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2| P a g e Table of Contents Topic Secret # 1: Listen Closely to Your Clients Secret # 2: There’s More to Sex Therapy than Performance Secret # 3: You Don’t Have to Have All the Answers (Really!) Secret # 4: Don’t Try to Fix Your Clients Secret # 5: Check Your Own Issues at the Door Page 4 7 8 12 15 ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals .

Great sex therapy involves trust that your clients are capable of acting in their own behalf. As you ask new questions. confidential space in which clients can begin to rewrite the negative scripts that keep them locked in unwanted sexual dynamics. women. Sometimes the most empowering intervention we can offer is to support our clients in exploring their sexual dilemmas for themselves. present. wishes. Let yourself listen with curiosity and wonder. It means openly inviting our clients to share nuances of their own unique erotic experience: their sensations. and the rest of us. not ourselves—even when our clients’ issues bring us face-toface with our own. memories. Sexual experience is complex. Professional ethics dictate that the therapy room is a place to model compassionate connection and clear. Work collaboratively with them rather than trying to fix them. Secret # 3: You Don’t Have to Have All the Answers (Really!) No therapist can know everything there is to know about sex and intimacy. Engage them in connecting the sexual complexities of their lives—past. Our job is to inspire self esteem and create a safe. empathic boundaries along with confidentiality and safety. dreams. fears. mind. Secret # 5: Check Your Own Issues at the Door Great sex therapy focuses on our clients. heart. Summon whatever it takes to resolve your own issues about love. so will your clients—and what is out there for them to discover is a rich new sexual landscape of feelings and meanings. and relationships so you don’t get caught up in clients’ stories and projections. Secret # 4: Don’t Try to Fix Your Clients It’s your client’s life.3| P a g e FIVE SECRETS OF GREAT SEX THERAPY from ExpandingSexTherapy. and future. sex. tastes. longings. especially as we all grow older: self-esteem. Focusing on performance aspects of sex leaves out much of what is crucially important for men. Think beyond symptoms and the goals of intercourse or orgasm. Solving all our clients’ problems is not our job. If you find yourself working harder than a client. Secret # 2: There’s More to Sex Therapy than Performance Great sex therapy often involves more than diagnosis and treatment of sexual dysfunction. this is a recipe for burnout—and a mixed message about responsibility. Predicting outcomes for our clients’ lives is not our job. Above all. or act on ego needs to enter into romantic or sexual relationships with them. and other connections of body.com Secret # 1: Listen Closely to Your Clients The details of our client’s lives are keys to their sexual mysteries. encourage every independent step your clients take toward sexual healing and pleasure. To evoke them takes more than just a routine sex history—“When did you first have intercourse?” etc. and the immeasurable joys of erotic connection. not yours. and spirit. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . pleasure. Witnessing and accepting clients’ experience can be a potent therapeutic strategy.

com Secret # 1: Listen Closely to Your Clients Secret # 2: There’s More to Sex Therapy than Performance Secret # 3: You Don’t Have to Have All the Answers (Really!) Secret # 4: Don’t Try to Fix Your Clients Secret # 5: Check Your Own Issues at the Door Great Reading for Great Sex Therapy— A Brief Guide ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals .4| P a g e FIVE SECRETS of GREAT SEX THERAPY A Guide for Sex Therapists and Other Health Professionals from ExpandingSexTherapy.

or that clients want to tell us. Then I set about evoking their stories in a more organic way. it sets a noncollaborative tone for the rest of therapy. But it can also feel intrusive. the client’s memories and how these affect present sexual experience and their wishes. because you’re opening up areas they want to discuss. tastes. ask why they’ve come to therapy and how they think I may be able to help them. abuse. To evoke them takes more than just a routine sex history—“When did you first have intercourse?” etc. mind. pleasure. too often. the categories on a sex history form may not directly relate to the issues clients came in to deal with. so that the client feels under interrogation rather than like a partner in the therapy process. I welcome them. A rote history taking process can sometimes feel freeing for clients. and resentment? It’s in the emotional story that I most often find scenes bubbling up from early life. longings. memories. incest. or substance abuse? What is their experience of performance-enhancing drugs. passion. orgasm. First. and more. Example: Taking a sex history that is therapeutic as well as data-gathering Sex therapists are routinely trained to take a chronological sex history—“What was your age of first menstruation?” “When was your first serious relationship?” “What were your family attitudes about sex before marriage?” The problem is that for most clients. How would they describe a wonderful sexual experience they’ve had? Or a disappointing or painful sexual experience? Is there any medical information that needs to be shared such as medications. and spirit.” The Spiritual Story: What does sexual experience mean in clients’ lives? How do they describe intimate connection and disconnection? What is the big picture of what they want? Does religion play a part?    I explore both positive and negative aspects of each area. rape.5| P a g e Great Sex Therapy Secret # 1 Listen Closely To Your Clients The details of our client’s lives are keys to their sexual my steries. I focus on relating directly to clients rather than a form. including the fallout from sexual control. wishes. and other connections of body. date rape. and can be time consuming without yielding vitally useful information. fears. Witnessing and accepting clients’ experience can be a potent therapeutic strategy. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . and compassion? How do they handle fear. I also explore past. fantasies. dreams. Let yourself listen with curiosity and wonder. and future—that is. they’re not the first things we need to know about clients. The Mental Story: What are clients’ experiences of choice and discernment in their sexual issues? What judgments and cultural messages do they carry with them—such as “Good girls don’t” and “Real men score. The Emotional Story: What are clients’ experiences of love. Moreover. present. The four areas of exploration are:  The Physical Story: How do clients experience sexual sensation. It means openly inviting our clients to share nuances of their own unique erotic experience: their sensations. Expanded approach to taking a sex history Instead of using a pre-determined sex history form. and dreams of the years ahead. heart. rage.

using the openended questions above. you may notice them shift quite literally to a younger age. to begin to explore the emotional quadrant: “What are you feeling right now as you talk about [X subject]?” “Is this feeling new to you? Or is it usual and familiar?” As clients are telling you their story. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals .6| P a g e You can find much more information about this organizing principle In The Heart & Soul of Sex. to begin to explore the physical quadrant: “What’s happening now…?” “What do you notice in your body (your breathing. 2) If this younger and vulnerable state is unacknowledged. This is a time to ask: “What age do you feel right now?” Listen for the answer and then address that four-year-old or that eight-year-old directly. You can start by asking: “What does [Xbehavior] feel like? What does it mean in your life? There are several phrases I urge my sex therapy supervisees to use again and again. and in The Return of Desire. which describes the findings from my nationwide survey. 1) You will miss valuable material for your therapy if you miss this shift. You may hear their voice change. You may see their posture change along with their face and gestures. to begin to explore the mental quadrant: “Are you responding to messages about sexuality that are out there in the culture?” “What are some of those messages?” “How do they make a difference in your life right now?” Or. Ask your clients to tell you their story from each quadrant. Hot Tips for asking open-ended questions Beyond the initial interview. “Tell me more…” “Can you clarify for me…” “ What does that mean for you…?” Another set of phrases. your clients may stay stuck in that state. you can continue to find out what you and your clients need to know by asking open-ended questions about each of these areas of your clients’ sexuality and their lives. and associate your therapy with pain and dissociation. your clenched fists)…? “What would your hands say if they could talk…?” Or. It is crucial for you to be sensitive to this shift for two major reasons. which describes the four energies that spark sexual desire.

©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals .” You can ask this question during an initial session of history taking. here’s a provocative question that will bring up many options beyond intercourse. and other goal-oriented activities. instead of repeating stories they already know by rote. this is a wonderful question to ask partners—and notice their responses to each others’ answers. or you can use it as an exercise during individual therapy. By opening up the questions you ask. where you can guide the discussion that follows. Outcome An engaged and attentive client means much more engaged and attentive therapy—and a more creative therapist. orgasm. Note that these options may be positive or negative.7| P a g e To get at what your clients really want in their sexual relationships. you are setting the stage for collaboration with your clients on exploring their sexual mysteries. and listening closely to the answers your clients give you. Benefits of asking open-ended questions instead of a prescribed sex history You will engage clients in becoming curious about their own therapeutic process as they hear themselves putting together their sexual experience in new ways. “Describe a sexual experience from any time in your past that touched your heart and soul—and that possibly changed the course of your life. In couple therapy.

Sexual experience is complex. especially as we all grow older: self-esteem. For instance she might say.” Then she might say. “I can turn myself off by thinking about our taxes. “I can turn myself off by answering e-mails all night. pleasure. Hot Tip for learning about couples’ desire A diagnostic exercise I use to help couples learn more about sexual desire is a simple sentence completion about how they can turn themselves off and on—I start with “turn off” because it is usually easier for couples to recite the negatives at first. As you ask new questions. or is it something else. as this couple is. it is the sense of love and tenderness that arouses her. She is anxious about what an affair might do to their marriage. married 17 years He complains that she has lost the desire for sex—he wants much more sex than she does. but argues that he just wants physical sex. I can turn myself off by noticing wrinkles around my eyes…” And so forth…. She says she needs more emotional connection. Example: Discrepancy of desire in a heterosexual couple—in their mid-40s. Expanded approach to discrepancy of desire When a couple presents with issues about desire. Begin by asking couples to complete this sentence: “I can turn myself off by…” Direct the couple to pass this sentence-completion back and forth. The effects of this exercise can be profound when partners engage in this together. and the rest of us. with new completions.8| P a g e Great Sex Therapy Secret # 2 There’s More To Sex Therapy than Performance Great sex therapy often involves more than diagnosis and treatment of sexual dysfunction. so that each partner repeats the sentence again and again. But I begin our therapy relationship by seeking to understand (and help them understand) a broader sense of all that sex might entail for them. and the immeasurable joys of erotic connection. Think beyond symptoms and the goals of intercourse or orgasm. so will your clients—and what is out there for them to discover is a rich new sexual landscape of feelings and meanings. and without that she can’t come to orgasm or even lubricate sufficiently for intercourse. and I want them to feel successful. and is so frustrated that he is fantasizing about having outside affairs. and perhaps not talked about? Sometimes partners are very clear about what they think they want. and fun. I do not immediately assume pathology in one or both partners. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . Focusing on performance aspects of sex leaves out much of what is crucially important for men. efficient. And I seek to evoke the details of their desires in a way that is collaborative. which has become boring and is now sometimes painful as she enters perimenopause. One of the first questions I ask each partner is: desire for what? Is it intercourse with a goal of orgasm a prescribed number of times a week. perhaps more complex.” He might say. women.

But they were setting aside time to be sexual and were exploring ways to give each other what they wanted. which have too often been unmet. their sexual interactions did not always include intercourse. but rather a shift in attitude that gave them a way to update what they each wanted. defense.  Offers the couple new language and a new process for articulating what they want. not on expectations of their partner. At last report. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . not about your partner. blames. your job is to help them process what they have learned from each other—and from themselves. When it is over. your role as therapist is to keep them on track— encouraging each set of these to go on and on. Outcome This simple exercise quickly and efficiently focused our therapy sessions on the complexities of the needs of both partners. Then ask the couple to complete this new sentence using the same back and forth format for another 5 minutes or so. or start to tell long stories. the husband. who had been lobbying for more intercourse. Do you need to begin by sending the woman partner for a hormonal workup? Or giving the couple information about lubrication? Or does it become evident that the crux of the desire discrepancy lies within the relationship? You may find a relevant piece of homework emerging from some of the things they say. keep the exercise going.9| P a g e Let the couple go back and forth for as long as possible—so that both partners have to reach deeply into themselves to articulate their turn-offs beyond the first few stock phrases they might come up with. Couples may have a great deal of fun with this exercise. acknowledged that his needs for sexual contact were as much about wanting a place to open his heart as they were about stimulating his penis. The eventual outcome was not a vast increase in the number of times this couple had intercourse. and a reconfirmation of their commitment to each other. and hold space for witnessing whatever happens. They may make jokes. As a result of this exercise. or they may become anxious or even inarticulate. Benefits of sentence completion as a diagnostic tool  Explores complexity of experience rather than pathology  Provides an enormous amount of information about each partner’s desire in a short time  Provides instant information about ways the partners relate to each other—and want to relate to each other sexually  Equalizes the conversation about desire  Allows partners to hear many levels of what each other wants and doesn’t want  Removes the option of responding to each other with judgments. The diagnostic value of this exercise is to identify where the therapy needs to focus. Allow at least 5 minutes for this part of the exercise. until they run out of stock phrases and reach deep into their wellspring of desires: “I can turn myself on by…” While the partners are doing the sentence completions. or say they can’t do the exercise. They said they occasionally felt like randy teenagers again. You may have to steer them off trying to put responsibility for their desire onto one another (“You turn me off (or on) by…. or self putdowns  Focuses partners on responsibility for their own sexual desire—on what they can do for themselves. rather than identifying the wife and husband at the opposite ends of the desire spectrum. Your job is to notice how they interact.”) The message you want to give to each partner is: This is about YOU.

and even more theories about how to treat repressive sexual attitudes and low sexual desire. Solving all our clients’ problems is not our job. His arousal template is to wait until she and the children go off to school. because their sexual dynamic was creating so much anger and tension in the house that the children were beginning to suffer. Example: A woman threatens to leave her husband because of his porn use. even though there were children involved. He says he uses porn because she’s a prude This couple has been together for 12 years—she’s a school teacher. which would point to a clear choice about ending the relationship. I stated that I had no agenda about keeping the marriage together. Sometimes the most empowering intervention we can offer is to support our clients in exploring their sexual dilemmas for themselves.10| P a g e Great Sex Therapy Secret # 3 You Don’t Have to Have All the Answers (Really!) No therapist can know everything there is to know about sex and intimacy. and I obtained their agreement for helping them investigate the sexual dynamic they had set up for themselves. or else underscore their differences in a non-blaming way. They have two boys. too. To expand their sexual script I created a safe place for them to look at their couple dynamic. and would surely suffer more as they became teenagers with their own issues and questions about sexuality. and totally turned off sex. Predicting outcomes for our clients’ lives is not our j ob. Expanded approach to hot-button issues with couples—helping them rewrite their own story There are many theories about how to treat the addictive and compulsive use of pornography. I began our therapeutic interaction by acknowledging the wide chasm between their sexual styles. I hoped this approach would help them either move closer to each other sexually and spiritually. he’s a computer programmer who works from home. I chose to bypass all of these approaches to personal pathology because I felt that pursuing them would reinforce the negativity and anger that was already tearing this family apart—and I was also factoring in the best interests of the children. age 9 and 11. She is distraught. Our job is to inspire self-esteem and create a safe. and then lie on the sofa. I chose to focus on expanding this couple’s awareness of each other’s sexual templates. and hurt and rage born of disappointed expectations. confused. I had no definitive answers for this couple’s profound disaffection with one another. The couple are barely speaking to each other when they arrive for their first session. smoke pot. and masturbate to Internet porn. An important part of this was teaching them how to to be still and listen to each other with open ears. and felt the wisest course was to offer ways to help them begin to make peace with themselves and each other. but backs off because of the children. In other words. Importantly. He blames her for threatening him with Catholic guilt. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . they had created a sexual script that left little scope for exploring what each of them wanted. confidential space in which clients can begin to rewrite the negative scripts that keep them locked in unwanted sexual dynamics. It was evident from the blames this couple threw back and forth that both were stuck in a loop between their heads and their hearts—expectations about what their sexual relationship “should” provide. The stated purpose was to see if new understanding they gained could help them rewrite their sexual scripts. angry. She wants to publicly shame him.

Though their ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . The sex was great until she became pregnant. they both laughed in a truly accepting way at how very different they were in terms of their sexual desires. his porn use was an anxiety releaser before it was a sexual turn-on. they can begin to understand how these connect with seemingly nonsexual issues such as needs for approval and inclusion.) When asked what does he need in order to relate sexually to his wife? He didn’t know. (They agreed about the welfare of the children. the wife is about to remarry—a childhood sweetheart. for him. she thought he would open her up to adventure. She brought in a bowl of water—to represent that what she wanted was for a relationship to be fluid and nurturing and also a container for deep spiritual connection as well as sexual connection. it helps them accept others where they are—and determine in a nonjudgmental way how closely they want to relate to them.)  Tell me something you agree on…” This was to determine what the core agreements of this couple are. their divorce proceedings were relatively seamless and kind.  “What attracted you to each other?” This question was to get them out of their heads and into their hearts. He brought in a Playboy magazine to show the kind of hot contemporary images that excited both his body and his imagination. but little else). what you get out of holding your position against each other…” (Basically. Benefits of allowing clients to rewrite their own scripts When clients are able to reach deep inside themselves to acknowledge what they want sexually and spiritually. the issue of divorce ceased to be a threat. and to find out their relational chemistry. He responded with a question: “How do I relieve my anxiety about not being good enough?”  (To the wife) “What do you really want--once he turns off the computer and pays attention to you? (She didn’t know: Her question was: “How do I maintain integrity in this humiliating situation—when what I want doesn’t match the male script?”) Finally. and a devout but not rigid Catholic—with the promise of the stable life she has dreamed of.11| P a g e Hot Tips for understanding the hot-button issues of pornography and religious repression My decision with this couple was to engage them in a series of questions designed to help them rewrite their sexual scripts by offering them some new ways to think about sexuality. a widower with two young boys. In fact. each wanted to be “right. I asked them each to bring into their next session an object to represent what they truly wanted in an intimate relationship that was just right for them. Outcome In this case. When they saw each other’s objects and heard the descriptions.”)  (To the husband) What do you get out of watching porn? ( He is able to create an alternate universe where he doesn’t have to live up to anything. At present writing. The husband has moved to an apartment nearby and is enjoying his bachelor existence. the couple eventually decided to split when they were able to acknowledge how far apart their intimacy and sexual needs really were.  “Describe to me in as much detail as you can. That is. (He thought she would provide stability. The questions below were investigated over several sessions. Not only does this motivate them to move toward what they want in their intimate relationships. they both felt disillusioned and defensive. Because this couple had worked out their confusion about their sexual differences.

who is more consistently nurturing. They see their father frequently. The boys live with their mother. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . who enriches their lives creatively in ways that their mother cannot. the couple was able to work out an agreeable financial arrangement and shared childcare based on the positive capabilities of each parent.12| P a g e lawyers advised them to be adversarial. The couple is agreed that he will not share his interest in Internet porn with the boys.

and future. Engage them in connecting the sexual complexities of their lives—past. this is a recipe for burnout—and a mixed message about responsibility. so emotionally constricted that I could feel her sapping my energy. and is so depressed that she rarely leaves her house except to go to her job as a bank teller. I decided to try some “wake-up” exercises during our sessions to see if these would help her expand her frame of reference so that she could find resources within herself. With the degree of immobilization in the client above. present. It is the client’s inner light. but that it doesn’t come from me. Above all. because her mother is so judgmental that this client feels like a sinner. Example: A menopausal woman is immobilized by obsessive thoughts about being a lesbian This 48-year-old single woman came to therapy because she said she finally had to talk with somebody about her attraction to women—her state for as long as she can remember. or even to address her sexual orientation issues head-on. Instead. Hot Tips for a meditation journey The first step was to teach her to breathe consciously and intentionally I begin every meditation journey by working closely with clients’ breathing. She fears growing old alone. She had a strict Christian upbringing with a devoutly religious mother who is still active in the church. it is not relieving her depression. needy. but ultimately disempowering for the clients. This client presented as ashamed. though she has never acted on it. not yours. My experience has been that there is light in every client. and that the exhale breath is “expiration”—letting go of ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . otherwise I realize that I will be doing more work than the client—a situation that is not only exhausting for me. and that my job is not to try to fix clients but to help them find their own light. Though her PCP has prescribed Paxil for her. encourage every independent step your clients take toward sexual healing and pleasure. I felt it was important to go slow with her in therapy. She has little contact with her mother. Work collaboratively with them rather than trying to fix them. and so scared of her sexual attraction to women. But my first aim is to help the client acquire some strong and dependable coping skills before we begin rooting around in what may be a traumatic past. She asked for help as if I had all the answers to her life. so ashamed. I assume there may be a history of some kind of abuse or neglect—perhaps triggered by her mother’s religious fundamentalism and unrelenting judgments. Great sex therapy involves trust that your clients are capable of acting in their own behalf. I also felt it would be unproductive to give her standard sex therapy homework right away. If you find yourself working harder than a client. and deferential. Because this woman was so immobilized. teaching that the inhale breath is “inspiration”—with all that stands for. The message she gave was one of desperation: “Fix me”—as if I could somehow absolve her of sin and bring her into the light. my first step is to try to engage them in their own behalf. and has never had an intimate relationship.13| P a g e Great Sex Therapy Secret # 4 Don’t Try to Fix Your Clients It’s your client’s life. Expanded approach to mobilizing clients who are stuck When a client presents with extraordinarily low energy (whether or not the issues are specifically tied to sexuality). I began with cumulative steps to what I call a Meditative Journey.

for her to access whenever she wanted. and to help them create a container for their inner journeys so they don’t feel they’re going to fall down an endless rabbit hole. I did not ask her to open the doors. Knowing specific details of this safe place gives clients a confident starting point from which to visit new emotional landscapes. Next. Finally. At the same time. I asked her to come back from the journey to discuss her experience. I ask them to notice what this place is like: Large or small? Indoors or outdoors? What are the textures and smells? Is anyone else there? And so forth. Once clients walk through a door I ask them to notice the space. From there. sometimes enigmatic. She was moved to tears when she came back with the Teddy bear. I do this to give clients a sense of mobility and power. and the message is always significant—sometimes funny. so they can use their breathing consciously at home for both comfort and awareness. Open-ended instructions for the journey allow clients to use their own images rather than trying to fit their experience into images I might choose. I asked her to follow her breath inside herself until she found a safe place I routinely ask clients to start their meditation journeys by finding a place inside themselves that has never been wounded—a place of ease and clarity and power. the other door was labeled Heterosexual. I suggested. This woman found a small brown Teddy bear that she remembered from her childhood. approach the doors. I asked her to follow her breath to her safe place. These doors (or they can be paths) represent dichotomies in the clients’ story. The next step was to have her return to the safe place and notice two doors there. this process establishes a sense of collaboration and teamwork with clients.14| P a g e all that is no longer useful or wanted. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . I asked her to follow her breath back into the room to discuss her experience. whose message for her had been inside its ear: “You are good!” She took this as a message from the universe that she was not a sinner. simply to notice that they were there. one door was labeled Lesbian. She had begun to find inner guidance through the wisdom of childhood knowing— the messenger was her beloved stuffed bear from whom she sought solace from her mother.  Engages clients’ imagination. Benefits of the Meditation Journey process  Engages clients’ breathing and teaches connection of body and spirit. or to revisit events that may have terrified them—and a home base for their safe return. Her relief was palpable. Again. “In this place that you are exploring. In this client’s case. but always meaningful to the client. also a rhythm of inspiration and letting go. choose which one to open—and walk through. Then I asked her to bring herself back into our room so that we could discuss her journey so far The point for this client was to give her the experience of briefly going into a meditative state and coming back safely.” Clients seldom fail to find a message. just as I did with the safe place: “What do you notice?” “Who is there?” And so forth. Next. This is an opportunity to tie the process of breathing with whatever issues the client is struggling with. find a message with your name on it.

watch films. ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . and future. she became engaged in actively exploring her sexual orientation. has weaned herself off antidepressants. and finally to join a “coming out” group for lesbians at her local women’s center. non-blaming approach to clients’ issues. whatever they are. present. Teaches clients a new skill to practice at home—involving breath. In her first journey. She no longer feels like a sinner. Offers a respectful. she received a message about the origins of her shame and internalized homophobia that gave us material to focus on in therapy. and had the sense of belonging she never felt growing up. Most importantly. and takes some responsibility for treatment outcome off the therapist. this process began to wake her from her chronic numbness. She began to make friends there. as for many clients I’ve initiated into meditation journeys. imagination.15| P a g e      Offers clients a way to find a path to a new positive place—that they can access whenever they breathe Invites clients to dive beneath the radar of cultural convention to access information about their lives—past. and hope. and is committed to expanding her life. Outcome For this client. Engages clients in acting on their own behalf. She was motivated to read books.

One is the idea that the feelings that flow between clients and therapists can be key to the therapeutic process rather than a launch pad for ethical censure. which may flatter the therapist greatly. they omit the truth that the feelings we may have for our clients. intangible force that moves between therapists and clients. All of these standards state that therapists must refrain from dual relationships with clients. Professional ethics dictate that the therapy room is a place to model compassionate connection and clear. Example: A client admits she is in love with you… A 39-year-old single dad has been in therapy for seven months. the client says to the therapist. Summon whatever it takes to resolve your own issues about love. Classically. and often praises him for his insights and commitment to growth and change. identifies with many of his issues. therapists do have feelings. and that they may spill outside the tidy box called “ethics. I love you.” Expanded approach to issues of transference and countertransference This is a classic scenario of boundary-hopping. and limiting our affect may prevent important material from surfacing for discussion. “You have become the most important person in my life. Instead of holding our clients’ issues in understanding and compassion. I wish I could be just like you. entering into ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . we may end up trying to influence their lives personally—by rescuing them. empathic boundaries along with confidentiality and safety. sex. and specifically from sexual relationships with clients. and that our clients may have for us. I want to spend time with you beyond our therapy sessions. or act on ego needs to enter into romantic or sexual relationships with them. or into their projections of us. Standards of professional behavior are now firmly set in place to protect both clients and therapists from forming inappropriate liaisons. During one session. particularly when clients are looking for guidance about intimate relationships. The upside of this energy exchange is that it can inspire and motivate both client and therapist to be the best that they can. But no matter how attracted the therapist may feel to the client at that moment. I like to think of both transference and countertransference as energy exchange—an invisible. sometimes powerfully enough to color their relationships. beyond simple boundary-setting. and relationships so you don’t get caught up in clients’ stories and projections. and the therapy relationship can flourish. there is only one clear response for the therapist: Just say “no. A downside comes when therapists have not fine-tuned their awareness of their own issues. This opens us to getting hooked into clients’ stories. therapists are trained to defend against unethical behavior by limiting their emotional connection with clients.16| P a g e Great Sex Therapy Secret # 5 Check Your Own Issues at the Door Great sex therapy focuses on our clients. not ourselves—even when our clients’ issues bring us face-to-face with our own. Clear and important as codes of ethical behavior are. But I don’t believe that’s the whole answer to a complex question.” The case above brings up a number of issues. can become deep and multifaceted over the course of therapy. and alter them. working hard to recover his sexual selfesteem after separating from his son’s cocaine-addicted mother. The truth is. The therapist is moved by his predicaments.” Guidelines about transference and countertransference date from almost a century ago when Sigmund Freud put these concepts into the literature.

how. it would dissipate the focused energy we bring into our sessions together.” 2) Let the client know that you care about him—why. you can use it as a way to discuss sexual energy in the interest of wakening the client’s awareness of what he really wants. Hot Tips: Beyond “Just Say No” A therapeutic conversation with the client above would contain these six elements: 1) Let the client know honestly and factually that he is heard: “I honor your feelings of trust and love.” 6) And furthermore…once the “elephant” is out in the open. By the same token. But it is unethical to act on our feelings for purposes of self-gratification.17| P a g e questionable financial arrangements with them. Acting with clarity and compassion. but models compassionate relational behavior. This is what Freud called transference.” 3) Acknowledge how he might take your feelings toward her as an invitation to love: “A therapy relationship that is vital is very much like a love relationship—because we are dealing with your deep concerns about love and sexuality. which is clear and comprehensive. and feel moved that you want to be like me and know me better. we need to find a place to work on our own issues so we don’t play them out with our clients. and as we discuss these. It would go against the professional code of ethics that I live by. This AASECT code stresses competence and integrity as well as moral. Equally important. ethical. obsess about them.” 5) Offer him something positive to do with his feelings: “So I would like us to continue to use the energy we generate as a way to help you get clearer and clearer with your girlfriend—so that you can develop the kind of relationship that will be wonderful for you. Or have sexual fantasies about us. a client will fall in love with us. Or obsess about us. and have sexual feelings for them. Outcome All of this said. not only allows the therapy to move forward. What’s important is for you to continue to take the energy we generate in our sessions and use it in your life. This is what Freud called countertransference. and legal responsibility to safeguard our ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . And it’s a real joy to work with you. We need to pay attention to all of these feelings and where they come from in us—not just intellectualize them away or hide from them behind a wall of defensiveness. or worse: teaching them about sex by engaging with them in sexual relationships.” 4) Let him know exactly what your boundaries are: “For us to extend our relationship beyond therapy is not possible. You bring wonderful energy to this work—and you have a beautiful way of translating what we do in therapy into your life and making it your own. I’m going to refer you to the AASECT Code of Ethics. An often unexplored truth of great sex therapy is that once in a while. Benefits of clarity about issues of transference and countertransference Making the commitment to acknowledge our own issues when they are triggered by clients allows us to focus on the wellbeing of our clients instead of getting hooked into co-dependent and even unethical behaviors. and which is required for any AASECT certified therapist to adhere to. and to what extent: “I want you to know that I am inspired by your efforts to rehab your life. you and I are passing a great deal of positive energy back and forth. we may fall in love with our clients. We need to learn how to recognize our feelings so that we can act in the best interests of our clients. Beyond that. A crucially important truth here is that it’s not unethical to feel deeply connected with a client.

If you’d like to learn more.  When a client’s issues are beyond a therapist’s expertise or abilities. and also join me at one of my workshops or trainings so we can work together to expand the practice of sex therapy to become more integrative and collaborative. see http://aasect.g. it’s been a pleasure to share with you five of my secrets to great sex therapy.  Sex therapists will maintain confidentiality and clarify any exceptions to confidentiality and privileged communications (e. and supervision. therapy. and Legal Responsibility to Clients  Sex therapists will not enter into any dual relationship that jeopardizes the well-being of the client. Please know that there are many more—these are only a few. PhD. religion. LMFT. sexual orientation handicap.18| P a g e clients’ welfare. Competence and Integrity of Sex Therapists  Sex therapists will commit to high standards of scholarship and training in sex education. To read the entire AASECT Code of Ethics. Gina@ExpandingSexTherapy. and will update their professional expertise through continuing education. duty to warn. Below are condensed and paraphrased excerpts. gender. when there is clear and imminent danger of bodily harm or to the life or safety of the client or another person). attempt to engage.org/codeofethics. please have a look at my books. a client in romantic or sexual behavior whether the client initiates or consents to such behavior or not. Ethical. or offer to engage. or condones inhumane practices regarding age.asp. or when boundary issues threaten. sexual intercourse and/or the touching by either therapist or client of the other’s breasts or genitals. the therapist will refer to a qualified professional who can better address that client’s needs. race. Moral. And do write to me—I would love to hear from you! Gina Ogden.  Sex therapists will not engage.com ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals . Sexual behavior includes kissing. In closing. or national origin.

2008 An Imago therapist looks at couples dynamics. and sacred union Esther Perel. NY: Haworth Press.). 2010 A practical exploration of breath and body to expand awareness and pleasure Sherri Winston. extragenital orgasm. Getting the Sex You Want. New York: Harper. abuse. Mating in Captivity. 2001 Feminist academics tackle the medicalization of sex therapy and offer alternatives Evelyn Resh. orgasm. 2009 All those issues your mother wouldn’t talk about and your daughter needs to know Suzanne Scurlock-Durana.com Riane Eisler. Boston: Trumpeter. New York: Harper. Boston: Trumpeter. Boston: Trumpeter.(Rev. 2007 Women redefine sex through stories of lust. affairs. and “thinking off”—orgasm with no hands Gina Ogden. Sacred Pleasure. N. sexual orientation.19| P a g e GREAT READING FOR GREAT SEX THERAPY A BRIEF GUIDE from ExpandingSexTherapy.). 2007 Erotic intelligence about men.: Hay House. 2001 A gathering of innovative sex therapists and activists speak their truth Tammy Nelson. The Return of Desire. and much more Leonore Tiefer and Ellyn Kaschak (Eds. 2008 Applying the ISIS process to sexual desire—including relationship issues. Kingston. Full Body Presence.: Quiver. affairs. and beyond ©2011 Five Secrets of Great Sex Therapy: An Inspiring New Guide for Sex Therapists & Other Health Professionals .: Mango Garden Press. love. sex. The Heart & Soul of Sex. relationships. 2006 Stats and stories from Gina’s nationwide survey on Integrating Sexuality and Spirituality (ISIS)—and introduction of the ISIS Wheel and how to use it in therapy Gina Ogden. The Secret Life of Teenage Girls. Women Who Love Sex (3rd Ed. trauma. Ed) New York. and offers scores of useful exercises Christiane Northrup. intimacy. Novato Calif.: New World Library. Carlsbad. Woman’s Anatomy of Arousal. energetics. women.New York: Brunner-Routledge. 2010 Richly illustrated manual and guide to anatomy. Beverly. childbirth. A New View of Women’s Sexual Problems Binghamton. 1995 A landmark history of sexuality through the lens of dominator and partnership societies Peggy Kleinplatz (Ed.) New Directions in Sex Therapy. Calif. 2006 An MD with soul lets women know that sexual pleasure doesn’t have to end with age Gina Ogden. Mass. The Wisdom of Menopause. Bantam. masturbation.Y.