Sex Talk: Sex Therapists Speak about Sex and Relationships


The Mindful Practice of Intimacy

The Mindful Practice of Intimacy by David Yarian PhD(This article was originally published in the Summer 2015 issue of NPI Reflects, the quarterly journal of the Nashville Psychotherapy Institute.)

Low Desire is a common reason for seeking Sex Therapy

Since becoming a certified sex therapist in 2004, I’ve worked with many couples who present with “low desire,” a rather subjective term. Remember Woody Allen and Diane Keaton in Annie Hall? A split-screen image showed each of them in their therapist’s office. Woody says to his therapist, “We hardly ever have sex, only two or three times a week.” Diane says to her therapist, “We have sex all the time, two or three times a week.”

Sexological research has not produced an objective standard for optimal sexual desire. Sexuality professionals prefer the more precise term discrepant desire, which allows the practitioner to view the couple’s problem systemically, as a mutually constructed though frustrating reality that satisfies neither. Polarized couples who define themselves as normal vs. abnormal on the desire continuum struggle to find a workable resolution. “Low desire” is the number one reason people seek sex therapy.

I don’t debate terminology with couples, but listen carefully to their stories and take note of the ways in which they may be missing each other: unresolved conflicts and conflict avoidance; chronic high stress levels from dual careers, children, and busy lives; inadequate self-care; overfunctioning and underfunctioning in the relationship; poor communication skills; emotional distancing; health challenges, including sexual pain.

A meditative approach to sex

I sought a new paradigm for approaching this common and agonizing problem. Inspired by experiences and training in Tantra, yoga, and mindfulness practices, I’ve come to believe there is a profound path to sustainable intimacy based on approaching sex as a form of meditation. Sexual meditation invites the participants to inhabit the present moment by attending to sensation in the body while letting go of cogitation, worry, and analysis.

Western approaches to sex prioritize quantity over quality, emphasizing physical signs of arousal such as erections and lubrication, paying attention to frequency of sex, promoting intercourse as the primary sex act and orgasm as the ultimate goal. In this scenario it is easy to pay more attention to Are we there yet? than to the pleasures of the journey.

When sex is approached as a meditative practice these values are upended. What happens is less important than the complex sensations of the experience. Giving and receiving pleasure is prioritized over trying to “achieve” erections or orgasms. Our language gives it away: we see sex as something we must accomplish.

This focus on tangible behavior explains our epidemic of sexual performance anxiety with its attendant ills: premature and delayed ejaculation, difficulty with orgasm, sexual pain, and unsatisfying sex. And, ultimately, avoidance. Who wants to sign up for sex that feels like a chore, or an exam you are likely to fail?

I suggest to my clients that they are wise to be intentional about their sexual relationship. The heart-pounding fireworks of the early days of spontaneity are behind them, and now they have children, careers, and mortgages. Finding a great person to settle in with is only step one: relationships require attention, maintenance, and periodic re-invention. Deferred maintenance works no better for relationships than it does for houses and automobiles.

Intimacy Practices: a mindfulness approach to intimacy

Many couples appreciate tangible and specific guidance in how to be intentional. Small, focused practices work best. Grand gestures are neither practical nor sustainable. What is needed is a plan, with daily activities that involve them in a process of exploration and development of relationship maintenance skills.

Enter Intimacy Practices: carefully graded couple exercises designed to be engaging, efficient of time, enjoyable, and relaxing. They are unusual activities, often non-verbal, that highlight connection and communication. Intimacy Practices are based on mindful attention to oneself and openness to the partner’s experience. Sensory awareness is the fundamental reality. Each Practice highlights a particular skill that easily generalizes within the larger context of the relationship.

Intimacy Practice is like other kinds of practice: football practice, play practice, band practice. It doesn’t require enthusiasm, but it does require showing up. You get the benefit of the practice by engaging in it. I encourage couples to be very intentional about their daily practice, which in the beginning is only five minutes.

The initial Intimacy Practice is a joint mindfulness meditation. The couple embraces as they synchronize their breathing for five minutes. The task is to simultaneously focus on their breath and their partner’s breath. Most couples find this to be pleasant. The differentness of the activity begins to set Intimacy Practice time apart from regular life. Time slows down as the partners perform this wordless and profound practice. A side effect of focusing on the breath is relaxation, which helps everything.

Subsequent Intimacy Practices include giving feedback about touch, with the partners taking turns touching and receiving touch. A related Practice offers couples the opportunity to exchange touch and caresses. Separating the roles of giving and receiving allows both partners to explore the nuances of each activity. Other Practices include mindful kissing, eye-gazing, dancing without music, facial massage, using reciprocal breathing to exchange erotic energy, and genital massage.

Using this process, I’ve seen couples move from bickering and blaming to clear, non-reactive communication about what they want and need in their sexual relationship. They learn to ask for what they want and to be clear about their boundaries. It becomes more possible to acknowledge fear and vulnerability.

Recovering Desire through intentional practice

With steady engagement with the Intimacy Practices model, many couples rediscover their desire. They learn not to panic if what they want is not immediately available. They find a sphere of safety in which their vulnerabilities are respected. They learn to give feedback rather than criticism, and to not take their partner’s responses so personally. Step by step, building confidence and trust, they practice intimacy.

I’ve been amazed at the power of this approach. A recent case began with the husband angrily demanding the sex he deserved, while the wife insisted she had to set boundaries to protect herself. They gradually settled into a process of exploring underlying difficulties in session and doing Intimacy Practice work at home. After a couple of months the husband, noticeably relaxed and at ease with his wife, wryly remarked, “I don’t know what’s come over me.” We all laughed. He described how he felt calmer, more able to think clearly and to talk with his wife about his desires, and to listen to her without experiencing a blaze of reactivity. They left the session holding hands.

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