Definition of the Presenting Problem

The therapist’s first task is to obtain each partner’s view of the sexual problem. Frequently
partners will have very different views. It is important for the therapist to evaluate factors such as
the current baseline level of sexual activity, amount of sexual desire in each partner, degree of
sexual satisfaction, and amount of distress over the sexual problems. A common example is that
when the therapist is asking the couple about the frequency of sexual interaction, the partners
may give radically different answers to this simple behavioral question. Questions about issues
that are internal or meaning-oriented may produce even larger discrepancies.

The final phase of the case formulation is a continually revised treatment plan that overlaps with
ongoing assessment. A list of problems and a treatment plan for each problem are generated. The
therapist and couple collaboratively decide which problems should be worked on first. In
addition, the therapist addresses problems as they emerge in order to reduce the couple’s distress.
Probing for new information about coexisting problems within different domains of the system
facilitates further treatment. In the following discussion, aspects of the treatment plan are
illustrated by clarifying common techniques.