As with many other physical and mental problems, self-help approaches for sexual dysfunctions have been pursued throughout human history. Examples include herbal and animal medicines that have been passed on through generations and were believed to enhance male potency and female erotic responsiveness, to delay male ejaculation, or to relieve sexual pain. General models of help-seeking behavior (Dean, 1989; Wills & DePaulo, 1991) have been applied to sexual dysfunctions (Catania et al., 1990). Catania et al. (1990) found a common sequence that individuals used for seeking help for sexual problems in a sample of community respondents. Individuals first utilized self-help approaches, then help from other persons in their informal network, and finally professional help. Across age groups, self-help remedies currently in use include many different types of media resources, such as books, almanacs, and journals.
Such materials were employed by 50-61% of the individuals who reported having sexual problems. Including other, unspecified, self-help methods, 72% of all individuals with sexual problems had tried some form of self-help. Most respondents (80%) who sought help from partners, friends, relatives, clergy, or other informal sources for their sexual problem, and the large majority (88%) of respondents who sought professional help, had employed some type of self-help before moving to remedies typical of later stages in the help-seeking process.
All self-help interventions share potential advantages. Privacy maintenance is more easily secured using self-help approaches. Moreover, improvements in problem status after self-help interventions are more easily attributed to the self-helper's own competence, with a concomitant increase in self-esteem. Autonomy is more easily preserved than in face-to-face therapy, as there is less dependence on a therapist. Moreover, because therapy is delivered in the natural environment, the failure of strategies and their effects to generalize to real-life sexual situations is seldom encountered.
The economic and societal advantages of successful self-help are obvious. "Care made to measure" converges with the governmental health care goal to decrease public health costs as much as possible. All other things remaining equal, successful evidence-based (assisted) self-help strategies would leave more time available for professionals to deliver face-to-face treatment to sufferers of more complex sexual problems.
The potential of self-help treatments for reducing shame and embarrassment attached to revealing sexual problems to a health expert is a major advantage. First, there is the common reluctance of many people to disclose details of their sexual life. Beyond that, individuals who suffer from sexual phobia, or of sexual problems that are associated with feelings of shame or guilt, may find the disclosure of such problems an insurmountable obstacle to seeking out effective professional help.
Possible disadvantages of self-help approaches should also be recognized and understood. Unsuccessful application of self-help strategies may lower the help-seeker's belief in the potential helpfulness of professional sex therapy, even when such approaches have a high effectiveness rate. Incorrect self-diagnosis of problem type may lead the help-seeker to embark on a mission impossible. A man who believes that his erectile problem is fully caused by being out of shape may start a self-help program of fitness training in vain.
It has long been recognized that therapy for sexual problems does not always require major psychotherapy. As early as 1974, Jack Annon launched his PLISSIT model for accessing professional help for sexual problems, which sequences interventions in terms of their comprehensiveness and cost (Annon, 1974). The term is an acronym for P(ermission), L(imited) I(nformation), S(pecific) S(uggestions), and I(intensive) T(reatment). This model advocates matching the type of help provided to the demands of the help-seeker and his or her problem. Increasingly complex and demanding sexual problems are matched with increasingly extensive treatment programs. Many sexual problems, especially when presented for treatment during their early stages, are little more than sexual health concerns and can often be solved with minimal intervention. For instance, giving a woman who is experiencing difficulty having an orgasm permission to masturbate often solves the problem. Other problems require education on sexual anatomy and physiology, on normal ranges of sexual experiences, etc. The next step in the intervention hierarchy involves giving specific suggestions, such as how to employ masturbation techniques, the use of lubricants, specific intercourse positions, or the squeeze technique for premature ejaculation (Masters & Johnson, 1970). Few problems are likely to require prolonged professional help in the form of in-depth analysis of sexual history, processing of childhood experiences, or cognitive restructuring.
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