Sexual Issues In Couples Therapy:
Practical Skills for Common Problems

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SESSION 1

1. What are examples of extraneous things people focus on during sex?*

a. How they look, sound, or smell

b. Discerning partner’s feelings or judgments

c. Trying to function “the right way”

d. All of the above

2. What can make sex unnecessarily complicated?*

a. Shame, guilt, embarrassment

b. Performance anxiety

c. Fear of psychological exposure

d. All of the above

3. We should understand and highlight patients’ sexual narratives because*

a. It will help us discuss what’s normal

b. This will help expand patients’ options

c. They’re usually wrong

d. They’re usually right

4. Which is true?*

a. We should help patients discover the true meaning of sexuality

b. The meaning of sexuality is constructed

c. Sexual dysfunction typically arises from meaningless sex

d. None of the above

5. According to the speaker, *

a. The concept of “normal sex” disrupts many sexual relationships.

b. Patients have a right to know what’s sexually normal

c. People rarely care about what’s sexually normal

d. Because of computers and social media, we now know what’s sexually normal

6. Which of these is a common feature of adult sexuality in America?*

a. Sex when tired

b. Unrealistic expectations

c. Awkwardness & self-consciousness

d. All of the above

7. According to the speaker, limiting masturbation generally increases desire for partner sex.*

a. True

b. False

8. According to the speaker, orgasm*

a. occurs every time healthy couples have sex

b. is the most important part of sex

c. is not the most important part of sex

d. is unaffected by emotions during sex

9. Sexual exceptionalism is the idea that*

a. Healthy adults have exceptional sex

b. Sexuality needs its own approach to communication, problem-solving, and ethics

c. Only unusual people should expect enjoyable sex

d. Studying sexuality guarantees enjoyable sex

10. According to the speaker, many therapists believe untrue myths about sex*

a. True

b. False

11. The two most practical suggestions for improving sex are*

a. Diet and organic supplements

b. Weight control and learning tantra

c. Self-acceptance and communication

d. Clandestine affairs and BDSM

12. According to the speaker, male and female sexuality are obviously more different than similar.*

a. True

b. False

SESSION 2

1. When it comes to reasons for having sex,*

a. Partners may not know each other’s reasons.

b. Partners may misperceive each other’s reasons.

c. Partners may not care about each other’s reasons.

d. All of the above

2. According to the speaker, which of these is an example of “normal sex”? Many people…*

a. Don’t expect to enjoy it

b. Feel rushed

c. Feel disconnected from their partner

d. All of the above

3. Fear of unwanted conception can complicate sex.*

a. True

b. False

4. Which is true?*

a. We don’t need to assess for alcohol use when evaluating sexual function

b. Worrying about a dysfunction can actually contribute to a dysfunction

c. Men have more sexual dysfunction than women

d. Women have more sexual dysfunction than men

5. Which is true?*

a. It’s unrealistic to think that people who are uncomfortable about sex can learn to talk about sex

b. If clients reveal they are uncomfortable about sex we should respect that and change the subject

c. There’s little disadvantage if couples don’t have words for sexual behaviors and body parts

d. Therapists have a responsibility to encourage clients to look at their discomfort about sex

6. Which is true?*

a. Only neurotic people have conditions for enjoyable sex

b. We should encourage couples to know and discuss their conditions for enjoyable sex

c. Conditions for enjoyable sex are just defenses against pleasure

d. All of the above

7. What are examples of conditions for enjoying sex?*

a. Privacy

b. Being in love

c. Anxiety about getting caught

d. All of the above

8. Sexual dissatisfaction when conditions aren’t met isn’t a dysfunction.*

a. True

b. False

9. Sexual fantasy…*

a. Is a good predictor of sexual desire

b. Is a good predictor of sexual behavior

c. Is a good indicator of psychopathology

d. Is common across gender orientation, and identity

10. As mandated reporters,*

a. We should report any sexual fantasy about illegal activity

b. We need specific criteria for evaluating if a client’s fantasy is reportable

c. We should understand how common fantasies of illegal activity are

d. Our first duty is to protect vulnerable members of the population

11. When couples are in conflict about porn,*

a. Men are as likely as women to be upset about their partner’s porn watching

b. We should help them decide whether the content of the porn is disgusting or not

c. There’s often another underlying unresolved conflict

d. It usually means one or both partners doesn’t like sex

12. According to the speaker,*

a. If a couple is really in love, they should share their sexual fantasies

b. Sharing sexual fantasies effectively requires good communication skills

c. Sharing sexual fantasies is a good way to resolve sexual dysfunction

d. Sharing sexual fantasies is mostly useful after infidelity

13. According to Ogas & Gaddam, submission is a common female sexual fantasy*

a. True

b. False

14. Which is true?*

a. “Kink” is a valuable clinical term with a specific meaning

b. Each person should decide if their partner is kinky or not

c. People who prefer kinky sexual acts are usually afraid of intimacy

d. None of the above

15. BDSM…*

a. Is primarily about trust

b. Is primarily about pain

c. Should only be tried by non-heterosexual couples

d. Doesn’t require much communication

16. Polyamory…*

a. Is another word for infidelity

b. Is a good relationship model for people inhibited in talking about sex

c. Is a great way to resolve sexual dysfunction

d. Has both advantages and disadvantages when compared to monogamy

17. When working with clients from cultures different from the therapist’s, the therapist…*

a. Should first become an expert in that culture

b. Should offer them a discount

c. Should treat the clients as individuals who will describe how their culture influences their experiences and decisions

d. Should feel guilty or self-conscious

18. According to the speaker, some cultural attitudes about non-sexual issues can influence a couple’s sexual relationship*

a. True

b. False

SESSION 3

1. Many sexual difficulties involve unrealistic expectations.*

a. True

b. False

2. Desire at 35, 45, and beyond may not feel like it did at 25. Therefore,*

a. Infidelity is inevitable

b. If we’re waiting to feel passionate urgency before initiating or having sex, we may think we’re never in the mood

c. Women should fake orgasm

d. All of the above

3. Which is true?*

a. Except for pregnancy, most people’s bodies remain consistent before age 50

b. In the big picture, things like hair loss and weight gain are trivial, and so they rarely affect sexual function and satisfaction

c. Developing sleep problems can contribute to sexual difficulties

d. The seriousness of COVID has reduced the stigma of STIs

4. Which of these health interventions can impact intimacy?*

a. CPAP machine

b. No-alcohol regimen

c. IVF & fertility treatments

d. All of the above

5. As clinicians, we should assess if patients have chronic pain because*

a. It often involves discouraging existential issues

b. People in pain aren’t attractive

c. It’s unusual for people under 40 to experience chronic pain

d. All of the above

6. Virginity is a social, not a medical, construct*

a. True

b. False

7. According to the speaker, it matters if people are comfortable having some light on when they’re having sex.*

a. True

b. False

8. Organized religion*

a. Typically attempts to regulate sexuality

b. Rarely attempts to regulate sexuality

c. Typically privileges non-reproductive sexual acts

d. Is rarely an issue worth clinical attention

9. According to the speaker, we should trust clients: if they feel out of control, they are out of control.*

a. True

b. False

10. If patients keep breaking agreements,*

a. We should evaluate how important the subject really is

b. There’s a high probability that addiction is present

c. We should explore the dynamic, independent of the content

d. It’s probably because there’s so much nagging in the relationship

11. The diagnostic criteria for sex addiction are culturally-syntonic for most Americans*

a. True

b. False

12. According to the speaker, for some people, *

a. Nothing is more embarrassing than having a “sex addiction”

b. A diagnosis of “sex addiction” ends most of the relationship’s conflict

c. Having a “sex addiction” is less troublesome than discussing masturbation

d. The solution to having a “sex addiction” is for people to stop having sex with their spouse.

13. In what ways can a “sex addiction” diagnosis shift the power balance in a relationship?*

a. One person gets to define who has the problem

b. One person doesn’t have to examine their contribution to relationship problems

c. Only one person has to make amends

d. All of the above

14. According to the speaker, most people who go to sex workers struggle with poor attachment.*

a. True

b. False

15. According to the speaker, *

a. Watching porn is a good thing for all adults

b. Since some people act out after watching porn, no one should watch it

c. Some people misuse porn

d. To enhance relationship satisfaction, people should demand that their partner quit watching porn

16. The origin of the sex addiction concept is*

a. The field of Sex Therapy

b. The field of Marriage & Family Therapy

c. Divorce lawyers

d. None of the above

17. What does it mean that “health issues can problematize bodies”?*

a. People can’t expect to be attractive once their health declines

b. Once health declines, people usually struggle with sexual dysfunction

c. Only people with low self-esteem find unhealthy people attractive

d. None of the above

18. According to the speaker, *

a. The most important cultural influences on sexual expression are race and gender

b. The most important cultural influences on sexual expression are religion and ethnicity

c. The most important cultural influences on sexual expression are different for men and women

d. The only way to know the most important cultural influences on an individual’s sexual expression is to ask many questions about it

19. When it comes to cultural influences on sexual expression,*

a. Our field privileges some over others

b. Our field’s ideas about what’s important has stayed consistent for 40 years

c. Sensitivity is pretty much the same as stereotyping

d. None of the above

20. When treating infidelity, it’s good to remember that*

a. Women forgive more easily than men

b. Once a cheater, always a cheater

c. Trust is a choice

d. A detailed and thorough confession of all details is essential to reconciliation

21. According to the speaker,*

a. Foreplay should last at least 15 minutes

b. It’s unrealistic to expect heterosexual men to enjoy more than a few minutes of foreplay

c. Foreplay is too private a thing for clinicians to ask questions about

d. Anxiety can interfere with enjoying foreplay

22. Arranged marriages and multi-generational households*

a. Can challenge Western ideas about intimacy and individuation

b. Are typically less enjoyable than love marriages and two-generation households

c. Rarely reinforce sex roles that can challenge ideas of Western therapy

d. All of the above

23. Erection drugs like Viagra*

a. Help women get aroused

b. Have few side effects or contraindications

c. Work best when accompanied by education and communication

d. Are pretty similar to various herbal remedies

24. In treating sexual difficulties,*

a. Some couples just need to be encouraged to have more sex

b. Various forms of mindfulness can be valuable

c. We shouldn’t complicate things by inquiring about contraception

d. The most important thing is to not offend clients by using words they’re uncomfortable with

SESSION 4

1. Which is not an element of the early-session dialectic?*

a. Collect information we hope will be relevant

b. Generate/shape hypothesis

c. Discuss fees and cancellation policy

d. Shape treatment plan and information-gathering

2. According to the speaker, which will typically be a more productive intake question?*

a. What would you like to accomplish in our work together?

b. What problems would you like to fix?

c. What is it that your wife needs to change?

d. What do you think is a fair price for therapy?

3. According to the speaker, the goal of the first session is to have a second session.*

a. True

b. False

4. What can be helpful to evaluate in early sessions?*

a. Early examples of the presenting problem

b. Examples of non-problematic function

c. How couples make decisions

d. All of the above

5. According to the speaker, the therapeutic alliance*

a. is only an option if a couple wants it

b. consists primarily of agreements proposed by the couple

c. describes the collaborative arrangement between therapist and couple

d. is mostly important in psychoanalysis

6. When it comes to discussing sex with couples,*

a. We should never use any words that will upset either one

b. We should ask them what topics are off-limits

c. We should discuss their discomfort with them

d. We should pretend we don’t notice their discomfort

7. Because people can feel anxious about discussing sex, we should lighten things up with plenty of jokes.*

a. True

b. False

8. According to the speaker,*

a. Every couple needs a way for one person to say “no, thank you” to sex without it requiring an argument or a long conversation

b. In a loving couple, people rarely decline sex with each other

c. Declining sex is okay, as long as someone has a good reason

d. None of the above

9. Asking a couple about contraception is just a little too personal.*

a. True

b. False

10. “Sensate focus” exercises*

a. should be used with most couples with sexual difficulties

b. should only be assigned if the therapist will do careful follow-up each week

c. are far more effective with heterosexual couples than any others

d. can conflict with our mandated reporting duties

11. Examples of countertransference with regard to sexuality can include:*

a. Feeling attracted to a patient

b. Feeling envious of a couple’s sex life

c. Wanting to seem knowledgeable

d. All of the above

12. According to the speaker,*

a. Only the most disturbed couples will argue in front of us

b. We should expect that many couples will try to control the logistics of sessions

c. Once therapy starts, the therapeutic contract pretty much fades away

d. Any time a couple demands that we tell them what to do, we should

13. According to the Sexual Intelligence model, which is part of sexual “function”?*

a. Comfort discussing birth control

b. Ability to enjoy sex when sober

c. Ability to express desire in a simple way

d. All of the above

14. According to the speaker, sexual self-acceptance*

a. Is primarily important to narcissists

b. Is more important for women than men

c. Is primarily important when working with sexual trauma

d. Should be independent of what someone’s body looks like

15. According to the speaker, therapists should focus on the large differences between male and female sexuality*

a. True

b. False

16. According to the speaker,*

a. There is virtually no room for self-disclosure in couples therapy

b. There can be unanticipated consequences from a therapist’s self-disclosure

c. We should ask couples how they feel about our self-disclosure before proceeding

d. None of the above

17. When discussing body image, it can be helpful to ask how someone feels during masturbation*

a. True

b. False

18. According to the speaker,*

a. it’s important to assess if a patient or couple are kinky

b. we shouldn’t expect to work effectively with sex addicts

c. sex toys dehumanize us, and so interfere with intimacy

d. none of the above

19. According to the speaker,*

a. Reframing a couple’s experiences as they describe them can trigger a trauma response

b. Pointing out a couple’s narratives can help provide insight about decision-making

c. Couples who have very little sex can’t be emotionally intimate

d. Couples who are securely attached continue having regular sex throughout their lives

20. Examples of problematic assumptions in couples include:*

a. How you treat me determines my parenting

b. Normal couples have sex three times a week

c. Normal couples have sex two times a week

d. All of the above

21. “I have a hot Irish temper” is an example of*

a. A micro-aggression

b. ADHD

c. A narrative that limits a person’s sense of responsibility

d. A psychological insight

22. Topics we might want to cover with couples include:*

a. Orgasm

b. Sexual initiating

c. Sexual variety

d. All of the above

23. The best way to gauge sexual satisfaction is*

a. Whether or not a person climaxes

b. How frequently a person initiates sex

c. How much noise they make during sex

d. Asking them to what extent they enjoy sex

24. When working with a couple around sexuality, talking about how they use their smart phones is a distraction*

a. True

b. False

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Sexual Issues In Couples Therapy: Practical Skills for Common Problems

SESSION 1

SESSION 2

SESSION 3

SESSION 4

Course Evaluation

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Sexual Issues In Couples Therapy:
Practical Skills for Common Problems