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HSX5555 - Assessment and Intervention with Sexual Problems for the Non-specialist in Sex Therapy

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ASSESSMENT AND INTERVENTION WITH SEXUAL PROBLEMS FOR THE NON-SPECIALIST IN SEX THERAPY

by Sally Lehr, PhD, APRN, BC, FAACS, CIRT

Sally Lehr, a faculty member of the Emory University School of Nursing since 1976, also maintains a private practice as a Clinical Nurse Specialist in Adult Psychiatric/Mental Health Nursing. She is a Fellow of the American Academy of Clinical Sexologists, an AASECT Certified Sex Educator and Sex Therapist, and a Certified Imago Relationship Therapist. She is an author and frequent presenter at conferences and seminars.

This course is the copyrighted property of yourceus.com and may not be copied in part or in entirety without the express written permission of yourceus.com. For information on how to secure permission to use this course or any part of this course, contact us at: info@yourceus.com.

OBJECTIVES

The objective of this course is to provide the mental health clinician with a comprehensive introductory overview of sexuality. When the trainee completes this course, he/she will:

1. Clarify personal values by becoming aware of and examining ideas, feelings, and attitudes about a broad range of the cognitive, affective, and behavioral aspects of human sexuality.
2. Comprehend strategies and tools for the assessment of sexuality and sexual concerns.
3. Understand the New View approach to sexuality and its relationship to treatment decisions.
4. Know the basic principles of sex therapy.
5. Be able to determine when it is appropriate to refer to a sex therapy specialist.
6. Understand the most common female sexual concerns and dysfunctions.
7. Understand the most common male sexual concerns and dysfunctions.
8. Know uses, limitations and contraindications for common medical approaches to sexual performance problems.

This course is primarily designed for clinicians in the early or middle stages of their career, or for more advanced clinicians reviewing basic concepts in this area.

Course length:
6 contact hours: core clinical

 

Section I: Introduction
Section II: Sex Therapy Questions and Answers
Section III: Clarifying Personal Values
Section IV: Sexuality Assessment
Section V: From Assessment to Treatment
Section VI: Sexual Desire Problems
Section VII: Using Sensate Focus
Section VIII: Addressing the Unconscious Sexual Saboteurs
Section IX: Clinical Cases and Therapists’ Responses
References and Test




Section I: Introduction

In the 1970s, when Masters and Johnson were doing their sexuality research, they stated, “A conservative estimate would indicate half the marriages [in this country] as either presently sexually dysfunctional or imminently so in the future” (Masters and Johnson, 1970). Sex therapists were saying that at least 50% of marriages have serious sexual concerns, and that if the truth were actually known, it would likely be closer to 75%.

The implication here is that most mental health clinicians would not have to look too hard to find problems with sexuality in the lives of their clients. Most clinicians who work with individuals, couples, or families will be confronted at some point in time with one or more clients whose problem may be - or may include - sexual concerns or sexual dysfunction.

This research occurred over a generation ago, taking place in the immediate aftermath of the “sexual revolution.” Clearly, a number of things in the sexual arena have changed in the roughly 40 years since. Sexual information and education is generally more prevalent, but so are lurid sexual images and easily accessible, graphic sexual material. Sexual interactions that in previous generations might have previously been labeled deviant, immoral, and/or illegal, such as homosexuality and some of the paraphilias, have secured a measure of acceptance / tolerance.

Meanwhile, new concerns about sex and internet pornography addiction have emerged. How these changes have affected sexual relationships between romantic and sexual partners is still in the process of being studied and evaluated.

Although as a healthcare professional the clinician may not be a sex therapist, it is important to be aware of the process of Sex Therapy. It is the role of the clinician to take the client from the assessment phase, through working on some possible solutions, to a referral, if necessary. An appropriate referral made by a knowledgeable clinician who can help the patient to understand the process s/he is about to enter is more likely to be a successful referral.

Sex Therapy, developed and defined by William Masters and Virginia Johnson (1970), is the direct, symptomatic treatment of sexual dysfunctions. Sex therapy employs many of the same basic principles as the other therapeutic modalities but is unique in that it was developed specifically for the treatment of sexual problems. Initially sex therapy involved brief, time-limited directive counseling aimed at symptom removal rather than attainment of insight, uncovering of repressions, or resolution of unconscious conflict.

Recognizing that sexual behavior occurs not in a vacuum but within a relationship, today’s sex therapy has expanded to recognize the influence of individual, cultural and relationship factors in creating, maintaining, or exacerbating sexual problems. While permission, limited information - including educational resources, and specific suggestions (see the PLISSIT Model) from the therapist might be effective in addressing and helping to resolve simple sexual issues, many of today’s clients will need additional focus on individual, cultural and relationship issues impacting their sexuality.

Because sexuality is such an important part of each person’s life, it is presumed that most clinicians have had at least some background and education in sex and sexuality. However, this is not the same thing as specialized training in addressing sexual problems, and clinicians who attempt to address complex sexual problems as part of couples counseling or as an adjunct to addressing mood or anxiety disorders can quickly find themselves operating outside of their area of competence. This does not serve the best interests of either the client or the clinician.

This course is designed to create improvements in this situation in several important ways. First, it will present some important information about what is involved in a thorough assessment of a client’s sexual life. In order to know if you are about to operate outside of your area of competence, you must first have a good idea of how to gather the information that will allow you to make that kind of determination.

Second, this course will address what kinds of problems might lend themselves to approaches and techniques that can reasonably be easily acquired and utilized by an experienced clinician who is not a sexuality expert and what kinds of problems would generally require a referral to a specialist in sex therapy or to some other kind of medical practitioner, such as a physician qualified to address medical concerns that are affecting a client’s sexuality.

Third, this course will present some of the approaches and techniques that may be more readily acquired by an experienced clinician, with recommendations of resources for further study. Whenever possible, this will also include information about guidelines, contraindications and limitations on the use of these techniques. Once comfortable and familiar with these techniques, a conscientious clinician can make determinations about whether he/she is ready to apply them in clinical situations.

Fourth, this course will attempt to build a useful bridge between problems with sexuality / sexual functioning and the knowledge base and skill sets that are the more familiar domain of the mental health clinician. Many sexual problems that present as physical concerns – erectile problems, diminished sexual arousal, inability to reach orgasm - may in fact have as their root cause relational, emotional or psychological problems. The work of fixing these “physical” problems involves exactly the kinds of aptitudes that the mental health clinician possesses.

This is to say that many of aspects of sex therapy can be successfully managed by a conscientious mental health clinician using skills and approaches that are already known and being applied to other complex problems brought into treatment by clients. However, this is contingent upon the clinician possessing a full and deep knowledge base on sex and sexuality to discriminate between problems that are within the clinician’s area of competence and those that are outside of that area of competence.

This means there are a couple of important pre-requisites for using this course wisely. First, it is extremely important that the clinician have a very thorough foundation in the knowledge base related to sex and sexuality. For clinicians who lack such a base, it may be helpful to consider taking yourceus.com's introductory course: Sex and Sexuality: An Introductory Overview for Mental Health Clinicians.


Second, clinicians who wish to address the sexual concerns of their clients must possess a considerable degree of comfort with their own sexuality and must be prepared to take into account the physical, mental, emotional, relational, cultural, and spiritual aspects of each individual.

Sexuality has the capacity to be an emotionally loaded area with which to work. Clinicians who have themselves been raised in sexually closed or repressive environments may harbor uncertainties, conflicts and cultural prejudices that make it difficult to keep the client’s wants, needs and aspirations for their sexual life in their rightful place as the primary focal point of treatment.

In yourceus.com’s introductory course on sexuality, a brief questionnaire was presented to allow the trainee to evaluate his/her own level of comfort with addressing problems in the sexual realm. Because this is such an important tool for any clinician who holds doubts in this arena, this questionnaire will be presented in this training program as well.


Every effort will be made in this course to present the information that is most likely to be useful to the greatest number of mental health clinicians. We will focus on the most common sexual concerns likely to be encountered, address the potential complications and pitfalls, and offer the best researched and validated treatment approaches that can be found.

 

 

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