Case Study
Patient Demographic: Client Age: 25 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: In a Relationship Counseling Setting: Private Practice Clinic Type of Counseling: Individual Counseling Presenting Problem: Premature Ejaculation Diagnosis: Provisional
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, time, and situation. The client appears comfortable in the session as evidenced by his openness, congruent affect, and verbal express
Presenting Problem: You are a counseling resident at an outpatient clinic. Your 25-year-old male client reports he was in a bicycle accident a year ago and that, resultingly, he had reconstructive surgery to his penis. The client identifies that it takes approximately 30 seconds to a minute to ejaculate following vaginal penetration. The client reports that the symptoms occur every time he engages in sexual activities with his girlfriend. The client is a car salesman and also reports anxiety about performance at work and other areas of life. You suspect that the client may also have generalized anxiety disorder. The client reports that his girlfriend does not seem to mind that sex does not last long, but he feels bad because he also wants her to feel good during sex.
Other Contexts: The client’s girlfriend comes to the session to give input about what she experiences when they have sex. The client started by saying he wanted to share his self-talk from the thought log. The client’s girlfriend denies any of the thoughts he thinks that she is having. You encourage the client to use her response as evidence for reframing his self-talk when he is nervous during sex. The client states, “the fact that she even has to say that means that I am inadequate.” The client’s girlfriend says she can tell that he is tense and “in his head” when they are having sex. She also notes that he appears sad after sex and often isolates himself for a while afterward. She also identifies that she feels tense when she notices that he is tense and that this makes her less likely to initiate sex. You empathize with the couple and provide psychoeducation regarding positive communication surrounding sex

Question: Based on the client’s presenting problems, all of the following would be a beneficial intervention for the girlfriend to use to support the client during sex EXCEPT:
(A): Positive affect
(B): Eye contact
(C): Comfort with silence
(D): Immediacy behaviors

Correct Answer: Comfort with silence
Explanation: Although comfort with silence can be a positive trait in a relationship, the client is still working through addressing negative self-talk and it would likely increase anxiety if silence is uncomfortable for him. Immediacy behaviors would involve the client’s girlfriend responding to what she sees the client experiencing either through reassuring statements, questions, or behaviors. Positive affect promotes a more positive environment and would likely result in a more positive experience. Eye contact demonstrates that she is present with him and attentive to him and would also promote a positive experience. Therefore, the correct answer is (C)
Competency: counseling skills and interventions