The influence of socio - psychological and cultural factors on the expectations of russian patients from the psychotherapy

The authors of this review demonstrate the correlation between the cultural features, social factors and the patients’ expectations from the psychotherapy. Russian psychologists have been paying very little attention to client expectations. It is very often that convergence between the patient´s expectations from psychotherapy and that the psychotherapist offers the patient - often depends on the success of the therapy. The results of many studies confirm that clients´ expectations are an important factor with regards to the efficiency of psy-chotherapy as well as to the rate of drop-outs. Reliable methods of assessment of clients´ expectations allow to create and to implement strategies of pre-therapy interventions. The theoretical structure of patients´ expectations is complex, as is the set of their determinants. Patients´ choices reflect their mentality, the social stratum and cultural tradition they belong to, their personal traits and value systems, inner dynamic factors including the type of attachment and particularities of the psychopathology, and so on. The paper covers multiple aspects of determination of the construct «patient´s expectations». Particular focus is on the cultural determinants of Russian patients´ expectations. In the analysis of cultural determinants of therapy expectations the authors used approaches of Ruth Benedict and Geert Hofstede. According to Benedict´s classification Russian culture might be considered more as so-called Dionysian culture. According to authors’ analysis more pertinent patients´ expectations formed by Russian culture might be such psychotherapies as psychodrama, NLP, Gestalt-therapy Holotropic Breathwork; and in a less degree – psychoanalysis.

Advances in male and female sex therapy: Expectations and disappointments

The introduction of the PDE-5 inhibitors for male erectile dysfunction (ED) evolved expectations for 70–80% of efficacy as has been shown in short term studies. Ten years later, we are aware of their limitation: PDE-5 inhibitors are not efficient when desire is lacking, as well as in severe ED. Also, long term studies showed a lesser degree of efficacy.The new pharmacological treatment for premature ejaculation, Dapoxetine, has been developed as a short acting SSRI. It has been shown to increase the time for ejaculation by three folds but has some adverse effects including nausea and fainting (due to hypotension).Low desire is the most common sexual complaint in females. New pharmacological treatments include Bupropion 150 mg/day and Flibanserin 150 mg/day, although the evidence for efficacy is not conclusive. Their proposed mechanism is an increase in dopamine and norepinephrine activity. Flibanserin is an antagonist at the serotonin 2A receptor and an agonist of the serotonin 1A and dopamine D4 receptors.Estrogen and/or testosterone replacement may be beneficial in appropriate cases.There is a growing awareness in the last decade that low sexual desire in women is associated with age, relationship duration, relationship distress and complaints of anxiety and depression. Those psycho-social factors might limit the role of pharmacological agents.Sex therapy should always consider and relate to these key issues