Therapists' Constructions of Practice in Relation to Women Experiencing Orgasm Difficulty: A Foucauldian Discourse Analysis

The aim of this thesis is to explore how clinicians construct their practice with women experiencing difficulty with orgasm, by adopting a Foucauldian Discourse Analysis (FDA).
In the first part, a critical review of the literature is presented, which illustrates the socio-historical constructions of female orgasm in relation to three distinct temporal periods; classical, modern and contemporary. The discursive constructions of orgasm within these epochs are considered in relation to research and treatment development.
The thesis then presents the analysis which used semi-structured interviews to explore how six clinical psychologists and two psychosexual therapists make sense of the work they do with women experiencing difficulty with orgasm. The transcripts were analysed using a FDA.
A critical realist social constructionist epistemological position was adopted in this research to facilitate the exploration of the constructed nature of orgasm, both at the local level of the text and the wider institutional level, to explore contextual and social factors and their implications for subjectivity.
The analysis identified that clinicians construct their understanding of therapy with women experiencing difficulty with orgasm in three main ways. They constructed their practice in terms of pursuing expert knowledge to secure professional power. They constructed the women with whom they work as ‘problematic’ yet ‘untreatable’ in the context of dominant biomedical discourses. Finally, they constructed the broader service context as regulating the ways in which they are able to conceptualise and ‘treat’ this presentation, thus perpetuating a pathologising construction.
This thesis recommends that clinicians should focus on interventions that promote a strength-based and systemic approach, which adopt a preventative stance towards addressing this phenomenon, involving social action and community development. Finally, supervision and reflective practice is recommended to increase awareness of the impact of social discourses on the subjectivity of the women who present for ‘treatment’.