Discussion Board DUE 7.5.2020 @ 9pm EST

Original Post

Maria was born into the lower-middle class Espinosa family, who lived in Bethlehem

Pennsylvania. Her father worked in the steel industry and her mother worked part-time as a

teacher’s aid at a local elementary school. Maria was the youngest of 4 siblings, two sisters and

a brother. By the time Maria came along, her mother Anna was having to work another job

cleaning office buildings at night to make ends meet and the children were often left with their

father or a baby sitter. Maria was raised with strong Catholic values and her parents felt that

private Catholic education was worth it, even though it was a strain on the family finances. The

family attended Mass on Saturdays and the children did not have a choice as to whether they

could go or not. For the most part, Maria described her childhood as a happy one stating that the

kids always got along pretty well, other than the typical fights that siblings get into and that they

never really wanted for anything. She described her parents as “strict” and very religious. Maria

also said that her parents got along pretty well and that, though they argued sometimes, they

never really yelled, hit each other or threw things.

Maria came to counseling as an adult because she and her husband were having marital

problems. Initially, Maria’s husband Mark had agreed to marriage counseling, but as the day of

the appointment grew closer, he started making excuses as to why he probably couldn’t go. By

the time the day of the appointment rolled around, he had decided that he just couldn’t make it,

so Maria went by herself. Maria and Mark had been married for 10 years and Maria was 32.

Mark was also Catholic, since marrying outside of the faith was never an option for the Espinosa

children, especially the girls. She admired her one sister who had gone against the family and

married a protestant, but Maria had always been a rule follower. She and mark had two children.

Fairly early on in the counseling sessions, Maria revealed that most of the marriage problems

revolved around the fact that Maria was “never in the mood” as Maria put it. She told the

counselor that mark pressured her a lot for sex and that, eventually, she would give in out of

guilt, but never enjoyed sex or got into it. Maria described sex as gross and messy and she hated

touching Mark because she didn’t like anything about “you know, the male anatomy,” as Maria

put it. Maria did admit one session, after having gotten very comfortable with her counselor, that

she did occasionally touch herself and that she could become aroused by doing this, but that she

always thought about Sarah or other women that she knew while she “touched” herself.

Growing up, Maria stated that she always identified more with her older brother than her sister

and that she was a “tomboy.” Her sisters were “girly” and were always doing each other’s hair

and dressing up, but Maria was never interested in “girly” things. She remembers being jealous

when her bother started playing football at school because she loved football and wanted to play

too, but she dared not mention this to her parents.

One of the most significant events in Maria’s life occurred while she was in middle school.

Other girls were always talking about boys and kissing and stuff like that, so she and a friend of

hers, Sarah, thought that they would practice kissing with each other so that they would know

how to kiss when they finally did have to kiss a boy. At first it was funny and they laughed, but

Maria admitted that she actually enjoyed kissing Sarah and soon they found themselves making

out and Maria began looking forward to these “make out sessions.” One day, Maria thinks that

she was a seventh grader, one of the “sister” caught Maria and Sarah kissing in their “secret

spot” under the staircase at school and scolded them, took them to the headmaster and threatened

to call their parents. The headmaster talked to them about how choosing to be with other girls

was a sin and that gay people went to hell. She scolded them for an hour and threatened to call

their parents if she ever caught them even talking to each other again. Maria stated that from that

point on she “buried” her attraction to Sarah and began “acting” like she liked certain boys and

even occasionally made out with boys even though it didn’t do anything for her. Maria

continued to date boys some in high school and eventually decided that if she would just get

married that, she could get used to being with a man. She thought it was working for a while.

Mark had no clue that she was only pretending to like sex, but soon she began to feel guilty and

became tired of faking a sexual attraction to Mark.

The turning point for Maria came when she made friends with another mother through the local

PTA program at her kid’s school. At first, Maria just saw Karen as a nice person with whom she

had a lot in common, but soon, she found herself constantly thinking about Karen and

daydreaming about buying Karen gifts and writing notes. One day she almost said something to

Karen, but the reality of what she was about to reveal really hit her hard, so she didn’t say

anything. Maria tells the counselor that she doesn’t think she’s gay or anything and that she’s

heard that here is a type of therapy called Conversion Therapy that can help people become

attracted to the opposite sex.

How would you diagnose Maria?

What would you tell her about her feelings of attraction to other women?

Respond to classmate 1:

Reading this scenario brought some similarities to my upbringing. I was raised Catholic and my

sister and I attended a Catholic school until the third grade. We went to public school because we

had moved and the school was about 20-25 minutes from our new house. We attended church

every Saturday and Sunday. My mother taught CCD, which was later changed to CCE. I believe

that is all the similarities that Maria and I share. I went back and forth in this DSM-5 book to try

to diagnose Maria and the only diagnosis that I could diagnose Maia with was Female Sexual

Interest/Arousal Disorder (302.72). I chose this one because in the criteria it states

absent/reduced interest in sexual activity. In the scenario Maria is not in the mood to have sex

with her husband. So instead I did some internet research and came across a book called “The

Complete Adult Psychotherapy Treatment Planner,” Fifth Edition. There is a section titled sexual

identity confusion which entails the religious conviction and conflicts with sexual identity. Such

as, Maria parents would direct her to read The Bible and point out the key points in regards to

same sex. As a clinician I would tell her to just be herself and do not worry about what other

people think. You only have one life to live and either you are going to live for you or live for

other people. I would also empathize with her and tell her it is okay to be the “different” one in

your family. I would also advise her to explore to see if it is just a phase or permanent. One of

my closest friends is gay and has never slept with a guy ever! Her mom forced her to go to prom

with a guy and homecoming with a guy and would even set her up on dates while she was still

living underneath her mothers’ roof. However, my close friend went along with it until after she

graduated high school and went off to college. That is when my close friend actually lived her

life being openly gay and proud! She stood up to her mom and her family and now they accept

her and the lifestyle she has chosen to live. I would tell Maria the story of my close friend to see

if that would put some ease to her mind in living in her truth.

Respond to classmate 2:

Maria is suffering from Gender Dysphoria (Gender-Related Diagnostics) 302.85 (F64.0)

Functional Consequences of Gender Dysphoria

Preoccupation with cross-gender wishes may develop at all ages after the first 2–3 years of

childhood and often interfere with daily activities. In older children, failure to develop age-

typical same-sex peer relationships and skills may lead to isolation from peer groups and to

distress. Some children may refuse to attend school because of teasing and harassment or

pressure to dress in attire associated with their assigned sex. Also in adolescents and adults,

preoccupation with cross-gender wishes often interferes with daily activities. Relationship

difficulties, including sexual relationship problems, are common, and functioning at school or at

work may be impaired. Gender dysphoria, along with atypical gender expression, is associated

with high levels of stigmatization, discrimination, and victimization, leading to negative self-

concept, increased rates of mental disorder comorbidity, school dropout, and economic

marginalization, including unemployment, with attendant social and mental health risks,

especially in individuals from resource-poor family backgrounds. In addition, these individuals’

access to health services and mental health services may be impeded by structural barriers, such

as institutional discomfort or inexperience in working with this patient population.

I would tell her that her feelings are confirmed in the DSM-5 by the diagnosis and then also ask

her how she feels about her disposition and see what type of treatment she would like to have if

any.

Gender Dysphoria in Adolescents and Adults 302.85 (F64.0)

A marked incongruence between one’s experienced/expressed gender and assigned gender, of

at least 6 months’ duration, as manifested by at least two of the following:

A marked incongruence between one’s experienced/expressed gender and primary and/or

secondary sex characteristics (or in young adolescents, the anticipated secondary sex

characteristics).

A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a

marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire

to prevent the development of the anticipated secondary sex characteristics).

A strong desire for the primary and/or secondary sex characteristics of the other gender.

A strong desire to be of the other gender (or some alternative gender different from one’s

assigned gender).

A strong desire to be treated as the other gender (or some alternative gender different from

one’s assigned gender).

A strong conviction that one has the typical feelings and reactions of the other gender (or

some alternative gender different from one’s assigned gender).

The condition is associated with clinically significant distress or impairment in social,

occupational, or other important areas of functioning.