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Abstract

Sexual scripts are socially constructed guidelines that purportedly determine sequencing of individual sexual behavior. For older adults' sexual scripts are often ageist, perceiving them as asexual and often times deterring physical intimacy in later life. This manuscript addresses these scripts through the implementation of narrative therapy with an older couple. We address: 1) the ageist assumptions about sex and older people, 2) relational issues that may occur when considering older couples and sexual intimacy, 3) how does scripts theory explain ageist sexual processes, and 4) how can narrative therapy be used to deconstruct ageist sexual scripts in older couples.
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The American Journal of Family Therapy
ISSN: 0192-6187 (Print) 1521-0383 (Online) Journal homepage: http://www.tandfonline.com/loi/uaft20
Sexual Scripts and Narrative Therapy with Older
Couples
Bertranna Muruthi, Megan McCoy, Jessica Chou & Andrea Farnham
To cite this article: Bertranna Muruthi, Megan McCoy, Jessica Chou & Andrea Farnham (2018):
Sexual Scripts and Narrative Therapy with Older Couples, The American Journal of Family
Therapy, DOI: 10.1080/01926187.2018.1428129
To link to this article: https://doi.org/10.1080/01926187.2018.1428129
Published online: 21 Feb 2018.
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Sexual Scripts and Narrative Therapy with Older Couples
Bertranna Muruthi, Ph.D.
a
, Megan McCoy, Ph.D.
b
, Jessica Chou, Ph.D.
c
,
and Andrea Farnham, MS
d
a
Assistant Professor in Marriage and Family Therapy, Virginia Tech, Falls Church, Virginia, USA;
b
Adjunct
Professor in Marriage and Family Therapy, Northcentral University, Prescott Valley, Arizona, USA;
c
Assistant Professor in Couple and Family Therapy, Drexel University, Philadelphia, Pennsylvania, USA;
d
Doctoral Candidate in Marriage and Family Therapy and Human Development and Family Science,
University of Georgia, Athens Georgia, USA
ABSTRACT
Sexual scripts are socially constructed guidelines that purportedly
determine sequencing of individual sexual behavior. For older
adultssexual scripts are often ageist, perceiving them as asexual
and often times deterring physical intimacy in later life. This
manuscript addresses these scripts through the implementation of
narrative therapy with an older couple. We address: 1) the ageist
assumptions about sex and older people, 2) relational issues that
may occur when considering older couples and sexual intimacy, 3)
how does scripts theory explain ageist sexual processes, and 4)
how can narrative therapy be used to deconstruct ageist sexual
scripts in older couples.
Sexual expression plays a signicant role throughout every human developmental
stage (Butler & Lewis, 2002), and is incredibly important in the later life stage,
when relationships with loved ones are vital (Cornwell & Waite, 2009). Unfortu-
nately, the desire for sexual expression is often ignored or even actively discour-
aged in older adults (Hillman, 2011; Tetley, Lee, Nazroo, & Hinchliff, 2016). This
discouragement is partially caused by ageist sexual scripts which are socially con-
structed guidelines that determine individual sexual behavior and sequencing
(Hillman, 2000). These scripts may cause conict when played out within older
adult couple relationships. Narrative therapy will be used to examine these domi-
nant discourses and invite older couples to step into alternative and/or preferred
roles to deconstructing ageist sexual scripts in their relationships (Nylund &
Nylund, 2003; White, 2011).
Research has shown that sexual desire and activity is widespread among older
adult men and women (Nicolosi, Moreira, Villa, & Glasser, 2004). According to
Montemurro and Siefken (2014), there are signicant numbers of women in their
CONTACT Bertranna Muruthi, Ph.D. MuruthBA@vt.edu Assistant Professor in Marriage and Family Therapy,
Virginia Tech, 7054 Haycock Road, Ofce 202G, Falls Church, VA 22043.
© 2018 Taylor & Francis
THE AMERICAN JOURNAL OF FAMILY THERAPY
https://doi.org/10.1080/01926187.2018.1428129
60s, 70s, 80s, and even 90s who remain sexually active and consider sex an impor-
tant aspect of their relationships (e.g., Gott & Hinchliff, 2003; Hinchliff & Gott,
2004; Hinchliff & Gott, 2008; Katz & Marshall, 2003; Loe, 2004; Sharpe, 2006;
Waite, 2010; Waite, Laumann, Das, & Schumm, 2009). Similarly, Lindau,
Schumm, Laumann, Levinson, OMuircheartaigh, and Waite (2007), found that
sexual activity in the form of vaginal intercourse, oral sex, and masturbation still
occurred in older adults in their 80s. Yet, the dominant discourse in this popula-
tion portrays an abstinent and asexual narrative within older couple relationships.
Sexual scripts have been applied to relationship initiation for younger popula-
tions, (Bartoli & Clark, 2006; Dworkin & OSullivan, 2005; Wiederman, 2015), but
limited works have considered how these scripts affect older couples. Therapists
must recognize the myriad of factors that impact older couples interest, needs, and
desires for sexual expression in their relationships (Lee, Nazroo, OConnor, Blake,
& Pendleton, 2016; Morely, 2006). Scripts theory helps to conceptualize how sexual
behavior in older couplescan be shaped by ageist social norms. Narrative therapy
offers a language to articulate how these social norms can be deconstructed and
offers practical interventions to help couples loosen the grip of ageist sexual scripts
on the couple dyad. The authors acknowledge that there are similarities and differ-
ences between scripts experienced by older heterosexual and older sexual minority
couples; therefore, this manuscript will specically focus on a heterosexual couple.
Sexual intimacy and older couples
The most prevalent psychosexual problems of older men and women are not those
directly attributable to age or to hormonal changes, but rather those related to
partner factors, such as a lack of tenderness, insufcient loving bodily contact, and
loneliness (Weeks, 2002). For example, one partner may assume the other does
not want to discuss sexual activities which can lead to couple misunderstandings.
According to Stausmire (2004), partners might avoid sexual intimacy for fear of
hurting the other who may have an illness or bodily change, which in turn may
create feelings of being undesirable from the reciprocal partner. This type of inter-
action can create conict and further exacerbate anxiety about aging and its rela-
tion to limited sexual interaction within the couple.
On the other hand, later life stages are also a time when relationship closeness is
deepened and sexual intimacy may transition from a focus on penetration in sexual
intercourse to a broader understanding of sexual intimacy (Morrissey Stahl et al.,
2017). For example, couples who were once sexually active found new ways to
remain intimate such as holding hands, dancing, caressing touch, hugging, and
kissing, which many reported satised their need for sexual connection (Lemieux,
Kaiser, Pereira, & Meadows, 2004). Other studies report a sense of emotional and
relational maturity (Shaw, 2012) and an increasing ability to claim ones agency in
terms of likes and dislikes, in older age (Lee et al., 2016). It is a myth that as people
age, they necessarily become more conservative in their values (Connidis, 2010).
2B. MURUTHI ET AL.
It is also important to consider health factors that may inuence sexual intimacy
in older couples. Older adults experience hormonal changes as they age, including
a reduction of androgens in men and estrogens and androgens in women, which
may result in a decline of general desire for sexual activity (Morely, 2006). The
onset of vascular disease, including hypertension, atherosclerosis, heart attack, and
even diabetes, can also have a dampening effect on sex drive (DeLamater & Sill,
2005). Medications and some forms of treatment may also reduce sex drive. Even
less severe conditions, such as discomfort from arthritis or back pain, can make
sexual expression more difcult (Butler & Lewis, 2002).
Ageist notions about sex
Stereotypical beliefs and attitudes about sexual intimacy between older people
remain a cultural norm, despite the widespread scienticliteraturecountering
this notion. It is suggested that, in western culture, sex is only for the young
(Katz & Marshall, 2003). Oppenheimer (2002), reports that stereotypes about
aging and sexual expression has three general themes: 1) sexuality for older
people needs to be marked by discretion; 2) sexuality in older people is per-
ceived as somehow inappropriate or at worse abhorrent, a perspective often
endorsed by the media (Walz, 2002); and 3) the belief that the aforemen-
tioned potential medical issues deteriorates the sexual organs and creates an
absence of sexual desire and activity (Lai & Hynie, 2011). It is important to
note that these perceptions may not be shared by the older adults themselves
(Gott & Hinchliff, 2003), but can be internalized and be expected as the
norm as they get older (Deacon, Minichiello, & Plummer, 1995).
Ageist perceptions associate sexual intimacy with youthfulness and the ability to
reproduce, therefore assuming that older people who cannot reproduce are asexual
(Deacon et al., 1995; Dominguez & Barbagallo, 2016). Perpetuating these stereo-
types and maintaining these ageist beliefs shape age-based sexual norms (Lai &
Hynie 2011), and reinforces the maintenance of such stereotypes and treatment of
older persons (Grant, 1996). According to Weeks (2002), cultural ageism has a
particular impact on attitudes about what is taboo or not acceptable, its restrictions
focus on what people should not imagine.Parke (1991), continues to assert, that
these misconceptions may generate excessive irrational feelings, and thus sexual
experiences become less enjoyable for partners within a relationship (Weeks,
2002).
Ageism also places a hyper masculine and heterosexist focus on the decline
rhetoric of sexual discourse in later life (Dominguez & Barbagallo, 2016).
Stereotypes such as dirty old manand indecent old womanare negative
messages conveyed to the older adults regarding their sexuality (Garrett,
2014). Sexuality breakdown syndrome, has been used to explain how elderly
people internalize these negative attitudes, and as a result, may begin to per-
ceive themselves as non-sexual (Kaas, 1981). Labeling and stigmatization has
THE AMERICAN JOURNAL OF FAMILY THERAPY 3
been shown to have a negative impact on the general well-being of older peo-
ple (Kaas, 1981). There is a strong relationship between the internalization of
negative attitudes towards older people and low self-esteem, increased depres-
sion, and lower quality of life in older adults (Stripling, 2016). Understanding
the social construct of ageism and its effect on sexual practices of older peo-
ple will help therapists as they work with older couples who present with a
lack of sexual intimacy in their relationships.
The use of sexual scripts in narrative therapy
Sexual scripts theory posits that humanssexual behavior, sexual responses, and
emotions about sex are determined by internalized social norms and meanings of
sexuality (Wiederman, 2005). Relatedly, narrative therapy posits that meaning is
co-constructed and that change comes through the creation of new meaning
through deconstruction. This manuscript will use sexual scripts to identify ageist
social norms and use narrative therapy to deconstruct these social norms. These
two concepts complement each other as a framework and as a therapy intervention
modality.
Sexual scripts theory
Sexual script theory, developed by Gagnon and Simon (1973), derives from the
symbolic interactionist perspective and incorporates Freuds conceptions of the
interaction of symbolic material within the psyche. Sexual scripts are the ‘‘blue-
prints’’ for sexual conduct, detailing with whom one will have sex, what acts one
will perform, when and where sex will occur, and for what reasons (Atwood &
Dershowitz, 1992). Gagnon (1984), noted: Sexual scripts are the plans that people
may have in their heads for what they are doing and what they are going to do, as
well as being the devices for remembering what they have done in the past(cited
in Amaro, Raj, & Reed, 2001, p. 325). According to scripting theory, behavior is
inuenced at three levels: cultural scenarios, interpersonal scripts, and intrapsychic
scripts (Simon & Gagnon, 1986). Cultural scenarios are collective instructional
guides that direct the performance of roles for the self as well as others. Interper-
sonal scripts reect individualsinterpretations of cultural scenarios. At this level,
individuals are scriptwriters or adaptors who rely on their socialization and unique
experiences to actively shape cultural scenarios into scripts for their own relation-
ship and sexual behaviors (Bowleg, Lucas, & Tschann, 2004). Interpersonal scripts
convert general cultural scenarios into scripts appropriate to specic situations. It
is at this level that individuals develop strategies for realizing their particular sexual
desires. Intrapsychic scripts include sexual fantasies, objects, and the sequence of
behaviors that elicit and sustain sexual arousal and connect individual desires to
social meanings (Simon & Gagnon, 1986).
4B. MURUTHI ET AL.
Narrative therapy
A narrative therapy approach offers a collaborative, respectful, non-blaming
approach to clients issues with an invitation for clients to tell their stories and ask
new questions to seek new solutions (White, 2007; White & Epston, 1990). The
purpose of the model is to interrupt recurring storylines that keep clients locked in
unwanted dynamics, in our case sexual dynamics. In the spirit of narrative therapy
problem saturated stories are externalized, witnessed by the therapist, and recast as
aspects of the clients personal history and experience, rather than as a static deni-
tion of who the client is (White & Epston, 1990). Curiosity is encouraged in the cli-
ent about self and the self in relation to others (Monk, Winslade, Crocket, &
Epston, 1997).
In other words, therapists evoke client narratives about sex and listen not only
in regard to clients physical responses, but also to their thoughts, feelings, and
meanings both past, present and future (Kleinplatz, 2012). The therapist collabo-
rates with the clients to allow clients to assume authority and power for their own
trajectory of growth. Collaboration, in this approach, refers to a therapistsexibil-
ity to move among various roles at appropriate times, such as the role of expert,
guide, and curious, intelligent co-conspiratorwho accompanies them on their
healing journey (White & Epston, 1990). Below we offer a case conceptualization
that was generated to highlight the practical application of narrative therapy
through scripts theory.
Case conceptualization and discussion: Elizabeth and Warren
Warren is a 74-year-old white male and is a retired insurance broker. Elizabeth is a
72-year-old white female, who is a retired nurse. They have been married for
54 years and just moved to an independent living, retirement community within
the last two years. The couple was referred to the clinic by family friends, and ini-
tially presented with trouble transitioning to their independent living community
and also feeling disconnected as a couple. After a few months of therapy, Warren
reported having difculty initiating sexual intimacy with his wife, whom he felt no
longer found him sexually attractive. Elizabeth then reported that she no longer
felt close to Warren and that insecurities about herself might be causing her to feel
this way.
Warren described feeling a drastic change after moving:
Well, moving to a retirement community was somethingElizabeth and I thought about
it for a few years after I retired. We were both very active sexually before the move. Some-
thing changed when we moved thoughthings just seemed to stop. The next thing I
knew we were eating at 4:30 and going to bed at 8:00 pm. It is pretty depressing.
When asked about sexual intimacy in his relationship, Warren explained: I still
feel the desire to be intimate with Elizabeth but I dont think she wants too at all
THE AMERICAN JOURNAL OF FAMILY THERAPY 5
anymore. She has had a hard time adjusting to everything since moving. I dont
want to bring up having sex in case it makes her feel worse.
Elizabeth reported similar concerns:
Warren has always had this charm that I have always been drawn to. After all the kids left
the house Warren and I had time to travel and spend more time together. Once he retired
something between us changed. Now we live in this retirement community and he is right
something feels different. I feel like Warren is not attracted to me anymore and I end up
feeling sad about it.
The following is a demonstration using Sexual Scripts theory (cultural sce-
narios, interpersonal scripts, and intrapsychic scripts) to deconstruct ageist
notions that are hindering sexual intimacy through the tenets of narrative
therapy (thin descriptions, externalizing, and amplifying). Authors have found
that narrative therapy and scripts theory complement each other when work-
ing through the narrative process of deconstruction. It is important to note
that neither Warren nor Elizabeth reported any sexual dysfunction, physical,
and/or emotional violence in their relationship.
Listening for cultural scenarios in thin description
Cultural scenarios depict how friends and family, as well as the community at
large, perceive the couple. These scenarios support the development of their thin
descriptions. Thin descriptions are stories that we create for ourselves and are a
reection of these social perceptions (Morgan, 2000; White, 2011; White 1995;
Monk et al., 1997). For example, Elizabeth and Warren both reported that retire-
ment home staff, family members, continuously give them messages about being
at the end of their life, making them feel older and ultimately making them both
feel inadequate about their sexual abilities. These ageist social constructs can
become intertwined with clientsperceptions of themselves and become a part of
their dominant stories (Morgan, 2000).
Therapists must listen for the cultural scenarios that make up the couples
thin descriptions. Elizabeth authors her story of being unattractive to War-
renand links her perceptions of what being older means to prove this plot.
According to Elizabeth, No one wants a grandmother, thats why men go for
younger womenI see it all the time in our retirement community.Elizabeth
is unable to hear other stories that go against her current preferred narrative.
For example, Warren still wanting to be sexually intimate with her becomes
less signicant because it does not t the cultural scenario that has formed
the outline of her thin description. Feeling unattractive privileges Elizabeths
dominant plot and providing the therapist with only these narratives, creates
a thin description of the couple experience and therefore creates negative
interpersonal scripts for the couple.
6B. MURUTHI ET AL.
Externalizing interpersonal scripts
Interpersonal scripts reect the stories that cultural scenarios have told the client to
believe about themselves. Through externalizing conversations, we put into prac-
tice the idea that people and problems are separate (Combs & Freedman, 2012).
Clients begin to infuse themselves with the problem where the problem becomes a
part of their identity and representation of self (I am old,”“I am tired,”“Iamno
longer attractive). The therapist restructures the client language in order to situate
the problem away from the self of the client (Monk et al., 1997). For example, in
the case conceptualization Elizabeth described how she felt that Warren saw her as
unattractive. The therapist worked on helping the couple speak for themselves
rather than attributing thoughts to their partners and both Warren and Elizabeth
disclosed how they were feeling about themselves.
Warren: I have to admit that I am feeling tired since we moved into the retirement home.
I feel like Ive aged a decade in just weeks and I am just avoiding all these feelings by
sleeping or at least lying in bed. I wish that me and Elizabeth could connect physically so
that I could feel closer to her but I dont want to pressure her.
Therapist: Pressure her? Elizabeth is that something you feel or have felt from Warren,
that he is pressuring you to have sex?
Elizabeth: Oh no! Warren has always been the exciting one in our relationship. He was
the one who pursued me romantically and sexually. Its always made me feel like he
wanted me and thought I was beautiful! When he started to withdraw I just felt so sad
and I thought that it was me and that I was unappealing to him.
Therapist: So, Elizabeth you have been feeling like you are no longer attractive to Warren?
Elizabeth: Yesbut just hearing how moving has affected himmakes sense of why he
has been so distant lately.
Warren: Moving here has been so hard on meI miss our houseand I didnt mean to
be distantI just wanted to give you space. I thought you didnt want to be intimate with
me because you never seem to want to when I try
Elizabeth: I thought you didnt want toI am not as attractive as I use to be
Warren: You will always be beautiful to me.
Warren and Elizabeth reveal that they both are having a hard time adjusting to
the retirement community. As the therapist worked on helping the clients identify
their individual problem, we were able to remove the interpersonal scripts
from their narrative to reveal their need for mutual intimacy from each other. At
this point we introduce the idea of Sparkling events. Sparkling events are times in
THE AMERICAN JOURNAL OF FAMILY THERAPY 7
a clients life when they feel like they were able to overcome the problem (McCoy,
Ross, & Goetz, 2013). Where the couple begins to identify times when the lack of
intimacy was not taking over their lives (White, 1991), and to also determine when
they go against their interpersonal scripts.
During this time, therapists should listen for behavioral sequences, which refers
to the order of behaviors that lead to the couples sexual initiation. This helps to
determine patterns of how initiation has changed from when their sexual expres-
sion was ideal, and to also identify new ways of initiating sex within the relation-
ship. By doing this, therapists can help to move the client progress further by
helping them see that the problem-saturated story was not the only possibility in
their narrative. It also helps the couple to see the times when they have power over
their interpersonal scripts.
The therapists goal is to seek out alternative meanings within the stories of
when the sexual needs of the couple were met in their relationship. This new alter-
native story gives clients the opportunity to look at their history and sequence of
events and the way these alternative meanings formed new stories that may contra-
dict the expectations of the cultural scenarios. In this process the therapist should
help the couple develop a rich description, which calls for a more detailed depic-
tion of these alternative meanings or narratives that contradict the negative domi-
nant story (White, 2011; White, 1995; Monk et al., 1997). Once the couple realizes
that these alternative stories are a part of their interpersonal scripts, therapists can
help them to develop strategies to make these stories dominant and to help them
to promote their sexual desires and make space to share their intrapsychic scripts
with one another.
Amplifying the intrapsychic scripts
Intrapsychic scripts refer to the individual sexual desires and fantasies of each
member of the couple and the ways that they negotiate these desires with pressure
of interpersonal scripts (Simon, & Gagnon, 1986). Once the client has found
the autonomy to overcome the inuence of interpersonal scripts they are free to
share their sexual desires with their partner, and dismantle the ageist constructs
that have saturated their life. The couple can then begin to identify and move
towards their envisioned solution (Berm
udez, Keeling, & Carlson, 2009).
Couples begin to identify their desires and where they conict with their scripts.
It is important for the therapist to highlight this cognitive dissonance, the contra-
diction between sexual desires and adherence to cultural scripts, and create space
for the couple to choose alternative behaviors.
Elizabeth: I think we both want the same thing Warren. We want to feel excitement and
not buy into this idea that we are old and done having fun [sexually]Im sorry that I
have always relied on you to pursue sexual intimacy in our relationship. It just seemed
like thats the path we were heading down
8B. MURUTHI ET AL.
Therapist: Will you turn to Warren and tell him what you want from him?
Elizabeth: I want it to be like it used to beI want to spend time togetherI want to be
fun and free like we were before we came here
Warren: I want that too! I also want to start traveling with you againwe had so many
chances to express our love for each other when we were hopping the globe. We are not
dead yet! We need to stop acting like it!
Therapist: I love how much you are on the same page with each other. Your past ways of
interacting were no longer working, that doesnt mean that you cant discover new ways
that can better t your needs from each other.
Recognizing the external pressures frees them to make alternative choices. Eliza-
beth recognized that her interpersonal scripts were hindering her from accepting
and believing that Warren was not nding her unattractive, but rather dealing
with his own adjustment to the retirement community. It was healing for Elizabeth
to discover that in his eyes she was still sexually attractive and for Warren to dis-
cover that Elizabeth still desired him. It is important to note that they both were
internalizing sexual scripts about themselves (I am unattractive to my partner),
and to a lesser extent they were internalizing scripts about their partners (they no
longer desire me). It is important that the therapist addresses both sides of this
dichotomy.
This envisioned solution provides an expanded sexual script that allows the cou-
ple to describe what their preferred sexual intimacy will look like in the absence of
the problem. The therapist can help the couple amplify the preferred co-con-
structed narrative that they created together over the course of therapy (White,
2011; White, 1995). Therapists need to be aware that they set up their clients for
failure if they think their job is done simply because the problem has been external-
ized. Amplifying the solution creates the reinforcement needed to help clients ght
their old narrative by solidifying their new story over time (Bermudez & Parker,
2010).
Clinical implications
The case conceptualization highlighted the need for therapists to integrate narra-
tive therapy and sexual scripts in order to execute meaningful clinical work with
older couples. Therapists must make an effort to understand the inuence of con-
textual factors on the development of couplesinternal scripts. Misinformation
about sex and intimacy can be explored internally for each member of the couple
as well as contextually in order to explore the external forces that are exerting pres-
sure on the couples sexual relationship. These external narratives can be held by
healthcare professionals, family, friends as well as society at large, and can lead to
THE AMERICAN JOURNAL OF FAMILY THERAPY 9
internalizing messages about sexual intimacy and sexual relationships that stand to
negatively impact couplesrelationships.
It is also important to note that many misconceptions about sex are not neces-
sarily related to aging, but simply the dearth of misinformation in media and pop-
ular culture about sex and intimacy. For older adult couples, specic strategies and
techniques can be applied to maintain intimacy and realistic expectations with
aging. Developing realistic expectations hinges on challenging myths and miscon-
ceptions about sexuality and aging so couples can make space for more accurate
and realistic expectations about their intimate lives (Deacon et al., 1995; Gott &
Hinchliff, 2003).
In addition to considering a couples relationship as it is situated in a larger con-
text, therapists must be active in exploring other relative components within the
couples relationship. Older couples navigating changes in their sexual relationship
may be a result of illness, physical changes, and hormonal changes (Weeks, 2002).
Older adults may initially seek medical help for a variety of sexual dysfunctions
(e.g. erectile enhancement medications to facilitate sexual activity). Therapists
must be mindful and work in collaboration with these healthcare professionals.
Therapist strategies can focus on normalizing continued sexual interest, decon-
struct denitions of sex and intimacy and broadening denitions to include sexual
touching, massage, toys, and synthetic lubricants to increase comfort (Morrissey
Stahl et al., 2017).
We must also be mindful that older couples may be hesitant to approach the
subject of sexual intimacy with therapists; moreover, they are more likely to speak
about sex when it relates to a sexual dysfunction and not when it is a relational
issue (Jo, Brazil, Lohfeld, & Willison, 2007; DeLamater, 2012; Price, 2014). Clini-
cians have the opportunity to help ageing clients negotiate these changes and over-
comes ageist constructs that hinder their sexual expression. One mechanism to
facilitate conversation is the utilization of psychoeducation. Psychoeducation about
sexual intimacy and sexual relationships for older couples may bring a broader
understanding of intimacy and aging that gives way to curiosity and
communication.
Lastly, clinicians must examine self of the therapist issues surrounding aging.
Self of the therapist is the internal workings of a therapist, ones feelings, fears,
ideas, etc. When a therapist is able to process their life events in a healthy way, the
self of the therapist can be a useful tool in treatment (Andol& Angelo, 1988).
Yet, the therapist must also bring into awareness their preconceived notions of
aging and older adults. Some clinicians may believe that older clients are fragile
and not open to direct conversations about their sexual lives while others may
hold on to the belief that older adults are asexual. When working with older adults
the therapist or service provider should be informed about the processes character-
izing healthy aging for a wide range of older adult experiences and the therapist
should strive to cultivate willingness to ask questions about sexuality and sexual
intimacy (Becvar, 2005).
10 B. MURUTHI ET AL.
Limitations
This case conceptualization offers insight into therapists helping older couples
negotiate changes in sexual desire and behavior. However, this case focuses on a
particular transition to an independent living community which offers unique fac-
tors exerting inuence over a couples sexual relationships, such as staff disapprov-
ing of sexual behavior, lack of intimacy, and loss of freedom. These factors are not
universally applicable. Another limitation is that scripts theory has most widely
been applied to relationship initiation with college age and early relationships
which limits generalizability to older adult long-term relationships. Thus, it is not
known exactly how well scripts theory applies to these populations and what
notions they have of initiating sexual intimacy that t a similar sequence of sexual
scripts.
Future directions
Future work is needed to examine the ways that conventional wisdom inu-
ences clientsunhelpful beliefs about sex and aging. Many couples regard-
lessofagehavemisbeliefsandhang-ups about sex. The particular problems
facing older adults are simply exacerbated by ageism both internalized and
external forces inuencing the sexuality of older adults. In order to make
wider generalizations, additional scholarship is needed to understand the
mechanism that police older adult sexual intimacy from relatives and
friendstomedia,toinstitutionssuchaschurchesandpoliticalforces.
Scholarship is needed on older adult populations specically focused on
strength based models of what healthy sexuality and sexual intimacy look
like in satised older couples. Many institutions have and continue to police
sexuality and in order to develop a more sex positive populous we must
understand the institutions, cultural and individual forces that produce the
misinformation and misbeliefs about sex in older adults. Lastly, future
research is needed to examine cultural inuences and variations in sexual
scripts and ageist beliefs that may vary by culture. Many misconceptions
about sex may be the product of cultural misconceptions that should be
explored.
Conclusion
This manuscript employed sexual scripts to identify ageist social norms and
the use of narrative therapy to deconstruct these social norms. Sexual scripts
have been applied to relationship initiation for younger populations, (Bartoli
&Clark,2006;Dworkin&OSullivan, 2005;Wiederman,2015), but limited
works have considered how these scripts affect older couples. Therapists play
an important role in discussing issues of sexuality and sexual intimacy with
older couples and individuals. As such, therapists must recognize the myriad
THE AMERICAN JOURNAL OF FAMILY THERAPY 11
of factors that impact older couples interest, needs, and desires for sexual
expression in their relationships (Lee et al., 2016;Morely,2006). Understand-
ing the social construct of ageism and its effect on sexual practices of older
people will guide therapists as they work with older couples who present
with a lack of sexual intimacy in their relationships.
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THE AMERICAN JOURNAL OF FAMILY THERAPY 15
... Twenty-two articles failed to define the term "sexuality" and instead relied on implicit definitions of sexuality. Definitions were absent in 36% of all theoretical articles, [13][14][15][16] 100% of all qualitative articles, [17][18][19] and 83% of all quantitative articles. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Despite this, most articles acknowledged the complexity of sexuality as a construct, and a broad range of topics were discussed across the included articles. ...
... However, these articles did discuss desire and/or sexual interest. 17,19 Without the presence of an explicit definition of sexuality, it is unclear whether the authors would include arousal and/or pleasure to be a part of desire and/or sexual interest, or whether they consider these to be conceptually separate constructs. Likewise, the distinction between arousal and/or pleasure and desire and/or sexual interest was not always clear across the included quantitative articles [eg 23 vs 30 ]. ...
Article
Full-text available
Objective To identify whether a consistent definition of sexuality is used across research articles to describe sexuality in later life for heterosexual men and women. Methods A systematic review was conducted that examined how researchers define sexuality for heterosexual adults. Peer‐reviewed journal articles on sexuality published between 1999 and 2018 were examined for the presence of sexuality definitions. Sexuality themes discussed in each article were recorded, and results were tabulated. Results Few articles explicitly provide a definition of 'sexuality' as it pertains to later life. Definitions from articles that defined sexuality explicitly were inconsistent across studies. Topics included in implicit and explicit definitions of sexuality were disparate across studies and included a diverse range of sexuality dimensions. Conclusion Greater consistency is needed in how “sexuality” in later life is defined across studies and should be informed by data so that it accurately reflects the sexual experiences of older adults.
... The initial baseline study (Study 1; n = 153) was conducted in June 2016. The sample was then divided into two groups: a control group (n = 75), and an experimental group (n = 78) who received narrative therapy [28][29][30][31][32]. The second wave (Study 2; n = 136) was conducted one month after the baseline study. ...
... It was then further conceptualised with an eight-factor structure by splitting interpersonal understanding into altruism and leadership and extracting emotional management from life skills; the other four factors remained unchanged. Hence, the latest version of the WDS comprises 66 items with eight dimensions, namely self-knowledge (items 1-4), emotional management (items 5-9), altruism (items [10][11][12][13][14][15][16][17][18][19][20], inspirational engagement (items [22][23][24][25][26][27][28][29][30][31], judgment (items [32][33][34][35][36][37][38][39], life knowledge (items [40][41][42][43][44][45][46][47][48][49][50], life skills (items 51-61) and willingness to learn (62)(63)(64)(65)(66), evaluated with a seven-point Likert type scale, ranging from 1 = strongly disagree to 7 = strongly agree [5]. ...
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Full-text available
This study was to develop an 18-item Brief Wisdom Development Scale, based on the original 66-item Wisdom Development Scale, and evaluate the psychometric properties of the proposed scale using a sample of older adults. This longitudinal study recruited 153 community-dwelling adults (mean = 72.55 years old; SD = 8.47) from older adult service centres. Using a repeated measures design, the study obtained four waves of data from the participants over 12 months. The Brief Wisdom Development Scale (BWDS) was developed based on the Stepwise Confirmatory Factor Analytical approach (SCOFA), with further verification of its factorial validity using confirmatory factor analysis (CFA). The results suggest that the BWDS comprising 18 items with a six-factor structure is comparable with its full version and possesses good psychometric properties in internal consistency, concurrent validity, and factorial validity. The BWDS provides an efficient, reliable, and valid construct to measure wisdom. The implications for research development are discussed here.
... On the interpersonal level, scripts are negotiated and adjusted between partners in sexual interactions (e.g., "We are OK with having oral sex or just cuddling when one of us is not feeling well"; "My husband requires intercourse once daily, so I comply"). Finally, on the intrapsychic level, sexual scripts consist of personal fantasies, motivations, and subjective interpretations (e.g., "For me, sex should be fun"; "I'm a widow, I should not seek a new partner") (see Muruthi et al., 2018;Simon & Gagnon, 1986. Sexual scripts can reinforce or limit an individual's sexual expression, which may be particularly visible in the case of the older generation. ...
Article
Older adults remain sexually active well into later life; yet, there is no consistency in the literature about what sex means to them. The study described in this paper investigated the understanding of sexual activity as reported by 30 women and men from Poland, aged 65 to 82 (M = 71, SD = 5,24). Semi-structured interviews were thematically analyzed in relation to sexual scripts theory and the participants’ specific sociocultural background. The results demonstrate the diversity of opinions on what sex is: from penetrative intercourse, through various expressions of physical intimacy, to emotional intimacy as a central concept. The dominant perception of sex as intercourse among some study participants evolved into an intimacy-oriented and partner-focused activity, with the discovery of fondling and female sexual pleasure as components of sex. Certain life events – such as ending a long-term marriage or engaging in a new romantic relationship – were identified as facilitating this change. Notable similarities in older women’s and men’s perceptions of satisfying sex in later life were observed. Acknowledging the nuanced meaning of sex for this population can contribute to a better understanding of the specificity of older adults’ sexuality.
... Gagnon and Simon's influential sexual script theory (2005) has played a central role in understandings of sexuality as taking shape along societal and cultural expectations. Still, little work has explored how sexual scripts influence older people's experiences of sexuality (Muruthi et al., 2018). Pervasive ageist sexual scripts where sexuality is deemed inappropriate, dysfunctional or non-existent in later life influence how older people perceive themselves sexually and deter them from engaging in sexual activity (Traeen et al., 2019). ...
Article
Full-text available
New sexual scripts on later life are emerging, discourses on “sexy oldies” challenge pervasive discourses on asexual old age. Still, sexuality among people with dementia, who are generally older, is rarely affirmed. Research on sexuality and dementia is, moreover, dominated by biomedical accounts that regard sexual and intimate behaviours as expressions of pathology. However, sexuality and intimacy could be significant aspects of later life, also when living with dementia. This qualitative study explores experiences of sexuality and intimacy among heterosexual couples where one partner was diagnosed with Alzheimer’s disease. Interviews were conducted with seven couples, aged 55–87, and both the person with the dementia diagnosis and their partner participated. The findings point to a diversity of experiences, with differences between the older and younger couples. The older couples experienced changes more as a result of embodied ageing, and sexuality and intimacy were experienced as sources of pleasure, comfort and recognition. The younger couples understood changes more as caused by Alzheimer’s disease and experienced a greater loss of intimacy and desire. The study shows how experiences of sexuality and intimacy when living with dementia are shaped by varying sexual scripts and expectations of health in different parts of the life course.
... Narrative therapy is sometimes used in counseling to help identify and counteract repeating "scripts." 50 In such a setting, the conceptual framework can be used to help a clinician gently prompt a client to discuss topics that may not outwardly appear to be related to the problem being treated but may provide important contextual information in developing a treatment plan. By guiding conversations using the proposed conceptual framework, clinicians can work with clients to identify problematic scripts that are impacting their sexuality that may not have been identified in sessions otherwise. ...
Article
Full-text available
Introduction: There is currently limited research that examines the meaning of sexuality at midlife and later life. Aim: This study investigates how heterosexual men and women in mid- and later life perceive their sexuality and the factors that influence it. Methods: Group concept mapping was used to produce a conceptual map of the experience of sexuality for heterosexual adults ages 45 years and above. Group concept mapping data were collected using 6 open-ended survey questions that asked about sexuality, intimacy, and desire. Thematic analysis was used to examine how participants perceived their sexuality to have changed as they aged. Thematic analysis data were collected using a single open-ended survey question. Main outcome measure: Statements generated from 6 of the open-ended survey questions were rated by participants using a 5-point Likert scale for how important participants felt that each statement was to themselves personally. Participants responses to the seventh open-ended survey question were examined using thematic analysis to understand whether participants felt that their sexual experiences had changed over time and, if so, how they had changed. Results: Eight themes were identified across the different phases of group concept mapping. These were, in order of importance, partner compatibility, intimacy and pleasure, determinants of sexual desire, sexual expression, determinants of sexual expression, barriers to intimacy, sexual urges, and barriers to sexual expression. Seven areas of change were identified in terms of perceived changes to sexuality with age. These included changes to perspective, relationship dynamics, environment, behavior, body/function, sexual interest/desire, and sexual enjoyment. Conclusion: The results highlight the prioritization of interrelationship dynamics in mid- and later life sexuality over sexual functioning and sexual urges. These findings may facilitate the development of new perspectives on how sexuality is experienced in the later years and provide new avenues for intervention in situations where sexual problems arise. Macleod A, Busija L, McCabe M. Mapping the Perceived Sexuality of Heterosexual Men and Women in Mid- and Later Life: A Mixed-Methods Study. Sex Med 2019; XX:XXX-XXX.
... Narrative therapy is sometimes used in counseling to help identify and counteract repeating "scripts." 50 In such a setting, the conceptual framework can be used to help a clinician gently prompt a client to discuss topics that may not outwardly appear to be related to the problem being treated but may provide important contextual information in developing a treatment plan. By guiding conversations using the proposed conceptual framework, clinicians can work with clients to identify problematic scripts that are impacting their sexuality that may not have been identified in sessions otherwise. ...
Article
Full-text available
Sexuality and intimacy, including contact, tenderness, and love, are important at every life stage. Intimate expression is especially vital at the end of life, when relationships with loved ones are time limited. Unfortunately, care providers often ignore the potential need for sexual expression, especially at the end of life. In this article, we consider current research on sexuality and end-of-life care and situate these two fields in an ecological framework. We explore how end-of-life sexuality and intimacy can be supported by practitioners in multiple nested contexts and provide suggestions for theoretically-driven interventions. We also provide reflexive considerations for practitioners.
Article
Full-text available
In 2012/2013 the English Longitudinal Study of Ageing (ELSA) included a comprehensive Sexual Relationships and Activities Questionnaire (SRA-Q). A total of 7,079 men and women mainly aged 50 to >90, primarily heterosexual and in a coupled relationship, completed the SRA-Q, answering a series of questions about their attitudes to sexual relationships, their own sexual activities, problems and concerns with sexual functioning, and quality of intimate relationships. The questions aimed to gain insights into the ways in which sexual relations and activities related to health, wellbeing and other lifestyle factors change as people grow older. The primary mode of data collection was a tick box response to a series of questions. However, at the end of the questionnaire an open comment box was provided, which asked respondents whether there was anything else that they would like to say; 1,084 respondents provided additional information and these comments created a unique qualitative data-set. The analysis of the data then illustrated how people's health, relationships, experiences and perceptions of ageing, along with sexual satisfaction, impact on sexual relationships and activities.
Book
Preface. 1. An Introduction to Elderly Sexuality. 2. Knowledge of Elderly Sexuality. 3. Attitudes toward Elderly Sexuality. 4. Elderly Sexuality within an Institutional Context. 5. Elderly Sexuality and Disability. 6. HIV/AIDS among Older Adults. 7. Women's issues in elderly sexuality. 8. Men's Issues in Elderly Sexuality. 9. Elderly Sexuality in Traditional and Non-Traditional Relationships. 10. Looking to the Future of Elderly Sexuality.
Article
Sexuality is a dimension that concerns human health with profound implications not only in the biological and psychological aspects, but also in the social and cultural dimensions, affecting all ages of life. Sexuality in old age is still conditioned by biases, prejudices and from a stereotyped vision, which considered older people as “asexual”, in spite of several studies and surveys showing that older persons have sexual potential to express. In population surveys, a fair number of men and women aged over 60 years reported having sex at least once a month. The most influential predictor of sexual activity seems to be the physical health in older men, and the quality of the relationship in older women. The most common sexual disorders are erectile dysfunction and delayed ejaculation in older men, and reduced sexual interest, arousal disorder, female orgasmic disorder, genitopelvic pain and ailments of penetration in older women. A careful evaluation can identify the presence and severity of disorders in different phases of the sexual response cycle. The management of sexual dysfunction in older people may include reassurance, education, sex therapy and/or the use of drugs in specific cases. Sexuality in patients with dementia may arise as inappropriate sexual behaviour (ISB) due to behavioural disinhibition. Manifestations of ISB can be very distressing for family members and other caregivers and can present substantial challenges for staff and health care providers in long term care. Although there is no established treatment algorithm for dementia-related ISB, there are various non-pharmacological and pharmacological treatments, which can help in the management of these patients.
Article
A number of unique physical, psychological, and social factors affect individuals as they achieve late life including, unfortunately, societally imposed, and internalized ageism. Women face a unique challenge in this regard, as this “-ism” often intersects with and compounds lifelong disempowering social forces (Rosenthal, 199046. Rosenthal, E. R. (1990). Women and varieties of ageism. Journal of Women & Aging, 2, 1–6. doi:10.1300/J074v02n02_01View all references; Saucier, 200447. Saucier, M. G. (2004). Midlife and beyond: Issues for aging women. Journal of Counseling & Development, 82, 420–425. doi:10.1002/j.1556-6678.2004.tb00329.xView all references). Furthermore, a majority of caregivers are women, which places additional burdens on this group. The current article proposes a time-limited, skills-based cognitive-behavioral treatment model based on feminist principles that targets the myths and misconceptions regarding aging in order to improve quality of life and decrease depressive symptoms in older adults and their caregivers.
Book
Sleep disorders cause considerable morbidity and distress in the aging population. By highlighting the clinical diagnosis and management of sleep disorders, this volume provides a valuable resource for all those involved in health care of older individuals. The changes in sleep patterns that occur during normal aging are described, followed by authoritative chapters on the presentation of various age-related sleep disorders. The book deals with the range of therapeutic measures available for managing these disorders and gives insight to potential areas of research that have emerged in the last few years, such as the study of circadian rhythms in later life, sleep patterns associated with co-morbidities and the use of quality-of-life measurement tools to determine sleep quality as we age. This volume is relevant to sleep disorders specialists, psychiatrists, geriatricians and gerontologists, and any professionals and researchers working in the interdisciplinary areas of sleep and aging.