The four-session assessment phase includes an initial couple session (to reinforce the concept of sexuality as a couple issue and to explore the sexual problem in the context of the relationship), an individual sexual history session for each person, and the couple feedback session.
The prime assessment procedure is the semistructured sexual history. Sexual histories are conducted individually so the person is able to give an uncensored report of his or her sexual strengths and weaknesses, both before the marriage and during the marriage. Although secrets are complex clinical issues for the couple and therapist, a greater danger is not knowing about crucial issues that may impact the therapeutic process. Sexuality, especially sensitive and secret issues, needs to be assessed individually so that the clinician has a clear understanding of the attitudes, behaviors, and emotions, which impact the individuals and couple. If the history is conducted with the partner present, the clinician is less likely fail to obtain a true picture since at least 75% of individuals report sensitive or secret material (McCarthy, 2003). During these sessions, the clinician must utilize open-ended questions, as well as be supportive and nonjudgmental. The history-taking interview should move from general, less anxiety provoking material to more sensitive and specific issues.
The feedback session is the core intervention in sex therapy and has three focuses: (1) present a way of understanding the sexual problem which motivates the couple and provides hope for change and resolution; (2) propose a therapeutic plan which focuses on specific individual and couple changes, as well as potential traps to monitor; and (3) give a sexual homework exercise and the assignment to process and clarify material from the feedback session. The couple leaves the feedback session with a clear understanding of the individual responsibility/intimate team model of change (each partner is responsible for his/her desire, arousal, and orgasm and the couple works together as an intimate team to develop a comfortable, functional sexual style), motivation to address the sexual problem, and willingness to explore personal and couple vulnerabilities in a nonblaming manner.
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