It’s a cold, late Tuesday evening. Your next clients are one of your most intriguing Emotionally Focused Therapy (EFT) cases. You’ve met with them a total of four times so far and they have begun to see progress in their relationship. You’ve taken a relationship history, a detailed history of their family of origin, held separate individual sessions, talked about their attachment, and have outlined their EFT cycle with them. The couple is aware of their cycle and is making steps to not engage when it comes up.

During the relationship history, the couple reported that there was a time where they were separated because of “something he was doing.” The way that the couple talked about this ambiguous thing was like it had a power of it’s own. You could tell they weren’t joined with you enough to begin talking about it, so you saved it for further assessment later on.

So you decide tonight seems like a good time to bring it up. When you bring it up, the couple looks at each other and then looks back at you and the wife says, “he has been experimenting behind my back with anal play, specifically to stimulate his prostate, and now he wants me to start doing it with him. I feel like this is what is preventing us from making any more progress in our relationship.”

This scenario could go one of three ways. First, you could refer this couple out to a sex therapist. You know as their therapist that the couple has identified this issue as being what is keeping them from progressing further in treatment, so you know the problem has to be addressed. Referring out to a sex therapist means that their treatment is paused or terminated. You haven’t begun to explore their primary emotions and underlying attachment needs and fears with them. You send them with a referral and a Release of Information for the sex therapist. You never hear back from the sex therapist when you attempt to collaborate, and the couple doesn’t return to therapy.

Second, you could be the sex therapist that is referred this case from a mental health provider. You have no idea that this couple has three children, one with Down Syndrome, which has put a major strain on the relationship. You have no idea that the husband’s father also enjoys prostate stimulation. You are clueless to the wife’s abandonment by multiple people in her life. You work closely with him, going back to understand how he learned about sex and his body and what his idea is of the origin of this “problem.” You co-create a a sexual ethic commitment for him that includes safety of himself when using anal play, and connect him with books to read and resources to utilize.

Believe it or not, there is a third option in this scenario! A couple’s therapist that is trained in systems thinking AND trained in sex therapy could treat this couple. The couple’s therapist could realize that this prostate stimulation is a part of their EFT cycle, as the husband tends to do this when his wife is emotionally unavailable for him. You could go back to the basics and give them both sex education around the genitals and stimulation. You could normalize, rather than pathologize the behavior by referring the husband out, the behavior by comparing the prostate to the female G-Spot. You could talk about how to be safe when using toys or other objects, and you could help the couple communicate about the prostate stimulation. You could help the couple co-create a sexual ethic around the prostate stimulation, use of erotic images, and then reframe all of these things in the lens of attachment. You could go deeper into the EFT cycle by helping the husband name his attachment need of being accepted, and you could name the wife’s need to be important.

Clearly, the third option is best for the client. In a world where we are trying to bring the mental health and physical health together in physician’s offices with a Patient Centered Medical Home, we can provide this in our therapy offices as well. Research shows that there are four main concepts that make for effective therapy: the relationship, utilizing extra therapeutic factors, placebo, hope, and/or expectancy and lastly, the structure, model, or technique (Donahey & Miler 2004). Dr. Peggy Kleinplatz (2013) makes an excellent case for combining couple’s therapy and sex therapy. She states that treatment of the symptom alone means that the context of the problem is often forgotten or dismissed. Had a sex therapist just worked with the husband, he or she would have missed that the wife is also experiencing a lack of pleasure. Emphasizing seeing the couple as a whole person, Dr. Kleinplatz makes a plea to combine the two therapies to best suit our clients and society as a whole.  This way they stay in therapy and reach their attachment goals through BOTH good therapy and improved sexual connection and shared pleasure. This is biopsychosocial-sexual therapy, and I have come to believe it is a core competency.

If you are a couple’s therapist interested in receiving training toward your AASECT certification for sex therapy, please visit

Taylor Ulrey is a graduate student at Seattle Pacific University studying Marriage and Family Therapy. Taylor is also obtaining her certificate in Medical Family Therapy and aspires to be an AASECT certified sex therapist in the future. Taylor is one of the administrative assistants at NWIOI. Taylor’s clinical work focuses on couple therapy, specifically postpartum couples and the many struggles that come with building a family.


Kleinplatz, P. J. (2001). New directions in sex therapy: Innovations and alternatives. Philadelphia: Brunner-Routledge.

Donkey, K. M., & Miller, S. D. (2004, November). Applying a common factors   perspective to sex therapy. 11(1), 42-51.


Until April 1st – Save $160.00 on the June SAR.  GRAB A SPOT WHILE THEY ARE STILL AVAILABLE

Becoming an AASECT Certified Sex Therapist is a two year process involving coursework and 50 hours of supervision. The Northwest Institute on Intimacy is the only place in the country where you can receive this training in an intensive highly efficient and cost effective two year format involving one four day class, one five day class, and 50 hours of supervision.  The next SAR Course (Sexual Attitude Reassessment) is June 22-25 and is now open for registration.  Until April 1st – the Early-Early Bird cost is $590.00 (regularly $750.00); $160.00 off the regular tuition cost. 

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