Hypoactive Sexual Desire - Treatment Approaches

Over the past 15 years, sex therapists have increasingly come to recognize and acknowledge the diversity of etiological factors implicated in sexual desire disorders. As a result, current psychological treatment approaches are varied, ranging from long-term, individual psychotherapy to short-term, problem-focused couples therapy. When working in this area, some therapists value a "toolbox" of eclectic interventions, including hypnosis, transactional analysis, systemic and feminist perspectives, Gestalt therapy, cognitive-behavior therapy, and other therapeutic techniques and frameworks.

There is increasing awareness of the possibility of organic etiologies for reduced sexual drive. Although our knowledge of how these operate has become more sophisticated, we continue to have only a rudimentary understanding of the ways in which psychological factors combine and interact to give rise to severe and long-standing difficulties with drive, desire, arousal, and orgasm in both men and women. We understand the power of these psychological forces, which extends to the capacity to overcome the action of drugs acting on sexual function, as we see them operating on a regular basis, but we have only a limited understanding as to how these forces function.

Relationship factors in absence of drive and desire are often played down by individuals, couples, and clinicians alike, because working with such factors is challenging, complex, and potentially "dangerous," the threat of change being an extremely destabilizing force, especially in long-term partnerships.

Psychodynamically Oriented Sex Therapy

Before Masters and Johnson, such sex therapy as was available was dominated by the work of Freud and the psychoanalytic movement. Some tenets of these early approaches have now been seriously challenged and superseded. The fundamental concepts developed by early theorists, however, remain an enduring factor in therapeutic work for sexual difficulties. Kaplan's contribution was the evolution of a sense of balance, in which the importance of psychodynamic aspects, alongside more practical behavioral programs, was highlighted. LoPiccolo reported successful outcomes for desire problems using a broad-spectrum approach.