You have another minute. Write down as many names as you can think of for male genitalia.

​

After two minutes of exciting brainstorming, I required participants to yell out some of the names.

​

As I laughed and processed with the large group, we discussed the differences in the themes of male versus female genitalia names, as well as the cultural differences in how we describe

genitals based on region, religion and race.

Finally, I asked the psychologists how they felt saying the names aloud.

​

I explained that if we are unable to match our client’s language, at least initially when they describe their sexual concerns with us, we risk rupturing the relationship before we have had a

chance to establish rapport. Since sex is such an intimate topic, strong rapport is essential.

​

However, many psychologists never even get to the point of talking about sexual concerns with clients because they do not ask. The first step in sex therapy is to ask your clients about sex.

​

If you are interested in seeing clients with sexual concerns, there are two easy questions to help you broach the topic. If you’re uninterested in doing sex therapy, these questions are still important because they can facilitate the normalization of sex and your appropriate referral process.

​

The questions are: How has your sex life been affected by (insert their stated presenting concern)? Are there any sexual concerns you would like to discuss?

​

Most clients have at least one sexual concern, but psychologists and other health professionals often hesitate or avoid asking about sex because of personal discomfort, perceived/ assumed client discomfort or assuming there is no con- nection to the presenting problem.

​

Here’s the takeaway: Clients actually want us to initiate the discussion.

​

Once you initiate the discussion and the client shares a sexual issue, your training determines the next steps. Many psychology programs do not require a sex-therapy course, so few of us have the training to do sex therapy because it is so specialized. If you haven’t completed any continuing education, you may want to simultaneously enroll in an in-person or online training and seek consultation if you choose to see clients for sex therapy.

​

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) offers certification for sex therapists already licensed in a mental health field. You can practice sex therapy without the certification, but you may still choose to attend the conferences and trainings to strengthen your skills. (See more about getting certified at aasect.org/aasect-requirements-sex-therapist-certification.)

​

If you have completed some training in sex therapy, you have a number of options

to treat sexual concerns. Among them, Sensate Focus integrated with Teyber

and McClure’s Interpersonal Process Therapy is my preferred orientation.

​

I ground this work in an intersectional framework, meaning I consider the client’s privileged and marginalized identities in conceptualizing and intervening in the sexual lives. Because certain identities have associated sexual stereotypes, this framework is an important way to tailor treatment.

​

Detailing the process of Sensate Focus is outside the scope of an article of this length, but I briefly identify the steps that you can read more about in “Sensate Focus in Sex Therapy” by Linda Weiner, MSW, LCSW, and Constance Avery-Clark, Ph.D. 

​

I like their process because it is intentional, pragmatic, structured, evidence-based and it allows you to integrate homework and cultural considerations in the parts where you discuss the relationship. It incorporates elements of mindfulness as well.

​

Sensate Focus Sex Therapy has seven elements, six steps and five foci that inform the 14 weeks of work for the Sensate Focus 1 process.

​

The seven elements are:

* Mutual responsibility between partners for addressing sexual needs and concerns;

* Information and education about sexual function and sexual activity;

* Willingness to change attitudes about sex;

* Getting rid of sexual performance anxiety;

* Helping couples improve communication around sex and sexual techniques;

* Reducing problematic behaviors and sex roles in the relationship; and

* Homework to help couples change their sexual relationship for the better.

​

The six steps are: non-genital touching; genital touching; mutual touching; genital contact without insertion; genital contact with insertion; and lying next to each other.

​

These steps are self-focused, rather than partner-focused, to remove the pressure of providing pleasure.

​

Lastly, in order to redirect attention from pleasure pressure, the five foci are temperature, pressure, texture, natural distractions and correcting judgments and emotions. The first three are for the client to focus on during the at-home work. The latter two are for the therapist and client/clients to discuss during the therapy session.

​

Other forms of sex therapy may incorporate some of these elements, but this has been the most comprehensive modality I’ve found. Sex therapy is a necessary, but underrepresented, niche in psychology. There is ample opportunity for psychol- ogists to obtain training and specialize in an area that affects the well-being of our clients, and the first step is to simply ask clients how their sex lives are going during intake. In this way, we begin to normalize talking

about sex as another part of our health.