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[This audiovisual has been acquired for distribution by the National Medical Audiovisual Center]
[?] Okay. [throat clearing]
[Bob, floor manager:] Stand by. We're rolling shortly.
[Copyright 1973 Ortho Pharmaceutical Corp. All rights reserved]
[Bob:] You might catch that drape again, Al, down at the bottom.
[footsteps, shuffling sounds]
[Stan, director:] We're rolling Noam, will you take your place for the opening, please?
[footsteps, shuffling sounds]
[Bob:] Get the appointment book. Have a good show.
[Dr. Beryl Chernick:] Thanks, Bob.
[Dr. Noam Chernick:] Say, I feel anxious.[Dr. Beryl Chernick:] Tell me about it.
[Dr. Noam Chernick:] Well, we're making a film and I'm not an actor.
[Beryl:] We're not expected to be actors. We're just supposed to do what we do.
[Noam:] Yeah, that's what makes me anxious.
You see, we do sex counseling and that involves talking about sex.
[Beryl:] Yes, I thought men talked about sex all the time.
[Noam:] Well, yeah.
They brag about it and they tell dirty jokes but they don't really talk about sexual feelings.
[Beryl:] But they know all about sex.
[Noam:] Where do you think they learn?
[Beryl:] Weren't they born knowing?
[Noam:] Not any more than any other kind of human being.
[Beryl:] Oh. Well if they don't know, why can't they ask?
[Noam:] Well, see, a guy can't ask because he's a expected to know.
Right? And if he asks, then it means he doesn't know, so he doesn't ask.
[Beryl:] I see. Well, that's an awful bind to be in.
I can see where that would make you uptight, not wanting to talk about sex.
[Noam:] You know, I got another problem.
[Beryl:] Well, you better tell me about that one, too.
[Noam:] Well, I'm a physician. You know, people go to their doctor and expect them to know all about sex.
Say, how are the people watching going to know we're doctors?
I mean, are we supposed to introduce ourselves?
[Beryl:] I don't know.
(shouting) [Noam:] Stan, how do the people know that we're doctors?
(over intercom) [Stan:] Don't worry about it Noam, we'll just burn it in.
[Avinoam B. Chernick, MD, FRCS (C)]
[Noam:] They're going to burn it in.
[Beryl:] What does that mean?
[Beryl A. Chernick, MD., Ph.D.]
[Noam:] I haven't the faintest idea. That's some kind of professional jargon.
[Stan:] We're ready to start.
(movie slate) [Bob:] Ortho Pharmaceutical Corporation presents "Bill and Sue", scene one, take one:
A Co-Therapy Team Approach to Conjoint Sex Counseling.
[slate snaps]
[Stan:] We're rolling.
Okay, Beryl, Noam, go ahead. Don't be nervous.
[Beryl:] Do you want to start?
[Noam:] I'm, I'm still nervous.
[Beryl:] Oh, I think we've got some patients outside. Would you like to see them?
[Noam:] Yeah, I always feel more comfortable when I'm with a patient.
[Beryl:] Good.
[Noam:] What are you doing?
[Sue Williams:] I'm Mrs. Williams, a patient. I'm a nurse and I've been married for three weeks.
[Noam:] I see. When you put on that jacket and that purse, then you're Mrs. Williams.
[Sue Williams:] That's right and I've got a problem. I'm married to you.
[Noam:] Oh, well.
When I put on this jacket, see, and this pair of glasses, then I'm Mr. Williams and I'm a retail clerk in a clothing store.
[Sue Williams:] Right. [Bill Williams:] And I've got a problem.
[Sue Williams:] Oh? [Bill Williams:] I'm married to you.
[Sue Williams:] And we've been referred by our minister for counseling.
[Bill Williams:] He's a pretty understanding fellow. Where are we?
[Sue Williams:] Oh, we're in the waiting room, waiting for our appointment.
[Bill Williams:] We are?
[Sue Williams:] Right.
[Noam:] Uh huh. [Beryl:] Yes.
[Sue and Bill Williamfidgeting in waiting room]
[Noam:] I'll bring them in.
[Beryl:] You can often get a very accurate impression of the patients you're going to
see simply by observing them as they wait in the reception area.
We find it's useful to conduct the patients in personally.
It gives us time for this first assessment and begins the establishment of rapport.
We notice, for instance, that much useful information can be gleaned from watching
how patients seat themselves and where they sit relative to each other.
It's very obvious at this point that the Williams' are both distressed.
His constant scratching and her fumbling with her hair or purse reveal their discomfort.
[footsteps, seat cushion crunches]
[Noam:] Two little things before we start.
But first, if it's all right with you, we'll use everybody's first name
and that gets away from the which doctor's which problem. Mine's Noam.
[chalk writing on slate board]
[Beryl:] And mine's Beryl.
[chalk writing on slate board]
[Sue Williams:] I'm Sue and his name is Bill.
[Bill Williams:] Yeah, well, like she says, my name is Bill.
[chalk writing on slate board]
[Noam:] Bill and Sue. That's fine.
Now, the second little thing, we tape all our sessions.
We do this so that we can play back to you what you say if this is helpful.
We don't keep the tapes. We just recycle them.
So if it's all right, we'll start the tape recording.
[recorder button clicks]
[Sue Williams:] I don't see anything wrong with it. It's okay.
[Noam:] Okay, let's go back to you. Bill, can you tell us right now how you're feeling.
[Bill Williams:] Fine, yeah.
[Beryl:] And how about you, Sue, how are you feeling right now?
[Sue Williams:] I'm feeling pretty nervous.
[Beryl:] Most people feel pretty uptight when we begin, Sue. That's pretty normal.
[Noam:] We find it very important to give the patient permission to feel the way he's feeling.
Many people feel anxious when they come to see the doctor for the first time and especially in this type of anxiety-provoking situation.
Bill, who said he is fine, is obviously not fine.
In our society, men need to be given even more permission than women before they are able to safely divulge their feelings.
Bill, can you tell us what you consider the problem between the two of you to be?
[Bill Williams:] Oh boy.
[Beryl:] I feel rejected.
[Noam:] Tell me about it.
[Beryl:] Well, I mean, I put out my hand and you rejected it and I feel rejected.
[Sue Williams:] That's right.
[Noam:] Well, you know how I get when you get sexy like that.
[Beryl:] I wasn't getting sexy. I just needed some comfort right then and I figured you did, too.
[Noam:] Well, I guess I did.
But I was sore because when he asked me my name, you answered for me like I didn't even know my own name.
[Beryl:] Oh, I'm sorry.[Noam:] Well, I guess I'm sorry, too.
[Beryl:] Sue, is that how you were feeling?
[Sue Williams:] Yeah. That's why I put out my hand.
[Beryl:] Bill, did you realize that's what she was doing?
[Bill Williams:] No, but what you said, yeah, I get it now.
[Noam:] We often mirror the actions of the patients and then show
them an effective way of letting each other know how they are really feeling.
Mirroring and modeling are useful tools to a co-therapy team.
[Beryl:] There was an apparent misperception on the part of the Williams'.
I decided it would be a useful time to pick up the feelings they had but were unable to express to each other.
Then I checked with them if we had accurately expressed their feelings.
It was important to each of the Williams' to receive support from the therapist of their own sex.
[Noam:] Okay, Bill, the problem as you see it.
[Bill Williams:] Well, we'd been going together for three years before we got married.
Well, we had lots of fun before we got married, you know, fooling around and, well, you know.
[Stan:] Hey, Noam?
(shouting) [Noam:] What now?
[Stan:] This film is only so long. We can't go into all the details.
[Noam:] Well, okay. We'll summarize.
During their courtship, Sue and Bill decided that they would save sexual intercourse until after marriage.
So they everything but including petting to orgasm.
The problem began on the wedding night
when an early attempt at intercourse provoked pain in Sue and Bill became frightened and backed off.
The rest of the two-week honeymoon was a disaster.
They continued on their planned motor trip but when they retired to the motel room, they renewed
attempts at intercourse the first two or three days.
After Bill encountered Sue's repeated distress, any further attempt at intercourse was prevented by his loss of erection.
This, then, became the focus of their fear and concern.
They avoided discussing sex and eventually even stopped having any physical contact.
[Beryl:] Sue, can you tell us what you consider the problem to be?
[Sue Williams:] Well, I mean, when I married him, I thought he was a man and knew about things.
Now I find he doesn't know anything.
[Noam:] I feel threatened.
[Beryl:] Tell me about it.
[Noam:] Well, it's this expectation that I'd know all about sex.
[Beryl:] You mean men weren't born knowing?
[Noam:] That's right.
[Beryl:] Oh. But I expected that my husband would be in charge of that area.
So you were pretty disappointed, Sue. But it wasn't a realistic expectation.
Sue, can you tell us what happened on the honeymoon?
[Sue Williams:] Well, I was real happy when we went to the motel on the first night and, well, we went to bed.
And then it all happened so fast.
He tried to put it in and it really hurt.
And then he couldn't do it anymore.
[Beryl:] Following the first part of the intake session where the couple was seen together,
each patient was then interviewed separately by the therapist of the same sex.
This is done not only to obtain an adequate history and helping the diagnosis, but also as a therapeutic measure
during which feelings are explored and information and reassurance given.
This session usually opens with history-taking over a cup of coffee or tea.
The intentions of the patients with regard to their partners is explored.
The intactness or ego strength of each individual is assessed with relation to their being able to continue with our form of therapy.
[Noam:] When we finish the individual interviews, the couple waits in the
reception area while we confer on what we found.
We see if we can establish a diagnosis.
We also compare their separate intentions with regard to the relationship.
Well, let's call them back in now.
[Beryl:] Right.
[dissolve transition]
[Noam:] Well, from what you people have told us, you've got a lot of things
going for you in your marriage, many strengths.
Most importantly, you want to put a lot of work into your marriage.
Now, let's take a look at some of the problems.
As you recall, on the night of your honeymoon,
Bill was pretty uptight and without stopping to deal with Sue's feelings,
[flow diagram]
he tried to insert the penis.
On the first night, Sue encountered pain and on succeeding occasions fear of pain which led in turn to increased vaginismus.
[diagram flipped]
The increased pain on Sue's part brought forth an impotence reaction on the part of Bill
and his fear of failure led to failure and more impotence.
[diagram flipped]
The fear of pain and fear of failure resulted in an avoidance of each other leading to loneliness,
accusations, withdrawal, and more avoidance, both of each other, and a lack of sex play.
Each time the penis is inserted without adequate sex play, the pain of vaginismus and the failure of impotence will occur.
[pointer dragging on the diagram]
[Beryl:] We regularly employ flow diagrams.
In a simple way, these illustrate for the patient our conception of the pathology, pathogenesis, and possible therapy.
Having what they consider to be an immense problem laid out on a green board
in less than five minutes allows the patients to see the situation in perspective and thereby reduces their anxiety.
[Noam:] At the end of the intake, the Williams' were offered a series of four conjoint sessions
spread over roughly four weeks with time in between to practice what they learn at each session.
These sessions are aimed at reducing anxiety, providing information concerning sexual function,
and setting up a series of tasks aimed at helping them to overcome the fear-of-failure cycles in which they are locked.
We encouraged them to discuss their feelings about the intake sessions in general,
and our diagnosis in particular before deciding to accept this therapy.
[Beryl:] Fine. We'll see you then. Bye.
[telephone hung-up]
That was Sue Williams...the newlyweds we saw yesterday.
They'd like to come back and we can see them in about two weeks.
[Noam:] Okay.
At the beginning of this session, we were pleased to learn that Bill and Sue had accepted
our earlier suggestion to refrain from having sexual intercourse.
By themselves, they resumed the petting they had enjoyed before they got married
with the result that they were again bringing each other to orgasm.
[Beryl:] Is there anything that concerns you now?
[Bill:] Yeah. Well, what I want to ask is, uh, when will we be able to do it the normal way?
[Beryl:] Well, what you're doing now, Bill, is one of the normal ways.
Having sexual intercourse is just one of the ways people communicate sexually.
Couples who are able to have sexual intercourse find that it's just one of the things that they choose
to do to give each other pleasure.
I'm sure you'll discover that, too.
[Noam:] The major event in this session is the physical examination of both partners.
[Beryl:] After the wife's general examination, the husband is brought into
the examining room where they both participate in the anatomy demonstration.
[door opening]
[Noam:] Fine. Come on in.
After Bill and Beryl enter the room, Bill is invited to look over my shoulder.
I give Sue a mirror, which she can hold,
and with Bill observe the demonstration of anatomy and explanation of the vaginismus phenomenon.
[Bill:] Wow, I never knew really exactly where it was or what was, you know, in it.
Well, for me it was always hit and miss.
[Sue Williams:] I didn't know either.
[Bill:] You didn't?
[Sue Williams:] No.
[Bill:] But you're a nurse.
[Sue Williams:] Ha, how was I supposed to know?
They never taught us about it and I wasn't even supposed to touch it and I certainly couldn't see it.
After all, I'm not that good an acrobat.
[Noam:] Now you both know that you're physically normal.
Bill, your penis is quite normal.
And Sue, your vulva and your vagina are quite healthy and quite adequate.
[Sue Williams:] Then why do I tighten up like that and why can't he put it in?
[Noam:] Watch, Sue.
[Noam waves his hand towards Beryl]
That was a perfectly normal reaction to fear.
When Beryl overcomes her fear of my hand, see, she doesn't blink.
[Beryl:] During Sue's examination, she was given a small lubricated dilator to insert in her vagina.
She will proceed through a set of graduated vaginal dilators at her own pace.
She has also been instructed to insert her finger into the vagina to have some idea where it is and how it feels.
Together, the Williams' are instructed in the principle of pleasuring as outlined by Masters and Johnson.
[Noam:] Well, it's now about four days later. The Williams' are back.
We've already learned that Sue's been able to insert the smaller dilators and has ever been able to put the tip of her finger in her vagina.
[seat cushion rustles]
Sue, Bill, what have you learned from pleasuring each other?
[Bill:] Well, once I got over being embarrassed, you know, I really enjoyed watching Sue.
[Sue Williams:] And I liked the chance giving pleasure to Bill, really giving, not just lying there and letting him do everything.
[Bill:] Yeah, only one thing still bothers me.
[Beryl:] Say it, Bill.
[Bill:] I still kind of come fast.
[Noam:] I can see how that would concern you, Bill.
We'll deal with that area.
We've dealt with other areas and made progress in them and we'll make progress in that area, too.
[Beryl:] I think it'll be clear if we just take a look at the whole sexual response cycle, just what happens.
And from that, we'll be able to see how the fear of pain and the fear of failure affect the response.
Okay? Let's just take a look at this graph.
[Noam:] Last time they learned the anatomy of the sexual organs,
and this time they learned the physiology of human sexual response.
By explaining the effects of feelings on the response curve, we can demonstrate how the fear of failure leads to failure.
This reinforces our earlier diagnosis and relates it to the therapy.
The point of no return prior to ejaculation is noted on the graph and related to the squeeze technique for learning ejaculatory control.
[Beryl:] In this session, we encouraged Sue to continue inserting the dilators,
her finger and later Bill's finger into the vagina.
Together, they will practice the squeeze technique to help them deal with Bill's ejaculatory control.
[Noam:] It's now a week later and time for our next session with the Williams'.
[Beryl:] Right. And Sue's looking fine but Bill's a bit unhappy. Tell us about it, Sue.
[Sue Williams:] Well, I'm doing just fine. I can insert those dilators and I could even get my finger in. But, uh...
[Noam:] Where'd you get stuck, Bill?
[Bill:] Well, when I came close to her with my finger...
[Sue Williams:] I had a spasm, and...
[Bill:] It made me feel just like a failure, back to the old business, you know, right back where I started.
[Sue Williams:] Oh, that's not true, Bill. You're a lot better.
Your erection lasts a lot longer before your ejaculation.
Hey, listen to the language I'm using.
[Noam:] I hear Sue saying that she's real pleased with you, Bill.
And I'm real pleased with you too.
That's real great.
[Beryl:] You're both doing well. It's predictable, Sue, that at this stage,
anything that you didn't insert in the vagina would cause spasm.
The next step will be for you to insert Bill's finger
into the vagina in the same way as you become comfortable with inserting those dilators.
In this session, the Williams' were given further reassurance and encouragement.
In addition to the earlier tasks, Bill would insert his finger in the vagina, first under Sue's control,
later on his own, and eventually during sex play.
I'd like to make a special comment.
It is important to understand the purpose of these tasks.
They are just a framework for the real learning experience.
This consists of constant feedback of feelings to each other.
The knowledge of their partner's feelings makes them confident that what they are doing is effective.
It protects them from turning their partner off and feeling like a failure.
[Noam:] Let's see. The next session is the fourth session with the Williams'.
[Beryl:] Right.
[Noam:] And they've reported real progress.
[Beryl:] And Sue's found great pleasure in her ability to stimulate Bill. Isn't that right, Sue?
[Sue Williams:] That's right. I never thought it would happen but I like seeing him, you know, react.
[Noam:] No kidding?
[Bill:] I mean, I've always enjoyed watching Sue but I didn't know you liked it, too.
[Sue Williams:] Well, you really turn me on.
[Bill:] Geez! How about that?
[Noam:] It's important to tell your partner when you're pleased and when you're not pleased.
Isn't that right, Beryl?
[Beryl:] I'm real pleased with you right now, Noam. You said that very well.
[Noam:] Well, thanks very much.
[Beryl:] This was the last of the sessions that we had contracted for with the Williams',
but they didn't feel ready to terminate the therapy just yet.
We agreed to see them again for two more sessions during the next month.
Bill and Sue were instructed to continue the tasks outlined earlier.
In addition, Sue would use his penis to caress her vulva and eventually her vagina.
[Noam:] The Williams' were seen two weeks later.
Both very pleased. They saw no further need for sessions.
We asked them to come in for a followup in two months and stressed to them
the importance of maintaining the effective pattern of communication they had learned.
We warned them that there would be ups and downs and invited them to contact us if they really felt stuck.
[Beryl:] Quite a difference, isn't there?
[Bill:] Well, it's just great and we're trying some pretty new things now.
[Sue Williams:] Bill has some pretty wild ideas.
[Bill:] Hey, look who, look who's talking. Guess who it was last night who...
[Stan:] Hey, Noam.
[Bill:] What is it?
[Sue Williams:] Hey, you're Bill, not Noam.
[Bill:] Oh, darn it. Yeah. Sorry, Noam.
[Noam:] That's okay, Bill. What is it, Stan?
[Stan:] You got about one more minute to wrap this up.
[Noam:] Okay. Beryl, do you want to start the wrap-up?
[Beryl:] Sure. When the Williams' first came to see us, they were very depressed, caught up in two vicious cycles.
[Noam:] By working with a male and female co-therapy team,
they have found out that it is quite possible for people to talk comfortably with each other about sex.
By sharing their feelings, they come closer together instead of withdrawing into the loneliness
they were experiencing when we first saw them.
[Stan:] That's it. Let's print it.
[Produced Ortho Pharmaceutical Corporation, Department of Educational Services]
[Executive Producer Charles Galbraith Producer-Director Stan Carlson]
[Video Tape Editor Bob Howard]
[Based on original material developed by Drs. Beryl and Avinoam Chernick
who appeared through the courtesy of Sound Feelings Limited, London, Canada]
[Produced through the facilities of Northwest Mobile Television]
[fade to black]
[end trailer]