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BINIK & MEANA - Is There A Future For Sex Therapy .doc

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McGill University
PSYC 436
Irving Binik

PSYC 436 Reading Pg. 381 The Future of Sex Therapy: Specialization or Marginalization? Yitzchak M. Binik & Marta Meana Abstract and Introduction: • The practice of sex therapy gained professional and popular acceptance since the publication of Masters and Johnson 1970 book: Human Sexual Inadequacy • The immediate future of this field is assured, as public demand fuels the need for more information and pharmacology institutes focus on finding medical approaches that promise a more fulfilling sex life • Consequently, this popularity and institutionalization may have a marginalization effect, as sex therapy begins to be thought of as a special form of therapy requiring highly specialized training • Therefore, the authors are investigating the future or sex therapy, and whether a re-calibration is in order Creating the “Sex Therapy” Brand • Origin of the term “Sex Therapy” o Masters and Johnson might have first used the term in their 1958 grant proposal, but those documents have been lost o Term linked to the publication of Human Sexual Inadequacy o 1974 – professional literature referenced “sex therapy” • Sex therapy as a novel approach to treat sexual dysfunction using: o Psychoeducational o Time-limited intervention o Behavioral homework techniques o Couple communication training •  Conceptualized as manifestations of underlying conflict in the individual or couple •  Treatment: target conflicts rather than sexual symptoms o Binik & Meana: believe this approach is not sufficiently different from other psychotherapies and does not warrant a special status o Why did it develop as a specialization?  Public: finally had a “legitimate” profession to consult about sexual dysfunction  Health Professionals: finally there was a group to refer patients toTaking Sex Therapy to the Public • Time hailed Masters and Johnson’s Human Sexual Inadequacy as pioneering work, while contrasting it with uncertain information presented in two self-help best sellers published around the same time: Everything You Wanted to Know About Sex But Were to Afraid to Ask (Reuben, 1969) and The Sensuous Woman (Garrity, 1971) o As a result: therapists honed in the publics demand for self- help books and videos o Radio, TV, and sex advice columns became important communication channels for therapists o Sex therapists became characters in movies and TV shows, ie. Sex and the City • The term “sex therapy” has become a brand name in the Western world o Internet: sexual information websites o Sexual advice pod-casts available o Google search (in 2007) – yielded 598,000 hits for “sex therapy”, outnumbering “couples therapy” and “marital therapy” • Reports of sex therapy clinics and practitioners outside of Western culture o Ex. Avasthi, Sharan, & Nehra, 2003 From Popularity to Institutionalization • Professional legitimacy was harder won than public acceptance • Behavior therapy movement and non-psychoanalytic medical community in the 1970-80s generally accepted Masters and Johnson type of sex therapy o Criticized by non-behaviorally oriented psychotherapists (ie. Shainess, 1971) – worried it would depersonalize sex • DSM-III (1980) o Reflected growing interest in sexual dysfunction o Created new category of psychosexual dysfunctions (ie. vaginismus)   shift towards symptoms and their operationalization • Currently: CBT, most psychiatry and gynecology residency programs have dropped sexuality from its agenda o Even though most sex therapy techniques apply CBT to treatments of sexual dysfunction • Only professional specialty in which interest in human sexuality has grown: urology o Established an international sexual medicine movementWill the “Real” Sex Therapist Please Stand Up? • At the time, there were few or any legal restrictions on the use of the term “sex therapist” o Some people from various backgrounds were advertising themselves as sex therapists o Unregulated growth; increasing professional, ethical and legal concerns   Lead to the development of self-regulating sex therapy associations, such as the American Association of Sexuality Educators, Counselors, and Therapists • Accepted professionals from varying disciplines so long as they could demonstrate knowledge and competence about sexual functioning and therapy o  Raised professional standards of sex therapy • Positive side: specialization breeds expertise • Negative side: breed general relinquishing of responsibility by non-specialists and expert superiority o Questions posed by Binik & Meana:  1. Is this distinction sufficient to warrant this supposed specialization?  2. Does this claim to specialization promise to deliver more than it can? Sex and the Other Psychotherapies • All major psychotherapeutic orientations are named in accordance with: o Theory underlying the therapy (ie. psychoanalytic, cognitive-behavioral) o Mode of delivery (ie. family, couple or group therapy) o Defining techniques (ie. play or narrative therapy)   Interventions are a conglomeration of well-known techniques/approaches that target a particular symptom or problem   Techniques are applicable to a number of mental or emotional problems • Sex therapy functions outside of these assumptions o “Sex therapy” rather than “sexual dysfunction therapy”  Binik & Meana: semantic argument, but unique use of language carry meaning and can reflect extraordinary circumstances No Unifying Theory of Sex Therapy • Masters and Johnson considered psychosocial factors to be the cause of most sexual dysfunction • Annon (1976) – sex therapy using learning theory principles o Notion: sexual dysfunction was mostly “learned” and could be “unlearned” through sex therapy • Kaplan’s (1974) The New Sex Therapist o Symptom-focused approach but maintained the use of traditional treatments to help with deeper individual or dyadic conflict o “Heretical” view o Paved the way for sex therapy’s adoption of non-behavioral form of therapy:  Systemic  Bowenian  Object relations  Hypnotic  Pharmacological  Ericksonian • LoPiccolo (1994) (leader in early sex therapy) o “Post-modern sex therapy”  Deal with individual dynamic issues  Systemic couple problems  Unresolved family of ori
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