Existential sex therapy

Abstract

This paper considers what existential psychotherapy has to offer the ever-expanding field of sex therapy. First it considers the critical stance that existential psychotherapy takes towards diagnosis and categorisation, explaining why it is important for sex therapists to engage critically with notions of “sexual dysfunction” and suggesting ways in which we might work with clients around the losses and gains of various labels. Following this, existential therapy is briefly outlined and applied to sexual issues, drawing particularly on the work of Peggy Kleinplatz and Irving Yalom as well as the author's own client work. Three aspects of existential therapy are explored in depth: the focus on client's lived experience; the multiple meanings they may have around sex; and the importance of considering the various dimensions of existence. Throughout this latter half of the paper, examples will be given where sex therapists worked with existential themes (including how to live a meaningful life, how to relate to others, mortality and the freedom to choose).

Keywords:

• individual therapy
• sexual psychology
• existential therapy
• critical psychology
• diagnosis

Acknowledgements

I would like to thank the fantastic multi-disciplinary team at Guys Sex and Relationship Therapy Clinic for introducing me to the world of sex therapy and for support and discussions. I am very grateful particularly to the clients who agreed that I could share their stories in my writing. Thanks to my tutors and fellow students at the New School who have helped me to apply existential ideas to these issues and to my academic colleagues in critical psychology whose research has informed my work in this area. Finally many thanks to all at BASRT for making me so welcome in the world of sex and relationship therapy and for offering me the chance to work on their website, the results of which (hopefully) bring critical perspectives together with more conventional sex therapy in a way which is useful to all (see www.basrt.org.uk).

Notes

1. Following the popular “monster of the week” format from sci-fi and horror shows like The X Files and Buffy the Vampire Slayer.

2. Kleinplatz does point out that, despite this, compliance levels with pharmacological and physical treatments for “erectile dysfunction” are low (e.g. Althof & Turner, 1992) and many women are reluctant to follow the “vaginismus” techniques, so there seem to be some limitations to these approaches, even under their own definitions.

3. This privileging of penile-vaginal penetration is also seen in the treatment of people who are born ambiguously sexed and are traditionally assigned as male or female by doctors based on whether they are physically able to penetrate a vagina or to be penetrated. “Corrective” surgery carried out often deadens sexual sensation (Fausto-Sterling, 2000; Kessler, 1998).

4. Although the related form of “experiential psychotherapy”, referred to by both Kleinplatz and Mahrer (Mahrer, 1996; Mahrer & Boulet, 2001), should also be considered in relation to existential issues.

5. Mental processes like emotions and memories occur on a physical level in the neural connections of our brains and relate to other aspects of our bodies (genitalia etc.) through our central nervous system. Similarly, physical processes require certain psychological states in order to take place (e.g. comfort, desire, arousal etc. for orgasm).

6. I say “everyone” because it is important to remember that sex can occur between more than two people, for example in some forms of open non-monogamy (Barker & Langdridge, 2010).