John and Jane came to see me together. The immediate problem was that Jane, aged 38 years, urgently wanted a baby. John, who was 43, was willing to have a child but was completely ‘off’ sex. They had not had sexual intercourse for more than a year. However, John described himself as being turned on by other women - but he chose to stay faithful to Jane.

Jane’s childhood was spent in a loving family where physical warmth and emotional expression were freely given and received. At school Jane was a high achiever and went on to university after which she made a succesful career as a journalist. In her adolescence Jane's Father, who was a Doctor, developed bouts of intense anger. Jane found this very frightening, although the anger was directed towards her Mother. She remembered that her Mother always gave in to her Father on these occasions.

John’s childhood was more difficult. There were long periods when his Father was absent from home. Emotions were constrained and little physical affection was shown him by his Mother. He, like Jane, was highly successful at school and university where he gained a good History degree. It was at university that John and Jane met. John was very taken with the easy going affection that Jane showed and Jane loved him for his quiet steadiness and attentiveness to her. They were constant companions, sexually excited and satisfied by one another.

They married, but after a few months sexual activity began to tail off and within eighteen months they were hardly having sex at all. Despite this, they remained very close and never rowed. But Jane missed the sex and physical closeness. As John became less available to her she grew unhappy and then anxious about starting a family. She shared her anxiety with John which led to his promising to change. However, nothing changed, and then John started being evasive.

As their therapist I was concerned at their ‘stuckness’: fear of abandonment on his side and fear of anger on hers had led them to a compromise which impoverished the relationship and failed to offer the fulfillment a family might bring. Initially I suggested a programme of sensate focus exercises with a ‘ban’ on sex to help with the physical deprivation they both felt. Sessions were spent working together to understand the issues that underlay his need to avoid sex. It took several months to set in place the tools for good communication between them.

John’s difficulty in allowing himself to be emotionally vulnerable was based in early failures to relate with his Mother. Her depression due to his Father’s protracted absences meant that John experienced her, whilst still a baby, as ‘toxic’. He never bonded with her. This produced in him throughout his later life an intense yearning for closeness matched by an intense fear of what might arise as a consequence.

Jane, for her part, learnt in a straight forward way to confront John with her needs from a loving position. Very gradually he risked trusting himself to her. After three years in therapy they resumed a sexual relationship. They still have time for her to become pregnant and they are clear that they both want to have a family - one of their own which will reflect the important values they have struggled so hard to understand.