本堂课 我们来讲讲性史记录和评估 In this segment, we'll discuss sexual history taking & assessment.
就像在其它咨询领域一样 Just as in other areas of counseling,
很重要的是 要记住在性咨询中 it's important to remember regarding sexuality counseling,
评估和干预是相互交织的 that assessment and intervention are intertwined.
在整个评估干预过程中 Across the processes of assessment intervention,
你要做历史记录 这点与生物-心理-社会评估没有什么不同 you will do history taking, not dissimilar from that bio psychosocial evaluation.
历史记录身可以被视为一种干预 History taking in and of itself can be viewed as an intervention
这有助于来访者了解和调整自己 that helps the client to understand and adjust their own personal.
相反地 对一个除了传递具体信息 如首次性经历的年龄 Conversely, as someone who's relaying their sexual history in addition to concrete information,
还讲述性史的人 such as age of first sexual experience,
评估向咨询师或治疗师传递信息的方式很重要 it is important to assess the ways that the information is communicated to the counselor or the therapist.
非语言线索可以传达很多信息 这些信息在评估中很重要 And nonverbal cues can communicate a lot of information that are important in terms of assessment.
信息在第一次接触时就开始传递 This information begins to be conveyed in the first contact.
传统上 是通过电话进行的 Traditionally, this was over the phone more frequently,
现在的第一次接触通过网络 now first contact occurs online.
了解对方在最初的电子邮件或消息中提到或没提到什么非常重要 It's significant to know what the person does or does not mention in their initial email, or message.
作为一名咨询师 接受额外的性培训的好处之一 One of the benefits of having extra training in the area of sexuality as a counselor
是很多人找你是解决性以外的问题 is that many people will come to you with a non sexual complaint.
但在治疗或评估过程中 And in the course of treatment or the course of evaluation,
会发现很明显性是所面临的挑战的一部分 it will become clear that sexuality is a component of the challenge,
对于披露的有关性的信息 要能够接受 you will be able to have the capacity to tolerate the revelation of sexual information.
我们将在后面讲到隐式模型 And as we will discuss later with the implicit model,
你将能够帮助引导人们采取一些非常有用的干预措施 you'll be able to help guide people towards some very useful interventions.
在性方面 性史记录 In terms of sex, sexual history taking,
重要的是不仅要考虑行为 it's important to account not only for behaviors,
还要考虑到这个人在一生中 but beliefs and attitudes that the person has or has received
对于性持有或已经接受的信念和态度 over the course of their life regarding sexuality.
我们之前讨论过的一个例子是对自慰的态度 An example we've discussed before is attitudes about masturbation
以及关于自慰的信息 and messages regarding masturbation.
其它重要的信念和态度 Other beliefs and attitudes important to consider are those
与宗教有关 这是美国文化中关于婚前性行为的态度的一个很好的例子 related to religion and a good example of that in American culture attitudes around premarital sex.
评估包括对不同类型评估工具的使用 Assessment may include the use of different kinds of assessment instruments
就像在其他咨询领域一样 你可以使用经过验证的筛选工具来获得更好的感觉 just as in other areas of counseling, you may use a validated screening tool to get a better sense,
特别是对于某些无法用语言表达经验的来访者 especially for certain clients who are not as able to put their experience in words.
这可能会帮助你更好地了解问题的范围 This may help you get a better sense of the scope of the problem.
也是评估最重要的部分之一 And one of the most important parts of assessment,
特别是在早期阶段 我们正在一起创造一种共同语言 and especially in the early stages is co creating a shared language.
这不仅仅是治疗师和来访者之间的共同语言 This is not just the shared language between the therapist and the client.
如果在开展夫妻咨询时 在夫妻和治疗师之间使用一些共同语言 If you're working with a couple of shared language between the couple and the therapist,
并确定个人 夫妻和治疗师一起应对的挑战 and a shared framing of the challenges that the individual or couple of therapists agreed to address.
在初次接触期间 解决以下问题可能会有所帮助 During the initial contact, it can be helpful to address the following questions.
为什么是现在 什么事件导致您在此时寻求帮助 Why now? What events led to you seeking help at this point in time?
这可能有帮助 能透露更多信息 可能是关于 This can be helpful and that it will elucidate further information about maybe a crisis
常常要提到的危机 that led to listen more often times,
如果是在做夫妻咨询 那可能是讨论离婚 if you're working with a couple it's a discuss a discussion about divorce within a couple
或是某种危机 that happened or some sort of crisis,
或者是婚外情 成了压死骆驼的最后一根稻草 such as an affair that led to the last straw, so to speak.
现在我们正在寻求帮助 And now we're seeking help.
关于咨询的过程和结果 What expectations does each individual or partner have
每个人或是伴侣都有什么期待 about the process and outcome of counseling?
有时了解人们以前是否接受过咨询或治疗是很有帮助的 It's helpful to understand sometimes if people have been in counseling or therapy before.
我喜欢问 如果他们过去接受过治疗 I like to ask people, if they've been in therapy in the past,
哪些他们喜欢 哪些有用 哪些没用 what they've liked, what has worked, what hasn't worked,
他们希望从新的治疗关系中得到什么 what they're hoping to honor from new therapeutic relationship.
这也有助于消除一些神话 This can also help to dispel some myths,
如果来访者对治疗或咨询的期待与媒体的描述有关 if expectations are related to portrayals of therapy or counseling, media,
但实际上没有自己的经历 and the person does not actually have their own experiences.
通常 流行文化中对治疗和咨询的描述不是很准确 Often, the way that therapy and counseling is portrayed in popular culture is not very accurate.
在这一点上 设定明确的期待是非常重要的 It's very important at this point to work to set clear expectations.
消除这些领域的任何神话 And to dispel any myths in these areas
也有助于询问他们为什么向你寻求帮助 can also be helpful to ask why they're seeking help with you in particular,
或者为什么出现在此时此地 or why if you're in a clinic setting like this context, like this place,
因为这是一种更间接的方式来了解他们的希冀和期待 because this can be a more indirect way to get at some of their hopes and expectations,
也能消除任何不切实际的期待 and again, dispel any unrealistic expectations.
还给你提供了一个机会解释你的背景 It's also helpful in terms of giving you as the provider and opportunity to explain your background.
例如 人们会来到我的诊所 会看到 For example, people will come to my practice and see that
我有博士学位 会默认我是心理学家 I have a doctoral degree and assume that I am a psychologist,
或者在某些情况下 精神科医生 or in some instances, a psychiatrist.
花时间向人们解释 And it's very helpful to take time to explain to people
我的背景和接受过的训练 what my background and training are
以及我能提供的服务是非常有帮助的 and the kinds of services that I can offer.
也许刚开始接触最重要的就是 Perhaps the most important part of the initial contact is
如果你决定接访 就和个人或夫妻建立连接 joining with the individual and couple if you decide to work with them.
这不仅适用于性咨询 也适用于一般咨询 This is true not just for sexuality counseling, but for counseling in general.
这在性问题上更加突出 So, this is heightened regarding issues of sexuality
因为人们常常会因为透露自己的私密信息而感到羞耻 because people often come in with heightened feelings of shame,
内疚 沮丧 愤怒 尴尬 guilt, frustration, anger, embarrassment, about revealing such intimate information about themselves.
在这一点上与个人或夫妻建立连接也很重要 It's also important to join with the individual or couple at this point,
因为通常 人们已经独自挣扎了很长时间 because oftentimes, people have struggled on their own for an extended period.
从历史上看 夫妻通常会等上几年才寻求治疗 他们的关注点在改变 Historically speaking, couples would wait several years typically before seeking therapy, their focus is changing.
最近的研究表明 平均等待时间为两年 And more recent studies show that the average length is two years.
根据我自己的执业经验 我会说等的时间在缩短 In my own practice, I would say that this is decreasing.
我认为有不同的因素在起作用 And there are I think, different factors that play into this,
在美国接受心理健康治疗的污名化程度降低了 as getting mental health treatment has become less stigmatized in the United States.
在新冠大流行期间 冲突变得更加激烈 And conflicts have become heightened during the covid 19 pandemic
因为人们被迫与伴侣呆在家里 when people have been forced to stay in their homes with their partners.
但建立连接是很重要的 因为人们经常来咨询 治疗 But it's important to join as people often come to counseling, therapy,
因为他们别无选择 失去了希望 because they've run out of options and they've lost hope.
重要的是与他们面对面 确认他们的挫折感 And it's important to meet with them to validate that frustration,
带来一点希望 and to offer a bit of hope, though,
不过设定现实的期待是非常重要的 it's very important here to set realistic expectations
不要承诺能给他们提供不可能的东西 and not to promise that you can offer them impossible things.
你不能抹去一段婚外情或过去发生的事情 You can't erase an affair, or things that have happened in the past,
但你可以提供现实的期待和现实的希望 but you can provide realistic expectations and realistic hopes
这将推动人们朝着共同努力解决问题的方向前进 that will move people in the direction of working together toward a solution.
我在这里插入了一个案例公式模板 I've included here a sample case formulation template,
如果认为有帮助的话 请随意使用 feel free to use this, if it's helpful.
这种框架也会有帮助 This kind of framing can be helpful again,
不仅仅是在处理性问题时 not just when working with sexual problems,
而且也适用于接待夫妻来访者的一般咨询 but when working with couples in general.
了解每个人对问题的看法很重要 It's important to get the perspective of each person on the problem,
一些治疗师会从每个人的角度了解这种看法以及对每个伴侣的个人意义 some therapists up to get this perspective and an individual meaning with each partner.
其他人会同时这样做 Others will do this in tandem.
你将及时决定在风格和务实方面对你有用的方法 And you will decide in time what works for you both stylistically and pragmatically.
理想情况下 当面对夫妻来访者时 Ideally speaking, when working with couples,
我喜欢在治疗早期开展个体治疗 I like to have an individual session usually early in the treatment.
通常 第一次治疗我会跟夫妻双方一起 Typically, I'll see a couple together for the first session
第二次和第三次会各见一个人 然后再一起见 and see an individual for the second and third sessions and then meet again,
虽然这并不总是可行的 though, this isn't always feasible,
取决于时间安排和成本 depending on scheduling and cost.
这可能很有启发性 It can be very revealing.
稍后我们会通过一个案例来说明这一点 And we'll go over a case example a bit later that demonstrates this,
它能很好地揭示每个伴侣是如何构建问题的 but it can be very revealing how each partner frames the problem.
在第一次见面时 解决有关知情同意的问题也很重要 It's also important in the first session to address issues surrounding informed consent.
在美国 各州的知情同意规则基本一致 In the United States, informed consent rules are generally consistent across states
尽管每个州都有一些细微差别 though there are some nuances in each state.
例如 对保密性的限制 For example, limits to confidentiality,
通常包括自伤和伤人的威胁 typically include threats to harm self, others,
或虐待或忽视儿童 or the abuse or neglect of children,
虽然在一些州 这也延伸到财产损失 though in some states, this is also extended to the damage of property.
因此 如果有人意图自杀 杀人或损坏财产 So if someone is suicidal, homicidal or damaging property,
他们的保密权可能就会被法律解除 their coming confidentiality may be violated by law.
性史记录可以非常非常有启发性 Sexual history taking can be very, very revealing.
在面对夫妻来访者时 And again, in working with couples,
这件事最理想是分开进行 this is one of the things that is ideal to do separate.
换言之 一方的性史 So in other words, there are some aspects of a sexual history
有些方面 另一方可能不熟悉 也可能不知道 that one partner may possess and the other may not be familiar with and may not know.
所以如果我们一起会面的话 结果会适得其反 And so it can be really counterproductive if we're working together,
我没有掌握一个伴侣的完整历史记录 and I don't have a full history of one partner
因为他们不想在伴侣面前谈论某件事 态度 信念或其它事情 because they don't want to talk about an event or attitude or belief or something in front of their partner.
对于性史记录 重要的是创造并保持一个不加评判的环境 For the sexual history taking, it's important to create and maintain a non judgmental environment.
这就是为什么在整个课程中 This is why, throughout this course,
我一直强调了理解自己的偏见 I've really stressed the importance of understanding your own biases,
并更好地处理这些偏见的重要性 and getting a better handle on where those things are.
所以当人们来到你办公室 So that when people come in your office,
他们会告诉你一些可能适合你的事情 and they tell you things that maybe are buttons for you or
或者他们会触动你的神经 让你提前意识到 they hit a nerve that you're able to have some awareness
这样当他们提起某些事情时 so that you can modulate your own body language and verbal language,
你就可以调整你自己的肢体语言和口头语言 when people bring things up.
当人们在治疗时提到敏感问题 It's important when people are bringing sensitive issues,
尤其是围绕性的问题时 especially surrounding sexuality, into therapy
重要的是我们能够调整自己的内在体验和外在表达 that we are able to modulate our own internal experiences and external expressions.
人们可能会预料到 你会感到厌恶 惊讶或震惊 People may anticipate that you will react with disgust or surprise or shock
当他们告诉你一些通常不会被讨论或忌讳的话题时 when they tell you about things that are not typically discussed or taboo subjects.
因此 这是重要的 治疗性的 本身也是一种对他人的干预 And so it's important and therapeutic and a kind of intervention in another itself
如果能够接受这些信息 聆听这些故事 to be able to tolerate that information and to be able to listen to those stories
且没有表现出大惊小怪 或是他们以为的那种反应 without gasping or providing them with that, that anticipated reaction.
在其它类型的虐待案例中也是如此 This is also true in terms of other kinds of instances of abuse.
所以如果你接触过 经历过身体创伤 So people working in areas where you've experienced hearing people's stories of physical trauma,
或者其它虐待的来访者 就会熟悉接受这些信息的重要性 or other instances of abuse will be familiar with the importance of being able to tolerate that information.
不改变身体姿势 让分享故事的人感觉 Without shifting the dynamic so that the person revealing the story feels that
他们必须照顾咨询师或治疗师的情绪 因为故事太可怕了 they have to take care of the counselor or therapist because the story is just so horrible
咨询师或治疗师无法接受 that the counselor or the therapist can't tolerate it.
通过其它方式 你可以帮助营造一种不加评判的环境 Other way that you can help to convey a non-judgmental environment,
特别是如果你要接待不同性别认同和性取向的来访者 especially if you'll be working with people across the spectrum of sexuality in terms of gender and sexual orientation,
可以通过办公室里的陈设来达到目的 is by the things that you have in your office.
比如说 在我的办公室 So, for example, in my office,
有一个书架 里面没包括我全部的藏书 I have a bookshelf, and it doesn't contain my full library.
但非常具体地传达了我想展示的信息 But I'm very specific about what I include to show that
我有知识和经验 接待不同背景 I have knowledge and experience and working with people from a variety of backgrounds,
不同身份的来访者 and with a variety of identities.
与此相关 选择合适的语言 Related to this, it's also important to choose the appropriate language and to do kind of balancing in act
在匹配来访者语言和提供专业科学语言之间取得某种平衡也很重要 between matching client language and providing professional scientific language.
因此 特别是在最初的接触中 So especially in initial contacts,
有一个好的规则 就是不要过于随意 it's usually a good rule of them not to be overly casual.
避免过于科学化是有帮助的 Though, it's helpful to not be overly scientific,
尤其是如果来访者不理解你所用词语的含义时 especially if your client doesn't understand the meaning of the words that you're using.
例如 使用“性交”一词可能会使治疗师与个人或夫妻疏远 For example, using the word intercourse might distance the therapist from the individual or couple,
我们用的是性这个词 这跟文化很相关 we're using the term sex, and again, this is very culturally bound.
这对每种文化来说都是独一无二的 And this will be unique to each culture.
但在美国文化中 使用性这个词更随意 但仍然是专业的 But in American culture using sex is more casual word that still is professional,
但又不会过于随意 比如勾搭或做爱 and not so casual as saying things like hooking up or fucking,
这些词太随意了 尤其是在早期的咨询中 which would be considered overly casual, especially in an early session.
使用开放式问题很有帮助 Use of open ended questions are really helpful.
在咨询过程中也是如此 This is true, again, across counseling sessions.
开放式问题很有帮助 Open ended questions are helpful
因为它提供了一些结构 人们经常带着极大的焦虑来咨询 because it provides some structure people oftentimes come in with a great deal of anxiety.
并不是每个人都能自由地谈论他们的问题 And not everyone is able to just start talking freely about their problems.
所以能够提出问题很重要 So it's important to be able to ask questions,
通过提出开放式问题而不是封闭式问题 but by offering open ended questions as opposed to closed, yes, no questions,
真正为人们提供了引导谈话走向正确方向的机会 really provides people with the opportunity to steer the conversation in a direction
这对于处理他们的问题 挑战或者是寻求治疗的原因都是有意义的 that makes sense for their problem or their challenge or what brings them into therapy.
使用这些问题时 重要的是 It's also important when using these questions,
以使性活动和性行为正常化的方式对其进行界定 to frame them in ways that normalize sexual activity and sexual behaviors.
因此 如果你的来访者受过虐待或其它禁忌话题 And so this is something that if you've worked with people who have abuse substances or other taboo subjects,
重要的是假设事情正在发生 对吧 it's important to assume that things are happening, right.
例如 如果你和某人谈论 比如说 他们的药物依赖性 Example would be if you're talking to someone about, say, their medication adherence,
医生不会问 你错过一剂吗 this is one that doctors use quite frequently rather than saying, do you miss a dose?
而是会问 每周有多少天你会错过一剂 You ask them, how many days a week do you miss a dose
这种措辞结构上的变化 是假设大多数人都会错过用药 and that change in frame assumes that most people miss doses
如果必须每天用药 那么大多数人都会错过 正常化这种行为 if you have to take medication every day, most people miss and normalizes that,
因此 在承认他们错过用药时 羞耻感就会减少 so that there is less shame, associated with acknowledging that they've missed some doses,
他们就会更加诚实 and they can be more honest.
会给你提供一些更准确的信息 This will give you some more accurate information.
所以 在性方面 与其问别人十几岁时是否自慰 So, in terms of sexuality, rather than asking someone did you masturbate as a teenager,
可能问 第一次是怎么了解到自慰的 you might say, how did you first learn about masturbation?
然后在结构上 再一次 And then in terms of structure, again,
这适用于针对不同类型的挑战和问题进行评估或咨询 this is true for in taking assessment or across counseling for different kinds of challenges and problems.
但一般来说 从最不敏感的信息过渡到最敏感的信息是一条很好的规则 But it's generally a good rule of them to move from least sensitive information to most sensitive information.
所以在开始阶段 在最初的谈话开始时 So in the beginning stages, the beginning of the initial conversation,
你可能想对人更随意一点 you might want to be a bit more casual with people,
确保能让他们放松一些 make sure that you're able to put them somewhat at ease,
从一开始 设定明确的期待 有助于降低焦虑 and start by one, setting clear expectations so that that helps to lower the anxiety of it,
只询问一般信息 人们以前回答过的问题 and asking just general information, questions that people have answered before
比如你结婚多久了 你在哪里长大的 such as how long have you been married? Where did you grow up?
从一般信息到敏感信息 general information to the most sensitive information.
询问性史 So asking about sexual history,
特别是询问性虐待史 and especially asking about history of sexual abuse,
把它放在后面的谈话中问很重要 is important to put that later in the conversation,
这样 来访者会更轻松 更容易提供准确的信息 so that someone is more at ease and more likely to give you accurate information.
他们不仅更可能提供更准确的信息 Not only are they more likely than to give you more accurate information,
而且可能更能容忍和控制 but they're likely more able to tolerate and to regulate.
到那时 治疗师已经与来访者或夫妻建立了一些连接 And the therapist by then has done some joining with the client or couple
如果再次出现任何失控 就能够提供帮助 and will be able to help if there is any dysregulation to ground things again.
所以这个三角形 我想从最不敏感到最敏感 So this triangle here, I like to think of least sensitive to most sensitive,
建立一些基础之后再回来 but then I like to come back out, right with some grounding.
最后回到不那么敏感 更注重目标的状态 And then moving back to less sensitive and more goal oriented at the end.
在这张幻灯片上 我提供了一些重要的基本信息 On this slide, I've included general information that is important to get
记录性史时 when you're taking a sexual history.
不必严格按照这个顺序 This is not in a rigid order.
我鼓励你根据个人或夫妻的实际情况 And I would encourage you to change the order depending on the individual or couple,
以及他们来咨询的原因调整顺序 and the reason they come in.
例如 这里我列出了当前的功能和满意度 So for instance, here I've listed current function and satisfaction,
性功能和满意度 sexual function and satisfaction.
那么 在当前的性关系中 个人或每一个伴侣是否能表现得令人满意呢 So is the individual or each partner able to perform satisfactorily in the current sexual relationship?
如果抱怨是关于性的 那么从这里开始可能是有意义的 This may make sense to start with if the complaint is sexual,
从这里开始可能没有意义 很可能从这里开始没有意义 it may not make sense to start here, most likely will not make sense to start here,
如果主要抱怨或最初抱怨不是关于性的 if the chief complaint or initial complaint is not sexual.
同样 从最不敏感的信息到最敏感的信息 And again, in terms of working from least sensitive to most sensitive information.
在这种情况下 你可能想先谈谈关系史 In that case, you might want to talk first about the relationship history.
关系的持续时间 So the duration of the relationship,
关系中的重大事件 major events in the relationship,
结婚 离婚 分居 怀孕等 marriage, divorce, separation, pregnancies, and so on and so forth.
伴侣的职能和满意度 Partner function and satisfaction,
那么 每个伴侣都能够刺激并满足对方吗 so is each partner able to stimulate and satisfy the other?
所以这同样重要 So this is important, again,
如果你的来访者是一对夫妻 if you're working with a couple,
这不仅有助于确定性功能障碍是否跟情境有关 and this will help to suss out not only if the in terms of sexual dysfunctions if this is situational,
还有助于提供每个伴侣 but it will help to give information about each partner's perspective of
对关系进展的看法 how things are going in the relationship.
解决避孕的影响很重要 It's important to address effects of contraception.
我们特别讨论激素避孕的影响 Again, we discuss the impact of hormonal contraception in particular,
以及这对性欲的影响 and how this may impact libido.
如果在你们的关系中有过怀孕 If there have been pregnancies during your relationship,
影响性满意度的因素就是夫妻间的性生活频率 the effects that these have had on the sexual satisfaction are the frequency of sex in the couple.
疾病 其它药物 衰老以及与衰老相关的正常性反应变化 illness, other medications, aging and normal sexual response changes associated with aging.
同样 在接待夫妻来访者时 Again, in working with couples,
跟双方单独交流可能会有帮助 it can be helpful here to interview each person individually.
应特别注意强奸 Special attention should be paid to incidences of rape,
猥亵和其它创伤性事件 流产 molestation, and other traumatic events, miscarriages.
而且 这些信息更有可能会在与咨询师或治疗师 And it is more likely that this information will be brought to the counselor or therapist
单独会话时提到 而不会在与夫妻同时会话时谈起 in an individual session than in a couple session.
虽然在很多情况下 来访者夫妻都知道 Though there are often instances in which the couple comes in with this knowledge,
双方都认识到 这是主要的抱怨 both partners have this knowledge and that is the chief complaint is,
她讨厌和我做爱 that she has an aversion to having sex with me
因为她在我们恋爱之前有过性创伤 比如说 because she had this sexual trauma before our relationship, as an example.
最后 当前的性问题和困难 And finally, current sexual concerns and difficulties.
所以 取决于个人或夫妻来咨询的原因 So, again, depending on what brings the individual or a couple to you,
这可能是一个或多或少合乎逻辑的开始 this might be a place that is more or less logical to start.
这也是夫妻向治疗师询问性功能问题的机会 This is also an opportunity for the couple to ask the therapist about sexual function in general.
再次 在美国文化中 Again, in American culture,
很多人有不准确的医学信息 assuming that many people have inaccurate medical information,
特别是关于性反应 什么是常态 especially regarding sexual response, what is normative,
什么是正常的性欲 等等 what is a normal libido, and so on, and so forth.
所以这对他们来说是一个从别人那里获得好信息的重要机会 So this is an important opportunity for them to get good information from someone
世卫组织是准确医学信息的可靠来源 who is a reliable source of accurate medical information.
在获取更详细的历史时 And then in terms of getting a more detailed history.
了解问题的发病时间和严重程度很重要 It's important to get the onset duration and severity of the problem,
再次回顾精神障碍诊断与统计手册和修订版中 针对不同的性功能障碍的内容 again, thinking back to the DSM and the modifiers, for the different sexual dysfunctions.
解决诱因很重要 诸如孩子出生和疾病 It's important to address contributing factors, such as the birth of a child and illness.
了解解决这个问题所做的尝试的完整历史很重要 And it's important to get a full history of previous attempts to solve the problem.
如前所述 了解个人或夫妻中的每个人 As discussed, it's crucial to get for the individual or each individual within the couple
性发育的详细历史很重要 the detailed history about their sexual development.
所以回想一下整个生命周期中的性发育 So thinking back to sexual development across the lifespan,
鼓励来访者就像我鼓励你反思自己的发育情况一样 and encouraging your clients as I've encouraged you to reflect on your own development,
童年时得到的最初信息 家庭信念体系 文化和宗教信仰体系 the early messages that you got in childhood, family belief systems, cultural religious belief systems.
青春期的性经历 第一次自慰 青春期开始 Sexual experiences in adolescence, first masturbation, onset of puberty.
青春期是提前还是推迟 Was puberty onset early or delayed,
这对青少年早期约会经历有什么影响 what impact does this have on the person in adolescence for early dating experiences,
对性经历的影响呢 for sexual experience?
再次强调 在这里提出开放式问题会很有帮助 And, again, it can be helpful here to ask open ended questions,
提出使性行为正常化的问题 并邀请来访者向你提问 to ask questions that normalize sexual behavior and to invite your clients to ask you questions.
在我们的文化中 当被问及第一次性经历时 So when asked about first sexual experience in our culture,
通常 人们回答时会扯开话题 会说 oftentimes people will kind of waffle when they give you an answer and say,
你说的性经历是什么意思 well, what do you mean for sexual experience?
我第一次给别人手淫 口交 The first time that I gave somebody a handjob, or a blowjob,
或者是第一次插入式性爱 or the first time I had penetrative sex,
因此这可以成为讨论通常将性定义为插入性行为 and so that can be a helpful point of discussion to talk about cultural attitudes and values
的文化态度和价值观的有用讨论点 that often define sex as penetrative sex.
这让你有机会告诉他们所有这些性经历的信息 And it gives you the opportunity to give them information about all of this experience being sexual.
当人们被要求反思性发育并回到童年时 This is especially true in terms of childhood when people
尤其如此 are asked to reflect on sexual development and to go back to childhood.
通常情况下 反应是 你什么意思 Oftentimes the reaction is what do you mean?
童年没有性 There was no sex in childhood?
这是一个禁忌话题 It's a taboo subject.
因此 在这里重要的是 了解清楚你问问题时的真实意思是什么 So it's important here to educate about what you mean when you ask the question.
我的意思是 你获得的最初信息是什么 关于你的身体 So what I mean is, what were early messages that you got about your body, or bodies in general,
或者性别信息 关于女孩应该做什么 男孩应该如何表现 or gender messages, about what girls should do, or how boys should behave.
然后了解成年史 And then getting a history of adulthood.
这对人们来说通常更直观一些 This, this is usually a bit more intuitive for people.
很多时候 他们不得不向全科医生 Oftentimes, they've had to do some version of this with their general practitioner,
或妇科医生解释不同的性经历 他们之前的性伴侣 or gynecologist in terms of explaining different experiences, they've had partners.
在这里 重点是 如果你从某人那里得到这样的答案 Here, it's important if those are the kinds of answers that you're getting from somebody,
比如 在询问过去的性关系或约会历史时 like, for example, you ask about past sexual relationships or dating history.
如果有人回答 哦 我约会过男人和女人 我和他们都做过爱 And if someone just says, Oh, I date, men and women and I have sex with both. Okay.
好 现在就是提出更多开放式问题的时候了 This is a time to ask more open-ended questions.
为了更好地了解各种关系 And to get a better sense of the kinds of relationships,
关系的质量 the quality of the relationships,
一个人对他们关系的感受 他们的感受 how a person felt, about their relationships, how they feel.
回顾他们的关系 Looking back at their relationships,
很多时候 都有未尽事宜 oftentimes, there's unfinished business and
人们会比较现在的关系和过去的关系 people will compare their current relationship to past relationships.
在这方面 接待夫妻来访者时很重要 And it's also important here in terms of working with couples,
特别是为了获得关于婚外情的信息 especially to get information about any extra marital relationships.
现在 这可能非常有挑战 Now, this can be very challenging.
如果你正在接待一对夫妻来访者 这会在单人会面时提起 If you're working with a couple, and this comes up during an individual session.
不同的治疗师有不同的规则 Different therapists have different rules.
我想说 一般来说 制定规则是有帮助的 And I would say that, in general, it can be helpful to have rules.
这有助于在与夫妻的第一次谈话中设定明确的期待 And this can be helpful to set these clear expectations in the initial session with your couple
我是否会保守秘密 that I do or do not hold secrets.
换言之 如果在个人会话中谈到了对方不知道的事情 So in other words, if something in our individual session comes up that the other person doesn't know,
你愿意保守这些秘密吗 are you willing to hold that information?
所以这可以很微妙 对吧 So this can be more nuanced too, right?
如果有人在个人会话中告诉我他们受到了性侵犯 If someone tells me in individual session that they were sexually assaulted,
他们不想让伴侣知道 and they don't want their partner to know,
或者他们小时候被亲戚猥亵过 or that they were molested in childhood by a relative,
他们不想让伴侣知道 and they don't want their partner to know,
因为还和家人有联系 because we still have contact with the family,
我可以说 好吧 这是我们可以保守的秘密 I may say, okay, that is a secret that we can hold.
我会鼓励你考虑 And I would encourage you to consider the potential benefit of
把这些信息告诉伴侣的潜在好处 bringing this information into the relationship,
不过 对我个人来说 作为一名接待夫妻来访者的治疗师 though, for me personally, as a therapist working with couples,
我不会保守外遇的秘密 I will not hold the secret of an affair,
因为我认为这对解决夫妻之间的问题是适得其反的 because I see it as counterproductive to addressing the couple problem.
换句话说 一些治疗师愿意在个人治疗中听到这件事 So in other words, some therapists are willing to hear about the affair in the individual session.
如果那个人说我不能告诉我的伴侣 And if the individual says I could never tell my partner,
这会终结一切 我知道后果会很糟糕 this will end everything, I know will go terribly.
治疗师可能会说 好吧 我们不会告诉伴侣 The therapist may say, okay, we won't tell the partner.
这是我鼓励你们现在去反思的事情 This is something that I encourage you to do some reflecting on now.
因为如果你接待夫妻来访者 就会遇到这个挑战 Because if you work with couples, this challenge will come up.
对你愿意保密的信息设定明确的期待非常有帮助 也很重要 And it's very helpful and very important to set clear expectations about what information you're willing to hold.
治疗师会为来访者保守哪些秘密 And what secrets are secrets that the therapist will hold with and for the clients
哪些事你不愿意做 以及哪些事你认为对治疗有反作用 and what you're not willing to do and what you think is counterproductive to the therapy.
再次强调 这确实与设定现实的目标和期待有关 And then again, this relates really to setting realistic goals and expectations.
那么人们认为问题会消失吗 So do people think that the problem is going to go away?
人们是否经常失去希望 Do people, have people lost hope oftentimes,
挑战不在于人们来接受治疗 the challenge is not that people come to therapy
认为一切都会被神奇地修复 and think that everything is going to be fixed magically,
而在于他们真的放弃了希望 不期待任何改变 but that they really have given up hope and don't expect anything to change.
因此 在致力于寻找解决方案时 So it's important to really evaluate their interests,
真正评估他们的兴趣和认同很重要 their buy-in, in terms of working toward a solution.
使用不同的工具 评估工具 In terms of using different tools, assessment tools.
以防有人不熟悉基因图谱 For anyone unfamiliar with genograms,
我在这里包括了基本的基因图谱和符号 I've included here basic genograms symbols.
这是一个用于收集信息的评估工具 This is an assessment tool useful for gathering information
直观地表示不同的信息 and visually representing different messages,
态度以及个人历史中代际发生的重大事件 attitudes and major events that happened intergenerationally in someone's own personal history,
这对夫妻或个人的第一次咨询很有帮助 and this can be really helpful for couples or individuals in the first session.
这样他们就可以直观地看到不同的信息 以及随着时间的推移而出现的挑战 So that they can visually see the different messages, challenges that have occurred over time.
所以性基因图谱 只是一个工具 So for the sexual genogram, this is just taking the tool,
基因图谱和对性的关注 the genogram and focusing on sexuality.
性信息 性别虐待 外遇 So, again, sexual messages, gendered abuse, affairs.
我在这里包括了一个样本 So I've included a sample here.
正方形代表男人 So the squares represent men,
圆圈代表女人 the circles represent women,
x表示此人已死亡 the x across means that the person is deceased.
这只是一个简单的例子 双方框里的人 And this is just a simple sample that shows the person with the two boxes,
是你治疗室里的来访者 this is your person in your therapy room.
我们可以看到 来访者父母 And so we can see the parents of the person in your therapy office
有几次婚外情 had several extramarital affairs,
可以想象一下 在治疗室里 and that they are now you can imagine, maybe in your office,
他们来咨询是因为他们觉得有与父母关系相关的未解决的挑战 they're there because they feel like they have unresolved challenges related to their parental relationship there.
举个例子 我有一个来访者 父亲二十年前去世 母亲最近去世 As an example, I'll take a client whose father died 20 years ago, mother recently died,
现在在反思和关注 and so is now reflecting and concerned that the kinds of conflicts
在自己婚姻关系中的冲突反映了父母间的一些冲突 that they're having in their own marital relationship are mirroring some of the conflicts that their parents had.
这个人担心配偶有外遇 And the person is concerned that their spouse is having an affair.
现在我们可以看到 如果能让配偶也接受治疗 And now we can see if we bring spouse into therapy,
他们接收到一些信息 that they got certain messages,
不在家里讨论性 sex was not discussed in their home, rolling up,
女方的母亲以及外祖母 women in the mother's family and maternal grandmother,
接受的信息都是女人待在家里 they both got the message that they were to stay at home.
现在她置身职场 And now she is in the work environment.
她认为丈夫会感受到她的威胁 And she's assuming that her husband feels threatened by her.
这就给他们的关系带来了问题 And so that's creating problems in their relationship.
同样 这只是一个样本 Again, this is just a sample.
但这真的很有帮助 因为家族史 性史都很复杂 And this can be really helpful because family histories, sexual histories are very complex.
它们存在于人们的思想和情感世界中 And they exist in people's minds and in their emotional worlds.
它不仅是一种非常有用的评估工具 And it can be a very helpful not only assessment tool,
本身也是一种干预手段 but intervention in and of itself.
帮助个人或夫妻看到他们面前 To help the individual or couple see in front of them
经历过的或是经过代际传递的所有挑战 all the challenges that they have either lived through or through the intergenerational transmission
经历过的二手或三手创伤和挑战 of trauma and challenges experienced second or third hand.
我在这里提供了另一个经过验证的筛选工具样本 I've included here another sample of a validated screening tool.
有许多经过验证的筛选工具专门用于夫妻咨询 There are many validated screening tools that are specific for working with couples,
还有很多是针对性问题的 and there are many that are specific for working sexual problems.
这是二元性沟通量表 This is the dyadic sexual communication scale,
是一种有助于评估个人及其伴侣如何就性进行沟通的工具 and it's a tool that helps to assess how individuals and their partners communicate about sex.
同样 这些工具也很有用 Again, these tools can be helpful.
你可以把它们交给来访者让他们在咨询之后做再带来 也可以现在做 You can give them to your clients to do out of session and bring in or now
取决于人们对电子邮件和电子邮件安全性的满意度 depending on people's comfort with email and email security.
人们可以把它们发给你 或者如果你有一个安全的在线门户网页 People can send them to you or if you have a secure portal online,
人们可以通过它在线提交 你可以事先得到这些信息 people can submit them through that and you can have this information beforehand.
然后在下一次咨询中 讨论结果和意义 And then in the next session, discuss the results and the meaning.
如果你选择对个人或夫妻使用评估工具 If you choose to use assessment tools with individuals or couples,
与他们分享这些结果非常非常重要 it's really, really vital to share these results with them.
有时会发生的一个重大失误是 工具已经给了来访者 A big misstep that sometimes happens is the tool is given,
来访者在咨询结束后填写 the person completes it out of session,
在两次咨询之间发生了别的事 and then something else happens between sessions.
然后下次咨询时都在讨论这件事 And then we spend the whole session talking about this,
这场新的危机 从来没有讨论过评估结果 this new crisis and never acknowledged the results,
或者结果让治疗师感到不舒服 or the results make the therapist uncomfortable at where they're,
结果在某种程度上是消极的 they're negative in some way.
治疗师很关心 And the therapist is concerned about
这将如何影响个人或夫妻接受治疗 how that may impact the individual or couples buy-in to the therapy.
但是分享信息是非常重要的 否则有什么意义 But it's very important to share the information because otherwise, really, what's the point?
同样重要的是要认识到 就最有效的筛查工具而言 It's also important to acknowledge that in terms of most validated screening tools,
尤其是在美国更加广泛使用的经过验证的筛查工具 especially more widely used validated screening tools in the United States,
一些抑郁症筛查工具非常常用 some of the depression screening tools are very commonly used.
而那些更好奇的来访者 可能自己已经算过分了 And for your more curious clients, they will probably have already scored this themself.
因此 就结果进行非常坦率和明确的对话是很重要的 And so it's important to have a very frank and explicit conversation about the results
这样就可以消除任何迷思 so that you can dispel any myths.
例如 我最近请某人填写了一份分离体验清单 So for instance, I recently asked somebody to fill out a dissociative experiences inventory.
在下次咨询时她说 让我们谈谈结果 And she came to our next session and said, so let's talk about the results.
我对她有点了解 我问她 你自己查过了吗 And knowing her a bit I said, did you look them up yourself.
她有 所以我们讨论了她对自己得分的解释 And she had, so we had a discussion about her interpretation of her own scoring,
以及分数意味着什么 and what that meant.
这样的对话完全不同于如果我刚才只是说 这是你的分数 And that was a very different conversation than if I had just said, this is your score.
它意味着什么 And this is what it means, right,
她自己已经做了一些工作 she had already done some of that work herself.
所以打破她关于分数意味着什么的假设很重要 So it was important to break down her assumption about what that score meant,
而不是 我进来 假装很了解她的经历 instead of me, just coming in and pretending to be the expert of her experience,
然后说 数字是这个 所以意味着那样 and say, the number was this, therefore that.
这是另一个样本 性满意度调查 This is another sample, the sexual satisfaction survey,
你可以在网上做 you can actually do this online,
可以付费使用 在线生成报告 you can pay for each time that you run the report online.
同样 使用这些量表也有一些好处 And again, there, there is some benefit to using these scales,
一些来访者会发现这些非常有用 非常有效 some of your clients will find these really helpful, really validating.
重要的是不对量表深入研究 So it's important to not read all the way into this or
不要让经过验证的工具成为对问题的 not have the validated tool become the entire assessment,
整体评估或全部框架 or the entire framing of the problem.
所以你可以在这里看到这个清单被分解了 So you can see here that this inventory is broken down.
而且它是非常以问题为导向的 And it's very problem-oriented.
它在某些方面可能是有害的 And so it can be harmful in some ways.
如果这个人拿到了结果 第一反应是 If the person gets their results, and it's like,
哦 天哪 一切都是问题 一切都很糟糕 oh, my goodness, everything is a problem. Everything is terrible.
我为什么还要烦恼 Why am I even bothering?
同样 如果你要使用这些工具 So again, if you're going to use these tools,
有选择地使用它们是非常重要的 it's very important to use them selectively.
为了说明你为什么要使用它们 And to give context to why you're using them,
以及它们如何帮助你 and how they will contribute to your understanding
以及个人或夫妻去理解问题 and the individual or couples' understanding of the problem.
举个例子来说明了解个人对问题的看法非常重要 As an example of the importance of getting individual perspectives on the problem,
我在这里举一个简和山姆的例子 I have included here a case example of Jane and Sam.
一对异性恋夫妻来咨询 简和山姆 So a heterosexual couple come into your office, Jane and Sam.
在山姆看来 简再也不想做爱了 And from Sam's view, Jane never wants to have sex anymore.
她对自己的事业和孩子更感兴趣 She's more interested in her career and the children.
在简看来 山姆不想再和我在一起了 And from Jane's view. Sam doesn't want to be with me anymore.
他每天晚上工作到很晚 He stays late at work every night.
也许她怀疑他有外遇 And maybe she's suspecting that he's having an affair.
你的工作是在第一次咨询时 和夫妻一起 Your job is in that initial session, to join with a couple,
在夫妻和你之间创造一种共同语言 to create a shared language between the couple and yourself
创造一种共同观点 影响你们的共同目标 and to cocreate this shared view which will then influence your shared goals.
所以在这里 共同观点不是简不想做爱 山姆有外遇 So the shared view isn't that Jane doesn't want to have sex, Sam is having an affair.
共同观点是 我们没有精力 The shared view is that we haven't had the energy or really been able to
从第一个孩子出生起就没能再抽出时间做爱 make time for sex since the birth of our first child.
那么之后 你们的目标是什么呢 So then what might your goals look like after that?
你们的目标可能是优先考虑性 Your goals might look like prioritizing sex.
你们的叙事重构可能是 Your narrative reframing might be about,
哇 自从我们有了孩子 wow, since we started having children,
我们都觉得压力更大了 要多多工作 we both felt more pressure to work more,
因为托儿费用很高 because childcare is very expensive,
或者孩子去的学校很贵 or the school that we send our children to is very expensive.
所以我们都觉得面临着压力需要赚更多钱 So we both feel like we're under this pressure to provide more financially,
在努力增加收入的时候 and where has our marital relationship and our sexual relationship gone,
我们的婚姻关系和性关系去哪儿了 as we've both worked to try to increase our income.
所以你可以在这里看到 评估和干预是交织在一起的 And so you can see here that both the assessment and the intervention are intertwined.
因此 在创建共享语言的最初阶段 评估和干预 So the assessment and the intervention in that initial session of creating that shared language,
揭示性史 也许是通过性基因图谱 revealing the sexual history, maybe through a sexual genogram,
共同创造可实现的目标 也许是约会之夜 co creating the solvable goals, maybe a date night.
这可能是你给这对夫妻布置的家庭作业 And that might be a homework assignment that you give to the couple.
正如我之前所说 许多干预措施 As I said previously, with many of the interventions,
依赖认知行为疗法 they rely on cognitive behavioral therapy.
所以家庭作业真的很有帮助 So homework can be really helpful.
用这种方式来给咨询收尾非常有用 And it can be really helpful way to end each session
给人们一些具体和有形的东西 by giving people something concrete and tangible,
特别是刚刚谈了 especially after talking about very,
一堆有的没的杂乱无章的内容 花了一小时 一个半小时 kind of ineffectively messy and laden subjects for an hour or an hour and a half,
乃至整整一次咨询的时间 however long your sessions with your clients are.
它可以是真正的基础 It can be really grounding.
目标是给人们布置具体的家庭作业 And you're very goal directed to give people concrete homework.
plissit模型就是这样一个模型 The plissit model is a model that very much does this.
这是从一个人的工作中借用的 This is borrowing from dragging one's work.
你们可以看到 我在plissit模型的前三个阶段加了一个框 And you can see here that I've put a box around the first three stages of the plissit model.
给予许可 有限信息和特定建议 So permission giving limited information and specific suggestions.
作为一名咨询师 这是你的领域 也是你的执业范围 As a counselor, this is your area, and your scope of practice.
除非你接受过高级训练 否则强化治疗 The intensive therapy is unless you have advanced training
用于夫妻治疗 创伤治疗 in providing these kinds of couple therapy, trauma therapy,
将超出您的执业范围 this would be out of your scope of practice.
好消息是人们估计大约90%的性抱怨 The good news is that people estimate that about 90% of sexual complaints
可以在前三个阶段内解决 can be resolved within these first three stages.
所以给予许可 去谈论性挑战 安慰和同情 So permission giving, permission to talk about sexual challenges, reassurance and empathy,
以及承认性是人类经验的一个组成部分 and acknowledgement that sexuality is an integral part of human experience.
再强调一次 这是以正常化的方式来构建你的问题和陈述 So, again, this is framing your questions and your statements in ways that normalize?
什么是正常的人类性体验 允许人们谈论禁忌话题 What is normal human sexual experience, giving people permission to talk about taboo subjects.
这是通过以这种方式构建问题和陈述来实现的 That's something that is achieved by framing questions and statements in this way.
这比仅仅说 And it's much more effective than just saying,
我允许你谈论禁忌的事情更有效 I give you permission to talk about taboo things.
通过问这些问题 通过使用适当的语言 But by asking these kinds of questions, by using the appropriate language,
治疗师或咨询师正在建模 这是可以讨论的 the therapist or counselor is modeling, that this is okay to talk about.
提供有限的信息 Providing limited information,
这可能是你在其他领域的实践中已经做过的事情 this is something that you probably already do in your practice in other areas,
提供心理教育或圣经治疗 so providing psychoeducation or biblical therapy,
给人们可能有用的书 或者可能有用的讲义 giving people books that might be helpful, or handouts that might be helpful.
这真的非常重要 This is really, really important.
正如我所说 在向人们提供关于性的医学准确信息方面 As I said, in terms of giving people medically accurate information about sex,
他们的性器官 什么是正常的性功能 正常的性反应 their sexual organs, what is normal sexual function, normal sexual response.
这是消除关于正常的不同迷思和刻板印象的机会 And this is the opportunity to dispel different myths and stereotypes about what is normal.
很多人担心 人们会把自己与在色情作品中看到的东西相比较 There has been a lot of concern about people comparing themselves to what they see in pornography
尤其是首次接触性行为的年轻人 and especially with young adults having their first exposure to sexuality.
而且 根据色情片获取关于 And, and to sex through pornography and getting information that is very distorted
正常性行为 正常性反应的信息 来进行性行为是非常扭曲的 about what is normal sexual behavior and what is normal sexual response.
因此 提供有限信息是非常重要和有力的 So it's very important and very powerful to give limited information.
有限信息的原因是 And the reason the information is limited is because
它应该是当时需要的特定信息 it should be specific to the information that is necessary in that moment.
所以你在这门课上得到的是相反的 你得到的是广泛的信息 So you're here in this course getting the opposite, you're getting expansive information.
这样你就可以根据自己的知识储备和自己的工具包 And that is so that you have the ability in your own knowledge and your own toolkit
获取必要的特定有限信息 to access the specific limited information that is necessary,
具体取决于个人或夫妻来咨询的内容 depending on what the individual or couple is bringing in to your office.
以及特定建议 And specific suggestions.
所以 从特定信息到特定建议 So again, moving from the specific information to specific suggestions,
所以作业要非常非常具体 非常有针对性 so very, very limited, homework, very focused homework.
你可以在YouTube上找到这些 So you can look some of these things up on YouTube.
并评估什么对你自己执业有意义 更多地了解感官焦点 And assess what makes sense for your own practice in terms of learning more about sensate focus,
这是一种有针对性的家庭作业 行为干预 which is a specific kind of homework, behavioral intervention,
这对有性抱怨的夫妻来说是很有帮助的 that can be quite helpful for couples coming in with sexual complaints.
再说一次 有针对性的作业非常有帮助 And again, it can be very helpful to have homework that is specific
因为人们在接受治疗时 感觉非常不知所措 because people come into therapy, feeling very overwhelmed
感觉他们的问题是如此普遍 是全球性的 压倒性的 没有希望 and feeling like their problem is so pervasive or global or overwhelming and hopeless,
为某人提供非常清晰的参数 本身就是一种非常强大的干预手段 that it can be a very powerful intervention in and of itself to give somebody very clear parameters.
关于他们应该实现的目标 Regarding a goal that they're supposed to achieve
或者他们应该在咨询间隔期完成的任务 or an assignment that they are supposed to complete between sessions
都是很常见的任务 矛盾的是 are very common assignment given that is, paradoxically,
对于没有性生活的夫妻来说 不做爱通常就是成功 usually very successful for couples who are not having sex, is to not have sex.
这实际上是感官焦点的一部分 That's, that's actually part of sensate focus.
在那个阶段 人们经常做爱 And in that stage, people often have sex.
现在 那是失败的家庭作业 Now, that's a failure of the homework.
但在咨询中谈论它很重要 But it's an important thing to bring into the session.
它推动了治疗 这不是治疗的失败 And it moves the therapy along. It's not a failure in therapy.
然后是强化治疗 And then the intensive therapy.
所以对于那些有严重创伤的来访者 So for the people who come to your office with significant trauma,
特别是那些可能符合创伤后应激障碍标准的人 especially, and people that might meet criteria for post traumatic stress disorder,
在我的诊所里 有人因为过去的性创伤而在性生活中游离 people who are, I have someone in my practice now who dissociates during sex because of past sexual trauma.
那种工作需要高阶培训 That kind of work requires advanced training.
在执业中你需要把这类人转介给别人 And so those are the kinds of people that you want to refer out of your practice
如果你没有受过这种训练的话 if you do not have this kind of training.
转介的其它原因包括 Other reasons to refer people out of your practice,
不一定是因为超出了你的执业范围 and not necessarily away from your practice,
正如我们之前提到过的转介 是转介给医疗机构 but, but the referrals that we discussed previously, are most commonly to medical providers.
所以 如果有来访者的咨询内容很明确是关于性的抱怨 你要做的第一件事 So the first thing you want to do if someone is coming in with an explicit sexual complaint,
是转介给他们的全科医生 the first referral that you want to make is to their general practitioner.
如果有人延迟射精 早泄 一般性盆腔疼痛 性欲低下 尤其是新发的 So if someone has delayed ejaculation, premature ejaculation, general pelvic pain, low libido, and it's a new onset,
你会想让他们接受全面医学检查 以排除任何医学原因 especially, you want to refer them for a full medical workup to rule out any medical causes.
最后 我想以你自己的任务结束 And finally, I want to close with your own assignment.
所以我要你完成自己的性基因图谱 So I want you to complete your own sexual genogram.
我想让你花十到十五分钟来做这个 I want you to take about 10 to 15 minutes to do this.
如果你过去没有完成过基因图谱 If you haven't completed a genogram in the past,
这可能会花更长时间 it might take you a little bit longer.
你可以返回到带有不同基因图符号的那一页幻灯片或谷歌一下 You can go back to the slide with the different genograms symbols or Google this.
但我希望你们这样做 然后反思一下这样做是什么感觉 But I want you to do this and to then reflect on what it was like to do this.
你是否学到了什么 If there was anything that you learned or anything
任何让你对自己 你的态度 对性的信念更有意义的事情 that makes a little bit more sense about yourself, and your attitudes, beliefs about sexuality.