Typically, the couple will not go to any therapist until the situation has become very painful. Up to that point, contending with change has seemed too much of a threat. Once in sex therapy the experienced married couple exhibits the same sabotaging behavior and fears of desertion as the young married couple does. Further, the experienced marrieds are much more likely than the young marrieds to have had extramarital affairs. In a sense, they covertly have left the relationship already.
Sometimes one has an affair in order to obtain the sexual (and other) satisfactions missing in the marriage, but often the purpose is to retaliate for the injuries, real or imagined, or to alert the partner that the marriage has reached the breaking point.
In two ways, the extramarital affair can at least temporarily assist the marriage. When it is done in order to obtain otherwise unavailable gratification, it can help that partner to be more generally content and better able to tolerate the other stresses in the family. Clearly, when the unfaithful partner deliberately allows the other to learn of the affair (one man phoned his lover from his home, knowing that his wife usually listened to his conversations on an extension phone), it is a signal that the relationship has become too dysfunctional to be tolerated, and a stimulus for change. Often it is the last stimulus for change before a permanent separation.
Although the early problems of the dysfunctional, experienced married couple may not have been sexual in nature, sooner or later (usually sooner) they reach the sexual sphere. A sexual dysfunction appears or becomes aggravated, or the sex life of the couple begins to suffer in one way or another. From that point on, as with the young married dyad, the experienced married couple usually identifies the sexual problem as the core problem. Although in an etiological sense this may not be true, the therapist may take advantage of this belief by starting sex therapy as early as possible (if hostility between the couple has not progressed too far). With the experienced married couples, the most dramatic extrasexual effects of sex therapy are encountered. Like most couples, they have begun their relationship by being in love and over a period of time have seen all or most of their positive feelings for each other change to or become over-laden with tension, hostility, distrust, resentment, and defensiveness, until they seem to themselves to be trapped in a situation at once intolerable and unchangeable. As sex therapy proceeds and as the initial and intermediate results bring both partners not only new sexual satisfaction but also new ways of relating, the incrustation of negative feelings and habits begins to drop off, and the couple experiences again the initial feelings of love, trust, and excitement. Whether or not other problems remain, and usually they do, this recaptured early ardor is almost always enough to propel them through those problems with eagerness and hope.
Of all the types of dyads or couples who come into sex therapy, the quickest and smoothest progress is often made by the experienced unmarried dyad or newly remarried. Usually but not always, these two people have been married before, care about each other, and are committed to a long-term relationship, usually remarriage. Resolved not to repeat the mistakes of the past, they also have learned how to help their partner avoid falling into old, painful patterns.
One middle-aged couple had just been married to each other, the second marriage for both. The presenting symptom was secondary impotence in the man. During their courtship he occasionally had experienced secondary impotence, but after their marriage it seemed to have become permanent. The man suggested to the woman that she see other men for sexual satisfaction, a clear regression to an earlier mode of coping with anxiety. The woman flatly refused and insisted that they go into sex therapy together. Within four sessions, with the wife’s full cooperation every step of the way, the secondary impotence was cleared up.
Although the rapidity of this cure was unusual, the general outlines of the case are not. The experienced unmarried couple, or the experienced newly married, are very promising candidates for sex therapy.
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