Sexual Disorders: Perspectives on Diagnosis and Treatment, Case Study Example

The interviewed patient’s name is changed for the sake of anonymity, and further on, the interviewee will be addressed as Julia.  Julia is 29 years old coming from mixed Ethno-cultural family of Slavic and American origin, born January 5^th 1986. The interview was conducted February 17^th 2015. The approximate time of the interview was 50 minutes. At first, Julia was not comfortable talking about the primary subject of our interview. After the suggested tea and a few words about the general expectations from this interview, that it was anonymous and aimed at talking and giving an advice if Julia wanted one, she relaxed and the conversation flew freely.

Julia said that, in fact, she was not sure whether she had any sexual concerns. She was in a stable relationship. She has been together with her young man for more than ten months. Their sexual life was regular, having 3-4 intercourses a week, depending on her menstrual cycle, which was within the norm of 29-30 days. However, her initial unease with the subject suggested that there was something she was uncomfortable about. When I first mentioned that, she said that she is not sure that she is sexually satisfied in bed. In this regard, she stated that she had orgasms before,but they were self-induced or when she was demonstrating to be more dominant in sexual intercourse. She argued that sex with her partner was bringing her pleasure, but not full satisfaction. When she was asked whether this occurred before, or it was just with this partner. She said that complete sexual satisfaction was never fully achieved with any of her partners. On various occasions, she could be satisfied but it would happen only, if she dominated her partner. She thought that it was normal because her sexual drive started quite late when she was twenty-two, and she was still in the process of exploring herself and sexual aspect of her life. Consequently, in terms of history of the complaint, it can be argued that Julia had this problem through the entire history of her sexual life, meaning the last seven years.

Regarding psychiatric and therapy history, Julia was amused by this question. She said that she was coming from the Slavic culture and that she did not believe in such things as physiatrists or taking anti-depressants. She was convinced that only weak people get depressed, while strong personalities simply endure difficulties and carry on with their lives. Therefore, she has never been under psychiatric observation or received medical treatment of any psychological disorders, like depression. Consequently, regarding substances use and abuse history, she said that she never took anti-depressants or was prescribed for any long-term medications. The only pills she would take light painkillers, cold and flu medications and calming pills. When she was asked why she was taking calming pills and of what nature, Julia said that she found it difficult to relax sometimes and that these pills helped her to fall asleep. She avoided taking anything hormonal, so these pills were exceptionally herbal. Regarding other substances, Julia was a casual alcohol drinker and could occasionally v(a few cigarettes once in 3-4 months). She said that both drinking and smoking relax her, but none of it is habitual.

In terms of her medical history, she had a history of long-termed history of polycystosis of both ovaries conditioned by metabolic disorder, particularly a high level of testosterone production. When she was asked what the cause of her illness was, she said that life can be quite difficult for a teenage girl to accept and survive. She had a lot of stress and obstacles to overcome. At present, the condition of her ovaries is satisfactory without any traces of polycystosis. Julia said that the treatment combined contraceptive pills that regulated her hormonal balance and menstruating cycle and low-testosterone diet.

In terms of social history, Julia works as a university tutor; she has diverse friends from different stages of her life. She is in a good relationship with her parents and younger brother. Reluctantly she admitted that relations with her father were not always that good. She did not want to elaborate, but said that she thinks she is stronger than him in many ways. Regarding her sexual history, in terms of dating pattern, this current relationship is the longest. She did not date men longer than three months. She did not have one-night stand experience because before becoming intimate with a man she needs to get to know him.  Most of her sexual partners before the current one were a few years younger than her. Regarding other relevant matters, she has no history of legal convictions or any violations. She has not been under any clinical observations or monitoring of her mental status.

Analyzing her case in the context of multi-axial diagnosis, the following considerations can be outlined. In terms of the first axis of clinical disorders, it can be argued that she has no clinical disorders, although she might have experienced depression, at present there are no signs that she is suffering from it (Woo and Keatinge, 2008). Regarding the second axis of personality disorder, it can be stated she does not have any significant pathologies in this dimensions. However, her reluctance to talk about her previous relationship with her father suggests that the conflict existed. It might have been something like family violence or failure of the father to protect her as a child that is why he lost her trust. In this regard, her initial experience and projection of father faults on all men create the source of mistrust and the necessity of control everything in her life (Fagan, 2004). In this regard, it is not classic obsessive-compulsive disorder, because she not driven by controlling small things or practices, it is more the matter of conscious control over the course of her life rather than necessity of doing the same things right (Kaplan, 2013). Thus, the source of her inability to relax and reach the orgasm is in her childhood psychological trauma of whichever nature it was. Regarding the third axis of her medical and physical conditions, her polycystosis might have been stimulating her desire to dominate and self-reliance due to the high level of testosterone (Fagan, 2004). However, since this condition was treated, and her ovaries function effectively, it is no longer a contributing factor to her current problem. Regarding the fourth axis of contributing environmental or psychosocial factors, she had no tremendous stressors in her life recently. On the contrary, the academic nature of her work is an ideal relaxing environment for her (Kaplan, 2013). In terms of the fifth axis of the global assessment of functioning, she would gain around 90, because she is perfectly in charge of her life and she functions very well, except for complete sexual satisfaction (Seligman, 2012).

In terms of conclusions and recommendations, Julia is advised to look at her problem from the perspective of her trust issues with her father. In this regard, except for being advised to visit a psychiatrist and follow a course of therapy, she was suggested to talk to her partner and explain the existing issues (Fagan, 2004). In this regard, she would need to explain it from her perspective and her inability to relate and trust someone entirely. Another advice for her was to analyze whether she wanted this relationship to continue and whether she was committed to them. In the context of her previous sexual relations and the age of her partners, it becomes obvious that she is afraid to commit and build a long-term relationship with a chosen man (Kaplan, 2013). In this regard, she needs to face her fears and overcome them, that is why she needs to see a psychiatrist in order to have a guided process of psychological recovery from her teenage experiences and difficulties (Seligman, 2012).

Summary

In terms of my performance in this interview, I managed to be successful in approaching the interviewee in a friendly, casual manner, which made the nature of the entire interview more easy-going and like chat between friends rather than doctor’s intervention. I think that in matters like this, friendly approach is more effective. On the other hand, one of the things that could be improved is the way of beginning conversation. It was awkward at first, so I decided to offer a hot beverage in order to easy the atmosphere. I think that a certain ice-breaker is crucial for the client’s story to flow in natural manner. However, the ice-breaker depends on the client and his/her personality; thus, studying of various techniques of communication with patients would be beneficial.

The new experience for me in this interview was that people can realize that something is not right in their life although they are managing quite well. It is also surprising how people can live with all these problems and manage to justify them as normal occurrences. On the other hand, the most challenging part of the interview was in trying to ask questions about Julia’s aspects of life that made her uneasy and emotional, like questions about her father and reason for her survival approach to life. The realization of the fact that this woman has been through a lot and has achieved success in her life is inspiring and reassuring in terms of her treatment, meaning that she will be able to overcome her present psychological problem with the additional help of a specialist.

This experience taught me that it was very easy to get too close to your interviewee and begin treating him/her as a friend. I think, eventually, it might become counter-productive in the course of treatment. Another essential aspect of this experience is that I realized that I could treat problems of other people, particularly such intimate like sexual concerns in a very neutral and professional manner, and I think it is a step forward in this studying.

References

Fagan, P. J. 2004. Sexual Disorders: Perspectives on Diagnosis and Treatment. Baltimore, MD: The Johns Hopkins University Press.

Kaplan, H.S. 2013.Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation. Oxon, OX: Routledge.

Seligman, L. 2012. Diagnosis and Treatment Planning in Counselling. New York, NY: Springer Science.

Woo, S. &Keatinge. 2008. Diagnosis and Treatment of Mental Disorders Across the Lifespan. Hoboken, NJ: John Wiley & Sons.