Relationship among social and intrapersonal risk, alcohol expectancies, and alcohol usage among early adolescents.

Numerous studies have shown that adolescents' expectancies about the effects of alcohol influence usage. Expectancies are described as mediators between social influences (such as peer and parental influences) and alcohol use. The present study examined the relationship between social risk factors (peer influence and parental approval), intrapersonal risk factors (tolerance of deviance and sensation seeking), alcohol expectancies, and alcohol usage in a cohort of seventh graders. It was hypothesized that social risk factors affected alcohol usage indirectly through expectancies, while intrapersonal risk factors influenced usage both directly and indirectly. Structural modeling was used to examine the hypothesized relationships between these four constructs. Results indicated that the hypothesis that expectancies mediate social influences was not supported, and that social influences exerted a direct influence on usage independent of expectancies. Results suggested that the view that expectancies mediate social risk factors may need modification. Suggestions for future research in this area include the need to examine the relationships among these constructs longitudinally and with adolescents over a broader age range.

Risk factors and their relation to initiation of alcohol use among early adolescents.

This study examined the relationship between risk factors and initiation of alcohol use over a 15-month period among a cohort of 7th graders who were abstainers at the time of initial testing. The relationship between risk factors and alcohol use was examined using a discriminant function analysis. At the univariate level, rejection of parental authority, deviant behavior, and sensation seeking were statistically significant. The discriminant function retained only three of the risk factors: rejection of parental authority, deviant behavior, and religious commitment. Implications for school-based prevention programs are discussed, particularly the need to target primary prevention programs based upon adolescents' risk.

Group treatment of secondary erectile dysfunction.

The effects of three group treatment formats on 20 men with secondary erectile dysfunction and their partners were contrasted. After a comprehensive medical and psychological screening, each couple was assigned to one of three treatment groups (Communication Technique Training, Sexual Technique Training, Combination Treatment) or to one of two control groups (Attention-Placebo, No-Treatment). Couples in the three treatment groups and the attention-placebo group participated in their respective formats in twice-weekly sessions for a total of 20 hours. The no-treatment control group received sex education and treatment after a 5-week waiting list period. All three treatment groups fostered substantial gains so that between-format differences were not statistically significant. Subject variables which predicted success/experience ratio gains included age of the male partner, perceived level of relationship adjustment, and the male partner's success/experience ratio prior to treatment. Eighty-one percent of the treated men reached the criterion of 80% or greater success/experience ratio (successful penetration and subsequent ejaculation) at the 6-month follow-up. Good nocturnal tumescence prior to treatment was correlated with a better treatment outcome than poor tumescence.

The treatment of secondary orgasmic dysfunction II.

This study investigated the impact of group treatment on women with secondary orgasmic dysfunction and their partners. Eleven couples received 4 hours of basic sex education, after which seven of the couples received a Combination treatment format consisting of communication skills followed by sexual skills, while four of the couples received the opposite sequence. No significant differences were found between the two sequences. When compared with similarly recruited control couples in a previous study, a significantly greater number of treated women reached or exceeded the 50% criterion for coital orgasmic functioning after treatment. Couples who reported a better relationship adjustment prior to treatment reported a significantly greater gain in total sexual harmony than did less adjusted couples. Across the treatment conditions, women who had reached coital orgasm prior to treatment reported a significantly greater increase in relationship adjustment between the post-sex education and 6-month follow-up testing periods than women who had never reached coital orgasm. Some discrepancies in outcome were found in comparison with our earlier study, suggesting that subject heterogeneity may influence differential outcomes.

Treatment of secondary orgasmic dysfunction: an outcome study.

This study investigated the differential effectiveness of various treatment formats for 55 couples in which the woman reported secondary orgasmic dysfunction (defined as the inability of the woman to reach orgasm during intercourse, with or without clitoral stimulation, more than 50% of the time for the last 5 months). Couples received two 2-hr sessions of sexual reeducation and were then assigned into one of four treatment conditions (a communication skills format, a sexual skills format, one of two combination formats) or into one of two control conditions (an attention-comparison control condition which consisted of didactic presentations, or a waiting-list control condition). Treatment was conducted by one of two female clinical psychologists in groups of between four to six couples. No significant differences were found between the different treatment conditions at the posttest or at the 6-month follow-up. Statistical comparisons conducted between the combined treatment and combined control conditions showed that the couples who received treatment reported significantly less overall sexual dissatisfaction and significantly greater sexual harmony at the posttest; however, these differences became nonsignificant at the follow-up. In comparison with the women in the control conditions, a significantly greater number of women who received treatment reached or exceeded the project's 50% criterion for coital orgasmic functioning at the posttest; however, these differences became nonsignificant at the follow-up. Couples who reported less relationship adjustment prior to treatment showed greater overall gains in coital orgasmic frequency than couples who reported better relationship adjustment.

Perspectives of sex therapy outcome: a survey of AASECT providers.

Randomly selected AASECT members who reported that they conduct sex therapy (N = 289) responded to a questionnaire about their sex therapy caseloads. Desire discrepancies between partners was the most common problem (31%). Least commonly reported problems were vaginismus (5%), ejaculatory inhibition (5%), and primary erectile dysfunction (2%). Highest success rates (client satisfaction with sexual functioning) were for premature ejaculation (62%), secondary orgasmic dysfunction (56%), and desire discrepancies (53%). Primary erectile dysfunctions had the lowest success rate (25%). The most commonly used treatment methods were a focus on communication skills, general sex education, homework assignments, and a focus on the sexual interaction; sensate focus, and the discussion of nonsexual individual and/or relationship issues also were quite commonly used. From a discriminant function analysis, the combined Therapists and Multiple-certified provider groups reported focusing on sexual interactions more than the combined Counselors and Educators; the Educators were the least likely providers to use a focus either on sexual interactions or on homework assignments. The Counselors were the most likely, and the Educators the least likely, to use communication skills. Therapists and the Multiple-certified providers estimated higher treatment success rates than Counselors and Educators for premature ejaculation, secondary erectile dysfunction, vaginismus, primary orgasmic dysfunction, sexual avoidance, ejaculatory inhibition, and sexual arousal problems. The Educators were the least successful with dyspareunia. Educators and Counselors were similar in reporting the fewest clients with sexual arousal problems. Therapists and Multiple-certified providers reported spending more treatment hours with desire discrepancies and desire problems. The implications of the findings for clinical practitioners and researchers are discussed.

The sexual interaction of women with secondary orgasmic dysfunction and their partners.

This paper reports the sexual interaction of 48 couples in which the women had secondary orgasmic dysfunction and the men reported no difficulties in sexual functioning. The results were contrasted with a sample of 63 "sexually satisfied" couples. On the Sexual Interaction Inventory, male and female members of the dysfunctional couples reported greater dissatisfaction with the frequency and range of specific sexual activities engaged in than their counterparts in the normative sample. Males in the dysfunctional group rated their sexual pleasure slightly higher than the norm, whereas the dysfunctional females' ratings were below average on this dimension. Within the dysfunctional group, males reported low self-acceptance and mate acceptance, while the females were less accepting of themselves but more accepting of their mates' responsivity. The female members of the dysfunctional couples had an average knowledge of their partners' sexual preferences, whereas the males were less accurate than the normative group in their perceptions of their partners' sexual preferences. As expected, the dysfunctional group reported greater overall disharmony and dissatisfaction in their sexual interaction. Implications of these findings for future research are discussed.

The effects of sex education on women with secondary orgasmic dysfunction.

This study evaluated the effects of sex education on 48 couples in which the women reported secondary orgasmic dysfunction. None of the males had a problem with premature ejaculation or with erectile dysfunction. Couples received two, two-hour sessions of sex education during a one-week period. From measures administered before and after treatment, the women reported significantly increased orgasmic frequency and decreased sexual anxiety. The males reported a significant increase in the duration of intercourse and in oral-genital sexual stimulation. None of the subject characteristics significantly predicted overall change. The findings underscored the important role of sex education in facilitating positive changes in a woman's orgasmic frequency and in a sexual relationship. Future research should assess the relative meaningfulness of the various components of the sex education package.

The user satisfaction survey: consumer evaluation of an inner city community mental health center.

The consumer movement has become a recognized force in American society. Yet consumer evaluation of community mental health services has largely been ignored or avoided particularly when users lack political or social power. As a first step toward increasing the accountability of providers to community users, a User Satisfaction Survey was developed. The 30-item scale is straightforward and requires 15 to 20 minutes to complete. The scale was field tested by 114 users of the adult outpatient services of an inner city community mental health center in Washington, D.C.