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Theodore Jacobs grounded his Introduction in Freud's early connection between the damming up of sexual libido and somatic symptoms. Later, anxiety and/or depressive affect would underlie inhibited sexual pleasure, as did incomplete resolution of the oedipal situation, castration threat and fear of superego retaliation. Most often, sexual problems exist alongside character difficulties, object relations, narcissistic disorders, aggressive vicissitudes, somatic symptoms and phobias. Rarely today is sexual phobia a chief complaint. The paradox: since psychoanalysis is associated with psychosexual development, it should be, yet often is not, the most effective treatment for sexual problems. Cognitive and behavioral approaches offer explicit techniques from therapists who claim a high degree of success, faster than psychoanalysis. For certain patients, however, more deeply rooted psychological issues are most responsive to a combination of psychoanalysis and formulaic tactics.
Barbara Stimmel began with the image of an existential disconnect felt by many patients between mind and body, a sense of ‘not me’ in the refusal of the sexual body to respond. Sex therapy - exercises, homework, journal-keeping - places attention on body parts and reactions. The laser beam aimed at the sexual functioning of the body eliminates scrutiny of the mind. However, the mind is always present. Through journals and exchanges with the therapist, thoughts, desires and sensations conveyed between the couple engaged in a sexual encounter, comes an increase in the ability to describe and share the essence of the