Sexuality Issues in the Therapeutic Setting

Article for Tone - January 2004

Sexual well-being is an intricate aspect of self-development. Where it is unaddressed in the therapeutic process, clients miss the opportunity to work with an important part of themselves that can significantly contribute to optimal wellness.

Sexuality provides a doorway into a wealth of issues, including self-esteem, self-expression, body-image, creativity, and relational abilities such as communication, intimacy and the capacity to give and receive love. As well it is an essential component in overall health and vitality.

However sexuality is often over looked in the healing process. Increasingly as various modes of therapy adopt a holistic approach where the connection between the body and emotions is honoured, issues of sexuality will manifest. Whether you are a holistic practitioner who works primarily from a body perspective or a therapist focused on the psychological realm, being open to aspects of sexuality is important.

It is equally significant to remember that whenever the body is engaged in a process, it is not uncommon for unresolved sexual issues to be brought to the fore.

These issues may or may not be addressed in sessions. Clients are highly attuned to the therapist and know on an intuitive level what is safe to bring forth. Practitioners need to be aware of the non-verbal communication that goes on between practitioner and client which speaks volumes conveying comfort or discomfort and willingness to open to any issue.

There are a number of aspects that need to be addressed in developing skills around sexuality issues in a therapeutic practice. First there is the consideration to be well versed on common issues about sexuality. You don't need to be an expert on the subject but minimally a sound baseline of knowledge from current research and objective information is required and will contribute to your confidence and comfort level in discussing the issues.

Being aware of your own values and potential biases regarding sexuality issues is crucial. These can show up in how one responds to what clients choose to share. Despite that fact that outwardly we appear to live in a sexually liberal society, there is still a tremendous amount of discomfort and shame about sexual energy and its expression. Moralizing, narrow mindedness or obvious discomfort can quickly shut the client down, thereby closing the door to a potentially important realm of exploration.

Therapists need to be well versed in issues of boundaries and transference. This helps practitioners recognize when potential risks for boundary invasion may be developing and as well, hone skills in handling transference. Education and self-awareness are tools that enable a therapist to work proactively to safeguard the client and yourself from an inappropriate and potentially damaging boundary transgression.

Knowing when to suggest a referral is equally relevant. Practitioners have to work within their own scope of practice and refer to a specialist when out of their skill range or comfort level. You can assist clients to determine their needs in terms of additional support. This means keeping up-to-date on resources in the community so referrals can be made to competent sources.

And lastly its essential that practitioners maintain their own sexual/relational well-being. This is particularly so when working with a substantial number of clients who have experienced sexual abuse and or abusive relationships. The comfort level with one's body, confidence that issues can be worked through, and a sense of one's own sexual well-being are all part of that subtle, non-verbal exchange that goes on in the therapeutic process. The therapist's own comfort level and confidence will go a long way to convey to clients that sexual well-being can be a significant aspect of a positive therapeutic outcome.

Madeline Dietrich M.A. is a Holistic Psychotherapist and Group Facilitator. She offers an introductory series for therapists, counsellors and holistic practitioners on sexuality issues in the therapeutic setting.