Why Don’t Therapists Talk About Sex?

As a sex therapist, I find that my clients often bring in topics that carry stigma. Whether it’s pelvic floor dysfunction, reconnecting with your postpartum body, or exploring ethical non-monogamy, clients report a sense of relief that they can finally talk about that thing. The thing that they have been carrying around like a heavy, shameful secret in their back pocket. The thing weighing them down. While I will admit that my profession does not always make for polite dinner conversation, it still surprises me that other therapists can’t (or won't) talk about sex.



Pardon my pun, but why is talking about sex such a touchy topic in the therapy world? Let’s explore a few commonly cited concerns by other therapists, and what to consider if they resonate with you.



#1: I’m not trained in sex therapy. When in doubt, refer it out.



Grad school taught us to “mind the gap” when it comes to our scope of practice. This can be a delicate balance. For example, while therapists cannot prescribe, we need a working knowledge of psychopharmacology. This includes common medications, their uses, side effects, and contraindications. A non-prescriber should not make recommendations or adjustments to a client’s medications. But they can counsel an anxious client who is meeting with a psychiatrist for the first time. They can role play in session to assuage their nerves and practice distress tolerance. They can empower their client to self-advocate for a dose change at the next follow up visit.



But if a client presents with a need that we cannot meet, we must refer them elsewhere. Having a robust network of trustworthy colleagues is important for this reason. I am not trained in EMDR. If a prospective client reaches out requesting this modality, I will give them a warm hand-off to my colleague with this specialty.



But when it comes to sex, the decision is not so clear. If a client brings up a recent sexual experience, is creating space to talk it through outside of your scope as a generalist? Would you feel the same way if they were questioning their relationship with alcohol, but you are not a substance use counselor? What about if the client lost their spouse, but you are not trained in grief work? There are no right answers to these questions – only your own clinical judgment.



Think about this: what would I need to feel competent talking about sex? There may be resources to consult, or supervision to seek, that could help you feel up to the challenge.



#2: It’s unethical for therapists to talk about sex with their clients.



Our professional ethical guidelines forbid sexual relationships with clients or clients’ relatives. The expectation is clear, but what is considered ethical communication about sex is less so. For example, section 1.09 of the Social Work Code of Ethics states that “inappropriate sexual communications through the use of technology or in person” are forbidden.³ Section 1.11 elaborates on the nature of sexual harassment that “other verbal, written, electronic, or physical contact of a sexual nature” are discouraged as well.³



A conservative interpretation of these recommendations would be, simply: don’t talk about sex. That may be a firm professional boundary that our more risk-averse colleagues maintain. But ethics are not cut and dry, and rarely do they offer binary choices.



There must be a difference between talking about sex in a clinical setting and doing so with your friends over drinks. If a client wants to talk about sex as it pertains to their treatment, how do you approach it as a professional? How is that different from the way you would in other settings?



Some of us may have heard stories about sexualized transference, where the client’s feelings towards the therapist take on an erotic or sensual quality.¹ These feelings towards the therapist are not always about sex or love, but rather other motivations. Even still, sexualized transference can shake even a seasoned provider.



Keeping in mind your responsibilities to the client and to the field, how can you meet the client where they are? How can you maintain professional boundaries that are firm enough to protect you both, while still allowing you to connect? Many would say the most important part of therapy is the relationship. What would it mean for your client to know that you are a safe person for them to talk about sex with? What would you have to do to be that safe person?



#3: Talking about sex makes me uncomfortable.



This feeling is valid, and is a big reason why your clients might want to talk about sex in therapy. They might be feeling the same way.



Sex can come with discomfort, awkwardness, and even pain. Research shows that between 10 and 28 percent of the world’s population will experience pain with sex at some point in their lifetime.⁴ A review of the literature in sexual health found that women often experience multiple co-occurring sexual dysfunctions, though there are more published studies investigating the sexual dysfunction of men.² These problems don’t discriminate, and can affect all of us at some point in our lives. I often find myself repeating to clients, “just because I’m a sex therapist doesn’t mean I have a perfect sex life – none of us do.” Shame and stigmatization can prevent both clients and therapists from starting the conversation.

Talking about sex, even in a clinical setting, can evoke feelings about our own sex lives. Just as our clients may feel embarrassment when disclosing this information to us, our own shame might be triggered. Therapists are humans, too. It follows that we might be caught off guard by the sensitive topics of our work.



Final Thoughts



It’s worthwhile for everyone to reckon with our relationship with sex at some point in our lives. For therapists, it might be worthy of supervision or consultation, to gain insight and develop your own clinical judgment as well. If your self-reflection leads you back to the same destination, it is OK to refer clients to a competent sex therapist. That is, after all, what we’re here for.