Sex & Sexual Inadequacy in Marital Adjustment

Sexual behavior is one of the most important aspects in the sustaining of any marital relationship. Goldenberg (2003) observed that, in addition to the role of procreation, the other important functions served by sexual behavior include, mental health, maintainance of relationships, possibly, self-esteem, and physical health.

Many couples have experienced difficulties in their relationships, arising form sexual disorders either from one of the partners or where both may be having a specific form of sexual dysfunction. The treatment of the sexual dysfunction has been undergoing a lot of change and development from the time the sex therapy was introduced and developed over 25 years ago. Since then, the treatment which is offered to sexual dysfunction has changed to a great deal.

Modification and introduction of new treatment techniques has been introduced with the introduction of therapeutic treatment methods that are comprehensive, and include the strategic models and the cognitive behavioral models in an attempt to fight with the problem of sexual dysfunction. Family therapy came about from the application of the principle which advocated for improvement in the method of communication between partners, problem solving skills and sex therapy treatment.

From the new approach and evaluation methods introduced by sex therapy, the result has been that, the format of a sufficient conjoint therapy has been made clearer, the aspect of sexual dysfunction is better understood, and researchers have been able to note what type of treatment can better respond to a certain sexual dysfunction situation, the study has also been able to find out the couple who may best benefit from a specific treatment (Joseph, 2006).

Dysfunction is viewed as a result of the cultural discourses that are predominant. Most people are absorbed in the dominant cultural believes of self-defeating and restricted feelings about their lives, and a negative view about the whole world. The stories that people have been told about past experiences and reality that is based on cultural views, make them interpret their own experiences in a way that is not productive.

People often become bogged down and see their experiences from a problem oriented view. This explains the reason as to why a couple who may be experiencing a sexual dysfunction problem, may think that it is impossible to improve from such a situation, and a couple may even opt for separation (Goldenberg, 2003). Family therapy has in effect come in to help solve such problems by emphasizing on the importance of communication between the couple, sex therapy and improvement of skills for solving problems.

Studies have shown that, clinicians have applied a cognitive behavioral approach of sex therapy to deal with the sexual dysfunction problems, therapists have also applied various techniques and strategies to deal with the problem which include, assertion training, sexuality, freedom, intimacy, fear, physical methods of treatment and the integral sex therapy. According to Keith (2004), the behavior of a couple is studied to determine what may have contributed to the sexual disorder in a partner, and sex therapy is applied strategically to assist the patient make a sexual adjustment.

Combining sex therapy, bibliotherapy, marital therapy and other methods of physical treatment have enabled therapists to deal with the problem of sexual dysfunction to a large extent. The findings of this paper is that, where sex therapy is provided by the use of comprehensive cognitive behavioral model and application of strategic models, therapists have been able to give a solution to the problem, both in the short term and in the long term.

The Nature of Sex Dysfunction and Family Therapy Sexual dysfunction refers to the persistent impairment in the normal patterns of sexual response or sexual interest in an individual or in a couple. According to Goldenberg (2006), sexual dysfunction can be classified into four categories which include sexual desire disorders, arousal disorders, disorders in connection to organism, any other problem relating to sex and cannot fit in the three mentioned categories fall in the fourth category.

The issue of low sexual desire in female and erectile dysfunction are the most reported problems in many of the clinics which deals with sexual dysfunction. According to Goldenberg (2005), a research study conducted in the sexual dysfunction clinics has indicated that, 63% of the male persons attending the sexual dysfunction clinics suffered from the erectile problem, 16% of the male partners suffered from premature ejaculation, 8% had a problem with regard to their sexual desire which was low, and a 6% of the males suffered from retarded ejaculation.

The female partners on the other side, had a 61% number suffering from a low desire for sex, 14% suffered from vaginismus, the female who suffered from dyspareunia were 11% and the rest 9% suffered from orgasmic dysfunction. Goldenberg (2003) stated that, any individual or couple who suffer from sex dysfunction should attend and get treatment from the intensive sex therapy. What is mostly required here is advice, a couple is also given counseling sessions and education pertaining the sex dilemmas that they may be facing.

The treatment that is offered include a comprehensive cognitive behavioral approach, where a therapist understands the behavioral character of a couple, and then apply any of the strategic measures depending on the person and the likely effect of the method used. This may include a homework assignment graded program, self-monitoring training, a couple may be presented with a potential aetiological formulation, and they are taught how to apply factors to maintain the process, therapeutic work is introduced to a couple where other strategies are applied including the use of educational measures.

Family therapy is used in addressing of sexual problems which couples face in their relationship. The family therapy treatment is conducted by a specific therapist, who attends to the couple in different sessions. Most of the time, couples are required to attend one secession a week during the early phases of the therapy. The program usually takes 3 to 9 months where couples attend an average of nine to 20 sessions. This approach of sexual dysfunction has been improved and modified, but the strategies used for the core treatment are still maintained and intact.

Short-term Results of Family Sex Therapy According to Goldenberg (2006), the different sexual dysfunctions have different responses to the cognitive-behavioral approach. A good response has been realized in the cases which involve vaginismus, the other area of sexual dysfunction which has had a positive response is the phychogenic origin where erectile dysfunction case is involved. Variable initial results have been discovered in the case of sexual desire treatment. With regard to treatment of sexual desire to male partners, the response was not good while excellent response was realized in treatment of premature ejaculation.

Results of Controlled and Comparative Studies The controlled outcome study used the patients who are placed on the waiting list and those who have been attending various sessions of the sex therapy, to show the adjustments and changes which have been noticed to the couples attending the family therapy. It was in fact proved that, couples who attended various sessions had shown a positive response and had made developments and adjustments with regard to sexual dysfunction. The comparative study has for a long time had drawbacks in the results, because of the method used in the research.

This study include couples suffering from different sexual dysfunction, without consideration of treatment to the specific type of dysfunction, the outcome realized was therefore not accurate. The most sophisticated research on record and one that is recognized to date was carried out in the U. S, where Goldenberg (2003) used the sex therapy and compared it with a method where self-help forms of instruction were used and the therapist had very little contact with the patients. This study also used a condition for third treatment which is known as systematic plus desensitization counseling.

The couples who received the cognitive sex therapy showed more favorable outcomes than when the other methods were applied, although there was a modest outcome for group studies. However, the design of the study had a loophole where the use of heterogeneous forms of sexual dysfunction was applied, and this may have affected the accurate treatment differences. The Effect of Modifying the Original Approach of Family Therapy Various studies have been conducted to evaluate the modifications done on the original approach of treatment including the co-therapist treatment and the sessions attended by both couples.

The comparative study results have shown that, treatment that involves less than one days session was likely to be more more successful. Researchers have stated that, couples who attended two sessions per week were responding better than those who were attending various sessions on daily basis. In one study Goldenberg (2005), explained that a one month session had no big difference compared to a weekly session where a woman in the relationship suffered from unresponsiveness in the sexual behavior.

In another study, it was shown that, women responded well when the therapy sessions were held weekly as opposed to a single session after a whole month. From all the studies carried, it was clear that, the sessions held on a weekly basis have been more effective and have had positive responses, especially in the early stages of the sex therapy. Studies have also been conducted to investigate on the effectiveness of family therapy when it is provided by a single therapist or by a co-therapist.

From various studies, it has been stated that, no major difference has been noted, and that what really mattered is the way in which a certain therapist handled the patient. A number of couples have however shown that, there is lack of continuous trends between the results of co-therapy and those of the single therapy. It is however advisable in terms of economy and efficacy for a therapist to carry our his duties alone. There has been a question as to whether the gender of the therapist had any effects to the presenting partner.

Studies carried out have researched into this area and the results found have shown that, the gender of a therapist has no effect on the outcome of a sex therapy (Goldenberg, 2003). Many clinicians however have been of the view that, a patient who is attended by a therapist of the same sex gains more, due to the fact that the therapist understands the nature of the problem better and is therefore able to address the issue accordingly. Factors Associated with Family Therapy Outcome Various factors have been identified as affecting the results of the family sex therapy in various couples who have different sexual dysfunctions.

The factor relates to the quality of a relationship that a couple has in general. According to Joseph (2006), in most of the couples experiences, it is the woman assessment of the pre-treatment that was normally associated with the results. This is an important aspect to the assessments of any couple, prior to the therapy. It was also identified that, sexual differences had an implication on the likely outcome of a sex therapy, the tendency of the male partners in accepting to join the therapy sessions was influenced by the expected outcome, while this is not the case with the female partners.

This finding has been looked at s appropriate to assessment, and is explained in terms of the model of sexuality which is embodied in the therapy or in the sense that, the way in which the process of therapy is structured is more acceptable to the female partners than it is to the male partners such that, a man is willing to engage in the therapy process, only if he is sure that he will benefit from the sex therapy. Certain factors have also been pointed out as having an impact of the therapy outcome with regard to an individual’s sexual dysfunction.

The general relationship, the attraction and interpersonal way of communication, ease and confidence of a couple has direct implication on the success of the treatment that is provided, where the female is suffering from lack of sexual desire. Where a couple were going through treatment of erectile dysfunction, researchers have found that the outcome is largely affected by the pre-treatment given to a woman with regard to sexual enjoyment and interest.

Studies show that, treatment should concentrate on the interest of both partners if the best results are to be realized. There may be challenges with regard to couples who may be from poor socio-economic status due to the fact that, such couples may not be able to attend the therapy sessions evenly. The Long-term Outcomes of Family Therapy Researchers have conducted various studies by looking into the short term and long term effects of sex therapy from various couples in the U. S, through the use of uncontrolled study.

It has been shown that, consistent findings were arrived at by various researchers and they stated that, where the results of erectile sex therapy were effective and accurate in the short run, such effects would be sustained by the men in the long run. Goldenberg (2005) observed that, with regard to premature ejaculation, the immediate positive results from the sex therapy were not sustained by most of the male partners. The results for the female partners with regard to sexual desire were only prevalent in the short run and disappointing in the long run.

The long term effects for the vaginismus were however seen to be excellent. Couples both in the U. K and in the U. S reported that, the outcome of a sex therapy worked out so well where there was a persisted follow up by a therapist. The U. S study specifically showed that, where marital adjustment had been realized at the initial stages of the therapy, a good follow up would ensure that sustainable improvement of the marital adjustment was prevalent.

Couples also reported that, one of the factors that contributed to the persistent of the therapy outcome was having a clear communication among the partners concerning the problem, applying techniques and practices which the couple learned during the therapy, and in situations where couples had positive attitudes and acceptance of each other. Group Family Therapy The practice of group treatment was common in the 1980s and the 1970s, especially with regard to women who suffered from orgasmic dysfunction. Programs were set up where the women would benefit from interacting with each other, and masturbation programs were offered.

Men with erectile issues were also put under specific programs where social interaction was allowed and social skills were offered. Study has shown that, the outcomes of this group treatments were good and effective. Individual partners have been put in the specific groups of sexual dysfunction and treated there. Evidence has shown that, such individuals have benefited by recovering from the sexual dysfunction and improving their attitudes. Goldenberg (2005) posited that, group treatment is also applicable in treating couples who suffer from similar sexual dysfunction and mixed sexual dysfunctions.

Treatment of a couple in a group where both of the partners had a sexual dysfunction was held to have the same outcomes compared to treating each person as an individual in a group setting. However, findings have shown that, a person responds better in group treatment at the early stages of the therapy where they can later be moved to a couple treatment. Despite the positive indications of the group treatment, many couples have shown a preference for individual treatment as opposed to group treatment.

Group treatments have been limited by various factors such as, the attractiveness of different partners of differing couples, issues of confidentiality, and the difficulty of follow up from a therapist with regard to a specific couple. Bibliotherapy as a Strategic Model This is a method of sex therapy, where instruction manuals are put in place to help the couples solve the issue of sex dysfunction. In this type of approach, couples are issued with instruction manuals or other similar materials such as the videotaped form of instructions.

Goldenberg (2003), has argued that if such method was effective, it would be very appropriate as it would reduce cost and save a lot of time for the therapists. Controlled studies done on this area have shown that, couples who do not have any major issues in their relationship have shown effective outcome by use of the bibliotherapy instructions. However, for such treatment to be accurate, it has been proved that, there is need to have limited contacts between the individual or a couple who is being treated either by use of a face to face communication or telephone communication with the therapist for more direction and instructions.

However, unless a couple has minor problems, use of instruction manuals without the guidance of a therapist may not be effective. Combination of Marital Therapy and Sex Therapy Studies have shown that, in order to attain the best outcome with regard to sex therapy where a couple has a difficulty in their general relationship, it is important to include the marital therapy, so as to come out with effective results.

This however depends on the couple. while the method may work out for a certain couple, it may not necessarily work out for the other couple. Studies have researched the area where couples who suffer from mixed sexual dysfunction received the marital and sex therapy separately, it has been found that, sexual therapy is effective to help in both marital and sex adjustments.

However, the marital therapy has shown that, it only helps a couple or an individual to make marital adjustments but does not play part in helping an individual or a couple to make sexual adjustment. Goldenberg (2005) showed that, it was important to provide marital therapy in certain cases before the sexual therapy can be offered in cases where the sexual dysfunction problem of a couple is so severe such that, they even consider that separation would be the best option.

An effective outcome was realized where both the marital and sexual therapy were provided as opposed to sex therapy that was followed by placebo forms of treatment. Joseph (2006) had a contrasting view where he expressed that, during the marital therapy process, effective sexual adjustments were seen as opposed to situations where only sexual therapy was offered separately, he argued that sexual therapy alone is not effective in realizing sexual adjustments and in solving problems in the general relationship of a couple.

Joseph (2006) therefore argue that, most couples who have sexual dysfunction problems are distressed in their relationships, and that it is appropriate and important to first solve the problem of a general relationship before solving the problem of sexual dysfunction, if the long term outcome is to be realized. Application of Family Therapy in other Areas Sexual Dysfunction in Victims of Sexual Abuse Female adults who have had a bad experience of of sexual abuse in their early childhood may develop phobia and negative attitudes towards sexual activities. This creates a problem of arousal and lack of sexual interest to the woman.

A comprehensive cognitive behavioral approach program is important to help such women overcome these difficulties. The women may be accompanied by their spouses, where the cognitive treatment may be accompanied by treatment for interpersonal and mood problems. Before initiating conjoint therapy for sex, individual group treatment may be more effective to begin with. Sexual Disorders Caused by abuse of Alcohol Abuse of alcohol has been characterized as one of the leading factors that cause sexual disorders such as, low sexual desire and erectile problems in men.

The effects are also present among the female partners. The effects are persistent even after a person stops the intake of Alcohol at a later stage. The treatment approach evaluated for such people and especially men, is the individual family group treatment, where education is offered, homework assignment is given which includes training of masturbation, and role play in the area of social behavior. The outcome of such treatment showed that, the men had shown a positive improvement of attitudes and sex education.

This approach has been rated as good when compared with the group control, and is recommended for critical alcohol abuse. Erectile Dysfunction Physical Treatments The practice of use of physical methods to treat the erectile dysfunction has been common in the recent years. Family therapy has recommended the injection of intracavernosal of the vasoactive drugs, the use of yohimbine, vacuum devices have also been used as physical methods of treating erectile dysfunction.

Studies have shown that, intracavernosal injections are the most commonly used methods and are effective, though other drugs are used such as the prostaglandin E. Unfortunately, controlled studies with regard to treatment of this area has not been conducted so as to give the accurate outcome of this physical treatment. The vacuum devices have been used to create erection where a vacuum is created around the penis by use of a plastic cylinder using a pump. The device may later be removed, but a person is able to sustain the erection.

Yohombine is treatment given in the oral form, and has had a positive outcome though in fewer cases especially in psychogenic. Such treatment must be focused on attaining the psychological needs of the patient failure to which the results may be poor. Conclusion Family therapy has played a big role in ensuring existence good general relationship of a couple, by ensuring that communication is enhanced, a couple has the best skills for solving problems and that sex therapy is provided to deal with sexual disorders.

The important aspect in dealing with sexual dysfunction problem, is the availability of psychiatrists who are well trained and skilled in the application of the best methods and strategies of dealing with the sex dysfunction problem including use of a comprehensive program that is cognitive for treatment, that is important to help in overcoming such difficulties (Goldenberg, 2006).

There is need to train psychiatrists on the best skills of assessing the problem and on the application of the best strategies to deal with the problem. Unfortunately, it has been shown that only a small group of psychiatric trainees have had the chance to attend to such trainings (Joseph, 2006).

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