Practical Modifications of Masters' and Johnson's Approach to the Treatment of Sexual Dysfunction

A study is reported in which Masters' and Johnson's rapid-treatment (14-day) programme for sexual difficulties was modified to once-a-week out-patient attendance; in which couples attending for treatment were allocated to treatment by two therapists of opposite sex, (cotherapy), or one therapist of either sex (single therapy); and in which observations were made upon the therapeutic efficacy of marriage guidance counsellors in treating sexual problems, following appropriate training, in comparison with the outcome results of an experienced clinician. By way of introduction, a survey of the literature prior to the publication of Masters' and Johnson's "Human Sexual Inadequacy" in 1970 identifies four main strands of therapeutic practice and development which potentiated the uptake of Masters' and Johnson's ideas. These four strands - the psychoanalytic, the sociological, the cultural and the behavioural - are related to the period of questioning about professional knowledge of sexual function that Masters' and Johnson's "Human Sexual Response" of 1967 provoked. The-marriage guidance counsellor training group is described in detail by reference to personality characteristics, as defined by the 16PF test, and sexual knowledge, as assessed by the Sexual Knowledge Inventory (SKI). Results are compared with a population of marriage guidance counsellors. The effects of training are demonstrated by changes in the acquisition of sexual knowledge in the training group and by improvement in diagnostic skills over the period of training. Under the two conditions of cotherapy and single therapy, it is demonstrated that there are significant differences in favour of cotherapy, on the basis of an analysis of variance of questionnaires completed independently by therapists, by client couples, and by an external assessor. Therapists recorded their judgements before and after treatment, whilst client couples and an external assessor made judgements at the conclusion of treatment only. Analysis of the questionnaire results suggested however that treatment produced greater effects upon the general and sexual relationships of presenting couples than upon their sexual function, though all treatment procedures produced some change in all three aspects. It was concluded that further work might isolate in more specific detail the differential effects of treatment upon sexual function as distinct from appreciation of the sexual relationship and the general relationship. In modifying the time structure of treatment from a daily to a weekly procedure, it was observed that treatment typically took 12 sessions over 17 weeks but that there wide variations both between and within specific disorders. Marriage guidance counsellors were shown to establish treatment results that were of the same order of success as an experienced clinician. Final observations made proposals for modifying the diagnostic schema proposed by Masters and Johnson, and reflected upon the nature of cotherapy.