Sexual intimacy and aging: An integrative framework to promote intimacy resilience in couple therapy

In our work at the Intimacies Project at The Ackerman Institute for the Family we became aware of a gap in attention about sexuality and aging in the couple and family therapy field. In this article, we provide an integrative framework to guide therapists on how to address problems of sexuality and aging in the therapy room. Starting from considerations about the social context of aging and the self of the therapist, we contend that when normative sexual challenges become entangled with stigma, misconceptions about sexuality, limiting gender narratives, vulnerabilities, and defensive postures, they often result in emotional and sexual shutdowns. Through a combination of the vulnerability cycle with an expansive definition of sexuality, we demonstrate how we deconstruct impasses, disentangle normative quandaries from reactive dynamics, and help couples transform their sexual narratives. We outline how we conduct individual sessions to obtain relational sexual histories, utilize Sensate Focus as a mindful touch exercise, and help partners expand their sexual menus beyond penetration and orgasms. We also describe relational skills that may need to be strengthened to help aging couples deal with the ebb and flow of intimacy, sustaining resilience over time.