The Future of Sex Therapy: Specialization or Marginalization?

Abstract

Sex therapy's claims to specialization may be exaggerated and ultimately damaging to the integrated treatment of sexual dysfunction. In fact, sex therapy does not have a unified underlying theory, a unique set of practices, or an empirically demonstrated efficacious treatment outcome. Paradoxically, the practice of sex therapy has gained widespread professional and popular acceptance since the publication in 1970 of Human Sexual Inadequacy by Masters and Johnson. Consequences of the widespread acceptance of this supposed specialization include the marginalization of sex therapy from other forms of treatment and the perpetuation of the notion that sex therapy is a special form of therapy requiring highly specialized training. This specialization focus also helps to perpetuate societal discomfort with sexuality. The very modest empirical success of most so-called sex therapy interventions and the lack of theoretical development suggest that sex therapy needs a recalibration in order to survive. It is suggested that the treatment of sexual dysfunction be integrated into the general psychotherapy enterprise and into a multidisciplinary biopsychosocial framework.

Sex Therapy is Special Because it Deals with Sex

“…I fully agree with Binik and Meana's (2009) assertions that the ''therapy'' part of sex therapy as it is practiced today is not unique from other types of psychotherapies. As one who practices sex therapy, I am not surprised or offended by this statement.…”

Sex Therapy: Brief Historic and Current Perspectives

“…Although this document has been lost, the authors mention in a later publication plans for a research program in psychotherapy targeted to sexual dysfunction. 5 According to some authors, 6 the birth of sexual therapy occurs with the publication of the book Human Sexual Inadequacy (Masters and Johnson, 1970). 7 In 1974, the psychiatrist Helen Singer Kaplan publishes the book "The New Sex Therapy", 8 in which integrates the psychoanalytic model to the sexual therapy proposed by Masters and Johnson.…”

“…Also, it may occur in individual, couple or group therapy formats. Despite the fact that there is no single theory underlying sex therapy and that professionals with diverse psycho-backgrounds can be sex therapists, some elements are common to psychotherapies focus on sexual dysfunctions: 6,13 i. They speak openly about sex;…”

Governance of Sexual Functioning by General vs. Special Psychological Mechanisms Remains an Empirical Issue

“…The discussion started by Binik and Meana (2009) is, in our opinion, a very well-timed and welcome initiative. We agree with their argument that development in isolation might bring high costs and small benefits and that a critical evaluation of this position is very important at this moment in time to avoid the danger of losing connection with mainstream developments of psychological therapies.…”