Many of the women I see in my practice have been with the same partner for years. These couples have made homes together, raised children together, weathered hard times and enjoyed happy moments together. And now—just as the pressures of career and family begin to ease up, they find themselves at odds with each other, especially in the bedroom.
The physical and emotional changes that come with aging can play havoc with a couple’s sexual relationship. It can feel as if the rules have changed overnight and finding intimacy with the person who has shared your life is suddenly impossible. This is when a couples therapist can help.
Women who have never been in therapy or participated in marriage counseling before sometimes feel anxious when I propose this idea. To help give them and our readers an idea of how couples therapy works and what they can expect from the experience, I asked Ann McKnight, an experienced social worker and psychotherapist, to answer a few questions.
Q: When couples who have been together for a long time come to you with sexual issues, what’s typically going on?
A: One of the most important things in intimacy is to be present and see clearly this person who is in front of us, and to be ourselves as open and receptive as we can be. That’s what makes great sex. In the beginning stages of a relationship, we have all our walls down—it’s exciting, it’s new, and we feel so open and vulnerable. But then as we move on together in life we start to get those walls built up again. Usually it’s our own fears that keep us from being present, from hearing or being heard by our partners. If our partners are unhappy with our sex life, we start thinking there’s something wrong with me, I’m aging, you’re not attracted to me anymore. But what’s going on for our partners may be something totally different. They likely have their own set of fears that we’ve never guessed at or heard at all because we’ve been so caught up in our own.
Q: So the stereotypical story of the middle-aged couple—she’s putting on weight and he’s looking at skinny 20-year-olds—isn’t one you often encounter?
A: I have to laugh, because in my experience, that is so not the case! Maybe those couples are going to different therapists, but I’m just not seeing them. Actually, as men age, they tend to have a greater desire for intimacy, to value their long-term relationships.
I think there’s just so much cultural downloading that women do, so many judgments about aging and what it means and our values around that. And I’m not entirely sure that that’s laid on us by men. I think that we do plenty of it to ourselves.
I think aging, because of life experience, gives us—women and men—an opportunity to be kinder and more understanding of ourselves. We can integrate more fully all the parts of who we are and all the different roles we play—open our hearts even more fully to each other, to really see our partners and all the change and growth they’ve done.
But in long-term relationships it can be hard for both partners to hold the space they need to express themselves and be seen. That’s when a therapist, a third person who can hold that space, who is trained to see where the communication is getting bogged down, where the stuck places are, can be a great help.
Q: What's the best way to find a good couples therapist?
A: Ask someone you know and trust, whether that’s your physician, a friend, your pastor—and then when you do get a name, use the first time you meet to make sure it feels like a good fit. Does this seem like a person who is understanding each of you and proposing a course of therapy you’re both comfortable with? If not, get another name.
Q: And what if the other half of your couple resists the whole idea?
A: Still go. If there’s something going on in the relationship that’s affecting you, that’s part of your personal experience that you’re ultimately responsible for. And whenever one person starts to make changes in a relationship, things shift and get stirred up in the other person as well.
Q: How should a couple prepare for their first session?
A: As a couple—or individually—think about what you really are hoping will come out of this experience so that you can be open about that with your therapist. Sometimes what we really want is not very realistic—I want you to totally change my spouse’s behavior in every way! Just understanding your own agenda is a big help.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.