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Minnesota Psychological Association (MPA) Minneapolis, MN April 25, 2008

Minnesota Psychological Association (MPA) Minneapolis, MN April 25, 2008. The “Good-Enough Sex” Model for Couple Satisfaction. Michael E. Metz, Ph.D. Private Practice, Meta Associates St. Paul, MN USA 651-642-9317 x 107 www.MichaelMetzPhD.com. Presentation Objectives:.

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Minnesota Psychological Association (MPA) Minneapolis, MN April 25, 2008

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  1. Minnesota Psychological Association (MPA)Minneapolis, MN April 25, 2008 The “Good-Enough Sex” Model for Couple Satisfaction. Michael E. Metz, Ph.D. Private Practice, Meta Associates St. Paul, MN USA 651-642-9317 x 107 www.MichaelMetzPhD.com

  2. Presentation Objectives: • Review the model and some support for the “Good-Enough Sex” (GES) model for lifelong couple sexual satisfaction. • A brief summary of the 12 core premises of the GES model -- a GPS for long-term, satisfying sex – with some inferential support / implications.

  3. Who are we and how do we practice? • What % of practice is couple work? • What are the chief complaints? • What % have a sex concern? • Do you consider sex indispensable to assessment? • What % do you lead a sexual history? • What do you do with sexual information? • What is your goal?

  4. Health Perspective… • Sexual problems offer an exceptional opportunity for the helping professional to offer support and to enhance the quality of life of the individual and couple. Few medical or psychological problems so clearly offer the clinician not only the opportunity to relieve distress but also to promote personal and relationship health and satisfaction.

  5. Michael E. Metz, Ph.D.

  6. National Health and Social Life Survey (1994) • Men’s Sexual Complaints(31%): • Premature Ejaculation 1 in 4 28.5 % • Performance Anxiety 1 in 6 17.0 % • Low desire 1 in 6 15.8 % • Erectile Dysfunction 1 in 10 10.4 % • Ejaculatory Inhibition 1 in 11 8.3 % • Sex not pleasurable 1 in 11 8.1 % • Pain with intercourse 1 in 33 3.0 % (N = 1,410, ages 19 – 59)

  7. National Health and Social Life Survey (1994) • Women’s Sexual Complaints(43 %): • Low Desire 1 in 3 33.4% • Inhibited Orgasm 1 in 4 24.1% • Sex not pleasurable 1 in 5 21.2% • Pain with intercourse 1 in 7 14.4% • Performance Anxiety 1 in 10 11.5% • Lubrication trouble 1 in 10 10.4% • Climax too soon 1 in 10 10.3% (N = 1,740, ages 19 – 59)

  8. Perspective on “Great” Sex • The idyllic pursuit of “great” sex is the source of extensive personal dissatisfaction (even agony) and relationship distress. • amplifies fears of inadequacy (e.g., penile & breast augmentations). • predisposes to life-long disappointment. • There is a poignant irony when the pursuit of “great sex” becomes the cause of dissatisfying, dysfunctional sex.

  9. Perspective • The “Good-Enough Sex” (GES) model intends to reposition, balance the cognitive focus away from: • the common cultural and interpersonal expectation that sex should always be “great” & perfect performance; and • the belief that when it is not, it is: • “inadequate” • a symptom of “falling out of love”, or • a flawed relationship.

  10. Basis the “Good-Enough Sex” Model • The Good-Enough Sex model for couple sexual satisfaction is built on a continuummodel (“more” or “less” ) : • an heuristic model (“replicable approach to direct one’s attention”) from enduring features of 40 years of biopsychosocial sex research and therapy; • inferences drawn from multiple empirical studies of couple sexual function and satisfaction (biopsychosocial literature: psychology, sociology, social psychology, marital & family, clinical, biomedical research…). • current clinical observations and outcome experience of a number of “seasoned” marital & sex therapists.

  11. Why Models…? • A model incorporates assumptions about what is important about a problem. • The model will focus a sexual problem as: • positive or negative • individual or couple • Cognitive – emotional – behavioral • The model determines the approach to clinical formulations, treatment goals and objectives, and clinical interventions and “tools.”

  12. Good-Enough Sex Model: Assumptions • Sexual Health is complex & complicated: • developmental & lifelong • multidimensional • multi-causal • multiple effects on the person, partner, their relationship • all dimensions are interactive, correlation variables, not “A  B” or direct cause-effect. • Any approach to sexual health should recognize that sex is inherently relational affecting the emotional life of the couple. • The relevance of an erect penis or sex desire is its role in individual self-esteem & relationship satisfaction.

  13. Good-Enough Sex Model: Assumptions • Comprehensive understanding of sexuality integrates medical, pharmacological, psychological, relationship, and social aspects. • Real-life problems rarely have a simple cause and a simple cure in spite of people’s longing for “quick fixes.” • Clinical practice & theory / research interact and are enriched when embedded in a detailed, comprehensive view of sexual health  not simply function or absence of illness.

  14. Good-Enough Sex Model is Grounded on Integrative Sexual Therapy Comprehensive Biopsychosocial Integrative Sexual Medicine & Sex Therapy  Inevitably facilitates  “Good-Enough Couple Sex”

  15. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  16. Cognitive-Emotional-Behavioral Psychological ComponentsNegative Positive Quality Quality 0 l 25 l 50 l 75 l 100 ___________________________________________________________________________________________________

  17. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  18. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  19. “GREAT SEX…” ? • “GREAT SEX” is • the unlikely alignment of all the stars in the “Great Sex constellation”, • the perfect confluence of the infinity of biopsychosocial dimensions of sex •  The “Great Sex Lottery.” • “GOOD-ENOUGH COUPLE SEX” is: • the couple’s developmental appreciation of the variability of interplay between: • the physiologic, cognitive, behavioral, emotional, relational & psychosexual skills dimensions of sex. • Reality based  “Pretty Good Sex…”

  20. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction • Sex is a good, positive element in life, an invaluable part of an individual’s and couple’s long-term comfort, intimacy, pleasure, and confidence. •  Antithesis: • sexual shame. • Sex negative experiences (e.g., abuse). • Sexual perfectionism.

  21. Sex is a Positive, Good Element in Life • Satisfaction or “happiness” is necessarily subjective and is essentially whatever the individual defines it to be.”(Lyubomirsky, Sheldon & Schkade, 2005)  “meaning.” • The positive role of general and sexual well-being is intentional -- inferences from “Positive Psychology”.

  22. Sex is a Positive, Good Element in Life • “These happy people … • found physical pleasure and emotional satisfaction with their sex lives and, • those who reported themselves more happy also reported far more frequent sex. • (Michael, Gagnon, Laumann, & Kolata, 1994. Sex in America; p.130).

  23. Suggestive Data: Positive Psychology • Seligman, M. E., P., Steen, T. A., Park, N., & Peterson, C., (2005). Positive psychology progress. Empirical validation of interventions,American Psychologist, 60, 410-421. • Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness. The architecture of sustainable change. Review of General Psychology, 9(2) 111-131 • Seligman, M. E. P., & Csikszentmihalyi, M. (Eds.), (2000). Positive psychology(Special Issue).American Psychologist, 55(1). • Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness. The architecture of sustainable change. Review of General Psychology. 2005, 9(2) 111-131

  24. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 2. Relationship & sexualsatisfaction are theultimatedevelopmentalfocus and are essentially intertwined. The couple is an “intimate team” for pursuing daily conflict resolution and mutual satisfaction in each stage in life.

  25. Relationship Conflict • Identification of how couples respond to inevitable areas of conflict … is frequently viewed as a metaphorical “window” through which one can observe how close relationships function. • (Braiker & Kelley, 1979).

  26. Interactive Paths Between Relationship Conflict & Sexual DysfunctionMetz & Epstein, (2002). The Role of Relationship Conflict in Sexual Dysfunction. Journal of Sex & Marital Therapy, 28: 139-164 A. Relationship Conflict as a Cause of Sexual Dysfunction. B. Relationship Conflict as a Consequence of Distress Generated by Sexual Dysfunction. C. Relationship Conflict as a Means to Enhance Emotional and Sexual Intimacy  conflict is the ordinary opportunity for intimacy growth.

  27. Relationship Conflict • Dimensions of Relationship conflicts: • Behavioral oppositions • Emotional alienations • Cognitive discrepancies

  28. Cognitive-Emotional-Behavioral Psychological Components

  29. Cognitive-Behavioral-Emotional (C-B-E)Dimensions of Two Individuals ______________________

  30. Types of Relationship Cognitions:Aaron & Sarah’s Cognitions About Use of Pornography ASSUMPTIONS –> what each believes an individual, relationship and sex actually is like. Sarah: • “Men are unfaithful.” • “Porn is sexist, bad. It is a betrayal of our commitment.” • “All men really want is sex.” Aaron: • “Sex is essential to a marriage.” • “Women use sex to control men.” • “Women are unwilling to understand men as men.”

  31. Types of Relationship Cognitions:Aaron & Sarah’s Cognitions About Use of Pornography STANDARDS what each believes individuals, relationships and sex should be like. Sarah: • “He should invest all of his sexual feelings and energy with me!” • “He should not look at porn.” • “He should not be unfaithful.” Aaron: • “She should not judge me only by a women’s view of men’s sexuality…” • “She should understand, not condemn me…” • “She should want to have sex.”

  32. Types of Relationship Cognitions:Aaron & Sarah’s Cognitions About Use of Pornography PERCEPTION (Selective Attention) what each notices about the partner, the relationship, sex, and the environment. Sarah: • “He avoids me sexually.” • “He looks at other women and finds those women more attractive than me.” Aaron: • “She’s sexually stiff, aloof… prudish…” • “She tired every night and not interested in sex.”

  33. Types of Relationship Cognitions:Aaron & Sarah’s Cognitions About Use of Pornography ATTRIBUTIONS  causal and responsibility explanations for relationship events which serve to increase an individual’s sense of understanding / control over complex events. Sarah: • “He hides masturbation, because he’s a liar. • He’s being unfaithful so he doesn’t love me anymore.” • “He doesn’t care…” Aaron: • “She withholds sex to punish and control me.” • “She’s betrayed me. We had a lot of sex before we were married, but now…? • She doesn’t care.” • “Because she’s so rejecting now, I’m no longer attracted to her.”

  34. Types of Relationship Cognitions:Aaron & Sarah’s Cognitions About Use of Pornography EXPECTANCIES -- predictions of what will occur in the relationship in the future;outcomes or efficacy. Sarah: • “He will do porn again.” • “He will lie to me.” • ”I try but it does no good…” Aaron: • “If I try to explain, she won’t listen to me. She’ll just tell me I’m bad.” • “I will get a reliable erection with pornography…” • “If I just masturbate, I won’t have to deal with her criticism.”

  35. Features of Relationship Satisfaction Sexual health and satisfaction is directly influenced by the quality of relationship conflict resolution. • Metz, M. E., & Epstein, N. (2002). The Role of Relationship Conflict in Sexual Dysfunction. Journal of Sex & Marital Therapy, 28: 139-164.

  36. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction • Realistic, age-appropriate, accurateexpectations of the bio-psycho-social dimensions of sex are essential for sexual satisfaction. • appreciate that media & advertisement exaggerate sex for commercial purposes: ”hype” • expectations vary according to the stages of one’s life and relationship development.

  37. “The problem isn’t that we know too little, but that we know too much that just ain’t so…” • (“Mark Twain”)

  38. Suggestive Data that Sexually Satisfied People are Apparently Realistic • Frank, Anderson, & Rubinstein, (1978). Frequency of Sexual Dysfunction in Normal Couples. NEJM) • Laumann, Gagnon, Michael & Michaels, (1994).The social organization of sexuality. • Byers & Grenier, (2004). Premature or rapid ejaculation: Heterosexual couples perceptions of male ejaculatory behavior. Arch. Sex. Beh., 2003 • Rosser, Metz, Bockting, Buroker, (1997). Sexual difficulties, concerns, and satisfaction in homosexual men. Journal of Sex & Marital Therapy. 23(1), Spr 1997, 61-73.

  39. What is Distinctive About Couples with SD?#1: Community Availability SampleFrank, Anderson, & Rubinstein, (1978). Frequency of Sexual Dysfunction in Normal Couples. NEJM) • Among “normal” (maritally and sexually satisfied) couples, the prevalence of sex performance problems is fairly high: • Sex Dysfunction common: • 40% men & 63% women. • Sex Difficulties high: • 50% men & 77% women. • Yet, 80%+ were maritally & sexually satisfied.

  40. Frequency of Sex Problems of Normal Couples (Frank, Anderson, Rubinstein, 1978, NEJM).

  41. What is Distinctive About Couples with SD?# 2: Representative Community SampleLaumann, Gagnon, Michael, & Michaels, (1994).The social organization of sexuality. • Despite many men and women reporting periods in the past year when they experienced one or another sexual problem, many reported satisfaction with their sex life (p. 373).

  42. Sexual Happiness by Type of Sexual Dysfunction Laumann et al., 1994.

  43. What is Distinctive About Couples with SD?#3: Community Availability SampleByers & Grenier, (2004). Premature or rapid ejaculation: Heterosexual couples perceptions of male ejaculatory behavior. Arch. Sex. Beh., 2003 • Evaluated PE among 150 university alumni couples. • The negative impact of sexual dysfunction is not solely determined by the behavioral performance deficit but rather by the significance to the man and notably to his partner. • Conclusion: “it may be that although partners are dissatisfied with the time of ejaculation, they have developed sexual scripts that allow them to experience sexual pleasure through other forms of stimulation.” (p. 269).

  44. What is Distinctive About Couples with SD?#4: Community Availability SampleRosser, B. R. S.; Metz, M. E.; Bockting, W. O.; Buroker, (1997). Sexual difficulties, concerns, and satisfaction in homosexual men.Journal of Sex & Marital Therapy. 23(1), Spr 1997, 61-73. • A sample of 197 homosexual males (over 18 yrs of age). • Results: Almost all (97%) reported some sexual difficulty over their lifetime, and more than half (52%) reported a current sexual dysfunction. A further 25% of the Ss identified other sexual concerns (e.g., fear of STD). • Despite these figures, most subjects -- whether single, dating, or in a relationship -- reported average to above-average sexual satisfaction.

  45. Such Multiple sources suggest realism… • 30 year old community availability sample (Frank et al, 1978) • recent (1994) U.S. representative sample (Laumann et al. 1994) • specific sex dysfunction (PE) couple availability sample (Byers & Grenier, 2004) • same-sex availability sample (simon et al, 1997).

  46. NHSL: Frequency of Sex • 33% of Americans aged 18 to 59 have sex with a partner as often as twice a week: • 1/3rd = >2x week. • 1/3rd = a few times a month. • 1/3rd = a few times a year.

  47. “Sex in America” (NHSL) Findings • “The general picture of sex with a partner in America shows that Americans do not have a secret life of abundant sex.” (p. 122) • “Once again contradicting the common view of marriage as dull and routine, the people who reported being the most physically pleased and emotional satisfied were the married couples.” (p. 124) • Virtually all the people who were happy in general also said they were happy with their sex lives.”(p. 130)

  48. The Crucial Variable for Sex Satisfaction: Reasonable, Age-Appropriate Expectations • The indispensable variable in sexual satisfaction is the “meaning” (cognitive dimension) of the sexual interaction (behavior) for the individual and the couple. • Couples “blend” sexual meanings as a “intimate team.” • Realistic, accurate, age-appropriate expectations are crucial • because this “meaning” essentially distinguishes satisfied vs. dissatisfied / dysfunctional couples. • Acceptance of sexual variability: “not perfect”.

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