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BookREVIEW: Sexual Diversity and Sexual Offending:

Sexual diversity imageResearch, Assessment and Clinical Treatment in Psychosexual Therapy

Ed. Glyn Hudson Allez,

Karnac
2014
Paperback
pp320

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Reviewer Lynda Woodroffe

When I was training to be a therapist, a client used one session to relate to me all about the sexual practices of gay men. He assumed that I knew nothing and in some ways he was right. I didn’t have first-hand experience and what I knew originated from conversations with gay friends, attending a few gay clubs and from the media. He needed me to know about him. He needed me to know about the physical as well as the psychological difficulties experienced by gay men.

Many psychotherapy training centres cover the basics of psychosexuality, but unfortunately this is not enough. Luckily, we can get access to CPD courses, usually day courses, which offer some source for understanding practices with which we are less familiar. This book is another source.

Sexual Diversity and Sexual Offending addresses these points. Therapists will be limited in their knowledge about sexual practices unless they specialise. The topics discussed in the book go beyond what we often picture in our heads as therapy – two people talking alone in a therapy room. Some of the authors suggest other tools to achieve greater understanding of and empathy for their clients. These can be sex films, pictures and anatomical models, cushions or other objects, and surrogate partners.

Throughout the book, the overall focus is the clients’ attachments styles. It is divided into three sections. Part I, ‘Walk the Line’, has eight chapters. The authors describe therapeutic work with gay, lesbian, bisexual and transgender (GLBT) people, problems with anal sex, shame in lesbianism, sex with dying people, the use of sex aids and the value of using sex films in therapy. Part II, ‘Pushing the Line’, has three chapters and the authors write about prostitution, internet porn and sexual surrogacy.

Part III, ‘Crossing the Line’, has six chapters and includes descriptions of therapeutic work with people who have had sex with animals, illegal internet porn and its effects on law enforcers, adolescent sex offenders, adults who are sexually interested in children and finally the therapy of the Pesso Boyden System Psychomotor (PBSP), a method that can be used with sex offenders and other traumatised people.

Throughout there are quite a few references to Masters and Johnson (1957 – 1990s). Their work seems to me to be quite dated now and I was surprised that it was still being cited, but considering the extent of the research carried out, maybe this is to be expected. I noted, again with surprise, that Shere Hite (1942 -) was mentioned only once, in the introduction.

In their chapters, the authors distinguish between what is legal and illegal. They address pathology and the guilt surrounding sex and sexual practices, and they stress the need to recognise abuse. There are explanations in practical terms for ‘taboo’ sex. Nomi Pitch, for example, explains bondage-discipline, dominance-submission, sado-masochism (BDSM) in simple language, with clear definitions as a way to aid understanding. She considers BDSM an extension of everyday customs such as the need for power and mentions the possible countertransferences that a therapist may have to endure to help a client to survive their feelings. She also stresses that BDSM must remain “safe, sane and consensual” (p.77), a tenet to which therapists need to adhere.

I was impressed by most chapters in the book, but one in particular stood out – chapter six, entitled ‘Why would you want to have sex – you’re dying’ by Peter Wells. This chapter related the feelings of a dying man who missed being sexually active in his last months of suffering from cancer. Part of the problem lay in the roles that he and his partner played out during these months; she had become his carer and no longer saw him as a sexual being, and due to his illness, he was often too lacking in energy to participate. With some careful therapeutic help, they were both able to enjoy some sexual intimacy before his death. The description of the meeting of their needs was both touching and informative.

In another chapter – chapter twelve on “The medical consequences of sex between humans and animals” by Stenio de Cassio Zequi – I experienced a strong countertransference. I had an embodied reaction – nausea. In this chapter, practitioners of bestiality (sex by humans with animals) and zoophilia (mutual interest in sex between animals and humans), explain their preferences for animals in terms of a lack of connection with them and their feelings. The justifications for sex with animals are that animals are “dispensable”, they “don’t ask for reward” and are “not jealous” (p.187). It is all about sexual gratification and not relationship. Attachment plays little part in this practice although there are some who are very fond of their animals. Trained animals are sometimes used for pornography. The author also describes the possible diseases that can develop through frequent practise, penile cancer being one. He reports findings of studies and explains some of the legal and health aspects, as well as the possible psychological underlying causes for them. For me this chapter offered no hope and I found it hard to feel empathy for the perpetrators of what I saw as abuse.

The final chapter is by Juliet Grayson (www.stopso.org.uk), a Pesso Boyden System Psychomotor (PBSP) therapist, who describes in detail how she uses this method with sex offenders.  It can address, Grayson writes, the root causes of trauma and poor attachment.  Grayson purports that PSBP is “particularly effective when dealing with insecure attachments, developmental deficits…or trauma” (p.252). Using resources such as a witness and ideal parental figures during the therapy, Grayson describes how a client can develop new and believable memories, memories which can bring about neurological changes and which can enable a wider range of choices. Although this method is, as yet, under-researched, Grayson cites the MRI results on seven trauma victims as having activated and deactivated parts of the brain relating to emotional control and cognitive functioning. The outcome from grieving and feeling contained throughout the process resulted in positive improvements in the clients’ sense of self-worth and a more profound ability for them to relate to others. Bearing this and the lack of research in mind, Grayson comments: “it seems remiss not to offer this method to those whose behaviour has such a damaging effect upon potential victims”(p.273).

In concluding, I wonder about the extent of the therapist’s need to be sexually knowledgeable – how much do we need to know before our clients come to us? Being equipped with the information in advance could facilitate reparation and acceptance more immediately were the issues openly discussed and raised without ignorance or judgement. Could the risk of not knowing result in unwanted judgements? Equally unhelpful, if a therapist is inhibited by his or her own inexperience and holds back his or her opinions as a result, could abusive behaviour in the client be inadequately challenged? The authors recommend training for therapists in these psychosexual issues. They recommend that clients’ practices, as well as their incumbent guilt, fears and possible self-hatred are examined in the therapy room. As well as this, the authors suggest that therapists need to be aware of public and private views that isolate and marginalise those who experiment, or which attack those who may not be happy with their gender or ostracise those who cross boundaries with illegal practices. Finally, the authors maintain empathy with their clients as long as they operate legally, safely, sanely and consensually, an exemplar for us all.

 Lynda Woodroffe is an integrative psychotherapist working in N W London.