli, F., 255
Andrews, B., 182 Biebl, W., 73
Angleitner, A, 102 Bigler, R. 5., 82
Anthony,S., 140 Billig, M., 68, 76
Araoz, D. L., 253 Bing, Y. M., 83, 100, 107
Arentewicz, G., 194 Binik, Y. M., 74
Aries, E., 77, 79, 105 Bishay, N. R., 253
Arlow, ]. A, 279 Blakeslee,S., 22
Aron, A P., 37 Blatt, S. j., 278
Aronson, E., 200 Blehar, M. C, 180
Auerbach, C. F., 76, 108 Bloch, D., 56, 168
Ayduk, 0., 205 Bly, R., 75
Ayoub, C., 123 Bocknek, G., 168
Bogaert, A E, 132
Bollas, C, 118, 139
Bach, G. R., 21, 172, 176 Bolton, F. G. , jr., 48, 60
Bachman, G. E, 122 Bonner, B. L., 50
Bader, E., 124, 216, 254 Borgida, E., 77
Bader, M. j., 45 Bornstein, R. F., 168
Balon, R., 113, 261 Boszormenyi-Nagy, 1., 155, 169
Bancroft, ]., 45, 68, 261 Both,S., 131, 132
Bandura, A, 53, 100, 125 Bowen, G. L., 125
Barash, D. P., 207, 217 Bowen, M., 22,128,129,130,132,
Barber, B. K., 91, 95, 178 146
Barnes, M., 102 Bowlby, j., 122, 180
Barrett, L. E, 85 Bray, ]. H., 132
Basson, R., 131 Brennan, K. A, 122, 244
Batgos, ]., 123 Bretherton, 1., 123
Beavers, W. R., 47 Briere,]. N., 65, 66,137,168
Beck, A T., 125, 127, 143, 254, 262 Brody,S., 114
Beck, ]. 5., 254 Broughton, R., 85
Becker, D. Y., 224 Brown, ]. T., 263

321
Brown, L. L., 37 Cummings, E. M., 92
Brown, L. S., 73 Cupach, W. R., 21
Brozek, j., 137
Burleson, B. R., 85
Burn, S. M., 85 Daly, M., 83, 206, 214, 217
Burton, R., 143 D'Angelo, L. L., 90
Buss, D. M., 80, 83, 102, 103, 108, 206, Darling, C. A., 50
207, 219, 222 Davidson, j K., 50
Bussey, K., 100 Davis, K., 217
Buunk, B. P., 102, 200, 203, 217 Deaux, K., 77
Byrne, u, 89, 125 DeMause, L., 56
Denton, W., 255
DeSteno, D. A, 199, 224
Detterich, L., 85
Calderone, M. S., 70 Deutsch, R. M., 21, 172, 176
Canary, D. ]., 21 DeVault, c, 12
Caplan, P. ]., 93, 114 deVos, E., 66
Carballo-Dieguez, A., 64 deWeerth, c., 215
Carlson, E. A, 180 Diamond, L. M., 103
Carnes, P., 172, 173, 186 Dicks, H. V., 120, 121
Carpenter, K. M., 85 Dindia, K., 85
Catlett, J., 7, 13,36, 44, 46, 59, 71, 96, Dittmann, M., 79
123, 136, 138, 155, 163, 172, Dix, c., 62
180,195, 198,214,216,219, Dolezal, c., 64
243, 252, 260, 284-285 Doll, L. S., 65, 74
Chapman, M., 107 Dorais, M., 58, 64
Chen, Z., 46 Dowling, c, 106
Chesler, P., 82 Downey, G., 205
Chessick, R. D., 19 Downey, ]. 1., 77
Chiland, c, 89 Downing, c, 197
Chodorow, N. J., 82,92, 100, 101, 114, Duck, S., 23
132 Dunn, ].,65
Clark, C. L., 122, 123 Dunner, D. L., 65
Cobia, D. c. 74 Durlak, J. A., 58
Coelho, P., 29, 38, 167, 221 Dutton, D. G., 37, 204
Cohen, D., 74
Cohn, j., 58
Cole, P. M., 66 Eagle, M., 23
Coleman, E., 27 Eagly, A H., 84, 103
Collins, N., 122, 123 Edwards, W. M., 27
Compton, N. c, 132 Egeland, B., 180
Conte, ]. R., 66 Elhai, J. D., 65
Conway, M., 85 Elliott, D. M., 66
Courtois, C. A, 58, 64, 182 Elliott, K. ]., 127
Cox, C. R., 69 Ellis, A., 127, 143, 204, 254
Cramer, B., 96, 97 Ellis, B. J., 97
Crick, N. R., 178 Elson, M., 139
Crnic, K., 91, 107 Emde, R. N., 107
Croft, S., 65 Emery, G., 125, 143
Crosbie-Burnett, M., 125 Epstein, S., 143, 144
Crowley, M., 84 Erikson, E. H., 138

322 AUTHOR INDEX

Erlich, H. 5., 278 Friedman, S. D., 65
Everaerd, W., 45, 131, 132 Fromm, E., 32, 119
Eyssell, K. M., 85

Gage, R. L., 30
Fagot, B. 1., 100 Gagnon, ]. H., 12, 50
Fairbairn, W. R. D., 118, 119, 120, 121 Galinsky, E., 50
Faller, K. c, 63 Gambescia, N., 112, 113
Fausto-Sterling, A., 45 Gartner, R. B., 59, 64, 184
Feeney, ]. A., 122, 132 Geary, D. c, 98, 99
Fehr, B., 85 Geis, F. L., 77
Feldman, S., 205 Genevie, L., 92, 114
Feldman, S. 5., 90 Gentzler, A. L., 86
Felitti, V. ].,66,137,168 Gershuny, B.S., 65
Felson, R. B., 47, 79, 198, 207 Gerson, R., 48
Fenchel, G. H., 53, 58, 92, 96, 101, 152 Gerstein, L. H., 85
Ferenczi, 5., 47, 116, 117, 141 Gewirtz, ]. L., 48
Fergusson, D. M., 65 Ghent, E., 278
Fierman, L. B., 135, 137, 138 Giddens, A., 45
Finnegan, A., 77 Gilligan, c, 82, 101, 106, 108
Firestone, L., 7, 36, 71,129,163,195, Gilmartin, B. F., 218
198, 285-287 Glass, S. P., 197, 202, 206, 209, 216, 220
Firestone, R. W., 7, 13, 36, 44, 46, 49, Glick, P., 78, 84
50, 53, 54, 56, 57, 58, 59, 62, 66, Goeke-Morey, M. c., 92
68, 70, 71, 90, 92, 93, 94, 95, 96, Gold, S. N., 65
113,114,116,117,123,129, Goldberg, c, 127, 195
136,137,138,139,140,141, Goldenberg, ]. L., 69, 163, 164, 165, 167,
142,143,145,146,148, 152, 207
154, 155, 163, 164, 168, 172, Golding, ]., 65
173, 180, 186, 193, 195, 198, Goldwyn, R., 22
208, 213, 214, 216, 219, 229, Goodwin, S. A., 79
243, 252, 253, 254, 260, 261, Goren, E., 261
279, 281-283 Gottman, J. M., 20, 21, 176
Fischer, K. W., 123 Greenberg, j, 69, 164
Fisher, H. E., 37, 38, 39, 45 Greenberg, L. 5., 36, 124, 255
Fisher, R. L., 49 Gridley, B., 85
Fisher,S., 49 Grossman, M., 85
Fiske, S. T., 77, 78, 83, 84 Guadagno, R. E., 224
Fleming, ]., 65, 66, 73 Guidano, V. F., 127
Foley, S., 162, 169 Gunderson, M. P., 70
Fosha, D., 36, 48 Guntrip, H., 118, 119, 120, 121, 139
Foster, T. L., 125 Gutierrez, P. M., 65
Fox, R., 56, 73
Fraley, R. c, 122, 244, 261
Francoeur, R. T., 68, 69 Hagan, R., 100
Freud, A., 47,116, 141 Hampson, R. B., 47
Freud, S., 45, 56, 83, 111, 118, 204 Handel, A. D., 71
Frevd, ]. j., 58, 63 Harding, C., 43
Friday, N., 50, 53, 62, 224 Harlow, H. F., 48
Fried, E., 182 Harlow, M. K., 48
Friedman, R. C., 77 Harmon, E. L., 91, 95

AUTHOR INDEX 323

Harper, J. M., 169 Johnson, E. W., 70
Harper, R. A, 127, 254 Johnson, S. M., 116, 124, 255, 256, 262
Harre, R., n Johnson, V. E., 111, 112
Hart, A. J., 21, 176 Jolliff, D., 91
Hartzell, M., 22, 48 Jordan, J. V., 106
Harvey, J. H., 43 [ureidini, R., 116
Hatfield, E., 36, 38
Hazan, c, 45,103,122,123, 124
He, Z., 70 Kalma, A P., 215
Heard-Davison, A R., 65 Kaplan, A G., 106
Heilman, M. E., 77 Kaplan, H. B., 46
Heiman, J. R., 65 Kaplan, H. S., 45,105,111,112,114,
Hellinger, B., 146, 148, 155, 156, 169, 116, 125, 126, 127, 171, 175,
171 180, 182, 183, 184, 186, 187,
Henschel, A., 137 193,195,235,255,262
Herbison, G. P., 65 Kaplan, L. J., 114
Herdt, G., 74 Karpel, M. A, 138, 146, 151, 156, 168,
Herman, J., 58, 66, 68, 98, 115 169
Hoenk, P. R., 143 Kart-Morse, R., 22
Hogben, M., 89, 125 Kaslow, N. J., 65
Hollenbeck, A R., 48 Kastenbaurn, R., 140
Holstein, C., 143, 144 Kaufman, G., 127, 195
Holtzworth-Munroe, A, 205, 215 Keeley, M. P., 21,176
Hook, M. K., 85 Keen, S., 25, 75, 78, 84
hooks, b., 78 Keller, A E. R., 58
Horne, AM., 91 Kellett, J. M., 235
Horney, K., 101 Kelsey, B., 50
Horvath, A 0., 253 Kelsey, M., 50
Horwood, L. J., 65 Kenrick, D. T., 103
Hudson, L., 92 Kernberg, O. F., 70, 100, 118, 119, 121,
Huh, E., 143, 144 122,221
Hunsley, ]., 255 Kerns, K. A., 86
Hupka, R. B., 200, 217 Kerr, M. E., 22,128,129,132, 146
Hurlbut, W. B., 30 Kestenberg, J. S., 56
Hutchinson, G., 205 Kestenberg, M., 56
Hyde, J. S., 75, 86, 89, 100, 106, 125 Ketcham, K., 73
Hvun, M., 65 Keys, A, 137, 168
Khalife, S., 74
Kindlon, D., 106
Ickes, W., 77 Kiml, J. F., 73,182
Ingram, M., 74 Kipnis, L., 155
Insel, T. R., 36 Kirkpatrick, L. A, 36, 205
lppen, C. G., 132 Kirschner, D. A., 65
Kirschner, S., 65
Kiselica, M. S., 99
Jacklin, c. N., 53, 125 Klein, Marty, 12
Jacobsson, L., 224 Klein, Melanie, 118, 121
Jacot, B., 92 Kleinplatz, P. J., 261
Jain, A, 91, 107 Koenig, L. J., 65
jessel, D., 39, 45 Kohut, H., 139

324 AUTHOR INDEX

Kope, S. A., 162, 169 Maccoby, E. E., 53, 125
Kramer, R., 278 MacEahron, A. E., 60
Kriegman, D., 102 Mahler, M. S., 254
Kristjanson, A F., 64 Main, M., 22, 27
Krokoff, L. J., 20, 21,176 Malone, P. T, 128
Kuczen, C. L., 65 Malone, T P., 51,128
Kunkel, A W., 85 Malow, R. M., 64
Kuperman, S., 143 Manlove, E. E., 97
Kupers, T A, 77, 79 Manson, W., 69
Margolies, E., 92, 114
Marmor, J., 88
Laan, E. T. M., 45,131,132 Martin, G., 65
Lachmann, F. M., 168 Martin, ]. L., 65
Lachmann, L. M., 48 Martinson, F. M., 50
Laing, R. D., 35 Marzol, P., 65
Lamb, M. E., 86, 98 Mashek, D., 37
Lannon, R., 37 Masters, W. H., 111, 112
Laumann, E. 0., 12, 15,27, 106, 112,230 Masterson, J. F., 58
Lawrence, D. H., 34 Mathes, E. W., 224
Leadbeater, B. ]., 123 May, R., 165
Leahy, R. L., 278 Mazur, R., 218, 221, 224
LeDoux, J., 48 McCanne, T R., 65
Leiblum, S. R., 112, 261 McCarthy, B. W., 171, 175, 192, 194,
Lester, D., 140 195,258
Levant, R. F., 76, 79, 80, 96, 99, 105, 107 McCarthy, E., 171, 175, 192, 194, 195
Levi-Strauss, c, 56, 73 McCary, J. L., 70
Levy, N. B., 75 McConaghy, N., 112
Lewis, c., 86, 98 McCoy, S. K., 164
Lewis, C. S., 30 Mead, G. H., 76
Lewis, M., 49, 127, 182, 195 Mead, M., 89
Lewis, T, 37 Melby, T, 131
Li, H., 37 Mendell, D., 53, 92, 100
Lieberman, A F., 68, 132 Messman, S. ]., 21
Liebowitz, M. R., 38 Meston, C. M., 65
Lindstrom, H., 224 Metz, M. E., 258
Liotti, G., 127 Michael, R. T, 12
Lipson, A, 143, 144 Michaels, S., 12
Lipton, J. E., 207, 217 Mickelsen, 0., 137
Lisak, D., 66 Mikulincer, M., 168
Loftus, E., 73 Miletski, H., 64
LoPiccolo, J., 14, 229 Milich, R. H., 168
Lott, B., 77 Miller, A, 56, 58, 60, 66, 68, 95
Lort, D. A, 48 Miller, G., 102
Love, P., 37, 39,59,60,61,95,96,105, Miller, J. B., 82, 106
172, 263 Millevoi, A, 224
Luborsky, L., 253 Miracle, A W., 12, 73
Lucenko, B. A, 65 Mitchell, S. A, 172, 173, 195
Lusterman, D., 202 Moir, A, 39, 45
Lynskey, M. T, 65 Montagu, A, 48
Lyons-Ruth, K., 107 Moore, D. S., 103, 109

AUTHOR INDEX 325

Morokoff, P. j., 108 Pollack, M. H., 65
Morris, L. A, 60 Pollack, W. S., 80, 90, 91, 96, 98, 99,105
Morrison, A P., 127, 195 Pope, K. S., 73
Mullen, P. E., 65, 66, 73, 200, 203 Post, S. G., 30
Munholland, K. A., 123 Prescott, J. W., 68
Murray, G L., 125 Purcell, D. W., 64, 65, 66, 115
Putnam, F. W., 66
Pyszczynski, T, 69, 164
Nagy, M. H., 140
Nealer, ]., 98
Neborskv, R. ]., 278 Radke-Yarrow, M., 107
Nelson, D. A, 178 Rank, 0., 158, 278
Newberger, G M., 66 Rapaport, D., 141
Nicastle, L. D., 224 Rapson, R. L., 36
Noller, P., 122 Raymond, J., 92
Noyes, R., 143 Reid, P. T, 83, 100, 107
Reik, T., 29
Reissing, E. D., 74
O'Connor, T., 65 Rheingold, ]. G, 53, 56, 94, 114
Oates, R. K., 65 Richard, D., 131
Oatley, K., 72 Richardson, AS., 65
Ogilvie, B. A, 64 Richman, j., 93
Oliver, K., 94 Ridley, M., 83, 108
Oliver, M. B., 75, 86, 89, 100, 106, 125 Rilke, R. M., 38
Olsen, K. L., 45 Ritter, K. Y., 260
Orbach, 1., 168 Roberts, R., 65
Orbach, S., 47, 48, 51, 62, 73, 152, 169 Robin, L., 85
Otto, M. W., 65 Robinson, j., 105
Oubaid, Y., 102 Robinson, ]. L., 107
Rochlin, G., 140
Roeger, L., 65
Pagels, E., 69 Rogers, A. G., 106
Paik, A, 112 Rohner, R. P., 46
Papalia, D., 86 Romans, S. E., 65
Park, ]., 90, 95, 96, 114 Rosen, R. G, 112, 261
Parker, G., 58, 91, 107 Rosenberger, J. B., 83
Parker, R., 46 Ross, D., 53
Parrott, W. G., 72 Ross, S. A., 53
Patty, J., 122 Rothschild, B., 182
Pearson, P. T, 124, 216, 254 Rubin, L. B., 75, 79, 82, 92, 94, 96
Perna, F., 168 Rudman, L A, 79
Perris, G, 224 Rush, A J., 125, 143
Perris, H., 224
Person, E. S., 209, 214, 220, 221
Phillips, N. A, 235 Sadava, S., 132
Pietromonaco, P. R., 85 Safran, j. D., 36
Pine, F., 254 Safran, S. A., 65
Pines, AM., 37, 197, 199, 200, 205, Sagar in, B. J., 224
206,224 Sager, C.]., 155, 169
Pleck, J. H., 80, 87, 105 Salovey, P., 199, 200, 203, 224
Plutchik, R., 203 Samter, W., 85

326 AUTHOR INDEX

Sanford, J., 35 Stephan, C. W., 122
Sarwer, D. B., 58 Stem, D. N., 48, 73, 114
Sayad, B. W., 12 Stem, S. E., 71
Schachner, D. A., 122, 123 Stevens, N. A., 169
Scharff, D. E., 121, 256, 262 Stiles, W. B., 143, 144
Scharff, ]. S., 121, 256, 262 Stiver, 1. P., 106
Schiffer, H. B., 50 Stoller, R. J., 116, 131
Schindler, D., 255 Stone, L., 12, 24, 26
Schloss, J. P., 30 Storr, A., 51
Schmidt, G., 194 Stritof, B., 14
Schmitt, D. P., 80, 83, 86, 102, 103 Stritof, S., 14
Schnarch, D. M., 14, 19, 128, 129, 130, Strong, B., 12
146, 258 Strupp, H. H., 253
Schoenewolf, G., 75, 114 Stuart, G. L., 205
Schore, AN., 48, 195 Suggs, D. N., 12, 73
Segraves, R. T., 113, 253, 261 Sugrue, D. P., 162, 169
Sellers, A. H., 65 Sullivan, H. S., 118
Sharpsteen, D. J., 205 Suomi, S. J., 48
Shaver, P. R., 45, 86, 122, 123, 124, 203 Surrey, J. L., 106
Shaw, B. F., 125, 143 Swingle, J. M., 65
Shea, E., 58
Shea, J. D., 68, 69
Sheehy, G., 75 Tannen, D., 79, 85
Shengold, L., 56, 60 Taylor, H. L., 137
Shopen-Koffman, R., 168 Tedeschi, ]. T., 47
Showalter, E., 82 Temdrup, A 1., 260
Shulkin, S., 172 Thakkar, R. R., 65
Siegel, D. J., 22, 27, 48 Thompson, M., 106
Silverman, D. K., 86 Tiefer, L., 69, 77
Silverman, L. H., 168 Trapnell, P. D., 65
Silverstein, J. L., 117, 131 Travis, C. B., 103, 109
Silverstein, L. B., 76, 80, 91, 105, 108 Traweger, c, 73
Singer, I., 12, 30 Tronick, E. Z., 58, 107, 195
Slowinski, J. W., 11 Trost, M. R., 103
Sluzki, C., 217 Turner, P. J., 101
Slvmen, D. J., 143 Twomey, H. B., 65
Smith, T. W., 86, 106
Sobansky, R. R., 74
Underwood, L. G., 30
Solomon, .1., 22, 27
Solomon, K., 75
Solomon, M. F., 255, 262, 278 Valliant, L. M., 36
Solomon, S., 69, 164 van der Velde, j., 131, 132
Spak, F., 65 Van Horn, P., 123, 132
Spak, L., 65 van Knorring, L., 224
Spark, G. M., ISS, 169 Vergote, A, 69
Spence, ]. T., 82 Vernon-Feagans, L., 97
Spiegel, j, 68, 73 Vogeltanz-Holrn, N. D., 64
Spiering, M., 45
Sroufe, L. A, 180
Steele, B., 63 Wachtel, P. L., 278
Steidl, ]., 138 Wagner, E., 107

AUTHOR INDEX 327

Wall,S., 180 Wilsnack, R. W., 64
Waller, N. G., 244 Wilsnack, S. c., 64
Wallerstein, J. 5., 22 Wilson, G., 103
Walsh, M. R., 75, 105 Wilson, M., 83, 206, 214, 217
Waring, E. M., 262 Winnicott, D. W., 73, 137
Waters, E., 180 Wolfe, T., 30
Weber, A L., 43 Wolitzky, D. L., 23
Weeks, G. R., 112, 113 Wonderlich, S. A, 64
Weinberg, M. K., 195 Wood, W., 85, 103
Weinberger, D. A, 90 Wright, T. L., 197,202,206,209,216
Weiner-Davis, M., 171
We infield, N. 5., 180
Welldon, E. V., 48, 53, 56, 92 Yanak, T., 82
Werking, J., 85 Youn~ C., 71, 75, 79, 82
West, M. L., 58
Westkott, M. c, 92, 107
Wexler, J., 138 Zahn-Waxler, c. 107
Whealin, J., 63 Zeanah, C. H. , j-, 107
Whitten, V. E., 124 Zilbergeld, B., 14
Whitaker, C. A, 51 Zilboorg, G., 163
White, G. L., 200, 203 Zinner, J. 121, 132
Wile, D. B., 262 Zoldbrod, A P., 43, 50, 73
Wiley, M.S., 22 Zurbriggen, E. L., 63
Willi, J., 146, 156, 158,257,258 Zutter, A, 255

328 AUTHOR INDEX

 SUBJECT INDEX

Abandonment anxiety, 204-205 Body image, 51-53

Absent fathers, 91, 97 distorted views of sexuality and
Active receptivity during love making, human body, 50-53
88 touching and, 48-49, 116
Adrenaline, 38 Buddhist conception of love, 30-31
Adult ego state, 145-146
Adverse Childhood Experiences (ACE)
Study, 74n Capacity to give and receive love,
Affair of mate, 197-225. See also affection, and sex, 23-24
Jealousy Child-rearing and sexual stereotypes, 86,
AIDS, 187,231 87
American Psychiatric Association, 112, Children's sexuality
113, 131n, 203 attitudes toward one's body, 51-53
American Psychological Association's attitudes toward sex, 50-51, 73n
Guidelines for Psychotherapy with competition and Oedipal issues,
Lesbian, Gay, and Bisexual Cli- 55-57
ents, 230, 260n exploitative use of child by parent,
Antilibidinal ego, 120 58-62
Antiself, 141-143, 168n female children, sexual abuse of,
Attachment perspectives 63-64
on gender differences, 100 harsh and negative attitudes, 49, 91,
on jealousy, 205 141
on love, 36 identification with and imitation of
self-knowledge and, 27n parent of same sex, 53-55
on sexual dysfunctions, 122-125 imitation of parents' views, 50
on sexual stereotypes, 86 interpersonal factors affecting, 46-64
Attitudes toward sex, 50-51. See also Cul- male children, sexual abuse of, 64
tural influences; Parental impact natural feelings of attraction within
on adult sexuality families, 62-63
Automatic thoughts, 127, 143,254 parental attitudes and behaviors,
Autonomy. See Individuality 46-47, 132n, 283-284
Averse Childhood Experiences (ACE), parental rejection and hostility, 47-
168n 49,142
Child sexual abuse
adult functioning and sexual rela-
Behavioral Checklist for Partners, 243, tions, effect on, 65-68, 73-74n
245, 246, 260n defined, 63
Benevolent sexism, 84 female children, 63-64, 65-66
Betrayal trauma theory, 63-64 male children, 64, 66
Bias of therapists, 230 recovered memories of, 64, 73n
Biological aspects sexual withholding due to, 182-183
of love, 36-38, 39n therapy for adult survivors, 256,
of sexuality, 45-46 262n

329
Cleanliness, obsession with, 49 psychodynamics and, 137-144
Closeness, 128-129, 132n, 255, 270 self-parenting process, 138-140
Cognitive-behavioral perspectives extension into self-gratifying
on couples therapy, 254 modes, 146-148
on sexual dysfunctions, 125-127 voice process, 140-144
Communication between genders, 79, 84, manifestations of, 161-162
85 Destructive thought processes underlying
Companionate vs. passionate love, 36, 85 sexual withholding, 185-192
Compassion and empathy, 22-23, 85, Developmental factors of sexual dysfunc-
264-265 tions, 115-118
Competition Diagnostic and Statistical Manual of Mental
among partners, 224n Disorders (DSM-IV) , 112, 113,
defined, 199 131n,203
jealousy and, 198-200, 201 Disruption of sexual relations by voices,
parental-child feelings of, 55-57, 90 230-234
sexual withholding due to fears of, Distortion
180-181 of body image, 50-53
Continuity benevolence assumptions, 144 fantasy bond and, 149-150
Continuum of eroticism, 131n sexual stereotypes and, 78-84
Continuum of sexuality, 114, 144-145 Dopamine, 38, 39n, 45
Core attitudes about love and sexuality, Double standard, 100
264-266 Durex Survey (2003) on American sex
Corrective suggestions, 167, 266-278, practices, 14-15
279n. See also Enhancing sexual Dysfunctions. See Sexual dysfunctions
intimacy
Couples therapy
approaches to sexual dysfunctions, Ego states
253-258 adult ego state, 145-146
voice therapy as adjunct to, 252, polarization of parental and childish
278 ego states, 157-159, 168n
voice therapy in, 234-251 Emotional hunger
Cultural influences defined, 34
on jealousy, 203, 217-218 of parent, 58-59
on love, 30-31 Emotional incest, 59-62
on parental attitudes and behaviors, Emotionally focused therapy (EFf), 255-
46 256, 261-262n
on sexuality, 12, 13, 26n, 68-70, Empathy. See Compassion and empathy
74n, 281-282 Enhancing sexual intimacy, 263-279
on sexual stereotypes, 105n, 108n compassion and empathy, 264-265
core attitudes about love and sexual-
ity, 264-266
Death anxiety, 136, 140, 163-167, 283 corrective suggestions, 266-278
Deception for expanding personal bound-
jealousy and, 216-217 aries, 269-270
seIf-deception, 157 for fantasy bond, 267-269
Defense formation for goal setting for one's sexual
death anxiety and, 136, 140, 163- relationship, 270-271
167 imaginary dialogue with one's par-
fantasy bond, 136, 137-138. See also ent, 273, 276-277
Fantasy bond for jealousy, 222-224
modes of sexual relating, 144-146 journaling, 273, 274-275

330 SUBJECT INDEX

 resistance to, 278 polarization of parental and childish
for voice disruption, 167, 271- ego states and, 157-159, 168n
273, 274-275 provocation and, 150-151
generosity, 265-266 routinized, impersonal sexuality and,
individuality, 266 153, 169n
overcoming stereotypes, 266 overcoming, 269-270
Enmeshed sexual relationship, 124 selection process and, 148-149
Envy compared with jealousy, 224n. See voice therapy and, 259
also Jealousy Fathers. See Parental impact on adult sex-
Etiology of sexual dysfunctions, 111-132, uality
284. See also Sexual dysfunctions Feminist movement, 78-79, 82, 106n,
developmental factors of, 115-118 131n
oral basis of sexuality, 113-115 Firestone Assessment of Violent
perspectives on, 113-118 Thoughts (FAVT), 224n
Evolutionary psychologists Firestone Voice Scale for Couples
on jealousy, 206-208 (FYSC), 244, 246, 260-261n
on mate selection strategies, 102- Form vs. substance in couple relation-
104, 108n ships, 154-157
Exclusive vs. nonexclusive relationships, Freudian approach. See Psychoanalytical
218-222. See also Jealousy perspective
Expanding personal boundaries, 23-24,
25,269-270
Experiences in Close Relationships Inven- Gatekeeper mothers, 105-106n
tory (ECR-R), 244, 247, 261n Gender equality, 104-105. See also Sex-
Exploitative use of child by parent, ual stereotypes
58-62 Gender identity. See Sexual stereotypes
Extramarital affair, 197-225. See also Gender relations, 75-76
Jealousy Gender-role socialization and develop-
mental tasks, 98-102, 105n
Gender studies
Family relationships. See also Parental on mate selection, 103
impact on adult sexuality on sexual stereotypes, 85-86
natural feelings of attraction within Generosity, 265-266
families, 62-63 Gestalt therapy, 254
as predisposing factors for sexual Goal setting for one's sexual relationship,
withholding, 178-185 270-271
Family systems theory, 128-129, 132n, Guilt, 59, 87, 93, 115, 116, 195n
257
Fantasy bond, 136, 137-138
corrective suggestions for, 267-269 Healthy sexuality
defenses against intimacy encourag- criteria used to evaluate, 14-15
ing, 148-151 defining, 11-12, 14
distortion and, 149-150 descriptions of, 14
form vs. substance and, 154-157 dimensions of ideal, 15-19
idealization of partner and, 159 "normal," 11-12
jealousy and, 197, 208-211, 219 personal traits for, 19-24
loss of independence and sense of perspective on, 13, 285-287
separate identity, 160-161 Homosexuals. See Sarne-gendered
manifestations in couple relation- relationships
ships, 151-161 Honesty, 20-21, 216-217
mutual self-deception and, 157 Humiliation. See Shame

SUBJECT INDEX 331

Hypoactive sexual desire (HSD), 126, evolutionary factors influencing,
187, 195n 206-208
exclusive vs. nonexclusive relation-
ships, perspectives on, 218-222
fantasy bond and, 197, 208-211,
Idealization
219
of parents, 168n
overcoming negative consequences
of partner, 159
of, 222-224
Ideal sexual experience, dimensions of,
psychoanalytic and attachment theo-
15-19
rists' views on, 203-205
Imaginary dialogue with one's parent,
sexual withholding and, 215-216
273, 276-277
subjective experience of, 200-203
Imitation of parents
voices intensifying, 211-215
children's sexuality and, 50, 89, 93
[ournaling, 273, 274-275
distorted views of sexuality and
[udeo-Christian conception of love, 31
human body, 50
negative traits of parent, 47, 141
Incest, 56, 63, 66, 67, 73n, 98
emotional incest, 59-62 Learning theory, 89
Individuality Lesbians. See Same-gendered relation-
loss of, 160-161 ships
respect for partner's, 21-22 Loss of independence and sense of sepa-
teaching client couples about, 266 rate identity, 160-161
Infants Love, 29-39
gender role identity and, 108n biological aspects of, 36-38
need for care-giver proximity, 122 descriptions of, 30-31
self-comforting, 137 genuine love, what is not, 34-35
Infidelity, 197-225. See also Jealousy mystery of, 39n
Inhibited sexual desire (ISD), 126, 192, passionate vs. companionate, 36
194n, 255 perspectives on, 31-34, 35-38
Integrity, 20-21 teaching core attitudes about, 264-
Internal thought process. See Voice 266
Internal working models and attachment
theory, 123
Internet, 71
Marriage contracts, 155, 169n
Interpersonal factors affecting children's
Mate selection. See Selection process
sexuality, 46-64. See also Chil-
Media
dren's sexuality
sexuality in, 70-71
Interviews with authors, 281-287
sexual stereotypes in, 109n
Intimacy
Men's movement, 78
defenses against, encouraging fantasy
Mixed messages
bond, 148-151
sexual withholding and, 175-178
enhancing, 263-279. See also
trust and, 21
Enhancing sexual intimacy
Morality, 12
Morbid jealousy, 204
Mortality salience, 207. See also Death
Jealousy, 197-225 anxiety
competition and, 198-200, 201 Mothers. See Parental impact on adult
cultural influences on, 203, 217-218 sexuality
deception and, 216-217 Mutual self-deception, 157
defined, 199 Mystery of love, 39n

332 SUWECTINDEX
National Health and Social Life Survey Penis envy, 101, 108n
(1992), 112 Personality of therapist, 253, 261n
Natural feelings of attraction within fami- Perversion, 131n. See also Sexual dysfunc-
lies, 62-63 tions
Nondefensiveness, 19-20 Phenvlethylamine, 38
Norepinephrine, 38, 45 Polarization of parental and childish ego
"No-sex" marriages, 258 states, 157-159, 168n
Popular culture's representations of sexual-
ity, 70-71
Object relations perspectives Pornography, 70-71
in couples therapy, 256-257 Posttraumatic stress disorder (PTSD),
on sexual dysfunctions, 119-122 182, 202-203
Oedipal issues, 55-57, 95, 101, 108n, Preoedipal stage, 114, 121
118, 121, 204 Projective identification, 121
Openness, 19-20 Provocation and fantasy bond, 150-151
Open relationships, 218-222. See also Pseudoaggression, 195n
Jealousy Psyche division into self and antiself,
Oprah, 71 141-143,168n
Oral basis of sexuality, 113-115 Psychoanalytical perspective
Orgasm on female psychosexual develop-
disorders, 115-116, 131n ment, 101
frequency of, 15 on infant's need for care-giver prox-
Overprotection of son by mother, 94-95, imity, 122
107n on jealousy, 203-205
Oxytocin, 39n, 45 on sexual dysfunctions, 111, 118-
119
on unconscious motives, 143
Parental impact on adult sexuality, 89- Psychodynamics of defense formation,
98. See also Children's sexuality; 137-144
Imitation of parents; Incest Psychological control of parent, 91, 178
emotional hunger, 58-59 Psychosexual development
exploitative use of child by parent, female, 100-102, 108n
58-62 male, 99-100, 108n
fathers and daughters, 96-98
fathers and sons, 52, 54-55, 57, 90-
92, 106n, 127 Receptivity vs. passivity, 88
imaginary dialogue with one's par- Rejection
ent, 273, 276-277 infidelity of mate as, 197-225. See
mothers and daughters, 53-54, 56- also Jealousy
57, 64, 92-94, 126-127 parental rejection and hostility, 47-
mothers and sons, 64, 94-96 49, 142
parental attitudes and behaviors, Rejection sensitivity, 205
46-47, 132n, 283-284 Relational diathesis model, 68
parental rejection and hostility, 47- Resistance
49, 142 to corrective suggestions, 278
Parentification, 58 to healthy sexual experiences, 25,
Passionate vs. companionate love, 36, 85 166
Passive-aggression sexual withholding, to love, 38
175, 181, 195n Respect for one's partner, 21-22
Paternity determination, 102-103 Rivalry, 197-225. See also Competition;
Patriarchal society. See Sexual stereotypes Jealousy

SUBJECT INDEX 333

Routinized, impersonal sexuality and dete- object relations approaches to, 119-
rioration of sexual relating, 153, 122
169n oral basis of sexuality and, 113-115
overcoming, 269-270 psychoanalytical approach to, 118-
119
social learning and, 125-127, 282-
283
Sadomasochistic fantasies or behavior, theoretical approaches to, 118-129
116-117 Sexual infidelity, 197-225. See also
Safe sex, need for, 187, 231 Jealousy
Same-gendered relationships Sexual Information and Education Coun-
jealousy in, 207 cil of the United States, 14, 26n
therapist's attitude toward, 230, Sexuality. See also Healthy sexuality
260n biological factors affecting, 45-46
types of sexual activities, 15 children's. See Children's sexuality
Selection process child sexual abuse, effect of, 65-68
evolutionary psychologists on strate- continuum of, 114
gies, 102-104, 108n cultural and societal influences, 12,
fantasy bond and, 148-149 13,68-70
Self-deception, 157 defined, 43
Self-denial as basis for sexual withhold- factors affecting, 43-74
ing, 173-174, 179-180 frequency of sex, 14-15, 27n
Self-differentiation, 128 interpersonal factors affecting chil-
Self-esteem, 79, 212, 224n dren's, 46-64. See also Children's
Self-evaluation maintenance (SEM) the- sexuality
ory,224n media's and popular culture's repre-
Self-parenting process, 138-140 sentations of, 70-71
extension into self-gratifying modes, oral basis of, 113-115
146-148 types of sexual activities, 15
Separation anxiety and sexual experi- Sexual rivals, 197-225. See also Competi-
ence, 145 tion; Jealousy
Sexism. See Sexual stereotypes Sexual stereotypes, 75-109
Sexual abuse of children. See Child sex- couple relationships and, 155-156
ual abuse distorted views, 78-84
Sexual anorexia. See Sexual withholding on men, 78-82
Sexual crucible model, 258 on women, 82-84
Sexual dysfunctions gender research and, 85-86
attachment approaches to, 122-125 gender-role socialization and develop-
cognitive-behavioral perspectives mental tasks, 98-102, 105n
on, 125-127 historical perspective
corrective approaches. See Enhanc- on men, 78
ing sexual intimacy on women, 82
couples therapy, approaches to, 253- infants and gender role identity,
258 108n
death anxiety and, 136, 163-167 mate selection as viewed by evolu-
defined, 112-113 tionary psychologists, 102-104,
developmental factors of, 115-118 108n
etiology of, 111-132,284 overcoming, 266
as expression of sexual inhibition, overview, 76-78
194n parental impact on adult sexuality,
family systems theory on, 128-129 89-98

334 SUBJECT INDEX

 fathers and daughters, 96-98 University of Chicago Harris School, 27n
fathers and sons, 90-92 University of Illinois, 14
mothers and daughters, 92-94
mothers and sons, 94-96
perspectives on, 86-89
Viagra, 261n
Sexual withholding, 171-195
Victimized orientation and jealousy, 213-
child sexual abuse, 182-183
214
competition fears, 180-181
Violence due to jealousy, 214-215
destructive thought processes under-
Voice, 136, 140-144
lying, 185-192
attachment and, 123
dynamics in ongoing couple relation-
defined, 140
ships, 192-193
disrupting sexual relations, 186,
family relationships as predisposing
230-234
factors, 178-185
corrective suggestions for, 167,
jealousy and, 215-216
274-275
mixed messages and, 175-178
critical voices about one's part-
passive-aggressive, 175, 181
ner, 233
self-denial as basis for, 173-174,
following sex, 233-234
179-180
prior to sex, 231-232
Shame, 49, 116, 127, 212
during sex, 232-233, 271
Social learning, 282-283
hostility and, 214-215
cognitive-behavioral perspectives on
jealousy and, 211-215
sexual dysfunctions, 125-127
loss of partner to rival and, 212-213
Societal influences. See Cultural
low self-esteem and, 212
influences
manifestations of, 161-162
Stereotypes. See Sexual stereotypes
shame and, 212
Stone Center's New Psychology of
victimized orientation and, 213-214
Women,107n
violence due to jealousy and, 214-
215
Terror management theory (TMT), 163, winning of partner from rival and,
164, 207 212-213
Testosterone, 45 Voice therapy, 229-262
Theoretical approaches to sexual dysfunc- as adjunct to couples and sex ther-
tions, 118-129 apy, 252, 278
Therapists in couples therapy, 234-251, 260n
bias of, 230 defined, 229
personality of, 253, 261n impact of, 251-252
Touching, 48-49, 60, 116 personality of therapist, 253
Toynbee, Arnold, 30 steps of, 235-237
Transactional Analysts (T.A.), 168n Vulnerability, 24, 148
Trends in sex therapy, 253-258, 261n,
262n
Willi Model, 257
Understanding. See Compassion and Withholding. See Sexual withholding
empathy World Health Organization, 11

SUBJECT INDEX 335

 ABOUT THE AUTHORS

Robert W. Firestone, PhD, clinical psychologist and author, has established

a comprehensive body of work that focuses on the concept that defenses
formed by individuals early in life often impair their ability to develop and
sustain intimate adult relationships and interfere with their achieving a
healthy, fulfilling sexual life. He was engaged in the private practice of
psychotherapy from 1957 to 1979, working with a wide range of patients,
expanding his original ideas on schizophrenia, and applying these concepts
to a theory of neurosis. In 1979, he joined the Glendon Association in
Santa Barbara, California, as its consulting theorist. His major publications
include The Fantasy Bond, Compassionate Child~Rearing, Fear of Intimacy,
and Creating a Lifeof Meaning andCompassion: The Wisdom of Psychotherapy.
His studies of negative thought processes led to the development of an
innovative therapeutic methodology described in Voice Therapy, Suicide and
the Inner Voice, and Combating Destructive Thought Processes.

Lisa A. Firestone, PhD, clinical psychologist, is the director of research

and education at the Glendon Association and an adjunct faculty member
at the University of California, Santa Barbara Graduate School of Education.
For the past 12 years she has been engaged in private practice, treating
couples and individuals struggling with intimacy issues. She has also been
involved in clinical training and applied research related to the assessment
of suicide and violence potential. She coauthored Conquer Your Critical
Inner Voice and Creating a Life of Meaning and Compassion: The Wisdom of
Psychotherapy and has presented these ideas in workshops. She has also
discussed these concepts in a video on sexual health from the American
Psychological Association. Her recent publications include chapters in ed-
ited books: Katie's Diary: Unlocking the Mystery of Suicide (D. Lester, Ed.);

337
Assessment, Treatment, and Prevention of Suicidal Behavior (R. Yufit & D.
Lester, Eds.): and Cognition and Suicide: Theory, Research, and Practice
(T. Ellis, Ed., in press).

Joyce Catlett, MA, author and lecturer, has coauthored four books with
Robert W. Firestone and coproduced 37 educational videos for the Glendon
Association, including a series on couples and sexuality. She developed the
Compassionate Child-Rearing Parent Education Program, a child abuse
prevention model curriculum that has been used in six U.S. states, Canada,
and Costa Rica. She currently lectures and conducts continuing education
workshops at universities and mental health facilities throughout the world.

338 ABOUT THE AUTHORS