Berry, MD; (2015) Towards a psychodynamically-informed model for the integrative psychotherapeutic treatment of male sexual dysfunction. Doctoral thesis , UCL (University College London).

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Abstract

Empirical research on sex therapy appears to be a significant and growing area in the social sciences, with researchers evaluating the use of a variety of different psychotherapy modalities in the treatment of male sexual problems. However, although clinical literature suggests that sex therapists may use psychodynamic techniques in their clinical practice, current empirical research on the place of psychodynamic methods in the sex therapy field is negligible. This research project aims to help fill this gap. The primary aim of this research project is to identify the role of psychodynamic methods in sex therapy. The principal research question underlying this work is: to what extent do psychosexual therapy specialists currently employ psychodynamic therapy techniques in treating men’s sexual dysfunctions? A number of secondary aims also guided this research programme. This work aimed to gather data on: • the ways in which sex therapists conceptualize and use the biopsychosocial model, • the diagnostic and assessment protocols they use with male clients, • the methods they use in establishing clinical goals and developing case formulations, • the ways in which sex therapy specialists conceive of and assess the aetiology of male sexual problems, and • the place that psychodynamic versus cognitive behavioural therapy (CBT) techniques play in the treatment of male sexual dysfunction. The role of psychodynamic theory and technique was considered in relation to all of these factors. Methods: To evaluate these issues, this research project used a combination of: 1) a questionnaire-based survey, administered to practitioners in the sex therapy field, and 2) interviews with sex therapists and subject matter experts. The questionnaire sample 6 consists of specialist sex therapists, and psychotherapy generalists who have experience in treating male sexual dysfunction. By examining the differences in technique reported by these two populations, this research sought to establish what is unique about psychosexual therapy, and what specific role psychodynamic techniques play within this specialization. The qualitative data generated from the interviews were used to clarify the integrative practices by which psychodynamically-based theory and technique are included in the treatment of male sexual dysfunction. Results: The data indicate that both sex therapists and psychotherapy generalists make use of prototypical and distinctive psychodynamic techniques to a significant degree in their work treating male sexual problems. Sex therapists report using psychodynamic and CBT techniques to approximately the same degree. Psychotherapy generalists report a higher level of adherence to psychodynamic techniques than sex therapists. Sex therapists report a high level of endorsement of the biopsychosocial model, and report drawing on a range of psychotherapy frameworks, including psychodynamic methods. A high level of focus on psychosocial and relational factors is reported, and attachment theory is identified as a key clinical factor in sex therapists’ work. The data suggest that sex therapists view insight—including insight into unconscious factors—as an important element of the therapeutic change process. Conclusions: The data indicate that psychodynamic theory and technique are integral to sex therapy practices. Often, however, psychodynamic techniques may be used implicitly and psychosexual therapists may not explicitly recognize their perspective as psychodynamic. Additionally, psychodynamically-informed techniques that focus on the client’s relationships, early life and development, and gaining insight into aetiology, may be of particular importance in the sex therapy field, and represent an area for future research.

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