People with sexual problems as their presenting complaint generally are not motivated to seek intensive treatment. What they desire is to function sexually as rapidly and normally as possible. Some therapists combine behavioral methods with exploratory techniques. They encourage their patients to verbalize their fears, guilt feelings, and misgivings and deal with resistances in traditional psychotherapeutic ways.
What to expect?
There are advantages to the couples working with the dual-sex therapeutic team since cooperation of both patient members is more easily obtained, resistances can be dealt with directly, misconceptions about sexuality can be effectively brought out in the open, questions about technique are less likely to be distorted, and desensitization of embarrassment and alleviation of guilt feelings are enhanced.
How does it work?
Appropriate treatment for all problematic sexual conditions will therefore require accurate diagnosis. In the case of inhibited sexual excitement with frigidity and impotence, once organic factors and medicinal agents have been ruled out, behavioral sex therapy may be effective in itself, especially when the onset has been recent or the causes minor. But where personality difficulties exist, or anxieties and phobias are strong, coordinate psychotherapy and behavioral sex therapy may be necessary. The same may be said for inhibited female and male orgasm, premature ejaculation, dyspareunia and functional vaginismus. Treatments as cognitive therapy to alter meaning systems, and dynamic psychotherapy to explore conflicts may be useful.
Perhaps the most important element in the treatment is the manner and attitude of the therapist. In working with patients who are seeking to liberate themselves from their sexual fears and inhibitions, the therapist presents as a model of a permissive authority. Therapists have tremendous leverage in working with sexual therapy because they fit into the role of idealized parental figures who can make new rules. An easygoing, non-condemning, matter-of-fact approach is quite therapeutic in its own right. The ideal therapeutic philosophy is that the patient has been temporarily diverted from attaining the true joys of sex and that if there is the desire to do so, it is possible to move toward reaching this goal of enjoyable pleasure without guilt and fear. In brief sexual therapy, countertransference phenomena can fleetingly occur. One must expect that a patient of the opposite sex will sometimes openly or covertly express sexual transference. This is usually handled by a casual matter-of-fact attitude of non-response. Problems occur when the therapist is deliberately or unconsciously seductive with patients.
When is it used?
Sexual problems do not occur in isolation. They appear as a manifestation of coordinate physical, marital, interpersonal, or interpsychic difficulties that are overshadowed by the patient’s concern with the sexual symptom.
Role of therapist:
In many cases the core problem is that of communication, particularly in relation to mutual sexual feelings. Breaking into the facade that sex is dirty, not to be talked about, practiced in the dark, etc. can release both partners and lead to a more natural and spontaneous functioning. Practical considerations, however, may make it impossible to utilize a dual-sex team, and the therapist may have to operate without a cotherapist. In some cases it will be impossible to get the patient’s spouse or sexual partner to come for interviewing. Then the therapist will have to work with the patient alone, briefing him or her on how to instruct and work with the partner. If both partners are available, a 2-week vacation period to initiate treatment is best since there will be less distractions. Here, too, modifications may be necessary; thus when the couple is ready for sexual exercises, a 3- or 4-day holiday may be all that is necessary.