Sessions - Sex Therapy

Sexual tasks are essential ingredients of sex therapies. I believe, however, that they are of limited value if not conducted within a rational psychotherapeutic context. On the other hand, using psychotherapy alone is relatively ineffective or, at best, a slow method of treating sexual dysfunctions. However when the two modalities are used together, when sexual exercises are combined with psychotherapy it becomes immensely important and indeed indispensable to the success of sex therapy.

The main purpose of the sex therapy intervention is to change the obstacles of immediate action to the couple's satisfactory sexual functioning. These obstacles often yield, at least in part, to education and clarification of sexual misconceptions and, more importantly, the experience that exposes the couple to new and previously avoided sexual interactions.

Treatment, however, is by no means limited to such “surface” interventions. Defenses and resistances are constantly being mobilized in the course of treatment, even when both partners are perfectly healthy, and need to be treated by the therapist through psychotherapeutic techniques that require a deep understanding of the psychodynamics of human behavior. Therefore, in addition to knowing the immediate causes of the patient's sexual disorder, in order to plan and conduct the treatment in a rational and efficient way, the therapist needs to understand the unconscious conflicts of each patient and the defense mechanism used, so that can deal with them, and know the sensitive areas of difficulty in the marital system. Prerequisites for the competent practice of psychodynamically oriented sex therapy are a deep knowledge and dynamics of interaction that the patient has in their relationships and the clinical capacity in individual and/or joint therapy.

Sex therapy practiced in this precise and psychodynamic way is very demanding. The therapist must have the theoretical knowledge and clinical skill necessary to make patients do things they have been afraid to do all their lives and to openly reveal material that was previously hidden, even to themselves. For this, he needs to know not only male and female sexuality, the emotional dynamics of the body, the dynamics of marital discord and the theory of learning. He needs to know exactly when and how to employ knowledge in these areas, and when to refrain from interpreting an obviously neurotic conflict because the patient's sexual functioning can be improved without such intervention, and when vigorous and persistent interpretation is necessary because the patient cannot will be able to function sexually as long as the conflict is not resolved, he must therefore be able to arouse the trust of both partners if he is to deal with the intensely emotional material that is important to their sexuality without mobilizing excessive defenses and resistance . Accurate determination of the appropriate level of intervention is crucial. He needs to recognize when his efforts should be limited to simply confronting the patient with the obvious obstacles that impede his erotic experience, as opposed to cases where it is necessary to deal with deeply threatening unconscious material. He must be sensitive to the subtleties of the couple's transactions, he must know when to let them match and when to try to change their mode of communication. He must be able to support one partner without mobilizing fear and defenses in the other, to work with both together or with one of them separately. In short, a sex therapist needs to have extensive knowledge of theory and practice in the dynamics of breaking down barriers and paradigms, with care and attention to the patient's limits.