Integrating Conversations About Sex and Sexuality into Your Practice

Size: px

Start display at page:

Download "Integrating Conversations About Sex and Sexuality into Your Practice"

Alfred Newton
5 years ago
Views:

1 Integrating Conversations About Sex and Sexuality into Your Practice TERA JANSEN, PSY.D. P O S T D O C T O R A L F E L L O W P R O G R A M I N H U M A N S E X U A L I T Y U N I V E R S I T Y O F M I N N E S O T A J A N S U M N. E D U

2 Purpose, Caveats, and Disclaimers Purpose- How to talk about sex and sexuality within a generalist setting and things to keep in mind. Disclaimers & Caveats: This is not a guide as to how to treat sexual disorders. If you are not a specialist, please refer if you believe a client is struggling with a significant sexual disorder or issue with sexual functioning. Research will be addressed, but much of this is anecdotal. Much research in the field of sexual health is limited to cisgender, Caucasian, heterosexual individuals. Please keep this in mind. I m going to talk about sex today. Use your internal reactions to measure personal beliefs about sex and sexuality. Ask questions!

3 Terms for Clarification Sexuality Cisgender Normative Just because something may be normative does not necessarily mean that it is legal.

4 The Normative Curve

5 Some Assumptions about Human Sexuality It s fluid rather than linear or binary It is positively and significantly correlated with overall life satisfaction It evolves over the lifespan There are significant gender differences It is historically and culturally relative It s complicated.

Kinsey Scale - 1948 Rating Description 0 Exclusively heterosexual 1 Predominantly heterosexual, only incidentally homosexual 2 Predominantly heterosexual, but more than incidentally homosexual 3

6 Kinsey Scale Rating Description 0 Exclusively heterosexual 1 Predominantly heterosexual, only incidentally homosexual 2 Predominantly heterosexual, but more than incidentally homosexual 3 Equally heterosexual and homosexual 4 Predominantly homosexual, but more than incidentally heterosexual 5 Predominantly homosexual, only incidentally heterosexual 6 Exclusively homosexual X No socio-sexual contacts or reactions

7 Some Assumptions about Human Sexuality It s fluid rather than linear or binary It is positively and significantly correlated with overall life satisfaction It evolves over the lifespan There are significant gender differences It is historically and culturally relative It s complicated. Healthy Sexuality is very hard to define.

8 Sexy Time!! Tips for addressing issues of sex and sexuality in session.

9 Know the basics! You should have better sexual education than you did in eighth grade. Great Resource: The Guide to Getting it On by Paul Joannides

10 Just ask already! If you re weird about it, they ll be weird about it. (i.e. Fake it til you make it.)

11 Never assume. Make questions about sex and sexuality a regular part of your intake process. Clients are unlikely to bring up sexual issues otherwise* *This is especially true in couples therapy

12 Ask open ended questions Any history of sexual problems? garners a very different response than: What improvements would you like to see in your sexual life?

13 Ask about online sexual behaviors.

14 Ask about sexual education Especially if you re working with adolescents* *Can be a slippery slope at times.

15 Figure out your sexual biases and morals. What you are into and not into does not matter.

16 Figure out how you feel about pornography and understand what is normative regarding pornography use. Because of the accessibility of pornography it is a common theme of conflict between couples and parents and children, as well as a source of concern for a number of people Check out: A Billion Wicked Thoughts By Ogi Ogas & Sai Gaddam

17 Limited understanding of what is and is not sexually normative can lead to over-pathologizing. ( Normal sexual behavior/thinking is historically and culturally relative) Check out: Perv: The Sexual Deviant in all of Us By Jesse Bering

18 For Example..

19 BDSM Includes sensation and power play 5-10% of the US population engages in sadomasochism for sexual pleasure on at least an occasional basis, with most incidents being either mild or stage activities involving no real pain or violence. (Reinisch & Beasley 1991) 36% of U.S. adults use masks, blindfolds, and bondage tools during sex. 30%-60% of women reported fantasies of being dominated, spanked or whipped, tied up, and forced to have sex (Joyal, Cossette & LaPierre, 2015). 50 Shades of Grey sold 45 million copies in the U.S. and over 100 million worldwide

20 Sex and Shame are Besties Reducing shame around sexual behavior, interests, attractions is a common therapeutic goal which is why: Your judgments matter.

21 So.Have a good poker face. Most people have very little practice talking about sex and it likely takes a great deal of courage to bring up sexual concerns.

22 Just because someone fantasizes about it doesn t mean they re going to do it or even want to.

23 Don t forget about gender. There is significant research out there on sex and gender differences Resources: A Billion Wicked Thoughts By: Ogi Ogas & Sai Gaddam Come as You Are By: Emily Nagoski, Ph.D.

24 Sex & Gender Difference Women s sexual satisfaction has been found to be more contextually based, while men s sexual satisfaction has been found to be more grounded in the physical aspects of sex Women are much more likely than men to report a decrease in sexual desire due to physical illness, hunger, or anxiety about physical security. Indeed, the male sexual brain is just the opposite: heightened physical threats- such as impending warfaretend to enhance male desire (Ogas & Gaddam, 2011, p. 75).

25 Sex & Gender Difference o Women tend to associate sex with more emotional intimacy and are more likely to engage in sexual behaviors with the purpose of creating a stronger emotional bond. o Male sexuality appears to be more cued to novelty and, in that males are more likely to desire new and novel sexual experiences.

26 Sex and Gender Difference Female vs. Male arousal Males tend to be more focused on physical cues while women tend to focus more on environmental, emotional, and psychological cues. Vaginal photoplethysmography- measures blood flow to vagina during arousal. physiological arousal vs. psychological arousal in women Physical cues are not good indictors of female psychological arousal (Chivers, 2005) Social influences on male & female sexual development The sexual education of boys vs. girls

27 The greatest hurdle to sexual harmony is ignorance of the fact that members of the other sex (and other sexual orientations) are fundamentally different from ourselves ( Ogas & Gaddam, 2011, p.240).

28 All that being said, remember: Within group difference is almost always greater than between group difference

29 Consider both the independent and holistic nature of sexual concerns, particularly within the context of a relationship. Sexual concerns in a couple do not necessarily indicate deeper relational issues or cannot necessarily be treated by solely addressing overall relational concerns. Check Out: Mating in Captivity: Unlocking Erotic Intelligence By Esther Perel

30 Be aware of where a person is at in their development Speaking with children and adolescents about issues of sexuality looks different than with adults.

31 Older adults can still really enjoy sex and are sexual people, as are individuals with physical and intellectual disabilities. Articles to check out: Sexuality and Disability: The Missing Discourse of Pleasure (Tepper, 2000) The S Words: Sexuality, Sensuality, Sexual Expression and People with Intellectual Disability (Gomez, 2012)

32 Sex after Children Children can have a great impact on parents sexual functioning, satisfaction, etc.

33 Heterosexual monogamy is not the only game in town.

Familiarize Yourself with the Following: Alternative relationship

bisexual, pansexual, queer, heteroflexible, homoflexible, demisexual,

34 Familiarize Yourself with the Following: Alternative relationship structures Open Relationships Polyamory Swinging The difference between sexual orientation and gender identity. Terms for sexual and romantic orientations: Gay, straight, lesbian, bisexual, pansexual, queer, heteroflexible, homoflexible, demisexual, bi-curious, heterocurious, asexual, Ace, questioning, etc Always check out what these terms might mean to your client.

35 Sex should be fun! If it s not that s meaningful.

36 When to Refer It is your ethical obligation to refer individuals who may be presenting with issues that are outside the scope of your competency. Just because it is interesting to you or seems like a great learning experience or a good challenge does not mean that it will be a great experience for the client. Sexual Health is a highly specialized field, if the sexual concerns are the primary diagnosis or appear to drive the treatment goals, this is likely a good indication that it is time to refer.

37 When to Refer Some issues are very complex and are typically recommended to be referred to specialists: Sexual pain Erectile dysfunction/pe Gender transition Open or poly relationships Sexual Offending (always) Compulsive sexual behavior Referring out to a specialty does not necessarily mean you will no longer be able to work with that client, it may be a case that you are coordinating care with a specialist but are still the primary provider. This may not be the case in all scenarios Need to be aware of over-lapping care Failure to appropriately refer can lead to adverse consequences for clients.

38 38 Final Reminder: It is your job to make it okay to talk about sexual health issues in session. You can create that environment by talking about sex and sexuality in a clear, assertive, and confident manner (even if you don t feel that way).

39 If you want to learn more: Check out new research, rather than old. Sexology is a relatively new field of study and it s ever-evolving.

40 Great local resource for sexual education and pleasure: The Smitten Kitten 3010 LYNDALE AVE S. MINNEAPOLIS, MN

Sexual Intelligence: A New View of Sexual Function & Satisfaction

Sexual Intelligence: A New View of Sexual Function & Satisfaction Marty Klein, Ph.D Entrepreneurs Organization February 23, 2017 What do most people say they want from sex? 1) Pleasure 2) Closeness But