International Handbook of Clinical Hypnosis - E-Lib FK UWKS

234 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
mined, as are socio-psychological in¯uences such as cultural expectations and
qualities of relationship.
The Diagnostic and Statistical Manual of Mental Disorders 4th edition) DSM-
IV; APA, 1994) details the most commonly used diagnostic criteria for these
disorders. Alternatively the World Health Organization's International Classi®cation
of Diseases 10th edition) ICD-10; WHO 1992) allows for the classi®cation
of sexual dysfunction by a set of explicit criteria. To be classi®ed as a sexual
dysfunction it is essential that the dif®culty causes distress to the individual concerned,
or results in interpersonal dif®culties. The disorder is not classi®ed as a
sexual dysfunction if it is the symptom of some other disorder classi®ed elsewhere
in the Axis 1 classi®cations of DSM-IV e.g. depression or general anxiety).
All disorders are classi®ed by type, that is the phase of the sexual response
involved, and along three other dimensions: a) whether lifelong or acquired; b)
whether generalized or situation speci®c; and c) whether due to psychological; or
combined psychological and medical causes; general medical condition-related; or
substance use-related prescribed or non-prescribed).
The lack of good epidemiological studies on normal sexual functioning, in
particular contemporary studies, means that at all times the diagnosis of a sexual
dysfunction relies upon clinical judgement. The presenting patients' culture, ethnicity,
social and educational characteristics, age and gender features need to be
taken into account in evaluating the appropriateness of the sexual response or
behavior. Expectations and behaviors are greatly in¯uenced by socio-cultural
factors and it is essential the treating clinician does not impose his/her own
expectations and standards onto the patient.
Where possible the clinician will bene®t from a full evaluation of the context in
which the sexual dif®culties arise. The partner's account of the dif®culties frequently
adds new perspective on the nature and causes of these disorders.
TREATMENT OF SEXUAL DYSFUNCTIONÐAN
INTEGRATED APPROACH
Masters & Johnson 1966, 1970) proposed an approach to the treatment of sexual
dif®culties that took these problems out of the realm of long-term psychotherapy.
Their investigation of sexual functioning, and focused therapy for sexual dif®culties,
was an important shift in treatment which created the specialty of `sex
therapy'. Their approach was essentially behavioral in its focus and based around
the in vivo desensitization, anxiety control and positive rehearsal of appropriate
intimacy skills, all incorporated into the `sensate focus' technique.
Kaplan 1974, 1979) later extended the Masters & Johnson 1966, 1970)
approach into a more comprehensive eclectic brief psychotherapy model. She
proposed a model of brief therapy for sexual dysfunction starting from a
psychotherapy base, but incorporating the cognitive-behavioral strategies available