Sexual satisfaction improvement in patients seeking sex therapy: evaluative study of the influence of traumas, attachment and therapeutic alliance

Sex therapy patients report high rates of childhood interpersonal trauma (CIT) and insecure attachment, which may negatively influence the quality of their alliance with the therapist. Poor therapeutic alliance is associated with weaker progress during treatment. However, the effect of CIT, attachment and alliance on progress in therapy has not yet been documented in patients consulting for sexual difficulties. With a pre and post-test design, a total of 74 adults (39 women; 35 men) seeking sex therapy completed questionnaires assessing CIT, attachment representations, and therapeutic alliance. The main outcome measure was evolution of sexual satisfaction over the course of therapy. Results showed that, on average, patients experienced an improvement in their sexual satisfaction. Patients showing the largest improvement reported less attachment anxiety and higher levels of therapeutic alliance at pre-test. Furthermore, although participants reporting four or more types of CIT showed lower sexual satisfaction at pre-test, they reached a level similar to patients with less CIT at post-test, and thus, they demonstrated the greatest level of improvement. These findings support the beneficial effect of sex therapy for patients with a CIT history, and that, with a strong therapeutic relationship and attachment, all patients can develop a more positive and enjoyable sexuality.