|
Appreciating the larger context of "sexual dysfunction" There has been
a trend in recent years to create the illusion that difficulty in sexual functioning is best managed by medical intervention.
While there is, clearly, a place for medicine in the realm of sexuality, it is not the only option. Concerned about the increasing
medicalization of human sexual experience Kaschek and Tiefer, (2001), developed a feminist, biopsychosocial perspective, which
they refer to as “The New View of Women’s Sexual Problems”. The New View perspective challenges the concept
that sexual problems are medical problems, and maintains that sexual problems are driven by multiple realities. These realities
include;- Sexual problems due to socio-cultural, political, or economic factors
- Sexual problems
relating to partner or relationship factors
- Sexual problems due to psychological factors
- Sexual problems
due to medical factors
I have found Kaschek and Tiefer’s model to be helpful to gay, straight,
bisexual, and transgendered, men and women. I have also found that this model invites people to view their sexual experiences,
expression and eroticism, as their own. This realization often empowers one to self define what is "normative" sexual
experience by ones own definition.
What is sex therapy? Our sexuality, as well as our understanding
of the erotic, is interwoven within the physical, emotional, psychological and spiritual dimensions of being human. Sex therapy
is about working with individuals and couples to learn new ways to explore, express and integrate the joy of sexuality, in
all it's complexity, more fully into our personal and intimate relationships. This may mean offering education about how to
better communicate ones sexual desire to a partner, for others it may mean focusing on, and resolving, sexual difficulties
such as erectile problems, low sexual desire and difficulties with orgasm or pain that occur during sexual activity. A sex
therapist may also work with a couple, or individual, to determine how they wish to define and pursue their own definition
of optimal sexual functioning and the struggles that prevent them from attaining this goal.
People who are interested in seeking help to improve their sexual relationships are frequently
left scratching their heads trying to understand what sex therapy is and what a sex therapist does. This lack of understanding
is often compounded by our cultures uneasy, and often hostile, relationship to sex, sexuality and sexual pleasure. The tragedy
of this discomfort is that it prevents people from understanding that sex and sexuality are multidimensional aspects of the
human experience and a powerful source of life affirming connection. Both straight
and gay couples benefit from sex therapy, often reporting that not only has there been an improvement in the quality of their
sexual intimacy but a deepening trust and emotional connection with their partner. Individuals can also benefit from sex therapy
by discussing concerns about their thoughts, feelings and experiences related to sex and sexuality and the desire to explore
other aspects of their sexual selves. What Can I Expect to Happen in
Sex Therapy:When a couple, or individual, enters sex therapy they can expect a combination of interventions
that include, a) assessment of the presenting issues, b) assessment of the couple, or individuals, style of relationship,
c) sexuality education, and d) directed therapeutic interventions. a) Assessment
of the presenting issues begins with the our exploring:• Current and past sexual functioning• Understanding
sexual attitudes and experiences• The ways in past experiences may contribute to issues in the here
and now• Discussing what one has learned about the role of sex and intimacy• Assessing
if body image is impacting on ones expression of sexuality• Exploration of health issues that
may interfere with current sexual functioning b) Assessment of the couples, or individuals,
interpersonal relationship styles begins with:• Exploring emotional issues that may impact sexual
expression• Exploring the sexual styles that each individual brings to their relationship• Understanding
the role of trust in emotional and sexual relationships c) Sexuality education:• Discussing
the anatomy and physiology of sex and sexuality• Discussing and combining sexuality, trust and play
into sexual expression• Suggesting reading materials d) Directed therapeutic
intervention:• Structured homework assignments• Challenging unhelpful patterns
of communication• Developing tools to enhance sexual expression and intimacy• Referrals
for medical evaluations or other interventions as needed Common questions
related to sex therapy. Q. Does a sex
therapist have sex with their clients? A. Absolutely NOT! This is illegal and
unethical. A sex therapist will not touch you, or expect you to be sexual with him or her, in any way, shape or form. A sex
therapist is a trained and licensed mental health professional such as a social worker, psychologist, marriage and family
therapist or licensed counselor. While sex therapy often includes the explicit discussion of sexual material, and the interventions
offered are sometimes sexual in nature, to be explored in the privacy of ones home with ones self or ones partner, there will
never be any form of sexual interaction with the therapist. Q. What are the
requirements to become a sex therapist? A. After completing a graduate degree
in some mental health discipline, this may be in social work, clinical psychology, marriage and family therapy or mental health
counseling, the clinician is required to complete a period of post graduate training and supervision, which then allows he
/ or she to obtain independent licensure in their specified discipline. The sex therapist then acquires additional specialized
training, and supervision in the field of sexology and sex therapy. The requirements
to become a certified sex therapist are demanding! All sex therapists are required to complete90 hours of basic
education in human sexuality including fetal gestation, sexual anatomy and physiology, variations in the types and expression
of human sexuality, coercion and consent in sexual dynamics, gender identity issues, relational dynamics, the impact that
substance abuse and dependency can have on sexual functioning, paraphilia’s and forensic issues, and research methodology
common to sexology, as well as understanding sexuality across the lifespan. Certified sex
therapists are also required to complete, and document 60 hours of course work specific to sex therapy interventions and techniques
designed to effectively treat aspects of human sexual dysfunction. Sex therapists must also complete a minimum 10 hour seminar
entitled the Sexual Attitude Reassessment, which is an educational workshop in which participants are presented with various
issues and forms of sexuality, and are required to identity their attitudes, feelings and reactions in small group settings,
to better clarify their own personal values and attitudes towards sexuality issues when working with client’s in psychotherapy. Sex therapists
are also required to engage in 50 hours of clinical supervision with an AASECT Certified Sex Therapy Supervisor. The supervisor
oversees, guides and ensures that the candidate has worked with at least one case from each of the DSM sexual dysfunction
categories. After completing these requirements, the applicant than obtains a letter
of support from at least one other sex therapy colleague, who is familiar with the applicants work, as well as a letter of
reference from a non-sex therapy colleague, who can attest to the character of the applicant. The applicant is then required
to write a position statement, clarifying their views, philosophies and perspectives on sex therapy. After these requirements
are completed, the candidates’ application is reviewed by the AASECT certifying committee for consideration. If the
applicant has met all of the listed requirements, their statement paper is accepted, and their supervisor and references are
positive, the applicant is granted certification as a sex therapist. Q. How long does
sex therapy last? A. Sex therapy, historically, has been considered a shorter-term therapy
that has focused specifically on sexual issues. However, like any form of therapy it is difficult to determine how long therapy
will last. This can be determined between you and your therapist. Q. Do sex therapists
only work with sexuality issues? A. As sex therapists are trained primarily
as psychotherapists, the scope of their practice frequently includes a broad range of clients. Most sex therapists have extensive
experience treating concerns such as substance abuse, depression, anxiety, sexual abuse and general life transition challenges.
Other sex therapists choose to focus specifically on issues of sex and sexuality. Q. If I have
a medical concern that is impacting my sexual functioning, can you help me locate a provider that will address this issue
with me? A. Absolutely! Sometimes problems related to sexual functioning require
medical intervention. For men, this may mean working with an urologist to explore issues related to genital blood flow, testosterone
levels, prostate issues or other concerns with genital functioning. For women, this may include meeting with a gynecologist
or other medical personal, to explore sexual pain issues or problems with lubrication. Whatever the issue, a medical consultation,
or consultation with other sexuality professionals can be arranged and included in your therapy.
Recommended
readings: Paul Joannides and Dearick Gross Sr. (2009). The Guide to Getting it On.
Goofy Foot Press. Felice Newman. (2004). The Whole Lesbian
Sex Book: A Passionate Guide for All of Us. California. Cleis Press, Inc. Barry W. McCarthy
& Michael E. Metz. (2008). Men’s Sexual Health: Fitness For Satisfying Sex. New York. Routledge. Tammy Nelson.
(2008). Getting The Sex You Want: Shed Your Inhibitions and Reach New Heights of Passion Together. Massachusetts. Quiver. Gina Ogden. (1999).
Women who Love Sex: Ordinary Women Discuss Their Paths to Pleasure, Intimacy and Ecstasy. Boston, Trumpeter Press. Gina Ogden. (2008).
The Return of Desire: A Guide to Rediscovering Your Sexual Passion. Boston. Trumpeter Press. Charles Silverstein
& Felice Picano. (2003). The Joy of Gay Sex 3rd Edition: Revised and Expanded. New York. Harper Collins.
|
