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Sexual Scripts and Narrative Therapy with Older
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.
, Megan McCoy, Ph.D.
, Jessica Chou, Ph.D.
and Andrea Farnham, MS
Assistant Professor in Marriage and Family Therapy, Virginia Tech, Falls Church, Virginia, USA;
Professor in Marriage and Family Therapy, Northcentral University, Prescott Valley, Arizona, USA;
Assistant Professor in Couple and Family Therapy, Drexel University, Philadelphia, Pennsylvania, USA;
Doctoral Candidate in Marriage and Family Therapy and Human Development and Family Science,
University of Georgia, Athens Georgia, USA
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.
Sexual expression plays a signiﬁcant 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 conﬂict 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 signiﬁcant 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, Ofﬁce 202G, Falls Church, VA 22043.
© 2018 Taylor & Francis
THE AMERICAN JOURNAL OF FAMILY THERAPY
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, O’Muircheartaigh, 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 & O’Sullivan, 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, O’Connor, Blake,
& Pendleton, 2016; Morely, 2006). Scripts theory helps to conceptualize how sexual
behavior in older couples’can 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 speciﬁcally 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, insufﬁcient 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 conﬂict 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 satisﬁed 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 one’s 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 inﬂuence 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 difﬁcult (Butler & Lewis, 2002).
Ageist notions about sex
Stereotypical beliefs and attitudes about sexual intimacy between older people
remain a cultural norm, despite the widespread scientiﬁcliteraturecountering
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,
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 man”and “indecent old woman”are 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 humans’sexual 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
Sexual scripts theory
Sexual script theory, developed by Gagnon and Simon (1973), derives from the
symbolic interactionist perspective and incorporates Freud’s 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
inﬂuenced 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 reﬂect individuals’interpretations 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 speciﬁc 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.
A narrative therapy approach offers a collaborative, respectful, non-blaming
approach to client’s 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 client’s personal history and experience, rather than as a static deﬁni-
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, &
In other words, therapists evoke client narratives about sex and listen not only
in regard to client’s 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 therapist’sﬂexibil-
ity to move among various roles at appropriate times, such as the role of expert,
guide, and curious, intelligent “co-conspirator”who 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 difﬁculty 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
Warren described feeling a drastic change after moving:
Well, moving to a retirement community was something…Elizabeth 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 though…things 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 don’t 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 don’t
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
reﬂection 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 clients’perceptions 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-
ren”and links her perceptions of what being older means to prove this plot.
According to Elizabeth, “No one wants a grandmother, that’s why men go for
younger women…I 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 signiﬁcant because it does not ﬁt the cultural scenario that has formed
the outline of her thin description. Feeling unattractive privileges Elizabeth’s
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 reﬂect 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 I’ve 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 don’t 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. It’s 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: Yes…but just hearing how moving has affected him…makes sense of why he
has been so distant lately….
Warren: Moving here has been so hard on me…I miss our house…and I didn’t mean to
be distant…I just wanted to give you space. I thought you didn’t want to be intimate with
me because you never seem to want to when I try…
Elizabeth: I thought you didn’t want to…I 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 client’s 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 couple’s 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 therapist’s 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 inﬂuence 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 conﬂict 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]…I’m sorry that I
have always relied on you to pursue sexual intimacy in our relationship. It just seemed
like that’s 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 be…I want to spend time together…I 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 again…we 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 doesn’t mean that you can’t discover new ways
that can better ﬁt 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 ﬁnding 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
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 ﬁght
their old narrative by solidifying their new story over time (Bermudez & Parker,
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 inﬂuence of con-
textual factors on the development of couples’internal 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 couple’s 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 couples’relationships.
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, speciﬁc 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 &
In addition to considering a couple’s relationship as it is situated in a larger con-
text, therapists must be active in exploring other relative components within the
couple’s 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 deﬁnitions of sex and intimacy and broadening deﬁnitions 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
Lastly, clinicians must examine self of the therapist issues surrounding aging.
Self of the therapist is the internal workings of a therapist, one’s 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 (Andolﬁ& 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.
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 inﬂuence over a couple’s 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 ﬁt a similar sequence of sexual
Future work is needed to examine the ways that conventional wisdom inﬂu-
ences clients’unhelpful 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 inﬂuencing 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
Scholarship is needed on older adult populations speciﬁcally focused on
strength based models of what healthy sexuality and sexual intimacy look
like in satisﬁed 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 inﬂuences 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
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&O’Sullivan, 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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