SCHOOL OF APPLIED HUMAN SCIENCES

DEPARTMENT OF PSYCHOLOGY & COUNSELING

MCP-645X: HUMAN ANATOMY AND SEXUALITY
END OF SEPTEMBER 2023 TRIMESTER EXAMINATION

Instructions:

Human Sexuality and Anatomy

MCP 645X
23-2716
14th September, 2023
Stephen Ndegwa, PhD

1. All Questions are Compulsory.

2. Duration: Within 2 hours
3. The submission will be as per the exam timetable through the eLearning platform.
4. Ensure you include a cover page to your answer sheet with: -
i) Course Title
ii) Student Number only and date of examination (Do not write your name)
iii) If it is a special examination, please state so and indicate which semester you
undertook the course
iv) Name of lecturer

Read the case below and answer the following questions.

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Matty is a 27-year-old young man who has been referred to you by his doctor. The referral note
states that he has had recurrent sexually infections. The doctor requested an assessment and help
in managing his sexuality. Matty reports to you that he has not been able to manage his sex life
since he was a child. He explained while crying how he has always had sex with different ladies,
and at times with men, but there is something he cannot understand about his lack of sexual
satisfaction. In addition, he masturbates at least three times a day and finds himself staying late
in the night watching pornography. Matty has never been married and cannot remember having a
relationship that lasted longer than 1 month.

While exploring his childhood, Matty said that he remembers being sexually abused by the
nanny from when he was 6 years old. He did not tell anyone about it because the sexual touch
would make him feel ‘good’ on one side, but he also felt it was not right, which would lead to
guilt most of the time. These sexual involvements with the nanny continued even after he went to
boarding school after class 8. By this time, the nanny had introduced him to pornography, and he
felt ‘hooked’ to watching it. While in boarding high school, he found himself exploring sex with
other boys. He would engage sexually with boys while in school and with the nanny and other
girls when at home. Nevertheless, he did not feel satisfied, and he continuously sought both male
and female sexual partners whenever he got an opportunity.

Matty feels confused about his sexuality and does not enjoy sex with either men or women. He is
stressed, feels ashamed and guilty. He fears that he will always be lonely and does not
understand how he cannot seem to control his sexual behavior. As a way of coping with the
shame and guilt that he experiences, Matty uses alcohol and smokes marijuana. He desperately
needs help to understand what could be ‘wrong’ with him hence he sought medical help.

1. Using the knowledge gained in this class, analyze four possible precipitators of
Matty’s sexual pathology.

(12 marks)

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Drawing from my coursework on human sexuality and anatomy, I aim to analyze the four sexual
problems that have been identified from this client’s case, they include porn addiction and
masturbation, sexual abuse, sexuality knowledge deficit, and sexual dysfunction. My goal is to
assist Matty in understanding these identified issues so that he can better understand his sexual
self and live a better life again

1) Addiction to masturbation and pornography

Although the American Psychological Association does not officially recognize porn addiction
as a mental health disorder, it can still have a significant impact on a person’s life, as
demonstrated by Matty, who is struggling with both addiction and compulsive masturbation. As
a result, he is unable to control his urges to view pornography and engages in compulsive
masturbation, which is causing him to experience clinically significant distress in his social life,
including his relationship with people, and even in his sex life, to the point where he can receive
a diagnosis of clinical anxiety. Considering that he spends the majority of his time alone having
these sexual issues, it is widely known that it has gotten out of control.

2) Sexual abuse

The abused becomes that abuser - that is introduction to inappropriate early sexual behaviors at
the age of 6 and 8 and the nanny using her to meet her sexual needs. In DSM V – checking the
life events checklist, this can be classified under criterion A, which requires exposure to sexual
abuse, and as per the case, Matty reports that this made him feel guilty about himself. Also, to
the point that he felt that the nanny was the one whom he would confide to. At school, it is
reported that Matty was exploring his sex life, which is a form of abuse that is also classified as a
criterion (A) for PTSD. At school, he also found himself in sexually abusive relationships which
would not last longer. Not only that the impact made Matty experience the emotions of fear,
shame, guilt, and confusion.
3) Sexuality knowledge deficit

Previously, Matty was introduced to sex abuse by their house nanny, the nanny never considered
age-appropriate/specific information. I suppose that Matty’s parents were not available for him

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to whom he could confide to. Again, he lacked information on how to stand on his own, engage
in a non-risky sexual activity, the holistic human sexuality composition, and use of contraception
e.g., condoms. This has even made Matty contract STIs because he has been having multiple sex
partners. This is a sexual problem because he was not made to understand his sexuality and to
explore it in the correct way. In human development – psychosexual theory by Sigmund Freud,
an individual must experience each stage, in this case, Matty was hooked on the latency period –
and he might find it hard to maintain or sustain long-term relationships.

4) Sexual dysfunction of performance

Matty reported that he feels he does not enjoy sex anymore which may cause him inability to
perform as he used to do previously with men and women. This could be either erectile
dysfunction premature ejaculation or even low libido/loss of interest – note he is using
psychoactive substances such as alcohol and smoking marijuana which may have been the case
of his addiction and that could be a predisposing factor for this disorder. I would probe, get the
criteria find out the appropriate dysfunction, and then help him using the techniques/treatment
plan which will be discussed in question three.

NB: For all those sexual issues discussed above, Matty will be assisted with the treatment plan
and approaches discussed in question 3, and help him achieve the goals discussed in question 2
and any other he might suggest.

2. Enumerate four goals that you would help Matty achieve as you work with him in
therapy.
(4 marks)

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SMART goal setting. A SMART goal is always the first thing that comes to mind regarding the
process of therapy. In collaboration with me (therapist), Matty sets therapy outcome goals, which
include the following:

The first goal is working towards improving his coping skills: in this first goal, Matty will be
helped to identify his struggles/issues to manage his emotions which are anxiety, and how he can
deal with his stressful situations. As Matty’s therapist, I would work with him and help him
develop healthy coping mechanisms that he can use in stressful periods. These coping skills will
involve problem-solving strategies, mindful meditation, and relaxation exercises, such as deep
breathing exercises, yoga, Tai Chi, etc.

The second goal we may include is enhancing self-esteem: as Matty reported the experience of
guilt and shame which can result in low self-esteem. This is as a result of his negative self-talk. I
will him to identify his strengths and what he has been able to accomplish so far channeling his
mind to more positive thinking. He may also need to challenge the negative beliefs that he has
about himself and why he feels that way. To achieve this, I may ask to record his thoughts either
by journalling or cognitive restructuring.

The third goal will focus on developing his social skills. As in Matty’s case, we can see that he is
having difficulty maintaining relationships both with men and women due to anxiety and fear.
To realize this goal, I will work with him to improve his social skills, such as being assertive,
listening actively, and communicating with people effectively. This is to help him reduce his
thoughts of being alone which might lead to suicide. We will employ role-playing exercises and
social skills training in this matter.

The final goal that we will set is building resilience: as we have seen in the case Matty who
experienced trauma as a young child (sexually abused) with his nanny. This experience left him
feeling vulnerable and fragile because he could not defend himself or confide with his parents at
that tender age. Here, I will help him develop resilience skills like, how to take care of himself
(self-care) and develop also positive self-talk. – instead of saying “Nobody like me, he could

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replace it with “I am loved by people around me” He also needs support from his family and
friends – social support. This will be supported by mindfulness, CBT, and SFT.

3. As a therapist, design a treatment plan for Matty using any two applicable theories
of counseling and give justification of using them.
(14
marks)

As we have seen Matty is in his 20s, and has been struggling with different symptoms such as
fear, anxiety, shame, and guilt. I will begin drawing the treatment plan for Matty by conducting
an initial clinical interview, and clinical assessment. From here, I will identify two applicable
theories that can help me inform the development plan for Matty’s treatment. These applicable
theories include:
Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT).

Cognitive Behavioural Therapy CBT – in brief, is a short-term, goal-oriented therapy that aims
to help clients identify and challenge their negative patterns of thoughts and behavior. As we
have seen in Matty’s case, CBT will be suitable for addressing his symptoms of anxiety and fear
by helping him identify and challenge, especially his unhealthy negative thoughts and beliefs.

To assist clients in altering their unfavorable thought patterns, we employ CBT. Therefore, I
would help Matty on how to identify and control the thoughts that lead him to various behaviors
and conditions, such as his addiction to porn and his masturbation, using cognitive restructuring,
motivational interviewing, and behavior modification. We can notice the evidence that Matty
reports feelings of unsatisfied sexual pleasure no matter how many people he has sex with.

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Treatment Plan
The first treatment plan that I will apply is: to identify Matty’s negative thought patterns: this
means that Matty will be encouraged to keep a thought diary to help him monitor and identify his
negative thoughts when they arise. This in turn will help him become more aware of his thoughts
and the impact they may have on his emotions and behaviour.

The second treatment plan is to challenge Matty’s negative thoughts. Since we have identified it
in the first plan. Here, Matty will be taught how cognitive restructuring techniques work to
challenge his negative patterns of thinking. In other words, it will involve identifying evidence
for and against negative thoughts by creating alternative explanations and evaluating the
evidence for each explanation. As we can see the evidence is already there when he said that, he
feels confused, frustrated, and lost.

On the third treatment plan, we will build on the behavioral experiments: this is where Matty will
be encouraged to conduct his behavioral experiments to test the validity of his negative thought
patterns. For instance, as he reported that he has been struggling to understand himself, he was
also unable to speak out as a young child when the nanny was abusing him. This might have
caused low self-esteem in him. Let’s assume that he finds it difficult to express himself in public,
he could practice giving a presentation in front of the class. This is to test the level of his belief
in himself.

In the fourth treatment plan, will design exposure therapy: on this treatment plan, however,
Matty will be encouraged to gradually expose himself to situations that trigger his anxiety. He
reported that he can no longer perform sexually either with men or women.

I will also use relaxation techniques as one of the treatment plans: here Matty will be taught how
to relax by using relaxation techniques. This is to help him manage his symptoms of anxiety and
any occurring depression.

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The sixth is goal setting: Matty will be encouraged to set achievable goals for himself, as we
have elaborated on in question two. This goal setting is to boost his self-confidence and reduce
feelings of off-seeing depression.

Acceptance and Commitment Therapy (ACT)

The second theory that I will use as one of my treatment plans for Matty’s case is known as
Acceptance and Commitment Therapy (ACT). In brief, ACT is a form of therapy that focuses on
helping clients accept their negative thoughts patterns, and feelings rather than trying to avoid
them or run away from them. As we know ACT can be very instrumental in addressing Matty’s
symptoms of anxiety and depression just like CBT by helping him develop mindfulness skills
which in turn will help him clarify his values.

The first treatment plan using ACT is mindfulness meditation: using this technique Matty will be
stimulated to practice mindfulness meditation, this is to help him develop greater awareness of
his emotions and thoughts without judging himself. To achieve this, I will help him learn how to
observe his thoughts without getting caught up in them, which can reduce feelings of anxiety.

On the second treatment plan using ACT, we will work on values clarification: this is where
Matty will be encouraged to clarify his values by identifying what is most important to him in
life. This will enable him to gain a greater sense of purpose and meaning, that all hope is not lost,
this can also help to reduce feelings of anxiety and may increase feelings of motivation and
fulfillment in his life once again.

For the third treatment plan, I will design defusion techniques: here, I will teach Matty how to
apply a sense of humor, to help him cope with his negative thoughts and beliefs. This can help
him see his thoughts as temporary events rather than permanent truths because no condition is
permanent, it is temporal and a question of time. This technique will also help him reduce
feelings of anxiety. When a person makes jokes and says some funny things, it helps to take
away some negativity in a person.

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Acceptance: we have been talking about ACT, the aim of using this is to encourage Matty to
accept his thoughts and emotions rather than trying to run away or avoid them. We don’t run
away from our problems, rather we try to embrace and accept them. By accepting them, is
already one process of healing. This acceptance can help him learn how to tolerate discomfort
without getting overwhelmed by it, which can reduce his feelings of anxiety.

The final treatment plan with ACT theory is Committed action: we will be working on nothing if
there is no action. Matty will be encouraged to take committed action toward achieving his goals
by breaking them down into smaller steps or goals and developing a plan that can be
implemented. This can be achieved by helping him to build his self-confidence which in turn
reduces feelings of anxiety and any form of depression. We are hopeful that there will be
progress toward achieving what is most important to him in life, especially his sexual life.