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.

Differentiation of Self is the Key To Keeping Things Sexy In A Long-Term Relationship

Take a moment to think about how you felt last time you started a new relationship. Remember the sunny, dreamy, head-in-the-clouds feeling of a brand-new love, the early days when you can barely stand to spend a second apart and you can hardly sleep for excitement.

In the Bader/Pearson Developmental Model of couple therapy, that stage of a relationship is called symbiosis. The purpose of the symbiotic phase is to build a strong bond between the partners. In this time, you look for signs of similarity, and you may find yourself playing down differences. You probably read your partner’s smallest signs and present yourself as the partner you think they want you to be. Do they seem to like it when you dress up? You dress up. Do they like it when you wear makeup? You wear makeup. Are they turned off by a potty-mouth? You try not to swear. Are they a big fan of that TV show? You watch every episode.

This is perfectly normal and to be expected. But what do you do when you wake up one day and notice you and your new love are different from one another? What do you do when you realize you’re not prepared to go through life concealing certain aspects of yourself? This is where symbiosis begins to give way to differentiation of self, or the process of becoming unique individuals who are different, yet still connected.

This requires a sophisticated skill set, and one that most of us spend a lifetime working on. Part of it is being able to figure out what you think/feel/believe/want separate from your partner, parents, or anyone else. Then, you need to be able to share that with your partner even if you think they might not like what you’re saying, and create space for them to do the same. A big project!

As a sex therapist, I focus on differentiation a lot, because without difference and the slight tension it brings, sex tends to go flat. Playing it too safe is not sexy. However, telling your partner something vulnerable about yourself (perhaps that you want to try a sex act they might not be interested in) is risky. Increasing differentiation in your relationship is all about taking that risk.

If your risky disclosure doesn’t break up your relationship, it will make for a hot conversation and hotter sex in the near future. Even if you don’t decide together to do THAT thing, you will have opened an important conversation about what you might want to explore together. Hot.

If that discussion DOES break up your relationship, you need a partner with a stronger sense of self so they can stay with the conversation even when they’re not completely comfortable. A difficult conversation now and then is just part of the landscape of long-term relationships. You can’t avoid them, so you might as well get good at them.

Discussions about what you do and do not want to explore sexually are just one example of an important kind of conversation to have about sex. You’ll also need to discuss

  • Your thoughts and feelings about reaching orgasm, or not
  • Your preferences when you want to change activities during sex
  • If something is uncomfortable or painful during sex
  • The meanings you attach to initiation of sex
  • The meanings you attach when your partner says no
  • What happens inside of you when something sexual doesn’t go as planned
  • And many, many more topics

The best way to inject some sexiness back into the relationship is to take a risk, to tell your partner the truth about what you really want–and to invite them to share their own unvarnished truth with you. Make a mutual vow not to freak out about what you hear. Create some safe space together to talk, and remember that discussing is not the same as doing.

As Esther Perel says, fire needs air. Letting go of the fear of rejection and allowing your partner to see your true self can be a surprisingly sexy experience.

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.