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Home , Premature ejaculation, Sex therapy

Issues in Religion and

Volume 8 Number 1 Article 5

1-1-1982

Sex Therapy With LDS Couples

D. Corydon Hammond

Robert F. Stahmann

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Recommended Citation Hammond, D. Corydon and Stahmann, Robert F. (1982) " With LDS Couples," Issues in Religion and Psychotherapy: Vol. 8 : No. 1 , Article 5. Available at: https://scholarsarchive.byu.edu/irp/vol8/iss1/5

This Article or Essay is brought to you for free and open access by the Journals at BYU ScholarsArchive. It has been accepted for inclusion in Issues in Religion and Psychotherapy by an authorized editor of BYU ScholarsArchive. For more information, please contact [email protected], [email protected]. SEX THERAPY WITH LDS COUPLES D. Corydon Hammond,· Ph.D. and Robert F. Stahmann,· Ph.D. Presented at the AMCAP CONVENTION 2 October, 1981

Recently, Allen Bergin in his President's Message in focused directly on the drinking itself. with disastrous the Spring 1981 AMCAP Newsletter presented a consequences. In our experience, both alcoholism and statement of his views on sex therapy suggesting that it sexual dysfunctions require direct attention to the merely represents "modern sensual technologies" which "symptom." Unfortunately many counselors, due to "too frequently offer sensual substitutes for genuine personal inhibition or lack of professional knowledge, intimacy" (1981a, p.1). It is our belief that Or. Bergin has avoid discussing sexual issues. Even more seriously, presented an extreme view which some members may some counselors refuse to refer patients to competent have misinterpreted as an AMCAP position paper rather professionals, or merely "educate" clients with their than an individual's opinion. The authors, having personal folk concepts and biases. specialized in the treatment of as 1t is very true that some sexual problems originate well as in marital therapy, will present an alternative from marital discord. Many couples seeking sex therapy viewpoint on the value and need for sex therapy among also need marital therapy, which we employ prior to LOS couples. focusing on the sexual dysfunctions. However, in most instances, sexual dysfunctions will not resolve The Need for Sex Therapy themselves even if the relationship improves. Sexual dysfunction is an exceptionally common This has been documented by various prominent sex marital problem, and one that is often neglected in the therapy authorities (Masters & Johnson, 1970; Kaplan, treatment of troubled couples. In studying 750 couples 1974) who have noted that once the vicious cycle of fear receiving marital therapy, Greene (1970) found that of sexual failure is set in motion, the original cause of the 80% were sexually dissatisfied; and Sager (1976) sexual dysfunction need no longer operate to cause the estimated that 75% of couples in marital therapy have a problem to be perpetuated in a marit~1 relationship. sexual dysfunction. In a sample of 142 family medicine One of the authors recalls a middle-aged LOS couple patients, Moore and Goldstein (1980) learned that 21% who requested sex therapy because the husband was identified a problem with inhibited sexual desire. In their experiencing . They had been in sample, 13% reported being unable to achieve , therapy for almost four years with four different 13% rated their partner as having premature therapists, and each therapist had offered them the same , and 13% experienced (pain with opinion: "The sexual problem is just symptomatic of intercourse). It has been 's estimate relationship problems, and as you improve the that one of every two couples struggles with a sexual relationship and communicate better it will resolve dysfunction. itself." The presenting complaint was never dealt with A widespread myth exists, however, in LOS culture. directly. The couple felt that they had a moderately good The myth is that sexual problems are only a relationship to begin with, but after four years of manifestation of marital discord and conflict. Therefore, therapy they agreed that their relationship had if the relationship is enhanced, the sexual dysfunction improved and was even better. Nonetheless, the sexual will automatically resolve itself. Bergin (1981b) has dysfunction WdS even more severe and was the cause of subscribed to this premise and expressed his belief in the gredt frustration and pain to the couple. superiority of a relationship-oriented therapy over sex Another young couple sought sex therapy after only a therapy in treating sexual concerns. This is reminiscent few months of marriage because the husband was of an outdated psychoanalytic concept which, for unable to ejaculate during sexual relations with his wife. example, approaches alcoholism as only a symptom of They were deeply in love, had been married in the historical conflicts and underlying pathology. According temple, and essentially were still on the honeymoon. to this position, if historical conflicts are resolved, the Nevertheless, a dysfunction existed. He had come from alcoholic will automatically stop drinking. Operating on an LOS home, but his two older brothers had gotten this assumption, the psychoanalyst has traditionally not their girlfriends pregnant and had to get married. He recalled vividly the anguish of his mother, and her threat "Brother Hammond is an Associate Professor and Co­ to disown and never speak to him again if he followed in Director of the Sex and Marital Therapy Clinic. their footsteps. Throughout his dating and courtship he University of Utah Medical School. Brother Stahmann was very proper, and he also never indulged in is Professor, Family Sciences and Director of the . However, after marriage he was unable Marriage and Family Graduate Program. Brigham to dispel overnight his previous limits. Furthermore, his Young University. He has also served six months as a wife experienced serious pain during intercourse, whkh Visiting Professor at the Sex and Marital Therapy also caused him great concern and preoccupation. Part of Clinic, U. of Utah Medical School. her dyspareunia appeared to be caused by the "horror"

13 AMCAP JOURNAL/JANUARY 1982 stories she had been told by her recently married and generally inaccurate statement that, "We have girlfriend about how painful sex was for her. hastened to turn people into sensual acrobats with Gynecologic evaluation also revealed' an organic criteria for judging success being established mainly on a problem which required minor surgery. Conjoint sex physiological base" (p. 13). He then quoted from Levine therapy followed the surgery and was successful in less and Agle (1978) only a portion of their criteria for sexual than three months. Emotional intimacy and personal improvement and reaching,. in our opinion, an righteousness had not safeguarded them against unjustified conclusion: "Such criteria mislead therapists dysfunction. and clients into targeting their efforts on sensual Sexual Dysfunction in Happy Couples performances rather than upon the relationship In the authors' experience, sexual problems are often qU~"lIes that are necessary for positive and lasting not a manifestation of marital discord and conflict. It is mtlmacy. It has been assumed by many therapists that not at all uncommon for dysfunctions to be present in either (a) the relationship in which sex occurs, its otherwise happy . At the Sex & Marital permanence or moral quality is not the therapist's Therapy Clinic at the University of Utah Medical School. business since he or she is a technician, or (b) the quality we have seen many relatively newlywed LOS couples as of the relationship is important; but that improving sex well as several members of stake presidencies, will improve the relationship" (p. 13). numerous bishops, and stake high councilors. In the vast Unfortunately, in selectively quoting from levine and majority of instances their overall marital relationship Agle (1978) their criteria were misrepresented. In the and communication were very good, but they still paragraph immediately prior to the one quoted by suffered with sexual dysfunctions. They were grateful Bergin, levine and Agle (1978) stated, "There are at to receive sex therapy and enthusiastic about its results. least two sets of distinct standards for success in therapy In the Nrw EI/glanil Jourl/al of Medic;lIr Frank, Anderson for any sexual dysfunction." Their first standard, also and Rubenstein (1978) presented the results of a study cited prior to that which Bergin quoted, was: "The of well-educated, white, middle-class couples-­ patient or couple should become aproblematic in the volunteers from church and community groups who areas of desire, performance alld .motiollal satisfaclioll" were not involved in therapy. The couples felt that their (emphasis added) (p. 236). Furthermore, in the results of marriages were working and they were definitely above their study, they found that "Of the 30 spouses, 24 average in marital satisfaction compared with the reported significant gains in nonsexual areas. These general population (83% rated their marriages as "very included freer communication and mutual happy" or "happy"). Despite the high degree of marital understanding, increased closeness, more 'self happiness, 63% of the women and 40°'0 of the men understanding'" (p. 24 Il. Furthermore, the couples they reported a sexual dysfunction, and sexual "difficulties" selected for study felt they did not have marital were described by 77% of the women and 50°'0 of the problems which were causing erectile dysfunction, and men. Among the women, 48°'0 had difficulty getting expressed that they were committed to their marriages. sexually excited, 33% had difficulty maintaining As clinicians, we have found that in fact the majority excitement, 46°'0 had difficulty reaching orgasm, and of relationships do improve when sexual functioning 1500 were unable to experience orgasm. Among the Improves, although if there appear to be marital conflicts men, 70'" reported difficulty getting an , 9% had which are causing sexual problems, we always employ difficulty maintaining an erection, 36% ejaculated too marital therapy before proceeding with sexual quickly, and 4"·., had difficulty being able to ejaculate. In counseling. Of the dozens of sex therapists the authors regard to sexual "difficulties," 47% of the women and have profeSSionally associated with, the vast majority 12'\, of the men were unable to relax during sexual emphasize and work to enhance both emotional and sexual intimacy for the couple. involvement. 35°'0 of the women and 16°'0 of the men expressed disinterest in sex, and 28% of the women and Bergin (1981b) further made what we perceive to be 10°" of the men described themselves as "turned off." an extreme statement, "Sex therapy with married The Frank, et al. study illustrates that a sexual couples can induce such concentration on bodily dysfunction does not always have to cause widespread sensations and excitement that the broader issues of disruption of the entire relationship and marital kindness, selflessness, patience, and loyalty are lost. In dissatisfaction. Where there is emotional intimacy and narrow eagerness to obtain sensations, a married couple high satisfaction in other areas of the marriage, some may lose those feelings which compose a broader and couples are successful in tolerating sexual problems deeper relationship" (p. 14). We consider this a generally with minimal disruption by compartmentalizing and distorted perception of the field of sex therapy and insulating them from the rest of the relationship. seldom find this to be true. Na turally, there is more to an However, sexual intimacy and fulfillment are important eternal companionship than sexual expression. A skilled and valued by most couples, and in the authors' sex therapist will not treat the sexual relationship in experience, dysfunction can over a period of time lSolallon, but always attend to the overall emotional frequently cause deep resentment. emotional distance, relationship of the couple. Sex and marital therapy are and deterioration in the marriage. often done in combination. We are pleased that what have been derisively called Sensual Substitute or Catalyst for Intimacy? "sensual technologies" have been developed because Bergin (1981 b) made what seems to us a misleading many couples lack skills, both emotional and sensual, to

AMCAP JOURNAL/JANUARY 1982 14 sensitively and tenderly convey love to their eternal cases, a marriage may even dissolve because of a companions instead of just "having sex." In many partner's unwillingness to continue living with severe couples, we find that sex is perceived as coitus alone; . there is relatively little touching and affection It is likely that some clinicians of questionable ethics exchanged in the marriage. These couples seem to only and training will disregard client values and suggest know how to relate in crude, sexual ways rather than things that would be offensive to lOS couples and other with tender gentleness. In these couples, we might refer moral persons. However, this is not a problem unique to to this unrefined sexual expressiveness and lack of the specialty of sex therapy. Mormon couples must affection as "sexual substitutes for s",sual tenderness always discriminatingly choose therapists who work and genuine initimate expression." with respect for their values and beliefs. One of the It is vital for us to acknowledge that sexual intimacy is characteristics that the authors most prize about J;;>r. also an integral part of marriage. True, many couples William Masters is his extreme emphasis on respe2ful need to learn to be less selfish, and achieve emotional affirmation and acceptance of the patient's moral values intimacy through improved commuication skills. At the when engaging in the clinical practice of se" therapy. same time, however, many of these same couples also Because of his international reputation, Dr. Masters has need to learn how to achieve sexual intimacy and worked with couples of many different cultures and fulfillment. What about those persons who are so religions from all over the world. He emphasizes very unknowledgeable that they are unable to please their strongly the need to work within the value system of the partners and whose partners are too shy to guide them? patient and to "never get anyone in trouble with their For example, we have seen many relationships where God." It is our belief that most mental-health the woman feels taken advantage of and believes that professionals who hav.. specialized in sex therapy adhere her pleasure and fulfillment are unimportant to herself to this philosophy. and her mate. She ends up feeling that it is her duty and The Code of Ethical Standards of the American obligation to "service" him, and feels unloved because he Association of Sex Educators and Therapists (AASECTl is unable to show love tenderly. specifically states: "Sex therapists should be aware of the Our goal must be to assist couples in achieving both personal value system that they introduce into the sexual and emotional-spiritual intimacy. Sexual therapy context and should disclose these values to the expression is for more than just procreation, as taught client when such information is relevant to treatment. by Joseph F. Smith: Moreover, therapists should an)id gratuitously Th~ lawful association of the se"es l~ I.Hd.Jlned of C(~. n~lr enunciating opinions or prescribing values that reflect only elS the sale means of race perpetuattc.m. but for the their personal biases rather than being responsive to the deveolopment of higher facultIes .tnd nubler traits of human needs and well-being of the client'· 'Masters, Johnson, nature. which I,we·in!oplrf>d UlmrJnlllnshlruf mJn Jnd \\t'tm.\n Kolodny, & Weems, 1Q80 p. -1151. In explicating these alonl" can Inspare ISmlth. 101:-. 2,,"1':"'JO views, those specializing in sex th.. rapy ha,·e taken a Sexual intimacy creates a deeper and closer intimacy stronger stand on th.. importance of affirming c1i .. nt and is one of the most powerful ways of communicating values than most other professional groups in their love, affection, and support. President Spencer W. ..thical cod..s. Kimball has addressed this issue on several occasIOns We agree that it is a tra"estv wh.. n an unethical For example, in the April, 1974 General Conference, h.. cliniCIan urges clients to violate th~ir values and stresses quoted with approval the following statement from Billv only phY>lcal t.. chnique and gratificat,on w,th,'ut the Graham: . perspectiv.. "f emotional-spiritu.ll intimacy and resp..ct The Bible celebrates st' .. and Its propt'f USf', prt";entln~ It ,)) fllr the partner's indi,',duality and free agenc),_ In God-crt'dtt"d. C ...-d-orlenlt>d.•JnJ (,l,J·bll·,;>S('J It m"L.."l" pl.lln considering destructi,'" outcnm..s, hll",.. ver, is it .lny less that C':od himself Implantt·d tnt' phY"holl m.l~nt·II':om bt'I\\('('" ~ the sexes for two red sons for the prOpd~alllln llf tnt' human travesty for an ignorant or ,nhibited helping race, and for th~ e"presslon of that kind of Ip\'e beh..... t'f'n mdn professinnal tl) cause Iatrogenic d,lm.lg.. to dl.. nts~ ,nd wift' that makes for true (lneness HI~ (omm.tnd Itl thE' fir.. , On.. llf the authllrs recalls ,1 ynunK lOS c,)uple, man and woman to be "l'nE' flesh" WtlS as Important .1" HI~ mMried In the tl'mple. Th.. h"sb.llld suffered .. j.llulatl'ry command to "bt> frUitful and multlply"/l

15 AMCAP JOURNAL/JANUARY 1982 year, report that after brief sex therapy (8 sessions) they He had gone to a physician to discuss the problem, but are expecting a child and fulfilling an important goal in had been given no information and was referred by the their marriage. Vaginismus is a condition 'that may be physician back to his bishop, who in turn referred him to cured virtually 100% of the time through "sensual the Sex & Marital Therapy Clinic. He did not realize that technology."lt is heartbreaking to see a couple unable to every male spends 20-25% of each night from birth until consummate their marriage because the 45-year-old death having , and that this is a natural husband suffers from primary erectile dysfunction and physiological occurrence for men during their life cycle, has never been able to maintain an erection sufficient for The pattern of having occasional morning erections intercourse, although nothing is physically wrong. We simply meant that he was alive and aware, not depraved. see couples every week who have been frustrated by This limited information greatly relieved him and helped years of sexual rejection, whose temple marriages have him understand both himself and a natural physical gradually deteriorated through hurt, resentment, and occurrence. deprivation. In utter hopelessness some divorce, while a The final level of intervention in the PUSSIT model is few, although married, seek consolation in the arms of a Intensive Therapy. Sex therapy requires the highest lover. level of training and expertIse. The Ethical Standard of Bergin (I981b) wondered about negative effects on Psychologists and the Standards for Providers of children, saying, "The sex therapies become so Psychological Services clearly the ethical preoccupied with pleasure that the consequences for obligation to recognize the boundaries of our marital stability and positive development in the child competence and training as professionals. Practice in a are lost sight of" (p. 14). We find that such a position new area of specialization such as sex therapy ethically cannot be supported. What about the potential impact of requires both a base of thorough knowledge obtained marit.ll di,solution on the children if frustrating sexual through advanced coursework, and supervision in the dysfunctions are not treated' The couples we counsel new specialty area. We deplore the blatantly unethical have often had relationships deteriorate because of trend among helping professionals to teach themselves sexual frustrations until they are unable to model a how to practice sex therapy, usually by attending one healthy relationship for their children or educate them brief workshop and then trying to stay a chapter ahead constructively about the sexual aspect of an eternal of the client couple in reading a sex therapy text. marriage. Our great concern is the negative impact on The ethical practice of sex therapy particularly children of sexually dysfunctional couples who model requIres the non-medical mental-health professional to aloofness and lack of affection. carefully master a complex body of medical knowledge relevant to conducting a thorough assessment. It is vital The Specialty of Sex Therapy for the sex therapist to be knowledgeable concerning Annan (\07,,) described a fl)ur-Ievel PLiSSIT model gynecologicaL urological, endocrinologic, neurologic, fl'C conceptualiZing the levels of intervention which are and vascular impediments to sexual function, as well as needed in treating sexual problems. The first level of the effects of various illnesses and medications on intervention is Permission. It is our hope that all sexuality. Without such a foundation of knowledge counsel"rs, as well as all physicians and other health (Kolodny, Masters & Johnson, 1980) the therapist professionals, will acquire a level of personal comfort cannot differentially diagnose organic from with sexual issues so that they can convey permission to psychogenic dysfunctions, and know when to have discuss sexual concerns to their clients. The next two special medical consultants conduct tests and levels of intervention require more in-depth knowledge evaluations. and training, and essentially comprise what we refer to Dr. Bergin (1 08\bJ noted that psychotherapeutic as a sex-counseling level of work. Limited Information research in general shows "few differences in the effects and Specific Suggestions can often be provided in a short of different techniques" (p. 3), and "in most cases, onlya period of time by the therapist who has studied sexuality modest amount can be attributed to technical factors." and acquainted himself with factual information In the psychotherapy literature, few differences are (Calderone and Johnson, 1081; McCary, 1978; 1973). found in outcome rates between different technical and This information may also include LDS philosophy. theoretical approaches, and most of the variance appears However, we express concern with what LDS to be accounted for by client and therapist counselors may present as Church doctrine. We have characteristics and relationship factors. This evidence often heard of individual Church members passing on does not appear to hold up as welL however, in much of information which reflects their own opinion and the sex therapy research literature. In the treatment of inhibitions about what is acceptable instead of Church vaginismus and , for example, policy. treatment programs using modern sex-therapy There are definitely times when limited information is techniques typically have outcomes of 90-100% all that is necessary to resolve a problem or conflict for a effectiveness, whereas traditional verbal therapies have client. One of the authors remembers receiving a been very ineffective (Stuart & Hammond, 1980; telephone call last year from a young returned Hogan, 1978). Ovesey & Meyers (1968) describe a 30% missionary. He was feeling very guilty and thinking he effectiveness rate in treating retarded ejaculation by was over-sexed, "carnaL sensuaL and devilish" because psychoanalytic therapy, while more recent sex-therapy he awakened with erections several mornings a week. compltttd on pagt 27

AMCAP JOURNAL/JANUARY 1982 16 for selecting competent referral sources in the area of sex therapy rests with counselors and clients. As in phychotherapy in general, we must counsel clients to question therapists as to whether they are willing to work respectfully within the client's value framework. LOS clients must further be educated to assertively speak up with therapists if they are insensitive to their values, and if this continues, to terminate therapy and seek help elsewhere. We do not believe, however, that AMCAP should be in the business of prescribing acceptable therapeutic approaches, either in sex therapy, psychotherapy or marital therapy. We hope that more LOS counselors will pursue specialty training and supervision in sex therapy, and that we will educate LOS clients on how to avoid disrespectful and psychonoxious therapists in any field of specialization. REFERENCES: Annon, J.s. Behavioral treatment of sexual problems. New York: Harper & Row, 1976. Bergin. A.E. President's message. IIMCIIP Newslelter, Spring 1981, 1. Bergin, A.E. The search for a psychotherapy of value. Tijdschrift vaor Psychotherapie (Journal of Psychotherapy) Amsterdam, 1981, 7, in press. Bergin, A.E., & Lambert,M.J. The evaluation of therapeutic outcomes. Chapter in S.L. Garfield and A.E. Bergin (Eds.), Handbook of psychotherapy and behavior change. (2nd Edition) New York: Wiley, 1978. Burr, W.R., Yorgason, B.G., & Baker, T.R. Creating a celestial marriage. Salt Lake City: Bookcraft, 1980. Calderone, M.s., & Johnson, E.W. The family book about sexuality. New York: Harper & Row, 1981. Frank, E., Anderson, c., & Rubenstein, D. hequency of sexual dysfunction in "normal" couples. New England Journal of Medicine, 1978,299, 111-115. Greene, B.L. II clinical approach to marital problems. Springfield, Ill.: Charles C. Thomas, 1970. Hogan, D.T. The effectiveness of sex therapy: A review of the literature. Chapter in J. LoPiccolo and L. LoPiccolo (Eds.), The handbook of sex therapy. New York: Plenum, 1978, 57-84. Kaplan, H.S. The new sex therapy. New York: Brunner/Maze!, 1974. Levine, S.B., &. Agle, D. The effectiveness of sex therapy for chronic secondary psychological impotence. Journal of Sex & Marital Therapy, 1978,4, 235-258. Masters, W.H., & Johnson, V.E. Human sexual inadequacy. Boston: Little, Brown & Co., 1970. Masters, W.H., Johnson, V.E., Kolodny, R.C., & Weems, S.M. (Eds.), Ethical issues in sex therapy & research, Vol. 2. Boston: Little, Brown & Co., 1980. Masters, W.H., Johnson, V.E., & Kolodny, R.C. Postgraduate workshop on human sexual function & dysfunction. St. Louis: Reproductive Biology Research Foundation, 1977. continued from page 16 McCary, J.L. Sexual myths and fallacies. New York: Schocken Books, 1973. methods have produced successful outcomes in to 60­ McCary, (3rd Ed.). New York: D. Van Nostrand, 1978. 80% range on two and five year follow-ups (Stuart & Ovesey, L., & Meyers, H. Retarded ejaculation. IImerican Journal Hammond, 1980; Masters, Johnson & Kolodny, 1977). of Psychotherapy, 1968, 22, 185-188. Sager, c.J, Marriage contracts & couple therapy. New York: Brunner! At the present time there is primarily one national Maze!' 1976. organization which is providing certification in levels of Smith, J.F. Quoted in Burr, Yorgason & Baker, op. cit; pp. 541-542. minimal competence for practice as a sex therapist. The Stuart, F.M., and Hammond, D.C. Sex therapy. Chapter in R.B. American Association of Sex Educators, Counselors and Stuart, Helping couples change. New York: GUilford, 1980. Therapists requires documentation of training, cour:JeworK/ and 5pecialty supervision for certification. They provide a national register of some 1300 certified sex therapists throughout the United States. AASECT certification does not insure competence, but it is making a helpful step in this direction by setting minimal standards of ethical practice. The ultimate responsibility

27 AMCAP JOURNAL/JANUARY 1982