The original goal of this research was to develop an empirically based, conceptual model of optimal sexuality. To that end, semistructured, phenomenologically oriented interviews were conducted with 76 key informants. The three participant groups consisted of men and women over the age of 60 who had been married for over 25 years, self-identified members of sexual minority groups, and sex therapists. Strikingly, the descriptions of optimal sexuality were nearly universally identical among the first two participant groups; that is, across men and women, older married people, and lesbian, gay, bisexual, and transgender (LGBT) or "kinky" participants; however, the sex therapists were conspicuous outliers. Even though five raters in the research team were blind as to the demographic characteristics of the participants, raters consistently and accurately detected the sex therapists' transcripts and conceptions as undeniably and markedly different. The repercussions of these findings for clinical work are explored. Most notably, assumptions about sexuality (e.g., malefemale sexual differences) at the dysfunctional to "normal" ends of the spectrum may not hold true at the high end of the continuum. Sex therapists may benefit from rethinking sexual potential to help in improving clients' sex lives.

Beginning in 2005, our team conducted a series of studies on optimal sexual experiences. We have applied our findings to develop a group therapy intervention for couples presenting with low sexual desire/frequency and sexual desire discrepancy. The goal was to improve the quality of erotic intimacy by focusing on such elements as being fully embodied during sex, increasing authenticity, trustworthiness, and vulnerability. Twenty-eight heterosexual individuals (14 couples) were seen in 16 hours of couples group therapy. Each completed the New Sexual Satisfaction Scale in pretests, posttests and six-month follow-ups. Significant differences in satisfaction (p <.001) were found in overall sample means from pretests to posttests and follow-ups. Significant differences were also found in 10 of 20 items, plus in two of three added items, including satisfaction with intensity of sexual arousal, variety, frequency, partner's initiation, and emotional opening up. Although this is a small sample, the results indicate that this intervention is effective. We interpret these findings in terms of creating just enough safety to enable couples to take erotic risks and thereby create desirable sexual intimacy.

Background Sexual desire or frequency problems are exceedingly common, but treatment of them has been less than effective. Aim The goal of this study was to develop a cost-effective, accessible intervention to deal with sexual desire or frequency problems, including sexual desire discrepancy, by enhancing the quality of couples’ erotic intimacy. Methods 45 couples (38 heterosexual and 7 same-sex couples) distressed by sexual desire or frequency problems were seen in a 16-hour, group couples therapy intervention. Participants completed the New Sexual Satisfaction Scale (NSSS) at pretest, posttest, and at 6-month follow-up. Outcomes The NSSS plus 3 additional items at pretest, posttest, and at 6-month follow-up and patients’ written feedback. Results Statistically significant differences were found between pre-tests and post-tests in satisfaction with intensity of sexual arousal; creativity; frequency; sexual functioning; partner's sexual availability; partner's initiation of sexual activity; emotional opening up during sex; positive sexual reactions to the partner; communication of sexual wishes, preferences and desires; and balance between giving and receiving during sex. The largest improvement and effect sizes were found in overall satisfaction with one's sex life from pre-test to post-test and 6-month follow-up. Clinical Implications Low sexual desire or frequency problems can be treated effectively by enhancing the quality of the couple's erotic connection, thereby creating desirable sex. Strengths & Limitations The strengths include the combination of quantitative and qualitative data. Limitations included the small number of same-sex couples. Conclusion Sexual enhancement group couples therapy provides an effective, accessible, and affordable approach to low desire or frequency complaints in distressed couples.