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The Future of Sex Therapy: Specialization or Marginalization?

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Abstract

Sex therapy’s claims to specialization may be exaggerated and ultimately damaging to the integrated treatment of sexual dysfunction. In fact, sex therapy does not have a unified underlying theory, a unique set of practices, or an empirically demonstrated efficacious treatment outcome. Paradoxically, the practice of sex therapy has gained widespread professional and popular acceptance since the publication in 1970 of Human Sexual Inadequacy by Masters and Johnson. Consequences of the widespread acceptance of this supposed specialization include the marginalization of sex therapy from other forms of treatment and the perpetuation of the notion that sex therapy is a special form of therapy requiring highly specialized training. This specialization focus also helps to perpetuate societal discomfort with sexuality. The very modest empirical success of most so-called sex therapy interventions and the lack of theoretical development suggest that sex therapy needs a recalibration in order to survive. It is suggested that the treatment of sexual dysfunction be integrated into the general psychotherapy enterprise and into a multidisciplinary biopsychosocial framework.

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References

  • Althof, S. E. (2006). Sexual therapy in the age of pharmacotherapy. Annual Review of Sex Research, 17, 116–131.

    Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • Ann, C. C. (1997). A proposal for a radical new sex therapy technique for the management of vasocongestive and orgasmic dysfunction in women: The AFE zone stimulation technique. Sexual and Marital Therapy, 12, 357–370.

    Google Scholar 

  • Annon, J. S. (1976). Behavioral treatment of sexual problems: Brief therapy. New York: Harper & Row.

    Google Scholar 

  • Araoz, D. L. (1982). Hypnosis and sex therapy. New York: Brunner/Mazel.

    Google Scholar 

  • Archer, J., & McCarthy, C. J. (2007). Theories of counseling and psychotherapy: Contemporary applications. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

    Google Scholar 

  • Assalian, P., Sungur, M., Aloni, R., & Hickman, B. (2007, August). Surrogate therapy has no place in the treatment of sexual dysfunction. In M. McCabe (Moderator), Conference conducted at the meeting of the World Conference of Sexology, Sydney, Australia.

  • Athanasiadis, L., Papaharitou, S., Salpiggidis, G., Tsimtsiou, Z., Nakopoulou, E., Kirana, P. S., et al. (2006). Educating physicians to treat erectile dysfunction patients: Development and evaluation of a course on communication and management strategies. Journal of Sexual Medicine, 3, 47–55.

    Article  PubMed  Google Scholar 

  • Avasthi, A., Sharan, P., & Nehra, R. (2003). Practicing behavioral sex therapy in India: Selection, modifications, outcome, and dropout. Sexuality and Disability, 21, 107–112.

    Article  Google Scholar 

  • Barbach, L. G. (1974). Group treatment of pre-orgasmic women. Journal of Sex and Marital Therapy, 1, 139–145.

    PubMed  Google Scholar 

  • Barbach, L. G. (1975). For yourself: The fulfillment of female sexuality. New York: New American Library.

    Google Scholar 

  • Barbach, L. G. (1984). For each other: Sharing sexual intimacy. New York: New American Library.

    Google Scholar 

  • Ben-Zion, I., Rothschild, S., Chudakov, B., & Aloni, R. (2007). Surrogate versus couple therapy in vaginismus. Journal of Sexual Medicine, 4, 728–733.

    Article  PubMed  Google Scholar 

  • Bergeron, S., Binik, Y. M., Khalife, S., Pagidas, K., Glazer, H. I., Meana, M., et al. (2001). A randomized comparison of group cognitive–behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91, 297–306.

    Article  PubMed  Google Scholar 

  • Betito, L. (2001, March 22–25). Hi, you’re on the air. Paper presented at the meeting of the Society for Sex Therapy and Research, Montreal, Canada.

  • Binik, Y. M., Bergeron, S., & Khalife, S. (2007). Dyspareunia and vaginismus: So-called sexual pain. In S. R. Leiblum (Ed.), Principles and practice of sex therapy (4th ed., pp. 124–156). New York: Guilford Press.

    Google Scholar 

  • Britton, P. (2005). The art of sex coaching. New York: W. W. Norton & Company.

    Google Scholar 

  • Carnes, P. J. (1983). Out of the shadows: Understanding sexual addiction. Center City, MN: Hazelden.

    Google Scholar 

  • Cole, M. (1985). Sex therapy: A critical appraisal. British Journal of Psychiatry, 147, 337–351.

    Article  PubMed  Google Scholar 

  • Corsini, R. J., & Wedding, D. (2005). Current psychotherapies (7th ed.). New York: Wadsworth Publishing.

    Google Scholar 

  • David, D. (Ed.). (2006). A critical review of the current trends in psychotherapy and clinical psychology. New York: Nova Science Publishers.

    Google Scholar 

  • Dr. Berman’s better sex podcast. (2006). [podcast]. Retrieved September 27, 2007 from http://www.nbc5.com/health/9697336/detail.html.

  • Ellis, A. (1966). Sex without guilt. New York: Lancer Books.

    Google Scholar 

  • Eysenck, H. J. (1970). Human sexual inadequacy: William H. Masters and Virginia E. Johnson [Review of the book Human sexual inadequacy]. Behaviour Research and Therapy, 8, 395–395.

  • Fisher, J. E., & O’Donohue, W. T. (Eds.). (2006). Practitioner’s guide to evidence-based psychotherapy. New York: Springer.

    Google Scholar 

  • Gabbard, G. O., Beck, J. S., & Homes, J. (2005). Oxford textbook of psychotherapy. New York: Oxford University Press.

    Google Scholar 

  • Galvin, R. M. (1970, May 25). Repairing the conjugal bed. Time, 95, 49–52.

  • Garrity, J. (1971). The sensuous woman. London: W. H. Allen/Virgin Books.

    Google Scholar 

  • Gertler, H., Perell, T. (Producer), & Mitchell, J. C. (Director). (2006). Shortbus [Motion picture]. United States: ThinkFilm.

  • Good, G. E., & Brooks, G. R. (Eds.). (2005). The new handbook of psychotherapy and counseling with men: A comprehensive guide to settings, problems, and treatment approaches (Rev. and abridged ed.). San Francisco: Jossey-Bass.

    Google Scholar 

  • Green, S., & Flemons, D. (2004). Quickies: The handbook of brief sex therapy. New York: W. W. Norton.

    Google Scholar 

  • Gurman, A. S., & Messer, S. B. (Eds.). (2005). Essential psychotherapies: Theory and practice (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Hawton, K. (1985). Sex therapy: A practical guide. New York: Oxford University Press.

    Google Scholar 

  • Heiman, J. R., LoPiccolo, L., & LoPiccolo, J. (1976). Becoming orgasmic: A sexual growth program for women. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Heiman, J. R., & Meston, C. M. (1997). Empirically validated treatment for sexual dysfunction. Annual Review of Sex Research, 8, 148–194.

    PubMed  Google Scholar 

  • Heinberg, A. (Writer), & Spiller, M. (Director). (2000). Hot child in the city [Television series episode]. In M. P. King (Producer), Sex and the city. New York: Home Box Office.

  • Hoch, Z. (1982a). A commentary on the role of the female sexological examination and the personnel who should perform it. Journal of Sex Research, 18, 58–63.

    Google Scholar 

  • Hoch, Z. (1982b). A rejoinder to the comments of Hartman & Fithian and Pomeroy & Brown on the female sexological examination. Journal of Sex Research, 18, 77–80.

    Google Scholar 

  • Kaplan, H. S. (1974). The new sex therapy. New York: Brunner/Mazel, Inc.

    Google Scholar 

  • Kaplan, H. S. (1987). Sexual aversion, sexual phobias and panic disorder. New York: Brunner/Mazel.

    Google Scholar 

  • Kleinplatz, P. J. (2003). What’s new in sex therapy? From stagnation to fragmentation. Sexual and Relationship Therapy, 18, 95–106.

    Article  Google Scholar 

  • Kleinplatz, P. J. (2006). Sex therapy: How do sex therapists think about and deal with sexual problems? In R. D. McAnulty & M. M. Burnette (Eds.), Sex and sexuality Vol. 2: Sexual function and dysfunction (pp. 179–209). Westport, CT: Praeger.

    Google Scholar 

  • Lambert, M. J. (Ed.). (2004). Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed.). New York: Wiley.

    Google Scholar 

  • Lazarus, A. A. (1971). Behavior therapy and beyond. New York: McGraw-Hill Book Company.

    Google Scholar 

  • Leiblum, S. R. (Ed.). (2007). Principles and practice of sex therapy (4th ed.). New York: Guilford Press.

    Google Scholar 

  • Leiblum, S. R., & Pervin, L. A. (Eds.). (1980). Principles and practice of sex therapy. New York: Guilford Press.

    Google Scholar 

  • Levine, S. B. (1989). Comprehensive sexual health centers: Is it time? Journal of Sex and Marital Therapy, 15, 215–224.

    PubMed  Google Scholar 

  • Levine, S. B. (1995). What is clinical sexuality? Psychiatric Clinics of North America, 18, 1–6.

    PubMed  Google Scholar 

  • Lobitz, W. C., & Baker, E. L. (1979). Group treatment of single males with erectile dysfunction. Archives of Sexual Behavior, 8, 127–138.

    Article  PubMed  Google Scholar 

  • LoPiccolo, J. (1978). The professionalization of sex therapy: Issues and problems. In J. LoPiccolo & L. LoPiccolo (Eds.), Handbook of sex therapy (pp. 511–526). New York: Plenum Press.

    Google Scholar 

  • LoPiccolo, J. (1994). The evolution of sex therapy. Sexual and Marital Therapy, 9, 5–7.

    Google Scholar 

  • LoPiccolo, J. (2002). Postmodern sex therapy. In J. Lebow (Ed.), Comprehensive handbook of psychotherapy (Vol. 4, pp. 411–435). New York: Wiley.

    Google Scholar 

  • LoPiccolo, J., Heiman, J. R., Hogan, D. R., & Roberts, C. W. (1985). Effectiveness of single therapists versus cotherapy teams in sex therapy. Journal of Consulting and Clinical Psychology, 53, 287–294.

    Article  PubMed  Google Scholar 

  • Manjula, M., Prasadarao, P. S., Kumaraiah, V., Mishra, H., & Raguram, R. (2003). Sexual dysfunction in single males: A perspective from India. Journal of Clinical Psychology, 59, 701–713.

    Article  PubMed  Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. London: Little, Brown.

    Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1976). Principles of the new sex therapy. American Journal of Psychiatry, 133, 555–559.

    Google Scholar 

  • Meana, M. (2009). Painful intercourse: Dyspareunia and vaginismus. In K. M. Hertlein, G. R. Weeks, & N. Gambescia (Eds.), Systemic sex therapy (pp. 237–263). New York: Taylor & Francis.

    Google Scholar 

  • Money, J. (1975). Ablatio penis: Normal male infant sex-reassigned as a girl. Archives of Sexual Behavior, 4, 65–67.

    Article  PubMed  Google Scholar 

  • Mort, C. (Writer), & Rozema, P. (Director). (2007). Tell me you love me [Television series]. United States: Home Box Office.

  • Ndetei, D. M., & Wazome, E. G. (1986). Experiences from a marital-sex therapy clinic in Nairobi. Acta Psychiatrica Scandinavica, 12, 479–484.

    Article  Google Scholar 

  • On the minds of men: Uncensored sex talk with Dr. Lori. (2007). [podcast]. Retrieved September 27, 2007 from http://www.personallifemedia.com/podcasts/minds-of-men/on-the-minds-of-men-show.html.

  • Perelman, M. A. (2005). Psychosocial evaluation and combination treatment of men with erectile dysfunction. Urological Clinics of North America, 32, 431–445.

    Article  Google Scholar 

  • Pierce, A. P. (2000). The coital alignment technique (CAT): An overview of studies. Journal of Sex and Marital Therapy, 26, 257–268.

    Article  PubMed  Google Scholar 

  • Pinsky, D. (Host). (1996). [Radio show]. In A. Wilkins (Producer), Loveline. USA: MTV.

  • Prochaska, J. O., & Norcross, J. C. (2007). Systems of psychotherapy: A transtheoretical analysis (6th ed.). Belmont, CA: Thomson Brooks/Cole.

    Google Scholar 

  • Ravart, M., & Cote, H. (1992). Sexoanalysis: A new insight-oriented treatment approach for sexual disorders. Journal of Sex and Marital Therapy, 2, 128–140.

    Google Scholar 

  • Reuben, D. (1969). Everything you always wanted to know about sex but were afraid to ask. New York: Bantam Books.

    Google Scholar 

  • Rhimes, S. (Writer), & Grossman, M. (Director). (2007). The other side of this life [Television series episode]. In B. Beer (Producer), Grey’s anatomy. California: American Broadcasting Company.

  • Rosenbaum, T. Y. (2007). Pelvic floor involvement in male and female sexual dysfunction and the role of the pelvic floor rehabilitation in treatment: A literature review. Journal of Sexual Medicine, 4, 4–13.

    Article  PubMed  Google Scholar 

  • Rosenthal, J. (Producer), & Roach, J. (Director). (2004). Meet the Fockers [Motion picture]. United States: Universal Studios.

  • Roth, A., & Fonagy, P. (2005). What works for whom? A critical review of psychotherapy research (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Rowland, D. L. (2007). Will medical solutions to sexual problems make sexological care and science obsolete? Journal of Sex and Marital Therapy, 33, 385–397.

    Article  PubMed  Google Scholar 

  • Salter, A. (1949). Conditioned reflex therapy. New York: Creative Age.

    Google Scholar 

  • Sansone, R. A., & Wiederman, M. W. (2000). Sexuality training for psychiatric residents: A national survey of training directors. Journal of Sex and Marital Therapy, 26, 249–256.

    Article  PubMed  Google Scholar 

  • Scharff, D. E. (1982). The sexual relationship: An object relations view of sex and the family. Boston: Routledge & Kegan Paul.

    Google Scholar 

  • Schnarch, D. M. (1991). Constructing the sexual crucible. New York: Norton.

    Google Scholar 

  • Schover, L. R., & Leiblum, S. R. (1994). Commentary: The stagnation of sex therapy. Journal of Psychology and Human Sexuality, 6(3), 5–30.

    Article  Google Scholar 

  • Seligman, L. (2006). Theories of counseling and psychotherapy: Systems, strategies, and skills (2nd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

    Google Scholar 

  • Sex surrogacy. Retrieved September 27, 2007, from http://www.sexsurrogateofla.com/.

  • Sexology training programs. Retrieved September 27, 2007, from http://www2.hu-berlin.de/sexology/TRAIN/index.htm.

  • Shainess, N. (1971). A look at Human Sexual Inadequacy. American Journal of Psychiatry, 127, 152–153.

    Google Scholar 

  • Snyder, C. R., & Ingram, R. E. (Eds.). (2000). Handbook of psychological change: Psychotherapy processes and practices for the 21st century. New York: John Wiley.

    Google Scholar 

  • So, H.-W., & Cheung, F. M. (2005). Review of Chinese sex attitudes and applicability of sex therapy for Chinese couples with sexual dysfunction. Journal of Sex Research, 42, 93–101.

    PubMed  Google Scholar 

  • Star, D. (Writer), & Coulter, A. (Director). (1999). The awful truth [Television series episode]. In M. P. King (Producer), Sex and the city. New York: Home Box Office, Inc.

  • Sungur, M. Z. (1999). Cultural factors in sex therapy: The Turkish experience. Sexual and Marital Therapy, 14, 165–171.

    Google Scholar 

  • Tiefer, L. (2007). Beneath the veneer: The troubled past and future of sexual medicine. Journal of Sex and Marital Therapy, 33, 473–477.

    Article  PubMed  Google Scholar 

  • van Lankveld, J., ter Kuile, M. M., de Groot, H. E., Melles, R., Nefs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: A randomized waiting-list controlled trail of efficacy. Journal of Consulting and Clinical Psychology, 74, 168–178.

    Article  Google Scholar 

  • Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Weeks, G. R., & Hof, L. (Eds.). (1987). Integrating sex and marital therapy: A clinical guide. New York: Bruner/Mazel Publishers.

    Google Scholar 

  • Wiederman, M. W. (1998). The state of theory in sex therapy. Journal of Sex Research, 35, 88–99.

    Article  Google Scholar 

  • Wiederman, M. W., & Sansone, R. A. (1999). Sexuality training for professional psychologists: A national survey of training directors of doctoral programs and predoctoral internships. Professional Psychology: Research and Practice, 30, 312–317.

    Article  Google Scholar 

  • Winston, A., & Winston, B. (2002). Handbook of integrated short-term psychotherapy. Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • Wollert, R. W. (1978). A survey of sexual attitude reassessment and restructuring seminars. Journal of Sex Research, 14, 250–259.

    Google Scholar 

  • Wolpe, J. (1966). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.

    Google Scholar 

  • Zeiss, R. A. (1978). Self-directed treatment for premature ejaculation. Journal of Consulting and Clinical Psychology, 46, 1234–1241.

    Article  PubMed  Google Scholar 

  • Zilbergeld, B. (1975). Group treatment of sexual dysfunction in men without partners. Journal of Sex and Marital Therapy, 1, 204–214.

    PubMed  Google Scholar 

  • Zilbergeld, B. (1978). Male sexuality: A guide to sexual fulfillment. Boston: Bantam Books.

    Google Scholar 

  • Zilbergeld, B., & Evans, M. (1980, August). The inadequacy of Masters and Johnson. Psychology Today, pp. 29–43.

  • Zucker, K. J. (2002). From the editor’s desk: Receiving the torch in the era of sexology’s renaissance. Archives of Sexual Behavior, 31, 1–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported, in part, by a grant from the Canadian Institute for Health Research. We are indebted to Sophie Bergeron, Seth Davis, Melissa Farmer, Kathryn Hall, Alina Kao, Peggy Kleinplatz, Tuuli Kukkonen, Marie-Andrée Lahaie, Louise Overington, Laurel Paterson, Kimberly Payne, Caroline Pukall, Gerry Wiviott, and the staff of the Sex and Couple Therapy Service of the McGill University Health Center for their comments and help in preparing this article. This paper is based, in part, on a Masters and Johnson award talk given by Yitzchak M. Binik at the annual meeting of the Society for Sex Therapy and Research in Atlanta in March 2007.

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  1. Department of Psychology, McGill University, 1205 Dr. Penfield Ave., Montreal, QC, H3A 1B1, Canada

    Yitzchak M. Binik

  2. McGill University Health Center, Montreal, QC, Canada

    Yitzchak M. Binik

  3. Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA

    Marta Meana

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Binik, Y.M., Meana, M. The Future of Sex Therapy: Specialization or Marginalization?. Arch Sex Behav 38, 1016–1027 (2009). https://doi.org/10.1007/s10508-009-9475-9

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