Part One

WEEK 1: History, Systems, and Professional Ethics

Begin by reviewing the Sexological Assessment (Appendix A), a supplement to a general intake assessment. Unlike an intake assessment, however, the Sexological Assessment is to be reviewed gradually with clients to build an understanding of their holistic sexual being. Take the time now to review the full assessment. While you are encouraged to answer the Sexological Assessment questions for your own use, do not submit your answers to the Sexological Assessment in this class. Submit your responses to the questions below.

1. What is it like to consider some of the questions from the Sexological Assessment for yourself? (Note: Do not submit answers to the questions in the assessment; only describe how it felt to consider the questions.) This is assessment is similar to a Bio-psychosocial, but places emphasis on sexuality, if you are not in tuned with your sexuality or you are hiding from your sexuality the questioning will make you uncomfortable to answer, but it also draw you to answer the questioning in an effort to seek the answer you are looking for about yourself.

2. Identify four sections from the Sexological Assessment you are most uncomfortable with. Write a sentence or two per section considering why you are uncomfortable with this area of sex or sexuality.

1. Sexual Health – Have you ever looked at your genitals? As I was reading this question, It made me visualize myself looking at my genitals, and because I have never done so, it made me very uncomfortable to ask this question, because of me visualizing their description of completing this task and how their genitals look.

2. Healthy Sexual Functioning – I have never been comfortable about discussing masturbation, this subject always made me feel uncomfortable or inadequate, not sure why but just mentioning the word masturbation makes me feel uncomfortable.

3. Sexual Exploitation – The questioning of sexual abuse, because I was molested as a child, I become extremely emotionally involved with others who were molested or raped a child and forget to distance my feelings, I am at a point that I can discuss my sexual abuse without it bothering my way of life, I still don’t like visiting this place.

4. Pornography – This is a fetish that I cannot get into, and am uncomfortable discussing it, because I do not like watching porn.

3. Explain an ethical implication(s) that you feel is most important for sexuality counseling based on historical trends. Include a citation from the readings.

Ethics is the key to any professional and consumer relationships; it is the key to how a relationship will either flourish or diminish if certain boundaries are not followed. The most important ethical implications in any counseling relationship is (1) Competency – According to AASECT it is important to be trained in sexuality education, counseling, and therapy. (2) Moral, Ethical, and Legal Standards – Avoid any action that might violate or diminish the legal and civil rights of the consumer and lastly (3) Welfare of the Consumer – your patient rights and best interest shall be protected at all cost during your relationship.

Citation(s): American Association of Sexuality, Educators, Counselors and Therapist (n.d.) Code of ethics http://www.assect.org (code-ethics).

The Professional Development section in Weeks 2–10 of the workbook provides you the opportunity to expand your knowledge and skills (or lack of) to better help your future clients. For example, consider the four sections from the Sexological Assessment you identified this week as being most uncomfortable with. What professional development opportunities are available to you so that you could address this discomfort and be better equipped to address these issues with a client? Throughout the course, you will find other topics you are unfamiliar with or that you are motivated to learn more about. Use the Professional Development portion of the workbook to identify opportunities to develop your expertise and increase your comfort level with these topics.

Beginning in Week 2, you must research and identify a minimum of three potential professional development opportunities that are related to the topics of that week. These opportunities may include, but are not limited to, trainings, workshops, events, webinars, conferences, books, TED Talks, podcasts, or participation in a professional organization. You must compile a list of all these opportunities in Appendix B, adding to it each week. You will turn in the first part of your list in Week 6 with the first half of your Sexological Workbook. This way, your Instructor knows you have been working hard each week on building your list.

Before Week 11, you must attend or participate in one of these professional development opportunities you have identified in Weeks 2–6. You will continue to add to your Professional Development list in Weeks 7–10. Your final Professional Development list is due in Week 10 when you turn in Part 2 of the Sexological Workbook.

In Week 11, you will create a 3- to 5-minute video presentation in the discussion board that presents the professional development opportunity you engaged in. Please take the time now to review the rubric for the presentation so that you know the expectations in advance.

The professional development opportunity you choose for your presentations must meet at least one of the following criteria:

· For trainings/workshops/events/webinars/conferences, the professional development opportunity must be at least 90 minutes long.

· If you are viewing an educational video, such as a TED Talk, you must find several TED Talks on a similar topic that equal at least 120 minutes.

· If you are listening to podcasts, listen to at least 120 minutes of podcasts.

· If you are participating in a professional organization, attend at least 90 minutes of meetings or other organizational instruction.

· If you are reading a book or journal articles, the reading materials must total at least 50 pages.

· If your professional development opportunity does not meet any of these criteria, please reach out to your Instructor to present your opportunity and ask if your opportunity will be accepted. Do this early so that you have time to locate a different opportunity if yours is not deemed acceptable.

This quarter, you will be building a local Sexological Resource List to use in your work as a counselor. Each week, you will continue adding resources to your list. Your objective is to identify the most local resources possible for clients to access. Resources are services that clients could use, such as a physical place a client could go to (e.g., a specific health clinic that serves individuals in your area) or a person with expertise; if you are unable to find either of those options, you may consider online resources or learning resources such as books and articles. You must find at least three resources (either local or regional) in the following categories:

· Healthcare (Week 2)

· Transgender and gender expansive (Week 3)

· Affectional/sexual orientation (Week 4)

· Children and adolescents (Week 5)

· Positive sexuality (Week 6)

· Sexual dysfunction (Week 7)

· Sexual pleasure/lifestyle (Week 8)

· Sexual exploitation (Week 9)

· Abortion (Week 10)

· Infertility (Week 10)

If you are having trouble finding resources, reach out to your Instructor for assistance by Day 3 of the week. Resources may be lacking in some areas. If this is the case, you are welcome to be creative!

In Week 10, you will turn in your final Sexological Resource List with the various resources you have compiled throughout the quarter. Review the template for your final Sexological Resource list in Appendix C. You will turn in the first part of your resource list in Week 6 with the first half of your Sexological Workbook. This way, your Instructor knows you have been working hard each week on building your list.

Reflect on the “Health: Sexual Anatomy and Physiology” section of the Sexological Assessment, specifically the section titled “Sexual Health.” Challenge yourself to answer one or more of the questions from the assessment for your own growth, self-awareness, and edification. Do not submit your answers in the Sexological Assessment. Instead, answer the questions below:

1. Why is it important to gather this information from clients? Justify your reasoning, citing from the Learning Resources. It is important to conduct full assessments on clients, to get a clear and precise understand of what the client is trying to say or to better develop a treatment plan for the client. Often times clients focus on the problem that they are having which is usually masked by something far deeper. Per Beuhler (2016) It is important to get a detail history on your client, because oftentimes there are underlying issues, that has been missed by previous therapist and clients.

Citation(s): Beuhler, S (2016) What every mental health professional needs to know about sex; Springer Publishing Company.

2. Consider two to three sexual anatomical or physiological structures discussed in this week’s Learning Resources. What are some misconceptions clients may have about the role and function of the anatomical structures you selected? The biggest misconception I believe would be where is semen ejaculated from – Often males would think that it comes from their penis, but in all honestly according to Beuhler (2016) the epididymous (a tube behind each testis) and the vans deferens (the duct that carries sperm from testicle to ureathra) it also carries sperm and urine from within the body to exit out the tip of the penis.

(2) The Pelvic Floor muscle is important that nearly not as many women are aware of. The floor muscle is important in holding up all of the internal organs within the abdomen. Muscles within the pelvic floor if too tight is the reasoning behind some painful intercourse, and muscles too lose it is said can prevent climaxing for women, it is often said that this is caused because women muscles are too loose from a significant amount of sex, but According to Beuhler (2016) another reasoning could be that a man is not fully erect. Something important to discuss with clients(s).

Citation(s): Beuhler, S (2016) What every mental health professional needs to know about sex; Springer Publishing Company.

3. Would you feel comfortable answering these questions for yourself in a private, safe counseling session? If a client is hesitant to answer these questions, what can you do you make them feel safer and more comfortable to answer these questions? Because I am not appropriately trained, answering these questions made me feel uncomfortable, and if I am feeling uneasy. I could only imagine how a patient is feeling seeking help. Any type of counseling sessions, it is always important to build a therapeutic alliance with your patient, make them feel safe, and let them know that their information is safe and most importantly let them know that they will not be judged.

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with sexual anatomy and physiology. If needed, review the criteria for the Professional Development List and Presentation from Week 1 here.

Go to Appendix C and provide at least three resources to which you could refer clients to learn more about their own sexual health functions. This could include medical providers, such as local OBGYNs or urologists. The resources should be as local as possible for clients to access. If needed, there are more detailed instructions in Week 1 here.

WEEK 3: Gender Identity

Reflect on the “Gender” section of the Sexological Assessment. Challenge yourself to answer one or more of the questions from the assessment for your own growth, self-awareness, and edification. Do not submit your answers in the Sexological Assessment. Instead, answer the questions below:

1. What is your comfort level with your gender? I dentifying with one’s gender goes beyond identifying as a female or a male, ironically the gender that some identify with does not correlate with what was branded at birth. I identify as cisgender woman, she/her, female. I was born a female and am comfortable with my identification as female.

2. Describe your comfort level when you consider asking your clients these questions. Before honestly taking this class, and truly be more open minded and reading, this was extremely uncomfortable mainly due to so much controversary around this subject. But because times and laws have been put into place, I am comfortable with asking clients about their gender, mainly because you definitely don’t want to misgender, anyone.

3. How might your comfort level be influenced by the similarities or differences between you and your clients, such as gender differences? For example, if you identify as a cisgender woman, how might your comfort level be different if your client is a cisgender man, a cisgender woman, a transgender man, a transgender woman, or a genderqueer person? Being more open minded, becoming culturally competent about human sexuality, I am comfortable working with transgender men or women or even genderqueer. Even though I have much more too learn, in becoming more proficient in working with this population, I believe my open mindfulness would assist in quieting any biases I might have.

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability related to gender. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three resources to which you could refer transgender and gender-expansive clients. For example, this could include a transgender support group, a gender clinic, or local community center where transgender and gender-expansive people can build community. The resources should be as local as possible for clients to access. If needed, there are more detailed instructions under Week 1 here.

WEEK 4: Affectional Orientation

Reflect on the “Affectional Orientation” section of the Sexological Assessment. Challenge yourself to answer one or more of the questions from the assessment for your own growth, self-awareness, and edification. Do not submit your answers in the Sexological Assessment. Instead, answer the questions below:

1. Consider your own affectional orientation and scale of desire. What is your comfort level with these two aspects of yourself? If you feel safe and comfortable sharing, consider what has impacted your comfort level. My affectional orientation is heteromantic – I am attracted to the opposite sex, but my scale of desire has been for the same sex – but never to the point to pursue a relationship.

2. Describe your comfort level when you consider asking your clients these questions. Again as previously stated, because of my ignorance to this topic about human sexuality, I was uncomfortable but now reading and learning more on this subject I am comfortable in speaking with a client that identifies as pansexual, transgender, bi-sexual, or queer.

3. Choose one of the case studies from class this week to respond to the following question: Describe three competencies from ALGBTIC LGBQQIA’s “Competencies for Counseling With Lesbian, Gay, Bisexual, Queer, Questioning, Intersex, and Ally Individuals” that you would use with this client. How would you demonstrate each competency?

1. Identify the heterosexism, biphobia, transphobia, homophobia, and homoprejudice inherent in current life-span development theories and account for this bias in assessment procedures and counseling practices.

2. Recognize how stigma, prejudice, discrimination, and pressures to be heterosexual may affect developmental decisions and milestones in the lives of individuals regardless of the resiliency of the LGBQQ individual.

3. Understand that an LGBQQ individual’s family of origin group and/or structure may change over time, especially as it relates to the family’s acceptance/rejection of the LGBQQ member, and acknowledge the impact that being rejected from one’s family may have on the individual. If problems exist in the “family of origin,” the individual may create a “family of choice” among supportive friends and relatives.

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with various affectional orientations. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three affirmative resources to which you could refer lesbian, gay, bisexual, queer, or pansexual clients. For example, this could include an LGBTQ+ support group or a local LGBTQ+ community center. The resources should be as local as possible for clients to access. If needed, there are more detailed instructions under Week 1 here.

Reflect on the “Sex History” section of the Sexological Assessment. Challenge yourself to answer one or more of the questions from the assessment for your own growth, self-awareness, and edification. Do not submit your answers in the Sexological Assessment. Instead, answer the questions below:

1. What messages did you receive as a child about topics related to sex and dating, such as masturbation or premarital sex? This subject was very taboo in my family growing up, because our family was dominated by women, we were taught that this subject was only meant for a husband and wife and you should not have sex until married, and masturbation was off limits, it was considered the work of the devil.

2. How have these messages impacted you as an adult? Having children of my own, and the way I was raised, I did not approve of with my own daughters. My daughters and I talked about sex and how yes, they should not engage in premarital sex, but I was also not naïve that often times adolescents/teens are inquisitive. I talked to my daughters about early pregnancies, STD’s etc. It has always been my belief that you can’t raise a generation in a past generation era, you could use some wisdom from a past era but you can’t completely raise a child in a past era.

Go to Appendix B and provide professional development activities to increase your competency, knowledge, and/or comfortability with issues related to sex and sexuality of children and adolescents. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three resources for child and adolescent sexuality. Where can clients go to learn more about child and adolescent sexuality? For example, there may be a workshop at a local children’s hospital. If you do not have any local resources, feel free to look at web-based resources. The resources should be as local as possible for clients to access. If needed, there are more detailed instructions under Week 1 here.

Reflect on the “Healthy Sexual Functioning” section of the Sexological Assessment. Challenge yourself to answer one or more of the questions from the assessment for your own growth, self-awareness, and edification. Do not submit your answers in the Sexological Assessment. Instead, answer the questions below:

1. What is your comfort level when you consider asking your clients about masturbation? Consider practicing talking about masturbation—either to yourself, a safe family member, or trusted friends—to help increase your comfort level. I definitely have to work on this (laughing) I was able to talk to my husband about masturbation because we are close, and as he was talking about it, I found myself extremely uncomfortable. I then attempted to have this conversation with my daughters and could not bring myself to have this conversation, so I am going to definitely work on this.

2. Describe your comfort level when you consider asking your clients about climaxing and orgasms. Then, practice talking about climaxing and orgasms—either to yourself, a safe family member, or trusted friends—to help increase your comfort level. Share in a sentence or two how this experience was for you. Again, I chose to ask my husband this question, as I asked, I was comfortable, it’s when he was describing his opinion, I felt uncomfortable, not sure why, I am going to have to continue working on this area.

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with positive sexuality and sexual functioning. If needed, review the criteria for the Professional Development List and Presentation here.

Additionally, this week, you will select one of the Professional Development activities you listed from Weeks 2–6 that you will present in Week 11. Below, indicate the activity you will complete and when you intend to complete it. Remember that this assignment is due by Day 3 of Week 11, so you will need to complete it before then.

The Professional Development activity I choose (include a link to the activity if there is one):

· Webinar presented by ISEE Online Learning – History of Sexology

I intend to complete this activity by the following date:

· July 30th, 2020.

The Professional Development activity must meet the following criteria for the assignment:

· For trainings/workshops/events/webinars/conferences, the professional development opportunity must be at least 90 minutes long.

· If you are viewing an educational video, such as a TED Talk, you must find several TED Talks on a similar topic that equal at least 120 minutes.

· If you are listening to podcasts, listen to at least 120 minutes of podcasts.

· If you are participating in a professional organization, attend at least 90 minutes of meetings or other organizational instruction.

· If you are reading a book or journal articles, the reading materials must total at least 50 pages.

· If your professional development opportunity does not meet any of these criteria, please reach out to your Instructor.

Go to Appendix C and provide at least three resources from which elderly clients or clients who are differently abled can learn more about healthy sexual functioning and positive sexuality. These resources do not need to be local or regional. These resources can be web based or written, such as a book or article. If needed, there are more detailed instructions under Week 1 here.

In Week 10, you will turn in your final Sexological Resource List based on the various resources you have compiled throughout the quarter. At this point, your Instructor will see that you have been working on your resource list throughout the first six weeks of the course.

— SUBMIT PART ONE BY DAY 7 OF WEEK 6 —-

Congratulations! You have completed Part 1 of your Sexological Workbook. Continue to the next page to start Part 2, which covers Weeks 7–10. You will submit Part 2 on Day 7 of Week 10.

PART TWO

Reflect on the “Sexual Dysfunction” section of the Sexological Assessment. Challenge yourself to answer one or more of the questions from the assessment for your own growth, self-awareness, and edification. Do not submit your answers in the Sexological Assessment. Instead, answer the questions below:

1. Describe your comfort level when considering the questions from the “Sexual Dysfunction” section. Would you feel comfortable answering these questions for yourself in a private, safe counseling session? Why or why not?

2. In your Discussion this week, you had to choose one of three case studies. Now, choose a different case study and respond to the following: Describe an intervention from the Learning Resources you would use with the client you chose. Justify why you chose this intervention by citing at least one resource.

Citation(s):

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with sexual dysfunction and health/medical factors. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three resources to which you could refer a client who is experiencing any sexual dysfunction or has a health/medical problem related to sex. For example, consider local medical providers such as local OBGYN, urologist, or local HIV center. If there are a lack of local resources, these resources can be the same as Week 2. The resources should be as local as possible for clients to access. If needed, there are more detailed instructions in Week 1 here.

Reflect on the “Pleasure and Sexual Lifestyles” section of the Sexological Assessment. Then respond to the following questions:

1. Have you considered these questions for yourself before?

Yes No Some of these questions

2. What is your emotional response when you consider these questions for yourself?

3. Describe your comfort level when you consider asking your clients these questions.

4. How might your comfort level be influenced by the similarities or differences between you and your clients, such as differences of your own pleasure and sexual lifestyle?

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with pleasure and sexual lifestyles. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three resources you could share with a client for pleasure and sexual lifestyles. If you do not have any local resources, these can be web based. You are encouraged to see if there are local centers for sex-positive culture, erotic festivals, or local munches. If needed, there are more detailed instructions under Week 1 here.

Reflect on the “Sexual Exploitation” section of the Sexological Assessment. Then respond to the following questions:

1. Describe your comfort level working with survivors of sexual exploitation, such as domestic violence and/or sexual assault (e.g., rape).

2. What is your comfort level when you consider asking your clients the questions under the “Sexual Exploitation” section of the assessment?

3. How might your comfort level be influenced by the similarities or differences between you and your clients, such as gender differences?

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with sexual exploitation. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three resources to which you could refer a client who has experienced sexual exploitation or has been involved as a perpetrator. For example, are there specialists in your area who identify as certified sex addiction therapists, or are there local domestic violence support groups? The resources should be as local as possible for clients to access. If needed, there are more detailed instructions under Week 1 here.

Reflect on the “Other Issues Related to Sex and Sexuality” section of the Sexological Assessment. Then respond to the following questions:

1. Choose to focus on either abortion or infertility for the journal. Describe your comfort level with discussing this topic with clients.

2. What is your comfort level when you consider asking your clients these questions?

3. Review the Comfort Scale you marked throughout the workbook. Looking back, share whether you feel your comfort level has changed throughout the quarter. How might your current comfort level impact your work with clients with issues related to sex and sexuality?

Go to Appendix B and provide three specific professional development activities to increase your competency, knowledge, and/or comfortability with abortion and infertility. If needed, review the criteria for the Professional Development List and Presentation here.

Go to Appendix C and provide at least three resources related to abortion to which you could refer a client. Examples could include where clients can receive an abortion or support groups for those considering abortions. Additionally, find at least three resources related to infertility services. The resources should be as local as possible for clients to access. If needed, there are more detailed instructions under Week 1 here.

This week, you will turn in a final resource list based on the various resources you have compiled throughout the quarter. You can copy and paste your resources from each week into the final resource list (see Appendix C for the template) to have a final resource list for you to use as a practicing counselor.

— SUBMIT PART TWO BY DAY 7 OF WEEK 10 —-

Is it okay to leave a voicemail? □ No □ Yes

Is it okay to leave a voicemail? □ No □ Yes

INTRODUCTION

Symptoms

What are your current symptoms in order of what you find most bothersome:

1.

2.

3.

How are your symptoms affecting your ability to function at home? At work? In the community?

In what ways did your culture, ethnicity, or family background influence your values, beliefs, and attitudes toward sex and sexuality? Consider whether religious or spiritual beliefs impacted your values, beliefs, and attitudes.

What were your family’s attitudes toward sex? How was affection shown in your family?

How is your general health? Any chronic illnesses? Injuries? Past surgeries?

Mental Health History

Have you ever received a mental health diagnosis? □ No □ Yes

If yes, please list diagnosis/es and date(s) first diagnosed:

Have you ever been hospitalized for mental health concerns? □ No □ Yes

If yes, list date(s) and length of stay:

Have you ever or are you currently engaging in self-harm (such as cutting)?

Currently: □ No □ Yes Past: □ No □ Yes

If yes, what type of self-harm and how often?

Have you ever experienced (if yes, please explain):

Extreme depressed mood: □ No □ Yes

Extreme mood swings: □ No □ Yes

Rapid speech: □ No □ Yes

Extreme anxiety: □ No □ Yes

Panic attacks: □ No □ Yes

Phobias: □ No □ Yes

Hallucinations: □ No □ Yes

Unexplained losses of time: □ No □ Yes

Unexplained memory lapses: □ No □ Yes

Eating disorder: □ No □ Yes

Repetitive behaviors (e.g., frequent checking, hand washing): □ No □ Yes

Homicidal thoughts: □ No □ Yes

Suicidal thoughts: □ No □ Yes

Suicide attempt: □ No □ Yes

Developmental History

Were there any complications with your birth? □ No □ Yes If so, please explain:

Did you reach developmental milestones within normal limits when you were a child (e.g., walking, talking)?

□ No □ Yes

Were you hospitalized for any accidents, illnesses, or high fever when you were a child? □ No □ Yes If yes, explain:

Medical History (Include medications)

Please answer the following question using 5—Excellent, 4—Good, 3—Average, 2—Poor, 1—Failing

How would you currently rate your physical health?

Do you now have, or have you had in the past, any of the following? Check all that apply:

Are you currently under the care of a medical doctor or other medical health professional: □ No □ Yes

Name of Primary Care Physician: Physician Phone: ______________

Are you taking any prescription medications? □ No □ Yes If yes, please list:

List any over-the-counter medications, vitamins, or herbal supplements you are currently taking:

Do you currently exercise: □ No □ Yes If yes, please indicate what type and how many times per week:

Are you having any problems with your sleep habits? □ No □ Yes

If yes, check where applicable:

□ Sleeping too little □ Sleeping too much □ Poor-quality sleep □ Disturbing dreams □ Other

Are you having any difficulty with appetite or eating habits? □ No □ Yes

If yes, check where applicable: □ Eating less □ Eating more □ Binging □ Restricting

Have you experienced significant weight change in the last 2 months? □ No □ Yes

History of Substance Use

Please indicate substances currently used (over the past 6 months), how much at one time, how many times per day/week, age of first use, past use history, and length of time used.

Potential for Acute Intoxication, Withdrawal Problems, or Relapse

Have you ever believed your substance use was a problem for you? □ No □ Yes

Has anyone ever told you they believed your substance use was a problem? □ No □ Yes

Have you ever had withdrawal symptoms when trying to stop using any substances? □ No □ Yes

Have you ever had problems with work, relationships, health, or law due to your substance use? □ No □ Yes

If yes, please describe:

Sexual Health

How is your sexual health?

People with vulvas: Any menstrual difficulties? Fibroids? Ovarian cysts? When was your last gynecological exam? Any abnormalities?

People with penises: Any discharge from penis during urination? Testicular cancer? When was your last prostate check? Any abnormalities?

How do you feel about your body? What do you like and not like about your body?

How do you feel about your genitals? Have you looked at your genitals before? (If you have a vulva, consider taking a mirror and looking between your legs in private.) How do you feel about touching your genitals? If applicable, how do you feel about touching and observing your partner’s/partners’ genitals?

GENDER

At what age did you first become aware of your gender? ____

a. Did it coincide with your biological sex? How well did it conform to traditional gender expectations in society and/or your family?

b. How do you identify your gender identity?

c. Do you currently have any discomfort with your gender identity?

If applicable, when did you first become aware of your attraction to others?

Where are you on the following Scale of Desire and Affectional Orientation?

 Orientation

Consider your response to the Scale of Desire and Affectional Orientation. How would you describe the sexual desire you chose? For example, if you chose “E (Mid-Range Sexual Desire),” how would you describe this for yourself?

Do you currently have any discomfort with affectional (sexual) orientation?

Do you or did you ever hide your affectional (sexual) orientation? If so, from whom?

Family History (Include significant relationship history)

Were you adopted? □ No □ Yes If yes, your age at time of adoption:

With whom did you live until the age of 18? __________________________________________

Please list names, ages, and relationship (e.g., mother, father, daughter) of those in your self-described family. Additionally, use the final column to indicate whether you have/had a positive relationship (+), negative relationship (-), or neutral relationship (o) with the family member:

Are your parents currently married/in a partnership? □ No □ Yes

Did your parents ever divorce? □ No □ Yes If yes, your age at time of divorce:

Were you ever in foster care or residential care? □ No □ Yes If yes, please list age and living situation:

Where did you live until the age of 18?

What is parent A’s current age? ___________ If deceased, your age at time of his/her death: ___________

What is parent B’s current age? ___________ If deceased, your age at time of his/her death: ___________

Other parent’s information here:

General Sex History

What messages did you receive about topics related to sex and dating, such as masturbation or premarital sex, as a child?

At what age did you begin puberty? Was this earlier, later, or about the same time as your peers?

Did you have accurate information about what would happen in puberty? □ No □ Yes

Did you have someone you felt comfortable asking questions about puberty? □ No □ Yes

If applicable, how do you or would you ideally raise children related to sex and sexuality? Any similarities or differences as to how you were raised?

If applicable, when did you first discover masturbation? Age: _______

· What was your reaction to this?

· Were there ever any embarrassing issues related to masturbation?

· Do you continue to masturbate? If so, how often? If not, why?

· Is there currently anything about masturbation that concerns you?

If applicable, when did you first begin climaxing/orgasming?

· What was your reaction to this?

· Were there ever any embarrassing issues related to orgasm?

Do you currently have orgasms? If so, what percentage of the time? If not, what are the reasons why?

· In what ways can you experience orgasm (e.g., stimulation, oral sex, penetrative)?

· Are you able to have multiple orgasms?

· Have you ever faked an orgasm?

· Is there currently anything about having orgasms, or not having orgasms, that concerns you?

Are you currently in a relationship(s)? □ No □ Yes

Name of person(s): ________________________

Length of time you have known each other:___________ Length of time together: ________

Do you currently live together? □ No □ Yes

Number of significant relationships: _________ Number of divorces: _________

Have you ever been diagnosed with a sexually transmitted infection/disease or HIV? If so, how old were you? From whom did you get it? What was your reaction to it?

Are you experiencing, or have you ever experienced, any of the following?

How often do you have sexual fantasies?

a. Briefly describe your fantasies.

b. Are you comfortable with the content of your fantasies? □ No □ Yes

Have you or your partner(s) engaged in sexual fantasies? Describe.

Have you ever engaged in sexual behavior that you worried about or knew was illegal?

Mark where you are based on your amorous expression:

Have you ever had any negative or upsetting sexual experiences? □ No □ Yes

How old were you? What effect has it had on you? What was the experience(s)?

Have you ever told anyone about this? If so, who? If not, why?

Trauma History

Please indicate whether you or a member of your immediate family experienced any of the following. If a family member, please indicate relationship(s):

Pregnancy

Have you ever been pregnant or gotten someone else pregnant? □ No □ Yes

Was this planned on unplanned? What was/were the outcome(s) of the pregnancy?

If you ever had children, how did you they affect your sexuality?

Have you ever struggled with infertility? □ No □ Yes

If yes, please share when.

Pornography

At what age were you exposed to pornography if you have been exposed? _____

What was your reaction? How much, if any, do you currently use/view pornography? Do you have any concerns about the amount of time you spend watching pornography or any concerns about the content you view?

Strengths and Interests

What are your strengths and interests?

Goals

What are the goals you hope to achieve in counseling:

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Is there anything you would like to add that I have not asked and that you would like to include?

Client Signature: ___________________________ Date: ___________________

Thank you for your time! Please contact me with any questions.

1. The Panpsycast Podcast https://thepanpsycast.com/panpsycast Sexual Ethics Parts 1-4

2. (Book) What every mental health professional needs to know about sex. Stephanie Beuhler (2016) Springer 2nd Edition.

3. Al Vernacchio at TEDxYouth – Whats your sexual footprint.

1. (Book) What every mental health professional needs to know about sex. Stephanie Beuhler (2016) Springer 2nd Edition.

2. The Gender Code (Gender & Sexuality Documentary) https://www.youtube.com/watch?v=Zph7H-O0d5w

3. Psychology of Sexual Orientation and Gender Diversity – M. Paz Galupo, PhD (2020) https://www.apa.org/pubs/journals/sgd/

1. (Book) What every mental health professional needs to know about sex. Stephanie Beuhler (2016) Springer 2nd Edition.

2. The Origins of Orientation: Sexuality in the 21st Century – https://www.youtube.com/watch?v=lZsnPmuYp9c

3. When Clients Want Your Help to “Pray Away the Gay”: Implications for Couple and Family Therapists – Monique Walker (2012) https://www.youtube.com/watch?v=lZsnPmuYp9c

1. (Video) Understanding Gender Nonconformity…” by Dr. Robert Garofalo – https://www.youtube.com/watch?v=zcJYq9U3v74

2. (Video) Gender Dysphoria in Children: Understanding the Science and Medicine – https://www.youtube.com/watch?v=GOniPhuyXeY

3. (Video) Childhood and Adolescent Sexual Development – https://www.youtube.com/watch?v=ZE0FXt7ODls

1. (Journal) Sexual Health and Positive Subjective Well-Being in Partnered Older Men and Women – Lee, D. M., Vanhoutte, B., Nazroo, J., & Pendleton, N. (2016). Sexual Health and Positive Subjective Well-Being in Partnered Older Men and Women. The journals of gerontology. Series B, Psychological sciences and social sciences, 71(4), 698–710. https://doi.org/10.1093/geronb/gbw018

2. Journal of Positive Sexuality – Contributions to Positive Sexuality from the Zen Peacemakers, E. Piskin (2020) Volume 6, Issue 1.

3. Sexual Health in Post-Menopausal Women – Panel Discussion – https://www.youtube.com/watch?v=t3gUi6d0a-A

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1. Planned Parenthood

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1. Compass Community Center

2. Meetup.com – Support Groups

3. Psychology Today – Therapist and Counselors

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