Sex Therapist Dr. Helen Singer Kaplan Promotes Love

But she takes a pragmatic, psychiatric approach to sex problems

The Washington Star News, September 8, 1974: Dr. Helen Singer Kaplan believes in love and marriage. Or love without marriage. “But, either way, a loving sexual relationship between a man and a woman is the most important thing in life.”

If this view seems a little old-fashioned for a woman who is leader in the new field of psychiatric sex therapy, it’s just because Dr. Kaplan approaches sex from a humanistic tradition. She deplores inhuman, mechanical, commercialized sex. A couple doesn’t necessarily have to be in love — although it helps — but Dr. Kaplan believes, “sex is only enjoyable within the context of a human, loving relationship and pleasure is far more important than the actual sex function.”

Dr.Kaplan’s philosophy of loving and caring distinguishes her new book, “The New Sex Therapy.” It was originally published as a textbook for psychiatrists, psychologists, physicians and med students by Brunner/Mazel. The book describes Dr. Kaplan’s use of many of the “sexual tasks” developed by Masters and Johnson, combined with her own psychiatric techniques she has been developing since 1970 in her sex therapy clinic at the Payne Whitney Clinic of New York Hospital.

The clinic has a staff of 12 and, every year, Dr. Kaplan trains another half-dozen psychiatrists. She also teaches physicians and obstetricians how to diagnose and deal with their patients’ sexual problems. Like Masters and Johnson, Dr. Kaplan prescribes specific sexual exercises (sometimes she calls them tasks. Both words were chosen for lack of any other less connotative expression) to help her patients overcome their sexual dysfunctions. But where she differs with them and other sex therapists, is that she also treats her patients psychiatrically.

When a couple comes into her clinic, it is because one of them is having a problem functioning sexually. The woman may be unable to have an orgasm; the husband may suffer from premature ejaculation. Or he may be impotent. Whatever the problem, it naturally affects them both.

Complete case histories — medical, sexual and psychiatric — are taken of the couple and based on this information, the first of the sexual tasks is prescribed. “These sexual exercises invoke intense and human reactions; they involve deeply emotional issues,” explains Dr. Kaplan. “They are very revealing of psychological factors and enable us to work psychoanalytically with the patients.”

On the next visit to the clinic, the couple is asked to speak openly about the emotional feelings the sexual task has aroused. Often, they are surprised by hostilities toward one another they never dreamed existed. “Sometimes,” says Dr. Kaplan, “it is simple rage and anger at or fear of the partner which inhibits the sexual response.” And, almost always, ignorance and guilt are prime offenders. The psychiatrist helps the couple discuss these feelings and understand them as well as possible early in the treatment. Then they are sent home with a second sexual task, and the process is repeated.

In several weeks — the treatment is swift — the couple has been given enough insights and psychiatric treatment to overcome the sexual problem. The sexual tasks have provided a casual, methodical process for perfecting their sex life.

“When you combine sexual prescriptions with psychiatry, you’ve got a very powerful treatment,” says Dr. Kaplan. Why does Dr. Kaplan’s psychiatric short-cut work so well? “It is possible to have psychoanalysis for years without specifically mentioning a sexual problem because there’s no active intervention by the analyst. But when you confront the patient with sexual situations and combine this with psychoanalysis, there has to be action.”

“Masters and Johnson were the great innovators because they dealt with factors we neglected in psychiatry: we dealt with deep factors but we neglected the touching, the actual experience of sex,” Dr. Kaplan says. “We only talked about the past. That’s a very inefficient method.”

Dr. Kaplan and her staff deal “directly with the immediate causes of sexual dysfunction, most often they don’t have to go deeper,” she says. “A man may be impotent because he is afraid of impotence. This is a simple, emotional thing to deal with. But a man may be impotent because of problems with his mother, which is a deeper problem. In either case, a very active approach is more rapid than a passive one.”

Eight or 10 visits to the clinic may be all it takes to “cure” premature ejaculation.” impotency may take 12 to 14 sessions. And simple forms of frigidity are often dealt with in a matter of days.Dr. Kaplan doesn’t treat people who hate each other, either. She sends them to a marriage counsellor. “If you have perfect mechanical functioning and no human pleasure, it’s no good.”

Following in the mode of Masters and Johnson, nearly all sex therapists work as male and female teams, but Dr. Kaplan can’t see that there are any advantages of two therapists over one, so she does not work with a partner. In her own training program, her students help each other become “sensitized” to the sexual responses of the opposite sex. “We sit down and talk about it all very explicitly and unemotionally, so we are able to deal with the problems of both genders sensitively.”

Dr. Kaplan says, candidly, that she, herself, is very responsive to the sexual response of a man. “Every person who’s really together is. If you’ve made love successfully with a member of the opposite sex, you develop that sensitivity.”

She is divorced, but reluctant to admit it partly because she worries about hurting the feelings of her ex-husband. But she’s also concerned about her image as a sex therapy counselor. “I don’t want people to think I’m just an old spinster who is doing all this sex therapy. I don’t want people to think I’m promiscuous or that I approve of mechanical sex. I don’t want to be seen as anti-love or anti-marriage.”

Dr Kaplan lives in Manhattan with her three children, Jenny, 10, Peter 15, and Phillip 18. And she’s engaged to be married, she says, happily. A small, dark, attractive woman, around 40, whose personality is warm as toast with the crisp crust left on, Dr. Kaplan’s manner is one of clinical professionalism. When she talks about sex, she could be talking about somebody’s gall bladder. She states, matter-of-factly that until she came along with her psychiatric approach, “the legitimate psychiatric community was very suspicious of sex therapy, it sounded too gimmicky and rapid.”

Now she’s been asked by the American Psychiatric Association to organize a session on sex therapy for its next meeting. Masters and Johnson are among the experts she has already asked to speak. Her book has been such a best seller among professionals that it has been put on the popular market despite its steep price.

Dr. Kaplan says she agreed to share the book with a lay audience for whatever educational value it may have. “It won’t hurt,” she says wryly, “but I doubt if it will work because emotional factors have to be dealt with. It will help people gain understanding and provide information, but you can’t cut out your own appendix even if you read exactly how to do it.”

Just as a surgery textbook would describe in detail how to take out an appendix, “The New Sex Therapy” gives directions on how to perform the “sexual tasks” she prescribes in helping patients overcome sexual dysfunctions. There is nothing in the book of prurient interest however, even the seven pen-and-ink sketches by Betty Dodson of couples performing sexual tasks have a romantic, loving tone. (The rest of the sketches look like something out of a biology textbook.)

Dr. Kaplan has received so many requests for more detailed descriptions of the sexual tasks that she is at work on a new textbook for professionals. It will be a spiral manual, containing dozens of drawings so explicit and erotic that it is earmarked for professional use only. Sex therapists may let their patients have a look at certain tasks, however, because it will save long, sometimes embarrassing explanations, Dr. Kaplan says.

She has been developing her psychiatric approach to sex therapy since 1964 when, as chief of psychosomatic medicine in Metropolitan Hospital in Harlem, she discovered a need for sex counseling among her patients. She found that ghetto women, with the least encouragement, wanted to tell her about problems in achieving orgasm. And often, she was able to help by merely providing information and counsel.

Dr. Kaplan is now clinical associate professor of psychiatry and in charge of student teaching at Cornell University of Medicine. For those seeking sex therapy, Dr. Kaplan strongly advises a couple to go to a group or a person associated with a hospital or a university.

“Then, you’re safe, you know they won’t just be dispensing straight, mechanical sex therapy.” While not all hospitals and universities have this service, many do “and within the next five years, there won’t be a single major hospital without it,” Dr. Kaplan predicts. And within the next three years, she says, there won’t be a med school in the country that won’t include human sexuality in the curriculum.

Dr. Kaplan urges too that young people seek help — perhaps just some counseling — if their first attempts at sex are failures. “Prompt treatment can prevent lifelong sexual difficulties.”

Original Title: Sex and Love — With or Without Marriage