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The New New Sex Therapy –
An Interview with Dr. David Schnarch

What made you decide to study sex?

Sex. I was in graduate school and interested in sex like everybody else. The people who taught the sexuality courses had qualities I really admired. Unlike their stereotypes in the 1970s, they didn't have their shirts open to their navel with gold chains hanging down. They were the nicest people I had ever met, and it was clear they were not seducible. They had their sexuality very well integrated – it wasn't the most outstanding part of them – they were just fine human beings. And I wanted to be like them. As I started getting into the field I found there were a number of people like that who I very much respected and liked.

You speak of a crucible, a sexual crucible, and you talk about therapy as a crucible. What do you mean?

In science, crucibles are basically non-reactive vessels in which metamorphic reactions take place. Similarly, a crucible is also a severe test or trial. The crucible image I use is simply a way of talking about natural and inevitable systemic conundrums that surface in emotionally committed relationships. These occur around sex and intimacy because they are part of the underlying processes of differentiation that play out – but they also surface around issues of money, parenting, in-laws, and vacations. Marriage – an emotionally committed relationship – is a crucible, and anybody who's been married knows exactly what I'm talking about. The problem is that when we feel its heat, we think something's going wrong in our relationship instead of realizing it's differentiation-in-action. Therapy is often a crucible for clients – and therapists – when things are really cooking.

You speak a lot about paradigms. What are the typical paradigms that people have about sex and intimacy and treatment?

Many therapists don't realize that a paradigm is not just a theory, it defines every aspect of reality: not just what but how clinicians think, what they do and don't do, how they relate to clients, everything. Paradigms do the same for society at large; every society has a paradigm for 'good' marriage, 'good' sex, and 'good' marriages facilitating some aspects of personal growth and limiting others. Clinical paradigms and social paradigms mutually influence and determine each other.

Masters and Johnson's work was a tremendous step forward and had tremendous impact – more than perhaps we realize. Typical sex therapy treatments up to now have been based on their anxiety reduction paradigm – seeking to make sexual experience stressless. Many therapists now realize their specific approach has limitations. But now, unfortunately, we have many other treatment approaches based on anxiety reduction models – sexual abuse, domestic violence, and PTSD treatments, for example. This surfaces in current approaches that emphasize safety and security and 'healing childhood wounds' that currently dominate clinical practice and popular psychology. Some therapists don't realize they're still using anxiety reduction models with their inherent problems because the focus area is different. However, the real issue in all these areas is anxiety tolerance, not anxiety reduction – which is what differentiation is all about. As a discipline, marriage and family therapy has stayed away from sex for more reasons than simply therapists' discomfort in talking about sex. As long as therapists stay away from sex and keep their focus limited, they don't have to reexamine many widely held but mistaken beliefs and strategies that permeate marriage and family therapy as well as individual therapy. The ebb and flow of a marriage is largely multi-systemic and rooted in differentiation, and the solution has to be isomorphic on many levels.

Clinicians are beginning to realize that the anxiety reduction paradigm does not work the way we thought. For example I ask people, "Think of the best sex you have ever had", and then I wait until people smile. While they're thinking about that experience I ask, "Were you totally relaxed?" No! They were nervous! Anxiety is often part of the best sex we ever have. And it's part of growing sexually, it's part of the deal. But what we therapists have unwittingly been doing is teaching people to have mediocre sex sex with no anxiety at all. That's what creates boredom. Anxiety makes us pay attention to what's going on. Think about the first time you had sex with somebody whom you've never had sex with before. There's a little anxiety, which is why some people say 'Look, lets get it over with' – but it also makes us pay attention because we don't know what's going to happen next. When we're married for thirty years and we know nothing new sexually is going to happen, there's no anxiety. We can tune out, only half be there, have our genitals function, and fool ourselves that our partners and we are really intimate and connected. We demand 'safety and security' in marriage, and then complain that we 're bored without realizing that's how we caused it.

By contrast, the Sexual Crucible Approach focuses on enhancing differentiation and anxiety tolerance instead of getting anxiety as low as possible. If we all waited for safety and security to have our first experience of intercourse, the species would die out! And, ironically, people grow by mastering their anxiety. We shouldn't wait until we're not anxious because we can only really resolve our anxiety by getting into the experience. Growth in general involves mastery in the face of anxiety, not reducing anxiety per se. People basically grow sexually by taking absolutely disgusting, filthy, repulsive acts, and turning them into the only conceivable way to enjoy sex. Think about when you first heard about intercourse. You probably thought, "You've got to be out of your mind!" The things that you heard about…

Like French kissing?

Absolutely! Why would somebody want to stick his tongue down someone else's throat and slobber? It sounds crazy, but that's the way we grow. Overall, sex therapy, marital therapy, and even family therapy have seldom focused on helping people develop as adults. Most often, therapy teaches people to have tolerable sex. We grease the person in the system who 'squeaks' the loudest until they stop complaining. They stop complaining when things are tolerable and their discomforts are reduced – which means they're usually having sex or a relationship as good and as bad as we have. But are they really happy – or any more adult?

Is there pressure on people to have good sex?

Let me answer this two ways because the issues behind such a seemingly simple question are complex. First, let me say "No". There's enormous pressure on people to have mediocre sex, and to tell themselves it's good. People think they want intimate sex, but they don't. What people want turns out to be mediocre sex, non-problematic sex, and they want to convince themselves that it's terrific. And that's what we (therapists) sell people. Take this whole idea that intercourse is the most intimate thing that two people can do – obviously concocted by somebody who'd never done it. Certainly, it is possible to get intercourse to be intimate, but of all the sexual behaviors its probably the most difficult, which is one of the reasons why we like it. We like it because it's not the most intimate thing that two people can do – given the way most of us do it. I discuss eyes open sex and orgasm to help people recognize the common lack of intimacy of in-the-dark intercourse. When people start having vastly more intimate sex, they often accomplish this by doing things other than intercourse because intimacy during intercourse takes a higher level of personal development than many people reach. Conversely, recognizing that this accounts for part the popularity of intercourse is another aspect of the paradigm shift. Conventional sex therapy placed a 'ban' on intercourse because it was presumed too anxiety provoking. In the Crucible Approach, we focus on things other than intercourse because intercourse like any other biologically driven behavior-isn't inherently intimate.

Now let me jump to the other side of the question and say, 'Yes'. There's tremendous pressure on people to have sex that is supposed to be good. The 'sex as a natural function' model ironically pressures people to want sex and have good sexual function, because it's 'natural' – meaning rooted in biological drives.

Like, three times a week being the average

That's right. Masters and Johnson shifted our paradigm from the idea that sex was inherently pathological to the notion that sex was a natural function. My work is the next shift, to the idea that 'sex is a natural system'. A natural function paradigm has a systemic backlash that most people don't recognize. It pressures people to have both sexual desire and function. A natural function model assumes that sexual function is supposed to be there in the absence of pathology. Helen Singer Kaplan built in the same pressure around sexual desire, by referring to low sexual desire as 'sexual anorexia'. Another problem with the 'sex is a natural function' paradigm is that it subtly encourages therapists to look for what's wrong with people or their relationship in order to explain why sexual function or desire isn't there. On the surface, a 'natural function' approach sounds sex-positive, but the way it functions makes it inherently pathology-based. A non-pathological approach can't be developed within the natural function model. What happened within the field of sex therapy has broad and important implications for marriage and family therapy. Although as therapists we tell ourselves that we're the 'good guys' who remove people's performance anxieties, we often exacerbate them instead. Our intent blinds us to aspects of contemporary clinical approaches that have negative impacts on clients and therapy. If more therapists understood how this went unrecognized for decades within sex therapy, they'd be less complacent accepting popular contemporary individual, marital and family therapies. In this sense, maybe sex therapy is a step ahead in recognizing that the impact of what we do is often antithetical to our intent, theories, and values. The impact of an intervention any clinician makes is determined by the paradigm it's imbedded in. It's not simply a function of the clinician's talent, or his or her philosophy. Unfortunately the 'sex is a natural function' paradigm is now normatively accepted by society at large.

What is wrong with that?

It's the notion that in the absence of inhibitions, intimacy and eroticism emerge full-blown. In reality, these are natural potentials but they have to be developed, and that involves personal development. The message from sex therapy over the last three decades has encouraged the public to believe that difficulties with sex and intimacy can be resolved through techniques, and that therapy can be reduced to a set of behavioral interventions. This is absolutely ludicrous. Eroticism is so much more complex; therefore many people are neither intimate nor erotic when they' re having sex. Therapists ought to recognize that sensate focus exercises focus on sensation rather than eroticism or intimacy. Rather than reducing sex to a technical intervention, the Sexual Crucible Approach addresses sex as a function of personal development. This has a couple of implications:

One is that therapists have to achieve significant personal development in order to be effective. Another is that therapists have to develop more expertise about sex in general. However, as more therapists scramble to avoid taking a superordinate position, we like to say we are not experts, that clients are the 'experts', but if we're not experts, what are people coming to see us for? If clients were experts on themselves, why would they need therapy at all? The primary problem isn't that therapists act like experts; rather it's that they often lack the necessary personal and professional expertise to help clients face and grow through their anxieties.

There is now a wide literature on sexuality. Is it helpful?

The literature of sex therapy, and I think also marital therapy, will be of more historical value than clinical value, because it documents now and forever the relatively limited development of the field. We teach people to have sex as bad as we have. Look at Kaplan's notion of 'bypassing', probably one of the most widely disseminated treatment approaches to problems of low of sexual desire. It teaches clients that if they don't like their partner, or if they have lots of underlying issues in the marriage, they should think about somebody else while they're having sex, using their partner like a fleshy dildo. Ironically many people use this same approach spontaneously, and when they do it creates low desire and yet it's been promoted as the cure for it. If therapists were having incredibly intimate erotic sex and intense intimacy in their own bedrooms, they would have strenuously objected to this approach. There's nothing in most clinicians' training – including sex therapists – that prepares them to have better sex or more intimacy than the people they treat. I think issues about 'the person of the therapist' are more serious and far reaching than is commonly discussed.

Sexual and marital therapy are still in their adolescence. We often misunderstand the fundamental nature of intimacy, much less intimacy during sex, because real intimacy, especially with one's underwear down, is a lot harder to tolerate than the average person or the average clinician wants to deal with. Clinicians pick paradigms that fit their personal experience. Look around and it is clear that most people believe marriage kills many of the very things they get married for. Conventional wisdom and common experience suggests that marriage kills sex, love, and intimacy. But it's not marriage that destroys sex and intimacy; it's how we go into marriage and the marriage we create according to our beliefs and abilities. And then we develop therapies, also in our own image. After all, who's creating the therapies? Freud said we marry our neuroses. If you're a Freudian, you think everything's going right when your marriage works that way. And if you believe the purpose of marriage is to heal each other's childhood wounds, then that's the way you steer your marriage – and the therapy you do. But when we recognize that marriages are people-growing machines, we can harness the natural growth processes built into the system. It's the end of the notion of 'working on the relationship', and the beginning of realizing that the relationship is working on us – to develop and grow, although not necessarily in ways we appreciate or like at the time.

How does this happen in marriage?

All 'normal' relationships develop by compromise and negotiation, including sexual relationships. Each partner gets to rule 'off limits' those sexual things that makes him or her uncomfortable – in other words, whatever is beyond their current stage of sexual development – and the couple does whatever is left. Do that for several years, and sexual boredom is the result. But we can't compromise and negotiate to create sexual novelty, because that's the way we get to sexual boredom in the first place! The only way that partners can get novelty is if one of them pushes for something that the other isn't comfortable with – if they were already comfortable with it, they would be doing it. That's where we begin to see that the way traditional marital therapy approaches sex – suggestions like 'compromise and negotiate' or teaching simple communication skills – doesn't work. Often, the result is mediocre sex.

Conventional approaches to marital therapy and sex therapy turn control of the relationship over to partners' anxieties rather than to partners' strengths. It creates what I call the 'tyranny of the lowest common denominator'. The lowest common denominator grabs hold of the relationship in the name of 'I feel pressured'. When that happens the relationship can't go forward. I want to be very clear I'm in no way advocating marital rape, nor am I advocating that one person bludgeon the other. But therapists fear of taking a clinical stand that might be politically incorrect blinds us from seeing that our current anxieties about abuse and domestic violence can easily make us clinically biased and ineffective. If the 'high desire' partner pressures the 'low desire' partner to do something, we may immediately be tempted to label this 'abuse'. But when the 'low desire' partner says to the spouse "I'm not doing this!" – implicitly meaning "And neither are you, because I'm going to use our monogamous agreement to bludgeon you into giving up what you want" – we don't see this as abuse but it is by the same measure. I'm not arguing that everything is abuse. Rather, I mean that as long as the 'low desire' partner – the partner with the most anxiety – pressures the other to accommodate and give up his or her preference, therapists don't see the bias because it's politically correct and fits an anxiety reduction paradigm. In the Crucible Approach, we help people see that this form of emotional gridlock is natural, inevitable, and even potentially productive. This is the concept of sexual intimacy as a natural system, which produces greater differentiation if handled properly.

So what you're talking about is people having the choice to use the marital relationship to actually intensify their experience of one another over time by learning to tolerate anxiety, learning that tolerating anxiety is a good thing, and it will actually bring a deeper, stronger relationship.

Being able to tolerate anxiety is the quintessential difference between being a child and being an adult. And when we do 'wounded child therapy', focusing on fears, deprivations and weakness, we may be doing therapy that fails to help people deal with the complexity of marriage. Thus, we fail to help people develop the strength to love, which is what I think sex in a monogamous relationship is truly designed to do. It unerringly pushes us to get strong enough to eventually love our partners on Life's terms. Not our own terms but on Life's terms. I talk about constructivism because I think a lot of what we do is based upon our constructions of reality. But I also talk about natural systemic phenomena that are hard wired, are rooted in sociobiology, and are invariant across cultures. One of the reasons I went to Japan was to find out whether or not my approach is culturally bound to the United States? But the processes I'm describing seem to be invariant aspects of sex and intimacy in emotionally committed relationships that are hardwired in the species. Culture operates by subverting these processes to favor the prerogatives of the privileged class within that culture. The natural processes of sex and intimacy in emotionally committed relationships seem designed to help people grow up and learn what it means to love, and to allow people not only to stay married, but to get married at a much deeper level.

What do you mean by a much deeper level?

I focus on helping people have deeper intimacy and more intense sex, not to reinforce the sexual pressure and inadequacy they already feel, but to help them realize their sexual potential. Because, the same personal development this requires is also required to love on Life's terms. The end result of every good long-term relationship is that one partner buries the other. Marriage is designed to help people become strong enough to do that; to not fall apart when one partner gets AIDS or cancer or dies, so that its safe to love. All the current focus on safety and security weakens that process. The first thing we realize when we mature is that there is no safety or security – every parent of an adolescent and every spouse whose partner has gotten ill knows that. And this whole notion that our partner is supposed to 'be there' for us? It's not safe to really love a partner if we need them to be there for us, because then we will emotionally withdraw when they get ill or when they are going to die. What's important is our ability to hold on to ourselves in the face of Life's challenges. We've developed forms of therapy that placate children who don't want to grow up, and placate therapists who want to pretend they're really helping people.

Does the spiritual dimension have a place in your theory?

When I started helping people have better sex; invariably they would begin talking to me about spirituality. When it first happened, I didn't understand why. At first I thought I was dealing with people who had strong religious background, parts of their lives that they hadn't yet talked about. They might say 'We're not into religion' – but invariably they would talk of spiritual feelings about what was happening to them, that the spiritual side of them was waking up. Gradually I began to recognize that the natural systemic phenomena – particularly in long-term monogamous relationships – in which sex and intimacy are imbedded come out of the same sociobiological forces that gave rise to our capacity for spirituality. The same forces Buddhists refer to as The Great Oneness, and philosophers refer as Creation seeking its own fulfillment through us.

But you try to avoid them?

Yes, in the process of getting to them. I don't start off talking about spirituality because I now see that it doesn't work that way. Spirituality often follows rather than leads the process of human development. It's all about respecting the process, even when it doesn't fit our preconceived plan. It's the same as recognizing that the crazy stuff we do in therapy is a necessary step in the evolution of our species. Intimacy has only been around for half a million years, and the therapy enterprise is just a fifty-year-old! Both are still evolving. So how can we be instant experts on something that is literally nature's latest freak? Intimacy is one of the latest human phenomena to evolve, and the evolution of psychotherapy is just a small part of the process.

David Schnarch's book, Passionate Marriage: Sex, Love and Intimacy in Emotionally Committed Relationships, was released in Australia in March 1998