Transcript PowerPoint 프레젠테이션 - 지성병원 해암 뇌 의학 연구소

부부성치료의 목표와 방향설
정
THE GOAL AND THE FUTURE DIRECTION OF COUPLE’S SEX THERAPY
2005. 10. 22.
한국상담심리학회-성상담연구회 심포지엄
정동철
정동철신경정신과의원
INTRODUCTION
Sex Therapy in the Age of Viagra(Leiblum SR, 2000)
Changing Perspectives and Practices
The Viagra Revolution
The Changing Social Climate
Changes in Sex Therapy
The new sexual pharmacology
Female sexuality
Technological changes in society: Effects of the Internet
Future Concerns and Directions
해암뇌과학연구소
CHANGING SOCIAL CLIMATE
(정동철, 2000)
DINK (Double Income No Kids, 맞벌이 무자녀 부부)족
① 저 체중 → 출산력 떨어지고 생리불순
② 저 출산 → 유방암.난소암 등 위험성-출산율은 1.26명이다. 미국 중앙정
보국(CIA) 통계에 따르면 전 세계적으로 우리나라보다 출산율이 낮은 나라
는 홍콩.마카오.싱가포르.리투아니아.체코.슬로베니아뿐이다.
③ 저 골 밀도 → 운동 못해 다른 병 불러
④ 저 모유수유 → 아기 아토피 등 원인
⑤ 저 쌀 소비 → 당뇨 등 성인병 많아져
Pre-marital Sex, Yes 76% [일간스포츠(연합)] 2003.07.31
Datemate
사귀기의 4대 원칙. 사랑하지 말 것, 스킨십은 키스까지만 할 것, 감정이 식
으면 깔끔하게 헤어질 것, 사생활에 간섭하지 않을 것 등, 다감정의 교류 없
이 만난다는 점에서 미국의 ‘퍽버디(fuck buddy)’와 유사하지만 섹스를 하
지 않는다는 점에서 다르다. .(조선;05.09.28.)
Abortion
낙태 年35만 건… 42%가 미혼. 기혼여성 3명중 1명이 수술 경험(조선;
2005.09.13.)
Media & Entertainment
Misconception and Abuse of Sex for Economic Performance Only
해암뇌과학연구소
NATURE OF SEXUAL DYSFUNCTION
Definition
Sexual health is the integration of the somatic, emotional, intellectual, and
social aspects of sexual being, in ways that are positively enriching and that enhance
personality, communication, and love. The concept of sexual health includes three basic
elements(WHO, 1975)
1. a capacity to enjoy and control sexual and reproductive behaviour in accordance with a social
and personal ethic,
2. freedom from fear, shame, guilt, false beliefs, and other psychological factors inhibiting sexual
response and impairing sexual relationship,
3. freedom from organic disorders, diseases, and deficiencies that interfere with sexual and
reproductive functions.
Triphasic Concept(Kaplan HS, 1987)
DSM-IV and ICD-10 DSM-IV는 H.Kaplan의 영향(triphasic concept)을 받아 진단분류가
그 전과 달라졌으나, 진단기준은; 우선하는 정신장애, 의학적 장애, 물질장애 등에 해당되지
않아야 한다는 입장과 달리 분류를 세분화하여 포괄하고 있다.
Epidemiology
One third of Couples;
Orgasm, M 10%, F 25% Pain Intercourse, M 3%, F 15%/극치장애;
남 10%, 여 25%/Desire, F 33%/PE 27%/ Excite, F 20%/-Generally Marital Sex Dysfunction
30~50%. Resemble Rate of Divorce 50%.
Prognosis
60~100%
해암뇌과학연구소
ETIOLOGIC DETERMINANTS
(Kaplan HS, 1974)
Psychological Determinants
Immediate Causes/ Conflict-Intrapsychic Causes/
The Relationship-Dyadic Causes/ Learned Causes
Biological Determinants
Physical Illness; Hormonal/ Nervous/ Vascular/ Pain/AIDS(정)
cardiovascular disease - high blood pressure, diabetes,
high cholesterol, lack of exercise, obesity and smoking are the same as those associated with impotence.
Substances(Drugs); Aphrodisiacs/ Alcohol/ Marijuana/
Amphetamine/ Cocaine/ Androgen/ Anticholinergic
(Anti-acid/ Antiadrenergic (Anti-hypertension)/
Anti-psychotics
Age-Prolonged Refractory period and Potency(preViagra, 정)
Sociological Determinants
Cultural/ Regional/ Religious View Points
해암뇌과학연구소
SEX THERAPIST
Orientation and Experience becoming as a;
1. Proper Sexo-sophist
2. Individual Psychotherapist
3. Marital Therapist
4. Behavior Therapist
5. Rational Emotive Psychotherapist
(정동철, 2002)
해암뇌과학연구소
AN OVERVIEW OF THE VARIOUS
TREATMENT APPROACHES
Blends of
Psychodynamic,
Behavioral,
Cognitive Therapies
1. psychoeducational remediation, 2. reduction of sexual &
performance anxiety,
3. script modification tech.,
4. relationship enhancement & conflict resolution strategies,
5. relapse prevention procedures.
THE PLISSIT Model(Annon, 1976)
Permission-Limited Information-Specific Suggestion-Intensive Therapy
해암뇌과학연구소
SEXUAL CRUCIBLE THERAPY
(Schnarch, 1991)
Sexual Desire is a Systemic Process
1. High & Low Positions in a System
2. The Least Desire Always controls Sex
Differentiation:
Alternative Paradigm
Why is Differentiation Important?
3. Couples’ Foreplay
4. Emotional Gridlock
5. Dependence on Empathy, Accommodation
6. Anxiety Reduction in the Natural System
7. Poorly Differentiated Monogamy Relationships
8. Continued Personal Development(Differentiation)
해암뇌과학연구소
THE FOUNDATION & FRAMEWORK
OF PSYCHOTHERAPY
The Therapeutic Contract-Fees, frequency, rule for
canceling, length, pt’s expect, therapist expect, focus of tx.
Therapist Active Level-Short-term>Long-term
Importance of Empathy-Stand inside patient’s Shoes
Engendering Hope- Positive therapeutic climate eliminating
Wallowing following by sadness and frustration/ Role play
Too Much, Too Soon-Too much inform, too early interpret
The Illusion of Rapid Cure-Working through
Cognitive Aspects of Treatment-Contextual, emotional>
cognition; Myths(6) & Cognitive distortions(8)
Alienation from the Self-the Penis is attached to the Heart
The Dysfunction as Friend or Solution-Symptom may
be his/their friend
해암뇌과학연구소
THE GOALS OF PSYCHOTHERAPY
(정동철, 1982, Kleinplatz PJ, 2001)
Men with ED often feel
puzzled
disgraced
weakened
frightened
Men’s Potency to the optimal
Level possible, so
1. You have to be willing to make love
2. You have to be relaxed
3. You have to be concentrate on your sensations
해암뇌과학연구소
MEDICAL AND SURGICAL
TREATMENTS
Oral Erectogenic Agents
Phosphodiesterase Type-5 Inhibitors(Sildenafil),
Cialis(Tadalafil), Levitra(Vardenafil HCL);80%
Dopamine Agonists-Apomorhine HCL(sublingual Uprima,
only one centrally active agent);60%
Alpha-1/ Alpha-2 Blockers-Phentolamine mesylate
(Zorgniotti) or Doxazosin;50%
Local Therapies
Intracavernosal Injection Therapy(Caverject);70~80%
Intraurethral Alprostadil(Muse);50~65%
Vacuum Constriction Device(VCD) Therapy;60~80%
Surgical Treatments
Prosthesis Implantation;5~20% complications
해암뇌과학연구소
CURRENT RESEARCHS
ON NEUROBIOLOGICAL DEVICES
Central Nervous System
Excitatory Systems
Inhibitory Systems
1. Fear of Performance Failure
2. Threat of Performance Consequences
Interaction of Cognition and Emotion
Neuro-Imaging Devices
Molecular Biology and Immunology
Genetics
해암뇌과학연구소
BRAIN AND SEX(Emotion)
Drives from Basic Drives: Feeding, Sex, Reproduction, Pleasure,
Pain, Fear, Aggression.
Emotion has three major aspects:
Integration and Correlation of Sensory Stimuli with Memory
Autonomic reactions to Sensory Stimuli
Perception and evaluation of Sensory Stimuli
Memory Consolidation Circuits appear to be especially
important. They are found:
In the Limbic System most prominent area/ Papez Circuit
In the Amygdala intergrating gate of internal & external stimuli
In the Frontal L-lift, R-depression and Temporal Cortex
TLE-personality(viscosity)/ L-humorless R-excessive
LH-Analytic, Limited Emotion RH-Affect, Socialization, Body Image
In the Hypothalamus hormonal control
해암뇌과학연구소
A Neural Circuit
for Emotion
James Papez &
Paul MacLean
Thick Line is Papez,
Fine Line, MacLea
해암뇌과학연구소
EARLY TREATMENT CONSIDERATIONS
process-of-care(POC) model
1. Identification & recognition/ 2. Goal directed, stepwise process/
3. Patient & partner education/ 4. Clear guideline for follow-up
The Therapist’s Illusion:
Evaluation, Not Treatment-Initiated with the First Handshake
Attend to the Therapeutic Relationship before Attending to the DataGathering data is secondary<respectful, comfortable,
healing relationship
Look for the Early Resistances-Resistance before Conflict,
when talking sexual problems, interior(bed)
The Secret:
The Pitfalls from Collusion-Secrets from 1) Oneself, 2) the Partner,
and 3) to Both
해암뇌과학연구소
THE FIRST DECISSION
Therapist’s Ideology and Treatment Modality
Guidelines for Recommending TreatmentLife long=individual, Acquired=conjoint, With extra=individual because
of ethic
Some Heuristic Guidelines for When to
Recommend an Adjunctive Medical
Intervention-
Medical; 1. Life long, 2. Low confidence with Partner, 3. Significant
medical factors, 4. Past Hx of psychotherapy
Not medical; 1. Recent acquired, 2. Couples with severe discord,
3. Young men with performance anxiety, 4. Patients don’t want
alternative intervention
해암뇌과학연구소
THE PRESCRIPTION
OF BEHAVIORAL TASKS
Behavioral tasks are employed to 1) overcome performance anxiety, 2) aid with
diagnostic assessment and clarification of underlying dynamics,
3) alter the previously destructive sexual system, 4) confront resistance in each
partner, 5) alleviate couple’s anxiety about physical intimacy,
6) dispel myths and educate patients regarding sexual function and anatomy,
7) counteract negative body image concerns, 8) heighten sensuality
Sensate Focus I(pleasuring), II(genital pleasuring),
and III(vaginal containment without active movement)(Kaplan
HS, 1983)
Other Behavioral Tasks-masturbate, squeeze,
Quiet Vagina(Master & Johnson, 1970)
Relapse Prevention-booster maintenance session
6mos later. 70% better, 56% initial gains
The Role of Adjunctive Medical
Interventions-oral medications, self-injection therapy
해암뇌과학연구소
LOVE CYCLE
(Masters, Johnson, &
Kolodny, 1985)
해암뇌과학연구소
CONCLUSION-1
但有生死心 造作趣向 皆是汚染. 若欲會其道 平常心是道.
Sex therapy should aim for more than remediation of symptoms of
sexual dysfunction.
Sexual Problems can provide opportunities to aim for profound
change for the individual or the couple.
The kinds of sexual issues that concern our clients may be much
broader than what currently exists or is envisioned in our
taxanomies.
Sexual dysfunctions must be understood in the contexts in which
they arise and come to be seen as problematic.
Sex therapists can and should assume a greater role in shaping
the public discourse surrounding sexuality, in helping the client
to mobilize resources that already lie within, and in looking
beyond the medical to see the whole person.
Technical solutions may be useful for treating technical difficulties.
However, in order to help individuals and couples optimal
sexual development, we need more innovative methods.
(Kleinplatz, 2001)
해암뇌과학연구소
CONCLUSION-2
何謂平常心. 無造作無是非無取捨無斷常無凡聖.
Interaction between Cognition and Emotion in the
Brain
Questions of Medicalization and Surgicalization
Treatment Methods only
Innovative Tools of Sex and Marital Therapy
Therapist’s Ideology and Orientation
Sex Therapy as a Proper Marital Life
Feminist sex therapy in the age of Viagra
Recognition of
1. Social & Cultural Gender Inequality 2. The Influence of Power Differential
3. Traditional Sex Roles 4. The Unique Experiences of Men & Women regarding
Sexual Socialization, Sexual Coercion, Sexual Decision Making & Relational
Factors
and
5. Valuing Equally the Subjective & Affective Aspects of Sexuality
Sex therapy with HIV status and Mass Media
해암뇌과학연구소
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