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When She is Never 'In The Mood' Can a Desire Pill Repair Couple's Dynamics?

Talli Rosenbaum, MSc
Certified Sex Therapist and Couples Therapist
        Couples seeking sex therapy, often indicate that a lack of sexual desire by one of the partners, more often than not, the woman, is the presenting problem. They often look for a behavioral solution, perhaps hormone treatments, exercises, sex toys or a libido boosting pill can ‘fix’ the problem for the low-desire partner.
        Certainly many factors can contribute to low desire in women. Hormonal changes, particularly after childbirth or related to menopause can certainly affect libido, as can other medical issues such as chronic illness, or certain medications and treatments. However,  when couples present with discrepancies in desire, is it really that one partner has a sexual problem and the other is ‘off the hook’ therapeutically? Because more often than not, it is the couple’s dynamic that needs to be addressed.
        Ari and Ilona (names are fake) are a busy professional couple in their forties. When presenting to therapy together, Ilona related feeling distressed in the marriage. "Ari is being mean, and distant, and acting like a child. He walks around angry all the time and nothing I do or say seems right. I don't feel close to him anymore."
Ari was angry and sarcastic. "Maybe if you would want to have sex more than once a month, it would help to feel closer".
Ilona quickly became reactive. "That is so not true and you know it! I OFFERED plenty of times and you were too busy with your computer games!"
“Right” responded Ari, “like you really meant it. I don’t need your favors.”
Since people don't pay me to fight in my office (they can do that at home for free), I quickly halted the argument before it escalated further.
         Ari and Ilona, both feeling lonely and hurt, had fallen in to a pattern of mutual triggering of one another. They blamed,  criticized, de-valued, and injured one another constantly. This dynamic, together with navigating the stress of their jobs and raising 4 kids, was creating a marriage that held little positive vitality; For Ilona this dynamic contributed to little interest in sex, and  resulted in frustration and anger for Ari. Neither partner felt heard or understood.
        Several months of therapy focused on recognizing how Ari and Ilona's way of communicating  triggered one another in their most vulnerable places.  As the daughter of two highly successful professionals, Ilona was held to very high standards of academic performance as a child, and recalled that her less than perfect achievements resulted in her parent’s expression of deep disappointment . Through the therapy process she was able to recognize that feeling criticized felt equal  to feeling undervalued, unloved and simply ‘not good enough.’ These feelings were also intertwined with the guilt she felt about not studying hard enough, and disappointing her parents. Her experience of guilt was further triggered when Ari expressed frustration about not having sex. Because she felt so guilty about her lack of desire, she became defensive every time Ari brought up the subject.
        Ari, who was raised in a large family, recalled the feelings of coming home from school unrecognized while his mother was busy with his four smaller siblings. This feeling was re-triggered frequently when arriving home from work without being greeted by his family members. Furthermore, when Ilona was distant and avoidant, which she often was in order to avoid sex, Ari’s loneliness and need for attention surfaced.
In the therapy precess, Ari and Ilona began to understand one another’s triggers, and soon began to communicate to one another with more honesty and vulnerability. Ari recognized that his frequent sarcasm was simply a defense mechanism he employed to protect himself from feeling rejected and Ilona recognized that she did avoid both emotional and physical intimacy. Learning to communicate without triggering one another, allowed Ilona to talk about how she had come to feel that sex is just another chore she has to fulfill, to keep Ari happy, much like she felt responsible for keeping her parents satisfied through her academic performance. And when she was simply too tired or stressed at the end of a long day, she felt guilty for not wanting sex, such that rather than providing empathy to Ari, she became avoidant and distant. Even when she did feel like hugging or cuddling with Ari, she refrained from touching him, for fear that this would be construed as an invitation for sex.
        Ari was able to communicate to Ilona that when they engaged in physical intimacy, he felt that he mattered to her. Ilona was able to recognize when she felt criticized and when she became defensive. More importantly, Ari and Ilona learned to communicate their feelings to one another without triggering each other . They learned that when they  felt reactive during an argument, they should each self-regulate and meet again when they both felt calmer, to discuss the issue. They learned to use “I feel” statements, rather than blaming and criticizing, which simply provoked defensive reactions. They learned to listen and reflect each others statements, and to provide empathy to one another.  
        Ari and Ilona also began to view sex not only as an act that they do, but as an energy between them. They began to affirm  and validate each other, spontaneously do nice things for one another, send flirtatious text messages to each other, and spend more quality time together. Once Ilona realized that physical contact did not always have to lead to sex, she allowed herself to initiate more physical affection and hugs regularly. The atmosphere of intimacy,  vulnerability, honesty, closeness and mutual acceptance, allowed Ilona to become more direct with Ari, and for the first time, to share with him what she felt was missing in their sex life, and what she would like to experience with Ari. At this point Ari and Ilona’s sex life improved dramatically.
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