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February 19, 2013

Human Sexuality Treatment Plan

Presenting Problems/Precipitating Event:
Client is frustrated by problems in his sex life. Client decides to seek advice from his physician.

Client Summary/Initial Clinical Impressions:
Client is a 33 years old, Korean-American, employed part-time as an English instructor in an adult education program. He was raised in Southern California by parents who were both born in South Korea and have since returned in their birth country, where his father is a politician and businessperson. The client punctually arrives for the session and appears to be casual in his manner of dressing and conduct but relatively composed in his speech. The client declares that he has been having great difficulty sustaining an erection while having sexual intercourse with his partner, although he admits that he does not experience any trouble if he masturbates alone. The client says that he has lost interest in sex for the most part of his sexual life. The client seems somehow unkempt and dejected when he enters for the first session.

The client discloses that his partner has also developed sexual apathy for the past three months. He thinks that this is because of frustration due to withdrawal from his partner sexually. The client is thus worried that his partner has lost attraction to him and thinks things might turn out worse, if he does not give him enough sex. The client also admit of getting battered a lot as a kid because he was Asian and not very masculine. He further says that his parents were initially upset at him when he confessed his sexuality at the age of 28.

The client continue to say that he presently do not talk about his sexual orientation with his parents regularly. The client states that he has not informed his parents yet about the truth his relationship with his partner. Instead, he told them that they are just roommates and nothing more. The client declares that his partner, on the other hand, also tells his parents the same story that they are simply roommates. The client receives financial assistance from his parents, but his partner foots all the mortgage and house bills. The client is concerned about his ability to afford the therapy. He proceeds and discloses that he is HIV positive and that he had discovered the same 5 months ago. The Client affirms that he had an initial visit to the doctor a month ago and that he has been on HIV medication for the past three weeks.

Provisional Differential Diagnosis:
(Possible Rule Outs):
1. Substance-Induced Sexual Dysfunction
2. Sexual Aversion Disorder
DSM-IV Multi-axial Diagnosis
Axis I: Depression and anxiety disorders
Axis II: Personality disorders: Antisocial personality disorder, intellectual disabilities and obsessive-compulsive personality disorder
Axis III: Injuries to the brain injuries, which may worsen existent symptoms of other disorders.
Axis IV: Psychosocial and Environmental Problems
1. Family problems, that is, his family does not fully approve of his sexual orientation and feels detached because of the distance between him and parents.
2. Economic problems since he is unable to cater for his own subsistence. His job is inadequate and relies on his parents to send him money, and his partner to shelter him.
3. Social problems due to sexism, racism, homophobia and his immigration status which makes him dejected and apprehensive of his partners sexual advances
Axis V: Global Assessment of Functioning-GAF
GAF score = 65
Crisis Situations:
-Physical/Medical Factors (Sexually Transmitted Infections, HIV)
– Unsafe sex
Steps to Stabilize Client:
The psychiatrist will lessen anxiety and depression and foster confidence and harmony through impartial and positive conversation. The psychiatrist will exhibit cognition of Gay Affirmative therapy as a way of building client confidence. The psychiatrist will enlighten Henry about the Gay and Lesbian community and offer reasoning and reassurance to the patient. The clinician will educate Henry that homosexuality is normal and is nothing to be afraid of. This will involve some psycho-education regarding sexual identity. Psychological treatment will not dwell much on the interpretation of the symptom but on bringing relief.
Referrals:
Psychiatrist for evaluation for depression and anxiety
Joining The South Bay Lesbian, Gay, Bisexual and Transgender Community Organization to build a support network where he can share his experiences.
Television Recommendations: Skin Deep, Modern Family, The New Normal and Gay Voices News. These will help shape his opinion on the gay and lesbian community.
Theoretical Orientation:
In facilitating Henry, I would consider a raft of approaches in assisting him deal with his erection and homophobic problems. I would assist him establish a broad “Gay Anonymous” network so as to give him a platform to share about the challenges he encounters with like oriented, understanding individuals. Our discussion would also explore the validity of his gayness and assist him feel accepted and wanted by not only his partner but also everyone around him. The correlation between thoughts, attitude and acts will also be at the centre of our session. I am convinced that it would be imperative for Henry to identify a possible cause for his withdrawal behavior and to implement the therapeutic measures as detailed out by his physician.
While Henry may have already accepted that he is gay, he may still not have come to terms with bullying in his childhood days because of his race his race and lack of masculinity. Because his condition manifests without intrinsic physical signs, it may be extremely difficult to accurately diagnose and treat his condition. Occasionally, physical conditions plays a part, among them include pain during intercourse, little sensation in the genitals and underdeveloped sexual organs. Key to Henry overcoming his problem is his parent’s unconditional acceptance of his sexual orientation.

Problems, Goals & Interventions:
Problem #1: Male erectile disorder due to depression
Goal #1: For the client to gain full understanding of his condition and help him recover.
Interventions:
1. Use of erectile dysfunction vacuum pumps to induce erection mechanically
2. Adoption of a better lifestyle for a better and sustained erection for healthy sexual life
3. Use of natural remedies for erectile dysfunction like nutritional supplements and herbs
4. Use of prescription medicine like Viagra, Cialis, Staxyn and levitra to improve erection
Goal #2: For client to be able to open up to his partner about his condition
Interventions:
1. Participate in gay and lesbian group gatherings to share experiences with other members.
2. Maintain a mutually gratifying gay relationship to avert a repeat of similar scenario.
3. Encourage the client to converse with his partner about their condition to cultivate openness and mutual understanding.
4. Identify characters in gay and lesbian community who also had similar condition.
Problem #2: Client is depressed, anxious and restless
Goal #1: Assist client overcome depression symptoms and eliminate restless behavior

Interventions:
1. Enroll in a support group for the gay and lesbian community so that he can freely disclose his woes
2. Frequently engage his parent in conversation about his sexuality and solicit their support
3. Motivate the client to open up about his feelings of depression so as to gain a deeper understanding of the probable causes
4. Evaluate the client’s mood and its intensity and duration
Goal #2: To be open and candid about his sexual orientation without fear of victimization
Interventions:
1. Lessen the severity of the anxiety of sexual intercourse encourage proper functioning
2. Identify social unions where the sexual orientation is kept secret
3. Discuss conditions of gay relationships which cause uneasiness

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