This article was downloaded by: [University of Aberdeen] On: 16 February 2015, At: 01:31 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
A false dichotomy? Published online: 14 Jan 2008.
To cite this article: (1975) A false dichotomy?, Journal of Sex & Marital Therapy, 1:3, 187-189, DOI: 10.1080/00926237508405287 To link to this article: http://dx.doi.org/10.1080/00926237508405287
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Sex & Marital Therapy Vol. 1 , No. 3, Spring 1975
Editorial
Downloaded by [University of Aberdeen] at 01:31 16 February 2015
A FALSE DICHOTOMY?
Like the relationship between sex and marriage, the relationship between sexual and marital therapy is highly complex. We chose Sex &' Marital Therapy for the title of this journal because we believe that both forms of treatment deal with aspects of the same entity and consequently are almost always interrelated clinically. However, each has in addition a validity of its own rooted in its own theoretical substructure, and each employs its own body of techniques which requires specialized training and experience. Sex is one strand in the cable of bonding. Effective sex therapy with a couple extends beyond sexual practices t o influence crucial aspects of the relationship, particularly the partners' feelings of love, concern, and commitment. Conversely, it is rare that marital therapy does not either deal directly with the sexual components of the relationship or dtimately have a bearing on the way that the couple interact sexually. In few other areas are psyche and soma so clearly interdependent. In clinical practice n o clear-cut, sharp distinctions exist between sexual and marital therapies. But training in marital treatment alone does not prepare the therapist t o treat the specific sexual problems of a marriage, while training in the specific techniques of sex therapy often ignores the complexities and intenveavings of the dyadic relationship, Certainly, there are areas t o study and research in each modality that would not require intensive knowledge of the other. Both the physiologist and the neuroanatomist, for example, might study certain aspects of the physiology of sexual functioning without becoming involved in the interaction of a couple or with the intrapsychic dynamics of an experimental animal or cadaver, But these are laboratory situations, far removed from the interpersonal clinical scene. Through the years, there have been numerous approaches to the treatment of the common sexual dysfunctions. Most sex therapists currently utilize the new briefer techniques described by Masters and Johnson' and H. S . KapIan' who stress the fact that sex therapy must b e carried out rapidly and remain focused on the specific sexual dysfunction. It therefore requires a spirit of cooperation and commitment on the part of both partners. In this framework, marital problems are viewed as an obstacle t o t h e continuance of the sexual program. If possible, they are treated and dispatched quickly; however, when it is apparent that the couple are unable t o put their battles or subversions aside or when there is evidence that one or both partners wish t o dissolve the relationship, they are usually advised t o avail themselves of marital treatment before working more directly on the sexual problem. 187
Downloaded by [University of Aberdeen] at 01:31 16 February 2015
188
Editorial
Either the therapist explicitly alters the initial contract at this point-with the couple’s full understanding and agreement-so that sexual therapy is discontinued and marital treatment begun or else the couple are referred elsewhere for marital or individual therapy. This change of course may occur either at the time of initial evaluation o r after a brief trial period of sex therapy if it becomes apparent that the partners are unable t o cooperate adequately. Communication problems, competition for power and control, fear of closeness or desertion, sadomasochistic psychological adaptations-all work against the successful treatment of a sexual dysfunction. Prescribed erotic exercises which the couple are expected t o carry out at home may not be followed in a particular week if, for example, they are ostensibly upset about a visit t o t h e husband’s parents wherein the wife once again felt ignored and bypassed by her mother-in-law. Instead of being affectionate and sexual, the couple spend the week arguing about the insult the wife received. It would b e therapeutically valid for a marital therapist t o pursue and t r y . t o work through what is involved in the mother-son relationship and t o understand this man’s failure t o ally himself with or protect his wife-if this is the root of the friction. But t o follow this course may result in a two-month “digression” from the initial sexual focus. Treatment of the dysfunction may b e again interrupted by future eruptions of marital disharmony that the therapist feels are appropriate t o pursue in behalf of an understanding of the marital relati onship. If this couple were t o b e primarily regarded as a sex therapy case, then the therapist would in all likelihood deal with the intrafamilial incident as a form of resistance t o carrying out the sex therapy program. The hostility and distress would have t o be worked through rapidly or bypassed if possible. If the couple were still unable t o put their feelings aside and the therapist were t o attempt t o continue sex therapy with two combatants rather than cooperators, his efforts would probably fail. Another alternative t o a concentration on either sex or marital therapy may be considered. There appears t o be a growing feeling among a number of professionals trained in both modalities that there are many situations in which the earlier rigid stipulation that sex and marital therapy must be sharply separated can safely be modified. Both the sexual and marital components of the total relationship can be worked with more effectively when each is viewed against the background of the total ongoing treatment program. The perplexing and resistant problem of lack of sexual desire or “sexual ennui” in a physically healthy individual or couple is one instance in which a sophisticated concurrent use of both modalities is required. Although H. S. Kaplan2 makes clear the complex and multideterminant roles of the immediate and remote causes of the sexual dysfunctions, in her effort t o sharply define sex therapy she fails t o make sufficiently clear the atten-
Downloaded by [University of Aberdeen] at 01:31 16 February 2015
Editorial
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tion she pays in her clinical work to the couple’s need for love and affection or to the resolution of marital conflicts. How to deal with cases at either end of the spectrum is clear. It is the large number of mixed maritaI and sexual complaints lying between that makes it necessary for the therapist t o be skillful in sex, marital, and individual therapy or for him t o be part of a treatment team in which these competences are distributed-so that the couple be best and most expeditiously served. This is a controversial and complex area. At present we lack hard data, but have a surfeit of bias. We hope that clinicians and researchers who are trained in these different modalities will rapidly move forward to provide us with the necessary factual material. This journal will b e open t o those who wish t o report their clinical and research work on these questions in articles or letters t o the editors. (A Letters to the Editors column will be instituted in the next issue for discussion of all articles, editorial material, journal format, etc.) C. J. S. REFERENCES 1. Masten WH,Johnson VE: Human Sexual Inadequacy. Boston, Little, Brown, 1970. 2. Kaplan HS: The New Sex Therapy. New York, Brunner/Mazel, 1974.
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
A false dichotomy? Published online: 14 Jan 2008.
To cite this article: (1975) A false dichotomy?, Journal of Sex & Marital Therapy, 1:3, 187-189, DOI: 10.1080/00926237508405287 To link to this article: http://dx.doi.org/10.1080/00926237508405287
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Sex & Marital Therapy Vol. 1 , No. 3, Spring 1975
Editorial
Downloaded by [University of Aberdeen] at 01:31 16 February 2015
A FALSE DICHOTOMY?
Like the relationship between sex and marriage, the relationship between sexual and marital therapy is highly complex. We chose Sex &' Marital Therapy for the title of this journal because we believe that both forms of treatment deal with aspects of the same entity and consequently are almost always interrelated clinically. However, each has in addition a validity of its own rooted in its own theoretical substructure, and each employs its own body of techniques which requires specialized training and experience. Sex is one strand in the cable of bonding. Effective sex therapy with a couple extends beyond sexual practices t o influence crucial aspects of the relationship, particularly the partners' feelings of love, concern, and commitment. Conversely, it is rare that marital therapy does not either deal directly with the sexual components of the relationship or dtimately have a bearing on the way that the couple interact sexually. In few other areas are psyche and soma so clearly interdependent. In clinical practice n o clear-cut, sharp distinctions exist between sexual and marital therapies. But training in marital treatment alone does not prepare the therapist t o treat the specific sexual problems of a marriage, while training in the specific techniques of sex therapy often ignores the complexities and intenveavings of the dyadic relationship, Certainly, there are areas t o study and research in each modality that would not require intensive knowledge of the other. Both the physiologist and the neuroanatomist, for example, might study certain aspects of the physiology of sexual functioning without becoming involved in the interaction of a couple or with the intrapsychic dynamics of an experimental animal or cadaver, But these are laboratory situations, far removed from the interpersonal clinical scene. Through the years, there have been numerous approaches to the treatment of the common sexual dysfunctions. Most sex therapists currently utilize the new briefer techniques described by Masters and Johnson' and H. S . KapIan' who stress the fact that sex therapy must b e carried out rapidly and remain focused on the specific sexual dysfunction. It therefore requires a spirit of cooperation and commitment on the part of both partners. In this framework, marital problems are viewed as an obstacle t o t h e continuance of the sexual program. If possible, they are treated and dispatched quickly; however, when it is apparent that the couple are unable t o put their battles or subversions aside or when there is evidence that one or both partners wish t o dissolve the relationship, they are usually advised t o avail themselves of marital treatment before working more directly on the sexual problem. 187
Downloaded by [University of Aberdeen] at 01:31 16 February 2015
188
Editorial
Either the therapist explicitly alters the initial contract at this point-with the couple’s full understanding and agreement-so that sexual therapy is discontinued and marital treatment begun or else the couple are referred elsewhere for marital or individual therapy. This change of course may occur either at the time of initial evaluation o r after a brief trial period of sex therapy if it becomes apparent that the partners are unable t o cooperate adequately. Communication problems, competition for power and control, fear of closeness or desertion, sadomasochistic psychological adaptations-all work against the successful treatment of a sexual dysfunction. Prescribed erotic exercises which the couple are expected t o carry out at home may not be followed in a particular week if, for example, they are ostensibly upset about a visit t o t h e husband’s parents wherein the wife once again felt ignored and bypassed by her mother-in-law. Instead of being affectionate and sexual, the couple spend the week arguing about the insult the wife received. It would b e therapeutically valid for a marital therapist t o pursue and t r y . t o work through what is involved in the mother-son relationship and t o understand this man’s failure t o ally himself with or protect his wife-if this is the root of the friction. But t o follow this course may result in a two-month “digression” from the initial sexual focus. Treatment of the dysfunction may b e again interrupted by future eruptions of marital disharmony that the therapist feels are appropriate t o pursue in behalf of an understanding of the marital relati onship. If this couple were t o b e primarily regarded as a sex therapy case, then the therapist would in all likelihood deal with the intrafamilial incident as a form of resistance t o carrying out the sex therapy program. The hostility and distress would have t o be worked through rapidly or bypassed if possible. If the couple were still unable t o put their feelings aside and the therapist were t o attempt t o continue sex therapy with two combatants rather than cooperators, his efforts would probably fail. Another alternative t o a concentration on either sex or marital therapy may be considered. There appears t o be a growing feeling among a number of professionals trained in both modalities that there are many situations in which the earlier rigid stipulation that sex and marital therapy must be sharply separated can safely be modified. Both the sexual and marital components of the total relationship can be worked with more effectively when each is viewed against the background of the total ongoing treatment program. The perplexing and resistant problem of lack of sexual desire or “sexual ennui” in a physically healthy individual or couple is one instance in which a sophisticated concurrent use of both modalities is required. Although H. S. Kaplan2 makes clear the complex and multideterminant roles of the immediate and remote causes of the sexual dysfunctions, in her effort t o sharply define sex therapy she fails t o make sufficiently clear the atten-
Downloaded by [University of Aberdeen] at 01:31 16 February 2015
Editorial
189
tion she pays in her clinical work to the couple’s need for love and affection or to the resolution of marital conflicts. How to deal with cases at either end of the spectrum is clear. It is the large number of mixed maritaI and sexual complaints lying between that makes it necessary for the therapist t o be skillful in sex, marital, and individual therapy or for him t o be part of a treatment team in which these competences are distributed-so that the couple be best and most expeditiously served. This is a controversial and complex area. At present we lack hard data, but have a surfeit of bias. We hope that clinicians and researchers who are trained in these different modalities will rapidly move forward to provide us with the necessary factual material. This journal will b e open t o those who wish t o report their clinical and research work on these questions in articles or letters t o the editors. (A Letters to the Editors column will be instituted in the next issue for discussion of all articles, editorial material, journal format, etc.) C. J. S. REFERENCES 1. Masten WH,Johnson VE: Human Sexual Inadequacy. Boston, Little, Brown, 1970. 2. Kaplan HS: The New Sex Therapy. New York, Brunner/Mazel, 1974.
