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Sexual Development
(Psychosexual Therapy Intake Form)
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Sex education as a teenager – where/what?
Were you an early or late developer?
For females: age of first period and parents’ reaction.
For males: wet dreams – how did you/parents react?
Masturbation – when, how, feelings, fantasies?
Any same-sex experiences?
Any difficult or pleasurable sexual experiences as a teenager?
Notes:
Early Sexual Experiences
(Psychosexual Therapy Intake Form)
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Age at first sexual relationship.
Did it include penetrative sex?
When was first intercourse?
Further/subsequent relationships?
Who ended them?
Difficulties or pleasures in those experiences?
Previous marriages or live-in relationships?
Any children or pregnancies? Terminations/miscarriages?
Sexual health issues in past relationships?
Notes
Current Relationship
(Psychosexual Therapy Intake Form)
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Any separations? Affairs?
First sexual experiences with current partner?
Any problems then or after living together?
Where did you live first together? Did moves affect?
How do you get on with partner’s parents? Yours?
Impact of children on relationship?
Any fertility/pregnancy issues?
Was partner present at births?
Any emotional difficulties around birth?
Contraception issues?
Plans for future children?
Notes:
Sexual Functioning in Present Relationship
(Psychosexual Therapy Intake Form)
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Frequency and timing of sex.
Who initiates? How? Response?
Forms of intimacy?
Preferences (lights, positions, clothing, toys, fantasies).
Mutual stimulation?
Difficulties (erection, ejaculation, lubrication, orgasm).
Use of books/videos/toys?
Impact of menstruation/HRT?
Notes:
Desired Sexual Functioning
(Psychosexual Therapy Intake Form)
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If you could have any partner and any setting, what would you choose?
How do you think your partner would answer this?
Notes:
General Relationship
(Psychosexual Therapy Intake Form)
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What interests do you both share?
What do you enjoy separately?
Do you spend time with others together?
Do you spend time alone together?
Is there anything you can’t talk about?
Notes:
Self-Perception
(Psychosexual Therapy Intake Form)
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How would you describe your personality and qualities?
How do you feel about your appearance?
General health, habits (surgery, drugs, alcohol, smoking).
Stress and coping methods?
How easily do you express emotions (anger)?
What does your partner like/dislike about you?
How do you feel about being a man/woman?
How do you see yourself as a partner/parent?
What ambitions do you have?
Notes:
Summary & Therapy Goals
(Psychosexual Therapy Intake Form)
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Anything missed that would help therapist understand you?
Any questions that affected you strongly?
Anything you’d rather your partner not know?
Feelings about future of relationship?
How would you describe your sexual problem?
How would your partner describe it?
Goals and expectations of treatment (for yourself, partner)?
Therapist’s diagnosis, notes on predisposing, precipitating, maintaining factors.
Notes:
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