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Is That All There Is? Problems with Current Sex Therapy

Is That All There Is? Problems with Current Sex Therapy. A New Critique of the Goals of Sex Therapy By Peggy J. Kleinplatz , Ph. D. Performance over Subjective Meaning and Experience. Focus on technical remedies vs. cognitive and affective components of sexual response.

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Is That All There Is? Problems with Current Sex Therapy

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  1. Is That All There Is?Problems with Current Sex Therapy A New Critique of the Goals of Sex Therapy By Peggy J. Kleinplatz, Ph. D.

  2. Performance over Subjective Meaning and Experience • Focus on technical remedies vs. cognitive and affective components of sexual response. • Focus on orgasm vs. passion • Focus on stimulation vs. eroticism • Focusing on performance may lead to disconnection with partner. • ALTERNATIVE GOAL: Focus on Client’s inner Experience

  3. One-size Fits All Goals over Allowing Individual Uniqueness • Diagnosis looks at the symptom only not underlying motivations, needs, and desires. • Think of how a dominatrix explores with the client, the client’s specific meaning of bondage – what the experience means, what needs and desires the client wants met. ALTERNATIVE GOAL: Therapist needs to look beyond the symptom to the underlying desires.

  4. Promotes Conformity to Toxic Norms over Social Change • Sexual norms – sex scripts that effect our relationships, sexual development, self-image,… • Toxic when they narrow what is considered “ideal” . • Examples related to: • Aging • Masculinity • Femininity • Appearance,… ALTERNATIVE: Be more proactive in preventing sexual problems, challenge media and sex education, promote social change!

  5. What can we do?http://www.advocatesforyouth.org/policy-and-advocacy/take-action-for-change?task=view

  6. A Priori Solutions over Change Generated From Within • “Text book” solutions. • Inner resources lead to individual outcomes, even with the same problem. ALTERNATIVE: Flowing with the client’s process: finding their strengths, abilities, inner motivations – joy, attention, humor…

  7. Stops Too Soon and Settles for Too Little • Settling for lowered expectations without growing toward fundamental change. • Sexual “safety” fearing “out of control” eroticism. • Focus on sexual performance “norms” instead of using sex as a tool for personal growth and interpersonal intimacy. • “Great therapy can be like great sex. The possibility is for utter transformation in the hands of someone who is willing to reach all the way inside and to help bring forth all that one can be.” (p.109) • ALTERNATIVE: Discover the core sources of pain and joy, and hope and despair using honesty, acceptance, openness, genuineness, vulnerability, and authenticity.

  8. Controlling Paraphilic Behavior • Paraphilic disorders – DSM-5 requires that people with these interests: • feel personal distress about their interest, not merely distress resulting from society’s disapproval; or • have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent. Paraphilic disorders includes eight conditions: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder, and voyeuristic disorder. www.dsm5.org/Documents/Paraphilic%20Disorders%20Fact%20Sheet.pdf

  9. Paraphilic Desires and Current Treatment • SSRIs, anti-androgens and CBT • Targets symptom without looking at the desire behind it. • Controlling behavior, may alienates self and make desires more menacing. • Think of how much you want to eat when you tell yourself that you are on a diet and can’t eat. • Think of a time when a secret grew power by trying to deny it/hide it. ALTERNATIVE: Bring desires out into the open. Explore the desires and needs behind them. Try to bring about personality change.

  10. New Direction: Promoting Optimal Sexuality a Way of Being • Eight components in optimal sexual experiences. • Being present and focused • Sense of connection and oneness with partner • Deep sexual and erotic intimacy with mutual respect, caring and acceptance • Extraordinary communication with heightened empathy • Interpersonal risk-taking viewed as a journey • Authentic, uninhibited, transparent • Being vulnerable, surrendering to the partner, in the moment • Sense of transcendence, bliss, healing and transformation

  11. Optimal Sexual Experience Studies • Extraordinary experiences develop over time • Needed to throw away what learned about sex growing up and reinvent themselves • Potency does not equal intercourse. • Evaluate quality over quantity • Encourage client’s to expand using Optimal Sexual Experience characteristics.

  12. How Do We Put It All Together?

  13. How Does This Relate to Us? • How do we define the “problem” in therapy? • What does our theoretical orientation say causes and maintains a “problem?” • How do we view an individual – mechanically or holistically? • Do we look at content or inner process? • What stops us from exploring and challenging expectations? • Think of own experiences… Where the Wild Things Are by Maurice Sendak

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