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Downloaded by [New York University] at 03:52 14 August 2016 SYSTEMIC SEX THERAPY This comprehensive textbook, intended for graduate students in couple and family ther- apy programs as well as for clinicians of diverse orientations, offers descriptive discussions of sex therapy based on the Intersystem Approach, as developed by Gerald R. Weeks. The Intersystem Approach considers the biology, psychology, couple dyad, family-of-origin, and larger contextual factors of any sexual disorder or issue. It is grounded in systems theory and represents a new understanding of human sexuality and sexual problems. Appropriate for anyone who wants to progress to a more comprehensive and integrative understanding of sexual dysfunctions, this text will teach the reader how to treat the couple, rather than the individual. Now in a second edition, Systemic Sex Therapy presents 12 updated chapters and two new chapters, bringing the material up-to-date with the DSM-5. Each chapter examines the defi - nition and description of a disorder, its etiology, assessment, treatment, research, and future directions. Experts in the fi eld discuss issues ranging from pharmacology, sexual compulsiv- ity, and therapy with lesbian and gay couples, to chapters on male and female lack of desire. A standard text in the fi eld, Systemic Sex Therapy integrates couple and sex therapy to inform the treatment of sexual problems, and to give beginning and experienced clinicians the abilities and confi dence they need to produce viable change in their patients’ lives. Katherine M. Hertlein , Ph.D., is an associate professor and Program Director of the Marriage and Family Therapy program at the University of Nevada, Las Vegas. She has published over 50 articles, six books, and 25 book chapters over the course of her career. She pres- ents nationally and internationally on sex, technology, and couples. Gerald R. Weeks, Ph.D., ABPP, is a certifi ed sex therapist with 30 years of practice experi- ence, and is a professor at the University of Nevada, Las Vegas. He is among a handful of Downloaded by [New York University] at 03:52 14 August 2016 individuals to be given the “Outstanding Contribution to Marriage and Family Therapy” award in 2009 from the American Association of Marriage and Family Therapy, and was named the “2010 Family Psychologist of the Year.” He has published over 20 books in the fi elds of individual, couple, family, and sex therapy. Nancy Gambescia , Ph.D., is a certifi ed sex therapist with 35 years of practice experience, and is the Director of the Postgraduate Sex Therapy Program at Council for Relationships in Philadelphia, Pennsylvania. She also maintains a private practice specializing in relation- ship and sex therapy in Rosemont, Pennsylvania. Dr. Gambescia has published numerous book chapters, journal articles, and fi ve books on couple and sex therapy. This page intentionally left blank Downloaded by [New York University] at 03:52 14 August 2016 SYSTEMIC SEX THERAPY Second Edition Edited by Katherine M. Hertlein, Gerald R. Weeks, and Nancy Gambescia Downloaded by [New York University] at 03:52 14 August 2016 Second edition published 2015 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Routledge is an imprint of the Taylor & Francis Group, an informa business © 2015 Taylor & Francis The right of the editors to be identifi ed as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice : Product or corporate names may be trademarks or registered trademarks, and are used only for identifi cation and explanation without intent to infringe. First edition published by Routledge 2008 Library of Congress Cataloging-in-Publication Data Systemic sex therapy / [edited] Katherine M. Hertlein, Gerald R. Weeks, Nancy Gambescia. — Second edition. p. ; cm. Preceded by: A clinician’s guide to systemic sex therapy / Katherine M. Hertlein, Gerald R. Weeks, Shelley K. Sendak. c2009. Includes bibliographical references and index. I. Hertlein, Katherine M., editor. II. Weeks, Gerald R., 1948– , editor. III. Gambescia, Nancy, editor. IV. Hertlein, Katherine M. Clinician’s guide to systemic sex therapy. Preceded by (work): [DNLM: 1. Couples Therapy—methods. 2. Marital Therapy— methods. 3. Sexual Dysfunction, Physiological—therapy. 4. Sexual Dysfunctions, Psychological—therapy. WM 430.5.M3] RC488.5 616.89′1562—dc23 2014037579 ISBN: 978-0-415-73821-7 (hbk) ISBN: 978-0-415-73824-8 (pbk) ISBN: 978-1-315-81752-1 (ebk) Typeset in Sabon by Apex CoVantage, LLC Downloaded by [New York University] at 03:52 14 August 2016 TO ERIC HERTLEIN —KH TO NANCY LOVE —GW TO MICHAEL, MATT, AND LAUREN—WITH LOVE —NG Downloaded by [New York University] at 03:52 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:52 14 August 2016 CONTENTS About the Editors xvii Contributors xix Preface xxiv Target Audience xxiv Purpose and Theoretical Framework xxiv Chapter Outline xxvi Changes From the Previous Edition xxvii Organization of the Text xxvii Acknowledgments xxxi SECTION 1 The Basics of Sex Therapy 1 1 What Every Sex Therapist Needs to Know 3 JANE RIDLEY Introduction: Resilience of the Therapist 3 Sexuality and Sexual Behavior: Social Norms 5 Sexual Minorities 6 The Ageing Population 6 Sexual Abuse, Rape, Domestic Violence 7 Conceptualizing Sexual Diffi culties 7 The Anatomy and Physiology of Sexuality 8 The Impact of the Internet 8 The Sexual Response Cycle 9 Downloaded by [New York University] at 03:52 14 August 2016 The Four Phases and Two Physiological Changes 9 Male/Female Similarities and Differences 9 The Signifi cance of Desire 10 The Analytic Contribution 10 Cognitive Behavior Therapy (CBT); Eye Movement Desensitization and Reprocessing (EMDR) and Mindfulness 11 The Complex Female 11 The Dual Control Model for Men 12 Balancing Medical Aspects of Sexuality 12 vii CONTENTS Conclusion 12 References 13 2 The Current Profession of Sex Therapy 17 PEGGY J. KLEINPLATZ The History of Sex Therapy 17 Recent Trends in the Field 19 The Medicalization of Sexual Problems 20 Responses to Medicalization 22 Professional Sex Therapy Associations 23 The Personal and Professional Process of Becoming a Sex Therapist 24 Ethical Principles of Sex Therapy 25 Is Sex Therapy a Distinct Modality? The Case for Certifying Professionals 26 Conclusions 28 Resources 28 References 28 3 Toward a New Paradigm in Sex Therapy 32 GERALD R. WEEKS AND NANCY GAMBESCIA The Lack of Integration in Couple and Sex Therapy 32 Traditional Sex Therapy Is Non-systemic 32 The Lack of Theory in Sex Science, Research, and Practice 33 The Lack of Integration in Professional Organizations 34 The Lack of Integration of Sex and Couple Therapy Practice 35 The Intersystem Approach 36 Major Domains of the Intersystem Approach 36 Integrational Constructs of the Intersystem Approach 38 Theory of Interaction 38 Intrapsychic Components of the Theory of Interaction 40 Interactional Components of the Theory of Interaction 40 Triangular Theory of Love 42 Attachment Styles 42 Bringing It Together: An Integrative Paradigm 43 Case Example 44 Intersystem Domains 44 Downloaded by [New York University] at 03:52 14 August 2016 Individual 44 Couple 44 Family-of-Origin 45 External Factors 45 Sternberg’s Triangular Theory of Love Constructs 45 Commitment 45 Intimacy 45 Passion 45 Theory of Interaction Constructs 46 Interpretation 46 viii CONTENTS Defi nition 46 Prediction 46 Congruence 46 Interdependence 46 Attribution 46 Attachment Style Constructs 47 Suggestions for Moving Toward Greater Integration 47 Envision Sexual Problems From an Expansive, Multivariate Framework 47 Expand the Context of Treatment Beyond the Use of Medications 47 Expand Clinical and Research Realms by the Use of: (1) Comprehensive Conceptual Frameworks, (2) Theoretical Models, and (3) Metatheoretical Issues 48 Facilitate Movement Away From Theoretical Purism 48 Conduct More Research on the Interface Between Diversity and Sexual Problems 49 The Future of Theory in Sex Therapy 49 Note 50 References 50 SECTION 2 Treatment of Specifi c Disorders 53 4 Male Hypoactive Sexual Desire Disorder 55 KATHRYN HALL Prevalence 56 Comorbidity With Other Sexual Dysfunctions 57 Etiology 57 Individual Medical Factors 57 Individual Psychological Factors 58 Intergenerational Factors 58 Interactional/Relationship Factors 59 Assessment 60 Diagnostic Dilemmas 60 Assessment Tools 61 Treatment 64 Downloaded by [New York University] at 03:52 14 August 2016 Case Vignette 67 Treatment Effi cacy—Research and Future Directions 67 References 68 5 Systemic Treatment of Erectile Disorder 72 NANCY GAMBESCIA AND GERALD R. WEEKS Diagnostic Criteria 72 Differential Diagnosis 73 Prevalence 73 ix CONTENTS The Intersystem Approach 74 Intersystemic Assessment 74 Individual Biological Issues 74 Individual Psychological Factors 75 Intergenerational Infl uences 76 Environmental Considerations 76 The Sex History 77 Intersystemic Treatment 78 Medical Treatments 79 Noncompliance With Medical Therapies 81 Psychological Treatments 81 Promoting Systemic Thinking 82 Reframing the Symptom 82