Men, sex and context in psychosexual therapy: finding a suitable frame

Abstract

This descriptive study explores contextual factors and psychosexual therapy with the first 70 consecutive male clients seen by one therapist in a regional, hospital-based Psychosexual Healthcare clinic. Clinical, demographic and referral data were examined to provide a snapshot of client characteristics, specific sexual problems and more general life adversities. The data were ordered and categorised into biological, psychological, inter-personal and environmental factors to provide a generic taxonomy of (mostly inter-related) client problems across the four dimensions. Findings indicated that good outcome was linked to completion of therapy, individual counselling, and treatment via masturbatory control or sensate focus. Single men or those with non-cohabiting partners were significantly younger than men with live-in partners. Variance across the four biopsychosocial domains centred on alcohol/drug use and smoking, childhood (sexual) abuse and neglect, relationship discord, infidelity, dissatisfaction with previous therapy, and new employment or work re-location. The multiplicity and complexity of the men's adversities suggested that contextual factors, personal and material, figured as highly as the referred psychosexual problems. Practically, the need to harness both biomedical and psychosocial expertise was apparent from the amount of co-working and cross-referral, both in-house and externally. Clinically, the use of ‘non-specific’ factors in therapy risks stretching treatment beyond its specialist frame, but can enhance engagement and subsequent intervention.