SEX THERAPY: HOMEOSTATIC CONSIDERATIONS
A question that might have occurred to the dyadic or family therapist or those familiar with dyad and family dynamics, is the relationship of sex therapy to the dyadic or family homeostasis. In the dyad/family context, homeostasis is the tendency of family members to maintain existing patterns of relationships and to resist change in another family member even if that change is constructive for the entire family or dyad. Homeostatic forces, usually described as “negative feedback” responses,* tend to be very strong in dyads and families; the literature** offers many examples and management techniques.
To a limited extent, homeostatic forces may appear in the course of sex therapy. They then manifest themselves in two situations, one involving the “healthy” (or at least, untreated) partner of the dysfunctional patient, and the other involving the children of the dysfunctional but improving couple.
Witkin summarized homeostasis in the dyad as follows:
With regard to the couple per se, frequently, improvement of the dysfunctional partner is seen as a threat by the “healthy” partner. The most obvious source of the threat lies in the “healthy” partner’s sense of his or her own inadequacy and worthlessness. The wife of a premature ejaculating man, for example, may feel that the only reason her husband tolerates her “faults” is that she tolerates his dysfunction and that once he is cured, he may leave her. Men have similar fears. The husband of an anorgastic wife may fear that once his wife can experience orgasms, his own inadequacy as a sexual partner will be revealed. Other men, knowing that some women can be multiorgastic, may fear that if the wife ever becomes able to have a single orgasm, she will become sexually “insatiable” (Sherfey), he will be unable to satisfy her, and she will seek other partners.
Within the family, children may behave in various ways in attempting to maintain the accustomed homeostasis. If the parents have visited a family therapist with the child as the identified patient, that child may tend at first to continue or even intensify his or her disruptive behavior; other children may persist in moderately dysfunctional patterns or adopt new roles aimed at restoring the familiar and therefore non-threatening, dysfunctional intrafamilial relationships. These occurrences are in every way consonant with the findings of the dyadic and marital/family therapist.
On the other hand, in sex therapy the homeostatic forces, dyadic and familial, are usually relatively weak. In the dyad, the sex therapist can usually deal with the negative feedback responses as they arise during the normal course of the therapeutic sessions. Similarly with the family: if the relationship between the parents can remain steady, and this is usually the case, the sabotaging efforts of the children almost always fail, and the children readily adapt to the new patterns of behavior.
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