Sexual Psychotherapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

At first, I really didn't want to write this text. You know, what is happening in the psychotherapist's office is very difficult to decompose into its component parts, and talking specifically about working with the sexual sphere is generally very difficult - most often this topic is closely related to many others. But after teaching the psychology of sexuality and the clinic of sexual disorders at the university, it becomes clear that there are questions that are important to answer

Yes, it is often necessary to work with the client's sexual sphere. More often than it seems. Working with client sexuality is one of the most challenging tasks in a therapist's daily practice. At the same time, tasks of this kind pop up very often, even if initially clients come with different topics. The theme of sexuality and corporeality in one form or another almost always "comes up" in long-term therapy. You can walk past her, go around sharp corners, not touch painful or "embarrassing" moments, and many psychologists do this if there is no specific request from the client - to help deal with the sexual sphere. It is not difficult to understand those who avoid this kind of work - it is scary to enter this territory, because here we are waiting not only for clients, but also for our fears, our shame, our own pain. And if the problems that lie in the sphere of corporeality and sexuality are not worked out by the therapist himself, not resolved, not fully realized, there is a great risk not only not to help the client, but also to harm himself. However, that's what supervision is for us.

Another reason forcing therapists to avoid deep work with the sexual sphere is the fear of their own power. Frightening, crushing, crippling the client while working with these topics is as easy as shelling pears. This topic is a real breeding ground for transference and counter-transference, and it is not only about erotic or eroticized transference. For example, if a so-called maternal transference has developed in a therapeutic alliance, then when working with sexuality, both the client and the specialist may have a lot of not at all pleasant sensations.

Finally, there is one more limitation, commonplace, but very significant. Any psychologist has heard that his judgments should be non-judgmental and depend on moral constraints. But the sphere of sexuality is one of the most tabooed and it can be difficult to get distracted from your own moral principles in a conversation with these topics.

However, clients themselves are usually not in a hurry to share intimate things with a psychologist, especially if problems in the sexual sphere are not among the so-called functional ones. And it's not just shame and embarrassment that is at work. Many clients are afraid not only of being judged by a psychologist, but also of being "treated" for their preferences. And they, in accordance with the old anecdote, may not suffer from them at all, but enjoy them completely for themselves.

In fact, if we are not talking about pathological paraphilias, there is actually no cure for sexual preferences and should not be. But the psychologist can see the relationship between some of the inclinations and other problems of the client, lying in the emotional, motivational, personal spheres. This does not mean that after working through them, sexual preferences will change. They can simply go from neurotic, forced, painful choices to mature, purposeful choices. Or they will cease to seem pathological to the client himself, if the relationship with shame, with fears, condemnation, and self-flagellation disappears.

How does the therapist work with the client's sexual sphere? Yes, just like with any other. This, by the way, is very important: not to whip up "solemnity" and not be afraid, not to single out this topic as something special (because, honestly, what could be more natural?), Not to make unnecessary accents. It is important to help the client get rid of shame and fear when discussing intimate topics - and this means, first of all, that the therapist should not be ashamed and scared. Sometimes a sense of humor is an indispensable help if it is necessary to defuse the situation, but jokes should not be offensive, should not devalue what is happening, and simply obscenity and obscenity in this process does not belong - because such jokes can only increase shame and disgust client. Otherwise, the rules are the same: work only on demand, be honest, do not be afraid of yourself and the client. If it is difficult for you, if you have your own taboos or you cannot accept the sexual characteristics of your client, you should say it honestly, transfer the client to someone from your colleagues who find this topic easier, and run to personal therapy - because this is yours a problem, not a problem of those who come to you. Yes, and this is another important rule that applies, in fact, to any area of counseling, but when working with sexuality it becomes especially significant - separate your problems from those of your client. And be sincere with the client: a psychologist is not a superman and a reference book of ready-made solutions, you can also be embarrassed, ashamed, scared, painful, sad.