The Dual Control Model · Clinical Exercise

Find the Brake

For most people presenting with a sexual concern the accelerator is not broken. The brakes are engaged. Eight lines of history to assign, one history to read for its most informative detail, and the model turned into the questions it actually generates.

What this exercise practises

Distinguishing the performance brake from the context brake by what the client's concern is about, recognising the line in a history that establishes excitatory capacity, and converting a theoretical framework into questions you would ask out loud.

This is formulation rather than diagnosis. Diagnostic criteria belong to Module 09 and treatment to Module 12.

Estimated time to complete this exercise: 25 minutes

1Three systems
2The lever
3The questions
4Close

Before you begin

How this one works

For most people presenting with a sexual concern the accelerator is not broken. The brakes are engaged. This exercise is about working out which brake, from what a client tells you.
Part 1 gives you eight pieces of history to assign to SES, SIS1 or SIS2. Two of them involve more than one system at once, and the notes say so.
Part 2 asks you to find the single most diagnostically informative line in a history. There is almost always one, and it is almost always the same kind of line.
Part 3 is the model turned into questions. Five of the eight are questions the model directs you to ask. Three are questions clinicians ask instead.
Nothing is graded and nothing is recorded. Reloading starts it again.

High sensitivity in either inhibitory system is a trait-like individual characteristic, normally distributed in the population and reasonably stable over time. It is not a disorder. What produces a clinical presentation is a sensitive brake meeting a context that keeps pressing it.

References

  1. Bancroft, J., & Janssen, E. (2000). The dual control model of male sexual response: A theoretical approach to centrally mediated erectile dysfunction. Neuroscience & Biobehavioral Reviews, 24(5), 571–579. https://doi.org/10.1016/S0149-7634(00)00024-5
  2. Carpenter, D., Janssen, E., Graham, C., Vorst, H., & Wicherts, J. (2008). Women’s scores on the Sexual Inhibition/Sexual Excitation Scales (SIS/SES): Gender similarities and differences. Journal of Sex Research, 45(1), 36–48. https://doi.org/10.1080/00224490701808429
  3. Graham, C. A., Sanders, S. A., & Milhausen, R. R. (2006). The Sexual Excitation/Sexual Inhibition Inventory for Women: Psychometric properties. Archives of Sexual Behavior, 35(4), 397–409. https://doi.org/10.1007/s10508-006-9041-x
  4. Janssen, E., & Bancroft, J. (2007). The dual-control model: The role of sexual inhibition and excitation in sexual arousal and behavior. In E. Janssen (Ed.), The psychophysiology of sex (pp. 197–222). Indiana University Press.
  5. Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Little, Brown.