Modelling Consent In The Therapy Room

Whenever I teach a class about sex, there’s one thing I hear over and over: “Wow, I learned so much about consent!”

I’m glad that my students are learning a lot, but I also take that as indication that we’re not getting nearly enough education about consent from our schools, from our families, or from our culture.

In my work as a sex therapist, I see that consent violations are distressingly common. I believe that a lack of education about consent is a major contributor to this problem.

There are two ways I address this as a therapist. The first is overt: I educate my clients about consent and help them build the skills which are necessary both to say “no” and to be able to hear and respect a “no” from a partner.

But there is also a more subtle way I teach consent in the therapy room. I call this modelling consent, and today I want to focus on how it works and how you can apply it in your therapy practice.

I model consent by making very small interventions that have a huge impact. I let my clients know I welcome their feedback, and when they give me feedback, I am clear that this is a positive thing, and important to me. A person can’t say “yes” unless they feel sure they can say “no”. This is as true in a conversation with a therapist or at the dinner table as it is in a more physical interaction.

Here are some examples of what I do to model consent in the therapy room:

1. I respect my client’s boundaries around sex. When I do my intake process and ask about sex issues, I always make sure to give my client the option to say, “No, I’m not comfortable talking about that.” If they’re not comfortable, I respect that, and I don’t push it. If, for instance, knowing about their experience with self-pleasure would help me assess a sex issue, but they’re not comfortable with self-pleasure, I may ask why, but I will certainly respect their boundary.
2. At any point in therapy, I respect my client’s boundaries. Any time my client is able to tell me something about their preferences, even if not particularly complimentary to me, I am truly grateful. Differentiation of self is crucial for both giving and withholding consent. So I help my clients identify what they think, feel, and prefer and then hold steady while expressing it even if the listener might feel uncomfortable hearing it, even if I am the uncomfortable listener. Giving me feedback in the therapy room is a courageous example of differentiation, and my job is to stay warm and curious so they get the message that they can say what is true for them whether or not someone else likes it.
3. I demonstrate consent with my anatomy psychoeducation.  Very often I do anatomy psychoeducation with my clients. When I do, I always make sure to model consent by showing respect for the model in the diagram. For instance, if describing a specific kind of touch that might be pleasurable, I will always say something along the lines of  “with permission, you could touch the clitoris through the labia,” and etc. This expresses to my clients that consent is a necessary prerequisite to any kind of touch.
4. I demonstrate consent when discussing my clients’ sex lives. I use similar strategy when talking about my clients’ sexual experiences–making sure to highlight consent as a prerequisite for any activity. For instance, when describing a possible intimate interaction the clients might try, I say something like: “If he were to allow, you could….” and etc.

These are just a few very small and simple ways to model consent in the therapy room, but they go a long way towards helping clients feel safe, and in a larger context, building a cultural expectation of respect for boundaries.