Being a Psychosexual Therapist, or Sex Therapist is less scandalous than the title would indicate. In the way that I see it, it’s the art of having open conversations and solving challenges around sex. The reasons that people attend psychosexual therapy are as varied as we all are individual; and really it’s about anything to do with sex that is troubling that person or couple.
In a social context, having the word sex in your job title, no doubt raises eyebrows and often either invites much interest, or a bid to get away from you as fast as possible. The reality being because it is somewhat hidden, no doubt a part of the behind-closed-doors approach to sex that has been so historically dominant, which now comes up to clash with the over-sexualised images and open discussions about sex which have burst into our society as a more acceptable topic recently. ( There have always been people having conversations like this, just not in such an open fashion ).
So the gap it leaves is the expectation vs reality. I wrote about this in a previous Volonté blog post, because the problems that people so often experience around sex, are so often exacerbated by how they feel about it. So often this is about perspective and how that person or persons, feel that they measure up to others around them, or to the ‘norm’. This dynamic creates a feeling of shame or embarrassment around sex, sexual functioning or sexual problems. And the place that shame thrives, is in silence. In therapy we tackle that head-on, creating a safe and boundaried space within which we can explore the role that sexuality has in someone’s life.
This typically starts by taking a detailed history take, painting the picture of what life so far has looked like for that person. The way I often describe this is that it is like me doing a jigsaw, each piece makes the picture a little clearer and I can understand where some of the pieces also don’t fit.
I trained in a Homeodynamic Model of Sexual Health (Cabby Laffy 2013) which is “an integrative view of human sexuality and relationships that encompasses the social and cultural environment, as well as the physical, mental and emotional”. We aim to understand the person as a whole, not just the challenge they are presenting with. So often what we don’t think about immediately with sexual difficulties, is that the messages that may be impacting that person, aren’t necessarily rooted in sex. Sex is a vulnerable space and a very intimate one, and what can happen is that it intensifies feelings that we already have. For example, if we have difficulty trusting people, we may hold ourselves at more of a distance; afraid to get close to someone for fear of them hurting us or breaking our trust. Getting close to a partner sexually, might feel emotionally risky, we feel unable to relax and let go. To relinquish control, even for that moment can be experienced as too much, and as a result we go back to the place of self-protection and stay in our comfort zone. In an example such as the above, if the feeling is intense enough, that person may experience sexual dysfunction such as vaginismus or erectile dysfunction. In a way, the body says what the voice can not. I often look to understand the function of the dysfunction, and together we explore how can this problem be explained in other terms. Obviously the above vignette is hugely over-simplified, and every case is different, individual, and context dependent; but so much of Psychosexual Therapy is explorative, gaining awareness, and understanding. We aim to work together to create a personal and personalised sexual education.
These are the conversations that take place between the walls of a therapy room. There is of course variation, the inclusion of at-home exercises for some people to do, helping them to connect to their bodies in a different way. Learning to be mindful and in the moment, and to hopefully gain some form of sexual rehabilitation and functioning. There is also the social aspect. I invite those I work with to welcome the topic of sex into their lives in different ways. To listen to podcasts, watch Ted Talks, to read articles and books. When our perspective is fixed or stuck around sex, listening to what others have to say can be enlightening. It encourages us to challenge and to consider our own views. The goal is to get people to a place of sexual health, happiness and wellbeing, whatever that looks like for them. There is no one size fits all approach to sex and sexuality, it is just finding which size works for you.
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