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International Society for the Study of Women’s Sexual Health (ISSWSH) San Diego, CA February 23, 2008

International Society for the Study of Women’s Sexual Health (ISSWSH) San Diego, CA February 23, 2008. The “Good-Enough Sex” Model for ‘Great’ Sex: Couple Growth and Satisfaction. Michael E. Metz, Ph.D. Private Practice, Meta Associates St. Paul, MN USA 651-642-9317 x 107

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International Society for the Study of Women’s Sexual Health (ISSWSH) San Diego, CA February 23, 2008

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  1. International Society for the Study of Women’s Sexual Health (ISSWSH)San Diego, CA February 23, 2008 The “Good-Enough Sex” Model for ‘Great’ Sex: Couple Growth and Satisfaction. Michael E. Metz, Ph.D. Private Practice, Meta Associates St. Paul, MN USA 651-642-9317 x 107 www.MichaelMetzPhD.com

  2. The GES model represents Dr. Barry McCarthy’s and my collaboration for a number of years. • PowerPoints can be downloaded from website: • “Resources” • “Powerpoints.

  3. Perspective on “Great” Sex • The idyllic pursuit of “great” sex is the source of extensive personal dissatisfaction (even agony) and relationship distress. • amplifies fears of inadequacy (e.g., penile & breast augmentations). • predisposes to life-long disappointment. • There is a poignant irony when the pursuit of “great sex” becomes the cause of dissatisfying, dysfunctional sex.

  4. Perspective • The “Good-Enough Sex” (GES) model intends to reposition, balance the cognitive focus away from: • the common cultural and interpersonal expectation that sex should always be “great” & perfect performance; and • the belief that when it is not, it is: • “inadequate” • a symptom of “falling out of love”, or • a flawed relationship.

  5. Presentation Objectives: • Review the model behind the “Good-Enough Sex” (GES) model for couple sexual satisfaction. • A brief summary of the 12 core premises of the GES model -- a GPS for long-term, satisfying sex – with some inferential support / implications.

  6. Average Time with Patients • Physician:  7 - 8 minutes • Psychologist  45 - 55 minutes

  7. Basis the “Good-Enough Sex” Model • The Good-Enough Sex model for couple sexual satisfaction is built on a continuummodel (“more” or “less” ) : • an heuristic model (“replicable approach to direct one’s attention”) from enduring features of 40 years of biopsychosocial sex research and therapy; • inferences drawn from multiple empirical studies of couple sexual function and satisfaction (biopsychosocial literature: psychology, sociology, social psychology, marital & family, clinical, biomedical research…). • current clinical observations and outcome experience of a number of “seasoned” marital & sex therapists.

  8. Good-Enough Sex Model: Assumptions • Sexual Health is complex & complicated: • developmental & lifelong • multidimensional • multi-causal • multiple effects on the person, partner, their relationship • all dimensions are interactive, correlation variables, not “A  B” or direct cause-effect. • Any approach to sexual health should recognize that sex is inherently relational affecting the emotional life of the couple. • The relevance of an erect penis or sex desire is its role in individual self-esteem & relationship satisfaction.

  9. Good-Enough Sex Model: Assumptions • Comprehensive understanding of sexuality integrates medical, pharmacological, psychological, relationship, and social aspects. • Real-life problems rarely have a simple cause and a simple cure in spite of people’s longing for “quick fixes.” • Clinical practice & theory / research interact and are enriched when embedded in a detailed, comprehensive view of sexual health  not simply function or absence of illness.

  10. Michael E. Metz, Ph.D.

  11. Good-Enough Sex Model is Grounded on Integrative Sexual Therapy Comprehensive Biopsychosocial Integrative Sexual Medicine & Sex Therapy  Inevitably facilitates  “Good-Enough Couple Sex”

  12. (Metz & McCarthy, 2004. Coping with ED)

  13. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  14. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  15. Cognitive-Behavioral-Emotional (C-B-E)Dimensions of Two Individuals ______________________

  16. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  17. Negative PositiveQuality Quality0 l 25 l 50 l 75 l 100____________________________________________________________

  18. “GREAT SEX…” ? • “GREAT SEX” is • the unlikely alignment of all the stars in the “Great Sex constellation”, • the perfect confluence of the infinity of biopsychosocial dimensions of sex •  The “Great Sex Lottery.” • “GOOD-ENOUGH COUPLE SEX” is: • the couple’s developmental appreciation of the variability of interplay between: • the physiologic, cognitive, behavioral, emotional, relational & psychosexual skills dimensions of sex. • Reality based  “Pretty Good Sex…”

  19. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction • Sex is a good, positive element in life, an invaluable part of an individual’s and couple’s long-term comfort, intimacy, pleasure, and confidence. •  Antithesis: • sexual shame. • Sex negative experiences (e.g., abuse). • Sexual perfectionism.

  20. Sex is a Positive, Good Element in Life • Satisfaction or “happiness” is necessarily subjective and is essentially whatever the individual defines it to be.”(Lyubomirsky, Sheldon & Schkade, 2005). • The positive role of general and sexual well-being is intentional -- inferences from “Positive Psychology”.

  21. Suggestive Data: Positive Psychology • Seligman, M. E., P., Steen, T. A., Park, N., & Peterson, C., (2005). Positive psychology progress. Empirical validation of interventions,American Psychologist, 60, 410-421. • Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness. The architecture of sustainable change. Review of General Psychology, 9(2) 111-131 • Seligman, M. E. P., & Csikszentmihalyi, M. (Eds.), (2000). Positive psychology(Special Issue).American Psychologist, 55(1). • Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness. The architecture of sustainable change. Review of General Psychology. 2005, 9(2) 111-131

  22. Sex is a Positive, Good Element in Life • “These happy people … • found physical pleasure and emotional satisfaction with their sex lives and, • those who reported themselves more happy also reported far more frequent sex. • (Michael, Gagnon, Laumann, & Kolata, 1994. Sex in America; p.130).

  23. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 2. Relationship & sexualsatisfaction are theultimatedevelopmentalfocus and are essentially intertwined. The couple is an “intimate team” for pursuing mutual satisfaction in each stage in life.

  24. Relationship Conflict • Identification of how couples respond to inevitable areas of conflict … is frequently viewed as a metaphorical “window” through which one can observe how close relationships function. • (Braiker & Kelley, 1979).

  25. Features of Relationship Satisfaction Sexual health and satisfaction is directly influenced by the quality of relationship conflict resolution. • Metz, M. E., & Epstein, N. (2002). The Role of Relationship Conflict in Sexual Dysfunction. Journal of Sex & Marital Therapy, 28: 139-164.

  26. Interactive Paths Between Relationship Conflict & Sexual DysfunctionMetz & Epstein, (2002). The Role of Relationship Conflict in Sexual Dysfunction. Journal of Sex & Marital Therapy, 28: 139-164 A. Relationship Conflict as a Cause of Sexual Dysfunction. B. Relationship Conflict as a Consequence of Distress Generated by Sexual Dysfunction. C. Relationship Conflict as a Means to Enhance Emotional and Sexual Intimacy  conflict is the ordinary opportunity for intimacy growth.

  27. Suggestive Data • Yeh, Hsiu-Chen, Lorenz, F. O., Wickrama, K. A. S., Conger, R.D., Elder, Jr., G. H., 2006. Relationships among sexual satisfaction, marital quality, and marital instability at midlife. Journal of Family Psychology, 20(2),339-343. • Boul, Lori, (2007). Sexual function and relationship satisfaction: An investigation into men’s attitudes and perceptions.Sexual and Relationship Therapy, 22(2), 209-220.

  28. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction • Realistic, age-appropriate, accurateexpectations of the bio-psycho-social dimensions of sex are essential for sexual satisfaction. • appreciate that media & advertisement exaggerate sex for commercial purposes: ”hype” • expectations vary according to the stages of one’s life and relationship development.

  29. Suggestive Data that Sexually Satisfied People are Apparently Realistic • Frank, Anderson, & Rubinstein, (1978). Frequency of Sexual Dysfunction in Normal Couples. NEJM) • Laumann, Gagnon, Michael & Michaels, (1994).The social organization of sexuality. • Byers & Grenier, (2004). Premature or rapid ejaculation: Heterosexual couples perceptions of male ejaculatory behavior. Arch. Sex. Beh., 2003 • Rosser, Metz, Bockting, Buroker, (1997). Sexual difficulties, concerns, and satisfaction in homosexual men. Journal of Sex & Marital Therapy. 23(1), Spr 1997, 61-73.

  30. What is Distinctive About Couples with SD?#1: Community Availability SampleFrank, Anderson, & Rubinstein, (1978). Frequency of Sexual Dysfunction in Normal Couples. NEJM) • Among “normal” (maritally and sexually satisfied) couples, the prevalence of sex performance problems is fairly high: • Sex Dysfunction common: • 40% men & 63% women. • Sex Difficulties high: • 50% men & 77% women. • Yet, 80%+ were maritally & sexually satisfied.

  31. Frequency of Sex Problems of Normal Couples (Frank, Anderson, Rubinstein, 1978, NEJM).

  32. What is Distinctive About Couples with SD?# 2: Representative Community SampleLaumann, Gagnon, Michael, & Michaels, (1994).The social organization of sexuality. • Despite many men and women reporting periods in the past year when they experienced one or another sexual problem, many reported satisfaction with their sex life (p. 373).

  33. Sexual Happiness by Type of Sexual Dysfunction Laumann et al., 1994.

  34. What is Distinctive About Couples with SD?#3: Community Availability SampleByers & Grenier, (2004). Premature or rapid ejaculation: Heterosexual couples perceptions of male ejaculatory behavior. Arch. Sex. Beh., 2003 • Evaluated PE among 150 university alumni couples. • The negative impact of sexual dysfunction is not solely determined by the behavioral performance deficit but rather by the significance to the man and notably to his partner. • Conclusion: “it may be that although partners are dissatisfied with the time of ejaculation, they have developed sexual scripts that allow them to experience sexual pleasure through other forms of stimulation.” (p. 269).

  35. What is Distinctive About Couples with SD?#4: Community Availability SampleRosser, B. R. S.; Metz, M. E.; Bockting, W. O.; Buroker, (1997). Sexual difficulties, concerns, and satisfaction in homosexual men.Journal of Sex & Marital Therapy. 23(1), Spr 1997, 61-73. • A sample of 197 homosexual males (over 18 yrs of age). • Results: Almost all (97%) reported some sexual difficulty over their lifetime, and more than half (52%) reported a current sexual dysfunction. A further 25% of the Ss identified other sexual concerns (e.g., fear of STD). • Despite these figures, most subjects -- whether single, dating, or in a relationship -- reported average to above-average sexual satisfaction.

  36. Such Multiple sources… suggest… • 30 year old community availability sample (Frank et al, 1978) • recent (1994) U.S. representative sample (Laumann et al. 1994) • specific sex dysfunction (PE) couple availability sample (Byers & Grenier, 2004) • same-sex availability sample (simon et al, 1997).

  37. The Crucial Variable for Sex Satisfaction: Reasonable, Age-Appropriate Expectations • The indispensable variable in sexual satisfaction is the “meaning” (cognitive dimension) of the sexual interaction (behavior) for the individual and the couple. • Realistic, accurate, age-appropriate expectations are crucial • because this “meaning” essentially distinguishes satisfied vs. dissatisfied / dysfunctional couples. • Acceptance of sexual variability: “not perfect”.

  38. Relationship & Sexual Satisfaction • an emotional dimension (i.e., feeling “good,” contentment), • grounded on the cognitivedimension – realistic and variable expectations (i.e., “meaning”), • about the behavioral dimension (i.e., adequate cooperation and realistic sexual function).

  39. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 4. Goodphysicalhealth and healthy behavioralhabits are vital for sexual health. Individuals value their and their partner’s sexual body.

  40. Healthy Behavioral Habits and Sexual Satisfaction • healthy sleep patterns • moderate physical exercise • eating habits and weight range • alcohol and drugs • Smoking • medication management (e.g., antihypertensive) • managing chronic illness

  41. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction • Relaxation is the foundation for sexual function and pleasure. • Physiological: PDE-5 inhibitors. • Psychological: balance of anxiety (Barlow). • Interpersonal: acceptance of touch, cooperation  e.g., “sensate focus” (M&J). • Developmental  “mellowing” (e.g., “better quality” of sex among 15 yr committed couples.)

  42. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction • Pleasure (physical touch) is as important as function (performance). • need for comfort, acceptance of touch • research on value of touch for youth, adults, elderly. • while sex function is important (especially for men), pleasure and cooperation are key.

  43. The Importance of Touch: “skin hunger” • Multiple, controlled studies with children, adolescents, and adults suggest that touch / physical pleasure: • reduces stress. • diminishes irritation, frustration, anger. • consoles and comforts. • reassures or soothes fear. • promotes connection, intimacy.

  44. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 7. Valuing VARIABLE & FLEXIBLEsexual experiences (the “85 percent approach”), and abandoning the “need” for perfect performance: • inoculates the couple against sexual dysfunction by overcoming performance pressure, fears of failure, and rejection. • frames the couple perspective towards cooperation as an “Intimate Team.”

  45. NY Times Best Selling Book: The Geography of Blissby Eric Weiner (NY: Twelve, 2008) • a Bhutanese hotel owner: the best explanation of happiness is… • “knowing your limitations…” • “knowing how much is enough…” • Or, an anonymous man in Iceland…” • “Happiness is when failure is an option…”

  46. The Quality of Sex in Well-Functioning, Satisfied Couples • 35 – 45% Very Good Quality. • 20 – 25 % Good Quality (at least for 1 partner). • 15 – 20 % Okay; Not Remarkable. • 5 – 15 % Mediocre, Dysfunctional. (Sources: Frank, Anderson & Rubinstein, 1978; Laumann, Michaels, Gagnon, et al., 1994)

  47. The 12 Core Premises of “Good-Enough Sex” for Couple Satisfaction 8. The five general functions or purposes for sex are integrated into the couple’s sexual relationship.

  48. The 5 Basic Purposes for Sex(Biopsychosocial Functions) In the order of prevalence: • Physical pleasure (bio-psych) • Tension / anxiety reduction (bio-psych) • Relationship intimacy (interpersonal). • Self-esteem, confidence (psych) • Reproduction or procreation (bio).

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