What to do when your therapist draws the line at your sex life.
Recently, a client sought me out for an interesting reason:
Their therapist told them to.
A sex specialist, the counselor explained, could better help my client with the guidance they needed.
A sex coach isn’t always the person to turn to when mental health and sexual health intersect. However, there are times when it’s the right move.
Other options do exist, which I’ll go over shortly. But first, a little background on sex, mental health, and why therapists sometimes tiptoe around human sexuality.
Sex is a basic need.
For most people, sex is a foundational part of overall wellbeing. It appears in the physiological level of Maslow’s hierarchy of needs, along with things like breathing, food, water, and sleep.
Since therapists learn about Maslow’s hierarchy as part of their education and training, you’d think they’d be on board with sex talk. However, this is far from the truth.
“A whole lot of marital therapists are uncomfortable talking about sex, so they don’t ask or they don’t create the kind of climate in their sessions that would give patients the idea that they can talk about anything or bring up sexual issues.” –Dr. Sara Rosenquist, Clinical Health Psychologist
Outside of marital counseling, other therapy providers can also be uncomfortable with or unprepared for counseling clients on sexual issues.
There are many possible reasons for this.
Why therapists avoid talking about sex
Many therapists are perfectly comfortable talking about sex. For some, however, it’s not so simple. Some reasons for this include:
- Professionalism. The American Psychological Association’s (APA) ethical principles forbid therapists from having outside relationships with clients. This includes relationships of a sexual nature. Some therapists may feel that simply talking about sex crosses this boundary.
- Sexual stigma. Therapists are people just like us, and as a result can hold many of the same stigmas we do about sex or sexual interests that aren’t a part of heterosexual, cisgender, and monogamous relationships. For some, even sex that does fall neatly into this category can cause discomfort.
- Lack of information. Historically, therapist training has only briefly touched on sexual health and human sexuality. Counselors have to seek additional continuing education in order to be adequately informed about how to help clients with sex-related issues.
“Considering that sex plays a primal and major part in all of our lives, too few of us — including therapists — are well-informed about the depth, breadth or range of sexual expression out there. Until recently and because as a society we’ve been skittish about discussing or teaching about sex, our sexual education has been woefully inadequate to help our clients.” -Joe Kort, Ph.D., Psychology Today
All of these reasons can be traced back to sex negativity, “a negative attitude or stance toward any sexual behavior other than procreative marital coitus.”
Sex negativity exists all around us. We see it when people shame premarital sex, homosexual partnerships, or non-PIV (penis in vagina) sex acts like oral or anal sex. Unfortunately, this shaming causes a lot of pain for people with perfectly natural interests in human sexual activity.
The same sex-negativity that causes this shame also leaves many therapists underinformed or uncomfortable with talking about sex.
What’s a person with sexual questions or issues to do?
The consequences of sex negativity in therapy
Put in the context of therapy, sex negativity is doubly alarming. Many common mental health conditions and treatments have well-documented effects on libido, desire, and/or the ability to experience erection or orgasm.
Clients can seek therapy for completely non-sex-related reasons, but then be unable to get help with the sex-related issues their condition or medication causes. There’s really no winning.
Sadly, therapists’ hesitancy to talk about sex leads to a myriad of problems.
Many therapy clients who experience sexual issues:
- don’t get the help they need
- lose romantic partners, or get divorced if married
- continue to feel shame about their sexual issues or desires
- develop unhealthy habits centered around sexual shame
- receive objectively terrible advice about sex
As you can imagine, many of these situations result in issues like continued depression, anxiety, or other unresolved conditions. In the case of bad advice, there’s even more cause for concern.
Underinformed therapy results in very bad advice.
When therapists who aren’t trained in sexual health and human sexuality attempt to address clients’ sexual issues, the results can be disastrous. I’ve heard of or read about clients receiving awful advice or feedback like:
- you need to redirect your sexual attraction to the appropriate gender
- your partner’s porn dependency means that you’re a bad spouse
- if your sexual needs aren’t being met, you have to open your relationship
Yikes! These are all examples of truly bad attempts at sex therapy. Another issue, according to Dr. Rosenquist, is misdiagnosis:
“A lot of general therapists lump ‘unusual sexual practices’ together as ‘sex addiction.’” -Rosenquist
Sex addiction: Is it real?
Sex addiction isn’t a recognized condition in the Diagnostic and Statistical Manual of Mental Disorders. Also called the DSM, this manual determines which issues are diagnosable in psychotherapy.
Though sex addiction isn’t included in the DSM, many people do suffer from compulsive sexual habits that interfere with their quality of life. These are often centered around masturbation and porn.
Sex therapists and sex coaches can and do help clients tackle what often feels like porn dependency.
It’s important to remember that all sex comprised of consensual acts is perfectly natural human sexual activity. Keep in mind what constitutes sexual consent, of course, and otherwise decide for yourself what feels right for you.
What to do if you need sex therapy
If your therapist won’t talk about sex or is sex-negative when they do, one option is to specifically seek out a sex therapist.
The American Association of Sexuality Educators, Counselors, and Therapists, or AASECT, certifies licensed therapists to provide sex therapy.
AASECT certification requires additional time and training on top of the usual licensing requirements for therapists. Standard licenses already take years of rigorous education and training to obtain. Thus, becoming a sex therapist requires high levels of interest and dedication on the part of the counselor.
Certified sex therapists are a rare and special kind of counselor. As Dr. Rosenquist puts it:
“Most general therapists would avoid learning about ‘unusual’ sexual experiences because they are frankly not equipped to deal with it.”
While finding an AASECT-certified sex therapist can be a relief for clients in need, not everyone is able to find an available one in their budget. Fortunately, not every sexual question or issue requires sex therapy.
When a sex coach can help
For many people with questions about sex, a sex coach might be the best option.
Sex coaches are not licensed therapists. As a result, they typically can’t provide adequate support for mental disorders or recovery from trauma, including sexual trauma.
However, a sex coach can supplement traditional therapy to make sure all of a client’s needs are met. They’re also sometimes easier to find and more affordable than licensed sex therapists.
Sex coaches can help with things like:
- issues with libido, arousal, and desire
- concerns about orgasm or erection
- struggles with body image and/or confidence
- sexual inhibition
- sexual compulsion (often called “sex addiction” or “porn addiction”)
- improving sexual communication skills
- building more sexual independence
- questions about sexual identity or orientation
- questions about kink, BDSM, or ethical nonmonogamy
Sex coaches are often certified by a professional organization in the human sexuality field. For example, I’m certified by the Sexology Institute, whose program meets the requirements set forth by the American College of Sexologists.
Not all sex coaches are certified. There is no requirement to be certified to open a sex coaching practice. If you do decide to seek a sex coach, be sure to look for their experience and any credentials. Ask about their background to get a feel for whether they’re the right fit for your needs.
Related Article: Is Sex Coaching a Scam?
Do I need a sex therapist or a sex coach?
If you’re not sure whether you need a sex therapist or a sex coach, there are a few rules of thumb that can help you decide.
- Coaching looks forward; therapy looks back.
As the name implies, a sex ‘coach’ helps clients set goals, create milestones, and track progress along the way. This is forward-looking. Clients are either mentally healthy or in a good place with managing any mental health conditions.
A sex therapist, by contrast, tends to specialize in looking back. In addition to goal-setting, they’re trained to dig into your past experiences, help identify how those shaped your views on sex, and discuss how all that intersects with other factors actively affecting your mental health.
2. Therapists diagnose; coaches cheer you on.
Sex therapists have the power to diagnose sexual disorders. These include erectile dysfunction, early ejaculation, anorgasmia, and other issues. Some therapists, if they are also psychiatrists, can prescribe medications.
Sex coaches cannot provide a formal diagnosis or medications. However, once a diagnosis is reached either by a therapist or via self-diagnosis, a sex coach can often help clients work towards overcoming these issues.
3. Coaches have niche skills; therapists are broadly trained.
Typically, sex coaches are focused strictly on your sexual hurdles and goals. They aren’t always trained in other areas, though it isn’t unheard of for sex coaches to also be certified in things like body image coaching, kink awareness, or providing safe spaces for LGBTQ+ individuals.
Sex therapists, on the other hand, have a much broader education and training background. If you’re also living with mental health conditions, processing sexual abuse or trauma, or have multiple factors complicating your sex life, a sex therapist may be a better fit.
Get the sex therapy you need.
Got a sex-shy therapist? Don’t let it stop you. A sex therapist or sex coach can help you with everything from experimenting with masturbation to finding great play parties. You’ve just got to be brave enough to ask.
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