Reframing intimacy in couples therapy
In couples therapy, maintaining a sense of hope and positivity about intimacy and sex is essential, even when sessions confront deeply entrenched patterns. As an experienced couples therapist, I often emphasise the importance of positive language. That doesn’t mean avoiding difficult truths or glossing over conflict. It means creating the conditions in which a couple can imagine something different – something better.
In a recent session, a couple kept returning to the same emotional injuries, again and again. We had already named the underlying dynamics and agreed on ways forward, but when hurt bubbled up again, the same historical examples were hurled across the room like accusations. And when that cycle sets in, progress gets stuck. I’m not suggesting that resentment vanishes overnight – far from it. But growth only happens when there is some movement. It’s about improving over time. If you constantly unpick the past without investing in something new, you risk never moving forward.
This is also true for intimacy. So many couples come in believing their dynamic is broken beyond repair, when in fact, they’ve never had the tools to build the kind of connection they want. And when intimacy has eroded, the tendency is to retreat even further. Into silence, into pornography, into assumptions and avoidance. That’s where we begin.
Understanding the legacy of intimacy issues
Often in therapy, we lay out the ‘intimacy blueprint’ inherited from each partner’s family of origin:
- How was love expressed or withheld?
- Was sex spoken about or treated as taboo?
- What messages were internalised about bodies, pleasure, and connection?
Even now, with more explicit messaging in the media – body positivity, sexual liberation, endless representations of sex on TV, people still carry deeply embedded scripts. Pornography, in particular, has shifted how many people experience the early stages of attraction. It short-circuits the slower, more layered progression from flirtation to affection to physical intimacy. It skips the work of knowing someone. Instead, sex becomes a mechanical release. Easier, neater, but ultimately unsatisfying when it’s disconnected from relational depth.
When working with couples, I invite them to ask: What kind of intimacy legacy do we want to pass on? What do we want our children to hear, see, and believe about love, connection, and sex? That reframe opens up creative possibilities.
Compliance VS connection
One dynamic I see again and again is what people often call ‘people pleasing.’ Personally, I don’t like that term. I prefer to name it as acquiescence and compliance. ‘People pleasing’ has become a catch-all phrase that loses meaning. Where do considered responses, compassion, or compromise end and people pleasing begin? We all make allowances for those we love. The key issue isn’t giving in. It’s whether the behaviour is honest or avoidant.
In couples, especially those in long-term relationships, this dynamic can fester. One person agrees to therapy sessions, says yes to sex, or nods along in conversations. Not out of genuine desire, but out of a need to preserve peace. This masks resentment. It reduces trust. And eventually, it increases that gulf between the partners in their sex life.
We live in a hyper-individualised culture. I see its effects in therapy rooms all the time. Particularly in neurodivergent (ND) spaces, where messaging is often about asserting difference and rejecting misunderstanding, the conversation can unintentionally become one-sided. Yes, ND experiences are valid. But so are neurotypical (NT) ones. We are not meant to live in silos. We must be accountable to each other in a relationship. That includes a shared willingness to try – to connect, to explain, to risk vulnerability.
What is intimacy?
We talk about sex all the time in therapy, but when I ask what intimacy means, most people default to physical acts. But intimacy is far broader. It’s energetic. Emotional. Psychological. It’s that reciprocal flow between two people. The ability to feel seen, safe, aligned. Most couples begin with it. But life – children, jobs, housework – gets in the way.
And that’s where things unravel. When intimacy is lost, sex often suffers too. Not because the desire is gone, but because the route to it is blocked. My work is often about helping couples remember how to access that connection again.
Setting realistic expectations is key
There’s too much pressure placed on novelty in long-term relationships. During those intense middle decades – children, mortgages, school runs – good enough connection is far more important than bedroom innovation. What matters isn’t swinging from chandeliers. It’s carving out space to connect amidst the noise.
“Good enough sex” is one of my favourite phrases. Every couple defines it differently. For some, it’s weekly. For others, monthly. It’s about having realistic expectations, especially during the ‘drudgery years.’ Post-50, there may be more time and energy for exploration, but only if the foundation has been sustained.
Communicating desire without demands
Initiating conversations about sex is difficult. Vulnerability is scary. Rejection hurts. And for many couples, previous attempts at openness have gone poorly, leaving scars. This is especially true for ND couples, where sensory needs, timing, and communication styles differ.
That’s why I always suggest scheduling the conversation. Forget the stereotype of spontaneous deep chats at bedtime. They rarely go well. Instead:
- Go for a walk.
- Reflect on what you miss (without judgement).
- Talk about what used to work.
Self-referencing helps: “I loved when we…” or “I feel like we haven’t…” It’s non-accusatory and keeps things grounded in the couple’s shared experience. The goal isn’t to negotiate a demand. It’s to open a dialogue about possibility.
And please, minimal alcohol. One glass might loosen nerves. More than that, and you risk a row.
Gaining a little perspective
I’ll never forget a couple I saw in Canary Wharf years ago. They were in their 50s. When sex came up, he said, laughing, “If I try ten times and get three, I’m thrilled.” She grinned and said, “Well, I do have a lot of headaches.” It wasn’t cynical – it was real. Warm. Grounded. That exchange has stayed with me for decades. It reminded me how normal, joyful, and light sex can still be when people accept each other and laugh together. Don’t take yourselves too seriously.
Common couples therapy complaints about sex
What comes up most often in sessions? Not specific sexual acts. Not even frequency. The two big ones are:
- Fear of rejection.
- Hesitation to initiate.
These undercurrents sit silently in many relationships. People worry they’ll hurt their partner’s feelings or feel embarrassed if turned down. In ND couples, this becomes even more complicated. Rejection sensitivity and emotional dysregulation can mean a single ‘no’ leads to weeks of avoidance.
Sometimes, ND individuals soothe through pornography or masturbation because it feels safer and easier. There’s no mess. No negotiation. But over time, this creates distance that can be hard to bridge. That’s why I use adapted versions of the Sensate Focus programme. Structured, gentle, exploratory exercises that build safety and gradually reintroduce connection.
Start the conversation where you are
The most important thing I tell couples is this: talk about sex before it’s a crisis. Start with what you miss. Ask what feels good. Keep it light. Schedule the time. Lock the bedroom door. Turn the dishwasher off. Make space for each other.
And don’t aim for perfection. Aim for good enough! Because that’s what keeps a relationship thriving – not just for now, but for years to come.
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