Downloaded by [New York University] at 04:00 12 August 2016 a CLINICIAN’S GUIDE to SYSTEMIC SEX THERAPY

Downloaded by [New York University] at 04:00 12 August 2016 A CLINICIAN’S GUIDE TO SYSTEMIC SEX THERAPY The second edition of A Clinician’s Guide to Systemic Sex Therapy has been com- pletely revised, updated, and expanded. This volume is written for beginning psychotherapy practitioners in order to guide them through the complexities of sex therapy and help them to be more effi cient in their treatment. The authors offer a unique theoretical approach to understanding and treating sexual problems from a systemic perspective, incorporating the multifaceted perspectives of the individual client, the couple, the family, and the other contextual factors. Both beginning and experienced sex/relationship therapists will broaden their perspectives with the Intersystem approach and gain information rarely seen in sex therapy texts such as: how to thoroughly assess each sexual disorder, the implementation of various treatment principles and techniques, how to incorporate homework, dealing with ethical dilemmas, understanding dif- ferent expressions of sexual behavior, and addressing the impact of medical problems on sexuality. Aside from bringing the diagnostic criteria up-to-date with the DSM 5, this new edition contains a new chapter on sensate focus, an expanded section on assessment, more information about development across the lifespan, and more focus on diversity issues throughout the text. Gerald R. Weeks, PhD, APBB, CST, is a certifi ed sex therapist with 30 years of practice experience and is a professor at the University of Nevada, Las Vegas. He is among a handful of individuals to be given the “Outstanding Contribution to Mar- riage 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. Downloaded by [New York University] at 04:00 12 August 2016 Nancy Gambescia, PhD, CST, 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 relationship and sex therapy in Rosemont, PA. Dr. Gambescia has published numerous book chapters, journal articles, and 6 books in couple and sex therapy. Katherine M. Hertlein, PhD, is a professor and Program Director of the marriage and family therapy program at the University of Nevada, Las Vegas. She has published over 50 articles, 7 books, and 25 book chapters over the course of her career. She presents nationally and internationally on sex, technology, and couples. “Written by master sex therapy clinicians, this second edition surpasses its predecessor by offering up-to-date research and clinical insight, making a compelling case for its use for systemic sex therapy with couples experiencing sexual problems. This text will serve as an outstanding resource for all clinicians, particularly those heavily entrenched in working with individuals and couples. It is an invaluable text for both beginners and seasoned practitioners. I applaud the authors on producing a masterful work and strongly recommend it.” —Frank M. Dattilio, PhD, ABPP, works in the department of psychiatry at Harvard Medical School “It is a pleasure to endorse such a strongly resourced, credible, and contemporary resource for the practicing sexual and relationship therapist. Throughout the text, the authors emphasize the crucial awareness yet problematic dichotomy between psychological and physiological states alongside relational and other factors that contribute to sexual functioning. The text offers practical tips, guidance and tools from a strong clinical background with clear emphasis to systemic practice. Key signposting throughout the text makes this especially meaningful to the audience of modern society with key literature sharing space with other media resources.” —Professor Kevan Wylie, MD FRCP FRCPsych FRCOG FECSM, is a consultant in sexual medicine, Sheffi eld, and President, World Association for Sexual Health “There are three reasons why you should read A Clinician’s Guide to Systemic Sex Therapy. It is the only book that places sex therapy squarely within a family systems approach. In other words, it focuses not only on the mechanics and biology but also on the couple relationship. Second, it is among the most comprehensive books on sex therapy with sections on diversity, diagnosis and ethics. Finally, as the title suggests, it is the most practical text available with cutting edge techniques described in detail and updated for DSM-V. Every clinician working with couples needs this book.” —Mark E. Young, PhD, works at the Marriage and Family Research Institute at the University of Central Florida “The only book you need to practice effective sex therapy. Drs Weeks, Gambescia, and Hertlein have improved on their original gem and expanded their integrated model to include the latest diagnostic categories of the DSM 5. The authors show how to treat sexual problems within the context of the couple relationship and not as an unconnected ‘plumbing’ problem. This easy-to-use guide that addresses the gamut of sexual and rela- Downloaded by [New York University] at 04:00 12 August 2016 tionship issues belongs on every clinician’s bookshelf.” —Jon Carlson, PsyD, EdD, ABPP, CST, is a Distinguished Professor of Adlerian Psychology at Adler University in Chicago “This is much more than a ‘Guide.’ The term ‘guide’ is really a humble misnomer. This is in the true term of the word a veritable encyclopedia of all you want to know and need to do systemic sex therapy. Beginning students as well as seasoned professionals will be brought up to date in all the myriad of possible information that makes this humbly-called ‘guide’ a classic source of information and knowledge about sex therapy. I wish I had it when I fi rst started doing couple therapy.” —Luciano L’Abate, PhD, ABEPP, is Professor Emeritus of Psychology at Georgia State University A CLINICIAN’S GUIDE TO SYSTEMIC SEX THERAPY Second Edition Gerald R. Weeks, Nancy Gambescia, and Katherine M. Hertlein Downloaded by [New York University] at 04:00 12 August 2016 Second edition published 2016 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2016 Taylor & Francis The right of Gerald R. Weeks, Nancy Gambescia, and Katherine M. Hertlein to be identifi ed as authors of this work has been asserted by them 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 utilised 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 2009 Library of Congress Cataloging-in-Publication Data A catalog record has been requested for this title ISBN: 978-0-415-73840-8 (hbk) ISBN: 978-0-415-73839-2 (pbk) ISBN: 978-1-315-81739-2 (ebk) Typeset in Bembo by Apex CoVantage, LLC Downloaded by [New York University] at 04:00 12 August 2016 To Nancy, for the love you bring to my life . — GW To Matt, Lauren and Michael, with love — NG To Adam, for fi lling my life with joy — KH Downloaded by [New York University] at 04:00 12 August 2016 This page intentionally left blank Downloaded by [New York University] at 04:00 12 August 2016 CONTENTS Preface xvi Chapter Overview xix References xxi Acknowledgments xxii 1 The Intersystem Approach to Sex Therapy 1 Theory and Integration in Couple Therapy 1 Moving Toward Theoretical Integration 2 Intersystem Theory and Application 3 Intrapsychic Components 4 Interactional Components 5 Understanding Etiology and Treatment within the Intersystem Approach 8 Individual/Biological 8 Individual/Psychological 9 Downloaded by [New York University] at 04:00 12 August 2016 The Dyadic Relationship 9 Family-of-Origin Infl uences 11 Contextual Factors 12 Conclusion 13 References 14 2 Diagnosis of Sexual Disorders 16 Introduction 16 viii Contents Diagnosing with the DSM-IV-TR and DSM-5 17 Specifi ers 18 Overview of Sexual Disorders in DSM-5 19 Sexual Interest/Arousal Disorder 19 Male Hypoactive Sexual Desire Disorder 20 Erectile Disorder 20 Premature (Early) Ejaculation 21 Delayed Ejaculation 21 Female Orgasmic Disorder 22 Genito-Pelvic Pain/Penetration Disorder 22 Limitations of the DSM Diagnostic Categories 22 Disorder versus Problem 23 Etiology: Physiology versus Psychology 24 Comorbidity with Other Conditions 24 Individual or Relational Problems 25 Clinical Judgment 26 Sexual Problems Not Currently in the DSM-5 27 Sexual Compulsivity, Addiction or Hypersexuality 27 Gender Nonconformity 28 Persistent Genital Arousal Disorder 28 Diagnosis from the Intersystem Perspective 29 References 29 3 Intersystem Assessment of Sexual Disorders 32 Introduction 32 The Biphasic Assessment Process 33 The Sexual History 35 The Intersystem Sexual History 37 Individual Physiological 41 Individual Psychological 42 The Relationship 42 Intergenerational Factors 43 Downloaded by [New York University] at 04:00

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