Thanks YAH. This actually is helpful. I think part of the reason I place such importance on her O is that she kind of skips over the foreplay leading me to feel she is "hurry up and get it done" I'm not feeling her desire to be sexual with me, rather she seems to exhibit an OK, lets take care of you.

Her body image is, I am sure, a part of it. She's about 60 lbs heavier than she feels she should be, and feels largely incompetent because she feels like she isn't doing anything right. Shes in individual counseling and has been for about 2 years. It has helped a little, but I think not as much as she thought it would. Right now, she is not open to going to a different counselor (i.e. for sex therapy). I do think we need some joint counseling, me because I am having a hard time identifying my part in all this. I know from here that it isn't all her.