International Handbook of Clinical Hypnosis - E-Lib FK UWKS

TREATMENT OF SEXUAL DYSFUNCTIONS 235
at that time, as an extension of their seminal works. While Kaplan 1974, 1979)
does not discuss the potential role of hypnotically based therapies in her excellent
work, she does offer an integrated approach into which hypnosis can be added.
Therapeutic intervention for sexual dysfunction involves at least ®ve sequential
components. Each builds on and is predicated by the previous stages, and while
early stages are seldom suf®cient for a successful treatment outcome, not all will
be necessary in a particular therapeutic intervention.
The ®rst stage begins with the diagnostic evaluation of the dysfunction within
one of the contemporary diagnostic frameworks such as DSM-IV APA, 1994). The
process then begins with the development of a therapeutic intervention based on
the aetiology, expectations and wishes of the patient concerned.
The second stage of treatment comes out of the developing rapport and the
process of establishing the aetiology. It involves giving the patient and their partner
permission to discuss openly in a non-judgemental way sexuality, sexual beliefs,
sexual feelings and the general emotional context within which the sexual involvement
occurs.
The third phase of treatment is an educative phase, which con®rms the appropriate
knowledge of the patient or couple, but most importantly corrects any
misinformation the patient accepts about their own sexual functioning or responses
or `normality'. Inappropriate beliefs and understanding, while becoming less
common, are still frequently implicated in the aetiology or maintenance of sexual
dif®culties.
The fourth component of treatment involves therapeutic interventions speci®cally
targeting sexual behavior and learning, those most commonly thought of as
`sex therapy'. A therapeutic agreement or contract is established with the patient,
or preferably the patient and partner, after an outline of the approach to be undertaken
has been given. Once the therapeutic intervention is embarked upon through
the cooperative effort of therapist and patient or couple, ongoing re-evaluation is
essential to determine whether further information relevant to the aetiology has
emerged in the process of therapy. Assessment of the outcome at each stage of
treatment is a useful feedback mechanism to assist the therapist and patient or
couple in re®ning the therapy focus. It is in this area that hypnosis may assist,
incorporating its advantages with other therapy approaches.
If resistance to therapy or change is met, or if treatment progress is poor, the
therapist may enter into a more long-term intensive psychotherapy approach, the
style of which will vary with the approach and expertise of the clinician. A more
extensive psychotherapeutic intervention may also be required if the aetiology of
the dysfunction is assessed to be the result of more extensive psychological
dif®culties.
In spite of the usefulness of hypnotic approaches Gilmore 1987) and Hammond
1990) noted that only 5±7% of sex therapists in the United States use hypnosis.
This is presumed to be a result of continuing professional ignorance about the
therapeutic use of hypnosis and the persistence of myths about hypnosis.