Target: Masters and Johnson

Researchers cast new doubts on their methods and results

The publication in 1970 of Human Sexual Inadequacy, by Dr. William H. Masters and Virginia E. Johnson, was one of those events that transform the clinical landscape. Afterward sex therapy seemed a brave new world, and Masters and Johnson were its gurus. Already known for their significant findings about the physiological processes involved in sex, the pair devoted the book to the therapies they had developed at their St. Louis clinic for such problems as frigidity, impotence and premature ejaculation. Over a period of 16 years, they reported, they treated 790 cases, mostly involving married couples; in each case they conducted intensive sessions for a few weeks, then followed up with consultations for five years. They laid claim to a remarkable success rate: only 20% of their patients, they said, failed to respond.

Last year Masters and Johnson published Homosexuality in Perspective, describing a similar program for homosexuals; this time, they said, only 28% of their patients resisted a conversion to heterosexuality.

The Masters and Johnson record in sex therapy was unparalleled, even unique, and therein lay the catch. Other sex therapists have since been unable to match their success rate and consequently have been growing increasingly skeptical of the reliability of their findings. Now two California psychologists, Bernie Zilbergeld and Michael Evans, in the current issue of Psychology Today, have written the sharpest, most substantial attack yet. "Masters and Johnson's research is so flawed by methodological errors and slipshod reporting that it fails to meet customary standards--and their own--for evaluation research," say Zilbergeld and Evans. "This raises serious questions about the effectiveness of the ten-year-old discipline they created."

The key to evaluating any research --"the only impeccable yardstick," as Masters and Johnson themselves put it --is the ability of other researchers to duplicate the results using the same techniques. But, say Zilbergeld and Evans, it is impossible to tell from Masters and Johnson's own account precisely what they did and how they did it. Among many unanswered questions, according to the two psychologists: How did Masters and Johnson define success and failure in sex therapy? Who decided if treatment had succeeded? By what criteria?

Many of Masters and Johnson's patients tended to be highly motivated and prescreened through referrals by psychiatrists and psychologists; hence they were probably likely to respond to treatment. Zilbergeld and Evans fault Masters and Johnson for not being more candid about the special nature of their sample. Masters and Johnson never divulged how many applicants they considered and how many they rejected, nor how many were accepted and then later quit or were asked to leave. Similarly, in their study of homosexuality, Masters and Johnson used a Kinsey-developed system of seven categories of sexual preference. Of their 67 patients, 82% fell under the heading of bisexuals, or "flawed" heterosexuals. This calls into question their claim to have turned true homosexuals to heterosexuality, say Zilbergeld and Evans.

Masters and Johnson turned down an offer to respond in print to the Psychology Today article. "We don't do that sort of thing," says Virginia Johnson. She concedes that she and her collaborator-husband may have been hasty in publishing Human Sexual Inadequacy before there was "time painstakingly to process and computerize our findings." But she maintains that the data that then: critics find missing are waiting in St. Louis. Says she: "Anyone who wishes to understand them had jolly well better come, because we're not going to publish prematurely again."

"Masters and Johnson were pioneers," says Psychologist Peter A. Wish, executive director of the New England Institute of Family Relations in Framingham, Mass., "and when people pioneer, they can't have all the answers." Dr. Carol Nadelson, professor of psychiatry at Tufts-New England Medical Center, agrees that "their research methodology raises some questions," but she cautions that "one could get sticky about methodology and never get anything done."

Still, therapists are encountering more tricky cases in which sexual difficulties are tied to psychological problems, as opposed to Masters and Johnson's emphasis on sex as a behavioral "natural function." Says Kevin Gordon of the Human Sexuality Program at the University of California at San Francisco: "The symptoms are part of larger issues--like anger in a marriage. It's all very complicated."

Such therapists would gratefully take guidance from Masters and Johnson's research; but while less harshly critical than Zilbergeld and Evans, they are frustrated by what they consider the inadequacy of Masters and Johnson's direction. "I would like to see the data," says Psychologist F. Paul Pearsall, on the staff of the Institute for Sex Research in Bloomington, Ind. "Until we can replicate their work, we will remain either awed, envious or suspicious of its validity."

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