Visually Enhanced Psychosexual Therapy (VEST)

As a philosopher at heart, I like to speculate that the acronym for Visually Enhanced Brief Directive Psycho-sexual Therapy is a fitting one.
In mindfulness the emphasis is on being rather than doing.
You are not IN-vesting, or else they would have made it Invivo (which means to confront directly) Visually Enhanced Psychosexual Therapy.

The emphasis is on learning to be present with your partner in a myriad of ways that takes the focus off of having to perform sexually, which is the doing part that we get hung up on which in turn leads to the depression, anxiety, and anger.

So, philosophical musings aside, what is VEST?

In the Canadian Journal of Psychiatry, an article was published by Frank G. Sommers, M.D., FRCPC, detailing VEST's origins as part in parcel of exploration of Virtual Reality Technologies. Researchers were interested in results that demonstrated that the erectile responsiveness of males was not necessarily experienced in conjunction with a mental arousal state.

Mechanically induced basically meant that audio-visual stimulation caused an erection in males, but there was little to no mental activity in the portions of the brain that we would expect to light up with arousal.

Due to this, researchers decided to drastically investigate the idea that medicinal and/or mechanical interventions were actually helping patients with dysfunction. They wanted to reevaluate the use of audio-visual stimuli to make it a more potent therapeutic tool, by teaching clients how to kindle that mental desire, rather than just treating their body like a puppet that must perform.

With that, followed 30 years of a private psychiatric/sexological practice in Toronto, Canada in which VEST has been used to treat a myriad of sexual dysfunctions such as vaginismus, erectile dysfunction, painful intercourse, lost sexual desire, orgasmic release problems, varying sex drives and the like. So think… for 39 years now (this article was published in 2003), many of us have sat around not knowing that good and meaningful work is being done in this area!
In all this work, the clinicians/researchers found that no matter the presenting problem, the clients all had some ‘problem of living.’ Whether we call that depression, anxiety, trauma… something had happened to them.

STEPS TO VEST

1. With VEST, both partners are interviewed and a very complex and detailed history is taken. Ideally both partners participate in the treatment, and the classic ‘identified patient’ model is swept aside to focus on re-bonding the two people.

2. There are 8 to 10 sessions that can last 2 to 3 hours or more, which contain psychosexual education components to help the clients understand the treatment, as well as understand contributing factors in their lives that have fed the current situation.

3. The educational component uses mindfulness language to help the couples relate, which is that they must be Present Centered (PC) and Process Absorbed (PA). As is the case with any mindfulness practice, PC is the same as moment to moment non-judgmental awareness that is not in the past or future, but the present. PA can be thought of as what I call the being mode rather than the doing mode. You want to be present with your partner in the process of loving and be absorbed fully in each moment as it happens. You do not want to think “what am I going to do next?”

4. Homework is given, but not unless the context of treatment and the language is understood by those involved.

5. Visual aids are crucial for VEST and are used during sessions and assigned as homework, and processing feelings and thoughts are a huge part of this process. This processing helps to do what therapists call “cognitive restructuring” to help increase the salience or importance, relevance, and meaningfulness of thoughts. This cannot happen unless the new processing strongly opposes old ways of processing and is producing meaningful change for the people involved. The visual materials are carefully selected and based on the individuals in order to minimize risk of harm, especially if trauma is at the root of the problem being experienced.

6. Finally, ethics are central to implementing VEST in a therapeutic way that is the least harmful as possible and the Guidelines for Ethical Use of Videos or Multimedia in Sex Education, Counselling and Therapy are strictly followed. Privacy is taken into extreme consideration, debriefing always occurs, and selection of materials is kept aligned with the client’s progress.

VEST does allow the addition of pharmacological interventions if it is soothing for the client, but discourages it because the dysfunction is not treated as a functional problem (go figure the root of dysfunction), but rather one that can be overcome with our powerful mental and relational faculties once we are given the right tools and training. This may be encouraging for those who have found such interventions to be largely unsuccessful or not their preferred method of dealing with things. VEST has had an 80-85% symptom reversal rate, even for desire difficulties (Sommers, 2003). Something amazing is undeniably happening here!

As mindfulness continues to catch on in the West, such is my hope that mindfulness based therapies that have proved more useful than, or just as useful as, pharmacological interventions will make their way into the therapy room here. In short, we deserve markedly better access to treatment. Even so, as some readers may be aware, until that ideal is achieved, there are steps that can be taken on our part to strengthen our faculties and the love and kindness we experience in our relationships, in order to help us overcome these happenings that do not define who we are.

*If you are interested in some of the statistics on VEST and the demographics for people that have been seen, please check my sources*