CC18 Workshop 03 - Sex! - Stan Tatkin, PsyD, MFT

Description:

Perhaps the single most discussed issue in couple therapy is sex. This two-hour workshop will lead clinicians through a series of interviewing techniques for examining sexual problems in couples. These techniques include questions to ask, assessment of explicit and implicit somatic answers, and other strategic, bottom- up methods for getting to the crux of the matter. We will also cover typical difficulties many therapists have with frank sexual questioning. We’ll examine attach- ment organization, arousal regulation, and neurobiological issues surrounding sexual dysfunction and sexual dissatisfaction. Attendees will gain valuable information on how to uncover the psychobiological underpinnings of sexual concerns as well as interventions for working with sex in couple therapy.

Educational Objectives:

1. List at least three sexual issues common to insecure avoidant partners.
2. List at least three brain regions known to cause disturbances in sexual performance.
3. Describe at least two interventions for working with sexual dissatisfaction among partners.

*Sessions may be edited for content and to preserve confidentiality*

Outline:

Workshop Overview

• Focus: Neurobiological involvement in sex; catching clients "in the act" through behavior over words.

• Goal: Understand couples’ comfort with sex and explore deal breakers and hidden dynamics.

Assessing Sexual Comfort

• Cover sexual issues lightly in early sessions to gauge comfort.

• Therapists must be skilled and comfortable discussing sensitive topics (e.g., sex, suicide).

• Pay attention to “near senses” (smell, touch, taste, near vision), which often hold deep emotional associations.

Understanding the Brain and Recognition

• The “automatic brain” fills in gaps based on memory and habit.

• Misinterpretation is common; therapists should cross-check and corroborate.

• Gather full sexual, medication, and health history for context.

Challenging Myths and Norms

• Address cultural myths (e.g., men always get bored, simultaneous orgasm = success).

• Question assumptions around monogamy; help couples define their own rules.

• Prefrontal cortex plays a role in sexual performance anxiety.

Attachment and Arousal Regulation

• Four regulation styles: auto, external, self, interactive.

• High arousal = quick libido and rage; low arousal = anxious, withdrawn.

• Attachment theory = about safety, not personality or sex.

Interviewing Techniques

• Use cross-questioning and observation to explore dynamics.

• Look for facial expressions, body movements, tone shifts.

• Stay curious, adaptable, and nimble in sessions.

Addressing Deal Breakers

• Confront major and minor deal breakers directly.

• Use interview demos to explore conflicting desires (e.g., monogamy vs. openness).

• Near senses and visual processing pathways impact perception of attraction and safety.

Non-Verbal Cues and Deception

• Read facial tension, microexpressions, and body language.

• Verify narratives through behavioral evidence, not just words.

• Live demos illustrate how to observe and intervene in real time.

Sexual Preferences and Body Image

• Explore preferences and discomforts (e.g., oral sex, swallowing).

• Use humor to ease tension and foster openness.

• Identify what each partner enjoys or avoids, and why.

Communication During Sex

• Track how couples talk during sex (e.g., dirty talk, silence).

• Note “revving up” language, which may suggest addiction or compulsive behavior.

Dysfunction and Addiction

• Distinguish between occasional masturbation and compulsive sexual behavior.

• Consider underlying issues like trauma or personality disorders.

• Manage therapist countertransference and biases.

Therapeutic Staging

• Create reenactments to understand clients’ patterns.

• Control environment and roles to foster insight and emotional safety.

Scenario Analysis

• Focus on clients’ body language, self-consciousness, and openness.

• Encourage mutual understanding and relaxation through role play.

Exploring History and Trauma

• Trace behavior back to earlier experiences or trauma.

• Avoid premature conclusions—dig deeper with open-ended questions.

Working with Deal Breakers

• Help couples explore core values and boundaries (e.g., exclusivity).

• Use structured argument and debate to reach clarity and resolution.

Enhancing Non-Verbal Awareness

• Train clients to notice their own non-verbal communication.

• Use mirrors, video, or therapist feedback to highlight patterns.

Addressing Trauma

• Explore how trauma affects intimacy and sexual behavior.

• Use staging and emotional safety tools to process trauma collaboratively.

Therapeutic Collaboration

• Ensure clients feel heard, respected, and safe.

• Therapist should model humility and openness.

• Work together with clients toward clear goals and relational growth.