I practice pro-sex therapy. I don’t really feel I have the option not to in my NYC therapy office. In the case of sex, everyone has it, had had it or has a significant relationship with it. Sex is such a vital part of who we are as human beings. To ignore it would be akin to ignoring feelings.
People need to talk about sex. This isn’t just because people can have all sorts of challenges related to sex (difficulty getting turned on, being too turned on, being into a partner and then not, negotiating safety, making sense of fantasies, negotiating consent and feelings around a pressured sexual experience, etc.). Understanding a particular individual’s life often needs to include an understanding of his or her sex life.
Anti-Sex Therapy?
Likely not many therapists would fancy themselves “anti-sex” therapists but–consciously or not–many therapists convey that they’re not comfortable “going there”. Patients share with me their previous experiences with therapists where they asked ignorant questions (quizzing a gay male patient about his HIV status immediately upon mentioning that he has sex with men, grimacing at the mention of anal sex, assuming that an individual who is contemplating an open relationship has difficulties with attachment or intimacy before exploring the nature of their interest). If sex can’t be talked about, the benefits of growing in that way are lost. It can also reify preexisting hang-ups about sex and perpetuate a great deal of shame.
When I was a therapist-in-training, I was, at first, terrified when a patient would bring up sex. If the conversation got anywhere near sex, I would interrupt and ask a question that steered the conversation elsewhere. I mention this to acknowledge that most of us–in some way or another–are at least somewhat screwed up about sex! That can involve a whole host of notions gleaned from parents, teachers, priests and television that can convey sexuality as shameful. And it can involve sexual abuse, assault, sexually inappropriate relationships or sexual advances at too young an age. We all have stories. Individuals who arrive at adulthood with a fairly carefree attitude about sex, masturbation, their own sexual identity and interests are fairly rare.
Sexual Fluency
As a pro-sex therapist, I believe that fun, healthy sex is an important part of most adults' lives. Beyond that, pro-sex therapy also reflects a strongly nonjudgmental stance about sex itself, as well as the kinds of sex people have.
Fluency, here, is key. I believe people ought to have the freedom–if they choose–to explore and create sexulity in whatever safe ways they choose. It is my obligation to both convey a nonjudgmental stance with whatever people bring in, as well as to be reasonably savvy about the range of activities people explore and enjoy around sex, including sex with same-sex partners, open relationships, BDSM, kink or multiple partners. I’m not an advocate for any type of sex, but I want to be fluent and supportive around what comes up.
Sex Is Fun
I find it important to talk about sex as fun. It's surprisingly often not how it's talked about in therapy. I want to share a position that sex is more than just "okay" or "normal", but a terrific part of a healthy life and a particularly terrific part of a healthy relationship. While I fully support an individual’s decision not to have sex, it’s likely that something is missing in their lives and, as with anything, I’m interested in inviting them to look at that.
What Does Pro-Sex Therapy Look Like?
In my NYC therapy practice, pro-sex therapy produces many fewer awkward conversations than you might think. Sex can be funny (it often needs to be) and awkward and very often raunchy and messy. We can laugh at ourselves. I’m certainly not immune to finding some things tricky to talk about. What patients need is for me to be able to hang in, to be respectfully curious, to learn what I need to be helpful to them and surely, that I refrain from passing judgments about safe behaviors.
To be clear, being a pro-sex therapist doesn’t mean I always drive the conversation toward sex. What we talk about and work on is mostly not up to me. But, when I think someone is talking about something close to sex or feeling out whether or not they can talk about sex, I find it helpful to name it. Simply saying the word “sex” or asking a question about sex can break the ice and create a good deal of comfort.
In other instances, there’s more we need to build to be able to talk about it. I don’t think I can just dive in with anybody. I may ask, “How do you feel about talking about sex with me?” or “I’m wondering what you and I might need to build in order to be able to talk about sex.” I’m tasked with providing leadership around that and with any topic, I work to let my patients know they can always pump the brake.
