Prescribed masturbation in sex therapy: a critique

The goal of this paper is to show from an interactional or systemic perspective how intimacy may be damaged through traditional sex therapy approaches. This is in opposition to stated claims by sex therapists, who have, since the pioneering work of Masters and Johnson, sought to improve intimacy by removing the impediment of poor sexual response. Prescribed masturbation in sex therapy is identified as particularly problematic in its potential for iatrogenic effects. These potentials are demonstrated from a relational perspective and from a functional perspective. Prescribed masturbation, intended to narrow the focus of attention from the "distraction" of a partner's response, may actually serve to further damage the openness and trust necessary for truly rewarding sexual expression. Difficulties in a relationship that preclude the trust necessary for open sexual interaction ought to be addressed before any sexual activity is prescribed. If clinicians' work circumvents the interactional component of the dysfunction, they may be guilty of colluding with clients in protecting them from intimacy. Recommended alternatives for clinicians are offered.