While virtually all therapists mean well, and many are quite skilled, most don’t get enough training in sexuality. Learning about sexual violence and sexual orientation (the most common sex-related topics) isn’t nearly enough to help us understand the sexual experiences, hopes, and difficulties of most people.
As a result, many therapists are not sexually literate—and they can harm people unintentionally.
Sexual literacy includes topics such as:
* Physiology of desire, arousal, and pleasure
* Cultural differences in sexual beliefs
* Causes of common sexual difficulties—and best practices in addressing them
* Self-awareness about therapists’ common prejudices and judgments (for example, about pornography or BDSM)
Here are some things a therapist who lacks sexual literacy might say. If your therapist has said one or more of these things, you might want to think about changing therapists:
* “Of course, sex sometimes hurts. You just have to bear it.”
For many people, sex occasionally hurts—and then you should stop immediately. The pain—like all physical pain—means something. It could be a herpes outbreak, involuntary muscle spasm, insufficient lubrication, or a dozen other things.
But the pain is never meaningless.
On the other hand, here’s what the pain NEVER means: the vagina is too small; the penis is too big; the woman is “frigid;” the woman “takes too long to get ready” someone is “lousy in bed.”
In my opinion, recommending a topical anesthetic to dull the pain borders on malpractice. Using such a product could result in tearing delicate genital tissue during sex. And, of course, it avoids the underlying reasons for the pain.
When a therapist tells a patient to ignore sexual pain and do it anyway, the therapist is usually saying they don’t know what’s wrong, or don’t know how to be helpful. A good therapist will admit that, and suggest a referral.
* “Orgasm is the deepest fulfillment of sex”
Orgasm, of course, can be quite delightful. But it’s not part of every sexual encounter, and it doesn’t guarantee that the other ten minutes (or one minute or one hour) of sex will be enjoyable.
Besides, most people can have orgasms on their own.
So what parts of sex require a partner? Kissing; hugging; closeness; smelling, tasting, and viewing another; feeling wanted; and the pleasure of giving someone a gift. It’s these things that motivate most sex, not orgasms.
Other things that motivate sex include the desire to feel youthful, graceful, manly or womanly, “sexy,” and to participate in something that has no rules.
A therapist who focusses too much on orgasm has only a limited grasp of what sex is all about—and how profound it can be. They’re unlikely to understand the majority of sexual complaints they hear.
* “You need to understand men”
* “You need to understand women”
Actually, no you don’t. “Men” is a gigantic, heterogeneous category—with all SORTS of people who have nothing in common besides anatomy. The same is true of “women”—a huge category that contains every sort of sexual person imaginable.
You do need to understand the person(s) with whom you’re sexual. The best way is to ask him/her/them whatever questions you have. It doesn’t matter if “men” like their balls stroked a certain way. It doesn’t matter if “women” like their hair pulled a certain way. What matters is the preferences of your partner(s) and you.
Telling you what a billion men or a billion women are supposedly like is a lazy and very unhelpful form of therapy. Discussing why you feel inhibited asking your actual sexual partner(s) questions—and then resolving those inhibitions—that’s real therapy. It’s a lot harder to do, and so it’s a lot harder to find.
* “Monogamy is the most mature kind of relationship”
This is one of the most entrenched sexual prejudices in the fields of psychology and marriage counseling.
Almost every therapist is taught that the desire for sexual exclusivity is the hallmark of fully developed adults. Those who don’t want monogamy—or aren’t very good at it—are variously pathologized as immature, afraid of intimacy, insufficiently attached, even sex addicts.
There is absolutely no data to support such judgements.
The modern expectation that adults will live into old age, AND be sexually exclusive that whole time, AND enjoy sexual desire and fulfillment with one person is a radical social experiment. So far, the results aren’t encouraging: enormous rates of both divorce and infidelity, alongside tens of millions of middle-aged and older people who live with little or no sex.
Of course, promising to be faithful and then lying about being unfaithful is far from ideal. Most people don’t feel they can actually suggest a consensual non-exclusive sexual arrangement.
Therapists who sympathize with people for whom monogamy is difficult are rare and desperately needed. On the other hand, therapists who say that monogamy is “natural” or “mature” and attempt to mold (or squeeze) every patient into that relationship model are ignorant of anthropology, naïve about sociology, and sexually illiterate—and dangerous.
* “There’s no reason to masturbate if someone’s having ‘real’ sex”
Sure there is. Masturbation isn’t a substitute for sex, it is sex. It’s a form of self-soothing and of autonomy that most people never “outgrow.”
If someone would rather masturbate than have sex with a partner, the problem is NOT that masturbation is so attractive, but rather with the partner sex or the relationship (or the person’s discomfort about intimacy in general).
Therapists who are wary of masturbation in adults are often concerned about the appeal of many forms of sexual expression. They fear that the “wrong” kind of sex will pull people away from the “right” kind of sex. Such therapists hesitate to trust people—including their patients—to evaluate their sexual choices. Instead of discussing and teaching sexual decision-making skills, they tend to tell people what to do and what not to do.
* * *
The sad truth is that your therapist almost certainly received very little training in sexuality. And there’s absolutely no guarantee that he or she is comfortable with sex in their own lives, or has had much positive experience around sexuality.
As I travel the country training therapists, I regularly hear that “patients are uncomfortable talking about sex” or that “As soon as patients bring up the topic, I address it.” Attitudes such as these are why therapists need more training in human sexuality—and why you should NOT give your therapist the benefit of the doubt if he or she seems uncomfortable talking about it.