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Systemic Sex Therapy

Systemic Sex Therapy. A Treatment Approach Model Anthony Hughes, Ph.D., LMFT. What is Sex Therapy?. Sex Therapy Highlights. Sexual socialization and culture Sexual development and understanding Sexual dysfunctions Sexuality and Illness Gender differences concerning sexuality

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Systemic Sex Therapy

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  1. Systemic Sex Therapy A Treatment Approach Model Anthony Hughes, Ph.D., LMFT

  2. What is Sex Therapy?

  3. Sex Therapy Highlights • Sexual socialization and culture • Sexual development and understanding • Sexual dysfunctions • Sexuality and Illness • Gender differences concerning sexuality • Sexual pharmacology • Sexuality and Minorities • Sexual trauma and abuse • Sex offenders

  4. Specializing in a Specialized Field • Sexual minorities • Gay and Lesbian • Sexual pain • Dyspareunia • Sex offenders

  5. Basics of Sex Therapy • Use of sound therapeutic principles and theory • Therapeutic alliance • Work through self-of-the-therapist issues • Supervision • Comfort level with sexuality • Sex offender • Traditional medical model • Behavioral interventions

  6. Basics of Sex Therapy • Knowledge and understanding • Sexual response cycle; Normal sexual functioning; Myths and misconceptions • Directive VS Non-directive • Psycho-educational component • Homework assignments, process and re-assign • Theory/effectiveness research driven

  7. My Therapeutic Model Intersystemic Sex Therapy informed by Attachment Theory

  8. Attachment Theory • Basics • Significant attachment figures • Safe haven and secure base • Insecure VS secure • Prototype VS revisionist

  9. Intersystemic Sex Therapy • Emergent conceptualization and treatment • Macro, mezzo, and micro • Individual bio/psycho • Dyadic • FoO • Social/Cultural/Religious • Societal • Traditional divergence • Assessment, conceptualization, and treatment implications

  10. Therapeutic Format • First session with the couple • Alliance building • Problem formation and reason for treatment • Observation and assessment • Second and third session individual • Each individual meets with therapist for sexual history assessment • Ease of disclosure • Factors affecting sexual relationship • Treatment protocol after 3rd session • Subsequent sessions • Couple focused • Sexual genogram • Accurately informed treatment plan facilitates appropriate focus

  11. Intersystemic Assessment • Attends to each part of the “system” • Equal attention to all parts in assessment • Accurately informed treatment plan facilitates appropriate treatment focus • Individual • Biological; Medical/Pharmacological • Individual • Psychological • Dyadic relational • Family-of-Origin • Social/Cultural/Religious

  12. Assessment ToolsSexual Genogram… • What are the overt or covert messages in this family regarding sexuality/intimacy? Regarding masculinity/femininity? • Who said/did what? Who was conspicuously silent or absent in the area of sexuality/intimacy? • Who was the most open sexually? Intimately? In what ways? • What questions have had regarding sexuality/intimacy in your “family tree” that you have been reluctant to ask? Who might have the answers? How could you discover the answer? • What were the “secrets” in your family regarding sexuality/intimacy?

  13. Assessment ToolsSexual Genogram… • Was anyone constrained or inhibited in communicating about sexuality, affection, intimacy, and other feelings that showed warmth? • Were any members of you family treated as outcasts because of their sexuality? To what effect? • What would you like to change about the way your family discussed and showed intimacy, affection, and sexuality? • How do you see your sexuality today connected to what you learned in your family? • What did you learn concerning sexuality from peers/school/religious or other affiliations?

  14. Assessment ToolsSexual Genogram • What do the other “players on the stage” have to say regarding the above questions? How did these issues, events, and experiences impact them? Within a generation? Between generations? With whom have you talked to about this? How could you do it? • How does your partner perceive your family genogram regarding the aforementioned issues? How do you perceive his/hers? • How would you change this genogram (including who and what) to meet what you wish would have occurred regarding messages and experience of sexuality/intimacy?

  15. Sexual Dysfunctions/Etiology • Sexual Desire Disorders • Hypoactive Sexual Desire Disorder • Bio-Depression • Psy-OCD • Dyad-Negative sexual experience (pregnancy) • FoO-Mother says sex is for man • S/C/R-Women don’t have drive, lack of sexual awareness

  16. Sexual Dysfunctions/Etiology • Hyperactive Sexual Desire/Sexual Compulsivity • Bio-stress, hedonic, set point • Psy-Avoid (function) • Rel-Feel close • FoO-Learned behavior, neg. coping • S/C/R-Pornography isn’t addictive, don’t talk about

  17. Sexual Dysfunctions/Etiology • Sexual Arousal Disorders • Erectile Dysfunction • Psy-Pornography (dopamine/conditioned responding) • Bio-Prostate, high blood pressure • Dyad-Lack of connection, safety, vulnerability • FoO-Shaming about masturbation • S/C/R-Myths about men

  18. Sexual Dysfunctions/Etiology • Female Sexual Interest/Arousal Disorder • Psy-Distorted body image, confidence • Bio-Birth control/low estrogen and testosterone • Dyad-Foreplay, gender differences • FoO-Mother initiating kiss/hug/touch (receptive not initiator) • S/C/R-Limited teaching/awareness (internal Vs exter)

  19. Sexual Dysfunctions/Etiology • Orgasmic Disorders • Premature Ejaculation • Psy-Pacing • Bio-arteriosclerosis, diabetes • Dyad-Poor communication • FoO-Parentified/reparentified by new responsibilities/metaphor feeling burden • S/C/R- Partner engagement vs. self entrancement

  20. Sexual Dysfunctions/Etiology • Delayed Ejaculation • Psy-Control, Comfort • Bio-Aging and neurological, endocrine, and vascular • Dyad-Focused on partner sat., spectator • FoO-Demand parents/perception in intimacy • S/C/R-Enjoyable sex requires orgasm

  21. Sexual Dysfunctions/Etiology • Female Orgasmic Disorder • Psy-Decision making • Bio-Clitoral stimulation • Dyad-Male thrusting Vs Female • FoO-Sex is for men • S/C/R-Lack of knowledge

  22. Sexual Dysfunctions/Etiology • Sexual Pain Disorder • Genito-Pelvic Pain/Penetration Disorder • Psy-Relaxation • Bio-Birth control • Dyad-Negative experiences • FoO-Sex just hurts • S/C/R-Get stretched

  23. Sexual Response Cycle • Masters and Johnson • Excitement, plateau, orgasm, and resolution • Kaplan • Desire, excitement, and orgasm • Basson • Need for intimacy • Desire can be reactive or spontaneous • Desire before or after arousal • Decision

  24. Intersystemic Treatment • Sexual Desire Disorders • Hypoactive Sexual Desire Disorder • Increase awareness through self monitoring • Fact finding • Fantasy • Hyperactive Sexual Desire/Sexual Compulsivity • Function • ARP • Relational and individual sessions • Cognitive behavioral interventions

  25. Intersystemic Treatment • Sexual Arousal Disorders • Erectile Dysfunction • Dispel myths- Psycho-edu • Adaptive (prostate) • Medical visit • Thought stopping and replacement • Female Sexual Interest/Arousal Disorder • Alternate methods of Birth control • Estrogen and testosterone pills/injections

  26. Intersystemic Treatment • Orgasmic Disorders • Premature Ejaculation • Sensate for self entrancement • Delayed Ejaculation • Communication (Comfort) • Address function of relational control • Female Orgasmic Disorder • Permission/sexual bill of rights • MFR class • SRC • Clitoral stimulation (Lack of knowledge)

  27. Intersystemic Treatment • Sexual Pain Disorder • Genito-Pelvic Pain/Penetration Disorder • Relaxation coupled with digital/dilator • Mirror and cotton swab • Medication changes

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