Individual, Couple, or Sex Therapy for Sexual Problems

Individual, Couple, or Sex Therapy for Sexual Problems

This distinction was clearer 10 years ago when sex therapy was primarily focused on a specific and highly detailed behavioral protocol. Sex therapy in the last few years has moved in the di-rection of further understanding of the physiologic causes of sex dysfunction on one hand, and cognitive–behavioral issues on the other. It is clear at this point that, in general, sexual problems do not disappear with couple therapy unless specific attention is paid to the nature and quality of the sexual problems. Usu-ally, it is most effective to deal with severe couple conflict before beginning to deal with sexual issues directly (Table 71.4). Sex therapy includes education, a focus on the intimacy and power aspects of sex, and often homework assignments that in some way deal with sexual anxiety and expansion of sexual options. Individual therapy is indicated if the problems are clearly related to the partner’s history (sexual abuse, hatred of women), have occurred in multiple relationships, and are not amenable to being worked on in the couple. Individual therapy is the most inefficient way of dealing with most couple centered sexual problems. It is

also important to consider the possible role of organic problems in any dysfunction.

Contraindications for Couples Therapy

Couples therapy is not indicated for every couple in distress. In fact, at times, it may even be contraindicated. If one mem-ber is keeping an important secret, an attempt to work with them as a pair may fail and the therapist often has to take a strong stand and refuse to treat the couple, as in the case of an HIV positive male who refused to share this information with his wife. At times, one member of a couple may be too ill to benefit from couples therapy. This may be the case when one partner has a bipolar disorder or schizophrenia and is acutely psychotic.

Other couples feel more comfortable when each partner has his or her own therapist. At times it can be more effective to have each member in individual therapy with good coordination between the two therapists. Finally, cases may arise where seeing a couple together may put one member of the couple in physical danger. When one member has a history of violence toward the partner, the therapist must often see each party alone to ensure the safety of a partner. Discussing areas of conflict together may risk increasing the violent behavior of one partner.

Sex therapy may be contraindicated in the same situations as above. In addition, many couples do not feel comfortable in a therapy exclusively focusing on sex. These couples may make more progress if the sex therapy is carefully included in the over-all treatment of the couple. When referring to a sex therapist, it is particularly important to be familiar with the skill and creden-tials of the therapist.