There are many reasons it’s hard to talk about sex. It can be uncomfortable, awkward, embarrassing, and most of us were not taught how to talk about sex effectively. In fact, many of us were taught explicitly to not talk about sex, let alone with people you are not having sex with. Most people do not communicate effectively about sexuality even when it is important to do so. So, is it okay to talk about sex in the therapy room?
Short answer: YES!
Therapy is a personal, intimate, confidential space where you delve deep into topics that your provider legally cannot share outside of session, unless your safety or the safety of others is at risk of being compromised. Therapy is meant to be a nonjudgmental space where you can talk about things you might not feel comfortable discussing with others in your life.
Typically in the first session, a therapist will gather basic information about you and ask you detailed questions about why you’ve come into therapy or what’s bothering you. They will likely ask about suicidality, drug and alcohol intake, relationship status, and medications.
These are all pretty intimate questions and require some sort of vulnerable and honest answer. So why wouldn’t therapy be a space to discuss your relationship with physical intimacy, especially if that’s something that’s important for you to explore?
Sex is referenced constantly in society and is a big factor in relationships. It’s the reason we all exist on this planet. For many people, it is an incredibly important part of their lives. Dr. Emily Nagoski, famous sex researcher and psychologist states,
“Orgasm is more about what’s going on in between your ears than what’s going on in between your legs.”
What is therapy if not a place to talk about what’s going on in between your ears?
It is very likely your therapist is experienced and comfortable with talking about a wide range of private topics. If your therapist sends a message that sex is not okay to talk about in session, then it’s possible they might be missing out on a huge part of your experience. Additionally, there are a variety of mental health concerns that may overlap with sexual impacts such as:
- Trauma and impacts on one’s relationship with intimacy, especially if the trauma is related to sexual assault/abuse/rape
- Eating disorders/body dysmorphia/self image/gender dysphoria and how this might impact using parts of your body in a sexual context
- Psychiatric medications, such as antidepressants, and the side effects these can have on sexual libido/desire
- Bipolar disorder and hypersexuality or sexually risky behaviors
- Anxiety and depressive mood disorders and how this may conflict with experiencing sexual pleasure and relaxation
When I meet with a client, I will usually bring up physical intimacy and ask about the client’s relationship with sex in the first couple of sessions (even if that means the response is there is no relationship with sex). I will ask about this topic even to only signal and let the client know we can discuss physical intimacy at any time in therapy if desired.
In general, therapy can have many benefits, including improving communication skills around difficult and vulnerable emotions that people have trouble putting into words. Therefore, therapy is a great place to start finding wording for effective ways to talk about sex with others. Effective sexual communication can have a range of positive outcomes such as more satisfying relationships, positive sexual health, and well-being over the life span.
Research shows that individuals are often open to or would like to talk about a range of sexuality and intimacy concerns with mental health clinicians. So what should you be looking for in a therapist if you want to discuss your sexual life in session?
If talking about sex is important to your mental health, be on the lookout for therapists who identify as being one of any of the following: sex positive, AASECT (American Association of Sexualilty Educators, Counselors, and Therapists) certified, experienced with couples’ counseling, poly/kink friendly, or LGBTQIA+ affirming.
Therapists with a sex positive approach essentially have/promote an open, tolerant, or progressive attitude towards sex and sexuality. Essentially, they believe everything you want to do sexually is A-OK and good as long as it’s consensual. Yes, this includes Kink and BDSM play, partner(s) you choose, and how you express/present your gender.
Sex positive views all consensual sexual activity as fundamentally healthy and pleasurable. This attitude approaches sexuality as a source of wellness, inclusivity, and joy. Having a sex-positive stance can even strengthen the therapeutic relationship between therapist and client.
Ultimately, being sex positive means respecting each of our unique sexual profiles, even as we acknowledge that some of us (women, trans and gender diverse people, LGBTQIA+ people, POC, disabled folx, people of size, etc.) have been damaged by a culture that tries to eradicate sexual differences and possibility.
A Final Note: What’s NOT Ok:
As important as it is to talk about sex in therapy, please note non-consensual sexual activity of any kind, including between you and your therapist, is inappropriate and unethical. As such, there is a difference between talking about your own sexual relationship and feelings about it vs. making sexual advances or comments towards/about your therapist.
It is also not appropriate to share explicit images/videos of a sexual nature with your therapist. The therapeutic relationship is a professional, boundaried ethical relationship that should never ever have a sexual nature. If you are having sexual feelings towards your therapist, this doesn’t mean you cannot bring up this concern, but be mindful to do it in a way to talk about the feelings that are coming up without engaging in behaviors that act on those feelings.
