MFT Practice Exam - Sex Therapy 58 Q & A Flashcards
(57 cards)
<p>Three categories of sexual dysfunction:</p>
<p></p>
<p>1. Sexual Dysfunction</p>
<p>2. Sexual Dissatisfaction</p>
<p>3. Sexual Deviation</p>
<p>Prevalence of Sexual Dysfunction (based on gender)</p>
<p>Women = 43%</p>
<p>Men = 31 %</p>
<p>Prevalence of sexual dysfunction in women</p>
<p>Hypoactive sexual desire disorder = 33.4%</p>
<p>Difficulty with orgasm = 24.1%</p>
<p>Pain during intercourse = 14.4%</p>
<p>Causes of low sex drive in women</p>
<p>Vary.</p>
<p>Fatigue/stress from daily responsibilities</p>
<p>Psychological</p>
<p>Certain health conditions or medications (ex. mood stabilizers)</p>
<p>Depression/anxiety</p>
<p>Birth control pills</p>
<p>Prevalence of sexual dysfunction in men:</p>
<p>Hypoactive sexual desire disorder = 15.8%</p>
<p>Erectile dysfunction = 34.8% (increases with age)</p>
<p>Premature ejaculation = 30%</p>
<p>4 Types of Sexual Dysfunction</p>
<p>1. Disorders of Desire</p>
<p>2. Arousal Dysfunction</p>
<p>3. Orgasm dysfunction</p>
<p>4. Pain</p>
<p></p>
<p>Disorders of Desire (male and female)</p>
<p>Hypoactive sexual desire disorder</p>
<p>Sexual aversion disorder</p>
<p>30% women, 15% men</p>
<p>Most common psychological causes of disorders of desire:</p>
<p>Depression</p>
<p>Anxiety</p>
<p>Stress</p>
<p>Substance abuse</p>
<p>Fatigue</p>
<p>Hypoactive sexual desire disorder</p>
<p>Persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts and/or desire for or receptivity to sexual activity that causes personal distress (not just partner distress).</p>
<p>Lifelong or acquired (lifelong = more difficult to diagnose/treat)</p>
<p>Generalized or situational</p>
<p>Single or multiple etiologies</p>
<p>Arousal Dysfunction (by gender)</p>
<p>Male erectile disorder</p>
<p>Female sexual arousal disorder</p>
<p>Sexual Arousal Disorder</p>
<p>The persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress.</p>
<p>May be expressed as a lack of subjective excitement, genital response (lubrication/swelling), or other somatic responses.</p>
<p>Orgasm Dysfunction (by gender)</p>
<p>Male orgasmic disorder</p>
<p>Premature ejaculation</p>
<p>Female orgasmic disorder</p>
<p>Orgasmic Disorder</p>
<p>The persistent or recurrent difficulty, delay in, or absence of attaining orgasm/ejaculation following sufficient sexual stimulation and arousal, causing personal distress.</p>
<p>Pain</p>
<p>(Type of sexual dysfunction)</p>
<p>Dyspareunia</p>
<p>Vaginismus</p>
<p>Dyspareunia</p>
<p>Recurrent or persistent genital pain associated with sexual intercourse.</p>
<p>Vaginismus</p>
<p>Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration, causing personal distress.</p>
<p>All 4 types of sexual dysfunction may be:</p>
<p>Lifelong/acquired</p>
<p>generalized/situational</p>
<p>psychological/combined factors</p>
<p>Masters and Johnson (1970)</p>
<p>Crystallized cognitive/behavioral methods to treat sexualized problems.</p>
<p>Revolutionized treatment (like Viagra revolutionized pharmacology) - prior treatment for sexual disorders was long-term, multi-year psychotherapy or psychoanalysis with very low rates of success.</p>
<p>Birth of the field of sex therapy.</p>
<p>Treatment created by Masters and Johnson</p>
<p>Devised a rapid (2 week) psychotherapy in couple, rather than individual, context, working with male/female therapist team - >80% success rate.</p>
<p>Strictly talking therapy (did not observe sexual activity).</p>
<p>Provide appropriate sex information, alleviate anxiety about sexual performance, and facilitate verbal/emotional/physical communication.</p>
<p>Still widely used today.</p>
<p>Revolutionary.</p>
<p>Female Sexual Response Cycle (Basson)</p>
<p>Non-linear, intimacy-based model.</p>
<p>Female dysfunction (and desire) appears to have many causes and many dimensions, including biological, psychological, and interpersonal determinants that can aid or impede arousal.</p>
<p>Responsive rather than spontaneous (i.e. sexual stimuli). Begins with cognitive decision to engage in sexual activity (ex. listen to music, direct stimulation).</p>
<p>Goal of sexual activity = personal satisfaction, not necessarily orgasm, but can be physical or emotional</p>
<p>Esther Perel on female eroticism</p>
<p>Diffuse, not localized in the genitals but distributed throughout the body, mind, and senses.</p>
<p>Tactile and auditory; linked to smell, skin, and contact.</p>
<p>Arousal is often more subjective than physical.</p>
<p>Desire arises on a lattice of emotion.</p>
<p>Healthy Sex (Wendy Maltz)</p>
<p>Conscious, positive expression of our sexual energy in ways that enhance self-esteem, physical health, and emotional relationship.</p>
<p>Mutually beneficial and harms no one.</p>
<p>Requires five basic conditions be met: CERTS</p>
<p>Sexual Energy (Wendy Maltz)</p>
<p>Powerful, natural force.</p>
<p>Potential to be channeled and experienced in either destructive or life-affirming ways.</p>
<p>Healthy Sex CERTS Model (Wendy Maltz)</p>
<p>1. Consent</p>
<p>2. Equality</p>
<p>3. Respect</p>
<p>4. Trust</p>
<p>5. Safety</p>
<p>All five must basic conditions must be met to foster healthy sex.</p>
Therapist's Comfort Zone
Create a sex-friendly space free of judgment and moralizing where people can safely talk about their sexuality:
Allow client to normalize when therapist conveys she is comfortable dealing with sexual issues.
Allow clients to reveal fantasies, concerns - often for the first time
Allows for greater creativity in the treatment room.
Be aware of countertransferene - aligning with one partner, acknowledging own arousal/discomfort
3 Dimensions of Assessment
1. Screening - may be the first screening by a professional
2. Incorporate ongoing practice in matter of fact manner
3. Specific requests for sex therapy = comprehensive sexual assessment
Importance of biopsychosocial dimensional components to assessment
Sexual dysfunctions are often highly related to physical and psychosocial dimensions of an individual's life.
Preventive treatment measure like sexual/senxual education would be more useful than only reproductive education.
Optimal treatments require careful histories and have the ability to impact psychological and physiological sexual response.
Sexualy is core human function but personal functioning remains a difficult topic to discuss for patients/physicians/therapists.
Screening Assessment
Are you sexually active?
Men, women, or both?
Are you satisfied with quality and quantity of sexual activity in your life?
Is this an area you would like more informaion on or to more fully explore?
Assessment: Incorporating in ongoing practice
Contraindicated in presence of severe marital distress - marital therapy to pave the way for future treatment of sexual problem.
Quality/quantity of sex and level of satisfaction
Meaning of sex
Comprehensive Sexual Assessment
Medical (thyroid disorder, depression, medications, menopause)
Psychosocial (messages from family/media)
Psychophysiological (which comes first: pain, dryness, erectile dysfunction, or loss of desire?)
Psychosocial Evaluation
(in comprehensive assessment)
Couple and individual sessions (have each state what they think the other wants,
Self-report questionnaires - expectations overt/covert (take-home)
Clinical interviews (when is last time felt aroused/most desired):
Couple - establish possible working relationship
Individual - treatment plan with both
Common male disorders
Premature/Delayed Ejaculation
Erectile Dysfunction
Disorders of Desire
Common female disorders
Dyspareunia/Vaginismus
Orgasmic Disorder
Disorders of Desire
Treating Premature/Delayed Ejaculation
Relaxation Response
SSRI's
Mindfulness - Fantasy
Relationship Issues
Squeeze Technique
Squeeze Technique
Ejaculatory control is learned through a stop and go exercise.
Stimulation of the penis until the man feels he will ejaculate unless stimulation stops. Stop simulation and the base of the penis is squeezed by the partner encircling it snugly with the thumb and forefinger. Stimulation is resumed when the ejaculatory impulse passes – usually after 10 seconds or more. After several sessions, regular intercourse may be tried without the squeeze technique.
>95% of men have learned to control ejaculation for five minutes or longer using this method.
Goal = for the man to become accustomed to the feeling of delayed ejaculation.
Treating Erectile Dysfunction
Focus on nonerotic stimuli
Encourage positive reinforcement
Decrease demands
Encourage open, positive communication
Treating Dyspareunia/Vaginismus
CRITICAL - Physical Examination
Vaginal dilators
Relaxation training
Greater success with partner involvement
Treating Orgasmic Disorder
Relaxation (sensate focus)
Mindfulness of sensual pleasure
Appropriate use of erotica/fantasy
Masturbation
Increase positive self-image
Pelvic floor exercises
Treating Disorders of Desire (Men & Women)
Education
Sensate Focus - sensual awareness
Appropriate exposure to erotica/sexual aids
Explore relationship to sex/erotic mind
Hormonal (estrogen/testosterone) screening (female issues not as related to plumbing)
Sensate Focus: Stage I
Weeks 4-6
First few weeks couples take turns non-genital touching to establish awareness of sensations.
Person touching does so on basis of what interests them or person being touched can "guide"
Sensate Focus: Stage II
Weeks 7-9 (longer as needed)
Expanded to breasts and genitals.
Emphasis on physical sensations, not sexual response - no intercourse
Take turns "hand riding" as a means of nonverbal communication
Sensate Focus: Stage III - IV
Weeks 10+
Mutual touching
Female on top w/out insertion
Progress to tip of penis, moving back if anxious
Full intercourse
Sensate Focus: Assessment
Weeks 1-3
Current Trends in Sex Therapy
1. Medicalization of sexual dysfunction
2. Esther Perel's notion of erotic intelligence
3. Jack Morin's peak erotic experiences and core erotic themes
4. Mind/Body Approaches (6th sense = interoception, pleasure-centered somatic tx; Dan Siegel's Mindsight = 7th sense)
Medicalization of sexual dysfunction
Current trend.
Aim to change person's physiological response.
Historic focus on male erectile disorder, more recently on premature ejaculation in men and sexual arousal/desire in women
Medically speaking, sexual issues fall into three general categories:
1. Nerve suppy
2. Blood flow
3. Hormones
Esther Perel's notion of erotic intelligence
Meaning of sex:
What does sex mean to you?
How is sex treated in your family?
What are the important events that shaped your sexuality?
What would you like to experience most with your partner sexually, and what are you most afraid of?
Jack Morin's Erotic Equation
Current Trend
Attraction + Obstacles = Excitement (flames of passion)
Unpredictability, spontaneity, and risk are where eroticism resides.
Privacy vs. Secrecy
Emotional connection can dampen desire when closeness becomes an obligation.
Threat to separateness = basis of all attractions
Need connection without terror of obliteration.
Need separateness without terror of abandonment.
Sex as source of shame vs. self--affirmation
When our innermost desires are revealed and are met by our loved one with acceptance and validation, the shame dissolves, and it becomes an experience of profound empowerment and self-affirmation.
Most feared challenge of erotic/sexual intimacy (+shield):
May be most fearsome intimacy because it is all-encompassing.
Reaches the deepest places inside of us and involves disclosing aspects of ourselves that are invariably bound up with shame and guilt.
When we express our yearnings, we risk humiliation and rejection.
Shield: many prefer workable, utilitarian type sex (that often leaves them feeling bored or dead inside)
Encouraging Change
Clarify goals and motivations
Nurture self-worth
Embrace uncertainty
Acknowledge and mourn your losses
Practice mindfulness using your senses
Risk the unfamiliar
Integrate your discoveries
Mind/Body Approaches = The sensuality solution
Gestalt therapy - focus on experience over performance, what is happening now
Growth model = treatment + enrichment
Mind and body as two-way street
Important issues that influence women's sexual well-being:
Self-image
Relationships
Psychological health
Social connectedness
Cultural expectations
(All intertwined)
Physiology plays into it for a very small percentage
Jack Morin's peak erotic experiences
Current Trend
As fulfilling as they are arousing.
Factors:
1. Firsts (new activities, settings, partners) and surprises
2. Idyllic settings/features
3. Extensions and restrictions of time
4. Knowledge of memorability factors that contribute to one’s arousal can help cultivate conditions for more fulfilling sex.
5 Personal Responses most mentioned for Peak Experiences (Morin)
1. Sensual and orgasmic intensity
2. Reduced inhibitions
3. Validation given and received
4. Mutuality and resonance (synchronicity)
5. Transcendence of personal boundaries
Investigate peak turn-ons to understand core erotic themes (Morin)
Current Trend
1. Most memorable real-life encounters – two specific that were the most intensely arousing in your entire life? Describe them in as much detail as possible.
2. Ideas about what made these encounters so exciting?
