REDUCE PARANOIA
Avoidants can become less suspicious of others by countering dis-tortive empathy, a process where they jump to the conclusion that others are judging them negatively because they assume that others are using the very same rigid, unfair, and excessively self-punitive yardsticks avoidants use to judge themselves.
DO AN EVIDENCE-BASED SELF-STUDY
Therapists should encourage avoidants to make a two-column list where they identify their positive features in column A and inscribe these beside the negative features they go on to document in column B—then do the math to see if, overall, they are “OK as is” and, if not, see what they can do to develop a more balanced, more positive self-view, one they newly create and maintain independent of what others seem to, or actually do, think about them. Avoidants who do this remedial exercise often collaterally decrease their need for impression management as they stop grading themselves based on what they believe others are thinking about and how others are responding to them. Instead, they develop internal strong, independent, unvarying self-standards that allow them to view themselves as viable individuals after asking themselves not “do I have what he or she expects of me?” but “do I think well of myself?” Now they refuse to calculate their self-worth entirely by what they assume their reputation to be with others. As a result, they start finding strength and self-approval from where it counts: mostly, or even entirely, from within.
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CHAPTER 19
Treating Sexual Avoidance: A n O verview
Treatment of sexual avoidance consists of an approach that I call “sexual avoidance reduction.” This approach involves a combination of psychodynamic, cognitive-behavioral, interpersonal, educational, and pharmacotherapeutic therapies. The goals are to generate improved performance indirectly through understanding the problem, in particular, relieving sexual inhibitions by reducing inhibitory responses, and to generate improved performance directly through learning the sexual “ropes” (“sexual skills training”), ideally enhancing motivation (the will to act) and increasing emotional expressiveness by reviving desire, improving confidence, and resolving conflict. Here presented in outline form for easy access and maximal utility are the main components of sexual avoidance reduction.
TECHNIQUES
Partner Involving: Prevention
Sexual avoidance between partners can often be prevented by making a good match in the first place. Thus a man with a Madonna complex is well suited to a woman who is Madonna-like. Men and women who are gay need to admit it to themselves as soon as possible to avoid trying to succeed heterosexually, losing valuable time, getting into a failed marriage, and harming their partners by promising them more than they can deliver.
A Case Example
After a few years of marriage, the husband of one of my patients moved out of their shared bedroom permanently. Initially, his wife had pushed for marriage and he had acquiesced, although he really wanted to be a priest. His telling her exactly that when they first met should have given her a hint of what was to come, but she had had a very sheltered upbringing and knew nothing about such matters. She wished she knew that the husband’s disinterest in her sexually was not a fixable thing, but she was too young to realize that, and she just assumed that he wasn’t attracted to her as an individual—because something was wrong not with him sexually, but with her personally. Therefore she concluded that repairs could be easily made if only she somehow took some action.
Stimulation Enhancing
Sexual avoidants need to identify the location of, and learn ways to stimulate, the erogenous zones. Sexual avoidants can learn about the mechanics of better sex through the use of sex manuals. Learning the principles of intimacy is different, and more complex, but it can be done through therapy or by using the many good intimacy guides readily available in bookstores such as books on the topic of “how to get closer.”
Guilt Reducing
Sex education has a collateral effect: reducing guilt by implying approval of the thing being taught. For sex education, among other things, effectively gives the individual permission to feel sexual and actually have sex. Sexual phobias respond especially well to permission giving through sex education. Its healing mantras stick with the learner, countering negative inhibitions by undoing negative parental and societal messages that have been internalized and crop up at the most inconvenient moments to intrude into and disrupt one’s bedroom activities.
Insight Developing
Improved performance can come from understanding the psychodynamics of sexual avoidance, particularly the role played in sexual conflict by the inhibitory factors discussed throughout. Therapists can impart this understanding through psychodynamically oriented therapy, for example, by analyzing masturbatory fantasies and transference distortions and through interpersonal treatment focused on how dyadic relationship problems express themselves sexually. Sexual avoidants can, on their own, use the dynamic formulations found throughout this book to help emerge from those destructive intrapersonal and interpersonal inhibitions that keep them in, or force them back into, their sexual cocoons.
A Case Example
A patient with multiple sexual performance difficulties was often unable to get an erection. If he got one, he would soon lose it. If he kept it for any length of time, he would sometimes experience premature ejaculation and sometimes suffer from ejaculatio tarda.
Through therapy, we discovered that his sexual symptoms were partly his (unconscious) way to tell his fiancée that he wasn’t planning to marry her or anyone else. Speaking of his trip to visit his fiancée in a foreign country, he said, “I never had an orgasm the whole time I was there. That’s because I wanted to let her know that she was getting too attached to me, and so I can’t go back to Europe for she has already planned a life for us when I return. As I always say, ‘If I want sex, I’ll find sex,’ but who needs a relationship for that?”
His sexual inhibitions were also a product of his intense fears of connecting and committing arising out of a conviction that being tender with a woman signified merging the intimate and sexual feelings he longed to keep separate. For being tender meant becoming feminine and sissified as well as inevitably being swallowed up by women to the point of losing his identity. Coming to orgasm meant yielding, and yielding meant becoming vulnerable to a woman’s hurting him— the wages of his sin of letting her up close to him and into his world.
We also learned that his sexual inhibitions were due both to a fear of success and a fear of failure. Erectile and ejaculatory functionality signified success, and success signified vulnerability to loss, and even meant punishment by death. A fear of failure took the form of compulsive self-spectatoring like that due to what the Psychodynamic Diagnostic Manual calls “feeling unsure of [oneself and being] preoccupied and worried about [one’s] general adequacy.”1 So when he was having sex, what went through his mind was, “Boy, she is sexy, and she’s brand-new, and we’re going at it top speed, and I’m almost there, and almost there, and almost there, but, oh boy, I am losing it, and I’ll never get there, and it’s another ruined attempt, and I wanted it to go so well, and what is she going to think of me, and what is going to happen to our relationship, this is awful, she will hate me and never see me again, it’s the end of my world.” As a result, he was unable to just let the sex be and, too focused on whether sex would work, and what was going to happen in the future if it didn’t, he became unable to just enjoy what he was doing in the here and now. For he had made every sexual act into a momentous test of how valuable he was both as a person and as a man, and thus into a commentary on what fate might hold in store for him in the immediate and far distant future.