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Your clients don’t have sexual dysfunctions? ....Why you should wonder why they don’t

by Greg Kilpatrick, LMFT, MSMFT, CST

This odd thing happened to my clients upon my return from my first weekend sex therapy

intensive training in 2017. They all developed sexual issues over just that short three days! At least that’s what it might appear like from the outside.

It’s an interesting thing: Why did all of my clients who had up until that point only been struggling with anxiety, depression, and adjustment issues suddenly find themselves with erectile problems, orgasmic problems, pelvic pain, questions about porn, sexual compulsivity, gender, and sexual orientation? Either I am the worst therapist alive, or my clients were finally sharing with me problems that had always been at play but what they had only recently felt safe to share.

It might be motivated by the preservation of my own ego; however, I tend to believe the reason that the majority of my clients “developed” sexual issues was because of the former! They either did not think to bring them up or they were afraid that they would be shamed when they did. Or maybe worse, as their therapist, maybe they feared I wouldn’t be able to hold the tender information they were about to share with me. And why would they? Most therapists will only have received one class in human sexuality in the course of their training. If you are one of these therapists, you are in good company.

Sometimes the continuing education of the therapist is more of an education of the soul (or the emotional body), more than it is an education of the mind. I think for many of us, the “education of the mind” was the primary focus of our graduate school training (I know that I can say this was the case for me). However, as the reflective writer, Henri Nouwen asks us, “Can you drink the cup?” Can you hold what your client is sharing with you in a way that is not only validating but encouraging? Can you get excited for your client as they are entering into a relationship or if they are working toward a sexual experience that is out-of-step with your interests or values? Let’s be honest. This is hard for many of us.

What we’re talking about here isn’t compassion or sympathy or empathy. We’re talking about something different. Compersion. We are talking about feeling joy for another, even as they may be feeling joy from something that we cannot imagine finding joy in, or may even disgust us! This is the education of the emotional body that sexological training can help us achieve. As we listen to the stories of dissimilar others with a curious and affirming ear, we can begin to learn of their experience, drawing us into the process of their joy in addition to the content.

We’re often told that we need to be more deeply in the process as a therapist. Curiosity and exposure can help us step out of the parts of content that can distract us from connection. Can you sit with your client in a way that you can hear all parts of their story with open ears and a soft heart?

Not to neglect the cognitive and procedural side of working with clients on sexual challenges, there are many things that a lot of therapists miss prior to referring a client to me. And once again, this isn’t their fault. The average therapist has simply not received adequate training in sex and sexuality. Something important to pay attention to when working with clients with sexual issues lies around order of operations. How do we enter into the work?

There are a number of factors that come into play in terms of what root causes of different challenges. Trauma, grief, depression, and anxiety are all huge contributors. As we might imagine. But how thoroughly were we trained to think about our client’s physical bodies?

When a client comes in with erectile dysfunction, for instance, it would be fair to think that anxiety may be a contributing factor. However, it would be unwise to not think about the client’s body also. What if the erectile problems are actually a manifestation of a physical heart problem? What if the client is experiencing low testosterone? Both of these biological factors often contribute to a problem like ED. In these instances, best-case scenario you and your client are unable to get a handle on the erectile issue. Worst case, your client may experience further medical complications. I’ll often say “If a penis-haver is experiencing erectile problems and they have low testosterone; you can do therapy ‘til the cows come home and that penis is not going to get any more rigid”.

And this is just one example of why we need to be thoughtful of the bodies our clients inhabit. And that means often bringing in specialists of the body including medical doctors and physical therapists.

Most therapists never will get the training needed to hold and help grow our clients’ sexual selves. But our clients need us to. If you’ve never gotten this training, it makes sense that you haven’t! Very few of us have. However, just a few adjustments to how you practice and a further deepening of your capacity to hold your clients’ stories, loves and erotic joys will make all the difference in your work. And if you start doing this work of professional and self-growth, don’t be surprised if you walk in one Monday morning to find that all of your clients have developed sexual issues. It’s a sign that you are on the right path.

If you are interested in getting this training, you can learn more here: and here:

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