1. The “Good-Enough Sex” Model
International Society for the Study of Women’s Sexual Health (ISSWSH) San Diego, CA February 23, 2008
The “Good-Enough Sex” Model
for ‘Great’ Sex:
Couple Growth and Satisfaction.
Michael E. Metz, Ph.D.
Private Practice, Meta Associates
St. Paul, MN USA
x 107

2. PowerPoints can be downloaded from website:
The GES model represents Dr. Barry McCarthy’s and my collaboration for a number of years.
PowerPoints can be downloaded from website:
“Resources”
“Powerpoints.

3. 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.

4. 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.

5. Presentation Objectives:
Review the model behind the “Good-Enough Sex” (GES) model for 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.

6. Average Time with Patients
Physician:  minutes
Psychologist  minutes

8. 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 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.

9. 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.

10. 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.

11. Michael E. Metz, Ph.D.

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

13. (Metz & McCarthy, 2004. Coping with ED)

14. Negative. Positive Quality. Quality 0. l. 25. l. 50. l. 75. l

15. Negative. Positive Quality. Quality 0. l. 25. l. 50. l. 75. l

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

17. Negative. Positive Quality. Quality 0. l. 25. l. 50. l. 75. l

18. Negative. Positive Quality. Quality 0. l. 25. l. 50. l. 75. l

19. “GREAT SEX…” ? “GREAT SEX” is “GOOD-ENOUGH COUPLE 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…”

21. 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.

22. 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).
The positive role of general and sexual well-being is intentional -- inferences from “Positive Psychology”.

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,
Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness. The architecture of sustainable change. Review of General Psychology, 9(2)
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)

24. 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, Sex in America; p.130).

25. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
2. Relationship & sexual satisfaction are the ultimate developmental focus and are essentially intertwined.
The couple is an “intimate team” for pursuing mutual satisfaction in each stage in life.

26. 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).

27. 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:

28. Interactive Paths Between Relationship Conflict & Sexual Dysfunction Metz & Epstein, (2002). The Role of Relationship Conflict in Sexual Dysfunction. Journal of Sex & Marital Therapy, 28:
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.

29. Suggestive Data
Yeh, Hsiu-Chen, Lorenz, F. O., Wickrama, K. A. S., Conger, R.D., Elder, Jr., G. H., Relationships among sexual satisfaction, marital quality, and marital instability at midlife. Journal of Family Psychology, 20(2),
Boul, Lori, (2007). Sexual function and relationship satisfaction: An investigation into men’s attitudes and perceptions. Sexual and Relationship Therapy, 22(2),

30. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
Realistic, age-appropriate, accurate expectations 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.

31. 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,

32. Sex Dysfunction common: 40% men & 63% women. Sex Difficulties high:
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 problems is fairly high:
Sex Dysfunction common:
40% men & 63% women.
Sex Difficulties high:
50% men & 77% women.
Yet, 80%+ were maritally & sexually satisfied.

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

34. What is Distinctive About Couples with SD
What is Distinctive About Couples with SD? # 2: Representative Community Sample Laumann, 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).

35. Sexual Happiness by Type of Sexual Dysfunction
Extremely
Happy
Very
Generally
Satisfied
Fairly Unhappy
Unhappy
Most Times
Lack of sex interest
15%
21%
29 %
42%
59% ED 6%
10%
12%
11%
28%
Poor lubrication
13%
17%
20%
27%
Inhibited orgasm
14%
24%
33%
Rapid orgasm
18%
19%
25%
Pain 5% 8%
Laumann et al., 1994.

36. What is Distinctive About Couples with SD
What is Distinctive About Couples with SD? #3: Community Availability Sample Byers & 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).

37. What is Distinctive About Couples with SD
What is Distinctive About Couples with SD? #4: Community Availability Sample Rosser, 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,
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.

38. Such Multiple sources… suggest…
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).

39. 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.
Realistic, accurate, age-appropriate expectations are crucial
because this “meaning” essentially distinguishes satisfied vs. dissatisfied / dysfunctional couples.
Acceptance of sexual variability: “not perfect”.

40. Relationship & Sexual Satisfaction
an emotional dimension
(i.e., feeling “good,” contentment),
grounded on the cognitive dimension
– realistic and variable expectations
(i.e., “meaning”),
about the behavioral dimension
(i.e., adequate cooperation and realistic sexual function).

41. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
4. Good physical health and healthy behavioral habits are vital for sexual health.
Individuals value their and their partner’s sexual body.

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

43. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
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”
(e.g., “better quality” of sex among 15 yr committed couples.)

44. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
Pleasure (physical touch) is as important as function (performance).
need for comfort, acceptance of touch
research on value of touch for youth, adults, elderly.
while sex function is important (especially for men), pleasure and cooperation are key.

45. The Importance of Touch: “skin hunger”
Multiple, controlled studies with children, adolescents, and adults suggest that touch / physical pleasure:
reduces stress.
diminishes irritation, frustration, anger.
consoles and comforts.
reassures or soothes fear.
promotes connection, intimacy.

46. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
7. 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.
frames the couple perspective towards cooperation as an “Intimate Team.”

47. NY Times Best Selling Book: The Geography of Bliss by Eric Weiner (NY: Twelve, 2008)
a Bhutanese hotel owner: the best explanation of happiness is…
“knowing your limitations…”
“knowing how much is enough…”
Or, an anonymous man in Iceland…”
“Happiness is when failure is an option…”

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

49. 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.

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

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

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

53. Cognitive 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.

54. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
10. Gender differences are:
respectfully accepted, embraced & valued.
generously accommodated.
similarities mutually enjoyed.
Couple as an “intimate team.”

55. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
11. Sex is integrated into real life and
real life is integrated into sex.
Sex is not an isolated fragment of one’s life.

56. 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.

57. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction
12. Sexuality is personalized:
Idiosyncratic
spiritual, transcendental, “prayerful”
playful, “special.”

58. “Good-Enough Sex” is Special Sex
Perhaps the more reliable indicator of “Good-Enough sex” is the occasional presence of playfulness at sex because:
for play to occur, certain other aspects of intimacy must be functioning well:
trust
mutual acceptance
priority on pleasure (more so than performance)
freedom to be oneself
deep valuing of the overall relationship – a “special feeling”.
Playful experiences “personalize” the bedroom.

59. Couple Reports of Sexual Playfulness
Special apparel (negligee, leopard-skin briefs).
Role play/enactments (e.g., acting out sex fantasy. (pirate/maiden; movie scenarios, etc.).
Sexual "toys" - vibrator, dildoe, fur mitt, body oil, etc.
Sharing fantasies and sexual dreams.
Erotic movies (R or X-rated).
Special places (Hotel, beach, woods, office, car).
Special affirming teasing (romantic seductions, playful withholdings, “playful jealousy”).
Special times -- 3 a.m., "afternoon delight."
Dancing: public and private dancing with/for partner.
Nicknames for sexual body parts (“Grand Tetons,” “Big Ben”).

60. 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."

61. Couple Reports of Sexual Playfulness
A 42 year old female teacher said:
"I love to dress up for my husband in lacy clothes one time, then my “Victoria Secret" lingerie 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...”

62. ****************
“Sexiness wears thin after a while, and beauty fades. But to be married to a man who makes you laugh every day, ah, now that's a real treat.”
Joanne Woodward

63. Humor in Science
“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).

64. Suggestive Data
Wilson, K. G., 2005). The serious matter of humor in science. The Behavior Therapist, 17.
Metz, M. E., & Lutz, G. (1990). Dyadic playfulness differences between sexual and marital therapy couples. Journal of Psychology and Human Sexuality, 3 (1),
De Visser, Smith, Richters, & Rissel, (2006). Associations between religiosity and sexuality in a representative sample of Australian adults. J. Archives of Sexual Behavior, 36(1)33-46.

65. SUMMARY

66. “Good-Enough Sex” = Quality sex
The concept of “Good-Enough Sex” challenges couples :
to adopt a positive, “balanced perspective”
& to incorporate realistic expectations:
relationship intimacy as the ultimate focus.
pleasure as important as function.
mutual emotional acceptance as the environment (“safe harbor”)
embracing flexibility and variability.
sex at times experienced as mature playfulness, “special”, “intimate team”.

67. KEEP PERSPECTIVE !
The idyllic pursuit of “great” sex is the source of extensive personal dissatisfaction (even agony) and relationship distress.
amplifies fears of inadequacy (penile & breast augmentations).
predisposes to life-long disappointment.
There is a poignant irony when the pursuit of “great sex” and/or “perfect sex function” becomes the cause of dissatisfying, dysfunctional sex.
The Good-Enough Sex model for couple satisfaction promotes humanly realistic, pretty-good sex as a valued dimension of self-esteem and relationship stability.

68. Clinical Suggestions for Comprehensive SD Care
Maintain a broad clinical perspective: even “small” sexual problems are usually meaningful human, relationship problems.
Maintain a reputable referral network:
individual mental health professionals.
couple/relationship professionals.
sex therapy professionals (individual & couple).
Ensure that our efficient (5”) history-taking probes are biopsychosocial.

69. Clinical Suggestions Biopsychosocial “verbal probes”:
“Let’s look at possible physical causes; What other ideas do you have that might cause your SD?” (theories, meaning probe).
“Okay, we’ll test for possible physical sources, but tell me what you and your partner have considered as personal or relationship stresses that could possibly contribute to your SD?” (biopsychosocial probe)
“Sexual difficulties are usually not simple, in spite of the TV commercials and our wish that problems have simple causes with simple cures… Let’s think this through together…”

70. Clinical Suggestions
Assess both objective and subjective features as continuum variables  levels of physiologic & behavioral function in relation to cognitive meaning / emotional satisfaction.
Appreciate that behavioral measures are not automatically personally meaningful:
PE  pharmaceutical research: behavioral prevalence of PE => 30% = 30 million men rapidly ejaculate; but as a meaningful problem (cognitive-emotional-interpersonal) prevalence is significantly less.
Appreciate that the placebo effect in sex research: 20-30%.

71. The “Good-Enough Sex” Model
International Society for the Study of Women’s Sexual Health (ISSWSH) San Diego, CA February 23, 2008
The “Good-Enough Sex” Model
for ‘Great’ Sex:
Couple Growth and Satisfaction.
Michael E. Metz, Ph.D.
Private Practice, Meta Associates
St. Paul, MN USA
x 107