SEXUAL DISORDERS: DESCRIPTION OF KAPLAN’S METHOD TREATMENT PROCESS
The therapy process consists of erotic tasks performed at home, plus weekly or semiweekly meetings with the therapist. At each therapy session, the therapist and patients explore together the feelings and emotions experienced during the erotic exercises, which often are deep and profound. The therapist must be sensitive to the verbal and nonverbal cues that reveal the anxiety beneath the overt and covert responses of the patients and takes great pains to uncover their real reactions to the therapy, if progress is impeded. In this way not only does the therapist help the couple to obtain a clearer picture of their individual functioning and dyadic transactions, but also the partners learn to be frank and open about their emotions in general and their erotic preferences in particular.
Typically, the patients are instructed to perform the exercises more than once during the week. It is common for couples to experience difficulties during the first attempt, and to resolve these difficulties by the last attempt. With these patients, it is necessary only to present the next set of tasks. It is also common for patients to experience initial difficulties that are only partially resolved during the week; with these patients, some exploration of the resistances encountered, with insights and/or interpretations offered by the therapist, is often enough for a complete resolution. These couples also would probably be instructed to go on to the next set of erotic tasks.
These outcomes used to be the most common. However, the population seeking help for their sexual problems seems to be changing. More and more couples are coming with more profound problems that have remote causes. This results in increased difficulties in performing the sexual prescriptions. These resistances and obstacles can occur even before the exercises take place, for example, in deciding which partner “should” initiate the exercises and whether the other partner “must” agree. Other couples can “misconstrue” the instructions or interfere with his or her partner by “sabotaging” the process. Such maneuvers will compound the difficulties normally encountered in performing the actual tasks. Some couples can perform exercises properly and ruin the results – by having intercourse, for example, when intercourse has been proscribed. When these patterns persist or appear deeply entrenched, more intense psychotherapeutic confrontations and explorations are required.
Such psychotherapeutic, as opposed to behavioral interventions are performed strictly in the service of the experiential aspects – the sexual therapy prescriptions. Resolution is attempted only to the depth necessary to allow the tasks to continue; the resolution of intrapsychic or interpersonal conflicts for their own sake is avoided. Similarly, the therapist will tend to avoid offering insights to the couple that may apply to other realms but not to the psychosexual, if they pose a resistance to treatment.
If the resistance seems slight or manageable, it is bypassed, and the couple is instructed to proceed to the next exercises. Bypassing may also be indicated in certain unusual cases, for example, a man with erectile problems may have difficulty assuming the passive role in non-genital sensate focus, but may be much less resistant to genital stimulation. (The former is “womanly,” the latter is “manly.”) Although the inability to accept affectionate “pleasuring” may imply a severe disturbance, it should not be explored in this case. Instead, the man’s resistance to non-genital pleasuring would probably be bypassed, and the couple would be instructed to perform the next exercise, genital stimulation.
If the problems experienced during the sexual exercises appear too severe to be bypassed and are obstructing the sex therapy process, they must be explored jointly by the therapist and the patients. The probable prescription will be a repetition of the same exercise for the next week, which is often enough to solve the problem. When bypassing and repetition techniques are both ineffective or when the resistances seem formidable, they must be confronted directly.
The erotic exercises themselves include those described by Masters and Johnson, in addition to many others which have been developed in the last five years, such as in the treatment of premature ejaculation. In the Masters’ and Johnson’s technique, the female is instructed in the “squeeze” technique, applying pressure to the coronal ridge area of the penis to inhibit the ejaculatory reflex. Kaplan uses a modification of the Semans technique (Semans), in which the female aids the male in what is essentially a desensitizing procedure. It is felt that the Semans’ technique gives the responsibility for ejaculatory control to the male, to whom it is most appropriate.
The Kaplan method prescribes a unique series of exercises for each couple. Other methods prescribe the same exercises to all patients, with specific exercises for the particular complaint. In Kaplan’s technique, the dysfunction, as well as the motivation and assets of each couple, determines the course of the treatment. Using this approach, relief of the symptom will usually take place between six and sixteen sessions, although some patients have reported cures in as few as three sessions.
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