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SSSS 2011 Annual Conference Houston, Texas, USA November 3-6, 2011 Coming Together: Integrating Sexuality, Theory, Research, Coming Together: Integrating.

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1 SSSS 2011 Annual Conference Houston, Texas, USA November 3-6, 2011 Coming Together: Integrating Sexuality, Theory, Research, Coming Together: Integrating Sexuality, Theory, Research, and Practice. and Practice.

2 Society for the Scientific Study of Sexuality 2011 Annual Conference Houston, Texas, USA November 3-6, 2011 FEATURES OF ENDURING DESIRE AND SATISFYING COUPLE SEX Michael E. Metz, Ph.D. Meta Associates 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 www.MichaelMetzPhD.com

3 Workshop “business” Slides and clinical handouts:  available on my website at:  www.MichaelMetzPhD.com  “Resources”, “Workshop slides”, “SSSS”. Books: Metz books and other recommended books on Metz website: “books” and “bookstore”. “Enduring Desire” book: flyers available at the back of the room.

4 What is EVIDENCE BASED PRACTICE (EBP)?

5 What is EVIDENCE BASED PRACTICE (EBP)? 1. (APA Policy Statement on Evidence-Based Practice in Psychology, 2005). 1. “The integration of best research evidence with clinical expertise and patient values.” (APA Policy Statement on Evidence-Based Practice in Psychology, 2005). 2. 2. Being anchored in the scientist-practitioner model. 3. EBP attempts to identify broader elements that intersect in practice to produce excellent outcomes. (Cox., L.M., The National Psychologist. May/June 2011 p.13)

6 What is Evidence Based Practice (EBP) with Couples Evidence based practice with couples integrates individual and relationship research (e.g., physical & mental health, couple interactions, couple empathy, conflict resolution ) and couple therapy practice experience. Evidence based practice with couples integrates individual and relationship research (e.g., physical & mental health, couple interactions, couple empathy, conflict resolution ) and couple therapy practice experience. Couple therapy promotes partners to grow in relationship and sexual satisfaction as a cooperative “intimate team” respecting their values and experience  race, nationality, age, mental status, politics, religion, economic status, sexual orientation… Couple therapy promotes partners to grow in relationship and sexual satisfaction as a cooperative “intimate team” respecting their values and experience  race, nationality, age, mental status, politics, religion, economic status, sexual orientation…

7 What are Evidence Based Features of Enduring Desire and Satisfying Couple Sex?

8 Satisfaction is Inherently Subjective Satisfaction or happiness is “necessarily subjective and is essentially whatever the individual(s) defines it to be.” (Seligman (2006); Lyubomirsky, Sheldon & Schkade, 2005) Satisfaction or happiness is “necessarily subjective and is essentially whatever the individual(s) defines it to be.” (Seligman (2006); Lyubomirsky, Sheldon & Schkade, 2005)  “meaning-making.”  “meaning-making.” The positive role of general and sexual well-being is INTENTIONAL - inferences from “positive psychology” and “mindfullness” practices. The positive role of general and sexual well-being is INTENTIONAL - inferences from “positive psychology” and “mindfullness” practices.

9 The CBE Variables for Relationship & Sexual Satisfaction an emotional dimension an emotional dimension -- (i.e., feeling fine, “good,” well, contented), -- (i.e., feeling fine, “good,” well, contented), grounded on the cognitive dimension grounded on the cognitive dimension – realistic and variable expectations – realistic and variable expectations and positive attributions (i.e., “meaning”) and positive attributions (i.e., “meaning”) as an individual and the couple, as an individual and the couple, about the behavioral dimension about the behavioral dimension -- i.e., adequate relationship cooperation -- i.e., adequate relationship cooperation and realistic and variable sexual function. and realistic and variable sexual function.

10 Why we need a new approach to integrate marital-relationship and sexual satisfaction: The “Good-Enough Sex” (GES) Approach for Couple Satisfaction.

11 Depictions of “Great Sex" in Popular Magazines. Menard & Kleinplatz, (2008). Sexuality & Culture,12(1), 1-20.  The prescribed means to achieve "great sex“ most frequently and overwhelmingly advocated: 1. technical 2. mechanical 3. physical factors 4. variety  Positive advice on how to achieve better or "great sex“ tended to promote: 1. sexual and gender-role stereotypes 2. enforced narrow sexual scripts 3. presented readers with contradictory and conflicting messages

12 Too often people chase great sex in the wrong directions, listen to the wrong sources. Great sex is not magically found in a pill – although sometimes chemistry can help. Great sex is not magically found in a pill – although sometimes chemistry can help. Great sex is not primarily found by making yourself “beautiful” or handsome” – although that can help. Great sex is not primarily found by making yourself “beautiful” or handsome” – although that can help. Great sex is not automatic, nor found by “fortune”. Great sex is not automatic, nor found by “fortune”. We too often “bark up the wrong tree” in our pursuit of great sex. We too often “bark up the wrong tree” in our pursuit of great sex.

13 Perspective on “Great” Sex Michael E. Metz, Ph.D. The idyllic pursuit of “great” sex is the source of extensive personal dissatisfaction (even agony) and relationship distress. 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). amplifies fears of inadequacy (e.g., penile & breast augmentations). predisposes to life-long disappointment. predisposes to life-long disappointment. There is a poignant irony when the pursuit of “great sex” becomes the cause of dissatisfying, dysfunctional sex. There is a poignant irony when the pursuit of “great sex” becomes the cause of dissatisfying, dysfunctional sex. Ameliorating this fundamental detriment is a major objective of the Good Enough Sex (GES) model.

14 The Good-Enough Sex (GES) Perspective The prevalent belief that the quality of sexual pleasure and satisfaction inevitably declines in on- going relationships is one of the most toxic and self- defeating erroneous beliefs. GES: The therapist, teacher, clergy person, educator, health care provider has the unique opportunity to re-educate a partners and encourage them to challenge this negative belief, and guide them about the meanings and pleasures of their sex life which will evolve, deepen, and expand as partners cooperate as an “intimate team.”

15 The “Good-Enough Sex” Approach for Couple Satisfaction.

16 How is Good-Enough Sex Better Sex? Do NOT think we’re encouraging acceptance of: Do NOT think we’re encouraging acceptance of: Mediocre Mediocre Second-rate Second-rate Bland Bland Take-what-you-have Take-what-you-have Boring sex Boring sex The blueprint or GPS for enduring high quality and satisfying sex – without unrealistic expectaions or “hype”. The blueprint or GPS for enduring high quality and satisfying sex – without unrealistic expectaions or “hype”.

17 Basis: the “Good-Enough Sex” Model ● The Good-Enough Sex model for couple sexual satisfaction is built on a continuum model ( “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 relationship and 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.

18 Merits of the “Good Enough Sex” Model The GES model (Metz & McCarthy, 2010a, 2010b; 2008, 2007a; 2007b; 2004; 2003; McCarthy & Metz, 2008a, 2008b) 1. 1. describes a positive set of principles for satisfaction. 2. 2. to facilitate couple reflection on the meaning and value of their general and sexual relationship 3. 3. which can guide clinicians endeavoring to promote healthy female, male, and couple sexuality as well as resolve SD. 4. 4. The model is relevant to all couples who want to enhance intimacy and sexuality  heterosexual, gay, lesbian, bisexual, and transgender couples.

19 RELATIONSHIP & SEXUAL MILIEU Enduring desire and satisfying sex requires understanding and appreciating the biopsychosocial dimensions and the interactive skills for relationship and sexual satisfaction over the life-cycle.

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21 Types of Relationship Cognitions Assumptions – what each believes people and relationships actually are like; the set of characteristics typical of a partner. Assumptions – what each believes people and relationships actually are like; the set of characteristics typical of a partner. Standards -- what each believes people and relationships should be like. Standards -- what each believes people and relationships should be like. Selective Attention (perception) – what each notices about the partner, the relationship, and the environment; what an Individual notices, depending on factors such as the individual’s emotional state, level of fatigue, prior experiences in similar situations. Selective Attention (perception) – what each notices about the partner, the relationship, and the environment; what an Individual notices, depending on factors such as the individual’s emotional state, level of fatigue, prior experiences in similar situations. “Filtering”; “selective abstraction” (Beck et al., 1979), “negative tracking” (Jacobson & Margolin, 1979), or “sentiment override” (Weiss, 1980) -- the selective attention or bias that is commonly unaware to the partners. “Filtering”; “selective abstraction” (Beck et al., 1979), “negative tracking” (Jacobson & Margolin, 1979), or “sentiment override” (Weiss, 1980) -- the selective attention or bias that is commonly unaware to the partners. Attributions – causal and responsibility explanations for relationship events; one’s causal explanations for relationship events, which serve to increase an individual’s sense of understanding and control over complex relationship events. Attributions – causal and responsibility explanations for relationship events; one’s causal explanations for relationship events, which serve to increase an individual’s sense of understanding and control over complex relationship events. Expectancies -- predictions of what will occur in the relationship in the future; outcomes or efficacy. (source: Epstein & Baucom, 2002) Expectancies -- predictions of what will occur in the relationship in the future; outcomes or efficacy. (source: Epstein & Baucom, 2002)

22 The “Good-Enough Sex” Approach for Couple Satisfaction.

23 GES Publications / Resources Metz, M.E. & McCarthy, B.W., (2010). Enduring Desire: Your Guide to Lifelong Intimacy. NY: Routledge. Metz, M.E. & McCarthy, B.W., (2010). Enduring Desire: Your Guide to Lifelong Intimacy. NY: Routledge. Metz, M. E. & McCarthy, B. (2012). The “Good Enough Sex” (GES) Model: Perspective and Clinical Applications. Chapter in Kleinplatz, P., New Developments in Sex Therapy. New York: Routledge. Metz, M. E. & McCarthy, B. (2007). The “Good Enough Sex” model for couple sexual satisfaction. Sexual and Relationship Therapy, 22 (3), 351-362. Metz, M. E. & McCarthy, B. W.(2010).'Male Sexuality and Couple Sexual Health: A Case Illustration', Journal of Family Psychotherapy, 21: 3, 197-212 Metz, M. E. & McCarthy, B. W.(2010).'Male Sexuality and Couple Sexual Health: A Case Illustration', Journal of Family Psychotherapy, 21: 3, 197-212 McCarthy, B. W. & Metz, M. E., (2008). The cognitive-behavioral “Good-Enough Sex” model: A case illustration. Sexual and Relationship Therapy; 23 (3), 227. Metz, M. E. & McCarthy, B. W. (2008). “Eros & aging: Is good-enough sex right for you?” Psychotherapy Networker, July/August 2008; 55-61 Metz, M.E. & McCarthy, B.W. (2004). Coping with Erectile Dysfunction. Oakland: New Harbinger Publication. Metz, M. E. & McCarthy, B. W. (2003). Coping with Premature Ejaculation: Overcome PE, Please Your Partner, and Have Great Sex. Oakland, CA: New Harbinger Publications.

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25 Metz, Michael E. & McCarthy, Barry W. (in press, 2012). The “Good-Enough Sex” (GES) Model: Perspective and Clinical Applications. Chapter in P. H, kleinplatz., New Developments in Sex therapy. New York: Routledge, 2012.

26 x Given the 2011 “BEST BOOK” award by AASECT (American Association for Sex Education, Counseling & Therapy ) Michael E. Metz Ph.D. & Barry McCarthy Ph.D. Barry McCarthy Ph.D. Enduring Desire: Your Guide to Lifelong Intimacy. Routledge, NY 2010

27 LIFELONG DEVELOPMENT TASKS The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction.

28 12 Dimensions of the “Good-Enough Sex” Model  Sex is a good element in life, an invaluable part of an individual’s and couple’s long-term comfort, intimacy, pleasure, and confidence.  Relationship and sexual satisfaction are the ultimate developmental focus and are essentially intertwined. The couple is an “intimate team.”  Realistic, age-appropriate sexual expectations are essential for sexual satisfaction.  Good physical health and healthy behavioral habits are vital for sexual health. Individuals value their and their partner’s sexual body.  Relaxation is the foundation for pleasure and function.  Pleasure is as important as function.

29 12 Dimensions of the “Good-Enough Sex” Model  Valuing variable, flexible sexual experiences (the “85 percent approach”) and abandoning the “need” for perfect performance inoculates the couple against sexual dysfunction by overcoming performance pressure, fears of failure, and rejection.  The five purposes for sex are integrated into the couple’s sexual relationship.  Integrate and flexibly use the three sexual arousal styles.  Gender differences are respectfully valued and similarities mutually accepted.  Sex is integrated into real life and real life is integrated into sex. Sexuality is developing, growing and evolving throughout life.  Sexuality is personalized: Sex can be playful, spiritual, “special.”

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31 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 1. Sex is a good, positive element in life, a “growth goal”  an invaluable part of an individual’s and couple’s long- term comfort, intimacy, pleasure, eroticism, and confidence. Antithesis: Antithesis:  sexual shame.  Sex negative experiences (e.g., abuse).  Sexual perfectionism.

32 Sexuality in Society & History: THE IMPORTANCE & VALUE OF SEX The Hegelian Dialectic / Cycle Positive Positive Vilifying RespectDemystifying _______________________________________ bad good mundane evil holy only a behavior sick meaningful meaningless dangerous healthy hollow

33 Barriers to Positive Sexual Feelings  SHAME can be evoked:  when sexuality is judged as “bad”…  when one believes she/he should never “fail”.  When she/he believes the partner is dissatisfied.  when there is a “secret” (masturbation, paraphilia, affair, gender dysphoria…)  HOPELESSNESS & POWERLESSNESS:  when sex performance “fails” again;  when sex function is believed it should be “automatic” and “autonomous.”  fear of sex dysfunction.  when partner seems critical or rejecting.

34 Sexual Self-Esteem Accepting and affirming one’s sexuality is the foundation for Accepting and affirming one’s sexuality is the foundation for  sexual self-esteem.  openness & engagement (not avoidance).  sexual self-regulation.  positive sexual interaction with the partner. “Self-esteem is the reputation you have with yourself.” (Brian Tracy) “Self-esteem is the reputation you have with yourself.” (Brian Tracy) “Self-esteem is that deep-down inside the skin feeling you have of your own self-worth.” (Denis Waitley) “Self-esteem is that deep-down inside the skin feeling you have of your own self-worth.” (Denis Waitley)

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36 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 2 Sex is developmental and relational. Sexuality develops, grows, and evolves throughout your life. Relationship & sexual satisfaction are the ultimate couple developmental focus and are essentially intertwined. The couple grows as an “intimate team”

37 Sexuality is Relational Partners grow to view the partner as one’s “Sexual Friend.” Partners grow to view the partner as one’s “Sexual Friend.” Partners view their relationship as an “Intimate Team.” Partners view their relationship as an “Intimate Team.”

38 Principles of Relationship Satisfaction. 8 Healthy Relationship Principles supported by couple research. (copies on website: www.MichaelMetzPhD.com www.MichaelMetzPhD.comwww.MichaelMetzPhD.com “resources”)

39 Principles of Relationship Satisfaction Michael E. Metz, Ph.D.  The Relationship is the Overall Priority.  Healthy Relationships are Founded in Personal Equity.  There is a Priority on Cooperation.  Each Puts the Other’s Satisfaction First.  There is a Priority on Mutual Emotional & Sexual Empathy.  Partners Distinguish Feelings & Behaviors.  All Conflict Resolution has as its Goal Mutual Emotional Satisfaction.  Relationship satisfaction is directly influenced by the quality of relationship conflict resolution.

40 Core Research Findings about Couple Conflict

41 Relationship Conflict Research Findings Metz & Epstein, 2002. The role of relationship conflict in sexual dysfunction.  Relationship conflict is normal. The important factor is how constructively couples resolve their differences.  Mutual conflict resolution is essential for satisfaction: the emotional core.  Cognitions are crucial as they strongly influence satisfaction and communication.  Conflict resolution styles are fundamental. Couples who address their conflicts with constructive styles (e.g., assertion, cooperation), avoid destructive styles (e.g., aggression, withdrawal), and resolve their conflicts with mutual satisfaction and equity, are more likely to be satisfied.

42 Relationship Conflict Research Findings Metz & Epstein, 2002. The role of relationship conflict in sexual dysfunction. 5. Distressed couples display gender differences in resolution styles. 6. Satisfied couples blend / merge gender differences in conflict resolution styles. 7. Healthy couples are non-aggressive. There is no empirical evidence that expression of verbal or physical aggression is ever helpful in an intimate relationship.

43 RELATIONSHIP CONFLICT THE ORDINARY OPPORTUNITY TO DEEPEN RELATIONSHIP INTIMACY (Issue of cooperation)

44 Conflict as an Opportunity for Intimacy – and “energy for the bedroom”. Constructive Conflict Resolution and Intimacy Conflict presents the ordinary, day-to-day opportunity for couples to deepen their emotional and sexual intimacy. Learn about your partner’s complexity and uniqueness. Reinforce respect and admiration for each other. Develop more confidence that future conflict can be positively resolved. Create positive feelings and comfort with each other that facilitate their sexual desire for each other. Develop a greater sense of pride in their relationship.

45 Making Some Sense of Couple Conflict and Identifying targets for Growth / Change.

46 The 5 Features of Relationship Conflict 1. Context: (a) Geology & (b) Geography 2. Content 3. Severity 4. Styles of Interaction 5. Meaning

47 Bridge – Blend – Bond (Michael Metz, Ph.D,) Bridge Blend Bond Blend Bond

48 Individuals without a Partner During periods when she/he may not have a significant partner, she/he anticipates developing and “growing” intimacy with a “VIRTUAL PARTNER” --> the mental or Imaginary focus of sexual cognitions, feelings, and behaviors: Past relationship (s). Past relationship (s). Present “idealized” relationship. Present “idealized” relationship. Hoped-for future relationship. Hoped-for future relationship. Issue of “reasonable expectations” of relational sex. Issue of “reasonable expectations” of relational sex.

49 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 3

50 Dimensions of the Good-Enough Sex Model 3 Realistic, age-appropriate, accurate and reasonable sexual knowledge and expectations sexual physiology, psychology, relationship health, and psychosexual skills are essential for sexual satisfaction.

51 Reasonable Sexual Expectations  Partners understand that the commercial marketing with sex is usually: 1. superficial & simplistic 2. plays on insecurities or inadequacies 3. manipulative -- in order to sell products. ► Partners learn how his / her person and sexual body “work:” 1. physiological  1. based on acceptance of lust & eroticism; 2. based on accurate knowledge of your body; 2. psychological  emotional integration.

52 What is Distinctive About Individuals & Couples with SD? There are individuals and couples with sexual performance (behavior) deficits that do not meet the DSM or ICD diagnostic criteria for SD. There are individuals and couples with sexual performance (behavior) deficits that do not meet the DSM or ICD diagnostic criteria for SD. The critical feature in the DMS-IV-R and ICD-10 classification of sexual dysfunction is: The critical feature in the DMS-IV-R and ICD-10 classification of sexual dysfunction is: “…marked distress or interpersonal difficulty.” interpersonal difficulty.”

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

54 What is Distinctive About Couples with SD? # 2: Community Representative Sample Laumann, Gagnon, Michael & Michaels, (1994). The social organization of sexuality. Despite many men and women (> 50%) reporting periods of a month or more in the past year when they experienced one or another sexual problem, many reported satisfaction with their sex life (p. 373). Despite many men and women (> 50%) reporting periods of a month or more in the past year when they experienced one or another sexual problem, many reported satisfaction with their sex life (p. 373).

55 Sexual Happiness by Type of Sexual Dysfunction Sex Dysfunction Extremely Happy Very Happy Generally Satisfied Fairly Unhappy Unhappy Most Times Lack of sex interest 15%21%29 %42%59% ED6%10%12%11%28% Poor lubrication 13%17%20%28%27% Inhibited orgasm 10%14%21%24%33% Rapid orgasm 15%18%21%19%25% Pain5%8%11%15%19%

56 What is Distinctive About Couples with SD? Such findings suggest realism… Such findings suggest realism… …that sex dysfunction as a clinical complaint is more complex and more distinctive …that sex dysfunction as a clinical complaint is more complex and more distinctive than behavioral function or physical performance. than behavioral function or physical performance.

57 A Crucial Variable for Sexual Satisfaction: Reasonable, Age-Appropriate Expectations Satisfaction is influence by realistic, accurate, age appropriate, reasonable sexual knowledge. Satisfaction is influence by realistic, accurate, age appropriate, reasonable sexual knowledge.

58 “The problem isn't that people know too little, but that people know too much that just ain’t so.” (Mark Twain) (Mark Twain)

59 Some Sex Behavior Data MEN, WOMEN, SEX MEN, WOMEN, SEX

60 Knowledge is Power… Some sexual behavior data from representative sample studies: Some sexual behavior data from representative sample studies: 2010 Study: Herbenick, D., Reece, J, Schick, V., Sanders, S.A., Dodge, B, and Fortenberry, J.D., (2010). Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14-94. J Sex Medicine, 2010;7(Suppl 5): 255-265 1994 NATIONAL HEALTH AND SOCIAL LIFE (NHSL) Study: Laumann, E. O., Gagnon, J. H., Michael, R. T., Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press. (The National Health and Social Life study) Michael, Gagnon, Laumann, & Kolata, (1994). Sex in America: A definitive survey. NY; Warner.

61 Some Descriptive Sexual Data of Adults The National Health and Social Life (NHSL) Approximate average of 6 sexual partners for men, and 5 partners for women in lifetime. Approximate average of 6 sexual partners for men, and 5 partners for women in lifetime. > 75 - 80% of men are sexually faithful, and > 80- 85% women. > 75 - 80% of men are sexually faithful, and > 80- 85% women. Average Couple Sexual frequency is 1- 2 x week. Average Couple Sexual frequency is 1- 2 x week. Sexual dysfunction (SD) is “normal” (average) – most men & women experience a SD by age 40. Sexual dysfunction (SD) is “normal” (average) – most men & women experience a SD by age 40.

62 National Health and Social Life Survey (1994) Women’s Sexual Complaints (43 %): Women’s Sexual Complaints (43 %): Low Desire1 in 3 33.4% Low Desire1 in 3 33.4% Inhibited Orgasm 1 in 4 24.1% Inhibited Orgasm 1 in 4 24.1% Sex not pleasurable1 in 5 21.2% Sex not pleasurable1 in 5 21.2% Pain with intercourse1 in 7 14.4% Pain with intercourse1 in 7 14.4% Performance Anxiety1 in 10 11.5% Performance Anxiety1 in 10 11.5% Lubrication trouble1 in 10 10.4% Lubrication trouble1 in 10 10.4% Climax too soon1 in 10 10.3% Climax too soon1 in 10 10.3% (N = 1,740, ages 19 – 59) (N = 1,740, ages 19 – 59)

63 National Health and Social Life Survey (1994) Men’s Sexual Complaints (31%): Men’s Sexual Complaints (31%): Premature Ejaculation 1 in 4 28.5 % Premature Ejaculation 1 in 4 28.5 % Performance Anxiety 1 in 617.0 % Performance Anxiety 1 in 617.0 % Lacked interest1 in 615.8 % Lacked interest1 in 615.8 % Erectile Dysfunction1 in 1010.4 % Erectile Dysfunction1 in 1010.4 % Ejaculatory Inhibition1 in 11 8.3 % Ejaculatory Inhibition1 in 11 8.3 % Sex not pleasurable 1 in 11 8.1 % Sex not pleasurable 1 in 11 8.1 % Pain with coitus1 in 33 3.0 % Pain with coitus1 in 33 3.0 % (N = 1,410, ages 19 – 59) (N = 1,410, ages 19 – 59)

64 Some Descriptive Sexual Data of Adults The National Health and Social Life (NHSL) 68% of single men and 48% single women masturbate regularly. 68% of single men and 48% single women masturbate regularly. 57% of married men and 37% married women masturbate regularly. 57% of married men and 37% married women masturbate regularly. 27% of men and 8% women masturbate at least 1 time per week. 27% of men and 8% women masturbate at least 1 time per week. 94% of men and 84% of women have sexual fantasy more than several times per month. 94% of men and 84% of women have sexual fantasy more than several times per month.

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66 The Appeal of Sexual Practices to Men and Women The National Health and Social Life (NHSL) % % Men Women Men Women  Vaginal intercourse95 96  Watching partner undress9374  Receiving oral7973  Giving oral7768  Group sex46 7  Lifetime anal intercourse (hetero)4555  Watching others do sexual things4017  Stimulating partner’s anus with fingers2615  Using vibrator/dildo2317  Anus stimulated by partner’s fingers2218 Laumann et al., 1994 Laumann et al., 1994

67 “Sex in America” (NHSL) Findings ● Duration of intercourse ranges from 2-7 minutes. ● Orgasm occurs approximately 80% of the time for men, 30% for women. ● satisfaction is determined more by “sexual meaning” than “sexual performance” ● The quality of sex varies.

68 The Role of Sex in Marital Satisfaction When sexuality functions well, it is a positive, integral component in the relationship, contributing 15 – 20% of satisfying, intimate feelings. When sexuality functions well, it is a positive, integral component in the relationship, contributing 15 – 20% of satisfying, intimate feelings. When sexuality is dysfunctional, it plays an inordinately powerful role, from 50-75%, draining the relationship of intimacy and good feelings. When sexuality is dysfunctional, it plays an inordinately powerful role, from 50-75%, draining the relationship of intimacy and good feelings.

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

70 “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) ● “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)

71 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 4

72 4 Good physical health and healthy behavioral habits are vital for sexual health. Individuals value their and their partner’s sexual body. Individuals value their and their partner’s sexual body.

73 Healthy Behavioral Habits and Sexual Satisfaction healthy sleep patterns healthy sleep patterns moderate physical exercise moderate physical exercise eating habits and weight range eating habits and weight range alcohol and drugs alcohol and drugs smoking smoking medication management (e.g., antihypertensive) medication management (e.g., antihypertensive) managing chronic illness managing chronic illness

74 Healthy Behavioral Habits and Sexual Satisfaction In healthy, satisfying relationships, emotional and sexual arousal are self-regulated. The importance of general cognitive-behavioral-emotional regulation (e.g., anger, anxiety) for satisfaction is evident in non- sexual studies. (e.g. Kirby, Baucom, & Peterman, 2007)

75 Sexual & Emotional Self-Regulation Self regulation is at the heart of developing relationship and sexual health. Self regulation is at the heart of developing relationship and sexual health. Emotional and sexual arousal regulation requires self-care and “sophisticated self-understanding” Emotional and sexual arousal regulation requires self-care and “sophisticated self-understanding”

76 Healthy Emotional & Sexual Regulation © Michael E. Metz, Ph.D. manage emotional & sex behavior (B) manage emotional & sex behavior (B) by regulating cognitive (C), and by regulating cognitive (C), and emotional & sexual drives (E): emotional & sexual drives (E): Western style: resistance Western style: resistance “Self Control”, discipline. “Self Control”, discipline. Repression / suppression. Repression / suppression. Eastern style: mindful a cceptance Eastern style: mindful a cceptance “Self-acceptance” emotions & sex drive-lust. “Self-acceptance” emotions & sex drive-lust. Willingness to let it “pass through…” Willingness to let it “pass through…”

77 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 5

78 5 Relaxation is the foundation for sexual function and pleasure.  Physiological: PDE-5 inhibitors.  Psychological: balance of anxiety (Barlow).  Interpersonal: acceptance of touch, cooperation  e.g., “sensate focus” (M&J).  Developmental  “mellowing” over time (e.g., “better quality” of sex among 15 yr committed couples.) (e.g., “better quality” of sex among 15 yr committed couples.)

79 Relaxation Relaxation vs. “performance anxiety”. Relaxation vs. “performance anxiety”. Relaxation vs. “spectatoring”. Relaxation vs. “spectatoring”. PM and Kegel skills / exercises. PM and Kegel skills / exercises. For cognitive relaxation monitoring For cognitive relaxation monitoring Use in premature ejaculation treatment Use in premature ejaculation treatment Use in erectile dysfunction treatment Use in erectile dysfunction treatment Use in sexual arousal. Use in sexual arousal. Use in inorgasmia. Use in inorgasmia.

80 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 6

81 6 VALUE SENSUAL TOUCH & EMOTIONAL PLEASURE AS WELL AS INTERCOURSE AND ORGASM. need for comfort, acceptance of touch need for comfort, acceptance of touch research on value of touch for youth, adults, elderly. research on value of touch for youth, adults, elderly. while sex function is important (especially for men), pleasure and cooperation are key. while sex function is important (especially for men), pleasure and cooperation are key.

82 The 6 Kinds of Touch COMFORT TOUCH AFFECTIONAL TOUCH SENSUAL TOUCH PLAYFUL TOUCH EROTIC TOUCH INTERCOURSE TOUCH

83 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 7

84 7 Valuing VARIABLE & FLEXIBLE sexual and relationship experiences -- abandoning the “need” for perfect performance and adapting with alternate sex scenarios: inoculates the couple against sexual dysfunction by overcoming performance pressure, fears of failure, and rejection. inoculates the couple against sexual dysfunction by overcoming performance pressure, fears of failure, and rejection. frames the couple perspective towards cooperation as an “Intimate Team.” frames the couple perspective towards cooperation as an “Intimate Team.”

85 GES Perspective… Quality Variability Sex is enhanced by appreciating its healthy variability. Researchers (Kleinplatz, Menard, et al., 2005; Lindau, Schumm, et al., 2007) have learned from older couples that optimal, exceptional sexual experiences and lackluster ones exist in the same very satisfying relationship.

86 The Variable Quality of Sex in Well-Functioning, Satisfied Married Couples 35 – 45% Very Good Quality. 35 – 45% Very Good Quality. 20 – 25 % Good Quality (at least 20 – 25 % Good Quality (at least for 1 partner). 15 – 20 % Okay; Not Remarkable. 15 – 20 % Okay; Not Remarkable. 5 – 15 % Mediocre, Dysfunctional. 5 – 15 % Mediocre, Dysfunctional. (Sources: Frank, Anderson & Rubinstein, 1978; Laumann, Michaels, Gagnon, et al., 1994)

87 Two Basic Components of Sexual Flexibility Satisfying sex realistically embraces: 5 Basic Purposes for sex --> flexible sexuality pursues multiple purposes (pleasure, tension release, emotional intimacy, sexual self- esteem, reproduction). 5 Basic Purposes for sex --> flexible sexuality pursues multiple purposes (pleasure, tension release, emotional intimacy, sexual self- esteem, reproduction). 3 General Sexual Arousal Styles --> Flexible sexuality blends the multiple arousal styles (e.g., sexual arousal varies from partner interaction to entrancement arousal, and role enactment). 3 General Sexual Arousal Styles --> Flexible sexuality blends the multiple arousal styles (e.g., sexual arousal varies from partner interaction to entrancement arousal, and role enactment).

88 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 8

89 The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 8. The five general functions or purposes for sex are integrated into the couple’s sexual relationship for flexibility.

90 The 5 Basic Purposes for Sex (Biopsychosocial Functions) In the order of prevalence: Physical pleasure (bio-psych) Physical pleasure (bio-psych) Tension / anxiety reduction (bio-psych) Tension / anxiety reduction (bio-psych) Relationship intimacy (interpersonal). Relationship intimacy (interpersonal). Self-esteem, confidence (psych) Self-esteem, confidence (psych) Reproduction or procreation (bio). Reproduction or procreation (bio).

91 Distressed – Dysfunctional Sex When the purpose becomes: When the purpose becomes: one-dimensional sex over extended periods of time, one-dimensional sex over extended periods of time, sexual dysfunction is common: sexual dysfunction is common: e.g., infertility protocol (procreation) e.g., infertility protocol (procreation) (e.g., Burns et al, 2005). e.g., only for intimacy; only for anxiety reduction. e.g., only for intimacy; only for anxiety reduction.

92 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 9

93 The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 9 Integrate and flexibly use the three basic sexual arousal styles.

94 Arousal Styles: Differences in Focus Arousal Styles: Differences in Focus  "Partner Interaction" focus on the partner. Person is active, eyes open, looking at the partner, talkative (romantic or "sweet" talk), and energetic. This is the sexual style on TV and in movies -- passionate and impulsive sex.  Sensual “Self-entrancement” focus on one’s own body. Person utilizing this style typically closes one's eyes, goes within, becomes quiet, and looks detached and passive. Routine and stylized touch help this person to become aroused.  “Role Enactment" focus on role play, fantasy, variety, and experimentation, such as dressing in sexy lingerie, role playing being "tough" or "hard to get," acting out a scene from a movie or fantasy, having sex in new places (e.g., vacation), using "toys" (massage oil, vibrator, dildoe) to find excitement and arousal through sexual playfulness.

95 What Couples Learn for Sexual Health What Couples Learn for Sexual Health Sexual arousal and the issue of Sexual arousal and the issue of “Sexual Familiarity” “Sexual Familiarity”

96 Emotional Emotional Closeness and Eroticism   Traditionally, both professionals and the public believed that if the couple focused on increasing loving feelings and communication that the sex would be easy and take care of itself.   This is not just a simplistic myth, it is also a dangerous one that can subvert quality couple sexuality. A healthy relationship involves both emotional intimacy and sexual eroticism (Perel, 2006).

97 Emotional Emotional Closeness and Eroticism   They are truly different, although ideally complementary, dimensions. Closeness is of central value in establishing couple identity, communication, and feeling connected. However, it may not improve sexual desire and function.   A real danger is that some couples feel so close and intimate (enmeshed) that it actually smothers sexual desire: they de-eroticize each other. They are such good, intimate friends that there is no space for sexual playfulness or eroticism.

98 Perspective… Perspective… Intimate and Erotic Friends   The role of emotional intimacy is to nurture your bond, cohesion. The role of sexual intimacy - eroticism is to energize your bond, specifically to enhance feelings of desire and desirability.   Sexuality can contribute 15-20% to relationship satisfaction when you see each other as intimate and erotic partners. It acts as a special relationship resource that helps maintain vitality and satisfaction.

99 Premier Principle ☺ The mutual priority to please the other in both the everyday emotional relationship and the erotic sexual component is the hallmark of enduring sexual desire and satisfaction.

100 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 10

101 10 Individual and gender differences are:  respectfully accepted, embraced & valued.  generously accommodated.  similarities mutually enjoyed.  couple works as an “Intimate Team”

102 Phases of Male & Female Sexual Response I. Masters & Johnson couple model: 1. Physiological MALE = “PROCEPTIVE ” drive model.  Physiological FEMALE = “RECEPTIVE” drive model. II. Basson (2001) FEMALE = “RESPONSIVE” model.

103 Basson Model of Female Sex Desire and Arousal Sexual Stimuli Emotional Intimacy Sexual Arousal Arousal & Sexual Desire Motivates the sexually neutral woman To find/ Be responsive to Psychological and biological factors govern arousability Emotional & Physical Satisfaction

104 New Model of Female Sexual Arousal - 1 Rosemary Basson, MD: Women have a lower biological urge for the release of sexual tension than men. Women have a lower biological urge for the release of sexual tension than men. Orgasm is not necessary for satisfaction and does not need to occur at each sexual encounter. Orgasm is not necessary for satisfaction and does not need to occur at each sexual encounter. Women’s sexual desire is often a responsive rather than a biological or spontaneous event, greatly influenced by subjective psychological excitement. Women’s sexual desire is often a responsive rather than a biological or spontaneous event, greatly influenced by subjective psychological excitement.

105 Basson’s Model of Female Sexual Arousal - 2  Typically, a woman’s sexual desire develops from her receptivity to gentle, relaxed sensual touching. This touching leads to sexual desire and continues to emotional closeness, affection, sensuality, and eroticism.  Sexual desire can develop after initial sensual contact.  Healthy female sexual response in an established relationship begins in sexual neutrality, but sensing:  an opportunity to be sexual,  the partner’s desire,  or an awareness of one or more potential benefits that are important to her and their relationship (for example, emotional closeness, bonding, love, affection, healing, acceptance, commitment), she elects to seek sensual contact and stimulation.

106 Basson’s Model of Female Sexual Arousal - 3 With beginning physical arousal, she may become aware at that time of desire to continue the experience for sexual reasons and experience more arousal which may or may not include wanting orgasm. This brings her a sense of physical well-being with added benefits such as emotional closeness, love, affection, and acceptance. With beginning physical arousal, she may become aware at that time of desire to continue the experience for sexual reasons and experience more arousal which may or may not include wanting orgasm. This brings her a sense of physical well-being with added benefits such as emotional closeness, love, affection, and acceptance. This model acknowledges that sexual desire for men may be more biologically driven while for women, more psychological and relational. This model acknowledges that sexual desire for men may be more biologically driven while for women, more psychological and relational.

107 The 12 Core Features of “Good-Enough Sex” for Couple Satisfaction 11

108 11 Sex is integrated into real life and Sex is integrated into real life and real life is integrated into sex. real life is integrated into sex. Sex is not an isolated fragment of Sex is not an isolated fragment of one’s life.

109 Integration of life events into lovemaking --> Living daily life provides the opportunity to experience sexual interactions in a subtly yet distinctively personalized and enriched way:  sex on vacation.  during pregnancy.  during times of loneliness.  after the wedding of your best friend.  after a parent’s death.  during times of career stress.  after a class reunion.  during periods of success  during periods of failures.  amidst childrearing.  family illnesses.

110 Integration of life events into lovemaking.  THE IMPORTANCE OF “REGULAR SEX” Sex is an accepted, consistent part of life. The healthy sexual couple integrates the daily events of life and blends this with the partner’s, to create the couple’s unique, realistic, sexual style. Sex “fits” real life: sex fits into one’s daily life; daily life fits into sex.  sex is commonplace with moments of tenderness, experimentation, sadness, playfulness, anxiety, passion, wildness, reflection, transcendence.

111 Regular Sex… Couples who permit life’s stresses, fatigue, careers, parenting, or irritations to override regular sex are at risk of alienation. Couples who permit life’s stresses, fatigue, careers, parenting, or irritations to override regular sex are at risk of alienation. Ongoing, real-time GES sex can produce benefits like comfort, lust, diversion, relaxation, trust, pleasure, cooperation, healing, and emotional intimacy and eroticism.

112 REAL LIFE REGULAR SEX – THE “INTIMACY BLENDER” Regular sex ensures that the moods and events of life are brought to your bedroom. Sexual Environment ▬► Mood Example Sexual Environment ▬► Mood Example 1. “Spirited Sex” ▬► when you feel full of life and vigorous. 2. “Standard Sex” ▬► when life is uneventful, sex is a shared 3. pleasure. 4. “Passionate Sex” ▬► wild, lustful, animalistic, abandoned, shameless, taking your partner and being taken, rough, undisciplined, rowdy, raucous, unruly, noisy, boisterous sex. 5. “Make-up Sex” ▬► after an argument to heal. 6. “Compassionate Sex” ▬► after the funeral of your close 7. friend; e.g., intercourse for soothing comfort. 8. “Bad Mood Sex” ▬► during despondent or glum moments. 9. “Angst Sex” ▬► sex for tension or stress release. 10. “Vacation Sex” ▬► on a holiday or escape trip. 11. “Role Play Sex” ▬► when you’re “stretching”, experimenting 12. “Transcendental Sex” ▬► sharing sex ”under the stars”, awareness and appreciation of the ultimate meaning of life, love, the universe. © Michael E. Metz, Ph.D.

113 Regular Sex as Gender Cooperation 1. Protects the sexual from avoidance due to mood fluctuationand life events. 1. Protects the sexual from avoidance due to mood fluctuation and life events. 2. Can better balance intimacy and eroticism. 3. “Tenderizes” the man and promotes emotional communication. 4. “Empowers” the woman and promotes eroticism. 5. Promotes sexual & emotional cooperation.

114 12

115 Core Principles for Couple Satisfaction 12 Relationship and Sexual Satisfaction are often personalized: idiosyncratic idiosyncratic spiritual, transcendental, “prayerful” spiritual, transcendental, “prayerful” playful, “special.” playful, “special.”

116 What Men Need to Learn for Sexual Health “Good Enough Sex” is: Occasionally PLAYFUL Personalizes the bedroom

117 Sex as Mature Playfulness The occasional presence of play is a reliable indicator of relationship and sexual health, because for play to occur, certain other aspects of intimacy must be functioning well: The occasional presence of play is a reliable indicator of relationship and sexual health, because for play to occur, certain other aspects of intimacy must be functioning well: trust. trust. freedom to be oneself. freedom to be oneself. mutual acceptance. mutual acceptance. pleasure is more important than pleasure is more important than performance. performance. priority upon the relationship (“special”). priority upon the relationship (“special”).

118 Adult Playfulness “To be playful and serious at the same time is possible; in fact it defines the ideal mental condition.” (John Dewey, American Educator. How We Think. Mineola, NY: Dover Publications; 2007).

119 Couple Reports of Sexual Playfulness ● A 34 year old male lawyer wrote: ● "We spend time tickling each other which is sometimes sexual and sometimes not. We will touch each other `sexually' while doing normal everyday things. We will 'accidentally' touch each other. We chase each other in the house. I will sneak up on her while she is changing. I will expose myself at times in the house when we are alone. My wife will give me a sneak peek when she teases. We take showers together and will sometimes wash each other with sexual overtones." (Metz, ME, (2004). The Role of Adult Play in Intimacy.)

120 Couple Reports of Sexual Playfulness ● A 32 year old female teacher said: ● "I love to dress up for my husband in lacy clothes one time, then my regular underwear another. I also sometimes beg him in a playful way (I get down on my knees and BEG dramatically!) to dress for me in his tuxedo or leopard skin briefs...that I have to have him this way... It's a spoof and a tease! But it really feels like we're willing to please each other....that's why I think I so love this... I also prize the way we can giggle and smile sometimes when we're making love. I feel so special then... (Metz, ME, (2004). The Role of Adult Play in Intimacy.)

121 Mature Couple Playfulness Play acknowledges: Play acknowledges: the complexity and ambiguity of life the complexity and ambiguity of life the multiple levels of reality the multiple levels of reality the priority is on interpersonal connection the priority is on interpersonal connection Play involves unconditional acceptance, cooperation, team-work, comfort, feeling safe and secure, trust, union, and delight. Play involves unconditional acceptance, cooperation, team-work, comfort, feeling safe and secure, trust, union, and delight. Sexual playfulness enhances and strengthens intimacy, and respects the capacity of sexuality as a transcendent or spiritual experience. Sexual playfulness enhances and strengthens intimacy, and respects the capacity of sexuality as a transcendent or spiritual experience.

122 Sexuality, Play & Spirituality ● Deep respect for the capacity of the human experience of couple sex. ● Transcendental experiences with sexuality  e.g., Roman Catholic “Sacramentality”. ● Prayer / philosophy and sexuality – celebrating the meaning of life & death.

123 Building Blocks Toward Optimal Sexuality (Kleinplatz & Menard, 2007) Being present –> “totally absorbed in the moment.” Being present –> “totally absorbed in the moment.” Authenticity –> “feeling free to be oneself.” Authenticity –> “feeling free to be oneself.” Intense emotional Intense emotional connection –> “deeply empathic.” connection –> “deeply empathic.” Sexual and erotic “deep sense of caring for Sexual and erotic “deep sense of caring for intimacy –> one another; generosity.” Communication –> “comfort with sexual talk and Communication –> “comfort with sexual talk and experimenting.” experimenting.” Transcendence –> “a portal to an alternate reality.” Transcendence –> “a portal to an alternate reality.”

124 DISCUSSION …

125 Society for the Scientific Study of Sexuality 2011 Annual Conference Houston, Texas, USA November 3-6, 2011 FEATURES OF ENDURING DESIRE AND SATISFYING COUPLE SEX Michael E. Metz, Ph.D. Meta Associates 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 www.MichaelMetzPhD.com

126 Thank You

127 x Given the 2011 “BEST BOOK” award by AASECT (American Association for Sex Education, Counseling & Therapy ) Michael E. Metz Ph.D. & Barry McCarthy Ph.D. Barry McCarthy Ph.D. Enduring Desire: Your Guide to Lifelong Intimacy. Routledge, NY 2010

128 Society for the Scientific Study of Sexuality 2011 Annual Conference Houston, Texas, USA November 3-6, 2011 FEATURES OF ENDURING DESIRE AND SATISFYING COUPLE SEX Michael E. Metz, Ph.D. Meta Associates 821 Raymond Avenue, Suite 440 St. Paul, MN 55114 Voice: 651-641-9317; fax 651-642-1908 www.MichaelMetzPhD.com


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