ABSTRACT
Among the caseload of psychotherapy, psychological therapy or counselling services there will be a small proportion of patients whose principal difficulties are enacted within sexual relationships and often expressed through their sexual behaviours. Psychotherapy can play a useful part in the treatment of patients with disorders of sexual arousal, desire, or response where the problem is psychogenic. This chapter focuses on the development of a Cognitive Analytic Therapy (CAT) approach to the treatment of patients with problems of sexual relationships. CAT focuses on repeating patterns in relationships; 'relationships' here includes the relationship to the self, to others, and to functions such as work. Like psychoanalytic therapy, CAT addresses the strategies used to manage and avoid experiencing the emotional pain and unmet needs associated with these reciprocal roles. An appreciation of the historical context may be useful when considering those elements of the psychoanalytic theory of perversions that seem to have some enduring clinical value, and those that are more problematic.
