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“In the third text using his Master Conflict Theory, Dr. Betchen illustrates how to
deal with unmet sexual and relational expectations in conflicted couples. Betchen is
masterful in integrating psychodynamic and systemic protocols, producing another
valuable resource for beginning and expert clinicians alike.”
Nancy Gambescia, PhD, Former Director, Post-​Graduate Sex Therapy
Program, Council for Relationships, Philadelphia, Pennsylvania

“In Unmet Expectations, Dr. Betchen masterfully synthesizes theory and practice
into a highly important text addressing the core issues of what brings couples into
treatment. Replete with diverse clinical examples, he outlines a well-​constructed,
comprehensive process by which therapists most effectively can conceptualize and
implement Master Conflict Theory step-​by-​step. This is a must-​have for a therapist
at any stage of practice.”
Katherine Hertlein, PhD, Department of Psychiatry and Behavioral
Health, University of Nevada, Las Vegas

“In Unmet Expectations, Betchen uses his Master Conflict Theory to explain why
some couples continue to fall short of what they want and how they pull unsuspecting
therapists into the same unsatisfying pursuit. In his usual insightful way, Betchen
cuts through the confusion to explain the dynamics at work for both romantic part-
ners and how a therapist can skillfully offer these clients the ability to grow beyond
the limits of their past. And, as with the rest of his writing, it is rich with clinical
acumen that will make you a better therapist with both couples and individuals.”
Ari Tuckman, PsyD, author ADHD After Dark:
Better Sex Life, Better Relationship
Unmet Expectations in Couple
and Sex Therapy

Stephen J. Betchen illuminates unmet expectations as one of the leading causes

of relationship problems, offering an integrative, systemic, and conflict-​oriented
treatment model that will help both therapists and couples develop happier and
more realistic relationships.
This clinical guide helps therapists provide couples with the ability to rec-
ognize the origin of their expectations and when their expectations might be
realistically or unrealistically too high or low. It defines and demonstrates
the complexity of what met or unmet expectations are, identifying common
symptoms as anger, incessant bickering, anxiety, disappointment, disillusion-
ment, and sadness. Chapters outline how to determine the origin and impact of
unmet expectations before discussing how and why we choose our partners that
do or do not meet our needs. Addressing sociocultural factors in depth, Betchen
provides tools to assess and treat both sexual and non-​sexual symptoms and
includes a chapter on how to manage the issue of when a therapist doesn’t meet
the expectations of their clients.
The book is invaluable for therapists who work with couples as well as
trainees and supervisors in couple, family, and sex therapy graduate and post-​
graduate programs.

Stephen J. Betchen, DSW, LMFT, is an AAMFT-​approved supervisor and

AASECT certified supervisor. He currently maintains a full-​time private prac-
tice in New Jersey specializing in couples and sex therapy.
Unmet Expectations in
Couple and Sex Therapy
Helping Couples Negotiate
Realistic Relationships

Stephen J. Betchen
Designed cover image: © Getty Images
First published 2024
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2024 Stephen J. Betchen
The right of Stephen J. Betchen to be identified as author of this work
has been asserted in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
Library of Congress Cataloging-​in-​Publication Data
Names: Betchen, Stephen J., 1954– author.
Title: Unmet expectations in couple and sex therapy: helping couples
negotiate realistic relationships / Stephen J. Betchen.
Description: New York, NY : Routledge, 2024. |
Includes bibliographical references and index.
Identifiers: LCCN 2023018148 (print) | LCCN 2023018149 (ebook) |
ISBN 9781032417301 (hardback) | ISBN 9781032417295 (paperback) |
ISBN 9781003359470 (ebook)
Subjects: LCSH: Sex therapy. | Couples therapy. | Marital psychotherapy.
Classification: LCC RC557 .B48 2024 (print) |
LCC RC557 (ebook) | DDC 616.89/1562–dc23/eng/20230607
LC record available at https://lccn.loc.gov/2023018148
LC ebook record available at https://lccn.loc.gov/2023018149
ISBN: 978-​1-​032-​41730-​1 (hbk)
ISBN: 978-​1-​032-​41729-​5 (pbk)
ISBN: 978-​1-​003-​35947-​0 (ebk)
DOI: 10.4324/​9781003359470
Typeset in Times New Roman
by Newgen Publishing UK
Helen Singer Kaplan, Elisabeth Young-​Bruehl and
Najla Kowalewski

– ​Three esteemed women whose personal words of encouragement

gave me the confidence to both practice and write.
Contents

About the Author xiii

Acknowledgments xiv
Preface xv

SECTION I
Understanding the Expectations of Couples 1

1 Introduction: Complexity and Conflict 3

Consequences 3
Pervasiveness 5
Complexity 6
The Continuum 6
Types 8
Internal Conflict 11
2 The Origin of Expectations 15
The Mother–​Infant Bond 15
Sigmund Freud 15
Anna Freud 16
Melanie Klein 17
Donald Winnicott 19
John Bowlby 20
The Family of Origin 21
Indulged/​Spoiled 21
Abused/​Neglected 23
Mixed Messages 24
Broken Promises 25
Traumatic Events 26
Siblings with Different Expectations 26
x  
Contents

3 Mate Choice and Expectations 29

4 Sociocultural Influences 34
Society 34
Money/​Finances 35
Work vs. Domestic/​Family Obligations 36
Changes in Society 37
Culture 39
American-​Born Greek Man and American-​Born Greek Woman 40
American-​Born Italian Man and American-​Born Italian Woman 41
American-​Born WASP Woman and Arab-​born Man (Jordanian) 42
American-​Born Jewish Woman and Israeli-​Born Man 43
American-​born Man and Columbian-​Born Woman 45
Israeli-​Born Man and Israeli-​Born Woman 46
Arab-​born Man and Arab-​Born Woman (Lebanese) 47
Asian-​Born Man and Asian-​Born Woman (Indian) 47
Irish-​Born Woman and Egyptian-​Born Man 48
Religion 49
Christian Man and Christian Woman (Methodist) 49
Jewish Man and Christian Woman (Lutheran) 50
Race 51
Black Man and Black Woman 51
Black Man and White Woman 51
Asian Man and Asian Woman (Chinese) 52
Sex Orientation 53
Gay Male Couple 53
Lesbian Couple 54

SECTION II
Clinical Assessment of Expectations 61

5 Assessing Couples with Unmet Expectations 63

The Initial Contact 63
The First Session 65
Questions for the Genogram 69
Interactional Styles 75
Symmetrical Styles 75
Complementary Styles 77
Assessing Latisha and Lucas 79
The Initial Contact 79
The First Session 79
 Contents   xi

The Genogram 81
Interactional Style 82
Assessment Results 83
Clinical Recommendations 84
Assessing Olga and Simon 84
The Initial Contact 84
The First Session 86
The Genogram 86
Interactional Style 87
Assessment Results 87
Clinical Recommendations 88

SECTION III
Clinical Treatment 91

6 Treating Couples with Unmet Expectations 93

Treatment Objectives and Therapeutic Goal 93
Sex Therapy Exercises 94
The Sabotaging of Sex Therapy Exercises 96
Selected Sexual Disorders and Exercises 98
Clinical Case Examples 104
Krish and Amita: Nonsexual Symptom –​Lack of Ambition 104
Initial Contact 104
First Session 104
Genogram 106
Interactional Style 107
Assessment 107
Treatment 109
Michael and Sharon: Nonsexual Symptom –​Feeling Unloved 116
Initial Contact 116
First Session 116
Genogram 118
Interactional Style 119
Assessment 119
Treatment 120
Dean and Maxine: Sexual Symptom –​Genito-​Pelvic Pain/​Penetration
Disorder (Vaginismus with Exercises) 126
Initial Contact 126
First Session 128
Genogram 128
Interactional Style 129
xii  
Contents

Assessment 129
Treatment 131
Treating Ken and Sybil: Sexual Symptom –​Premature
Ejaculation (PE) 140
Initial Contact 140
The First Session 142
Genogram 142
Interactional Style 143
Assessment 143
Treatment 144
7 The Therapist’s Expectations 157
The Therapist’s Failure to Structure Treatment 158
The Therapist’s Expectation of Reciprocity 158
The Therapist’s Misplaced Empathy 159
When the Therapist Rushes Clinical Progress 159
The Therapist’s Worst Fantasy 161
When the Therapist Expects Too Little from Couples 162
The Dynamics of the Therapist’s Conflict 163

Epilogue 166
Index 170
About the Author

Stephen J. Betchen, DSW, is a licensed marriage and family therapist and a certi-
fied sex therapist. He completed his doctorate at the University of Pennsylvania
with a specialization in marriage and family therapy and trained at Penn’s
Marriage Council of Philadelphia. He followed with a post-​doctoral fellowship
at the New York Hospital-​Cornell University Medical Center’s Payne Whitney
Clinic in psychology (sex therapy), a clinical psychoanalytic fellowship (clas-
sical) at the Institute of the Philadelphia Association for Psychoanalysis, and
study at the William Alanson White Institute in their Intensive Psychoanalytic
Psychotherapy Program. Dr. Betchen is the author of several scholarly articles
and chapters, magazine pieces and blogs, over 500 newspaper columns, and six
books on relationships. He is an AAMFT-​approved supervisor and an AASECT
diplomate and certified supervisor and a former adjunct clinical professor in
the Department of Couple and Family Therapy at Thomas Jefferson University
and senior supervisor in the post-​graduate Sex Therapy Program at the Council
for Relationships. He currently writes a monthly blog on relationships for
PsychologyToday.com and maintains a full-​time private practice specializing in
couples/​sex therapy in Cherry Hill, New Jersey.
Acknowledgments

My thanks to those couples who have shared their expectations, met and unmet,
with me over the years. Without them this book would never have been written.
I would also like to thank Heather Evans at Routledge who has now served as
editor for my third consecutive book. I could not have asked for anyone more
supportive and open to innovative ideas.
Preface

This is the third book on Master Conflict Theory (MCT) published by Routledge,
although each stand on its own. The first book, Master Conflict Therapy: A New
Model for Practicing Couples and Sex Therapy (co-​authored), outlines the foun-
dation of the model, which was specifically designed to treat couples, and its
origins in Pre-​Socratic Western Philosophy and the Greek theory of opposites.
The second book, Couples in Conflict: Clinical Techniques for Navigating
Sexual and Relationship Control Struggles, applies MCT to chronic control
struggles in couples. This third book, Unmet Expectations in Couple and Sex
Therapy: Helping Couples Negotiate Realistic Relationships, demonstrates the
use of the MCT model in working with couples who are conflicted about what to
expect from their relationships.
After writing the foundation book, I was mainly interested in exploring those
issues that are common to couples but have received only scant attention in the
couples therapy literature. Almost every book on couples therapy mentions the
concepts of “control” and “expectations,” but no therapist or theoretician that
I am aware of has dedicated an entire book to either subject.
By examining control and expectations from the perspective of conflict, these
concepts can be seen in all their complexity, yet are much more understand-
able and treatable. When applying conflict theory, it suddenly makes sense why
someone who claims to want control might also give it up or reject it, and why
an individual with certain expectations might also block them from being ful-
filled. These individuals are in conflict about their desires. A part of them needs
these desires fulfilled and part of them is uncomfortable achieving this. The
counterintuitive conflict theory approach explains, better than any other theory,
why couples are stuck with symptoms for years. As a colleague once said about
the model: “It makes sense of the nonsense.”
Because I have always believed that every couples therapist should have sex
therapy training and vice versa, MCT is designed to treat those couples with
sexual and nonsexual problems. It has never made sense to me that marriage
and family therapy are inextricably linked whereas couples and sex therapy are
not. Families rarely report for therapy because of sexual problems, but this is a
common occurrence for couples.
xvi  
Preface

The master conflict approach is an integrative, systemic approach. And

I believe that it is the most inclusive model available to treat couples. It can be
applied equally to couples regardless of age, race, ethnicity, sexual orientation/​
identity, and to a wide array of problems. In this book, I deal exclusively with
both therapist and couples’ expectations in a sexual and nonsexual context. The
following material is included in this compact but comprehensive text:

• Section I: Understanding the Expectations of Couples – ​in “Chapter 1.

Introduction: Complexity and Conflict,” I define the concept of “expect-
ation” in the context of relationships and address the consequences that can
occur when they go unmet. Because expectations exist on a continuum,
I address several types of expectations (e.g., Realistic Expectations-​High;
Unrealistic Expectations-​Low). And finally, I examine expectations from a
conflict theory perspective.
• “Chapter 2. The Origin of Expectations,” explores how expectations are
generated. This chapter covers the early research on the mother-​infant bond
espoused in the psychoanalytic literature of Sigmund and Anna Freud,
Melanie Klein, Donald Winnicott, and John Bowlby, as well as in the sys-
temic family of origin work of Murray Bowen. The chapter ends with the
MCT model, which has already been established in the literature by the
author.
• In “Chapter 3. Mate Choice and Expectations,” I explain how partners
choose each other based on a shared conflict around expectations.
• In “Chapter 4. Sociocultural Influences,” I demonstrate the pervasiveness of
the concept of expectations by its application to couples of various cultures
(e.g., American-​Born Man and American-​Born Greek Woman; Israeli-​Born
Man and Israeli-​Born Woman). Race, religion, and sexual orientation are
also considered in the context of conflicts and expectations.
• Section II: Clinical Assessment of Expectations – ​“Chapter 5. Assessing
Couples with Unmet Expectations.” helps the couples therapist assess the
symptoms of unmet expectations, nonsexual and sexual. The Genogram
is the assessment tool used in this process. I include sample questions
specifically aimed at helping the therapist assess a couple’s conflict with
expectations and use two detailed cases to illustrate the assessment process.
• Section III: Clinical Treatment – ​“Chapter 6. Treating Couples with Unmet
Expectations,” demonstrates the use of the MCT model to treat couples
suffering from symptoms, nonsexual and sexual, because of an unbalanced
conflict around expectations. The model is made up of a 5-​step treatment
process which includes the uncovering of the couple’s shared conflict and
the differentiation process used to balance or rebalance it. Sexual exercises
and case examples are included.
newgenprepdf

Preface   xvii

• “Chapter 7. The Therapist’s Expectations,” explores the therapist’s own

conflicts around expectations, suggesting that to maximize the effectiveness
of the MCT approach, it would be helpful for the couples therapist to have
experienced personal psychotherapy. Without this background, the therapist
is more likely to have an unbalanced conflict around expectations that may
exacerbate or further unbalance the conflicts of those couples in treatment.
Section I
Understanding the Expectations
of Couples
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