New Directions in Sex Therapy Chapter 2

2 The “New View” Campaign A Feminist Critique of Sex Therapy and an Alternative Vision

LEONORE TIEFER, Ph.D.

Sex therapy is an area of psychotherapy that developed in the 1970s during the so-called sexual revolution. from a superficial perspective, it seemed simply to be a pragmatic approach that used education and behavioral interventions to help people with sexual performance problems. from a political and cultural perspective, however, sex therapy’s inattention to factors like social and cultural context, gender construction, and heteronormativity; its reliance on limited and intercourse-centered diagnoses; and its neglect of preventive sex education mark it as narrow and politically conservative (Irvine, 1990; Becker, 2005). many chapters in the first edition of this book, including mine on feminism and politics (Kleinplatz, 2001; tiefer, 2001b), were attempts to correct, or at least to challenge, the narrow, essentialist, and depoliticized aspects of sex therapy that dominated most texts. The continuing success of thefirst edition speaks to the frustration many progressive scholars and practitioners of sex therapy feel with the field’s unexamined assumptions and conservative spirit, and I can only hope that this second edition will excavate even more of those assumptions and help to redesign sex therapy’s boundaries. let us begin with what a feminist perspective is and why it is needed in sex therapy.

Feminist Perspectives feminism is a social change movement of many phases, facets, components, and constituencies that advocates for the eradication of gender inequities

Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright in a world of socially constructed and institutionalized gender differences (ferree & mueller, 2004). The academic wing of feminism, women’s studies (now often gender studies or gender and sexuality studies), puts women’s perspectives and interests at the center of scholarship that utterly transforms

Kleinplatz, P. J. (Ed.). (2012). New directions in sex therapy : Innovations and alternatives. Retrieved from http://ebookcentral.proquest.com21 Created from lewisclark on 2020-03-31 09:16:21. 22 • leonore tiefer, Ph.D.

our views of culture, history, science, and social life. gender scholars have described at length and with great attention to local detail how sexualities are constructed within cultures, organizations, relationships, and individual lives (e.g., Corrêa, Petchesky, & Parker, 2008; Jackson & Scott, 1996). In the 1970s and 1980s, feminist therapists had many things to say about revising and expanding sex therapy (Cole & rothblum, 1988). They argued (e.g., Ellison, 2000; hare-mustin, 1991; Keystone & Carolan, 1998; tiefer, 1991a) that sex therapy • Was too genital and goal oriented • relied on sexist sex research, language, and theory • used a sexist nomenclature of sexual problems • neglected gender-related power differences • marginalized pleasure in favor of normative sexual performance • Was oblivious to subjective sexual meaning and ignorant of cultural variations • unintentionally (or not) reinforced patriarchal interests and sexual double standards • unintentionally (or not) supported compulsory heterosexuality • Ignored social causes and solutions of sexual problems feminist sex therapy reformers offered various suggestions to improve the field. tiefer (1996a), for example, suggested that a reformed and transformed sex therapy would include remedial and corrective psychoeducational elements such as: • feminism 101 to raise awareness about sexism, i.e., emphasizing gender in political context—not just as an identity category • Deconstruction of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic categories as part of the critique of medicalization • Positive genital education to counteract widespread and even institutionalized pudendal disgust • Assertiveness training to counteract internalized sexual censorship • Body-image reclamation to exorcize the effects ofsexual objectification • Physical and mental masturbation education to engender sexual entitlement, self-knowledge, and subjectivity • Extragenital and non-orgasmic pleasuring instruction to counteract performance-oriented sexuality and encourage lifelong adaptive sexual learning

• Political education of sex therapists and a commitment to social change Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright The commercial landscape changed in the 1980s and 1990s, and popular sex advice books became easily available in big chain bookstores and, then, through the Internet. They often included some of the suggestionsmade earlier

Kleinplatz, P. J. (Ed.). (2012). New directions in sex therapy : Innovations and alternatives. Retrieved from http://ebookcentral.proquest.com Created from lewisclark on 2020-03-31 09:16:21. The “new View” Campaign • 23

by the feminist reformers. But by the 1990s and the new “post-feminist” era, political critiques of sex therapy and calls for problem prevention through gen- dered analysis and antisexism work were played down in favor of a narrower focus on personal, interpersonal, technical, and lifestyle changes (e.g., Becker, 2005; Cass, 2007; hall, 2004; Pertot, 2005). It was assumed that society had gotten enlightened and that gender equality had been won. Also, it became unfashionable to “politicize” professional activities. Political voices labeling sexology and sex therapy as conservative moved to interdisciplinary and critical social studies while sex therapists focused on the good news about healing and women’s entitlement to pleasure and satisfaction (Albrecht, fitzpatrick, & Scrimshaw, 2000; morrow, 2007; Seidman, fischer, & meeks, 2007). It was rare to find a therapy text that offered both a strong critique of the field and practical approaches to people’s sexual insecurities. (for one exception to the rule, see tiefer & hall [2010].) Political interest in feminist sexual values and goals could still be found outside sex therapy, for example, in sex education curricula from various nonprofit groups.* In addition, feminist therapists (not usually sex therapists) continued to underscore political topics like sexual violence against women and media objectification of women’s and girls’ bodies and the need for therapists to be politically engaged. feminist values are also present in qualitative and multimethod sex research that seeks complex, politically informed discussions about what women mean when they speak of sexual desire or satisfaction or complain about sexual problems (e.g., Bancroft, loftus, & long, 2003; goberna, francés, Paulí, Barluenga, & gascón, 2009; graham, Sanders, milhausen, & mcBride, 2004). Explicit feminist perspectives in sex therapy (e.g., women’s entitlement to pleasure; women’s right to refuse unwanted sex; the need for women to know their own bodies) have been absorbed without acknowledging that these are political gains that are still far from universal. Any discussion of the need for further political struggle has been sidelined in the current apolitical epistemology (Becker, 2005). Thus sex therapy focuses on proper technique and communication, with interventions assumed to be scientific, professional, neutral, objective, and value free. But who does what to whom sexually is fundamentally a political matter rather than a scientific one, and “experts” are people who have been trained in and then promote culturally dominant paradigms. feminists repeatedly point out that experts are “political appointees” who represent a point of view rather

* http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=948 Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright &Itemid=629 http://www.plannedparenthood.org/resources/implementing-sex-education-23516.htm http://www.siecus.org/index.cfm?fuseaction=Page.viewPage&pageId=514&parentID=477 http://www.uua.org/religiouseducation/curricula/ourwhole/

than being neutral (rubinstein, Scrimshaw, & morrissey, 2000). feminists point out that “expertise” has hurt women in the past more times than can be counted when it comes to sex and reproduction, and that while it might be nice to believe that science is always neutral and health authorities are motivated only by the best interests of their patients, this is a fairy tale (Ehrenreich & English, 1978). The best practice acknowledges that everyone has special interests and blind spots, and that informed patients and ethical providers must function in a complex and ambiguous world where plans and decisions are made on the basis of careful thought, but in the absence of truth or certainty.

Current Limited Sexological Reforms The APA is in the process of revising and updating its classification system and list of mental disorders for the upcoming fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) scheduled for publica- tion in may 2013 (c.f., www.dsm5.org). Some of the alterations planned for the sexual dysfunction section* have emerged in debates about sexual arousal and desire initiated by feminists (Brotto, 2010). for example, graham and Bancroft (2006) argue that clinicians need good community survey information that validly identifies current norms for a woman’s “ethnic, cultural, religious and social background” (p. 55) before concluding that her sexual patterns are abnormal. however widespread the recognition exists regarding the limitations of the DSM nosology, though, the changes planned for DSM-5 seem to be minor, and certainly they will not disrupt assumptions that there is some under lying, universal, “hard-wired” human sexual response cycle or that sexual activity and interest are objectively necessary and “normal” aspects of medical and mental health. This is deeply disappointing to those of us who have spilled tons of ink over the last three decades showing how these essentialist notions are flawed, biased, and perpetuate a genital-centered rather than meaning-centered view of sexuality that ignores the enormous variability of sexuality throughout the life cycle and around the world (e.g., tiefer, 1996a).

Roots of the New View Campaign I contributed steadily to the critical and social constructionist feminist literature on sexuality and sex therapy from the late 1970s through the middle 1990s, when I summed up my thinking in the first edition of Sex Is Not a Natural Act (tiefer, 1995). I had published professional journal articles, book chapters, book reviews, conference and university presentations—the usual items. During 1976 and 1977, I briefly got roped into writing magazine sex Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright advice in Playgirl and Playgirl Advisor magazines, efforts that taught me how

* http://www.dsm5.org/Proposedrevisions/Pages/SexualandgenderIdentityDisorders. aspx

phony popular media can be.* But, mostly, I wrote sober calls for reform in conventional professional publications. And then, a funny thing happened. I convened a social movement. In march 1998, the u.S. food and Drug Administration approved a new drug, Pfizer’s sildenafil citrate (brand name Viagra™), for the treatment of erec- tile dysfunction. I had worked in hospital urology departments from 1983 to 1996 and had observed at close hand the way urologists and “sexual medicine” specialists treated sexual problems of individuals and couples. It seemed to me that the medical model of diagnosis and treatment was standardized, reduc- tionistic, and normative, and merely paid lip service to a psycho-bio-social model of sex (tiefer, 1996b). It excluded the partner and invariably offered medications as “first-line” therapies to one and all. This was disturbing because many patients had little or no understanding of sexual arousal and satisfaction other than their own personal experience. They came to the doctor often needing some simple facts and advice, only to find themselves in a lavish biomedical production. Yet, despite the scientific packaging, the costly medical work-up of physical exam, blood work, genital ultrasound testing, and nocturnal measurements rarely produced the kind of clear-cut answers or treatment directions that patients expected. moreover, far from an individualized approach, patients confronted many standardized and assembly-line assumptions about sexual relationships and goals. I wrote frequently about this situation as “the medicalization of sexuality” (e.g., tiefer, 1996b). The approval of Viagra™ set off an explosion of publicity that encouraged “sexual medicine specialists” along with numerous pharmaceutical companies to explore the possibilities for a new, nongynecological specialty devoted to women’s sexuality.† A Boston urologist, Irwin goldstein, announced a conference on “female Sexual Dysfunction (fSD)” to be held in October 1999 (tiefer, 2001a). At first I was dismissive, but I changed my mindwhen I learned that many professionals planned to attend to hear about “new medical developments,” and that a new organization might be formed. It seemed likely that pharmaceutical companies looking for blockbuster profits would give large financial contributions to such a meeting, and that paid speakers would promote a medicalized perspective of women’s sexual problems. I became alarmed at the thought that the type of medical management I had observed in hospital urology departments would be extended to new women’s sexual

* The questions were concocted by staff writers, although real people did write in. The Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright real people’s real questions were apparently too mundane and too brief for popular magazine standards. † An enjoyable film about this “hunt for the pink Viagra™” was released in 2009. titled Orgasm, Inc., it is available online for rental and purchase (see orgasminc.org or netflix.com).

medicine clinics, and that this could eclipse two decades’ worth of feminist research, theory, and writings on women’s sexualities. I planned actions modeled on the feminist “Coalition Against misdiagnosis” campaign that successfully opposed a slate of new disorders proposed by the APA for the 1987 DSM revision, e.g., “premenstrual dysphoric disorder”, “paraphilic rapism”, and “self-defeating personality disorder” (Caplan, 1995). In that campaign, feminist psychologists and psychiatrists worked together to articulate our objections and prepare a demonstration that would raise questions about the damaging political and health consequences of these new “disorders ”. ultimately, the new diagnoses were not put in the DSM-III-R. Drawing on that activist model 20 years later, I asked feminist colleagues to submit critical abstracts to goldstein’s 1999 fSD conference and proposed one myself entitled, “The Selling of female Sexual Dysfunction.” I wrote a “call to arms” article for a Boston women’s newspaper, Sojourner (tiefer, 1999), and recruited my friend, Carol tavris, to help with an op-ed essay for the Los Angeles Times (tiefer & tavris, 1999). Almost as an afterthought, I called for people to attend a planning meeting in Boston the day before goldstein’s fSD conclave to figure out what, if anything, we could do during the conference itself. In retrospect, that planning session was the birth of the new View Campaign (tiefer, 2001a). The new View became a group taking public action to challenge the edi-m calization of sex at the same time as our scholarship continued to analyze sexuality and sex therapy. We found unexpected allies in the new fields of critical psychology, critical health studies, and anticorporate public health advocacy (freudenberg, 2005; Crossley, 2008). In the past decade, we have participated in u.S. food and Drug Administration (fDA) hearings about new drugs for “female sexual dysfunction,” debated the role of the pharmaceutical industry at medical conferences, and attended international “disease-mongering” conferences (Kelleher, 2005; Wilson, 2010; moynihan, 2010). In each instance, we joined with a wide variety of activists, including reform-minded physicians and health care providers.

Central Elements of the New View Model The DSM locates sexual desire in a universal, reductionist, standardized, and normative “healthist” model of sexuality, the “human sexual response cycle” of desire, arousal, and orgasm, ignoring innumerable historical and cultural permutations of sexual meaning, priority, and script. It specifies sexual problems as distressing failures in performing the normative sexual response cycle. I convened a group of feminist social scientists and health professionals

Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright following goldstein’s 1999 meeting in Boston to develop an approach to sexual experience that could guide sex education and treatment without using or imposing norms. Although feminist theory teaches us that it is problematic to search for “pleasures that are free from sexual normalization, free from

disciplinary practices” (tuana, 2008), nonetheless we felt that we could avoid some of the major pitfalls of the DSM if we jettisoned the “human sexual response cycle” model (tiefer, 1991b). Our resulting approach, the New View Manifesto (Working group for a new View of Women’s Sexual Problems, 2001; also on the new View Web site, newviewcampaign.org), has been widely published and presented in workshops and conferences. The most revolutionary element of the New View Manifesto is its definition of sexual problems. The document reads, “Sexual problems are defined [ italics added] by the Working group as discontent or dissatisfaction with any [ italics added] emotional, physical, or relational aspect of sexual experience” (Working group for a new View of Women’s Sexual Problems, 2001). The new View approach allows people to define their own problems (we intentionally avoided the medicalized terms of “dysfunction,” “disorder,” and “ disease”) because we assume that discontent and dissatisfaction vary widely and are created and affected by culture, life stage, and relationship idiosyncrasies. This is to be contrasted with the “response cycle” approach of the APA’s DSM that embraces medical language and specifies which sexualproblems are legitimate (desire, arousal, orgasm, and pain dysfunctions) and ignores everything else. The sexual dysfunctions are characterized by disturbances in sexual desire and in the psychophysiological changes that characterize the sexual response cycle [sic] and cause marked distress and interpersonal difficulty (APA, 1994, p. 493). for those using the new View approach, the absence of norms for sexual desire and activity offers some important clinical advantages (tiefer & hall, 2010): • A position from which to construe differences in sexual interests between sexual partners as discrepancies like other discrepancies or disputes (e.g. whether to spend limited family funds on a trip to Disneyland; when to take out the garbage) • A starting point for exploration and behavioral change that mini- mizes partners’ “You’re not normal” name-calling • An immediate focus on cultural influences that can be used throughout treatment in terms of understanding each partner’s sexual history and in terms of creative homework assignments • A focus on sexual habits and preferences as learned that can similarly be used throughout treatment The other crucial element of the New View Manifesto is its four-category classification of factors contributing to sexual distress and dissatisfaction.

Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright This is a focus onetiology that is completely absent in the DSM. It symbolically parallels the four-category classification of dysfunctions in the DSM (desire, arousal, orgasm, and pain); however it is not a classification of problems but rather of problem causes:

• Sexual problems due to sociocultural, political, or economic factors • Sexual problems due to partner and relationship • Sexual problems due to psychological factors • Sexual problems due to physiologic or medical factors The expansive lists of dozens of etiological elements we provided (they are listed in the manifesto on newviewcampaign.org) draw therapists’ attention to the multifarious ways that sociocultural factors can contribute to sexual problems. This offers directions for focused sexual history taking and ideas for bibliotherapy, clinical interventions, and homework assignments. Once a therapist is alerted to the likelihood of inhibitions resulting from clashes between family of origin values and mainstream sexuality culture values, for example, she knows to explore this area and create appropriate homework. Once a therapist is aware of the potential sexual impact of non-sexual con- flicts in a couple’s life, she can incorporate such topics into“sex” therapy without feeling she is being distracted or deflected. Once a therapist sees that lack of sexual interest because of family or work obligations is acknowledged as a legitimate therapeutic concern, she feels more supported in discussing the way gender politics affects families. And so forth. Each one of the many items in the new View classification scheme is meant to provoke therapist reflection on the way sexuality is contextualized in the real world, and stimulate creativ- ity beyond the simple behavioral exercises popular in both early sex therapy and contemporary magazine recommendations.

New View Cornerstones In addition to the philosophy and pragmatics of the manifesto, the new View Campaign has made several other substantive contributions to sex therapists.

Activism Is Important! from our first moments in Boston in 1999, new Viewers have construed our group as doing politics through scholarship and activism as we challenged the medical model of sexuality and sexual problems. much of our work in the past decade has involved analyzing how the pharmaceutical industry is influ- encing sex research, professional education, and the public’s understanding of sexuality. most sex therapists notice that pharmaceutical companies spon- sor clinical research and professional education, but, like most physicians, they do not fully grasp the consequences. to illuminate how pharmaceutical industry money has significantly skewed research and education, we have not merely written scholarly articles and delivered conference talks; we have also

Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright prepared fact sheets and press releases for medical and business journalists, posted on blogs and comment pages, and organized appearances at fDA hearings to advocate for our perspective. We also post all these materials on our new View Web site.

Our most recent appearance, for example, in June 2010, was at an fDA Advisory Committee meeting called to evaluate a new central nervous system drug (flibanserin) for the “treatment” of “hypoactive sexual desire disorder (hSDD)” in women.* A new View team in new York, new Jersey, Vermont, and Vancouver, BC (about eight of us) researched and brought copies of six fact sheets for scholars and journalists that tackled issues of misdiagnoses, overmarketing, gender rhetoric, “distress”, adverse effects, andproblems with the clinical trials. We developed an online petition and brought 650 signa- tures to the fDA hearing.† We prepared a bibliography of “counter-narratives” of research and theory contradicting the pharmaceutical industry’s perspective on hSDD. One member of our group “tweeted” live commentary from the hearing. We sent information to feminist and progressive public health blogs both before and after the hearing. Obviously, we were delighted when the fDA advisory committee voted against the drug application. Because we had demonstrated that the manufacturer of the drug (Boehringer-Ingelheim) was mostly interested in marketing, we were not at all surprised when the company announced a few months after the hearing that it was terminating its research on the drug. Our public activism blossomed in the last 3 years when we branched out from our original focus on sexuo-pharmaceuticals to take on a new develop- ment in the medicalization of sex: the growth of cosmetic genital surgeries for women (fgCS, female genital cosmetic surgery). These include partial or full amputation of, or injecting fat into, the labia (“labiaplasty”), cutting the muscles in and around the vagina, stitching them back together and burning off the excess skin (“vaginal rejuvenation”), partial or full amputation of the clitoral hood, stitching across the vaginal canal to create bleeding during the first intercourse after surgery (“revirginization”), suctioning tissue from the pubic mound, and injecting artificial collagen into the vaginal wall (“g-Shot injec- tions”). Again, in addition to publishing well-researched academic articles, we took public actions. We organized a street demonstration in 2008 in new York to call attention to the need for closer regulation and monitoring of this new industry. We organized an art exhibit in 2009 in Brooklyn to celebrate genital diversity.‡ In September 2010 we held a conference in las Vegas on fCgS, our third scholar-activist conference since 1999, and included, along with presentations on the intellectual complexities of fCgS, several workshops teaching and doing activism.§

* http://newviewcampaign.org/flibanserin.asp

† http://www.change.org/petitions/view/low_sexual_desire_is_not_a_disease_stop_fda_ Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright approval_of_flibanserin ‡ http://newviewcampaign.org/fgcs.asp http://newviewcampaign.org/vulvagraphics.asp § http://newviewcampaign.org/conference3.asp

Is it part of sex therapy to do public activism? many therapists would demur, citing an apolitical definition of professionalism. I think that position is not tenable, and it certainly is not feminist. Sexuality is an inescapable part of the political as well as the commercial landscape. hiding in a consulting room or behind a conference podium abdicates a responsibility to use our professionalism on the public’s behalf and on behalf of sexual emancipation. nevertheless, there are numerous ways to play a public role, and feminist advocacy is only one strategy.

Feminism and Expertise Make an Awkward Pair! The early counterculture days of second-wave feminism were full of argu- ments that women and their lives had been neglected, stereotyped, and mis- represented by researchers and theorists. history, literature, health care, psychology, and psychotherapy came in for particular drubbing (e.g., gornick & moran, 1971; millman & Kanter, 1975). Classics of the period taught me and others of my generation that “experts” in academics, the sciences, and the professions were often blinded by stereotypes although they waved the flag of “objectivity”, especially when it came to subordinated groups or politicized topics like sex. This skepticism returned as I witnessed sex therapy’s shift from themes of humanistic psychology (learning, diversity, growth) to those of the medical model (diagnosis, treatment, norms). Skepticism toward the sexual medicine emphasis in sexology became a major theme of the new View Campaign (tiefer, 2006). The seductions of funding and other pharmaceutical industry “perks” seemed to have caused a generation of researchers to focus on industry-abetting questionnaires and clinical trials and to neglect the qualitative, “thick”, context-relevant study of sexuality (c.f., rosen & Barsky, 2006). randomized clinical trials (rCts) became the expert-approved gold standard of sex research, and yet they failed to produce the kind of local knowledge needed in the fields of hIV-AIDS and sexual rights, and also women’s empower ment (Corrêa, Petchesky, & Parker, 2008; timmermans & Berg, 2003). The new View’s interest in fostering grassroots approaches to women’s sexuality led us to prepare the bibliography of “counter-narratives” contradicting Big Pharma’s perspective on so-called hSDD that was mentioned previously.* most of the studies that give voice to women’s felt concerns use qualitative research methods. Qualitative approaches do not standardize experience or make assumptions about meanings the way statistically analyzed question- naire research often does. Our grassroots focus has also led us to encourage experiential workshops as part of spreading the message about the new

Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright View Campaign. In 2003 we self-published a teaching manual that included a dozen classroom and workshop exercises (tiefer, Brick, & Kaplan, 2003).

* http://newviewcampaign.org/media/pdfs/CounternarrativesBiblio.pdf

Experiential workshops can help people break out of medical-model thinking about sex through exercises that challenge assumptions and acknowledge diverse sexual goals. many sex therapists have published popular sex advice books that ignore political debates about gender and social justice. These books by “ sexuality experts” claim to offer sexual empowerment through self-improvement, but the new View argues that ignoring the social and economic forces behind sexual values and expectations does not fully empower people. Community-based, affordable, accessible, comprehensive sex education would be a better way to offer independent sexuality information and give women power in their sexual lives. Currently, the only community-based approach to sex education in the united States seems to be offered by feminist-owned sex stores, where the sales associates offer the expertise (loe, 1999; Comella, 2004).

Sex Therapy Is Politics! Defining, legislating, treating, teaching, adjudicating, and researching sexuality are all “charged battlegrounds of the 21st century” (Corrêa, Petchesky, & Parker, 2008, p.1). Sexuality is a permanently controversial topic, with the power to mobilize intense public and personal reactions in the pulpit, the street, the classroom, the courtroom, the newsroom, the bedroom, or the legislature. Even in the 21st century, people are being stoned to death in Iran, Iraq, Afghanistan, Pakistan, and various countries in Africa for sexual “crimes” like adultery and homosexuality. Sex offenders are not treated fairly, and often are not released after serving their jail terms in the united States, but are rather stuck in “post-incarceration civil commitment.”* Once we start to view sex therapy as part of larger political debates about sexuality in contemporary culture, it seems inevitable that sex therapy training should move beyond limited technical discussions to include larger socioeconomic frameworks. A good sex life is not just the result of good sex therapy(!), but requires a world with emancipatory sexual values and politics. Consequently, part of the job of being a “sex therapist” might be political—to help bring about that world. Only one professional sexology organization I know has taken this responsibility seriously: The World Association for Sexual health (WAS). After a groundbreaking Declaration of Sexual rights in 1999,† WAS went on to offer a lengthy document in 2008, the millennium Declaration,‡ incorporating

* http://www.nytimes.com/2010/08/22/weekinreview/22worth.html; also follow the human

rights Watch Web site and the national Center for reason and Justice Web site. Copyright © 2012. Routledge. All rights reserved. rights All Routledge. 2012. © Copyright † http://www.worldsexology.org/sites/default/files/Declaration%20of%20Sexual%20 rights.pdf ‡ http://www.kinseyinstitute.org/resources/SExuAl%20hEAlth%20fOr%20thE%20 mIllEnnIum%20formated%20mrCh%201%202008lD.pdf

united nations conference ideas from the past three decades that connected sexual rights and sex education with human rights, an end to sexual violence and hIV-AIDS, sexual concerns and dysfunctions, and the importance of sexual pleasure. unfortunately, the document is presently a patchwork prod- uct, and medical thinking dominates too many of its 171 pages for the new View to offer a strong endorsement. It is difficult for professional organizations to develop emancipatory positions, as was shown by the pre–World War II efforts in germany. At that time, reform-oriented physicians and social services providers collaborated to create sexually progressive congresses, doc- uments, and journals, only to see the entire edifice destroyed yb the nazis in the 1930s (haeberle, 1981).

Conclusion Since 1999, the new View has offered an alternative to mainstream (and medicalized) sex therapy practice. rather than a series of tips, it offers a framework that rejects norms; beyond just a technical strategy, it offers a vision of diversity in sexual goals and values. my favorite analogy has been that “sex is more like dancing than digestion.” This means that the body is relevant, but culture predominates, and perhaps even more importantly, that it is best to view sexuality as more akin to a hobby than a health neces- sity. People can be helped with their problems, blocks, misunderstandings, and distress without resorting to assumptions about sexual universals. The construction of a model is a political act, and professionals need to see that the dominant “health model” serves but also limits sexual pleasure and freedom. The new View offers a humanistic alternative to the medical model that requires active engagement with contemporary sexual politics. Join us at www.newviewcampaign.org. Soon.

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