Sex Therapy Sex problems: Hidden psychological defects Pathological deviant Last century Destigmatizing Demystifying Now Want to understand what the normal experience is
News alert: Men and women are different! Today’s researchers recognize real differences Women masturbate at a later age and with less frequency Have more sexual complaints and concerns Men seek treatment for : Sexual performance Women seek treatment for: concerns about sexual feelings Many drugs for men None for women
Historical Perspective of the human sexual response Initially the human sexual response was viewed as a single event of desire to excitement to orgasm Sexual dysfunctions were addressed as a single clinical problem: Anxiety
Integrative approach Treating the genitals alone is unlikely to lead to long-term success
Nomenclature-DSM Tended to be pejorative Impotence Inhibited Nymphomania Frigid What is normal? Perceived times Germany: 7 minutes Britain, Fance, Italy: 9.6 minutes US: 13 minutes
Psychosomatic concepts in the medical field brought a new dimension to treating sexual dysfunctions. Psychoanalysis continued to hold the sole concept of sexual response and thus treated all sexual complaints the same way. Psychoanalysis viewed sexual dysfunction as profound and serious unconscious conflicts about sex.
History con’t Masters and Johnson first researchers to have the determination, despite social/moral prejudices around sex, to study the sexual response from an objective biological perspective. Their work produced the first clear and still accurate explanation of the sexual response.
History Con’t Masters and Johnson and other researchers ushered in the biphasic model of the sexual response: Excitement phase and orgasmic phase. This led to different treatments depending on which phase the problem presented.
Helen Singer Kaplan Psychiatrist and specialist in sex therapy. 1970’s Translated the findings from Kinsey, and Masters and Johnson’s research into a treatment of sexual dysfunctions. Addition of a third phase: Sexual Desire Phase – Developed by Kaplan (1970’s) Kaplan Model is an integration of psychodynamic, sexual therapy techniques and learning theories.
Kaplan Model of Sexual Response Desire – Excitement – Orgasm Desire Phase – prelude to physical sexual response and hypothesized to be a unique physiologically related but discrete phase. Each phase has a “common generator”, but each has its own “circuitry.” Only one or all three phases can be disrupted.
Sexual Response Cycle Excitement Plateau Orgasm Resolution Refractory period (men)
Physiology of Desire Phase The physiology of the Desire phase is inferred from clinical evidence and drawn from knowledge of brain functioning and neurophysiology of other biological drives. Thus we do not have as concrete and accurate map of the desire phase as the other genital phases of excitement and orgasm.
Physiology of Desire Con’t Desire Phase is believed to be similar to other drives; there is an anatomical structure in the brain that produces it there are centers in the brain that enhance the drive and inhibit it and two neurotransmitters that does the same - one that excites and one that inhibits the sex drive is connected to other parts of the brain which allows the sex drive to be influenced by one’s total life story. (Kaplan, 1979)
Physiology of Desire Con’t Sexual Desire is the sensation or drive to seek out or become receptive to sexual experiences. The sensations are activated by a specific neural system in the brain. Just what is the neural activity of the sex circuits is unknown. Men and woman are similar in the neurological aspect of sex but differ in the stimuli that evoke desire. Hard to differentiate between biological and experiential basis of sexual desire.
Female Orgasm Controversy Is the female orgasm clitoral or vaginal? Freud theory – Mature female orgasm is vaginally triggered. Early stage of psychosexual development erotic activity centered on the clitoris Psychosexual maturity leads to transfer of sexual sensations from the clitoris to the vagina Retention of clitoral sensation was considered evidence of neurosis (Kaplan, 1974)
Female Orgasm Controversy, Con’t Masters and Johnson’s research - clitoris stimulation is required to produce female orgasmic response. The only function of the clitoris is to transmit and conduct erotic sensation. Clitoris has no role in the execution of the orgasm. The orgasm is a reflex which consists of rhythmic contractions of the striated circumvaginal muscles. All female orgasms are physiologically identical.
Comparison of Female and Male Sexual Response In both genders, the genital organs and the underlying neural administrative apparatus are derived from identical embryological structures. More similarities then differences in the sexual response of men and women.
Sexual Health Evolution of sexual health “mantras” Arousal and Orgasm (Masters and Johnson) Desire, Arousal, Orgasm (Kaplan) Desire, Pleasure, Orgasm, Satisfaction Today Healthy sexual relationship is defined by the right degree of intimacy that leads to a mutually satisfying sexual relationship.
The Role of Chemicals Hormones Androgens Testosterone Estrogens
Sex Hormones Gonads produce hormones and secretes them in to the bloodstream Women (Ovaries) Estrogen- class of hormones that produces female physical sex characteristics and regulates menstrual cycle. Progestational compounds (class of hormones, most important is progesterone) – regulates menstrual cycle and stimulates development of uterine lining in prep for pregnancy
Sex Hormones Con’t Men (Testes) Androgens, a class of hormones. Testosterone develops male sexual characteristics and sexual motivation.
Sex Hormones Con’t In both sexes, the adrenal glands secrete small amounts of estrogen and greater quantities of androgen hormones. Testosterone appears to be the libido hormone for both genders. Luteinizing hormone-release factor (LH-RF) secreted in the brain may enhance sexual desire
Menstrual Cycle and Hormonal Fluctuations Menstrual Cycle and Hormonal Fluctuations Menstrual cycle reveals the effects of sex hormones on the behavior of women. Female sex hormones drop sharply for approximately 8 days Estrogen peaks at time of ovulation and estrogen and progesterone increase during luteal phase of cycle
Menstrual Cycle Con’t Androgen (testosterone) supply remains constant throughout the cycle with slight elevation near ovulation and in the luteal phase Women’s desire response is multidetermined Some women report no libidinal changes during their cycle
Menstrual Cycle Con’t Many women report fluctuations of desire with cycle changes Masters and Johnson and Kinsey found women’s sexual desire and orgasms were most intense in the premenstrual, menstrual and post menstrual periods when the estrogen and progesterone levels dropped to their lowest. (Kaplan, 1974)
Ovulation and eroticism About to ovulate=Increased sexual fantasies Increased pheremone production Increased sense of smell
Prefer “ruggedly handsome” Men’s shifting hormones Anticipation increase Married men = lower testosterone at end of day More time with wife = lower testosterone Oxytocin
Senses and Sexual Arousal Touch appears to play the greatest role in sexual intimacy, however, all senses have the potential to contribute to erotic arousal. Everyone has their own unique individual triggers for arousal
Sexual Stimuli Visual stimuli Men more aroused than women Nature of video (audience) Less important for women Olfactory stimuli
Transference and Counter- Transference Three Definitions for Transference The irrational attitude manifested by a client which is not evoked by the realities of the present. Rather it is derived from the client’s relationship with a significant figure of his/her past
Types of Transference Con’t Transference also refers to the displacement of infantile attitudes both with in a treatment situation or in everyday life. Transference denotes the intense sexual feelings which some patients develop for the therapist.
Transference Con’t Sex Therapy and other types of therapy do not use transference between the client and therapist as the central focus of treatment. Sex Therapy rather focuses on the mutual transference between the couple. Sex Therapist may utilize some of the positive transference – qualities the client often transfers onto the parents. Omnipotence, power to give permission to engage in forbidden activities, to pronounce moral judgments
Counter-Transference Therapist’s projections of his/her own unresolved infantile attitudes onto the client. Healthy Attitudes of Therapist Help the client relieve his suffering To earn a good living To attain prestige To do good, responsible, creative work
Counter-Transference Con’t Unconsciously try to compete with the female/male client for the man/woman’s love and attention. Therapist may act in seductive manner thus eliciting erotic feelings in the client.
Counter-Transference Con’t Not all emotional responses are counter- transference Real attributes of the couple may elicit responses in the therapist – sexual attraction, wish for closeness, irritation, competitiveness with one’s client, etc. Don’t act on these emotional responses Do use emotional response as CUES Example: Slight sexual revulsion towards a client. Explore why client is sending message “Don’t touch me”.