When I started this series, I hadn’t really thought about including sex therapy as its own unique modality or school of therapy as part of the series – which is funny, since a big part of the work I do as an educator, therapist, and coach has to do with sex and sexuality. It wasn’t until Autostraddle’s Valentine’s Day AMA, however, that I realized how little is known about what happens in sex therapy – or, perhaps, how much intimidation there is around asking.
For a field as obsessed with sexuality as psychology (Freud, you might recall, was very into sex drives and death drives), it’s amazing how patchy our curricula as therapists-in-training is with regard to sexuality itself. Queer clients are still included as one of the “special interest” demographics in social work school (pretty much anyone of any marginalized identity is included under that umbrella, which to me felt very othering and made the normative white lens of social work school uncomfortably clear), and there was never any mention of what it might mean to practice kink-affirming or non-monogamy affirming therapy as part of my clinical training.
For me, this wasn’t a problem, since I came to therapy by way of sex education: In 2016, I began my sex educator certification program, years before pursuing Master’s degree in Social Work was even a blip on my radar. Once I got to grad school, I’d already been working for two years as a sex educator. The lack of emphasis on sexuality as a core part of our curricula, however, did make me wonder about what it was like for my fellow students who didn’t have my background and training by the time they started school. It is a skill that takes practice to hold space for someone around sexuality, especially considering just how lackluster most mainstream sex education is, at least in the United States.
Now that I’ve been working in private practice for a couple of years, more and more, it strikes me as a huge oversight that a thorough education in sexuality and relationships is left out of our social work clinical training. After all – therapy is primarily about relationships, both in the room, and out of it. And sex, romance, dating, intimacy, gender feels, sexual orientation, relationship style, and understanding and self-awareness around attachment are the topics that make up the conversations that I have with my clients week in and week out. Not a day goes by that I don’t use my background as a sex educator in my work as a therapist. It’s important to remember that sex therapy – like CBT, somatic therapy, the expressive therapies, and relational therapy – is a specialization. Not every therapist is trained as a sex therapist, or chooses to offer sex therapy, and therapists are not immune to dominant messages about sexuality, purity, pleasure, and what is “normal.” So, just as with the other modalities and specializations, it’s important to ask any therapist you plan to work with a lot of questions and assess for yourself whether they seem like someone you could feel comfortable talking to about your sex life.
What Is Sex Therapy?
Sex therapy is one of those things that sounds simple on the surface, but is really much more widely encompassing that one might originally suspect. As mentioned above, it can include some of the first things that come to mind when we think about sex: romance, dating intimacy, coming out, etc. But sex is positioned in a complex and complicated way in our society: Sex is not just about how much sex you’re having or whether or not you’re enjoying it. Sex is also about power (take, for example, the Me Too movement, and the power dynamics inherent in sexual harassment, topics that frequently arise in the work that I do with survivors of sexual assault). It’s about desirability and body image, two topics that are often inextricably tied to broader understandings of race, fatphobia, and respectability politics. Discussing intimacy and communication in adult partnerships often sends me and my clients down roads of reflection about early attachment styles with caregivers (parents, grandparents, aunts and uncles) or formative relationships with peers, especially around puberty and early adolescence. And of course, all of these topics kick up a whole slew of emotions in us: anxiety, sadness, grief, frustration, rage, shame, self-consciousness, and also profound joy and healing, when we’re offered a space and encouraged to explore our sexual selves freely and without judgment.
Sex therapy also encompasses all of the “shoulds” of social conditioning – What should I want? How much sex should I be having (and what does it say about me if I’ve had more – or less – than this arbitrary but loaded number?) How easy or not easy should it be for me to have an orgasm? Should I want to be in a monogamous relationship? What if I don’t? The “shoulds” that we grapple with in our sexual lives even extend to our fantasies and fantasy life, the places of our mind that are ours alone, and that we can choose to share, or not. Often times, a big part of my work is to normalize the wide and wild expanse of human fantasy and sexual desire, to destigmatize fantasies that have people feeling ashamed, and create a safe container to feel that shame, be held through it, and grieve for the way it has kept us feeling isolated and alone.
I started my sex education training after having realized that most of my writing flirted with all of the above topics, particularly the ones about body image, shame, healing from trauma through pleasure, creativity, radical self-awareness and acceptance, and creating practices around consent culture that enveloped much more than just my sexual life. To my knowledge, there is still not one exact way to become a sex therapist through traditional academic routes (for example, you can’t get a Bachelor’s or Master’s in sex therapy, specifically, though I imagine that Gender Studies courses may offer a valuable academic, sociological, and historical background). I was part of a two year certification program that had a track for sex educators, and a separate one for licensed therapists (i.e., folks who had already gone through their Masters’ programs and licensing), that is compliant with the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). I know of only one school (Widener University) that offers a hybrid Masters of Education in Human Sexuality and Masters of Social Work. Other than that, most of what is available for aspiring sex therapist involves amassing enough Continuing Education credits to qualify for a sex therapist certificate in addition to whatever license (social work, clinical psychology, licensed marriage and family therapy, mental health counseling, etc.) one is practicing under.
What To Look For in a Sex Therapist
The qualities you want in a sex therapist are largely the qualities you would seek in other modalities as well: You want someone warm, non-judgmental, and skilled at creating a space in which you feel safe enough to be vulnerable. This last part is particularly important in sex therapy, especially if sex is a tricky subject for you, or if you grew up inundated from messages about purity culture and shame. Part of the process of sex therapy might include simply feeling safe enough to tolerate distressing feelings that come up just from talking about – or even thinking about talking about – sex, so be on the lookout for someone who helps you access that sense of safety, and who encourages you to take it at your own pace.
In terms of training, you might want to ask about their certification program. What kinds of courses did they take? If you are seeking kink/BDSM, polyamory/ethical non-monogamy, or LGBTQ+ affirming therapy, don’t be afraid to ask what their training in these areas was like. What perspectives were they taught? Do they have experience working with clients who are kinky/polyamorous/queer?
One of the most impactful aspects of my training happened right at the very beginning: I took part in a three day long SAR, which stands for sexual attitude reassessment. For eight hours a day, my cohort and I were guided through different topics within the sexuality field. We watched clips of movies and scenes of documentaries about pretty much everything that could fit under the umbrella of sexuality education and sex therapy – kinks, fetishes and fantasies, obscure sexual practices, sex and disability, sexuality and spirituality, and things that – even within the sex positive sphere of sexuality education – might still be considered taboo. The point of a SAR isn’t to learn everything there is to know about sexuality – years of study wouldn’t even scratch the surface of that – but rather, to introduce us to the wide array and diversity of experience in human sexuality, in order to get us to turn the lens on ourselves, to notice where our particularly strong reactions were (in the study of mental health, this is known as countertransference).
This practice of self-awareness is integral to therapeutic practice: in my practice, it notifies me to my limitations, my biases, and my areas for growth. If you’re looking for a sex therapist and are curious about their training, I would certainly recommend that they recount to you what their experience of their SAR was like. You could also ask how many SARs they’ve attended – different certification programs use different materials in their SARs, and things like sex work, for example, are still somewhat taboo even in the purportedly sex positive spaces of sex education and sex therapy. (Some programs also offer SARs for lay people, and even if you’re not interested in becoming a sex educator or therapist yourself, attending one can be a great and illuminating experience. In particular, I recommend the SAR led by the Center for Sexual Pleasure and Health, or any of the sexuality and reproductive justice courses taught by Bianca Laureano.)
Is Sex Therapy the Only Way To Go?
Since sexuality is so understudied within the field of mental health, it can be challenging to find a knowledgeable and trustworthy sex therapist – but the good news is, it is possible to have transformative and healing experiences outside of a therapist’s office! Depending on what you’re seeking therapy or support for, you might consider working with a sex educator or sexuality coach. These resources can be particularly helpful for queer, kinky, and non-monogamous folks, whose experiences are still so under-represented among therapists with lived experience (basically, therapists who also might identify as queer, kinky, or non-monogamous, or any other identity/experience you might be seeking as common ground with a clinician). We’re out here, but the gatekeeping and respectability politics we face in academia, and the intense pressure not to self-disclose with clients (or fears around “good character” clauses in our licensing stipulations, for social workers) can make some therapists keep their more stigmatized lived experience close to the vest. To me, this does a disservice both to clients and the field itself, which could do with being a little less stuffy, oppressive, and, to be frank, steeped in white supremacy and elitism. But that’s another, much longer story.
The choice between sex therapy, or working with a sex educator or coach is ultimately up to you, but here are some things to think about: Are you distressed enough in your day to day that you are primarily looking for support with mental health, or healing from trauma? In that case, you might find a better fit with a sex therapist, especially for specific trauma modalities or approaches. If, however, you want support around a specific topic within sexuality – opening up a relationship, differences in libido, mismatched kink orientations or desires – but otherwise feel pretty stable (or already have a therapist who you trust and feel supported by!), it might be a good idea to look into a sex educator or coach. Similarly, as a sexuality coach myself, one of the ways I understand the differences between therapy and coaching is that therapy is slower paced, more insight-oriented, and reflective; I work as a support and a sounding board for my therapy clients, and do not often offer “advice” in my role as a therapist. My approach to sexuality coaching, by contrast, is specific, targeted, solution-focused, and directive, full of offerings of resources, book recommendations, writing prompts, and exercises.
Finally, creating a world that is more affirming of sexuality in all its many beautiful and varied forms is a responsibility that belongs to all of us. When you decide that moving towards authenticity and realness in your sex life, you are doing the work of choosing to live in resistance to damaging white supremacist and cisheteronormative roles and ways of being. Our willingness to resist this in our own lives is a threat to these systems – which we can see in the ways that people who exist OUTSIDE those norms (sex workers, queer and trans Black and brown folks, fat folks who unabashedly own their bodies and their sexiness in public) are censored, shadowbanned, and policed. As you step into your own authentic sexuality through this work, think about the ways you can turn that erotic power into action! Speak up for sex workers, support the work of sex educators and artists of color, and live your resistance and your joy for yourself, and for the collective change we all so desperately need and deserve.