Intimacies: An Integrative Multicultural Framework

for Couple Therapy

MICHELE SCHEINKMAN

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giv-
ing direction to the process of couple therapy. Yet, as a field, we have spent little time con-
ceptualizing intimacy and even less time considering the diversity of priorities and
meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kalei-
doscope of contexts—socio-historical, cultural, gender, life cycle, and developmental—that
inform our ideas and expectations for intimacy in couples’ relationships. I highlight differ-
ent spheres in which intimacy may take place such as the emotional, sexual, intellectual,
or familial. I propose a starting point in which the therapist, in a collaborative manner,
helps the partners articulate their yearnings and priorities in order to negotiate a shared
vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that
gives room for each partner’s subjective meanings, yet consider diverse relational processes
that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part
Three, Sexual Intimacy, I outline conditions in which sex is more likely to be experienced
as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Princi-
ples to guide the therapist in taking couples from reactivity to dialogue to negotiations of
intimacy. The integrative framework proposed here discourages monolithic a priori notions
of intimacy and highlights instead: nuanced meanings, relational processes to be consid-
ered differentially, present and past emotional blocks, and a flexible clinical approach to
foster conditions for the creation and resilience of intimate experiences.

Keywords: Couple Therapy; Intimacy; Integrative; Multicultural; Theoretical and Clinical

Framework

Fam Proc x:1–19, 2019

“Intimacy stubbornly resists simple definition. Ephemeral and often elusive in daily life, it
becomes even more so as the object of intellectual analysis. But if the concept of intimacy is blurry
and indistinct, our longings for it are powerful, at times overwhelming. The pleasures of intimacy
are so deeply satisfying, its failure so painful, its vicissitudes so central to the concerns of couples
who seek therapy together, that it demands an effort to wrestle conceptually and clinically with
its ambiguity.” (Karpel, 1999, p. 84)

PART ONE: VARIETIES OF INTIMACY: A MULTICULTURAL PERSPECTIVE

W e have come to accept that our needs for human connection are neuro-biologically
wired, primal and intense, and that we suffer whenever our bonds are threatened
or severed (Fishbane, 2013; Fisher, 2004; Siegel, 2012). Yet, it seems equally

The Ackerman Institute for the Family, New York City, NY.
Correspondence regarding this article should be addressed to Michele Scheinkman, 400 Park Avenue
South, apt 32B, New York, NY, 10016. E-mail: michelescheinkman@gmail.com
The author thanks Froma Walsh, Mona Fishbane, Suzanne Iasenza, Lois Braverman, and Peggy Papp
for their suggestions and encouragement, and the Ackerman Institute for its ongoing support of the Cou-
ples and Intimacy Project.

1
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doi: 10.1111/famp.12444
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incontrovertible that what we refer to as “intimacy” varies from person to person and
from culture to culture. Our expectations are socially constructed and shaped by many
different contexts—such as the zeitgeist of our times, cultural and generational norms
and values, gender training, class, race, sexual orientation, and life stage—as well as by
developmental markers in a person’s life. In addition, we can experience intimacy
through many different kinds of activities such as sex, conversation, sharing experiences
and routines, and also through diverse relational processes such as collaboration, care-
taking, exposing feelings and vulnerabilities, listening, and more. It is also the case that
the experience of intimacy can happen in different spheres of a couple’s life such as in
the parental, physical, aesthetic, religious, or intellectual, to mention a few. Moreover,
priorities tend to change in the course of the life cycle so that yearnings for sexual con-
nection in the initial phase of the relationship may be surpassed by wishes for effective
collaboration during child rearing years, or by dependability in situations of illness, dis-
ability (Rolland, 2018), and aging. Defining intimacy gets even more tricky when we con-
sider that our expectations are infused with longings and fears that spring from our
early attachments, previous love relationships, traumas, and from gender and cultural
legacies that tend to operate below awareness. Above all else, intimacy is contingent on
the interplay of the partners’ vulnerabilities and their reciprocal defensive strategies
(Scheinkman & Fishbane, 2004).

So, What Is Intimacy?

Even linguistically speaking intimacy has many different meanings. The Merriam-
Webster defines intimacy as “something of a personal or private nature.” The Oxford dic-
tionary defines it as “close familiarity and friendship” and it lists togetherness, affinity,
rapport, attachment, companionship, affection, warmth, understanding and also sexual
relations, intercourse, and lovemaking as synonyms.
In the professional literature, many theorists have acknowledged that, as concept,
intimacy is indeed very slippery and difficult to define (Karpel, 1999; Weingarten,
1991; Wynne & Wynne, 1986). In The Intimate Couple Carlson and Sperry (1999a)
preface their edited volume saying: “. . . there seem to be as many definitions of inti-
macy as there are individuals writing about it” (p. xix). They point out there is not
only a lack of consensus about what intimacy means but also how to approach it clini-
cally. In my view, this is a problem. Without an explicit conceptualization of intimacy,
therapists can only work by default on the basis of personal biases. Without a teach-
able framework to guide the therapist we run the risk of shoehorning couples into
dominant cultural discourses instead of helping them to reflect and decide about their
priorities and yearnings.
In this paper, I use the term intimacy broadly to encompass a range of experiences that
include a sense of connection, feeling known, sharing, togetherness, or belonging. I start
from the assumption that intimacy, in all its variations and turns, is a fundamental
human need and a quality of relationship that couples today expect to have in their lasting
bonds. My focus is not merely on one single moment of intimacy but on the ebb and flow of
connection, disconnection, and reconnection over time. In the following pages I suggest for
the therapist to remain curious about the diversity of intimacies he may encounter, and to
keep in mind the many different situations and contexts through which the partners’
expectations are being sifted, filtered, and experienced.

The Filter of History, and Challenges of the Evolving Paradigm

In Marriage, a History, Coontz (2005) observes that couples relationships have
changed more in the last 50 years than in the previous 5,000 years. She reminds

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us that for most of our recorded history marriages were arrangements promoted by
the families to insure procreation, paternity, property rights, and economic security
of women and children. In the old order, since the church, the state, and the fam-
ily dictated the rules of couples’ engagement within a rigidly established patriar-
chal system, young adults had very little to say about who they married or how to
structure their relationships.
It was only after the notion of companionate love became increasingly popular since the
1960s (Reibstein & Richards, 1993), especially in the West, that the word intimacy became
part of couples’ lexicons. In the new paradigm the partners have come to expect love and
intimacy, equal rights to education and working lives, and equitable sharing in the domes-
tic realm. Moreover, as love and partnership become important elements of the glue that
keeps couples together—instead of procreation and property rights—cohabitation without
marriage and same-sex unions have become normalized and increasingly sanctioned.
Many scholars and researchers have distinguished passionate and companionate
love (Fisher, 2004; Hatfield, Pillemer, O’Brien, & Le, 2008; Mitchell, 2002). While
passionate love tends to include novelty, risk, excitement, and intense emotional
yearnings, companionate love is thought to combine a steady sense of attachment,
dependability, security, and emotional support. Nowadays many couples have come to
expect to combine companionate and passionate love (Perel, 2006). While for some
these expectations lead to efforts to cultivate sexuality and romance in their relation-
ships (Iasenza, 2010), for others these expectations lead to confusion and pressure.
Some couples try to solve this riddle of “companionate passionate love” by opening
their relationships to swinging, virtual sex, pornography, polyamory, or specific types
of consensual affairs. While for some these experiments are important and stimulat-
ing, for others they are mine fields of jealousy and insecurities and require intense
verbal processing about the relationship and its rules (Scheinkman & Werneck,
2010). In the clinical situation, the therapist needs to keep in mind that while some
couples are able to manage the challenges involved in these nonmonogamous
arrangements, for many individuals these experiments are problematic and unsafe, a
foreshadowing of the relationship’s demise.
The shadow of divorce
In the last 50 years the institution of marriage has gone from being a permanent sacred
union to a nonbinding legal contract in which divorce is a looming possibility. This change
has contributed to a paradoxical proposition in which couples must create lasting bonds
against a backdrop of potential dissolution of their union. This can be a delicate balancing
act. In order to bond each partner must loosen his or her boundaries, at least part of the
time, for the good of the union and the family. Yet they must also remain protective of
their boundaries and personal growth, just in case the relationship does not work out.
Coontz (2005) makes the point that what makes marriages special today—that they are
based on love and freedom of choice—is also what makes them dispensable, optional, and
fragile.
The sexual revolution
Side by side with these changes toward companionate love, over the last 60 years
couples have come to expect a lot from their sexual relationships. As sex becomes
increasingly disconnected from procreation—through birth control and reproductive
technologies—couples expect their sexual relationships to be focused on pleasure and
self-fulfillment (Giddens, 1992). Practices that were once considered “perversions” or
“sins,” such as masturbation, premarital sex, homosexuality, bisexuality, pornography,
threesomes, fetishism, sadomasochism, and open relationships, are increasingly

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normalized and, for many, conceived as self-actualizing experiences instead of

pathologies. While before the sexual revolution couples had very narrow expectations,
today they must sort through different practices. One client remarked: “Joseph and I
are at odds; I like vanilla sex, while he wants to explore toys, bondage, and three-
somes.” Such differences require couples to reflect about what they like and prefer,
to negotiate skillfully, and to stretch in the direction of the partner in order to reach
a good enough sexual fit between them.
The digitalization of intimacy
We are living in times in which there is a growing preference for the virtual over the
real (Turkle, 2011) and complaints about texting, tweeting, emailing, and social media are
everyday grievances in the therapist’s office. While the Internet revolution provides imme-
diacy across continents, it has also promoted distance and disconnection in which partners
can be together in the same room yet distracted and emotionally absent.
As far as intimacy is concerned the most challenging aspect of technology is the
way in which the Internet offers exponential opportunities for betrayals and sexual
escapades. Virtual hook ups, reconnection with ex-lovers, and ongoing affairs can all
happen within the confines of one’s home. Moreover, since fantasy can easily surpass
the drudgeries of daily obligations, many individuals find virtual relationships more
alluring than intimacy with an actual partner. When discovered, digital records often
expose intimate details that are difficult to forgive and forget. Intrusive thoughts
about the partner’s blatant exchanges are difficult to erase from one’s mind. They are
painstaking to repair, and can become major stumbling blocks in the reconstruction of
intimacy after infidelity.

The Filter of Culture

We live in a highly interconnected world in which more and more individuals, in
different parts of the globe, are seeking democratic relationships based on companion-
ship, partnership, and love. However, in my view, it is crucial for the therapist to
keep in mind that these expectations are happening in different ways and at different
paces as they are integrated with values and priorities of specific cultures and subcul-
tures. In a demographic study about the decline of marriage throughout Asia (The
Economist, 2011) the authors describe how young women in Korea, Japan, and China
have been for years on a “marriage strike,” resisting traditional arrangements by post-
poning marriage or not marrying at all. Likewise in Russia, where women have tradi-
tionally married young, and often to older men, many are choosing careers before
marriage. In India, Pakistan, and Bangladesh, where arranged marriages still prevail,
brides and grooms are increasingly involved in choosing their mates (Harris, 2015). In
many European countries, couples prefer civil unions to the traditional marriage vows.
In the US, changing mores are reflected in delayed marriages and pregnancies, cohab-
itations, the rise of divorce, single parent families, same sex marriages, open relation-
ships, and also several marriages in a lifetime. In broad terms we can say that we are
witnessing a radical social transformation of intimate relationships all over the world
and particularly among younger generations. These changes are occurring very rapidly
in the West and urban centers. However, gender equality, same sex relationships, and
freedom of choice are values that are still strongly resisted by fundamentalist cultures
and conservative groups, in the United States and abroad.
Although cultural values embedded in our notions of intimacy may be hidden or subtle,
they can promote serious misunderstandings between the partners. One example is a cou-
ple that I saw in therapy. Peter, a 38-year-old Midwestern Caucasian man, expressed

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frustration about his wife who “never talks to me about her wishes and feelings.” For that
reason, he felt emotionally disengaged from her. His wife Mari, a 35-year-old Japanese
woman who grew up in Tokyo, was puzzled by his expectations. She explained that in
order for her to feel intimate with Peter she expected him to work hard at figuring out
what she wanted and needed without having to spell it all out. Having to be explicit actu-
ally spoiled the intimate experience for her. At a later time, when I was teaching in Japan,
I understood more clearly that in Japan, and many other Asian cultures, intimacy is con-
ceived through a collectivistic filter of anticipating other people’s needs, generosity, and
belonging and that direct communication about one’s feelings and wants is often times
perceived as selfish and distasteful. Tamura and Lau (1992) explain that while Anglo
Saxon cultures prioritize individualistic notions such as autonomy and definition of
boundaries, Asian cultures share the belief that successful marriages are based on how
well the partners complement each other and integrate with their respective families.
In order to highlight these subtle cultural filters, family therapists from other countries
have helped me diagram intimacy in terms of how much the partners typically share in
terms of talking about feelings and doing joint activities (Figure 1).

FIGURE 1. Cultural Norms about Togetherness and Separateness

While in The United States couples give a great deal of importance to talking about feel-
ings and vulnerabilities, and also to spending a lot of time together, in France couples pre-
sume a smaller intersection of these kinds of intimacy but expect a lot of respect for
privacy, separateness, and mystery. While teaching in Paris, my host explained to me that
in France the “ability to accept the other person as is” is a crucial dimension of intimacy.
Speaking from his experience he said: “In order for me to feel intimate with my wife I need
to know that I can be myself and that I have the right to be quiet, to be left alone, and even
to be grouchy some of the time.. . . Intimacy presumes she tolerates my foibles and that I
tolerate hers. In addition, it implies a certain degree of mystery in which I am curious
about her separate life and she is curious about mine.” By contrast, Japanese couples tend
to expect almost no communication about feelings and concerns and very little time spent
with the partner. My host explained that in Japan the norm is for married partners to
share emotional concerns with individuals of their own gender. According to T. Tamura
(personal communication), what gives couples a sense of intimacy and connection is their
joint “sense of belonging” to a common world, i.e., to their families and their communities.
From an individual’s satisfaction point of view I assume that each of these cultural per-
spectives responds to a somewhat different yearning and therefore each perspective has
its pros and its cons. While the North American individualistic perspective addresses
being known and knowing the other person subjectively, it underplays the kind of fulfill-
ment that comes from belonging together to the extended family and larger community.
While the collectivistic Eastern perspective emphasizes generosity, respect, and inclusion,

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it muffles clear communication that allows for a more attuned sense of connection between
the partners.
In addition, even within the same culture, values related to intimacy may differ depend-
ing on the subculture of the partners. For instance, while an academic couple may priori-
tize their intellectual sharing, an immigrant couple may feel most bonded through their
transcultural journey, and a religious couple may feel that their spiritual pursuit is what
is most important to their sense of connection and belonging.
I want to make clear that as we locate the couple’s priorities about intimacy within each
partner’s culture and subculture, it does not mean we stay neutral about matters of social
justice. Forced marriages, coercion, violence, and double standards are all practices (Okin,
1999) that are incompatible with feeling intimate and connected. When a person feels vio-
lated, humiliated, powerless, or mistreated he or she becomes neurobiologically compelled
to protect the self and in doing so, intimacy is compromised. In terms of clinical interven-
tion, in order to promote connection, the therapist must of course challenge any oppressive
cultural norm. Yet, to prevent colonization, I believe therapists are better off if they locate
their comments and recommendations within their own cultural and professional values,
as another perspective to be considered. This involves a delicate therapeutic balance. On
one hand the therapist must empower the partners to think outside their cultural box in
order to consider different choices about how to be in the relationship. On the other hand
she must convey understanding of their cultural norms and binds, always careful to avoid
proselytizing. Falicov (2014) emphasizes that to be multiculturally sensitive it means to
step outside of our own personal and professional system and remain curious about the
cultural, generational, gender, familial, and personal values and norms subsumed in the
couple’s modes of relating.

The Filter of Gender

Tannen (1991) observed that when men and women engage in conversations, their par-
ticipation tends to be based on different paradigms. These different paradigms create gaps
in their ability to feel connected. One example is the case of Susan and Paul: Every time
they have an intellectual conversation, Susan ends up in tears and Paul is disappointed
and frustrated. In therapy Susan explained: When she shares her ideas with Paul her
expectation is that he will listen, validate the points he finds interesting, and then add his
thoughts and ideas so that together they might weave a greater knowledge. However, this
is not what happens. Instead Paul challenges her for more evidence, proposes counter-
points, and highlights weaknesses in her arguments. The result is that Susan ends up
feeling very angry and defensive, and Paul considers her a “wishy-washy” debater. Tan-
nen (1991) makes the point that while women tend to look at interpersonal situations
though the filter of affiliation and cooperation, men tend to consider the same situation
through the filter of debate, autonomy, and power. It is as if they are trying to communi-
cate yet speaking different languages.
More recently, Real (2002) added a new layer to our understanding about the gender
gap. He proposes that most impasses between men and women are due to a disparity of
emotional skills between boys and girls, as they are still being trained to fulfill their roles
in the patriarchal deal: men as providers and women as caregivers. He makes the point
that we are at a difficult crossroad. As women master traditional “male skills” to function
in the working world, they expect that their male partners should reciprocally be able to
master the typical “feminine skills” that are necessary in the domestic realm. These expec-
tations, not only about chores and division of labor, are also about the emotional expertise
necessary for raising children, attending to elderly parents, and listening empathically
after a long day of work. Our dilemma is that women are changing faster than men and

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are often frustrated that their partners are not reciprocally acquiring skills such as accept-
ing vulnerability, sensing what others need and feel, or even introspection. Real says that
women are unhappy in their marriages because they want men to be more related than
most men know how to be, while men are unhappy in their marriages because their female
partners are so often frustrated and complaining about them (Real, 2002, p. 41). It is of
course important not to overgeneralize these patterns since there are plenty of exceptions.
Yet, to help many heterosexual couples create a good enough fit between them, it is useful
for the therapist to articulate these macro level gender gaps and coach each partner to
recalibrate both instrumentally and emotionally.

Changing Priorities over the Course of the Life Cycle

As couples relationships change over time, so does the kind of intimacy the partners pri-
oritize at each stage. For instance, in the initial phase of their relationship, Judith and
Martha dedicated a great deal of time to getting to know each other emotionally and sexu-
ally. They talked a lot about their childhoods and families, traveled the world, and had sex
every day. With the arrival of children their priorities changed. Martha became disinter-
ested in sex, they moved to the suburbs for the good of the family, and they focused on par-
enting and mutual support in their careers. Their sexuality stayed on the backburner;
they judged their sense of closeness on the basis of how well their partnership was work-
ing. Later on, when their children left home, they found themselves renegotiating a new
chapter. They resumed their travels, explored new ways of being sexual, and eventually
moved to a coastal town where they started a small business. While some couples feel con-
fused about or depleted by these life cycle shifts, others are able to keep a long-term per-
spective, roll with the structural demands of each stage, and renegotiate their meanings
for intimacy accordingly.
As therapists, as we consider these moving priorities, it is important to keep in mind
that ethnicity and cultural values interact with the family life cycle at every stage (McGol-
drick, 2015). In other words, what is highlighted as intimate in each stage of the life cycle
will vary depending on the culture and subculture of the persons involved. The North
American lesbian couple mentioned above considered their sexual sense of connection to
be of critical importance in the early phase of their relationship. Yet an Indian couple,
married by arrangement, may consider the initial phase of their relationship as a time to
develop their sense of partnership and their integration within their respective families.
Given the meaning of marriage in their culture, a satisfying sexual connection is consid-
ered to be an outcome of the trust and collaboration developed in the early years.

The Filter of Internalized Stigma

Alan Downs (2012) has coined the term “velvet rage” to describe the deep feelings of
self-loathing and shame that result from growing up in a homophobic environment where
the person has learned that who he or she is, as a sexual minority, is unacceptable and
unlovable. These self-directed feelings tend to have a profound effect on the ways in which
individuals experience intimacy. Sometimes the person overcompensates, trying to earn
love and acceptance by striving to be perfect—i.e., more beautiful, more sexy, or better
than others. Sometimes he or she hides from intimate involvements by engaging in self-
destructive patterns such as drug addictions, self-mutilation, or suicidal ruminations. Or
the person gets involved in relationships but remains oversensitive to criticism and rejec-
tion. The same predicaments are true of internalized stigma pertaining to ethnicity and
race. The journey out of internalized stigma includes pushing through these self-defeating
feelings and behaviors and taking risks in being known by another. Feeling accepted for
who he or she is can be the basis of a deep sense of intimacy (Iasenza, 2010).

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Intimacy Takes Place in Different Spheres

One of the major challenges in defining intimacy is that the experience of intimacy
can happen in many different spheres of a couple’s life such as the sexual, emotional,
intellectual, creative, spiritual, or companionate realm. Depending on the combination
of partners, intimacy may take place predominantly in one sphere rather than
another. For example, Robert feels deeply connected to his wife Joana with whom he
collaborates academically and shares a range of intellectual and familial interests. Yet
he misses the easy sexual connection he had with a girlfriend with whom he was not
intellectually compatible. In addition, intimacy may have different flavors. While with
one partner it may be spiced up by playfulness and humor, with another it may be
grounded in similar vulnerabilities, traumas, or family of origin patterns. Intimacy
can also be based on shared routines that give the couple a sense of familiarity and
belonging. This diversity of spheres, flavors, and activities contributes to the slipperi-
ness of conceptualizing intimacy.

Prioritizing Expectations
As our values about intimacy are changing rapidly, many couples come to therapy
confused about what to expect and how much to expect. Some find themselves caught
between the norms of two different generations or cultures. Others struggle to combine
their need for security and safety with their yearning for passion in their lives. Yet,
more than anything else, couples come to therapy feeling frustrated that their partners
are not fulfilling all their emotional needs. The problem is that the more couples expect
from their relationships, the more room there is for disappointment. In order to address
these contemporary pressures, the therapist may need to help the partners lower the
bar. She may need to suggest that they can strengthen their bond by diversifying their
sources of support and asking less from one another (Finkel, 2017). She can remind
them that they need friends (Braverman, 1995). One strategy to help partners lower
their expectations is to ask them to make a list about their most urgent needs and
yearnings, encouraging them to figure out what is most pressing, and what in their
lists are they willing to let go and dismiss.
Culturally speaking, the therapist needs to keep in mind that there are many possi-
ble hierarchies of values and meanings. What might be on the top of the list for a Latin
American person is probably not the same as what is most important for a Hassidic
Jew, or for a Japanese individual, or for a young hipster in Brooklyn. The therapist will
be most useful if she maintains a position of “not knowing” what is most relevant to
each partner personally, culturally and subculturally. This exploration is crucial when
working with intercultural couples who typically have different assumptions and priori-
ties about the meaning of intimacy. Their lack of awareness about these different
cultural meanings often leads to pathologizing the partner or to serious misunderstand-
ings in the relationship.

PART TWO: CONCEPTUALIZING INTIMACY FOR A MULTICULTURAL PRACTICE

In previous efforts to define intimacy therapists have sometimes equated intimacy with
a specific activity (communication, sex, or sharing experiences), sometimes with a rela-
tional process (differentiation, attunement, or secure attachment), and other times with a
specific relational value (honesty, fidelity, or transparency). Here I propose we consider
intimacy more generally as: a subjective relational experience (of connection, together-
ness, sharing, or belonging) that happens through many different activities, processes, and
shared values, and also in diverse spheres of a couple’s life. Furthermore, I propose that

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such experiences will happen more reliably if they are grounded in a bedrock of optimal
relational processes and conditions that foster their occurrence and their resilience.
This open-ended definition gives latitude to the partners to define the activities, feel-
ings, values, and meanings that are most important to them as far as intimacy is con-
cerned. It also encourages the therapist to consider various relational processes and
conditions that may need to be strengthened in order to support the creation and resili-
ence (Walsh, 2012) of intimacy over time.

Relational Processes that Sustain Intimacy

Over the years family therapists have identified several processes associated with inti-
macy in couples relationships. In their seminal paper, Wynne and Wynne (1986) high-
lighted “self-exposure and trust” as the most basic process underlying intimacy. Kerr and
Bowen (1988), Lerner (1989), and Schnarch (2009) have underscored “differentiation of
self” as a sine qua non condition for intimacy to be created and sustained. Weingarten
(1991) has emphasized the partners joining one another in cocreating meaning. Abrahms
Spring (1997) and others writing about infidelity have considered transparency and hon-
esty as essential conditions for the recovery of intimacy in post affair situations. Siegel
(2012), Fishbane (2013), and others have emphasized the importance of attunement and
empathy, while Johnson (2008) has equated intimacy with the establishment of secure
attachment and safety.
Here, in keeping with a multicultural perspective, I caution therapists not to define
intimacy in terms of one single relational process but instead to consider several potential
relational processes that might be relevant depending on the case (Figure 2).

FIGURE 2. Relational Processes that Support Resilience of Intimate Experiences

In addition, I suggest that as we introduce relational skills related to these processes

(such as helping couples express wants and needs, talk from positions of vulnerability, lis-
ten actively, hug one another, or set up dates) that we consider how these particular tasks
and suggestions fit or clash with the cultural standards of each partner.
The list of relational processes mentioned below is not exhaustive. Nor are all the pro-
cesses mentioned here required in every case. Instead this list is more like a menu of

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options for the therapist to consider in terms of what might be needed to support and
strengthen the foundation of the couple’s bond.
Differentiation of self
Couples typically come to therapy entangled in reactive cycles that may include com-
plaining, blaming, withdrawing, or forceful attempts to change the other person. In
these situations there is usually a sense of blurriness about self and other. Kerr and
Bowen (1988) have proposed that we consider the difference between fusion and inti-
macy. While in a fused state the partners may have an intense sense of proximity, their
sense of intimacy is compromised by anxiety and confusion about their boundaries. One
client asserted: “When Miriam is angry, even if it is not about me, I lose my center. I
can’t concentrate on my own wishes and agenda and I feel compelled to do whatever
she wants, only to resent her later.” Anxiety travels very fast. It is a contagious feeling
that generates a sense of enmeshment (Kerr & Bowen, 1988) and suffocation (Napier,
1999). By contrast, in a differentiated state the partners retain a sense of self, personal
boundaries, and choice. Lerner (1989) notes that while maintaining a differentiated
state we feel entitled to our own feelings, ideas, and needs and are able to communicate
and act upon them, even when they conflict with the ideas, feelings, and needs of our
partner. It also means we can allow the other person to do the same without getting
reactive. Without a well-defined sense of personal boundaries, relationships get overly
intense or distant and often times the partners alternate between these two poles. Dif-
ferentiation of self should not be misconstrued as distance or disengagement since to
cultivate intimacy the partners must be able to sustain a clear sense of self but also to
“bring that separate self in all shapes and forms to the interior of their relationships”
(Lerner, 1989).
In considering the concept of differentiation of self we must keep in mind that different
cultures have different priorities in the continuum of separateness and connectedness. As
mentioned before, North American cultures tend to privilege individual needs while Asian
cultures tend to prioritize accommodation and harmony above self-fulfillment. In Japan,
for example, there is a prevailing belief that a strong person is the one who sacrifices the
self in service of others (Tamura & Lau, 1992). While both “differentiation of self” and “in-
tegration into the family and community” may be relevant for human growth, therapists
working with Asian couples must be thoughtful on how to acknowledge and incorporate
these different priorities in the clinical process.
Self-exposure, empathy, and trust
The therapist may focus on definition of boundaries with one couple, yet with another
he may focus on self-exposure and the ability to trust. Wynne and Wynne (1986) have
pointed out that when a person reveals private aspects of the self, he or she must believe
the other is going to respect that which is being exposed and is not going to betray that
trust. Such exposure can be verbal or nonverbal. It can be exposure of a feeling, desire, or
one’s naked body. Conversely, the acceptance by the other person can also be verbal or
nonverbal, such as a gesture or an action. Here again it is important to keep in mind that
different cultures consider exposure of feelings differently. A Korean client explained it
would be terribly humiliating for her to expose her wounded feelings about her husband’s
betrayal. She wanted him to realize the obvious, that she was hurt and offended, and to
repair without her having to talk about her devastation. In situations such as this the use
of individual sessions, metaphors, sculpting (Papp, Scheinkman, & Malpas, 2013),
and other indirect techniques can be more syntonic than verbal exposure of feelings
and dialogue.

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Joining in the co-creation of meaning
In order to feel close, couples tend to evolve activities and rituals through which they
cultivate their sense of connection. Weingarten (1991) points out that to feel intimate one
partner may need to temporarily enter into an area of interest or concern of the other per-
son and join him or her in the co-creation of meaning:
For many couples, sex, or going to a concert or dinner are settings conducive to but not predictive
of intimate interaction . . . individuals may need to negotiate with each other, develop interests,
learn skills—in order to join with a chosen other. . . . So if a woman experiences intimacy when
she talks about relationships, then any man who wants to be intimate with her may choose to
develop an interest in this as well. If a man loves sitting in a boat fishing, then those who wish to
be intimate with him may find themselves joining him fishing. (p. 292)
The cultivation of intimacy requires stretching the self toward the other person. However,
in cultures in which activities are divided by gender, this kind of joining may be less
important than creating a harmonious overall coexistence.
Ability to relate from both self-directed and other-directed modes
Traditionally, women have been socialized to relate predominantly in other-directed
ways as nurturers and caretakers, whereas men have been raised to operate primarily
in self-directed modes in which they must act on the basis of their individual agendas.
However, as our paradigm for relationships is changing toward equitability and
reciprocity, it is imperative for both men and women to relate fluidly between those two
modes.
To clarify, while relating in an other-directed mode, we are driven primarily by consid-
eration of the other person’s needs and priorities. Our moral sense of responsibility is for
that moment on the other person, and there is satisfaction in empathizing, giving, and
joining. Alternately, when we act from a self-directed position we are driven by our own
agenda. We feel entitled to do so, and we experience satisfaction from our ability to stay
centered and be productive (C. Jenkins, personal communication).
In our practices, we often encounter women who are conflicted about their personal
sense of direction, especially after motherhood. Compelled to be caregivers, they don’t feel
entitled to act from their own agendas, even if only temporarily. Yet we see many women
who become depressed and resentful because they are not pursuing their own goals. In a
parallel way, we encounter many men who desire more intimacy with their partners yet
have a short fuse for listening, empathizing, and nurturing. Therapists trying to promote
intimacy may need to help women feel entitled to pursue their own individual goals, and
conversely to challenge men to let go of entitlement and develop emotional skills such as
empathy, joining, and caregiving.
Here again it is important to consider cultural variations. While Anglo-Saxon cultures
tend to prioritize individualism and self-direction, Asian and Latin cultures tend to con-
sider accomodation and pleasing others as higher values. We may need to emphasize to
the couple that in order to function within an egalitarian framework, men and women
must find a balance within themselves between those two pulls, even if these modes are
qualified differently by their cultures.
Reciprocity and equitability in the quid pro quo
Balance of power is a fundamental issue in couples relationships (Goldner, 1988; Walsh,
1989; Walsh & Scheinkman, 1989) and a basic condition for couples to feel good about
their connection. Given the stressful life of couples today, where partners expect to share
domestic responsibilities, it is common for individuals to feel mistreated and for couples to
bicker about division of labor. Being able to manage the logistics of domestic life in ways

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that are considered equitable and fair is crucial for intimacy. A persistent power imbal-
ance or skew (i.e., one partner privileges his or her own needs, or one partner over-func-
tions while the other under-functions) inevitably leads to resentment, loss of sexual
interest, or depression in one or both partners (Walsh, 1989). In order to address power
imbalances clinically the therapist must talk about the sharing of chores and responsibili-
ties explicitly.
It is important to keep in mind that distribution of power is distinct from whether the
couple organizes their relationship in a symmetrical or complementary way. Many couples
with dissimilar roles still negotiate arrangements in which they feel their exchanges are
equitable (Walsh, 1989). What matters is not a tit for tat, but that their arrangement is
experienced as fair overall.
Ecology of positive and negative interactions, and the cultivation of playfulness
In order to feel intimate, couples usually need to maintain an emotional atmosphere
that is more positive than negative. In his research Gottman (1995) found that marriages
that thrive tend to have a ratio of five positive interactions to each negative one, and that
even high-volume volatile couples can succeed if they maintain this ratio. Examples of pos-
itive interactions include showing appreciation, interest, gratitude, smiling, joking, or
touching. These behaviors work like repair mechanisms that counteract defensiveness
and de-escalate tensions. In a similar vain, evolutionary biologist Behncke (2011) stresses
the role of playfulness in the resilience of adult relationships. Play increases dopamine in
the brain, which neutralizes tension and helps individuals manage ambiguities, frustra-
tion, and conflict.
Ability to relate on the basis of yearnings
When couples come to therapy, their interactions are usually calibrated by defen-
siveness and blame (Scheinkman & Fishbane, 2004). In order to restore productive
dialogue the therapist must impress on the partners that defensiveness undermines
intimacy. She must help them reach beneath their shields and relate to one another
on the basis of vulnerabilities and yearnings. This clinical operation is essential to
help the partners understand one another and thereafter negotiate a better intimate
fit between them.
In North American professional circles verbal communication about feelings is often
equated with intimacy. However, for many people, and in many cultures, talking about
feelings is not the essence of intimacy. Instead intimacy is about sharing experiences, gen-
erosity, caretaking, or having pleasure together. Even if talking about feelings is a neces-
sary therapeutic step to help partners clarify their needs and make reciprocal
adjustments, talking can be simply a means to an end, the end being the creation of what-
ever they deem as intimate experiences.
Ability to distinguish present from past
Often times, as the therapist encourages negotiations of intimacy, she encounters a
stubborn resistance. For instance, Julia might say she wants to have a closer sexual
relationship with Fernanda. Yet, whenever Fernanda approaches her, she recoils as
she experiences Fernanda’s approaches as intrusions. In these ambivalent moments it
is relevant for the therapist to freeze frame the couple’s interaction (Scheinkman &
Fishbane, 2004) and carefully inquire if there have been other situations in the past in
which Julia might have felt intruded upon or violated. It is also useful to ask if she
can remember the very first time she experienced such feelings. This line of explo-
ration helps the therapist understand if there are feelings from the past being
imported to the present situation, thus adding an additional layer of confusion or

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distress to the couple’s dynamics. Such layer may have something to do with the his-
tory of the couple’s relationship itself or with experiences in other love relationships.
However, very often, the therapist finds a layer of pain and trauma associated with
the more distant past. As partners bring forward their hidden stories the therapist
can help them realize there is a historical subtext to their difficult interactions. In
helping them separate the present from the past, she encourages them to relax the
grip of their defensive strategies.
Recapitulation of the parent-child bond
As therapists, we often hear about occurrences in the couple’s life in which one part-
ner feels profoundly indignant whenever the other is not perfectly attuned or available.
We may sense there are elements of entitlement, irrationality, or childhood yearnings
that are contaminating these situations. There is an extensive literature on the applica-
tion of attachment theory that is helpful to understand these predicaments (Greenberg,
2008; Johnson, 2008). Napier (1999) has described how the hypnotic state of adult inti-
macy—with its moments of blurred boundaries, merging, flesh sharing, and the joys of
playfulness—inevitably touches on early experiences, and in doing so it re-awakens pri-
mal yearnings for dependability, trust, and attunement. He also points out, and I agree,
that although adult intimacy taps into primal longings and frustrations, clinically speak-
ing the therapist should be careful not to conflate the couple’s relationship with the part-
ners’ early bonds. While during childhood there is a necessary fusion between child and
caretaker, in adulthood we assume the partners have gone through a process of separa-
tion and individuation, even if tumultuously so, and ideally they should be able to deal
with the borders between self and other. Expectations that one partner “should” repair
the developmental shortcomings of the other are problematic for many people who feel
they did not sign up for such a role. Furthermore, in working multiculturally, the thera-
pist should remain clear that in many cultures it is incongruous to equate marriage with
therapy. In my view, in dealing with primal yearnings activated in the couple’s relation-
ship, the best route is for the therapist to assume that the burden of family of origin
work, and emotional regulation, belongs to each individual. The therapist encourages
empathy between the partners, yet remains cautious not to presume it is the partners’
responsibility to repair each other’s past injuries. Such an assumption can easily back-
fire.
Re-enactment of one’s parents’ dynamics
Another perspective for understanding couples’ recalcitrant patterns is the frame-
work that considers that couples often recreate dynamics that are similar to those of
their parents. They either replicate their same pattern or else go overboard in the
opposite direction (e.g., my parents fought all the time; I will never raise my voice).
When Patricia stopped working as a lawyer to become a full time parent, a decision
she made willingly, she was unprepared for the intense resentment that she ended up
experiencing. Mystified by her irritability, Paul reacted with increasing frustration
and over time they found themselves bickering in a very similar way to Patricia’s par-
ents. Confused about his own frustration, Paul began to feel ashamed of “turning into
his father,” who was prone to fits of rage. Patricia, on the other hand, saw herself
becoming her mother, who was depressed and intimidated by Patricias’s father. In sit-
uations like this, the therapist can help the partners overcome their scripted bilateral
predictions by focusing on each partner’s unfinished business with their families
(Fishbane, 2013; Scheinkman, 2008) and helping them see that their relationship is
not the same as that of their parents.

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PART THREE: SEXUAL INTIMACY

Since sexuality is a vast and complex topic, here I consider sex as a critical sphere in a
couple’s life in which the partners may or may not experience intimacy. In order to distin-
guish sex that is intimate and nonintimate, it helps to clarify some terms.

Arousal, Passion, and Intimacy

While many sexual activities may be arousing—such as masturbation, pornography,
virtual sex, casual hook ups, or swinging—they are not necessarily intimate in the rela-
tional sense of the word. These experiences may become intimate if they become part of a
sense of sharing or complicity in which the partners rely on these activities to enhance
arousal in their connection.
It is also important to distinguish passion and sexual intimacy. While passion emerges
spontaneously, sexual intimacy requires intentionality and cultivation over time. Passion
is uncontrollable and compelling; sexual intimacy involves self-awareness, deliberation,
communication, and efforts to adjust and repair. While lust tends to fade away with time,
sexual intimacy tends to generate a lasting sense of bonding. Many couples feel distressed
when passion fizzles; it is crucial for the therapist to normalize this predicament and
remind the couple about the pleasures involved in a more intentional sexual bond (Iasen-
za, 2010).

Sex Can Be Intimate or Non-Intimate

Sex tends to be experienced as intimate when it is shared between people who care
about each other or are developing a bond. Sex can be a way of knowing the other person
or a space for expressing different feelings; it can be a time for self-abandonment, self-dis-
covery, or repair. It can also be simply an activity for being close. In intimate atmospheres,
sex becomes infused with feelings and meanings such as “I love you,” “You are special,” or
“You are the one I choose to do this with.” While sexual intimacy takes the subjective expe-
rience of the other person into account, sex is usually experienced as non-intimate when it
is objectifying, mechanical, or dutiful and the feelings of the other person are ignored or
obliterated. In situations in which sex is demanded or imposed by force, the experience
can be profoundly traumatic and toxic.

Relational Processes that Support Sexual Intimacy

All the relational processes described above also apply to the sustenance of sexual inti-
macy over time. Sex tends to be experienced as intimate when the partners communicate
in differentiated ways. It is also intimate when they expose desire, feelings, fantasies, and
their naked bodies, trusting that the other person will accept that which is being exposed.
The ability to join the partner in the co-creation of pleasure is also critical. Furthermore,
sex tends to be more satisfying when it occurs in a context of more positive interactions
than negative ones. The partners’ ability to switch back and forth between self-directional
and other-directed modes is crucial for creating arousal and for giving and receiving plea-
sure. In addition to these processes, there are a few other conditions that may be neces-
sary for the sustenance of sexual intimacy over time.
Intentionality
In order to maintain an ebb and flow of sexual intimacy couples may have to dispel
the myth of spontaneity and approach sex intentionally, planning for occasions in which
they rid themselves from the interference of children, chores, work worries, tablets, and
phones. In addition, the established assumption about “normal sexual functioning”—

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that sex must start with spontaneous desire and end with orgasm—is also counterpro-
ductive to the cultivation of sexual intimacy (Iasenza, 2010). Iasenza contends that the
sequential model of sexual response proposed by Masters and Johnson (1966)—arousal,
plateau, orgasm, resolution, plus Kaplan’s addition that spontaneous desire must pre-
cede this sequence—is problematic and male centered. It ignores the fact that a great
number of women (also older couples) experience desire more reliably as a response to
being seduced and stimulated rather than as an unprompted yearning. She proposes
that what is crucial for cultivation of sexual intimacy is the partners’ willingness to
enter the sexual situation without expectations that their responses will follow a partic-
ular order.
The sense of one’s body and the body of the partner
In order to cultivate a reliable flow of sexual experiences, the partners usually need to
feel good enough about their bodies and the bodies of their partners. This is not simple
given that women’s relationships to their bodies have been so profoundly damaged by con-
sumer society and stereotypes of female beauty (Wolf, 1991). Most women go through life
with an omnipresent feeling that there is something wrong with their appearance and
that only thin, young, and beautiful women are entitled to experience sexuality. Without a
sense that one’s body is deserving, it is difficult to stay focused on one’s own sensations
and pleasure. I often work with women who objectify themselves to such an extreme that
even when their partners express their attraction, shame impedes them from enjoying
sex.
The male counterpart of the beauty myth is the creed that “to be a man” one must be
powerful, aggressive, and invulnerable. Such template induces boys to inhabit their sexu-
alities as performers who must prove they are “macho” and powerful. The myth of mas-
culinity deters men from vulnerability, tenderness, and empathy, elements that are
usually necessary for sex to be experienced as intimate (Kimmel, 2005).
Allowance for short-term “ruthlessness”
Sexual arousal requires the person to remain focused on his or her own sensations and
fantasies and not worry about the needs of the other person temporarily, while building
excitement (Bader, 2002). This can be complicated for women, who historically have been
discouraged from pursuing their own desire and tend to feel guilty and ashamed to be self-
ish. Many men in our post feminist era also feel conflicted about focusing on themselves
with someone they care about. Thus the appeal of casual sex and prostitution, where the
other person’s feelings do not matter. The cultivation of sexual pleasure in an intimate
relationship requires balance between selfishness and caring, giving and receiving. If
either of these poles is absent, intimacy is usually compromised.
Resentment
When resentment insidiously pollutes a couple’s relationship, it usually impacts their
ability to experience pleasure with one another. Resentment may stem from the couple’s
sexual relationship itself, such as from a discrepancy in desire, or it may spring from other
spheres in the couple’s life such as an unequal division of labor, or feeling criticized and
unappreciated. The couple’s sexuality may be blocked due to dynamics in the here and
now, but it can also be due to a stockpile of resentments that were never addressed.
Despite its source, when resentment infuses the couple’s relationship it usually impacts
their willingness to connect sexually. Moreover, the longer the couple goes without sex,
the more awkward it is for them to be sexual again. The therapist may need to encourage
intentional steps toward sexual re-engagement in order to help the couple break through
their avoidant negative cycle.

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The relative importance of sex for each partner

Sex is not equally important to all individuals. While for some, sex is a panacea that
provides a sense of identity, connection, or emotional regulation, for others it is less impor-
tant, one arena for intimacy among many others. When sex is not a priority for one part-
ner, but is demanded, it can lead to negative cycles of pursuit and evasion that escalates
easily. Although it may not be possible for the therapist to level discrepancies in sexual
desire, he can still help the partners define their priorities and stretch towards the other
on a basis of empathy, generosity, and willingness.

PART FOUR: BASIC THERAPEUTIC PRINCIPLES AND SKILLS

When couples arrive in our offices they are typically mired in reactive cycles from
which, on their own, they cannot escape. The therapist must help them de-escalate beha-
viorally before facilitating a dialogue about their vulnerabilities and the intimacy they are
seeking. The therapist does so by interrupting reactive responses and helping them to
translate frustrations and anger into narratives of possibility and yearnings. The clinical
strategies proposed in The Vulnerability Cycle (Scheinkman & Fishbane, 2004) and The
Multi-Level Approach (Scheinkman, 2008) are pertinent for this purpose. Here, I suggest
some additional principles and skills to help the therapist facilitate this process.

Assuming a Position of Curiosity

After containing the couple’s more intense escalations, in order to help the partners
define their goals, the therapist maintains a position of curiosity and not knowing (Ander-
son & Goolishian, 1992) about a variety of issues such as:
• Their hopes, yearnings, and expectations
• Their individual hierarchy of priorities and values as far as intimacy is concerned
• The activities and spheres in which they each see intimacy flourishing
• The relational processes and emotional blocks that may be interfering with the cre-
ation or sustenance of intimacy.

Mentalizing Feelings and Curating Behavior

When couples start therapy, their narratives are typically loaded with implicit or expli-
cit blame. Mentalizing (Fonagy, Gergely, Jurist, & Target, 2002) is a skill in which the
therapist attempts to put into words the vulnerabilities, intentions, and expectations
underlying the partners’ complaints. The therapist may have to guess. Or she may have to
lend words to the partners, always with a question mark, checking for consensus. The
therapist may say to David: “Could it be that behind your withdrawal there is a wish for
Carla to be more appreciative? What kinds of behaviors on her part might give you the
feeling that she appreciates what you do for her?” As the therapist helps the partners ver-
balize their yearnings, she also curates their behaviors by blocking ineffective reactivity
and by encouraging more effective ways of expressing feelings and wishes.

Focusing on Specific Moments, yet Promoting Intimacy over Time

In addition to mentalizing yearnings and intentions, the therapist must also help the
partners concretize their expectations. Weingarten (1991) makes the point that couples
feel more empowered to create intimacy when they are helped to focus on specific situa-
tions. She says: “People select a range of activities as ones in which it is likely that inti-
mate interactions will occur between themselves and the people who participate with

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them,” such as sex, having meals together, going on biking trips, or having specific types
of conversations. However, while these specific moments are crucial building blocks of inti-
macy, couples also need to maintain continuity in terms of the flow of connection, discon-
nection, and reconnection.
Disconnections between the partners happen all the time and may spring from many
sources such as: everyday stresses related to work, raising children, or dealing with
extended families. Or they may be the result of an accumulation of disappointments and
injuries in the relationship itself. Alternately, disconnections may be due to an activation
of older wounds. In order to counteract these fractures couples need to uphold values and
principles that can help them withstand the more difficult periods. Examples of such val-
ues are: commitment, loyalty, and tolerance. The partners must also be willing to forgive,
repair, and keep trying again and again (Goldner, 2006).

Encouraging Negotiations
As the therapist helps the partners articulate their expectations, she also encourages
negotiations of specific changes. For example, one partner may express the wish for more
equal sharing of responsibilities at home, while the other wants more playfulness and joy
in their lives. The therapist may help them schedule time to go dancing and be with
friends, yet in the same session help them create a chart of chores to be divided. These
straightforward homework tasks become barometers of change indicating week after week
if the couple is moving toward what they claim they want. When the partners persistently
avoid or forget doing their tasks, a different approach may be needed.

Identifying and Strengthening Relational Processes

As the therapist encounters inertia, it may be necessary to assess if there are specific
relational processes that need to be strengthened for the couple to be able to keep moving
in the direction they want to go. For instance, the therapist may need to encourage the
partners to define clearer boundaries, or to express more positive feelings, or to make
adjustments in their quid pro quo, or to clearly express their yearnings. If these efforts are
not sufficient to help the couple feel more connected and closer, the therapist may have to
explore even more remote kinds of impediments.

Exploring Complex Emotional Blocks

It is impossible to approach intimacy clinically without considering its ambivalent nat-
ure. Although intimacy is an intensely sought after experience, it is also a quest that taps
into primal anxieties which paradoxically block the very experience the partners are seek-
ing. These anxieties may involve existential fears of being abandoned, rejected, neglected,
criticized, or engulfed. The anxiety can also be related to previous emotional injuries, trau-
matic experiences, or hostile environments that have contributed to crystallization of
defenses. In order to explore and work through these multiple layers, “The Vulnerability
Cycle” (Scheinkman & Fishbane, 2004) and “The Multi-Level Approach” (Scheinkman,
2008) are complementary articles to the framework presented here.

CONCLUSION
This paper proposes an integrative multicultural framework for considering “intima-
cies” in couple therapy. Cautioning clinicians against monolithic notions, it encourages
the therapist to work collaboratively with the partners to help them identify their yearn-
ings, contextualize their meanings, and make choices about their preferences. The thera-
pist facilitates self-reflection, mutual understanding about their expectations, and

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negotiations of mutual adjustments to help them create the best possible fit between them.
Assuming that the continuity of intimacy over time does not “just happen”, but instead
must be cultivated, the therapist identifies relational processes that may need to be sup-
ported, as a foundation for a fluid ebb and flow of intimate experiences. When negotiations
and support of these relational processes do not suffice, the therapist may need to focus on
complex emotional blocks related to traumas, family of origin, or to cultural and multige-
nerational legacies that might be interfering with the creation of intimacy. The approach
proposed here integrates respect for the unique preferences of each partner with the
ample knowledge developed in the field of family therapy. It highlights contextual mean-
ings and relational processes that are critical to the therapeutic process and also to the
resilience of intimacy in couples relationships.

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