Treatment RecommendationsSusie exhibits increased anxiety about beginning a sexual relationship with her fiancé John. She has already felt shame for having pleasured herself through fantasy and masturbation. His last sexual encounter with a partner was 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 will integrate a relational form of CBT, family cognitive behavioral therapy (CBFT), and psychoeducation into a sex therapy approach for anorgasmia. The approach combines “three interrelated 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 introduce acceptable fantasy exercises to improve responses. Susie's physiology. Therapy must begin with communication. exercises designed to increase intimate communication in the marital relationship and to help the woman facing disruption “develop and explore” her emotional responses (McCabe, 2009, p.221). The essential steps in this phase are improving cognitive awareness in 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 their sexual relationship, the second phase will include psychoeducation of the anatomy of each sex. The goal of this step is to improve each partner's understanding...... middle of article ......e.Leiblum, SR, (Ed.) (2007). Principles and Practices of Sex Therapy (4th ed.). New York, NY: Guilford Press. McCabe, MP, (2009). Anorgasmia in women. In KM Hertlein, GR Weeks, & N. Gambescia (Ed), 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 KM Hertlein, GR Weeks, & N. Gambescia (Ed), Systemic sex therapy (pp.211-235). New York, NY: Routledge.Weeks, G.R., Gambescia, N., (2009). A systematic approach to sensory concentration. In KM Hertlein, GR Weeks, & N. Gambescia (Ed), Systemic sex therapy (pp. 341-361). New York, New York: Routledge.