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1/6. The role of dreams in sex therapy.

    The interpretive use of dreams has become an established part of all dynamic psychotherapies. Their usefulness in sex therapy has thus far not been acknowledged. For the psychodynamically oriented sex therapist dreams can be particularly valuable in furnishing an understanding of those unconscious factors that cause sexual dysfunction, those that perpetuate dysfunction, and those that interfere with efforts to treat the dysfunction. By utilizing and integrating dream material into the sex therapy format, treatment is more likely to be successful and in a shorter period of time than can be accomplished by either sex therapy or psychoanalytic psychotherapy alone.
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keywords = psychotherapy
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2/6. sex therapy in an in-patient and out-patient setting.

    This paper summarizes the experience with sex therapy in an in-patient ward for neurotics (N = 82), where it could be combined with interpersonally oriented group psychotherapy in a therapeutic community setting. Outcome data are compared with an out-patient form of sex therapy, used in several counseling centers (N = 111). The in-patient form of therapy had a success rate of 76% at completion of treatment and 52% after a follow-up period of 15 months. The out-patient therapy was successful in 71% but no follow-up was carried out. Almost 50% of the couples who originally started therapy dropped out. Three illustrative successful cases are described.
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ranking = 1
keywords = psychotherapy
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3/6. infertility. A psychiatrist's perspective.

    This paper discusses issues relevant to psychiatrists working in a reproductive biology unit: 1. The couple's anxiety. 2. The question of whether psychological conflict can cause infertility. 3. Dealing with the outcome of the workup. 4. Donor insemination. The anxiety of couples applying for an infertility workup can usually be countered by supportive and educative measures. More problematic sources of anxiety that require psychiatric consultation are: 1) fear that the workup may shatter a myth that explains the infertility, a myth reinforced by unconscious conflicts; 2) An untenable wish that having a child will repair problems in the marriage or in the sense of relief. The psychiatrist is often asked whether psychological conflicts can cause infertility. The most understandable manner in which they do is by their effect on sexual performance. Where there is no sexual performance problem, psychotherapy can be offered if one or both partners experiences psychological pain, but with the understanding that therapy cannot be expected to cure the infertility. Psychiatric consultation at the end of the workup is indicated 1) where irreversible infertility is discovered and mourning is excessive, 2) where a myth to explain the infertility has been shattered, 3) to reassess sexual performance and to deal with the uncertainty, where no physical cause has been discovered. Donor insemination (AID) is fraught with legal and ethical problems. There are no criteria for selecting donors or recipient families, and there is concern that AID may lead to genetic engineering. The psychological effects of AID are uncertain. A study at our clinic suggests that the pursuit of AID involves a two-stage process: first, dealing with the outcome of the infertility workup and second, confronting AID itself; and that the secrecy that surrounds AID obstructs resolution of conflict.
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ranking = 1
keywords = psychotherapy
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4/6. pregnancy after electroejaculation in combination with intracytoplasmic sperm injection in a patient with idiopathic anejaculation.

    OBJECTIVE: To assess the possibility of achieving a pregnancy in the wife of a patient suffering from idiopathic anejaculation who failed to respond to therapeutical modalities such as psychotherapy, sex therapy, and vibrostimulation. DESIGN: Case report. SETTING: The IVF program at the Leuven University Fertility Centre. PATIENT(S): A patient suffering from idiopathic anejaculation. INTERVENTION(S): Intracytoplasmic sperm injection (ICSI) in combination with electroejaculation. MEAN OUTCOME MEASURE(S): Fertility rate, cleavage rate, clinical pregnancy. RESULT(S): Two IVF procedures were performed of which the second resulted in an ongoing pregnancy and the delivery of a healthy boy. CONCLUSION(S): Electroejaculation may offer fertility chances in a patient suffering from idiopathic anejaculation resistant to conventional treatment modalities. When sperm quality shows very low motility, ICSI should be offered to improve pregnancy chances.
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ranking = 1
keywords = psychotherapy
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5/6. Treatment of vaginismus by i.v. diazepam (Valium) abreaction interviews.

    A new method of treatment of vaginismus by using intravenous diazepam abreaction interviews is reported. Four patients between the ages of 19 and 28 were interviewed. The duration of their main complaint varied from 6 months to 3 years. Three to six abreaction interviews were conducted; the maximum dosage of Valium used was from 20-30 mg. All of these patients reported having successful intercourse after these interviews. Individual psychotherapy continued after the interviews on a weekly basis, and marital therapy on a monthly basis, for a period of 2 to 6 months. Three out of four women reported being orgasmic for the first time. It is the opinion of the author that this new method of treatment of vaginismus is greatly beneficial.
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ranking = 1
keywords = psychotherapy
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6/6. Concurrent sex therapy and psychoanalytic psychotherapy by separate therapists: effectiveness and implications.

    Since the publication of Masters and Johnson's Human Sexual Inadequacy in 1970, sex therapy has become an established, though controversial, new approach to the treatment of sexual disorders. Masters and Johnson adopted the position that any other form of psychotherapy should be avoided or suspended during the two- or three-week period of sex therapy. Helen Kaplan, in considering sex therapy to be a type of psychotherapy, has stressed that the skillful trained psychotherapist uses his awareness of the psychodynamics and unconscious conflicts of the couple in modifying and tailoring the sex therapy program to their individual needs. In the present study, sex therapy, utilizing a second therapist, was introduced into an ongoing psychoanalytic psychotherapy.
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ranking = 7
keywords = psychotherapy
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