How To Know When To Discuss Sex With Clients

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How To Know When To Discuss Sex With Your Clients

This is a question I wrestled with for a number of years. Both in my private practice, as well as agency work. When is it okay to talk with your clients about sex? It took up sizeable amounts of time and thought in my mind.  It didn’t often come up in my agency work, but it did in private practice.

Are There Agency Guidelines?

If you do agency work, there are probably guidelines about when you can talk with clients about sexual issues. Whether you work with children and adolescents, there are probably some strict guidelines about this so as to avoid liability with this population.  Whatever the case, you first should seek out some guidance. Seek advice from your higher ups to be sure you don’t expose the agency to potential legal issues. I’m not an advocate of avoiding conversations about sexuality, but also try to be sure to keep overarching considerations at the forefront of my mind.

What About With Private Practice Clients?

This will largely be determined by your :

  1. Training
  2. Comfort level
  3. Particular clients you are working with

I tended to defer discussions about sexuality with clients until I had some training under my belt. One of the typical responses I would give clients when they had sexual complaints was to tell them “I don’t do sex counseling’. I would suggest that if they had particular concerns about sexuality that I didn’t feel qualified to field (which was most of them) that I could refer them out to someone who could.  Once I did get some training on sexuality and sexual health issues, I could tell them otherwise.

Training Helps

I got some training in sex counseling and sexual health matters. This made me feel much more capable of at least fostering discussions in session with clients who had these issues.  I would tell them that although I wasn’t a ‘sex therapist,’ I was fine with them talking about whatever they needed to in the area of sexuality. This helped qualify my credentials so they didn’t think I was holding myself out there as an ‘expert’. They did however feel they could bring these topics up for us to discuss.  That really has helped to foster what are called ‘sexual health discussions’ (which I will address in a later post) with my clients that can help them gain clarity on particular issues with sexuality they may be struggling with.

Clients That May Trigger Your Issues

If your particular client is one that may be triggering for you in some way, it may be best to defer discussions on sexuality to another time or another clinician for sex counseling.  I say this because to discuss sexuality with your clients you need to be able to be objective and non-judgmental. When you can’t maintain objectivity and suspend your judgments about your clients, letting them know this is not in your scope of practice (in this case) is the best thing.  If you are able to get effective consultation with respect to certain clients, then you may be able to discuss sexuality; but you are always best served to refer out or to let clients know that these issues are not ones you are qualified to counsel them on. Again, effective consultation from a certified sex therapist (CST) is the best way to sift out these cases from the ones that aren’t.  It can also help you figure out how to deal with these clients in a way that isn’t shaming or off-putting.

Where To Start With Training Options

There are a number of organizations and books to seek out to help. This could get you started in being able to help your clients in talking about sex in therapy.  One of the best books on the topic I have read is What Every Mental Health Professional Needs To Know About Sex by Stephanie Beuhler, PhD.  There are several professional organizations that provide trainings on sexuality as well:

  • American Association of Sex Educators, Counselors, and Therapists (AASECT)
  • Society for the Advancement of Sexual Health (SASH)

I encourage all therapist and counselors to at least get some training in sexuality. Mental health tends to touch on sexual issues at some point in people’s lives. Sexuality is important to overall health and wellness for most or all people.  

Scott Kampschaefer, LCSW is a private practice therapist in Austin, Texas.  He has an extensive background in working with depression, anxiety, and bipolar disorder at a clinic for older adults with these disorders in Austin.  He now works with adults and adolescents of all ages in private practice. Find out more about Scott here: