[This audiovisual has been acquired for distribution by the National Medical Audiovisual Center]

[Anatomy of a Sex History: The Wife's Husband]

[From the Center for the Study of Sex Education in Medicine, University of Pennsylvania School of Medicine]

[Produced by Ortho Pharmceutical Corporation, Department of Educational Resources]

[Dr. Harold Lief:] The film you are about to see is a sequel to the film entitled A Frigid Wife.

You may recall that at the end of that film,

Dr. Reed, the interviewer, had asked the patient, Mrs. Martin,

to return next time with her husband.

It is important to review the previous film in order

to fully appreciate this one.

The one-to-one model of interviewing

with which most clinicians are comfortable

is inadequate in treating sexual problems.

We prefer the conjoint interviewing method.

Although clinicians may be uncomfortable with this method,

we feel that this film is an effort

to make them more comfortable 

and more competent with this form of treatment.

It is crucial to see both people.

And for this reason, the husband has been asked

to come back with his wife.

One way of phasing into the conjoint session 

when one partner has been seen alone is to see the spouse alone

to begin with.

And this is what Dr. Reed will do

in this particular interview.

This gives the spouse the feeling

that he being given the same amount of time,

and it avoids putting the blame or making one person

the sick one.

This is a way of emphasizing that we

are treating the relationship.

It's a way, also, of eliciting information from the spouse,

and it gives us a chance to appraise

the husband's perception and compare it with the wife's.

We must, of course, enlist the husband's support,

for without his support, we will not

be effective in treating the wife's sexual problem.

As the scene of this interview opens,

Bob, the husband of the patient that we had previously seen, 

is being interviewed by Dr. Reed.

Because of the limits of time, 

we will only show you the beginning and end

of the interview with Bob,

and then move from that into the conjoint interviewing session.

Following the conjoint session, as we do in all these films,

we will have a replay analysis of interview techniques

and of interactional dynamics.

Now let's turn and watch the interview as it unfolds.

[Dr. Reed:] Mr. Martin, I appreciate your coming in.

As you know, I saw Linda last week.

May I call you Bob? [Bob:] Certainly.

[Dr. Reed:] Tell me how you felt about coming in.

I want very much to meet you and get your perspective,

but do you have any reactions to her asking you to see me?

[Bob:] Irritation.

[Dr. Reed:] Tell me about that.

What do you mean?

[Bob:] Well, I had to reshuffle an entire week's schedule.

I'm afraid I'm very busy in the office.

[Dr. Reed:] You're a lawyer.

[Bob:] That's right.

[Dr. Reed:] Right.

[Bob:] And it required quite a bit of redoing.

And I'm questioning the importance 

of my being here at all.

[Dr. Reed:] So you have some personal irritation

besides the professional?

[Bob:] Oh, yes, of course.

As I said, I'm very busy

and this is Linda's problem, basically,

and I don't understand what value my being here can be.

I don't think I can contribute anything that's significant

except to probably restate what Linda's already said.

[Dr. Reed:] Let me tell you my findings.

I feel that Linda is suffering from some emotional blocks

about her sexual performance.

She felt she was frigid, which is a bad word.

She's not.

She simply doesn't have orgasm during intercourse.

That means that you're involved.

And I would like very much to have your perspective

on the situation in order to be able to have you help her

through me.

Would this be a possibility?

[Bob:] Well, I suppose it is.

[Dr. Reed:] All right.

Tell me, if you can, something about your analysis

of the situation.

How do you see it?

[Bob:] Well, of course, I'm somewhat subjective about it, but...

her sexual performance is diminished.

She doesn't seem to be enjoying it.

Consequently, my enjoyment is a little less.

She's snappy around the house, a little quick to anger.

[Dr. Reed:] And you don't know why this is.

[Bob:] No, no I don't.

[Dr. Reed:] It's been about two months as far as you can tell?

[Bob:] That's right.

[Dr. Reed:] All right.

Tell me, if you can, something, then, along these lines.

We'll get back to the cause of all this.

Something about yourself.

Where do you come from and what kind of a sexual upbringing

have you had?

[Bob:] I suppose I'm an average middle-class American.

My parents went to church regularly.

They didn't discuss sex much.

I don't think they had any particular [?] tie in.

We had hotter and heavier arguments,

but up to that point, everything had been going quite well.

Dr. Reed:] And you still can't quite explain

why the sexual problem has occurred

in the midst of all this.

[Bob:] No, I can't.

[Dr. Reed:] Let me give you some ideas about your own history,

and then we'll get back to this and talk to Linda, too.

Your own history indicates that you had

a casual upbringing about sex.

And most of the encounters that you've had with women

are largely short-term relationships.

Linda is the first complex relationship with a woman

that you've had.

Am I correct?

[Bob:] That's true.

[Dr. Reed:] All right.

And apparently you're also a very busy guy

working on his career, and you said

that there's lots of responsibilities

on your shoulders concerning the home since you've been married.

[Bob:] Of course.

[Dr. Reed:] And the only thing you know is that in the past couple of months, 

Linda has become irritable

and her sexual response has gone down, 

and that brings you here, and that's sort of up to date?

Is that correct?

[Bob:] Well, that's true.

[Dr. Reed:] Now we've talked for a bit about this.

Do you feel, having talked for a while, any more involved

in the situation?

[Bob:] There is obviously some involvement that I have.

I'm still not convinced that the problem is based on that.

But certainly the situation is a little more complex

than I at first imagined.

[Dr. Reed:] Let's bring Linda in now and talk it over.

Before she comes in, do you have any questions for me?

[Bob:] I don't think so.

[Dr. Reed:] All right.

We'll bring her in and go on with the rest of the session.

Linda, Bob and I have just been talking in the same way

that you and I talked as to how he views the situation

and what might be done to correct things

as they've developed.

I want to know something about your feelings,

for starters, in terms of being out there in the waiting room.

Incidentally, I see you got your hair cut

since you were here last.

[Linda:] Yes, do you like it?

I feel like I needed a change of some kind.

I don't think Bob likes it.

[Bob:] I like it.

[Linda:] Oh, you like long hair.

You know you do.

[Bob:] Looks fine.

Looks fine.

[Linda:] Well, anyway.

[Dr. Reed:] She didn't believe you.

OK.

How did you feel sitting out there?

[Linda:] Well, a lot better today than I did last week when I was here.

I feel much more relaxed, and...

I'm anxious to talk about these things.

When I went home I told Bob that I already felt a lot better.

And if we could come together and talk,

we could probably find out more about what was wrong.

I was so relieved.

I told him I was so relieved last week to find out

I wasn't frigid because that had been one of my big worries.

Also, I realized that I did have trouble communicating to Bob

how I felt.

[Dr. Reed:] Tell him now. Go ahead.

[Linda:] Well, you know I have trouble talking to you sometimes.

I always feel like I'm on the witness stand,

and I have to make a logical argument the way

your clients do, or your colleagues do.

[Bob:] You don't have to make a logical argument the way

my clients or my colleagues do.

All you have to do is make a logical argument.

[Linda:] Well, sometimes, you know, it's hard to say

exactly how you feel.

I know I have that difficulty and I have to work on it.

But that's one of the reasons you're here, 

because it's both of our problems,

and because sometimes I think you don't listen to me.

[Dr. Reed:] So what you picked up, if I may, the last time we were together,

is that you have been trying to get through to Bob

and feel you've failed.

And one of the side effects of this,

perhaps, has been the sexual problem.

Am I correct?

[Linda:] I guess.

[Dr. Reed:] Something like that appears to be involved,

which is why it was important to bring you in.

Now if I can, Bob, would you tell Linda

your summary, so to speak, of what we just talked about?

Give her some feedback, and then we'll build on this.

Can you please?

[Bob:] I presume you mean the...

[Dr. Reed:] What we just talked about.

Tell her your view of what we just discussed.

[Bob:] Well, I guess we arrived at two main points, 

which were the fact that there is an involvement on my part

with your problem, and the fact that ours

is a complex relationship, 

contrasted against the casual relationships that I had with other women

before we were married.

Ours is in a much more complex one,

and therefore the solutions to problems

are a little more complex.

I think that about touches it, doesn't it?

[Bob:] Well, why don't you check that out with Linda?

[Linda:] So cut and dried.

[Dr. Reed:] Let me ask you a question.

When Linda get emotional, what goes on in you?

What do you feel at a gut level when she gets emotional?

[Bob:] Well, I just find it impossible to deal with that, 

with anyone on that level.

What am I supposed to do?

Am I supposed to get equally emotional,

and then we get nowhere?

[Dr. Reed:] I don't know. What do you do?

[Bob:] What I try to do is to calm her down and to the point

where we can talk rationally, 

and not with a great deal of emotion, which is unintelligible.

[Dr. Reed:] I see.

[Linda:] But you never seem to sense anything.

I feel like I can sense your mood or sense your needs, 

and you don't ever seem to sense mine.

You're always distracted.

You're not romantic anymore.

You don't ever touch me.

You know, it's always just, let's go to bed.

[Dr. Reed:] You seem to have some hostilities here

that are getting the better of you in your relationship, 

and I'd like you to keep that in mind

because I'm very aware of them, that you're drifting apart

and you have some differences and grievances

that haven't been brought to the light of day.

Now let's go back to this kind of a situation.

I want you to try to go back in your mind to an experience

somewhere where things got bleak in the sexual area.

What did you try to do that failed in some way

when it somehow wasn't quite the same thereafter?

Can you think of some...

do you know what I mean?

[Linda:] I can remember one very specific incident when things

were getting bad between us, 

and I began to feel unattractive,

that he wasn't attracted to me, 

never sensed that I needed anything.

He seemed so distracted all the time.

So one day I, 

I always keep the house very clean, and when he comes home

there's not garbage all around from the kids.

I always try to keep a nice atmosphere for him

to come home to.

But this particular night, I had cooked a special dinner

from Gourmet cookbook, and I had a low-cut dress on,

and I had the lights down.

I had candles on the table.

I had everything, you know, I wanted to show him that 

I wanted to be attractive for him, and I wanted him to think of me as a...

[Dr. Reed:] Tell him the story while you're [?]

[Linda:] As a woman.

[Dr. Reed:] You seem to know what she's talking about. Do you?

[Bob:] I know now, yes, what she's talking about.

[Dr. Reed:] All right. Go ahead, finish...

[Linda:] Because, well, he came in, didn't even notice

that I had anything different on or that there were candles

on the table, or even smelled the fantastic aroma of the food

I was cooking.

Walked right through the room.

I had made sure the kids stayed with my parents.

He walked right through the room,

opened his briefcase, fumbled around, papers,

turned around, said, where are the kids?

[Dr. Reed:] And then what happened after he did that?

[Bob:] She launched into hysterics.

[Linda:] Not right away!

[Bob:] Well, if it wasn't right away, it was certainly very fast.

I walked in, and as she says, I can't remember

what it was I was doing.

But I'd just come in from a busy day at the office,

and I had some something on my mind

about something I was going to be doing the next day,

preparing a brief or something.

[Linda:] You always do.

[Bob:] Well, that's the nature of my business.

But at any rate, I walk in, and then was

prepared to be a father and husband, as I

thought would be nice to do, 

and I said, where's the kids?

And she launched into a scene.

[Linda:] Well, how could you turn and look at me

in a beautiful dress like that with candlelight

and say where's the kids?

I'm not just a housemaid.

[Bob:] I hardly had time to take a look at the stage setting.

[Linda:] That's ridiculous. You'd have to be blind.

That was then that I decided he really

wasn't attracted to me at all anymore,

and that he probably saw women from the office.

I didn't know.

[Bob:] Oh, that's ridiculous.

[Linda:] Well, that's the way I felt.

[Dr. Reed:] This fight that you're having, a struggle for power

within this relationship, is something

that has to be settled, not in the sense of having a winner

and a loser, which is what you've done...you win,

she loses, and out goes sex.

There's got to be, perhaps, a better way

to work out your hostilities and your grievances

and your anxieties than just kind of carrying away

at each other.

I think you can see that what you do

is you tend to overreact, both of you.

You both tend to overreact to each other.

You get really, too tense, when she gets over-emotional, if you will.

And you get too tense when he gets too preoccupied.

And rather than try to engage each other

and, like, negotiate about that or deal with it,

you tend to both withdraw.

And your sexual problem is a result of that withdrawal.

She can't respond to you because she feels

put down by you, as though she's constantly

got this residual anger, can't get it out,

and that's when sex gets turned off.

If you could handle this level of communication

between you, if you can start to get acquainted

in the non-sexual area, which seems like it's possible

that you can recognize that you really have something

to go with, you seem to have much fondness for each other.

What you're no good at is having a good, healthy argument, 

which just gets the feelings out.

If you can handle thatin a non-sexual area,

let's move on to the sexual.

I'm going to try to change the topic in some way, slightly.

Seems to me that what we've got to do with the sexual area

is also get you reacquainted.

What I want to do is suggest this.

For the next three nights, I'm going

to ask you to make a deal with me, 

and that is, you agree to meet in your bedroom

and do some things thatI'm going to suggest.

Now the first thing I'm going to suggest

is no fighting in the bedroom.

If you're going to work on your sexual response,

have your fight someplace else.

Don't have it about sex, OK?

What I'd like us to do is to learn

about your sexual expression with each other.

Not fight about sex.

The second thing is no intercourse

until further notice.

I'd like you to begin some kind of sexual fun,

some kind of pleasure together that excludes intercourse.

Do you know why that's important?

[Bob:] Not yet.

[Linda:] Every time intercourse is likely to occur, a couple of messages

go through Linda's mind.

One is you're getting your way, and the second is, she's gonna fail.

So she cannot anticipate any reward.

And what she does is she enters the bedroom,

and she's going to have to perform,

and then she has to say relax, damn it, relax,

and she fails again.

And that becomes a vicious cycle.

[Bob:] That conditioned reflex we were talking about.

[Dr. Reed:] Right.

I need your help to help her with that.

This is what I suggest.

Now I would like you to do something for me, to learn.

Would you reach over and touch Bob's hand, OK?

Caress his hand in some way and show me how you might do this.

Just take his hand, and I don't think he'll hit you.

Go ahead.

Try.

Go ahead.

Caress his hand.

What goes through your mind as you do this now?

Describe what it is you think.

[Linda:] It feels good.

[Bob:] Working in the garden.

[Linda:] When?

[Bob:] Occasionally I do.

[Linda:] What goes through my mind?

[Dr. Reed:] Yeah.

You're wondering about his hand, and...

Yeah.

[Linda:] I feel the hairs on his hand.

[Dr. Reed:] Fair enough.

All right.

I'd like you to stop.

Now Bob, would you mind, do this in return.

Would you touch her hand in some way?

And tell me what goes through your mind as you do this now?

Go ahead.

[Bob:] I feel her skin and her bones, knuckles.

[Dr. Reed:] All right.

Now both of you focused on the other person's hand.

You wondered about her hand, you wondered about his.

Am I correct?

You both wondered about the receiver.

Now I'm going to suggest that the next three nights, 

when you touch, change that.

Rather than trying to worry about the receiving hand, 

if you do this to yourself, you see,

we typically think about the receiving hand, 

think about the sender.

When you touch each other, don't worry so much

about what the receiver is getting.

Think about what you're getting out of it.

Think about what you go through when you're touching

your partner in some way.

[Linda:] But isn't that just selfish, 

just to think about what feels good to me?

[Dr. Reed:] Yes, it is.

But it's selfish within a good relationship,

within some capacity for concern.

The reason it's important is this.

Now watch.

When she starts to be concerned about her own sexual comfort,

she gets critical and then she withdraws.

Part of her is up there in the corner of the bedroom

saying relax.

The moment that happens, you're trapped.

When that  starts to happen, I'd like you 

to be able to touch this guy in such a way

that you are pleased.

Not him.

He'll be all right.

He'll tell you if it's no good.

And in order to get to this point.

I'd like you to learn that.

So for the next three nights, 

I'd like you to get physically acquainted

without touching the breasts or the genitals

on the basis of, as you touch, are you giving to your partner

some kind of caressing, some sensual expression?

The reason you're doing it is because 

you're getting something from it.

Do you understand?

You look a little puzzled, Bob.

Do you understand?

[Bob:] Yeah, I...

[Dr. Reed:] Is it worth a try?

[Bob:] I suppose so. It just seems like a very artificial kind of setup.

[Linda:] I would like to try it. That's what I miss about...

remember before we began to have sex,

we did a lot of holding hands and silly things.

But I really, I miss that.

[Dr. Reed:] It's called foreplay.

A lot of people make it forework, which is too bad.

Now let me explain his dilemma.

He's an ordinary American male 

who was brought up in a casual atmosphere about sex

and really hasn't had very close, longstanding

intimate relationships with women.

And also, he is conditioned, as a sexual animal,

to really be more concerned about his genital sensations

than anything else.

We're like that.

We don't have the same kind of skin hunger

that the Lindas of the world have for a total caressing experience.

Our bodies aren't used to that.

And I really bring this us up because 

I think that the women are right, that their desires for a more

generalized sexual experience are probably healthier

than just you and I, who get a genital sensation, get aroused,

and want to get to it, down to the nitty gritty,

and stop all this messing around.

That's what you call artificial.

I'd like to suggest that we do this

because it's going to be rather like learning a new sport...

[Linda laughs uncomfortably]

[Dr. Reed:] At first artificial, but then you'll slip into it naturally.

What I'm going to ask you to do is simply record in your mind

what it's like to receive.

You take 10 minutes each, all right?

10 minutes giving and 10 minutes receiving each, each night.

And your task when you return here

will be to share with us what it is you went through as a giver

and as a receiver.

And we'll try to start out your signals.

You're not working clearly with each other

in the sexual communication sphere.

You're misreading things.

You hoped he could understand you without being clear,

and you end up overreacting when she's getting emotional,

whether it has to do with sex or not.

And that has created this kind of Mexican standoff

that you run into every now and then.

So what I want to do is come back,

and we'll work on the sexual pattern.

We'll go next to caressing the genital area and the breasts,

and then the face.

Beyond that, we'll go to intercourse itself.

But this one is as I described it, kind of the early phase.

Your marriage can obviously work out fine

if you just work at it.

You're too preoccupied, and you have to get back in it.

And you've got to be able to get through

without being so threatening.

OK?

It's not that difficult if you let her hang in there.

[Bob:] Hmmm.

[Dr. Reed:] So I think you can see we want to work out both the non-sexual

and the sexual together.

For now, correct the sexual pattern,

and I think you'll have an interesting time.

I think you'll see that it'll have a ripple effect

and improve lots of things.

All we have to do is learn.

So I'll see you in a few days, and we'll get together then.

[Linda:] Okay.

[Dr. Reed:] Fair enough?

[Bob:] Well, we'll give it a try.

[Dr. Reed:] OK. See you then.

[Linda:] Thank you.

[Dr. Lief:] As we always do, we will now take a closer look

at the interview.

The viewer should pay particular attention

to the interaction between husband and wife,

as well as the interaction between the doctor

and the couple.

We are interested in all dimensions

of interactional dynamics.

We are also concerned with interview techniques.

Through instant replay, we will observe

these details more thoroughly.

[Dr. Reed:] You have some personal irritation

besides the professional?

[Bob:] Oh yes, of course.

As I said, I'm very busy, and this is Linda's problem, basically, 

and I don't understand what value my being here can be.

I don't think I can contribute anything that's significant.

[Dr. Lief:] Anger at being involved in therapy

is commonplace, especially if this partner

himself has no problem with sexual performance.

He would like to make his spouse the sick one, and at some level

is fearful that he will be judged

to be an ineffective lover.

It takes some education to get husband and wife

to focus on the relationship and to 

stop blaming each other or oneself.

The therapist is taking time to educate

Bob about his part in the relationship.

This reduces confusion and gives him

the feeling that he will get something of value

from becoming involved in treatment.

This "sells him" that the results may

be worth the price and paves the way

for more effective cooperation in the conjoint interview.

[Dr. Reed:] I want to know something about your feelings,

for starters, in terms of being out there in the waiting room.

Incidentally, I see you got your hair cut

since you were here last.

[Linda:] Oh yes, do you like it?

I felt like I needed a change of some kind.

I don't think Bob likes it.

[Bob:] I like it.

[Linda:] Oh, you like long hair.

You know you do.

[Bob:] Looks fine.

It looks fine.

[Dr. Lief:] You will note that the therapeutic relationship begins

immediately.

Linda, who has a new hairstyle, turns to the therapist

for affirmation.

His response is important to her.

Her self-esteem is low.

She needs constant reassurance 

that she is attractive and lovable.

Even when her husband gives her the support

and shows signs of his affection, she doesn't hear it

or she tunes him out, even though she readily

hears his criticisms.

This is a classical gambit of the person

whose self-esteem is low.

The therapist must be very careful

not to overplay his hand in this type of situation.

[Bob:] When I point out what is obvious

is that she either does that, which is just disappears,

or she gets completely irrational

and eventually hysterical.

And I try to keep whatever discussion

we're having on an intelligent level 

rather than an emotional one.

[Dr. Lief:] Notice his perception of the communication process.

If he expresses himself well, he believes

he has handled communication effectively.

He fails to consider if his message is getting across

to his wife and leaves out a consideration: 

his listening and understanding his wife.

Note, too, his overemphasis of the verbal,

logical, rational aspects and his underemphasis

of the emotional dimensions of communication.

Decreasing his need to control 

and increasing her control of her feelings 

and the expression of those feelings will be the job 

of the skilled marriage counselor.

[Dr. Reed:] Let's go back to this kind of a situation.

I want you to try to go back in your mind to an experience

somewhere where things got bleak in the sexual area.

What did you try to do that failed in some way, when...

[Dr. Lief:] Dr. Reed takes the pair from the general to the specific

in order to see how the abstractions they have

been hurling at each other are played out

around a specific event.

After concentrating on their relationship

and decreasing their angry feelings somewhat,

and partially clarifying the problem in communication,

the therapist feels that he has paved

the way for a specific sexual reeducation.

This is a subtle point.

The timing of this may be difficult to ascertain.

If it is premature, the couple will sabotage 

the specific techniques explained by the therapist.

If this happens, the resistances to therapy

will be dealt with directly, the couple learning

from their mistakes something more about the nature

of their relationship.

[Dr. Reed:] What you're no good at is having a good, healthy argument, 

which just gets the feelings out.

Now if you can handle that in the non-sexual area,

let's move on to the sexual.

I'm gonna try to change the topic in some way slightly.

Seems to me that what we've got to do with the sexual area

is also get you reacquainted.

[Dr. Lief:] Make careful note of the therapist's emphasis

on the broad range of sensual feelings and behavior,

decreasing the emphasis on genitality.

This allows people to de-emphasize 

the performance aspects of their relationship.

Hopefully, this is the beginning of a continuous learning process.

Couples not infrequently learn more from their mistakes

than from their successes.

[Harold M. Lief, M.D., Director of the Center; David M. Reed, PhD., MPH, Assistant Director of the Center]

[Executive Producer, Charles Galbraith; Producer-Director, Stan Carlson]

[Video Tape Editor, Bob Howard]

[Produced through the facilities of Northwest Mobile Television]

[End of film]