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Dr. Dan Pollets

A COMMENT FOR PRACTICING THERAPISTS: I am often referred couples whose presenting problem is a sexual one and where there often is a physically-based sexual dysfunction. At the same time, there is inevitably a deformity in the relationship dynamics which confounds and interacts with the sexual dysfunction. I have found RLT extremely helpful in diagnosing this “deformity” and then correcting it. In this blog post, I described my method of working with these couples and how to integrate RLT into the sex therapy (or the sex therapy into the RLT).

To paraphrase Terry Real, here’s the deal on cases that involve a sexual problem or dysfunction: identify the physical, refer the medical, and then focus on the relational.

Treating cases that involve a sexual problem or dysfunction necessitates a level of knowledge about the medical aspects of sexual dysfunction so that a valid physical issue (e.g. erectile dysfunction, desire disorder, premature ejaculation, sexual pain disorder, arousal disorder, anorgasmia) is not glossed over. It is crucial not to “psychologize” a sexual problem that has an underlying physical basis. The specific sexual problem and physical correlate needs to be validated in its own right and referred for medical evaluation and then treatment. This, of course, can go on concomitant with the couples’ work. An urologist or gynecologist who specializes in sexual medicine would be your best bet to refer to.

Acknowledging the reality of the physical component by the therapist and getting the partner appropriate help can be extremely stress/anxiety/shame relieving. I am reminded of Terry’s concept of “joining through the truth.” You solidify your standing as a knowledgeable treatment agent when you are able to juggle the three “balls” of mind, body, and relationship in these cases. A strong alliance follows.

Once you get the partner with the sexual dysfunction referred for medical evaluation, you can focus on the relational “dance” that plays out between the two. The problematic interpersonal dynamics that interacts with the sexual problem is your “patient” and needs correcting if there is to be recovery of a functional sex life.

What has been so helpful to me about using RET in these cases is how you can label and define with accuracy the couples’ self-defeating “dance” that generates the conflict from which they withdrawal. It is often the case that the conflict in the sexual realm parallels the couples’ classic “fight.” For instance, the more the woman asks for romance, foreplay and sensitivity from her man, the more he feels criticized, inadequate and then withdrawals or gets angry. In other words, it is one partner’s Core Negative Image (CNI) versus the other’s CNI in the bedroom.

Once “the more, the more” takes hold, the romantic and relaxing environment that is needed for good sex evaporates and instead, it is “off to the races.” In the bedroom as in the other rooms in the house, there is often the “blatant” and “latent” and the therapist move is to empower the latent, find leverage, and connect the blatant. The leverage can be that they both want a better sex life.


I think Matt's problem is that he has Maggie on the brain (paragraph 6). Fess up Matt you bum.


Awesome--I really enjoyed this. I've been a fan of yours for a little over a year now and I think all of your material is excellent.

Thanks for this blog--it gives us all more access to you and your life-changing material.

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