“Sexuality affects every aspect of our identity, and everything affects our sexuality.”
Definition: Sexual health, from the perspective of the Health Psychologist, encompasses a range of social-cultural and personal health concerns. According to the World Health Organization (2010), sexual health includes family planning, sexually acquired infections (formally called STD – or, sexually transmitted disease), female genital mutilation, and sex/relationship education. The Health Psychologist must demonstrate professional competency in each.
Working In Sexual Health
Clinicians working in Health Psychology and Behavioural Medicine are tasked with providing education and counselling to clients grappling with sexual identity/orientation, psychological trauma caused by sexual exploitation, physical trauma resulting from cultural practices (female genital mutilation) , while prioritizing sexual health and wellness from a harm reduction perspective. This important niche is not informed by personal judgments and/or moral opinion regarding identity and/or behaviour.
Why Sexual Health Matters
Competency in sexual health matters because it is the topic that few want to talk about. Clinicians must have clear insight about personal bias and reactions regarding sexual behaviour. It is easy to do harm in an area perceived as difficult to navigate. Moreover, because sexuality has such a wide influence on our biopsychosocial selves, purpose driven conversations often reveal challenges in other areas. If you ignore one, you are in essence, ignoring them all.
Do No Harm
Clinicians must be prepared to address individual concerns of sexual health and human sexuality. It is an easy area to do harm if the clinician is not well prepared. While there are specialists working in the field, every mental health professional must have a clear understanding of the complicated emotions associated with sexual health, while prioritizing harm reduction as the primary backdrop to care.
Avoiding Conversations On Morality
Sex education is not moral education. By making morality the primary focus concerning sexual behaviour, you quickly alienate the individual while instilling a profound sense of shame. For instance, if your client reveals that they have been participating in the sex trade industry to support substance misuse behaviour, you must prioritize health while creating a judgement free atmosphere. Harm reduction seeks to improve wellness through prevention.
To be clear, providing condoms to clients in your office might go against your own moral position. However, your number one priority must honour health related outcomes (such STI prevention). If a clinician cannot put their own moral values aside, then this is an area to absolutely avoid. Finally, be transparent with your client about your own bias. Refer your client to a specialist.
Shifting Beliefs Of Acceptable Expression
Personal morality is often tested by shifting cultural standards towards sexuality. In this case, we are not talking about the perceived permissiveness regarding the sex trade industry, to be specific. What some call permissiveness, we call reducing harm by prioritizing health. The topic of shifting cultural standards relates to the degree of acceptance by society for changes in the definition of sexual expression.
For example, the polyamorous movement has been given a significant voice by the LGBT activist, Dan Savage. Dan argues that monogamy is not natural, while stating that society is finally starting to accept a need to change older definitions of what it means to, ‘couple’. In fact, he argues that his own marriage is both open, and has been thriving for more than a decade.
You Might Not Agree – That’s Okay!
Not everyone agrees with such activists. However, be aware of your own potential for misinformation (or the lack of). For instance, people incorrectly assume that polyamory is largely an LGBT movement. You might be surprised to know that, millennials, regardless of sexual orientation, are participating in this wider definition of coupling compared to previous generations.
What does this mean for the Health Psychologist? If you want to work in sexual health, you must have a clear understanding of trends. Assuming that any deviation from the norm is only seen in subcultures (LGBT), is grotesquely misinformed. You must also know your own biasses and challenge them. While you might not agree with Dan Savage, do not allow activism to taint your understanding of population behaviour statistics.
What Is Not Included
It is important to know where we draw the line regarding sexual behaviour. Being an open-minded therapist while attempting to create a judgement free zone of care, does not mean providing permission for behaviour that harms another. While this is a complicated conversation in and of itself, and might even deserve its own article, it is critical to be clear about what is not permitted.
Specifically, any behaviour that harms another person, or is not consensual, requires clear communication and intervention on the part of the therapist. You must explicitly indicate during intake the limits of confidentiality in such cases. Any disclosure of sexual contact with children, or those that are unable to provide consent, must be reported. You are required to let every client know this limit to confidentiality up front. The harm associated with sexual exploitation is profound and requires absolute attention. While this type of disclosure is rare, it does happen – You must be prepared to handle the conversation and report it to authorities.
Sexual Health Therapy
One area of specialty is sex therapy. Couples engage in this type of counselling primarily in an effort to improve their relationship. Sex therapists are concerned with the physical and psychological health of their clients. It promotes healthy expression of sexuality, while engaging the principles of harm reduction and emotional connection between individuals.
Problems in sexual expression between couples is often the first sign of marital problems. Working with a therapist that specializes in this area is often helpful and might even save a relationship. Sexuality is important and its impact should never be minimized.
So, what happens in your sex therapy sessions?
- You build report with your therapist. Both individuals in the relationship must trust the therapist.
- You will explore the emotional issues regarding sexuality in your relationship. This might be shame, self-esteem, etc.
- Your therapist will cover health related considerations, such as disease prevention. For instance, if your partner has Hep-C, what are the measures you can take to prevent acquiring the infection?
- Your therapist might give you homework. Yup! Be prepared. It sometimes involves toys.
Sexual health and sexuality are in integral part of being human. Do not minimize the impact of sexuality for yourself, or the people you work with. Finally, it is important to understand the breadth of what it means to work as a Health Psychologist in sexual health and human sexuality. While the field is not for everyone, having a clear awareness of the topics covered in this article will engage your competency.