HUMAN SEXUALITY RESEARCH AND ANALYSIS

Human Sexuality Research and Analysis

Applied to the Claudia and Joseph Study

Erin A. Alexander, LPC

Capella University

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Human Sexuality Research and Analysis Applied to the Claudia and Joseph Study

Human sexuality refers to the ways in which people experience and express themselves as sexual beings (Rathus, Nevid, & Fichner-Rathus (2011). This paper will address the following questions as they apply to the case study of Claudia and Joseph: Howare the anatomy and physiology of the human female and male identified? What are the types of sexual desire and sexual arousal disorders, and how do these apply to Claudia and Joseph? How do any psychosocial contributions apply to the case? How would one analyze the biological, cultural, and psychosocial issues related to sexual behavior as it applies to Claudia and Joseph?

The female anatomy includes the external sex organs, the internal sex organs, the breasts, and the menstrual cycle. The mons veneris, “the mound of Venus”, is the fatty tissue that covers the joint of the pubic bones in front of the body, below the abdomen and above the clitoris (Rathus, et al, 2011). During puberty, this area becomes covered with hair. The mons veneris provides a cushion during the sexual act. It also has a number of nerve endings, which can produce pleasurable feelings when touched. The labia majora are the large folds of skin that run down from the mons along the sides of the vulva (Crooks & Baur, 1996). The labia minora, or inner lips, are located within the outer lips and often protrude between them. They are hairless folds of skin that join at the clitoral hood, and extend downward past the urinary and vaginal orifices. They contain sweat and oil glands, blood vessels, and nerve endings (Crooks & Baur, 1996). The clitoris includes the  external shaft and glans, and the internal crura. The word comes from the Greek word, “kleitoris”, which means hill or slope (Rathus, et al, 2011). It is the female

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counterpart of the penis. Both develop from the same embryonic tissue. The clitoris is very sensitive to sexual sensations. The vestibule refers to the area that contains the openings to the vagina and the urethra. Urine passes from the female’s body through the urethral opening, however, the other urinary organs are not related to the reproductive system. The vaginal opening lies below the urethral opening and is larger (Rathus, et al, 2011). The hymen is the fold of tissue across the vaginal opening, and is intact until the female engages in coitus. The perineum is the skin between the vaginal opening and the anus. It has many nerve endings, and stimulation of this area may heighten sexual arousal (Rathus, et al, 2011). Finally, there are structures that underlie the external organs, such as the vestibular bulbs and the Bartholin’s glands. The Bartholin’s glands secrete lubrication before orgasm (Crooks & Baur, 1996).

The internal sex organs for the human female include the vagina, the cervix, the uterus, the fallopian tubes, and the ovaries. The neck of the uterus is the cervix, and it opens to the birth canal, or vagina (Campbell & Reese, 2002). The vaginal wall has many blood vessels but not many nerve endings. The wall secretes substances that help regulate the pH levels in that area. The cervix also secretes these substances. The uterus, or womb, is the organ in which a fertilized egg implants and develops until birth. The uterus is suspended in the pelvis by ligaments, and like the vagina, it has three layers. The innermost layer is the endometrium, which sheds and some of the tissue is discharged through the vagina during menstruation (Campbell & Reese, 2002). The fallopian tubes extend from the upper end of the uterus towards the ovaries. Ova pass from the ovaries through the fallopian tubes. The two ovaries are almond-shaped organs that lie on either side of the uterus. They produce the ova, or egg cells, and the hormones that regulate the menstrual cycle (Rathus, et al, 2011).

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The breasts are considered secondary sex characteristics, which distinguish women from men.

Each breast has milk-producing mammary glands, and each gland opens at the nipple (Rathus, et al, 2011). The breasts are sensitive to stimulation.

During menstruation, eggs are expelled from the ovaries. The cyclical bleeding that occurs is called menstruation. The follicle that releases the eggs (the corpus luteum) produces large amounts of hormones. The entire menstrual cycle is governed by the hypothalamus and pituitary gland in the brain (Campbell & Reese, 2002). The changes in the menstrual cycle include changes in the uterine lining, changes in the follicles, changes in the ovarian hormones, changes in pituitary hormones, and changes in basal temperature (Rathus, et al, 2011). An egg can be fertilized during the ovulatory phase, but if it is not fertilized, the hormone levels decrease and the lining of the uterus sheds.

The male anatomy seems to be less complicated. It includes the external organs, which are the penis and scrotum; and the internal organs, which are the testes, the vas deferens, the seminal vesicles, the prostate gland, and the Cowper’s gland.  The penis, like the vagina, is the sex organ used in sexual intercourse. Unlike the vagina, the penis is a passage way for both semen and urine (Rathus, et al, 2011).

The skin of the penis is hairless and loose, allowing expansion during erection or arousal. During sexual arousal, the corpora cavernosa and corpus spongiosum become congested with blood, causing the penis to enlarge and stiffen (Rathus, et, al, 2001).  The average size ranges from 3 inches in length to 4 inches when flaccid. The average size of an erection ranges from 5 to 7

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inches. In the Western culture, the size of a man’s penis is often seen as a measure of his masculinity and his ability to please his partner (Rathus, et al, 2011). An Internet survey of 52,000 heterosexual men and women found that about 66% of the men rated their penises as average size, 22% of them rated them as large, and 12% rated their penises as small (Lever, Frederick, & Peplau, 2006).

The scrotum is a pouch of lose skin below the base of the penis. It has two compartments that hold the testes (Rathus, et, al, 2011). Each testicle is held in place by a spermatic cord, which is the structure that houses the vas deferens. The scrotal temperature tends to be about 5 degrees lower than the rest of the body so that sperm production can occur. The testes serve two purposes and are analogous to the female ovaries. They secrete sex hormones and produce germ cells. The hormones are androgen and testosterone (Rathus, et al 2011). Testosterone is the hormone that is responsible for a male’s secondary characteristics, such as facial hair, deep voice, and muscle mass.

The tube that lies against the back wall of the testicles is called the epididymis, and this is where the sperm is stored.  The small glands behind the bladder are the seminal vesicles; this organ secretes fluids that combine with the sperm during ejaculation. The prostate gland is located beneath the bladder and it is responsible for the secretion of the milky part of the seminal fluid. It also neutralizes the acidity of the vaginal wall during copulation, which helps to prolong the life of the sperm cells (Crooks & Baur, 1996). Fluid from the Cowper’s gland also helps to buffer acidity. It precedes ejaculation and usually contains sperm cells.

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An erection is caused when the penis becomes engorged with blood. It acts as a funnel for depositing the sperm into the vagina (Rathus, et al, 2011). A man can experience the loss of an erection if he feels anxious. Tactile stimulation of the penis may trigger an erection through the spinal cord, but the sexual sensations come from the brain (Rathus, et al, 2011). Ejaculation is also a spinal reflex, and generally occurs with orgasm.

The human sexual response can be divided in to four phases: excitement, plateau, orgasm, and resolution (Campbell & Reese, 2002). During sexual intercourse, or coitus, vasocongestion occurs in the clitoris and the erect penis. There may also be enlargement of the testes, labia, and breasts. This phase is where the penis and vagina are prepared for intercourse. In the plateau phase, breathing increases and the heart rate rises as an involuntary response to the stimulation of the autonomic nervous system. The vagina continues to expand. Orgasm is when there are rhythmic and involuntary contractions of the reproductive organs in both the male and female. There is an expulsion of the semen in to the vagina. The orgasm is the shortest phase, lasting just a few seconds (Campbell & Reese, 2002). The resolution phase completes the cycle and reverses the responses back to normal, which includes the loss of the erection and muscle relaxation.

The case of Claudia and Joseph talks about a seemingly ordinary couple in their mid-thirties. They have been married for 5 years. Joseph is having problems with getting past the excitement phase of sex. Claudia is unsatisfied and frustrated. Upon review of their sexual histories, it is discovered that Claudia grew up in a family that was very open about sexual matters. Joseph was raised in a family that rarely expressed affection. Sexual issues were not discussed in the home, so his first sexual experience resulted in his feelings of shame and embarrassment.

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Male sex hormones are known to influence the sex drive and sexual response. James Barbaree and Ray Blanchard reviewed ethical considerations regarding the practice of chemical castration for sex offenders in 2008. They discovered that men who are chemically usually exhibit a gradual decrease in the incidence of sexual fantasies and loss of desire. Men also gradually lost the capacity to get an erection and ejaculate. In the case Claudia and Joseph, it is possible that he may have some issues with low hormone levels, however, based on the sexual history, Joseph’s problem sounds more psychosocial and psychological, not biological.

According to the article, Claudia and Joseph had a whirlwind courtship and married quickly. They did not talk about sexual roles or expectations before they married. There was not time during the dating period for “small talk”, which is a useful way for a couple to find a common ground (Rathus, et al, 2011). Small talk enables people to find similar attitudes and interests. Self-disclosure is essential to building a healthy relationship. This type of communication, or intimacy is a key ingredient to enhancing the passion in a relationship. In Sternberg’s triangular theory of love, intimacy is listed as one of the basic components of romantic love (Sternberg, 2004).  During intimacy, the couple would have the opportunity to discuss sexual roles, expectations, and cultural issues; Claudia was raised in a liberal New York community, while Joseph was raised in a traditional Latin Roman Catholic family.

In reading the article, it was also noted that Claudia has continued to verbalize her frustration and disappointment regarding their sex life. Although she is engaging in communication, her comments seem to be negative in nature. Perhaps, it may be more beneficial if she were to approach her husband with word of affirmation, such as verbal compliments, encouraging words,

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and respectful words. He needs to be able to express himself without feeling punished. She could also encourage Joseph to spend more time being affectionate with her in ways that do not lead to sexual intercourse. She can also tell him what she likes in the bedroom, versus what she does not like.

There are 4 types of sexual dysfunction: sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorder (Rathus, et al, 2011). Joseph seems to be suffering from sexual desire disorder; he is displaying a lack of interest in sex. Since Claudia has a higher sex drive, the couple may have to compromise. They can also participate in couples counseling to resolve issues within the relationship. Consulting a professional may also help them both to communicate more openly about sex.

References

Campbell, N. A. & Reece, J. B. (2002). Biology. San Francisco, CA: Pearson Education, Inc.

Crooks, R. & Baur, K. (1996). Our sexuality. Pacific Grove, CA: Brooks/Cole Publishing.

Lever, J., Frederick, D. A., & Peplau, L. A. (2006). Does size matter? Men’s and women’s views

on penis size across the life span. Psychology of Men and Masculinity, 7(3), 129-143. Retrieved from http://psycnet.apa.org/journals/men/7/3/129/

Rathus, S. A., Nevid, J. S., & Fichner-Rathus, L. (2011). Human sexuality in a world of diversity.

Boston, MA: Allyn & Bacon.

Sternberg, R. J. (2004). A triangular theory of love. London: Taylor & Francis.

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Coordination of Care

Here is information I received from Cigna. Many insurance companies are encouraging Coordination of Care, which in my opinion is a more holistic and integrative approach to patient care.

We understand the complex relationship between the emotional and physical factors related to behavioral health, as psychiatric symptoms may be present that complicate medical illnesses.

Alternatively, medical illnesses may also be identified via psychiatric symptoms. That’s why clear communication must exist among a patient’s treating practitioners and primary care physician (PCP). This coordination of care between behavioral health and general medical care is imperative to a patient’s effective treatment.

We recommend that the following steps be taken at the beginning of treatment to help ensure you have access to the clinical information you need to thoroughly assess the patient’s condition:

• Have the patient sign a “Release of Information” form.
• Collect all information from the patient’s PCP and other practitioners who provide care to the patient.

With this consent, the appropriate clinical information can be exchanged directly with the PCP throughout the patient’s treatment, while facilities can notify the PCP upon admission and discharge. Communication with the PCP should occur:

• After the initial assessment, and should include diagnosis, medication, initial treatment plan, and any recommended or ordered diagnostic tests.
• When the patient does not comply with treatment recommendations.
• When patient’s level of care or condition has significantly changed.
• When behavioral treatment has been completed.

All communication with the PCP and other practitioners should be documented and presented to CIGNA Care Managers as clinical updates are needed.

Please note that compliance with coordinating behavioral care is monitored through care management and medical record reviews.

Additional Information

For more information on Coordination of Care, please access the Medical Management Program (Section 5, Pages 29-30).

We also provide clinical screening tools as a resource to aid in the coordination of care with PCPs. These documents, including consent forms and a sample of structured communications, can be found in Appendix G of the Medical Management Program.

We Want To Hear From You
If you have topics you'd like to see addressed here please let us know. Contact us at behprep@cigna.com and we'll dig into them. We want this brief to be as informative and insightful as possible and to address topics important to our practitioner community.

20 Ways to Tell Someone "No" - By Ramona Creel

This was one of the best articles I have read in a long time! I tell people all the time that saying "NO" is so relieving. Once you get in to the practice, the guilt eventually disappears because you begin believing that YOU are important enough to set boundaries for yourself. Follow along! I welcome discussion!

Tell me if this sounds familiar -- someone asks you to do  something that you really don't want to do or you honestly don't have time for.  It might be a church bake sale, a school fundraiser, participating on a  committee, or even just working late. But you feel like you will let the other  person down if you say no. You feel GUILTY already, and you haven't even  responded yet! So you say, "Sure," even though doing so is going to  put you under tremendous stress and PRESSURE. You know that you will probably  end up resenting this activity, and maybe even ducking some of your  responsibilities because your heart's just not in it, but you go ahead and  agree anyway.

Why are we so afraid to tell people "no"? For some  reason, we have been taught that "no" is DISRESPECTFUL -- and even  insulting. We seem to value other people's time more than our own -- feeling  that we need to bend over backward to accommodate others, even if it  inconveniences us. I know we're atoning for the "me" 1980's, but  let's be reasonable! "No" is actually one of the healthiest words  that can come out of your mouth. When you tell someone "no," you are  really saying that you understand and accept your own LIMITS, and don't want to  do a shoddy job by overwhelming yourself. That you value your time and  priorities and aren't willing to take away from the truly important things in  your life. A little selfishness is necessary, if you want to maintain a  balanced and sane life!

So how do you say "no" without insulting the other  person, feeling consumed with guilt, or hurting your own credibility? We need  to find a way to say "no" without dragging up all of those HIDDEN  FEARS -- they'll think I'm lazy or selfish, that I have no career drive, that  I'm not ambitious, that I have no concern for other people. And it's time to  give up all of those roles you're so proud of -- supermom, martyr, hero -- but  are keeping you from finding true peace. Once you've accepted that you have the  right (and often responsibility) to turn someone down, you can do it in a way  that doesn't seem like a REJECTION. Let me show you how:

1. "I CAN'T  RIGHT NOW, BUT I CAN DO IT LATER"
If you really want to help the person but don't have time  now, tell them so. Offer a later time or date -- if they can't wait for you  they will find someone else.

2. "I'M REALLY  NOT THE MOST QUALIFIED PERSON FOR THE JOB"
If you don't feel that you have adequate skills to take on a  task, that's okay. It's better to admit your limitations up front than feel  overwhelmed down the road.

3. "I JUST DON'T  HAVE ANY ROOM IN MY CALENDAR RIGHT NOW"
Be honest if your schedule is filled -- and  "filled" doesn't have to mean really FILLED! It just means you have  scheduled as much as you are willing and you're stopping.

4. "I CAN'T, BUT  LET ME GIVE YOU THE NAME OF SOMEONE WHO CAN"
If you aren't available to help out, offer another qualified  resource. Professionals do this all the time when they refer a client to a  colleague.

5. "I HAVE  ANOTHER COMMITMENT"
And it doesn't matter what that commitment is. It could be a  meeting or a dentist appointment or a day in the park with your kid. The point  is, you aren't available.

6. "I'M IN THE  MIDDLE OF SEVERAL PROJECTS AND CAN'T SPARE THE TIME"
Let people know when you have already accepted other  responsibilities -- no one is going to fault you for having already filled your  plate.

7. "I'VE HAD A  FEW THINGS COME UP AND I NEED TO DEAL WITH THOSE FIRST"
Unexpected things happen that throw your schedule off -- it  happens. So accept that you may need to make a few adjustments until your life  stabilizes again.

8. "I WOULD  RATHER DECLINE THAN END UP DOING A MEDIOCRE JOB"
Knowing that you aren't able to deliver a quality product --  for whatever reason -- is reason enough for turning a request down.

9. "I'M REALLY  FOCUSING MORE ON MY PERSONAL AND FAMILY LIFE RIGHT NOW"
People act ashamed of wanting to spend time with their  families -- like it means they don't have goals. Having a strong family is a  goal in and of itself!

10. "I'M REALLY  FOCUSING MORE ON MY CAREER RIGHT NOW"
The reverse is true also -- you may have to give up some  civic or community duties to focus your energies on a work-related task (and  that's fine, too!)

11. "I REALLY  DON'T ENJOY THAT KIND OF WORK"
Who said you were supposed to enjoy your chores and  assignments?! Well, if you don't enjoy them, why do them? Life isn't about  drudgery and boredom.

12. "I CAN'T,  BUT I'M HAPPY TO HELP OUT WITH ANOTHER TASK"
If someone asks you to do something you really despise,  refuse -- but then offer to help with something you find more enjoyable or  stimulating.

13. "I'VE  LEARNED IN THE PAST THAT THIS REALLY ISN'T MY STRONG SUIT"
Another way of admitting your limitations. Did you know that  actually makes you stronger? Knowing what you can handle and what you can't is  a tremendous talent!

14. "I'M SURE  YOU WILL DO A WONDERFUL JOB ON YOUR OWN"
Many times, people ask for help because they doubt their own  abilities. Let the other person know that you have confidence that they will  succeed.

15. "I DON'T  HAVE ANY EXPERIENCE WITH THAT, SO I CAN'T HELP YOU"
Volunteering to help out shouldn't mean that you have to  learn an entirely new set of skills. Offer to help out with something you  already know how to do.

16. "I'M NOT  COMFORTABLE WITH THAT"
You might be uncomfortable with the people involved, the  type of work, the moral implications -- this is a very respectful way to avoid  a sticky situation.

17. "I HATE TO  SPLIT MY ATTENTION AMONG TOO MANY PROJECTS"
Let people know that you want to do a good job for them --  but that you can't when your focus is too divided or splintered.

18. "I'M  COMMITTED TO LEAVING SOME TIME FOR MYSELF IN MY SCHEDULE"
Selfish, selfish, selfish! But in a good way! Treat your  personal time like any other appointment -- block it off in your calendar and  guard it with your life!

19. "I'M NOT  TAKING ON ANY NEW PROJECTS RIGHT NOW"
You aren't saying that you will never help out again -- just  that you feel your schedule is as full as you would like right now.

20. "NO"
Sometimes it's okay just to say no! Just make sure  that you say it in a way that expresses respect and courtesy -- that leaves the  door open for good relations. (THIS ONE IS MY FAVORITE)
                             
  About the Author:

Ramona  Creel is Professional Organizer, NAPO Golden Circle Member, and the original  founder of OnlineOrganizing. A former Social Worker, she has always enjoyed  helping people find the resources and solutions they need to improve their  lives. Ramona now travels the country as a full-time RVer, sharing her story of  simplicity with everyone she meets. She leads by example -- having worked for  more than 10 years as a Professional Organizer, and having radically downsized  and simplified her own life as a full-time RVer.

Ramona  now considers herself a "Renaissance Woman" -- bringing all of her  passions together into one satisfying career. As both a virtual and traveling  organizer, she can create a customized organizing plan for your home or office,  put on a workshop, or educate you through one of her popular teleseminars. As a  simplicity coach, Ramona provides a proven program for making every area of  your life a little bit easier -- perfect for those who want to make the time  and space to focus on their true priorities. As a Professional Photographer,  Ramona captures powerful images of places and people as she travels. And as a  freelance writer and blogger, she shares organizing techniques, social  commentary, travel tips, and film reviews with others.

Upcoming Life Skills Classes!

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August 13^th& August 20^th, 2011

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Agenda                                                                                                     

Life Skills Education for Adolescents ages 13-16

August sessions:

      Self-Esteem: Gaining self-confidence and self-acceptance with positive reinforcement.

      Social Skills: Greater self-esteem leads to improved social skills and social acceptance.                          

Future Sessions:

      Anger Management: Learning to understand anger and using healthy ways to control anger.

Instructors

Carolina Garcia                            Licensed Professional Counselor Intern

Name: Melynda Hudson                                   Licensed Professional Counselor Intern

Name: Erin A. Alexander                                   Licensed Professional Counselor

Registration and Other Information

Go to https://brighterfuturee-counseling.com to complete the intake form. Be sure to provide an email address. Each class is $50.00 and lasts for 1.5 hours. The class must be paid for 24 hours before the class starts. To receive a certificate of completion for the  90-min course, you must have your balance paid and you must be present for the entire class. Please make all payments online at the above site. Brighter Future E-Counseling is a state approved Continuing Education Provider.

Therapy Documentation

SAMPLE

Client Name: Vera Hylee Motivated DOB: 9/22/1982 Session Date:  7/25/20xx  Time:  1600-1700

Client Description:

Manner of dress, physical appearance, illnesses, disabilities, energy level, general self-presentation. 

Dressed in professional attire. Appeared fatigued, dark circles under eyes.

Subjective Complaint:

Presenting problem(s) or issue(s) from the client’s point of view.  What the client says about causes, duration, and seriousness of issue(s).  If the client has more than one concern, rank them based on client’s perception of their importance.

Depression for about 2 months, after she moved from her home town. Adjustment to a new job. She has noticed that she no longer has a social life, and is tending to isolate herself. She has not engaged in any of her usual hobbies since she moved to Texas from Minnesota.

Objective Findings:

Counselor’s observation of the client’s behavior during the session.  Verbal and nonverbal, including eye contact, voice tone and volume, body posture.  Especially note any changes and when they occur (such as a client who becomes restless in discussing a topic or whose face turns red under certain circumstances).  Note discrepancies in behavior. Mental Status Exam.

Client was alert and oriented x3. She was interactive, good eye contact. Soft voice. Her overall mood was mildly depressed, affect was constricted. She denied any thoughts of harm to herself or others. She appeard to have good insight and was receptive to feedback.

Assessment of Progress:

Counselor’s view of the client, beyond what the client said or did.  Continual evaluation of client in terms of emotions, cognitions, and behavior.  Identification of themes and patterns in what client says and does.  Use of developmental (Erikson, social learning theory) or mental health models (DSM-IV).  Include your hypotheses, interpretations, and conceptualization of client.

Client verbally acknowledged what was missing in her life and she talked about the current life situation which contributes to her unhappiness. She moved to the area 4 months ago and left her family/friends behind. She has not developed a social support system. She is learning her new job description with no difficulties and does enjoy her work.

Plans for Next Session:

 Plans for client, not for the counselor.  Short and long-term goals.  How you want to interact with client; what you may plan to respond to in next session with client (follow-up on family issues discussed).  Do you plan to help client focus on thoughts, feelings, or behaviors?  What particular strategy or theoretical approach might you use?  What do you base your plan on? What reading or research do you need to do in preparation?  Practice?  What help do you need from your supervisor?

Urge client to formulate a plan that leads to taking action. Encourage her to initiate and respond to at least one social interaction per week. Recommended that she go online to investigate the San Antonio Adventure Club. Recommended that she obtain a weekly copy of the San Antonio Current. Will assist client in solution-focused interventions.  AXIS I: Adjsutment Disorder with depression, 309.0, AXIS II: V71.09, AXIS III: None, AXIS IV: primary support group, social, employment, AXIS V: 63. Next appointment 8/15/20xx at 1600.

Signature, printed name, and credentials of therapist

 

                               

Remember these things when you write notes:

• Always make sure that the name of the client and the date of the session are on each note.

• Always sign and date the notes.

• Try not to be too wordy. Be as concise as possible, but include relevant information.

• Explain to client (if he/she is not aware) that you will be taking brief notes during the session to help focus on the treatment plan goals and progress.

• Try to make sure that notes are written as close to the time of the session as possible. End the session before the end of the hour (5- 10 min) so that you can write your note.

• Include a diagnostic code from the DSM-IV as well as the GAF score.

• Note any of the following symptoms: anxious, aggitated, angry, bitter, bored, confused, delusional, detached, fearful, forgetful, frustrated, grandiose, hostile, impulsive, irritalbe, irrational, manipulative, paranoid, tearful, withdrawn, tense.

• If there is any suicidal or homicidal ideation, ask about any intentions or plans. Be sure to have a safety plan if needed.

• Other issues to note: Abuse, Academic, Adjustment, Anxiety, Conduct, Defiance, Depression, Domestic Violence, Family Conflict, Grief/Loss, Limits, Mania, OCD, Parenting, Phobias, PTSD, Self-esteem, Self-harm, Sleep, Relationships, Thinking Errors.

• Write down the therapeutic interventions/techniques used in the session: Cognitive-Behavioral, Insight-Oriented, Behavior Modification, Play Therapy, RET, Clarification, Provided Emotional Support, Solution-Focused, Problem-Solving, Parenting,  Role Play, Self-disclosure, Reassurance.

• Notate the client's response to interventions

• Write down any referrals and/or assignments

Erin A. Alexander, LPC-S

Upcoming information on: More on Note-writing and Documentation, Treatment Planning, Interventions, Mental Status Exams, Interviewing techniques, Diagnosing (use of the DSM-IV).

To all Interns: How to Develop Rapport With Clients

Greetings:

We need to start working on ways to develop rapport with clients. This is essential in this line of work.

When people come to counseling, they are either in some level of crisis and/or emotionally vulnerable. Even if they have been to counseling in the past, when they meet with you, there is a certain level of apprehension. They want for you to reassure them. They want to talk to a "real" person.

Do what is necessary to make the client feel comfortable. Use self-disclosure activities during the session, and offer to respond to some of the self-disclosure questions yourself. The clients are not too concerned about the academics behind counseling. They just want help during the crisis period. It will be on your shoulders to find ways to develop rapport.

Here are some pointers that I have found useful over the years:

1). Dress comfortably, not like a parole officer. Casual dress tends to help the client see you as a person (less intimidating).

2). Smile. Smile. Smile!

3). Do not get too caught up in the theoretical and counseling approaches. You need to be where the client is at the time of each visit. That shows empathy and it shows that you are capable of flexibility.

4). Be willing to share things about YOU when appropriate. The client will trust you more, and you will be modeling the self-disclosure behavior.

5). Use a lot of humor (as much as you can, but of course use humor when appropriate).

6). You CAN touch clients. There are times when gently touching a child's head is comforting. There are times when a child may hug you. Adults may also initiate touch. Use good judgment and make sure that whatever you do, it is ethical and in the best interest of the client. Think about the cultural issues with regards to touch.

7). Help the client to see you as a human being, but balance this with being an expert in your field. Be yourself. Be willing to change your approach to make the client more comfortable and receptive.

I hope this has been helpful. I have informed my clients that you will on occassion be in sessions with me to observe. 
Ms. Erin

Why Do Men Cheat?

Approximately 40% of men seek sexual satisfaction outside their relationships, estimates Kat Hertlein, Ph.D., professor of human development at the University of Nevada - Las Vegas and a marriage and family therapist.

That number hasn’t changed much since 1950, when the famous Kinsey sex study found that 50% of U.S. men cheat at some point in their marriages.

Why They Cheat

The No.1 reason: Men crave sexual “variety,” according to David Buss, professor of psychology at the University of Texas and author of The Evolution of Desire: Strategies of Human Mating (BasicBooks).
“They’ve evolved the desire to be with different women,” he says.

That’s because it’s very simple for men to reproduce (one act of sex versus nine months of pregnancy for women), so to create as many offspring as possible they’re biologically programmed to mate with many women.

“The ‘payoff’ in reproductive currencies [kids] of a short-term mating strategy generally has been higher for men than women,” Buss says.

So after thousands of generations, “this has forged in the male brain a desire for sexual variety.”

Other top reasons men cheat? They’re unhappy with their mates - and extramarital sex is cheaper and easier to get these days, Buss says.

And "power wives" beware: Being married to a high-profile guy ups the odds he’ll wander.

“Women are attracted to men who have power and status, so public figures usually have plenty of opportunity,” Buss says.

Whether your guy is a political animal, an A-list celeb or just a cubicle-mate, his motivation to cheat is the same, according to one relationship expert.

“Ninety-nine percent of the time, there’s a simple reason why: boredom,” says Steve Santagati, author of The Manual: A True Bad Boy Explains How Men Think, Date and Mate – and What Women Can Do to Come Out on Top (Crown).

Whatever the reasons, cheaters give monogamous men (the majority) a bad name.

Why They Say They Cheat

Here are 9 excuses guys give for doing the extramarital mambo:

1. She ain’t what she used to be.

Like Adam, the typical man can’t resist the temptation of riper fruit, especially if the woman in his life has let herself go.

“If she got lazy or gained weight or just doesn’t take care of herself, a guy will start looking at other women,” Santagati says.

Women who want to keep their men on a short leash need to take a “good, hard look in the mirror,” he adds.

And men should do the same. He might be a complete slob and still be demanding perfection from her. “It’s the typical double standard.”

For their part, guys should also make an effort to rediscover the spark at home.

“Make her feel pretty, even if you’re lying,” he advises. “Tell her how beautiful she is and how much you appreciate it. It will make her feel sexy and she’ll want to make you happy.”

That attention can lead to a more satisfying sex life, agrees Sue Johnson, a professor of clinical psychology at the University of Ottawa and author of Hold Me Tight: Seven Conversations for a Lifetime of Love (Little Brown and Company).

“All the evidence shows that when [women] feel safe and connected, you’re better at taking care of your partner.”

2. No one loves a ball buster.

Perhaps nothing will drive a married man into the arms of another woman faster than a nagging wife.

“She’s like a mosquito,” Santagati says. “He doesn’t want to have sex with her; he wants to [swat her away].”

The more viable option: hot sex with a more “understanding” woman.

Hogwash, says Steven Solomon, Ph.D., author of Intimacy After Infidelity: How to Rebuild & Affair-Proof Your Marriage (New Harbinger).

“[A woman] didn't do something that excuses cheating." Whatever the relationship dynamic, it’s not that healthy to begin with if it leads to infidelity, Solomon says.

3. She just doesn’t “get” me.

Men who cheat say they don’t feel understood by their mate. But it’s not always the woman. Mostly they’re either angry or afraid to connect.

“It’s easier for men to go outside the relationship than work it out with their partner,” says UNLV’s Hertlein. “We see this ‘triangulation’ a lot.”

A deep-seated fear of intimacy can be hard for some guys to overcome. And they’re more likely to cheat again, especially if they don’t go to couples therapy, Hertlein says.

4. It’s the thrill.

Most guys who have affairs are getting in touch with their inner caveman: They like to play with fire. “It adds a level of danger,” Santagati says, “and danger adds to the excitement.”

By keeping surprise and sizzle in your sex life, a woman can keep the home fires burning so hot that her man won’t have any reason to cheat.

But that's not the whole story. Solomon says men also cheat because of fear, loneliness or anger.

“The betraying partner's failure to deal with these feelings is what causes him to be unfaithful," he says.

5. Blame it on the “hunter.”

Often, married men who cheat can’t quite explain their motivation. They just find themselves compelled to bust out of their day-to-day routine in search of something new. It’s a primitive instinct that dates back to their role as hunter and gatherer – only this time, they’re hunting and gathering new women.

“Maybe he married too young,” Santagati says, “or he just feels as if he hasn’t seen everything.”

Women can protect themselves by getting wise to this behavior early in the relationship – and getting out.

Santagati suggests you can find out more about a man’s dating history by watching how he acts in a room full of gorgeous women.

If you can’t rein him in when your romance is new, you’ll never control him down the road when your life together is more settled. “The first three months are critical,” he says.

6. Biology, baby.

“It’s our biological nature to be with as many females as possible,” Santagati says.

“Once we’ve seen a woman naked several times, it becomes commonplace. It doesn’t matter if you’re Jessica Alba or Sienna Miller, we become accustomed to your body and want to experience something different – different lips, different body types. We’re only monogamous because we realize that love and friendship are more important than getting laid.”

But Juliet Williams, associate professor of women’s studies at UCLA disagrees. “No matter how stunningly high the number of male cheaters, we know it’s not biological,” she says. “There are still a higher percentage of men who are monogamous.”

Whether it’s evolution, biology or simple novelty, infidelity researchers agree that men do seek different sex partners. However, the decision whether to cheat is entirely in a man’s control.

“Most men don’t act on those desires because they don’t want to jeopardize social reputations or marriages,” says University of Texas’ Buss.

“Former President Jimmy Carter, for example, told an interviewer that he had ‘lust in his heart’ but as far as we knew, he never acted on it,” he says.

7. It’s just sex.

For most guys, sex and love are two entirely different things.

“We really believe, ‘I can still love my wife and want to have sex with other women.’ We separate it in our brains,” Santagati says.

That rationale allows guys to cheat guilt-free, with one notable exception:

“Any guilt that a man has after sex isn’t about the sex itself, it’s about the consequences,” Santagati says. “Will she be a stalker? Will my wife find out?

"If a guy is in a committed, monogamous relationship, he should ask himself one question before he cheats: Is it worth it? He should consider the worst-case scenario, meaning that his wife finds out and is now brokenhearted. Is it worth it?”

8. Not tonight, dear.

Let’s face it. Men want more sex than women.

So when their partner is tired from wrangling kids all day and unwilling to try new things, even the most loyal hubbies get bored and go looking for nookie.

More sexually permissive men who don’t have equally adventurous partners are also more apt to wander, says UNLV’s Hertlein.

Their sexual values are just not compatible.

9. Because we can.

OK, we’re guys, remember? It’s hard to resist temptation, especially when it’s at our fingertips.

Thanks to the Internet, it’s easier for men to cheat anytime, anywhere… while they’re watching TV or on the laptop in bed next to their sleeping wives.

“We’re not talking about penis and vaginas,” Hertlein says. “Cheating is defined as anything that breaches a relationship contract.”

“That includes “sexy communication and flirting that’s kept secret from your partner.”

Forgive and Forget?

Whether your man is having sex online or in a hotel room, should you take him back?

“We think of people who betray us as cads, bad people, immature,” Solomon says. “But most are normal folks who get lost in not taking care of themselves and their marriage.”

And if you forgive and forget, could he cheat again?

Despite guys’ excuses, the decision to cheat or stay faithful isn’t something women can control.

“Even if you’re the worse spouse on Earth, your partner can find better ways to deal with his unhappiness,” Solomon says. “You can't make someone cheat any more than you can make someone drink or abuse you.”

http://www.lifescript.com/life/relationships/wreckage/6_reasons_why_men_cheat.aspx