Sometimes a psychological block must be removed before physical function can recover
One thing can be many things.
Sex can be just sex. It can be a mechanical chore at the end of a day of tax returns, fixing the carburettor and arranging child care. Something to tick off.
Or, sex can be lovemaking. An act of deepening connection; a gateway to a profound, timeless unification of (usually) two people; an intense merging of not only bodies but also minds.
But not for Graham. Or at least not right now.
Forlorn, glum, and despondent. That’s how I felt as he described what happened.
Ripped-down dreams
“We had a great sex life. Once.”
I nodded knowingly and interjected. “Ah… routine, predictability, the 9-to-5 slog, loss of excitement, exhaustion, one last chore at the end of a long day, sex no longer sexy… am I close?”
“Not at all.”
I shut up, let my assumptions scatter to the wind, and let the poor man speak.
“It happened like this. We were desperately trying for a baby. We would have sex pencilled in specifically at my wife’s most fertile times. We want three children.”
Unbidden, the phrase ‘glutton for punishment’ entered my head. I hastily cast it aside and let him continue.
“Anyway… we had our first child’s bedroom all done up. My wife had the colour schemes just so. She’d chosen Disney wallpaper with Dumbo and Mickey Mouse, perfect for a girl or a boy.”
I noticed Graham wince when he said “wallpaper.”
“She was late. She… we thought she was pregnant. We were so excited. Finally the little occupant of the room was on its way. But…” He paused for a moment. “It was a false alarm. Or false hope, I should say.”
“So what happened?”
“We kept trying… religiously! She was late again and again, but we soon learned that it didn’t mean anything. Our hopes were dashed, and she was getting more depressed with every passing month. Then it happened – the straw that broke the camel’s back.
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“She was really late. She even felt pregnant. There was no reason for her not to get pregnant. We’d even been to a fertility clinic and everything. But again it wasn’t to be. And this time it was different.
“This time she sort of went crazy. She’d taken her test in a friend’s bathroom and she came out sobbing. She started hitting me. Thumping my chest! On the drive home she wouldn’t stop screaming. She was just so angry. Then we got home, and she raced up the stairs and…” Now Graham’s words came in staccato chokes.
“She started wrecking our child’s… our future child’s bedroom. She ripped down the Disney wallpaper. I can still see Dumbo and Mickey Mouse torn to shreds. After that she sort of didn’t mention it again. And we didn’t even go in that room. We still haven’t been in there.
“When the time came to try for a baby again… I couldn’t. Just nothing. I felt like it was all my fault. And then she got even angrier. Now I can’t get it up at all!”
I thought about how I could help Graham, and I also wondered whether I should see both of them.
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Graham and his wife are just one of the many cases of psychological impotence I’ve treated over the years. Here are some tips I have found really useful.
1. What is the cause?
It’s been said that the quickest way to treat a sexual problem is to get a new partner. I’m not advocating that as a treatment, but if there’s any truth to that then it tells us that sexual problems exist within a context.
Psychological impotence needs to be distinguished from physiological impotence. Medications such as antidepressants can inhibit erections. Hypertension, diabetes, exhaustion, too much alcohol, and poor diet can all interfere with our sex lives.
That’s not to say that causes can’t be intertwined; they certainly can. A physiological cause can lead to a psychological cause even after the illness has lifted if anxiety remains.
To make the distinction between physiological and psychological impotence we can start by asking questions about general health, but it’s also important to find out whether the man ever has erections.
We know that during REM (Rapid Eye Movement) sleep, men without physiological impotence experience erections as they sleep and that ‘morning wood’ often occurs because the minutes before awakening tend to contain more REM-rich dream sleep than other parts of the sleep cycle.
So does the client ever wake with an erection? Do they have erections at all? A word of advice: don’t make this the very first question you ask when they step in the door! Let the guy sit down first!
If they do sometimes have spontaneous erections (and there really are no other kind) then the cause is likely to be psychological, not physiological. And if that’s the case, we always need to look at the context of the erectile dysfunction. In fact, often ‘erectile dysfunction’ might just as well be called ‘relationship dysfunction’ or ‘work/life balance dysfunction’.
2. When did it start (or stop!) happening?
One guy I worked with told me he worked 13 hours and smoked 40 cigarettes a day. He ate junk food like it was his life’s mission, and a date with his girlfriend usually involved both of them getting drunker than Oliver Reed on a late-night chat show.
His impotence, which somehow was still only intermittent, had him completely baffled. But to me it was clear as day. Excessive alcohol and weight are not a recipe for erectile health.
Other men came to me because they had been sexually abused in the past and now associated sex with threat and shame. Some had never been able to consummate a relationship.
Another client had gotten married only to discover on his wedding night that his new wife had hired a call girl to help him “gain the experience he was so obviously lacking”. He hadn’t managed to get an erection – with either the call girl or his wife – ever since. He went from inexperienced to unable to experience.
Some men feel emasculated in some sense (and impotence only adds to that feeling). They may lack body confidence, or just feel disconnected from their partner. They may misunderstand or feel misunderstood by the very person they are supposed to be close with.
It’s a myth that for men sex is always totally compartmentalized from the wider relationship.
Certainly, for Graham it was pretty clear what the cause was. In fact, as I suggested to him, it might have been more surprising had he not been experiencing temporary (as I framed it) impotence.
Sex had ceased to be spontaneous and fun, or even intimate. It had become a means to an end. But when that end wasn’t met, Graham had been traumatized by his wife’s intense anguish.
He sobbed just to recall his wife ripping down the wallpaper in their as-yet unconceived child’s bedroom. Sex for him now was wracked with guilt, performance anxiety, and embarrassment.
3. Deal with the cause
Easier said than done of course. In Graham’s case, one thing I could do for him straight away was to decondition what was for him quite a traumatic memory – that of his wife tearing down the Disney-themed wallpaper. He told me this horrible memory would resurface whenever he tried to have sex with his wife.
Sometimes we also need to help the client deal with general stresses in their lives. We can reassure them that erections are supposed to vanish during times of stress. Developing an erection when faced with an angry mob or a bad-tempered tiger isn’t particularly adaptive (possibly a sentence never before written in the history of the English language!).
But my point is, if there is a particular memory or series of memories that play on your client’s mind, that’s a good starting point. Help your client take the emotional charge out of that memory so it no longer matches to current sexual situations. I used the Rewind Technique with Graham, but it wasn’t all we needed to do.
4. Take the pressure off
Graham talked about “performance” issues and “not achieving”. I was keen for him to step outside of that mindset. I talked in terms of “letting it happen”.
We are often told we have to really want something to attain it. This is a staple of motivational books and talks. And in some arenas of life it’s absolutely true.
But sometimes wanting something too much makes us, paradoxically, less likely to attain it. Some things we just need to let happen. In the words of The Supremes, you can’t hurry love – and nor can you force an erection. Okay, so that last bit isn’t in the song.
Some parts of experience happen outside of conscious will. For example, we are more likely to fall asleep when we try to stay awake than when we try to sleep, even if we’re tired out of our brain. Sleep and erections, and many other things besides, are side effects of the right balance of circumstances.
Worrying about outcome blocks performance. Sex needs to be relaxed, spontaneous, and fun; a chance to deepen intimacy and be totally absorbed in the immediate. Instead, many men feel it is a test of their manhood. But ‘tests’ can be passed or failed, and that’s the problem.
In Graham’s case, his own test was followed by his wife having a test. Being unable to get an erection could have been Graham’s unconscious mind’s way of avoiding having his wife fail any more tests.
A tried and tested (sorry for the T word again) way of treating performance-anxiety-related impotence is to suggest a couple lie naked together and on no account have sex. We call this a paradoxical intervention. Now the pressure is off – if the man is to complete the task successfully, he needs to ‘succeed’ in not having an erection.
I suggested Graham and his wife do this. They were to do it outside of his wife’s most fertile time, just to “instigate intimacy” but not to “get an erection”, or at least “not for now”.
When I saw Graham the next time, he told me that he had happily failed the task. He and his wife were having better sex than they’d had in years.
But of course, I also did plenty of hypnotic rehearsal with Graham.
5. Use hypnosis for fertility and virility
I will avoid the obvious joke about me having got lots of women pregnant (through hypnosis!), but it’s true. Hypnosis does seem to have a pedigree in helping women conceive, at least when they are using IVF.1
I did see Graham’s wife, not just for fertility but also to help her re-establish her sex life with her husband not as a means to an end, but as a spontaneous act of love.
I suggested during hypnosis that she could greatly love the moments, and the outcomes of those moments could take care of themselves. I suggested she would forget about conceiving and really start to enjoy sex again. This in turn would further help her husband.
With Graham in trance, I revivified earlier and happier memories of making love with his wife. I suggested to him that his unconscious mind would look after his erections and he wouldn’t even have to think about it.
Between taking the pressure off, hypnotically re-evoking great sex and deconditioning unpleasant memories that had become tagged onto sex, Graham and his wife began to enjoy sex again for its own sake.
The ripped Disney wallpaper began to fade in Graham’s mind.
Years passed, and I forgot all about Graham. Then one day I saw him in the street. He was pushing a pram. It took me a couple of seconds to place him, but I think I covered it up pretty well! Proudly he introduced me to his son, who was wearing a Dumbo T-shirt. “This is Michael”, he said.
I looked at the wee lad and, without even thinking, I heard myself say, “Hello Mickey!”
And you can learn more about treating clients with hidden traumas that are negatively affecting their lives with our online Rewind Technique course. Read about the course here and sign up to be notified when it’s open for booking.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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