Learning to Talk About Sex in Therapy and Counselling

Sex represents more than the physical act. It can represent intimacy, connection and desire. A loss of sex in long term relationships can therefore mean a lot more to a client than just the loss of the sex itself.

Sex is therefore something that commonly comes up in counselling. As counsellors, we must know how to talk about sex when in the therapy room, but first we must ask what sex means to us?

If we don’t talk about sex in our private lives, then how can we effectively talk about sex with our clients? Start by addressing some of the following questions…

  • Who knew the most about sex in your family? And who knew the least?
  • What was said openly about sex and intimacy? What was implied but not said?
  • What were the rules around gender roles for men and women?
  • Who talked about sex and who didn’t?
  • How much understanding was there of different sexualities?
  • Where did your family members get their sexual information?
  • As a therapist when you speak and listen with clients about sex, what can be most challenging for you?

In considering how we think about sex, we can see how clients might approach sex in different ways and be open to what they may or may not want to bring to sessions.

Changes in relationships, changes in sex

Relationships change over time, but how these changes affect both partners can depend on many different factors.

Changes can be seen as a loss of the initial excitement, or as a gain of something new. But in relationships where sex is lost, that loss can translate into a loss of desirability which can be key component in self confidence both in and out of the relationship.

Attachment styles and sex

Understanding what attachment style we are can help us understand what sex means to us.

Attachment styles can play a significant role in the purpose of sex for an individual.

  • Avoidant Attachment – Those with avoidant attachment may be unable form long-term bonds and so be unable to sustain a relationship once the initial glow of ‘love’ has faded. Those with avoidant attachment may also seek sex for different reasons – rather than as an act of intimacy, they might see sex as a pleasurable release of tension without emotional connection.
  • Anxious Attachment – Those who are classed as anxiously attached will see sex very differently and may use it as a way to feel connected to their partner. For them a reduction in the frequency of sex might be interpreted as a lack of interest from their partner. Sex can therefore be an act of reassurance.
  • Secure Attachment – Sex for those who are securely attached will be a meeting of mutual minds in an act of connection and will help to form a secure base on which the relationship is built. Sex is therefore synchronous – between two people who know where they stand.

No matter what your attachment style, it’s important to recognise that relationships change over time, as we change as people over time, but that the changes might not necessarily be negative, even if they do bring a decreased frequency to our intimate lives.

Causes of low sexual desire

Low sexual desire can be caused by a huge range of factors from individual factors such as:

  • Low self esteem
  • Previous negative sexual experience
  • Insecure attachment patterns
  • Body image
  • Familial / societal myths around sex and pleasure inducing guilt

What kind of messages does your culture portray about sex? It serves as a backdrop to our understanding, and induce guilt or shame in sexual thoughts and acts.

Yet sex is an act between two or more people and it is important to also consider that there can be issues between a couple which induce low sexual desire too such as:

  • The sex they have isn’t worth having
  • The loss of idealised passion from the early days of the relationship
  • A muddling between sex and affection in which pressure can be placed on one or both parties to provide more than the act itself
  • Fear of closeness
  • Punishment of a partner by withholding sexual contact
  • Rivals for their lovers attention in the form of children, pets, porn, family etc.

Yet sometimes the thing holding us back can be much more wider reaching:

  • Shame stemming from religious or cultural messages
  • Intergenerational messages and unconscious scripts that we have internalised throughout our lives

Exploring low sexual desire in therapy

With so many reasons for our sex lives to dwindle its easy to see why this is an issue which affects so many couples. Yet, even in therapy, a space specifically designed to allow us to explore all of our thoughts and feelings, it very rarely comes up.

So how do we broach sex in the therapy room?

It is important for us to have first explored our own sexuality so that it’s a topic we feel comfortable discussing. We can then help the client to explore what is it that’s going on.

Questions we might explore could be…

  • What is sex for them? Procreation? Fun? Exploration?
  • What each partner feels blocks the desire for sex for them?
  • What would a good sex life look like?
  • What positives are there within your relationship which could be expanded upon to help break down the barriers they’ve built around sex?

Allow for sexploration

When working either with couples or individuals who are experiencing a reduced sex life with their partner the most important thing is to be open and able to facilitate exploration.

If we can model a healthy relationship to sex in which we are able to talk openly about desire, emotional and physical needs then we will be setting the client up with the tools to explore and repair their relationships resulting in their (and their partners) needs being met in a healthy and satisfying way.

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  1. Katrina Redpath on 17 August 2018 at 10:23 pm

    Hi very interested ….I completed my masters dissertation in what themes emerge when therapists discuss sex in the therapeutic relationship
    I ran two focus groups with six therapists in each group willing to share more ideas and systemic integrative therapy themes

  2. Charlotte on 20 August 2018 at 10:27 am

    This is interesting and I would like to find out more. Can you give recommendations for further reading please

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