Pitfalls of Not Being a Sexually Informed Therapist

Sexually informed therapist.

Years ago, I read a cartoon that really made me laugh: In the therapist’s office, a woman is lying on the typical Freudian couch, and says to the therapist, “you know, doctor, there are some things I don’t tell you.”

The therapist responds, “I want you to know, Mrs. Jones, that I really appreciate that!”

Like most jokes, it hits on a truth we, as therapists, rarely acknowledge – we don’t know what we don’t know, and maybe we don’t want to know.
As a sex therapist, I give talks to groups of therapists across the country, and often, I ask for a show of hands to see how many in the room have had any kind of sex therapy training – even a one-day workshop. In a roomful of 50 to 60 therapists, I usually find no more than a half-dozen hands.

When I give talks on problematic sexual behaviors, marital therapy or sexual abuse, the room is packed, but when I present a talk on helping couples with sexual pleasure, I’m lucky to get a room half full.
In a profession seeking to help people in their relationships and personal struggles, why is it that a fundamental element like sexual intimacy is avoided or not deeply understood by therapists?

I am finding that during therapy, when sexual issues arise, even therapists who have had minimal sex therapy training divert back to their training on sexual trauma, sexual abuse and problematic sexual behaviors to help their clients.
I, too, was a long-time therapist with little training in healthy sex, until I realized I had been taking the wrong approach with my clients when it came to sexual issues.

Once I sought out training, I learned what a great disservice it was to my clients not to have the adequate training to help them appropriately.

This doesn’t mean I don’t examine possible trauma-driven and pathological reasons for sexual issues. It does mean I now have the tools to examine a client’s issues with informed, healthy sex and sexuality information.

Couples are seeking our help with relationship problems and often these problems are related to the sexual side of their relationship. If we are not trained to deal effectively with these issues, we are not doing our job as a therapist competently.

We need to have two separate, but parallel conversations – one about their relationship and one about their sexual health. Many of us think that if the relationship improves, the sex automatically will get better, and vice versa. That is a myth.
Far too often, therapists untrained in sexual health will default to their own judgments about what constitutes a healthy sex life – sometimes based on their own sexual history of abuse or trauma or infidelity – and lead the clients on the wrong path of healing.

When therapists begin their studies on healthy sex, they unexpectedly are presented with myriad worlds of sexual desires and practices, many of which are considered taboo by the culture in which we live, yet they are quite normal and even healthy for many people. Up to this time, the untrained therapist hasn’t opened up the conversation about sexual pleasure or sexual differences.

Here are a few examples of the types of clients who are seeking sexual health help:

Scenario #1: the porn couple
The untrained therapist:

Married for 30 years, they say they have enjoyed a pretty good sex life until she finds his porn. She thinks he is a sex addict and starts comparing herself to the images he’s looking at. Her self-image takes a hit and so does their sex life. An untrained therapist often will take her side, asking her partner why he needs to watch porn. “Isn’t she enough?”

The sexually informed therapist:

Even women are watching porn, imagining themselves with a hunky actor or character in a romance novel. Also, most couples never talked about watching porn. As a result, there is no agreement or conversation about what is okay in their relationship. An untrained therapist may fall into the trap of good porn/bad porn and jumps into the couple’s power struggle instead of helping them work out their sexual differences. The marriage had no problems until the wife learned about the porn and made it about her not satisfying him when it had nothing to do with her. A trained sex therapist would understand that.

Resolution:

The therapist will direct the couple into a conversation about sexual differentiation – what one person likes may not match what the other person enjoys and it is okay to have these differences.
Scenario #2: the sexually fluid partnerThe untrained therapist:The woman discovers her husband is watching gay porn. The well-intended, but untrained therapist may conclude that the man is gay or bisexual.
The sexually informed therapist:By facilitating the conversation, the wife realizes her husband always has had this fascination and it hadn’t affected their sex life. He is not gay or bisexual; he is a straight man who enjoys gay porn. His interest simply represents a variation in erotic interest and sexual fluidity.

Scenario #3: the affair couple
The untrained therapist:

A man discovers his wife has had multiple affairs. He calls her a liar and a cheater for breaking their marital contract. The untrained therapist begins investigating a history of sexual abuse or other negative pathologies.
The sexually informed therapist:Even though we live in a culture that expects a one partner relationship, a sex therapist would explore a monogamous vs non-monogamous relationship. The wife may want an open relationship or a polyamorous relationship, but the couple has not talked about it.

Scenario #4: The kinky couple
The untrained therapist:

A couple is involved in consensual kinky behavior (eg, choking, spanking, slapping, spitting on each other) and they enjoy it. An untrained sex therapist will worry they are re-enacting early trauma and they should not be engaging in this type of sexual behavior.

The sexually informed therapist:

The sexually informed therapist will ask if the kinky behaviors are safe, is it mutual and consensual, and is the couple having open and honest communication about these behaviors?

I highly recommend therapists complete as many sexual health educational trainings and workshops as possible. You can find some on SSTAR (Society for Sex Therapy and Research), AASECT (American Association of Sex Educators, Counselors and Therapists), SSS (Society for the Scientific Study of Sexuality). You also can read sex research and sex therapy-related journals to keep up in the field. Your practice will become far more effective with these additional tools you can use to help your clients.