society for sex therapy & research (sstar) april 3, 2009 - arlington, va. contemporary sexual...

Society for Sex Therapy & Research (SSTAR)Society for Sex Therapy & Research (SSTAR)April 3, 2009 - Arlington, VA.April 3, 2009 - Arlington, VA.

Contemporary Sexual Medicine Contemporary Sexual Medicine

for Sex Dysfunction: for Sex Dysfunction:

What Would Hippocrates DoWhat Would Hippocrates Do??

Michael E. Metz, Ph.D.Michael E. Metz, Ph.D.

821 Raymond 821 Raymond Avenue, Suite 440St. Paul, MN 55114

Voice: 651-641-9317; fax [email protected]

www.MichaelMetzPhD.com

Dr. Hippocrates, MD, PhD, MPHDr. Hippocrates, MD, PhD, MPH

Many images of Many images of HippocratesHippocrates

HippocratesHippocrates Hippokrates of Kos (c. 460 BC – ca. 370 BC)Hippokrates of Kos (c. 460 BC – ca. 370 BC)

● an ancient Greek physician an ancient Greek physician of the Age of Pericles – 25 of the Age of Pericles – 25 centuries ago! centuries ago!

● considered one of the most considered one of the most outstanding figures in the outstanding figures in the history of medicine. history of medicine.

● referred to as the "referred to as the "father of father of clinical medicineclinical medicine" in " in recognition of his lasting recognition of his lasting contributions to the field.contributions to the field.

● Born c. 460 bc; Island of Cos.Born c. 460 bc; Island of Cos.

Island of Cos, GreeceIsland of Cos, Greece

● Trained under his father, a Trained under his father, a physician. physician.

● Studied in Athens.Studied in Athens.● Traveled extensively.Traveled extensively.● Returned to Cos to Returned to Cos to

● writewrite● teach teach ● practicepractice

● Lived to age of 83 – 90.Lived to age of 83 – 90.

Hippocrates the Man: VitaeHippocrates the Man: Vitae

Credited with being the first physician to Credited with being the first physician to reject reject beliefs that credited supernatural or divine forcesbeliefs that credited supernatural or divine forces with causing – and curing – illness.with causing – and curing – illness.

deductive reasoning.deductive reasoning.

He believed that the goal of medicine should be He believed that the goal of medicine should be to to build the patient's strengthbuild the patient's strength through appropriate through appropriate diet, life-style and hygienic measures, diet, life-style and hygienic measures, resorting to resorting to more drastic treatment onlymore drastic treatment only when necessarywhen necessary when the symptoms showed or clarified the ilnesss.when the symptoms showed or clarified the ilnesss.

Practice anchors:Practice anchors: patient education.patient education. problem (not symptiom) focused medicine.problem (not symptiom) focused medicine. Interventions: cautious & incremental.Interventions: cautious & incremental.


founder of the founder of the Hippocratic or Hippocratic or Coan AsklepieionCoan Asklepieion (school of (school of medicine).medicine).

waswas of enormous importance of enormous importance in in separating medicine from separating medicine from superstition and philosophic superstition and philosophic speculationspeculation..


Asklepieion on Cos -- Medical SchoolAsklepieion on Cos -- Medical School

Tree where Hippocrates lecturedTree where Hippocrates lectured

Tree of Tree of HippocratesHippocrates National Library of National Library of MedicineMedicine, USA-NIH, , USA-NIH,

Bethesda, MDBethesda, MD

A cutting from the A cutting from the Tree of Tree of Hippocrates, gift Hippocrates, gift from the Island of from the Island of Cos, Greece. Cos, Greece.

Planted December Planted December 14, 1961 at the 14, 1961 at the dedication of the dedication of the National Library National Library of Medicine, of Medicine, Bethesda, MD.Bethesda, MD.

National Library of Medicine, NIH, National Library of Medicine, NIH, BethesdaBethesda

Dr. HippocratesDr. Hippocrates__________________________

The seasoned The seasonedphysicianphysician

& & sex therapist sex therapist ??

Galen Galen (c. 129 – 200 AD)(c. 129 – 200 AD)

After Hippocrates, After Hippocrates, the next significant the next significant physician was physician was GalenGalen, a Greek who , a Greek who lived from 129 to lived from 129 to 200 AD. 200 AD.

Galen perpetuated Galen perpetuated Hippocratic Hippocratic medicine.medicine.

photo photo Nina Aldin ThuneNina Aldin Thune

22ndnd century centuryPhysician,Physician,

GalenGalen,,teaching teaching medical medical studentsstudentsabout about

couple sexcouple sex

(14(14th th century century manual)manual)

HIPPOCRATIC OATHHIPPOCRATIC OATHEthical Practice of MedicineEthical Practice of Medicine

● The Hippocratic Oath is an oath The Hippocratic Oath is an oath traditionally taken by traditionally taken by physiciansphysicians pertaining to the ethical practice of pertaining to the ethical practice of medicine. medicine.

● Basis for Basis for other helping professionals other helping professionals codescodes of ethical practice. of ethical practice.

● It’s summary axiom: “It’s summary axiom: “Do No HarmDo No Harm.”.”

Question?Question?

o In addressing sexual In addressing sexual problems and sexual problems and sexual medicine / therapy medicine / therapy for the 21st centuryfor the 21st century

o is the Hippocratic Oathis the Hippocratic Oath sufficient guidancesufficient guidance for for sexual health sexual health specialists?specialists?

The Classic Hippocratic OathThe Classic Hippocratic Oath

I swear by ApolloI swear by Apollo Physician and Asclepios and Hygeia and Panacea and all Physician and Asclepios and Hygeia and Panacea and all the gods and goddesses, making them my witnesses, that I will fulfill the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:according to my ability and judgment this oath and this covenant:

1.1. To hold him who has taught me this art as equal to my parentsTo hold him who has taught me this art as equal to my parents and to and to live my life in partnership with him, and if he is in need of money to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but covenant and have taken an oath according to the medical law, but no one else.no one else.

2.2. I will apply dietetic measures I will apply dietetic measures for the benefit of the sick according to for the benefit of the sick according to my ability and judgmentmy ability and judgment; I will keep them from harm and injustice.; I will keep them from harm and injustice.

3.3. I will I will neither give a deadly drug to anybodyneither give a deadly drug to anybody who asked for it, nor will who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my an abortive remedy. In purity and holiness I will guard my life and my art.art.

4.4. I will not use the knife, not even on sufferers from stone, but I will not use the knife, not even on sufferers from stone, but will will withdraw in favor of such men as are engaged in this workwithdraw in favor of such men as are engaged in this work..

5.5. Whatever houses I may visit, I will come for the benefit of the sick, Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injusticeremaining free of all intentional injustice, of all mischief and in , of all mischief and in particular of sexual relations with both female and male persons, be particular of sexual relations with both female and male persons, be they free or slaves.they free or slaves.

6.6. What I may see or hear in the course of the treatment or even What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no outside of the treatment in regard to the life of men, which on no account one must spread abroadaccount one must spread abroad, I will keep to myself, I will keep to myself, holding such , holding such things shameful to be spoken about.things shameful to be spoken about.

7.7. If I fulfill this oath and do not violate it, If I fulfill this oath and do not violate it, may it be granted to me to may it be granted to me to enjoy life and art, being honored with fame among all men for all enjoy life and art, being honored with fame among all men for all time to cometime to come; if I transgress it and swear falsely, may the opposite of ; if I transgress it and swear falsely, may the opposite of all this be my lot.all this be my lot.

6 Classic Medical Ethics Principles:6 Classic Medical Ethics Principles: Ethical Values and Sexual Health Ethical Values and Sexual Health

1.1. Non-MaleficenceNon-Maleficence – “ – “first, do no first, do no harmharm”.”.

2.2. BeneficenceBeneficence – always – always ensure the best ensure the best interest of the patientinterest of the patient..

3.3. AutonomyAutonomy – the – the patient right to patient right to choosechoose or refuse treatment or refuse treatment based on based on full disclosurefull disclosure..

4.4. JusticeJustice – – fairness and equalityfairness and equality concerning treatments.concerning treatments.

5.5. DignityDignity – the patient and professional – the patient and professional have the right to have the right to personal respectpersonal respect..

6.6. TruthfulnessTruthfulness – – honesty about honesty about evidence based treatmentsevidence based treatments, and , and freedom from dual relationships.freedom from dual relationships.

Dan’s article, Dan’s article, “The Ethics Corner” “The Ethics Corner”

in Jan.09 SSTAR Newsletter in Jan.09 SSTAR Newsletter..

DAN WATTERS, Ph.D.DAN WATTERS, Ph.D.

PEGGY KLEINPLATZ, PEGGY KLEINPLATZ, Ph.D. Ph.D.

SSTAR Sunday Workshop:SSTAR Sunday Workshop: ““Ethical Dilemmas & Ethical Dilemmas &

Clinical Conundrums Clinical Conundrums

in Sex Therapy” in Sex Therapy” 9:00 a.m. – 12:00 noon.9:00 a.m. – 12:00 noon.

HIPPOCRATES HIPPOCRATES TODAY ?TODAY ?

1.1. ScientistScientist

2.2. TeacherTeacher

3.3. ClinicianClinician

I.I.HIPPOCRATESHIPPOCRATES

SCIENTISTSCIENTIST

Objective ObserverObjective Observer

Caring ThinkerCaring Thinker

Ancient Greek Medicine

The Pantheon of The Pantheon of gods…gods…

Zeus.Zeus.

gods vs. giants.gods vs. giants. Haides – god of Haides – god of death.death.

Hekate -- goddess of Hekate -- goddess of

witchcraftwitchcraft

The gods…The gods…<-- Athene being reborn<-- Athene being reborn Plaque with figures Plaque with figures

from head of Zeus.from head of Zeus. from from religious rituals.religious rituals.

Goddess Nyx (Night)Goddess Nyx (Night) driving her chariotdriving her chariot with winged horses.with winged horses.

<- Zeus disguised as a<- Zeus disguised as a swan seduces Leda.swan seduces Leda.

Healing Healing Stele of Stele of Horus Horus

(Egyptian, c. 300 b.c)(Egyptian, c. 300 b.c)

Asklepios – god of medicine and Asklepios – god of medicine and healinghealing

AsklepiosAsklepios Hippocrates teaching and Asklepios Hippocrates teaching and Asklepios arriving at the Cos Asklepieion School.arriving at the Cos Asklepieion School.

Hippocrates the Scientist:Hippocrates the Scientist:

He He challenged beliefschallenged beliefs of supernatural or of supernatural or divine forces as:divine forces as:

sourcessources and and causescauses or or

curescures of illness. of illness.

Hippocrates Hippocrates TODAYTODAY: Sex : Sex TherapyTherapy

would teach to would teach to demythologize demythologize

unreasonable claims of sexual unreasonable claims of sexual performance:performance:

treat “treat “hypehype” about sex (e.g., perfect ” about sex (e.g., perfect erections) as though it were erections) as though it were claims from the claims from the “gods“gods”.”.

would promote would promote reasonable sexual reasonable sexual knowledge and expectations knowledge and expectations of of sexual performance and couple sexual performance and couple satisfaction.satisfaction.

Hippocrates Hippocrates TODAYTODAY: Sex : Sex TherapyTherapy

would would teach an integrative teach an integrative biopsychosocial approachbiopsychosocial approach to to sex problems: sex problems:

he’d teach the he’d teach the inseparable inseparable unification and interactionunification and interaction of of biological, psychological, and biological, psychological, and interpersonal dimensions interpersonal dimensions andand

never address one without never address one without consideration of the others.consideration of the others.

II.II.HIPPOCRATESHIPPOCRATES

INSIGHTFULINSIGHTFUL

TEACHERTEACHER

TrainerTrainer

MentorMentor

Hippocrates the Hippocrates the Teacher Teacher TODAYTODAY

He would be concerned about the He would be concerned about the misinformation and “primitive misinformation and “primitive skills” levelskills” level of many of many professionals / clinicians to professionals / clinicians to address sexual concerns.address sexual concerns.

He would strongly promote He would strongly promote greater and specific sex therapy greater and specific sex therapy training requirementstraining requirements for for degree degree programs and licensureprograms and licensure for all for all healthcare professionals.healthcare professionals.

Hippocrates the Hippocrates the Teacher Teacher TodayToday

Would promote sex therapy Would promote sex therapy trainingtraining in traditional and new in traditional and new ways:ways:

traditionaltraditional: : ““First be a good clinician, First be a good clinician,

then a good sex therapist.” then a good sex therapist.” (Harold Leif, M.D.)(Harold Leif, M.D.)

newernewer:: Interactive on-line Interactive on-line knowledgeknowledge

and and

skills trainingskills training resources. resources.

Hippocrates the Hippocrates the Teacher Teacher TodayToday

ExamplesExamples::

RUThinking.co.ukRUThinking.co.uk – UK teen sexual – UK teen sexual health.health. http://www.ruthinking.co.uk/http://www.ruthinking.co.uk/

““Children in the MiddleChildren in the Middle” (divorce)” (divorce) interactive classesinteractive classes, seminars for:, seminars for:

ParentsParents ProfessionalsProfessionals http://www.childreninthemiddle.com/classes2.hthttp://www.childreninthemiddle.com/classes2.ht

mm

III.III. HIPPOCRATESHIPPOCRATES

COMPASSIONATE COMPASSIONATE CLINICIAN CLINICIAN

& &

Sex TherapistSex Therapist

Hippocrates the Sex Hippocrates the Sex Therapist:Therapist:

Professional identity: Professional identity: VOCATIONVOCATION

““callingcalling” to serve others, to ” to serve others, to use knowledge in the use knowledge in the service of service of his patientshis patients’ overall (sexual) ’ overall (sexual) health.health.

focus on the total personfocus on the total person – – physical, mental & physical, mental & interpersonal/family.interpersonal/family.

Hippocrates the Sex Hippocrates the Sex Therapist:Therapist:

professional “patient collaboratorprofessional “patient collaborator”” more than a “technician”more than a “technician” fellow-worker fellow-worker with his patients for their health.with his patients for their health.

credited with practicing with credited with practicing with an an eye for evidenceeye for evidence from: from:

● detaileddetailed personal & family personal & family historyhistory;;

● kept a patient kept a patient recordrecord● that would follow to other physician.that would follow to other physician.

● patient observatonpatient observaton ● continuous pulse during history for continuous pulse during history for

evidence!evidence!

Hippocrates the Hippocrates the Sex Therapist Sex Therapist TODAYTODAY

would assess and treat from a would assess and treat from a comprehensive evidence-based comprehensive evidence-based approachapproach::

empirical knowledgeempirical knowledge – “factual” – “factual”

qualitative knowledgequalitative knowledge -- -- “compassionate”“compassionate”

Professional Myopia ?Professional Myopia ?Awareness of our “Professional Filters…”Awareness of our “Professional Filters…”

Hippocrates would also Hippocrates would also challenge our clinical challenge our clinical perceptionsperceptions because: because:

““We tend to ‘find’ what we’reWe tend to ‘find’ what we’re

looking forlooking for”:”:

MDMD: DX & TX --> only: DX & TX --> only

physiological ?physiological ? MHMH: DX & TX --> only: DX & TX --> only

psychological ?psychological ? SW / MFTSW / MFT: DX & TX --> only: DX & TX --> only

interpersonal ?interpersonal ?

Hippocrates would Hippocrates would integrateintegrate “ “all of the above…”all of the above…”

Hippocrates the Hippocrates the Sex Therapist Sex Therapist TODAYTODAY

► ► He would pursue the He would pursue the

sexual problem:sexual problem:

● with careful, detailedwith careful, detailed historieshistories,,

● to seek the to seek the sourcesource and and the the impact,impact,

● and and treat all featurestreat all features..

TREAT THE DISEASE, TREAT THE DISEASE,

NOT THE SYMPTOMNOT THE SYMPTOM..

Hippocrates the Sex Therapist Hippocrates the Sex Therapist TODAY: TODAY:

SUMMARYSUMMARY

1.1. would honor his “would honor his “callingcalling” to be a ” to be a sexual health professional sexual health professional with with loyalty to the ethical principlesloyalty to the ethical principles..

2.2. would be would be steadfastly patient-steadfastly patient-centeredcentered..

3.3. would would treat the sex problem as an treat the sex problem as an all-encompassing biopsychosocial all-encompassing biopsychosocial problemproblem

not simply symptom relief.not simply symptom relief.

Hippocrates the Sex Therapist Hippocrates the Sex Therapist TODAY: TODAY:

SUMMARYSUMMARY4.4. Would teach / Would teach / educateeducate to empowerto empower his his

patientspatients with accurate knowledge and with accurate knowledge and reasonable expectations.reasonable expectations.

5.5. promote individual & couple promote individual & couple satisfactionsatisfaction as as the vital purposethe vital purpose of sex of sex medicine & therapy.medicine & therapy.

6.6. teach reasonable sexual healthteach reasonable sexual health such assuch as:: Metz & McCarthy (2007)Metz & McCarthy (2007)

--> “--> “Good-Enough Couple SexGood-Enough Couple Sex”” Kleinplatz, Menard et al, (2007) Kleinplatz, Menard et al, (2007)

--> “--> “Optimal SexualityOptimal Sexuality” AND….” AND….


……He would be He would be a a

SSTAR SSTAR

COLLEAGUECOLLEAGUE

Any resemblance between Any resemblance between HIPPOCRATES HIPPOCRATES

and the god ZEUS is purely and the god ZEUS is purely coincidental.coincidental.


OUROUR

SSTAR SSTAR

COLLEAGUECOLLEAGUE

Society for Sex Therapy & Research (SSTAR)Society for Sex Therapy & Research (SSTAR)April 3, 2009 - Arlington, VA.April 3, 2009 - Arlington, VA.

Contemporary Sexual Medicine Contemporary Sexual Medicine

for Sex Dysfunction: for Sex Dysfunction:

What Would Hippocrates DoWhat Would Hippocrates Do??

Michael E. Metz, Ph.D.Michael E. Metz, Ph.D.

821 Raymond 821 Raymond Avenue, Suite 440St. Paul, MN 55114

Voice: 651-641-9317; fax [email protected]

www.MichaelMetzPhD.com

society for sex therapy & research (sstar) april 3, 2009 - arlington, va. contemporary sexual...

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