Sunday, July 31, 2011

Adolescent Conflicts: How to deal with them?

This piece of information may be helpful for the parents and families where the children are approaching adolescence. Problems in these areas mostly lands the families in trouble.

The home should be a safe base
Adolescent children are exploring life, but need a base to come back to. Home should be the place where they feel safe, protected cared and will be taken seriously. A safe place is usually a peaceful one.

 
Mutual support
Parents need to agree between themselves about their basic values and rules, and be supportive and unambiguous in applying them.
It's difficult for a teenager to respect parents who are always at each other's throats or undermining each other. A common problem is for one parent to ally with their child against the other parent. This usually leads to constant family trouble.

Listening Really
Parents are a source of advice, sympathy and comfort, if they listen to the youngsters. A teenager needs to know that his or her parents will not automatically pass a judgement and criticise. They will be forthcoming with their problems, rather than raise a tantrum. Patient listening is important.

Rules
It is reasonable that parents should decide what the ground rules are. Whilst adolescents may protest, sensible rules can be the basis for security and agreement. They must be:
  •  Clear, so everybody knows where they stand.
  •  Where possible, they should be agreed with the children.
  •  Consistent, so everyone sticks to them.
  •  Reasonable.
  • Less restrictive as children become more responsible.
You can't (and shouldn't) have rules for everything. While some issues will not be negotiable, there should be room for bargaining on others.
Punishments, such as loss of pocket money, will only work if they are established in advance. Don't threaten these if you are not willing to carry them out.
Rewards for behaving well are just as important - probably more important, in fact.

 
In case of disagreements
Involve your children in making family rules - like all of us, they are more likely to stick to rules if they can see some logic to them and have helped to make them. If a teenager is reluctant to discuss rules for him or herself, they may still do this if they can see that it might be helpful for younger brothers or sisters.
A lot of things adolescents do may be irritating to parents (as parents probably irritate them), but not all are worth an argument. It's usually better to spend time on praising good decisions or behaviour. Many annoying habits will burn themselves out once parents stop reacting to them.
 
Don't compete with them
Adolescents are growing and gaining strengths, and having a lot of opportunities and may be very busy, making the parents feel older for the first time. At times jealousy can be the underlying reason for all sorts of arguments and trouble.

 
Physical punishment
Although it is now viewed as unhelpful, many people still occasionally smack younger children. It create’s the impression that violence is an acceptable way to solve difficulties. This means that they are more likely to grow up to use violence as adults. It can create a cycle of violence

 
Parents are the prime example

Although they are becoming more independent, the children will still learn a lot about how to behave from the parents. If you don't want them to swear, don't swear yourself. If you don't want them to get drunk, don't get drunk yourself. If you don't want them to be violent, don't use violence yourself. If you want them to be kind and generous to other people ….. try to be like this yourself. “Do as I say, not as I do” just won't work.

 
Thankless Teenagers

Don't worry if your children aren't as grateful as you' like. It's great if they are, but they may not be until they have children of their own and realise how demanding it can be.

 
When to seek help

  • Sometimes, all of this may not be enough and you (or your child) may be unable to cope. Worries about the physical changes of adolescence can be discussed with the family doctor
  • If there is violence in your family - parents hitting one another, children hitting each other, parents hitting children or children hitting parents - ask for help.
  • When problems arise at school, school refusal or decline in grades are there.
  • Psychological help may be needed if relationships are the issue.
  • Adolescents who experience turmoil or distress for more than a few months - persistent depression, anxiety, serious eating disorders or difficult behaviour - generally require professional help.
  • Specialist help can help the whole family.

Tuesday, July 26, 2011

Unravelling Adolescence Conflicts: Few Facts

The Growing Years
The teenage years can be a source of emotional trauma for whole of the family. A void can grow between parents and their children during adolescence. Why should many of the families land into trouble?
It's a time of rapid physical development and deep emotional changes. These are exciting, but can also be confusing and uncomfortable for child and parent alike.
The process of rapid physical changes in adolescence is called puberty. The hormone changes responsible actually begin some years earlier and may produce periods of moodiness and restlessness.
Besides rapid physical growth and these changes include
For girls: menstrual periods, breast development, growth of under-arm, body and pubic hair.
For boys: voice becoming deeper, growth of body and pubic hair, facial hair, erections and nocturnal emissions.
Teenagers may sleep more as growth and development uses a lot of energy
Parents become less important in their children's eyes as their life outside the family develops.
Parents often feel rejected, and in a sense they are. But this is often necessary for young people to develop their own identity. In spite of the differences and arguments the children will usually think a lot of the parents.


Behavioural Problems in Adolescence
Teenagers and their parents complain about each other's behaviour. Parents often feel they have lost any sort of control or influence over their child.
Adolescents want their parents to be clear and consistent about rules and boundaries, but at the same time may resent any restrictions on their growing freedom and ability to decide for themselves.
Young people can crave excitement in a way that most adults find difficult to understand - and exciting activities may be dangerous.
Disagreements are common and normal, but when to conserned? As a general rule, the chances of children being at risk of getting into trouble are more if their parents don't know where they are. So, try to keep a track of what the children want and where they are going to spend their time
School Refusal can be due to:
  1. difficulties in separating from parents
  2. being perfectionist, and becoming depressed because they can't do as well as they would want to disturbed family life, with early separation from or death of parent.
  3. an established pattern which may have started at primary school. Such children often have physical symptoms, such as headache or stomach-ache.
  4. Bullying can also cause all of the above. Most young people do not break the law, but those who do are usually boys. 
Many adolescents diet. Fortunately, few will develop serious eating disorders like anorexia or bulimia. However, these are more likely to occur in those who take up serious dieting, think very little of themselves, are under stress and who have been over-weight as a child.
Many teenagers experiment with alcohol and illegal drugs. Regular use of drugs or alcohol is much less common.
Adolescence has often been projected as bad time. However, the scenario is not as bad and most teenagers actually like their parents and feel that they get on well with them.
It is a time when the process of growing up can help people to make positive changes, and to put the problems of the past behind them.
It is not just a difficult stage, although it can feel very much like it at times. The anxiety experienced by parents is not one sided. Periods of uncertainty, turmoil and unhappiness are also experienced by the adolescent.
Difficult times come and go, but most adolescents don't develop serious problems. It's worth remembering this when things are difficult.
Parents may sometimes start to feel that they have failed. But still they continue to play a crucial part in their children's lives. Helping the children grow through adolescence can be profoundly satisfying.

Monday, May 30, 2011

Marital Therapy

Marriage is one of the biggest gambles of life. If the gamble works, adjustment and compromise becomes the life mantra and if it doesn’t work then divorce or extramarital affairs are the outcome. If the marriage works, it doesn’t mean it is perfect. Perfect marriage is an illusion. It happens only in Mills and Boons novels. Once the honeymoon period is over, the curtain from the eyes is lifted and a clearer picture emerges. The same spouse who seemed to be carved out with utmost perfection becomes a bundle of imperfections. Fights, arguments, negative feelings & cribbing become a rule rather than an exception. If you feel that now nothing can happen and separation is the answer, think again. If love and motivation to stay together exists and no present extra marital affairs and violence or gross untreatable mental illness exists in either of the partner hope exists.


Marital therapy is the treatment of choice when such a problem becomes difficult to solve. The problem is approached in a step wise manner through a series of sessions. These are paced as per the problems in a professional and scientific manner. Few tips are given below.

No one is 100% bad or good. If there are lacunae within your partner, there must be something good as well. You can keep concentrating on the negatives and keep feeling worse but if there is anything positive, think about it which will give at least a ray of hope to move on.

Whenever feeling low, think of all the happy memories and the good times you spent together which will not only lift away the despair but also will help you in thinking clearly.

Years of marriage results in blame game whereby responsibility for anything that has gone wrong is passed on to the other partner. Shedding away the responsibility is the easiest thing to do and takes the guilt away as well. Think again. Attacking your partner will always result in defensive reaction by the other partner, the result of which will always be a fight.

Discuss issues with your partner, things that make you happy or sad, what are your expectations, how can this alliance be improved. Communication very important; which should be done in the right fashion. If you don’t talk; you can’t talk your way out.

Realise your own mistakes and how you rectify them. Change has to be brought in both the partners so why not start from your own self. Write down your positives and negatives and do the same for your partner as well.

Imagine how it would be like to be married to your own self. Then you might be able to understand the position of your spouse better. It would also help you in understanding your own self.

Long term marriages work on strengths and not weaknesses. Concentrate on the strengths of your partner and build upon it. Concentrate your energies in constructive things around you which give you happiness.

Sunday, May 29, 2011

Depressed? Dont be.

We all at some point in life we all have had periods of feeling blue. The feeling persists till the time the desired goal is not achieved or some compromise is done. Depression is a feeling state which persists over a long period of time causing disturbance in thinking, behaviour, feeling, biological functions, interpersonal relations and psychosocial functioning.

Depression is such a common problem that sometimes it is referred to as common cold of psychiatry. The depression may be unipolar or bipolar. It may be endogenous or exogenous. The cause may be either internal or external. There is imbalance of neurotransmitters in the brain. Sometimes the environmental conditions may be so harsh that inability to cope up may result in depression. The range of severity may differ from mild, moderate to severe. There may be prolonged periods of feeling sad, loss of interest in the self, world and the environment. There may be severe loss of energy and initiative taking. The guilt feelings can be extreme. The perception of the world becomes negative. Biological functions like sleep, appetite and sexual performance may deteriorate and in the extreme state, suicide may be sought. In psychotic depression, there may be extreme immobility and the patients may experience hallucinations and delusions as well. The contact with reality may be lost.

The treatment depends upon the severity of the condition. There are a lot of misconceptions ignorance and regarding treatment leading to a lot of unnecessary suffering and loss of productive time. Depression is not because of lack of effort from the patient. Don’t get angry if the person cannot be positive despite ‘instructions’.
In mild or moderate depression, the patient is managed either with Medications or Psychotherapies, with medications becoming more important as the severity increases. In severe depression, hospitalisation may be required whereby the patient is managed with medications. The medications given are very safe and effective if taken under proper supervision. These do not cause dullness and do not make a person lethargic. These are also not addicting or causing dependence. And the treatment results are most encouraging.

Saturday, May 21, 2011

Anger Management

Anger is an emotion related to one's psychological interpretation of having been offended, wronged or denied and a tendency to undo that by retaliation.
Being angry is not always bad. Anger is a normal human emotion, which prepares a person for dealing with the anticipated threat. Anger becomes a problem when due to various factors it becomes excessive, persistent, poorly controlled and starts interfering a person’s usual routine or social life.


Anger Management Therapies are tailor made as per the requirements of the clients. The personality, psychological mindedness of the clients, perspective on life and how the client has led one’s life is all crucial for determining the progress of therapeutic intervention. The number of sessions depends upon the severity of the problem. It can range from 5-10 sessions with adequate spacing in between.

Cognitive Restructuring is the treatment of choice. It is the process of guided self- discovery whereby the client realises that anger is just one of the many responses that can be given to any dissatisfying situation. Anger is felt when some goal is not achieved, things do not function the way they are planned or when dissatisfaction is felt over one’s life. The result is frustration and subsequently anger is felt. In Cognitive restructuring the clients are made to see the power of cognition as to how it can affect behaviour either positively/negatively which thereby determines the consequence. Cognitions are nothing but the belief system of the client. The situation is not held responsible for the action but the thoughts and beliefs are. One experiences anger and expresses it because there is fear of loss of control over the situation. This inability within oneself to tackle the situation fruitfully is hidden behind the facade of getting anger and hiding the insecure selves. So belief is generated within oneself and the clients are made to realise that they are not passive recipient of the harsh environmental forces but with ones beliefs, can change the consequences. Clients are made to realise with the help of techniques of Reflective listening, Motivational interviewing, Socratic questioning and empathetic understanding that anger at some point can serve some functional utility but if crosses the threshold then can be self destructive and debilitating. Other better options also exist which the clients fail to see which are then made more visible therapeutically. If one changes the belief regarding a situation and doesn’t feel threatened, then the consequences can also change.

A-B-C Model of anger management works by the understanding that the anger is a behaviour which has antecedents (i.e. the situations and conditions leading to Behaviour of being angry) and consequences (i.e. the after-effects of anger, e.g. being angry repeatedly can further sour a strained relationship, increasing chances of being angry). By manipulation of these antecedents (e.g. by trying to repair a strained relation) and consequences(e.g. delaying an angry response) in such a way that decreases the likelihood of thebehaviour of being angry.

Stress Inoculation Therapy is an option too, where the clients are inoculated against stress and trained to deal with stress effectively as the need arises. Anger is just one of the responses to frustration.

Mindfulness training where clients are trained towards self awareness and understanding that both good and bad are parts of the big picture and not isolated phenomena, leading to less violent reactions.

Metacognitive therapy is a higher order form of therapy where clients are trained to think about one’s own thoughts and to develop discrepancy between self owned thoughts. The clients can see, as a result, the fallacies in one’s own thinking process.

Other techniques are also taught which helps the clients to channelize their anger more productively. When in anger, analogy is given of a traffic signal. The clients are encouraged to “stop, look, think and act” which when followed can save oneself from accidents. Withholding ones immediate response can give some time to think and this can save oneself from impulsive decisions. One can drink a glass of water or box out ones anger on the bed are probably withdraw from the situation which can at least bring some momentary relief.
ANGER is only one letter short of DANGER

Thursday, May 12, 2011

Weight loss: The Psychological Aspect

Dealing with weight gain is one of the most difficult psychological tasks. Many people might not agree with this but having consensus on this issue is not the aim. The intention with which this piece is written is just to inculcate hope and motivation regarding one’s ability in dealing with their own body.


There are a lot of issues associated with weight gain which is why loosing weight is regarded as a psychological battle rather than a physical one.

Self image which is derived primarily from body image is an important facet associated with person perception which our opinion is regarding our own self. How others perceive us also forms an important part of self image which largely determines our self esteem. Having an appropriate body weight is considered attractive. The day you look good is the day you feel good. If you feel good, self confidence shoots up and vice versa. Slow weight gain is like slowly losing control over one’s body and involuntarily surrendering oneself. Slowly we sit in silent and magical anticipation that a day will come when we will be able to fit ourselves in the old jeans. But obviously that day never comes. Sizes sought after are mostly L or XL with just cold sighs towards the S or M range. Dining outside is always associated with severe guilt which is compensated for by missing the next day breakfast or lunch and suffering perennially from hunger pangs. The taste of biryani is forgotten, cold drinks and meethi lassis are replaced by cold water. Mangoes and bananas are replaced by water melons, oranges or grapes. Wardrobe slowly is overflowed with baggy like clothes and good fitting clothes are said bye-bye to. One avoids fridge as if it contains some infectious microbes which will contaminate you permanently .The routes are changed so that the favourite sweet shop or junk food outlet is not crossed. One remains always hungry and frustrated. The results are either bulimic munching or anorexic dieting. Eventually long term outcome is loss not of those extra kilos but of self esteem, self confidence and happiness .

But the belief in oneself that one has control over one self is like half the battle won. The golden rule behind weight loss is not exercise primarily but PERSEVERENCE and MOTIVATION. These important traits are responsible for any act whereby long term goal is expected. Shedding those extra kilos is not impossible task nor does it require the help of those weight loss pills or slimming centres which claim weight loss of 3-5kgs in a short time. It results in more harm than good. If one is motivated enough to realise ones goals, there is no stopping. Motivation to shed those extra kilos will act as a fuel to the fire and if it is backed by perseverance then the aim is not far reaching any more. Usually time is taken out for all the important tasks except exercise. Remember that you are important, all the work and the world can take a back seat. If you can’t love or take care of your own self, how can you love or take care of others. Respect your own self first. Give yourself priority. In 24hrs, take out at least ½ hr for exercise. You can dance, do aerobics, cycle, treadmill or walk, do yoga or whatever form of exercise you prefer. Fix this time. Use music to make it enjoyable. Every mobile phone has got this option. Whatever you do, just do it regularly. Sunday can be an off day.

PATIENCE and HARD WORK is the key to success. Just give yourself a time frame and aim at loosing 5-6kgs. It is not a question of a month or two; it might take a year, so just keep going on. Something which you have nurtured over all these years like your own baby will take some time to shed away. Do not weigh yourself every day. Just hide the machine and weigh yourself once a month. It is very much acceptable that you do not loose even an inch in two months. Every machine takes some time to pick up momentum. Our body is the most astounding god made machine. The resistant extra kilos which have accumulated over all these years will take some time to go. When you invest your money, the long term investment pays higher dividends. Similarly you are investing time in your body, returns will take some time. After first three months of regular and rigorous exercise, returns will be visible. The body will be more toned up, mood will be fresh, and probably one or two kgs are lost. From there on, aim at loosing 1 kg per month. If the weight loss is slow, weight gain will also be slow. But never over do. Listen to your body.

Accompanying this is the right kind of DIETARY HABITS. Do not avoid healthy food like rice, roti, fruits, vegetables or non veg. The amount needs to be monitored. One can avoid excess oil, unsaturated fats, red meat, artificial beverages etc. People often stay hungry while dieting which should not be done. Where will you get the energy from to exercise? You should be found on the treadmill or park and not on the hospital bed. Eat everything but in moderation. Never skip breakfast, that’s the most important meal of the day. Avoid paranthas, eat roti instead or brown bread. Never push out anything completely from your diet like sugar or rice or meat etc. When you restart all these things, you gain more rapidly. Our body requires all these things including fats. You can even treat yourself to your favourite sweet or dish or can dine outside after a week. Eat small portions more frequently rather than following thrice a day meal plan. Eating in short intervals will kill the hunger pangs and the amount of food intake for the next meal will be reduced. The cravings will also reduce. Along with your body one has to take care of one’s face as well. Do not loose the lustre of your face in the race to shed off those extra kgs. Facial will improve only outside skin. If the skin is healthy it will show.

Be REALISTIC in your aim. One has to decide how much is extra and this goal has to be realistic. Every body’s body chemistry is variable and therefore the response to exercise differs. Be realistic in the amount of weight you want to loose. Do not expect drastic results. Do not aim at size zero as well. Every body’s tendency to loose or gain kgs is variable. Stop comparing yourself to your friend who has followed the same diet plan as yours and doing the same set of exercise yet has shown better results than you. Whenever your hope start diminishing or motivation starts dwindling, thing of what you will look like after 6-7 months, the feeling of getting back into your old jeans or eating as much as you want, is motivating enough.

“Every time I feel like exercising, I lie down till the feeling passes”, if your life mantra is this.....then you do not need anything but motivation.

Sunday, March 6, 2011

Child Psychology: Behavioural Management of problem behaviours in Children

The following is the out line of modules used to manage manage Problem behaviors in Children. It is not an exclusive list and is intended only for education of Parents and Caregivers. These are highly effective and proven measures of intervention.
The strategies are arranged as to be least intrusive to most intrusive. Therapist should be clear and confident about specific strategies. Parental consent is a must for using these strategies.

Depending on the degree of the problem, the strategies are used at several levels.

Level I: It includes manipulation of the antecedents that trigger the problem behaviours.
Eg. If a child is engaging himself in thumb sucking behaviour whenever he is free this behaviours can be reduced by keeping him busy in some adaptive manual activities like, counting objects, finger painting etc.

Level II: Strategies of differential reinforcement, where Differential Reinforcement refers to the process in which desirable behaviours are reinforced and undesirable behaviours are not reinforced.
Types:
1. Differential reinforcement of low rate behaviors (DRL).
2. Differential reinforcement of other behaviours (DRO)
3. Differential reinforcement of incompatible behaviours (DRI)
4. Differential reinforcement of alternative behaviours (DRA)

DRL: It is used when the primary focus is to reduce the behaviour but not to eliminate the behaviour.
Eg: If child has habit of shouting we can’t expect him to totally stop talking but he will be rewarded when he speaks at normal voice.

DRO: When a target problem behaviour has not occurred/ or been postponed for a specific period of time, then the reinforcement is provided.
Eg: If a child has a habit of getting up from seat frequently, he would be reinforced when he remains in seat for a specific period of time.

DRA: Here reinforcement is provided on occurrence of alternative desirable behaviours.
Eg: In a specific interval, if the child asks permission to go out rather than running away, he will be rewarded for asking permission (i.e. alternative behaviour).

DRI: In this module, reinforcement is provided on occurrence of the behaviour that is physically incompatible to the problem behaviour.
Eg: If child has the habit of thumb sucking, he will be engaged in some manual activity so that his hand will not be free for sucking. And reinforcement is given when he engages in that particular manual activity.

Level III:
Extinction: It simply means terminating reinforcing event that maintains problem behaviour.
Eg: If a child cries only to get the attention of adults that can be safely ignored.

Extinction is mainly used for attention seeking behaviours or if, the function is clearly measurable.
It should not be used if the function of behaviour is escape or self stimulatory.

Level IV: Removal of undesirable behaviour stimuli. It includes 2 techniques:

Response cost: If a child shows a particular target behaviour he will be made to pay cost for it.
Eg: Tokens or rewards may be withdrawn when a child breaks an object. But, this technique is possible only when the child has some token/rewards and does not run out of them to pay as cost.

Time-out: It means, removal of reward from the child or the child from reinforcing situation.
Eg.: While everybody is playing, if a child is disturbing others with a toy, the toy will be taken away from him or he will be removed from the situation for a specific period of time.
In case, if time-out room is used, the child should not be secluded for more than 1 to 5 minutes. And there should not be any recreational or potentially dangerous articles in the time- out room.
This strategy should not be used with very young children, or if they have associated medical problems like seizures etc. or if the function of behaviour is “escape” or “self-stimulatory”.

Level V:  Presentation of aversive stimuli.

Unconditioned aversive stimuli: It includes the use of stimuli like water spray directly on face or mild tick or pungent odors. But this strategy is very rarely used. It is proved to be successful in managing stereotypical behaviours.

Conditioned aversive stimulus: As in conveying verbal displeasure (Like, an emphatic ‘No’)

Over-correction: It is considered to be educative. The purpose of overcorrection is to teach student to take responsibility for their problem behaviour and teach them desirable behaviors. It involves two methods.
a. Bringing the situation back to normalcy (Restitution)
b. Teaching appropriate behaviour (Positive practice)
Eg: If a child spits on the floor, he will be made to wipe the place (Restitution) and also taught where to spit, like in a wash-basin. (Positive- practice).

Sunday, February 6, 2011

Sexual Disorders: Premature Ejaculation

According to the tenth revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10, WHO), sexual dysfunction refers to a person's inability to “participate in a sexual relationship as he or she would wish.” The dysfunction is expressed as a lack of desire or of pleasure or as a physiological inability to begin, maintain, or complete sexual interaction.”
They can be lifelong or acquired, generalized or situational, and due to psychological factors, physiological factors, or combined factors. They can be attributable entirely or partially to a medical condition, drug/alcohol use, or adverse effects of medication.

PREMATURE EJACULATION (PME)
From an evolutionary point of view, a rapid completion of coitus is more adaptive in situations where predators are at large, but then we have moved out of jungles a long time back.
In PME, the man repeatedly reaches orgasm and ejaculation occurs before he desires to do so...and before there is full satisfaction in the sexual act. There is no definite time frame within which to define the dysfunction. The diagnosis is made when the man regularly ejaculates before or immediately after entering the vagina or after minimal sexual stimulation. Sometimes 15 seconds taken as the upper time limit, at other times when a man could not control ejaculation long enough during intravaginal containment to satisfy his partner in at least half of their episodes of coitus).
Duration = ?
The factors that affect duration of the excitement phase, such as age, novelty of the sexual partner, and the frequency and duration of coitus should also be considered before making a diagnosis.

Difficulty in ejaculatory control is sometimes associated with anxiety regarding the sexual act. Both anxiety and ejaculation are mediated by the sympathetic nervous system. Other psychological factors that can contribute are sexual guilt, a history of parent–child conflict, interpersonal hypersensitivity, and perfectionism or unrealistic expectations about sexual performance.

Few men are more vulnerable to sympathetic stimulation, hence, they ejaculate rapidly. Others have found a shorter bulbocavernosus reflex nerve latency time in men with lifelong premature ejaculation than in men who had acquired the dysfunction.

Premature ejaculation also may result from negative conditioning. The man who has most of his early sexual contacts in situations in which discovery would be embarrassing, such as there is lack of privacy or with has had prior intercourses with prostitutes who demand that the sex act proceed quickly, become conditioned to achieving orgasm rapidly.
A stressful marriage exacerbates the disorder.

The problem is quiet common, but under reported due to obvious reasons. About that 30 percent of the male population are reported to suffer, and approximately 40 percent of men treated for sexual disorders have premature ejaculation as the chief complaint.

Sex therapy

This shoud be done under supervision of an expert only. In cases of premature ejaculation, an exercise known as the squeeze technique is used for the purpose of raising the threshold of penile excitability. In this exercise, the man or the woman stimulates the erect penis until the earliest sensations of impending orgasm and ejaculation are felt. Penile stimulation is then abruptly stopped, and the coronal ridge of the penis is squeezed for several seconds. The technique is repeated several times.

Another variation is the stop–start technique, in which stimulation is interrupted for several seconds but no squeeze is applied. The man is encouraged to focus on sensations of excitement rather than distract himself from them. This makes him more familiar with his excitement pattern and lets him feel in control rather than overwhelmed by sensations of arousal. Communication between the partners is improved because the man must let his partner know his level of sexual excitement so that she can squeeze the penis before the ejaculatory process has started. Sex therapy has been successful with some premature ejaculators; however, a subgroup of dysfunctional men may need pharmacotherapy as well.

Medications

Delayed orgasm is a peculiar side effect of Selective Serotonergic Reuptake Inhibitors type of antidepressants, and this aspect has been used to prolong the sexual response in patients with premature ejaculation. This approach is particularly useful in patients refractory to behavioral techniques or who may have physiologically determined premature ejaculation.
Dapoxetine is a new, short acting SSRI specifically developed to treat premature ejaculation.
Other on demand treatment for premature ejaculation is topical anaesthetic such as lidocaine cream or spray in mild strength, which is applied to the glans of the penis.

Again all these approaches are to be used only under medical supervision.