This document discusses various psychotherapies for treating sexual disorders, including dual-sex therapy, hypnotherapy, behaviour therapy, group therapy, and integrated sex therapy. Dual-sex therapy treats the marital relationship and sexual functioning as a part of that. Hypnotherapy focuses on alleviating anxiety through imagery and relaxation techniques. Behaviour therapy uses a hierarchy of exposures and exercises to treat sexual dysfunction as learned behavior. Group therapy provides information, support, and assignments. Integrated sex therapy combines behavioral techniques with psychodynamic insights.

1. Psychotherapy for Sexual
Disorders

2. Psychotherapies
• Dual-Sex Therapy
• Hypnotherapy
• Behaviour Therapy
• Group Therapy
• Integrated Sex Therapy

3. Dual-Sex Therapy
• Originated and developed by Masters and Johnson
• Marital unit or dyad as the object of therapy.
• The marital relationship as a whole istreated, with emphasis on sexual
functioning as a part of that relationship.
• Improved communication in sexual and nonsexual areas is a specific goal
of treatment.
• Psychological and physiological aspects of sexual functioning are discussed
with an educational attitude.
• Suggestions are followed in the privacy of the couple’s home.

4. • Concurrent psychotherapy with a psychiatrist while participating in
dual-sex therapy is sometimes recommended.
• For example, the partner of a man with erectile disorder may be
relieved of the concern that his problem is a result of her being
insufficiently attractive.
• The individual sessions also help the therapist understand the
patients’ lifestyle and allow for suggestions that fit into that lifestyle.

5. Behavioral Exercises
• Treatment is short term and behaviourally oriented.
• Specific exercises are prescribed to help the couple with their
particular problem.
• Sexual dysfunction often involves a fear of inadequate performance;
thus, couples are specifically prohibited from any sexual play other
than that prescribed by the therapist.

6. Sensate Focus Exercises
• Initially, intercourse is interdicted, and couples learn to give and receive bodily
pleasure without the pressure of performance.
• Beginning exercises usually focus on heightening sensory awareness to touch,
sight, sound, and smell.
• They are urged to use fantasies to distract them from obsessive concerns about
performance, which is termed spectatoring.
• If either partner becomes sexually excited by the exercises, the other is
encouraged to bring him or her to orgasm by manual or oral means. This
procedure is important to keep the nondysfunctional partner from sabotaging the
treatment.
• Genital stimulation is eventually added to general body stimulation. The couple is
sequentially taught to try various positions for intercourse without necessarily
completing the act and to use varieties of stimulating techniques before they are
permitted to proceed with intercourse.

7. • In cases of premature ejaculation, an exercise known as the squeeze
technique is used to raise the threshold of penile excitability. In this
exercise, the man or the woman stimulates the erect penis until the
earliest sensations of impending orgasm and ejaculation are felt.
Penile stimulation is then stopped abruptly, and the coronal ridge of
the penis is forcibly squeezed for several seconds. The technique is
repeated several times.
• A variation is the stop–start technique, in which stimulation is
interrupted for several seconds but no squeeze is applied.
Masturbation to the point of imminent orgasm raises the threshold of
excitability to a more tolerant stimulation level.

8. • In cases of vaginismus, the woman is advised to dilate her vaginal
opening with her fingers or with size-graduated vaginal dilators as
part of the therapy. She may also be referred to a physiotherapist,
specializing in pelvic disorders.
• The man is encouraged to focus on sensations of excitement rather
than distract himself from them. This makes him more familiar with
his excitement pattern and lets him feel in control rather than
overwhelmed by sensations of arousal.
• Communication between the partners is improved because the man
must let his partner know his level of sexual excitement so that she
can squeeze the penis before the ejaculatory process has started.

9. • A man with sexual desire disorder or erectile disorder is sometimes told
to masturbate to demonstrate that full erection and ejaculation are possible.
• A woman with lifelong female orgasmic disorder is directed to masturbate,
sometimes using a vibrator.
• Kegel’s exercises may be introduced to strengthen the pubococcygeal muscles—
that is, the woman is encouraged to contract her abdominal and perineal muscles
during masturbation and coitus.
• When a man has erectile disorder, the woman may be instructed to stimulate or
tease his penis. The same technique is used with men who suffer from retarded
ejaculation, with stimulation sometimes involving a vibrator. Delayed ejaculation
is managed by extravaginal ejaculation initially and gradual vaginal entry after
stimulation to the point of near ejaculation.

10. Treatment Goals
• The overall goal of treatment is to initiate an educational process, to diminish the
fears of performance felt by both sexes, and to facilitate communication in sexual
and nonsexual areas.
• Therapy sessions follow each new exercise period, and problems and
satisfactions (both sexual and nonsexual) are discussed. Specific instructions and
new exercises geared to the individual couple’s progress are reviewed in each
session.
• Gradually, the couple gains confidence and learns (or relearns) to communicate
verbally and sexually.
• Dual-sex therapy is most effective when the sexual dysfunction exists apart from
other psychopathology.

11. Hypnotherapy
• Hypnotherapists focus specifically on the anxiety-producing symptom—
that is, the particular sexual dysfunction.
• Patient cooperation is first obtained and encouraged during a series of
nonhypnotic sessions with the therapist, designed to develop a secure
doctor–patient relationship and a sense of physical and psychological
comfort on the part of the patient and to establish mutually desired
treatment goals.
• Treatment focuses on symptom removal and attitude alteration.
• In a trance state, patients can entertain ideas incongruent with their usual
(nonhypnotized) perceptions of reality.

12. • Patients are instructed in developing alternative means of dealing
with the anxiety provoking situation (i.e., the sexual encounter).
• For example, a woman with vaginismus is given the posthypnotic
suggestion that she will feel no pain during intercourse and will be
able to relax the muscles surrounding her vagina. If compliance with
the suggestion is successful, she can deal with the anxiety produced
by the sex act. She is also taught new attitudes, such as being entitled
to sexual pleasure. Under hypnosis, her fear or anger at sexual
contact can be examined, and she learns how her emotions are
expressed by involuntary vaginal spasms.

13. • Typically, patients are instructed to conjure up images and develop
ideas antithetical to their dysfunctional responses. For example, a
woman with an arousal disorder may first agree to concentrate on
imagery that causes her to salivate. She is then told that, just as she
has made her mouth water by focusing on stimulating images, she
can affect the lubricating response of her vagina by focusing on
images she finds erotic or romantic.
• Patients are also taught relaxing techniques to use before sexual
relations. With these methods to alleviate anxiety, the physiological
responses to sexual stimulation can more readily result in pleasurable
excitation and discharge.

14. Behaviour Therapy
• Behavior therapists assume that sexual dysfunction is learned,
maladaptive behavior.
• Behavioral approaches were initially designed to treat phobias. In
cases of sexual dysfunction, the therapist sees the patient as phobic
of sexual interaction.
• Using traditional techniques, the therapist sets up a hierarchy of
anxiety-provoking situations for the patient, ranging from the least
threatening to the most threatening.

15. • For example, mild anxiety may be experienced at the thought of
kissing, and massive anxiety may be felt when imagining penile
penetration.
• The patient first deals with the least anxiety-producing situation in
fantasy and progresses by steps to the most anxiety-producing
situation. Medication, hypnosis, or special training in deep muscle
relaxation is sometimes used to help with the initial mastery of
anxiety.

16. • Assertiveness training helps teach patients to express their sexual
needs openly and without fear. Exercises in assertiveness are given in
conjunction with sex therapy, and patients are encouraged both to
make sexual requests and to refuse to comply with requests
perceived as unreasonable.
• Sexual exercises may be prescribed for patients to perform at home,
and a hierarchy may be established, starting with activities that
proved most pleasurable and successful in the past.

17. • One treatment variation involves the participation of the patient’s
sexual partner in the desensitization program.
• Behavior therapy techniques have been particularly effective in
treating women with severe inhibition of excitement and orgasm
when such feelings were accompanied by strong feelings of anxiety,
anger, or disgust.

18. Group Therapy
• The therapy group provides a strong support system for patients who
feel ashamed, anxious, or guilty about a particular sexual problem. It
is a useful forum in which to counteract sexual myths, correct
misconceptions, and provide accurate information regarding sexual
anatomy, physiology, and varieties of behavior.
• Groups for the treatment of sexual disorders can be organized in
several ways. Members may all share the same problem, such as
premature ejaculation; members may all be of the same sex and have
different sexual problems; or groups may be composed of both men
and women who are experiencing different sexual problems.

19. • Specific physiological information, sometimes with the aid of
audiovisual materials, is presented to the group members. Members
are given homework assignments (e.g., they may be instructed to
masturbate). A combination of group support and group pressure
helps some of the participants complete assignments they might
otherwise avoid.
• Groups have also been effective when composed of sexually
dysfunctional married couples. The group provides an opportunity to
gather accurate information, provides consensual validation of
individual preferences, and enhances self-esteem and self-
acceptance.

20. Integrated Sex Therapy
• One of the most effective treatment modalities is the use of sex
therapy integrated with supportive, psychodynamic, or insight-
orientated psychotherapy.
• Adding psychodynamic conceptualizations to the behavioral
techniques used to treat sexual dysfunctions allows treatment of
patients with sex disorders associated with other psychopathology.
• Also, this type of therapy is appropriate for patients with hypoactive
desire disorders, or interest/arousal disorder.

21. • Insight-oriented therapy helps them deal with problems in their
interpersonal relationships or intrapsychic conflicts that frequently
are at the root of the problem.
• The themes and dynamics that emerge in patients in analytically
oriented sex therapy are the same as those that emerge in
psychoanalytic therapy— relevant dreams, fear of punishment,
aggressive feelings, difficulty with trusting the partner, fear of
intimacy, oedipal feelings, and fear of genital mutilation.