Clinical Decision Exercise
Mapping an Initial Session
A first session with a new client is below. Three tasks follow: map what she has told you to the relevant domain, identify what you still do not know, and decide what the next session should open with. The third task is the one that matters. Assessment is only useful if it changes what you do next.
First Session
Maya is 44 and was referred by her family physician for pain with penetration, present for about two years and worsening. She has a two year old and returned to shift work six months ago.
She describes the pain as burning, at the entrance rather than deep, and says it is worse in the second half of her cycle. She has been on a combined hormonal contraceptive for three years. She has a history of depression, treated some years ago, and is not currently on medication for it.
She has stopped initiating, and has started going to bed at a different time from her partner so the question does not come up. She says she has never really been a very sexual person and has always felt somewhat behind her friends in that regard. Her partner has told her he can wait as long as she needs. She says, without elaborating, that this somehow makes it worse.
She grew up in a house where sex was not discussed and mentions that she still cannot say the word vulva out loud. She has raised the pain at three medical appointments over the past two years. On two of those occasions she was told she needed to relax.
The Four Domains
BiologicalTissue, hormones, medication, physiology, medical history.
PsychologicalBeliefs about the self, mood, cognition, learned avoidance.
InterpersonalWhat happens between her and her partner, including what each does in response to the other.
SocioculturalMessages received from family, culture, and the health system itself.
Task One
Map what she has told you
Select the domain each disclosure belongs to. Two of the eight accept more than one answer.
0 of 8 mapped
Task Two
Identify what you still do not know
Select every item that has not been assessed in this session. Select as many as apply.
Task Three
What should the next session open with?
Choose one.