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Individual Psychological/Relational/Sexual History Assessment

Contact Information
Name:
Phone Number:
Email:

Background
What did you value about growing up and what caused you problems and regret?
What is your formal education? Sex education?
What is your religious background? Religious sex education?
Did your parents provide a good marital and sexual model? What were their attitudes towards touching and privacy?

Social and sexual experiences as a child
Social and sexual experiences with others (siblings or peers). How have your siblings done sexually as adults?
Comfort with body and gender?
Did you have a happy or troubled childhood?

Puberty and adolescence
First orgasmic experience – age, situation, feelings
Masturbation – how learned, technique used, first orgasmic experience, use of fantasies and written or online material (has that changed or stayed the same?) How and when did you begin self-exploration and masturbation?
For females – menstruation: age at onset, preparation for cognitive and emotional response of self and others.
Socially and sexually, what was high-school like? Did you feel good about your body image? Was dating a positive experience or a source of anxiety or guilt?
How old were you at first orgasm with a partner? How old were you at first intercourse? Was this a positive or negative experience? How long did the relationship last and how did it end?
Same sex question – Many men (women) have sexual thoughts, feeling fantasies, and experiences with men (women). What were your experiences and feelings about being sexual with other men (women)?
Many people experience unwanted pregnancies or sexually transmitted infections – What were your experiences? How did you handle the problem and feel about it at the time? In retrospect?
As you review your childhood and adolescence, what were your most important positive learnings and experiences?
As you review your childhood and adolescence, what was the most negative, confusing, guilt-inducing or traumatic sexual experience?

Present Relationship
How did you meet? What was the initial attraction? What were the first sexual experiences like?
When was sex best in this relationship? What made it good for you? How do you communicate sexually (verbally and non-verbally)? When was desire/pleasure/eroticism/satisfaction best?
Are you attracted to your partner? Do you have loving feelings? When did sexual problems begin? What caused this and how has it played out? Do you view the sexual dysfunction as an individual or couple problem? How much anger, guilt, resentment, blaming is involved?
What are your strengths and vulnerabilities as a couple? What three changes would you request of your partner?
How is your general health and what are your health problems? What medications do you take and what are the sexual side-effects? Have you talked to your internist or specialist about sexual concerns?
Are financial issues a relational strength or vulnerability? What doesn’t your partner understand about how you deal with work and financial issues?
(If parents) What are your strengths and vulnerabilities as a parent? Do you enjoy parenting?
People have thoughts, feelings, fantasies, and experiences regarding extra-marital What have your experiences been? How did you feel about the extra-marital involvement and how did it end? Is it secret? What’s your guess about your partner’s extra-marital experiences?
What is the role of alcohol or drugs in your life and relationship?

Wrap-Up Questions
What else should I know about you psychologically, relationally or sexually?
What was the most negative, confusing, guilt-inducing, or traumatic sexual experience in your life?
Is there anything you do not want shared with your partner? What is the positive reason for keeping this secret?
What else should I know about you, your relationship and your life which would help in treatment planning?
Is there anything you want to ask me?