Appendix A:Sexual Dysfunction: History-Taking for Sexual Distress, Adapted from Masters & Johnson Institute©

Linda Weiner, MSW, and Constance Avery-Clark, PhD

I.Purpose of Taking the History

A.To establish diagnosis

B.To assess contributing and maintenance factors

C.To assess who these partners are as individuals (style of thinking, biases, etc.)

D.To tease out relationship strengths and weaknesses

E.To determine views of therapy; therapist

F.To plan appropriate intervention

II.Format

A.Introductory remarks and review of procedures

1.History-taking on partners and their relationship

2.Psychological testing (as needed to diagnose Attention Deficit Hyperactivity Disorder, depression, etc.)

3.Physical exams and laboratory work (as needed)

4.Roundtable or sharing perceptions of problem/treatment plan

5.Daily suggestions; processing

B.Red flagging, or limited confidentiality

C.Presenting problem and the client’s perception of it

1.Detail of the problem

2.Onset and duration

3.Manifestations (variability, consistency, trends)

4.Coping strategies

5.Feelings associated with the problems

6.Attribution

7.Impact of problem on relationship and individuals

8.Attempts at remedy; effects, level of success

9.Reason for entering therapy at this time

10.Client and partner’s commitment to therapy

11.Therapy goals

D.Present relationship

E.Development of present relationship

1.Meeting

2.Attraction

3.Evolution of relationship

F.Family of origin/childhood

1.Atmosphere

a.Regarding nudity, physical modesty

b.Bathroom and bedroom privacy

c.Amount and type of discipline

2.Parent’s relationship

3.Relationship between parents and children

4.Birth order of and relationship between siblings

5.Sexual interaction between siblings

6.Sexual interaction among other family members

7.Physical illness or disorders during childhood

G.Religious issues

1.Specific religious/spiritual orientation

2.Religious orthodoxy of family of origin

3.Client’s commitment at present

4.Client’s perception of religious background, current beliefs and their effects on:

a.Attitudes towards self

b.Attitudes towards sex

H.Career issues

1.Perception of self in relation to employment/career

2.Academic/professional/career ambitions

3.Extent to which these have or have not been met – reasons – reactions

4.Amount of time and energy expended in career activities

I.Sex history

J.Dating history

1.When began and associated expectations

2.Significant partners

3.How did relationship end?

4.Type and frequency of sexual activity

5.Attraction

6.Degree of emotional involvement

7.Perceived consequences

K.Prior marital/committed relationship history

L.Reproductive issues

1.Menstruation (for women)

a.Preparation

b.Onset

c.Difficulties

d.Use of tampons

2.Post-menopause (for women)

a.Onset

b.Difficulties

c.Hormone replacement therapy

3.Contraception

a.Type

b.When started

c.Any type used with first intercourse?

d.Difficulties

e.Current method

f.Pregnancies

g.Scares premaritally/postmaritally

h.Abortions/terminations – complications?

i.Deliveries – complications?

j.Children

k.Planned?

l.Desired currently?

m.Pelvic/genital exam

n.First age

o.Reactions

p.Current reactions to pelvic exams

M.Emotional issues (level of feelings: depth, lack of, distress with)

1.Self

2.The relationship

3.Sexual issues

4.Partner

5.Sex roles

6.Self-concept

a.Presently

b.Any changes especially in relation to body image

c.Self-esteem

N.Coping strategies (how are feelings handled/personality style)

O.Medical history

1.Illness

2.Surgeries

3.Medications

4.Sexually transmitted infections

P.Drug or alcohol use/abuse assessment

III.Partner History

A.Each member of the couple is asked about his or her own history following the format above

B.However, during the history-taking, each client is also asked about his or her:

1.Impressions of the partner

2.Understanding of the partner’s history including:

a.Partner’s current functioning

b.Extended family relationships

c.Any other information useful for understanding the other client through the eyes of the partner

IV.Concluding Comments and Questions

A.“If there were one thing about yourself/partner you would like to change, what would that be?”

B.“What is it that you most like about yourself/partner?”

C.“Is there anything else you think I should know about you or the relationship that I have not asked?”

D.End by reassuring that there will be ample opportunity to modify or add to information already presented.

© This history-taking outline is the copyrighted material of Linda Weiner, MSW, and Constance Avery-Clark, PhD. There is no reproduction or use of these materials without written permission from the authors.