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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.

By Imei Hsu

Imei Hsu is a mental health counselor, active retired RN, writer, triathlete and arts promoter in the Seattle area and through online services. With 29+ years in healthcare (20+ years in mental health), Imei has a commitment to helping people discover insight into their health, relationships, and connecting. She is the owner of Seattle Direct Counseling and the blog, a presenter and speaker on a variety of psychological topics, and a positive force on the Internet. She is launched her personal project, My Allergy Advocate, in 2018. Imei is two-time Ironman Finisher (Mont-Tremblant 2016, Ironman Canada 2018), and is currently training for her third Ironman in August 2020; she also finished her first ultramarathon in 2017 and has gone on to race the 100K distance while preparing for two separate 100 Mile trail races in 2020. You can find her running everywhere and eating all the thingz, watching movies, and cooking real food.

3 replies on “How Therapists Learn To Talk About Sex”

FYI: Babeland in Seattle thanked me for the shout out about their special evening for medical professionals coming up in August 2011. Check it out!

Thank you so much for including our class. We spend each and every day here talking about sex with customers, many who are just relieved that they can talk so open and honestly with someone about this part of their lives. In the class we will also cover how to talk with patients regarding sexual topics including terminology and common questions that we get that border on the medical. If you are interested in attending and want to make sure a specific topic will be covered, please call the store and ask for Audrey or Shannon or email either one of us.

Thank you,
Audrey McManus
Education Coordinator

Shannon Solie
Store Manager

I was not aware that sex therapists will read books of both literature and publications. [A friend] is thinking about hiring a sex therapist to help her marriage, and we are looking for advice. I will let her know how to hire a sex therapist to help her marriage.

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