3. Behavior therapy of impotence

Abstract

Behavior Therapy consists of a number of treatment methods derived from experimental psychology, particularly the application of learning principles, both classical and operant. These techniques constitute a break with traditional insight therapy, emphasizing symptoms rather than personality review and change. They do not handle unconscious dynamic factors; the symptoms, or behavior as a whole, are considered the disease, but cognizance is taken of the person behind the symptom, and consideration is given to values, attitudes and beliefs. Neurosis is defined by Wolpe (1958) as learned behavior which is persistent and unadaptive, and which is acquired anxiety-generating situations. Historically, symptoms arise by training or trauma, by purpose or accident, during the life span of the individual who is more or less predisposed toward them. Included the behavioral therapies are systematic desensitization, active, graded therapy, assertive techniques, sexual responses, operant approaches, and numerous others. These approaches require four essentials: (1) contact with the feared object, situation, or feeling, (2) a graduated approach to the contact, (3) motivation of the patient to make this contact on a regular basis, and (4) fear reduction, induced by reassurance, relaxation training, medication, distraction, hypnosis, or other technical means. Additionally, these are preceded by a proper behavioral diagnosis, order to target in upon the symptom. Systematic desensitization is done through visual imagery the doctor's office, having the patient live through his fears and anxieties while a relaxed state. Active, graded therapy requires contact with the feared object, situation, or feeling a realistic manner. Male sexual inadequacy includes premature ejaculation, erective impotence, orgastic impotence, i.e., ability to perform but not to enjoy coitus (the frigid man), and retarded ejaculation, i.e. inability to reach ejaculation during coitus (ejaculatory incompetence of Masters and Johnson [1970]). I shall limit my discussion to the first two problems.