it is more observable and quantifiable.

Although it makes therapeutic sense to focus on the nonsexual problems first, some individuals and couples may be so invested in the belief that the problem is only sexual that there may be resistance to a different conceptualization. Therapists must make sure that when the focus shifts away from sex, the couple or individual fully understands the rationale and agrees to the protocol change. Benefits The information contained in this program is based on empirical research. The organization and presentation of the material is based on what has worked best in the author s clinical experience. The manualbased structure of this program, which consists of this therapist guide and corresponding workbook, has several benefits. Self-Paced Progress It is rare that therapists and clients can schedule regularly paced sessions without interruptions. The Enhancing Sexuality program manual allows individuals or couples to slow down or speed up the pace of sessions, and accommodate irregular personal schedules. Workbook as a Reference The client may refer to the workbook when necessary. For one reason or another, clients with sexual problems often participate in therapy without their partners. Partners may be supportive but too embarrassed to attend therapy sessions. In such cases, clients often convey to their nonattending partner the essence of the therapy session. Note, however, that total reliance on this indirect communication may result in inaccuracies and confusions. Use of the workbook will help avoid confusion and miscommunication. Even when both partners are present at a session, there is often disagreement following a session as to the exact nature of an assignment. SomePathway 2: Mini mal Couples Problems Some couples have difficulty getting along with each other although they feel positive toward and are physically attracted to each other. They may have inefficient problem-solving skills and poor communication skills. If the couple wishes to work toward staying together and strengthening their relationship, it is possible to address the mild relationshi p issues while simultaneously working on the sexual problems. Start by directing couples to follow these instructions: 1. Prioritize time for each other 2. Attend to the communication guidelines Sex issues can be addressed and worked on while couples improve other aspects of their relationship. Only in cases where anger or discouragement interferes with progress should sex therapy be delayed while these issues are addressed. Pathway 3: Individual Psychological Problems In some cases, an individual may have such overwhelming nonsexual psychological problems that focusing on sexual problems is extremely difficult. Severe depression, post-traumatic stress disorder, acute adjustment reactions, and psychotic states are examples of psychological problems that may interfere with treatment for sexual problems. Good clinical judgment and diagnostic skills are important to determine the presence of a comorbid disorder, and in deciding how to proceed. In some cases, pharmacological intervention will stabilize a person enough to proceed, and in other cases, psychotherapy must be conducted to control the psychological problem. It is not unusual for a client to overlook the impact of a nonsexual problem. The fact that a nonsexual problem preceded the sexual problem does not mean that it isn t contributing to the sexual problem. For example, depression symptoms may have been overridden by the newness of