A Treatment Approach Model Anthony Hughes, Ph.D., LMFT

What is Sex Therapy?

• • • • • • • • • Sexual socialization and culture Sexual development and understanding Sexual dysfunctions Sexuality and Illness Gender differences concerning sexuality Sexual pharmacology Sexuality and Minorities Sexual trauma and abuse Sex offenders

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Sexual minorities

• Gay and Lesbian

Sexual pain

• Dyspareunia

Sex offenders

• • • • Use of sound therapeutic principles and theory • Therapeutic alliance Work through self-of-the-therapist issues • Supervision Comfort level with sexuality • Sex offender Traditional medical model • Behavioral interventions

• • • • • Knowledge and understanding • Sexual response cycle; Normal sexual functioning; Myths and misconceptions Directive VS Non-directive Psycho-educational component Homework assignments, process and re-assign Theory/effectiveness research driven

Intersystemic Sex Therapy informed by Attachment Theory

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Basics

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Significant attachment figures

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Safe haven and secure base

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Insecure VS secure

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Prototype VS revisionist

• • • • Emergent conceptualization and treatment Macro, mezzo, and micro • • • • • Individual bio/psycho Dyadic FoO Social/Cultural/Religious Societal Traditional divergence Assessment, conceptualization, and treatment implications

• • • First session with the couple • • • Alliance building Problem formation and reason for treatment Observation and assessment Second and third session individual • • • • Each individual meets with therapist for sexual history assessment Ease of disclosure Factors affecting sexual relationship Treatment protocol after 3 rd session Subsequent sessions • • • Couple focused Sexual genogram Accurately informed treatment plan facilitates appropriate focus

• • • Attends to each part of the “system” Equal attention to all parts in assessment • • • Accurately informed treatment plan facilitates appropriate treatment focus • Individual • Biological; Medical/Pharmacological • Individual • Psychological Dyadic relational Family-of-Origin Social/Cultural/Religious

• • • • • What are the overt or covert messages in this family regarding sexuality/intimacy? Regarding masculinity/femininity?

Who said/did what? Who was conspicuously silent or absent in the area of sexuality/intimacy?

Who was the most open sexually? Intimately? In what ways?

What questions have had regarding sexuality/intimacy in your “family tree” that you have been reluctant to ask? Who might have the answers? How could you discover the answer?

What were the “secrets” in your family regarding sexuality/intimacy?

• • • • • Was anyone constrained or inhibited in communicating about sexuality, affection, intimacy, and other feelings that showed warmth?

Were any members of you family treated as outcasts because of their sexuality? To what effect?

What would you like to change about the way your family discussed and showed intimacy, affection, and sexuality?

How do you see your sexuality today connected to what you learned in your family?

What did you learn concerning sexuality from peers/school/religious or other affiliations?

• • • What do the other “players on the stage” have to say regarding the above questions? How did these issues, events, and experiences impact them? Within a generation? Between generations? With whom have you talked to about this? How could you do it?

How does your partner perceive your family genogram regarding the aforementioned issues? How do you perceive his/hers?

How would you change this genogram (including who and what) to meet what you wish would have occurred regarding messages and experience of sexuality/intimacy?

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Sexual Desire Disorders

• Hypoactive Sexual Desire Disorder • Bio-Depression • • • • Psy-OCD Dyad-Negative sexual experience (pregnancy) FoO-Mother says sex is for man S/C/R-Women don’t have drive, lack of sexual awareness

• Hyperactive Sexual Desire/Sexual Compulsivity • Bio-stress, hedonic, set point • • • • Psy-Avoid (function) Rel-Feel close FoO-Learned behavior, neg. coping S/C/R-Pornography isn’t addictive, don’t talk about

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Sexual Arousal Disorders

• Erectile Dysfunction • Psy-Pornography (dopamine/conditioned responding) • • • • Bio-Prostate, high blood pressure Dyad-Lack of connection, safety, vulnerability FoO-Shaming about masturbation S/C/R-Myths about men

• Female Sexual Interest/Arousal Disorder • Psy-Distorted body image, confidence • • • Bio-Birth control/low estrogen and testosterone Dyad-Foreplay, gender differences FoO-Mother initiating kiss/hug/touch (receptive not initiator) • S/C/R-Limited teaching/awareness (internal Vs exter)

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Orgasmic Disorders

• Premature Ejaculation • Psy-Pacing • • • Bio-arteriosclerosis, diabetes Dyad-Poor communication FoO-Parentified/reparentified by new responsibilities/metaphor feeling burden • S/C/R- Partner engagement vs. self entrancement

• Delayed Ejaculation • Psy-Control, Comfort • • • • Bio-Aging and neurological, endocrine, and vascular Dyad-Focused on partner sat., spectator FoO-Demand parents/perception in intimacy S/C/R-Enjoyable sex requires orgasm

• Female Orgasmic Disorder • Psy-Decision making • • • • Bio-Clitoral stimulation Dyad-Male thrusting Vs Female FoO-Sex is for men S/C/R-Lack of knowledge

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Sexual Pain Disorder

• Genito-Pelvic Pain/Penetration Disorder • Psy-Relaxation • • • • Bio-Birth control Dyad-Negative experiences FoO-Sex just hurts S/C/R-Get stretched

• • • Masters and Johnson • Excitement, plateau, orgasm, and resolution Kaplan • Desire, excitement, and orgasm Basson • Need for intimacy • Desire can be reactive or spontaneous • Desire before or after arousal • Decision

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Sexual Desire Disorders

• Hypoactive Sexual Desire Disorder • • • Increase awareness through self monitoring Fact finding Fantasy • Hyperactive Sexual Desire/Sexual Compulsivity • • • • Function ARP Relational and individual sessions Cognitive behavioral interventions

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Sexual Arousal Disorders

• Erectile Dysfunction • Dispel myths- Psycho-edu • • • Adaptive (prostate) Medical visit Thought stopping and replacement • Female Sexual Interest/Arousal Disorder • • Alternate methods of Birth control Estrogen and testosterone pills/injections

• Orgasmic Disorders • Premature Ejaculation • Sensate for self entrancement • Delayed Ejaculation • • Communication (Comfort) Address function of relational control • Female Orgasmic Disorder • • • • Permission/sexual bill of rights MFR class SRC Clitoral stimulation (Lack of knowledge)

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Sexual Pain Disorder

• Genito-Pelvic Pain/Penetration Disorder • Relaxation coupled with digital/dilator • • Mirror and cotton swab Medication changes