A Sexological Approach

1. A Sexological Approach Tory Clark, DHS, MPH

2. History of Sexology • Sexology: the study of sexuality • “Sexuality encompasses far more than how you have sex, or if you have it at all.  Sexuality is a central part of our identity, and includes our feelings about our gender, how we express ourselves, our sexual orientation, our body image, and, yes, our sexual behaviors.”   ~Logan Levkoff, Ph.d. • By definition, a Sexologist is a person with expert knowledge in sexual science who devotes him/herself to its objective observations which are logically consistent. • An infant science, originated in 20th century

3. 1897 Havelock Ellis - a British sexologist, co-authored the first English medical text book on homosexuality • 1908, the first scholarly journal of the field, Journal of Sexology with articles from Sigmund Freud and Adler • 1913, the first academic association was founded: the Society for Sexology • Sigmund Freud developed a theory of sexuality. These stages of development include: Oral, Anal, Phallic, Latency and Genital. • 1919, Magnus Hirschfeld founded the Institute for Sexology in Berlin. Its library housed over 20,000 volumes, 35,000 photographs, a large collection of art and other objects. The Institute and its library were destroyed by the Nazis less than three months after they took power, May 8, 1933. • He is credited with the terms transsexual, transgender • 1947 Alfred Kinsey founded the Institute for Sex Research at Indiana University at Bloomington – Kinsey Reports and Kinsey Scale • 1966 and 1970, Masters and Johnson released their works Human Sexual Response and Human Sexual Inadequacy • Vern Bullough was the most prominent historian of sexology during this era, as well as being a researcher in the field

4. Programs with little training in human sexuality: • Psychiatric residencies • Medical schools • Psychology internships • Counseling internships • Marriage and family therapy training programs • Social work agency placements

5. The Profession of Sex Therapy • Deviations from Masters & Johnson’s (1966) model became the criteria for defining sexual disorders in the DSM • Let’s discuss page 25 & 27…. • Antidepressants- know how they affect sex drive/orgasm! • Female Sexual Dysfunction • “Most couples are seeking more than “erections firm enough for penetration” or to be free of “vaginal spasms preventing intercourse;” they are hoping for sex that is desired and worth wanting, a feeling of connection with their partners during sex, and feelings of shared contentment thereafter”(p.30) • Our job is to help them along this path!

6. A Word on Anti-Depressants • Neurotransmitters: chemicals that transmit messages in the nervous system • Dopamine: facilitates sexual arousal and activity • Serotonin: inhibits sexual arousal and activity • Of the approximately 40 million brain cells, most are influenced either directly or indirectly by serotonin. This includes brain cells related to mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and some social behavior. • Temporarily reduces sex drive and behavior by inhibiting the release of dopamine and suppresses sexual arousal by blocking the action of oxytocin • 90% of our serotonin supply is found in the digestive tract and in blood platelets. • Selective Serotonin Reuptake Inhibitors (SSRIs), aka, Anti-Depressants (Paxil, Prozac, Zoloft, Wellbutrin, Lexapro) • Supposed to increase serotonin levels in the brain- quite often interfere with libido and sexual response • 30-70% of people report side-effects

7. Personal & Professional Process of Becoming a Sex Therapist • Why is training in sex therapy so vital? Page 35 • Welcome to this class! • Your program now…. • When can you call yourself a specialist? • “Sex Therapist” is not a registered title… • Board Certified Sexologist • 300-5,000 hours of training • Doctor of Human Sexuality • 3,000 hours of training • Attend a SAR (sexual attitude restructuring)process • http://www.theissr.com/SAR_trainings.html • www.iashs.org or www.aasect.org • Mary Minten http://www.marymintencounseling.com/

8. Sex Therapy ModelsPatti Britton • Masters & Johnson • Sensate Focus • 4 part sexual response cycle (next slide) • Lack of theoretical foundations • Kaplan model (DSM) • Hartman & Fithian • Augmented M&J – more detailed • The Plissit Model

9. Master’s & Johnson’s 4 Phases • Excitement • Vasocongestion & myotonia • Plateau • Time varies a lot here, sometimes age dependent, sometimes training dependant (did you learn to masturbate really fast and really quiet?) • Orgasm • Possible for males without an erection, especially with aging • Possible without ejaculation, especially in Tantra • Resolution (sometimes this is not what you want) • Refractory period highly variable among males • Can be really short with high levels of stimulation for some

10. DSM Sexual Response CycleHelen Singer Kaplan (Kaplan model) • Desire: fantasies about sexual activity & the desire to have sexual activity • Excitement: a subjective sense of sexual pleasure & accompanying physiological changes. The major changes in the male consist of penile tumescence and erection. For females, vasocongestion in the pelvis, vaginal lubrication and expansion, and swelling of the external genitalia. • Orgasm • Resolution

11. Traditional Therapy • Rational Emotive Behavioral Therapy (REBT) • Albert Ellis • Thinking = feelings = behavior • Help clients redirect their thinking • Writing & self-talk = change internal dialogue • The Schnarch Model • Passionate Marriage & The Sexual Crucible • Treat everything as an intimacy issue – confront the issue • LIGHTS ON!!

12. Traditional Therapy Cont’ • Gestalt Therapy • Fritz Perls • Focus on the present (here & now)- the whole person • Allow client to direct therapy • Help client read clues expressed by the body • Gestalt therapists are body readers • Breathing techniques (phone apps) • “Getting it out” chair exercise

13. Traditional Therapy Cont’ • Transactional Analysis (TA) • Eric Berne “Games People Play” • Analysis of the dynamics of relationships • Always in 3 ego states when relating to others: • Parent: Critical Parent & Nurturing Parent • Adult: Offers info & is neutral in matters of can/can’t • Child: Adaptive, Codependent, have no boundaries, no self-identity, or needs like good girls. The child can be angry & prone to acting out like bad boys. Or the child can be free. Your free child is the part of you who plays during sex! • Romantic love = C-C • P-C = resentment rather than sex play • A-A = kills desire – news, laundry

14. Holistic/New Age • Esoteric Models • Carolyn Myss “Sexual Contracts: Awakening Your Divine Potential” • Eckhart Tolle “Power of Now” • Body Work • International Professional Surrogates Association (IPSA) • Surrogacy IS NOT prostitution • Healing Arts • Shamanism, Reiki, Tantra, Homeopathy, Acupuncture • Books/Websites/DVDS • http://www.drpattibritton.com/ • http://www.sexsmartfilms.com • http://www.GottSex.com • Betty Dodson • Bibliography on class website

15. Solution-Focused Brief Therapy • De Shazer • Future oriented & goal directed • Asks clients to describe a detailed resolutin of the problem that brought them to therapy, thereby shifting the focus of treatment from problems to solutions. • Sexual dysfunctions & disorders – NO. • Focuses on client strengths by examining previous solutions to the problem • *Belief that clients know what is best for them & to effectively plan how to get there

16. A Sexological Approach

17. A Sexological Approach to Treating Sexual Issues • PLISSIT model • Sex positive • Non judgmental • Focus on pleasure/A non-pathological approach • Educative

25. How We Convey Permission • Bring up sexuality (Intake/Sex History) - see “The First Interview” • Be mindful of our language • Understand the full range of sexual expression • Become aware of our biases & assumptions

26. What makes it difficult to bring up sex with our clients? • Our own discomfort with sexuality. • Theoretical orientation “Let the client bring up what they want.” • Respect for privacy “Not my business.” • Then what… “It may be beyond the scope of what I know.” • Have a referral list!

27. Benefits to Bringing Up Sex 1. Permission giving Opens a door Indicates your comfort Indicates your willingness to hear anything 2. Sexuality is part of life Normalizes it. Equates it with other aspects of life. 3. Avoiding it sends a message.

28. Initial Intake/Sex History SEXOLOGICAL INTERVIEWING TECHNIQUESJanice M. Epp, Ph.D.

29. Language… • Is it pathologic or normative based? Heterocentric? • Are you comfortable being explicit? • Is it sensitive to different definitions of relationship, marriage, family, sex?

30. Become Aware of Your Biases • Religious • Cultural • Sexual • Moral • Psychological • Informational • Educational

31. What are your assumptions? • About sexual orientation. • About monogamy. • About what “sex” means. • About “private” sexual behavior. • About the relevance of my feelings about my own sexuality and sexual life.

32. The Importance of Taking a Sex History • Corrects misinformation • Opportunity to supply information if the client requests it. • Allows us to present a nonjudgmental attitude that can relieve the client’s anxieties.

33. Remember… • Don’t assume anything. Be continually curious. • Pay attention to how the client participated in childhood sexual contact, and their feelings about it. • Watch for your agenda, honor their values. • Meet your clients where they are at!