Addressing Sexual Shame in Therapeutic Settings
Because sexuality is considered taboo by many cultures, clients are often denied the experience of openly and honestly discussing sexual health within social networks, which may contribute to feelings of reluctance and discomfort in initiating sexual discussion in therapy. A client entering into counseling for the first time may not feel like sexuality is appropriate or relevant to their reasons for seeking counseling, so the counselor is responsible for conveying that sex and intimacy are significant facets of overall health and wellness (Sellers, 2017). The PLISSIT model (Permission, Limited Information, Specific Suggestions, and Intensive Therapy; Annon, 1976) details the importance of giving clients explicit permission to discuss sexuality in counseling, which can begin as early as the informed consent and continue throughout the counseling relationship. Clients facing sexual shame can benefit from the assurance and normalization provided by a trusted professional that their sexual concerns are a valid and meaningful aspect of their lives.
Upon normalizing sexual discussion and establishing rapport with clients, counselors may gain more information related to the client’s current level of sexual health through formal and informal assessment. In addition to basic intake questions related to sexual and affectional identity, gender identity, and partnership status, the counselor may also include open-ended questions related to sexual wellness, such as: 1) How would you describe your current level of sexual or intimacy satisfaction? 2) What barriers do you face in experiencing healthy and pleasurable sexual intimacy? 3) What changes might you like to see is this area?
Because clients may come from religious or cultural backgrounds that discourage the open discussion of sex, counselors should strive to develop a strong therapeutic rapport and may convey sensitivity by framing questions as voluntary and directly related to the client’s mental health. If the client indicates some distress related to sexual wellness, the counselor may explore the issue in more depth by incorporating questions geared to assess the role of culture and religion, family upbringing, relationship history, and previous sexual trauma in the client’s sexual health concerns. From this discussion, the counselor acquires a more illustrative conceptualization of the impact of sexual shame on the client’s presenting concerns. An additional structured assessment such as The Kyle Inventory of Sexual Shame (KISS; Kyle, 2013) may be useful in tracking changes in perceptions of sexual shame throughout the course of therapy.
While most clients can experience positive therapeutic outcomes by simply being accepted as sexual beings, some clients may require additional therapeutic interventions to recover from sexual shame (Annon, 1976). Counselors may provide clients additional information related to the presenting sexual issue, such as resources related to healing from religious sexual shame (Sellers, 2017) or sexual abuse (Maltz, 2012). This may also include providing clients with medically accurate information about their bodies, safer sex practices, variations in sexual activities, or other aspects related to intimacy enhancement. Many clients may experience relief from sexual shame by accessing increased information about sexuality, which can address the knowledge gaps incurred from prior sex education deficits and sexual stigmatization.
Table of Contents
- Introduction
- Sexual Shame
- Factors That Influence Sexual Shame
- Deconstructing Sexual Shame in Counseling
- Developing a Sex-Affirming Counseling Framework
- Common Issues Related to Sexual Shame
- Addressing Sexual Shame in Therapeutic Settings
- Specific Strategies to Enhance Sexual Empowerment
- Referral to Specialists
- Attending to Countertransference
- Conclusion
- References