People who contact The Buehler Institute for sex therapy are often confused about the nature of their problem. They are usually upset, but also uncertain what is getting in the way of their sex life. That's pretty normal, because people are often too close to the problem to objectively study it. Also, people tend to focus on symptoms rather than on what is causing them to appear.
Symptoms can be thought of as distress signals sent out by your brain to alert you that something is wrong. The symptoms themselves are annoying, but the real distress is what is causing them to erupt. It's as if someone is getting daily postcards to pay attention, but they are ignored and begin to pile up, getting bigger and bigger until the person is overwhelmed with paper.
This relates to the common question of what happens in sex therapy. The first step is generally for the client to talk about their view of the problem--to list out all the symptoms. The next step is to gather information about why those symptoms might occur. This entails taking a thorough and detailed history, first a general one asking about the client's psychological, family, and work history, then a second one that focused on sex and relationship experiences. Attention is paid to particulars such as when the symptoms appeared, and drawing parallels between what was happening in the client's life at the time and why the symptoms appeared.
People are often so upset and embarrassed about symptoms that it takes them awhile to calm down and focus. That's normal. Also, people need to feel comfortable with the therapist so they can trust that the therapist won't judge, criticize, or ridicule them. Once they have calmed down a little and can open up, then the reasons for the appearance of the symptoms becomes apparent.
Therapists take different approaches to organizing information and explaining symptoms. For example, some therapists may look at a person's irrational beliefs. A man who is experiencing erectile dysfunction and his partner may share an erroneous belief that one of them must have a hard penis in order to have sex. While that may be desired, the fact is that there are other ways to achieve sexual satisfaction than through intercourse.
Other therapists may be more psychodynamic, studying a person's development. What were early relationships like? Was there any trauma? Did the person get stuck in their development? What kept them from moving forward and maturing?
At The Buehler Institute, we take a systemic approach. This is a very thorough, encompassing way to assess sexual problems at multiple levels. We look at:
- Biological causes: Presence of chronic illness, pain, or cancer; hormonal changes; diet and activity level; sleep; use of medications, both legal and illicit; alcohol intake
- Familial causes: Messages from parents about relationships and sex; what was modeled by parents; permissiveness vs. restrictiveness; communication patterns; secrets
- Cultural causes: Messages from one's own culture and the larger culture; acculturation; media messages; pressures
- Psychological causes: Depression, anxiety, trauma, attentional problems, compulsions, eating disorders, substance abuse, personality disorders
- Relationship causes: Poor communication; poor conflict resolution; lack of empathy; resentment; contempt; denial; differences in expectations
As you can see, it's pretty complex! But once information is gathered, then therapy can begin in earnest. An understanding is reached. Client(s) and therapist set goals. A plan is created. Books are suggested, activities are tried, analysis of what worked and what didn't occurs.
In my office, I tend to be solution-focused, working in the here and now to get results. Sometimes results happen quickly, which is nice for everyone. Sometimes change happens more slowly. I like to think of "clock time" and "mind time." Clock time depends on objective ideas about how long change should take--six weeks? Three months? Mind time depends on how long the psyche takes to heal--six weeks? Three months? A year? The mind can only take on so much. In some instances it really is best to go slowly, to be sure change is accepted and becomes more or less permanent--and to avoid creating additional symptoms.