Therapists know that during this period of life or life stage change, there are also increased pressures on the adolescent in terms of fitting in with a peer or social group, which is replacing the family group in terms of the ways that the individual feels compelled to spend their time. This is why the therapist should not be seen as siding with Anna's mother. The development of a greater cognitive and social sophistication is one side of the adolescent experience, in which thoughts, feelings, and behaviors become more part of an individual's self-awareness and growth. There are also changes going on in the adolescent individual from a neuro-chemical point of view. "Recent imaging studies in humans show that brain development and connectivity are not complete until the late teens or early twenties" (Adolescence, 2006). However, this is also a high risk case situation, so the therapist may also want to make Anna more aware and educated about making mature and responsible sexual decisions, including the role of contraception, and effective planning regarding sexual behavior.
Tom and Susan are an elderly couple, but they have different bio-mechanical activities going on that the therapist needs to realize. Sexually, Tom is waning, while Susan may even be waxing in terms of her appetites. Males generally peak sexually in adolescence; females reach sexual peak much later. There are many issues in this case, because there are also psychological changes and factors going on with Tom and Susan's retirements. There are specific issues to Tom's sexual performance during late adulthood which are more complicated for him, than for Susan. The therapist should advise that their transition into retirement is an opportunity to reappraise and modify the sexual structure of their relationship, and to create the basis for a new sort of sexual structure advocated by Susan's increased appetites. If Tom is nervous about performance issues such as maintaining an erection, there are pharmacological alternatives that he can assumedly take advantage of. Holistic and preventative approaches to looking at sexual health in late adulthood are relatively innovative, in that they take the existing paradigm of reproductive health and take it to a new level of promoting wellness, so that people like Tom and Susan who are in the stage of late adulthood can learn to maintain a healthy and active sex life instead of just thinking of a decrease in sex as being an inevitable factor of aging. If Tom and Susan are educated by the therapist, with a focus on Tom, about how to live a healthy sexual lifestyle during these later age stages and how to cut back on his performance anxiety that are hurting the couple and stepping up to the habits that are healthy and worthwhile, they will be more likely to be healthy and require less care from therapy. The therapist should help Tom and Susan develop a daily routine that they can take past the therapy sessions.
Since Bill is paralyzed from the waist down, it is assumed that his disability may prevent him from achieving and maintaining an erection for traditional sexual intercourse. However, thinking that an erection is all that is necessary for a sexual experience is somewhat limited, although all too common. Since Bill is involved in a romantic relationship, it is assumed that he is undergoing a lot of stress and self-induced pressure to