Like most phobic conditions, learned sexual anxiety responses generally have a history of specific trauma (anxiety shock) associated with them. Some patients were physically or psychologically punished through guilt for masturbation as teen-agers, or were not reassured emotionally or helped by their first sexual partner when they were too anxious to perform that first time (a common occurrence). Most often, patients with sexual phobic reactions report that for a variety of causes, physical tiredness, upset over other problems, general stress, excessive demands by their mates, etc., there was a definite period of time when they did not perform well sexually in the opinion of either the patient or the sexual partner, but the patient was not reassured by the sexual partner of its relative unimportance. During this time, the typical patient anticipated further failure, and, in being sensitive to the slightest sign of failure during the next sexual act, induced further anxiety in him or herself, thereby producing the complete failure he or she was looking for (a self-fulfilling prophecy!). In cases where their sexual partners were quite unsympathetic with such failure and put pressure on them to perform adequately, the patient’s own worries made the initial anxiety even more intense and guaranteed failure. Eventually, after a number of sexual failures caused by worrying about sex in and out of bed, no matter what the initial stimulus-reason for the anxiety was, almost any sexual stimulus becomes something to make the patient nervous—a trigger stimulus for debilitating anxiety during sex. To illustrate the involuntary physiological characteristics of sexual arousal to my students in class, I take a $20 bill out of my wallet and make them an offer: “If you can command yourself to be sexually aroused, to control your sexual physiology, to command an erection or engorged vaginal tissue, I’ll give you $20! Take thirty seconds. That’s not enough? You want a minute? You got it!” No one has ever picked up my $20 bill. The important point, of course, is that willpower—commanding yourself to feel sexy—
doesn’t work; any more than commanding yourself not to feel anxious in other phobic situations alleviates the anxiety.
Again, as with the other phobias, the sexually conditioned anxiety response may generalize to all sorts of other stimuli associated with the sexual act to the point of producing a general avoidance or flight response. When this extreme conditioning takes place, the unfortunate sexually phobic patient may avoid any contact that has even a low possibility of leading up to sex, such as just talking to possible sexual partners (let alone dating them!). Contrary to some archaic and moldy, but still popular professional beliefs, sexual phobia is not a sign of a twisted personality or some deeply hidden incestual, homosexual, or psychotic conflict but, like the other phobias, is learned and can usually be “unlearned” in relatively short order (several weeks to several months) with behavioral treatment methods.
Unlike the anxiety model with all its diagnostic clues indicating a psychophysiological inability to have successful sexual relations, sometimes with very rapid onset, the
anger model
has only one clear indication that a sexual difficulty exists—a gradual decrease in frequency of sex with a spouse over a long period of time, several months to several years. Although sexual frequency in couples with a sexual problem described by the anger model often reaches zero for significant periods of time, frequency invariably bounces back and forth between periods of no sex and periods of low-frequency sex. During these periods of low-frequency sexual intercourse, none of the types of sexual difficulties described in the anxiety model is observed. The male “patients” have no significant problems with lack or loss of erection or other anxiety-produced difficulties, although they often report lack of ejaculation. Some of the female “patients” report they are “just lying there going through the motions,” totally disinterested; some even contemptuous and therefore usually nonorgasmic.
The anger model assumes, unlike the anxiety model, that the low frequency of sexual intercourse is a result
of problems between spouses outside the bed. Typically one of the sexual partners holds many “hidden” grudges against the other; he or she has a lot of unexpressed anger against the spouse. The anger may be denied, the fact that a sexual problem exists may even be denied. The other partner is typically willing to show anger and does, and is usually manipulative as well as angry in dealing with his or her “passive” mate. In my clinical experience in treating this problem, one mate is
always
too tired or not in the mood or has a headache, or is too busy, or feels a bit ill, or has something more important to do, or has to get up early and go to work tomorrow. And this is the mate who directly causes the drop in sexual frequency by avoidance of sexual contact—not out of fear, but out of dislike and unexpressed anger of the spouse’s everyday living behavior toward him or her. Clinical experience with this type of problem is common, and a common observation—made by other therapists as well as myself—is that the withdrawing partner is not only withdrawing in bed, he or she is withdrawing from intimate contact and sharing in all areas with the sexual partner. The withdrawal of the passively angry partner is a result of having no effective outlet for communicating his anger. He seems, clinically, to be either unable or unwilling to show his anger toward his mate as one way of putting down strong limits on what he will and will not tolerate as well as effectively venting this uncomfortable emotion and clearing the air between them. In addition, and perhaps even more important than the lack of open, angry communication by the withdrawing mate, in the clinical cases I see with this problem, the withdrawing partner, without exception, is not assertive to his or her mate. He does not seem to be able to express his own likes to her, or she is able to manipulatively block him from acting on his own wants. In addition, he seems dreadfully lacking in the ability to calmly, or even not so calmly, tell his spouse of his displeasure with the way she behaves toward him. Without effective assertive communication, or even generally ineffective angry communication, available to him, he withdraws. He does not
willingly share any close intimate contact with his mate—his worries, his hopes, or even his joys—in anticipation of being impotent to cope with her ability to make him feel guilty or anxious if she does not like what he says. Consequently, over a period of time, as resentment and dislike for her manipulative behavior toward him build up, the frequency of his sharing anything intimate with her goes down, including sexual love.
The generally accepted treatment for this sexual problem involves getting the withdrawing sexual partner to be able both to express appropriate anger toward his mate when she takes away his self-respect as well as to be more assertive on an everyday basis concerning what he wants for himself, what he is willing to give her, what he will not tolerate, and what compromises they can work out in living together. When I first presented my work in developing the concepts and verbal skills of systematic assertive therapy at the 1972 meetings of the American Psychological Association in a symposium entitled “New Directions in Psychotherapy,” one of the co-participants, Dr. Harold Segal, made a witty comment on the preferred treatment of this sexual problem that was understood immediately; “First assertion, then insertion.”
The
mixed model
of treatment for sexual dysfunction assumes that both anxiety and anger components are involved in the history of the problem. For instance, a withdrawing spouse may be coerced into having sexual intercourse without really wanting to, without really being interested in close communication with his (or her) mate; he isn’t aroused enough sexually to either maintain an erection during intercourse, or perhaps even during foreplay. If he is not assertive enough to say: “I just don’t want to have sex with you now,” he is likely to be talked into at least giving the appearance of wanting to go to bed. After several failures due to disinterest, his manipulative spouse is likely to give him a strong message that either makes him feel guilty or anxious; in some cases, this is done quickly and efficiently right in bed, an
in vivo
phobic conditioning procedure.
At other times his mate may express her sexual displeasure other ways, sometimes silently, but in any ease, a message is eventually given and received that sexual failure is not surprising; it is only one more item added to the already great list of frustrations in this manipulative-passive relationship where both spouses are angry with each other—one actively—one passively.
In treating sexual problems having elements of both anger and anxiety in their development, it is generally a waste of time to (1) do sexual anxiety deconditioning without resolving the anger produced in this manipulative-passive relationship; or (2) to simply teach the couple how to effectively live with each other without treating the anxiety-produced sexual failure. If one is done without the other, it is likely that the anger component will induce further sexual failure, starting the whole process over again, or the untreated sexual anxiety component may preclude future sex; a condition likely to reevoke rational angry feelings from both partners over sexual frustration that may be very difficult to cope with without destroying the marriage. Using the mixed model, it is imperative to treat both components of the sexual problem, feelings of anger from and about the spouse, and feelings of anxiety about sexual performance.
Some therapists, like Dr. Masters and Dr. Wolpe, point out that it may be impossible to treat the sexual anxiety component in such cases without dealing first with the anger component if it is very pronounced. Using descriptions like lack of caring and sabotage of sexual therapy to talk about the anger component, their experience in such cases parallels my own, and I agree with their warning. Conjoint sexual therapy using a mixed model is difficult, if not impossible to do without replacing under-the-table manipulation with straightforward assertive communication, without replacing hidden anger with nondefensive, assertive statements of emotion.
With this prologue, let’s turn to the teaching of assertiveness in sexual matters to show how being assertive
can help in coping with sexual naïveté and sexual problems, but also to show that the assertiveness used in working out sexual conflicts in close relationships is basically no different from the assertiveness used to resolve other problems in that same relationship.
In teaching people to openly and assertively talk to their mates about what they want sexually and to evolve some compromise between them, I give them several actual examples to work with. These are sexual problems that other learners (or patients) have dealt with previously—we discuss how these often delicate and sometimes embarrassing problems can be handled. Some of these learners were married, some living together, some unattached and only dating or having extramarital affairs. In all of these actual conflict situations, one partner of each pair was dissatisfied with the sexual relationship and the other had either manipulatively or passively resisted any change in the sexual status quo. For some of the “satisfied” sexual partners, there were hidden anxiety agendas which prompted them to resist change. These resistant sexual partners were probably like many people I see in sexual therapy—anxious that any change would expose some sexual “weakness” in them such as sexual ignorance about techniques to please their partners (and themselves), or fear that if their mates who wanted a change expanded their sexual horizons, who knew where such appetites might lead! And could they satisfy these appetites? What were they letting themselves in for? Could they cope if their mates suggested something far out, such as a trio? What would that “kinky” twist do to their own already dimly sensed feelings of jealousy and insecurity when they observed their mates flirting in response to overtures from other possible sexual partners? Would such a change signal the end of their own established sexual relationship—one perhaps not quite yet dull, but certainly secure and ordered? The actual difficulties in expanding sexual horizons with one’s mate that I have observed in both clinical and teaching settings are probably not statistically representative of the general population; even so, these examples (a few of
which are presented here) provide assertive learners with a sample of situations that they can use to practice being more assertive when communicating their sexual wants.
In describing the sexual wants that many couples have trouble communicating about, I lump all the difficulties together as if I were talking about only one pair of unfortunate hypothetical lovers, Jack and Jill, who have a host of complaints about their sex life. As always, I have learners start out with the simplest sexual request such as wanting a variation from the “missionary” position, and then given the examples of actual complaints, to build upon them by letting their imaginations run wild with the most erotic fantasies. I suggest this learning procedure to them as a way to provide some “safe” experience and social exposure that may help reduce their anxieties by talking about their sexuality and sexual wants first with someone they are not close to and have no great personal investment in. This procedure also produces tears of laughter for some learners, a condition in which anxiety-induced inhibitions wither away and die. As you can see in the following dialogues, a request for sexual change is linked exclusively to neither male nor female sexuality. During the assertive verbal rehearsals, I have the learners make Jack the dissatisfied mate who wants some things changed in his sexual relationship with Jill, who then manipulatively resists because of her feelings of sexual insecurity. Alternatively, in another conflict situation, I have the learners make Jill the assertive prompter and Jack the resister. The following dialogues are short, edited versions of rehearsals between assertive learners communicating their sexual wants to each other. Not surprisingly, these practices produced some of the same end compromises worked out by previous learners in reporting their own real-life experiences. Note that in these close, equal relationship dialogues, late in the training of learners, the stereotyped language of the assertive verbal skills, which was stressed in earlier dialogues, has been adapted to fit the learner’s own speaking style. Although quite a bit of “regular” language
goes on to give information to one another, the verbal skills, however personalized, are still used when conflict arises in the situation.