SEXUAL DISORDERS: THEORETICAL CONTEXT OF HELEN SINGER KAPLAN’S TREATMENT METHOD
In Kaplan’s view, sex therapy is considered a form of psychotherapy, conducted in an experiential/psychodynamic conceptual framework. It considers superficial and profound causes, and immediate and remote determinants. Treatment focuses on the immediate and the superficial, but the differences among patients demand skill in confronting profound and remote etiology.
Kaplan assumes that sexual dysfunctions have many causes and calls for an eclectic, equally multi-faceted approach. Depending upon whether the primary pathology is intrapsychic or interpersonal, the treatment will emphasize individual or dyadic in – will depend on the nature of the symptoms as well as on the skills and preferences of the therapist. This, of course, is true in any psychotherapeutic relationship. In practice, both intrapsychic and interpersonal factors are encountered in almost all cases.
Kaplan’s treatment does not ignore the total system, the ecology in which the patients’ functioning is integrated. No person or couple can escape the effects of a destructive family system; these ecological considerations are confronted and explored when they arise.
Theoretical flexibility extends not only to the treatment offered but also to the definition of the “patient.” Although it is traditional in sex therapy to define the patient as a couple, Kaplan feels this is not always appropriate, nor is it necessarily the best procedure. In particular, one type of sexual dysfunction has been addressed by the Kaplan method with only a single person without a partner as the “patient”; lack of orgasm in the female. Since the treatment of the anorgastic woman with or without a partner has the same initial goal – the attainment of orgasm through self-stimulation – the participation of a male is not essential. The step toward having orgasms with a partner and eventually during coitus may or may not require further clinical therapy with a male; whether to seek such therapy is the choice of the individual woman.
In addition to the patient without a partner, it is occasionally considered appropriate to see one member of a dyad alone for a number of sessions. A common situation is for the couple to have bilateral dysfunctions, for example, premature ejaculation or secondary impotence in the male and lack of desire or lack of orgasm in the female. In those cases, a typical treatment schedule would begin by seeing the couple together for one or two sessions, and then seeing the woman alone until she is able to have orgasms by herself through self-stimulation. At that point, work with both partners resumes until the couple has full sexual functioning. Individual sessions might also be indicated when one partner has a special sexual “secret” whose revelation to the other partner might have a deleterious effect on the overall relationship (Kaplan).
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