Tag: Partner

While developing therapy concepts and procedural patterns at onset of the clinical investigative approach to sexual dysfunction in 1959, there were many severe problems to be faced. One of the most prominent concerns was the demand to develop a psychosocial rationale for therapeutic control of unmarried men and women that might be referred for treatment.

During 11 years of treatment, 54 men and 3 women were unmarried when referred by their local authority with complaints of sexual dysfunction. In a statistical breakdown relative to intake diagnosis, 16 men were premature ejaculators, one was an incompetent ejaculator, 21 were primarily impotent, and 16 were secondarily impotent.

The three women were orgasmically dysfunctional, one primarily and two situationally (coital orgasmic inadequacy).

The immediate problem to be faced was the obvious clinical demand for a female partner a partner to share the patient’s concerns for successful treatment, to cooperate in developing physically the suggestions presented during sessions in therapy, and most important, to exemplify for the male various levels of female responsivity.

All of these factors are essential, if effective sexual functioning is to be returned to the sexually inadequate man. In brief, someone to hold on to, talk to, work with, learn from, be a part of, and above all else, give to and get from during the sexually dysfunctional male’s two weeks in the acute phase of therapy.

The term replacement partner is used to describe the partner of his or her choice brought by a sexually inadequate unmarried man or woman to share the experiences and the education of the clinical therapy program.

Partner surrogate has been reserved to indicate the partner provided by the cotherapists for an unmarried man referred for treatment who has no one to provide psychological and physiological support during the acute phase of the therapy.

The final listing, that of marital partners, includes not only husband and wife units, but also former husbands and wives, divorced or legally separated, who choose to join each other in mutual hope of a reversal of the sexual dysfunction that was a major contributor to the legal dissolution of the marriage.

Nine such units legally separated at intake have been seen in therapy in the last 11 years. Statistically, these units have not been treated separately from the legally married units referred for therapy.

Thirteen of the 54 non-married men brought replacement partners of choice who were most willing to cooperate with the therapists to enable their sexually dysfunctional men to establish effective sexual performance. The three unmarried women also brought replacement partners of their choice to participate in therapy.

These replacement partners were men with whom they had established relationships of significant duration, as well as the personal warmth and security that develops from free exchange of vulnerability and affection.

Partner surrogates have been made available for 41 men during the 11 years. This situation has involved basic administrative and procedural decisions. Should the best possible climate for full return of therapeutic effort be created for the incredibly vulnerable unmarried males referred for constitution or reconstitution of sexual functioning, or should there be professional concession to the mores of society, with full knowledge that if a decision to dodge the issue was made, a significant increase in percentage of therapeutic failure must be anticipated?

Unmarried Impotent Men

Whose dysfunctional status could be reversed to allow assumption of effective roles in society would continue sexually incompetent. From a clinical point of view there really was only one alternative. Either the best possible individual return from therapeutic effort must be guaranteed the patient, or the Foundation must refuse to treat unmarried men or women for the symptoms of sexual inadequacy.

Either every effort must be made to meet the professional responsibility of accepting referrals of severely dysfunctional men and women from authority everywhere in or out of the country, or admission to clinical procedure must be denied. It would have been inexcusable to accept referral of unmarried men and women and then give them statistically less than 25 percent chance of reversal of their dysfunctional status by treating them as individuals without partners.

This figure has been reached by culling the literature for material published from other centers, since it is against Foundation policy to treat the sexually dysfunction individual as a single entity. If the concept that therapy of both partners for sexual inadequacy has great advantage over prior clinical limitations to treatment of the sexually dysfunctional individual without support of marital partner, then partners must be available.

Statistically there no longer is any question about the advantage of educating and treating men and women together when attacking the clinical concerns of male or female sexual inadequacy.

For these reasons the therapeutic technique of replacement partners and partner surrogates will continue as Foundation policy:

It should be emphasized that no thought was ever given to employing the prostitute population. For reasons that will become obvious as the contributions of the replacement-partner and partner-surrogate populations are described, so much more is needed and demanded from a substitute partner than effectiveness of purely physical sexual performance that to use prostitutes would have been at best clinically unsuccessful and at worst psychologically disastrous.

The specific function of the partner surrogate is to approximate insofar as possible the role of a supportive, interested, cooperative wife. Her contributions are infinitely more valuable as a means of psychological support than as a measure of physiological initiation, although obviously both roles are vitally necessary if a male’s inadequacies of sexual performance are to be reversed successfully.

As stated, partner surrogates have:

A significant degree of sexual experience before joining the program. They are fully sexually responsive as women, and, as is true with most confidently responsive women, understandingly and compassionately concerned for the frustrations of a sexually inadequate male.

It would have been a tragic mistake to assign to the role of partner surrogate any woman with the slightest question as to her own facility for sexual responsivity, or a woman who could not convey pride and confidence in her own innate femaleness. It is only from a baseline of psychosocial confidence that effective therapeutic support can be projected by sexually secure women.

Sexual Performance Psychological Support

When a partner surrogate joins the therapy program she is subjected to exhaustive description of male sexual functioning with explanations oriented to both the physiology and psychology of male sexual response. The male fears of performance, his spectator role in sexual inadequacy, the inevitable sense of failure as an individual developed in the bedroom and then applied to daily living, his sense of personal inadequacy as a man are all discussed in detail.

Sexual Responsivity Question

based on the woman’s experience with adequate male sexual functioning are raised and answers are interpolated into’ examples of simple variations that develop into sexual dysfunctions.

In short, as thorough indoctrination as possible is always the procedure of choice.

In the orientation of a woman as a potential partner surrogate, specific attention is devoted to techniques that will tend to place the anxious, tension-filled male at ease socially as well as physically.

The therapists begin by relying on the specifics of the woman’s basic experience with interpersonal relationships as elicited from detailed history-taking during her interviews. Each woman’s security in her own role as a human female is a vitally important departure point in the area of social exchange.

When assuming an active role in the clinical therapy of any sexually incompetent man, the partner surrogate is given detailed information of the individual male’s psychosexual background and the cause for and specifics of his sexual dysfunction and is kept thoroughly informed on a day-to-day basis as to the professional team’s concept of therapeutic progress.

No other identifiable personal details of the involved male other than name are ever provided. Even this is masked if the name is well-known. The patient is cautioned against providing relevant personal information.

In the same vein, the partner surrogate never exchanges any personal information that might lead to her identification in the future.

Shortly after the roundtable discussion, the first meeting between the patient and his partner surrogate is arranged. The first meeting is always limited to a social commitment. Usually the couple go to dinner and spend a casual evening in order to develop communication and comfort in each other’s company.

It is at this first meeting that the partner surrogate makes one of her most important contributions. Before any attempt can be made toward reversal of existent sexual dysfunction, the anxious male must first be placed at ease socially.

He develops this ease from first hand knowledge of the partner surrogate through observing her personal appearance, preference in food or drink, manner of dress and of social conduct, and the way she verbally communicates with him.

During the evening the man also has an opportunity to define the general level of her formal education. She may discuss at some length such relatively non controversial subjects as sports, the arts, current events, but discussions of such explosive subjects as comparative religions or partisan politics are left to the patient.

Sexual research:

Every effort is made by cotherapists to match the sexual dysfunctional man and his partner surrogate as to age, personality, and educational and social background. It has been infrequent that a partner surrogate has contributed in this clinical role more than once a year in view of the number of 13 volunteers available for the 41 partnerless men, over the 11 years existence of the research program.

Some partner surrogates have not been utilized by the therapy teams with even this frequency. The psychosocial strain involved in making such an immeasurable personal contribution under the difficult circumstances prohibits frequent use of a particular partner surrogate.

Sexual Social and Physical Support

Once social exchange has been established, the partner surrogate moves into a wife’s role as the treatment phase is expanded. She joins the sexually inadequate male in both social and physical release of the tensions that accrue during the therapy.

With the exception of attending the individual therapy sessions, every step that a wife would take as a participant with her husband in the therapeutic program is taken with the dysfunctional non married male by his partner surrogate. The partner surrogate is briefed on a daily basis (as described above) but under separate circumstances so that her identity is never connected with the program.

The use of a partner surrogate (who is far better oriented to problems of male sexual dysfunction than most wives), although lacking the established pattern of communication possibilities and the mutual opportunity at full exchange of vulnerabilities potentially present in any established marriage, has achieved excellent results.

Levels of success have been far better than originally anticipated. One would expect that if the concept of the partner surrogate had real clinical value, the statistics of symptom reversal would have to approach those attained by the husband and wifes referred to the Foundation for relief of sexual dysfunction.

Male sexual dysfunctions

In fact, the values in reported reversals of male sexual dysfunctions returned by the admixture of partner surrogates and sexually inadequate males were approximately equal to those achieved by cooperative wives and husbands in marital-unit referrals.

The 41 unmarried men that worked with a partner surrogate included 12 premature ejaculators, 1 incompetent ejaculator, and 19 primarily impotent and 9 secondarily impotent men. It should be emphasized that 8 of the 12 premature ejaculators, 7 of the 9 secondarily impotent, and 4 of the 19 primarily impotent men had previously been married. Three of these men had been married twice previously.

In all cases the marriage had been terminated, reportedly due to the couple’s distress occasioned by the basic sexual inadequacy. Each of these formerly married men had been previously exposed to psychotherapy to relieve their dysfunctional symptoms without success.

With direct support of the partner surrogate all 12 of the premature ejaculators and the 1 incompetent ejaculator were relieved of their dysfunctional symptoms. There were 7 failures to establish effective coital function among the 19 primarily impotent unmarried men treated with the support of partner surrogates. There were 2 failures to reverse symptoms among the 9 instances of secondarily impotent unmarried men.

Thus of the 41 unmarried men referred to the Foundation by a source acceptable to the Foundation for treatment of sexual dysfunctions, 32 had their symptoms reversed with the support of partner surrogates and 24 of these 32 have subsequently married. All 24 have described an on-going, successful marriage. There has been one reported reversal of sexually functional status (a secondarily impotent man) in the newly contracted 24 marriages.

In view of the statistics there is no question that the decision to provide partner surrogates for sexually incompetent unmarried men has been one of the more effective clinical decisions made during the past eleven years devoted to the development of treatment for sexual inadequacy.

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