This article was downloaded by: [McMaster University] On: 28 January 2015, At: 11:54 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
The evaluation of sexual health services in a medical setting a
a
James P. Held BChE , Constance Logan BA , James W. Maddock a
a
PhD , Daniel S. Weiss BS & Theodore M. Cole MD
a
a
Program in Human Sexuality at the University of Minnesota Medical School , Minneapolis—James Held as Evaluation Coordinator and Research Fellow, Constance Logan as Assistant Scientist, James Maddock as Education and Training Coordinator, Daniel Weiss as former Administrative Director of the Sexual Health Services, and Theodore Cole as Director of the Physical Disability Section as well as a Professor of the Department of Physical Medicine and Rehabilitation Published online: 14 Jan 2008.
To cite this article: James P. Held BChE , Constance Logan BA , James W. Maddock PhD , Daniel S. Weiss BS & Theodore M. Cole MD (1977) The evaluation of sexual health services in a medical setting, Journal of Sex & Marital Therapy, 3:4, 256-264, DOI: 10.1080/00926237708402993 To link to this article: http://dx.doi.org/10.1080/00926237708402993
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 &
Downloaded by [McMaster University] at 11:54 28 January 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Sex & Marital 'Therapy Vol. 3, No. 4, Winter 1977
The Evaluation of Sexual Health Services in a Medical Setting
Downloaded by [McMaster University] at 11:54 28 January 2015
James P . Held, BChE, Constance Logan, BA, James W. Maddock, PhD, Daniel S. Weiss, BS, and Theodore M . Cole, M D
ABSTRACT: An interdisciplinary Sexual Health Services unit has been established at the University of Minnesota Medical School that offers counseling and treatment programs for a wide variety of sex-related concerns and problems. T h e programs are based on the principles of responsibility for self, permission to be sexual, the use of reeducation, the facilitation of increased awareness in clients, and structured behavior change. T h e programs have been evaluated according to client satisfaction with the extent to which they have met pretreatment goals and according to results of preiposttesting with objective instruments. One year follow-up results from 131 clients and immediate posttreatment results from 4 11 clients show positive change in a large majority of cases.
When created as a unit of the University of Minnesota Medical School, the Program in Human Sexuality (PHS) was charged with developing education, research, and service capabilities in the newly emerging field of human sexuality.' I n 1973 a clinical arm of the program began to offer counseling for sexual dysfunctions to the general public and thereby to provide a training arena for health professionals. Today the Sexual Health Services (SHS) clinic offers treatment programs for a wide variety of sex-related concerns and problems. Evaluation is an increasingly prominent component of SHS, both for diagnostic purposes and for evaluation of services to clients.
TREATMENT PHILOSOPHIES
A fundamental aspect of SHS treatment philosophy is the recognition that sexual concerns and problems are not synonomous with All of the authors are affiliated with the Program in Human Sexuality at the University of Minnesota Medical School, Minneapolis-James Held as Evaluation Coordinator and Research Fellnw, Constance Logan as Assistant Scientist, James Maddock as Education and Training Coordinator, Daniel Weiss as former Administrative Director of the Sexual Health Services, and Thcndore Cole as Director of the Physical Disability Section as well as a Professor of the Department of Physical Medicine and Rehabilitation. Reprint queries should be directed to James P. Held, Evaluation Coordinator, Program in Human Sexuality, University of Minnesota Medical School, Research East Building, 2630 University Avenue SE, Minneapolis, Minnesota 554 14.
256
Downloaded by [McMaster University] at 11:54 28 January 2015
/. P . H u l l , C. Logun,,]. W . Muddock, D.S . Wviss and T. M. Cole
257
psychopathology. Instead, patients are helped consciously to find those aspects of their sexuality with which they are dissatisfied and to choose realistic goals for change. SHS also reflects the conviction that health is more than simply the absence of disease. Among the variety of services offered to clients are enrichment programs aimed at increasing the sexual satisfaction and enjoyment of clients with no particular identified problems. Certain basic principles underlie the programs offered by SHS, regardless of the particular problem or focus of the couple o r individual in the particular style and technique of the consultant. T h e first and foremost principle is the concept of responsibilityfor self, This principle recognizes that many people who seek help for sexual dysfunction or dissatisfaction have been found to be either underresponsible or overresponsible sexually.2 That is to say, partners may project imaginary assets or liabilities onto themselves or each other and operate as if these projections were a reality in their sexual interaction. T h e SHS approach assumes that an individual has the desire to enhance his or her satisfaction and the capacity to choose more effective behavior patterns. Each person is treated as a unique individual, with legitimate sexual needs and desires. Simply put, this approach teaches an individual to be responsive to his or her sexual partner but responsible for him or herself. T h e second basic principle is the permission to be sexual.3 Consultants use their considerable authority with clients to convey to them the message that it is alright to be sexually active, think about sex, to be interested in sex, to experience sexual feelings and fantasies. Consultants help clients accept sex as a natural function that need not be associated with guilt. Many dysfunctional and dissatisfied individuais require only this kind of permission to overcome the negative messages received during their previous socialization experiences. T h e third principle, closely related to permission, is the use of methods of reeducation. Consultants provide clients with accurate information about sexual functioning. In a warm and supportive context they help clients understand and appreciate their own bodies and their own potential capacity for giving and receiving erotic pleasure. Consultants also provide clients with an informational context for sexual behavior, helping them to dispel myths and correct distortions about various kinds of sexual practices. T h e fourth basic principle is thefacilitation of increased awureness in the clients. This includes awareness of each individual’s own feelings and fantasies as well as awareness of a sexual partner’s likes and dislikes. T h e program seeks to foster an effective communication between partners and to point out various dynamics in the 1 elationship that may be affecting the way they behave sexually. T h e fifth and final basic principle of SHS services is structured behauior change. Drawing on basic learning theory, consultants seek to modify
Downloaded by [McMaster University] at 11:54 28 January 2015
258
Journal of Sex and Marital Therapy
behavior through the use of assigned tasks, or “homework,” carried out by an individual or couple according to specific instructions. These structured experiences seek to retrain individuals in effective methods of sexual stimulation and response, without the concomitant anxiety of performance demands or the pressures of having to fulfill their own or other’s stereotyped expectations of sexual behavior. T h e exact content and timing of homework assignments varies according to the needs, interest, and particular problems of an individual or couple. Sexual Health Services offers individual, conjoint, and group therapy as well as a variety of enrichment programs. T h e unit sees individuals and couples with specific sexual dysfunctions and also those with more complicated and diffused problems of personal sexual conflict or relational incompatibilities in the sexual area. Sexual enrichment and therapy programs are time limited but flexible. They combine basic education, communication training, self-awareness and insight therapies, gestalt techniques, small-group processes, and behavior homework sequences. Programs last from approximately 10 to 60 hours, spanning a time period of any where from 3 to 12 weeks. Services include same-sex groups for sexually dysfunctional men or women, conjoint or group therapy for sexual dysfunction or relationship problems, individual counseling for sexual conflicts, and a special education and enrichment sequence. STAFF SELEClION A N D TRAINING
T h e selection and training of staff is critical for the development of any effective clinical unit and no less so in a new and innovative field like sexual health services. Academic training in traditional disciplines does not necessarily imply competence o r comfort in sexual therapy, so demonstrable abilities in dealing with sexual matters are accorded independent value. A multidisciplinary staff of traditionally credentialed professionals (psychologists, social workers, psychiatrists, clergy) serve as trainers and supervisory personnel. Several paraprofessionals and training interns complete the service-providing staff. A staff physician serves as medical director and overall clinical supervisor.
EVALUATION METHODS T h e evaluation of the effectiveness of client services is conducted in two ways. One is to have clients rate their satisfaction with the services and the extent to which they have met their pretreatment goals. T h e second method of evaluation is the prelposttesting of clients using objective instruments.
Downloaded by [McMaster University] at 11:54 28 January 2015
1. P . Hrld, C. Logun, J .
W . Maddock, D.S. Writs a n d T . M. (;olr
259
Prior to beginning service, all clients are medically screened by a thorough health history and status questionnaire. Then medical examinations and/or laboratory evaluations are arranged if needed. All clients are given sexual attitude and behavior surveys and a self-esteem q ~ e s t i o n n a i r eT. ~ h e latter consists of two scales measuring attitude toward self and attitude toward others. It is primarily a research instrument with strong reliability and validity. Clients seen as couples are also given two other tests. Their overall level of marital adjustment is measured5 as are their degree and kind of sexual dissatisfaction. T h e latter is done via an instrument known as the Sexual Interaction Inventory.6 This is a paper-and-pencil self-report inventory for assessing the sexual adjustment and satisfaction of heterosexual couples. T h e test consists of a list of 17 heterosexual behaviors (e.g., the female caressing the male’s genitals with her mouth). Clients respond by answering six questions on a 6-point rating scale about each of the behaviors listed. T h e questions ask ( 1 ) how often the behavior currently occurs, (2) how often the respondent would like it to occur, ( 3 ) how pleasant the respondent finds this activity, (4) how pleasant the respondent thinks his or her partner finds the activity, (5) how pleasant the respondent would like to find the activity, (6) how pleasant the respondent would like hidher partner to find the activity. Responses from each partner regarding all 17 behaviors are summed, and from the totals is derived an 1 1-scale profile. When the intake consultant wishes to explore clients’ personalities more deeply or to exclude psychopathology as a determinant of the sexual concern, the Minnesota Multiphasic Personality Inventory (MMPI) is administered. At this point some clients may be referred for additional psychotherapy, chemical dependency counseling, or marital therapy, prior to working with SHS. Tests and self-report inventories are administered at the time of the intake interview, again at the last meeting of a group or last counseling session, and finally by mail 1 year after service has been completed. Included in the t w o postservice evaluations are a goal statement questionnaire and goal evaluation feedback questionnaire, which determine the extent to which clients have met their goals and how helpful they believe the processes were in helping them to meet these goals.
EVALUATION RESULTS T h e evaluation results reported here are based on our experience with 4 1 1 clients who have completed pretreatment and immediate posttreatment questionnaires and 131 clients who have completed materials after having finished with SHS more than 1 year ago. T h e response rates have been a problem in SHS because until recently all testing was done
journal qf Sex and Moratrtl Therapy
260
TABLE I Sexual Interaction Inventory Raw Score Means on Client Couples Matched Pre- to Immediate Post-Treatment
N
Downloaded by [McMaster University] at 11:54 28 January 2015
Scale
-
103 couples
Pre-treatment Mean
Imediate Post-treatment Me an
Difference*
Male Frequency Dissatisfaction
22.9
15.7
-7.2
Female Frequency Dissatisfaction
20.1
14.0
-6.1
9.0
6.6
-2.4
19.6
10.0
-9.6
Male Self-Acceptance Female Self-Acceptance Male Pleasure Mean
5.21
5.35
.14
Female Pleasure Mean
4.48
5.13
.65
Perceptual AccuracyFemale of Male
14.1
10.0
-4.1
Perceptual AccuracyMale of Female
15.8
11.9
-3.8
Mate AcceptanceMale of Female
23.6
13.6
-10.0
Mate AcceptanceFemale of Male
13.8
7.5
-6.3
137.1
81.4
-49.7
Total Disagreement
*
Negative change on all scales except Pleasure Means indicates
increased satisfaction.
Positive change on Pleasure Means indicates
increased satisfaction. All changes significant at the p C O l level or better according to one-tailed matched pairs t-test.
through the mail. T h e response rate for immediate posttreatment follow-up had been slightly over 35%, though this has improved to nearly 100% since clients are now required to fill out the test materials at their final counseling session. T h e 1-year follow-up questionnaires still must be administered by mail, and the response is approximately 60%.A factor that further reduces usable data is the requirement that all questions on the Berger Test’s, Sexual Interaction Inventory, and Marital Adjustment Test be completed for the results to be valid. About 5% of the Berger Tests and over one-quarter of the Sexual invalid because they are incomplete. T h e Sexual Interaction Inventory has been completed by 103 couples before and immediately after their work with Sexual Health Services (Table 1). Changes significant at the p < . O l level are evident on all of the 1 1 scales. A decrease in the disparity between the male and female scales indicates increased agreement on what they erperience within the
Downloaded by [McMaster University] at 11:54 28 January 2015
/. P . Hrlrl,
C. L O ~ T,/.I W , . M d d o r k , D. S. Weiss und T. M . Colt9
261
sexual partnership. T h e total disagreement scale (scale 11) sums the disparities between the partners across the other scales and gives an overall indicator of sexual satisfaction. (As can be seen in Table 1 , each scale changed toward greater sexual satisfaction, and most changed more than one standard deviation closer to the mean for sexually satisfied couples.) T h e total disagreement scale average score changed from 137.1 to 87.4 for the immediate posttesting. T h e results in the 1-year follow-up data show a similar trend, as seen in Table 2, though the sample is small. Changes in the direction of increased satisfaction were significant at the p
Journal of Sex & Marital Therapy Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/usmt20
The evaluation of sexual health services in a medical setting a
a
James P. Held BChE , Constance Logan BA , James W. Maddock a
a
PhD , Daniel S. Weiss BS & Theodore M. Cole MD
a
a
Program in Human Sexuality at the University of Minnesota Medical School , Minneapolis—James Held as Evaluation Coordinator and Research Fellow, Constance Logan as Assistant Scientist, James Maddock as Education and Training Coordinator, Daniel Weiss as former Administrative Director of the Sexual Health Services, and Theodore Cole as Director of the Physical Disability Section as well as a Professor of the Department of Physical Medicine and Rehabilitation Published online: 14 Jan 2008.
To cite this article: James P. Held BChE , Constance Logan BA , James W. Maddock PhD , Daniel S. Weiss BS & Theodore M. Cole MD (1977) The evaluation of sexual health services in a medical setting, Journal of Sex & Marital Therapy, 3:4, 256-264, DOI: 10.1080/00926237708402993 To link to this article: http://dx.doi.org/10.1080/00926237708402993
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 &
Downloaded by [McMaster University] at 11:54 28 January 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Sex & Marital 'Therapy Vol. 3, No. 4, Winter 1977
The Evaluation of Sexual Health Services in a Medical Setting
Downloaded by [McMaster University] at 11:54 28 January 2015
James P . Held, BChE, Constance Logan, BA, James W. Maddock, PhD, Daniel S. Weiss, BS, and Theodore M . Cole, M D
ABSTRACT: An interdisciplinary Sexual Health Services unit has been established at the University of Minnesota Medical School that offers counseling and treatment programs for a wide variety of sex-related concerns and problems. T h e programs are based on the principles of responsibility for self, permission to be sexual, the use of reeducation, the facilitation of increased awareness in clients, and structured behavior change. T h e programs have been evaluated according to client satisfaction with the extent to which they have met pretreatment goals and according to results of preiposttesting with objective instruments. One year follow-up results from 131 clients and immediate posttreatment results from 4 11 clients show positive change in a large majority of cases.
When created as a unit of the University of Minnesota Medical School, the Program in Human Sexuality (PHS) was charged with developing education, research, and service capabilities in the newly emerging field of human sexuality.' I n 1973 a clinical arm of the program began to offer counseling for sexual dysfunctions to the general public and thereby to provide a training arena for health professionals. Today the Sexual Health Services (SHS) clinic offers treatment programs for a wide variety of sex-related concerns and problems. Evaluation is an increasingly prominent component of SHS, both for diagnostic purposes and for evaluation of services to clients.
TREATMENT PHILOSOPHIES
A fundamental aspect of SHS treatment philosophy is the recognition that sexual concerns and problems are not synonomous with All of the authors are affiliated with the Program in Human Sexuality at the University of Minnesota Medical School, Minneapolis-James Held as Evaluation Coordinator and Research Fellnw, Constance Logan as Assistant Scientist, James Maddock as Education and Training Coordinator, Daniel Weiss as former Administrative Director of the Sexual Health Services, and Thcndore Cole as Director of the Physical Disability Section as well as a Professor of the Department of Physical Medicine and Rehabilitation. Reprint queries should be directed to James P. Held, Evaluation Coordinator, Program in Human Sexuality, University of Minnesota Medical School, Research East Building, 2630 University Avenue SE, Minneapolis, Minnesota 554 14.
256
Downloaded by [McMaster University] at 11:54 28 January 2015
/. P . H u l l , C. Logun,,]. W . Muddock, D.S . Wviss and T. M. Cole
257
psychopathology. Instead, patients are helped consciously to find those aspects of their sexuality with which they are dissatisfied and to choose realistic goals for change. SHS also reflects the conviction that health is more than simply the absence of disease. Among the variety of services offered to clients are enrichment programs aimed at increasing the sexual satisfaction and enjoyment of clients with no particular identified problems. Certain basic principles underlie the programs offered by SHS, regardless of the particular problem or focus of the couple o r individual in the particular style and technique of the consultant. T h e first and foremost principle is the concept of responsibilityfor self, This principle recognizes that many people who seek help for sexual dysfunction or dissatisfaction have been found to be either underresponsible or overresponsible sexually.2 That is to say, partners may project imaginary assets or liabilities onto themselves or each other and operate as if these projections were a reality in their sexual interaction. T h e SHS approach assumes that an individual has the desire to enhance his or her satisfaction and the capacity to choose more effective behavior patterns. Each person is treated as a unique individual, with legitimate sexual needs and desires. Simply put, this approach teaches an individual to be responsive to his or her sexual partner but responsible for him or herself. T h e second basic principle is the permission to be sexual.3 Consultants use their considerable authority with clients to convey to them the message that it is alright to be sexually active, think about sex, to be interested in sex, to experience sexual feelings and fantasies. Consultants help clients accept sex as a natural function that need not be associated with guilt. Many dysfunctional and dissatisfied individuais require only this kind of permission to overcome the negative messages received during their previous socialization experiences. T h e third principle, closely related to permission, is the use of methods of reeducation. Consultants provide clients with accurate information about sexual functioning. In a warm and supportive context they help clients understand and appreciate their own bodies and their own potential capacity for giving and receiving erotic pleasure. Consultants also provide clients with an informational context for sexual behavior, helping them to dispel myths and correct distortions about various kinds of sexual practices. T h e fourth basic principle is thefacilitation of increased awureness in the clients. This includes awareness of each individual’s own feelings and fantasies as well as awareness of a sexual partner’s likes and dislikes. T h e program seeks to foster an effective communication between partners and to point out various dynamics in the 1 elationship that may be affecting the way they behave sexually. T h e fifth and final basic principle of SHS services is structured behauior change. Drawing on basic learning theory, consultants seek to modify
Downloaded by [McMaster University] at 11:54 28 January 2015
258
Journal of Sex and Marital Therapy
behavior through the use of assigned tasks, or “homework,” carried out by an individual or couple according to specific instructions. These structured experiences seek to retrain individuals in effective methods of sexual stimulation and response, without the concomitant anxiety of performance demands or the pressures of having to fulfill their own or other’s stereotyped expectations of sexual behavior. T h e exact content and timing of homework assignments varies according to the needs, interest, and particular problems of an individual or couple. Sexual Health Services offers individual, conjoint, and group therapy as well as a variety of enrichment programs. T h e unit sees individuals and couples with specific sexual dysfunctions and also those with more complicated and diffused problems of personal sexual conflict or relational incompatibilities in the sexual area. Sexual enrichment and therapy programs are time limited but flexible. They combine basic education, communication training, self-awareness and insight therapies, gestalt techniques, small-group processes, and behavior homework sequences. Programs last from approximately 10 to 60 hours, spanning a time period of any where from 3 to 12 weeks. Services include same-sex groups for sexually dysfunctional men or women, conjoint or group therapy for sexual dysfunction or relationship problems, individual counseling for sexual conflicts, and a special education and enrichment sequence. STAFF SELEClION A N D TRAINING
T h e selection and training of staff is critical for the development of any effective clinical unit and no less so in a new and innovative field like sexual health services. Academic training in traditional disciplines does not necessarily imply competence o r comfort in sexual therapy, so demonstrable abilities in dealing with sexual matters are accorded independent value. A multidisciplinary staff of traditionally credentialed professionals (psychologists, social workers, psychiatrists, clergy) serve as trainers and supervisory personnel. Several paraprofessionals and training interns complete the service-providing staff. A staff physician serves as medical director and overall clinical supervisor.
EVALUATION METHODS T h e evaluation of the effectiveness of client services is conducted in two ways. One is to have clients rate their satisfaction with the services and the extent to which they have met their pretreatment goals. T h e second method of evaluation is the prelposttesting of clients using objective instruments.
Downloaded by [McMaster University] at 11:54 28 January 2015
1. P . Hrld, C. Logun, J .
W . Maddock, D.S. Writs a n d T . M. (;olr
259
Prior to beginning service, all clients are medically screened by a thorough health history and status questionnaire. Then medical examinations and/or laboratory evaluations are arranged if needed. All clients are given sexual attitude and behavior surveys and a self-esteem q ~ e s t i o n n a i r eT. ~ h e latter consists of two scales measuring attitude toward self and attitude toward others. It is primarily a research instrument with strong reliability and validity. Clients seen as couples are also given two other tests. Their overall level of marital adjustment is measured5 as are their degree and kind of sexual dissatisfaction. T h e latter is done via an instrument known as the Sexual Interaction Inventory.6 This is a paper-and-pencil self-report inventory for assessing the sexual adjustment and satisfaction of heterosexual couples. T h e test consists of a list of 17 heterosexual behaviors (e.g., the female caressing the male’s genitals with her mouth). Clients respond by answering six questions on a 6-point rating scale about each of the behaviors listed. T h e questions ask ( 1 ) how often the behavior currently occurs, (2) how often the respondent would like it to occur, ( 3 ) how pleasant the respondent finds this activity, (4) how pleasant the respondent thinks his or her partner finds the activity, (5) how pleasant the respondent would like to find the activity, (6) how pleasant the respondent would like hidher partner to find the activity. Responses from each partner regarding all 17 behaviors are summed, and from the totals is derived an 1 1-scale profile. When the intake consultant wishes to explore clients’ personalities more deeply or to exclude psychopathology as a determinant of the sexual concern, the Minnesota Multiphasic Personality Inventory (MMPI) is administered. At this point some clients may be referred for additional psychotherapy, chemical dependency counseling, or marital therapy, prior to working with SHS. Tests and self-report inventories are administered at the time of the intake interview, again at the last meeting of a group or last counseling session, and finally by mail 1 year after service has been completed. Included in the t w o postservice evaluations are a goal statement questionnaire and goal evaluation feedback questionnaire, which determine the extent to which clients have met their goals and how helpful they believe the processes were in helping them to meet these goals.
EVALUATION RESULTS T h e evaluation results reported here are based on our experience with 4 1 1 clients who have completed pretreatment and immediate posttreatment questionnaires and 131 clients who have completed materials after having finished with SHS more than 1 year ago. T h e response rates have been a problem in SHS because until recently all testing was done
journal qf Sex and Moratrtl Therapy
260
TABLE I Sexual Interaction Inventory Raw Score Means on Client Couples Matched Pre- to Immediate Post-Treatment
N
Downloaded by [McMaster University] at 11:54 28 January 2015
Scale
-
103 couples
Pre-treatment Mean
Imediate Post-treatment Me an
Difference*
Male Frequency Dissatisfaction
22.9
15.7
-7.2
Female Frequency Dissatisfaction
20.1
14.0
-6.1
9.0
6.6
-2.4
19.6
10.0
-9.6
Male Self-Acceptance Female Self-Acceptance Male Pleasure Mean
5.21
5.35
.14
Female Pleasure Mean
4.48
5.13
.65
Perceptual AccuracyFemale of Male
14.1
10.0
-4.1
Perceptual AccuracyMale of Female
15.8
11.9
-3.8
Mate AcceptanceMale of Female
23.6
13.6
-10.0
Mate AcceptanceFemale of Male
13.8
7.5
-6.3
137.1
81.4
-49.7
Total Disagreement
*
Negative change on all scales except Pleasure Means indicates
increased satisfaction.
Positive change on Pleasure Means indicates
increased satisfaction. All changes significant at the p C O l level or better according to one-tailed matched pairs t-test.
through the mail. T h e response rate for immediate posttreatment follow-up had been slightly over 35%, though this has improved to nearly 100% since clients are now required to fill out the test materials at their final counseling session. T h e 1-year follow-up questionnaires still must be administered by mail, and the response is approximately 60%.A factor that further reduces usable data is the requirement that all questions on the Berger Test’s, Sexual Interaction Inventory, and Marital Adjustment Test be completed for the results to be valid. About 5% of the Berger Tests and over one-quarter of the Sexual invalid because they are incomplete. T h e Sexual Interaction Inventory has been completed by 103 couples before and immediately after their work with Sexual Health Services (Table 1). Changes significant at the p < . O l level are evident on all of the 1 1 scales. A decrease in the disparity between the male and female scales indicates increased agreement on what they erperience within the
Downloaded by [McMaster University] at 11:54 28 January 2015
/. P . Hrlrl,
C. L O ~ T,/.I W , . M d d o r k , D. S. Weiss und T. M . Colt9
261
sexual partnership. T h e total disagreement scale (scale 11) sums the disparities between the partners across the other scales and gives an overall indicator of sexual satisfaction. (As can be seen in Table 1 , each scale changed toward greater sexual satisfaction, and most changed more than one standard deviation closer to the mean for sexually satisfied couples.) T h e total disagreement scale average score changed from 137.1 to 87.4 for the immediate posttesting. T h e results in the 1-year follow-up data show a similar trend, as seen in Table 2, though the sample is small. Changes in the direction of increased satisfaction were significant at the p
