Peter R. Kilmann

Crisis Intervention: A Review of Outcome Research

Crisis intervention studies conducted in suicide prevention/crisis intervention programs, in psychiatric settings, and with surgical patients are critically evaluated. In the first area the impracticality of suicide as an outcome measure and the need for shifting evaluation emphasis from crisis worker performance to client behavior change measures is stressed. Also, the virtual impossibility of demonstrating overall program impact on the community and the need for developing internal program evaluation procedures is noted. Studies in psychiatric settings suffer from considerable methodological shortcomings that prohibit definitive conclusions; studies operationally specifying treatment components are greatly needed here. Studies with surgery patients indicate the necessity for developing intervention techniques most appropriate for individuals differing in their typical manner of dealing with stress. In all settings, outcome measures should be appropriate to the situation and logically related to the goals of intervention. In the two decades following Eysencks (1952) classic survey calling into question the effectiveness of the traditional psychotherapies, the growth in output of research studies of therapeutic process and outcome has been phenomenal (Bergin, 1971; Marsden, 1971). However, crisis intervention, a therapeutic technique that is receiving increasing use, as indicated by the recent proliferation of suicide prevention/crisis intervention centers and telephone hot lines, has gone largely uninvestigated until recent years. This is probably due to the fact that as a clinical technique it does not fall under the rubric of traditional psychotherapy, and since initial attempts at formulations of crisis theory and delineation of technique have not been developed until recently (Aguilera & Messick, 1974; Caplan, 1964; Lieb, Lipsitch, & Slaby, 1973; McGee, 1974; Schulberg & Sheldon, 1968; Taplin, 1971).

Physical Attractiveness and the “Nice Guy Paradox”: Do Nice Guys Really Finish Last?

The nice guy stereotype asserts that, although women often say that they wish to date kind, sensitive men, when actually given a choice, women will reject nice men in favor of men with other salient characteristics, such as physical attractiveness. To explore this stereotype, two studies were conducted. In Study 1, 48 college women were randomly assigned into experimental conditions in which they read a script that depicted 2 men competing for a date with a woman. The niceness of 1 target mans responses was manipulated across conditions. In Study 2, 194 college women were randomly assigned to conditions in which both the target mans responses and his physical attractiveness were manipulated. Overall results indicated that both niceness and physical attractiveness were positive factors in womens choices and desirability ratings of the target men. Niceness appeared to be the most salient factor when it came to desirability for more serious relationships, whereas physical attractiveness appeared more important in terms of desirability for more casual, sexual relationships.

Perspectives of sex therapy outcome: A survey of aasect providers

Randomly selected AASECT members who reported that they conduct sex therapy (N = 289) responded to a questionnaire about their sex therapy caseloads. Desire discrepancies between partners was the most common problem (31%). Least commonly reported problems were vaginismus (5%), ejaculatory inhibition (5%), and primary erectile dysfunction (2%). Highest success rates (client satisfaction with sexual functioning) were for premature ejaculation (62%), secondary orgasmic dysfunction (56%), and desire discrepancies (53%). Primary erectile dysfunctions had the lowest success rate (25%). The most commonly used treatment methods were a focus on communication skills, general sex education, homework assignments, and a focus on the sexual interaction; sensate focus, and the discussion of nonsexual individual and/or relationship issues also were quite commonly used. From a discriminant function analysis, the combined Therapists and Multiple-certified provider groups reported focusing on sexual interactions more than the combined Counselors and Educators; the Educators were the least likely providers to use a focus either on sexual interactions or on homework assignments. The Counselors were the most likely, and the Educators the least likely, to use communication skills. Therapists and the Multiple-certified providers estimated higher treatment success rates than Counselors and Educators for premature ejaculation, secondary erectile dysfunction, vaginismus, primary orgasmic dysfunction, sexual avoidance, ejaculatory inhibition, and sexual arousal problems. The Educators were the least successful with dyspareunia. Educators and Counselors were similar in reporting the fewest clients with sexual arousal problems. Therapists and Multiple-certified providers reported spending more treatment hours with desire discrepancies and desire problems. The implications of the findings for clinical practitioners and researchers are discussed.

The treatment of sexual paraphilias: A review of the outcome research

Abstract Studies which investigate the impact of treatment on subjects with singular and multiple sexual paraphilias (exhibitionism, fetishism, pedophilia, transvestism, voyeurism) are reviewed. A methodological evaluation was conducted with attention to six categories: design, subjects, therapists, treatment, time periods, and outcome measures. Subjects included sexual offenders and non‐offenders. Most of the studies were single‐case reports. The methodological shortcomings in the literature included the failure to control for social desirability factors, especially in the case of sex offenders, and the reliance upon verbal self‐reports in the evaluation of outcome. Almost all of the studies found positive treatment effects, either immediately after treatment or at various follow‐up periods. However, periodic booster treatment sessions sometimes were necessary with paraphilias of long duration. Across the paraphilias reviewed, the literature offered tentative support for the efficacy of a multiple behavi...

The effects of group systematic desensitization on secondary erectile failure

Sixteen subjects were assigned to group desensitization (SD) or treatment control groups. The groups were balanced with respect to age, education, severity of disorder, duration of disorder, number of sexual partners, cooperativeness of female partner, and marital status. The SD group received 15 45-min sessions of relaxation plus a common hierarchy of sexual scenes, while the control group received 15 sessions of relaxation alone. Subjects in the SD group reflected significant positive changes when compared with control subjects on measures of sexual performance and satisfaction and satisfaction with nonsexual aspects of their relationship with their most frequent sexual partner. These gains were maintained over a 3-month follow-up period. The control subjects who received subsequent treatment made substantial gains which persisted over 3 months. Implications and suggestions for future research are discussed.

Treatment of Secondary Orgasmic Dysfunction: An Outcome Study

This study investigated the differential effectiveness of various treatment formats for 55 couples in which the woman reported secondary orgasmic dysfunction (defined as the inability of the woman to reach orgasm during intercourse, with or without clitoral stimulation, more than 50% of the time for the last 5 months). Couples received two 2-hr sessions of sexual reeducation and were then assigned into one of four treatment conditions (a communication skills format, a sexual skills format, one of two combination formats) or into one of two control conditions (an attention-comparison control condition which consisted of didactic presentations, or a waiting-list control condition). Treatment was conducted by one of two female clinical psychologists in groups of between four to six couples. No significant differences were found between the different treatment conditions at the posttest or at the 6-month follow-up. Statistical comparisons conducted between the combined treatment and combined control conditions showed that the couples who received treatment reported significantly less overall sexual dissatisfaction and significantly greater sexual harmony at the posttest; however, these differences became nonsignificant at the follow-up. In comparison with the women in the control conditions, a significantly greater number of women who received treatment reached or exceeded the projects 50% criterion for coital orgasmic functioning at the posttest; however, these differences became nonsignificant at the follow-up. Couples who reported less relationship adjustment prior to treatment showed greater overall gains in coital orgasmic frequency than couples who reported better relationship adjustment.

Group treatment of secondary erectile dysfunction.

The effects of three group treatment formats on 20 men with secondary erectile dysfunction and their partners were contrasted. After a comprehensive medical and psychological screening, each couple was assigned to one of three treatment groups (Communication Technique Training, Sexual Technique Training, Combination Treatment) or to one of two control groups (Attention-Placebo, No-Treatment). Couples in the three treatment groups and the attention-placebo group participated in their respective formats in twice-weekly sessions for a total of 20 hours. The no-treatment control group received sex education and treatment after a 5-week waiting list period. All three treatment groups fostered substantial gains so that between-format differences were not statistically significant. Subject variables which predicted success/experience ratio gains included age of the male partner, perceived level of relationship adjustment, and the male partners success/experience ratio prior to treatment. Eighty-one percent of the treated men reached the criterion of 80% or greater success/experience ratio (successful penetration and subsequent ejaculation) at the 6-month follow-up. Good nocturnal tumescence prior to treatment was correlated with a better treatment outcome than poor tumescence.

Sexual orientation and sex role conformity

Homosexuals are stereotypically viewed as deviating from the conventional sex role standards of our society. Homosexual males are regarded as effeminate, while homosexual females are seen as masculine. Some limited empirical support for these stereotypes has been reported in the literature. However, results remain inconclusive. In order to provide a further test of these stereotypes, 186 male and female homosexual, bisexual, and heterosexual subjects were administered the Bem Sex Role Inventory. Results showed no significant support for prevailing stereotypes. Possible reasons for the discrepancy between these findings and previous reports are explored and suggestions are offered for future research.

The treatment of primary and secondary orgasmic dysfunction: A methodological review of the literature since 1970

This paper reviews the studies since 1970 which examined the treatment outcome of primary and secondary nonorgsmic women. The studies were evaluated within the following sections: subjects, therapists, time format, treatment, and outcome criteria. Many methodological deficiencies were found, most notably the lack of specificity regarding subject characteristics, a reliance on womens self-reports of outcome without obtaining partner validation, the failure to assess the influence of the womans partner on her orgasmic responsivity, the failure to control for expectancy factors, and the use of different criteria for treatment success. The problems in the literature suggest that it is premature to place any confidence in the identification of the treatment format which is most successful for a defined population of women who experience a specific form of primary or secondary orgasmic dysfunction. The data tentatively suggest that (1) secondary nonorgasmic women would show greater gains than primary nonorgasmic women in treatments emphasizing sexual and nonsexual communication techniques, (2) primary nonorgasmic women would show greater gains than secondary nonorgasmic women in desensitization and sexual technique training procedures, (3) desensitization may be the appropriate treatment for women whose sexual anxiety contributes to secondary orgasmic dysfunction. These hypotheses should be examined in controlled research.

Effects of sex education on sexual guilt, anxiety, and attitudes: A comparison of instruction formats

Previous sex education research has neglected to examine systematically the effects of different types of instruction formats. In the present study, 193 undergraduates were assigned to one of the following conditions: (1) lecture only; (2) small group discussion only; (3) lecture + small group discussion; (4) lecture + extra lecture/review; and (5) no intervention control. Pre- and posttest measures assessed the dimensions of sexual guilt, sexual attitudes, and sexual anxiety. Results revealed significantly greater reductions in sexual guilt for the lecture only, lecture + small group discussion, and lecture + extra lecture/review conditions than for the no intervention control condition. Significantly greater changes in the direction of more tolerant sexual attitudes were found for the small group discussion only and lecture + extra lecture/review conditions than for the no intervention control condition. No other significant results were found. Contrary to expectation, the addition of 9 hours of small group discussion to a semester-long lecture format course did not result in significantly greater positive changes on the dimensions assessed than those achieved by lecture alone. The implications of these findings for the design of sex education courses are discussed. Recommendations for future research include assessment of the long-term effects of sex education on dimensions such as quality of sexual adjustment and consistency of contraceptive usage.