Enhancing Sexuality: A Problem-Solving Approach To Treating Dysfunction (Second Edition): Therapist Guide
Enhancing Sexuality provides mental health professionals with a structured, evidence-based approach to assessing and treating sexual dysfunction. This book guides clinicians through a step-by-step treatment model designed to help clients improve sexual satisfaction and relationship intimacy. A client workbook is downloadable separately.
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Overview
Sexual dysfunction affects many individuals and couples, often causing distress and impairing quality of life. This therapist guide presents a structured, problem-solving approach to treating sexual difficulties, integrating cognitive-behavioral techniques, psychoeducation, and targeted interventions. The treatment is designed for both individuals and couples and is adaptable for clients with diverse backgrounds and relationship structures.
This book is part of the Oxford University Press Treatments That Work™ series, offering step-by-step guidance on identifying, assessing, and addressing sexual concerns. It includes practical strategies, case vignettes, and exercises that therapists can use to help clients overcome barriers to sexual well-being.
Why Use This Resource?
Sexual dysfunction is a complex issue with psychological, relational, and physiological components.
- A structured, research-supported approach to treating sexual dysfunction.
- Guidance on assessing contributing factors, including medical, psychological, and interpersonal elements.
- Tools to help clients challenge myths, modify negative beliefs, and develop healthy sexual behaviors.
- Strategies for working with couples to enhance intimacy and communication.
Key Benefits
Structure
Provides a clear, step-by-step approach to treating sexual dysfunction.
Assessment
Helps clinicians identify psychological, medical, and interpersonal contributors.
Education
Addresses common misconceptions and provides psychoeducational interventions.
Exercises
Includes practical worksheets and exercises to facilitate treatment progress.
Who is this for?
Low Sexual Desire
For individuals feeling distressed, frustrated, or disconnected due to a reduced interest in sex.
Arousal Difficulties
For people who find it hard to become or stay physically aroused during sexual activity.
Orgasm Uncertainty Or Difficulty
For those unsure whether they’ve had an orgasm, or who struggle to reach climax despite adequate stimulation.
Emotional Discomfort With Sex
For individuals who feel anxiety, fear, or unease during sexual activity, even when the situation seems right.
Sex-Related Pain Or Discomfort
For people experiencing physical pain or difficulty during sexual activity, including penetration.
Ejaculation Concerns
For individuals worried about ejaculating too quickly, or those who find it difficult to ejaculate at all.
Differences Between Partners
For couples experiencing tension or distress due to mismatched levels of desire, preferences, or expectations.
Impact Of Mood, Anxiety, Or Trauma
For people whose sexual functioning is affected by psychological challenges like depression, anxiety, or past trauma.
General Sexual Wellbeing
For clients who feel uncertain about what is “normal” and want to improve their relationship with sex in a safe, guided way.
Integrating it into your practice
01
Assessment
Conduct a comprehensive evaluation of medical, psychological, and relationship factors.
02
Education
Provide psychoeducation on sexual health, anatomy, and myths.
03
Communication
Teach couples how to discuss sexual concerns openly and constructively.
04
Cognitive Restructuring
Help clients challenge negative beliefs and anxieties about sex.
05
Behavioral Exercises
Guide clients through graded exposure and sensate focus techniques.
06
Intimacy Building
Encourage clients to develop emotional and physical closeness with their partner.
07
Maintenance
Support relapse prevention strategies to sustain treatment gains.
Theoretical Background & Therapist Guidance
The Enhancing Sexuality program is rooted in cognitive behavioral therapy (CBT), a well-established psychological framework that emphasizes the reciprocal interaction between thoughts, emotions, and behaviors in maintaining sexual dysfunction. CBT interventions for sexual difficulties target maladaptive beliefs, performance anxiety, and avoidance behaviors, while promoting skills development and communication. The treatment approach presented here is grounded in decades of clinical research and empirical refinement, much of it pioneered by Barlow, Wincze, and colleagues.
The model acknowledges that sexual problems often emerge from a complex interplay of biological, psychological, and situational factors. Generalized difficulties — such as lifelong dysfunctions occurring across contexts — can be harder to treat, while acquired and situational problems tend to respond more readily to intervention. As detailed by Heiman (2002) and Heiman & Metson (1997), CBT techniques, including cognitive restructuring, behavioral rehearsal, and gradual exposure, have proven effective for a wide range of sexual dysfunctions. Sensate focus exercises, developed as a core component of CBT treatment, are used to reduce anxiety by shifting focus away from performance and toward pleasurable, non-demanding experiences of physical intimacy.
The structure of this guide reflects the cumulative work of numerous controlled studies and clinical trials (e.g., Barlow, 1972; Wincze & Carey, 2001), with additional insights from the author's clinical experience in hospital, university, and private settings. The program integrates key elements such as psychoeducation, cognitive and behavioral strategies, sexual response awareness, and couples-based communication training. Therapists are supported with detailed guidance and worksheets that enable flexible adaptation to individual and relational needs, while maintaining fidelity to empirically supported techniques. This approach ensures that both therapist and client are equipped with tools to address distress, improve sexual functioning, and promote meaningful change.
What's inside
- Guidelines for conducting thorough assessments.
- Structured interventions for various sexual dysfunctions.
- Case vignettes illustrating treatment approaches.
- Exercises to enhance intimacy, communication, and sexual satisfaction.
- Strategies for working with both individuals and couples.
FAQs
This guide covers disorders related to desire, arousal, orgasm, and pain, including erectile dysfunction, premature ejaculation, female sexual arousal disorder, and genito-pelvic pain disorder.
Yes, it provides guidance for treating both individuals and couples, with tailored interventions for each.
While medical factors are considered, the primary focus is on psychological and behavioral strategies. Collaboration with medical professionals is encouraged when necessary.
It includes techniques for reducing performance anxiety, challenging catastrophic thinking, and using graded exposure to increase comfort with intimacy.
How This Resource Improves Clinical Outcomes
By integrating this resource into therapy, clinicians can help clients:
- Overcome anxiety and negative beliefs about sex.
- Improve communication and intimacy with their partner.
- Increase confidence in their sexual functioning.
- Develop adaptive coping strategies for maintaining progress.
Therapists benefit from:
- A structured, evidence-based treatment model.
- Clear guidance for assessing and treating sexual dysfunction.
- Practical worksheets and exercises to use in therapy sessions.
- A resource that complements multiple therapeutic modalities.
References And Further Reading
- Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869-878.
- Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
- Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. University of Chicago Press.
- Wincze, J. P., & Carey, M. P. (2001). Sexual dysfunction: A guide for assessment and treatment. Guilford Press.
- Yang, C. C., & Donatucci, C. F. (2006). Emerging treatments for erectile dysfunction. Nature Clinical Practice Urology, 3(10), 540-547.
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