5 Secrets

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Table of Contents
Topic Secret # 1: Listen Closely to Your Clients Secret # 2: Theres More to Sex Therapy than Performance Secret # 3: You Dont Have to Have All the Answers (Really!) Secret # 4: Dont Try to Fix Your Clients Secret # 5: Check Your Own Issues at the Door
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2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals
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FIVE SECRETS OF GREAT SEX THERAPY

from ExpandingSexTherapy.com Secret # 1: Listen Closely to Your Clients
The details of our clients lives are keys to their sexual mysteries. To evoke them takes more than just a routine sex historyWhen did you first have intercourse? etc. It means openly inviting our clients to share nuances of their own unique erotic experience: their sensations, tastes, fears, longings, memories, wishes, dreams, and other connections of body, mind, heart, and spirit. Let yourself listen with curiosity and wonder. Witnessing and accepting clients experience can be a potent therapeutic strategy.
Secret # 2: Theres More to Sex Therapy than Performance

Great sex therapy often involves more than diagnosis and treatment of sexual dysfunction. Sexual experience is complex. Focusing on performance aspects of sex leaves out much of what is crucially important for men, women, and the rest of us, especially as we all grow older: self-esteem, pleasure, and the immeasurable joys of erotic connection. Think beyond symptoms and the goals of intercourse or orgasm. As you ask new questions, so will your clientsand what is out there for them to discover is a rich new sexual landscape of feelings and meanings.
Secret # 3: You Dont Have to Have All the Answers (Really!) No therapist can know everything there is to know about sex and intimacy. Sometimes the most
empowering intervention we can offer is to support our clients in exploring their sexual dilemmas for themselves. Solving all our clients problems is not our job. Predicting outcomes for our clients lives is not our job. Our job is to inspire self esteem and create a safe, confidential space in which clients can begin to rewrite the negative scripts that keep them locked in unwanted sexual dynamics.
Secret # 4: Dont Try to Fix Your Clients

Its your clients life, not yours. If you find yourself working harder than a client, this is a recipe for burnoutand a mixed message about responsibility. Great sex therapy involves trust that your clients are capable of acting in their own behalf. Work collaboratively with them rather than trying to fix them. Engage them in connecting the sexual complexities of their livespast, present, and future. Above all, encourage every independent step your clients take toward sexual healing and pleasure.
Secret # 5: Check Your Own Issues at the Door

Great sex therapy focuses on our clients, not ourselveseven when our clients issues bring us face-toface with our own. Professional ethics dictate that the therapy room is a place to model compassionate connection and clear, empathic boundaries along with confidentiality and safety. Summon whatever it takes to resolve your own issues about love, sex, and relationships so you dont get caught up in clients stories and projections, or act on ego needs to enter into romantic or sexual relationships with them.
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FIVE SECRETS of GREAT SEX THERAPY

A Guide for Sex Therapists and Other Health Professionals from ExpandingSexTherapy.com
Secret # 1: Listen Closely to Your Clients Secret # 2: Theres More to Sex Therapy than Performance Secret # 3: You Dont Have to Have All the Answers (Really!) Secret # 4: Dont Try to Fix Your Clients Secret # 5: Check Your Own Issues at the Door
Great Reading for Great Sex Therapy A Brief Guide
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Great Sex Therapy Secret # 1 Listen Closely To Your Clients

The details of our clients lives are keys to their sexual my steries. To evoke them takes more than just a routine sex historyWhen did you first have intercourse? etc. It means openly inviting our clients to share nuances of their own unique erotic experience: their sensations, tastes, fears, longings, memories, wishes, dreams, and other connections of body, mind, heart, and spirit. Let yourself listen with curiosity and wonder. Witnessing and accepting clients experience can be a potent therapeutic strategy.
Example: Taking a sex history that is therapeutic as well as data-gathering Sex therapists are routinely trained to take a chronological sex historyWhat was your age of first menstruation? When was your first serious relationship? What were your family attitudes about sex before marriage? The problem is that for most clients, the categories on a sex history form may not directly relate to the issues clients came in to deal with; too often, theyre not the first things we need to know about clients, or that clients want to tell us. A rote history taking process can sometimes feel freeing for clients, because youre opening up areas they want to discuss. But it can also feel intrusive, and can be time consuming without yielding vitally useful information. Moreover, it sets a noncollaborative tone for the rest of therapy, so that the client feels under interrogation rather than like a partner in the therapy process. Expanded approach to taking a sex history Instead of using a pre-determined sex history form, I focus on relating directly to clients rather than a form. First, I welcome them, ask why theyve come to therapy and how they think I may be able to help them. Then I set about evoking their stories in a more organic way. The four areas of exploration are: The Physical Story: How do clients experience sexual sensation, pleasure, orgasm. How would they describe a wonderful sexual experience theyve had? Or a disappointing or painful sexual experience? Is there any medical information that needs to be shared such as medications, or substance abuse? What is their experience of performance-enhancing drugs. The Emotional Story: What are clients experiences of love, passion, and compassion? How do they handle fear, rage, and resentment? Its in the emotional story that I most often find scenes bubbling up from early life, including the fallout from sexual control, abuse, incest, rape, date rape, and more. The Mental Story: What are clients experiences of choice and discernment in their sexual issues? What judgments and cultural messages do they carry with themsuch as Good girls dont and Real men score. The Spiritual Story: What does sexual experience mean in clients lives? How do they describe intimate connection and disconnection? What is the big picture of what they want? Does religion play a part?
I explore both positive and negative aspects of each area. I also explore past, present, and futurethat is, the clients memories and how these affect present sexual experience and their wishes, fantasies, and dreams of the years ahead.
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You can find much more information about this organizing principle In The Heart & Soul of Sex, which describes the findings from my nationwide survey, and in The Return of Desire, which describes the four energies that spark sexual desire.
Hot Tips for asking open-ended questions Beyond the initial interview, you can continue to find out what you and your clients need to know by asking open-ended questions about each of these areas of your clients sexuality and their lives. Ask your clients to tell you their story from each quadrant. You can start by asking: What does [Xbehavior] feel like? What does it mean in your life? There are several phrases I urge my sex therapy supervisees to use again and again. Tell me more Can you clarify for me What does that mean for you? Another set of phrases, to begin to explore the physical quadrant: Whats happening now? What do you notice in your body (your breathing, your clenched fists)? What would your hands say if they could talk? Or, to begin to explore the mental quadrant: Are you responding to messages about sexuality that are out there in the culture? What are some of those messages? How do they make a difference in your life right now? Or, to begin to explore the emotional quadrant: What are you feeling right now as you talk about [X subject]? Is this feeling new to you? Or is it usual and familiar? As clients are telling you their story, you may notice them shift quite literally to a younger age. You may see their posture change along with their face and gestures. You may hear their voice change, This is a time to ask: What age do you feel right now? Listen for the answer and then address that four-year-old or that eight-year-old directly, using the openended questions above. It is crucial for you to be sensitive to this shift for two major reasons. 1) You will miss valuable material for your therapy if you miss this shift. 2) If this younger and vulnerable state is unacknowledged, your clients may stay stuck in that state, and associate your therapy with pain and dissociation.
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To get at what your clients really want in their sexual relationships, heres a provocative question that will bring up many options beyond intercourse, orgasm, and other goal-oriented activities. Note that these options may be positive or negative. Describe a sexual experience from any time in your past that touched your heart and souland that possibly changed the course of your life. You can ask this question during an initial session of history taking, or you can use it as an exercise during individual therapy, where you can guide the discussion that follows. In couple therapy, this is a wonderful question to ask partnersand notice their responses to each others answers.
Benefits of asking open-ended questions instead of a prescribed sex history You will engage clients in becoming curious about their own therapeutic process as they hear themselves putting together their sexual experience in new ways, instead of repeating stories they already know by rote. Outcome An engaged and attentive client means much more engaged and attentive therapyand a more creative therapist. By opening up the questions you ask, and listening closely to the answers your clients give you, you are setting the stage for collaboration with your clients on exploring their sexual mysteries.
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Great Sex Therapy Secret # 2 Theres More To Sex Therapy than Performance
Great sex therapy often involves more than diagnosis and treatment of sexual dysfunction. Sexual experience is complex. Focusing on performance aspects of sex leaves out much of what is crucially important for men, women, and the rest of us, especially as we all grow older: self-esteem, pleasure, and the immeasurable joys of erotic connection. Think beyond symptoms and the goals of intercourse or orgasm. As you ask new questions, so will your clientsand what is out there for them to discover is a rich new sexual landscape of feelings and meanings.
Example: Discrepancy of desire in a heterosexual couplein their mid-40s, married 17 years He complains that she has lost the desire for sexhe wants much more sex than she does, and is so frustrated that he is fantasizing about having outside affairs. She is anxious about what an affair might do to their marriage, but argues that he just wants physical sex, which has become boring and is now sometimes painful as she enters perimenopause. She says she needs more emotional connection; it is the sense of love and tenderness that arouses her, and without that she cant come to orgasm or even lubricate sufficiently for intercourse. Expanded approach to discrepancy of desire When a couple presents with issues about desire, I do not immediately assume pathology in one or both partners. One of the first questions I ask each partner is: desire for what? Is it intercourse with a goal of orgasm a prescribed number of times a week, or is it something else, perhaps more complex, and perhaps not talked about? Sometimes partners are very clear about what they think they want, as this couple is. But I begin our therapy relationship by seeking to understand (and help them understand) a broader sense of all that sex might entail for them. And I seek to evoke the details of their desires in a way that is collaborative, efficient, and fun. Hot Tip for learning about couples desire A diagnostic exercise I use to help couples learn more about sexual desire is a simple sentence completion about how they can turn themselves off and onI start with turn off because it is usually easier for couples to recite the negatives at first, and I want them to feel successful. The effects of this exercise can be profound when partners engage in this together. Begin by asking couples to complete this sentence: I can turn myself off by Direct the couple to pass this sentence-completion back and forth, so that each partner repeats the sentence again and again, with new completions. For instance she might say, I can turn myself off by thinking about our taxes. He might say, I can turn myself off by answering e-mails all night. Then she might say, I can turn myself off by noticing wrinkles around my eyes And so forth.
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Let the couple go back and forth for as long as possibleso that both partners have to reach deeply into themselves to articulate their turn-offs beyond the first few stock phrases they might come up with. Allow at least 5 minutes for this part of the exercise. Then ask the couple to complete this new sentence using the same back and forth format for another 5 minutes or so, until they run out of stock phrases and reach deep into their wellspring of desires: I can turn myself on by While the partners are doing the sentence completions, your role as therapist is to keep them on track encouraging each set of these to go on and on. You may have to steer them off trying to put responsibility for their desire onto one another (You turn me off (or on) by.) The message you want to give to each partner is: This is about YOU, not about your partner. Couples may have a great deal of fun with this exercise, or they may become anxious or even inarticulate. They may make jokes, or say they cant do the exercise, or start to tell long stories. Your job is to notice how they interact, keep the exercise going, and hold space for witnessing whatever happens. When it is over, your job is to help them process what they have learned from each otherand from themselves. The diagnostic value of this exercise is to identify where the therapy needs to focus. Do you need to begin by sending the woman partner for a hormonal workup? Or giving the couple information about lubrication? Or does it become evident that the crux of the desire discrepancy lies within the relationship? You may find a relevant piece of homework emerging from some of the things they say. Benefits of sentence completion as a diagnostic tool Explores complexity of experience rather than pathology Provides an enormous amount of information about each partners desire in a short time Provides instant information about ways the partners relate to each otherand want to relate to each other sexually Equalizes the conversation about desire Allows partners to hear many levels of what each other wants and doesnt want Removes the option of responding to each other with judgments, defense, blames, or self putdowns Focuses partners on responsibility for their own sexual desireon what they can do for themselves, not on expectations of their partner, which have too often been unmet. Offers the couple new language and a new process for articulating what they want. Outcome This simple exercise quickly and efficiently focused our therapy sessions on the complexities of the needs of both partners, rather than identifying the wife and husband at the opposite ends of the desire spectrum. As a result of this exercise, the husband, who had been lobbying for more intercourse, acknowledged that his needs for sexual contact were as much about wanting a place to open his heart as they were about stimulating his penis. The eventual outcome was not a vast increase in the number of times this couple had intercourse, but rather a shift in attitude that gave them a way to update what they each wanted, and a reconfirmation of their commitment to each other. At last report, their sexual interactions did not always include intercourse. But they were setting aside time to be sexual and were exploring ways to give each other what they wanted. They said they occasionally felt like randy teenagers again.
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Great Sex Therapy Secret # 3 You Dont Have to Have All the Answers (Really!)
No therapist can know everything there is to know about sex and intimacy. Sometimes the most empowering intervention we can offer is to support our clients in exploring their sexual dilemmas for themselves. Solving all our clients problems is not our job. Predicting outcomes for our clients lives is not our j ob. Our job is to inspire self-esteem and create a safe, confidential space in which clients can begin to rewrite the negative scripts that keep them locked in unwanted sexual dynamics.
Example: A woman threatens to leave her husband because of his porn use. He says he uses porn because shes a prude This couple has been together for 12 yearsshes a school teacher, hes a computer programmer who works from home. They have two boys, age 9 and 11. His arousal template is to wait until she and the children go off to school, and then lie on the sofa, smoke pot, and masturbate to Internet porn. She is distraught, confused, angry, and totally turned off sex. She wants to publicly shame him, but backs off because of the children. He blames her for threatening him with Catholic guilt. The couple are barely speaking to each other when they arrive for their first session. Expanded approach to hot-button issues with coupleshelping them rewrite their own story There are many theories about how to treat the addictive and compulsive use of pornography, and even more theories about how to treat repressive sexual attitudes and low sexual desire. I chose to bypass all of these approaches to personal pathology because I felt that pursuing them would reinforce the negativity and anger that was already tearing this family apartand I was also factoring in the best interests of the children. Importantly, too, I had no definitive answers for this couples profound disaffection with one another, and felt the wisest course was to offer ways to help them begin to make peace with themselves and each other. I chose to focus on expanding this couples awareness of each others sexual templates. I began our therapeutic interaction by acknowledging the wide chasm between their sexual styles, and I obtained their agreement for helping them investigate the sexual dynamic they had set up for themselves. The stated purpose was to see if new understanding they gained could help them rewrite their sexual scripts. I hoped this approach would help them either move closer to each other sexually and spiritually, or else underscore their differences in a non-blaming way, which would point to a clear choice about ending the relationship. I stated that I had no agenda about keeping the marriage together, even though there were children involved, because their sexual dynamic was creating so much anger and tension in the house that the children were beginning to suffer, and would surely suffer more as they became teenagers with their own issues and questions about sexuality. It was evident from the blames this couple threw back and forth that both were stuck in a loop between their heads and their heartsexpectations about what their sexual relationship should provide, and hurt and rage born of disappointed expectations. In other words, they had created a sexual script that left little scope for exploring what each of them wanted. To expand their sexual script I created a safe place for them to look at their couple dynamic. An important part of this was teaching them how to to be still and listen to each other with open ears.
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Hot Tips for understanding the hot-button issues of pornography and religious repression My decision with this couple was to engage them in a series of questions designed to help them rewrite their sexual scripts by offering them some new ways to think about sexuality. The questions below were investigated over several sessions. What attracted you to each other? This question was to get them out of their heads and into their hearts, and to find out their relational chemistry. (He thought she would provide stability; she thought he would open her up to adventure. The sex was great until she became pregnant.) Tell me something you agree on This was to determine what the core agreements of this couple are. (They agreed about the welfare of the children, but little else). Describe to me in as much detail as you can, what you get out of holding your position against each other (Basically, they both felt disillusioned and defensive, each wanted to be right.) (To the husband) What do you get out of watching porn? ( He is able to create an alternate universe where he doesnt have to live up to anything. That is, for him, his porn use was an anxiety releaser before it was a sexual turn-on.) When asked what does he need in order to relate sexually to his wife? He didnt know. He responded with a question: How do I relieve my anxiety about not being good enough? (To the wife) What do you really want--once he turns off the computer and pays attention to you? (She didnt know: Her question was: How do I maintain integrity in this humiliating situationwhen what I want doesnt match the male script?) Finally, I asked them each to bring into their next session an object to represent what they truly wanted in an intimate relationship that was just right for them. She brought in a bowl of waterto represent that what she wanted was for a relationship to be fluid and nurturing and also a container for deep spiritual connection as well as sexual connection. He brought in a Playboy magazine to show the kind of hot contemporary images that excited both his body and his imagination. When they saw each others objects and heard the descriptions, they both laughed in a truly accepting way at how very different they were in terms of their sexual desires. Benefits of allowing clients to rewrite their own scripts When clients are able to reach deep inside themselves to acknowledge what they want sexually and spiritually, they can begin to understand how these connect with seemingly nonsexual issues such as needs for approval and inclusion. Not only does this motivate them to move toward what they want in their intimate relationships, it helps them accept others where they areand determine in a nonjudgmental way how closely they want to relate to them. Outcome In this case, the couple eventually decided to split when they were able to acknowledge how far apart their intimacy and sexual needs really were. At present writing, the wife is about to remarrya childhood sweetheart, a widower with two young boys, and a devout but not rigid Catholicwith the promise of the stable life she has dreamed of. The husband has moved to an apartment nearby and is enjoying his bachelor existence. Because this couple had worked out their confusion about their sexual differences, the issue of divorce ceased to be a threat. In fact, their divorce proceedings were relatively seamless and kind. Though their
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lawyers advised them to be adversarial, the couple was able to work out an agreeable financial arrangement and shared childcare based on the positive capabilities of each parent. The boys live with their mother, who is more consistently nurturing. They see their father frequently, who enriches their lives creatively in ways that their mother cannot. The couple is agreed that he will not share his interest in Internet porn with the boys.
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Great Sex Therapy Secret # 4 Dont Try to Fix Your Clients

Its your clients life, not yours. If you find yourself working harder than a client, this is a recipe for burnoutand a mixed message about responsibility. Great sex therapy involves trust that your clients are capable of acting in their own behalf. Work collaboratively with them rather than trying to fix them. Engage them in connecting the sexual complexities of their livespast, present, and future. Above all, encourage every independent step your clients take toward sexual healing and pleasure.
Example: A menopausal woman is immobilized by obsessive thoughts about being a lesbian This 48-year-old single woman came to therapy because she said she finally had to talk with somebody about her attraction to womenher state for as long as she can remember, though she has never acted on it, and has never had an intimate relationship. She fears growing old alone, and is so depressed that she rarely leaves her house except to go to her job as a bank teller. Though her PCP has prescribed Paxil for her, it is not relieving her depression. She had a strict Christian upbringing with a devoutly religious mother who is still active in the church. She has little contact with her mother, because her mother is so judgmental that this client feels like a sinner. This client presented as ashamed, needy, and deferential, so emotionally constricted that I could feel her sapping my energy. She asked for help as if I had all the answers to her life. The message she gave was one of desperation: Fix meas if I could somehow absolve her of sin and bring her into the light. My experience has been that there is light in every client, but that it doesnt come from me. It is the clients inner light, and that my job is not to try to fix clients but to help them find their own light. Expanded approach to mobilizing clients who are stuck When a client presents with extraordinarily low energy (whether or not the issues are specifically tied to sexuality), my first step is to try to engage them in their own behalf, otherwise I realize that I will be doing more work than the clienta situation that is not only exhausting for me, but ultimately disempowering for the clients. With the degree of immobilization in the client above, I assume there may be a history of some kind of abuse or neglectperhaps triggered by her mothers religious fundamentalism and unrelenting judgments. But my first aim is to help the client acquire some strong and dependable coping skills before we begin rooting around in what may be a traumatic past. Because this woman was so immobilized, so ashamed, and so scared of her sexual attraction to women, I felt it was important to go slow with her in therapy. I also felt it would be unproductive to give her standard sex therapy homework right away, or even to address her sexual orientation issues head-on. Instead, I decided to try some wake-up exercises during our sessions to see if these would help her expand her frame of reference so that she could find resources within herself. I began with cumulative steps to what I call a Meditative Journey. Hot Tips for a meditation journey The first step was to teach her to breathe consciously and intentionally I begin every meditation journey by working closely with clients breathing, teaching that the inhale breath is inspirationwith all that stands for, and that the exhale breath is expirationletting go of
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all that is no longer useful or wanted. This is an opportunity to tie the process of breathing with whatever issues the client is struggling with, so they can use their breathing consciously at home for both comfort and awareness. From there, I asked her to follow her breath inside herself until she found a safe place I routinely ask clients to start their meditation journeys by finding a place inside themselves that has never been woundeda place of ease and clarity and power. I ask them to notice what this place is like: Large or small? Indoors or outdoors? What are the textures and smells? Is anyone else there? And so forth. Knowing specific details of this safe place gives clients a confident starting point from which to visit new emotional landscapes, or to revisit events that may have terrified themand a home base for their safe return. Then I asked her to bring herself back into our room so that we could discuss her journey so far The point for this client was to give her the experience of briefly going into a meditative state and coming back safely. I do this to give clients a sense of mobility and power, and to help them create a container for their inner journeys so they dont feel theyre going to fall down an endless rabbit hole. At the same time, this process establishes a sense of collaboration and teamwork with clients. The next step was to have her return to the safe place and notice two doors there. These doors (or they can be paths) represent dichotomies in the clients story. In this clients case, one door was labeled Lesbian, the other door was labeled Heterosexual. I did not ask her to open the doors, simply to notice that they were there, for her to access whenever she wanted. Again, I asked her to come back from the journey to discuss her experience. Next, I asked her to follow her breath to her safe place, approach the doors, choose which one to openand walk through. Once clients walk through a door I ask them to notice the space, just as I did with the safe place: What do you notice? Who is there? And so forth. Next, I suggested, In this place that you are exploring, find a message with your name on it. Clients seldom fail to find a message, and the message is always significantsometimes funny, sometimes enigmatic, but always meaningful to the client. This woman found a small brown Teddy bear that she remembered from her childhood. Finally, I asked her to follow her breath back into the room to discuss her experience. She was moved to tears when she came back with the Teddy bear, whose message for her had been inside its ear: You are good! She took this as a message from the universe that she was not a sinner. Her relief was palpable. She had begun to find inner guidance through the wisdom of childhood knowing the messenger was her beloved stuffed bear from whom she sought solace from her mother. Benefits of the Meditation Journey process Engages clients breathing and teaches connection of body and spirit, also a rhythm of inspiration and letting go. Engages clients imagination. Open-ended instructions for the journey allow clients to use their own images rather than trying to fit their experience into images I might choose.
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Offers clients a way to find a path to a new positive placethat they can access whenever they breathe Invites clients to dive beneath the radar of cultural convention to access information about their livespast, present, and future. Offers a respectful, non-blaming approach to clients issues, whatever they are. Teaches clients a new skill to practice at homeinvolving breath, imagination, and hope. Engages clients in acting on their own behalf, and takes some responsibility for treatment outcome off the therapist.
Outcome For this client, as for many clients Ive initiated into meditation journeys, this process began to wake her from her chronic numbness. In her first journey, she received a message about the origins of her shame and internalized homophobia that gave us material to focus on in therapy. Most importantly, she became engaged in actively exploring her sexual orientation. She was motivated to read books, watch films, and finally to join a coming out group for lesbians at her local womens center. She began to make friends there, and had the sense of belonging she never felt growing up. She no longer feels like a sinner, has weaned herself off antidepressants, and is committed to expanding her life.
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Great Sex Therapy Secret # 5 Check Your Own Issues at the Door
Great sex therapy focuses on our clients, not ourselveseven when our clients issues bring us face-to-face with our own. Professional ethics dictate that the therapy room is a place to model compassionate connection and clear, empathic boundaries along with confidentiality and safety. Summon whatever it takes to resolve your own issues about love, sex, and relationships so you dont get caught up in clients stories and projections, or act on ego needs to enter into romantic or sexual relationships with them.
Example: A client admits she is in love with you A 39-year-old single dad has been in therapy for seven months, working hard to recover his sexual selfesteem after separating from his sons cocaine-addicted mother. The therapist is moved by his predicaments, identifies with many of his issues, and often praises him for his insights and commitment to growth and change. During one session, the client says to the therapist, You have become the most important person in my life. I love you. I wish I could be just like you. I want to spend time with you beyond our therapy sessions. Expanded approach to issues of transference and countertransference This is a classic scenario of boundary-hopping, which may flatter the therapist greatly. But no matter how attracted the therapist may feel to the client at that moment, there is only one clear response for the therapist: Just say no. Guidelines about transference and countertransference date from almost a century ago when Sigmund Freud put these concepts into the literature. Standards of professional behavior are now firmly set in place to protect both clients and therapists from forming inappropriate liaisons. All of these standards state that therapists must refrain from dual relationships with clients, and specifically from sexual relationships with clients. Classically, therapists are trained to defend against unethical behavior by limiting their emotional connection with clients. But I dont believe thats the whole answer to a complex question. The truth is, therapists do have feelings, and limiting our affect may prevent important material from surfacing for discussion, particularly when clients are looking for guidance about intimate relationships. Clear and important as codes of ethical behavior are, they omit the truth that the feelings we may have for our clients, and that our clients may have for us, can become deep and multifaceted over the course of therapy, and that they may spill outside the tidy box called ethics. The case above brings up a number of issues, beyond simple boundary-setting. One is the idea that the feelings that flow between clients and therapists can be key to the therapeutic process rather than a launch pad for ethical censure. I like to think of both transference and countertransference as energy exchangean invisible, intangible force that moves between therapists and clients, sometimes powerfully enough to color their relationships, and alter them. The upside of this energy exchange is that it can inspire and motivate both client and therapist to be the best that they can, and the therapy relationship can flourish. A downside comes when therapists have not fine-tuned their awareness of their own issues. This opens us to getting hooked into clients stories, or into their projections of us. Instead of holding our clients issues in understanding and compassion, we may end up trying to influence their lives personallyby rescuing them, entering into
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questionable financial arrangements with them, or worse: teaching them about sex by engaging with them in sexual relationships. An often unexplored truth of great sex therapy is that once in a while, a client will fall in love with us. Or have sexual fantasies about us. Or obsess about us. This is what Freud called transference. By the same token, we may fall in love with our clients, obsess about them, and have sexual feelings for them. This is what Freud called countertransference. We need to pay attention to all of these feelings and where they come from in usnot just intellectualize them away or hide from them behind a wall of defensiveness. A crucially important truth here is that its not unethical to feel deeply connected with a client. But it is unethical to act on our feelings for purposes of self-gratification. We need to learn how to recognize our feelings so that we can act in the best interests of our clients. Beyond that, we need to find a place to work on our own issues so we dont play them out with our clients. Hot Tips: Beyond Just Say No A therapeutic conversation with the client above would contain these six elements: 1) Let the client know honestly and factually that he is heard: I honor your feelings of trust and love, and feel moved that you want to be like me and know me better. 2) Let the client know that you care about himwhy, how, and to what extent: I want you to know that I am inspired by your efforts to rehab your life. And its a real joy to work with you. You bring wonderful energy to this workand you have a beautiful way of translating what we do in therapy into your life and making it your own. 3) Acknowledge how he might take your feelings toward her as an invitation to love: A therapy relationship that is vital is very much like a love relationshipbecause we are dealing with your deep concerns about love and sexuality, and as we discuss these, you and I are passing a great deal of positive energy back and forth. 4) Let him know exactly what your boundaries are: For us to extend our relationship beyond therapy is not possible. It would go against the professional code of ethics that I live by. Equally important, it would dissipate the focused energy we bring into our sessions together. Whats important is for you to continue to take the energy we generate in our sessions and use it in your life. 5) Offer him something positive to do with his feelings: So I would like us to continue to use the energy we generate as a way to help you get clearer and clearer with your girlfriendso that you can develop the kind of relationship that will be wonderful for you. 6) And furthermoreonce the elephant is out in the open, you can use it as a way to discuss sexual energy in the interest of wakening the clients awareness of what he really wants. Benefits of clarity about issues of transference and countertransference Making the commitment to acknowledge our own issues when they are triggered by clients allows us to focus on the wellbeing of our clients instead of getting hooked into co-dependent and even unethical behaviors. Acting with clarity and compassion, not only allows the therapy to move forward, but models compassionate relational behavior. Outcome All of this said, Im going to refer you to the AASECT Code of Ethics, which is clear and comprehensive, and which is required for any AASECT certified therapist to adhere to. This AASECT code stresses competence and integrity as well as moral, ethical, and legal responsibility to safeguard our
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clients welfare. Below are condensed and paraphrased excerpts. To read the entire AASECT Code of Ethics, see http://aasect.org/codeofethics.asp. Competence and Integrity of Sex Therapists Sex therapists will commit to high standards of scholarship and training in sex education, therapy, and supervision, and will update their professional expertise through continuing education. When a clients issues are beyond a therapists expertise or abilities, or when boundary issues threaten, the therapist will refer to a qualified professional who can better address that clients needs. Moral, Ethical, and Legal Responsibility to Clients Sex therapists will not enter into any dual relationship that jeopardizes the well-being of the client, or condones inhumane practices regarding age, gender, sexual orientation handicap, race, religion, or national origin. Sex therapists will maintain confidentiality and clarify any exceptions to confidentiality and privileged communications (e.g. duty to warn, when there is clear and imminent danger of bodily harm or to the life or safety of the client or another person). Sex therapists will not engage, attempt to engage, or offer to engage, a client in romantic or sexual behavior whether the client initiates or consents to such behavior or not. Sexual behavior includes kissing, sexual intercourse and/or the touching by either therapist or client of the others breasts or genitals. In closing, its been a pleasure to share with you five of my secrets to great sex therapy. Please know that there are many morethese are only a few. If youd like to learn more, please have a look at my books, and also join me at one of my workshops or trainings so we can work together to expand the practice of sex therapy to become more integrative and collaborative. And do write to meI would love to hear from you! Gina Ogden, PhD, LMFT, Gina@ExpandingSexTherapy.com
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GREAT READING FOR GREAT SEX THERAPY A BRIEF GUIDE from ExpandingSexTherapy.com Riane Eisler, Sacred Pleasure. New York: Harper, 1995 A landmark history of sexuality through the lens of dominator and partnership societies Peggy Kleinplatz (Ed.) New Directions in Sex Therapy.New York: Brunner-Routledge, 2001 A gathering of innovative sex therapists and activists speak their truth Tammy Nelson, Getting the Sex You Want. Beverly, Mass.: Quiver, 2008 An Imago therapist looks at couples dynamics, and offers scores of useful exercises Christiane Northrup, The Wisdom of Menopause.(Rev. Ed) New York, Bantam, 2006 An MD with soul lets women know that sexual pleasure doesnt have to end with age Gina Ogden, Women Who Love Sex (3rd Ed.). Boston: Trumpeter, 2007 Women redefine sex through stories of lust, relationships, intimacy, extragenital orgasm, and thinking offorgasm with no hands Gina Ogden, The Heart & Soul of Sex. Boston: Trumpeter, 2006 Stats and stories from Ginas nationwide survey on Integrating Sexuality and Spirituality (ISIS)and introduction of the ISIS Wheel and how to use it in therapy Gina Ogden, The Return of Desire. Boston: Trumpeter, 2008 Applying the ISIS process to sexual desireincluding relationship issues, masturbation, childbirth, affairs, sexual orientation, abuse, trauma, and sacred union Esther Perel, Mating in Captivity. New York: Harper, 2007 Erotic intelligence about men, women, love, sex, affairs, and much more Leonore Tiefer and Ellyn Kaschak (Eds.), A New View of Womens Sexual Problems Binghamton, NY: Haworth Press, 2001 Feminist academics tackle the medicalization of sex therapy and offer alternatives Evelyn Resh, The Secret Life of Teenage Girls. Carlsbad, Calif.: Hay House, 2009 All those issues your mother wouldnt talk about and your daughter needs to know Suzanne Scurlock-Durana, Full Body Presence. Novato Calif.: New World Library, 2010 A practical exploration of breath and body to expand awareness and pleasure Sherri Winston, Womans Anatomy of Arousal. Kingston, N.Y.: Mango Garden Press, 2010 Richly illustrated manual and guide to anatomy, energetics, orgasm, and beyond

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FIVE SECRETS OF GREAT SEX THERAPY

Secret # 2: Theres More to Sex Therapy than Performance

Secret # 4: Dont Try to Fix Your Clients

Secret # 5: Check Your Own Issues at the Door

FIVE SECRETS of GREAT SEX THERAPY

Great Sex Therapy Secret # 1 Listen Closely To Your Clients

Great Sex Therapy Secret # 4 Dont Try to Fix Your Clients

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