Why I Teach Anatomy to My Clients

If you’ve been reading my blog for a while, you know that I think discussing sex in therapy is crucial. Sex issues have emotional ramifications, and I hope I’ve convinced you that the ability to communicate openly and honestly about sexual desires, preferences, and boundaries is an important relationship skill, and that therapists have a role to play in helping clients develop that skill.

In addition to working with the emotional aspects of sex issues, I also very often spend time in the therapy room educating my clients on topics like sexual health and anatomy. Sex is a stigmatized subject, and many people don’t have access to trusted, reliable, and accurate information on sexuality. Many people have had only abstinence-focused sex-ed in school, or no sex-ed at all. Many people have gotten most of their information about sex from porn and peers.

Lack of access to information about sexuality can end up having all kinds of negative effects on mental health and relationships. For instance, many people feel embarrassed by the appearance of their sexual anatomy. This is the result of a lack of accurate and non-judgemental information about sex, and it can do a lot of harm to self-esteem. Sharing accurate information about anatomy can do a world of good. Even something as simple as asserting that  everyone’s body is different, and wide variation is completely normal, can make a huge different in people’s lives.

There are also cases of sexual problems that can be resolved with just a little bit of anatomical info. For instance, many people don’t realize that it takes a person with a clitoris an average of twenty-five minutes of direct clitoral stimulation to achieve orgasm. Lots of people think there’s something wrong with them or their partner if they can’t orgasm just from penetration, or if they can’t orgasm in just a few minutes. In a situation like that, you can provide a lot of relief by supplying a few facts about orgasm and anatomy.

I believe in the importance of providing accurate, non-judgemental information about topics your clients struggle with. I’m always surprised at how many people express astonishment and relief when I provide simple psychoeducation about anatomy, and debunk a myth or two. As I see it, alleviating distress in this way falls well within the bounds of a therapist’s role.

Does this leave you wondering where you can get accurate information about anatomy, and learn how to share it with your clients skillfully? You might want to consider joining my 2019 course, Assessing and Treating Sex Issues in Psychotherapy. Sign up for the waiting list now, and you’ll be the first to know when sign-ups open this February!

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.

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

  1. Learn about how you get turned on–and off. All too often we think about arousal as if it’s an off-on switch–you’re either turned on or you’re not. In reality, research shows that it’s more like an accelerator and a brake. Doing things that turn you on is like pushing the accelerator. No matter how hard you push, you’re still not going to get anywhere if you have your foot on the brake. However sexy you find the other person, if you’re in a situation that grosses you out, or if you’re worrying about that fight you had over breakfast, or whatever else hits YOUR brake, you’re probably not going to get turned on.
  2. Don’t be spontaneous. Spontaneity is great if you’re feeling safe, in charge, and able to easily say yes, no, or not now.  But if you’re nervous about something, being put on the spot will only make it worse. Do yourself and your partner a favor and talk things through a bit first. If either of you is nervous, definitely check in frequently as the action unfolds.
  3. Take your foot off the brake. Ask yourself what keeps you from experiencing desire. What hits the “off” button for you? What interrupts your groove? This is very individual, and there is no right or wrong answer. For some it helps to remove distractions, or find a good babysitter, or maybe take a bath or nap to get in a relaxed place, or go to the gym to get some energy flowing. Whatever it is for you, take some pressure off the brake so you and your partner can make the “on” button work better. If you can work together to take pressure off of both your brakes, both of you win!
  4. Help your partner get their foot off the brake, too. Talk to them about what helps them relax and help get them into a situation that feels comfortable. Be prepared to compromise and start with a less-intense version of the activity if necessary.
  5. Engage the accelerator. Now that you’re a little more relaxed, and your foot is easing off the brake, you and your partner can begin to explore what feels sexy and pleasurable to each of you. Let desire begin to bloom.
  6. NOW is a good time to introduce the new thing. Once you’re feeling connected, and sexy vibes are flowing, you are much more likely to move toward a new activity with curiosity rather than fear.

  7. Assess. If you and your partner enjoy the activity, great–you’ve discovered something you can add to your repertoire, and next time you almost certainly won’t be as nervous. If you’re on the fence, remember that familiarity and freedom to stop, start, and slow down can build over time into a resounding “yes!” You don’t have to cross it off the list entirely, but be careful not to pressure your partner to do something they feel uncertain about. That safe, permissive environment is what creates an ability to explore new things. If one or both of you realizes the new activity isn’t for you at this time, that’s okay. Relish the success: you have learned more about yourself and your partner, and strengthened your connection at the same time.