Month: December 2020

Sexual Therapy

A basic premise of therapeutic approach originally introduced, and fully supported over the years by laboratory evidence, is the concept that there is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy.

Therapeutic technique emphasizing a one-to-one patient-therapist relationship, effective in treatment of many other psychopathological entities, is grossly handicapped when dealing specifically with male or female sexual inadequacy, if the sexually dysfunctional man or woman is married. Isolating a husband or wife in therapy from his or her partner not only denies the concept that both partners are involved in the sexual inadequacy with which their marital relationship is contending, but also ignores the fundamental fact that sexual response represents (either symbolically or in reality) interaction between people. The sexual partner ultimately is the crucial factor.

If treatment is directed separately toward the obviously dysfunctional partner in a marriage, the theoretically “uninvolved” partner may actually destroy or negate much therapeutic effort, initially from lack of knowledge and understanding and finally from frustration.

Sexual Response

If there is little or no information of sexual import, or for that matter, of total treatment progress reaches the wife of the impotent husband, she is in a sincere quandary as to the most effective means of dealing with the ongoing marital relationship while her husband is in therapy. She does not know when, or if, or how, or under what circumstances to make sexual advances, or whether she should make advances at all. Would it be better to be simply a “good wife,” available to her husband’s expression of sexual intent, or on occasion should she take the sexual initiative.

During actual sexual functioning should she maintain a completely passive, a somewhat active, or a mutually participating role? None of these questions, all of which inevitably arise in the mind of any intelligent woman contending with the multiple anxieties and the performance fears of an impotent husband, find answers in the inevitable communication void that develops between wife and husband when one is isolated as a participant in therapy.

Of course, an identical situation develops when the wife is non orgasmic and enters psychotherapy for constitution of effective sexual function. It is the husband that does not know when, or if, or how, or under what circumstances to approach her sexually.

If he approaches his wife in a physically demanding manner, she reasonably might accuse him of prejudicing therapeutic progress. If he delays or even restrains expression of his sexual interest, possibly looking for some signal that may or may not be forthcoming, or hoping for stone manner of behavioural guideline, he may be accused of having lost interest in or of having no real concern for his sexually handicapped wife.

Not infrequently he also is accused (probably with justification) of being a significant contributor to his wife’s sexual dysfunction. But if no professional effort is made to explain his mistakes or to educate him in the area of female sexual responsivity, how does he remove this continuing road block to his wife’s effective sexual function?

Methods of therapy using isolation techniques when approaching clinical problems of sexual dysfunction attempt to treat the sexually dysfunctional man or woman by ignoring half of the problem, the involved partner. These patient-isolation techniques have obliterated what little communication remained in the sexually inadequate couple at least as often as the techniques have returned effective sexual functioning to the distressed male or female partner.

It should be emphasized that the Foundation’s basic premise of therapy insists that, although both husband and wife in a sexually dysfunctional marriage are treated, the marital relationship is considered as the patient. Probably this concept is best expressed in the statement that sexual dysfunction is indeed a husband and wife problem, certainly never only a wife’s or only a husband’s personal concern.

Dual Sex Therapy

Definitive laboratory experience supports the concept that a more successful clinical approach to problems of sexual dysfunction can be made by dual-sex teams of therapists than by an individual male or female therapist.

Certainly, controlled laboratory experimentation in human sexual physiology has supported unequivocally the initial investigative premise that no man will ever fully understand woman’s sexual function or dysfunction. What he does learn, he learns by personal observation and exposure, repute, or report, but if he is at all objective he will never be secure in his concepts because he can never experience orgasm as a woman. The exact converse applies to any woman.

Since it soon became apparent in the laboratory that each investigator needed an interpreter to appreciate the sexual responsivity of the opposite sex, it was arbitrarily decided that the most theoretically effective approach to treatment of human sexual dysfunction was to include a member of each sex in a therapy team. This same premise applied in the clinical study provides husband and wife of a sexually dysfunctional couple each with a friend in court as well as an interpreter when participating in the program.

By repute, report, observation, and by personal exposure in and out of bed, she too learns to conceptualize male sexual functioning and dysfunctioning, but she will never fully understand the basics of male sexual responsivity, because she will never experience ejaculatory demand or seminal fluid release.

For example, it helps immeasurably for a distressed, relatively inarticulate, or emotionally unstable wife to have available a female cotherapist to interpret what she is saying and, far more important, even what she is attempting unsuccessfully to express to the uncomprehending husband and often to the male cotherapist as well.

Conversely, it is inevitably simpler for any wife to understand the concerns, the fears, the apprehensions, and the cultural pressures that beset the sexually inadequate man that is her husband when these grave concerns can be defined simply, effectively, and unapologetically to her by the male cotherapist. The Foundation’s therapeutic approach is based firmly upon a program of education for each member of the dysfunctional couple.

Multiple treatment sessions are devoted to explanations of sexual functioning with concentration on both psychological and physiological ramifications of sexual responsivity. Inevitably, the educational process is more effectively absorbed if the dual-sex therapy teams function as translators to make certain that no misunderstandings develop due to emotional or sexual language barriers.

The ultimate level in couple communication is sexual intercourse. When there is couple complaint of sexual dysfunction, the primary source of absolute communication is interfered with or even destroyed and most other sources or means of interpersonal communication rapidly tend to diminish in effectiveness.

Again, this loss of warmth and understanding is frequently due to fear and/or lack of comprehension on the part of either marital partner. The wife is afraid of embarrassing or angering her husband if she tries to discuss his sexually dysfunctional condition. The husband is concerned that his wife will dissolve in tears if he mentions her orgasmic inadequacy or asks for suggestions to improve his sexual approaches.

Usually the failure of communication in the bedroom extends rapidly to every other phase of the marriage. When there is no security or mutual representation in sexual exchange, there rarely is freedom of other forms of marital communication.

It should be made abundantly clear, in context, that Foundation philosophy does not reflect the concept that sexual functioning is the total of any marital relationship. It does contend, however, that very few marriages can exist as effective, complete, and ongoing entities without a comfortable component of sexual exchange. With detailed interchange of information, and with interpersonal rapport secured between marital partners, the dual-sex therapy team moves into direct treatment of the specific sexual inadequacy brought to its attention.

After roundtable discussion, the team anticipates that both partners in the distressed couple will have become reassured and relatively relaxed by the basic educational process and will have established a significant step toward effective communication. Treatment approaches to specific sexual dysfunctions will be discussed separately under appropriate headings in subsequent individual case.

Sexual Advice

From a professional point of view, formal training contributes little of positive value if a specific discipline is emphasized to a dominant degree in the treatment of sexual dysfunction. It is current foundation policy to pair representatives of the biological and behavioural disciplines into teams of cotherapists.

From a purely practical point of view, there is obvious advantage in having a qualified physician as a member of each team. This disciplinary inclusion avoids referring embarrassed or anxious couples to other sources for their vitally necessary physical examinations and laboratory (metabolic function) evaluations. The behavioural member provides invaluable clinical balance to each team with his or her particular contribution of psychosocial consciousness.

Many combinations of disciplines should and will be used experimentally as representative individuals are available, complying with the Foundation’s basic concept of a member of each sex on each team.

The Foundation is constantly looking for professionals with the individual ability necessary to work comfortably and effectively with people in the vulnerable area of sexual dysfunction. There must be an established research interest; this requirement is peculiar to the Foundation’s total research program but is unnecessary for purely clinical programs.

There also must be an expressed interest in and demonstrated ability to teach, for so much of the therapy is but a simple direct educational process. Not a negligible requirement is the willingness to make a commitment to a seven day week or its equivalent.

Most important, the individual must be able to work in continual cooperation with a member of the opposite sex in what might be termed a single standard professional environment. Team dominance by virtue of sex-linked or discipline-linked status by either cotherapist would tend to dilute their mutual effectiveness in this particular psychotherapeutic design.

Finally, individual members of any dual sex therapy team, if they are to concentrate professionally on the distress of the couples complaining of sexual inadequacy, must be fully cognizant and understanding of their own sexual responsivity and be able to place it in perspective. They must be secure in their knowledge of the nature of sexual functioning, in addition to being stable and confident in their own sexuality, so that they can in turn be objective and unprejudiced when dealing with the controversial subject of sex at the fragile level of its dysfunctional state.

Many men and women who are neither personally secure in nor confidently knowledgeable of sexual functioning attempt the authoritative role in counselling for sexual inadequacy. There is no place in professi6nal treatment of sexual dysfunction for the individual man or woman not culturally comfortable with the subject and personally confident and controlled in his or her own manner of sexual expression.

The possibility for disaster in a therapeutic program dealing with sexual dysfunction cannot be greater than when the therapist’s sexual prejudices or lack of competence and objectivity in dealing with the physiology and psychology of sexual functioning become apparent to the individuals or couples depending upon therapeutic support.

If the therapist is in any way uncomfortable with the expression of his or her own sexual role, this discomfort or lack of confidence inevitably is projected to the patient, and the possibility of effective reversal of the couple’s sexual dysfunction is markedly reduced or completely destroyed.

At onset of the program, couples were requested to devote three weeks of their time to the therapeutic program. This concept of time commitment was maintained for the first two years of this clinical research program.

Evaluation of sexual experience made clear that three weeks was simply too long for a couple’s comfortable commitment of time away from home and, from the stand point of therapy demand also was an unnecessarily extended period. Therefore, the outer limit of time demand became two weeks and has remained so for the last nine years.

An important clinical contribution to effective therapy in sexual dysfunction can be made by scheduling husband and wife partners on a continuum; all units in the acute phase of the treatment program are seen daily (seven days a week) during their two weeks in the foundation’s intensive educational program.

One of the therapeutic advantages inherent in the two-week phase of rapid education and/or symptom reversal is the isolation of the husband and wife partners from the demands of their everyday world.

Approximately 90 percent of all couples treated by the Foundation are referred from outside the St. Louis area. These people are regarded and treated as though they were guests. Every effort is made to insure their enjoyment of a “vacation” during time spent in the city.

Care is taken to familiarize them with the geographic area and supply up-to-date information regarding restaurants, areas of interest, amusement, educational potentials, etc.

Inevitably they rekindle, in part, their own communicative interests when there is no child crying, no secretary reminding of business commitments, or no relatives or friends inadvertently intruding. With this isolation from social demand, opportunity develops for closeness or a unity that almost always is missing between marital partners facing crises of sexual dysfunction.

This arbitrary social isolation certainly is an important factor supporting the effectiveness of the therapy program. Under these circumstances protected from outside pressures the marital partners frequently accept for the first time the Foundation’s basic premise that “there is no such thing as an uninvolved partner in any marriage distressed by a complaint of sexual inadequacy.”

Sexual Interest

Yet another advantage of the social-isolation factor is its effect upon the sexual interest of both marital partners. With the subject of sex exposed to daily consideration, sexual stimulation usually elevates rapidly and accrues to the total relationship. This specific psycho physiologieal support is indeed welcome to the cotherapists dealing with the blocking of sexual stimuli in individuals distressed by sexual inadequacy.

To help develop a level of sexual interest:
for the couple which is realistic to their life style, vacations from any form of specific sexual activity are declared for at least two 24-hour periods during the two weeks, in a system of timely checks and balances. However, daily consideration of sexual matters and social isolation continue to give maximum return to this facet of the psychotherapy.

It might be held as part of this therapeutic concept that patients must have the opportunity to make those mistakes which reveal factors contributing to their particular distress. This means of learning is particularly important in reversing sexual dysfunction. In this interest, the patients are told that the cotherapists are not interested in a report of perfect achievement when they are following directions in the privacy of their own bedroom. Article Sponsored Find something for everyone in our collection of colourful, bright and stylish socks. Buy individually or in bundles to add color to your drawer!

The cotherapists are interested in couple’s making their usual errors of reaction and interaction as they involve themselves in situations that provide opportunity for natural response to sexual stimuli. If the mistakes then are evaluated and explained in context, the educational process is infinitely less painful and more lasting. There are significant advantages in this technique.

When mistakes are made, they are examined impartially and explained objectively to the unit within 24 hours of their occurrence. Additionally, they are discussed within the context of the misunderstanding, misconceptions, or taboos that may have led to or influenced their occurrence initially.

There is yet another specific advantage in daily conferences. If the distressed unit waits a matter of days after mistakes are made before consulting authority, the fears engendered by their specific episode of inadequacy or mistake in performance increase daily in almost geometric progression. In such a situation, alienation between partners is a common occurrence. By the time the next opportunity for consultation arises, a great deal of the effectiveness of prior therapy may have been destroyed by the takeover of the fears.

Fears of performance do not wait a few days or a week until the next appointment; in the meantime, the couple, separately or together, must use their own methods of coping. Most often this will be withdrawal of sexual or total communication, which places them further away from altering the sexual distress than before therapy was initiated.

When patients do not make mistakes during their acute phase of treatment, the cotherapists arrange for them to do so. It is inevitably true that individuals learn more from their errors than from their ability to follow directions effectively on the first attempt.

If marital partners reverse their sexual dysfunction and fully understand, through comparison with episodes of failure, why and what made it possible for them to function effectively, the probability of reduplicating the success in the home environment is increased immeasurably.

As evidence of the advantage to the therapeutic program of the unit’s social isolation, those couples referred from the St. Louis area require three weeks to accomplish symptom reversal rather than the standard two weeks for those living outside the local area. It is difficult to isolate oneself from family demands and business concerns if treatment is being ear tied out in the environment in which the couple lives.

For this reason it has been found more effective to see patients referred from the St. Louis area on a daily basis for the first week, there after five times a week, and to assign a total of three weeks to accomplish reversal of symptomatology. Partners in sexually distressed marriages who cannot or do not isolate themselves from the social or professional concerns of the moment react more slowly, absorb less, and communicate at a much lower degree of efficiency than those advantaged by social retreat.

The Foundation’s request for two weeks’ withdrawal from daily demands, at first rather an overwhelming suggestion to most patients, pales into insignificance when compared to the isolation demands engendered by necessary hospitalization for acute surgical or medical problems. When the couple’s presenting complaint is one of sexual inadequacy, it should constantly be borne in mind that there is not only the equivalent of two distressed people but also an impaired marital relationship to be treated.

In therapeutic procedure involving the dual-sex teams, the control within the team rests primarily with the silent cotherapist during treatment sessions. The silent cotherapist is literally in charge of each therapeutic session. He or she, as the observer, is watching for and evaluating levels of patient receptivity to therapeutic concept and to the educative and directive material presented by the active cotherapist.

The silent cotherapist’s role is to define, if possible, degrees of understanding, acceptance, or rejection of material and to identify immediate areas of concern in either member of the dysfunctional couple.

The silent observer really acts as the coach of the team. As soon as it is apparent that there is need for a situational change of pace, that the individual subject under discussion can be presented in a different, possibly more acceptable or understandable manner, or that it requires further clarification, the roles reverse and the cotherapist functioning previously as the observer, fortified and advantaged with the salient features of patient reaction to the on going situation, becomes the active discussant.

The previous discussant then assumes the role of observer. And so roles change back and forth as indicated by patient responses or the immediate need for a particular sex-linked definition or explanation of material. Much of the patient’s reaction can be identified by the observer that cannot be immediately apparent to any individual therapist simultaneously attempting to direct therapy and to evaluate levels of patient receptivity.

In the finite cooperative interaction between mutually confident cotherapists in any dual-sex therapy team, the currently dominant partner influence at any particular time is not being exercised by the one that is talking, but by the one that is observing.

Inevitably any sexually dysfunctional couple has, as one of its fundamental handicaps, insecurity in any and all sexual matters.

How often have the sexual partners asked themselves if they are really “complete” as individuals?
Has their functional efficiency been diminished in stressful situations other than in bed?
How do their patterns of sexual response compare to those of their peers?
How can a particular sexual situation or any confrontation with material of sexual content be handled without awkwardness or embarrassment?

The cotherapists encounter a multiplicity of these problems to which they can respond by holding up a professional “mirror” and helping the marital partners understand what it reflects. With the non-judgemental mirror available, constructive criticism can be accepted in the same non-prejudiced, comfortable manner in which it must be presented.

With this educational technique of reflective teaching, the distressed couple can be encouraged to take that first step that ultimately presages success in therapy for sexual dysfunction. The step consists of putting sex back into its natural context.

Seemingly, many cultures and certainly many religions have risen and fallen on their interpretation or misinterpretation of one basic physiological fact. Sexual functioning is a natural physiological process, yet it has a unique facility that no other natural physiological process, such as respiratory, bladder, or bowel function, can imitate.

Sexual responsivity can be delayed indefinitely or functionally denied for a Iifetime. No other basic physiological process can claim such male ability of physical expression.

With the advantage of this unique characteristic, sexual functioning can be easily removed from its natural context as a basic physiological response. Everyone takes advantage of this characteristic every day as he rejects or defers untimely or inappropriate sexual stimuli in order to comply with the social requirements of the moment.

Religions have found dedicated support from those willing to sacrifice their functional physical expression of sexuality as a devotion to or an appeasement for their god or gods. If the natural physiological process of human sexual response did not encompass this completely unique adaptability, the sacrifice of denying one’s sexual functioning for a lifetime could never have been made.

But the individuals who involuntarily take sexual functioning further out of context than any other are those members of couples contending with inadequacy of sexual function. Through their fears of performance (the fear of failing sexually), their emotional and mental involvement in the sexual activity they share with their partner is essentially nonexistent.

The thought (an awareness of personally valued sexual stimuli) and the action are totally dissociated by reason of the individual’s involuntary assumption of a spectator’s role during active sexual participation.

It is the active responsibility of therapy team members to describe in detail the psychosocial background of performance fears and “spectator” roles. This explanation is best accomplished by the cotherapist of the same sex as that of the individual whose performance fears are to be discussed. Again, education is the basis for therapeutic success, and the dual-sex team can best present this information by following a sex-linked guideline.

Sexual Dysfunction Treatment

In any approach to a psycho-physiological process, treatment concepts vary measurably from school to school and, similarly, from individual therapist to individual therapist. The Reproductive Biology Research Foundation’s theoretical approaches to the treatment of men and women distressed by some form of sexual dysfunction have altered significantly and, hopefully, have matured measurably during the past 11 years. There are founded on a combination of 15 years of laboratory experimentation and 11 years of clinical trial and error.

Sexual Response

When the laboratory program for the investigation in human sexual functioning was designed in 1954, permission to constitute the program was granted upon a research premise which stated categorically that the greatest handicap to successful treatment of sexual inadequacy was a lack of reliable physiological information in the area of human sexual response.

It was presumed that definitive laboratory effort would develop material of clinical consequence. This material in turn could be used by professionals in the field to improve methodology of therapeutic approach to sexual inadequacy. On this premise, a clinic for the treatment of human sexual dysfunction was established at Washington University School of Medicine in 1959, approximately five years after the physiological investigation was begun. The clinical treatment program was transferred to the Reproductive Biology Research Foundation in 1964.

When any new area of clinical investigation is constituted, standards must be devised in the hope of establishing some means of control over clinical experimentation. And so it was with the new program designed to treat sexual dysfunction. Supported by almost five years of prior laboratory investigation, fundamental clinical principles were established at the onset of the therapeutic program. The original treatment concepts still exist, even more strongly constituted today. As expected, there were obvious theoretical misconceptions in some areas, so alterations in Foundation’s policy inevitably have developed with experience.