The Connection Between Attachment and Sexuality

By Michael Aaron

One of the subjects that I have spoken on extensively on over the last few years is the topic of attachment. By
attachment, I am referring to the style of interpersonal relating that we have learned and internalized from
childhood experiences. According to decades of research, started by psychoanalyst John Bowlby and extended
by Mary Ainsworth, among many others, psychologists have identified four main types of attachment styles-
secure, anxious/ambivalent, avoidant, and disorganized. The secure attachment style, prevalent in 65% of the
population is marked by emotional stability and a childhood featuring stable and nurturing caregiving.
Anxious/ambivalent attachment is characterized by obsessive preoccupations about the object of the intimate
relationship and intense fear of abandonment. People with this attachment style typically have experienced
inconsistent caregiving, and so have grown to feel unsafe in the stability of close relationships. Avoidant
attachment is marked by the avoidance of intimacy, as well as of experiencing feeling and emotions. These folks
have typically experienced more neglectful caregiving as kids. I will put aside the disorganized attachment for
the moment, as it is not very common, and is typically a byproduct of more severe abuse.

At this point, I want to make an important note about what I mean by intimacy. I think sometimes folks get
caught up in some kind of a rigid idea about what intimacy means, one that is cooked up in romance books, soap
operas, and Hollywood Happy Endings. This involves the kind of romantic closeness, actually known as partner
engagement, which involves the typical aspects of what we would all consider as deep and meaningful love
making the pillow talk, the eye gazing, the deep kissing, the sensual touching, and so on. However, based on
my experience as a sexologist and sex therapist, working with numerous individuals and couples, I do not define
intimacy in that way. To me, intimacy simply means being able to be emotionally vulnerable and transparent
with another person. In that sense, two friends can be extremely intimate, a mentoring relationship can be
intimate, and sexual exploration can be intimate, while eye gazing and pillow talk may not. Its all about the
context.

Anyway, lets get back to how attachment styles start to interact with and affect sexuality. Taking the above
childhood attachment styles, psychologist Kim Bartholomew applied them to adult behavior and created a new
matrix of terms. In her conceptualization, secure childhood attachment remains as secure adult attachment,
while anxious/ambivalent childhood attachment is now termed Preoccupied, and avoidant childhood attachment
is divided into two new categories- Fearful and Dismissive. The chart below illustrates this concept:

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It is with these four adult attachment styles that we start to see a pattern of sexual behavior. Secure adults are
able to feel comfortable being emotionally vulnerable and dependent on others. These are not the kinds of folks
who are typically prone to experiencing sexual difficulties. Preoccupied attachment, in the upper right hand
corner, typically involves obsessive thoughts revolving around the fear of abandonment. These are the kinds of
folks who may appear to be overly needy, dependent, or overbearing very early on in relationships. The last
two Dismissive and Fearful are probably the most common attachment styles that I see in my office. They
crave love just like everyone else, but are so uncomfortable in the face of closeness, that they seek to escape and
create as much safe distance as possible. This kind of discomfort with closeness can play out in sexual
dysfunctions such as erectile dysfunction and premature ejaculation as well as sexual compulsivity and/or
infidelity. My colleague, Dr. Crocker and I, have spoken at length at numerous events about how frequent
infidelity or paying for sex workers may actually be an attempt for some to enjoy sex at distances far enough to
actually feel safe. Indeed, it is far less likely to feel emotionally vulnerable with a stranger than with a long-
term partner.

Ill end this topic here for now. The main takeaway is that we all want to enjoy life, be happy, and be loved, but
sometimes, depending on our attachment style (which weve picked up from childhood) it just feels too
overwhelming to be able to experience that with someone who is too close. A myriad of sexual problems can
creep up as a result, preventing us from experiencing sexual satisfaction within close relationships. The good
news is that research shows that through a commitment to consistent therapy with a well-trained clinician,
attachment patterns can and do change. Learning to tolerate the higher levels of anxiety that emotional closeness
produces allows us to eventually change our patterns of relating, finally giving us the freedom to experience our
natural full range of sexual pleasure

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A Therapists Missed Opportunity: Sex, Intimacy,
and Sensuality for One
by Denise C. Onofrey

Therapists working with individuals miss an essential component of their clients mental, emotional, spiritual,
and physical well-being by not inquiring about sexuality, intimacy, and sensuality. Much to my chagrin, I have
heard seasoned and admired therapists admit to not doing so. It seems many therapists consider sex, intimacy,
and sensuality up for discussion only if the presenting problem is related to a relationship. Our cultural
messaging distracts and dilutes us into believing sex, intimacy, and sensuality exist only in a relationship of
some configuration. The cultural message has created a taboo and an ingrained belief that talking about,
thinking of, and celebrating ourselves as sexual beings outside of a relationship does not have value.

Sex, intimacy, and sensuality for one is about enjoying, relishing, and leveraging our bodies, minds, and beyond
to increase mental, emotional, spiritual, and physical health. Opportunity to support our clients in discovering a
new way to interact with their bodies and minds is lost when we assume that sex, intimacy, and sensuality are
not vital components of our single clients health and well-being. It is essential to understand a clients

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relationship with his or her body, sexual health, interests, and experience to fully understand the clients
worldview and state of being.

I have worked with a number of women who report putting their sexuality on hold, as if those days are over or
sexuality just isnt a fit at this point in their lives. It is essential as therapists to investigate a clients interest in
finding what more there could be. There may be medical, hormonal, psychosocial, or cultural dynamics at play
in the lives of clients who imply that the sexual part of them has terminated or is not for them anymore. It should
be noted that cultural messages may lead us to not investigate or consider a persons exploration of sexuality
with a partner or partners unless that exploration is in the context of a relationship, which, according to those
cultural messages, tends to require a commitment and monogamy.

Sex, intimacy, and sensuality are not for othersrather, theyre for us as individuals. Not only do they not
require a bedroom, they dont require a partner. As human beings, it is imperative that we indulge in self-care
such as rest, real food, enough water, and exercise. In or out of relationships (and that gray area in between),
self-care needs to include relating with self and others care in which we strive for effective communication,
intimacy, and, for many, being mindful of maintaining a healthy, balanced sex life, intimacy life, and sensual
life. I insist it is equally important to ensure that single clients of all genders are equally as mindful of a healthy,
balanced sex life, intimacy life, and sensual life as our partnered and married clients.

It should be noted that we tend not to investigate and celebrate a persons exploration of his or her sexuality
with a partner or partners outside of our cultures definition of a relationship, which tends to require
commitment and monogamy. As clinicians, it is important for us to question our own definitions and worldview
when it comes to commitment and monogamy. If our beliefs impede our unconditional, positive regard and
clinical judgment, we need to consider who may serve our clients better.

It is important to ask yourself, as a clinician: Why arent I asking and encouraging my single clients sexuality,
intimacy, and sensuality as a means to a balanced, enriched, intimate lifestyle? What is it about my own
worldview of those in and outside relationships that compels me to inquire about sex, intimacy, and sensuality
only with clients who are in relationships?

Steps to begin introducing sensuality for one into your practice:

Intake forms: What components of your intake forms encourage clients to identify as a single person
versus a person in a relationship? What can be altered to add dynamic to these components to reflect a
clients relationship with self? For example, an intake form could ask: What do you do with alone time?
What activities do you engage in alone? What activities do you enjoy most/least when you are alone?
This could provide a wonderful facilitation of understanding and expanding your clients experience.
Intake questioning: Have you asked a client outside of a relationship how his or her life is enhanced by
being out of a relationship?
Leveraging data: Once the work with a client has momentum, we can return to the intake and expand the
clients intimacy, senses, and sensuality. How could you leverage intake-form responses such as: I love to

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 go to yoga classes alone, or, When I hike with others, I feel a disconnection from the mountains that I
have when I am alone? In addition, if the client has a visceral reaction to alone time, you have insight
into his or her experience.
History taking/genogram: What messages has the client received about relationships? About not being in
a relationship? What threads exist in the clients history that are worth exploring to enhance being out of a
relationship?
Self-care conversation: Is self-care explored beyond food, exercise, and balance? How are clients caring
for themselves or not caring for themselves? Is care focused on self for selfs sake?
Relationship history: Is the history focused on former lovers and the periods between relationships? And
what are we using to define relationship?
Psychoeducation: Beyond sex, intimacy, and sensuality for one implying masturbation, what pearls of
wisdom are we sharing about how to increase tender, loving care for self?
Goal setting: Often times in goal setting, I hear clients outside of relationships wanting to work on
themselves so they are ready for a relationship with someone else down the road. How can the goals
enhance the clients current experiences and their relationship with themselves?

Now armed with a handful of tactics to begin implementing the concept of sex, intimacy, and sensuality for one
into our practices, it is my hope that clinicians begin to view themselves and their clients as sexual beings
regardless of relationship status. Sex, intimacy, and sensuality are enriching, vital components of all of us,
requiring differentiation from the cultural messages in order to maintain mental, emotional, spiritual, and
physical well-being.

2012 GoodTherapy.org

Sex Talk: How Communication Builds Intimacy

By Jill Denton

I just finished a wonderful book by Peter Lovenheim called In the Neighborhood; The Search for
Community on an American Street, One Sleepover at a Time. The author laments that we dont really
know the folk who live on our block. So he goes to his neighbors homes and spends the night, just like we did
as teenagers. Each time he invites the adults to really open up about their lives and values. The one thing he
avoids discussing is sexual intimacyhow sexual a relationship is and whether or not the partners are happy
with their current level of intimacy. My own friends know Im a marriage therapist and clinical sexologist, but
none of them have ever spontaneously opened up to me about their sex lives. Most people are just not
comfortable talking about sex.

What would we ask? What would we share? The big question in our highly quantitative culture is probably, are
we having enough? Most sex therapists concur that a sexless relationship is defined as one in which the partners

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have sex less than once a month or less than ten times a year. My colleagues are, of course, referring to pivi
(penis-in-vagina intercourse). This eliminates same-gender couples and heterosexual couples who prefer other
forms of sexual intimacy. Ive certainly worked with many couples happy to have pivi less than monthly who
would not describe their relationship as sexless!

After all, sex isnt the only way to express love or show affection.

Ive also worked with dozens of women over the years who submit to pivi once a week because their partners
demand and expect it. These women become increasingly resentful and even hostile, which certainly doesnt
make for a mutually satisfying and trusting relationship. Compare this to the couple that makes time at least
once a week to truly connect in ways that might not be overtly sexual. If sharing time, feelings, and needs
without pivi truly meets both partners intimate needs, they will be quite happy.

Do you believe that you and your partner are mutually satisfied? If youve never talked about it, youre not
alone. We often assume that talking about sex will lead to our partner wanting more or wanting it with someone
else. And we dont want to embarrass, wound, or create tension by admitting that we yearn to have our partner
bathe or shower before sex or would prefer to be approached in a more romantic way. So we silently comply,
disengage, or withhold.

By the time people make it into my office this silence has usually become deafening. You might find yourself in
these examples: a man who is worried that he might be impotent, so erectile problems lead to his withdrawal; a
woman who feels rejected by his lack of overtures and says nothing; or a woman who fears shes becoming
frigid (yes I still hear this term!) and avoids intimacy by staying up late doing Facebook or going to bed hours
before he does.

In my office Im constantly looking for ways to help my couples become more comfortable talking about sex.
One of the most important ways to approach this difficult subject is through appreciation. Something I really
enjoy (or enjoyed, even if it was a long time ago) and would like more of is ______. Regardless of the rate or
type of expression of intimacy in your relationship, appreciate it when and if it occurs. I really loved it when
you tenderly stroked my cheek just nowit makes me feel that you truly care.

Sexual intimacy comprises so much more than genital contact. Its about how we embrace, touch, chide,
celebrate, lean on, listen to, nickname, and especially laugh with one another. Sometimes cake is even tastier
without the icing!

2012 GoodTherapy.org.