Relationship and Sexual Problems
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At the core of cognitive behavioural psychotherapy is the idea that automatic thoughts are ideas that we, come spontaneously, and seem plausible to are often be associated with negative feelings about your self, your relationship and your partner in distressed couples. Automatic thoughts, however, are only thoughts and they may or may not be true.
Labeling you attribute a negative personality trait to your spouse leading you to believe that he or she can never change. “He's/she is aggressive” “she's/he is neurotic” “He/she is lazy”
Fortune-telling you forecast the future and predict that things will never get better, leaving you felling helpless and hopeless. “She/He'll never change” “I'll always be unhappy in my marriage/relationship.”
Mind-reading you interpret the motivations of your spouse as hostile or selfish on the basis of very little evidence. “You don't care how I feel” “You're saying that because you're trying to get back at me” “You don't really mean what you are saying.”
Catastrophic thinking you treat conflict or problems as if they indicate that the world has ended or that your marriage is awful. “It's awful that we have these arguments” “I can't stand her nagging” “It's awful that we haven't had sex recently.”
Emotional reasoning you feel depressed and anxious and you conclude that your emotions indicate that your marriage is a failure. “We must have a terrible marriage because I'm unhappy.” “I don't have the same feelings toward him that I used to — therefore we're no longer in love.”
Negative filter you focus on the few negative experiences in your relationship and fail to recognise or recall the positives. You probably bring up past history in a series of complaints that sounds like you're putting your spouse on trial. “You were rude toward me last week.” “You talked to that other person and ignored me entirely.”
All or nothing thinking you describe your interactions as being all good or all bad without examining the possibility that some experiences with your spouse are positive. “You're never kind toward me.” “You never show affection.” “You're always negative.”
Discounting the positive you may recognise the positives that do exist, but you disregard them by saying — “that's what a wife or husband should do.” “Well, so what that he did that — it means nothing” “these are trivial things that you're talking about”
Perfectionism you hold up a standard for a relationship that is unrealistically high and then compare your relationship to this standard. “It's not like it was in the first year — so it's not worth it” “my wife (husband) should make me happy all the time.”
Shoulds you have a list of “commandments” about your relationship and condemn yourself (when you're depressed) or your spouse (when you're angry) for not living up to your shoulds. “My spouse should always know what I want without my asking” “If my spouse doesn't do what I want her (him) to do I should punish her (him).” “I shouldn't ever be unhappy (bored, angry, etc.) With my spouse.” “I shouldn't have to work at a relationship — it should come naturally.” “Our sex life should always be fantastic.”
Personalising you attribute your partner's moods and behaviour to something about yourself or you take all the blame for the problems. “He's in a bad mood because of me.” “If it weren't for me, we wouldn't have any of these problems.”
Externalisation of responsibility you believe that all the problems in the relationships are out of your control. “If it weren't for her, we wouldn't have these problems.” “He argues with me, that's why we can't get along.”
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In cognitive behavioural psychotherapy your therapist can help you learn to recognise the thinking that is helping to maintain the distress in your relationship and then coach you in strategies for changing the most unhelpful aspects. You will also learn how to act differently in your relationship so that both of you can experience greater rewards and importantly be able to accept and recognise the rewards without discounting them. Wide ranges of techniques are used with cognitive behavioural psychotherapy. Some of the techniques that you may learn about are:
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Identify your automatic thoughts when you are angry, anxious or sad. What are the advantages and disadvantages to your thought?
What cognitive distortions (errors in thinking or reasoning are you using?
What if your thought is true--what if your spouse is not paying attention to you — why does that bother you?
What is the evidence for your thinking? For example, if you label your spouse as unloving, is there any evidence for and against this label?
What are the underlying assumptions? Your “should” statements? What are the advantages and disadvantages of your assumptions?
If you had a friend who had this problem, what would you advise them to do?
Are there less negative explanations for your partner's behaviour?
What is your role in the conflict? Do you provoke? Do you ignore his/her positives? What alternative adaptive behaviour could you use in the future?
You may think that what has happened is awful. Think about what happened along a continuum — what could be worse? Are you looking at things out of proportion to what they are?
What could you do to correct the situation in the future?
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Rules for arguing — Learning how to avoid arguments are disruptive and unproductive. That doesn't mean that you should never disagree with your spouse. However, if you and your spouse are going to get the most out of your disagreements, it would be useful to develop some ground rules for your arguments.
Rewards — Learning how to positively change each other behaviour and regulate ones own behaviour. giving each other positive or balanced feedback, undertaking mutually enjoyable activities, praise, recognition of each others contributions, gifts, self reinforcement.
Communication — Learning how to effectively listen to each other and understand issues from your partners perspective, learning how to be attentive, understanding and empathic.
Problem Solving — Learning about and how to generate and solutions and solve problems that my seem insoluble.
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Minor worries or concerns about sex are a very pervasive problem and so are real sexual problems. People often put up with sexual problems for many years or never seek help due to embarrassment or feeling of failure. This is unfortunate because many people can be helped to overcome such problems.
Painful intercourse or vaginismus — spasm of the muscles around the vagina.
Anorgasmia (an inability to reach orgasm, although not everybody can be expected to reach orgasm each time they have sex)Lack of sexual skills
Failure of erection (impotence)
Premature ejaculation
Failure of ejaculation
Principles of treatment
Cognitive behavioural psychotherapists must rule out sexual problems that are secondary to other causes. This is because reduced sexual interest or performance can occur with depression, diabetes, drug & alcohol abuse or be a side effective of some times of medication. Your therapist will ask you about each of these areas and may ask you to see your GP for assessment to check that everything is as it should be physically.
The mainstay of treatment for sexual difficulties is graded practice to help people to overcome their sexual problems very much in the same way as other anxieties. But in addition to overcoming fears couples also need to learn how to have enjoyable sex, this will take time to develop but with couples willing to work at overcoming their problems this is usually effective. Specific techniques are also available to help each of the problems listed above. Your therapist will outline which techniques they think might best help you and explain how you might put these into practice. To get started reading a reputable book about sex, which includes pictures of the genitals and people having sexual intercourse in different positions. Reading this book with your partner and discussing your problems in light of what you have learned can be a useful starting point for many couples. -
Sometimes one or more partners may also be depressed be anxious or have some other mental health or behavioural difficulties. These may be contributing to the relationship problem or have lead to the relationship distress in the first place. Your cognitive behavioural psychotherapist will carry out an assessment of any such problems and either help you to work on these problems or advise you here to seek out appropriate assistance.
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Relationship and sexual problems are many times more effectively dealt with if both partners attend therapy sessions. Most problems can be helped with two willing and co-operative partners. A wide variety of techniques are used to improve the distress of couples by cognitive behavioural psychotherapists. Ruling out physical problems for sexual problems is also important. If this is a direction that you want to take, you may discover things about yourself and those close to you that will allow for a better, happier and more fulfilling home life.
Beck, A.T. (1988) Love is Never Enough. Harper and Row. New York.
Marks, I.M. (2001) Living with Fear. McGraw Hill. Maidenhead.
Comfort, A (1974) The Joy of Sex. Simon and Schuster. New York.