Wednesday, August 17, 2005

Reading, reading...

One of my favorite aspects of train travel is the opportunity to read on the train. So in my recent trip to NYC, I was able to finish reading a new book of essays on brief sex therapy:

Green, S., & Flemons, D. (Eds.) (2004). Quickies: The Handbook of Brief Sex Therapy. W. W. Norton.

I have little background in the theory and practice of brief therapy, so it was fascinating to learn more about the brief therapy approach. Each essay was by a different clinician, and each approached therapeutic practice slightly differently. Each then discussed how their therapeutic approach was applied to sexual difficulties, with examples from individuals and couples they had treated.

Overall, I was impressed by their sensitivity to the client's worldview -- most of the essays emphasized respecting the client's understanding of the problem, their framing of the issues, their values, and their current stage of change. At the same time, the therapists stressed the potential for the therapeutic context to shift the client's framing of the problem and perspective in ways that facilitated positive change and greater satisfaction. Over and over, the therapists revealed the power of language and how the problem was framed. By normalizing the experience, being nonblaming, stressing the strengths of the clients, and reframing the issue in ways which emphasized new possibilities, the therapists could promote positive change in remarkably short periods of time. While certainly not all problems can be solved in 5-10 therapy visits, and no therapist can claim universal success, many of these cases revealed dramatic change within a few sessions. This was particularly impressive when the couple has been struggling with the problem on their own or with doctors for years, and they saw resolution of the issues in only a few therapy sessions.

In addition, I appreciated the emphasis on understanding sexual issues as contextual and relational, best understood within the clients' relationships and current context. The therapists resisted the notion of one member of the couple being "the patient with the problem", and instead engaged both members of the couple in defining the issue and moving toward resolution. As many sex therapists have noted, a great number of sexual problems are related to relational issues, each influencing the other.

Finally, I really valued the willingness of the therapists to embrace sexual diversity. Not only were there several articles devoted to treatment of same-sex couples, there was also a strong emphasis on sexual expression beyond traditional phallocentric intercourse models and on intimacy, not just goal-oriented sexuality. Several articles stressed the necessity of being open to varied sexual expressions, as long as they are consensual and not harmful or abusive. For example, there was a fascinating article on sex addiction which challenged the application of this diagnosis, focusing on whether the sexual behaviors are actually harmful within the client's life or not.

Overall, an excellent book which broadened my knowledge of therapy and sex therapy. I recommend it to anyone interested in couples therapy or sex therapy.

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