Sexuality in Women

1With this book, our knowledge and understanding of the intricacies of sexual functioning were broadened considerably. The authors were pioneers in the study of human sexual physiology in the laboratory, and they developed a systematic way of looking at difficulties affecting various phases of the sexual response cycle. They provided a truly novel model for therapy—a specifically directed approach that produced dramatic changes in the couples they treated. Kaplan, in The New Sex Therapy,2 began the process of integrating principles of couples and individual psychodynamics with the “directed” approach of Masters and Johnson. Until relatively recently, the field involved primarily specialists in mental health. Over the last 15 years, there has been more attention from urologists, gynecologists, and endocrinologists, and research on sexuality has benefited enormously with the contributions from many disciplines. As the discipline has grown, much focus has been placed on the psychological factors that contribute to sexual difficulties, and a therapeutic approach has evolved that integrates behavioral techniques with psychodynamic understanding. Couples (or individuals) are given specific sexual “exercises” and coaching, and particular attention is paid to their reactions to the assignments. As a therapist from a traditional background of psychoanalytically oriented psychotherapy, I initially found this directed approach contrived and foreign. I was uncomfortable with giving people specific directions, had little experience in talking directly about sexual matters, and was wedded to the belief that sexual difficulties had their roots in deepseated conflicts that needed to be explored. I was therefore quite surprised to notice the resulting significant and rapid changes in couples’ sexual functioning, which bore no relation to what I might have predicted from my formal training. In the 25 years since I began working in the field of sexuality,