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Sex! The elephant in the room: how to manage sexual concerns in the therapy room

Sometimes talking about sex in the therapy room can be as just as intimidating and uncomfortable for the therapist as it is for the client. Yet its importance must not be underestimated and by ignoring it we can seriously limit the efficacy of therapy. Not only might a client’s problem impact their sexual identity, but a sexual issue might well be the source of their problem. Sex is often the proverbial elephant in the room and it is the responsibility of the therapist to create a safe space for the client to allow it to be a part of their therapy. If you or someone you know needs help for sexual issues, don’t suffer in silence.

As part of my intake process I regularly ask about sex. This has three immediate benefits:

  • If there is a sexual issue, this can enable the client to talk about it and immediately make it part of their treatment plan.
  • If there is a sexual issue but they are not ready to talk about it yet, this can create a safe space for them to bring it in to therapy when they are ready.
  • By tackling this sensitive subject up front, if can often have the beneficial effect of helping the client feel that there is no subject too personal to discuss.

Some time ago a woman came to me to work on her lack of confidence in the workplace. As we discussed why this might be, I wondered if her lack of confidence might be linked to other areas.  I asked if she struggled with performance issues in the bedroom. At which point her head shot up and she nodded.  Lack of confidence in her sexual performance (coupled with poor communication) with her partner had resulted in transference of this insecurity to her work.

At the end of the first intake session she revealed that she had seen three other therapists about this same issue (lack of confidence at work) but had been too embarrassed to bring up the issue of sex herself. But by avoiding asking about this critical topic these therapists had unknowingly prevented her from making the changes she needed to resolve her problem.

As therapists we have a duty to make our clients feel comfortable talking about sexual issues. But surely it must start with us feeling comfortable about it ourselves? If sex is not an issue for the client then it will be quickly discarded. I am not suggesting that if someone wants to stop biting their nails that you should leap into a discussion about their sex life. However problems such as over or under eating, anxiety, depression, trauma, chronic pain or illness can often be connected to problems of sexual image, sexual pleasure and interest. Therefore, it is crucial that clients be given the opportunity and space to talk. Getting help for sexual concerns can create powerful changes, so don’t delay.

Needless to say, that once the topic has been broached, the “elephant in the room” is no more.

If you or someone you care about could benefit from getting help with sexual concerns then contact me today.

* Details that do not impact the message of this post have been removed or modified from this case description to ensure anonymity.