Putting Clients At Ease With Sensitive Topics

A lot of my clients come to me specifically to work on sex-related issues. Nonetheless, I find that even those clients are often quite uncomfortable talking about their sex lives.

That’s perfectly understandable. Most people were taught not to talk about sex openly–not even with lovers, in some cases, let alone strangers or therapists. Because of this, lots of people don’t have comfortable or accurate language to discuss sex, and some don’t know enough about sex to be specific about what is going on when things go amiss.

At the same time, I am a much more effective helper when my clients are comfortable enough to share unreservedly.

I’ve developed a few strategies that help put my clients at ease when talking about sensitive topics, including but not limited to sex. Whether or not you frequently work with sex issues in your practice, these tips may come in handy with clients who struggle to discuss topics that are sensitive, emotionally charged, and/or somewhat taboo.

  • Remind clients that you’re comfortable. Often, a client’s discomfort comes from a fear of freaking you out or putting you off. I see this all the time, even when the thing they’re afraid of sharing is far from freaky! I can’t tell you how many clients have told me that they were too afraid of being judged by their previous therapists to bring up the topic of sex. That, to me, implies that you need to be proactive. Reassure your clients that you want to hear whatever they have to tell you, or else they are likely to assume otherwise. Personally, I like to tell my clients that I’ve pretty much heard it all, and that they’d have to work pretty hard to shock me. That might be more true for me than it is for you. But even if you think your client MIGHT tell you something that could shock you, get clear in your mind why it is important for you to create a safe space for honest disclosure, and don’t make a big fuss. Probably you will hear things that are very easy for you to hear, but in case you hear something that rocks you a little, control your facial expressions, stay calm and normalize (or at least remain neutral and don’t pathologize). Get some consultation or supervision if you need to (certainly before deciding there is a problem). If you can tell you’re way out of your depth, you can always refer the client to a certified sex therapist.
  • Focus on the process, not the content. This is one of the most useful strategies in my toolkit. Focussing on process–by which I mean how an interaction plays out, and how both participants feel about it, rather than what specific activity is involved–keeps clients from feeling pathologized, while also keeping therapists from getting overly unsettled by uncomfortable explicit information. It also means that often clients can share just as much as they’re comfortable with, telling you everything you need to know about a sexual interaction, without going into details that feel too personal.
  • Ask permission before asking a question about specifics. Although focussing on process rather than content means that I let clients determine how much they’re comfortable sharing, sometimes I need to know something really specific in order to understand an interaction or figure out what the problem is. In those instances, it helps to gain consent for the deeper conversation, and explain why I need the information. I might say something like, “Would it be ok with you if I ask you some very specific detailed questions about this? This is a situation where some specific information will help me figure out what is going on, and then I’ll be more likely to be able to help”. Once in a while, a client is quite reserved and says they don’t feel comfortable. I always let them know that is fine with me. We can continue in vague terms, and focus on process, and probably make some good progress. However, this doesn’t stop me from gently inviting deeper or more specific disclosures, never with any pressure. My comfort with the topic, combined with this absolute permission not to tell me anything they don’t want to reveal, often ends up making my client comfortable enough to open up.

Why I Hate the Concept of “Compromise”

What can you do to help a couple shift from an adversarial stance to a collaborative alliance?

Couples often come to therapy with at least one big difference or disagreement, and an expectation that I will “fix” it. They hope that I will verify that their partner is wrong and they are right–problem solved!

I’m sure you’re not surprised to hear that this is not my agenda at all. Not even close.

In this and the next blog post, I’ll let you know more about my perspective, and how I work with impasses. Much of this material is drawn from the Bader/Pearson Developmental Model of Couple Therapy. The rest comes from my experience with consensus process as a Quaker.

Once I let my clients know that I won’t be acting as arbiter regarding their disagreements, they assume I will be guiding them through some sort of process to arrive at a compromise. I think many couple therapists do just that. However, I do not believe in or strive for compromise.

To me, compromise can be described as “lose/lose”, as it implies that everyone will give up something of value to them in order to “meet in the middle”. I think a middle ground that requires everyone to give up something of value sounds like quite a dull place to live in, particularly when we’re discussing lifelong commitment.

I much prefer a process of creating space for a miracle.

Gridlock is not a space for a miracle to occur. Neither is polarization. However, that is how most of us learned to disagree. We learned to lock in to “I’m right and you’re wrong.” If we have to come to an agreement, and I have to give up something, so do you. Obviously one will win, and one will lose, and I’m determined to be the one who wins.

Instead, I help my clients step into another space entirely. (This strategy comes from Ellyn Bader and Peter Pearson, and fits my belief system perfectly.) What kind of a person do you want to be in your committed relationship? Kind? Loving? Compassionate? Reliable? Strong? Whatever it is, my next question is, when you are a compassionate (or insert another value here) partner, how do you behave? What do you do? How do you know you’re being compassionate? What does it look like? And the next question: how far from that are you now, in your current relationship? Another question: how would it benefit you directly (not your partner but you) if you were able to act from your compassionate self more often?

Every person in a relationship ends up shooting themselves in the foot with their own behaviors now and again. Until this is looked at very directly and some motivation to change is identified, that conversation about the dishes (or sex, or kids, or whatever) is not going to shift. Even if it does, it will take many months of one-step-forward-two-steps-back therapy, and that’s frustrating and discouraging for all involved.

More importantly, the magic can’t happen until the adversarial stance is changed to something more collaborative. The abovementioned sequence is designed to switch adversarial thinking (characterized by hyper-focus on the other and the oppositional forces) to self-focus. This is so important because it leads to empowerment; a realization that there is something here that I have the power to change and it will make a difference.

Next week I’ll tell you about another strategy I have for shifting the adversarial stance and working with internal impasses.

Helpful Links

I started blogging in 2016. Now, two years later, I’ve amassed a pretty significant backlog of posts, each of which strives to provide something of value to therapists and individuals: useful tips about building fulfilling relationships, sorely-needed little-known facts about sexuality, answers to pressing questions from my subscribers and students.

When my course started at the beginning of this month, I received tons of questions from my new students–and realized that a good many of them related to topics I have written about here. I write about these topics because I want therapists to have access to thoughtful, high-quality information and advice about how to handle sex issues in therapy, and I want that information to be easy to access whether or not you take my course. For that reason, I thought I’d put together a guide to the topics I’ve covered before on my blog, so that you can easily find answers to your questions if I’ve addressed them before here.

As I wrote in the very first post on this blog, I’m on a mission to change the culture of therapy regarding sex, to create a world in which every therapist feels confident addressing sex issues, and every person struggling with a sex issue can access the help and healing they need. A big part of that mission is making sure that therapists and individuals have access to the information they need. This compilation is one small step in the direction of making that kind of information more readily available and easy to find for you and your colleagues.

Thanks so much for being part of that mission; I wish you much success!

Martha

 

Desire Discrepancy

One Question You Can’t Fail to Ask Your Clients

What Do You Do When There’s Love But No Lust?

All Levels of Desire Are Normal

Shifting an Unhelpful Dynamic in Desire Discrepancy

Why Desire Discrepancy is So Tough

Desire Discrepancy Lesson #1: Normalize Variation

Desire Discrepancy Lesson #2: Look for the Blocks

 

Consent

Modelling Consent in the Therapy Room

Nuances of Consent: The Therapist’s Side

When Consent Isn’t Simple

 

Managing Conflict in Relationships

How to Keep Fights From Damaging Your Relationship

10 Calming Strategies for Managing Conflict

7 Steps to Stay Steady in Tough Conversations

Don’t Let Strong Emotions Control You

Don’t Try to “Win” A Fight With Your Partner

The Case for Going “Slow and Steady” to Resolve Couple Conflict

The Key to Resolving Couple Conflict? Uncovering Internal Motivation to Change

Addressing the Issues Without Getting Swept Up in Emotion

Promoting Healthy Differences of Opinion Between Partners

 

Differentiation of Self

How to Build a Long-Term Relationship with Courage and Compassion

3 Ways to Handle New Relationship Bliss that Support a Long-Term Healthy Relationship

Sex and Differentiation of Self

The Discovery That Turned My Practice Around

Better Than “Better Half”

Sexual Intimacy and Vulnerability: Paths to Personal Growth

When Partners Encourage Each Other To Lie

Stop Negative Meaning-Making In Its Tracks

Helping Your Clients Find the Courage to Make a Vulnerable Disclosure

The Power of Checking Your Assumptions With Your Partner

Why Helping Your Clients Find the Joy is a Crucial Part of Couples Therapy

Differentiation of Self is the Key to Keeping Things Sexy in a Long-Term Relationship

Why I Hate the Concept of “Compromise”

What Kind of Partner Do You Aspire To Be?

 

Relationship Agreements

There’s No Such Thing as a One-Size-Fits-All Relationship Agreement

Making Relationship Agreements that Support Growth

What If One Partner Wants an Open Relationship, and the Other Isn’t So Sure?

Rules for Poly Relationships? It’s Not That Simple.

 

Building A Flexible, Resilient Sexual Relationship

When Sex Doesn’t Go As Planned

Beyond Communication Skills: What DOES Improve Intimacy?

Postpartum Low Desire: Improving Intimacy and Strengthening Relationships

Postpartum Low Desire: Emotional Causes

Sexual Intimacy and Vulnerability: Paths to Personal Growth

Willingness is Enough

What To Do When You Don’t Have an Orgasm With Your Partner

What Makes Good Sex Good?

Getting What You Really Want Out of Sex

Good Sex Over a Lifetime

 

Pleasure

Are Vibrators Habit-Forming?

7 Tips For Getting Creative: A Sex Therapist’s Guide to Trying New Things

How (and Why) to Talk About Self-Pleasure in Therapy

 

How and Why To Talk About Sex In Therapy

What Terms Should I Use When Talking About Sex in Therapy?

3 Reasons Therapy Clients Need to Discuss Sex, Not Just Connection

I’m On A Mission–To Change the Culture of Therapy Regarding Sex

After Will Lily: How to Use What You Learn in Brief Assessment (Part 1)

After Will Lily: How to Use What You Learn in Brief Assessment (Part 2)

How Asking About Satisfaction Can Guide Your Treatment Plan

Putting Clients At Ease With Sensitive Topics 

 

Unscripting Sex

When Sex Doesn’t Go As Planned

Unscripting Sex for More Connection and Pleasure

Flexibility is the Key to a Satisfying Sex Life

Good Sex Over a Lifetime

 

Non-Normative Sexualities

Reader Question: What is Gender Fluidity? Part 1 and Part 2

Reader Question: Is Abstaining From Sex Healthy?

 

Polyamory

Rules for Poly Relationships? It’s Not That Simple.

Should Polyamorous Couples Share Everything?

What If One Partner Wants an Open Relationship, and the Other Isn’t So Sure?

What Polyamory Can Teach Us About ALL Relationships

Poly 101: Working With Jealousy

Discussing Poly in the Aftermath of an Affair Part 1 and Part 2

Working With Secondary Partners

A Common Dynamic that Causes Problems in Primary/Secondary Poly Relationships

 

Health and Physiology

Orgasm and Heart Conditions

How To Set Loving Goals for Lifestyle Change

Body Positivity and Health Consciousness

Life After STIs: The Therapist’s Role

How to Talk About STIs With Your Clients

Postpartum Low Desire: Physical Causes

Mindfulness: A “Magic Bullet” for Building a Healthy Sex Life

Having a Satisfying Sex Life on Antidepressants

Why I Teach Anatomy to My Clients

Facts About Anatomy that Your Clients Need

Facts About Anatomy that Your Clients Need, Part 2

 

Body Positivity

How To Set Loving Goals for Lifestyle Change

Body Positivity and Health Consciousness

Resolution: Start Loving Your Body, Today

How You Can Help a Client With Negative Body Image