Making sexuality a part of your clinical work is absolutely essential. Let’s start by looking at why this is so.
Sexuality is where the body and psychology come together without trying. Our sexual dynamics in partner sex, as well as in masturbation, are a stripped-down version of our m.o. The body speaks in clear and simple terms. What happens when someone is using her body so directly for experience and communication is the clearest possible message about what it’s like for her to relate to herself and to others. It is for this very reason that the sexual self is a primary interest in a client’s self-exploration in therapy. But do not expect your clients to be the one to broach the subject. More importantly, do not confuse a client’s reticence with a lack of desire, or even a lack of willingness, to explore their sexual life.
When I was 17, I was at a pool party with my friends and I brought up the topic of masturbation. I was aware that it was taboo, but when it came up organically in a discussion, it suddenly seemed silly to me to hold back from commenting. So I didn’t. And the response was pretty intense! Everyone there exclaimed some version of surprise, relief and excitement about the unfolding conversation. “You do that, too? Oh my god! I thought I was the only one!” I was happy and relieved that bringing it up went well, and amused at how little it took to get the discussing going. I was also a little angry. Why had we been so secretive? Something needed to change. For me this moment solidified my understanding of the need for an invitation.
Sexuality is sacred, but that does not mean it has to be secretive. We tend to like to keep it private, but secretive can breed misunderstanding and shame. Sexuality is a thing to be explored and understood and wondered at. And we could all use a little help with exploration of such a powerful force. Many clients simply don’t realize that it’s ok to talk about sex. Follow their pace, but let them know that it’s a welcome and important topic.
If you’d like to make this part of your practice, here’s how to successfully navigate this territory, especially if you feel hesitant:
1. Know your own sexual self. This is no different than the ongoing work of being a therapist: You must know yourself well, and know how to continue to do so, before you can assist others.
- Bring up your sexuality with your own therapist (a move which will itself propel forward the ability of our field to be awesome at this).
- Revisit your psychodynamics. What did you learn about sex and the body? From who? What were the gender rules or expectations in your family? What wasn’t ok? What’s hot to you? Why? What isn’t? Why? When one of your clients tells you that they want to urinate on their partner’s face, because it’s always been a fantasy of theirs, you’ll need to have already practiced telling your internalized parental voice that judges such things to stfu, and let you explore this with your client.
- Find books you’re pulled to and read them (see my resources for some curated options).
2. Know your facts and/or where to find them. Learn all of the basic facts you can, and develop go-to resources for yourself as well as your clients. As with any topic that arises in the room, be mindful of your blindspots, and be sure that your self-education includes the following:
- Basic anatomy and physiology. A few things that come up regularly with my clients are the facts about the orgastic cycle and related hormones, the complicated nature of expecting vaginal orgasms, and the fact that men still ejaculate after a vasectomy.
- Cultural awareness and sensitivity. For some cultures, the mere existence of this blog is blasphemous. I know that. For that reason, I don’t recommend it to everyone, and sometimes I give warnings about the content. Know your client’s cultural and religious background as you begin to guide them into exploration. This includes generational considerations. Find out what the general teachings are about sexuality within their culture(s), so that you can remain sensitive and empathetic. And enjoy the gift of an expanded body of knowledge. There are so many ways to get sex “right.”
- Trauma considerations. If you do not already work somatically, get very familiar with the nervous system. It will be crucial for you to be able to track any traumas responses during your discussions with your client. This can be especially important when it comes to BDSM play, which toys with the line between healing and catharsis.
While being informed is important, do not be held back by the feeling of not knowing enough facts. Your training and experience as a therapist will guide you here, as it would with any other topic that arises in the room. As always, it is ideal for you to be a little ahead of the game, but your willingness to engage in the exploration is often enough for you to be of service to the client. This does not apply to trauma awareness.
3. Cultivate a matter-of-fact tone. One of the main qualities shared by my favorite sexologists is that they all speak matter-of-factly. Sex is a big deal, but it also just isn’t that big of a deal. You will help to normalize the discussion by speaking about it with confidence and directness. I strongly encourage you to practice speaking aloud about sex. You will encounter any stuck places very quickly! Penis! Cunt! Fucking! Dildos! This leads me to my next point.
4. Have a sense of humor. Be willing to laugh. This also helps with normalization, and it can bring a little relief into the room. As is often the case with laughter in therapy, there may be a need for you to clarify what you’re laughing at and why. It is very important not to perpetuate any shame for your client, which is rampant when it comes to sex. But laughter can be healing when it comes to shame. And sex is just funny sometimes! Sometimes your cat watches you, sometimes you run out of lube at an inopportune time, sometimes the body makes funny noises, and sometimes things just get a little awkward. Your client will benefit enormously from being able to laugh about sex. Show them how.
When you feel ready, make sure that clients and prospective clients know that sexual exploration is part of your skill set. Check that box for “sexual issues” on those therapist search engines. And make use of me! I offer one on one coaching for psychotherapists, as well as case consultation.