Clinical Evaluation and Case Conceptualization

Solution focused brief theory primarily focuses on finding solutions at the present time and exploring the hope for an individual in efforts to finding quicker solutions to their problems (Gingerich & Eisengart, 2000). The theory contradicts the traditional forms of therapy which usually take time to analyze individuals problems and their past life events. Therefore it applies the approach in which an individual knows what they want in efforts to improve their own life, thus they are offered the most appropriate coaching and guidance to enable them find the best solution (Gingerich & Eisengart, 2000). It was developed out of the interest that paying attention to what people want and what works the best for an individual.

 The theory begins and pays attention to the efforts that the individual has embarked to facilitate their behavioral and lifestyle changes. The interventions used by the therapist in this case include specific questioning methods ,empathy, scaling, and compliments which are aimed at helping the client to recognize their virtues that are likely to help them out of the troubled situation and in the future as well(Gingerich & Eisengart, 2000).  These interventions also open up the minds of the clients and help them to think critically and creatively and develop clear plans that will help in coming up with solutions that will change their lives. Consequently, the clients concentrate on what they can do as opposed to what they cannot, and this helps them to find solutions to their problems and adjust towards positivity promptly (Gingerich & Eisengart, 2000).  The theory can be used alone as a therapeutic intervention or may be used along other styles of therapy and treatment

How to Assess the Clients

In this case, I would use a sexual genogram to assess a myriad of factors that are related to the sexual behavior patterns of the couple which include the gender roles, secrets, behavior, communications and the history that is related to their sexual experiences (Gingerich & Eisengart, 2000).  For instance, I would assess the aspects of communication the couple uses while expressing their sexual wishes, desires and frequencies to determine whether that is the root cause of their strained sexual relationship. I would also be observant on the client’s verbal and nonverbal behavior which is a critical in providing more insights to the underlying couple’s problem. For each of the client, I would be interested in their sexual history to assess their sexual behavior over the past years in order to determine whether they are contributing to the current woes.

Who Would You Meet With and In What Sequence

I would consider meeting with both Henry and Oni, in order to get the two sides of the story and their perspectives regarding their sexual relationships. This will also help in the elimination of bias and favoritism as well as facilitating a quicker way in finding the solution. I would organize to meet them thrice per week for three hours in each session.

Assessment Methods to Gather Information

 First I would use the informal unstructured clinical interview method which would enable me interact with the clients on a personal level to gather information on the client’s comprehension, perspective as well as the feelings towards their problem. While applying this technique I will be in a position to observe the non-verbal behavior of the clients as well as build a rapport which will be relevant in gaining further insights to their marital affairs. In addition to this method, I would incorporate some few aspects of the formal, assessment technique since I would require them to fill out questionnaires structured in a way that will enhance further information gathering.

Areas Most Important To Investigate

In this case, I would consider pornography addiction as most important to investigate because it is affecting the sexual frequencies and desires of the clients. Henry has admitted that he is addicted to online pornography and thus it would be important to understand why he uses pornography and now that it is straining their relationship, it is in order to find out how he can get help and stop the behavior (Sun, Bridges, Johnson & Ezzell, 2016). In addition, the aspect of desire and arousal is an important factor to investigate in this case since it has a role to play in affecting the couple’s sexual woes.

Clinical Issues Presented By the Case

One of the clinical issues that I have identified is the effect of masturbation in decreasing sexual pleasure. Unarguably, due to the adverse effects it is causing to the couple’s sexual health and life, it requires clinical assessment and intervention, whereby he will acquire coping strategies for the excessive masturbation and consequently manage this sexual behavior.

How the Issue Would Have Been Viewed In The Past

The issue of masturbation in the past could be classified among the sexual behaviors that were viewed as deviant and were also considered taboo. It was an issue that was pestering people but they could not address it using dialogue since it was and still is surrounded by myths, beliefs and misconceptions as well as causing feelings of guilt and embarrassment. Compared to the past, the view of masturbation has changed in the contemporary society due to the results of research which has delineated it from the said myths and misconceptions. Research has indicated that other than being associated with a plethora of adverse effects, masturbation has more benefits for the sexual and overall health benefits to an individual and is normal but becomes a problem only when interferes with the daily life ad relationships with family, romantic partners among others.

Diversity Issues in the Case

The issue here could be the different cultural aspect of the clients.  Given that they originate from different cultural backgrounds, it is possible that cultural aspects such as beliefs, values, behavior and gender roles among others have contributed to their current sexual difficulties. I would explore on the role of beliefs informed by each client’s culture and how they regard sexual activities to determine whether they are playing a role in the couple’s sexual satisfaction. In addition, the behavior of each individual regarding sexual activities is an important factor of consideration in this case.

Ethical, Legal or Crisis Issues Identified

The seemingly ethical and crisis issue identified in the case is pornography which has contributed to Henry being unfaithful to Oni emotionally. Pornography could be a symptom of a deeper issue that he is using to cope with unresolved emotional pains among other problems (Sun, Bridges, Johnson & Ezzell, 2016). The problem in this case has led to him attempting to get intimate with his partner while asleep which could be an indication of other underlying problems.  He seems to have turned to pornography instead of facing the rejection of his wife since it is easier and does not require an emotional relationship to meet his basic need. Even though the act made him feel guilty and defeated, he feels as if he has no other alternative to meet that physical basic need.

Issues Raised By This Case That Would Require Clinical Research

The case presents a myriad of clinical issues that would require more research for better comprehension. For instance, the role of depression and rejection in an intimate relationship and how they can be solved are among the issues raised by the couple’s case and calls for prompt research. Depression has been identified to interfere with a person’s daily routine and overall functionality, and thus, it would be essential to research on how it contributes to issues such as bonding with the loved ones, low sexual energy, sensitivity in terms of emotions and lack of pleasure when it comes to intimacy.

In addition, the role of rejection and how repeated rejection can ruin relationships. There is need to explore whether it is the fear of rejection or the actual rejection that hurts the sexual relationship. Clinical research would assist to determine the perpetrators of rejection in intimate relationships and how it brews bitterness and consequently hate and hurt in the relationship. Research will also inform partners on the effective strategies on how to deal with sexual rejection to promote overall health and improve the sexual strains among romantic partners.

Supervision Needed To Remain In the Area of Competence

In the course of helping the couple revive their sexual frequencies, there are areas I feel i would need supervision to remain on course of therapeutic competence. For instance, in my personal opinion, the case presents a man who seems selfish and cares of his needs gratification without considering the sexual needs and desires of his wife. He substitutes sex with pornography and finds reasons such as rejection to blame the wife instead of dealing with the root cause of their sexual woes. Therefore, in order to remain fair and avoid diverging into such issues that would lead to offering therapeutic counseling with an element of bias and being informed by emotions, supervision is essential.

Need for referral to community services

There is need for the couple to be referred to a crisis intervention and crisis and additional community resources to ensure follow up and prevent relapse. The resource will also assess the outcomes of the sex therapy and ensure they are following the recommended interventions to maintain a healthier sexual relationship.

Part 2

Case conceptualization

The Clinical Goals for the Clients

 In the application of the solution- focused brief theory, it will be possible to identify the couple’s attitude regarding sex and the specific problem to be addressed. The clinical goals will be tailored to help the couple in specific exercises that will help the couple to refocus their attention, expectations and desires regarding sex.  In this case, the clinical goals include embracing open and positive communication that will identify what they want sexually, increasing and enhancing sexual stimulation and learning. These goals will help the couple to understand how to recognize and communicate their preferences sexually.  In addition, it will include the revitalization of their sexual desire for one another and help them maintain that sexual desire which will in turn result in an increase in the erotic flow and achieve sexual satisfaction. The goals will enable the couple to develop a comfortable style and become an intimate team that will be responsible in communicating what each wants to give and receive sexually without feelings of pressure, guilt and blame.

Systematic Based Treatment for the Couple

In applying the Solution Focused Brief Theory to solve the sexual issues for the couple, I will develop a systematic treatment plan and interventions that will bring to life the sexual life of the couple. The treatment will be structured in sessions that will lead to the ultimate solution as well as a follow up plan to enhance they couple does not relapse.

The first session will begin with the problem free talk which will enable the creation of the good relationship with the couple as well as enhancing a friendly and respectful climate therapy where they will feel safe and relaxed to enable them talk freely about their sexual problems (Althof, 2006). The problem free talk will involve a small talk on general issues and then invite them to talk about the therapy session to inquire about the therapy to determine whether it is their first experience and comprehending how   to make them feel comfortable since it is hard to discuss issues pertaining sex.

The second stage of treatment will involve the pre-session change to determine whether there are changes that the couple has experienced since the time they decided to attend therapy sessions (Gingerich & Eisengart, 2000). If the replies are positive, the solution talk will begin from there into digging deeper to get the details on what has happened and what actions they took to achieve these changes and know whether they would like it to continue that way.  If the replies are negative, I will proceed on asking the couple the kind of help they would like from me as well as understanding their hopes for the therapy session.

The next step would be looking for previous solutions. The couple may have experienced such sexual problems in the past and tried solving it but they did not come up with a successful solution. If they had faced such a problem previously, it will be important to note down how they dealt with it and whether it was helpful at the time and if not, they might as well have exceptions to their problem in that the time when such a problem could have occurred and it did not.

The next stage would be identifying whether the couples problem is physiological or psychological (Althof, 2006) .It will also be essential to find out how the problem occurs, when it began. After the response, it will be important to know how the problem affects their relationship. The next stage will involve seeking exceptions and by doing so, sensitive questions regarding sex will be addressed to open ground for the couple to openly discuss their sexual issues such as frequencies, motivators of sex among other issues that they cannot discuss openly in other forums.

Competence seeking is the next stage which will guide in finding out how the couple managed developed competencies when they tried to solve a previous problem and how it has changed them. The next stage of treatment will comprise of the miracle question which will be helpful in identifying the existing resources and solutions as well as inviting the couple to come up with a vision of their preferred future in their sexual life and their marriage as well (Hawton, 2005). The miracle question will prompt the couple to imagine how different their sexual relationship would be different if the miracle happened while in their sleep. After the miracle question and assessing how they would react to the miracle scaling the couple on a scale of 1-10 to determine where things are standing at the moment and what needs to be done to move their sexual relationship one small step further as well as identifying how they will notice they have moved the step further. 

The last stage of treatment according to the theory includes offering approaches and offering possible solutions that the clients should choose from (Hawton, 2005). In this case, I will offer systemic interventions that will guide the couple in implementing the goals that have been set in prior stages and will work well to improve their sexual relationship. The interventions will include training them on embracing open communication when it comes to sex that may include the non-demand pleasuring activities that are not necessarily aimed at leading to sexual intercourse but for their own sake and well-being.

The exploration of the past sexual experiences of each client to determine whether there are past experiences with their partners that may be contributing the current woes is essential. The provision of a physical awareness and suggestions for the couple on the sensuality exercises that are aimed at significantly changing their negative attitude towards their intimacy will be vital (Hawton, 2005).  For the husband who has openly admitted to engaging in sexual behaviors that are discouraging his partner from getting intimate, counseling services that will help him to direct his efforts towards her partner in order to achieve the satisfaction he needs other than opting to online pornography and masturbation ought to be offered.

 In addition, there will be other factors that the couple should put in in mind at the end of the therapy session to enhance sexual satisfaction. They include having realistic goals regarding their future sexual performances, for instances, they ought not to expect perfect episodes of sex every time, as well as being prepared to deal with sexual failures or sexual experiences that did not meet their expectations.

Cultural and Diversity Issues in the Theory Used

The application of clinical social work knowledge and practice theories in the contemporary society to people with diverse cultural background requires clinicians to be sensitive. During questioning, the role of aspects such as behavior and the cultural background of the clients have been considered, to gather whether they have contributed to the current sexual relationship problems. There were no questions that have led the clients to feel embarrassed or guilty of their values, behavior among other cultural aspects that inform the conduct of the overall human being functionality.

Effect for Personal Identities on the Case

Being a lady, I might be biased while dealing with the case and lean on Oni’s side who seem to be suffering while her husband is content and he is quenching his sexual thirst elsewhere. Instead of focusing on addressing the deeper issues that are possibly affecting their sexual relationship he focuses on a blame game that escalates the problem further.