Sex therapy and counselling service - who needs it?
Sex therapy and counselling service - who needs it? |
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Key words: Sex therapy; assessment; counselling; sexual dysfunction.
Introduction
The Sex Therapy and Counselling Service offered by County Durham and Darlington Priority Services NHS Trust is unique in the northern region of England, UK. The service is based in Darlington Memorial Hospital and is accessed by patients living within County Durham, England. The service is set up specifically for the treatment of various aspects of sexual difficulties. These difficulties may be of either organic or psychological origins. The range of sexual dysfunction management can be broadly broken down into two: Sex Therapy and Psychosexual
Counselling.
Sex Therapy
Sex therapy is offered for the treatment of all clinical sexual dysfunctions. These include:
a) In the male: Primary and secondary impotence; premature ejaculation; retarded ejaculation; and inhibition of sexual desire.
b) In the female: Vaginismus; dyspareunia, anorgasmia; coital orgasmic dysfunction; and inhibition of sexual desire.
Psychosexual Counselling
Psychosexual counselling is offered for a range of disorders such as: general sexual problems, sexual health concerns, sexual phobias and paraphilias, gender dysphoria and sexual orientation difficulties. Others include rape victims, survivors of childhood sexual abuse; pre and post abortion counselling. Risk assessment is carried out on sexual offenders and counselling offered where appropriate.
The need for a sex therapy and counselling service
People often wonder what happened in the past to patients suffering from sexual difficulty.
A commonly held belief is that "people just got on with it" and somehow managed quite well without any help for their sexual difficulty. This assumption is far from true. Sexual problems left untreated, like any other disorder, have far reaching consequences. The social costs in marital breakdown, infertility and offending behaviour is well known. These factors in turn escalate health costs and human suffering from the resultant mental health problems such as low self-esteem, depression, anxiety, insomnia etc. If the patient's source problem is one of sexual difficulty then these complications will continue to persist. It is therefore the source problem that requires treatment. People's reticence in revealing sexual difficulties could lead to the belief that sexual disorder is transitory and uncommon. However, the recent fear expressed in many newspaper headlines that Viagra could potentially bankrupt the NHS would seem to acknowledge the extent of suspected sexual disorder in the general population. If sexual disorder is suspected to be widespread, it is a wonder why more specialist treatment centres are not available. There are many reasons for this.
The role of the general practitioner
Firstly, all general practitioners (GPs) would need to identify the lack of services available to them by a needs assessment of the population they care for. They are only able to do this if their patients reveal to them what their real needs are - something most patients find very difficult indeed. Secondly, there is at present, a scarcity of trained sex therapists. It is not unusual to find the duration of a sexual problem to far exceed that stated in the original referral letter. Patients frequently suffer sexual difficulty for many years before seeking help. When, usually in desperation, they finally disclose to their GP, patients tend to minimise both the extent and duration of the problem. The main reason given for this behaviour is one of embarrassment, along with the belief that their GP has little or no available treatment that they can access. This belief is based on fact in many areas where GPs do not have access to speciality help. However, the GPs attitude to sexual matters also seems to play a part in patient's ability to discuss sexual concerns with them. Although the Sex Therapy and Counselling Service receives referrals from more than 50 practices widely distributed across county Durham, it is notable that these come mainly through certain GPs within most practices. It is possible that either these doctors have a higher proportion of their registered patients suffering from sexual difficulties or that they are more receptive to disclosures of sexual problems. There may however be other explanations for this disparity in referral patterns. General practitioners who are frequent users of this service do acknowledge that their patients both need and benefit from such a specialist service. Many of these same GPs also admit that they refer only "the tip of the iceberg" of the patients that approach them with sexual difficulties as they are aware that the service is often over-stretched. Although patients may have to join a waiting list before they can be seen, they are assured that they will receive a thorough assessment, and if possible treatment for, their specific difficulty.
Assessment
Patients referred into the service are offered appointments which are usually of one hour's duration. This allows for the therapist to devote enough time to put the patient at ease and discuss at length with them the nature of his/her sexual difficulty and the context in which it occurs. Sexual difficulties seldom occur in isolation, but normally occur within the context of a relationship. It is because of this factor that the patient's sexual partner is also encouraged to attend. Having both partners present helps to clarify the difficulty because it is often found that one partner is complicit in the maintenance of a sexual dysfunction. An example is that of a man presenting with premature ejaculation because his partner dislikes sexual activity and this encourages a rapid conclusion to sexual behaviour. In such a case, if a person cannot see any benefit to them-self in a change to their sexual practice as such, he/she will actively sabotage any therapeutic help that can be offered to their partner. It is also our experience that individuals with sexual dysfunctions unconsciously seek each other out as partners. It is not uncommon to find a woman presenting with primary vaginismus who has a partner who is also suffering from erectile difficulty. Although the male may report adequate erectile capability, this is not sustained once the female is free of her vaginistic response and is able to be penetrated. Consequently it is the couple who must be considered as a unit for treatment and not only the initially referred individual. Assessment of a couple for a sex therapy programme takes approximately seven one hour sessions. This time is required to gain the trust of the couple and to enable the therapist to identify all of the factors involved in the dysfunctions. It is only after this period of assessment that any treatment regime can be offered, whether this is Sex Therapy, Psychosexual Counselling or both. During the assessment for sexual dysfunction, therapists often uncover a history of sexual abuse. As this is often the root cause of the presenting sexual dysfunction then a treatment plan would probably begin by first offering psychosexual counselling to the patient who has suffered the abuse. Only after this treatment has been concluded would 'couple work' to address the presenting difficulty begins.
All therapists working within the service are highly trained. Sex therapy training is available in only 5 specialist centres in the UK and candidates can only apply to access the training after having already qualified, and have experience in, a complimentary profession such as counselling, psychology, nursing, etc. Therefore there is, unfortunately, a scarcity of trained therapists available. It is hoped that eventually the service provided by county Durham and Darlington Priority Services NHS Trust will develop further thereby ensuring the security of the service and continuance of a treatment resource to the people of county Durham. In the long term it is hoped that a Masters degree in Sexual Therapy can be developed with one of the local universities which will potentially increase the amount of trained therapists in the northern region of England. This could facilitate the development of similar services to that provided in county Durham in our surrounding counties. However, this will only be achieved if GPs continue to identify sexual problems existing within their patient groups and identify this area of treatment need as one that requires financial support and development.
In conclusion, the answer to the question, "sex therapy and counselling service - who needs it?", is "many more patients than currently have the opportunity to access such a service". There is evidence that this applies not only to county Durham but also across the country.
©2000 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough,
UK
ISSN 1469-7556
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