Treatment of Traumatised Sexuality

Based on therapeutic meetings with individuals who have experienced sexual violence and abuse, the challenge is how do we help these couples to establish sexual relationships on their own terms, without interference of defence or coping strategies they have used to protect themselves against the overwhelming experiences of violence or abuse in the past? This article will focus on therapeutic work with such couples and how to interact with them and support their efforts to establish satisfying sexual relationships, based on sexological experience as well as experience from work with traumatisation. The basis for our treatment is a modified version of William Masters and Virginia Johnson’s approach. The technique of sensate focus is central, modified by trauma theory, including the understanding of dissociation, and the need to integrate memories from different levels: somatic, emotional, and cognitive. The traumatised client needs special attention to the experiences of predictability and safety and respect due to their history of being transgressed against. The therapists must be aware of the issue of dissociation; different dissociated inner parts can play different roles in the interaction between client and therapist. While couples therapy is a necessary frame for this therapy, the therapist often needs to work with issues unique to each individual. Each partner must be able to identify their own responses and their own sexual needs and preferences. It may therefore be valuable to have a co-therapist. The central goal is for the clients to identify responses to stimulation as a here and now experience in a setting that feels safe and welcome.

Role of Multimodal Psychotherapeutic Approaches in Bisexual Adult Man: A Case Study

The objective was to see the effectiveness of multimodal psychotherapeutic approaches on depression, anxiety, stress, sexual arousal, and desire in bisexual adult man. There was a positive change in the level of depression, anxiety, stress, sexual arousal, and desire after the intervention in a bisexual adult man. Single case design was used. He was seen in an independent practice setting with once in a week, 90-min duration of sessions for 8 months. Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, ICMR Psychosocial Stress Questionnaire, and Sexual Arousal and Desire Inventory were used. Orgasmic reconditioning, cognitive behavior therapy, mindfulness meditation, and sensate focus were carried out. Pretest, midtest, and posttest assessments were done. Two months follow-ups were carried out. Preassessment revealed that client had severe depression, very high stress, moderate anxiety and very high sexual arousal and desire, frequently masturbation, guilt feeling, and tingling sensation in genital area. Postintervention results revealed remarkable reduction in the level of anxiety, depression, stress, improvement in sexual knowledge and functioning, management of sexual arousal and desire, and achieving sexual satisfaction with his spouse. It can be concluded that multimodal psychotherapeutic approaches have been proven effective.

Should “sensate focus” have a place in couple psychoanalytic psychotherapy?

In the UK, psychotherapeutic treatments for sexual problems are split between couple psychoanalytic or psychodynamic psychotherapy, which focuses on the mind, and psychosexual or sex therapy, which focuses on the body, principally using the intervention “sensate focus” (Masters & Johnson, 1970). Remarkably, there are few published papers on the integration of these two approaches, indicating a near-absence of debate and perpetuating the professional bifurcation. More contributions on this topic are needed. This article provides an overview of the field (psychoanalysis and sex therapy) and presents excerpts from the author’s recent doctoral study (Pacey, 2018), using Winnicottian theories to link the two paradigms and support the integration of sensate focus into psychoanalytic couple therapy.

An Integrative Model for Treatment of Sexual Desire Disorders

An integrative model for treating sexual desire disorders was developed from the original work of Masters and Johnson Institute. Sensate focus exercises and psychoeducation were combined with couple therapy for relationship conflicts and individual therapies for issues with trauma and attachment disorders. The resulting model fits trends in systemic and integrative treatment.