Dear Duana,
Both my roommate and I have been in relationships that started out great: emotional commitments and all, lots of time together. But then it came time for sex. In both our cases, the men (50’s and early 60’s) had ED and took Viagra. In one case, his ED led to him blaming her for his “failures” and she broke it off. In the other, the sex was fine the first time, but he felt he had to apologize for being inadequate (he wasn’t at all) and then stopped seeing her because of this. Do we need to avoid men with ED in the future due to their anxieties and self-image problems? How do you deal with this in a relationship that isn’t marriage? Our dating pool is the 50+ crowd.
Annie
Dear Annie,
That’s really unfortunate that you and your roommate have both had experience with men whose sexual insecurities led to the demise of promising relationships. I can see why you might want to simply avoid those men to prevent the disappointment you’ve experienced. But I think avoiding men with ED is going to be rather limiting for you. Here’s why, and what to do about it.
As men age, ED increasingly goes with the territory. It’s normal for men to experience ED at some point; for most, it will be in their 50s and later (see stats in letter below). And even if you get a healthy young ‘un, things happen; odds are, at some point he’s not going to rise to the occasion, at least some of the time.
Better, then, to have a strategy for helping a man who either has ED or will have it someday. Plus, unless you’re okay with blurting out something like, “So, how ‘bout that Levitra?” you’re really not going to have knowledge of whether a particular guy deals with it anyhow—until it’s time to deal with it anyhow.
When ED arises, regardless of circumstance, most if not all men are going to be terrified. The ones who will be most threatened and thus most likely to wig out are a) the guys who have false beliefs about masculinity and aging (“Mr. Big should always get and stay hard when I want it to, and age has nothing to do with it.” “Real men get it up and keep it up.”) and b) the guys who tend to look at sex competitively rather than as an emotional expression. Men in category b usually engage in spectatoring—experiencing their sexuality as if they are on the sidelines, critiquing their performance. Men in category b are also frequently in non-committed relationships, like dating; unlike in marriage where there’s more trust, in dating, folks are evaluating one another. And men are keenly aware of the high potential costs of being evaluated in this most sensitive, most core aspect of their very selves.
Put another way, when a guy doesn’t know you well enough to trust that you love him no matter what, he’s likely to critique his performance, and that can lead down rocky roads you and your roommate already know too well. So, being with an older man, moreso than a younger one, is all about intimacy if you want great, connected sex and emotional bonding.
Intimacy is gradually revealing all aspects of the self without fearing loss of identity; it takes time. For many if not the vast majority of men, whether or not Willie is doing what the guy wants is a big part of identity. Losing a formerly dependable erection is terrifying, and sharing this shift of identity is highly threatening. And all the moreso with a new partner.
What can you do? Well, there are many techniques. You’ve probably read my article about treating ED when the guy does not want treatment, which published last week: http://www.lovesciencemedia.com/love-science-media/do-it-yourself-sex-therapy-the-sneaky-way.html
And there is a good book I recommend about making love to a man who is 50+, which you can see here: http://www.amazon.com/All-Night-Long-Make-Love-ebook/dp/B006C4G8L8/ref=sr_sp-atf_title_1_6?s=books&ie=UTF8&qid=1407265857&sr=1-6&keywords=barbara+keesling
These sources have plenty of tips.
The problem is, the tips ALL require levels of intimacy younger people rarely have to think about. I mean, can you imagine saying to your new boyfriend, “Okay, I need you to lie very still so I can massage your penis, and then after we are both accustomed to your erection coming on without intercourse, we can eventually try insertion—but only for a moment. Then, you can give me oral and we’ll call it good, eventually moving towards more intercourse?” Me neither. These techniques are simply not dating-appropriate. They are for solid relationships with a really high level of trust and love.
This does not always mean marriage; it does mean intimacy. True, time-taking intimacy.
Upshot? The strategy here is Waiting. It’s vital to Wait to get intimate sexually until there is a very solid base of emotional intimacy and deep level of knowledge of each other and high level of trust present. You need to know an older guy better than you would a younger guy before you have sex, because it’s likelier you’ll be dealing with ED at least sometimes, and you don’t want that to break apart what could have been a delightful relationship.
So read Keesling’s book and my article. When your relationship has reached a point where you could say and do the things that they recommend, your relationship is ready for sex—ED or no!
Cheers,
Duana
Book coming in January, 2015: Love Factually: 10 Proven Steps from I Wish to I Do
—“If you are going to read any book about love – make it Love Factually.” ~eHarmony
Duana C. Welch, Ph.D.
LoveScience: Research-based relationship advice for everyone
http://www.lovesciencemedia.com
Duana@lovesciencemedia.com
—The Many (Sometimes Surprising) Causes of ED (and if it’s so normal, should we call it a disorder?)—
From SPC Horrigan:
As a male I find this incredibly difficult to read so I can easily understand Eric’s discomfort and embarrassment. In Eric’s defense, I think there are other contributing factors to having his body shut down the way it has. In relationships life becomes overwhelmingly busy, routines in the home that become patterned can be a threat to keeping the passion and intimacy alive for a couple.
A colloquial phrase that comes to mind in terms of the aging process is “you gotta use it or lose it,” and unfortunately this pertains to our sexual biology as much as it applies to other physical functions.
Fortunately, as couples grow older together they have each other to witness signs of decline in each other’s health. Since there is an overriding expectancy for males to be heroes, leaders, and problem solvers for others it’s very difficult for men to address their own needs for help. I admire Cassandra’s tenacity in staying dedicated to her marriage outside of having her own needs met and out of true concern for her husband. Cassandra demonstrates bravery in not giving up amidst her frustrations and for stepping out on a limb to write and submit a letter asking for expert advice.
The main factor that allowed me to read through such an uncomfortable article was the fact that there was so great compassion and support being offered as a solution to the problem. Luckily Cassandra’s bravery met its match in finding Dr. Welch’s confidence in how to plot an effective recovery system complete with step-by-step instructions on how to win back pleasure that was lost. Aside from Dr. Welch’s scientific training and Cassandra’s strength as a wife, I have no idea how women intuitively sense what turns men on the most.
This situation has been gradual in the time it’s had to subside and shut-down; I think the recovery strategy balances against that gradual slide by also maneuvering slowly in its graceful approach guiding Eric back to life. Eric, like most men, feels striped of his power and bravado with what he’s facing, so I think it’s clever to tease and hold out providing him room to engage as the aggressor as he regains his footing sexually.
I wish we could fast-forward in time, because this article leaves nothing to the imagination in how to seductively recapture passion after falling astray into a long dormancy.
I might also suggest Viagra™ for Eric. Viagra™ doesn’t work all by itself, but it would definitely help in the middle of getting a massage. I think it would be beneficial even as an experiment when the focus is directed away from the genital area. There’s enough heartache and embarrassment involved here already, so I’m glad the therapy suggested offers playful participatory ways to toy around and have long-range fun, bringing recreation back for both to share. I’m glad there’s no expectation for Eric as well, it seems like everyone gets to enjoy the rewards that simple closeness and touch allows so everyone can sit-back allowing nature to undo what it’s done while no one paid attention. Good catch on the wife’s part. Erick’s lucky to have a partner who has not only his back but tackles his needs head on from the front as well. Sorry, I’m a guy, but mean well, and hope for the best!
From Tom:
Well, if I was a Chevy I’d be a classic and probably in a Frankie & Annette movie. And all the original hydraulics still lift just fine. Yeah, with age comes an undeniably greater chance of failure but fortunately it’s not a given.
There was one time that I experienced that letdown … it was the first time after my divorce. My female friend was more disappointed for me than I, I think. I was somewhat embarrassed, but fortunately I hadn’t left her frustrated. A week later, I was as good as new and we went on to date and have fun for a few months.
My point: it was all in my mind at the time. Too many memories of being married, and too much self-imposed performance pressure. I had to learn to relax, slow down, focus on the person I’m with, and take myself and “performance” less seriously.
Being tired can put a guy at risk. That includes being “tired” … not having had enough of an interval since the last time. And that one varies per individual guy.
Ideal frequency: I know I’d be perfectly happy with a couple times a week, at my advanced age ;-) More often than that and I start feeling like I’m a quart low. It can be a good thing to be rested and eager.
From Vincent:
Wow!!! Beside the actual problem, I “loved” the details. :)
As a comment on the Viagra™ or Cialis™, I agree with Dr. D. that you might want to check with your physician. I have know men to have heart attacks using them. Also, some high blood pressure meds can have the ED effect. It might be as simple as a med change.
From B:
Difficult subject, lots of variables. A morning erection indicates normal functioning, but fatigue, depression, or a lack of “excitement” can reduce or disable the sexual response when it may desired.
I read that those of who perform aerobic and anaerobic exercise regularly are increasing the lactic acid or lactates in our blood, acidifying the blood and inhibiting nitric oxide.
Nitric oxide allows our blood vessels to operate properly to fill and regulates them to help seal off the corpus cavernosum (the erectile tissue of the penis) once it is filled with blood.
Viagra™ (Sildenafil) helps with vasodilation and assists by providing a competitive molecule that binds to receptors that would otherwise remove or degrade nitric oxide and important transmitter chemicals in the blood that are used for getting and keeping an erection.
Turns out we men are a little bit complicated too.
From Anon:
Interesting article. Eric’s age isn’t given, but if he’s over the hill it comes with the territory, hun. If he’s young, consider the ears, as in what’s between them. Some men think sex is dirty. Or at least they think the woman is too pure. Once upon a time a guy told me I was “Snow White” and that’s why his ding didn’t dong. True story. Nice article.
Duana’s response: What causes ED?
Dear SPC Horrigan, Tom, Vincent, B, Carmen, and Anon:
Thank you so much for your thought-filled letters (Tom, I particularly admire your bravery and Carmen’s in sharing your personal experiences).
This article was among the most difficult for me to write, for two reasons:
a) To state the obvious, I don’t have a penis, and therefore I don’t possess the psychology that comes with such ownership; the learning curve was larger than usual for me. So I really appreciate all the feedback from those of you in the trenches ;).
b) As you’ve all pointed out most correctly, there are *so many factors* that can cause ED. It was frustrating to describe just four in a 1,000-word article.
You each mentioned things that didn’t seem to play a role in Cassandra’s and Erik’s case, but which are *definitely* important for many men: age, medications, depression, stress, the refractory period, and lack of excitement (false beliefs such as those reported by Anon; performance pressure such as Tom experienced; illness as Carmen detailed; and others were covered in the original article).
It’s true that all of these and more contribute to ED.
AGE:
Age does not actually cause anything. But the passage of time permits the accumulation of plaque in the arteries, the progression of many chronic disease processes, the need for meds to control disease processes, and many other things (too much nicotine and/or alcohol; uncontrolled blood sugars) that mess with blood flow.
And since erections are about blood flow, anything that messes with that can quash The Hydraulics. Therefore, ED increases significantly with age.
In fact, ED is the most common sexual problem men report, and with age that only becomes truer; whereas 7% of men in their 20’s have had at least one time in the last year where they couldn’t get or keep an erection, the rate jumps to nearly 40% by age 60+ (as Carson and others found in 2002, and a helluva lot of other guys figured out in their bedrooms before that).
The truth is, ED is basically a normative thing. If you look at the lifespan, at some point, most men will experience a time when Willie won’t do his will.
Which makes me wonder: Should we call ED a “dysfunction” or “disorder” at all?
MEDICATIONS:
Some medications (for example, many that are used to treat high blood pressure) have the unfortunate side effect of causing ED.
Pharmacists—*not doctors*— are generally the best-educated professionals regarding what meds do. If you want a professional opinion about whether your meds could cause ED, and whether there’s another med that could treat the health issue *without* limping your Noodle—take your meds list to a pharmacist. Usually, they’ll give you a free consult!
DEPRESSION:
Clinical depression is often referred to as the common cold of mental disorders, but it feels more like the aftermath of a train wreck. One of its possible symptoms is loss of interest in activities that used to be enjoyed…such as sex. ‘Nuff said.
STRESS:
Men may have the Ever-Ready reputation, but stress isn’t an aphrodisiac for either sex. And chronic stress, or stressors that attack a man’s sense of self-worth (such as long-term unemployment) are wood-busters.
THE REFRACTORY PERIOD:
Tom, this wouldn’t have made the list without your astute and brave personal assertions about tiredness between sexual encounters. So thank you for that.
I don’t know if you ever heard the claim that men are at their sexual peak in their late teens. ? But that claim is based on this fact: The time between a man’s orgasm and his ability to have his next erection—aka the refractory period—is at its shortest when guys are really young.
And this timeframe steadily increases over the lifespan. By the time a guy is in his 60’s, it may take a full 24-48 hours or (much) longer before a guy can get wood after he’s had an orgasm. (It also takes more and more physical stimulation for an erection to appear even after the refractory period.)
Fortunately, a short refractory period is *not* how women define a guy’s sexual peak :). Simply watching It go up and down in rapid succession is not really a WooHoo for us.
In fact, studies of aging show that women and men become more similar sexually as they age—both taking more time to Get Aroused, more time to Get There, both becoming more about the Process than the Result, both becoming more into feeling With Their Entire Bodies.
And especially in long-term relationships, if men will let go of their Wrong Beliefs About Their Penises/Performance, the opportunity may never have been greater for sexual closeness and physical expression of intimacy. In fact, really intimate sex—the kind where you *have* to talk to one another and be attuned to a particular person and not just another body—almost becomes the only form of sex that’s available!
LACK OF EXCITEMENT/THE COOLIDGE EFFECT:
As B rightly observed, lack of excitement can play a role in ED. In fact, throughout the entire mammal world, young and healthy males—including humans—will often develop an erection right away in response to a new partner when their response to an established partner has ceased.
It’s called the Coolidge Effect due to an apocryphal story about the former US President and his wife. Apparently, while touring a chicken farm, Mrs. Coolidge asked if the roosters mounted the hens every day, and was told that indeed, roosters mated multiple times a day. “Tell that to Mr. Coolidge,” replied she. The President then enquired, “Always with the same hen?” When told that no, the rooster always chose a new hen, President Coolidge responded, “Tell that to Mrs. Coolidge.”
Anyway, the evolutionary reason behind the Coolidge Effect seems to be that males can sire a lot more offspring—casting a wider genetic net—if they fool around, since if they are utterly faithful, a wife can only produce a few children.
That said, the Coolidge Effect is not the only reason for Boredom. Sometimes, Boredom isn’t that at all—it’s Anger or emotional disconnection, as this partial comment from Quinn indicates:
“….I think many men would agree, even in our youthful age when the smell of perfume in passing could trigger a semi, a relationship that is stagnant or personal issues that are weighing heavily in one’s life could compound the issue. It may not be the partner’s fault but the partner is the face of that reality and there’s no way to escape the issues to get motivated for passion. I’ve heard of young married couples in their late 2o’s and early 30’s who say they no longer have sex. Cheating would be an easy assumption but they claim to be embedded in their lives and have simply no energy or desire for that part of their relationship anymore. And to their proclamation, “They’re fine!” We know they can’t possibly be, but if not addressed, like with anything, that part will atrophy. (No pun intended.)”
Although women are the ones with the reputation for sexual shut-downs if the quality of the relationship is poor, there are men who lose all sexual interest in a partner to whom they no longer feel close. Some men will end the sexual element of a marriage and stay for the childrens’ sake, for instance, so they can provide for their family without facing the false intimacy of sex with someone who is no friend.
—The End Of Sex?—
From Gillian:
Gillian finds the article and its comments to be most excellent. Earthy. And Vivid. However, being somewhat of a prude (she is working on that) she finds it warm it here, and has decided to open the window. Ah, much better.
I would like to know: Are there any studies about the frequency of married sex between mates for the middle-aged set? Say those of us 40- 55, or better?
Duana’s response:
Gillian, I am glad opening the window helped, lol.
Thanks for your question. I could not tell whether you were more concerned about how common ED is with age (if so, I’ve answered under “Age” in the comments above)…
or whether you were more worried about whether loving couples still continue to have sex as they age from their 40’s onward.
If your question is the latter, here’s some news: The #1 reason middle-aged and older women don’t have sex is the lack of a willing and able partner.
And if we eliminate Unwillingness (please see “Lack Of Excitement” in the comments above), then we’re looking at disability. Which can equate ED, or physical immobility as from Parkinson’s or MS or another issue with movement.
I’d like to add, though, that I think it’s very important to consider the Big Picture when thinking about What Sex Is. If it’s strictly penetration with a penis, then that rate declines over time even in the era of Viagra™.
But if we’re willing—as Cassandra was—to consider our sexuality in totality, then sex never needs to stop. Barring a really severe impairment, most of us will have hands or tongues that can tease and please a mate all our lives.
Aging, if anything, may gradually close the door (for many, though not all) on Penetration As The Only Form Of Sex…but it opens a whole lot of windows into the joys of touching and being touched, loving and being loved, in an abundance of Other Ways.
Go open that window again :).
—Treating ED: Can you screw up sensate focus?—
From Monica:
Dr. D. — do we have any way of knowing how many couples actually go through this process as you have spelled it out? I can only imagine how hard it would be for a man to hold off after finally getting an erection, no matter how “unstable” it is. How often does one partner get too excited and blow the whole thing? Can jumping the gun become an issue in itself?
Duana’s response:
Dear Monica,
Great questions. I want to thank you for asking for specifics about sensate focus, because I think it’s gotten short shrift ever since Viagra’s™ advent.
I don’t know—or even know if it can be accurately known—how many couples per year use the Masters & Johnson-developed process of sensate focus. I *do* know that M&J claimed a success rate of about 82% across multiple kinds of sexual disorders when couples used sensate focus, and that sensate focus “works” for everyone in the sense of restoring various levels of physical intimacy.
And here’s my opinion: You can’t really screw up sensate focus. Even if a couple jumped on the first erection like a duck on a junebug, they could always treat it like any other lapse (such as lapses in dieting, alcoholism recovery, etc.):
Think to oneself, “lapses happen”; return to The Plan (or diet, etc.); and in sensate focus, continue to reconnect with the whole body in a gradual, pleasure-rather-than-goal-focused-way; enjoy.
—Treating ED: What About Using Drugs (with or without other things) To Free Willie?—
From Carmen:
When I hear of 80-yr-old men fathering children, my response is HOW?!! Guess I just assume that ED occurs in all men as they age. When my sweetie was in his mid-50’s he began having problems. My first thought was Low Testosterone, thanks to the hilarious TV episode when Coach procured a testosterone patch. Hubby was terribly frustrated, and I asked when he’d had his last complete physical exam. 35 years. Honey, we should all get a complete physical once we turn 55…there may be something physical that’s causing this problem. When he arrived home from his visit with the doc to discuss results, he said he was met with this question: “What the hell is going on with your blood?!!!” Turns out he was anemic. Long story, not relevant to this discussion. After a series of tests, all serious medical problems ruled out, his blood pressure med was changed and he began taking multivitamins. His stamina and vitality did improve, but some other medical problems began to surface.
When he was in his early 60’s I began accompanying him to the Dr., which did not bother him at all. He finally told his urologist of the ED, which was occurring more often. Viagra was suggested, and he agreed. Long story short…4 yrs ago he was diagnosed with early-stage Parkinson’s. We’ve gone through many adjustments involving our sex life because of this illness…trying Cialis (no help), then learning to enjoy our rolls in the hay without worrying about Results. He now uses Viagra™ and a pressure pump…I’m post-menopausal & use sensual jellies. We do massage, we massage all areas…if you get my drift…and have a wonderful time together. Fortunately he is a wise man who realizes his worth does not lie in his dick.
For those men who shut down emotionally when Johnny no longer obeys his instructions, Dr. Duana’s advice is perfect.Communication is the Key, but when communication breaks down one must seductively sneak in the back door.
In these cases, the Hands are more effective than the Voice. Subtly & seductively demonstrating to your sweetheart that he is desirable & turns you on is paramount.
To you guys out there…this will very likely happen to you. Take it from a couple who has lived through it and still giggles w/joy between the sheets, it is not the end of the world.
Duana’s response:
Carmen, what a fantastic, inspiring letter. I so admire your honesty and candor about an issue many people won’t discuss in even the most roundabout way. You’re a one-woman guru when it comes to showing us the path to Intimacy—damn the ED.
Before I go on with the details, this sentence of yours bears repeating: It’s “a wise man who realizes his worth does not lie in his dick.”
And a wise woman who helps lead him to that realization.
That said, I really like how you shared your process of reclaiming your sex life with your beloved husband, from going to doc appointments with him, to understanding what various meds and physical ailments were doing to his body—and how that was affecting his psyche—to ultimately, through a combination of approaches, mutually “learning to enjoy our rolls in the hay without worrying about Results.”
Which brings us to Levitra™, Viagra™ and Cialis™, Oh My!
I really appreciate that nobody took me to task because I skipped over these three wonder drugs—and truly, they have done wonders for millions— in the article. It’s not that I fail to appreciate the impact they’ve had on many, many a couple’s lovelife.
But. As Vincent and Carmen pointed out, the drugs themselves can cause other problems, mask dangerous problems, or just plain not work for a given man. Or they work, but partially.
For instance, for you and your husband, Carmen, it took a couple of years of trying out various meds (including Cialis™, which didn’t work, and Viagra™, which did) *plus* a penile pump, erotic massage, lubrications, honest discussion with compassion, and an understanding that an erection *still* might not occur.
And as SPC Horrigan pointed out above, for many couples, ED came on gradually and took its toll emotionally over a period of time; often, part of the fallout is an eventual and total cessation of *any* kind of physical contact, which can really get in the way of emotional connection. It’s said that men need to have sex to feel emotions, and women need to feel emotions to have sex, but any way you look at it, touch is important. For couples who haven’t touched one another in years, Day 1 of sensate focus is a breakthrough that no drug on its own could achieve.
There Is No Substitution For Getting Touched. Touch is a human need, not merely a want. Before there were drugs for ED, perhaps there was a bit more understanding that It’s Not ALL About Dick. ;)
—Treating ED: Will Sex Therapy Work If Just One Person Goes?—
From Duana:
Dear Duana,
Why didn’t you recommend that Cassandra go to a sex therapist on her own? You’ve said research shows that *one* person can go to therapy and change the entire relationship, right?
Duana
Duana’s response:
Dear Self,
Thank you for asking that question. It was really bothering me that neither the article nor the thread talked more about therapy in general. Also, I think the article could be construed to mean I think therapists are all quacks. Which I don’t think.
I’d like to do a full article about the benefits of therapy (especially cognitive behavioral therapy) and how to find a good couples counselor (even just for oneself). For now, suffice it to say that there are many qualified therapists, and approaching the local psychological association is often a good way to go about finding one.
Also, Cassandra could indeed go to a therapist on her own, and I think it’s a great idea. She could ask a sex therapist, for instance, to teach her about the techniques the article describes, and to mentor her while Cassandra goes through the sensate focus exercises at home with Erik.
Or, Cassandra could go to a cognitive-behavioral therapist to learn more about false beliefs (her own and/or Erik’s) and how to challenge those beliefs so as to enhance her sexlife with Erik.
Note that in both cases, Cassandra can go to therapy *on her own* and still positively impact her marriage and her and Erik’s sexlife. Fortunately, the proverbial “balls” are often in the court of whoever is willing to start making improvements, starting with themselves.
Cheers,
Duana
*ED = erectile disorder: The inability to get or keep a desired erection
If this article surprised, enlightened, helped, or made you squirm, please click “share article” below to distribute to your favorite social media.
Do you have a question for Duana? Contact her atDuana@lovesciencemedia.com.
Related Love Science articles:
Penis size—when it counts: http://www.lovesciencemedia.com/love-science-media/when-size-matters-penis-size-and-womens-satisfaction.html
Penis size Q&A: http://www.lovesciencemedia.com/love-science-media/comments-from-when-size-matters-penis-size-and-womens-satisf.html
The author wishes to thank the following scientists and sources:
—Janet Shibley Hyde and John D. Delamater, for Understanding Human Sexuality
—Inigo Saenz de Tejada’s thorough work on how the penis functions, as well as pathologies (such as diabetes) that cause dysfunction.
—Linda J. Waite and Maggie Gallagher, for proving that Nagging Saves Lives in their book The Case for Marriage
—William H. Masters and Virginia E. Johnson, of course. They invented sensate focus and changed the world for countless people with ED and other sexual problems way before Viagra™, Levitra™, or Cialis™, oh my. Their book Human Sexual Inadequacy
—Raymond Rosen, Sandra Leiblum, and Ilana Spector, for creating a comprehensive way to treat ED that includes sensate focus, education that combats false beliefs, sexual novelty to keep the fire burning, help with conflict-resolution strategies so you’ll still like one another enough to have sex, and (most brilliantly, I think) training to prevent ED relapses. If I were looking for a sex therapist, I’d click the link and call Dr. Leiblum.
—Paul Joannides’ The Guide to Getting It On
—And if you just want to read a quick, accurate overview of general sensate focus techniques on the Internet, this was the resource I found to be most clear: http://www.partnertherapy.com/node/365
All material copyrighted by Duana C. Welch, Ph.D. and LoveScience Media, 2014.