Long-Term Psychodynamic Treatment Needs in Sex Therapy

This paper explores the reasons why many couples fail in Masters and Johnson's short-term “sex therapy.” A clinically based discussion illustrates how unconscious sexual or interpersonal conflicts not only make it necessary to modify Masters and Johnson's technical approach, but also require the therapist to integrate sex therapy techniques into a larger matrix of long-term individual or couple psychotherapies.

When Masters and Johnson1 first introduced sex therapy, it appeared to be extremely effective, rapid, and universally applicable. Recently, however, its efficacy has been questioned in both the professional and the lay literature,2-5 and experience indicates that the original method is not universally applicable. Some clinicians feel that unmodified sex therapy is applicable to as little as 20% of the current patient population and, without coordination or integration with other psychotherapies, has only limited, if any, long-term effectiveness. Moreover, it may not even be as safe as originally thought.6

Unmodified, sex therapy works well only with people who lack accurate sexual information, who have difficulty in communicating with their partners about sexual matters, and whose anxieties about sexual performance exist only on the conscious level, rather than being rooted in unconscious sexual or interpersonal conflicts.

In my experience, moreover, even when sex therapy is modified by tailoring it to individual needs and by employing a flexible rate and sequence of task assignments, and even when other psychotherapies are integrated, certain cases of sexual dysfunction prove very difficult to treat. In 1977, a colleague and I reported on our experience with a large group of patients who returned for additional treatment following two weeks of conventional short-term sex therapy.5 The majority required extensive further psychotherapy to help them deal with what emerged as impairments in