On “sex therapy” (and universal design)
So the question of the hour is: Am I a sex therapist?
And in very therapist-y fashion I’ll respond with what I think is the more important question: What is a sex therapist?
And it turns out, there isn't really an agreed upon definition of sex therapy or set of competencies for sex therapists, even in the field itself - which is very much interdisciplinary.
Realistically, in most of the U.S., almost any licensed health professional may claim that label. Although there are certifications for “sex therapy” as a practice... I think the one you’re most likely to hear about is AASECT (which is The American Association of Sexuality Educators, Counselors and Therapists).
On that note, I’ll share that I’m not AASECT or otherwise certified, and I’m not planning on pursuing those credentials at this time.
My ongoing experience throughout graduate and professional training is that our field teaches to a white-, cis-, heteronormative standard, and if that is not the lived experience of the clients you serve, then you have to figure out how to adapt those frameworks or that information on your personal time.
Its hard. And I might be biased or even a bit jaded, but after literally 13 years in higher education, I’m fucking tired of doing that.
And right now, it feels like a better use of my time to to strictly focus on what's relevant to my clinical work.
I also find the dominant framework for “sex therapy” to be really rooted in the diagnosis of some dysfunction. So, out of the DSM, those diagnoses are gonna be things like:
delayed ejaculation,
erectile disorder,
female orgasmic disorder,
female sexual interest/arousal disorder,
genito-pelvic pain/penetration disorder,
male hypoactive sexual desire disorder,
premature ejaculation
and a handful of others
Certainly, this somewhat medicalized approach has a place, but its really not the focus of my work or even how I orient to therapy as a practice.
I think of myself as a sex therapist in the terms that sex is spelled with a lower case “s” instead of a capital letter. You know, “sex” as sexuality in all its vastness, instead of “Sex” as an event (that’s focused on performance or penetration).
Meana et al. (2020) speaks to this a bit in their discussion on the field’s progression as a whole; they say:
Sex therapy is no longer just for dysfunction, but is increasingly directed toward treating the sexual ramifications of infidelity, disability, illness, and trauma. Sex therapy is an appealing approach for sexual minority groups who may feel misunderstood and disenfranchised by mainstream psychotherapy, which historically and mistakenly identified their sexual differences as the cause of their unrelated psychological complaints. Sex therapists, correctly or not, are often identified as therapists who will know about sex and therefore understand and respect sexual differences.
Ding ding ding! That, I think, is where my practice falls. Sex is such an important and omnipresent part of our life and of our wellness. And yet, is so taboo.
I think about sex-therapy-as-a-practice as in alignment with a concept that I learned out of disability studies called the curb-cut effect.
A curb-cut is that ramp at an intersection that transitions the sidewalk down to street-level. The concept of the curb-cut effect essentially notes that when you design spaces for folks with disabilities, you inherently create benefit and accessibility for everyone. Certainly, anyone with a wheelchair may require a curb-cut for their mobility, but this design will also benefit children, elderly folks, and anyone with a stroller, a walker, or limited mobility of some kind.
And so - do you need to have a sexual “issue” or “dysfunction” or be exploring your sexual orientation to work with me? No.
But does my training about sex and sexual minorities, and having a general non-judgmental stance around sexuality create accessibility for other vulnerable topics that you might want to discuss with a therapist? Absolutely, yes. Because in a society with such a complicated relationship to sex and sexuality, if we can talk about sex... Shit, we can talk about anything.
Citations
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Meana, M., Hall, K. S., & Binik, Y. M. (2020). Where is Sex Therapy Going?. In K. S. K. Hall & Y. M. Binik (Eds.), Principles and Practice of Sex Therapy (6th ed., pp. 505-522). Guilford Publications.