Treating Couples Versus Individuals
In Human Sexual Inadequacy, Masters and Johnson also advocated conjoint marital-unit therapy, or therapy where both partners are present. Their rationale for this is that both partners in a relationship where there is sexual dysfunction are involved, and that sexual response represents interaction between two people. To isolate a husband or wife from their partner in therapy, is eliminating the crucial factor and ignoring the inherent interactive nature of sexual functioning. Without the involvement of the theoretically “uninvolved” partner, Masters and Johnson believed that the therapy might actually be rendered ineffective due to that partner’s lack of knowledge and understanding of the process, and finally due to their frustration. In fact, the treatment for sexual dysfunction often requires the actual participation of the “functional” spouse. Masters and Johnson went as far as to refer to the couple, rather than the dysfunctional spouse, as “the patient.”
In The New Sex Therapy, Kaplan agrees that both partners should be treated as a couple, primarily because the treatment requires the cooperation of the two sexual partners. She also notes that many of the sexual difficulties between couples are rooted in their pathological system, the product of the couple’s disturbed interactions —another important reason for involving both partners in therapy. However, Kaplan also remarks that sometimes a person’s sexual dysfunction is primarily intrapsychic, and antedates the current relationship, and that there are those who “couldn’t function within any system.” (p. 236. Kaplan) This person’s sexual dysfunctions should be considered independent of their marital relationship; however, Kaplan believes that both partners should still be involved in therapy because “shared sexual experiences are a crucial ingredient of treatment.” (p. 236. Kaplan)
Although there is a strong argument for treating couples versus individuals, there are some cases where individual sex therapy is necessary and even preferred. It is not uncommon for individuals who are not involved in a committed relationship to seek sex therapy. Some of these individuals may even have a lot of anxiety about sex that prevents them from developing a sexual relationship. In other cases, perhaps a sexual partner is not able to attend therapy sessions for one reason or another. Or maybe, a person’s sexual dysfunction predates their current relationship, as I mentioned above, and is clearly the result of their own history, perhaps a traumatic sexual experience or a severely moralistic upbringing, and they feel they could use individual therapy to work on some of their issues without a partner present.
Several kinds of treatment have been successful in curing a variety of sexual dysfunctions in individual therapy. For example, systematic desensitization, rational emotive therapy, and masturbation therapy, have all been successfully used to treat pre-orgasmic women. A 1972 study done in treating pre-orgasmic women, where one sample was assigned joint treatment, and the other, individual treatment, found that there were no significant differences on all of the dependent measures. These measures included “reduction in sexual anxiety, increase in coital frequency and enjoyment, and increase in frequency of orgasm through coital and non-coital stimulation.” (p. 79. LoPiccolo)
Moreover, individual therapy allows the therapist to put all of their focus on the one client. This could be significant, in that a client may feel they need the undivided attention of the therapist and in conjoint therapy, they would have to share the time with the therapist. The strong argument for conjoint sex therapy seems to be overly focused on mainstream monogamous heterosexual relationships, as if these are the only people who might be seeking treatment for sexual dysfunctions. Individual sex therapy allows a person to work on his or her own sexuality, and their relationship to themselves, which in turn will have an effect on their sexual relationships with others.
Hartman, William E. and Fithian, Marilyn A. Treatment of Sexual Dysfunction: A Bio-Psycho-Social Approach. New York: Jason Aronson. 1974. pp 268.
Masters, William H. and Johnson, Virginia E. Human Sexual Inadequacy. Boston: Little, Brown, and Co. 1970. pp 384.
Kaplan, Helen Singer. The New Sex Therapy: Active Treatment of Sexual Dysfunctions.
New York: The New York Times Book Co., Inc. 1974. pp 544.
LoPiccolo, Joseph and Leslie. Handbook of Sex Therapy. New York: Plenum Press. 1978. pp 531.