Ethical Considerations in Sex Therapy

The most ethical sex therapy is that which cures the symptom and improves the marital relationship in the briefest time at the least cost. Neither insight therapy, nor direct sexual interaction with the client satisfy these criteria. Examples are given of effective ethical therapies, useful in male and female sexual dysfunctions.     

The Dynamics,Implications and Treatment of Extramarital Sexual Relationships for the Family Therapist*

This article presents the dynamics, implications and treatment of extramarital sex. Historical and cultural perspectives, various types of infidelity experiences and family therapy implications will be discussed. Marital styles will be outlined as a frame of reference in understanding the topic and the importance of symptom generation vis-a-vis infidelity. Finally, specific recommendations for treatment and a brief consideration of extramarital relationships as a healthy alternative marital style will be offered.     

CONTESTED PORTRAYALS: Medical and Legal Social Control of Juvenile Sex Offenders

While juvenile courts were originally designed to respond to troubled youth by providing treatment appropriate to the needs of individual offenders, advocates of a system that "gets tough" on young criminals by meting out punishments based on offense characteristics (both present offense and past offense history) have become increasingly influential in recent years. In this article, I examine a special case, that of juvenile sex offenders in a Washington State county. for whom a 1990 law reintroduced treatment as a central goal. While Washington has been a forerunner in the shift toward a juvenile justice system in which offending behavior is the central factor in decision making, I argue that, largely as a result of this law, juvenile sex offending has been "medicalized" and that, in this process, distinctions based on offense characteristics have noticeably diminished. This case study provides both empirical support for established theoretical arguments regarding medicalization and a detailed explication of the differences between medical and legal assumptions about social problems.     

The Couple Relationship as the Focus of Sex Therapy: The Integration of Sex Therapy Ideas and Techniques with Marital and Family Therapy

The marriage and family therapist needs basic information about techniques used in sex therapy in order to deal with the sexual issues they may encounter in their practice. This paper outlines a method of incorporating the psychotherapeutic techniques presently used in sex therapy into the marriage and family counselling setting when there is a sexual issue involved. The paper is separated into (1) a discussion of the problem, (2) recovering the relationship as the focus for sex therapy, and (3) the main approaches to treatment. Next, (4) practice issues are considered, with a presentation of couple therapy using concepts and techniques of sex therapy, including discussions on A. Identification of Organic Causes, B. Identification of Psychological Issues, C. Examination of Interpersonal Issues, and D. Assessment of Systemic Issues. (5) Some more common interventions are then presented.     

Fundamentals of Theory and Practice Revisited: Sex Therapy: Historical Evolution,Current Practice. Part 2

This is the second of a two‐part series on the treatment of sexual difficulties. It presents a systemic approach to sex therapy and uses illustrative case histories to explore: the interrelationship between the presenting person or couple; the ‘sexual’ as part of the relationship; the symptom; the medical considerations; the cultural context; and the framework and thinking of the therapist.     

"SECRET BALLOTS" AND SELF-REPORTS IN AN EXIT-POLL EXPERIMENT

A controlled exit-poll experiment on Election Day (November3, 1992) shows that refusals to answer questions and other evasiveforms of responding were significantly lower when respondentswere given a self-administered "secret-ballot" questionnairethan when they were interviewed face-to-face. While there weresome suggestive interactions of this mode-of-data collectioneffect with age and sex, and with the partisan atmosphere ofthe precinct in which the interviews were conducted, they wereborderline in significance, inconsistent in pattern, or difficuitto interpret. More important, comparisons with official electionreturns (the truth) indicated that the secret-ballot techniquewas more accurate than were face-to-face interviews in estimatingthe final outcome on the most socially sensitive of three self-reportedvotes: a vote for or against a tax levy for elderly services.Using a genuine secret ballot in the tradition of the olderGallup preelection polls can thus increase the validity of self-reportsin exit polls today.     

The sex composition of the Japanese American population

While both aversion therapy and psychotherapy can claim considerable success, they also fail occasionally. In view of this experience an attempt has been made to intergrate these therapies. Two cases are discussed in which such collaboration of representatives of both schools was achieved. After successful termination of the treatment, the patients filled out questionnaires in which they evaluated the contribution of each of these therapies.     

AVOIDING A COMMON PITFALL IN COMPULSORY SCHOOL REFERRALS

When a family is compulsorily referred by the school for therapy, treatment failure often ensues if the family therapist, ignoring the probability of a powerful conflict between family and school, focuses prematurely on family dynamics. An alternative approach to such cases is proposed, based on questioning the "function of the symptom" notion, acknowledging the parents' predicament vis-à-vis the school problem, and conceptualizing therapy as the development of better teamwork.     

Community Organization and the Oppressed

There is sexist bias in social work education, as teaching materials for the courses Human Growth and Development and Family Casework exemplify. Two leading authorities on adolescence, for example, accept a stereotypic view of female development. Family treatment writers reveal their ambivalence about male dominance within family structures, as they invoke such concepts as the “male head of the house,” and “sex role reversal,” while simultaniously encouraging independent development of each partner. In addition, the Women's Liberation Movement has created complex reactions among student practitioners.     

KNOWLEDGE AND POWER, BODY AND SELF:

Symbolic interactionists have widely established the tenet that the self is formed in interaction with others. Despite this great contribution, this perspective has tended to sidestep discussions of the relationship between the body and the self and to overlook systems of power and the ways in which they impact upon the self and the body. The more recent contributions of postmodernists and critical theorists have focused on knowledge as a system of power. An examination of a sample of transgendered persons, individuals who endeavor to present alternatively gendered selves within a social system that proclaims males to be men and females to be women, provides a unique opportunity to analyze the ways in which knowledge systems affect gender identity and the embodied self. While individuals are not able to fully escape the dictates of the binary system of knowledge about sex and gender, they are capable of devising alternative ways of "doing" gender that more closely adhere to an internalized sense of self. In the end, individuals neither passively enact nor completely escape the dictates of the binary system of gender knowledge.     

Complementary health approaches for postpartum depression: A systematic review

Postpartum Depression (PPD) affects approximately 9 - 20% of women. Many women with PPD go undiagnosed and/ or do not follow through on referrals for treatment. Although the most routinely prescribed treatments for PPD are antidepressant medication and psychotherapy, a significant number of women desire non-traditional options. This article provides a systematic review of ten recently published, randomized clinical trials in the examination of the effectiveness of complementary health approaches—the use of non-mainstream products and interventions—on PPD. A search of nine databases of the English language literature from the years 2006 to 2018 was performed. Review criteria included published work, utilization of randomized-controlled trials, and the use of a reliable and valid measurement tool to identify cases of PPD and monitor changes in symptom severity. The studies reviewed focused on the following interventions: aromatherapy, bright light therapy, electroacupuncture, infant massage, iron supplementation, mindfulness training, omega-3 fatty acids, saffron, and yoga. Outcomes demonstrate the feasibility and safety of these approaches, as well as varying degrees of effectiveness. While many were pilot studies using small sample sizes, the results are encouraging and substantiate the need for additional trials. Studies are summarized and limitations and implications for social work and future research are described.     

Gonadotrophin receptor hormone analogues in combination with add-back therapy: an update

Gonadotrophin receptor hormone analogues (GnRHa) have been used in a range of sex hormone-dependent disorders. In the management of premenstrual syndrome, they can completely abolish symptoms. The success of GnRHa in the treatment of endometriosis and adjuvant therapy in the management of fibroids is proven. This efficacy does not come without a cost and the side-effects of the hypo-estrogenic state have limited their application. The use of add-back therapy to counter these effects has enabled wider application, longer durations of treatment and an increase in compliance. This review article is an update on the evidence supporting gonadotrophin receptor hormone analogues in combination with add-back therapy.     

Fundamentals of Theory and Practice Revisited: Sex Therapy: Historical Evolution,Current Practice. Part I

This is the first of a two‐part series, and provides a contextual history of major trends in sex therapy, notably the psychoanalytic, behavioural and medical models, as well as detailing the family therapy contribution to the field. Part 2 will present the outline of a first interview, and use it to demonstrate a systemic model which explores the interrelationship between the symptom, the presenting person(s), the ‘sexual’ as part of the relationship, the biological, the broader cultural view of sexuality — and the therapist's framework and thinking. Case studies are used as illustration.     

The therapist's pregnancy: Impact on the treatment process

As soon as she becomes aware of her pregnancy, the therapist is confronted with a barrage of issues involving her identity, integration of roles, maternal identification, and redenfinition of important relationships, including those with her patients. While she works at becoming aware of and responding to the dramatic emotional and biological changes of pregnancy, and emerges with corresponding maturational adjustments, her patients enter an often stormy period of therapy in which they respond to the changes in the therapist's appearance, the threat of the growing infant, and the reality of the therapist's needs and inevitable absence for maternity leave. The special event of the pregnancy alters the therapeutic setting and affects both the transference and coun-tertransference, initiating reverberations in the therapeutic relationship which provide opportunities for marked advances in therapy.     

Aging androgens and the metabolic syndrome

Objective: To assess the responses of a symptom complex related to partial androgen deficiency in the aging male (PADAM) to androgen supplementation. Subjects and methods: Eighty-six men from five hospitals in Beijing aged 50-70 years with symptoms related to PADAM received oral testosterone undecanoate for 2 months, and the effects of the therapy were evaluated. Results: After treatment, the symptom scores were significantly improved (all p < 0.001). Serum levels of luteinizing hormone and follicle stimulating hormone were suppressed, and free testosterone and albuminbound testosterone levels were elevated. However, they were not significantly different from the pretreatment values. Waist/hip ratio and blood pressure were markedly decreased, but no changes were found in serum levels of total cholesterol, triglyceride, albumin and prostate specific antigen. Conclusions: Two months of treatment with oral testosterone undecanoate clearly improved the symptoms related to PADAM. No statistical relationship was found between symptom improvement and androgen levels. Androgen therapy for 2 months was beneficial to the waist/hip ratio and blood pressure, and no harm was done to the prostate gland or lipid metabolism.     

Treatment for Juveniles Who Sexually Offend in a Southwestern State

A 25-item questionnaire was mailed to sex offender treatment providers from counties with 60 or more reported juvenile sex offenders in a Southwestern state to determine the most effective treatment for juvenile sex offenders. Results indicated that cognitive behavioral therapy was the most successful reported approach to treatment with an average success rate of 87%. The most commonly used approach was cognitive behavioral therapy with relapse prevention. The most common sexual offense was indecency with a child involving sexual contact, contrary to studies that found that in the Probation Commission data, aggravated sexual offense was the most common. These results have ramifications for state policies on treatment for juvenile sex offenders.     

Dyadic Playfulness Differences Between Sexual and Marital Therapy Couples

Thirty-three clinical couples (17 sex therapy and 16 marital therapy) and fifty non-clinical couples were examined for potential differences in relationship playfulness utilizing the Couples Play Questionnaire. For clinical couples, Spanier's Dyadic Adjustment Scale, and Edmond's Marital Conventionalization Scale scores were also comparcd. Both sex therapy and marital therapy couples were found to be deficient in play compared to non-clinical couples, while marital therapy couples were found to be most deficient. Greater marital conventionalization scores were found for sex therapy couples suggesting that they favorably distort their self-assessmcnts. Results suggest that sex therapy couples may be the more inflexible of the three sample groups and may need therapeutic assistance with general relationship play as well as sexual play.     

"LEARNING TO LEARN" AND THE FAMILY SYSTEM: NEW PERSPECTIVES ON UNDERACHIEVEMENT AND LEARNING DISORDERS

A new frontier for family therapy is emerging from recent studies of under-achievement in school, learning disabilities and parental communication. Although poor school performance is frequently the presenting problem (or an associated symptom) in family therapy, this topic still lacks a coherent conceptual framework. An ecological model is proposed for understanding child and adolescent achievement problems. Four dimensions of a family's learning environment are suggested as foci: (a) family communication deviances; (b) family structure; (c) family attributions; and (d) family achievement values. The metaphor of the family as "primary classroom" is offered as a way to think about learning styles across home and school contexts, and some treatment guidelines are suggested.     

Long-acting injectable risperidone: an emerging tool in schizophrenia treatment

Long-term treatment of patients with schizophrenia remains challenging. Functional and cognitive declines associated with schizophrenia compromise patients' ability to adhere to therapy. While medications can improve outcomes, partial adherence limits effectiveness and is associated with relapse and rehospitalization. Partial adherence has been shown to be high with both oral conventional and oral atypical antipsychotic agents. While long-acting conventional antipsychotic agents provide ensured medication delivery and reduce relapse rates, they carry a substantial risk of movement disorders. A new long-acting formulation of the atypical agent risperidone has shown improved efficacy with decreased risk of adverse events. Its use, along with psychosocial approaches focused on adherence, may help, if initiated during inpatient treatment, by promoting adherence immediately postdischarge and improving long-term treatment outcomes.