Sexual Health

Format: DVD [Closed Captioned]
Other Format: VHS
Running Time: Over 100 minutes
Item #: 4310832
ISBN: 978-1-4338-0233-1
List Price: $99.95
Member/Affiliate Price: $69.95
Copyright: 2002
Availability: In Stock
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For individuals in the U.S. & U.S. territories

APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.

In Sexual Health, Dr. Lisa Firestone demonstrates her approach to counseling couples who are experiencing relationship difficulties. Because sexuality is such an important part of a relationship, improving sexual intimacy often becomes central in any relationship counseling. Sexual issues themselves are often psychological in nature, and even where sexual problems are physical, a client's reaction to them is treatable psychologically.

In this session, Dr. Firestone works with a couple who, although they have been married for 23 years, have been distant and hostile with each other for much of their marriage. Dr. Firestone first looks at how partners see themselves and each other and then helps them set realistic goals to improve their communication and intimacy by reducing self-critical thinking.


The theoretical approach developed by Robert W. Firestone represents a broadly based, coherent system of concepts and hypotheses that integrate psychoanalytic and existential systems of thought. The theory explains how early interpersonal pain leads to defense formation and how these original defenses are reinforced as the developing child gradually becomes aware of his or her mortality.

This approach is referred to as "separation theory" because it focuses on breaking with negative parental introjects and moving toward individuation. "Separation" as conceptualized here is different from "isolation," "defense," or "retreat;" it involves the maintenance of a strong identity and distinct boundaries at close quarters with others. Indeed, without a well-developed self-system or personal identity, people often distort, lash out at, or withdraw from intimacy in interpersonal relationships.

The therapeutic approach emphasizes the exposure of destructive fantasy bonds (i.e., imagined connections) as externalized in interpersonal associations or internalized in the form of object representation (i.e., parental introjects). Dissolution of these bonds and movement toward separation and individuation are essential for the realization of one's destiny as a fully autonomous human being.

Major Concepts

The "fantasy bond" is an imagined connection with another person that is used to alleviate the emotional pain of rejection and the fear of separation and aloneness (Firestone, 1985). Paradoxically, the imagined fusion that provides relief for the infant or young child later restricts his or her adult life to a significant degree. As such, the term is used to connote bondage or limitation of freedom. The concept of the fantasy bond also refers to the transference of the original fantasized connection to a romantic partner in one's adult life. Firestone and Catlett (1999) described it as follows:

Most people have a fear of intimacy and at the same time are terrified of being alone. Their solution is to form a fantasy bond—an illusion of connection and closeness—that allows them to maintain emotional distance while assuaging loneliness and, in the process, meeting society's expectations regarding marriage and family. (p. 163)

The couple interviewed by Dr. Firestone exemplifies numerous manifestations of a fantasy bond in the partners' style of interacting. For example, in such couples, the partners' communications tend to become less honest and more duplicitous and are characterized by small talk, bickering, speaking for the other, interrupting, criticizing, and speaking as a unit. Both partners may manipulate by playing on the other's guilt or provoking angry or parental responses. Self-doubts and self-critical thoughts are often projected onto the mate, leading each person to complain about the other's traits, habits, and behaviors.

In relationships characterized by a fantasy bond, both partners, more often than not, are listening to the dictates of their respective voices. The term "voice" in this context refers to a systematized pattern of destructive thoughts that is the basis of an individual's maladaptive behavior (Firestone, 1988). Communications are filtered through a biased, alien point of view that distorts a partner's real image. Both parties ward off loving responses from the other, using rationalizations—promulgated by the voice to justify their anger—and distancing behavior. As noted, they often project their specific self-attacks onto one another and respond inappropriately—that is, as though they were being depreciated by their mates (Firestone & Catlett, 1999).

Voice Therapy

"Voice therapy" is a cognitive–affective–behavioral methodology that brings internalized negative thought processes to the surface with accompanying affect in a dialogue format so that a client can confront alien components of the personality. It is referred to as "voice therapy" because it is a process of giving language or spoken words to destructive thoughts, attitudes, and beliefs that are at the core of an individual's maladaptive, self-destructive behavior.

The methods are varied; however, the primary technique consists of asking clients to verbalize their negative thoughts toward themselves in the second person, "you," as though they were talking to themselves, instead of the first-person, "I," which are statements about themselves.

Putting self-attacking statements in this form often releases strong feelings followed by spontaneous insights. Next, clients develop insight into the origins of their voice attacks, thereby regaining feelings of compassion for themselves in relation to childhood experiences. Finally, in collaboration with the therapist, clients plan corrective measures to change self-limiting, self-destructive behaviors that are influenced or controlled by the voice.

The goal of voice therapy with couples is to help each individual identify the voice attacks that are influencing distancing behaviors and creating conflict in the relationship. The therapeutic process consists of four steps:

  • Each partner formulates the problem he or she perceived is limiting satisfaction within the relationship.
  • Each partner verbalizes self-critical thoughts and negative perceptions of the other in the form of the voice and is encouraged to release the associated affect.
  • Each partner is supported in developing insight into the origins of the voice and in making connections between past experiences and present conflicts.
  • Each partner collaborates with the therapist in identifying specific behaviors regulated by the voice and in formulating corrective suggestions for altering defensive responses and habitual behaviors. Between sessions, both partners attempt to change behaviors in a direction that opposes the voice and represents their own point of view and goals for their relationship.

For couples experiencing difficulties in their sexual relating (as illustrated in the video), there may be two additional steps:

  • In the intervals between sessions, couples are encouraged to give away their "voices" and maintain personal communication during sex.
  • It is often suggested that partners maintain physical contact while giving away their self-attacks and critical thoughts about each other. In other words, they try not to allow their voice attacks to interfere with the physical embrace or sexuality. This technique often leads to the arousal of deep feelings from the past that can be worked through in sessions.

The results of these suggestions are discussed with the therapist in subsequent psychotherapy sessions.

About the Therapist

Lisa Firestone, PhD, is program and education director of the Glendon Association and adjunct faculty at the University of California (Santa Barbara) Graduate School of Education. She received her PhD from the California School of Professional Psychology in Los Angeles.

Dr. Firestone is also a clinical psychologist in private practice and provides consultation to agencies and therapists regarding the treatment of their high-risk clients. She is a nationally recognized researcher, trainer, and lecturer in the areas of suicide prevention, violence prevention, and couples relations.

Dr. Firestone's publications include

  • "Assessing Violent Thoughts: The Relationship Between Thought Processes and Violent Behavior" (with A. Doucette-Gates and R. Firestone);
  • "Voices in Suicide: The Relationship Between Self-Destructive Thought Processes, Maladaptive Behavior, and Self-Destructive Manifestations" (with R. Firestone);
  • "Suicide Reduction and Prevention" (with R. Firestone) in What's the Good of Counselling and Psychotherapy? The Benefits Explained (2002);
  • "The Treatment of Sylvia Plath" (with J. Catlett);
  • Sex and Love in Intimate Relationships (with R. Firestone and J. Catlett; American Psychological Association [APA], 2006);
  • Creating a Life of Meaning and Compassion: The Wisdom of Psychotherapy (with R. Firestone and J. Catlett; APA, 2003);
  • Firestone Assessment of Self-Destructive Thoughts (with R. Firestone, 1996); and
  • Conquer Your Critical Inner Voice: A Revolutionary Program to Counter Negative Thoughts and Live Free From Imagined Limitations (with R. Firestone and J. Catlett, 2002).
Suggested Readings
  • Bader, E., Pearson, P. T., & Schwartz, J. D. (2000). Tell me no lies: How to face the truth and build a loving marriage. New York: St. Martin's Press.
  • Firestone, R. W. (1985). The fantasy bond: Structure of psychological defenses. Santa Barbara, CA: Glendon Association.
  • Firestone, R. W. (1987). Destructive effects of the fantasy bond in couple and family relationships. Psychotherapy, 24, 233–239.
  • Firestone, R. W. (1988). Voice therapy: A psychotherapeutic approach to self-destructive behavior. Santa Barbara CA: Glendon Association.
  • Firestone, R. W. (1990). Voices during sex: Application of voice therapy to sexuality. Journal of Sex and Marital Therapy, 16, 258–274.
  • Firestone, R. W. (1997). Combating destructive thought processes: Voice therapy and separation theory. Thousand Oaks, CA: Sage.
  • Firestone, R. W., & Catlett, J. (1999). Fear of intimacy. Washington, DC: American Psychological Association.
  • Firestone, R. W., Firestone, L., & Catlett, J. (2002). Conquer your critical inner voice. Oakland, CA: New Harbinger.
  • Firestone, R. W., Firestone, L., & Catlett, J. (2003). Creating a life of meaning and compassion: The wisdom of psychotherapy. Washington, DC: American Psychological Association.
  • Firestone, R. W., Firestone, L., & Catlett, J. (2006). Sex and love in intimate relationships. Washington, DC: American Psychological Association.
  • Gilligan, C. (2002). The birth of pleasure. New York: Knopf.
  • Lerner, H. G. (1985). The dance of anger: A woman's guide to changing the patterns of intimate relationships. New York: Harper & Row.
  • Lerner, H. G. (1989). The dance of intimacy: A woman's guide to courageous acts of change in key relationships. New York: HarperPerennial.
  • McKay, M., & Fanning, P. (1991). Prisoners of belief. Oakland, CA: New Harbinger.
  • McKay, M., Fanning, P., & Paleg, K. (1994). Couple skills: Making your relationship work. Oakland, CA: New Harbinger.
  • Schnarch, D. (1991). Constructing the sexual crucible: An integration of sexual and marital therapy. New York: Norton.
  • Schnarch, D. (1997). Passionate marriage: Love, sex, and intimacy in emotionally committed relationships. New York: Holt.

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