Reference no: EM133351152

Clinical Assessment and Treatment Plan for Nestor

A Hispanic male in his 40s who struggles with sexual dysfunction and porn use.

Nestor is a 54-year-old male who says he is attending counseling today because his wife made him. He states that she is tired of catching him with pornographic materials on his phone and on the computer.

Nestor reports a long history of porn watching beginning in childhood. He thinks his family dynamic was "fine" and that "there weren't any problems when I was growing up." He says his mom and dad were distant and very conservative, and that they treated him like a child even after he became an adult. He had many rules he had to follow as a young boy, so when he was tired of following the rule, he just hid what he was doing from them. He reports his mom used to say that it was her job to make sure he turned out right and he always felt like it was his job "to make sure she didn't find out what I was up to."

Nestor has two younger brothers, and says his relationship with them has always been fine. He attends ball games with them and sometimes watches Monday Night Football at the bar with them. He and his brothers still have dinner with their parents every Sunday.

Nestor has been married to his current wife, Alicia, for 25 years. He says the relationship has had "ups and downs" over this time but that it is generally "all right." Nestor reports that it is currently "down" because she learned about the pornography use.

Nestor and Alicia have owned their home for 20 years. He has worked as a journeyman tool maker for the past 33 years and is satisfied with his job. Nestor served in the army for four years, completing his service he was 23. He says he makes enough money but always could use more.

Nestor was recently diagnosed with high blood pressure and has started taking medication for this. He reports currently smoking about half a pack a day. States that he has smoked half a pack a day for the past 10 years and does not think he will ever quit. Client reports no other medical conditions at this time.

The client says he has never had any mental problems, but he does report that he and his wife went to counseling about a year ago for three or four sessions. States that he really "didn't appreciate having to spend his money that way because the counselor wasn't all that helpful." He reports that the therapist said that it was all his problem and he needed to change.

Nestor began drinking alcohol when he was 13. Currently, he states that he is drinking 3 to 4 times a week and he drinks two to three rum and Cokes when he does. He received a DUI when he was 23 and attended a weekend program, but had no other treatment for alcohol use. He says he does not believe his drinking is a problem.

Nestor has several hobbies, including boating, snowmobiling, fly fishing, and amateur photography. They help keep him busy when he's not at work, and he enjoys them.

He has two grown children who are happy and on their own. His daughter is 24 and lives in California, and his son is 23 and lives in Nevada. Nestor says he talks with them by phone once every few weeks.

He also reports intermittent use of marijuana throughout his life, which also began around age 13. States that he used heavily throughout his 20s and 30s but now only uses occasionally, about one joint one to two times per month. He has never been in trouble because of drugs, and reports no other drugs of abuse.

Nestor is Presbyterian and attends church on holidays, but his wife goes more often and is involved in church activities.

Nestor's first experience with porn occurred when his father gave him a Playboy magazine to look at. States his dad told him that he could learn about sex if he looked at these pictures and read the articles. He was supposed to ask his dad after reading the magazine if he had any additional questions. Nestor says he learned about masturbation by reading an article.

Since that time, his pornography use has increased and decreased, but has always been present. When the Internet boom happened, porn became more and more of an issue because it was so easily available. Nestor estimates that over the past 10 years, he has spent one to two hours a day looking at porn sites on the internet. He also reports utilizing chats. He says he once got in trouble at work after they found porn on his computer. Now he is more careful and only uses his phone and the home computer.

Nestor is bothered by how much time his porn watching consumes, and sometimes wishes he could break away from it. He spends considerable time thinking about sexual acts and knows that women look at him the same way he looks at them. He reports sex with strangers, internet hook-ups, and sex for pay on several instances over the last 20 years. He says he does not know why those urges come and go, and that his wife is unaware of these additional issues. He does not think porn watching is a problem, but says he is open to discuss this issue if you think it is a problem.

Nestor says he is worried for another reason: He is having a lot of trouble getting and maintaining an erection. He says, "I just wanna have and keep an erection during sex." He has been having difficulty having erections for the past year, and his porn watching has increased due to these difficulties. He wishes his wife could be a little more understanding about his inability to have sex with her without the pornography.

What is his diagnosis?

What are his short-term and long-term goals to address the diagnosis?

Strategies to promote optimal sexual functioning

Evidnence-based treatment to support strategies