512 CHAPTER 11
Typically, the therapist explains a homework assignment
during a session, and the patient or couple reports the results
during the following session. The goals of behavioral tech-
niques are to help patients develop a more relaxed aware-
ness of their bodies and increase their orgasmic responding
and control. Treatment may also involve a realistic look at
an individual’s or couple’s daily work schedule, which is fol-
lowed by a discussion of how to create the time and energy
to begin a sexual encounter so that the partners are not tired
or busy. In addition, therapists typically use specifi c behavioral techniques for dif-
ferent sexual dysfunctions. For instance, people with sexual aversion disorder may
undergo desensitization as part of their treatment, gradually exposing themselves to
frightening or aversive elements of the sexual situation (Kaplan, 1995).
Researchers have examined how well specifi c psychosocial treatments (that is,
treatments that directly target psychological and social factors) help people with
particular sexual disorders. For erectile dysfunction, treatments such as psychoedu-
cation and behavioral homework assignments (such as increasing communication
skills) can help to increase satisfaction with erectile functioning, sexual frequency,
and satisfaction with the relationship (Heiman & Meston, 1997). Premature ejacu-
lation is signifi cantly helped by behavioral techniques (de Carufel & Trudel, 2006),
such as the squeeze technique (Kaplan, 1989): Right before ejaculation, the man
squeezes the base of the tip (just below the head) of his erect penis for about 4 sec-
onds. When he feels his ejaculation to be under control, he begins stimulation again.
Once he has mastered this technique during masturbation, he tries sexual relations
with his partner; if necessary for control, he can employ the squeeze technique dur-
ing sexual relations with his partner (Heiman & Meston, 1997).
Women with vaginismus may be helped by systematic desensitization, which in-
volves gradual dilation of the vaginal opening until vaginal spasms no longer occur.
Biofeedback may be helpful for some women with dyspareunia.
For orgasmic disorders, treatments that target psychological factors are more
effective for people who have never experienced orgasm; people who have infre-
quent orgasms, or situational problems achieving orgasm, may be better treated by
methods that target the couple’s interactions or biological problems (depending on
the specifi c reason for the inconsistency of orgasms; Heiman, 2000). Unfortunately,
there are, as yet, few well-designed studies that have assessed specifi c psychoso-
cial treatments for women’s sexual dysfunctions (Heiman, 2002a) in part because
research on these treatments is not sponsored by an industry (as is research on the
effectiveness of medications).Targeting Social Factors: Couples Therapy
The sex therapy techniques discussed in the previous section may be implemented
alone (by the individual with a sexual dysfunction) or with a partner. Sex therapy
may involve teaching couples specifi c cognitive and behavioral techniques. However,
implementing such techniques with a partner requires motivation and willingness to
be open with the partner about sexual matters and to experiment sexually. More-
over, how a couple interacts sexually occurs against the backdrop of their overall
relationship. Treatment may focus on the couple’s relationship issues (couples ther-
apy, rather than sex therapy per se) and include teaching communication, intimacy,
and relationship skills (Baucom et al., 1998; Beck, 1995; Heiman, 2002b; Masters
& Johnson, 1970), such as assertiveness, problem solving, negotiation, and confl ict
management (Malatesta & Adams, 2001). Couples therapy may also address issues
of power, control, and lifestyle as they relate to the sexual dysfunction; for example,
the therapist may employ techniques from systems therapy (see Chapter 4) to focus
on assertiveness within the sexual aspects of the relationship. Treatment for a sexual
dysfunction in a partner of a lesbian or gay couple may also address special issues
that affect their sexual relationship, such as living “in the closet” or sexual intimacy
when one partner is HIV positive (Nichols, 2000).Sex therapists may recommend
sensate focus exercises—a grad-
uated series of tasks that focus
on body awareness and sexual
sensations. One such task might
be a sensual bath, either alone
or with a partner; the goal is not
to come to orgasm but rather to
become aware of pleasurable
sensations. Comstock/Punchstock
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