"Anyone who is in love is making love the whole time, even when they're not. When two bodies meet, it is just the cup overflowing. They can stay together for hours, even days. They begin the dance one day and finish it the next, or--such is the pleasure they experience--they may never finish it. No eleven minutes for them."
Mindfulness
For those of you familiar with some of my previous writings, I have made you well aware that I am a huge proponent of mindfulness practice and have been actively doing body scans, eating meditations, concentration meditations, working meditations etc. for about 4.5 years. Understandably, mindfulness is as elusive to pin down and explain as it is to accept the idea that there is no self. However, this does not need to be a bad thing, because all that means is that things ‘happen’ to this transitory self and, therefore, we are not the sum of those happenings. These happenings are guests in our guest house, to reference a poem “The Guest House” (by Rumi), and they do not stay.
Taking this idea a step further to sexual dysfunction, it is something that happens to us, we are not defined by it. However, as you may be aware dear reader, sexual dysfunction can cause anger, anxiety, and depression at the self, as if you are the dysfunction—as if you are the defect, which in a word is not true. It is something that is happening to you. I believe this mindset cannot only help the sufferer to have compassion for themselves, but it is one that can help whomever is affected by it. Partners should adopt this mindset as well in order to have compassion and sympathy for their partner and share in the burden of suffering that it causes for both people.
*Please note that although I am using monogamous language, I am in no way limiting my exploration of VEST to that relational dynamic. This is mostly for ease of communication.*
Moving on…
Since there are a score of articles that have been written on sexual dysfunction, I have chosen to reference them in related articles rather than get into definitions here. This way, there is some room, for The Good Stuff.
However, in short - and before - the good stuff, I do think it is important to say that I do not mean dysfunction in a narrow-focused sense. Sometimes doctors tell us our differing sex drives are dysfunctional, how wet we don’t get is dysfunctional, or not sporting an erection during every sexual encounter is dysfunctional. So, my hope is that whatever category you might have fit yourself into, or let yourself be fit into, or you are just curious about, I will shed light on VEST, which has mindfulness at its core.
The Good Stuff: VEST
As a philosopher at heart, I like to speculate that the acronym for Visually Enhanced Brief Directive Psycho-sexual Therapy is a fitting one.
In mindfulness the emphasis is on being rather than doing.
You are not IN-vesting, or else they would have made it Invivo (which means to confront directly) Visually Enhanced Psychosexual Therapy.
The emphasis is on learning to be present with your partner in a myriad of ways that takes the focus off of having to perform sexually, which is the doing part that we get hung up on which in turn leads to the depression, anxiety, and anger.
So, philosophical musings aside, what is VEST?
In the Canadian Journal of Psychiatry, an article was published by Frank G. Sommers, M.D., FRCPC, detailing VEST's origins as part in parcel of exploration of Virtual Reality Technologies. Researchers were interested in results that demonstrated that the erectile responsiveness of males was not necessarily experienced in conjunction with a mental arousal state.
Mechanically induced basically meant that audio-visual stimulation caused an erection in males, but there was little to no mental activity in the portions of the brain that we would expect to light up with arousal.
Due to this, researchers decided to drastically investigate the idea that medicinal and/or mechanical interventions were actually helping patients with dysfunction. They wanted to reevaluate the use of audio-visual stimuli to make it a more potent therapeutic tool, by teaching clients how to kindle that mental desire, rather than just treating their body like a puppet that must perform.
With that, followed 30 years of a private psychiatric/sexological practice in Toronto, Canada in which VEST has been used to treat a myriad of sexual dysfunctions such as vaginismus, erectile dysfunction, painful intercourse, lost sexual desire, orgasmic release problems, varying sex drives and the like. So think… for 39 years now (this article was published in 2003), many of us have sat around not knowing that good and meaningful work is being done in this area!
In all this work, the clinicians/researchers found that no matter the presenting problem, the clients all had some ‘problem of living.’ Whether we call that depression, anxiety, trauma… something had happened to them.
STEPS TO VEST
1. With VEST, both partners are interviewed and a very complex and detailed history is taken. Ideally both partners participate in the treatment, and the classic ‘identified patient’ model is swept aside to focus on re-bonding the two people.
2. There are 8 to 10 sessions that can last 2 to 3 hours or more, which contain psychosexual education components to help the clients understand the treatment, as well as understand contributing factors in their lives that have fed the current situation.
3. The educational component uses mindfulness language to help the couples relate, which is that they must be Present Centered (PC) and Process Absorbed (PA). As is the case with any mindfulness practice, PC is the same as moment to moment non-judgmental awareness that is not in the past or future, but the present. PA can be thought of as what I call the being mode rather than the doing mode. You want to be present with your partner in the process of loving and be absorbed fully in each moment as it happens. You do not want to think “what am I going to do next?”
4. Homework is given, but not unless the context of treatment and the language is understood by those involved.
5. Visual aids are crucial for VEST and are used during sessions and assigned as homework, and processing feelings and thoughts are a huge part of this process. This processing helps to do what therapists call “cognitive restructuring” to help increase the salience or importance, relevance, and meaningfulness of thoughts. This cannot happen unless the new processing strongly opposes old ways of processing and is producing meaningful change for the people involved. The visual materials are carefully selected and based on the individuals in order to minimize risk of harm, especially if trauma is at the root of the problem being experienced.
6. Finally, ethics are central to implementing VEST in a therapeutic way that is the least harmful as possible and the Guidelines for Ethical Use of Videos or Multimedia in Sex Education, Counselling and Therapy are strictly followed. Privacy is taken into extreme consideration, debriefing always occurs, and selection of materials is kept aligned with the client’s progress.
So What?
VEST does allow the addition of pharmacological interventions if it is soothing for the client, but discourages it because the dysfunction is not treated as a functional problem (go figure the root of dysfunction), but rather one that can be overcome with our powerful mental and relational faculties once we are given the right tools and training. This may be encouraging for those who have found such interventions to be largely unsuccessful or not their preferred method of dealing with things. VEST has had an 80-85% symptom reversal rate, even for desire difficulties (Sommers, 2003). Something amazing is undeniably happening here!
As mindfulness continues to catch on in the West, such is my hope that mindfulness based therapies that have proved more useful than, or just as useful as, pharmacological interventions will make their way into the therapy room here. In short, we deserve markedly better access to treatment. Even so, as some readers may be aware, until that ideal is achieved, there are steps that can be taken on our part to strengthen our faculties and the love and kindness we experience in our relationships, in order to help us overcome these happenings that do not define who we are.
*If you are interested in some of the statistics on VEST and the demographics for people that have been seen, please check my sources*