Demand for male sexual performance is never made by authority.
Historically, years of failure in treatment for sexual dysfunction has pinpointed the fact that, regardless of length, depth, concept, or technique of therapy, at some point in time the therapist has turned to his patient and suggested, permitted, or even directed that he "have intercourse tonight."
Instantaneously with that fatal suggestion, all the fears of performance came flooding back and, regardless of the effectiveness of prior therapeutic commitment, the husband was placed under authoritative direction to "do something."
Current therapeutic concept is that no dysfunctional man should ever be under any form of suggestion or direction to accomplish anything specifically of a sexual nature. When there is need to communicate specific functional direction, such suggestion always is made to the wife, not to the husband.
It is a naturally occurring phenomenon and cannot be controlled, directed, or even initiated unless it is in some manner related to the natural cycle of sexual response. No man can will an erection, but he can relax and enjoy it.
Understandably, all therapy flows toward a concept of a mutual pleasure return for both members of the couple.
Instead of being suggested, directed, or given permission, as in prior therapeutic concept, to go all the way from A to Z sexually on any specific occasion, it is suggested that husband and wifes go from A to B one day, possibly from A to C or D the next, and even from A to E or F the third day.
Although physical evidence of improvement of sexual functioning may come haltingly, it is definitive. Every step in the therapeutic program is explained in detail in advance of any opportunity for sexual expression.
Both positive and negative reactions of the tentatively experimenting partners to sexual material and to overt sexual stimulation are anticipated, explained, supported, or dismissed. It is hoped that both authoritative suggestion and basic sexual information are understood and appreciated.
With this low-key, non goal-oriented technique, erection appears without fanfare, comfortably, and certainly without the husband's forcing or the wife's demanding its attainment.
When erection does develop in these non pressured circumstances, the couple, previously following the therapeutic tenet of maintaining "healthy skepticism", soon becomes confident that the end of their sexual dysfunction is within sight.
Once erective return is re-established, the most effective step in the physical aspect of the therapeutic program can be taken.
The day after full erection is developed and maintained, it is suggested that the husband and wife enjoy this return to erective prowess by experimenting with the erective reaction. A pattern for unit response is suggested that includes manipulative play to erective return, cessation of play to allow a period of distraction for the male with consequent loss of erection, and then return to play and resurgence of erective attainment.
This "teasing" technique is continued for a full half-hour in a slow, non demanding fashion.
The man's immediate reaction to this suggestion may be fear oriented. But how can one be sure that if he has an erection and lose it, can he get it back?
Cotherapists quickly underscore this specific evidence of the husband's indulgence in fears of performance and his return to the past patterning of anticipation of failure so firmly rooted before referral for therapy.
It is pointed out that when he has relaxed, he and his wife have enjoyed the return of his erections during the sensate-focus period. It is further suggested that his wife also will enjoy the "teasing" technique.
She will be sexually stimulated by the opportunity for developing, losing, and developing again the penile erections. This thought rarely if ever has occurred to the husband.
He usually takes the next step in the natural progression of sexual functioning without much performance tension, for again it is emphasized that if he has an erection, fine, if not, there's another day.
With this attitude, the "teasing" technique usually works well. During the conference period on the day following some degree of success with this technique, the improved levels of male confidence are indeed obvious.
What is even more important is that both members of the couple be made to realize that they are helping each other immeasurably with their mutual problem of sexual dysfunction.
Cotherapists constantly must reemphasize the fact that authority is not capable of teaching a physical reaction. The husband and wifes are given an opportunity to convince themselves that there is nothing wrong with their ability to respond to effective sexual stimulation.
As partial or complete erective security returns in these first few days, the husband and wife proves to itself that there is no suggestion of physical permanency to their established sexual dysfunction.
As their confidence increases, the partners move toward the next step in sexual functioning.
Within a week after the roundtable discussion, the impotent male generally has evidenced partial or complete erection.