Monday, December 8, 1997
10 am. Initial Session with Claire Steven. I got a phone call this morning and set up an appointment for Claire Steven. She's a 22 year old personnel officer for SII. Classically beautiful, she looks more mature than her young age would suggest, with long blonde hair and brown eyes; her beauty is only slightly marred by a slight scar that runs across her right cheek. It looks like a crease that might be made from sleeping on the seam of a pillow case. Claire was very tired and emotionally labile, crying frequently during the session. I decided to primarily allow her to talk without insisting on a direction. She spoke of her upbringing in Indiana and how she met Aaron, her husband of two years, at Indiana University. She is evidently very much attached to him. But something about sexual intercourse causes her distress--either apprehension beforehand or guilt and a feeling of being dirty afterwards. Although she'd like to enjoy sexual relations with her husband, she doesn't. However, she's afraid that she'll lose him. She described Aaron as being very sensitive, caring, and sexually skilled. She was looking for a silver bullet, but all I could do is recommend that she practice intimacy with her husband after agreeing in advance that it would not lead to intercourse. I would like her to be able to experience intimacy without the apprehension that she describes. Claire suffers also from insecurities--including insecurity over her looks. It never fails to amaze me how many truly stunning women are insecure about the way they look. I'm certain that in a population of beautiful women, there is a higher percentage who are insecure about their looks than in a general population sample. Claire began to tell me something of her sexual history, but I only got a very general sense of it. Apparently, her apprehension began on her wedding night. I got the feeling that she was a virgin until she was married. Aaron did not brutalize her, but something wasn't right. I'd like Claire to see a gynecologist to rule out any physical causes that might make intercourse unpleasant before tackling possible emotional causes in earnest.

Wednesday, February 18, 1998
2 pm. Telephone Conversation with Claire Steven. Claire called, evidently very nervous. I tried my best to calm her down, and think I sort of succeeded. Apparently, after our first session, she walked away with the impression that I didn't consider her problems as serious. I tried to disabuse her of that notion, and she scheduled a session for next week. At the end of our conversation, I was about to hang up the phone, but she obviously wanted to talk about her current problem, so I listened. She admitted to having cyclical patterns to her interest in sex and she told me that she was the currently the aggressor in initiating sexual contact with her husband. But he is apparently not overly interested right now. Claire believes that her current interest in sex is likely to give way to a period where she will have to work hard to get herself into the mood.

Friday, February 27, 1998
10 am. Second Session with Claire Steven. Claire arrived late and was agitated early in our session. I took her through a guided relaxation exercise which helped her focus. I found it ironic that a patient who was complaining of a lack of interest in sex would be as provocatively attired as Claire was. She must create quite a stir at the office--not only is she physically very attractive, but she was wearing a very short miniskirt and a halter top that exposed her midsection. It's casual Friday, so I assume that conservative business attire is not required at SII. I suspect that Claire's evocative attire is linked to her low self-esteem--an attempt to feel desired by those around her. Claire's agitation was clearly greater than reasonably explained by the personnel interview that she attributed it to. She started her job in human resources just a short while ago, but already it is not satisfying to her. She complained that she has to dash the hopes of a number of young applicants, and that those who she decides to hire will probably end up in positions of authority over her. I believe that Claire's negative self-image underlies her sexual problem--which is clearly a symptom of something more fundamental. We talked about Claire's childhood. When Claire was 7, Claire's 19 year old brother was shot to death by a policeman during a traffic stop. Apparently, he was involved in criminal activity with a friend who was in the passenger seat when the car was pulled over. The friend fired a gun at the policeman, who responded by shooting both of them to death. Claire's parents, especially her mother, reacted by becoming extremely overprotective, to the point that Claire felt imprisoned by their worries for her safety. She described her father as somewhat detached--only concerned about her grades and then, usually, in a negative context. I got the impression of parents who punished rather than rewarded. She told me that her parents treated her brother preferentially and didn't care about his grades, which she described as low. But he must have been a senior in high school when she was about five or six, so she couldn't have a good sense of what her parents' real attitude was. However, it's important to realize that's how Claire perceives it. Her parents failure to trust Claire is clearly be an important factor in her low self-esteem now. I told Claire that I wanted to see her every week and that we could try to address some of these issues in therapy.


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