Principles in treatment - Attitude Change - Related to the article "Not all gay man are DTF" i listed in [[20220909 Reflection on my sexuality]] There are much power, and influence by social values and narratives on how people should have sex. - It affect self-image. - This is related to how much social value rubbish one absorbed into our mind without questioning, if it is true. We try to live up to an expectations, an image we hold on to without questioning. Think of the problem with [[202209081214 Majority does not mean it is right, such as the ending of slavery]] simply because everyone is doing it, doesn't mean it's truth. - Eliminating Performance Anxiety - Stop "keeping score", focus on process instead of the goal. - Changing Destructive Life-styles and Sex Roles - Remove barriers, duties and occupations that take away time for intimacy and sex. ## Overcoming Sexual Inadequacy. Arnold A Lazarus. - Very few sexual problems stem entirely from structural, hormonal, or neuronic deficiencies. The overwhelming majority of sexual problems stem from psychological (attitudinal) determinants. ### Forms of Sexual Inadequacy - Frigidity and Impotence Causal factors in Impotence and Frigidity - Parasympathetic systems is related to emotions, and mood. Related to psychology issues? - Erection in the male and clitoral enlargement and vaginal distension in the female are predominantly parasympathetic functions. Discharges of the sympathetic division exert an inhibitory effect on sexual arousal and performance. Thus, doubt, fear, guilt, shame, conflict, embarrassment, tension, disgust, irritation, resentment, grief, hostility, and most other "negative emotional reactions" will tend to undermine, diminish, or extinguish sexual capacities in men and women. - Appetite - both physical and sexual are stimulated by past experience and cultural conditioning, and have wide individual differences. - Despite obvious differences between so-called hunger pangs and a sexual appetite, both are stimulated by complex central and peripheral physiological processes, and both show wide individual differences in taste and appeal which, in turn, are a function of past experience and cultural conditioning. #### Simple and Complex Factors - 1. Developing a "fear of fear" to defend against anxieties. - Because of beliefs, a man become frigid, but because this affect his self-image as man. He develop an anxiety to prevent sexual feeling. - Bottom line, it is complex personal philosophies concerning the concept of pleasure. - Not all problems need to be extensive!! Don't Oversophisticate issues. - I have observed a tendency among some psychologists and psychiatrists to view sexual difficulties with unnecessary pessimism. This stems from the habit of compounding sexual problems by insisting that nearly all cases of sexual in- adequacy are deep-seated in origin and require extensive reconstructive therapy. - A case worth citing is that of a nineteen-year-old lad, seen at a psychiatric ward round, who mentioned his overriding fear of sexual intercourse and described how friends had informed him that in certain women the vagina was capable of such violent spasms and contractions as to endanger the male organ. The chief psychiatrist accordingly referred to "deep-seated castration anxieties" and pre- dicted that even long-term analysis might not yield improvement. Yet, when one of the doctors simply corrected the lad's misconceptions and offered him factual information bolstered by the force of his own prestige, the problem was instantly resolved. In this age of psychological oversophistication, the search for complex answers to simple questions has become an international malady. - 2. Pseudoinadequancies - Pseudoproblem - when a male compare with other males, seems to have "fallen short" of what is expected of him to be. (e.g i am not having enough sex as a gay man) After intake assessment of problems. Then treatment. 1. The correction of misconceptions 1. Direct advice, guidance, information, reassurance, or instruction may suffice to overcome the milder, simpler, and more transient cases of impotence and frigidity. The correction of faulty attitudes and irrational beliefs is often an essential forerunner to specific techniques of lovemaking. One should endeavor to impart nonmoralistic insights into all matters pertaining to sex. It is often helpful to prescribe nontechnical but authoritative literature (e.g., Ellis, 1958, 1962, 1965; Kronhausen and Kronhausen, 1965; McCary, 1967). Patient and therapist may then exchange views on a variety of topics and examine sex in a rational, objective, and enlightened manner. 2. Desensitisation Sessions 1. What is this? group sex? 3. Assertive Training for Impotent Men 1. This is interesting! How a "passive" outlook of man 1. "Many impotent men appear to have servile attitudes toward women and respond to them with undue deference and humility. Their sexual passivity and timidity are often part of a generally nonassertive outlook, and their attendant inhibitions are usually not limited to their sex life. These men feel threatened when required to assume dominance in a male-female relationship." Page 63. - Anxiety - a sympathetic response inhabits sexual arousal. A parasympathetic response .[[Anxiety]] - Page 64. "Performance Concerns" - 1. Affective Components - Performance Anxiety - 2. Cognitive components - involves thoughts in which the patient questions and evaluates his performance, then severely criticizes himself for failing. ## Chapter 27. Treatment of Erectile Failure and Ejaculatory Incompetence of Homosexual Etiology Page 346 is interesting. Not going to believe that this is going to remove homosexuality but what if we are constrained by our own concepts and language use. When we are boxing ourselves even when labelling ourselves according to sexuality? - A case study of gay men. One of the gay male want to "increase his heterosexuality arousal without eliminate the male's homosexuality. To enhance his heterosexuality." - The use of "Arousal reconditioning technique"