By Kelifern Pomeranz, PsyD, CST

PACT Level 3 Therapist

Yolanda and Miguel struggle to talk about sex. Yolanda worries that Miguel is no longer attracted to her and feels insecure, rejected, and confused. Miguel has always had a low libido and more recently has been having difficulty maintaining erections. He is embarrassed, sad, and full of shame about his lack of desire and sexual performance and often withdraws as a result. Miguel’s withdrawal only increases Yolanda’s suspicion and anxiety that he no longer wishes to be with her. 

Tao and Arthur struggle to talk about sex. While deeply in love they have always had different sexual wants and desires. Upon mutual agreement, they seek sexual partners outside of their relationship to satisfy the majority of their sexual needs. As time goes on, they worry about how this sexual incompatibility (not having sex with each other) will impact their future together.

Maddox and Penelope struggle to talk about sex. He is...

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...