SEX THERAPY: BEING TREATED BY HOLISTIC THERAPIST
The holistic therapist, by assessing the intrapsychic and interpersonal functioning of each patient, may decide, on concluding sex therapy, to refer one or both members of the dyad or members of the family to another therapist, or may elect to treat any or all members of the family himself or herself. There are no rules. There are, however, advantages in having a single therapist treat all the problems of the couple and family, the advantage of being able to shift emphasis as the need arises and to treat new material and different family members in the most appropriate way. One excellent example is the following:
A couple in their early forties was referred to sex therapy by a psychiatrist treating the woman. The presenting symptom was occasional impotence on the part of the man; the woman was orgasmic. The woman was a compulsive cleaner, vacuuming the house several times a day. She also suffered from severe constipation. They had two daughters, sixteen and twelve years old. It was the psychiatrist’s opinion that her constipation was the result of poor sexual function, even though she experienced orgasm every time she and her husband had intercourse.
This couple practiced the very common “Sunday morning sex” ritual, common because that is when couples with children usually have the time for sex, or when excuses for not having sex no longer hold. It was an ordeal for them both, a duty repeated weekly. Even when he was potent the husband found the entire experience unsatisfying; his wife was even more inhibited than he. Neither disrobed in front of the other, nudity was strictly under the cover. Intercourse was quick—and they both felt that sex was supposed to be better than it was for them.
Both partners were virgins when they married, and neither had had any other partner. The woman never initiated the Sunday ritual, a fact that also irritated the husband.
It was clear that this couple was eager to improve their sexual functioning but was in a state of high anxiety. Rather than prescribing even the mild relaxation exercises, it was suggested that they begin by sleeping in the nude (a form of desensitization) together. At the same time, the therapy sessions began to explore the wife’s inhibitions and the husband’s anxieties, using various extrasexual modalities.
Initially, it appeared that the husband was indeed justified in his irritation with his wife’s inhibitions, since she refused to undress in front of him. However, as time went on she was able to remove her outer garments in his presence, to complete disrobing in bed, and finally to undress completely while he watched. At that time the relaxation exercises were prescribed, and the husband’s inhibitions appeared in full force.
Extrasexual exploration revealed that he had been hiding behind the Sunday ritual as a protection against his own anxieties about his performance in spontaneous intercourse. Further, while complaining about his wife’s failure to initiate sex, he in fact had been discouraging her every time she did initiate, claiming that he needed extra sleep, was tired, and so on.
As the therapy and the relaxation exercises (of the non-demand type) proceeded, the couple gradually grew more at ease with their own needs and desires and bodies. Finally, intercourse was prescribed—for any day except Sunday. The husband was potent; both found the experience the best they could remember. Their sexual functioning continued to improve, the wife’s constipation improved, and her compulsive cleaning was markedly reduced.
Many inhibitions and problems remained, however, so the couple elected to continue therapy. Soon they brought up the subject of their daughter. Almost seventeen years old, she had been seeing a boy for a year, and while they suspected that the daughter and her boy friend were having intercourse together, they were not sure. By now they had only two concerns about her: that she use a birth control device and that she have a positive experience; the last thing they wanted, both husband and wife declared, was for their daughter to be as “hung-up” about sex as they were, and for so long a time. They recommended to the daughter that she contact the therapist, which she did.
It turned out that the parents were correct: the daughter was having intercourse with her boyfriend, was not practicing birth control, and was not enjoying sex at all. She was also very fearful of sharing this information with her parents. And she volunteered that most of her friends were in exactly the same predicament.
After several counseling sessions (no real therapy was required), the girl, without telling her parents that she was sexually active, did notify them that she was going to be fitted for a diaphragm and that she wanted to visit the physician by herself. This opened the way to a whole new level of communication between the parents and the girl, who still, however, did not reveal her sexual activity. But the family grew much closer as a family, and the twelve-year-old daughter began to wonder when she could go into therapy—she had no apparent problems. In her last session with the therapist, the girl reported that she was using the diaphragm, that sex was becoming very enjoyable, and that many of her friends were trying to find the courage to do the same.
A few months later the girl left town to go to college and from the safety of that distance, phoned her parents and mentioned that she had been having sex. She was astonished at their concern for her own welfare and pleasure, and the family has never been closer in an emotional sense. In addition, she altered her original intention of studying education, because “teaching is easy for women to do,” to taking pre-law courses, because she had always wanted to be a lawyer but never felt capable until recently. The mother, meantime, was preparing for the absence of both her children by resuming a career in real estate and insurance that she had abandoned eighteen years earlier. The entire household was more relaxed, and the parents report that the younger daughter’s friends, who formerly resented the restrictions against messiness, now love to come over.
It should be clear that the holistic therapist can begin as a sex, dyadic, family, or individual therapist. Initial theoretical orientation is not crucial. But any expansion of the scope of practice requires new skills, and it is expected that the therapist entering a new field will obtain them. This granted, the advantages of combining individual, dyadic, sexual, and family therapy in a single therapist are clear and will surely be realized more and more in the future.
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