Treatment of secondary orgasmic dysfunction: a comparison of systematic desensitization and sex therapy

Forty-eight couples complaining of secondary orgasmic dysfunction were randomly allocated to one of three treatment methods or to a control group. Sexual function, sexual anxiety and satisfaction with the total relationship were evaluated in a pretest, an intermediate test (after 12 therapeutic sessions) and a follow-up test. The intermediate test revealed significant improvement in the sexual function of women treated by systematic desensitization, and that of women and men treated by an adapted version of the Masters and Johnson method. The follow-up test showed significant improvement in women and men treated by desensitization. Both methods significantly improved the satisfaction with the total relationship in men and women, and desensitization significantly reduced sexual anxiety in men and women. The results of combined treatment —desensitization followed by treatment according to Masters and Johnson—were very poor. The control group showed no significant changes. Evaluation of the differences between the treatments revealed a near-significant difference in sexual function of women in the intermediate test, with desensitization and the Masters and Johnson method yielding better results than combined treatment or no treatment.     

The behavioural treatment of sexual inadequacy: A comparative study

Thirty-six couples complaining of sexual difficulties were treated with one of three methods: (1) systematic desensitisation plus counselling. (2) directed practice—based on that of Masters and Johnson—plus counselling. (3) directed practice with minimal contact. Both members of each couple were seen together, but half in each treatment group were treated by a single therapist and half by a therapist pair. Differences in outcome among the groups were not highly significant, but consistent trends were found which suggested that the combination of directed practice and counselling was associated with most change, particularly when two therapists were involved.     

A repertory grid study of therapist/couple interaction

A case of marital therapy is described in which the presenting problem, one of non-consummation, is treated by the standard Masters and Johnson's technique. Using repertory grids at the start and finish of treatment the changing perceptions of both partners and the therapist were determined. In spite of an ostensibly behavioural treatment, substantial changes occurred in the couple's understanding of the nature of their problem. The changes undergone in the couple's perceptions, and their differences from the therapist's assessments of change give rise to speculations about the nature of the therapeutic interaction and suggest further lines of exploration.     

Marital Status and Gender Similarity in Marital Therapy

This analogue study was designed to examine the effects of therapists' marital status and therapist and participant sex on participants' perceptions of therapist and expectations for therapy. Each partner of 20 couples presenting for marital therapy at four outpatient counseling centers independently completed one of four protocols. The protocols differed only on the therapist's marital status and sex. Results revealed that neither therapist marital status nor therapist sex had an effect on participants' perceptions of therapists or therapy expectations. Female participants, however, perceived therapists as more trustworthy, attractive, and expert and had higher expectations for therapy than did male participants.     

The effects of state and trait self-focused attention on sexual arousal in sexually functional and dysfunctional women

This study examined the effects of state self-focused attention on sexual arousal and trait self-consciousness on sexual arousal and function in sexually functional (n=16) and dysfunctional (n=16) women. Self-focused attention was induced using a 50% reflectant television screen in one of two counterbalanced sessions during which self-report and physiological sexual responses to erotic films were measured. Self-focused attention significantly decreased vaginal pulse amplitude (VPA) responses among sexually functional but not dysfunctional women, and substantially decreased correlations between self-report and VPA measures of sexual arousal. Self-focused attention did not significantly impact subjective sexual arousal in sexually functional or dysfunctional women. Trait private self-consciousness was positively related to sexual desire, orgasm, compatibility, contentment and sexual satisfaction. Public self-consciousness was correlated with sexual pain. The findings are discussed in terms of Masters and Johnson's [Masters, W. H. & Johnson, V. E. (1970). Human sexual inadequacy. Boston: Little, Brown) concepts of "spectatoring" and "sensate focus."     

Evaluation of self-administered rational emotive therapy programs for interpersonal anxiety

Self-administered rational emotive therapy (RET), withA New Guide to Rational Living (Ellis & Harper, 1975), as the treatment manual, was evaluated by comparing three groups which varied in terms of therapist contact (therapist administered, minimal contact, self-administered). University students who volunteered for the research program involving the treatment of interpersonal anxiety were randomly assigned to one of these treatments or to a wait-list control group. The results for 72 subjects who completed the 5-week program indicated the three treatment groups made significant gains over untreated controls on some of the self-report measures. No between-group differences appeared on ratings by significant others. A four- to five-month follow-up, which obtained data from 41 (58%) of the subjects, provided some support for the maintenance of treatment effects for the therapist administered and minimal contact groups. Correlations of assessed irrational beliefs with outcome measures provided some support for the RET model.Norris D. Vestre, Ph.D., is a Professor in the Department of Psychology, Arizona State University. Terrence J. Judge, M.C., R.N.C., is a nurse therapist at Camelback Vista Treatment Center, Scottsdale, Arizona.     

Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children

Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered video-tape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.     

The Effectiveness of an Occupational Therapy Program for Chemically Dependent Adolescents

This research study, conducted at a residential treatment center for chemically dependent and emotionally disturbed youth, was designcd to answer the following questions: is occupational therapy effective in producing behavioral change in the adolescent chemically dependent population and, if so, what are the factors producing the change? An assessment tool was designed and used in conjunction with observations to determine each resident's behavioral status before and after involvement in occupational therapy groups. All residents admitted to James- town wcre involved in a Work Skills Group (focusing on pre- work skill development) and/or a Relationship Skills Group (fo-cusing on interpersonal skill development). The behavioral status was measured by the therapist using a defined rating scale in an interview format. The changc in ratings from pre- to post-treatment was used as the basis for the data analysis. Groups of residcnts were compared to each other on the, variables of age, sex, attendance, rate of goal completion, group membership, and completion and type of occupational therapy goals. The results of the study indicate that rcsidents who attended occupational therapy, were involved in both groups, completed their occupational thcrapy goals, and completed the occupational therapy program demonstrated significant behavioral change, especially in relationship skills. Age and sex variables alone did not produce significant behavioral change.     

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.     

The Effect of Expectations on Intention to Persist in Therapy

ABSTRACT

Little is known about the impact of expectations on persistence in couple and family therapy. A better understanding of the factors that contribute to persistence in therapy is key to understanding therapeutic dropout. We report results of a secondary grounded theory analysis of individual, couple, and family therapy clients' therapy expectations and their intention to persist in therapy. Participants were 19 clients of MFTs. Results indicate that clients carry expectations about the therapist, therapy process, duration, and outcome. Positive disconfirmation (Tambling & Johnson, 2010) of negative expectations contributed to therapy persistence.     

Changes in verbalizations during sandplay: an empirical study

This is a quantitative study of an 11-year-old boy diagnosed with major depression who in all but one session made a sandplay. A computerized system was used to analyse the written verbalizations on four dimensions of positive and negative: emotions, contracts (psychosocial agreements, relationships, etc.), performance (behaviour) and rewards. It was hypothesized that the verbalizations made by the patient (recorded by the therapist) would become more positive and less negative during the course of therapy. The positive and negative values of the four dimensions were correlated with the session number. This was supported on two (performance & contract) of the four positive dimensions (statistically significant). The hypothesis that the negative dimensions would become less negative was supported on all four dimensions (statistically significant). Thus, six of the eight hypotheses were supported. This uninvestigated area of research illustrates verbal interactions between patient and therapist were an important aspect of sandplay therapy. Through reanalysing the sessions for quantitative content, written recording of direct quotes and observation of behaviour, data was entered into a valid and reliable coding system to quantitatively analyze the verbalizations. This analysis of verbalizations of the patient and observations made by the therapist indicates sandplay therapy is multifaceted.     

The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.     

To be in touch

This study examined the constellation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – that emerged in the psychodynamic therapy (PDT) of a child diagnosed with borderline personality disorder and treated by two doctoral student therapists. Identification of these interaction structures can inform therapists of what might be expected from patients with particular symptom or behaviour patterns and how interactions change over time. This study also examined each session’s adherence to three session prototypes: PDT, cognitive-behavioural therapy (CBT) and reflective functioning (RF) process. The Child Psychotherapy Q-Set (CPQ) is a 100-item instrument that assesses the processes within a single psychotherapy session. Items reflect a wide range of therapist attitudes and behaviours, patient attitudes and behaviours and interactions between therapist and patient. Experts used the CPQ to define PDT, CBT and RF process session prototypes. The results suggested that four distinct interaction structures could be identified and that their constellations differed between the two therapists and also differed over time within each treatment. Therapists were more structured and accommodating early on in their treatments and more interpretive later. Prototypical PDT process was more prominent in the sessions than RF process, which in turn was more prominent than CBT process. Unique therapeutic processes are at work in every dyad, despite holding the patient and theoretical orientation constant. An effective treatment in one dyad might not work in another due to therapist-specific and dyad-specific effects.     

Creative Use of Gender While Addressing Early Attachment,Trauma, and Cross-Cultural Issues in a Cotherapy Group

This paper examines how early attachments, trauma, and transference are modified by cross-cultural issues in a group therapy setting. The paper focuses on preparation of an appropriate group after individual treatment, attention to composition in that group, and use of a female-male cotherapist team in helping two Latin American female group members work through their early traumas. In addition, the paper speaks about times when individual treatment with the group therapist of the opposite sex should be added. The paper emphasizes and clarifies how not to get caught up in cultural stereotypes and how the clinician needs to stay with the specificity of the person's organizing experiences.     

Expectations About Couple Therapy Over Time

One common factor of therapy, expectations, has been demonstrated to be a significant contributor to outcome in individual therapy. Despite this, little is known about expectations about couple therapy. This paper presents the qualitative results of a study exploring clients’ expectations before beginning couple therapy and after six sessions. Results indicate that clients form pre-therapy expectations about their therapist, the process of therapy, and their partner. Results also showed that after six sessions, clients’ expectations about therapy were often met or modified in ways that were positive. Implications for therapists and researchers are included.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

The Effects of Religiosity on Preferences and Expectations for Marital Therapy Among Married Christians

Highly religious couples constitute a substantial portion of marital therapy clients in the U.S. Married Christian individuals ( N = 211) completed a survey of demographics and religiosity (religious values and Christian beliefs). They rated preferences and expectations for one of four marital therapy situations: Christian therapist using Christian practices (e.g., prayer or reference to Scripture), Christian therapist using psychological practices only, non-Christian therapist willing to use Christian practices, and non-Christian therapist using psychological practices only. High religious values and high Christian beliefs predicted ratings of marital therapy situations, where high was defined as one standard deviation above the mean of standardized norm groups. Low to moderate religious values or Christian beliefs did not predict ratings of marital therapy. It was concluded that highly religious couples present a special situation where the marketing, assessment, and practice of marital therapy might differ from therapy with other types of couples.     

Client,Treatment, and Therapist Variables Related To Outcome in Brief,Systems-Oriented Family Therapy

Client, therapist, and treatment characteristics were examined with respect to how much of the variance they could account for in a variety of outcome measures. Multiple regression analyses were used to examine relationships among each of the client, therapist, and treatment characteristics studied and the various outcome measures. For the 219 families that were treated with brief family therapy, only a relatively low amount of variance in any of the outcome measures could be accounted for. The amount of explained variance, however, varied considerably from one outcome measure to the other. When the more homogeneous groups of clients (single parents or adolescent identified patients) were considered, the amount of explained variance generally showed an increase. Different sets of client, therapist, and treatment variables accounted for the variance in these outcome measures across client groups, demonstrating both the complexities of the relationships and the relative independence of various outcome measures. New variables are suggested for future research.     

The Use of Time Limits in Brief Psychotherapy: A Comparison of Six-Session,Twelve-Session,and Unlimited Treatment with Families

This study compared the relative effectiveness of two durations of time-limited psychotherapy with time-unlimited treatment and a waiting list control group. Thirty-seven families applying for treatment at a child guidance clinic were randomly assigned to one of four treatment conditions: (a) time-limited therapy of 6 sessions within 8 weeks; (b) time-limited therapy of 12 sessions within 16 weeks; (c) time-unlimited therapy; and (d) a waiting list control group in which families waited approximately four months before beginning treatment. Outcome was assessed from multiple sources: parents, child, therapist, family interaction ratings, and missed and canceled sessions. Analysis of data provided some evidence that families who received treatment fared better than those on the waiting list. There were no consistent differences between 6-session, 12-session, and unlimited therapy. A model is proposed for the further investigation of time-limited treatment.