As a psychosexual therapist, I have had to work on my own sexual issues in the knowledge that the degree of comfort I have in facing myself and my own sexuality will adjudicate the limits of the therapeutic support I can extend to my clients. Like most bought up in a culture of secrecy and shame, it is easy to allow my own discomfort to impact this most delicate of territories. I have worked to understand my own familial culture as I developed through childhood, along with my own experiences. I have thankfully found a place whereby I believe I can offer my clients a place whereby they can confront the truth of who they are and the challenges they are facing.
There are so many things that bring an individual or couple to therapy with sex often being one, but rarely immediately voiced. Over the years, I have learnt the importance of creating a space whereby my clients can address sexual issues, supporting them to find the language to say what has never been said or to put into words the secrecy-ridden issues that have been hidden away, shrouded in anxiety and shame. As clients are continually picking up cues of safety and non safety I find it useful to mention sex in our initial assessment meeting. This is amongst all sorts of other questions and normalises a topic that so many therapists don’t address. This sets the tone for my clients to know that sex is something they can discuss as and when they feel ready.
There can be little doubt that the shape of human sexuality and its behavioural expressions are many and varied. Few of us grew up in an environment where sex and sexuality was openly talked about. With no one to ask our questions to or allay our fears, many relied on the internet and or porn, which in itself often fuelled additional feelings of anxiety and inadequacy. Whether it be loss of desire, lack of confidence, inexperience, boredom or any of the many psychosexual issues, many of my clients have used therapy as a starting point in learning how to talk about sex and confront what, for some, has been hidden for many years.
There is not a one size fits all approach when working with clients around sexual issues. For me, I consider it essential to assess for levels of comfort or discomfort and at all times, be led by my clients. I remind myself of my own embarrassment when starting out on my psychosexual training and treat my clients with respect, offering them a “parental” acceptance as a sexual being. Always mindful of the existence of sexual anxiety I start with using my clients language as a way to be guided by them, respecting their sexual vulnerabilities and finding a common language from which our work can begin. Many clients find it difficult to come straight to the point. They fear making a fool of themselves, using the wrong words or causing offence by being too explicit. By being empathetic to the struggle, they can share their concerns and, with time, replace any shame and anxieties with acceptance and an understanding of themselves that hopefully offers them a way forward that will offer a more satisfying intimate life.
Sexual attitudes and taboos are powerfully shaped by the predominant culture, along with the expectations of what is seen to be ‘appropriate’ sexual behaviour. This cannot but impact how we behave sexually and what our expectations of ourselves and others are. Therapy is a place where we can acknowledge the full range and intricacies of human sexual expression and its motivations, whilst allowing us to focus on specific parts of it without losing sight of the whole. Sexual problems present in a multitude of ways, many indirect, locked away and hidden under a cover of shame and discomfort. Many clients come to me with no understanding of what is ‘wrong’ but with the knowledge and or sense that something is. It is hard to help ourselves if we do not understand the cause of our sexual problems.
What often strikes me is how clients see issues as separate from the whole. One of the first things we work through is to understand that sex, intimacy, compassion, passion, love and partnership all work together in harmony. It is often the case that when one of these factors is not present, or under strain, that is when sexual problems arise. One of the tasks of therapy is to support individuals and couples to move their sexual expression and thoughts about the sexual experience from non verbal to verbal. So many people live with unspoken thoughts, concerns, frustrations and disappointments that cause distance and conflict. Therapy offers a place to practice conversations for those that come alone and somewhere were couples can start fo respectfully share their truth, working towards creating a new, and mutually satisfactory, way of relating sexually.
Living in a culture whereby sex is cloaked in secrecy and consequential silence, we need to consider some of the myths and messages that people carry that prevent them from discussing their sexual domain. There is so much fear, along with thoughts: “Sex is private.” “It’s embarrassing.” “I don’t want her to leave me.” “I don’t know what to say.” I see my role is to normalise discussing sex as well as to educate those who have no real understanding of sexual anatomy and physiology.
I am not someone that often uses diagrams, but one that I use often is the diagram of the sexual arousal circuit. One of the benefits of this is that it shows clearly that sexual problems are usually in response to something that is not solely located in the genitals. Sexual response can be described as an electrical circuit that can start from body, emotion or mind, but that also has three break points in each area. By working through this model, it allows clients to understand the possible roots of their problem, and gives us something to focus on.
The first break point occurs when there is inappropriate stimulation or pain. Understandably pain often cancels out any possibility of response and causes people to start to dread, put off and resist sexual contact as they begin to associate it with pain. There are many reasons for pain which can be discussed once bought out into the open. The same goes for inappropriate touch. There is so often an assumption that our partner will know what will bring us pleasure and with that a lot of pressure for the partner to do so. One of the things that I often ask my clients is whether they actually know what pleases them, whether they know their bodies, what turns them on, how they like to be touched. So often the answer is ‘no’ with the expectation that somehow arousal will happen. This is where psycho education plays a part.
The second break point occurs when the mind is pre-occupied with other things. When sex fails, it is often as a result of the state of our relationship rather than touch. When there is much unspoken between a couple, it creates a disconnect that makes sexual connection challenging. Our frame of mind, attitudes towards our self and our partner as well as many other things influence how much we want sex, how aroused we get and how much we enjoy it. Outside influences such as work, financial worries, young children and other internal/external stressors all impact our ability to relax and become aroused.
The third break point is often caused by “spectatoring”. As examples, men worried about erectile dysfunction, premature ejaculation. Women concerned about what their body looks like in certain positions, whether they are taking too long to orgasm. There are so many differing thoughts, belief systems, messages and myths about sex and sexual performance that take the mind away rather than focussing on connection and pleasure. Through exploration clients can start to reframe and challenge some of the myths and anxieties, as well as any negative past experiences that they have they have been bringing to their sexual relationships.
It is surprising how many people will say that they fall into one or even all of these categories. It is a useful model to work from, giving me and my client(s) a concrete platform from which to explore the details of sexual behaviour that so often reflect the meanings, beliefs, perceptions and values that shape them and impact their sexual relationships. I am aware that each detail is intimate and by working collaboratively, we create a platform from which they can be kinder, more honest and realistic to themselves and their sexual partner.
Because sex is so often veiled in secrecy many people are often quietly wondering whether they are okay. With the fantasy model of sex holding up standards that are for the most part unattainable, many of my clients questions whether their sex life is ‘normal’ and have a deep fear that by sharing their thoughts and concerns they will be seen as abnormal, strange or weird. Therapy offers a safe haven where clients can put their anxieties to one side and feed themselves with the understanding that there is an incredible range of sexual thoughts, feelings, fantasies and problems. By taking time to explore themselves, their fears, anxieties and struggles they can move forwards in their lives with hope in the knowledge that they had the courage to go where many fear to go.