Written by Westland Researcher Adrianna Xue

Throughout the course of history, sexual health has often been overlooked as a ‘legitimate’ medical and self-care practice. Due to this, there are only a handful of published sex researchers that have contributed the bulk of our knowledge in sexual and reproductive health. The research produced in the early to mid-20th century still forms the foundations of the modern practice of sex therapy today.

The 1950s saw the rise of aversion therapy to treat what was considered “deviant sexual behaviour” by Behavioral Therapists. During this time, sex therapy was often centered on controlling sexual expressiveness; such as imprisoning “sexual perverts” or predators, suppression of masturbation in children, and finding ways in which to minimize the need for frequent intercourse (Leiblum & Pervin, 1980). Behavioural therapy believed sexuality was a conditioned anxiety response, therefore, therapists aimed to extinguish the anxiety or performance demands through systematic desensitization (LoPicollo & LoPicollo, 1978; Lazarus, 1963; Goodwach, 2005).

Knowledge of sexual health and expression – and how it was diagnosed and treated – took a leap forward from these behavioural treatment styles with the work of William H. Masters and Virginia E. Johnson. In their book Human Sexual Inadequacy (1970), they used brief, intensive, behaviour-oriented interventions to treat specific symptoms. Masters and Johnson also pioneered the idea of couples therapy for sexual difficulties, and popularized “sensate focus” exercises to help aid in this therapeutic work. Sensate focus exercises were, and are, meant to alleviate performance anxiety, with the goal of becoming absorbed in the pleasures of the moment. They also introduced other techniques, such as the “stop-start and squeeze” technique for premature ejaculation. They felt these exercises helped to build confidence and control in their patients. Masters and Johnson also recognized women as equal to men in their ability to enjoy sex and the sexual experience, and produced research on sexual performance for homosexuals as well (to mixed reviews).

Masters and Johnson based the majority of their clinical work on reports of the human body- specifically, the body’s physiological responses to erotic stimulation. Through this research they developed the four-phase model of arousal: excitement, plateau, orgasm, and resolution. They drew parallels between male and female sexual responses by describing changes in males and females in each phase of the cycle, and they viewed sexual arousal as a linear progression toward one’s orgasm (Goodwach, 2005). Masters and Johnson were significant contributors to the modern understanding of sexuality largely because the legitimacy of their work was formed on the basis that therapy can be constructed around measurable physiological responses.

Through this new lens, more measurable and innovative sex therapy techniques began to form. In the 1970s, Dr. Helen Kaplan experimented with various treatment formats, including same-gender group therapy and conjoint couple therapy. She also introduced the notion of desire as a three-pong model (desire, excitement, and orgasm), and placed desire before physiological responses. Kaplan used behavioural exercises to help stimulate therapeutic dialogue when patients were experiencing sexual dysfunction, and used brief psychodynamic therapy to help relieve patient’s sexual dysfunction symptoms to deal with their inner and current conflicts. As a whole, Kaplan’s techniques were vast, and also included a mix of marital therapy, dynamic counselling, masturbation, and behavioural exercises. Medication, such as SSRI’s, were also used by Kaplan to help clients overcome sexual phobias (Goodwach, 2005).

Today many institutions, organizations, and universities continue to use the work pioneered by these researchers. However as our understanding of sexual health and expression grows, so does the need for more research in this field, as well as trained and knowledgable sex therapists and counsellors. Research is slowing continuing to evolve in this growing field, and unfortunately pharmacological research and discoveries often lead the way. However, there is still a long road ahead in order to progress this modality forward in a fully holistic and comprehensive way.


Works Cited:

Goodwach, R. 2005. Sex Therapy: Historical Evolution, Current Practice. Part I. ANZJFT, 26(3), 155–164.

Leiblum, S. & Pervin, L. 1980. Principles and Practice of Sex Therapy. Guilford, NY: The Guilford Press.