When and how do you bring up sex with your clients in therapy?

Jeff Guenther on Jun 02, 2019

This week I started thinking about when exactly I bring up sex with my new clients in therapy. I was reflecting on it because I talked with Julie Jeske, LPC, a sex and relationship counselor on my podcast, “Say More About That.” Julie and I talk about how she became a sex therapist, how therapists can be better at talking about sex, how therapists can check their sexual bias and what clients should know about sex therapy. You can listen on Apple Podcasts, Spotify or by clicking play below. It’s a really fun conversation.

In the episode, Julie talked about how early she brings up sex when she talks to new clients. She basically brings it up in some form when she first meets them. How she brings it up and the language she uses differs from client to client. But it makes sense that she starts with sex because her clients are typically seeking her out for help with sex. I, on the other hand, don’t specialize in treating sexual issues. However sex is a common topic in my counseling sessions. Although, I will admit that there are some clients I have never talked about sex with. Is that because it really doesn’t need to be talked about? Maybe. Is it because I would feel uncomfortable bringing it up with them? Possibly. Should I have brought it up sooner in our relationship? Probably.

When should you bring up sex?

Let’s say you are not a sex therapist. You’re just a regular old generalist therapist like me and you see adults for individual and relationship counseling. If a new individual came in to see you so they could talk about anxiety, would you ask them about how satisfied they are in their sexual life? My first thought would be no. Why would I bring up sex if they came in to focus on anxiety? And if they haven’t even brought up dating or being in a relationship, then why would I focus on anything sexual? Especially if I am just starting to establish a trusting relationship with them. If I ask about their sex life, then that could force them into talking about something that’s a little too vulnerable.

However, when I am conducting an intake session and I am gathering basic info about them, I ask clients about their drug and alcohol intake. I ask them if they take any medications. I ask them if they are in a relationship or dating anyone. I then go on to ask them detailed questions about why they came in and what’s bothering them. All of those questions are pretty intimate and require some sort of vulnerable and honest answer. So why not include a question about sex?

Historically, I haven’t talked about sex because I thought it would be too awkward of a question to ask. I didn’t want the client to feel uncomfortable. But the more I reflect on it, I think I didn’t ask the question because I personally would feel uncomfortable. I’m not exactly sure what I would feel weird about. Right now I am trying to figure out what would make me feel awkward and I can’t really come up with anything specific. I just think I’d feel nervous. I can’t name exactly where that nervousness is coming from. I have a feeling it comes from the messages I pick up from society that tells us not to bring up sex with people we’ve just met. Our culture says that sex is a taboo subject and you should only bring it up with people you’re close to or in a relationship with. And while that might be an appropriate guideline for strangers you meet in the world, is it the same for new clients in therapy? I don’t think there is a “right” answer to that question. It depends on tons of variables. But unless I am picking up on strong vibes from a new client that they don’t want to talk about sex, I’m going to bring it up in my first meeting with clients. If only to send the message that it’s totally normal to talk about sex in here.

How should you bring up sex?

That all leads to the next obvious question: how should you bring up sex and what exactly should you say? In the podcast episode with Julie, I asked her specifically what words she uses when she wants to get clarification from a client when they bring up sex. I asked if she uses the word “intercourse” or something else like, “penis in vagina sex” to get even more specific about what they are talking about. She said that instead of defining the sexual act for them, she asks them to be really specific about what they mean. She talked about how the client sometimes just tosses that question aside by saying, “you know what I mean,” but Julie doesn’t let them avoid it and gently asks them again to describe the sexual act they are referencing. The way she talks about sex with clients is really interesting. She says a lot more about it in the episode.

The way I have been starting to bring it up in my intakes is just sliding it in between other typical questions I ask. After I ask them if they are seeing anyone, the next question I’ll ask is, “How satisfied are you in your sex life?” I don’t ask the question any differently than I might ask, “Are you living with any roommates?” I ask it casually and directly. And I accept whatever answer is given. If they are guarded, I don’t pry. If they are thrown off, I might talk about how weird it is that I am that forward, but I don’t judge them for it. Doing this makes it a lot easier to bring up sex later on if it seems like we need to talk more about it.

But what about those clients I didn’t initially ask about their sex life? If I want to bring it up with them, how could I do it without it feeling abrupt and awkward? For those clients, I have decided to bring it up at the start of a new session. Before we have a chance to really get into what’s going on with them that week, I’ll say something like, “Hey, I realized earlier this week that we haven’t ever talked about sex in here. I don’t want you to get the impression that it’s not an okay thing to talk about in therapy. I feel comfortable talking about sex and I want you to feel fine about it too. I am not bringing this up right now because something has caused me to think that we really need to dive into it. I just want to mention it so that you know you could talk about anything with me and that if I brought it up all of a sudden it wouldn’t feel so jarring.”

This approach usually goes over well with clients and can sometimes lead to new and insightful conversations with them. For more ideas, listen to this week’s episode of “Say More About That.” Like I said at the start of this article, there is no one right way to bring up sex in session. All that matters is that you are creating a safe space for your clients to talk about whatever is on their minds. How you do that is up to you!

Are you a sex positive therapist?

Swoon” co-host Gina Senarighi defines being a sex positive professional as someone who doesn’t have judgment about the client’s sexuality, no matter what the fantasy, and will support the client’s exploration as long as it is based in consent. Ideally, all therapists are, or are striving to be, sex positive therapists. I run TherapyDen.com and it is 100% evident that clients are searching and filtering for therapists that are sex positive. If you’re sex positive, please consider signing up for a listing. You’ll get your first six months free and you can cancel any time. And you’ll also feel great about signing up with a therapist directory that is inclusive and progressive.

And don’t forget to listen to this week’s episode of “Say More About That” with Julie Jeske. The podcast had it’s best week ever last week with our episode about when therapists should use self-disclosure in session. If you want me to focus on a specific topic in future episodes just shoot me an email at hello@therapyden.com. Thanks for listening!

Jeff Guenther, LPC, is a therapist in Portland, OR. He has been in private practice since 2005. Jeff is the creator and owner of Portland Therapy Center, a highly ranked therapist directory. Jeff, and his team, have launched a new progressive therapist directory, TherapyDen.

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