Table 1.
Study Flow Chart in Women Surviving Breast Cancer
| Session content | Specific objectives | |
|---|---|---|
| - Introduction and acquaintance of consultants and patients with each other - Explaining the objectives and rules of the meetings, asking for mutual respect, regular participation and etc. - Explaining the details of counseling sessions and the objectives of counseling and familiarize couples with the GES model - Explaining the importance of sexual activity, sexual education, definition of sexual satisfaction and performance and the factors affecting it, the effects of marital happiness on self, children, social relations and academic and professional performance, and relationship with spouse - Providing information about the reproductive cycle and effective methods of assisted reproduction and the mechanism of action of contraceptive methods and counseling on choosing the appropriate method - Explaining the four stages of the sexual response cycle with emphasis on the importance of recognizing the cycle of sexual "desire" - Explaining the effect of breast cancer and mastectomy on sexual function and its mechanism - Joint contract making technique to take note of needs and expectations in regards to sex, clarifying expectations, correcting misconceptions and superstitions about sex, and creating an optimistic attitude (counseling and teaching positive thinking style in interpreting sexual events and relationships) - Homework - Answering possible questions of couples - Summarize the first session of counseling and planning the next session |
Implementation of the first three aspects of GES model - Explaining the importance of sex as a Crucial element of life - The importance of quality of sex and sexual satisfaction in the sexual development of couples Setting realistic expectations for sexual relations |
1 |
| - . A review and summary of the previous session - Nutritional recommendations, sleep hygiene, stretching and exercising and recommendations for daily walks for couples - Observing health tips and ensuring the selection of a suitable contraception method - Teaching meditation skills and training of mindfulness, body examination and conscious attention to different parts of the body, conscious movements and three-minute breathing exercises (directing air as a tool to direct attention to yourself and establish the mind in the moment) - Providing a timeline to record the thoughts and mental status of the person in instances of desirable and pleasant sexual experiences, unpleasant experiences, disgust, muscle contractions and emotional pressures - Teaching couples to enjoy each other (teaching lust and sexuality, stereotypes, misconceptions, fantasies and mental errors about sex) - Homework - . Answering possible questions of couples - Summarizing the second consultation session and planning the next session |
Implementation of the fourth, fifth and sixth dimensions of GES models - Emphasis on physical health and healthy habits for reviving sexual health - Behavioral training and counseling (mindfulness) - Paying equal attention to gaining sexual pleasure as much as achieving proper sexual function |
2 |
| - . Considering the problems and concerns noted by the couple during the previous week - Changing expectations regarding the length of the period of sexual arousal, sexual vigor and orgasm - Benefiting from sexual fantasies - Advice on visual adaptation to anatomical changes - Helping to maintain verbal and emotional relationship with the spouse and emphasizing the importance of flirting and foreplay - Explaining the pattern of sexual changes and possible physical problems after treatment and focusing on the five goals in sex - Identify five principles of sex (1- Reproduction 2- Reducing stress and anxiety 3- Sexual pleasure 4- Self-esteem and trust 5- Intimacy and satisfaction with the relationship), Acceptance of multiple objectives by both parties, avoidance of one sided and inflexible objectives and clarification of the sex schedule - Explaining the different positions of intimacy and sexual arousal styles - Three styles of sexual arousal with a focus on body and interpersonal activities, sexual and emotional pleasure, daydreaming and role playing - Combining styles and creating variety in the relationship - Homework - . Answering possible questions of couples - Summarizing the third consultation session and planning the next session |
Implementation of the seventh, eighth and ninth dimensions of the GES model - Counseling to overcome sexual fears and worries - Training to have flexible sexual experiences - Letting go of idealistic ideas about sex - Defining objectives in sex - Getting familiar with sexual arousal styles |
3 |
| - Counseling and education about the physical and psychological differences between men and women at each stage of the sexual cycle - Explaining the factors affecting sexual satisfaction and subsequent marital satisfaction - Communication skills training, skills to create and maintain intimacy (training to talk, listen empathetically, clarify hidden assumptions to resolve emotional sensitivities and share emotions in order to create intimacy) - Counseling and training in trust, mutual acceptance, freedom and deep appreciation of the relationship. Giving a special nature to sex such as cuddling or giving nicknames to sexy parts of the body and adding unique experiences in couples' relationships - . Answering possible questions of couples - Summarizing the whole process of references - Planning to follow-up the performance status and sexual satisfaction of the clients in 2 and 3 months after the fourth session |
Implementation of the tenth, eleventh and twelfth dimensions of the GES model - Getting familiar with gender differences and acceptance of similarities and differences - Strengthening communication skills - Sexual desire cycle training and counseling to personalize sexual desire |
4 |