I often get asked both from prospective clients and colleagues in the field how seeing a specialist in sex therapy can assist in resolving sexual difficulties. This is a very important question and cuts right to the heart of the psychotherapeutic process. In order to give a more complete, yet concise answer, it’s important to briefly trace the history of psychotherapeutic practice in general, and sex therapy in particular.
The practice of psychotherapy as we know it can be traced to the late 19th century and Sigmund Freud, the founder of psychoanalysis. Even though Freud had his own influences and some professionals were speaking of concepts related to the unconscious at that time, he was the first to really propose a comprehensive theory of the workings of the unconscious process, identifying such structures as the ego, id and superego. As psychoanalysis developed the focus was on interpretation and insight; however, since Freud was basing his theories on a very limited subset of the population of turn of the century Vienna, the problem was that these techniques proved to be unsuccessful with many clients that he did not account for. In the mid 20th century, Aaron Beck and his cohorts started looking at the role of cognition (thoughts) in human misery and, combining this research with techniques developed by behaviorists, introduced cognitive-behavioral therapy (CBT).
It is at this time, with the pioneering work of Masters and Johnson, that sex therapy as a separate discipline was born. Masters and Johnson saw the act of sex as a purely behavioral process and incorporated behavioral techniques of graduated exposure to sexual arousal. These techniques were shown to be highly effective in helping patients to acclimate themselves gradually to the sexual response cycle; however, research subjects were very carefully vetted in order to maximize the potential for success, leaving out a large set of the population that Masters and Johnson didn’t even bother to study.
Today we know that a focus on insight, thoughts and behavior isn’t enough. Current research, ranging from neuroscience to attachment research to studies of therapy outcomes, shows that working with emotion is a crucial aspect of therapeutic change. Most difficulties that we recognize as psychological problems are actually not psychological at all, but rather either physical, emotional, or most likely a combination of both. For example, research shows that schizophrenia may have a strong physiological aspect, but many conditions such as depression, anxiety, and personality difficulties have strong emotional components. Similarly, sexual difficulties can either be physical, emotional or both. Erectile dysfunction may be a vascular problem, or as research shows, much more likely to be entirely emotional. Often problems such as erectile dysfunction, premature ejaculation, pain or tightness during sex, issues with desire (in one extreme or another), and problematic behaviors are rooted in such emotions as anger, rage, fear, and shame. Similarly, sexual problems within couples are often not mechanical in nature, but rooted in issues of power, control, hostility, and resentment. A qualified sex therapist understands the role that emotions play in sexual difficulties, and can expertly move forward towards resolving the underlying emotional issues, without being bogged down or distracted by the sexual nature of the issue. At the SAT Project, we understand that the problem is not the sex, but the emotional difficulties underlying the sex.