Iam acounselor and i deal with client female 24 years suffer from sexual disorder according to DSM4 her diagnosis is 302.9sexual disorder not oher wise specified , i know that we not use diagnosis in Reality Therapy but according to my job i have to , she come to me at Julay1998 and last seesion was on April 1999 it was 14 session and 2 session was with psychiatric i used Reality Therapy with her and taught her choice theory and during the session she progress very well and gradually she change her pictuers to males insted of female my guestion is that this client back to me again last week is ther specific skills or treatment for her?

-- Bashaer AL.Zawawi (b21century@hotmail.com), June 24, 2003

Answers

I am confused re DSM4 diagnosis but understand certain job descriptions may require use of "resource." I think 302.9 is sometimes reserved for Paraphilia not otherwise specified and this does not seem to fit the treatment which sounds more like what some have called conversion therapy. If a female client attempts to change her pictures from females to males, she sounds like a Lesbian client to me. Bill's work has not contributed to the labeling of gender variant clients as disordered in any way. A superb case is George-Georgina and I recommend careful study of its contents: (1) complete acceptance of the client, (2) offer of support even to extent of involving spouse (family) in the management of case. Licensure may require us to fulfill obligations which exist elsewhere. In this case, if the clent is a Lesbian client who returns to tell you that she has tried to change her erotic picturees from female to male but is not able to do so, I would see her as a Lesbian client and would assist her and support her. The differential diagnosis may include distinguishing this from a transgendered client. I would attend to Dr. Henry Benjamin's Standards of Care for gender variant clients. Total Behavior concepts will assist you enormously with this case. If the 302.9 indicates marked distress about her sexual orientation, it is probably useful to discuss the stress sources and possible ways to reduce the stress (rather than to change the orientation). Discussion of themes of exploitation or betrayal are sometimes useful. She is doing the best she can do and may need a new direction, a new way of understanding and managing her challenges and frustrations. Strongly suggest supervision of case of a reality therapist with gender expertise. Support groups can be very helpful too. Am glad to dialog further, but such dialog is not the same as supervision.

-- suzy hallock-bannigan (suzyatdonegal@aol.com), July 29, 2003.