What part of this dilemma should a counselor point out is Yelena’s responsibility to acknowledge and address?
The sexual disconnect between James and Yelena is essentially a consequence of an absence in open and honest communication between them about sex, particularly in expressing their specific needs in relation to sex, which is referred to in psychological literature as ‘sexual self-disclosure’ (Tang, Bensman, & Hatfield, 2013; Litzinger & Gordon, 2005) or ‘dyadic sexual communication’ (Pazmany, et al., 2014). Yelena had been enduring an unsatisfactory sex with her husband for more than two decades because she decided not to communicate her needs on the mistaken notion that doing so is being unfeminine.
Yelena felt the dilemma between her need for adequate foreplay from her husband and her inhibition to tell her husband about this need, considering the fact that James apparently was not aware of this need. She knew that she need to tell James about her need. However, she was inhibited by her belief that it would be unfeminine for her to bring the issue of foreplay, or more precisely her need for more foreplay, to her husband. This is the particular dilemma that the counselor must point out to Yelena, which she has responsibility to acknowledge and address.
The counselor must point out to Yelena that she must acknowledge the validity of this need and invalidate her issue about unfemininity in bringing the issue up with James. The counselor must point out that it is Yelena’s obligation to the relationship to be honest and forthright with James over her needs. Moreover, James also deserves to be informed about her need, which he may be able and even willingly to address.
1.0 Discuss how effective you think Viagra will be for improving James’ sex life, and why?
Essentially the use of Viagra constitutes a quick fix, which does not really provide a lasting effect in improving James’ drug-free sex life if the cognitive issues between him and Yelena is not corrective. Moreover, the drug has associated adverse effects, such as priapism, sudden loss of vision, and even hearing loss (Viagra, 2016).
2.0 Suppose Yelena’s discovery that James is using Viagra secretly is the “last straw” for her after years of unsatisfying sexual life with him and she demands that they seek marriage counseling and focus on their sex life:
2.1 What part of this dilemma should a counselor point out is Yelena’s responsibility to acknowledge and address? The sexual disconnect between James and Yelena is essentially a consequence of an absence in open and honest communication between them about sex, particularly in expressing their specific needs in relation to sex (Tang, Bensman, & Hatfield, 2013; Pazmany, et al., 2014; Litzinger & Gordon, 2005). Yelena felt the dilemma between her need for adequate foreplay from her husband and her inhibition to tell her husband about this need, considering the fact that James apparently was not aware of this need. This is the particular dilemma that the counselor must point out to Yelena, which she has responsibility to acknowledge as valid and address by invalidating unfemininity myth.
2.2 What special issues regard her perimenopause will need to be addressed?
Yelena’s perimenopausal state added hormonal complication to the situation. Pazmany, et al. (2014) noted a significant literature on the psychosexual issues often experienced by women in this state, such as declined sexual satisfaction, troubles with sexual desire, and inadequate vaginal lubrication, among others. These factors can pose additional challenges in the couple’s sexual readjustment. For instance, Yelena’s potential problem with inadequate vaginal lubrication can take more time than James may have patience in providing adequate foreplay and may end up with impatiently hurried and painful sex or dissipation of his sexual desire due to a longer foreplay than he may be prepared for or have the patience of.
2.3 What part of this dilemma should a counselor point out is James’ responsibility to acknowledge and address? James is facing the dilemma between his knowledge of less firm and predictable erection and his belief that it will be unmasculine to ask her wife to help him in this area. This hesitance can be exacerbated by their lack of open sexual communication, which may create an impression in his mind of seeking help from his wife for erection after all these years that he had been performing the sexual act without help. Moreover, the counselor must point out to James of the necessity to acknowledge his need for his wife’s help in maintaining firm and predictable erections during or prior to their sex.
3.0 Discuss specific treatment options for this couple that are supported by the research you learned about in your readings. At this point, cognitive-behavioral therapy is the most appropriate treatment option. The therapy must focus on resolving their individual cognitive myths with regards to their issues over femininity and masculinity and in disclosing their personal needs during sex (Tang, Bensman, & Hatfield, 2013; Litzinger & Gordon, 2005). Resolving this problem will provide significant improvement their sexual life to the point of normalizing it. In fact, James may not necessarily have to continue using Viagra once Yelena gets involved in helping James. However, due to her potential premenopausal symptoms, Yelena may need to take a female dose of Viagra initially just to help her improve her sexual desire after all those decades of sexual dissatisfaction and even suppression. Moreover, there might be no need to treat her premenopausal symptoms until cognitive-behavioral adjustment had been successful but still failed to accomplish their respective sexual objectives.
References
Litzinger, S. & Gordon, K.C. (2005). Exploring relationships among communication, sexual
satisfaction, and marital satisfaction. Journal of Sex & Marital Therapy, 31(5): 409-424.
Pazmany, E., Bergeron, S., Verhaeghe, J., Van Oudenhove, L., & Enzlin, P. (2014). Sexual
communication, dyadic adjustment, and psychosexual well-being in premenopausal women with self-reported dyspareunia and their partners: A controlled study. Journal of Sex Medicine, 11(1): 1786-1797.
Tang, N., Bensman, L., & Hatfield, E. (2013). Culture and sexual self-disclosure in intimate
relationships. Interpersona, 7(2): 227-245.
Viagra. (2016). Important safety information. Viagra.com. Retrieved from:
https://www.viagra.com/ <17 May 2016>
