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Expanding the Practice of Sex Therapy: An integrative model for exploring desire and intimacy by Gina Ogden

(Winner of 2014 American Association of Sexuality Educators Counsellors and Therapists book award) 

Reviewed by Alison Richardson (Editor ASSERT NSW)

Defining what we mean by sexual health is something of an ongoing challenge. Most therapists will probably agree that it is much more than addressing sexual performance – the frequency and duration of the sex act, the number of orgasms and other measurable components. In helping people achieve happy and fulfilling ways of expressing their sexuality many clinicians are seeking to expand their treatment and go beyond behavioural therapy and pharmaceutical intervention and explore the multiplicity of issues (physical, emotional, spiritual and mental) that effect our sexuality.  

Looking to expand my own practice I came upon, rather late in the day, the work of veteran US sex therapist, teacher and author Gina Ogden, and the groundbreaking research based on her nation-wide survey, Integrating Sexuality and Spirituality (ISIS). Prior to this the more than 700 sex studies conducted since the 1930s in the US had focused on performance issues and “almost always portray women as sexually deficient or dysfunctional…(and) less interested in sex than men”. The mistake, says Ogden, was that these studies omitted all emotional and relational issues that are an “essential component of women’s experience of sex”. The ISIS survey, (1997-9) asked such questions as How does sex feel? and What does sex mean in your life?

The survey, was groundbreaking in three ways. Findings verified that: sexual experience is multidimensional, sexual satisfaction is embedded in relationship and, excitingly, sexual satisfaction increases with age. Indeed ISIS found that “sexual satisfaction increased with every decade” with the “overwhelming message…that growing older can be a time of aligning body and soul rather than defining one’s self by medical conditions and sex negative attitudes”. Essentially it revealed that the core power of sexual connection is its ability to transform our lives, whatever our age and whether or not we have a partner.

The results of the survey led Ogden to declare three primary secrets to sexual satisfaction:

  1. Maturity allows us to discover ways of moving beyond sexual stereotypes about age related messages like: “good girls don’t” and “real men score” and “sex is dirty”. Above all it revealed that women enjoy sex!
  2. Maturity also allows people to come to terms with past sexual negativity and to move beyond disappointments and even abuse in early sexual lives to embrace full and satisfying sexual lives
  3. Relationships, like individuals, “ripen over time” and that far from sex declining with years spent together many couples find they grow more proficient and lead increasingly interesting erotic lives

Today these “secrets” are, to a large degree, incorporated into sexual therapy but, the abiding legacy of the ISIS survey is the realization that “crucial aspects of sexual experience reside in emotional and spiritual realm” and it is this fact that drives Ogden’s passion for understanding the dynamics of sexuality and to create her “expanded model of sex therapy” that forms the bedrock of her latest book, Expanding the Practice of Sex Therapy.

Historically models to explain human sexuality have neglected the emotional, relational and spiritual aspects of sex. Masters and Johnson’s sexual response cycle focused on male ejaculatory response. Kaplan’s model of desire focused on physiological factors and, while Basson’s model of female sexual response emphasizes the importance of emotions in determining arousal, spiritual and intellectual aspects of the sexual experience were not accounted for. “Even more narrowly focused are the pharmaceutical protocols, introduced increasingly since 1998 with the advent of Viagra”.

Ogden’s search for a vehicle for her “expanded theory” led her to the Medicine Wheel, central to spiritual practice across so many cultures and signifying the unending circle of life. This ancient template became the core for her model of sexual experience. The ISIS Wheel is the organizing principle to help clinicians help their clients “explore the totality of their sexual stories – past, present and future”. Unlike previous models of sexual behavior the ISIS wheel is neither prescriptive or predictive but instead allows and encourages sexual awareness across all levels – a sort of multi-dimensional sexual history where clients locate their areas of discontent and initiate their own new direction.

At the heart of this expanding model is the collaboration between client and therapist where the client is the interpreter of events and the most meaningful factor for positive change. The therapist’s role is to witness, guide and expand stories and to engage the client in their own therapy.

For clients presenting with sexual challenges defined by the DSM as dysfunctions, the Wheel allows exploration as to how symptoms of physical dysfunction may be linked to emotional, mental or spiritual issues as well as providing space for partners to voice their concerns and perspectives through exploration of feelings, meanings and motivations.

As Ogden says the ISIS Wheel is “a kind of generator for therapists who are hungry for healing modalities beyond performance-orientated and evidence-based approaches to sexual dysfunction”.

The Wheel itself is divided into four sections (the physical, emotional, spiritual and intellectual quadrants) which Ogden invites clients to view as a “kind of therapeutic Petri dish in which they can closely investigate certain kinds of sexuality issues and dynamics” they may bring.  Exploring issues using the quadrants allows for the emergence of new information about both the issue and the attitudes of the client to that issue. For example Ogden suggests a client complaining about vaginismus or premature ejaculation might begin to explore in the physical quadrant. Similarly clients might explore the impact of sexual abuse in this quadrant before moving into other quadrants to gain new insights and perspectives.

A female client’s urge to appease her angry father, who died when she was ten years old, might start exploring this issues in the emotional quadrant while a couple whose relationship is full of “shoulds” and “oughts” might begin in the mental quadrant and another couple who are exploring their opposing views about having a baby could start in the spiritual quadrant.

“The point is that using the wheel and the core dynamics offers therapists a frame to hold space for clients to discover their own paths” says Ogden. Interestingly she notes “the places clients avoid on the Wheel are the places they most need to explore”!

For Ogden the therapeutic wheel allows therapists and clients to become aware of the transformative aspects of sexual experience that has been largely ignored by contemporary psychology. However she does cite work by Barry Komisaruk and Beverly Whipple and their work on The Science of Orgasm, whose studies with women showed that sexual stimulation and orgasm activate “multiple regions of the brain – not just the centres of physical reward and gratification but also (and most importantly for ISIS consciousness) the centres of emotional, spiritual and cognitive response”.

In sum the client’s journey around the Wheel “intrinsically connects physical, emotional, mental and relational experience by offering the large picture – the connections and meanings of sex”.

For those wishing to discover more about the Wheel the book is packed with anecdotes and case studies and Ogden also offers extensive training to practitioners who can get to the USA! For those who can’t though she offers an excellent on-line booklet on the Five Secrets of Great Sex Therapy. It’s FREE on her website, and inspired me to go on to read her books. And even though I have yet to attend any formal training Expanding the Practice of Sex Therapy has already provided me with practical and exciting new ways of engaging my clients in exploring their sexual issues to good effect!

Expanding the Practice of Sex Therapy: An integrative model for exploring desire and intimacy, by Gina Ogden (Routledge,  New York ) is available from Amazon or from www.expandingsextherapy.com


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