This book uniquely combines CBT with the Department of Health stepped care model to provide the first comprehensive case study-approach textbook. A step-by-step guide to using CBT, the book is structured around case examples of clients who present with the most commonly encountered conditions; from mild depression and GAD to more complex, enduring symptoms and diagnosis like OCD, personality disorder and social phobia.

The distinctive practical format is ideal in showing how to put the principles of CBT and stepped care into effect. As well as echoing postgraduate level training, it provides an insight into the experiences the trainee will encounter in real-world practice. Each chapter addresses a specific client condition and covers initial referral, presentation and assessment, case formulation, treatment interventions, evaluation of CBT strategies and discharge planning.

The book also includes learning exercises and clinical hints, as well as extensive reference to further CBT research, resources and reading. It will be invaluable for trainees on Improving Access to Psychological Therapies (IAPT) programs, and anyone studying graduate CBT courses.

Client Presenting with Vaginismus

Client presenting with vaginismus

Learning Objectives

By the end of this chapter you should be able to:

  • Describe the sexual response cycle
  • Explain the symptoms of vaginismus
  • Discuss how the vicious cycle maintains symptoms of vaginismus
  • Outline the main components of systematic desensitisation used in the treatment of vaginismus
  • Recognise how cultural and community values may influence treatment progression

Diagnostic Criteria

The sexual response cycle was first proposed by Masters and Johnson (1966) as a four-stage model and although it is a highly individual physical, emotional and psychological process there are physiological stages common to healthy adults: excitement, plateau, orgasm and resolution. Kaplan (1979) outlined a three-stage model of desire, excitement and orgasm and her description of desire as a prelude to physical sexual response is widely accepted. The DSM-IV-TR ...

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