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Let’s Talk about Sex (In Therapy) Baby! by Kristin Ritchey, MEd




As a mental health therapist, I feel privileged that clients trust me with navigating challenging, often painful experiences that they might not share with others. So, imagine my surprise when a client asks “can I talk about…. Sex… in here?” in a hushed tone. My answer is always an enthusiastic YES! 


Sexuality comprises a significant piece of overall well-being and pleasure that can impact symptoms of mental health concerns, so it’s extremely relevant in the therapeutic relationship. I find seeking support for sexual concerns to be especially powerful, as it assists clients in increasing pleasure in their life rather than reducing suffering. 


Today’s society sees sex as taboo, however, it represents a basic human need like eating or sleeping. But when individuals hesitate to discuss sex and related topics with even their inner circle, how to bring it up in therapy? Will my therapist judge me? And what kinds of things are relevant? Here’s a brief overview of common questions I hear from friends and clients: 


How do I even bring it up? How awkward! 


If you’re confident and have a strong relationship with your therapist, dive right in! It’s okay to acknowledge your comfort level as well. Consider something like “I feel awkward even saying this out loud, but I’ve been thinking a lot about insert sexual concern* lately”. 


Sometimes, receiving reassurance and validation that your concerns will be honored can be important. It’s also ok to ask “Would it be ok to talk about sex in here?” if you worry about shocking your therapist. (Spoiler alert: we are a tough crowd to shock). 


Therapists are trained in supporting you through sexual and relationship concerns (as well as assisting you in tolerating uncomfortable emotions that arise when talking about sex!) 


Will my therapist judge me if I have .. less traditional… sexual interests? 


If they are a good therapist, nope! Bring on the kink, bring on the things you might feel shame about (especially since shame is a particularly unhelpful emotion). Many times, clients hem and haw over sharing or naming a sexual interest, experience, or even abuse due to internalized shame. However, when they finally share, it’s usually much less shocking, shameful, or “dirty” than they think. Personally, I feel proud of a client's courage and grateful for their trust when they disclose a deeply held shameful experience or belief.

For additional peace of mind, Psychology Today offers providers the option to indicate that they are Kink Friendly, Queer Friendly, among other communities. Filter along these options as you’re looking for a provider to help find the best fit. 


What kinds of sexual concerns tend to come up during therapy? 


Probably too many to list in this blog, but here’s some common issues clients tackle around sex: ● Sexual assault/ abuse 

● Anxiety around sex 

● Body image concerns 

● Porn addiction 

● Low libido or inability to achieve orgasm 

● Distressingly high libido or uncontrollable urges 

● Sexual identity 

● Unwanted sexual thoughts/ fetishes 

● Overall, a lot of questions about “is this normal?” or “there must be something wrong with me” related to nearly any topic you can think of 


Remember: therapy is YOUR space to discuss what feels the most helpful for you. You decide the “right” topics to talk about, not your therapist. 

Ok but what does a therapist actually DO when someone has a sex problem? 


The short but unsatisfying answer is, it depends. Typically, therapists use similar approaches and modalities as they would with any other problem brought into the space. For example, PTSD-like treatment for survivors of sexual assault, CBT for sex anxiety, etc. What sex therapists DON'T do is have sex with clients, watch clients have sex, take their clothes off, etc. (If your therapist in any way indicates that this is normal RUN and report them to your state’s board immediately). 


Sex is a normal part of the human experience that can be joyful, pleasurable, and provide positive benefits for mental and emotional health, so don’t hesitate to bring it up with your therapist. You deserve compassion, support, and encouragement with all aspects of your life, so take a deep breath and …. Let’s talk about sex, baby, in therapy!


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