Most people have heard of Masters and Johnson. Their contributions to sex therapy really can’t be overestimated. Most people have probably never heard of Jack Annon. In 1974 he published a book called The Behavioral Treatment of Sexual Problems. In it, he built on the work of Masters and Johnson and formulated his own treatment model, which he called the PLISSIT model. PLISSIT stands for permission, limited information, specific suggestions, and intensive therapy. The main idea of the PLISSIT model is that people with sexual problems may need help at several different levels. Some people are afraid to try new sexual activities and really only need a therapist to give them permission to do so. Others have a lack of knowledge about sexual matters and just need some information, often the same type of information one could get from taking a college course on sexuality. Still others will benefit from specific suggestions: detailed techniques for touching the genitals that can improve one’s ability to become aroused. And, of course, there are some people whose sexual problems genuinely result from past sexual trauma or deep-seated personality issues. These individuals will benefit from intensive therapy. When I was studying to become a surrogate partner and later a sex therapist, I read the works of Masters and Johnson, Helen Singer Kaplan, and Jack Annon, among many others. The work that was most helpful to me over the years was Annon’s.
What is the current state of sex therapy? Most psychologically based sex therapies still rely on treatment concepts that began with Masters and Johnson. Cognitive-behavioral sex therapy has had very good treatment success. However, in the last ten to twenty years, sex therapy has become increasingly medicalized. The introduction of Viagra and other medical treatments for sex problems has taken the focus off psychology.
Where This Book Fits In
Like Kinsey’s work, Sexual Healing provides you with facts about sexuality. It builds on the work of Masters and Johnson because it is behavioral in approach by virtue of its reliance on exercises. In terms of Annon’s PLISSIT model, Sexual Healing addresses sexual problems at the first three levels: permission, information, and specific suggestions. I give you permission to take action to heal your sex life. Some readers may need only limited information about sexuality, such as the role of anxiety in sexual problems; this book provides such information. The main thrust of Sexual Healing, however, is to offer help in the form of specific suggestions, the third level of Annon’s model. The majority of the book’s content consists of practical, easy-to-understand exercises that you can do alone or with a partner to heal your sex life.
Although this book may give you some insight into what has caused your sexual problems, if your problems are very serious and long-term there’s no substitute for intensive therapy. If that’s the case, I encourage you to find a professional to help you explore your sexual history in depth.
What Happens in Sex Therapy?
Sex therapy is a narrowly focused professional specialty that deals with the treatment of sexual dysfunctions. Typically, a couple would be referred to a sex therapist by a marriage counselor or physician. Sex therapy is meant to be short-term—usually a few weeks to about six months or so. It is behavioral. Clients are asked to do specific homework assignments that involve touching.
Most sex therapists treat couples, because sexual problems generally occur in the context of a relationship. When a couple first visits a sex therapist, the therapist takes a detailed sex history from each partner. This can be in the form of an interview or a written questionnaire. During the course of the sex history, the couple will list their present complaints, which could be any of the sexual dysfunctions. A person could have more than one sexual dysfunction, and both members of a couple can have problems.
Based on the couple’s sex histories and current complaints, the sex therapist forms a treatment plan that usually includes bonding and touching exercises (called sensate-focus exercises). These start with sensual touching and relaxation exercises and gradually progress to exercises that include oral sex, high levels of arousal, and intercourse, if all of these are agreeable to both members of the couple. In most cases a couple meets with the therapist once a week. The therapist gives the couple a touching assignment to do at home. When the couple returns the following week, they discuss how the assignment went. The therapist then outlines a new homework assignment and also deals with any concerns the couple has. When a married couple comes in for sex therapy, the focus is on keeping the couple together. No reputable sex therapist or marriage counselor would try to split up a couple, except in cases of abuse. Certainly, no therapist would advise one member of a couple to have sex with a third person! Instead, sex therapists ask couples to do certain touching exercises together in the privacy of their own home or another private place, such as a hotel room.
All of the exercises in this book are based on sex therapy exercises. You’ll find treatment programs here that therapists would use for all of the most common sexual problems. The book allows you to set up your own personal program of touching exercises so you can be your own sex therapist.
Much of my training in sex therapy was as a surrogate partner. Surrogate partners work with single clients who have sexual problems but don’t have a partner available to work with. I’d like to explain to you what surrogate partners do so you will be confident that I have the experience you can draw upon to help you solve your own problems.
How Surrogate Partners Heal
When a single person comes to a sex therapist for a problem such as lack of desire or difficulty with orgasm, arousal, or erection, he or she is in a bind. He or she needs to do the same exercises a couple would do but has no partner to practice them with. To address single people’s needs, some sex therapists work with trained, professional surrogate (substitute) partners, who act as the client’s partner during therapy. Professional surrogates always work under the supervision of a licensed therapist.
For twelve years, from 1980 to 1992, I worked as a professional surrogate partner. I personally treated hundreds of sex therapy clients, mostly men suffering from erection problems or premature ejaculation, although I also worked with some women who experienced problems with arousal and orgasm. It was during those years that my colleagues and I developed and refined many of the exercises included in this book. I was inspired to become a surrogate partner so that I could help to heal others. It is a helping profession, akin to teaching or nursing. In fact, it has much more in common with professions like nursing and counseling than it does with prostitution or other sex-industry occupations, although surrogate partners are often considered “sex workers.” I also became a surrogate partner because I believed that sex therapy worked, and that it changed lives. I believe that in certain relationships lovemaking can be a life-affirming and potentially lifechanging experience.
The therapy practiced by surrogate partners is powerful and unique, but many misconceptions exist about what surrogate partners do. Many people consider surrogate partners essentially prostitutes who are paid to have sex with people they don’t know. In fact, nothing could be further from the truth. Based on my years of experience as a surrogate partner, I strongly believe that the relationship between a client and a surrogate is a healing one. It is not the best of all healing scenarios, since neither person is the other’s physical choice or emotional mate, and the relationship is somewhat artificial because it is time-limited. Nevertheless, a great deal of emotional, physical, sexual, and spiritual healing has taken place in client-surrogate relationships. I’ve even known people whose lives have been changed dramatically by one episode of lovemaking.
So what do surrogates and their clients actually do? In the first session, I would begin by sitting and talking with the client, kind of like a first therapy session or a first date. Then, usually during the first session, we would take turns doing a sensate-focus touching exercise called the face caress, which you will learn in Chapter 19. The client and I would meet with his therapist before and after our session, which usually lasted about an hour. By the second session, most clients
were comfortable with nudity, so we would take off our clothes and do a back caress (Chapter 20). If the client were comfortable, the next session would include a front caress, and then a genital caress (Chapters 21 and 22). Depending on the client’s problem, we would then progress to the more advanced sensate-focus exercises for specific problems that you will read about in Chapters 23 through 31.
As a surrogate partner, it was my job to create a relaxing atmosphere for my clients. As you can imagine, they were very nervous. I taught them all how to breathe, relax their muscles, and do pelvic muscle exercises (Chapters 16 and 17). Meanwhile, I had to be alert for any signs that they were anxious. If a client became too anxious, we would stop the exercise and back up to a more comfortable activity. I also had to figure out whether the client was responding normally or had some kind of physical problem. There were multiple things going on that I had to be aware of. In addition, I had to be ready, willing, and able to do an exercise when I came to work—but I also had to be myself and not fake a response.
Since surrogate work is a healing profession, practitioners are very subject to burnout. My work as a surrogate partner meant a lot to me, but it is the type of job most people cannot do forever. I eventually reached a point where I couldn’t do it anymore. Most people think I stopped working as a surrogate because I got tired of impersonal sex. Actually, the opposite is true—it’s too personal. You run the danger of caring too much about your clients and taking their problems home with you.
What You Can Learn from My Experience as a Surrogate Partner
Either as a person who needs sexual healing or as a beginning sexual healer, what can you learn from my experience as a surrogate? Some of the things you can learn are very concrete, and some are intangible. The first seems pretty basic, but it eludes a lot of people. That is, if you want to be healed or be a sexual healer for yourself and your partner, you must schedule a time to do exercises together, and you must both agree to honor that scheduled time. Second, if you agree to the scheduled time, you should be ready to fully engage in the exercises—mentally, physically, and emotionally. If you and your partner are not emotionally or physically prepared to do so, recognize this fact and don’t pursue the exercise; if you have already begun, stop and backtrack. Third, for sexual healing to take place, you should have a comfortable room that is completely free of distractions. All of these points relate back to the healing mindset I mentioned in the Introduction.
The intangibles also relate to the healing mindset, starting with attitude. You can heal yourself and your partner if you stay in that mindset., which involves several things. As a surrogate partner, I always did my best to nonverbally convey the expectation that the client would be fine and everything would be all right. A big part of the attitude is also what you don’t convey: You don’t convey anxiety or performance pressure about desire, arousal, or erections. The best way to describe my professional healing experience is to say that for one hour at a time my client and I were absolutely absorbed in and involved with each other. As lovers, you and your partner will experience the added force of working to be sexual healers for and with each other.
The sexual activities you will learn in this book will promote confidence and self-esteem. You will feel better about yourself not only because you have learned to enjoy sexual expression, but also because you know your partner enjoys what you do and is able to become sexually aroused with you.
How can I make these claims? When I worked with clients, I often saw people who were extremely anxious and depressed, not only because of their sexual problems, but also because of their lack of a satisfying intimate relationship. One client in particular stands out in my mind. I’ll call him Gary. The first time I met Gary he entered the room hunched over and could not look me in the eye. He stammered when he talked and looked as if he wanted to run away. He was one of the most anxious and withdrawn people I had ever met. It was extremely gratifying for me to see that after only a few sessions of therapy, Gary walked into the room with perfect posture, exuding self-confidence. He looked his therapist and me in the eye and talked animatedly. He had even bought new clothes!
I hope that interacting with your partner in a healing way and learning to communicate honestly about your sexual experiences will have some of the same effects on you. I believe this is possible, and that is why I wrote this book. Join me now on the journey of sexual healing.
chapter 2
Sex 101
Let’s begin your sexual healing process with a review of sexual anatomy and physiology. This chapter is based on a lecture I give to my university class on human sexuality. You probably already know about the genital organs and their functions, but I’ve included this chapter as reference material, and I’ve focused on the significance of the genital organs for sexual healing. I’ve also included information about medical problems with the genitals that can complicate sexual problems.
Although in this chapter I’ve focused on the genitals, there is certainly much more to sexual functioning and enjoyment than just the genitals. People receive sexual pleasure from touch on other areas of the body, such as the breasts, the back of the neck, or the anus. Anal sex, especially, has become increasingly popular in recent years. Studies show that between 20 and 40 percent of heterosexual couples have experimented with some form of anal sex. I don’t include in this book a section addressing anal sex practices because there are no specific sexual dysfunctions associated with anal sex. If your sexual repertoire includes anal sex, or if you would like for it to, many of the sensate-focus exercises included in this book can be adapted for anal sex practices. The anal area can be caressed just like any other body area.
At the end of the chapter I’ve included a section on Masters and Johnson’s sexual response cycle: the physical changes that men and women go through when they receive sexual stimulation. As you’ve read, Masters and Johnson were quite influential in developing many of the techniques for solving sexual problems that I’ve built upon in this book.
Male Sexual Anatomy and Physiology
The penis is the male organ that is used for sexual intercourse and to convey both urine and semen outside the body (see Figure 1). If you look at a penis, you’ll see that it has two structural divisions: the shaft and the head. The head of the penis is very sensitive because it contains many nerve endings. The shaft of the penis does not contain muscles or a bone. Instead, it contains three cylinders of erectile tissue—tissue containing many tiny blood vessels that fill when a man has an erection. The two cylinders on the sides of the penis are called the corpora cavernosa (Latin for “cavernous bodies”) and the cylinder that runs along the bottom of the penis is called the corpus spongiosum (Latin for “spongy body”). Assuming a man has the normal ability to have an erection, these cylinders fill with blood when he receives either direct physical stimulation or mental stimulation. Male erectile disorder occurs when this response does not happen.
Figure 1. Male sexual anatomy
The penis itself does not contain muscles. However, a very important muscle group runs from the pubic bone, in the front of the body, to the tailbone (coccyx), in the rear. This muscle group is called the pubococcygeus or pubococcygeal muscle group—PC muscle for short. It supports the whole pelvic floor. In order for an erection to occur, this muscle has to relax to allow blood to flow into the penis. The PC muscle is very important for sexual healing in several ways. Many men experience erection problems because they have chronic tension in their PC muscle, which prevents blood flow into the penis.
The PC muscle is also the muscle that spasms when a man has an orgasm and ejaculates. Spasms in the part of the PC muscle called the bulbocavernosus (BC) muscle cause semen to be expelled from the penis. Sexual problems can occur when the BC muscle spasms out of control following minimal stimulation, resulting in premature ejaculation. The opposite problem, male orgasm disorder, can occur when a man consciously or unconsciously tightens his PC muscle as he nears orgasm, causing him to be unable to reach orgas
m and ejaculation.
The testes are the male reproductive organs that are housed in a skin pouch called the scrotum, which hangs outside a man’s body between his legs. The testes produce both sperm, for reproduction, and the male hormone testosterone, which is responsible for the male sex drive. Several problems can occur if a man does not produce enough testosterone or if for some reason he can’t use the testosterone he does produce. For one, it can cause a loss of the sex drive, which, as you read in Chapter 1, is called hypoactive sexual desire disorder or low sexual desire. Testicular cancer, which is obviously a very serious medical condition, can cause swelling in a testicle, a lump in a testicle, or a sense of heaviness or dragging in a testicle. It can cause pain during sexual arousal or intercourse. In many cases of testicular cancer a testicle must be surgically removed, which need not affect sexual functioning if replacement hormones are administered.
Another male organ that’s really important in terms of sexual functioning is the prostate gland. Although the prostate gland is not directly involved in reproduction, it can have an effect on whether or not a man has sexual problems. The prostate is a walnut-sized gland located near the bladder. The urethra, the tube that travels through the penis and carries semen and urine outside the body, passes through the prostate. The prostate gland contributes some of the liquid content of semen. Sexual problems can occur if the prostate becomes enlarged, which tends to happen in older men. An enlarged prostate can cause difficult or painful urination or ejaculation, as well as erection problems.
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