"Treatment Concepts and Techniques in Sexual Therapy" by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching for "Symposium - Sex and the Spine: All You Ever Wanted to Know about Sex and the Spine but Were Afraid to Ask" by NSpine as part of SpineWeek, at Marina Bay Sands Expo & Convention Centre on Mon 16 May 2016. Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.

1. Treatment Concepts and
Techniques in Sexual
Therapy
Dr. Martha Tara Lee, D.H.S.
16 May 2016
Symposium: Sex and the Spine: All You Ever Wanted to Know about Sex and the Spine but were
Afraid to Ask

2. Agenda
• What is Sex Therapy?
• Myths and Misconceptions
• Common concerns addressed
in Sex Therapy
• Sexual Response Cycle
• DSM-5 Sexual Dysfunctions
• Sexual Function Assessment
Tools for Clinicians
• More Sex Therapy Models
• Treatment Techniques

3. Dr. Martha Tara Lee
Clinical Sexologist
• Doctorate in Human
Sexuality
• Masters in Public Policy and
Management
• Bachelor of Arts (Comm)
• Certificate in Sex Therapy
• Certitificate in Practical
Counselling
• Cert in Life Coaching

4. Multi-disciplinary Field
• Masters level clinicians, Psychologists and
Medical professionals, academics, PTs all
provide sexuality-related services
Requires these characteristics:
• Self-knowledge
• Professional judgment
• Ability to monitor and manage own reactions
• Willingness to research new perspectives,
practices and identities

5. Values
• What qualities and behaviors do sexuality
professionals consider in determining
sexual health?
• How do we support clients in identifying
their sexual needs and aspirations?
• How do our personal beliefs and
experiences inform or interfere with this
aspect of our work?

6. Sex Myths
1. Sex is a sensitive topic.
2. Sex is only for making babies.
3. There is a cut-off age for sex
4. He knows what he is doing.
5. There is a “best” way to have sex
6. More sex is better.
7. Faster is better.
8. Sex is incomplete without the orgasm.
9. Need desire for sex.
10.Need emotional connection for sex to happen.

7. Misconceptions about Sex and
Intimacy After SCI
1. Be grateful to be alive.
2. Things will get better.
3. Sex is about
penetration.
4. Sex is about the
orgasm.
5. Sex is all about him.
6. No need to think about
sex if single.
7. Too old anyway.

8. Sex Myths after SCI
1. I have no feeling = My sex life is over!
2. I’m not experiencing pleasure or orgasm anymore =
Sex is pointless! Why bother?
3. My partner left me, cheated on me, avoided having sex
with me = I’m not lovable and I’m not a capable partner.
4. No one will want a person with a disability for a lover.
5. Just give it time. Everything will fall into place.
6. If you have high self-esteem, everything else will follow.
7. I shouldn’t be thinking of sex now, I should be focused
on ____.
8. Once SCI cuts the connection between the genitals
below and the brain above, orgasm is dead.
Tepper, Mitchell (2015) Regain that Feeling, The Sexual Health
Network Inc.

9. Sexual Functioning Concerns and
How to Find Help
Negative thoughts and feelings during sex
• We often find themselves
distracted during sex by
negative images and thoughts.
• Try focusing on pleasurable
feelings in your body or on a
sexy thought or fantasy. If that
does not help, ask for a referral
to a mental health professional
who can help you change
negative feeling and thinking
patterns

10. Factors Modulating Sexual
Functioning

11. ISIS Model by Gina Ogden

13. Alternative Model of Woman’s
Sexual Response

15. • Hypoactive Sexual Desire
Disorder
• Sexual Arousal Disorder
• Sexual Aversion Disorder
• Female Orgasm Disorder
• Sexual Pain Disorder
▪ Dyspareunia
▪ Vaginismus
Female sexual
interest/ arousal
disorder
Genito-pelvic
pain/penetration
disorder
DSM-5 Female Sexual
Dysfunctions

16. Frigidity
Inhibited Sexual Desire
Disorder - DSM-3
Hypoactive sexual desire
disorder - DSM-3-R
Female sexual interest/
arousal disorder - DSM-5
A Name is Just a Name?

17. • Sexual dysfunctions (except substance-/medication-induced
sexual dysfunction) now
o Require a duration of approximately 6 months and
o More exact severity criteria
• Subtypes for all disorders include only
o “Lifelong vs. acquired" and
o “Generalized vs. situational”
• Two subtypes were deleted:
o “Sexual dysfunction due to a general medical condition"
and
o “Due to psychological versus combined
factors"
More on DSM-5

18. Kinsey Scale
0- Exclusively heterosexual with no homosexual
1- Predominantly heterosexual, only incidentally homosexual
2- Predominantly heterosexual, but more than incidentally homosexual
3- Equally heterosexual and homosexual
4- Predominantly homosexual, but more than incidentally heterosexual
5- Predominantly homosexual, only incidentally heterosexual
6- Exclusively homosexual

19. Klein Sexuality Grid

20. Sexual Orientation
Our pattern of
sexual, romantic,
and emotional
attraction to
others

21. Gender Identity
Our deepest feelings
about our gender,
and the display of our
identity and
personhood

22. Gender Roles and Culture
• The clothing styles
• The stereotyped
personality differences
• The tasks assigned to
one gender or the other
• The question of status
between the two
genders

23. GLBTQ*
• Language keeps
changing
• Must educate
ourselves
• Ask people what
they like to be
called

24. Sexual Diversity
There is some overlap
between the GLBTQ and
alternative communities, but
only a minority of GLBTQ
people report considering
themselves kinky or in open
relationship.
Kinky sexual practices and
flexible relationship structures
occur in all populations, age
groups and social strata.

25. Assessment by interview of
Both Partners

26. Assessment by interview of
Both Partners

27. Assessment by interview of
Both Partners

28. Quick Assessment

29. Psychological therapy

30. 1.Relationship Assessment Scale
2.Men: Erection Hardness Score
3.Men: International Index of Erectile Function
4.Female: Female Sexual Function Index
5.Female: Female Sexual Distress Score - Revised
Sexual Function Assessment Tools for
Clinicians

33. Sex Therapy Principles
• PLISSIT Model
• Psycho-education, information and
resources
• Mindful awareness and relaxation skills

35. PLISSIT Model
Permission to self – Pleasure; to use vibrator, Ask for
certain kinds of touch, caress.
Limited Information – Changes in sexual response with
pregnancy, menopause, aging. Impact of
medication(s) on sexual function.
Specific Suggestions – HRT benefits and risks, use of
lubricants; Positions.
Intensive Therapy – Refer to specialists for couple
therapy, resolution of long-standing problems.

36. Postmodern and Integrative
Approaches
Bring together:
• Narrative
• Cognitive-Behavioral
• Solution-Focused
• Contemporary
Psychoanalysis
• Existential-
Humanistic

37. Sensate Focus
Stage 1
–Without genital touch
Stage 2
–With genital touch
Stage 3
–Go with the flow

38. Treatment Techniques
• Kegels
• Stop-start method
• Scale
• Pendulum
• Progressive steps
• Sexual Attitude
Restructuring

39. Sex Secrets for SCI
1. Pleasure is not merely a physical sensation.
2. Orgasm happens between your ears, not just between
your legs.
3. Trust, safety, and connectedness matter more than
physical and genital function.
4. The calling card of intimate connection is desire.
5. Pleasure and orgasm after serious injury are the result
of a process of sexual self-discovery.
6. Awareness and acceptance are the first steps to
transformation.
7. Love is an action, not a feeling.
Tepper, Mitchell (2015) Regain that Feeling, The Sexual Health
Network Inc.

40. Relationship Problems
• Anger
• Poor Communication
• Criticism
• Neurotic Interactions
• Incompatible Sexual
fantasies
• Alcoholism & Sexual Abuse
• Phobic Avoidance of Sexual
Intercourse
• Unconscious Conflict about
Sex, Commitment, Pregnancy
• Sexual Abuse Issues

41. Psychosocial Issues
• Lifelong or acquired
• Symptom or situational
• Unresolved history of sexual abuse or
trauma
• Body image/ Self-esteem issues
• Psychiatric history
• Stress, anxiety, sadness
• Relationship conflict
• Partner’s sexual dysfunction

43. 1.Get educated
2.Don't personalize it
3.Don't feel rejected
4.Be positive
5.Discuss things calmly
6.Discuss outside of the bedroom
7.Reassurance - treat your man as your best
friend
8.Encourage but don’t push
9.Continue being sexual - lots of different ways
to be sexual
10.Go with your guy to the doctor
11.Adopt a healthy lifestyle together
Suggestions of What to Do

44. Communication
• Code Words
– Red, Yellow,
Green
• Open Ended
Questions
• Closed Ended
Questions
• Scale 1 to 10

45. Why Do Medical and Mental Health
Care Professionals Need to
Understand Sexual Problems?
Sexual problems have
an adverse effect on
interpersonal relationships
and the quality of life.
Copyright 2012 Eros Coaching

46. We Don’t Ask Because Of…
• Personal embarrassment
• Lack of knowledge re: clinical relevance
• Ignorance re: who, when, how, or what to ask
• Concern re: not knowing how to answer
questions
• Concern re: becoming aroused/uncomfortable
• Concern re: appearing seductive/intrusive
• Uncertainty about legal issues
• Time constraints

47. Lack of Sexuality Education

48. We Can Make a Difference
By Talking about Sex

49. 1. Sex Is Bigger Than Any
Body Part
2. Even If You’re Afraid To
Ask — Ask
3. Don’t Wait, Act Now
4. You Are Not Alone
5. Don’t Give Up
Takeaways

50. Professional Organizations
• AASECT - American Association of Sexuality Educators,
Counselors & Therapists
• SSSS - Society for the Scientific Study of Sexuality
• SSTAR - Society for Sex Therapy & Research
• Kinsey Institute
• WPATH - World Professional Association for Transgender
Health
• IPSA - International Professional Surrogates Association
• ACSB - Association of Certified Sexological Bodyworkers
• Source School of Tantra Yoga

51. Resources
• Disabilities Health Research Network http://www.dhrn.ca/
• Kenneth Ray Stubbs www.sexualshaman.com
• Dr Mitchell Steven Tepper www.mitchelltepper.com (incomplete C6-7)
• Cory Silverberg http://corysilverberg.com/
• Sex and Paralysis Video Series created by Dr Mitchell Steven Tepper
http://www.drmitchelltepper.com/sex_and_paralysis_video_series
• SexSCI www.sexsci.me

52. Thank you!
Dr. Martha Tara Lee, D.H.S.
Clinical Sexologist
Eros Coaching Pte Ltd
Website: www.eroscoaching.com
Email: drmarthalee@eroscoaching.com