A 49-year-old professional man sought me out for treatment to: help him get divorced. Parodying the comedian Henny Youngman, he flopped down into a deep, soft-cushioned chair in my office and said, "Take my wife, please!" I take it Youngman was practicing his trade and that Chaucer's assertion that "...A man may say full sooth [the truth] in game and play," didn't apply to the funny legend. Nevertheless, this client, who I'll refer to as Bob, was dead serious. "I've tried everything to get out of my marriage," Bob said. "I've even had a few affairs, but I couldn't leave my wife for any of my lovers, even the single ones. You're my fourth therapist and I chose you because you specialize in relationships. You're my last resort."
Making a case for what he hoped would be a great escape, Bob told me told me that he has "hated" his 47-year-old wife, Hope, for 21 of the 22 years they've been married. Why I asked? What was she like? "She's really not a horrible person," he responded. "She loves me blindly and I even get all the sex I want, any time I want it. I'm just not attracted to her—she nauseates me—and I can't even sleep in the same bed with her. She also tries to micromanage me even though her heart is in the right place."
After taking a detailed history from Bob, as well as constructing a genogram, I hypothesized that Bob was in a whopper of a conflict: his wife, like his mother, was very supportive, but dominant and controlling. And while he wanted to escape her control, he was too dependent on her to do so—he relied heavily on her love and guidance. Bob validated my hypothesis by eventually admitting that he never even wanted to marry his wife in the first place. "My mother encouraged me to marry Hope," he said. "She told me it was the right thing to do. Mom was so forceful, I rarely challenged her." What about your dad I asked? Didn't he weigh in on the subject? "No," Bob said with a sad look on his face. "Dad was so passive mom could have run him over with a lawnmower and he wouldn't have made a peep."
It was pretty clear that because Bob wasn't able to internalize a healthy dose of personal power from his father he didn't have the fortitude, or differentiation if-you-will, to take on his mother-like wife. But I offered that if he could garnish some internal power via the therapy, perhaps he could stand up to her and save his marriage. "No, Bob said, "I never loved her to begin with. Get me out of this mess and you'll be helping the both of us."
I let Bob know that I would help him, but I warned that he better be prepared to "give up something to get something." While he intellectually acknowledged that he couldn't seem to "have his cake and eat it, too," he still tried his darndest—he even embarked on another brief extramarital affair. But after two years of treatment, Bob exhaustively gave in to his conflict (pushing fifty helped) enough to make a decision to leave. He filed for divorce and he was the happiest client I'd ever seen-and he loved me. Game over? Not quite.
Fast forward five years and I receive a call from Bob requesting an appointment. "Steve," he said waving one of those blue medical prescriptions at me, "I have a new girlfriend and I'm having erection problems. I saw my urologist and he gave me a script for this Ed drug but I thought I would see you before I filled it." Okay, I thought, he's replicating—I know it. "Bob," I said, "I have one question for you. Are you attracted to this woman?" "Yeah," he answered. "No," I said, "are you really attracted to her? Does she really turn you on? "Well, not really, I mean she's okay." "I'll tell you what," I said, "go home and put that script in a drawer somewhere. Then, end your relationship and go out and find someone you're really attracted to. If you find such a person and you still have a problem, come back to see me or fill the script. If you don't, throw it away." "I get it," he said, "Take my girlfriend, please!" "More like: own your power Bob," I responded. Anyway, something stuck because about 6 or 7 months later Bob called to tell me that he found someone he really liked both emotionally and physically, and that his penis reacted with approval.
So, what's the purpose of this rant? Well, aside from having the opportunity to tell you a nice therapeutic tale, I feel compelled to convey my annoyance with Bob's urologist and other physicians like him who fail to ask about the quality of a patient's relationship with his or her partner before prescribing medication. As a couple's and sex therapist, I can't tell you how many men I've seen over the years who have been treated similarly—treatment that even predates the availability of ED drugs. For example, a man I once saw admitted to me that he actually cringed while having sex with his girlfriend—he was upset with her for several reasons but feared if he refused to have sex until his issues with her were resolved he would jeopardize his relationship. What was his physician's response? To enable this man's relationship difficulties by prescribing a vacuum constriction tumescence device—this, by the way, barely worked under such conditions.
But it's not just the professionals who may be guilty of this type of omission. Sex therapist Barry McCarthy holds clients responsible as well. He wrote: "Both the general public and the medical community now prefer use of a medical intervention first, and only if that is unsuccessful are psychological or sex therapy assessment and interventions considered." Look, I'm fine with a client getting a physical exam before they see me or any other sex therapist—it helps to rule out organic problems. But when it comes to sexual symptoms, nobody, physicians or professionals alike, should automatically rule out relationship difficulty without inquiring about whether it exists. Asking a simple question or two may, in the end, save a few relationships. "Take a brief relationship history, please!"