How to talk about sex in couples counseling?

If you provide marriage counseling or couples counseling you probably have discussed sex during a session. Maybe your client brought the topic up as an issue in their relationship, or you asked if there are any problems with intimacy.

As a therapist, there is no way to escape the topic of sex and intimacy. Sex is a significant issue that leads people to begin couples therapy. In relationship counseling and marriage therapy, there is always something to learn about sex and intimacy.

Even though I have a doctorate in clinical sexology and am a certified sex therapist, I continue to attend training so that I can provide the best therapy for couples in sex counseling. Your goal may not be to specialize in sex therapy, but you can benefit from the following tips about how to talk about sex in couples counseling.

It’s okay to feel uncomfortable in the beginning

As a couples therapist, you have experience with clients discussing their issues with communication, trust, parenting, family, work, and stress. If you find yourself avoiding asking about any complications with sex, then you are normal. It can feel uncomfortable and maybe even intrusive when you haven’t had experience in sex counseling.

It is normal to feel awkward or even shy about bringing up the topic. However, when you do, you permit your clients to talk about sex openly. Tell the couple that it is okay to feel uncomfortable discussing sex in therapy and that you are providing a nonjudgmental space to talk. When you normalize this discussion, it can help the couple feel more comfortable.

Remember that for many clients, sex is a taboo topic that they may not commonly talk about even within their relationship.

Ask if both individuals are open to the discussion

One partner may want to talk about their unhappiness with the lack of sex in the relationship. The other partner may not want to discuss sex in the session.

As the clinician, it is your role to validate that you heard the first partner and their desire to discuss the lack of sex. However, you need to check in with the other partner and ensure they are open to discussing the topic.

For example, “Would it be okay with you to discuss your partner’s feelings about sex during this session?” You are giving the client the opportunity to enter the conversation or end it. Don’t pressure a partner to discuss the topic if they aren’t ready.

Here are a few tips on what to do and not do when discussing sex in couples counseling.

Do’s

• Be aware of your nonverbal communication. For example, your client tells you they have an open relationship, and you raise your eyebrow. Your client may feel that you are judging them. This may cause them to shut down.
• Normalize that it can be difficult for clients to discuss sex issues in counseling.
• Become familiar with your state licensing board ethics and rules about sex therapy. For example, in the state of Florida, a licensed clinician can’t provide sex therapy unless they are a certified sex therapist.
• Attend training, workshops, and seek supervision to feel more comfortable discussing sex when counseling couples.

Don’t

• Judge your client for what they tell you. If one partner tells you during the session that they want to explore an open relationship, don’t give them your opinion on the topic. Your opinion about open relationships shouldn’t affect the couples exploration of the issue.
• Work with a couple in sex therapy without being trained in this area. Don’t assume that you can provide the best care for a couple who is struggling with sex issues if you don’t have clinical experience. Many clinicians advertise that they offer sex therapy or sex counseling without being trained or having clinical experience. This can be very dangerous and do more harm than good for the couple in need of help.
• Share your personal sexual experiences with the couple to connect with them or assist them. Doing this crosses many ethical lines and can cause boundary issues.
• Feel that you have to answer every question the couple has about sex and intimacy. Give yourself permission to not have to know everything in the clinical setting. You can look for the answer after the session and follow up with the couple. You can also seek supervision from a certified sex therapist who can help you improve your clinical skills. For example, if you want to suggest a few couples games to increase intimacy, you can follow up after the session with an email to the client.

Your comfort, confidence, and competence in discussing sex issues with your couples can have a significant impact on the counseling experience. Creating a nonjudgmental space for your clients to share their concerns and find answers needs to be your goal as a clinician.

Remember to let the couple set the pace for the discussion. Also, validate the couple’s concerns and reassure them that you are there to help. Even if talking about sex is difficult in your personal life, know that you can still be a competent clinician that helps couples solve their intimacy issues.

Dr. Kristie Overstreet is a clinical sexologist, certified sex therapist, licensed professional clinical counselor, author, speaker, and consultant. She holds a Ph.D. in Clinical Sexology, Master of Arts in Professional Counseling, and a Bachelor of Science in Biology. She is a licensed counselor in California, Florida, Georgia, and Louisiana. She is also a Certified Sex Therapist and Certified Addiction Professional. She has over 12 years of clinical experience specializing in sex therapy, transgender healthcare, relationships, and helping counselors build their private practice. She is president of Therapy Department, a private practice that provides counseling, training, speaking, and consulting services across the United States.  For more information about Dr. Kristie's work visit www.KristieOverstreet.com.