A Clinician's Guide to Systemic Sex Therapy Book

Acknowledgments xiii

About the Authors xv

Section I Conducting Sex Therapy Step by Step From an Intersystems Approach

1 The Intersystems Approach to Sex Therapy 3

Introduction 3

Couple Therapy, Sex Therapy, and the Intersystems Approach 3

Therapy and Integration in Couple Therapy 3

Moving Toward Theoretical Integration 4

Intersystems Theory and Application 6

Intrapsychic Components 7

Interactional Components 8

Understanding Etiology and Treatment Within the Intersystems Approach 10

Individual and Biological 11

Individual and Psychological 12

Dyadic/Couple Relationship 12

Family of Origin 14

Society, Culture, History, and Religion 15

Conclusion 16

2 Assessment Within the Intersystems Approach 19

Introduction 19

The Biphasic Assessment Process 20

Taking a Sex History 21

Guidelines in Taking Sexual History 26

Understand One's Own Sexuality 26

Never Assume and Always Assume 26

Normalize Sex Talk 27

Promote Clarity While Using the Client's Language 28

Promote the Client's Comfort and Ease in Disclosing 28

Interview Individually but Systemically 29

Be Clear and Avoid Shaming 30

Conducting an Intersystems Clinical Interview 32

Conducting the Clinical Interview 32

Individual Factors-Biological 33

Individual Factors-Psychological 33

Relational Factors 34

Sociocontextual Factors 34

Family of Origin 35

Interviewing for Specific Disorders 35

Sexual Desire Disorders 35

Hypoactive Sexual Desire Disorder 35

Sexual Aversion Disorder 36

Hyperactive Sexual Desire/Sexual Compulsivity 39

Sexual Arousal Disorder 40

Male Erectile Dysfunction 40

Female Sexual Arousal Disorder 40

Orgasmic Disorders 41

PrematureEjaculation 41

Female Orgasmic Disorder 42

Sexual Pain Disorders 44

Vaginusmus and Dysparenuia 44

Focused Genograms 45

Importance and Application 45

Administering a Genogram 46

Gender Genograms 47

Sexual Genograms 50

Romantic Love Genograms 51

3 Step-by-Step Diagnosis of Sexual Dysfunctions 55

Introduction 55

Diagnosing With the DSM-IV-TR 56

Limitations of the DSM Diagnostic Categories 57

Dysfunction Versus Problem 60

Etiology-Physiology Versus Psychology 60

Comorbidity 61

Individual or Relational Problems 62

Sexual Problems Not Currently in the DSM-IV-TR 63

Sexual Compulsivity or Nonparaphilic Hypersexuality 64

Female Persistent Gential Arousal Disorder 64

Noncoital Sexual Pain Disorder 64

Multiaxial Diagnosis From the Intersystems Perspective 65

4 Case Formulation 67

Introduction 67

Presenting Problem 67

Developing an Intersystems Case Formulation 68

Individual Systems-Physiological 69

Individual Systems-Psychological 70

Individual Systems-Family of Origin 70

Interactional Components 70

Intrapsychic Components 70

Society, Culture, History, and Religion 71

Therapist's Overall Impressions 72

5 Treatment Principles, Strategies, and Techniques 75

Introduction 75

Beginning Treatment 76

Initial Phone Call 76

The Initial Session 77

The Triage Tree 77

Presenting Problem Versus Other Clinically Relevant Problems 78

Multiple Dysfunctions in an Individual 80

Co-Relational Sexual Dysfunctions 80

Keeping Treatment Systemic 81

Treatment of Specific Sexual Dysfunctions 82

Hypoactive Sexual Desire 82

Strategies and Techniques 84

Erectile Dysfunction (ED) 87

Strategies and Techniques 88

Premature Ejaculation (PE) 91

Strategies and Techniques 91

Inorgasmia 93

Strategies and Techniques 94

Vaginismus 97

Strategies and Techniques 98

Treatment Concerns of Gays and Lesbians 101

Sexual Ignorance Among Sexual Minority Clients 104

HIV Status Discrepancy 104

Anodyspareunia 106

Role and Practices Discrepancy 106

6 Factors Complicating Treatment 109

Sexual Misinformation 109

Fears 110

Fear of Intimacy 110

Fear of Anger 111

Fear of Feelings 113

Fear of Losing Control 114

Fear of Rejection or Abandonment 115

Fear of Dependencey 116

7 Working With Particular Populations 119

Introduction 119

Sexual Difficulties Among Chronically Ill Individuals 120

Clients With Neurological Illness 120

Clients With Cardiovascular Illness 121

Oncology Clients 121

Clients With Diabetes 123

Sexual Difficulties Among Physically Disabled Individuals 125

Sexual Difficulties Among Geriatric Individuals and Couples 126

Treatment Strategies for Special Populations 129

Collaborate With Client's Physicians 130

Provide Psychoeducation 131

Address Anxiety, Minisformation, and Myths 133

Attend to Affect and Self-Image 135

Expanding the Sexual Repertoire 136

Enhance Couple Communication 137

Address the Self of the Therapist 137

Section II Practice Issues and Resources for Sex Therapy

8 Practice and Ethical Issues 141

Introduction 141

The Process and Structure of Treatment 141

Client Identification 141

Problem Definition 142

Goal Setting 143

Secrets in Therapy 144

Scope of Practice 145

Referrals and Consultations in Sex Therapy 145

Managing Ethical Dilemmas 146

Sex Therapy Surrogates 147

Organizations and Guidelines for Ethical Issues in Sex Therapy 148

Monitoring Biases in Treatment 149

Gender 149

Religion 151

9 Formalized Assessments and Inventories in Sex Therapy 153

Introduction 153

Behavioral Assessment 153

Physiological Measures 154

Psychological Measures 155

Collections of Assessments 157

10 Handouts, Exercises, and Worksheets 161

Introduction 161

Handouts 161

Exercise 162

Sensate-Focus Activities 162

Homework 163

11 Psychoeducational Resources in Sex Therapy 169

Bibliography 169

Videos and Multimedia 170

Internet Resources 170

Appendix A Bibliotherapy Resources 173

References 175

Index 189