BEHAVIORAL APPROACH TO SEXUAL DISORDERS: TARGET BEHAVIORS
From this perspective, the characteristics of the behavioral treatment of sexual disorders differentiating it from the Freudian-based treatments are clear. (1) The behavioral methods are concerned with the maintenance rather than with the origin of the sexual disorder. Origin and history become important only as they reveal what the person does to perpetuate the very things he wants to change. (2) The identification of very specific target behaviors (including such covert behaviors as fantasies, feelings, and desires) that maintain the disturbing condition is the core of the behavioral diagnostic and evaluative procedure. Deliberate and systematic efforts to modify these target behaviors are the core of the treatment. Measurement of change in target behaviors and of disturbed behaviors in the life situation also is an integral part of the therapeutic procedures. (3) Modification of the problem maintaining behaviors is a sufficient goal for treatment, and exploration of intrapsychic dynamics is not necessary for successful and permanent change. As the target behaviors change (assuming the therapist has chosen the correct targets), there will be a feedback into the person’s psychological organization that will bring about a “healthier” realignment of the intrapsychic forces.
Indeed, from a behavioral perspective, the consideration of intrapsychic dynamics may often be irrelevant, a waste of time and distract from an efficient course of treatment. This is especially true of those sexual maladaptive behaviors that, whatever their origin, have now achieved functional autonomy from the general psychological organization. These behaviors persist in the present as blind habits.
Premature ejaculation appears to be one such autonomous condition. As long as it is treated as a blind habit and as long as it is treated by the Seman’s method of training, the counter habit of ejaculatory control, good results will be obtained in a large majority of the patients. It is true that some patients do have complications that interfere with treatment. High levels of anxiety (often but not always secondary to the premature ejaculation habit) may impede progress. Specific reinforcers (secondary gains), such as a feeling of vindictive satisfaction in frustrating the partner, may also impede progress. A general attitude of passivity on the part of the patient may make any new learning (including the learning of the Seman’s counter-habit) slow and uncertain. However, once these complications have been dealt with, almost invariably the premature ejaculation must be treated as if it were an autonomous blind habit.
Many sexual variant behaviors also appear to have attained a functional autonomy from the general psychological organization. In our own experience this seems to be particularly true of transvestites, exhibitionists, and fetishists. Fensterheim has already noted that although the Freudian theory of the genesis of these disorders may (or may not) be completely correct, the traditional methods of treatment are remarkably unsuccessful. However, when they are treated as simple autonomous habits through such behavioral methods as aversion (Rachman and Teasdale) or thought stoppage (Cautela; Fensterheim), a high rate of successful change is attained. Further, instead of the development of substitute symptoms, the removal of the variant behaviors often quickly leads to increased self-esteem and decreased anxiety and depression (cf., Morgenstern, Pearce and Rees).
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