August 17, 2012
The following review has been written from the perspective of a sex therapist, Dr. Barbara Bartlik, MD (http://drbarbaramd.com/) and Gary Krane, PhD, co-founder of couplewise.com.
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The recently released movie, ?Hope Springs,? (GET TICKETS) depicts couples? counseling and in a sensitive and realistic manner, providing viewers with a glimpse of what couples? therapy actually is like. In addition, the film portrays sexuality in older people in a positive light, which is rare in our society. The film also underscores the importance of good communication and demonstrates how couples can grow in their relationship beyond that which they thought they were capable. We highly recommend the film for people in significant relationships, whether they are new or longstanding. Nonetheless, viewers should realize that the filmmaker?s creative process involved taking liberties with the subject matter, so the treatment depicted deviated from that which is standard in the following ways:
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Sexual Fantasies
For example, most therapists would never ask a patient about specific sexual fantasies in front of his or her partner, as did the therapist, Dr. Feld, played by Steve Carell. In ?real life?, couples? therapists are discreet. When they ask that question it?s with respect for patient privacy concerns. They will ask it when the partner is not present, or in a more subtle way, such as, ?Is there something you want to do sexually with your partner, which you don?t do now?? The response to the fantasy question is important because often it can point therapy in the direction of the person?s true desires.
Fantasies are deeply ingrained and not easy to change. The fact is, to get aroused, the vast majority of couples in longstanding, satisfying sexual relationships conjure up sexual images that bear little resemblance to their partner or what they do when they are having sex with him or her. However, in some cases, revealing specifics about fantasies to a partner can hurt that partner?s feelings and do harm to the relationship.
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Holding
When couples stop having sex, they often discontinue other forms of touching as well, usually because it could lead to discomfort about whether or not to attempt sexual intimacy. Holding one another for extended periods of time as Dr. Feld suggested, may be a valuable initial exercise for a couple who has stopped touching. However, normally when such touching exercises are given, they are accompanied by a caveat to not have any intercourse (More on this below). The road back to sexual intimacy may require physical exercises designed to break down the barriers to touching.
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Sensual Massage
The second exercise prescribed by Dr. Feld, to give a sensual massage, is a mainstay of couples-sex therapy. However, in the movie, Kay, played by Meryl Streep, and Arnold, played by Tommy Lee Jones, attempt the massage completely clothed. Usually, it is done naked or, if preferred, in underwear. Professional therapists instruct couples at first to touch only the non-sexual areas of the body (all but the breasts, genitals, and anal areas). Later these areas are included, with gradually increasing degrees of stimulation.
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Homework Assignments
!!!!SPOILER ALERT!!!!
Do not read this section unless you have seen the movie
In addition, Dr. Feld failed at the onset to specifically advise Kay and Arnold not to attempt sexual 
intercourse early on in the course of the homework assignments. Ironically, most sex therapy treatment starts with this prohibition, to reduce the risk of failure. One night when Kay and Arnold get sexually aroused together and he attempts penetration, he loses his erection and they both feel dejected. Kay assumes incorrectly that this occurred because he looked at her face and found her unattractive, whereas it was more likely that his anxiety got in the way. In therapy, we like to proceed slowly and build upon the couples? success. We don?t expect them to go from not getting aroused together at all, to intercourse and orgasm all at once. We advise them to pleasure themselves in front of one another, to have orgasms in each others? presence, to stimulate one anothers? genitals, and then briefly to penetrate without experiencing orgasm.
We also teach men that it is normal for erections to come and go, and that it is not the end of the world or the end of the lovemaking session if they lose one. After a period of time in therapy, the couple progresses to intercourse and then they are more likely to succeed. Through therapy, they also learn that a lot of pleasure can be had without intercourse and their sex life will be richer and more varied for it. This is particularly important as people age and their bodies change. It?s unrealistic to expect performance in any physical endeavor to be on par with that of a 25 year old; instead people are encouraged to be mentally flexible and creative in the way they find sexual pleasure.
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Cost of Treatments
Finally, the cost of treatment. Kay found an intensive one week couples therapy treatment program 1500 miles from home that cost $4000. Most people would consider that pricey, if not prohibitive, but it is important to know that there are numerous less expensive options. Many counseling programs are provided in different localities several times a year and offer a combination of lectures, group therapy, and couples sessions over the course of a few days for considerably less than $4000. In addition, a couple could enter couples sex therapy with a local therapist, weekly, or more or less frequently. The American Association of Sex Educators, Counselors and Therapists (AASECT) provides lists of therapists in most locations. Costs start at about $100 a session, and may even be covered by health insurance.
The most reasonable and cost effective option for those unable to afford a professional therapist is an online form of couples counseling, such as couplewise.com. In full disclosure, we (the authors) both work with couplewise.com. Each person who enrolls goes through a quick process clarifying their most important relationship needs, deciding how well these needs are being satisfied and then decides what to share with their partner and when, as well as how often to regularly check in with regard to these needs.
Based on this, the couple can then choose from different tools to help get whichever needs they agree upon to be better met. Once couplewise.com integrates its conflict resolution interactive video tool (expected in the next 2-3 weeks), the advice they will receive will be similar to that which they would from a live cognitive behavioral therapist, and in some ways in the near future, will be more comprehensive:
Like its other tools (eg MotivateMyPartner to go live this weekend), couplewise.com hopes to draw advice and tactics from not just from one expert, but various experts, and also from other husbands, boyfriends, girlfriends and wives (vetted by professionals) who have solved the same or similar challenges the user faces. Considering ROI (return on investment) the cost of couplewise.com will be extremely appealing.
Two other films that depict sexuality in older individuals in a positive light that we recommend are, ?Something?s Gotta Give,? and, another film starring Meryl Streep, ?It?s Complicated.?
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AUTHORS
Barbara Bartlik, M.D. (http://drbarbaramd.com/) is a psychiatrist in New York City who practices couples-sex therapy and integrative psychiatry.
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Gary Krane PhD is an educational psychologist, author of Simple Fun for Busy People and the co-founder of couplewise.com.
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