Shaw J
J Sex Marital Ther. 1994 Spring;20(1):46-55. doi: 10.1080/00926239408403416.
This paper challenges the efficacy of a cognitive-behavioral treatment model for women with primary vaginismus and proposes a conceptual shift from a focus on behavior to a focus on differentiation. Primary vaginismus is viewed as a somatic boundary, a symbolic description of an opportunity for differentiation. Four relevant themes are considered: 1) mastery versus incompetence; 2) autonomy versus dependence; 3) boundary versus fusion; and 4) the effect on the therapy of the therapist's level of differentiation. Change at this particular time in history involves shifts in clinical focus from sexual frequency to quality, from performance to experience, from compliance to mastery, and from utilization function to sexual potential. A case is made for sexual competence based on self-competence instead of on behavior. A reevaluation of what constitutes success, both behavioral and developmental, proposes an increase in differentiation in addition to symptom relief.
本文对针对原发性阴道痉挛女性的认知行为治疗模式的疗效提出质疑，并提议从关注行为转向关注分化，进行概念上的转变。原发性阴道痉挛被视为一种躯体界限，是分化机会的一种象征性描述。文中考虑了四个相关主题：1）掌控与无能；2）自主与依赖；3）界限与融合；4）治疗师的分化水平对治疗的影响。在历史上的这个特定时期，变化涉及临床焦点从性频率向质量、从表现向体验、从依从向掌控、从利用功能向性潜力的转变。提出基于自我能力而非行为的性能力观点。对行为和发展方面成功的构成要素进行重新评估，提议除缓解症状外，还应增加分化。
