Sex therapy with lesbian couples: a four stage approach.

The many factors--social, cultural, psychological--that shape homosexual sexual expression render purely behavioral sex therapy models one-dimensional and ineffective for lesbian clients with sexual presenting problems. Though a behavioral approach may be useful later in the treatment of such problems, the effective clinician must first address the inimical social and cultural contexts that frame lesbian sexual impasses. This paper offers specific techniques, both direct and indirect, designed to illuminate and neutralize these contexts. Additionally, the author presents a sequence of sensate focus exercises tailored to the particular needs of lesbian couples.