SEX THERAPY: READINESS OF PATIENTS, POSSIBLE PROBLEMS

Posted by admin on April 6, 2009 under Men's Health-Erectile Dysfunction | Be the First to Comment

Some couples are obviously not ready for sex therapy as indicated by their resistance to the exercise. Typical responses are to blame the surroundings (it was too cold, too slippery, the shower was too small), or to retreat to personal idiosyncracy (prefer baths, don’t like being touched, don’t like to wash anybody). One couple, having been told not to use washcloths, used sponges—an obvious case of resistance.

When the reported results are uniformly negative, and further psychodynamic exploration reveals significant intrapsychic pathology or interpersonal hostility, the couple is usually considered not ready for sexual therapy, and additional individual or dyadic therapy is needed. When the resistance to shower or relaxation exercises appears to be more a matter of fear of intimacy than hostility toward the partner, it is possible to proceed with sex therapy, bypassing the relaxation phase and proceeding to the intensive exercises.

In many cases, the results of the probe are not clear. Typically, the partners feel awkward, clumsy, and embarrassed, afraid of each other’s comments and fearful that they will do something wrong. Usually by the end of the second shower, the situation has eased considerably, but there still may be tension if not outright hostility. In these instances, although intimacy is desired, the tension is so great that intimacy seems threatening. Each has staked out a position in which one is “right” and the other is “wrong,” and intimacy can undermine these positions. Such dyads almost always can benefit by starting with the relaxation exercises.

When the therapy is terminated, the sex therapist reports the results to the referring therapist, and these reports, with the permission of the patients, will include discussions of any new material that may have arisen in the course of treatment. The holistic therapist, having incorporated dyadic and family therapy in the process of sex therapy, will reassess with the couple the direction in which they wish to proceed. Even unsuccessful sex therapy can help to clarify the underlying causes of the basic dyadic problem.

In the majority of referrals, treatment proceeds smoothly and there are no unusual complications. In some cases, special problems unrelated to sex therapy itself may arise. Because sex therapy per se encourages pleasure and enjoyment, positive transference to the therapist is sometimes very strong: a dyad still under treatment by a dyadic therapist may wish to leave and continue with the sex therapist; a member of the dyad undergoing individual intrapsychic treatment may wish to discontinue treatment or switch to the sex therapist. In both cases, the dyad or individual is advised to discuss his or her motives with the original therapist.

When does the sex therapist consult other therapists? The answer is, when it is in the best interests of the patient. This may occur when the sex therapist is only or primarily a sex therapist and the problem is not amenable to sex therapy, or if the dyad wishes to pursue another modality in which the sex therapist does not feel competent.

It may also occur when the patient and therapist have different priorities. Although dyadic therapists place a high priority on the stability of the dyadic relationship, they will not sacrifice the integrity or growth of the individual to the maintenance of the dyadic relationship, but they usually will try to ensure that this growth occurs within the boundaries of the relationship, if possible, and will devote considerable effort to this end. The dyad is indeed “the patient,” (as the family is “the patient” for family therapists), and the point of view of the dyadic therapist is that both partners are equally involved in the problem.

The sex therapist, on the other hand, often encounters situations in which only one member of the dyad has a dysfunction and the treatment, although pertaining to both partners, is aimed primarily at that one person. As progress is made and the dysfunction improves, the partner sometimes exhibits change in other areas (the individual ripple effect) that appears to threaten the dyad and may in fact destabilize the relationship. The sex therapist must be very sure whether he or she wishes to encourage the individual to change at the expense of the relational stability, to discourage such change, to work with the dyad on the relational problem, or to refer to another therapist. The sex therapist must be aware of his or her attitude toward extrasexual change if the therapy begins to go, as it often does, beyond the resolution of the sexual dysfunction.

*255/187/5*