Following a traumatic brain injury (TBI), individuals may experience cognitive, emotional, and physical deficits. However, one of the most prevalent effects is a disruption in sexual activity due to the brain being the primary organ responsible for sexual function (Aloni et al., 1998). Sexuality encompasses an individual's emotions of self-worth, ability to receive or deliver affection, desirability, and love, as well as being a component of one's relationships (Medlar, 1998). Disruptions in this domain may lead to significant distress to the individual and their partners. TBI survivors may also experience impairment and negative emotions related to self-image. In the context of society, topics regarding an individual's sexuality may seem stigmatized; however, without treatment or a proper plan of care, many individuals suffering from sexual dysfunctions may be left to find relief on their own.
Often, barriers in treatment present themselves, such as a lack of therapeutic interventions focused on sexuality and limited inclusion of this topic during the rehabilitative process (Connell et al., 2014). Group psychotherapy may be an effective tool in assisting TBI survivors with uncovering and addressing sexual disturbances experienced. During group therapy, clinicians can assist in equipping patients with psychological tools and strategies to manage distress related to sexual difficulties and to reduce emotional distress. In a study by Wiley & Sons, Inc (2007), researchers found that group psychotherapy was more effective than psychopharmacological treatment alone. Group psychotherapy is an effective tool that may help individuals address any interfering factors related to sexual functioning, such as anxiety, guilt, fear, avoidance, or shame. Other areas that may be explored in group psychotherapy are perceptions related to trauma or body image, which may adversely affect an individual's sexual functioning.
Individuals in group psychotherapy will benefit from engaging in open dialogue with other TBI survivors experiencing similar sexual dysfunctions. Participating in this treatment modality will allow members to explore and define how these disruptions affect their lives and those within their group. Group psychotherapy may focus on multiple domains of functioning, and participants will benefit from participating in discussion within a collaborative approach. Doing so will ultimately enhance the learning experience and allow for vicarious learning within the group. TBI survivors will share experiences they are grappling with regarding sexuality which may elicit similar issues faced by other group members. This may ultimately assist the group in working cohesively on common difficulties, negative emotions experienced, and coping strategies, which is the most beneficial aspect of group psychotherapy. When discussing coping, adjustment to new limitations, and modifying maladaptive behaviors, feedback from others within a group setting is essential. Individuals in a group setting will benefit from receiving reactions and comments from a supportive network such as the therapist and other group members.
In reference to psychoeducation, this would include topics such as learning about sexual anatomy, responses, and behaviors, which may reduce anxious symptomatology. Due to the complexity of a topic such as sexuality and its stigmatized nature, discussion requires openness, trust, and cohesion within a group setting. The therapist must be careful and should create a group and environment where patients will be able to accept themselves, their sexuality, and each other.
Since sexuality is part of a person's health, including mental health, interventions such as group therapy should be considered an intervention to aid those who experience sexual difficulties post-TBI. Although there is a lack of resources available for this population regarding sexual difficulties, treatments that effectively address and aim to reduce negative emotions experienced due to sexual dysfunctions should be provided. Sexual disorders are organic and psychological in nature and due to this, may require both psychotherapeutic and medical treatment (Kockott, 2007).
Psychopharmacological treatment has been and continues to be used to treat sexual difficulties; however, increased focus should be given to psychological intervention such as group therapy to assist with low self-esteem, lack of desire, and avoidance of intimacy.
Aloni, A., Keren, O., Cohen, M., Rosentul, N., Romm, M., & Groswasser, Z. (1999). Incidence of sexual dysfunction in TBI patients during the early post-traumatic in-patient rehabilitation phase. Brain injury, 13(2), 89–97. https://doi.org/10.1080/026990599121755
Connell, K. M., Coates, R., & Wood, F. M. (2014). Sexuality following trauma injury: A literature review. Burns & trauma, 2(2), 61–70. https://doi.org/10.4103/2321-3868.130189
Kockott G. (2007). Psychotherapie sexueller Funktions- und Erlebnisstörungen [Psychotherapy for sexual dysfunctions and desire disorders]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 50(1), 11–18. https://doi.org/10.1007/s00103-007-0112-2
Medlar, T. (1998). The manual of policies and procedures of the SHIP sexuality education program. Sexuality and Disability, 16, 21–42. https://doi.org/10.1023/A:1023019714519
John Wiley & Sons, Inc. (2007, July 18). Erectile Dysfunction: Group Psychotherapy Can Help. ScienceDaily. Retrieved January 18, 2022, from www.sciencedaily.com/releases/2007/07/070718002446.htm