The Dirty Little Sex Secret of Therapy

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It’s National Psychotherapy Day.

I’ve been a Licensed Marriage & Family Therapist for 34 years—over 35,000 hours of therapy with men, women, and couples. I make a living from it. Most of my friends are therapists. Like most therapists, I’ve been in therapy more than once. I really, really believe in it.

Nevertheless, it’s time, once again, to critique the institution of therapy. Today’s criticism:

If the public knew how little most therapists learn about sexuality, they’d be stunned. While there are exceptions, here’s what most therapists (and social workers) in America learn about sex as they’re being trained:

* How to define, assess, and treat victims of child molestation;
* How to talk to people who have been raped;
* How to discuss infidelity—generally using a perpetrator-victim model;
* How to encourage couples to “compromise” their differences in sexual desire or preference;
* It’s OK to be gay (finally!) (unless you go to some “Christian counselors”);
* In general, men want sex more than women;
* Men who go to sex workers have an emotional problem, often a fear of intimacy;
* The traditional Masters & Johnson model of sexual response, in which you either get erect or wet, get excited, and then climax—or you have a “dysfunction.”

Like I said, there are exceptions. But the chances are that your therapist didn’t learn much more about sex than that. And a lot of it is crap. Almost all of it is negative.

Here’s what your therapist should have learned as part of his/her training:
* Exactly how difficult long-term monogamy is for people who like sex. How to talk with—and be compassionate for—people having difficulties with monogamy, or couples having conflict over their different preferences.

* The actual content of most internet porn. Why so many people prefer masturbating to porn than having sex with their partner. How to talk with couples about this without demonizing the porn consumer.

* “Romantic” sex isn’t better than other kinds. “Spontaneous” sex isn’t better than other kinds. Intercourse isn’t better than other kinds of sex. Monogamy isn’t better than other arrangements. People’s insistence on one or more of these fairy tales is the source of great misery, whether they’re patients or therapists.

* Most normal children experiment with sex with their peers in ways that could get them in huge trouble with the law.

* Vibrators. Nipple clamps. Fingers in anuses. Hair-pulling. “Accidental” exhibitionism. “Accidental” voyeurism. Deliberate exhibitionism and voyeurism. What people actually do sexually.

* In adulthood, male sexuality and female sexuality are far more similar than different.

* Not only do women fake orgasm, men do, too. And for the same reasons.

* Straight people have same-gender sexual experiences. Gay people have mixed-gender sexual experiences. Some of these people are comfortable doing so. Others feel awful, and consider it a dark secret. The secrecy is almost always destructive.

* The extraordinary range of human sexual fantasies. Fantasy does not typically reflect true desire; in sex, fantasy doesn’t predict behavior any more than it does in other parts of life (daydreamed about killing your boss or neighbor lately?). While some fantasies have “meaning,” most are simply low-cost, calorie-free entertainment.

There’s a lot more about sex that therapists should know. And therapists should be more comfortable about sex than we are, including activities that a therapist thinks are weird.

It’s also important to note that most of what therapists learn about sex is pathology oriented—that is, distortions of sexual behavior and motivation. But what about healthy sexuality—what do therapists learn about that? Other than society’s norms (love drives desire; intercourse is the most intimate kind of sex; etc.), not very much. It’s the equivalent of going to a knee surgeon who knows all about damaged knees but very little about healthy ones. That’s not the surgeon I would pick.

When it comes to sexuality, the fields of psychotherapy and couples counseling are way behind the times. When shopping for a therapist, regardless of your issues, you may want to ask about his/her philosophy regarding sex, gender, and intimacy—because that will color their attitude about a lot of topics that seem unrelated, but aren’t.

How to ask? Just ask. Listen to how comfortable your would-be therapist seems, and what vocabulary she/he uses. “Private parts” and “marital relations” is probably not a good sign.

How many therapists does it take to change a lightbulb? Only one—but the lightbulb really has to want to change. When it comes to sexuality, it’s time the therapy field changed dramatically—so we can more effectively help our patients change and grow. Of course, it’s unnecessary for every therapist to specialize in sex. But patients’ assumption that every therapist knows a lot about sex—and doesn’t simply believe common, destructive myths about it—should not be unreasonable.

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