Introduction
Why should psychotherapists be interested in sexuality?
Authored by Henry Strick van Linschoten
There are a number of reasons for psychotherapists and counsellors to take an interest in and become knowledgeable about sexuality, and its relevance to their practice.
Three major reasons can be distinguished:
1. Sexuality is an integral and important part of human beings and the human person. It plays a major role in many emotions. Sexual development is an integral part of personal development, and of fundamental importance in the development of the self. It is an ongoing part of bodily functioning and plays a role in the mind-body interaction. It is at least as much of the mind as of the body. Is a significant element in health and well-being, by most standards. Sexuality is an important potential or actual element in almost all relationships and forms of relating. The neurobiological counterpart and manifestation of sexuality are mainly hormones. And the hormones in question are always there – they don’t suddenly disappear when you are not consciously experiencing sexual feelings, arousal or desire.
2. Sexuality, aspects of sexual functioning, gender identity and awareness, and desire, can become problematic. Although psychotherapists are not always the best specialist or professional to deal with such problems, sometimes they are. And knowing when to work with something and when to refer is one of the topics in this module. Professional psychotherapists and counsellors have often been embarrassed to speak about or deal with sexuality and gender, and most training programmes continue to maintain that situation.
3. As a third matter, less completely to do with the client as a whole, there is the virtually inevitable presence of sexual or erotic feelings in a client, in the therapist, and hence in the therapeutic relationship. Since Freud it is seen as important for the therapy taking place that the therapist is aware of this, does not get anxious or severely triggered by these feelings and states, can process them positively and helpfully, and will use them as part of the therapy as and when appropriate and in a professional manner. There are pitfalls on this path, but overall it is bound to be better to be conscious of what is happening in this respect, rather than suppressing it. Working with erotic counter-transference can be a powerful way of bringing the client back to life and relationship. If the therapist supresses or denies erotic feelings or does not take them to supervision, then clients may be re-traumatised and abused.
Sexuality in psychotherapy and counselling
There is sometimes confusion about other possible or imagined ways in which sexuality could play a role or be considered. It is rare, and is unethical, to try to use psychotherapy to attempt to change a person’s sexual identity or orientation, or preference for certain sexual practices or ways of expression. In addition, it is highly unlikely to be successful. Dealing with identifiable sexual “problems” or “disorders” should rarely be a focus of psychotherapy in the sense of trying to fix or remove the problems. Especially in the sexual field, it is far more often the case that the focus is on normalising the activity, behaviour and / or feelings, and explaining or demonstrating to a client that they do not need to change, but adapt to and work with who and how they are. The ideal approach is non-pathologising, and integrated with the whole person. Issues of non-consensual actions, or urges, are about consent more than centrally or only about sexuality. Working with this involves improving self-control, regulating feelings, and managing urges, impulses and compulsion – all these have more general dimensions than only or mainly sexuality.
If a client-defined problem is sexual in some rather narrow way, somewhat independent of the whole person, it becomes more likely that it would be better dealt with by a more focused specialist, i.e. a sex therapist or sexological body worker with dedicated training, or of course a medical specialist – depending on the issue. Recognising such situations, and swiftly and positively facilitating an effective referral, are in such cases the only correct approach.
What is sexuality about?
– Pleasure
– Impacting an existing relationship or relationships, or leading to desired forms of emotional intimacy
– Using it to obtain other benefits, e.g. financial, commercial, power-related or directly political
– Reproduction
Definitions
The WHO (2006) developed two working definitions in 2006, which are much used, and which are amongst the better-known international conceptualisations of these important terms:
“Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.”
“Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”
References
WHO World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health 28–31 January 2002, Geneva [Technical report]. Retrieved from World Health Organization website: https://www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf