Treatment RecommendationsSusie displays an increased amount of anxiety about starting a sexual relationship with her boyfriend John. She has previously felt shame for pleasuring herself through fantasy and masturbation. His last encounter with a sexual partner occurred 25 years ago. John had a mutually enjoyable sex life with his late wife. He currently suffers from intermittent erectile dysfunction. To best address the couple's concerns, treatment will include a multifaceted approach that integrates a relational form of CBT, cognitive behavioral family therapy (CBFT), and psychoeducation into a sex therapy approach for anorgasmia. The approach combines “three related treatment strategies: communication exercises, sensory focus exercises, and guided fantasy” (McCabe, 2009, p.221). This blended treatment is designed to reduce Susie's anxiety, educate the couple about human anatomy and sexuality, provide exercises designed to enter into a sexual relationship at an emotionally safe pace, and to introduce acceptable fantasy exercises to improve physiological responses by Susie. Therapy should begin with communication exercises designed to increase intimate communication in the relationship with the partner and to help the woman experiencing the breakup to “develop and explore” her emotional responses (McCabe, 2009, p.221). The essential steps of this phase are enhancing cognitive awareness within partners and deepening the woman's emotional security in the relationship (p. 222). Once the couple is able to discuss their fears and expectations regarding the sexual relationship, the second phase will include psychoeducation of the anatomy of each gender. The goal of this phase is to improve each partner's understanding... half of the article ......e.Leiblum, SR, (Ed.) (2007). Principles and practices of sex therapy (4th ed.). New York, NY: Guilford Press.McCabe, M.P., (2009). Anorgasmia in women. In K. M. Hertlein, G. R. Weeks, & N. Gambescia (Eds.), Systemic sex therapy (pp. 211-235). New York, NY: Routledge.Rosen, R.C., (2007). Erectile dysfunction: integration of medical and psychological approaches. In S. R. Leiblum (Ed.), Principles and practices of sex therapy (4th ed.) (pp. 277-310). New York, NY: Guilford Press.Verhulst, J., Reynolds, K.R., (2009). Sexual pharmacology: love potions, pills and poisons. In K. M. Hertlein, G. R. Weeks, & N. Gambescia (Eds.), Systemic sex therapy (pp. 211-235). New York, NY: Routledge.Weeks, G.R., Gambescia, N., (2009). A systematic approach to sensory focus. In K. M. Hertlein, G. R. Weeks, & N. Gambescia (Eds.), Systemic sex therapy (pp. 341-361). New York, NY: Routledge.