Turn-Ons and Shut-Downs: Exploring Sexuality with PACT

Caroline Russell Smith, LCSW-R

PACT Level 2 Therapist

I was voted “Most Likely to Become the Next Dr. Ruth” in my high school yearbook, but not until 16 years into my career as an individual therapist did I finally complete sex therapy certification. I had virtually no experience with couples therapy (let alone the PACT approach), but I would soon know a lot about sex! What could possibly go wrong?

I nailed my framed certified sex therapist diploma to the wall and got to work. The first three couples who sought my services were kind, collaborative souls, more reticent than fiery, whose secure functioning gifted me a false sense of clinical competence. Psychoeducation did the heavy lifting, and the couples happily headed off into the sunset with improved sexual functioning. 

My fourth couple continued chatting with each other on their way to my office from the waiting area, hardly acknowledging me, then sat on my couch (no PACT set-up then) and stared at me in stony silence. All I knew how to do was jack-hammer them with questions.  My efforts yielded sparse historical data, though they were generous with lavish descriptions of each other’s shortcomings. Neither believed themselves responsible for their five-year sexual drought. Both were certain that therapy could fix their beloved.  

Approaching the Challenge in a New Way

“You’re a sex addict!” was met with “You’re a frigid tease!” Their glares, curled lips, cutting criticism, whining, staring out the window, phone-checking and attempts to triangulate me were punctuated with explosive bursts of anger. I was all sweat-and-fumble during those first few sessions. Both men fiercely protected themselves from one another and from me. At least I knew enough to know this wasn’t therapy. I needed help. 

During the first year of the pandemic, I signed up for PACT and completed Levels 1 and 2. My challenging couple declined to meet virtually, giving me plenty of time to change the course of treatment.   

Sex therapists are fond of saying that mutual understanding and excellent communication do not guarantee a vibrant sex life. What turns us on and what allows us to get along aren't one and the same. If we don't help our clients talk about their erotic lives openly and honestly with one another, teaching them how to play together in the flesh and encouraging them to abandon the rabid pursuit of orgasm and pair embodiment with external attunement, they cannot operate as, what sex therapist Dr. Barry McCarthy calls, a sexual team. 

PACT teaches us that the reverse is also true: hot sex does not guarantee relational happiness or security. If we don't address the overall functioning of the couple, their capacity to tell the truth, to take care of each other, to play, to understand how their nervous systems respond to each other, and to repair efficiently and effectively, their sex life as well as their relationship will likely suffer.

Challenging the Challenging Couple

With a dismissive glance, my challenging couple continued their conversation en route to my office for their first session in more than a year. This time I directed them away from the couch toward two chairs. They looked startled when they found themselves facing each other and immediately turned their chairs to face me. My heart softened. How could they possibly find their way back to each other if they couldn’t tolerate each other’s gaze?

“Therapy isn’t possible when there is acting out” was the PACT mantra in my head. Though I needed to focus on relaxing my own bodily tension throughout the next few sessions, I was comfortable holding on to the principles of secure functioning, insisting that they give up on changing each other and get on board with changing the relationship if they wanted to find their way back to the bedroom. Crossing my questions, confronting the minutia of their many forms of disengagement, and directing statements down the middle about their tendency to drop each other to alleviate their mutual discomfort with intimacy helped me begin, as Stan often says, to sew this couple together. I introduced the concept of the couple bubble and said, “I can teach you all there is to know about sex and desire, but if there isn’t a couple to hear it, nothing will change.”   

Most powerful was the session when I staged the couple getting into bed together. For two people hoping for intimacy, just about every action and comment betrayed their interests. As we slowly progressed through each moment, I was able to highlight their movements toward and away from each other. We were able to explore their wishes, fears, memories and fantasies, as well as their habit of protecting themselves at the expense of the relationship.  

Using PACT as a Sex Therapist

Unpacking one partner’s sarcastic comment unearthed his fear that their different fantasies rendered them sexually incompatible. We explored how fantasies reveal the way we want to feel about ourselves during sex and how there are many ways they could comfortably collaborate to achieve this. Later, inviting the couple to hold each other’s gaze in silence, the other partner snapped, “This is such a waste of time!” Pausing here and cross-questioning his partner, we came to understand this outburst. The angry partner dropped his head and confessed that he felt sexually broken. “What kind of a man am I if I don’t feel horny all the time?” Wearing both my PACT and sex therapist hats, I gently acknowledged his shame and then offered psychoeducational material about spontaneous versus responsive desire – both normal – to facilitate a healing repair for them both.  

The couple later established an agreement to take as much time as they each needed to turn up the heat in bed. They also agreed that intercourse need not always be the goal. Instead, as author and researcher Dr. Emily Nagoski says, “pleasure is the measure” of a successful intimate encounter. 

Today when I meet with new sex therapy couples, I always wear these two hats. After I gather the biopsychosocial history of each member of the couple, I dive deeply into the realm of sexuality. What exactly was sex like in the beginning of the relationship? How about the last time they had sex? Have they ever had sex worth having? For whom and why? Do they look forward to sex or dread it? Do they touch each other outside of the bedroom? Do they like the way each other smells? Kisses? What about oral and anal sex? Fetishes and kink? Gender roles, identity, and expression? 

I have them show me how they get into bed at night, show me how they move toward each other for a kiss or hug, show me how they touch each other’s hands or arms and share moment by moment what they are thinking and feeling and sensing. I gather their individual sexual histories, preferences, and spend a lot of time talking about their fantasies. We also explore their sexual practices during solo sex.  

Creating Safety and Success

All the while from the PACT perspective, I create containers in which they can show me and each other how their autonomic nervous systems respond to safety and threat in the kitchen, in the car, and certainly in the bedroom. Couples begin to see that what they are calling a sexual problem is far more nuanced and relational than simply low desire, erectile dysfunction, anorgasmia, or genital pain.  

I love talking about sex because when the conditions are safe, couples can learn deep truths about each other.  Our turn-ons and turn-offs say so much about where we’ve been and how we want to live our lives. The ability to be open, imaginative, playful, generous, and flexible while embodied in the presence of another requires courage and practice but is learnable even with a history of trauma. 

Great sex isn’t just for the young and able-bodied. Pairing sex therapy principles with the PACT approach allows us to teach couples first how to operate as a couple. They can then learn to grab on to pleasure and ride its waves unselfconsciously as well as dedicate themselves to their partner’s delight. The PACT approach offers a solid container for therapists and couples to explore the sometimes terrifying and beautiful terrain of human sexuality.    



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