This Couple Contacts Me From South America…

“…We know we need sex therapy, but there isn’t anyone in our country we can talk to,” read the email. “We’d like to speak with you by skype so you can help us fix our sex problems. Will you do this with us?”

They live in a major city whose name you probably know. He’s a professor, she’s a dentist. They speak excellent English, she says, and when they read my website, they knew I was the guy to help them. They’ll pay by credit card, she adds.

Fast forward a couple of emails, and at exactly 6PM my time yesterday they call. Skype video works, showing them sitting together at their kitchen table. I’ve put on a dress shirt for the occasion. We have 30 minutes to get acquainted, see if we understand each others’ English, and bridge two continents’ worth of cultural expectations.

I say I’d like to ask some simple questions, then we’ll get into the more complicated part of the story, and then we’ll decide if we want to proceed. OK? OK.

They seem like a pretty normal couple, whatever that means. He’s 36, she’s 35. They’re married 5 years, have no kids. What about pets? Yes, they have a dog named Achilles. I wheel in 31 years of clinical wisdom: “Where does the dog sleep?” “In bed with us,” they smile sheepishly. I say nothing, but we all know something’s already happening.

What do they wear when they sleep? Pajamas, both of them. And where do they change from their clothes into their pajamas? “I change in my room,” he says, “and she changes in the bedroom.” Why? That’s where their respective dressers and closets are. So do they ever see each other naked? Yes, they shower together almost every morning. Why together? “It saves time when getting out in the morning for work,” they agree.

Birth control when they have intercourse? Condoms. Yes, 100% of the time, “no problem.” Good. Because it’s almost impossible to do effective sex therapy when a couple doesn’t have a consensus about this. Without consensus, every sexual occasion highlights a fundamental problem, an existential challenge that makes relaxation, pleasure, and trust unlikely. That’s even true with couples mutually attempting to conceive—it just makes the sex too important.

But I see that they’re dying to tell me their story their own way. Faces creeping closer to the webcam, their impatience is beginning to show. So I invite them to do so.

“After we had been dating a while, Maria’s mother fell ill and Maria moved in with her,” Jose says. Was this in the same city where they’d been dating? Yes. “And since we weren’t going to live together, I moved in with my parents soon after,” says Jose. “Not much privacy, then,” I venture. “Oh no,” they blurt out at the same time.

“What about a hotel?” I ask. “You were both already working, so you each had some income, yes? So couldn’t you go to a hotel 2 or 3 times per month?” “I would have, but she refused,” says Jose. “She said those places aren’t for good girls, and she was afraid we’d get caught.” Is he still resentful about this, or is our cultural chasm interfering with my perception? Or is that just a bit of skype on his face, rather than the resentment I imagine?

So for three years they hardly ever had sex. Then Mama died, they married, and moved into their own place. But the sex never rebounded, and in fact eventually melted away. Now the lack of sex is awful. Can I help them have more sex?

“Is that all you want?” I ask. It rarely is. “We also want to communicate about sex more easily,” she says, and he nods. And how do they communicate about other things? Fine, they agree. “I wonder why you don’t just use those same good communication habits and skills when the subject is sex,” I venture. They say they don’t know. “But that does seem like an important question, doesn’t it?” Yes, they both nod.

I pause to let them think.

“How does your treatment change if you know we’re thinking of divorce?” Maria asks abruptly. “I understand you’re each in a lot of pain,” I reply. “If by mentioning divorce you hope to let me know that this is a really, really, really serious problem, thank you—I understand that you really want to fix this, and you’re frightened that we won’t. I assure you I’m taking this as seriously as possible.”

Any other questions?

“How long will this take? What will the therapy be like? Do you think you can help us?” These are the same questions almost all patients have. You don’t have to come from South America to want some certainty about the process. The only certainty is that this is going to cost them plenty of hard currency. I answer honestly, appropriately vague, encouraging, and slightly cautionary.

“Let me say two things,” I add. First, things happened during your three-year sort-of separation that probably need discussing, understanding, forgiving, and letting go. I don’t know what they are, but given the structure of how things unfolded, I’d be surprised if this weren’t true. You can start talking about that this week, or you can wait for our sessions.

“The second thing,” I say, “Is you might find that getting undressed together for bed—even occasionally undressing each other—might be enjoyable and a little sexy, even though you’re simply going straight to sleep. And speaking of sleep, I wonder if it’s time to prepare for more regular sex by finding a new place for the dog to sleep.”

On that optimistic note—we’re already talking about preparing for more sex!—our half-hour is up. We’ve actually accomplished quite a bit, particularly given the language and technology issues. So do they want to continue, or not, or do they want to think about it? “We’ll get back to you,” they say. We’ll see if they do. Adios.

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