National Psychotherapy Day: What Shrinks Get Wrong About Sex

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Today is National Psychotherapy Day. Every year, it comes seven weeks after National Psychic Day (yes, really).

The point of NPD is to promote awareness of the profession, challenge myths about it, give constructive feedback to therapists, share therapy effectiveness research, and recommend therapy to a friend or loved one whom you think needs it.

Every one of these is a great idea, except the last. If you try it, you’re more likely to get an argument than a thank you. A full third of my patients periodically argue that they don’t need therapy—and they’re already IN therapy. Imagine what your narcissistic Aunt Esther would say.

Psychotherapy involves a wonderful set of tools. Every year, skillful therapists save marriages, facilitate divorces, educate parents, ease trauma, and help people overcome depression or anxiety, sometimes providing a link between patients and psychiatrists.

But one of American psychotherapy’s main weaknesses is in the area of sexuality.

Most therapists get very little training in human sexuality–often as little as ten hours. The focus is often on child molestation and sexual violence on the one hand, and sexual orientation and gender identity on the other.

What’s missing? Frequently, such mundane issues as the sexual side effects of common medications; contraception; why many women can’t orgasm with a partner; how Viagra works; just how common masturbation is; and the truly ambiguous nature of sexual exploration, hooking up, seduction, desire, and teasing. The world may be focused on MeToo, but in real life, “no” doesn’t always mean “no”—just like “yes” doesn’t always mean “yes.”

Without specific training in day-to-day sexuality, most therapists have to fall back on their personal experience and cultural norms. The former is always limited and frequently negative, while the latter is typically shame-centered and culturally slanted.

To observe National Psychotherapy Day (or Seven Weeks After Psychic Day), here are some notes about what psychotherapy could do way better about sexuality.

~ “Porn addiction” and “sex addiction”

These dangerous concepts are considered mainstream by therapists who don’t know much about sex. Clients who use a lot of porn (almost entirely men) or go to sex workers (ditto) are often considered “addicts” who need to be in lifelong “recovery.”

Most therapists don’t have a model of using porn or visiting sex workers that imagines a guy making a rational choice, or loving his partner. And when a woman busts a guy for watching porn, most therapists don’t talk about why she finds his porn watching so upsetting, or the fact that they didn’t have a no-porn agreement when they coupled up. No, the question is typically “How do we get the guy to stop this disgusting habit?”

~ Infidelity

The typical therapist sees infidelity as involving a selfish betrayer and a victimized betrayed. There’s rarely much discussion of the betrayed’s contribution to the messy relationship—especially if it’s a woman who has gradually withdrawn from her mate sexually.

Unfortunately, most therapists handle infidelity by supporting radical power imbalances—from unlimited (yes, unlimited) discussions of “how could you do this to me” to giving control of the betrayer’s phone and laptop to the betrayed. This kind of control does not build trust—it never satisfies the betrayed, and only creates distance with the betrayer.

Worst of all is the new fad of “formal therapeutic disclosure.” This is where the betrayer (often identified as a sex addict, if it’s a male) is required to tell his partner every feature of his unauthorized sexual behavior—how many times, how many minutes, how many orgasms, which positions, what color lingerie, etc.. The process is labelled as part of healing, but it simply gives the betrayed a jillion details to obsess about, preventing real peace or reconciliation. I sometimes wonder if the main purpose is to provide titillation to repressed, voyeuristic therapists, but…well, if the vibrator fits…

~ The “meaning” of sexual fantasies

Almost everyone has fantasies that they don’t act out: leaving your family and starting a new life in Paris; embezzling money and paying off your house; finally telling off that bossy sister-in-law; and eating all the chocolate in the entire world, to name a few.

Most people know these fantasies are not dangerous, and that they have no predictive value. Most people don’t avoid driving past a bank because they fantasize about robbing a bank.

Unfortunately, many people lose that common understanding when the fantasy is sexual—and too many therapists do, too. So patients wracked with guilt or fear about their fantasies (“Does that mean I’m gay?” “Does this mean I’m a child molester?” “Am I doomed to be unfaithful?”) don’t get the friendly reassurance they need. Instead, some therapists want to decipher what a sexual fantasy “means,” or try to change it to something more “normal.”

Repeat after me: unless it’s totally obsessive, sexual fantasies have no meaning. No, you don’t “really” want to have sex with Lassie. If your therapist tries to make your sexual fantasy more “normal,” more “ethical,” or less “patriarchal,” run in the opposite direction.

~ Sexual orientation

Oh, today’s therapists are making the whole sexual orientation so complicated—it’s now the tail wagging the dog. “Asexual? “Demisexual?” “Graysexual?” The definitions of the now-dozens of orientations are virtually indistinguishable from what used to be called “preference,” “ambivalence,” and even “I’m not sure.”

We don’t need a special word for people who lack interest in sex (no ex-huband jokes here please), or are turned on only when they feel emotional connection, or like a bit of risk-taking with their sex. These are just common configurations of the wide range of human sexualities.

Why does it matter? As a therapist, I know that categories typically end conversations. “Why did you decide that?” “I’m conflict-avoidant (or cupioromantic, or whatever)”—patients say something like that instead of actually investigating how they feel, what they want, and what they were trying to accomplish. You know—who they are, not what they are.

Therapists strive to be understanding and accepting. That’s fine—as long as we keep encouraging people to investigate themselves, rather than accepting shortcuts that require little thought and mean nothing.


I won’t ever celebrate Psychic Day, as I don’t believe in psychics. I’d like to celebrate National Psychotherapy Day, because I very much believe in psychotherapy. I wish I could feel more enthusiastic about how psychotherapists relate to sexuality. If only I had psychic powers…

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