Introduction to Psychosexual Medicine

Third Edition

Philipa A. Brough, Margaret Denman, Philipa A. Brough, Margaret Denman

• Publisher: CRC Press
• Year: 2019
• ISBN:
  9781351601528
• Edition: 3
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This authoritative text for those training in Sexual Medicine now returns in a new edition that builds on what clinicians found most useful in the previous editions - physical and psychological background knowledge and all relevant treatments, combined with psychological therapies, principles, and case examples applied to common problems.

1

The Institute of Psychosexual Medicine Approach to Psychosexual Medicine as Practised by Health Professionals

Margaret Denman

The Buddha (480–400 bce), founder of Buddhism, is said to have described the mind and the body as depending on each other in a way that two sheaves of reeds were to stand leaning against one another

The Institute of Psychosexual Medicine (IPM) was founded in 1974 by the psychoanalyst Tom Main, and he became Life President until his death in 1990. He was a colleague of Michael Balint, who wrote the seminal book The Doctor, His Patient and the Illness (1). This was based on transcripts from a series of seminars held with a group of London general practitioners (GPs). The format was case presentation and discussion. The seminar group became aware that they had patients in whom no physical cause could be found for their disease, and they came to accept the existence of psychosomatic illness. The GPs realised that to help these patients they had to deviate from the standard hospital-based tradition of investigation and treatment. Balint developed the concept of the ‘doctor as the drug’, also using this model of case presentation to a group, and Main held seminars with GPs and family planning doctors. Patients in family planning clinics were increasingly presenting with sexual difficulties, and the doctors felt ill-equipped to help them. Main’s groups began to specialise in this field, and from these seminars the IPM evolved as discussed in his book The Ailment and Other Psychoanalytic Essays (2).

The IPM is still primarily a teaching organisation where doctors, and increasingly other allied health professionals, can learn by case presentation to a seminar group with a trained leader. This leader does not supervise or teach but allows a safe space in which the material can be discussed with an emphasis on looking at what happened in the room between that healthcare professional and that patient on that day. The leader and the group members all start from a place of ignorance with each new piece of case material presented. Feelings are looked at, but personal experiences and revelations are discouraged. The leader studies and manages the atmosphere in the group and, at times, will relate this back to the case material presented.

Building on their medical training and knowledge, this experiential learning allows doctors, nurses and physiotherapists to gain skills that enable them to treat patients with all types of sexual difficulties. These are mainly patients that they come across during the course of their day-to-day clinical work, while those with further training may treat patients in specialised psychosexual or sexual problem clinics. Clinicians are encouraged not to imitate their leader or other members of the seminar group but to learn to work in their own individual ways.

What does psychosexual mean? There are various definitions, but I like to think of it as:

The psychological and emotional attitudes concerning sexual thought and activity.

Increasingly we are understanding the scientific connections between the mind and the body. Since time immemorial people have been aware of the connections. Our language is littered with expressions such as ‘butterflies in the stomach’, ‘gut reaction’, ‘pain in the neck’ and many more. A blush of embarrassment is an instantaneous physical response to a psychological stimulus. We can see that many diseases, for example migraine and eczema, can be exacerbated by stress. On a more scientific level studies are showing that stress and depression can affect white cell function. Neuroimmunologists are increasingly studying the effects of stress on health at the hormonal and molecular levels. For sexual activity to be successful and fulfilling, the body has to be functioning and there needs to be no psychological or emotional barrier affecting libido or limiting sexual enjoyment. Patients do not like being told that their disease is ‘in their head’, but can often accept the explanation that the mind can affect the body, or that they are feeling their mental anguish as a pain or dysfunction in their body. This approach helps patients understand the concept of a psychosomatic or a psychosexual problem, i.e. their psychological and emotional attitudes are affecting their sexual thought and activity. Elsewhere in this text authors will discuss the physical aspects of the sexual response, the psychological components and their interaction.

As medical professionals, we have a duty to first exclude any physical disease. We are licensed to examine our patients and need to do this. Unlike psychotherapists and counsellors, IPM-trained clinicians also have to manage the physical aspects of the sexual problems that their patients present. It is not possible to look at the psychological issues until physical problems have been considered. Physical sexual difficulties may cause primary sexual difficulties sometimes leading to secondary psychosexual problems in the patient and sometimes their partner. The power of the IPM training is that one health professional can learn to manage both the mind and the body and thus help the patient to see the link between them.

You will discover as you delve into this text that the IPM training puts an emphasis on observation of the patient’s behaviour during the genital examination. This information can help the health professional unravel the patient’s problem. Because this is an important part of the jigsaw, the IPM does not train therapists who cannot examine their patients. The doctor or allied health professional who is treating and examining the body is also exploring the mind. This consolidates the link between the two.

As soon as health professionals start doing clinical work they are trained to ask questions. Of course, this is often necessary to exclude disease and make a diagnosis, but may allow the patient’s agenda to escape. The following chapters show how the IPM training empowers patients to have a voice. The patient, not the health professional, is the expert in his or her problem and the feelings about it. The text also demonstrates how the health professional studies what is happening between them and the patient in the consulting room and, using this information, learns to reflect and interpret what is going on. At times this can also be related back to the patient’s sexual life. To help illustrate this psychodynamic method of ‘brief interpretive therapy’ subsequent chapters contain case histories. These case histories are almost entirely fictional but based on situations that the authors have come across during their working lives. Anyone who thinks that they can recognise themselves can be reassured that no one else will be able to do so. It is more probable that they are identifying with similarities in the story of some other person. Although some patterns arise, it is shown that is impossible to have a preconceived theory of causation or generalise about an individual’s sexual problem based on their gender, age, sexual orientation, culture, social status or religion. Every human being has a different experience of life and reacts to it in his or her own unique way. This will become apparent as you experience the diversity of case histories described in this book and the unique experience of each health professional/patient interaction.

As a multi-author book there is inevitable overlap between chapters, but it will be appreciated that each contributor has interpreted the material in his or her own way. Each chapter stands alone.

References

1.Balint M. The Doctor, His Patient and the Illness. London: Pitman, 1957.

2.Main T, ed. by Johns J. The Ailment and Other Psychological Essays. London: Free Association Books, 1989, Chap. 15.

2

Identifying and Managing Problems in Different Settings

Margaret Denman

Different Types of Sex Therapy

This book mainly demonstrates how the Institute of Psychosexual Medicine (IPM) method of brief interpretive therapy is used to help patients with sexual and psychosexual problems. There are, of course, many other types of therapy for people with sexual difficulties. Counsellors, psychologists and psychotherapists treat people with psychosexual problems using a whole variety of skills. These include cog...