Cognitive distraction during sexual activity still had a statistically significant relationship with how satisfied women were with their sexual experience and how they viewed themselves as sexual partners. The concept of spectatoring described by Masters and Johnson (1970), and Barlow (1986) has also been proposed as an explanation in level of sexual experience. Faith and Schare (1993) hypothesized that individuals negatively focused on their bodily appearance would tend to be sexually avoidant and would therefore show lower levels of sexual experience than less self-focused individuals.
Therapeutic Implications According to Masters and Johnson, the major task of therapy lies in overcoming performance fears and feelings of sexual inadequacy. Some significant forms of treatment revolve around developing more effective communication skills, practicing specific behaviors (i.e.:sensate focus exercises), and taking a closer look on the interactions within a couple and the functions of the sexual problems in the relationship (systems therapy).
The fact that several studies have investigated the veracity of the interplay between cognitive distractions and sexual relationships, and continues to be regarded as an important etiological factor in sexual dysfunction requires us as therapists to incorporate some form of cognitive treatment in couples suffering from sexual dissatisfaction. Application of Self-focus For the purposes of demonstrating the importance of cognitive therapy in sexual relationships, let us consider the following example.
Mary and Tom are seeing a therapist concerning their sexual experience as a couple. Furthermore, Tom is experiencing difficulties with premature ejaculation. A common approach to this situation would include the technique of sensate focus. An essential guideline of this exercise involves sensual touching in the context of both partners remaining nude in each others presence.
Undiscovered by the therapist, Mary is ashamed of her body and doesnt feel comfortable exposing herself under such terms. Mary is a shy, reserved woman who will try anything to help the sexual intimacy between herself and her husband, so she follows according to the plan. When they come in for the following session, Tom bursts with anger complaining about the ineffectiveness of the exercise. What has occurred here is an example of a woman who is so intensely self-focused on her poor body image, and low sexual-esteem that she is unable to enjoy the intimacy of sex with her husband. As the sessions progress, Mary hesitatingly reveals to the therapist that she cannot focus on pleasure because she is distracted by other things.
How can I relax knowing that my body looks like this? I hate the way I look; and I know that I am unappealing. Based on Marys statement about herself, she views herself negatively and holds the belief that others have the same assumptions of her. In this case, it becomes necessary to explore Marys maladaptive cognitive distortions. It would be beneficial for the therapist working with this couple to demonstrate to Mary how her irrational thoughts have contributed to the sexual difficulties.
Consequently, the previously held cognitions are changed into more appropriate ones. For instance, I always believed that I was ugly because people made fun of me when I was growing up, but I know now that I am an adult and that is no longer the case. By altering and shifting the focus from an internal to external locus of control, Mary forms new ways of thinking, in turn leading to more opportunities for sexual intimacy.
Plausible Therapeutic Strategies Distractions can be used effectively as a therapeutic strategy for the control of emotional responding. Therapeutic techniques such as thought stopping and covert sensitization, may be useful in working with women who have a tendency to self-focus and remain cognitively distracted in sexual interactions. The reliability and validity of the Sexuality Scale (Snell and Papini, 1989) indicate that it might be advantageous when working with couples or individuals who are suffering from sexual dysfunctions.
One method of incorporating the items from the scale can be to present the client(s) with a questionnaire. Or the therapist can verbally pose the questions, if the therapeutic alliance has been firmly established. Some of the items derived from the sexual-esteem scale include: I am a good sexual partner. I am not very confident in sexual encounters.
I would rate myself low as a sexual partner. Clients can then respond with one of the following five options: agree, slightly agree, neither agree nor disagree, slightly disagree, or disagree. Sexual adjustment and satisfaction are important features of personal well-being and satisfaction with intimate relationships. In this regard, the importance of cognitive processes and the utility of applying concepts from cognitive psychology to human sexuality cannot be disregarded. Granted, numerous studies indicate other valid, sound, concrete contributing factors of sexual dysfunction. Nevertheless, these findings should not discount the significance of the role of self-focus in sexual relationships.
Implications for Future Research The field of cognitive psychology has offered much insight and elucidation in furthering our understanding of the capacity our internalizations have in our sexual relationships. However, much research is needed to gain a richer understanding of the influence that self-focus plays on human sexuality. The limited number of studies available to date are not sufficient in providing therapists with adequate information regarding the applicability of Masters and Johnsons (1970) original concept of spectatoring.
Much remains to be investigated in terms of the prevalence, level of dysfunction, and specific treatment modalities in working with individuals who have a tendency to self-focus. Without further exploration we are devoid of reaching outcome goals with clients in the therapeutic process.
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