Joe was a professional photographer, working for a magazine, when at the age of 44, he became aware of weakness in his arms and legs, and pain in his eyes on occasion. He was devastated, after several investigations, to be told that he had Multiple Sclerosis.

Joe and his wife, Jean, had had an active and good sex life until then. A few weeks after the diagnosis, Joe began to experience either partial erections, or could not perform at all. This was a very embarassing and difficult situation for both. After some months of struggling with the problem, they decided on seeing a sex therapist. Once the therapist had ascertained that Joe still had morning erections, and was aware of feelings of arousal, when wanting to make love to Jean, it was felt that the impotence was probably due more to his anxiety and panic at his diagnosis, and what the future held, than caused by the MS itself.

The therapist placed a ban on penetration for some weeks, and suggested various ways of spending time together, caressing, exploring each other's bodies, and generally relaxing with each other. This brought about the desired effect, removing the pressure to perform for Joe, and he discovered that he had erections while doing the 'exercises' with Jean. Over the ensuing weeks, using a graduated programme, they built up towards full intercourse, and after about 8 weeks, the ban was removed, and Joe discovered that he could perform just as well as before.

The psychological causes of erection difficulties are most often related to fear of failure, performance pressure and anxiety. There may be relationship stresses which make the problem worse. You really need to see a therapist for psychological treatment.

The first stage is to understand all the things which are causing the problem. There is often more than one cause. As far as possible, it is better to be seen with your partner if you have one, as it is much easier to overcome the psychological causes with the help of a partner. This is especially so where the problem only happens in the relationship.

Once the causes are understood, the next steps will be agreed with the therapist. Sometimes there are Sexual Abuse issues to be managed. Relationship stresses may need to be resolved. Any unrealistic expectations will have to be changed.

In the end, the most effective treatment will probably be sex therapy, but at first you may not be ready for it. Your therapist will guide you through it, and deal with any obstacles along the way.
A userful book is The New Male Sexuality, by Bernie Zilebergeld

The key to the management of anger is self awareness. Most people do not blow up about tiny things, unless the tiny thing acts as a trigger to set off a reaction that really belongs to another thing. For example, a man may explode because his son left the newspaper folded badly, when what is really making him angry is worry about money, fear of redundancy and just finding out his father is dangerously ill.

1. The first step is to write a list of the things that make you angry, and a detailed account of the last 3 outbursts and what was on your mind at the time. Next write your lifestory, and remember times of upset as you were growing up. Remember the people who made you angry or hurt you. Think about how you feel as you remember them now.
2. See if there are any connections between any of those things. A therapist may be able to help you with this, as they know what to look for. If you can see connections, it may help you to understand the reasons for your anger being hard to manage.
3. The next step is to watch yourself very carefully and notice when you start to feel angry. At that point stop whatever is going on, and make connections with the step before. (This means you will have to slow down!) If you make a connection, you will see that some of the anger comes from the past, or to another situation.

Babies are born quite relaxed, but learn to fear, to be anxious and to be stressed. Later in life, we can learn how to relax again- sometimes a vital part of dealing with a sexual or relationship problem. Your therapist will assess any difficulties you have with relaxing, as well as help you identify the situations when you are most likely to become anxious or tense. You can learn how to breathe deeply, and then through a systematic programme of taped exercise, identify tension and how to release it immediately. Relaxation training is effective, and is often a good start in therapy where you may want to make an 'early gain'.

Counselling by e-mail and chat or web conferencing is now well established as a useful way of getting help. The results are as good as, and in some cases better than, face to face, and many people prefer the anonymity of it. Also, it is usually cheaper than face to face counselling. You will not meet your counsellor or therapist unless you decide together to do so.

Your first step is to mail the counsellor of your choice and ask if they are available and willing to take you as a client. Sometimes they may refuse if they have a heavy caseload, or feel the issue you want to deal with is beyond their expertise.

The counsellor will then tell you their terms and conditions, what they will charge and what they will do for your money! and how and when you should pay. Any counsellor will be happy to answer questions about qualifications and training, codes of ethics and practice, what professional bodies they belong to and anything else about their professional status. They are most unlikely to answer any personal questions! Your counsellor will often ask for your real name, address, date of birth, and your doctor's name and address, in case of emergency.

To begin counselling, you will have to explain your problem and answer questions from the counsellor, some of which may seem unrelated, but there will be a good reason behind any question. If you really have to think about your answers, that is good. In counselling, it is generally the client who has to do the thinking. Your counsellor will not have the answers for you! You may be given tasks to fulfil, and books or articles may be useful for you to read. There may be web sites the counsellor can reccommend you to visit. Sometimes just telling somebody helps you to see your own way forward.

Mandy, age 38, was fed up with Tony as he complained all the time about her loss of sexual desire. They had been together sixteen years, and he kept waiting for her to be sexy again like she was before they had any children. They had Patrick, age 15, and Gemma, age 12. She could be sexy for a few days, but then something would upset her and she would turn off. It would be several weeks before she would be feeling sexy again.

Assessment
The therapist helped the couple to see the pattern of behaviour that turned Mandy off. Tony did not realise that he was aggressive when drunk. He thought it was just a bit of fun. He also did not realise, because Mandy had not told him, that Patrick was getting rude and upsetting Mandy, his teacher, and Gemma. The couple began to feel closer to each other as they discussed these things.

Increase Sexual Awareness
For Mandy the whole topic of sex was difficult as she had bad experiences with har family's attitudes in the past. These experiences were preventing her from feeling good about herself, and from feeling OK about sex. The therapist helped her to get over her past, and allow herself to feel sexy if she wanted. Also, it became clear that Tony wanted more sex than she did, because it was the only time he felt close to her.