If psychotherapy in general is evolving toward a holistic approach, where does sex therapy fit in? The immediate answer is that it is a subspecialty within dyadic therapy, since it deals with a special class of dyadic problems. This classifies sex therapy by the symptoms treated and not by the effects of the therapy— a classification with which most sex therapists would probably agree. However, to narrow sex therapy to symptom removal alone is to ignore the significant role of sex in human functioning. Poor sexual functioning wrenches individual, dyadic, and family functioning into distorted, painful shapes; good sexual functioning can restore inner and outer harmony.

Successful sex therapy has a very strong “ripple effect”; the resolution of sexual problems usually resolves or moderates other problems, interpersonal and intrapsychic. Indeed, the ripple effect is really threefold—a triple ripple, so to speak.

The first ripple is the effect on the formerly dysfunctional patient. In helping a woman achieve orgasm or a man overcome impotence or premature ejaculation, the therapist has usually helped that person gain a whole new self-concept.

One woman, about thirty years old, visited her physician complaining of severe headaches and menstrual cramps which had started many years before and persisted ever since. The physician, a highly sensitive man with a superb ear for unexpressed problems, inquired about her sex life. It turned out that she was anorgastic and her husband was “all right,” but “very fast.” (This bilateral dysfunction, failure to reach orgasm in the woman and premature ejaculation in the man, is very common.) The physician referred the couple to sex therapy.

They were highly motivated people, and it was decided to address both dysfunctions together. (Usually, the orgasmic difficulties are treated first, then the premature ejaculation.) Results were surprising even for the experienced therapist: the woman had several orgasms after only the second therapeutic session, and the man achieved substantial ejaculatory control after the fourth session. This couple was seen a total of six times; by the end, the woman’s headaches had disappeared, and she had had one menstrual period with no cramps at all!

The relief of physical symptoms is not the only effect of sex therapy on individual functioning and usually is not the most important effect.

A man in his early fifties, an important executive in a major corporation, appeared for sex therapy with one wish: to have at least one firm erection, one penetration, and one thrusting experience before he died. Describing himself as impotent, he had been examined by a “famous doctor” when he was twenty years old and was told that he would never have an erection as long as he lived. Although the man later married and had two children, he never had a firm erection and of late, having an erection and full-scale intercourse had become an obsession with him.

Although successful at his job, this man almost always had lunch by himself, never went out after work “with the boys” for a drink and some “man talk,” and never told— and could barely listen to – risqu?, off-color jokes: they reminded him of his problems and aroused the fear that his reactions would reveal that he was less than a man. Socially, he and his wife merely fulfilled their obligations, entertaining others and going out as a matter of duty rather than of pleasure.

The first step in therapy was to send this man to an endocrinologist, who found nothing physiologically wrong with him; in fact, his testosterone level was slightly above normal. The man received this information, from the therapist, with complete neutrality; it took, in fact, several weeks for him to internalize and accept its implications. During this time initial sex exercises were prescribed. When the man, by his comments, indicated a readiness for more intensive work, exercises were given aimed at helping him achieve firm erections. He was told, however, not to attempt intercourse with his wife until he did have a firm erection and then to avoid using their bed, since that had been the scene of many disastrous attempts at intercourse and had depressing associations. In the course of the exercises the man for the first time in his life had a firm erection; he and his wife of twenty-seven years piled blankets on the floor and had successful, thrusting intercourse for the first time in their marriage. During the weekend, this was repeated several times.

The couple now enjoys sexual intercourse regularly. At his work the man now goes out with his colleagues, tells and listens to any kind of sexual joke, and has become, as he reports, not only more liked but also more respected. On that first weekend he and his wife went to a party at which, as they gleefully reported, they astonished everybody by dancing every dance and generally leading the festivities. Since then their social life has been much richer and more enjoyable.


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