Psychology 492- Quiz 12 Review

Racial Competency (Contemporary Approaches to Sex Therapy)

In the United States, white therapists are overepresentative of the white population, there are often too few black, hispanic, asian, and indigenous sex therapists available 1. Power dynamics- it is less likely for a white person to be in an interracial relationship than a person of color (there is a complex past and present of racial inequities) 2. Manifestation of psychological conditions- psychological conditions are different across racial groups (like SBD) The symptoms of an anxiety disorder is different for people of different races 3. Racial differences in assumptions- the typical frequency for sex and promoting sexual experiences is different for every culture

Inclusive Competency (Contemporary Approaches to Sex Therapy)

In this competency, one must know what kinds of issues they can provide therapy for (and what kinds of issues they cannot provide therapy for) 1. Know boundaries of own competence- this is based on education, experience, training, etc. Psychotherapists tend to exaggerate their own competence 2. Educate yourself on marginalizing factors- learn what kinds of frustrations minorities face when a therapist is of a disparate ethnic identity

Biological Factors That Can Contribute To Sexual Problems

The biological factors that can contribute to sexual problems are: 1. The natural aging process 2. Physical Disabilities 3. STIs 4. Drugs These factors can impair sexual functioning or cause pain during sex

The Adaptive Nature of the Dual Control Model

The excitatory and inhibitory system are thought of as being adaptive The excitatory system is important for ensuring that reproduction happens The inhibitory system may be useful for helping maintain harmonious interpersonal relationships

Orgasmic Imperative

The pressure many people feel to reach orgasm every time they have sex

Tips For Avoiding Sexual Difficulties

1. Communication specifically with your partner both verbally and nonverbally during sex- this is positively correlated with sexual satisfaction 2. Do not look at sex as an activity in which you are "supposed" to achieve something- your body will also not always function the way you want it to 3. Take care of yourself physically and psychologically

Cultural and Religious Factors Effect on Sexuality (Social Factors)

Cultural and religious factors may dictate certain prohibitions when it comes to seeking out and experiencing pleasure from sex East Asian cultures tend to have more conservative attitudes towards sex than European cultures- those of East Asian descent tend to report lower sexual desire and functioning than their European counterparts

Causes of Sexual Problems (Masters and Johnson- 1970)

According to Masters and Johnson, most people have a clear awareness on what is wrong with their sexuality Anxiety goes hand in hand with spectatoring

Roundtable Conversations (Masters and Johnson- 1970)

According to Masters and Johnson, the organization of the therapy room should eliminate hierarchy One should sit at the table and work together with their therapists

Characteristics of Treatment (Masters and Johnson- 1970)

According to Masters and Johnson, treatment should focus on the relationship and not the individual client- the relationship is the client Radical self-responsibility- couples had a tendency to blame the other, they should be asking "what can I do to improve this situation?". Cooperatively problem solve with their partner

Mental Illness' Effect on Sexuality (Psychological Factors)

Affective disorders are sometimes associated with low libido (like with major depression) and other times hypersexuality (like the manic phase of bipolar disorder) Psychotic disorders like schizophrenia are associated with several forms of sexual dysfunction Oftentimes, those with mental disabilities are denied a sex life altogether

Partner's View on Sex's Effect on Sexuality (Social Factors)

Couples who are actively trying to have a baby put too much performance pressure on one another, which may create anxiety about arousal problems Couples who turn sex into a chore or duty or whose sex lives become very routine may risk reducing enjoyment

Drugs' Effect on Sexuality (Biological Factors)

Antidepressants (namely SSRIS) tend to delay orgasm in men and women because they keep serotonin in the brain longer Antipsychotics and tranquilizers also have neurological effects that can inhibit the ability to reach orgasm Some blood pressure and allergy medications have been repotted to have negative sexual side effects as well Long-term use of alcohol, tobacco, and other drugs (like cocaine and opiates) can generate persistent sexual dysfunction

Natural Aging Process' Effect on Sexuality (Biological Factors)

As we get older, most of us will experience a decrease in sexual functioning as our bodies and hormone levels are changing With age, we are also more likely to develop chronic illness (like cardiovascular and nervous system diseases) Diabetes is a major contributor to male erectile dysfunction and can reduce blood flow to the clitoris and vagina for women Multiple Sclerosis can impact the ability to reach orgasm Cancers are also linked to sexual problems (although it is sometimes the cancer treatment that is more damaging to one's sexuality than the cancer itself)

Couples Therapy

Coitus prohibition- instruction to stop having sex for a period of time When sex stops, verbal communication, affection, and attraction all increase If one's sex life becomes predictable- one can break the rule ( which may add excitement) Reintroduction- this is when a couples meets each other for the first time again Begin forming connection with your current partner without the past of your relationship Simple technique: Yes/No/Maybe- this will help break out of what's scripted Here, a therapist would provide couples with a list of sexual activities.. and they have to respond yes, no, or maybe to them Sexual websites/ apps, like Mojoupgrade, are a modern way to use this technique

Treating Desire Problems

Desire dysfunctions tend to be the most difficult to treat and typically have the lowest success rate of all sexual disorders 1. Self-help strategies- increase communication., introduce sexual novelties, have regular "date nights", etc. 2. Behavioral Therapy or CBST- low desire often stems from relationship problems 3. Pharmacotherapy- testosterone supplementation. for both men and women, testosterone may need to be jointly administered with estrogen for women

PLISSIT Model of Sex Therapy

Developed by Jack Annon in 1976 who wondered what the role of a sexologist was This is an acronym that stands for: Permission- we need to give people permission to talk about sex, and permission to have pleasure Limited Information- there is too much misinformation on sexuality, sex therapists should debunk myths and provide an anatomy lesson Specific Suggestions - specific techniques given pertaining to sex The majority of people are fine after the first three steps and most do not need intensive therapy Intensive Therapy- AASECT- the most accepted certification for sex therapists

Sensate Focus Techniques

Example of a technique found in Masters and Johnson's approach to sex therapy This can be thought of as a gradual reconditioning process in which individuals ultimately come to associate sexual arousal and activity with pleasure instead of anxiety Partners will gradually build up sexual intensity as they learn to let go of sexual fears and distractions These exercises are based on the notion that both touch and communication are vital aspects to healthy sexuality This is often combined with sex education This is a remarkably successful technique, and is often the only thing needed for many people

Treating Arousal Problems

For women, difficulties with becoming aroused can be treated with CBST if psychological factors or relationship factors are the root of the issue Hormone therapy is an option for physical causes of arousal problems EROS Clitoral Therapy Device- an option for increasing arousal in women (draws blood into the clitoris)

LGBTQ+ Competency (Contemporary Approaches to Sex Therapy)

Generally, there is a good representation of LGBTQ+ therapists for people to pick from 1. Internalized queerphobia- most queer people have been told sometime in their life that they are horrible based on their disparate sexual orientation Many straight people aren't aware of the self-hatred that many queer people possess 2. Gender role questions- many have been told "you're not a real man/woman" which leaves the lingering question of what is one's gender role in society if they don't fit the norm.. straight people often don't understand this 3. Safety in expressing interest in a potential partner- queer people may get assaulted if they express interest in a potential partner (who may not be queer like them)

Sexual Desire Statistics

Low sexual desire is the most common form of female sexual dysfunction The odds of reporting a sexual dysfunction increases with age and the nature of the difficulties people experience change with age, too It is perfectly normal for sexually active people to experience fluctuations in desire throughout their lives

Body Image and Lack of Knowledge On One's Own Body's Effect on Sexuality (Psychological Factors)

Many women are dissatisfied with the appearance of their breasts and vulvas, while many men are unhappy with their penis size- this can create distress and anxiety that ultimately leads to people with poor body image to avoid sexual activity altogether or have sex under limited circumstances A lack of familiarity with one's own genital anatomy is sometimes implicated with orgasm difficulties (particularly among women)

Effectiveness of Behavioral Therapy

Masters and Johnson (1970) reported a 20% failure rate overall- the 80% success rate represents a mix of both partial and complete successes

Beliefs About Sexual Dysfunctions' Effect on Sexuality (Psychological Factors)

Our beliefs about sexual dysfunctions are linked to our experiences with sexual problems Research has found that, at least among women, the more prevalent they believe sexual difficulties to be, the lower their own sexual functioning is

Paraphilic Disorders (Sex in the DSM-5)

Paraphilia would refer to atypical sexual interests (such as BDSM) These disorders are generally not the focus of sex therapy

Past Learning Experiences' Effect on Sexuality (Psychological Factors)

Past learning experiences have important implications for sexual functioning People who grew up learning sex is a shameful/sinful activity and women who have been taught to think that they should not enjoy sex may end up thinking these things during the act, thereby dulling sexual response and pleasure People who have experienced traumatic sexual events in the past may feel an aversion to sex or have post-traumatic stress

Personality and Attachment Style's Effect on Sexuality (Psychological Factors)

Personality and attachment style can affect our degree of comfort with intimacy, as well as how we approach sexual interactions Lower levels of extraversion and openness to experience are associated with worse sexual functioning among women For men, research has found a link between reports of attachment- disrupting events during childhood (like growing up with an alcoholic parent) and erectile dysfunction in adulthood Among women, insecure attachment styles are associated with reduced arousal and orgasmic responsivity and elevated rates of vaginismus (painful, involuntary vaginal contractions)

Psychological Factors That Can Contribute To Sexual Problems

Psychological Factors that can contribute to sexual problems include: 1. Distraction 2. Previous learning experiences 3. Beliefs about sexual difficulties 4. Body image 5. Personality and attachment style 6. Mental illness

Spectatoring

Psychological factor that can contribute to sexual problems Distraction often takes the form of this This involves overthinking or over-analyzing one's own sexual performance while having sex Think of this as the act of becoming a spectator to your own sexual activity by mentally stepping out of the moment and evaluating how you are doing Overthinking your sexual performance may create anxiety that reduces arousal and the likelihood of orgasm

Global Dysfunction

Sexual Issues that occur with all partners and all sexual acts

Is Sexual "Addiction" Real?

Sexual addiction seems to follow a predictable pattern in that addiction only comes to light after the guy is caught cheating- this has lead many to question whether this is even real or not Sexual addiction is not included in the DSM-5 It seems odd to many that the opposite end of the spectrum is not addressed in the DSM-5, as low sexual desire and arousal is addressed in the DSM

Primary Dysfunction

Sexual issues one has had their entire life

Situational Dysfunction

Sexual issues that only occur with one partner or during one type of sexual activity

Secondary Dysfunction

Sexual issues that spontaneously appeared one day after a period of healthy sexual functioning

Social Factors That Can Contribute To Sexual Problems

Social Factors That Can Contribute To Sexual Problems include: 1. Ineffective communication about sex- correlated with lower sexual satisfaction 2. Relationship problems- problems like anger and unresolved conflict often reduce desire for partnered sexual activity 3. Partner's views on sex 4. Cultural and religious factors

Adaptive Advantage to Premature Orgasm

Some have suggested that premature orgasm may serve as an adaptive advantage- since male orgasm is essential to reproduction, having it occur faster will maximize the likelihood of conception by reducing the odds that the sexual act will be interrupted before completion

Physical Disabilities' Effect on Sexuality (Biological Factors)

Spinal cord injuries are linked to erectile dysfunction and ejaculatory difficulties in men and can often impair the ability to reach orgasm in women Creating secondary erogenous zones is one way to help people with physical disabilities develop and maintain mutually satisfying sexual relationships

Behavioral Therapy

The view was that sexual dysfunction can often be explained by basic principles of psychological learning theory, namely punishment and reinforcement (classical and operant conditioning in a sex setting) This approach was pioneered by Masters and Johnson in 1970 This type of therapy has been shown to be effective for both heterosexual and same-sex couples Stimulus Control- associating sexual events with positive and pleasurable situations (for those who do not enjoy sex) Relaxation training with biofeedback- here, one learns what physiological behaviors make them relaxed Electromagnetic biofeedback- measuring the amount of muscle tension in the body (for those with vaginas, what does it feel like to tense/ release the vaginal muscles)

How Long Should Sex Last and How Can I Last Longer In Bed?

Therapists have indicated that an "adequate" intercourse session should last anywhere from 3-7 minutes, a "desirable" one lasts anywhere from 7-13 minutes What matters most is how satisfied both you and your partner are, not a specific length of time

Kink/BDSM Competency (Contemporary Approaches to Sex Therapy)

Therapists may have been trained at a time when these kinds were considered to be pathological 1. Navigating consent- The BDSM community does focus on consent.. however, asking for consent might not fit in a BDSM scene (it can ruin the moment) 2. Incomplete catharsis- most assume that BDSM is tied to abuse in childhood/ adulthood- which is a MYTH! There will be some people who are into BDSM that were abused, and those who are into BDSM may have trouble navigating this (lingering anxiety)

Neurodiversity Competency (Contemporary Approaches to Sex Therapy)

There are inaccurate beliefs that are commonly taught about autism spectrum disorders (applied behavior analysis teaches one how not to show symptoms of autism) 1. Sensory sensitivities- tactile stimulation can be unpleasant for those who are autistic 2. Communication challenges- for those who are autistic, it is often harder to pick up on conversation nuances/ subtleties 3. Social norms- it is often hard for those who are autistic to pick up on social cues and read the room they are in

Polyamory/ Consensual Non-Monogamy (CNM) Competency (Contemporary Approaches to Sex Therapy)

There is a growing number of people who are polyamorous or are into consensual non-monogamy- the assumption has always been that people are monogamous 1. Navigate polycule relationships: Polycule- groups of people in a poly relationship Polycule people are often told they shouldn't be jealous when their partner has sex with someone else.. many will feel jealous, though

Female Sexual Interest/ Arousal Disorder (SIAD)

This and HSDD are the most common difficulties pertaining to sexual desire This is characterized by absent or reduced sexual fantasies and thoughts, a lack of desire for sexual activity, and personal distress resulting from these symptoms This is much broader than a lack a sexual desire and also includes reduced or absent excitement during sex, as well as a lack of responsive desire (desire that sets in after sexual activity has started) Female HSDD and female sexual arousal disorder were combined into one in the latest version of the DSM This is only considered a disorder when it is both persistent and personally distressing

Male Hypoactive Sexual Desire Disorder (HSDD)

This and SIAD are the most common difficulties pertaining to sexual desire This is characterized by absent or reduced sexual fantasies and thoughts, a lack of desire for sexual activity, and personal distress resulting from these symptoms In the DSM-5, this label is now only applicable to men This is only considered a disorder when it is both persistent and personally distressing

Cognitive- Behavioral Sex Therapy (CBST)

This builds upon the behavioral approach to sex therapy by combining it with theories of cognition This looks at the thoughts and feelings underlying our behaviors Here, the client is involved in "talk therapy" The goal is to reshape thought patterns to make them more positive (this is called cognitive restructuring) This approach would be most applicable to clients who engage in spectatoring This is reasonably effective

Ex-PLISSIT Model

This gives an explicit invitation to talk about any topic related to sexuality

Sex Surrogacy

This involves cases where a therapist provides clients with a substitute or "practice" partner in order to reach the desired therapeutic outcome This was first advocated by Masters and Johnson A sex surrogate may work with a physically disabled client who has never have a partnered sexual experience before and can even provide emotional support, the building of social skills, and the teaching of how to relax Surrogates should be applied by the therapist and remain anonymous The few studies that exist on this topic would suggest it is high effective Questions about the ethicality and legality of this are as strong today as when this was originally introduced in 1970

Squeeze Technique

This involves continuing sex until the point of an impending orgasm, but then squeezing the head or the base of the penis to prevent ejaculation

Pharmacotherapy

This involves the treatment of sexual difficulties with medicinal drugs Only psychiatrists can practice the full range of this There is a growing list of medications included in this, like: hormonal therapy, viagra, SSRIS, and even Botox More and more people are receiving medication instead of working with therapists to deal with their sexual difficulties The growth in this area has been controversial- we may be altering the nature of sex therapy away from an emphasis on the couple and toward the individual

Peyronie's Disease

This is a condition in which a build-up of scar tissue around the cavernous bodies results in a severe curvature of the penis and makes intercourse difficult and painful This is extremely rare Anti-inflammatory medication and physical therapy may be enough to manage the pain that is brought about from this, but surgery may be needed to correct penile curvature for some

Phimosis

This is a condition in which an uncircumcised male's foreskin is too tight and makes erections painful This is extremely rare Circumcision and superincision/ dorsal slit can alleviate the tightness of the foreskin- topical steroids can help, too

Compulsive Sexual Behavior

This is also known as hypersexuality This refers to instances in which people have "excessive" sexual desire and/or behavior that results in distress or impairs daily life This can include using porn non-stop or having a large number of anonymous sexual encounters This was not recognized as a disorder in the DSM-5 The most common critique of the sex addiction concept is that it presumes there is a "correct" amount of sex that people should be having- this is far too much of a subjective experience There is a listing of excessive sexual drive in the International Classification of Diseases (ICD)- it is subdivided by satyriasis, for men, and nymphomania, for women

Priapism

This is an erection that simply will not go away on its own in biological men, an erection lasting longer than four hours Such erections are painful and should be viewed as a medical emergency because a blood clot can potentially develop This condition can also severely damage penile tissues and eventually result in ED Most cases are caused by medications or physical conditions are not the result of having a high sex drive This is quite rare (and even more rare in women)

Delayed Ejaculation

This is orgasmic disorder's technical name in the DSM-5 when it affects biological men This involves a man whose ability to ejaculate is either significantly delayed or frequently absent during intercourse, but functions normally during masturbation and other activities There may be a psychological explanation- such men have preference for other sexual activities over intercourse Transexuals may also face issues with orgasms largely because gender affirmation surgery may disrupt the body's original sensory pathways

Persistent Genital Arousal Disorder

This is sometimes called "restless genital syndrome" This is a relatively rare and new diagnosis This is uncontrollable sexual arousal that occurs spontaneously, without being preceded by sexual desire or activity- in such cases, arousal can last for days at a time with orgasms only providing temporary relief Constant arousal is reported to be physically uncomfortable and significantly impairs concentration This may be the result of cysts affecting nerve sensation in the lower region of the spine

Stop-Start Technique

This is the most commonly prescribed technique for men who experience premature orgasm This was developed by Dr. Semans This technique involves continuing sexual activity to the point where orgasm is about to happen, then stopping everything until the feeling goes away- going through this cycle of starting and stopping stimulation typically produces better ejaculatory control

Sexual Desire Discrepancy

This occurs in cases where one partner has less sexual desire than the other and it generates relationship difficulties This is considered a couple-level problem, not the fault of one individual This can affect same-sex couples, too Research suggests that desire discrepancies are among the most common sexual problems

Premature Orgasm

This occurs when an individual consistently reaches orgasm before it is desired This is more common among men, even though it has been documented among women, too This is also known as premature ejaculation or early ejaculation In men, this may even occur before a full erection is reached The DSM-5 defines male premature ejaculation as occurring within one minute, it is probably best to focus on how the orgasm is subjectively perceived, though This may have either physical or psychological roots Some have argued we may be unnecessarily pathologizing it as it is so common Botox may be a useful treatment for male premature orgasm

Genito-Pelvic Pain/Penetration Disorder (GPD)

This occurs when women experience pain in anticipation of or during vaginal intercourse Painful sex is more common for women than it is for men In the DSM-5, this represents the merging of two previous diagnostic categories- dyspareunia and vaginismus To treat this, women must figure out the source of their pain

Vaginismus

This refers to a situation in which the lower third of the vagina exhibited sudden and severe contractions during any attempt at vaginal penetration, thereby making intercourse difficult and painful This usually represents a conditioned response, and often stems from a chronic history of painful sex This can be treated by either using dilators or botox

Sexual Aversion Disorder

This refers to an aversion to any type of partnered sexual activity The aversion can take many forms ranging from fear to disgust This is thought of as being rare- it was even dropped from the DSM-5 (it has also been subject to scarce research and psychological professionals continue to debate whether this is best considered a sexual dysfunction or a specific phobia associated with sexual activity)

Dyspareunia

This refers to any type of pelvic or genital pain that occurs during sexual arousal or activity STIS are one reason for this to occur- there are many others, too Psychological factors may also play a role in painful intercourse, too When women with this condition were shown erotic images, they spent less time looking at the sexual aspects of the scene and more time looking at the background and contextual features compared to women with no sexual difficulties- women are either distracted from sexual stimuli or seek to avoid it

Sexual Dysfunction

This refers to cases in which a specific sexual issue persistently emerges (it is not a one-time thing) and creates distress at either the level of the individual or of the relationship It is important to take care when labeling certain sexual attitudes and behaviors as "dysfunctional" or "pathological" as subjective perceptions matter The absence of sexual dysfunction does not necessarily mean that someone is sexually healthy and satisfied (having functional genitalia is not a guarantee of great sex)

Erectile Disorder (ED)

This refers to the persistent inability to develop or maintain an erection sufficient for sexual performance in biological men This is also known as erectile dysfunction or impotence This is one of the most common forms of sexual dysfunction in men, especially as they get older This can have physical or psychological causes This can be treated with CBST, drugs, pumps, or surgery Kegel exercises are a good place to start before seeking medical treatment

Orgasmic Disorder

This term is used to refer to women who either have an inability to reach orgasm or greatly delayed orgasm during sexual activity Women are more likely than men to have the problem of never reaching orgasm This is also known as anorgasmia This may be a lifelong pattern for some or situational for others This may have either physical or psychological roots

Acceptance and Commitment Therapy (ACT)

This was not initially developed for sex therapy, but it was applied early on Primary concepts of ACT: 1. Experiential Avoidance- we are the only species that can think of things that give us anxiety We often avoid things that cause us anxiety We will go on auto-pilot and coast through experiences to avoid the things that may give us anxiety 2. Cognitive Fusion- words and emotions often become fused together "I am worthless"- can make one very emotional

Critiques and Controversies in Sex Therapy

Thomas Szasz argued that having diagnoses based upon patterns of behavior is completely arbitrary because what represents a sexual "problem" for one may be a desired outcome for another person Thomas Szasz viewed the notion of a "sexual dysfunction" as a social creation Subjective perception plays a huge role when it comes to diagnosing and treating sexual problems

Biomedical Therapy

Tibolone- this is a drug for vaginal atrophy and dryness (it is a substitute for estrogen) Sildenafil and tadalafil- these are drugs for erectile dysfunction (helps one get or maintain an erection) SSRIs- this can be used for premature ejaculation

Acceptance and Commitment Therapy (ACT)'s Treatment

Treatment for ACT: 1. Cognitive defusion- separate words from emotions 2. Use the self as context of experiences- thoughts can be in conflict with one another 3. Acceptance or present moment awareness- I recognize that I am having this thought 4. Values Clarification- what kind of person do you want to be? (this is different from client to client and is lengthy) 5. Committed Action- this occus when one makes the decision to engage in behaviors that align with one's own values

Dual Control Model

Underlying sexual arousal and behavior are two important brain mechanisms: an excitatory system and an inhibitory system Activation of the excitatory systems promotes sexual arousal and activity Activation of the inhibitory system suppresses sexual arousal and activity When one system becomes disproportionally active, sexual difficulties are more likely to occur

STIs' Effect on Sexuality (Biological Factors)

Untreated STIs like chlamydia and gonorrhea can turn into pelvic inflammatory disease (PID) in women, a condition that can lead to painful intercourse and impair the ability to reach orgasm