The Process of Change in Brief Sex Therapy

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Had the couples described in these vignettes gone to a sex therapist in the 1950s or 60s, they would have probably found themselves involved in long-term psychodynamic work, with their therapist going in search of the underlying causes of their sexual difficulties. Had they simply consulted some sex manuals, they would likely have encountered prescriptive techniques, heterosexual assumptions, and the idea that foreplay is a prerequisite to insertion and orgasm for both partners (the closer to simultaneous the better)—the universally desired end (Apfelbaum, 2001). The manuals, implicitly suggesting that sexual contact is a “performance” to be judged, would have inadvertently heightened the couples’ performance anxiety.

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