What Your Therapist Asks Me About Sex

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The general public doesn’t realize that most therapists and marriage counselors get practically no training in human sexuality. These days, it’s typically a few hours about sexual exploitation and violence, plus a few hours about gender and sexual orientation—that the human family contains more than men and women, and more than straights and gays.

In other words, your therapist may not know much about sexuality that’s relevant to three-quarters or more of their cases. And that may include you. In fact, your therapist may not know how to talk about sexuality much better than you do.

Some of these therapists attend my training webinars, and others consult me about their cases. I applaud these professionals who enhance their knowledge and effectiveness. Their questions are often examples of the sexual myths that they need to challenge, so I often discuss them instead of answering them. Then I suggest alternative, more helpful questions.

Here are some examples of questions therapists ask me–and how I change the questions before answering them.

* “How do I increase someone’s sexual desire?”

Say I invite you to eat with me at Antonio’s Café. And say you expect to have an overpriced, poorly cooked meal there, served by an unfriendly waiter, while you sit in an uncomfortable chair. If you said “Oh, I’d rather not,” I wouldn’t say you have a problem. I’d say you have good sense. And if I knew that’s what you expected when you said no, I wouldn’t take your refusal personally, even if I myself expected a fine dining experience at Antonio’s.

There are lots of good reasons that people don’t desire sex: it hurts; it’s boring; it goes on for too long; there’s little emotional connection; they’re tired or unhappy or unwell; they need more privacy than is available; they don’t like the way their partner touches them; they know their partner will want to do something they don’t; they’re afraid they won’t get hard, or get wet, or orgasm; they expect to be criticized afterwards.

When someone who expects an unpleasant or unenjoyable sexual experience has low desire, that isn’t a pathology—it’s good sense. So when working with anyone who isn’t as interested in sex as they want to be, they should be asked why. Therapists (and physicians, too) often forget to ask.

There are plenty of psychological reasons that people don’t want sex (or don’t want it in a committed relationship) which are problematic. These include past trauma, poor body image, fear of inadequacy, fear of closeness, fear of unintentionally disclosing a secret, fear of becoming sexually ravenous, guilt and shame about sexual preferences or orientation.

I treat patients like this every single week. When a new patient approaches me with low desire, though, first I inquire about all the good reasons they might be unenthusiastic before talking about the problematic ones.

* “Is X sexual fantasy normal? How can I tell?

A patient reveals their sexual fantasy of x, or y, or z (or sometimes, all three). Is it normal?

Whether it’s asked by the therapist, the patient, or the patient’s partner, this is the wrong question.

When asked by a patient, the right response is for the therapist to ask them “How do you feel about this fantasy?” If the answer is “fine,” the next question is “Why are we discussing this?” If the answer involves guilt, shame, confusion, anxiety, or fear, the therapist should ask lots more questions, mostly about the patient’s relationship to the fantasy—does he or she think it has meaning? Predictive value? Does the patient feel he or she ought to be able to stop having this fantasy? Is he or she afraid that their fantasies will become more extreme?

And how does the patient imagine the therapist now feels about him or her? There’s something two people can discuss quite intimately and helpfully.

Is the patient concerned that he or she is, unfortunately, going to enact this fantasy despite their best judgement? Note that this is different from “I’d love to, but of course not,” or “It’s great in my fantasy, but no way would I do this in real life.”

That covers the fantasies of the majority of people.

So the issue is not about the content of the fantasy, and therefore we don’t have to assess its “normality.” What therapists need to do is take a deep breath and evaluate their own relationship to fantasy, remembering that every—repeat every—aspect of human life is, somewhere by someone, transformed into fantasy with sexual power.

Once in a blue moon we see a patient who relishes their fantasy of hurting someone to the point that they seem intent on doing it. We’re mandated to report that to the authorities. We’re not reporting their fantasy, an action which is prohibited by our obligation of confidentiality. Rather, we’d be reporting our concern that they seem intent on harming someone.

The range of human sexual fantasy is extraordinarily wide, and typically does NOT predict behavior. Of course, people don’t discuss their fantasies much. So just because someone has a fantasy that neither they nor their therapist have come across doesn’t mean it’s actually unusual.

Remember, fantasies don’t have “meaning,” any more than our choice of movies or music has “meaning” beyond simple personal preference. What kind of a person enjoys Game of Thrones, or Lady Gaga, or college basketball? Apparently, almost everyone.

* “Is polyamory or open relationships a good idea?”

When most individuals or couples first have the bright idea to “go poly,” or do consensual non-monogamy, they generally don’t have enough information, and often have unrealistic expectations.

They typically imagine lots of sex with highly motivated, energized partners, while their own partner looks on beaming with approval—or is so involved with several other partners that they’re beaming across town.

Non-monogamy actually involves way more conversation than most people imagine—setting it up, negotiating specific situations, and periodically processing things. Frequently processing things.

So when therapists or patients about me about non-monogamy, I ask what their expectations are. How much they enjoy talking about relationships and feelings, and negotiating boundaries and logistics. If they have a current partner, how much they’ve discussed this with them; why they want this change (and why now); and if they’ve told their partner pretty much all the relevant facts about their own sexuality.

Therapists ask me how non-monogamy typically works out. I tell them it generally works out as well as monogamous relationships do—which is to say, sometimes.

And no, poly isn’t simply one person telling the other “I’m going to sleep with Jose every other Friday. You’re now free to sleep with whomever you like.” That doesn’t get a fancy name, and it isn’t a new sexual orientation. It’s simply a selfish power grab, an upmarket form of infidelity.

* “How do I help a woman have orgasms?”

Instead of this eternal question, we should be asking many, many others. With any given woman, does she want orgasms, or she being pressured by a partner? Are there sexual issues more important to her (like sex is painful, or she does it when she doesn’t want to)?

From what activities is she expecting an orgasm? For most women, the clitoris (not the vagina) is the primary sexual organ. Something going in and out of the vagina will typically miss the clitoris by a country mile, so while some women can climax from intercourse, no woman should expect to.

After how much stimulation does she expect to climax? Particularly if her partner orgasms within minutes, she may feel pressure to do the same, and inept when she doesn’t. That simply may not be realistic.

Does she masturbate? Many therapists hesitate to say the word, much less to raise the question. If a woman climaxes from masturbation but not with a partner, we know that her plumbing works, and we can assume that either she’s not getting the physical stimulation she enjoys, or she has an emotionally sensible reason for not orgasming with a partner.

And finally, what does she expect from the experience of orgasm? If she’s concerned that she’ll wet the bed, howl at the moon, disclose state secrets, or be more vulnerable than she’s comfortable with, she may unconsciously prevent herself from climaxing.

Therapists who check all these (and more) possibilities will find that they can help a lot more women who are frustrated about their difficulty climaxing.
If you enjoyed this, check out my video quickies at youtube.com/c/drmartyklein1

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