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HBO presents

Dr. Perelman
"Sex and the City"-Shrink Talk

September 27, 2000

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Cynde: If Trey is masturbating to porn magazines and not having sex with Charlotte, does that mean that Charlotte doesn't do it for him?

Dr. Perelman: No, it does not necessarily mean that at all. Truly, Trey has difficulty integrating the concept of sexuality with the woman he loves and has married, and his own quite specific 'tension release'. However, we have no indication at all that Trey does not find Charlotte sexually desirable and attractive. What we do know is that he has a tendency to both deny and hide his sexuality. Fortunately, as the therapist did correctly note, (given the fact that he is married), he definitely seems heterosexual in his orientation, to the extent that we learned something of his fantasy life by observing the content of the porn magazines he chooses to masturbate with. For better or worse, that's all we've learned so far. We can, of course, entertain ourselves with making some learned guesses as to what other factors may be working. More about that next week!

Jodi: What were your impressions of the sex therapy session portrayed in the past episode? A realistic portrayal?

Dr. Perelman: I think my earlier answer dealt with what I perceived as the therapist's own difficulty in not directly focusing the couple on helping them articulate what their specific sexual problem was, which is what I believe Charlotte, for certain, would be able to do. The goal of an evaluation session is to obtain the necessary information to be able to make a diagnosis, develop a treatment plan, and communicate a prognosis to the couple while maintaining an emotional rapport with them. So if Charlotte 'spills the beans', it would be important to help Trey feel comfortable and not demeaned by that process. Charlotte is desperate to make things better, so the trick would be to help Trey feel comfortable and not overly threatened by the situation that he is already resistant and anxious about feeling forced to endure. There were actually two sessions that took place in the therapist's office in tonight's session. The therapist did correctly note an indication of heterosexual orientation, and he did correctly support the masturbation as an example of an existing sexuality for Trey, contrary to the notion that he was not interested at all. It would be more important, however, to engage Trey in whether or not he would like to be able to function sexually with his wife independent of his concept of sex as a 'tension release' to help him sleep. The therapist was correct in thinking that it was important to integrate Charlotte into Trey's sexual expression. However, the way he expressed this and the timing with which it was done is really quite different than what we would recommend. Finally, this is a situation, like many desire problems, where you would want to have a follow-up session with each person individually, and then meet again for a couple's consultation. While seemingly controversial on the surface, this would actually allow you to clarify goals, without the pressure of the partner being present, and establish a therapeutic alliance with each individual within the couple. The outlook for success in such a situation would actually be quite good. Let's hope their therapist is able to be a drop more effective than what we have seen so far. Again, it does make for good television, however. Unfortunately, that's all we have time for this evening. Thank you all for joining us, and I look forward to hearing your questions in response to the next episode. Have a great week! Good night!

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