Sanders Articles, Essay Example

In “Recovering from Paraphilia: An Adolescent’s Journey from Despair to Hope,” Sanders recounts the case of Robert, a fifteen-year-old boy who had sexually abused his eight-year-old sister and her friend.  While in treatment, he had difficulty accepting responsibility for his actions and had begun to exhibit extreme behaviors associated with his fixation on anal insertion, diapers, and feces.  Psychiatric reports suggested that Robert had pedophelic tendencies and was unlikely to live a ‘normal’ life; Robert himself could not foresee an existence that did not revolve around the acquiring and use of the infant paraphernalia (bottles, diapers, etc.) that had taken on fetishistic properties for him.  Treatment staff had become increasingly concerned that his interference with children (such as taking their diapers) would escalate further.

At the Phoenix Program, Sanders implemented a four-part treatment plan that began with the assertion that “sex is an experience, not a set of specific behaviors” (Sanders).  This was used to help Robert learn how power dynamics effect sexual and non-sexual relationships, allowing him to better understand the effect of his sexual assault upon his sister.  This assisted him in developing an appreciation for consensual sexual activity based on mutual trust and attraction. Sanders also worked with the premise that “thoughts do not predict actions” (Sanders) to help the Phoenix Program staff deal with Robert’s extreme fantasies.  Staff was encouraged to support Robert’s ‘diaper thoughts’ but instead redirect him towards private self-stimulation rather than the wearing of soiled diapers, leading to a marked change in both his behavior and his attitude. Sanders also made Robert aware of the “imposition of violence” (Sanders) using tools such as the baseball metaphor to assist Robert in recognizing the distinctions inherent in sexual assault. Finally, Sanders’ treatment included an understanding of “the tyranny of cultural conditioning” (Sanders) to help Robert externalize his own helplessness in relation to the manner in which he felt controlled by his thoughts and fetishistic actions. This allowed for Robert to reverse the power dynamic and gain some level of control by channelling his thoughts into different, less extreme and damaging, actions.

As with therapy that is based on linear questioning strategies, those employing “descriptive circular questioning” (Sanders) is part of an attempt to get a broad idea of what is going on in the life of the client.  This method uses circular assumptions and intents in order to allow the client to engage more interactively in the question and answer format of the interview session. Reflexive questions which build upon and reflect back on questions asked earlier in the session allow for a greater level of awareness for the client when considering how their behavior has impacted on their experiences.  The client is liberated by the exploratory and facilitative components of this method, as opposed to more linear questioning methods which tend to be more investigative on the part of the therapist and thus have a greater investigative and constraining effect.   In his own work, Sanders found that linear questions are based more on defining a problem, as in the case of Bill and Marie as discussed in his essay “The Interview as Intervention in Sexual Therapy.”  Linear questions about their sexual relations include “what is the main problem now? and “have the symptoms changed at all over time?” (Sanders), whereas a circular approach would aim to use each question as a building block for the following question. Thus, asking Bill and Marie which of them desired sexual intercourse more greatly, and then following that question by asking which of them desired sexual intimacy other than intercourse would allow for the therapist to learn a great deal about their relationship both by what they said and what they left unsaid.  The ability to make a distinction between intimacy and sexual activity opens the floor to discovering the attitudes of both Bill and Marie to a relationship in which intimate relations may sometimes take precedence over sexual relations.

Sanders’ “experiential definition of sex” (Sanders) is one in which there is no set definition of sex; instead, the definition is provided by the client and is based on their best memories of sexual experience rather than those dictated by our cultural and historical understanding of sexual activity.  This definition guides his therapeutic process by enabling him to connect his patients to their most positive sexual experiences so that they draw a connection between positive sexuality, their own volition in that activity, and the sense of trust that they had with their partner in said positive activity.  In the case of Mary, whose case is discussed in the article “Violence, Sex, and Therapeutic Healing,” Sanders used this definition to help her understand that the incident in the park was an act of sexual violence rather than an act of sexual activity.

In the article “Escape from Sexual Tyranny,” Sanders provides the case study of Ian and Lori, whose busy work and home life prevented them from achieving the level of sexual connectivity they desired.  In his intervention, Sanders demonstrated that both had fallen victim to the tyranny of patriarchy in which Lori took on the bulk of home and child rearing responsibilities while Ian contrived to remain unaware of the negative effect this burden had on his wife.  Sanders used language to illustrate that both Ian and Lori had been victimized by this cultural assumption rather than blaming one specific party for the uneven distribution of work and power in their relationship.  This allowed the couple to realize how the reactions of those outside of their relationship plays a role in their personal choices; for example, he pointed out that “mothers may wonder why Lori is not ‘fulfilling her wifely duty’, [while] male

friends and colleagues of Ian’s may wonder why he ‘lets Lori get the best of him’ (Sanders).  In framing his questions this way, Sanders allowed them to seek a way to ‘escape’ from this tyranny and find a more balanced and mutually-enjoyable sexual relationship.

In “Recovering from Paraphilia,” Sanders performed an intervention with Robert that allowed him to address the teenager’s victimization at the hands of oppressive social expectations and conditioning regarding his sexuality.  Sanders helped Robert to externalize the manner in which his fetishistic activities had come to dominate both his thoughts and actions, giving him the language and tools to express how his thoughts were “bossing” (Sanders) him. This allowed for Robert to gain some measure of control over his obsessive actions by allowing him to divert them into more productive channels.

The attitude of the therapist plays a crucial role in practising Sanders’ mode of therapy.  This attribute can be achieved by remaining neutral when discussing sexual issues with patients so as to counteract their own fears of disclosure and culturally-supported reluctance to discuss sexual function.  For example, the therapist can refrain from stating that there is only one ‘right’ way of expressing sexuality.  It would likely become easier to practice this attribute by confronting (through one’s own therapy, perhaps) one’s own attitude towards varying sexual practices and identities so that the therapist will be able to work with clients from a perspective of neutrality.

Another attribute that contributes to Sanders’ overall therapeutic mode is the ability to provide circular hypotheses when working with clients.  Although the linear hypothesis offers a good starting point, circular methods allow for a greater level of depth and the ability to involve patients more proactively in their therapeutic process.  It would be helpful for the therapist to become consciously aware of the manner in which they use hypotheses when treating a patient, and to remain open-minded to having multiple and alternate hypotheses throughout that treatment.