Treatment Of Sexual Dysfunctionan Integrated Approach

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Masters & Johnson (1966, 1970) proposed an approach to the treatment of sexual difficulties that took these problems out of the realm of long-term psychotherapy. Their investigation of sexual functioning, and focused therapy for sexual difficulties, was an important shift in treatment which created the specialty of 'sex therapy'. Their approach was essentially behavioral in its focus and based around the in vivo desensitization, anxiety control and positive rehearsal of appropriate intimacy skills, all incorporated into the 'sensate focus' technique.

Kaplan (1974, 1979) later extended the Masters & Johnson (1966, 1970) approach into a more comprehensive eclectic brief psychotherapy model. She proposed a model of brief therapy for sexual dysfunction starting from a psychotherapy base, but incorporating the cognitive-behavioral strategies available at that time, as an extension of their seminal works. While Kaplan (1974, 1979) does not discuss the potential role of hypnotically based therapies in her excellent work, she does offer an integrated approach into which hypnosis can be added.

Therapeutic intervention for sexual dysfunction involves at least five sequential components. Each builds on and is predicated by the previous stages, and while early stages are seldom sufficient for a successful treatment outcome, not all will be necessary in a particular therapeutic intervention.

The first stage begins with the diagnostic evaluation of the dysfunction within one of the contemporary diagnostic frameworks such as DSM-IV (APA, 1994). The process then begins with the development of a therapeutic intervention based on the aetiology, expectations and wishes of the patient concerned.

The second stage of treatment comes out of the developing rapport and the process of establishing the aetiology. It involves giving the patient and their partner permission to discuss openly in a non-judgemental way sexuality, sexual beliefs, sexual feelings and the general emotional context within which the sexual involvement occurs.

The third phase of treatment is an educative phase, which confirms the appropriate knowledge of the patient or couple, but most importantly corrects any misinformation the patient accepts about their own sexual functioning or responses or 'normality'. Inappropriate beliefs and understanding, while becoming less common, are still frequently implicated in the aetiology or maintenance of sexual difficulties.

The fourth component of treatment involves therapeutic interventions specifically targeting sexual behavior and learning, those most commonly thought of as 'sex therapy'. A therapeutic agreement or contract is established with the patient, or preferably the patient and partner, after an outline of the approach to be undertaken has been given. Once the therapeutic intervention is embarked upon through the cooperative effort of therapist and patient or couple, ongoing re-evaluation is essential to determine whether further information relevant to the aetiology has emerged in the process of therapy. Assessment of the outcome at each stage of treatment is a useful feedback mechanism to assist the therapist and patient or couple in refining the therapy focus. It is in this area that hypnosis may assist, incorporating its advantages with other therapy approaches.

If resistance to therapy or change is met, or if treatment progress is poor, the therapist may enter into a more long-term intensive psychotherapy approach, the style of which will vary with the approach and expertise of the clinician. A more extensive psychotherapeutic intervention may also be required if the aetiology of the dysfunction is assessed to be the result of more extensive psychological difficulties.

In spite of the usefulness of hypnotic approaches Gilmore (1987) and Hammond (1990) noted that only 5-7% of sex therapists in the United States use hypnosis. This is presumed to be a result of continuing professional ignorance about the therapeutic use of hypnosis and the persistence of myths about hypnosis.

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