Woman; 341; Sex Therapy. Part 1

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good evening and welcome to woman. Tonight part one of a discussion of sex therapy. With me is Dr. Helen singer Kaplan who serves as head of the sex therapy and Education Program at the pain Whitney clinic of New York Hospital Cornell Medical Center where she has developed and direct the clinic for brief treatment of sexual disorders. Dr. Kaplan is the author of the illustrated manual of sex therapy. She also conducts a private practice in psychoanalysis and sex therapy. Dr. Caplan new book you and sex a book on the biology and psychology of sex for young people will be out in the fall. Hello and welcome to woman. I'm delighted to be here. It's a real pleasure to be here. Helen could we talk about the kinds of therapy that are available and that are usually used to treat sex dysfunctions such as analysis marriage therapy and behavior therapy. Well I'm really glad you put it that way because recently there's been so much

over publicity with sex therapy that everybody I think is beginning to think that everybody with a sexual problem needs sex therapy united through. A sexual difficulty has to be very carefully evaluated and we have treatments that range from psycho analysis behavior therapy sex therapy marital therapy and even surgery and hormones. We have a whole range of medical and psychological treatments available for each you know appropriate after the appropriate evaluation been made. Now which one of those you want to hear. Well I guess what I want to know is whether you think that it's important to go to a sex therapist and I'm beginning to get a clue that you don't think it's all that. Well it's terribly important. If you have a sexual problem. I have. To become educated. In other words to have it evaluated intelligently so that you can see that you can live with it. Or maybe you don't even have a sex problem when you think you have one. And if you're really happy to get some idea what the.

Outcome is and what kind of treatment would be appropriate. If you go into and Ellis's which is years and years of deep therapy and you only have a mild disorder or dysfunction. I mean isn't that a. Waste of your time and money. If you properly evaluate a sexual problem of that let's put it more specifically where the people come to our clinic or to our group for an evaluation. About 50 percent would probably respond to the brief sex therapy that you've heard so much about. And that's what they're suitable for a smaller percentage have very deep even marital problems or are psychological problems that wouldn't respond to sex therapy and they may be the marital therapy or psychoanalysis. And another small group don't even have a sexual problem I just thought they read so much about. Sexual functioning they have all kinds of fantasies of what good sexual functioning should be and they should just be sent home when reassured. Others have organic problems and need

hormones and I said some people benefit from surgical operation and everything so you really you really. Need an expert to tell you what kind of therapy you need the person can make their own evaluation. Can you go to an analysis. I mean the narrow list and I'll be fairly certain that he will say you only need brief intervention here no. You see most people will recommend what they can do. You go to a sex therapist they will recommend sex therapy and if you go to a psychoanalyst they will recommend psych right now and so forth. So you really should go to somebody who. Or a place where everything is available where can be evaluated properly and get the appropriate treatment. It certainly is a waste of time if you the woman can't have an orgasm say Iraq for a rather superficial reason. If she goes into analysis that's a terrible waste of time and it probably won't work.

That's pretty much been the case though hasn't up until recently when when certain kinds of sex therapy have been developed. True. We used to think that everybody who couldn't have an orgasm was suffering from very deep problems. They hated their father and they were afraid of their mother. Or they really wanted to be a man they hated the female world for him rather than deep inner conflict and it was really Masters and Johnson who pointed out very correctly that there could be superficial reasons that are much more easily removed and don't require analysis and fact analysis and appropriate for that. There is only one reason people can't have one yet. Just one. Just going to get you know to pay and that's anxiety anxiety I'll stop that reflects cold. But there are many sorts of the things that I. See I mean. The body doesn't know whether being's ideas coming from I would have to hurry up and come

faster he'll be disappointed with me. Or were anxieties coming from my. I can't trust them. I can't let myself go he'll abandon me tomorrow. You can consciously or. Even deeper thing. Anxiety is physical anxiety. Fortunately we found that in many cases the anxieties rabbit usually dispelled with some. Open communication and reassurance and education and that's the miracle of the new sex therapy. Let's talk let's talk very specifically about the new six there being what makes it unique. When I gave that as the title of the book which I wrote you being you you know read the text now I wasn't thinking of. My own specific development but what I was thinking of that a brief rapid. Ah behavioral approach. It was a new development and that's really what I meant by the new sex therapy. More accurately we should be talking about the new

sex therapies because since the original NASA's Johnson model. And even before that many different varieties of being practiced. They all have one essence however. And two characteristics that make them unique one is that they really don't try to fix the whole person. Really focus on the sexual seven. Not just the genital sexuality the emotional aspects to what really sexual function. And let other things alone. That's one unique thing because all the other therapies that have been used try to fix the whole marriage in the home or to this it's pretty limited. And the other thing is the other unique characteristic is that sex therapy uses a combination amalgam of very specific erotic patch that the woman does alone at home with the couple do alone at home. And these tasks bring up very profound emotional feelings you write and these feelings are then dealt with in therapy with psychodynamic. Means by the therapy.

And that sort of combination of the behavioral and psychological psychodynamic is what makes us unique. And the third thing that makes it unique if it's going to work it's going to work very rapidly. Within 10 to 20 some rather than conventional three or four years. How does it. Is it different from what Masters and Johnson I mean are people my own ranching out. Yes well my approach is quite different and yet it has some of the same characteristics. Because you know I come from psychiatry and a psychiatrist so on Actually I'm more interested in the I'm motional psychodynamic aspect of the person and the relationship doesn't mean I don't work. Briefly I do. But I would be more interested in some would be unkind factors and emotional factors. That are contributing to the Told picture and work more specifically with then I work with greens. If I for instance tell a woman to go home and stimulate herself suggest that as a. Means of first of all we can

orgasm or at least starting to explore some of the anxieties that have blocked her from reaching orgasm she may come in with her dream. And that dream may reveal more to me. Than. When I say Well how did you feel about it. All right and feel much better. They're very anxious or guilty you know. And then she tells me she had a dream of being chased by six men with guns and knives and falling into the pond and almost drowning that tells me some thing. You know it tells me that our. Catching herself which I suggested might have evoked the deep with kind of early guilt against masturbation things and then I had to deal with that. And I will. Do you think what you define it the new sex therapy and what you therapy and what you are practicing you think it's more flexible. Than what's been done in the past. When you say done in the past the original Masters and Johnson Yes or even even an analysis or some of the other kinds of therapy that I like to think of myself as being more flexible it's a very flattering so it will

be very to me very individualized. It is highly individual. And it uses a variety of modality and sort of orchestrate behavior on psychodynamic Cup therapy. Sometimes we stay strictly behavioral all the time. We delve deeply. It's much more active flexible and more difficult. So you have to you know you have to work much harder. Much. I work much harder with a sex therapy kids than I do with one of my analytic A. I've become more tired it's a more tired and horrible. Case it's becoming harder. Yes. We were talking about before that's one of the interesting phenomenon is that. In the beginning of five six years ago when I recognized the planet. We had many very cases. In fact there were so easy to I mean it's an easy case. Well for example you are you evaluate a couple. And. When I evaluate a couple I was trying to give them something so they don't

feel like they inspect the block a piece of it. Yes you're suitable you're not with a stamp. I try to give the person something a couple something and I usually get some advice and some of that you wage and share my evaluation with them. And very often after 3 months when an opening occur and then my secretary will. You know on the phone to write we have an opening for you now that's all that is necessary it was such a graphic let's look at it. For example our human What yourself. Business I hope. Well that's my aim with it. Education and prevention I sure as heck hope to put myself on the net very soon. Why do you think the cases are more difficult. Because because we know more. Well I think there's been an enormous. Probably even over saturation of the Public Media. But I don't mind the oversaturation it's a small boredom and though it's a very small price to pay for the real positive educational job the media programmes such as yours for

example have been doing. Good articles in magazines television programme books. Have. Done a great deal to educate people on children de-sensitized them. People can even talk about sex before. And as I said before the penis or vagina can tell a being's ID which is blocking its functioning as coming from just a little ignorance and a little shyness and anxiety or something deep. And the easy cases bite easy cases I mean. Cases which are people who I don't even like to think of people as case. But people who are not functioning well because they're blocked by anxiety which is easily dispelled by some information some reassurance by the knowledge everybody is doing it I'm not the only one. And these. Are also the men of the medical profession and the health professions in general. I've received a great deal of education I'm now able to obstetrician. Psychologists and physicians are now able to counsel patients much more intelligently.

And are probably doing therapy on the quote easier cases. Would you like an example of what I mean by Easter. Yes. There was one a couple came in with an unconsummated marriage. And unconsummated marriage is really not of this function. But it certainly is troublesome it means for some reason people have not. Had sexual and as couple was married career back three years. A lovely couple so I looked for the. Obvious cause as the man was not and the woman was not in our gas to come and love each other and neither one was terribly neurotic. So in order to evaluate what's wrong I take a very careful. Reading of their sexual interactions with each other that was very very deep hole that there were exactly what goes on. When I tried to have sex with each other what their thinking feeling. Smelling and everything else and that was fortunate because it did period in this instant.

That the man thought it was not masculine to take a shower or a bath before having sex with one. And she was far too shy and came from a cultural group where women did not speak up. And she never said anything but she was really repelled. By his. Body odor. And this came out for the first time in four or five years. In the search. So my obvious advice while I put them on the getting list was that perhaps it's not. Unmasculine to take a shower with but it's certainly not any sign of nothing that you were nor was it unfeminine that's the. Point. Except gently and then. Whereupon he went home took a shower and a couple cured. That's an easy case. You know that it's not that rare. It's not that used to be fairly common where the most simple information are two or three rear sharing humane sessions. Could really make a considerable difference in people's functioning.

Do people no more. Are you still surprised that people don't know. I still and even though I'm in New York City and still really surprised at the. Lack of knowledge combat. Genital. What are some of the things that people don't know some of the surprising things that have happened here recently. When I don't have to think of my memory would very often. Either the woman or the man will really know what the female genital look warnings they won't know where the clutter is from what the code was so they won't know whether Vadra opening years. Don't have all kinds and they won't know what's seen and. Someone think that's poisonous and harmful. And can and will have all kinds of feelings about menstruation. So those are still fairly surprising things and it's surprising that otherwise educated people will put up with three four five ten years. Of an unconsummated marriage without doing and they're asking them.

But that might be because of something you said earlier the fact that we have Brianna gotten the message that sexual dysfunction it's a sign of being deeply disturbed. I think people. Think that still their identity is people's identity you're so tied up with their sexual functioning. If a man is impotent that's not bad enough. You also suffer the terrible loss of self-esteem things that work and nobody will. Want me and I'm no good and that. Shane and thinking of the Southwest thing there's a very actually prevents him from seeking getting help and one of the first things we do. Is say your penis is not you or your orgasm and you as a reflex and efforts and have a good. That will work and that it doesn't mean you are worthless or not lovable. That's in the book you deal with three dysfunctions that are female and three that are male and I think the first one you do it is. Sexual. I can't remember the first win of the female.

OK well it's a race responsible for total sexual and fun as that's the most trouble. This Far. What does that mean. When someone is totally sexually unresponsive. That means that even if the man gently. Parted them and properly stimulate such a woman she feels nothing. I don't mean she hasn't got a sense of touch. But touching the other nipple that clutter of her vagina which would give you an erratic feeling. One might say was was that he was touching my hand I feel a touch but I feel no. Sexual pleasure no arousal so there is absolutely no feeling and there is no physiological arousal. The first stage of physiological arousal in the man and the woman is a basic congestion in other words the genitals become swallow and filled with blood. That's why the penis becomes erect and that's why women lubricate in the vagina become sort of swollen. The unresponsive woman or the impotent man of the man was an erection problem doesn't experience either the

pleasure. Or. The physiological function otherwise there's no erection or arousal. Now a woman who was totally unresponsive suffers from that. That's the worst one. What are some of the causes. Well they range that's a more severe one than the more common one or. Most common female. I'll get that I'm not ducking that but the most common sexual dysfunction of women proper women is having some degree of difficulty in achieving or catching. That's in the mild climate and that fortunately much easier to treat than a totally unresponsive one and that's a difficult the drug prognosis for the sexually unresponsive female female is not dire and you know no it's not hopeless but it's probably the most difficult of Warley sexual dysfunction. What are some of the causes. Well most two most common chords are. The shame and fear about sexuality that causes even a young

girl as soon as she feels anything sexual just repress it and wipes it at. So that's a you coming cause the other most common cause is partner rejection a woman really doesn't. Love her as attracted to her partner. That unfortunately is a very common question can sometimes you can remedy that and sometimes you cannot. So what do you do it. What do you do when you try to treat them. What I want to get to the more hopeful one. There are simply women who have performance anxiety they're so worried about pleasing a man or having a response that they never take the time which is normally necessary for a woman to become respond and don't take responsibility for their own sexual pleasure stifling. And then sometimes those with simple cases. A couple is just using protect rape. Or she's guilty about the use of it. See. Those are the easy ones as I said they're easy 101 to the final common pathway though with anxiety but he or. I would say

that's a common final pathway but the quote is from God and they're. Easy ones are when you just teach a couple better techniques. You believe a woman's anxiety. About expressing her need for more tactile stimulation. A little more time. And. I have a couple share this information on that very often is very helpful. And I arrive the gradual matching of the coupled with the war the warm and sensitive areas in Iraq and. That kind of. Behavioral work along with cycles of psychological counseling is very often successful. But there are some women who are totally unresponsive who simply don't love their are not attracted to them. Again sometimes you can sex that. If the lack of attraction to one some neurotic base has some fear of trusting him some fear being abandoned. Some. Characteristic of his that he could change when used to Boeing or. To defense or were him thing in the back

and chain. That's rehabilitation. Sometimes no matter what the woman simply isn't drawn. To that woman or no way. She's ever going to respond to that. How do people respond to that kind of news. You know while I don't usually say that. The First Amendment. That's unbalanced relationship is one of the more difficult troublesome. Sensitive areas to work with and I don't know you know on some level. Probably the patient knows on some level right that that's a guess but that you'd be surprised how vigorously couples will be known for that. Both the one who is not able to deal with as much a victim of the sun balance. As the one who's able. Is always yearning and gets no response. Both partners feel very badly about that the one who can't feel. Feel guilty and press. Badly about it and the one who wants that respond feels awful because they feel rejected. But very often coupled with an eye

that and will say well if I learn a technique then everything will be all right and the only way to handle is this to first frankly admit open. Between. Therapist and then work with them and me I'm ok with that. Let's hope that's not always unfixable. Sometimes that's Ramadan. And sometimes it really can be. And then the couple has to make a choice is there enough in relationship. Other. Beyond sex which still makes it worthwhile keeping or is it really too destructive and should it be. Given up and that's a hard decision. What are the essential ingredients in a therapeutic situation for a couple with that problem in other words what kinds of therapy should they look for specifically. What are the ingredient once they realize they're unbalanced and once a woman is on with plans when what you want is unresponsive. What she should get that the couple need to have the cause of that on responsiveness. Evacuated. What if it's only poor technique or ignorance or

something else. And she never said But dear I can't comment to a minute she never got enough nerve to say that. So he's been victimized by herself not even by you know I've never yet met a man who wouldn't be happy to be a good lover. And really give their partner pleasure I've never met a man that's just. Women assume that if they if they expressed and all they're going to be rejected. And that certainly is true there are of course harsh ways and demanding ways. To ask for him. You know also gentle and sensible what. Asking for him. And when we get into next week we'll probably have to do this but strode into talking about you know gas make women. I'm curious to know what the new aggressiveness that some women have to experience does to men. We talk about that next time. In the meantime though there are some very basic fundamental things about human sexuality that we don't have definitive answers to. Isn't that correct.

Not really you know there were a few things but not really thinking of. Yes the area of bonding and gender specific there and that that I called her and we don't know but we know. See it's easy for anybody to be an expert in the field. Because it's relatively simple. There's nothing more. Complex about the sexual responses than about the digester responses or the cardiovascular demands of men it's far less complicated than brain functioning. I guess it only seems complicated because until 10 or 15 years ago nobody looked at the sexual reflex with masts and guns and were really the first ones who had the foresight and the courage. To look at the sexual reflexes but they're basically very simple two sets of reflux. And there is as I said it's very easy to be an expert. Because people are so complex when it isn't. I hope when five years every second year medical student as I do about. It is not difficult to basic reflexes the excitement

reply because the basic congestion as well and the orgasm went well. And that's really all hurt. And then you have to find out at what stage something went wrong. Right now that cycle the psychopathology of sexual relationships is complicated. What's the relationship between love and sacrifice. What attracts people to each other how long do we bide a wee lifetime blinders. Are we for your blinders. We haven't answered like Monk died and we haven't answered that. What are the basic differences between men and women biological differences we really don't know that. What about the human sexual response we really know a great deal and really not. What. Do we know if monogamy is the best thing for us. Don't. I have a sense. We don't know what I'm saying now. The purest sense either sense when people are left alone. With that. Which pressure like young kids today. People in our society tend to be more comfortable in and

comfortable life. And when I say explosive I don't mean. I don't mean that in the strict sense of the word terms of commitment. People comfortable that other people. Probably. Think. In other words. Cows. And sheep don't make with any. Other species such as certain species of monkey apes. Well only really be comfortable having sex with that one individual. My feeling is that we're like that. Well to continue this next week and we will continue part two next week. A.

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