Personality change in sex therapy.

Lasting symptomatic change in sex therapy is not possible without relevant character change. Character change is most likely to take place in the areas of pleasure, assertion-aggression, and object-relatedness, if the therapy is successful. Such positive changes, however, may be accompanied by negative characterological shifts in the areas of dependency and autonomy. In addition, in failed therapy, existing negative character traits may be reinforced or exacerbated. Character change in sex therapy is brought about by a combination of factors, some familiar from psychoanalysis and some unique to sex therapy. These are, principally, identification, transference resolution, and new learning, both behavioral and cognitive, in a couple format. It is the synergistic effect of the cognitive and behavioral elements of this therapy that catalyzes the treatment process in favorable cases, resulting in accelerated character change.

The role of resistance in sex therapy.

Resistance, the sum of forces opposing the treatment process, is particularly manifest in conjoint sex therapy and may well threaten the successful conduct of treatment unless recognized promptly and dealt with appropriately. A classification of resistant behaviour most common in sex therapy is proposed and illustrated with clinical vignettes. Treatment strategies are discussed as well as indications for referral to longer term therapy.

Issues of transference in sex therapy.

When Masters and Johnson introduced the new sex therapy, it was thought that transference responses and related psychodynamic factors did not have an essential role in the treatment of sexual dysfunction. However, subsequent clinical experience has shown that in a substantial number of cases transference phenomena are crucial and need to be worked with in order for the treatment to be successful. This paper reports on the types of transference reactions observed, the process by which sex therapy energizes these reactions, and the therapist's role in dealing with them. Two cases are presented as illustrations of this process.

The role of dreams in sex therapy.

The interpretive use of dreams has become an established part of all dynamic psychotherapies. Their usefulness in sex therapy has thus far not been acknowledged. For the psychodynamically oriented sex therapist dreams can be particularly valuable in furnishing an understanding of those unconscious factors that cause sexual dysfunction, those that perpetuate dysfunction, and those that interfere with efforts to treat the dysfunction. By utilizing and integrating dream material into the sex therapy format, treatment is more likely to be successful and in a shorter period of time than can be accomplished by either sex therapy or psychoanalytic psychotherapy alone.

A study of treatment needs following sex therapy.

The authors describe 19 couples who returned for additional treatment after traditional short-term sex therapy. Eight couples required additional short-term sex therapy, and 11 couples were treated primarily with individual psychoanalytic psychotherapy or conjoint therapy for an extended period of time. The authors identify three reasons for return to therapy: 1) treatment overload, 2) severity of symptoms, and 3) presence of psychopathology relevant to the sexual dysfunction. They point out that pleasure, intimacy, and cooperation dysfunctions need to be worked through if sex therapy is to have lasting effects.

Ego deficiencies in the areas of pleasure, intimacy, and cooperation: guidelines in the diagnosis and treatment of sexual dysfunctions.

Psychopathology, in the form of a deficiency in the ego functions of pleasure, intimacy, or cooperation, is usually associated with sexual dysfunctions that prove refractory to sex therapy techniques alone. Each of these deficiencies forms a distinct clinical syndrome with specific treatment requirements, necessitating further diagnostic subcategorization of sexual disorders.