For the sex therapist things are relatively straightforward. After careful analysis of the nature and causes of the dysfunction, the therapist diligently leads the clients through a series of carefully structured and designed homework tasks. Thus previously absent orgasms are experienced, premature ejaculations are brought under control whilst reluctant ones shed their inhibitions, and lost erections once more stand proud without the help of Viagra. For the relationship counsellor, however, sex is a rather more complex and meaningful activity.

What is sex for, besides procreation? This is not an academic question and the answers from those whose relationship problems are focused between the sheets are illuminating. ‘For relief and release,’ some will reply.

‘OK, but you can fulfil that function on your own without need of a partner,’ I point out.

‘Yes, but it’s not the same!’ the man retorts.

‘So what’s the difference?’

‘Well, there’s no-one there wanting you, is there?’ he explains, as if the answer was glaringly obvious. And for the first time that session, she looks across at him.

‘And what’s the difference for you?’ I ask her.

‘Well, when it’s good, I don’t feel so alone afterwards.’

To feel wanted and to feel less alone. Of course, sex has other meanings: a currency of reward or punishment; mutual fun and playfulness; a vehicle for intimacy; an opportunity to experience power and potency, or the excitement of letting go.

But sex isn’t all about the action down below. Much of it takes place in that large erogenous zone located between our ears. I wonder how much the partners know and understand about each other’s desires? How do they approach each other sexually? What are the signals, invitations or rebuffs, and how are these couched, proffered, and interpreted? ‘Oh, I always know when he’s in the mood,’ one wife told me. ‘He spends longer in the bathroom before bed, vigorously brushing his teeth.’

If the Desire Stage is about recognition and approach, then the Excitement Stage is about co-operation and communication, ie how we give, take, ask for, and negotiate what we want (or don’t want): ‘Up a bit, down a bit, yes, like that, a bit more’ etc. Some of us have trouble asking, whilst others struggle with receiving. ‘I’m good at sex,’ one young woman boasted. ‘I can perform every trick in the book, as long as I’m in charge of proceedings.’ What she couldn’t bear, was to lie back and allow a partner to pleasure and attend to her.

The Orgasm Stage is about letting go control, and therefore to do with trust. ‘Am I safe to let go with you? And will you still be there for me when I come back to my senses?’ Popular romance has it that simultaneous orgasm is the ideal, the lovers melting into each other in a state of blissful union. The reality is that orgasm is one of the most insular experiences of which a human being is capable. In the moment of orgasm we don’t hear the telephone ring, or see our lover’s face, we briefly leave the world of relationships and plunge into our falling selves.

The Resolution Stage is where we come back to an awareness of our surroundings; ‘It’s cold, pull the covers over. Oh my god, is that the time?’ It is when men describe feeling spent and a woman speaks of feeling full; and the moments when both feel most vulnerable and exposed. It is a time heavy with the challenge of, and opportunity for, intimacy. But when things are bad, it is the time when we feel most alone.

I’ll sometimes invite clients to speak of the part of sex I term coupling. Intromission is the technical term for it, although you might call it penetration, or enclosure, depending on your point of view. I offer the metaphor of a party. If you are the host, your anxieties are to do with whether anyone will come, and if they do, will they appreciate and value what you have on offer, or just eat and drink their fill then clear off leaving you the dishes? Whereas the guest’s anxieties tend to be to do with whether they are really welcome, or are they just tolerated out of duty? Funnily enough, this mirrors the common complaints of women and men sexually. ‘I feel used, like an object,’ she complains, ‘then left with all the mess.’

‘And I feel like a thief in the night,’ he replies, ‘when what I really long for… is to feel wanted.’

Kevin Chandler is a therapist, supervisor and author of Fifty-Minute Hour, a novella about a man dragged along to Relate (in the collection 8 Hours), and the novel Listening In: A Novel of Therapy and Real Life.