“We just don’t communicate well,” Merle reported in our first session while her husband, Luke, nodded quietly in agreement. Like many couples presenting for couples counseling, Merle and Luke believed “communication issues” were causing much of their relationship distress.

As a couples therapist, I knew that “communication issues” could mean myriad things. As is the case with many couples I see, I found that Merle and Luke were actually communicating well with each other. The conflict seemed to have more to do with the fact that they did not like what the other was saying.

The distress that Merle and Luke were experiencing in their relationship was affecting their sexual relationship too. When it comes to couples, whatever issues are going on outside of the bedroom also play out in the bedroom. Recent research shows that 40% to 50% of women (Marita McCabe et al., publishing in The Journal of Sexual Medicine in 2016) and 31% of men (Cleveland Clinic, 2016) experience a sexual disorder. The research suggests that even if couples initially report a nonsexual problem such as communication issues, they are likely experiencing sexual difficulties as well.

Despite how common sexual issues are, many counselors are uncomfortable discussing sexual matters with their clients. Counselors who fail to ask about a couple’s sex life, even in cases in which couples are presenting with the generic complaint of communication issues, are neglecting important information that would help them develop a deeper understanding of the couple. The therapist who disregards the sexual aspect of the couple’s relationship will struggle to help the couple achieve a healthier level of functioning.

As both a couples therapist and certified sex therapist, I believe that a couple’s sexual dynamics can tell us a great deal about their nonsexual dynamics and vice versa. Master conflict therapy has provided me the skill set and ability to go deeper with couples who present with a wide variety of relational and sexual problems.

Identifying the master conflict

Master conflict therapy is an integrative approach to treating couples that combines Freudian psychoanalytic conflict theory and Bowen theory with basic principles and practices of sex therapy. We each have a master conflict and unconsciously choose a long-term partner with the same master conflict. The master conflict stays with us for life, regardless of whether we stay with our long-term partner. The goal of master conflict therapy is for couples to learn how to healthily balance and manage their master conflict, because it will never go away.

A couple typically has the same fight over and over again. While the content of the fight may change, the process of the fight looks the same. For instance, Merle and Luke fought often about how to spend their money, how to spend their free time and even how often they should visit their in-laws. But the process of their fighting was that of two partners vying for the other’s acceptance while simultaneously rejecting each other. The process of the fight can sometimes be a good indicator of what the master conflict is.

Counselors should familiarize themselves with several important facts about master conflicts. First, master conflicts are internalized in childhood by verbal and behavioral messages from one’s family of origin. The master conflict can be influenced by religion, culture, ethnicity or experiences of traumatic events in childhood. Commonly, clients are aware of one side of their conflict, but rarely are they aware of both. Clients might have multiple conflicts, but the master conflict is the most influential or most powerful. In addition, the master conflict is evident is many areas of the client’s life (work dynamics, career choices, friendships, hobbies, etc.). It is also important to note that neither side of the conflict is better than the other. Rather, both sides of the conflict have pros and cons.

Although master conflicts do not influence who we choose for short-term relationships or casual sexual encounters, they do determine the choice of a long-term partner. Long-term partners will share the same master conflict. Master conflicts are normal and exist in every relationship. However, when the conflict becomes unbalanced, the couple will find themselves in distress. Once the master conflict becomes unbalanced, it can be very difficult for the couple to manage. Ultimately, to balance the master conflict, both partners must agree on a strategy and work collaboratively to manage the master conflict.

Many events can unbalance a master conflict, including major career changes, financial changes, a new baby or even living with your partner in quarantine during a global pandemic. For Merle and Luke, problems had been brewing for some time, but the crisis of quarantine unbalanced their master conflict of acceptance vs. rejection. Those with an acceptance versus rejection conflict have one side of themselves that needs to be accepted and another side that needs to be rejected. Merle and Luke both desired to please others and had a strong desire to be accepted by the other. Paradoxically, those with this master conflict also unconsciously set themselves up to be rejected by others.

In our book Master Conflict Therapy: A New Model for Practicing Couples and Sex Therapy, published in 2018, Stephen Betchen and I outline 19 of the most common master conflicts we see in our clinical practices. In addition to acceptance vs. rejection, another very common master conflict that I see is commitment vs. freedom. Clients with this master conflict have one side that wants stability and the security of commitment, but the other side longs to be free of restraints. People who have a history of affairs or a pattern of quickly getting in and out of relationships may be likely to have this master conflict. Clients who witnessed their parents’ affairs or demonstrated lack of commitment to each other may also develop this master conflict. Those with this master conflict may have patterns of changing careers or jobs often, moving frequently or getting involved in many different hobbies or interests without pursuing any of them long term.

Counselors who work extensively with addictions should become familiar with the getting your needs met vs. caretaking master conflict. For this master conflict, one side of the client wants to meet their own personal needs, while the other side desires to be selfless and martyrlike. Clients who have this master conflict often were raised in families in which addiction was present or a parent or sibling had a disability or illness that required most of the family’s attention and resources. These clients often have specific life goals that they would like to achieve, but their martyrdom at work, in friendships, and with their families and significant other consumes most of their time and energy needed to meet these goals.

Another common master conflict is specialness vs. ordinariness. Clients with this master conflict have one side that needs to feel special or different, while the other side feels ordinary or even less than ordinary. The client who builds themselves up while simultaneously putting themselves down could have this conflict. People with this master conflict seek constant validation and pursue materialistic possessions or unique life experiences that they believe make them different. Those with this master conflict are at higher risk of engaging in affairs because affairs are an easy way to experience the high of being “special.” Despite the constant chasing to set themselves apart from the crowd, people with this master conflict continue to feel as though they are “less than” or just ordinary, often because what they have built their specialness up from is not authentic.

Counselors who work with high achievers, including those at the top of their professional fields, celebrities and elite athletes, should look out for success vs. sabotage. Clients with this master conflict want to be successful or big and often have achieved something major, but the other side of themselves desires to be small or to fail. With great success comes the risk of great failure. Individuals with this conflict will sabotage their own success, and because their partner shares the same master conflict, their partner will also sabotage them if they become too big or too successful. 

Assessment and development of relationship symptoms

The first three to five sessions should serve as the assessment phase of treatment. While I let couples start where they need to in the first session, during the next few sessions I collect a genogram and history for each partner. As I gather this information, I also pay attention to both the language they use to describe their presenting problems and to their nonverbal communication.

Merle often used the word “rejected” and described her position in the relationship as “unfair.” She tended to be the more vocal and active partner in couples therapy. Luke, on the other hand, presented as distant and seemed shut down or dismissive toward Merle. Luke reported that “Merle just does not like what I value,” and I observed resentment in many of the passive-aggressive comments he would make toward Merle in session.

The couple explained that they were seeking couples therapy because of “bad fighting and poor communication” since being quarantined with each other. Some of the fights were related to sharing household tasks and parenting while still trying to work. But the major source of conflict concerned whether now was an appropriate time to try having a second child. Luke believed the couple should delay or not even have a second child because of the economic instability associated with the global pandemic. Merle accused Luke of being “selfish” and concerned merely with having time to pursue his artistic interest (an interest with which he was experiencing success).

The couple reported meeting as young 20-somethings at work. They both described the dating and engagement phase of their relationship as positive. At the time, Merle was supportive of Luke pursuing art, and in turn he supported Merle going after her dream career even though it was in a low-paying field. Although the young couple had always planned on having a family eventually, they were surprised to learn a few months before their wedding that Merle was pregnant. They both cited the unplanned pregnancy as the beginning of their relationship’s demise, but they each had different beliefs as to why that was.

Merle came from a warm but intrusive family. She described having close relationships with her sisters. She had excelled in school and sports as a child and teen. Merle described herself as a “people pleaser,” and she often worried about disappointing her family and friends. When one of her sisters dropped out of college to pursue a different career path, Merle saw her parents struggle deeply with that decision. Merle’s father was a first-generation immigrant who had never had the opportunity to go to college. It was very important to him that all of his daughters complete college, and Merle believed that he never fully recovered from her sister’s decision to leave school.

When Merle discovered she was pregnant before her wedding, she was so terrified to disappoint her parents that she concealed the news until after the event was over, even though it was obvious that she had gained weight. As Merle explained, “I would rather deal with my parents’ disappointment about me getting fat than their disappointment in me getting pregnant before being married.”

Luke came from a disorganized and controlling family. Both of his parents came from working-class backgrounds and were religiously conservative. Although Luke had an interest in pursuing the arts, both of his parents prohibited him from getting involved in such an “impractical” interest and pushed him into activities that were “better for getting into college,” even though he had little interest in them. Luke was also deaf in one ear, which had created learning difficulties for him as a young child. This was another trait he felt made him “less than” his other siblings. While his siblings followed in the path of their religious parents, Luke showed little interest in organized religion and eventually left his parents’ faith as a young adult. This decision caused much conflict within the family.

As the third child of seven, Luke had often witnessed his mother being overwhelmed by their large family, especially given that her husband worked long hours to support them. Luke described feeling robbed of what he perceived to be normal childhood pleasures and experiences due to his parents’ inability to provide adequate attention and financial support to their children.

Luke had spent much of his 20s getting his professional day job to a place where he was secure and could devote more time to pursuing his artistic interests, which his parents continued to disapprove of from a distance. Although Merle tried to reassure Luke that their baby would not change his ability to engage in his artistic pursuits, he knew from his own childhood that this simply was not true. Luke described a period of depression during the pregnancy. Merle reported being excited about the pregnancy but also stressed about how to “make Luke be OK with it.”

During the assessment, I always take a sexual history. In this case, both partners denied experiencing any sexual trauma, and both reported having long-term relationship partners before they met each other. Luke acknowledged being less sexually experienced than Merle due to his upbringing. Despite this, the couple felt positive about their sexual relationship before having a child; they were both happy with the frequency and believed they shared mutually in pleasure. In recent years, however, their sexual frequency had declined. Luke attributed this to stress, whereas Merle worried that it was more personal.

Discussing a couple’s sexual development and history helps the counselor to recognize sexual patterns. It also helps the couple become more comfortable talking about sex. Merle eventually disclosed tearfully that she worried Luke was no longer attracted to her because he experienced delayed ejaculation. Luke claimed to be unsure about why he was experiencing this problem and denied that he was no longer attracted to Merle. Both reported that the delayed ejaculation began around the same time they were fighting over whether to have a second child.

In treatment, Luke eventually admitted feeling conflicted about having a second child and worried that the additional demands would take away from his pursuit of a side career as an artist. Merle dismissed his concerns as selfish and lashed out at him for “taking away” her dreams of a larger family. Living under quarantine caused Luke rarely to have time to do anything with his art. In fact, he spent most of his time balancing working from home and trying to parent. The result of these sexual experiences left both partners feeling rejected by the other: Merle by Luke’s delayed ejaculation and lack of desire for another child, and Luke by Merle’s reaction to his sexual difficulty and overly optimistic stance on having another child.   

Treatment and relapse prevention

Master conflict therapy consists of four treatment goals:

1) To help the couple uncover their shared master conflict

2) To help the couple determine the origin of their master conflict

3) To help the couple decide which side of the conflict to choose, or to integrate both sides of the conflict to a tolerable, balanced state

4) To alleviate the couple’s symptoms, both sexual and nonsexual

Couples should leave treatment knowing how to manage their master conflict, which will prevent a relapse when their conflict becomes unbalanced in the future. Their fighting should become less intense and less frequent, and they should have the skills to collaboratively manage their master conflict.

It takes many sessions to fully understand a couple and to gather enough data to support whatever master conflict a therapist might suspect. During this time, the therapist should be conducting a thorough assessment, providing the couple with relevant psychoeducation regarding their presenting problem, and providing the couple with behavioral strategies that can help them get out of crisis.

With Merle and Luke, I discussed psychoeducation regarding delayed ejaculation and sexual desire. I also helped the couple improve their basic communication skills. Because Luke did not have any medical risk factors that would have caused delayed ejaculation (we ruled these out with an extensive medical history, a visit to a urologist and routine bloodwork), I suspected most of the problem was psychological. I also explored with the couple the behaviors and emotional baggage that each of them brought to the relationship from their families of origin that not only informed their conflict style, but also colored the way each of them viewed this conflict.

Merle and Luke soon began to see the ways in which they were similar, including both never feeling fully accepted by their families and both fearing rejection by the other. They eventually recognized the ways that their own acceptance vs. rejection master conflict played out in other areas of their life unrelated to their romantic relationship. Merle had a long history of people pleasing and a yearning to be accepted by female friends; this often set her up for disappointment and rejection. Luke was a hard worker and longed to be acknowledged at work, but when he did receive praise, he would act out, leading his superiors to feel frustrated with him. Discovering how similar they were to each other helped Merle and Luke to build mutual empathy.

Once this couple gained a better understanding of their master conflict and the impact it had on their lives, we turned to the issue of having a second child. Merle felt conflicted between wanting to please Luke by limiting the family to one child and wanting to expand the family, even if this meant additional challenges for them and more tension between them. Luke saw Merle as willing to risk their relationship, their financial stability and the overall stability they had created for their first child just to have another child. He explained that he worked hard in a day job that he did not particularly like and put his artistic pursuits to the side for the sake of family stability. This had also enabled Merle to take her “dream job” even though it was low paying — something the couple agreed on during their engagement.

After much processing, Luke expressed that the only way he would agree to having a second child would be if Merle took a higher paying job or they found a way to move to a much more affordable area of the country. Faced with the idea of losing her career, Merle was better able to resonate with Luke’s position. Ultimately, the couple decided to shelve the decision to have another child for one year. Merle would explore other career opportunities that could provide the family with additional financial security, while Luke agreed to look for affordable places that the family could live and examine whether a more permanent work-from-home situation might ever be available to him.

Upon termination, the couple reported fighting much less frequently and with less intensity. They reached an understanding of their master conflict and could now easily predict where each of them might struggle or feel triggered by the other. As they had resolved their conflicts, gained more understanding over their pattern of fighting and mutually agreed not to have another child at this time, Luke’s delayed ejaculation subsided. Merle’s fears of not being attractive to Luke waned, and the couple both reported feeling more emotionally and sexually connected.

Master conflict therapy prepares couples to manage their differences and conflicts for the long term. By providing a framework for better understanding themselves and each other, the couple can better manage future conflicts — regardless of the content — as they see how the process is the same.

 

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Heather Davidson is a licensed professional counselor and the founder/owner of a boutique private practice in Bryn Mawr, Pennsylvania, called Better Being Main Line. She is both a certified sex therapist and a certified eye movement desensitization and reprocessing therapist and specializes in treating individuals and couples with sexual issues and those with traumatic experiences. She is the co-author of the book Master Conflict Therapy: A New Model for Practicing Couples and Sex Therapy (Routledge, 2018) and is an instructor for the Council for Relationships’ postgraduate certificate program in sex therapy. Contact her at heatherdavidsonlpc@gmail.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.