How Psychotherapists Learn to Get Comfortable Talking About Sex

Considering how common sexual problems are for individuals and people in relationships, it's surprising that most postgraduate psychotherapy training programs don't even offer one course about sex (see my article: What is Sex Therapy?).

Psychotherapists Learn to Get Comfortable Talking About Sex?

Even the more progressive programs might offer only one elective course that isn't nearly enough to deal with all the sexual issues that clients deal with on a daily basis, including (but not limited to):

• sexual desire discrepancy 
• difficulty talking about sex in a relationship
  
• sexual arousal issues
• an orgasm gap in a relationship
  
• arousal nonconcordance
• guilt and shame about sex and sexual fantasies
• the paradox of love and sexual desire
  
• sexual fluidity
• ethical nonmonogamy (also called consensual nonmonogamy)
• negative body image

And so on.

Even many couples therapists aren't trained to deal with sex-related problems, which is even more surprising.  Many believe that if they help couples to be more emotionally intimate, this will automatically resolve their sexual problems, but very often it doesn't.

Worse still, clients usually sense when their therapists are uncomfortable about certain topics, especially sex, and they avoid talking about it--to their detriment.

Unfortunately, this can reinforce the idea that sex is a taboo, shameful topic to discuss--even in therapy.  This confirms the messages clients often get throughout their life--in their families, culture, religion and in society in general (see my article: What Does Sex Positive Mean?).

Clients can go through an extended period of time in therapy without the topic of sex ever coming up.  This is usually because both the therapist and the client avoid bringing it up--sometimes consciously and often unconsciously.

In addition, since sex isn't a topic covered in most postgraduate psychotherapy training programs, psychotherapists often don't know about their own blindspots, prejudices, countertransference and possible unresolved sexual trauma.

What Can Psychotherapists Do to Get Comfortable Talking About Sex?

As previously mentioned, when you avoid talking about sex, this can increase a client's shame and guilt about their sexual issues, which is not what most therapists want to do.  

So, what can therapists do who aren't sufficiently trained or comfortable to talk about sex with their clients?

• Get Professional Training: There are sex therapy postgraduate training programs that provide sex therapy certificates for licensed psychotherapists.  If you don't want to get certified in sex therapy, institutes like the Institute For Contemporary Psychotherapy (ICP) in New York City or the Modern Sex Therapy Institutes offer continuing education courses you can take on specific topics, including basic principles and practices of sex therapy, problems with sexual discrepancy issues in relationships, sexual arousal issues, countertransferential issues, and so on.  Many of these courses are online and they are taught by recognized sex therapy experts in the field.  

• Get Clinical Supervision From a Certified Sex Therapist: If you know you lack training, seek supervision from a skilled sex therapist who can provide you with clinical guidance.  

• Keep Up With the Sex Therapy Literature: There are excellent books available that you can read to educate yourself. The following is a list of some of the many books which are available:

• Come as Your Are By Dr. Emily Nagoski
• So Tell Me About the Last Time You Had Sex by Dr. Ian Kerner
• Transforming Sexual Narratives by Dr. Suzanne Iasenza
• Mating in Captivity by Dr. Esther Perel
• Tell Me What You Want by Dr. Justin Lehmiller
• The Erotic Mind by Dr. Jack Morin
• Becoming Cliterate by Dr. Laurie Mintz
• Better Sex Through Mindfulness by Dr. Lori Brotto
• The Leather Couch - Clinical Issues With Kinky Clients by Stefani Goerlich, LMSW
• Becoming a Kink Aware Therapist by Caroline Shabaz, MA and Peter Chirinos, MA
• Polysecure: Attachment, Trauma and Consensual Nonmonogamy by Jessica Fern, MS
• Open Monogamy by Dr. Tammy Nelson

• Listen to Podcasts: There are excellent podcasts available for free on many contemporary sex issues, including:

• Sex and Psychology with Dr. Justin Lehmiller (he also writes a blog)
• Foreplay Radio with Dr. Laurie Watson and George Faller, LMFT
• Sexology with Dr. Nazanin Moali
• Sluts and Scholars with Nicoletta Heidegger, LMFT
• Sex With Emily with Dr. Emily Morse
• Sex With Dr. Jess with Dr. Jess O'Reilly

• Know Your Blindspots and Seek Help in Your Own Sex Therapy: Without a doubt, therapists can't be experts on every topic, but it's important to know your own blindspots that could get in the way of helping your clients, and to seek help for yourself if necessary:

• Do you have your own sexual issues or problems in your relationship that you're still struggling with that require professional help? 

• Were you raised in a traditional family where sex was considered sinful so that you struggle now with sexual issues?

• Are there particular sexual issues that make you cringe which could add to a client's guilt or shame?

• Work Within the Scope of Your Expertise and Know When to Refer Out: As previously mentioned, there are so many issues in contemporary psychotherapy that clients bring into treatment so that no therapist can be an expert in everything.  Without even realizing it, many therapists provide clients with the wrong information that doesn't work for them. This will leave clients feeling like they have failed or, worse still, that their situation is hopeless. So, if you know you're not professionally trained or personally equipped to talk about certain sexual topics, know when to refer out to a skilled sex therapist.  You'll be helping your client and yourself.  Also, most sex therapists are willing to do adjunctive therapy with your client where you can remain the primary therapist for other issues and you and the sex therapist can collaborate if this is agreeable to your client and to you.

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing therapist and Sex Therapist.

I am a sex positive therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW.

To set up a consultation, call me at (917) 742-2624 or email me.