Sex therapy is probably the most successful of all psychological therapies. It deals only with sexual problems so it cannot be regarded as a mainstream psychotherapy. However as a successful application of psychological principles to an area that has a huge effect on human happiness it comes within the scope of this column.
The boom time for sex therapy began in the early 1970s, following the work of the US researchers Masters and Johnson who pioneered the technique known as sensate focusing. Early enthusiasm for the approach was fuelled by the belief that sexual problems are all in the mind. “That belief was probably part of Freud’s legacy” says Anne Hooper, author of a best-selling self-help guide*.
In fact we now know that the causes of some problems can be physical rather than mental, Hooper says. However, there is no denying that the mind controls the body and that physical problems can often be resolved by psychological techniques.
People may seek therapy to address a non-specific dissatisfaction with the sexual side of a relationship, or they may have a specific physical problem such as premature ejaculation or impotence. The general approach is similar to that used in behaviour therapy. It is based on the fact that the same physical reaction normally elicited by a powerful stimulus can be elicited by weaker stimuli or even by thoughts that occur at the same time as the natural stimulus for that reaction. The original example of this comes from the experiments of Pavlov in the early 1900s: a bell that announced the presence of food came to elicit the same physical mouth-watering reaction as the food itself.
To apply Pavlov’s principle to sexual behaviour it is important first to know what are the powerful stimuli. Sensate focusing allows couples to discover exactly that. It is a combination of exploratory massage – touching and stroking different parts of the body in different ways, and talking to each other about how it feels. “Learning how to talk about your feelings is very important” says Hooper. “One of the things people find very difficult is to talk about what they like in bed.”
It is easy to see how sensate focusing – particularly when combined with extra stimulation using artificial aids such as vibrators – might help couples overcome problems where the basic failure is insufficient stimulation or a lack of reaction. “The vibrator was a godsend for women who were unable to experience climax” says Hooper. However, behavioural principles can be used in a more complex way to deal with problems where the reaction is too rapid, or excessive – such as premature ejaculation, or vaginismus (spasm of the vaginal muscles).
Behavioural control of premature ejaculation relies on what is known as the squeeze technique. The first stage is straightforward: when ejaculation is about to occur it can be prevented by squeezing the penis. The second stage is to produce the same effect by a mental rather than a physical stimulus. By carefully monitoring the sensations associated with the squeeze, a man can learn to elicit the same effect by a voluntary effort. This approach is much more effective than physical approaches. There are a variety of creams that are designed to control premature ejaculation by reducing stimulation: “they are useless: don’t waste your money” says Hooper.
Unlike much premature ejaculation, impotence often has a physical rather than a psychological cause. Hence the success of the drug Viagra, which is a real breakthrough in this area according to Hooper. One advantage of seeing a good therapist, says Hooper, is that they will know when it is appropriate to seek medical rather than psychological help.
Usually both partners will see the therapist together. During sessions they will discuss their progress, and the therapist will give them exercises to do as homework. It is impossible to generalise about the duration of treatment because it depends on how severe the problem is and how rapidly the clients progress. Usually a therapist will review progress after six sessions, which will take between six and twelve weeks. “I usually see clients fortnightly – if the gap between sessions is too short then they may not have time to do the homework” Hooper says.
Your doctor may be able to refer you to a therapist. If you want to find one yourself, most UK therapists will be registered with the British Association of Sexual and Relationship Therapists who have a listing of therapists by region on their web page www.basrt.org.uk tel 0208 543 2707. Many branches of the charity Relate (formerly the marriage guidance council) offer psychosexual counselling (tel 01788 573241) or see their web page www.relate.org.uk. See also www.philliphodson.co.uk for advice on how to choose a therapist and for an email query service. In the US the American Association of Sex Educators, Counselors and Therapists, PO Box 238, Mount Vernon, IA 52314, www.aasect.org have a referral service.
*Anne Hooper’s ultimate sex guide, Dorling Kindersley is available from Amazon