Complex Couples: Multi‐Theoretical Couples Counselling with Traumatised Adults Who have a History of Child Sexual Abuse

One of the major ways child sexual abuse can have an impact on individuals is in their later ability to have and maintain fulfilling couple relationships. Survivors may experience avoidance behaviours that become problematic in their adult intimate relationships. If couple therapists fail to focus on these traumatic imprints, the therapy may founder. This paper proposes that a multi‐theoretical approach enables the couple therapist to deal with the complex problems such couples present including sexuality and intimacy concerns. Such an approach integrates trauma theory, attachment theory, feminist principles, body‐oriented psychotherapy, and systemic couple therapy.     

Moments in Laplanche's Theory of Sexuality

This paper is a brief introduction to some of Laplanche's thinking, as well as a commentary on his essay that is published here. Some salient issues in Laplanche's theory are introduced, such as the decentering of the subject and the prioritizing of the other, the postulation of the “reality of the message,” in which gestures from the other both signify and excite/seduce, and an enlarged meaning of seduction. The child's translation of the enigmatic messages conveyed by the adult is a process of being seduced into building interiority and subjectivity. In effect, the present paper proposes not only that “otherness” constitutes the subject, but that an “asymmetrical intersubjectivity” is what enables the transition from instinct to drive and the creation of paradoxical human sexuality. In a meditation that illuminates significant issues in American feminist and psychoanalytic theory, Laplanche's essay analyzes and distinguishes three interrelated terms, gender, sex, and “the sexual” (“le sexual”), or so-called “infantile sexuality”, the latter documenting a Freudian and French emphasis on an additional, counter-realistic, counter-adaptational, and counter-social conception of sexuality. What stands out in this paper no less than “le sexual” is the use of the term “gender” by a French psychoanalyst, who is at once nodding in acknowledgment to contemporary American thinking, and enlisting the concept of gender to reaffirm its “intimate enemy,” infantile sexuality, “le sexual.” Laplanche sees the American-conceived couple sex/gender as a “formidable tool against the Freudian discovery.” Formidableness is what is common to gender and to infantile sexuality, in that both concepts resist and destroy the clear-cut biological/anatomical “destiny” of sex. Both pertain to cultural/acquired/constructed aspects of sexuality; both are phantasmatic and both subvert sexual role divisions. But gender is organized by, hence possibly subordinate to, sex. Laplanche acknowledges gender yet at the same time he makes it dependent on sexuality and thereby “downgrades” it in favor of the inarticulate, perverse, subversive, untameable aspect of human sexuality—“le sexual”, infantile sexuality—which remains outside and in excess of gender.     

SPEAKING OF BODIES,PLEASURES, AND PARADISE LOST: EROTIC AGENCY AND SITUATIONIST ETHNOGRAPHY

This ethnographic account of a love story of two elite-level bodybuilders addresses the ways in which broad cultural histories are relevant to understanding contemporarily situated problematics of sex and sexual identity. Specifically I argue that strategically placed historical and cross-cultural studies are useful in understanding in this context how: (1) subjects are configured as gendered, sexed, and sexually-oriented; (2) subjects make love; and (3) attempts to remake love outside the episteme of sexuality are confined. The love story, configured as a ‘paradise lost’ narrative, provides evidence suggesting that the occularcentric and muscularcentric practices of bodybuilding within this specific setting combined to offer the featured couple the material grounds upon which to venture temporarily beyond the pleasures circumscribed by the historical shift in subjectivity associated with Modernity. I conclude the piece by looking to the 1960's European revolutionary aesthetic movement of the Situationists to suggest how a ‘situationist ethnography’ might be used to create conditions of possibility for progressive work in the area of sexuality.     

An Attachment Primer for Couple Therapists: Research and Clinical Implications

According to attachment theory, humans are relational beings and even a child's earliest experiences with caregivers have a profound effect on emotional development and an overall approach to relationships. With increasing regularity, couple therapy has utilized attachment language as a conceptual tool, but more work is needed to understand the full clinical implications of attachment theory. These include understanding the intergenerational nature of attachment and adapting the delivery, timing, and pace of interventions to client attachment strategies. In this article, we summarize the origins of attachment theory, its measurement, the role of attachment in couple relationships, attachment stability and change, and ways that attachment informs therapy process and intervention. We hope that this article will provide an impetus for couple therapists to expand their conceptualization and use of attachment in their clinical work and for couple researchers to conduct more clinically relevant, attachment‐oriented process research.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

Medicalizations and demedicalizations of sexuality therapies

This article complicates recent discussions about the expanding zones and influences of medicalization and biomedicalization on sexuality and sex therapy by contextualizing them with competing nonmedicalizing trends. These latter developments include an escalating nonexpert commercial sexuality sector on the Internet, as well as a long history of anarchic and democratizing social politics, such as "the counterculture" and "free love movements." What these nonmedicalizing trends have in common is the view of sexual problems and solutions as far broader than sexual dysfunctions and sex therapies, a belief in the social determinants of individuals' sexual experiences, and a deep concern regarding the socially harmful consequences of medicalization. With the quantity of sexuality information and advice available to the public through the Internet only likely to expand, a long era of clashing claims about relations between sexuality and health and about the role of expertise in sexual life can be foreseen.     

Close relationships research: a resource for couple and family therapists

This article describes the relatively new field of close relationships research, offering a representative list of topics studied by relationship researchers. Some of the common interests shared by both close relationships researchers and couple and family therapists are described, with the shared emphasis on relationships as an anchor for both fields. Some representative love theories are discussed, and Love Styles theory and research are presented in considerable detail. A clinical case example indicates how love styles research may be employed to advantage by couple therapists, and the utility of other close relationships theories and measures for therapy is briefly discussed.     

The Influence of Attachment Styles on Sexual Communication Behavior

Attachment theory is one of the major theoretical frameworks for understanding romantic relationships. Attachment styles are formed through interactions with caregivers and shape an individual’s expectations of subsequent interpersonal relationships. In this study, we examined how attachment styles influence participants’ ability to communicate with their partners about problems in their sexual relationship. A community sample of 81 couples engaged in two video-recorded discussions, one representing an aspect of the couple’s sexual relationship where the male partner wanted change and the second representing an aspect of the sexual relationship where the female partner wanted change. Conversations were then coded, with each person being rated on three positive communication dimensions (positive affect, offering solutions, and responsiveness) and three negative communication dimensions (hostility, negative affect, and unskilled communication behaviors). As predicted, attachment avoidance was related to more negative and less positive communication for both the individual and his or her partner. Our observational data did not reveal any significant effects of attachment anxiety on sexual communication. These results can be contrasted with findings from self-report studies that do suggest an anxious attachment adversely impacts sexual communication.     

Emotionally Focused Therapy for Couples and Attachment Theory

Emotionally focused therapy for couples (EFTC) is an important framework for couples therapy. It provides an integrative model, drawing upon experiential, systems and attachment theory to understand the dynamics of the couple relationship and to describe the therapeutic process. The aim of this paper is to ask how EFTC uses attachment theory, and whether it draws as fully as it can upon the richness of that theory to inform the process of therapy. This is set in the context of the evolving importance of attachment theory for therapeutic work.     

Enactments in Emotionally Focused Couple Therapy: Shaping Moments of Contact and Change

Emotionally focused couple therapy (EFT) uses enactments to shape responsive attachment‐significant contact and to change couple interaction. In this article, we show how EFT enactments differ from enactments in other therapy approaches, present a theory of EFT enactments, a model for creating EFT enactments, and an extended case example of an EFT enactment. Video Abstract     

Confronting Anxiety in Couple and Family Therapy Supervision: A Developmental Supervisory Model Based on Attachment Theory

Referencing relevant supervisory literature and attachment theory, this article presents a developmental couple and family therapy supervisory model that emphasises the efficacy of the supervisory relationship. Issues concerning anxiety, cognition and learning theory are addressed and phases in the supervisory process are identified and described. Cognitive, emotional and social development are linked to attachment theory and discussed in the supervisory context.     

Predicting Change in Marital Satisfaction Throughout Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. EFT is recognized as one of the most effective approaches to couple therapy, but to guide therapists in their use of EFT, a theoretically based model to predict change is needed. This study tested such a model by recruiting 32 couples, and 14 therapists who provided approximately 21 sessions of EFT. Couples completed self‐report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre‐ and posttherapy and after each therapy session. Results of hierarchical linear modeling suggested that individuals higher on self‐report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction across EFT sessions. Assessing attachment security at the start of therapy will inform therapists of the emotion regulating strategies used by couples and may help couples achieve positive outcomes from EFT.     

Passion,Intimacy, and Commitment in Casual Sexual Relationships in a Canadian Sample of Emerging Adults

Research on casual sexual relationships (CSRs) among emerging adults is prevalent, yet our empirical and theoretical knowledge of relationship processes involved in these relationships is limited. The present study’s objective was to compare four CSR partner types (acquaintance, friend, non-dating partner, ex-romantic partner) on passion, intimacy, and commitment, the components of Sternberg’s triangular theory of love. A total of 441 Canadians aged 18–25 years who were not in a romantic relationship, and who reported having had more than one sexual contact with their last CSR partner, completed an online survey. Across all partner types, passion was highest, followed by intimacy and commitment. Levels of passion, intimacy, and commitment generally increased with partner familiarity. However, CSR partner type differences on the three components were partially explained by CSR components (i.e., frequency of sexual activity, frequency of social activity, whether partners saw each other with the main goal of having sex, sexual exclusivity agreement, and hopes about the relationship). Results are consistent with CSRs’ emphasis on sexuality, and, to a lesser extent, emotions. However, they challenge the mainstream and scientific conflation of CSRs with an absence of emotional bond, commitment, or love.     

‘I myself had a sweetie …’: re‐thinking female same‐sex intimacy beyond the institution of marriage and identity politics

This article is understood as an intervention into current debates around the question of rights in relation to sexuality and in particular to issues of same‐sex marriages and alternative family structures. As the interpretation of rights in relation to sexuality generally focuses on gay identities, this article reflects on the effects of these discourses on non‐normative modes of sexuality and intimacy. More specifically the article focuses on interviews conducted in Johannesburg on ‘mummy–baby’ relationships. By contextualising these relationships in the historical and cultural framework of sexual cultures and cultures of intimacy, this article argues that the South African history and cultures provided and provide a space which accommodates forms of female same‐sex intimacy that are not necessarily linked to metropolitan sexual cultures. The article discusses the tensions between non‐lesbian same‐sex intimacy and metropolitan lesbianism by focusing on homosociality as a gender theory. The article questions the regulatory functions of identity and problematises the practice of ‘coming out’ as always being a liberating moment.     

Facilitated Sex and the Concept of Sexual Need: disabled students and their personal assistants

This paper explores the complex issue of facilitated sex, an issue that has received very little attention by the disability movement. It draws on a small, qualitative study of a personal assistance scheme in a British University, and on interviews and correspondence with disabled students and personal assistants. The paper discusses the way in which disabled students define their sexuality as a 'need', but highlights how this view is not shared by those providing assistance. Personal assistants are more inclined to define sexuality as a sexual 'want' and to conflate physical impairment with either asexuality or a limited potential for sexual activity. The discussion concludes by suggesting that, whilst the issue of facilitated sex is morally complex, the sexual needs of disabled people are more likely to be met if the issues of sexuality and facilitated sex can be discussed and negotiated, in a frank and open manner.     

What women talk about. Sexuality issues of chemically dependent women

1. In group discussions on sexuality, the topics discussed most often by recovering chemically dependent women were incest and sexual child abuse; rape; sex while sober; values regarding sex; battering; women's health concerns; and coping strategies. 2. Addressing sexuality in an unstructured format allows the women time to deal with these issues as they are able, since strong emotions are evoked. 3. The group leader needs to be knowledgeable about sexuality and be comfortable with explicit sexual and abuse talk.