Discuss the treatment options for Pam to address infidelity.

Sex Addiction Course

Please put the question or section name above each paragraph.

As vignette application is required, please reference the people and situations within the context of your answers. All answers must consider legal and ethical considerations, as well as issues related to culture and human diversity.

Vignette:

Pam is a 45-year-old bisexual Caucasian female, who began counseling due to her sex and drug addiction. She wants to find a way to deal with her feelings of sadness, difficulty sleeping, anxiety, difficulty concentrating, rumination, thoughts of hurting herself, and nightmares. Pam attributes her symptoms to the recent emergence of some repressed memories. Pam describes the memories as “coming out in my dreams” of her father sexually abusing her, when she was approximately 10 years old. Pam appears anxious, uncomfortable, and tearful as she describes the memories of the trauma. She reports she has been struggling with this for the past 2 months. Pam has been in a relationship for 1 year with a woman of Middle Eastern descent, and has been unfaithful. She feels guilty for cheating on her partner and would like to stop having sexual affairs. Pam reports not having any children nor having an interest in starting a family.

Pam received her master’s degree in film and television from a highly recognized university at the age of 35. She describes feeling frustrated with not being able to find employment in her field of study. She currently works for a major film and television studio in the accounting department and has been employed there for nearly 6 years. Pam describes the work as “boring and unfulfilling,” but does not have the motivation to look for employment in her field of study.

Prior to her current therapy, Pam reports receiving services at the USC Neuro-Psychiatric Center for five sessions due to symptoms of anxiety, depression, difficulty concentrating, and nightmares; but because her medical insurance ran out, she was unable to continue. Pam currently receives therapy two times per week. She denies being hospitalized in the past even though she has had thoughts of hurting herself.

Pam reports that she has one sister 8 years younger than she, who is married with a 2-year-old daughter. Pam also states that she had a younger brother, two years her junior, who died from cancer when Pam was 20 years old. Pam states that her parents divorced shortly after the death of her brother. Pam describes her mother as “encouraging” in regards to her work and academic performance but also “controlling.” She describes her father as distant, unemotional, and expressing love through monetary means. Pam describes her parents’ relationship as tumultuous with “a lot of yelling.” She states that when her mother would get angry with her, she would yell and “dig her nails into her arm” and her father would withdraw and avoid all contact with her. She states that prior to the emergence of her memories of abuse, she would visit with her parents approximately one time per month. Pam reports she has not made any contact with her father since the recall of her memories. She describes her relationship with her sister to be distant, but cordial. She reports she visits with her sister approximately two times a month. Pam describes her mother as “always appearing depressed” and states her sister has been struggling with an alcohol addiction for many years.

Pam is currently married and describes her relationship with her wife as difficult at times. With further prompting, she states that the cultural differences between her and her wife create challenges in their communicating with one another.

Pam denies any medical problems. Pam reports she smokes marijuana at least two times per day, and started doing so at the age of 13. She reports using cocaine once or twice a week at a party setting, as well as having sex with multiple partners while under the influence. She reports drinking two to three glasses of wine each night as a way of “relaxing and taking the edge off.”

· Theories of sexual compulsion have pointed to a variety of other factors, including co-morbid diagnosis of other disorders such bi-polar depression, obsessive-compulsive disorder, and ADHD as underlying them. With the information presented for Pam, what other disorders might he also be dealing with?

· What steps would you take in initiating treatment for Pam?

· Discuss the treatment options for Pam to address infidelity. Which mode of treatment (individual, group, or couple’s therapy) would you recommend for Pam? What short and long-term goals would you set up in the treatment plan?

· Discuss interventions/techniques that you could use with Pam.

· How do gender and ethnicity/culture play a role in treatment for Pam?

· What legal and/or ethical issues are inherent in providing treatment for Pam?