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Peggy Kleinplatz
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October / November 2003

NEW DIRECTIONS IN SEX THERAPY: Innovations and Alternatives
EDITED BY PEGGY J. KLEINPLATZ
Brunner-Routledge, 2001, 375 pp., $41.95, ASIN: 0876309678.

Reviewed by Daniel A. Helminiak

Dr. Peggy Kleinplatz has presented a collection of essays for advancing the field of sex therapy. The result of her work is a weighty contribution of sixteen chapters by innovative thinkers and skilled practitioners who clarify the current problem and suggest new approaches. The writers of the impressive chapters in this remarkably consistent book are Christopher Aanstoos, Donald Boulet, Gary Brooks, Alex Carballo-Dieguéz, Karen Donahey, Carol Rinkleib Ellison, Marny Hall, Peggy Kleinplatz, Alvin Mahrer, Wendy Maltz, Scott Miller, Charles Moser, Gina Ogden, Robert Remien, Jeanne Shaw, Wendy Stock, and Leonore Tiefer. On its own, the lead chapter by Bernard Apfelbaum makes this book worth having.

The current problem is that sex therapy has become too focused on physical performance and overlooks persons and their relationships. Since the groundbreaking work of William Masters and Virginia Johnson, techniques have emerged that rather effectively treat premature and delayed ejaculation, vaginismus, anorgasmia, and the like. The advent of ViagraTM now allows the pop of a pill apart from any personal counseling to restore sexual functioning in many cases. As Gary Brooks phrased the matter, the field has shifted from mechanical engineering to chemical engineering, and this shift represents no advance. Helen Kaplan’s desire to liberate us sexually and to eschew guilt over pleasure and orgasm resulted in the counterproductive notion of “bypassing”—losing oneself in fantasy and, in effect, ignoring one’s sexual partner. For Kaplan, sex is “fantasy plus friction,” and the partner is there to provide the friction. Even David Schnarch’s powerful treatment of sexual relationship as a crucible, an occasion for personal growth, ends up seeming to emphasize autonomy, the ability to be self-validating, to be one’s own person without dependence on one’s partner. Then, advocating “eyes-open orgasm,” which would seem to foster personal presence, suggests, rather, assertion of one’s self-fulfilled self even in the face of, or despite, one’s partner. As Apfelbaum points out, such emphasis downplays the personal vulnerability that is essential to deep sharing during sexual intimacy. Thus, despite good-willed and hard-worked attempts to deepen the field of sex therapy, the current result, more often than not, is emphasis on successful sex acts and oversight of the interpersonal relationship from which human sex acts derive their meaning.

That meaningfulness is the point: human sexuality lives on it. Even restoration of sexual functioning eventually brings “relationship” to the familiar dead end: sex goes on, but no one is present. In humans, biological function is the expression of a personal being. If problems in physical response between partners emerge, they indicate problems at a deeper level. In the metaphor of Stock and Moser, performance problems are “the canary in the mine.” Keeping the canary singing by medical intervention does not eliminate the poisons in the air. If sex is not working, almost inevitably the relationship is broken. As Kleinplatz playfully phrased the matter, it is not the penis and vagina that need attention, but the people who are attached to them. To a certain extent, therapy can now sustain sex as a mechanical operation, but such operation is certainly not what human sexuality is about, and to this extent sex therapy is a failure. To wit, current technology is notoriously poor in dealing with the increasing complaint of lack of sexual desire. Desire has its roots in something other than biology.

To be sure, there is no consensus on what sex is about. All agree, at the least, that sex is a multivalent phenomenon. However, that passion, desire, and ecstatic sexual experience depend on the quality of human relationship, this no one denies. So this collection of provocative, solid, and carefully crafted essays examines the possibilities of helping people find sexual passion, which magically makes performance problems disappear.

NO SUCH THING AS SEX THERAPY

Perhaps the most innovative chapter is that of Mahrer and Boulet. They do not criticize current emphases in the field of sex therapy but the very notion of sex therapy. They baldly insist that they do not know what a sexual problem per se is or how focus on sex could ever constitute a separate field of therapy. Their case study in experiential psychotherapy demonstrates their point. When a client accesses deep feeling, in whatever context, and pursues the feeling to the core of his or her self-affirming self, a new person emerges, and this new person spontaneously restructures his or her life, including sexual relationships. Sex is just one dimension of the person. Therapeutic focus on it makes no sense. Kleinplatz’s inclusion of this essay demonstrates both her courage and the power of this collection.

Also striking is Moser’s criticism of the Diagnostic and Statistical Manual of the American Psychiatric Association. The paraphilias that it lists have no more scientific basis than homosexuality, which was removed from the list of disorders. Moser’s sane suggestion is to create one comprehensive category, “sexual interest disorder,” defined by significant distress or impairment resulting from sexual urges. This disorder would apply only in clients who themselves complain of distress. Harm to others would constitute a criminal offense and would be beyond the realm of therapy. This latter construal seems too simple in that it removes from mental-health concern the client who, sociopath-like, is unconcerned about destructive and uncontained sexual urges. But for Moser this client would be suffering from antisocial personality disorder, not a sexual disorder. Perhaps Moser’s suggestion does cover all the bases. However, his insistence that healthy, criminal, and moral are separate categories is problematic.

Hall’s essay on narrative therapy with lesbian couples also raises important theoretical questions. This therapy is grounded in postmodern thought. The main idea is to reconstrue—dare I say, “inflect”?—a situation so that it is no longer problematic to the clients. The therapist is to offer new interpretations of the “text” (presenting problem), and because, in postmodern theory, one interpretation is as good as another, a richness of interpretations offers new possibilities for living. The stated goal of such therapy—“to legitimize nonerotic partnerships” and to “make it possible for couples to connect sexually in post-passionate ways”—runs counter to the thrust of this volume. On the other hand, the case study in this chapter ends precisely in restoring passionate sex to a waning relationship —and not by offering any old interpretation that might minimize the clients’ complaint about a sexless relationship, but precisely by helping the couple to understand each other’s points of view. The case study reads like exceedingly good therapy in a rather traditional mode. Once again postmodern theory and its practice do not match. Is it not, then, finally time to abandon the fanciful appeal to radical postmodernism? Can we not affirm the postmodern lesson that things are more complicated than we think without giving up the ever necessary human effort to understand them aright?

A MALE MODEL OF SEXUALITY

In fact if not in rhetoric, adolescent male sexuality remains the problematic, current model of sexual health: what matters is to manufacture orgasms and to produce arousal on demand. Brooks calls this mentality “the centerfold syndrome”: sex is voyeuristic, objectifies the other, validates the masculinity of the man, generates sexual trophies, and avoids intimacy. In light of the contrast between this cultural emphasis and the concerns of this volume, some discussion of long-term, male homosexual relations would have been welcome, for gay male relationships are “hyper-male,” they engage “masculinity squared.” Carballo-Diéguez and Remien’s chapter does discuss male couples who are mixed (sero-discordant) in their HIV status. This specialized chapter is superb, but it does not address the challenge of gay relationships in general. Of the going strategies for dealing with waning romance in long-term gay relationships, of course there are the chemical “cures.” There are the “open relationship” and the “three-way,” wherein one has sex with strangers but finds companionship and emotional intimacy with one’s partner. And there is the turn to sadomasochism to heighten the physical intensity of sex. But these solutions reinforce the standard stereotype of male sexuality as a physical experience.

Is it possible that gay men could sustain a long-term, passionate sex life? Could the therapies reported in this volume restore such sex in a gay couple? What is the nature of sex, in any case? Is the male brand so different from the female? Is a supposed “feminist” approach to therapy different from good therapy in general? What is the ideal of sexual relationship? And beyond sex, where does love—virtually unmentioned in this volume—play into this picture? Numerous questions surround the discussion of sex therapy. This book does not avoid them, and it raises still others—the promise of group therapy, the requirement of sexual integration in the sex therapist, the pressing need for therapists to become public educators. New Directions in Sex Therapy, complete with a 20-page Index, makes a major contribution. Professional sex therapists and people naive about the field will all find this collection a valuable and (intellectually) stimulating resource.

DANIEL A. HELMINIAK, Department of Psychology, University of West Georgia, Carrollton, GA 30118, (770) 838-3035.