Principles and Practice of Sex Therapy, Fourth Edition
It is nearly three decades since the publication of the first edition of Principles and Practice of Sex Therapy (1980). Much has changed since then, but much remains the same.
In 1980 there was both excitement and enthusiasm about time-limited, problem-focused learning approaches to overcoming sexual dysfunction. This was the method advocated by Masters and Johnson in their groundbreaking volume Human Sexual Inadequacy (1970). The promise of a rapid resolution to long-standing sexual problems was alluring. Sex counseling came to be practiced by a wide variety of health providers, including professionals, clergy, educators, social workers, and clinical psychologists. Expectations for treatment outcome were high, since almost all sexual problems were believed to stem from faulty learning, sex-negative family histories, guilt, and anxiety. The tools available for intervention were modest, but seemingly quite effective—behavioral therapy, sensate focus, imagery and paradoxical intention, the challenging of erroneous cognitive beliefs, the teaching of effective communication and enhancement of social skills, couple therapy, and masturbation training. And, in fact, in the initial period following the publication of Human Sexual Inadequacy, treatment outcome was impressive, particularly with the most common presenting complaints of the time, lack of orgasm in women and early ejaculation in men.
Already, though, even by 1980, when Principles and Practice of Sex Therapy was first published, it was becoming apparent that the high expectations for success needed to be tempered. As we wrote back then, “We realize that short-term approaches work well for some patients, with some problems, and only some of the time.” That realization prompted the writing of our book. We knew there was a significant disparity between theory and practice, that some problems were more modifiable than others, that some interventions might work well for some patients, but the same intervention with a different client or couple would have little impact. We wanted to explore the factors that contributed to treatment success or failure through the medium of in-depth case studies. By inviting the most prominent experts practicing in the field to contribute chapters highlighting their particular areas of expertise and favored theoretical approaches, including clinical illustrations, we believed it would be possible to identify both the best treatment approach for a particular problem and the psychological and interpersonal factors contributing to treatment success or failure.
Now, nearly 30 years later, we are somewhat more sophisticated in our understanding of sexual difficulties. We have a far greater appreciation of the role of biological and hormonal factors in the genesis and maintenance of sexual problems. We have a new respect for the contribution that drugs and hormones can make in both causing and ameliorating sexual complaints. We are grateful for the availability of safe and effective oral medications to treat erectile dysfunction. But we realize, too, that even with our considerably more advanced understanding of the anatomy and physiology of sexual response, our appreciation of the role of neurotransmitters and sexual pharmacology, and our investigations of brain functioning during sexual arousal, we must still rely on our clinical and psychological skills and sophistication in order to be effective. Above all, we must appreciate the psychological and relationship realities of our patients’ lives and their complicated, often ambivalent, feelings about sex. This fourth edition of Principles and Practice of Sex Therapy brings together the most current, evidence-based, clinically sophisticated, integrated and interdisciplinary approaches to the assessment and resolution of sexual complaints. Every chapter is written by a nationally or internationally recognized expert in sex therapy, one who is cognizant of both the research and practice in this fascinating field. Chapters focusing on heretofore neglected areas are included—such as cultural and ethnic contributions to sexual function and dysfunction, the treatment of men and women who have experienced sexual coercion, and persistent genital arousal in women—as well as a new and comprehensive overview of treating sexual problems associated with chronic medical illness. In recognition of the challenge and complexity of desire problems and the differing presentations by women and men, we have invited two experts to contribute chapters on sexual interest and desire disorders. We believe this volume will prove to be a useful and trusted guide to the principles and practice of sex therapy as it is practiced in the 21st century. I am indebted to the enormous contributions of scores of exceptional therapists and colleagues who have provided inspiration and feedback over several decades. In particular, I must acknowledge my appreciation and affection for Raymond C. Rosen, with whom I have talked, taught, learned, argued, and written for more than 30 years. As coeditor with me of the last two editions of Principles and Practice of Sex Therapy, his stamp on this book is indelible. He is indeed a giant in our field. The truth is that there are many outstanding clinicians and physicians currently practicing in the field of sex therapy and sexual medicine. Some deserve special recognition for having influenced my thinking and my therapy: Bernard Apfelbaum, John Bancroft, Lonnie Barbach, Rosemary Basson, Eli Coleman, Judith Daniluk, Lorraine Dennerstein, Marion Dunn, David Goldmeier, Irwin Goldstein, Julia Heiman, Marty Klein, Jean Koehler, Arnold Lazarus, Stephen Levine, Joseph LoPiccolo, Marita McCabe, Barry McCarthy, Michael Metz, Michael Perelman, Derek Polonsky, Candace Risen, Bonnie Saks, David Schnarch, Pepper Schwartz, Leslie Schover, Patricia Shreiner-Engel, William Stayton, Kevan Wylie, Beverly Whipple, and, of course, the deeply missed Bernie Zilbergeld. As well, I could not have edited this book without the help of three very special individuals: my much-loved husband, Frank Brickle; my secretary, Susan Connolly; and my research assistant and treasured helper, Rachael Fite. Finally, I must acknowledge my most heartfelt and warmest thanks to Seymour Weingarten, Editor-in-Chief of The Guilford Press, who helped launch me at the same time that he was first launching Guilford in 1978. He has stood by me for nearly 30 years, and I am grateful for his encouragement and friendship.
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