There is a title to make people sit up a bit straighter on a wintery Saturday afternoon. The stereotype of the uptight English who do not talk about such things is one, sadly, that has its roots in reality. Sex however is a part of someones inner world, something that can bring great joy, or despair, and often something they will wish to raise in the process of therapy.

Here is the World Health Organisation definition of sexuality— from Defining Sexual Health (2006)

“Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can influence all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal,historical and religious and spiritual factors.”

A part of people’s experience so all-encompassing, so intertwined with who we are, how we view ourselves and how others view us is bound to impact on our mental health at some point in our lives. Upon occasion it will be the factor, or one of the factors which brings someone to counselling. There are two barriers which need to be overcome however, the therapists and the clients.

For some within counselling the psychoanalytic tradition of looking at the sex drives was so directive that I believe there may have been a throwing out of the baby with the bath water. Whilst as a person centered counsellor I am unlikely to see a fear of horses as a case of penis envy as in the case of Little Hans it does not mean that I should ignore sex altogether. From a person centered perspective I need to follow where the client takes me. Or perhaps a better way of phrasing it is I have to be willing to follow where the client takes me.

Sex can be a difficult topic to talk about,  the client may struggle to believe that the therapist will be willing to listen, to demonstrate the lack of judgement which is core to counselling.  When it comes to issues around sex we may need to make that lack of judgment explicit, sometimes this is described as permission giving. Simply by saying that issues around sex are OK to talk about the client is reassured what non judgemental actually means.

Of course this demands that we have examined our prejudices and biases around sex. Are we really comfortable with the full rainbow of sexualities, from asexual to queer? Do we have stereotypes of sex workers, people who enjoy BDSM, non monogamous people, to name a few, that may be expressed in the therapy room?  A client may not be able to quiz us, to ascertain our competency on such issues however to be ethical we must be examining these issues within ourselves.

A Case Study *

Richard is 23 and arrives at counselling suffering from stress and depression, he has accessed counselling via his university health service. In the course of a therapy session he discloses he is still a virgin.

This is the point at which permission giving is so important, in our current society which is filled with gender stereotypes and assumptions admitting this could be a huge step for Richard. However we also need to not make assumptions. Richard could be asexual, he might be happy with not having sex, but struggling with society’s perception of that. Simply by saying that for many people that is a huge admission, and asking if Richard wants to talk about being a virgin we make clear this is a safe, non judgemental space.

However none of this can be brought into the therapy room unless we are willing, and able to talk about sex.

*This is a completely hypothetical case study bearing no relation to any real life clients