Sex Therapy
From Encyclopedia of Sex and Sexuality
Although we are certainly more open about sex than our Victorian great-great grandparents, and studies have shown we probably experience sex earlier, in more ways, and with more partners than preceding generations, it seems certain that we are not totally free of sexual illiteracy or sexual problems. Studies have shown that a majority of adults, when interviewed, claim to have experienced periods when they had difficulties with their sexual desires, performance, or response (see Sexual Dysfunction, Female; Sexual Dysfunction, Male). Dr. William Masters, the great pioneer of modern sex therapy in the United States, believed that as many as 50 percent of all Americans—single or married—have developed or will develop sexual difficulties at some point in their lives.
Modern sex therapies are based on the scientific information that came out of the first large-scale research into sexual behavior and practices of Americans, carried out by Dr. Alfred C. Kinsey in the 1940s, Masters and Dr. Virginia E. Johnson, beginning in the 1950s, and Dr. Helen S. Kaplan, beginning in the 1960s. Earlier sex research and theorizing by Dr. Sigmund Freud and others had centered on middle class groups in prewar Germany and France and much of it was rooted in the rigid biases of the time. For example, Freud and many of his colleagues believed that women were and should be sexually passive and should be brought to orgasm primarily by the efforts of the man. They also thought that women who showed too lively an interest in sex should be classified as deviates or even as nymphomaniacs—a term that has since fallen into disuse because of its pejorative implications. We see things very differently today.
The key breakthrough in modern sexual science was the work of Masters and Johnson (as they came to be known), who gave us the first information on human sexual behavior and responses under truly laboratory conditions. They studied nearly seven hundred men and women for more than ten years, observing and analyzing more than ten thousand sexual episodes. The subjects, who were paid for their participation in the research, were filmed and monitored by sensitive medical instruments during their experiences. Some of the women were even filmed internally before and during orgasm by tiny cameras contained in clear plastic dildos inserted in their vaginas. This gave us the first—and very vivid—pictures of what really happens inside a woman during sex. The pictures were linked to precise medical data on heartbeat rates, blood pressure, and other important measures at each moment of the experience. The Masters and Johnson research, published in 1966, provided the scientific basis for much of the development in sex therapy that came in later years.
Sex therapists today have built upon these and other findings to develop an effective treatment method that focuses on helping persons or couples to overcome their problems and attain sexual fulfillment in a nonjudgmental framework. Although some of their early work—including some of Masters and Johnson’ s therapy—involved the use of sex surrogates, i.e., trained sex partners, their use has largely been abandoned for legal and ethical reasons. Sex therapists now focus on helping single and married persons work out their sexual problems and overcome them by themselves or together with their partners. Theirs is largely a “talking cure.”
The most common sexual problem reported by Americans—but not necessarily the one for which help is most likely to be sought—appears to be a lack of sexual interest. Sexual, that is, performance problems are much more disturbing to individuals—particularly persons involved in ongoing relationships—and are more likely to be thought of as problems justifying discussion with a sexual therapist. Fortunately these performance problems are easily diagnosed and can be as successfully treated as problems of inhibited desire. In men, the most common problems of sexual response include anticipatory anxiety, premature ejaculation, and erectile difficulties. Among women, the problems most commonly reported include anorgasmia, orgasm difficulties, and painful intercourse.
How does someone who wants help find a reliable sex therapist? There are three main ways: choosing a therapist certified by the American Association of Sex Educators, Counselors, and Therapists at 11 Dupont Circle, NW, Suite 220, Washington DC, 20036; contacting the nearest teaching hospital and asking for a recommendation; and asking a family physician or other helping professional, whose competence you respect, for a referral source. Modern sex therapists will most often be professionally trained and licensed individuals with backgrounds in psychology, education, medicine, psychotherapy, social work, or nursing.
Most sex therapists work on a sliding fee scale. That means that what they charge will depend on your ability to pay. On average, fees for sex therapy are usually somewhat lower than those charged by a clinical psychologist. However, sex therapy, as other behavior therapies, is usually short-term and generally does not go beyond ten to twelve one-hour sessions. It is best suited for persons who are highly motivated to help themselves to change and are partners in a good stable relationship. The age of the client is not a factor because people of all ages can be successfully treated.
While most sexual dysfunctions can be successfully treated, some persons may want a homosexual or bisexual partner or loved one to be “treated” so that they may become exclusively heterosexual. However, there is no evidence that a bisexual or homosexual orientation can be altered through sex therapy or any other known traditional therapeutic modality. But if a person has doubts and anxieties about their own sexual identity and orientation, a sex therapist may help him or her understand and accept what they are rather than remain torn by inner conflict.
In short, almost any sex difficulty that does not have a physiological or pathogenic basis can be treated and usually can be helped, resulting in a more confident sexual person. Successful sex therapy may even help one in the search for a romantic partner by reducing anxiety about one’s sexual performance.
A basic principle underlying sex therapy holds that sexual responses of males and females are natural, not learned, functions, in the same sense that a sneeze is produced by inborn physiological processes. However, the inhibition of these natural sexual responses may be learned through behaviors that negatively alter or inhibit the conditions that precede these natural responses. Therefore, a main goal of sex therapy is to remove these conditions and allow natural sexual functioning to continue.
What does a sex therapist do with clients during these therapeutic interviews? In order for a therapist to understand the full nature and depth of the client’s problem(s), a sexual history must be taken. This is known as a “sexual status examination.” However, if the sex therapist is a physician and the nature of the complaint might be physical rather than behavioral, a physical examination may be given. If there is a physical complaint (e.g., pain or an apparent physical irregularity) the nonmedical sex therapist will invariably refer the client to a physician and will be informed of the results of the physical examination and any treatment by that physician.
During the sexual status examination, the therapist will try to determine the client’s specific sexual dysfunctions, the causes of these problems, the presence of other problems that may affect the main sex problems, the objectives of the therapy and the client’s relationships, and his or her level of sexual literacy.
Sessions with sex therapists are essentially “talk therapy” accompanied by specific sex exercises conducted by the clients in the privacy of their own homes to teach them skills in coping with those parts of their lives that may be affecting their sexual performance. After practicing the recommended exercises at home, clients report results to their therapist, who may suggest modification of the exercises or suggest moving to a more advanced stage of exercise pertinent to the specific problem of the client. Most sex therapists do not use trained sex partners to assist in the exercises. They believe that a partner is more effective for exercises involving couples. In addition, as most sex therapists believe it is more efficient for both partners in a stable relationship to be involved in the therapy, they will usually ask to meet with the partner. Some therapists will work with a cotherapist of the opposite sex because they believe that when each partner has a therapist of his or her own sex it may enhance communication between them.
