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How Therapists Learn To Talk About Sex

When it comes to talking about sex, it seems like all roads lead to Rome it. It does not make a difference if a person comes to my office to talk about depression, worries about a child’s progress in school, or thoughts about the future. If therapy sessions last long enough to build a trustworthy and meaningful connection, nearly every client will eventually bring up the topic of sex. Some clients seek therapy specifically around sexual issues arising in their relationships, and sex becomes the primary lens into the relational style of the client. If you are considering therapy for the first time, you’ll likely want to choose a therapist who feels comfortable talking about your sexual concerns, questions, and interests. Developing that comfort has a lot to do with how therapists learn (or don’t learn!) about how to talk about sex.

Can you talk to your therapist about sexual issues?

While therapists in training and therapists in practice are expected to read a lot of material about sex, sexuality, and sexual dysfunction, therapists spend many hours listening to the stories of others, drawing from their own experiences, and learning the language of their client’s world in order to speak into the delicate issues arising in the lives of their clients. But as the subtle nuances of social circles and relationships evolve to include those who practice less “traditional” forms of sexual expression, such as hookups, sexting, “friends with benefits”, polyamorous couples and tribes, BDSM and kink, shared erotica, experimental or temporary gay or lesbian sex, clients express how difficult it is to find therapists who are comfortable and knowledgeable about the new sexual landscape. Even those who want to improve their sexual connection in a monogamous and committed relationship need to know that their therapist isn’t going to choke on his or her words when talking about sex.

From MGMhd on Youtube, a clip from “Everything You Wanted To Know About Sex (but were afraid to ask)”.

How Therapists Learn To Talk About Sex

The main ways therapists learn to talk about sex are not surprising.
1. They recall the good elements of how they learned about sex and sexuality.
2. They read books, both textbooks and popular literature and publications.
3. They practice talking about sexual issues in their training.
4. They receive supervision from a qualified professional, and receive feedback on how they are addressing the sexual issues of their client’s stories.
5. They may have completed additional coursework on specific sexual disorders or dysfunction arising from issues of sexual abuse.
6. They learn from discussing their own sexual concerns with a therapist, which is a requirement of most Master degree programs.

BTW, sex therapists have additional coursework and specific licensure requirements to call themselves sex therapists. Not every client will wish to seek a sex therapist, but all therapists share a minimum amount of hours studying about sexual issues addressed in therapy sessions.

How Therapists Can Learn To Talk More Effectively About Sex
Here are a few more ways therapists can improve the way they talk to their clients about sex, and how you as a client can find out if your therapist is comfortable addressing sexual issues.

1. Therapists can spend time carefully listening to how their clients talk about sex, such as lingo and terminology, body language, current interests, areas of shame, confidence, or experiences.
2. Therapists can regularly share and post resources that might help their clients expand their knowledge base about sex. For example, if you are a young, lesbian woman with concerns about recent sexual experiences, your therapist should know how to direct some of your concerns to available A/V material and books that support what you are learning in the therapeutic hour.
3. Therapists can spend time attending community-based workshops on sex and sexual expression that might better meet the needs of their clients.
4. Therapists can attend CEU’s (continuing education units) required for licensure renewal that are related to sexual topics. While these tend to be clinical in nature, such as “Addressing The Needs of the AIDS-affected Family”, how the clinician discusses those needs to the family, including sexual content, will help therapists build stronger rapport with their clients.

Long ago, I used to occasionally watch a late-night TV show featuring a call-in sex-advice spot similar to what cable TV has with Dr. Drew. Not only was it entertaining (the show included the star’s outtake moments breaking condoms over outrageously-bulbous dildos), it was also informative. People would call in with questions about various sexual practices, and she would non-judgmentally answer their questions. I watched the show because I felt all therapists should be this comfortable and informative talking and listening to people who are talking about sex.

While therapy is less about advice-giving, clients are reading the reactions of their therapist when they bring up sensitive stories about their sexual practices. A less experienced therapist (or an uncomfortable therapist) may be sending messages to the client that discourage open dialogue, but even experienced therapists who encounter clients with less-familiar (to the therapist) sexual practices should take immediate steps to: 1) inform a client when a topic is less familiar, and 2) educate him or herself about the topic in a reasonable period of time.

Uh, So What Happens If Your Therapist Says Something Stupid
Let’s say you picked a therapist, things are going well, and you start talking about sexual issues in your current relationship. Your therapist squirms, and talks about something else. You address the topic again. Your therapist looks at you like you’re an alien with three heads. Then he says something completely “wrong” to you, and you’re beside yourself with frustration, but since he’s the “expert”, you hold your tongue. Both of you look at your feet, and the last minutes of the session feel like a waste. You look at his website, and double-check that the therapist has listed “sexual issues” or “non-judgmental counseling” among the aspects of his practice. Now what?

I recommend you bring this up during your next session. Ask directly, “What kind of experience do you have addressing these concerns?” If you believe your therapist has misrepresented his scope of practice or experience, you have the right to terminate therapy and to break any signed contracts without fear of litigation. I know of at least one client who saw a therapist for five sessions before the therapist admitted that he did not support the kind of sexual practice the client stated he wished to address in the initial therapy session. While I find this unethical, it is not illegal. It is not uncommon for potential clients to ask directly such questions as, “How much experience do you have addressing lesbian issues?” Substitute lesbian for just about anything else you can think of that might be met with discrimination! An trustworthy counselor should meet your question with a direct answer and with understanding.

If you sense that your therapist can’t address your sexual issues, you might want to consider asking for a referral for another therapist. At the very least, it could provide your therapist with some pointed feedback on how he or she could have been of more help to you. If you see your therapist making reasonable efforts to help you explore your sexual concerns, you may decide to stick with the therapist. I can’t tell you enough how my first gay and lesbian clients over 10 years ago were so very patient with me as I learned how to better address their issues, even though I made it clear that I am a heterosexual woman. By allowing me to learn from them, I’ve been recommended several times over to the gay and open-relationship communities in the Seattle area. It had to start somewhere. I will forever be grateful to those who played guinea pig. Still, as a consumer you should know that as a professional, I made it clear that I was not claiming experience that I did not possess. Take the time to familiarize yourself with the claims of any therapist you are seeking to hire, and request a short interview by phone or in person to answer questions about their practice, methodology, and experience.

Attention Seattle-Area Therapists
If you are a therapist reading this article, thank you for taking the time to consider how you can improve the way you talk with your clients about sex. If you are in the Seattle area, Babeland is hosting a free event for medical professionals focused on products “that could help your patients whether they’re going through menopause, are pre-orgasmic, or have concerns with erection or ejaculation control.” It’s one thing to know about the existence of some of these pleasure-enhancing tools, but it’s another when your client’s lives are directly affected by how much you know or can recommend they try new pathways to improving their sex lives.

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How To Find Good Health Care Advice

The Internet busily buzzed when the cancer arm of the WHO (World Health Organization) recently went on record to say there is a “possible” carcinogenic link between mobile phones and brain cancer in humans. While the report puts cell phones in the same category as the pesticide DDT and gasoline engine fumes, the kerfuffle about such reports highlights a problem I encounter often with my clients, friends, and other Social Media savvy people: when there are many voices speaking at once, and all have supposed or assumed authority, how do you find good healthcare advice?

You have a suspicious mole. How can you get reliable information about it before you go to your doctor's office?

The answer to how one goes about finding good healthcare advice depends on your resources and the urgency of your healthcare issue. First of all, I think it’s fantastic if you take the time to know as much about what is going on with your health issue as possible. Writing down notes such as onset of symptoms, reactions, any treatments you’ve tried, and any history surrounding the issue that might be relevant may be very helpful in your search options.

Here are some practical tips for starting your search for sound advice:

1. Triage the problem for its urgency. If you have trouble breathing, have uncontrolled bleeding, heart pain (angina), or someone you are trying to assist loses consciousness, these are all situations where looking up information on the Internet about what is happening are not helpful. Time is of the essence. Call an emergency number such as 911 or your local hospital or fire department.

If you are trying to help someone who is suicidal, there are specific crisis hotlines available 24/7. You an Google your local crisis line number by entering in the keywords, “crisis line” ,and the name of your city. Suicide hotline numbers can also be found by searching “suicide hotline” and the name of your city. The great thing about this is if a friend is in another city and mentions to you that she’s feeling suicidal, you can help by giving her that number and urging her to call while you stay on the computer or phone with her. It truly is the next best thing to being there.

2. For non-urgent but critical issues, turn to your smartphone or computer for help. Some of the best help is available at your fingertips by using your browser to search for everything from signs of pregnancy to moderate allergic reactions to medications. However, some medical advice is better than others. The best are usually attached to places like WebMD or MayoClinic, and articles there are listed with the author and his/her credentials, or links to reputable medical and mental health websites.

Don’t rely on programs like Yahoo! Answers for medical advice, especially if the answers are made anonymously. If you must ask questions on these sites, understand that you get what you pay for (and you aren’t paying anything). Crowd sourcing for answers is a new and novel way to find out the opinions of others, but you probably don’t want to put your urgent medical question up to a vote.

3. Search online newspapers with a healthcare section, and do word searches within the newspaper itself. These newspapers (like CNN) post articles from reputable doctors who stand by their word with their own professional licenses to practice. Their work is researched, and they are often well-published enough to hold credibility in the medical community.

Suppose you want to know more about the practices of doctors who use cellphones. You can search CNN’s health section for Dr. Gupta‘s article describing why he does not hold his cell phone to his ear, and why he has chosen to use a wired earpiece. While his post is his personal opinion, his article presents his thought process on his personal decision, allowing the reader to weigh in on the same research that guided his decision.

4. Pick up your phone and call your health insurance’s hotline. If you work for a large company, chances are you have been given the number for a nurse on call 24/7 for your healthcare questions from diet and exercise to crisis-oriented situations. Some small company insurance plans include a call line for questions of a non-urgent nature.

While we’re on the topic of calling a hotline, many hospitals have an telephonic triage nurse call center that takes your calls and helps determine if you need emergency care, and what kind of care you need even if you don’t need to visit a hospital. Recently, I visited one in the Renton, WA area. The entire room is outfitted with new computers and phones, and the latest triage decision tree software applications. Several nurses, a floating nurse supervisor, and a physician are available for more challenging client calls.

5. If you need professional mental health help, it’s only a phone call or Google search away. I cannot reiterate how thankful my clients have been that I offer some of my services online and by phone. Recently, a friend mentioned how phone counseling sessions helped her through a difficult time, and she chose a therapist over the phone versus meeting with a therapist F2F. This can be really helpful after you’ve done some reading, you’ve bounced thoughts off of trusted friends, and you still feel stuck with whatever you’re dealing with, but F2F therapy isn’t going to work for you for a variety of reasons (cost, convenience, availability and scheduling, commute, etc). This is not surprising news. An article posted online in Psychology Today cited a 2008 launch of a depression treatment program in Japan accessed over a mobile phone, with a drop out rate significantly less than that of F2F psychotherapy. While the article did not state all the factors that reduced the drop out rate (and the link posted went to the 2008 journal that would require me to plunk down some cold hard cash to access information that is now at least three years old), it appears safe to conclude that teletherapy and therapy provided by through the Internet by trained helping professionals are an effective way of providing depression treatment to those who seek it, and it may provide higher compliancy for the treatment time required to see an improvement in mood.

And is there anything you don’t want to be doing when looking for healthcare advice online?

The major thing you don’t want to be doing is self-diagnosis. Even doctors themselves are not allowed to write their own prescriptions for their diagnosed conditions; they also have to submit themselves under the care of another physician or psychiatrist, nurse or therapist. I see this as a good thing.

When you have a troubling, chronic, or fairly new health condition, it’s good to go into the search for answers with a fairly open mind about treatment options. I’m not saying that everyone is going to be miraculously cured by sound treatment using bells and gongs, but then again, many cancer patients and those experiencing long-term illness have received benefit from sound treatment. Consult an expert. Get a proper diagnosis, where possible, and if there is some question to the diagnosis, ask for a second outside opinion. Read up on the lastest research. In essence, knowledge is more than power; it’s empowerment.