To establish at least a minimum of patient screening, at the onset of the clinical treatment program, no units were accepted in therapy unless the complaining partner in the couple (e.g., the impotent male or the non-orgasmic female) had a history of at least six months of prior psychotherapeutic failure to remove the symptoms of sexual dysfunction. Very soon this proved to be a poorly contrived standard, of little screening value.
As should have been apparent at the onset, there was no secure way of establishing the functional effectiveness of the prior therapeutic program. How determined and well oriented was the therapist, how cooperative or fully responsible was the patient? After two years this original standard was abandoned in favor of that currently in effect.
Sexual Screening
A reasonably effective method of screening has been substituted by requiring that no patients be accepted at the Foundation unless they have been referred by the authority. As the authority, the Foundation accepts physicians, psychologists, social workers, and theologians.
Beyond screening the patients for appropriate referral to the Foundation, the referral source further is asked to provide available details of psychosocial background relevant to the husband and wife’s sexual dysfunction.
A telephoned report is made to the referring authority describing husband and wife’s progress (or lack of it) during or immediately following the acute phase of treatment at the Foundation. The well-informed authority then can provide the most important reinforcement for newly acquired patterns of sexual interaction for the couple once removed from the Foundation’s direct control by the termination of the acute phase of therapy.
In many instances, patients in established psychotherapeutic programs have been referred for removal of symptoms reflecting a somewhat broad area of distress in which sexual inadequacy is only a part. After their two weeks at the Foundation, these couples are, of course, returned to referring authority to continue their established treatment programs.
Obviously, the referring authority, before continuing in therapy with his patient, is briefed in detail as to the couple’s response to its Foundation exposure. The screening process as currently constituted has several aims, all obviously selective in nature.
Symptoms of Sexual Inadequacy
Primarily, control which prevents referral of major psychopathology is presumed. In other words, the psychoneurotic is acceptable, but not psychotic.
It should be emphasized that the reversal of symptoms of sexual inadequacy in psychoneurotic patients is indeed a significant portion of the Foundation’s objectives. Acceptance of this role by the Foundation is based on the premise that the reversal of particularly troublesome sexual symptoms may speed the progress of a psychoneurotic patient within the greater context of his established and broader-based psychotherapy.
However, the majority of the couples contending with sexual dysfunction do not evidence psychiatric problems other than the specific symptoms of sexual dysfunction. Socio-cultural deprivation and ignorance of sexual physiology, rather than psychiatric or medical illness, constitute the etiologic background for most sexual dysfunction.
Therefore, when a couple is properly educated in sexual matters, and their specific symptoms are reversed, there is no need for further psychotherapy unless the extensive duration of the distress has created psychosocial complications no longer directly related to the sexual dysfunction.
Other areas of selective screening for information vital to the therapeutic program center on such questions as:
- Are both members really interested in reversing their basic dysfunctional status? If one member of the unit simply has no interest whatsoever in reversing the symptomatology of sexual dysfunction in the marital relationship, the unit probably needs legal rather than medical or behavioral advice. The chances of reversing sexual dysfunction under the circumstances of total disaffection for a marital partner are negligible.
- What, if anything, is known of the couple’s adjustment or maladjustment to its social community?
- Do the referred members of the couple understand the programs, procedures, and policies of the Foundation? If not, it is suggested that the local authority, quietly briefed in advance by the Foundation’s professional staff, present the information in more specific detail to his patients.
- What is the couple’s basic financial picture? Should the Foundation offer the patients an adjusted fee scale or free care?
Sexual Therapy Commitment
The original research premise emphasized the fact that the positive reversal of symptoms of sexual inadequacy during the acute phase of the treatment program was not of great importance. If there were to be any clinical claim for positive effect in the Foundation’s concentrated approach to symptom reversal, the clinical results would have to be judged in retrospect over a significant period of time, not at the termination of the acute phase of therapy.
Therefore, the policy of five years of follow-up for couples after the termination of the rapid-treatment phase of the program became an integral part of research standards. Failures to reverse symptoms are, of course, considered most significant.
Little clinical value can be established for any therapeutic program, regardless of the length of its ongoing treatment phase, if the results are not evaluated in long-term follow-up after the termination of the acute phase of therapy. The abiding guide to treatment value must not be how well the patients do under authoritative control but how well they do when returned to their own cognizance without therapeutic control.
This result finally must place the mark of clinical failure or success upon the total therapeutic venture.
Individual members of couples seen in treatment must agree to cooperate with five years of follow-up after the termination of the acute phase of the therapy program. They fully understand.
The Foundation’s basic premise that success in a reversal of the symptoms of sexual dysfunction means little during the two weeks of intensive treatment unless the symptom reversal is maintained for at least the first five years after separation from direct Foundation influence.
Success in the maintenance of symptom reversal for this length of time does provide some sense of permanency in the continuing effectiveness of the couple’s sexual functioning.
Those couples whose acute treatment phase was judged inadequate or a failure arbitrarily have not been placed in the five-year follow-up program. This type of follow-up would indeed have been a study of major importance, but such continuing interrogation certainly could have interfered seriously with other clinical approaches designed to relieve the unit’s problems of sexual dysfunction.
The therapy concepts and clinical procedures depict the basic methodology of co-therapist interaction, first, between team members, and second, directed toward husband and wife of the sexually dysfunctional marital, unit. Jules Masserman has so aptly described psychotherapy as “anything that works.” This “works” in a healthy percentage of cases.