Hypoactive Sexual Desire in a Couple With Unresolved Loyalty Conflicts: Discussion

Abstract

In this paper, the author responds to Dr Stephen Betchen's clinical presentation of a couple with hypoactive sexual desire disorder and his hypothesis that this is due to parallel loyalty conflicts. The importance of psychodynamic couples counseling in a case of this complexity is supported. The author asserts that while the husband may, indeed, have been conflicted about success, the wife suffers more from unresolved loss stemming from early childhood rejection and neglect—and an accumulation of losses in her adult life that revived these old losses. Interactions with her passive-aggressive husband exacerbate her long-standing hostility and depression. Suggestions for siding more with the wife, providing further individual therapy for her, and urging her to reconsider her refusal to take antidepressant medication are made.