Tag: Function

During the rapid treatment program, the daily report and ensuing discussions between the cotherapists and marital partners describing the non orgasmic wife’s reactions and as well as those of her interacting husband, provide an incisive measure of the degree to which the requirements of her functioning sexual value system are being met or negated, or the extent to which she progressively is able to adapt her requirements.

These discussions provide simultaneous opportunity for a more finite evaluation of the levels of interactive contribution to sexual function by her bio physical and psychosocial systems.

The treatment of both primary and situational orgasmic dysfunction requires a basic understanding by patients and cotherapists that the peak of sex-tension increment resulting in orgasmic release cannot be willed or forced.

Orgasmic experience evolves as a direct result of individually valued erotic stimuli accrued by the woman to the level necessary for psycho physiological release. Just as the trigger mechanism which stimulates the regularity of expulsive uterine contractions sending a woman into labor is still unknown, so is the mechanism that triggers orgasmic release from sex-tension increment.

Probably they are inseparably entwined to identify one may be to know the other.

It seems more accurate to consider female orgasmic response as an acceptance of naturally occurring stimuli that have been given erotic significance by an individual sexual value system than to depict it as a learned response.

There are many case histories recorded in this and related studies reporting orgasmic incidence in the developing human female at ages that correspond with ages reported in histories of onset of male masturbation and nocturnal emission.

These clearly described, objective accounts are considered accurate by reason of their correlation with subjective recall provided by several hundred women interrogated during previously reported laboratory studies. The initial authoritative direction in therapy includes suggestions to the marital unit for developing a non demanding, erotically stimulating climate in the privacy of their own quarters.

At no time during the two-week therapy program is either of the marital partners under any form of observation, laboratory or otherwise. Only the phenomenon of vaginismus is directly demonstrated to the husband of the distressed wife, under conditions routinely employed by appropriate practitioners of clinical medicine.

The cotherapists’ initial directions suggest ways of putting aside tension-provoking behavioral interaction for the duration of the rapid-treatment program and allow the woman to discover and share knowledge of those things which she personally finds to be sexually stimulating.

Further professional contribution must suggest to the marital unit ways and means to create an opportunity for the woman to think and feel sexually with spontaneity. She must be made fully aware that she has permission to express her sexual feelings during this phase of the therapy program without focusing on her partner’s sexual function except by enjoying a personal awareness of the direct stimulus to her sexual tensions that his obvious physical response provides.

Every non orgasmic woman, whether distressed by primary or situational dysfunction, must develop adaptations within areas of perceptual, behavioral, and philosophic experience.

She must learn or relearn to feel sexually (respond to sexual stimuli) within the context of and related directly to shared sexual activities with her partner as they correlate with the expression of her own sexual identity, mood, preferences, and expectations.

The bridge between her sexual feeling (perception) and sexual thinking (philosophy) essentially is established through comfortable use of verbal and nonverbal (specifically physical) communication of shared experience with her marital partner.

Her philosophic adaptation to the acceptance and appreciation of sexual stimuli is further dependent upon the establishment of “permission” to express herself sexually. Any alteration in the sexual value system must, of course, be consistent with her own personality and social value system if the adaptation is to be internalized.

Keeping in mind the similarities between male and female sexual response, the crucial factors most often missing in the sexual value system of the non orgasmic woman are the pleasure in, the honoring of, and the privilege to express need for the sexual experience.

Restoration of sexual feeling to its appropriate psychosocial context (the primary focus of the therapy for the non orgasmic woman) is the reversal of sexual dissembling. This, in turn, encourages a more supportive role for her sexuality. In the larger context of a sexual relationship, the freedom to express need is part of the “give-to-get” concept inherent in capacity and facility for effective sexual responsivity.

Professional direction must allow for woman’s justifiable, socially enhancing need for personal commitment, because her capacity to respond sexually is influenced by psychosocial demand.

The commitment functions as her “permission” to involve herself sexually, when prior opportunities available to formation of a sexual value system have not included an honorable concept of her sexuality as a basis upon which to accept and express her sexual identity.

Commitment apparently means many things to as many different women; most frequently encountered are the commitments of marriage or the promise of marriage, the commitment of love (real or anticipated) according to the interpretation of “love” for the particular individual.

Regardless of the form the commitment takes, after it is established the goal to be attained is enjoyment of sexual expression for its own positive return and for its enhancement of those involved.

During daily therapy sessions, interrogation of the sexually dysfunctional woman is designed to elicit material that expresses the emotions and thoughts that accompany the feelings (sexual or otherwise) developed by the sensate-focus exercise.

Also continually explored are the feelings, thoughts, and emotions that are related to the behavior of her marital partner. Her reactions when discussing material of sexual connotation are evaluated carefully to determine those things which may be contributing to ongoing inhibition or distortion being revealed by the regular episodes of psychophysiological interaction with her husband.

When a non-orgasmic female involves herself with her partner in situations providing opportunities for effective sexual function, her ever-present need is to establish and maintain communication.

Communication, both physical and verbal in nature, makes vital contributions, but it loses effectiveness in the rapid-treatment method is allowed to be colored by anger, frustration, or misunderstanding. While verbal communication is encouraged throughout the two-week period, physical communication is introduced in progressive steps following the initial authoritative suggestion to provide a non-demanding, warmly encompassing, shared experience for the woman, with optimal opportunity for feeling.

After the early return from sensate-focus opportunity as directed at the roundtable discussion has been judged fully effective by marital partners and co-therapists the marital unit is encouraged to move to the next phase in sensate pleasure genital manipulation.

The cotherapists should issue specific instructions to the marital partners as “permission” is granted to the female to enjoy genital play.

Sexual instructions should include details of positioning, approach, time span, and above all, a listing of ways and means to avoid the usual pitfalls of male failure to stimulate his partner in the manner she prefers rather than as she permits him the privilege to function.

In order to establish at least a minimum of patient screening, at onset of the clinical treatment program no units were accepted in therapy unless the complaining partner in the couple (e.g., the impotent male or the non orgasmic female) had a history of at least six months of prior psychotherapeutic failure to remove the symptoms of sexual dysfunction. Very soon this proved to be a poorly contrived standard, of little screening value.

As should have been apparent at onset, there was no secure way of establishing the functional effectiveness of the prior therapeutic program. How determined and well oriented was the therapist, how cooperative or fully responsible was the patient? After two years this original standard was abandoned in favour of that currently in effect.

Sexual Screening

A reasonably effective method of screening has been substituted by requiring that no patients be accepted at the Foundation unless they have been referred from authority. As authority, the Foundation accepts physicians, psychologists, social workers, and theologians.

Beyond screening the patients for appropriate referral to the Foundation, the referral source further is asked to provide available details of psychosocial background relevant to the husband and wife sexual dysfunction.

A telephoned report is made to the referring authority describing husband and wife progress (or lack of it) during or immediately following the acute phase of treatment at the Foundation. Well-informed authority then can provide a most important reinforcement for newly acquired patterns of sexual interaction for the couple once removed from the Foundation’s direct control by termination of the acute phase of therapy.

In many instances, patients in established psycho therapeutic programs have been referred for removal of symptoms reflecting a somewhat broad area of distress in which sexual inadequacy is only a part. After their two weeks at the Foundation, these couples are, of course, returned to referring authority to continue their established treatment programs.

Obviously, the referring authority, before continuing in therapy with his patient, is briefed in detail as to the couple’s response to its Foundation exposure. The screening process as currently constituted has several aims, all obviously selective in nature.

Symptoms of Sexual Inadequacy

Primarily, control which prevents referral of major psychopathology is presumed. In other words the psychoneurotic is acceptable, but not the psychotic.

It should be emphasized that the reversal of symptoms of sexual inadequacy in psychoneurotic patients is indeed a significant portion of the Foundation’s objectives. Acceptance of this role by the Foundation is based on the premise that the reversal of particularly troublesome sexual symptoms may speed the progress of a psychoneurotic patient within the greater context of his established and broader-based psychotherapy.

However, the majority of the couples contending with sexual dysfunction do not evidence psychiatric problems other than the specific symptoms of sexual dysfunction. Socio-cultural deprivation and ignorance of sexual physiology, rather than psychiatric or medical illness, constitute the etiologic background for most sexual dysfunction.

Therefore, when a couple is properly educated in sexual matters, and their specific symptoms are reversed, there is no need for further psychotherapy unless the extensive duration of the distress has created psychosocial complications no longer directly related to the sexual dysfunction.

Other areas of selective screening for information vital to the therapeutic program center on such questions as:

Are both members really interested in reversing their basic dysfunctional status? If one member of the unit simply has no interest whatsoever in reversing the symptomatology of sexual dysfunction in the marital relationship, the unit probably needs legal rather than medical or behavioural advice. The chances of reversing the sexual dysfunction under the circumstances of total disaffection for a marital partner are negligible.
What, if anything, is known of the couple’s adjustment or maladjustment to its social community?
Do the referred members of the couple understand the programs, procedures, and policies of the Foundation? If not, it is suggested that the local authority, quietly briefed in advance by the Foundation’s professional staff, present the information in more specific detail to his patients.
What is the couple’s basic financial picture? Should the Foundation offer the patients an adjusted fee scale or free care?

Sexual Therapy Commitment

The original research premise emphasized the fact that positive reversal of symptoms of sexual inadequacy during the acute phase of the treatment program was not of great import. If there were to be any clinical claim for positive effect in the Foundation’s concentrated approach to symptom reversal, the clinical results would have to be judged in retrospect over a significant period of time, not at the termination of the acute phase of therapy.

Therefore, the policy of five years of follow-up for couples after termination of the rapid-treatment phase of the program became an integral part of research standards. Failures to reverse symptoms are, of course, considered most significant.

Little of clinical value can be established for any therapeutic program, regardless of length of its ongoing treatment phase, if the results are not evaluated in long-term follow-up after termination of the acute phase of therapy. The abiding guide to treatment value must not be how well the patients do under authoritative control but how well they do when returned to their own cognizance without therapeutic control.

This result finally must place the mark of clinical failure or success upon the total therapeutic venture.

Individual members of couples seen in treatment must agree to cooperate with five years of follow-up after termination of the acute phase of the therapy program. They fully understand.

The Foundation’s basic premise that success in reversal of the symptoms of sexual dysfunction means little during the two weeks of intensive treatment, unless the symptom reversal is maintained for at least the first five years after separation from direct Foundation influence.

Success in maintenance of symptom reversal for this length of time does provide some sense of permanency in the continuing effectiveness of the couple’s sexual functioning.

Those couples whose acute treatment phase was judged inadequate or a failure arbitrarily have not been placed in the five-year follow-up program. This type of follow-up would indeed have been a study of major importance, but such continuing interrogation certainly could have interfered seriously with other clinical approaches designed to relieve the unit’s problems of sexual dysfunction.

The therapy concepts and clinical procedures depict basic methodology of cotherapist interaction, first, between team members, and second, directed toward husband and wife of the sexually dysfunctional marital, unit. Jules Masserman has so aptly described psychotherapy as “anything that works.” This “works” in a healthy percentage of cases.

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