Barriers to Intimate Sexuality: Concerns and Meaning-Based Therapy Approaches

Despite the voracious need for intimate connection, Western society does not promote intimacy, particularly with regard to partner sexuality. Obstacles to sexual intimacy that are discussed include: Media portrayals of sexual and gender role stereotypes, performance-oriented sexual standards, the invisibility of the elderly as sexual beings, and the glamorization of nonrelational sexuality and clandestine affairs. Unfortunately, the sex therapy literature, too, tends to focus on depersonalized and goal-oriented models of sexuality. Paradigms which can overcome barriers and promote intimate sexual connections are required. This article calls for humanistically based changes, in the media and in sex therapy, to satisfy the need for sexual intimacy.     

Mitigating the Mental Health Impact of Marginalization and Discrimination

In honor of the life and work of Aaron T. Beck, this paper describes the application of cognitive therapy to management of marginalization stress among minoritized communities. Collaborative empiricism, cognitive restructuring, and behavioral interventions are highlighted as being particularly useful in a contemporary multicultural approach for the anxiety, depression, stress, and other sequelae of marginalization due to a stigmatized identity. Although primarily illustrated through recent work with transgender and gender diverse adults, the discussion extends to other groups including racial, ethnic, and sexual minorities and immigrants. This work illustrates the power of Dr. Beck’s approach to address the presenting concerns of contemporary clinical work.     

Aging families: The personal, permanent group

Later life families present a very special instance of group psychotherapy with older adults. This paper describes the challenges faced by later life families, including major life events to which multiple family members must adapt, and the increasing dependency of some elderly members. A developmental framework for later life problems is offered as a therapy frame useful to families. Key aspects of therapy process with later life families are also presented. Goals, strategies, structures of therapy, and the therapist’s role are all shaped by the long and intimate history of the members of this special form of group.     

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

Watching pornographic pictures on the Internet: role of sexual arousal ratings and psychological-psychiatric symptoms for using Internet sex sites excessively

Excessive or addictive Internet use can be linked to different online activities, such as Internet gaming or cybersex. The usage of Internet pornography sites is one important facet of online sexual activity. The aim of the present work was to examine potential predictors of a tendency toward cybersex addiction in terms of subjective complaints in everyday life due to online sexual activities. We focused on the subjective evaluation of Internet pornographic material with respect to sexual arousal and emotional valence, as well as on psychological symptoms as potential predictors. We examined 89 heterosexual, male participants with an experimental task assessing subjective sexual arousal and emotional valence of Internet pornographic pictures. The Internet Addiction Test (IAT) and a modified version of the IAT for online sexual activities (IATsex), as well as several further questionnaires measuring psychological symptoms and facets of personality were also administered to the participants. Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. Personality facets were not significantly correlated with the IATsex score. The study demonstrates the important role of subjective arousal and psychological symptoms as potential correlates of development or maintenance of excessive online sexual activity.     

Prognostic factors and classification issues in the treatment of secondary orgasmic dysfunction

The present study examined patient and problem characteristics as well as therapy process factors associated with success and failure in sex therapy for secondary orgasmic dysfunction. Ss were 23 married couples selected for emotional and marital stability; all wives were suffering from secondary orgasmic dysfunction. Sexual functioning and satisfaction were evaluated before and after 15 sessions of therapy. Ss also engaged in daily self-monitoring throughout the therapy program. Two criteria of therapeutic success were used: the couples' global sexual harmony and the females' frequency of orgasmic response in couple sexual activity. Higher pre-treatment masturbation rates by the female, as well as better awareness of her partner's sexual tastes and preferences, were related to poor therapeutic outcome. Greater pre-treatment enjoyment of non-genital caressing by the female as well as higher incidence of interpersonal orgasmic response in the past were associated with therapeutic success. The theoretical and research implications of the present findings are discussed.     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

Sexual Peak: Socially Shared Cognitions About Desire,Frequency, and Satisfaction in Men and Women

Is a man’s sexual peak earlier than a woman’s? Three studies were conducted to examine (a) whether the perception that men achieve their sexual peak at a younger age than do women is shared across individuals of different ages and sexes, (b) whether sexual peak is defined differently for men and women, and (c) whether differences between definitions contribute to differences in the age at which men and women are perceived to reach sexual peak. Study 1 suggested that participants believed that females reach their sexual peak at an older age than do males. Study 2 indicated that the defining feature of sexual peak for males was sexual desire and for females was sexual satisfaction. Study 3 suggested that predictions of male sexual peak coincided with participants’ predictions of male age of highest desire and frequency, but not satisfaction, and that female sexual peak coincided with participants' predictions of female age of highest satisfaction but not frequency or desire. Discussion focuses on potential reasons for differences between the perception of male and female sexuality, as well as the social and evolutionary importance of each of the dimensions of sexuality for both males and females.     

Sexual and relationship problems among people affected by AIDS: Three case studies

The importance of emotional support to people affected by HIV and AIDS is now well recognized. In addition to general counselling and therapy, clinical experience shows a high occurrence of relationship and sexual problems requiring specific interventions. Case material is presented for three people-one an AIDS phobic woman, the second a physically well man with HIV infection, and the third the partner of a man with AIDS. Details of interventions are given for each case. Relationship and psychosexual work is identified as an important aspect of assessment and therapy with people affected by AIDS.     

Rational-emotive treatment for the sexual problems of couples

A rational-emotive approach to the treatment of sexual dysfunction is presented. It is asserted that the attitudes with which RET therapists approach sexual problems are as important in determining therapeutic outcome as are the techniques utilized in treating those problems. Regardless of whether one is treating disorders of desire, arousal, or orgasm, the rational-emotive sex therapist remains committed to the stoic position that is is not the unfortunate events in life but rather one's perceptions and evaluations of those events that cause distress. In this regard, the distinction between sexual dysfunction (unfortunate life events) and sexual disturbance (exaggeratedly negative perceptions and evaluations of those events) is emphasized. It is further asserted that only therapy regimens utilizing behavioral strategies within the context of what we have labeled elegant or preferential RET will adequately and comprehensively treat all sexual disorders.     

Reproductive life events and sexual functioning in women: case reports

Are reproductive life events in women associated with an increased risk of sexual dysfunction? Female sexual dysfunction effects up to 40% of women in the United States between 18 and 59 years of age. Sexual dysfunction may be accompanied by fluctuations in gonadal hormone secretion, making women more vulnerable to sexual symptoms, especially during times of reproductive life events. Reproductive life events, such as the use of birth control pills, various phases of the menstrual cycles, postpartum and lactation states, and perimenopause, are highly correlated with changes in sex steroids. As an understanding of the role of sex steroids on sexual functioning is elucidated, clinicians will be able to offer more specific and effective treatment options for women during various phases of reproductive life. Several case studies are presented to illustrate the unique clinical considerations that a clinician must consider when treating the biologic component of female sexual dysfunction.     

Bridging the Divide

Abstract

Women who consider themselves traditional or conservative in the context of religious practice often experience tremendous conflicts regarding the integration of same-sex emotional and sexual feelings with their religion and spirituality. Current religious teachings about homosexuality make this combination difficult as only heterosexual sexuality within marriage is permitted in most orthodox faiths. Further, the way that spirituality and sexuality are conceptualized as opposing dichotomous categories (e.g., body vs. soul) presents women with a framework where integration does not seem possible. Observant women who come to psychotherapy often experience tremendous distress, guilt, depression, and even suicidality due to the conflict between their sexual feelings and religious doctrine. Relieving the distress, and resolving the conflicts while honoring the emotional complexity of sexual feelings, spirituality, and religious orthodoxy can present tremendous dilemmas for the practitioner as well as the client. Using the example of psychotherapy of an Orthodox Jewish woman who integrated same-sex desire into her life, this article describes psychotherapy process and alternative ways of viewing spirituality and sexuality that permit possible resolutions for clients.     

Raising Consciousness About Women's Groups: Process and Outcome Research

Although therapy is a misnomer for consciousness-raising ( CR ) groups, some criterion for "therapeutic" or desirable outcome is necessary for evaluating clinical and social psychological change in the CR format. Quantitative and non-quantitative process and outcome findings are reviewed, and implications for theory, research and practice are discussed. Women in CR groups give testimony to their global effectiveness in fostering personal development as well as political awareness. Empirical findings likewise support the notion of the CR group as a potentiator of pro-feminist attitudes. However, those data are equivocal with regard to the formulation that any such liberalization of sociopolitical beliefs promotes personal growth and self-esteem.     

La famille face aux violences extrafamiliales : émotions et victimisation dans la narration de parents et enfants en UMJ

The traumatic impact linked to the revelation of an assault, at the time of the announcement of the abuse, but also in the daily life of the family, disrupts the family system. This study aims to compare the perception of the parent and his child when the child has been the victim of a sexual, psychological and/or physical extra-family assault, particularly around emotions, guilt and the victimization experience. The exploratory research approach is through the qualitative analysis of the content of interviews conducted with parents and children received by the Medico-Judiciary Unit (UMJ) and the Youth Victims Reception Unit. (UAJV). Our results show the presence of a strong emotional state in parents that results in anger, as well as a difficulty in naming emotions in their children. Children have difficulty to express their emotions, but everyday life seems less difficult than parents. Despite the limitations due to the small sample and the conditions for data collection, recommendations for clinical treatment of families are proposed.     

(Emotion-centered) problem-solving therapy: An update

Problem-solving therapy (PST) is a psychosocial intervention, typically considered to be a member of the cognitive and behaviour therapies family, and is based on a biopsychosocial, diathesis-stress model of psychopathology. The overarching goal of this approach is to promote the successful adoption of adaptive problem-solving attitudes and the effective implementation of certain behaviours as a means of coping with life stressors in order to attenuate the negative effects of such events on physical and mental well-being. Over the past several decades, in addition to accumulating strong support for its efficacy as a clinical intervention, similar to many other forms of psychotherapy, PST has undergone various evolutionary changes. Developed primarily as a more cognitive-based approach, due to the large body of literature in the field of affective neuroscience that underscores the importance of the impact of affect on problem solving, PST has evolved into emotion-centered problem-solving therapy (EC-PST). This article provides for a brief excursion into the historical roots of PST and why it has evolved into EC-PST, as well as providing support for its characterisation as a transdiagnostic approach. In addition, several meta-analyses that underscore its efficacy are described, as well as the most recent clinical guidelines that comprise EC-PST.     

Tatcharakteristika, Rückfallrisiko und Rückfallprognose bei Sexualstraftätern vom Jugend- bis ins Seniorenalter

The basis of this study was a census of all offenses of sexual assault and sexual abuse that were reported to the Berlin police between 1994 and 1999 (N?=?2,446). The purpose was to analyse the particularities of elderly offenders (60 years or older, n?=?68) compared to the 273 juvenile and the 2,105 younger adult offenders with regard to prior offenses, index offenses and recidivism rates. Furthermore, the analysis focused on the prediction of sexual and violent reoffence by means of the static-99 within the elderly age group. The analysis showed that the rate of former sexual offence committed by seniors was comparable to the younger adults; however, sexual and non-sexual violent pre-offences were much less frequent. On the other hand, the seniors were more frequently involved in sexual abuse, their modus operandi showed lesser degrees of intensity of the sexual acts and less use of force and violence (even among sexual abusers only) and group-offence was definitely uncommon. Furthermore the rate of sexual reoffence was similar to the juvenile offenders, but lower in comparison to adult offenders younger than 60 years. A more sophisticated analysis of the age-effects on recidivism-rates confirmed the anticipation of growing risks until middle adulthood and decreasing risks of reoffence afterwards. However, an explicit trajectory of first growing and than decreasing risks in the course of aging could only be found among offenders with sexual abuse, whereas the zenith was shifted in elderly stages of age. On the other hand, among offenders with sexual assaults, the risks of sexual reoffending seemed rather similar until the middle adulthood and increasingly lower in later stages. In spite of these aging-effects and the particularities of the elderly sexual offenders, the static-99 predicted sexual reoffence among the senior offenders quite well and there was no difference in comparison with the total sample.     

child pornography and the internet: perpetuating a cycle of abuse

Thirteen men convicted of downloading child pornography were interviewed with a view to understanding how these men talked about the photographs and the function such talk played in their accounts. The interviews were informed by earlier work with defended subjects and were analyzed within a discursive framework. Quotations are used from the interviews to illustrate the analysis. Six principal discourses emerged within these accounts in relation to child pornography: sexual arousal; as collectibles; facilitating social relationships; as a way of avoiding real life; as therapy; and in relation to the Internet. These are discussed in the context of previous research. The analysis illustrates the important role that the Internet plays in increasing sexual arousal to child pornography and highlights individual differences in whether this serves as a substitute or as a blueprint for contact offenses. It also draws our attention to the important role that community plays in the Internet and how collecting facilitates the objectification of children and increases the likelihood that in the quest for new images children continue to be sexually abused. Discourses focussing on both therapy and addiction serve to distance the respondent from personal agency and allow for continued engagement with child pornography.     

Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options

Abstract

Substance use disorders are nearly twice as common among sexual minority youth (SMY) as among their heterosexual peers. Most applied literature about this population suggests interventions on either the individual or community level, and the benefits of family therapy for this population are often overlooked. The present literature review (a) outlines clinical knowledge related to sexual minority youth and substance use (e.g., prevalence rates, contributing factors), (b) discusses the importance of clinical self-awareness around these topics, and (c) outlines clinical behaviors and interventions from literature that may be employed when working with substance-using SMY and their families.     

Antipsychotika und sexuelle Dysfunktion

Antipsychotic drugs are used in the treatment of psychotic symptoms in schizophrenia and affective disorders. A direct correlation between increased dopaminergic activity and increased sexual desire and sexual activity is well documented in animal experiments and from observations in humans. Comparatively little researched and recognized is pharmacologically induced sexual dysfunction. In contrast to the antipsychotic effect and extrapyramidal motor side effects, no dose–response relationships are known for sexual side effects. This may be due to the fact that antipsychotics act at different levels in the sexual experience. Sexual dysfunction may be present on social, psychological, central nervous system and peripheral–organic levels, respectively. These levels are closely associated with each other and influence each other. Therefore, sexual dysfunction is generally a combination of dysfunctions at several of these levels. For a variety of reasons, there are no generally accepted standards for a healthy and fulfilling sex life. As a treating physician, the fact that sexual disorders are also not a rare phenomenon in mentally and physically healthy people should be kept in mind and that patients with schizophrenia regardless of the etiology of the sexual dysfunction may also benefit from sexual medicine or specific psychotherapeutic treatment.