Sex
Therapy Application
You
will be provided a vase vignette below. You need to address the following:
1.
Which theory are you using? Describe the theory in 2-3 paragraphs.
2.
What issue is the client/couple experiencing?
3. What is the etiology of that issue, based upon your theory?
4.
What would your treatment goals be?
5. What interventions would you use?
6. How would you evaluate success?
This
paper should be in APA format and include appropriate reference and citations.
Vignette:
Barbara Garrison was concerned
about a number of problems when she arrived
for her first appointment at the
mental-health center. Her principal complaint
was an inability to achieve orgasm
during sexual intercourse with her husband,
Frank. They were both 33 years old
and had been married for 15 years. Frank
was a police detective, and Barbara
had recently resumed her college education.
Their children, a daughter and a
son, were 15 and 12, respectively.
Barbara’s orgasmic problem was
situational in nature. She had experienced
orgasms through masturbation, and
she masturbated an average of once
or twice a week; however, she had
never reached orgasm during sexual activity
with Frank. The problem did not
involve sexual desire or arousal. She found
Frank sexually attractive, wanted
to enjoy a more satisfying sexual relationship
with him, and did become aroused
during their sexual encounters. They had
intercourse two or three times each
month, usually late at night after the children
had gone to sleep and always at
Frank’s initiative. Their foreplay was primarily
limited to genital manipulation and
seldom lasted more than 5 minutes.
Frank always reached orgasm within
a minute or two after penetration and often
fell asleep shortly thereafter,
leaving Barbara in a frustrating state of unfulfilled sexual arousal.
On many occasions, she resolved
this dilemma by slipping
quietly out of the bedroom to the
TV room, where she would secretly masturbate
to orgasm. Frank realized that
Barbara did not experience orgasms during
intercourse but chose not to
discuss the problem. He did not know that she
masturbated.
This situation was distressing to
Barbara. She felt considerable guilt over
her frequent masturbation,
particularly after sexual intercourse, because she
believed that masturbation was a
deviant practice. She was also concerned about
the sexual fantasies she had during
masturbation. She often imagined herself in a luxurious hotel room having
sexual intercourse with a sequence of 8 or 10 men.
They were usually men she did not
know, but she would sometimes include men to
whom she had been attracted, such
as classmates from the university and friends
of her husband. Barbara believed
that these promiscuous fantasies proved that
she was a latent nymphomaniac. She
feared that she could easily lose control
of her own desires and worried that
she might someday get on a train, leave her
family, and become a prostitute in
a large city.
Her anxiety regarding sexual
interests and arousal was also a problem during
intercourse with Frank. He had, in
fact, made numerous efforts to find out
what she found arousing, but she
remained uncommunicative. She was afraid
to tell him what she liked because
she thought that he would then realize that
she was “oversexed.” She was
self-conscious during sexual activity with Frank.
She worried about what he would
think of her and whether she was performing
adequately. Questions were
continually running through her mind, such as
“Am I paying attention to the right
sensations?” or, “Will it happen this time?”
The combination of fear of loss of
control of her sexual impulses and continual
worry about her inadequacy as a
sexual partner finally persuaded Barbara to seek
professional help.
In addition to Barbara’s inability
to reach orgasm during intercourse,
Barbara and Frank were not getting
along as well as they had in the past. Several
factors were contributing to the
increased strain in their relationship. One
involved Barbara’s decision to
resume her education. Frank had not completed
his college education, and the
possibility that Barbara might finish her degree
was threatening to him. He was also
uncomfortable around the friends Barbara
had met at the university. His job
as a detective seemed to increase this tension
because relations between students
and the police had been strained by campus
arrests for use of drugs and
alcohol. Frank believed that Barbara’s younger classmates
saw him as an unwelcome authority
figure who could present a threat to
their independence. He resented
changes in the way she dressed and also attributed
their increasingly frequent
disagreements to the influence of the university
environment.
They also had more financial
concerns than in previous years. Barbara’s
tuition and other fees amounted to
a considerable amount of money each semester,
and within 3 years, their daughter
would be old enough to go to college. They had
also taken out a substantial loan
to build an addition onto their home. To make
more money, Frank had been working
many more overtime hours. Considering
that he was away from home so
often, Barbara resented the fact that he spent most
of his spare time working on the
new rooms in their house.
Despite their frequent arguments
and differences of opinion, Barbara and
Frank were both seriously committed
to their marriage. Neither of them was
particularly happy, but they were
not considering a divorce. Barbara believed
that their relationship would be
markedly improved if she could overcome her
orgasmic dysfunction. Frank was
less concerned about that particular issue but
agreed that Barbara might feel
better if a therapist could “help her understand
her
problem.”
Barbara’s parents were both in
their middle forties when she was born. They had
one other child, a boy, who was 5
years older than Barbara. Her father was a
police officer, and her mother was
a homemaker. Barbara’s parents clearly cared
for each other and for the
children, but they were not openly affectionate. She
could not remember seeing them
embrace or kiss each other except for occasional
pecks on the cheek or top of the
head; nor, on the other hand, could she
remember hearing them argue. It was
a quiet, peaceful household in which emotional
displays of any kind were generally
discouraged.
Barbara’s parents and her older
brother were unusually protective of her.
She was “the baby of the family”
and was always closely supervised. It seemed
to Barbara that she was not allowed
to do many of the things that her friends’
parents permitted. When she was
young, she was not allowed to leave their yard.
When she was older and in high
school, she was not allowed to go out on school
nights and had to be home by 10
p.m. on weekends. Her parents insisted on
meeting all of her friends and, in
some cases, forbade her to associate with certain
other children. Until she was 16
years old, Barbara was not allowed to go to
parties if boys were also invited.
She remembered her first date as an
awkward experience that occurred
during her junior year in high
school. A boy whom she had admired for several
months had finally asked her to go
to a movie. Her parents agreed to allow
her to go after her father asked
several of his friends about the boy and his parents.
When he picked her up before the
movie, Barbara’s parents asked so many
questions that they were finally
late for the show. Later, as they were leaving the
theater, Barbara realized that her
brother and his girlfriend, who both attended
a local junior college, had been
sitting several rows behind them. Their parents
had called him and asked if he
would keep an eye on her “to be sure everything
was okay.” He did not intend to be
secretive and, in fact, asked Barbara if she
and her friend would like to go out
for hamburgers and Cokes after the show.
This carefully arranged supervision
did not ruin the experience. Everyone had
a good time, and Barbara went out
with this same boy several times in the next
year. Nevertheless, the protective
manner in which Barbara’s family treated her
prevented her from developing close
relationships with boys her own age and
later left her feeling
uncomfortable when she was alone with men.
Barbara’s knowledge about and
experiences with sexual activity were
extremely limited during childhood
and adolescence. Neither of her parents
made an effort to provide her with
information about her own body or reproductive
functions.
Her mother did discuss general issues such as romance and
marriage with Barbara, but only at
the most abstract level. All of the books and
magazines in their home were
carefully screened to avoid exposing the children
to suggestive literature or
photographs. Barbara was not able to learn much about
these matters from her friends
because she was so closely supervised. After she
began menstruating at the age of
11, her mother gave her a book that explained
the basic organs and physiology
associated with the human reproductive system
and, once again, avoided any
personal discussion of Barbara’s concerns about
sexuality. The implicit message
conveyed by her parents’ behavior and attitudes
was that sex was a mysterious,
shameful, and potentially dangerous phenomenon.
After she graduated from high
school, Barbara began taking classes at the
local junior college. She continued
to live at home with her parents and maintained
several of the same friends she had
had in high school. During her fi rst
semester, Barbara met Frank, who
was then a student at the police academy.
After several weeks, they began to
see each other regularly. Her parents liked
Frank, perhaps because her father
was also a policeman, and they gradually
began to allow her greater freedom
than they had when she dated in high school.
Frank and Barbara were both 18
years old, but he was much more mature and
experienced. He had been dating
regularly since he was 15 and had had sexual
intercourse for the first time when
he was 17.
Their sexual relationship
progressed rapidly. Although she was initially
apprehensive and shy, Barbara found
that she enjoyed heavy petting. She
refused to have intercourse with
Frank for several months; finally she gave in
one evening after they had both
been drinking at a party. She later remembered
being disappointed by the
experience. Frank had climaxed almost immediately
after penetration, but she had not
reached orgasm. Her guilt was replaced
by utter shock when she realized
several weeks later that she was pregnant. They
did not discuss the pregnancy with
her parents and agreed they should be married
as soon as possible. Their daughter
was born less than 6 months after their
marriage. Despite the obvious
“prematurity” of the birth, Barbara’s parents never
mentioned the issue of premarital
intercourse or pregnancy. Barbara dropped out
of college and did not return to
school for many years.
Barbara and Frank’s sexual
relationship did not change much over the next
few years, although their frequency
of intercourse declined markedly during
their second year of marriage.
Intercourse continued to be a pleasurable experience
for both of them, even though
Barbara was not able to experience orgasm.
Her fi rst orgasm occurred after
they had been married for more than three years
and both of their children had been
born. Following their typical pattern, Frank
had fallen asleep after intercourse
and Barbara was lying in bed, half awake and
very much aroused. She was lying on
her stomach, and some of the blankets
happened to be bunched up under her
pelvis and between her legs. Without recognizing
what she was doing, Barbara began
rocking rhythmically from side to
side. She was relaxed and noticed
that this motion created a pleasurable sensation.
Several minutes after she began
rocking, she experienced an intense,
unmistakable orgasm. It was an
extremely pleasurable phenomenon restrained only by her fear of waking Frank.
After her accidental discovery of masturbation,
Barbara experimented further with
various styles of self-manipulation and
was soon masturbating regularly.
She was afraid to describe these experiences
to Frank, however, because she
believed that masturbation was an immoral and
selfish act, and her ability to
reach orgasm by self-stimulation did not generalize
to intercourse with Frank. Barbara
also avoided conversations about sex when
she was talking to other women. She
believed that masturbation and sexual fantasies
were immoral, and she was convinced
that none of her friends had ever
had such
experiences.
