In REBT the most effective interventions used to help people with sexual problems are those that identify beliefs, personal philosophies, and perceptions about love and intimacy that lead to distress or conflict. Consequently, the first step in counseling an individual for sexual problems is to explore his or her viewpoints and consequent emotions that arise before sexual encounters or in response to sexual problems. Specifically each person experiencing sexual distress needs to be helped to find any rigidity of thinking, demandingness, and damning nature of their beliefs. In short, their irrational beliefs need to be illuminated. Importantly, sexual problems commonly yield more intense irrational thinking than many other therapeutic issues. Very few sources of adversity are coupled with the stigma and shame that accompany sexual dysfunction. Consequently beliefs related to self-downing, awfulizing, and demandingness will be particularly salient. This is an essential reason that REBT is the approach I strongly advocate and apply. A key reason for this choice is t the fact that no treatment has been shown to be more effective. Furthermore, REBT has a compelling face validity that clients readily accept and can learn to apply.
Albert Ellis late in his career adopted a constructivist view of psychotherapy; this will be an integral component of my approach. To expand upon this, I will apply the extended theory of personality that he set forth in his 2009 textbook on the subject. Specifically, he added developmental forces, genetic inclinations, and personality factors in the expression of irrational beliefs. I will also apply Ellis’s assertion that sexual irrationalities are generated by innate (e.g. Ellis, 1971) qualities of the person. Finally, I will take a humanistic approach that Ellis long asserted was a critical component of REBT
Along with demonstrating that REBT is the essential treatment for all sexual problems, new methods explore evolutionary psychology’s essential role in both conceptualizing and addressing sexual dysfunction. Recently, Buss and Abrams (2016) and Abrams (2016) have advocated adding evolutionary psychological principles to traditional REBT/ CBT techniques. They proposed that doing so would add greater efficacy to the REBT based sex therapy first set forth by Albert Ellis in the 1950's. Ellis had long asserted that the irrational beliefs or behaviors that impede intimacy were often a result of biologically innate tendencies. Ellis later clarified this assertion by stating that these innate tendencies were evolutionarily endowed adaptations. Consequently, by understanding the evolutionary origins of these problematic adaptations REBT therapists will be more effective in assisting clients with intimacy problems. This can include helping afflicted individuals better understand the origins of their irrational or self-defeating thinking relating to love or intimacy. This understanding will enhance the client’s commitment to contesting and altering beliefs leading to his or her sexual distress.REBT etiologies and treatments are offered for problems in arousal in both degree and direction, i.e. paraphilias. Such etiologies are utilized for dysfunctional jealousy, mate guarding, and problems in sexual bonding. In addition, techniques are provided for assisting clients who have difficulty with adjusting to problems related to sexual variations such as gay bias, gender identity, erotic target difficulties and physical disorders affecting sexual function.