The use of punishment procedures to suppress seriously disruptive behavior has generated considerable controversy. Differential reinforcement of behaviors incompatible with disruptive behavior is attractive to many because it does not involve aversive procedures. Unfortunately, differential reinforcement has shown mixed results and may be effective only when combined with other procedures. Contingent removal of reinforcement (time-out) has been found moderately effective for dealing with self-stimulation and aggression but is of more limited value in treating severe self-injury. Overcorrection also has a beneficial effect on a variety of serious management problems. Electric shock, the most controversial procedure reviewed here, has been the focus of considerable debate but may have value under certain conditions. Research on generalization, maintenance, and side effects attached to these various procedures is reviewed, and ethical issues are examined.

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Three groups of women with sexual dysfunction were evaluated pretreatment and posttreatment. Two of the groups (mixed sexual dysfunctions and primary orgasmic dysfunction) did not involve partner participation, while the third group (mixed sexual dysfunctions) included partners on two occasions. Results for all groups were similar. Of the 16 women involved, 14 became reliably orgasmic through self-stimulation. Generalization of orgasm to partner stimulation or coitus was less reliable. Although partner presence did not enhance behavioral outcome measures, highly significant findings were achieved in terms of enhanced marital and sexual satisfaction. The question of whether orgasm through coitus alone is a reasonable goal is raised and challenged.

The effects of couples versus women group treatment for primary orgasmic dysfunction and massed versus distributed spacing of sessions were assessed. Twenty-two women and their partners were blocked and randomly assigned to one of four treatment groups: couples massed, couples distributed, women massed, women distributed. All participants served as their own waiting list controls. Results supported the expectation that the couples and women groups would not differ on the self-activities measures. Contrary to the hypothesis, the couples groups were not superior on multiple measures that assessed couple activities and frequency of orgasm via couple activities. Spacing was significant on one variable: Distributed groups rated their spacing more helpful than did massed groups. Analyses of combined-group data for females revealed significant improvements in both self-sexuality and couple sexuality. Data for males showed significant long-term improvements on the majority of couple-activities measures. Clinical and methodological implications of these findings are discussed.New methods have become available during the past decade for treating preorgasmic women. Directive approaches focusing on changing specific behaviors have reported high success rates (LoPiccolo, 1978).

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