The collection of brief sex therapy models provides a vast array of techniques that may be employed with heterosexual couples, homosexual couples, and singles of either gender. The models include narrative therapy, catalytic therapy, multi-contextual therapy, relational approach, and techniques rooted in MRI and solution focused based therapy. These models employ a variety of techniques and in some cases crossover in ways that would be described as hybrid models. At the same time, all of the models presented in this work value similar approaches to the conceptualization of the therapeutic process.
The strongest technique that crossed all of the models presented was that of deep respect and the honoring of the client's individual and couple worldviews. The various therapists worked with their clients from an open and collaborative position. It seemed that most of the work exemplified in the case studies reflected a therapeutic stance from a position of second order cybernetics. In some cases, the therapists functioned from a both/and position in which they moved from first to second order cybernetic positions and back as the situation required. The fluidity of movement from these two positions was impressive and invoked a great deal of thought in how I may develop ways to utilize both positions effectively with clients.
A second major commonality across modalities was the respectful shelving of the DSM-IV and the medical model of sex therapy. While the therapists highlighted in this work recognized the impacts that physical health and disease may have on sexual functioning, they did not allow the medical model and the approaches to sex therapy rooted within to organize their treatment methods. Consistently, these therapists both checked with their clients about their physical health and if they had been recently examined with regard to their problems, or required their clients to obtain an examination in relation to their identified problem prior to continuing psychotherapy. It is refreshing to observe clinicians operating from a both/and position in which the validity of physical impairment may exist and at the same time, not allowing physical symptoms whose cause cannot be determined by a physician to organize how they approach therapy.
In addition to continuity of conceptualization in the approach of these clinicians, a careful understanding and a willingness to understand clients and educate regarding the newest pop pathological disorder of sexual addiction was refreshing. One of the contributors, Tracy Todd, labeled this trendy diagnosis the "premature ejaculation of sexual addiction diagnosis. Todd spent a great deal of space addressing the numerous online self assessment instruments that have become widely available to internet surfers who are attempting to understand their own behavior or label the behavior of someone else. Yet, as she pointed out, these instruments are not valid assessments and more importantly, the absence of any DSM criteria for this now popular diagnosis. As systemic theorists, we have come to understand that everything makes sense in context. These various therapists make clear that through the teasing apart of the contextual realities of each case, an understanding of behavior becomes clear. In the cases representing sexual addiction, the context and its deconstruction revealed that the behavior label as sexual addiction was revealed when the clients were asked what they were hoping to gain from the behavior. Rather than a compulsive need for some form of gratification, there were other reasons related to maintaining the existing relationship, avoiding external relationships that may exacerbate emotional pain, and research to teach themselves betters ways to please their partners.
As a reader and clinician, the efforts of the writers to expose how easily the medical models may seduce one and past practices of sex therapy rooted in that model were appreciated. Moreover, the emphasis and examples on how the interactions between partners seem to be more influential in how couples may or may not relate sexually, than the physical dysfunction that may presented. In the several cases provided, the presenting problems that were held prisoner by the medial model of sex therapy gained the freedom to change as the interactions between partners and those around them were altered.
In much of the writings, the influence of Milton Erickson, Don D. Jackson, John Weakland, Gregory Bateson, Jay Haley, and Paul Watzlawick were quite strong. The post modern and social constructionist roots of these "Fathers of Systemic Thinking" were evident in all of the models. In addition, the use of humor and irreverence seems to be a useful method to aid in creating space to talk about this sometimes-difficult subject. I noticed the influence of Erickson, Bateson, and Jackson in some of the humor used and found myself laughing and recognizing some of the comments from their case examples.
While there was much information across models of their effectiveness as sex therapy interventions, the reflection by some of the writers about their failures and difficulties throughout the history of their practice was a strong connection for this reader. This reflection of failures and difficulties experienced by these clinicians, normalizes for practitioners that nothing is 100% and creates room for mistakes, errors, and full-blown blunders from which to learn as well as normalize the sometimes trial and error nature of therapy.
The content and writing style of the authors easily maintained this reader's attention throughout the various models and approaches until reaching the last chapter, John Weakland at Work. While I appreciate and value the incredible knowledge that Weakland has given to the field of marriage and family therapy, this particular transcript lost me as a reader. Becoming lost was not about the content and did seem to be a matter of style. I found this particular chapter to be long and boring. The beginning of this chapter was strong, held the readers attention, and then suddenly lost it. Feeling lost and irritated, the continued reading of this chapter became too monotonous and rather than continue plowing through it, the after word, suddenly became irresistible.
The editors have succeeded in providing an excellent resource that exhibits the creativity and wisdom of some of the best brief therapists in the field. The book invites a variety of conversations concerning the approaches to sex therapy. These conversations contrast with the longer processes; traditional approaches pioneered by Masters and Johnson, and others.
As a new clinician entering the field, I anticipate using some of these models and have already begun conceptualizing how some of these may be combined as a means to increased effectiveness. In addition to my own use of these models, I would strongly recommend this handbook to any clinician working in the field of marriage and family therapy, and especially to those working with sexual issues.
In spite of the attention-losing final chapter, this book rates 5 stars!