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“So I get people that are terrified about their relationship, or they’re sent to me by another clinician who has then recognized. Oh, this is well outside of my training, which I am so grateful that clinicians do realize that. So when you get to that space of where it’s beyond kind of general questions, when you are hearing about maybe physical impact of the relationship, whether it’s painful, and that is really impacting the client every day and or every other day are very significant. One, we need to refer that client to the doctor to take you back to their court, which okay, we all know how to do that. But then, hey tell me you’re talking more about the relationship specifically. And if you’re like, why don’t you I don’t know vaginismus misses like pain during sex, then it’s time to send that person on over.” – Sarah Watson

Welcome to the colleague down the hall podcast. This episode is sponsored by the collab Oasis clinical consultation groups. Hi, I’m Jeanene Wolfe, and I’m your colleague down the hall. I have a passion for helping fellow therapists get the clinical and collegial support, we all need to do this work. And wow, it just keeps getting harder every day. I’m the founder and facilitator of the collaborative aces clinical consultation groups. I have been a social worker for almost 30 years and I own a successful solo online private practice, more of us than ever are practicing and solo or online practices. And we all need colleagues to process cases with commiserate with on those really hard days and also to celebrate our successes with in this podcast, I’ll bring you insights about trends and changes in our field and sit down with amazing therapists who are doing amazing work will discuss fictionalized cases, way to practice sustainably and of course, there will be plenty of laughing I love laughing with friends. I’m so glad to have you as one of my colleagues down the hall.

Hello, everyone, you are listening to another episode of The colleague down the hall podcast. I’m your host Jeanene Wolfe joined today by Sarah Watson. Sarah is an LPC and a sex certified sex therapist in Michigan. Today, we’re going to chat about how sex shows up in our sessions and how to navigate the subject as clinicians. Welcome, Sarah.

Thanks for having me. I’m happy to be here. Yeah, happy

to have you here, too. So you did a presentation at a summit that I was at, which was really fun and amazing. And one of the things that I hope to accomplish with this podcast is to help clinicians understand areas where our training didn’t quite get us far enough for the things that show up in the therapy room. And we’re sitting there with the client going, Oh, my goodness, I don’t know how to react to this thing you’re talking about with sex that I don’t know how I feel personally or even know enough about, about what you’re discussing. So it can be stressful for therapist.

So stressful. I think, you know, in that particular conversation, I opened up my talk with the story about when it first happened to me. And my client at the time, and I was a baby therapist, right was she was coming to me this client was coming to me and talking about how she liked more aggressive sex, sexual contact from her partner and was just concerned that she wasn’t normal. And she was terrified. Like, I don’t know why I like this, what do I do? And I’m like, you know, I didn’t, I didn’t Oh out loud, but I would I probably a little bit of a deer in headlights. And then I kind of took a breath and kind of met her where she was. But that was the first moment that kind of led me on to my journey to becoming a sex therapist, and just going like, wow,

I I don’t know anything about this. And I was, you know, we were taught in my graduate course, just about development, but not about sexual health and relationships and pleasure and how that how that can come into the room for us. Yeah, absolutely. And as a therapist, like I think we should be telling baby therapist, you’re talking about sex a lot. So you better figure out how to be comfortable with that because I had no idea how often it would come up. I feel grateful that clients have because I haven’t done anything and we’re going to talk about this I’m sure but I haven’t done anything to really let them know that this is an okay subject I don’t bring it up in my intake but I feel grateful that they have felt safe enough with me that they have brought it up. Yeah, but then we also are seeing as our world is becoming more open and a lot of ways that people are more comfortable discussing different types of sexual preferences and things like that. And there’s a lot of dial lingo out there and terminology and it can be can be a lot not just the basics.

Yes, it is so much and I’m I learn every day like I’m always learning new terms or new things and and how to do that. So I think one of the things I would encourage clients to do is put it on your intake. If you’re working on your own, and you have control over what your intake paperwork looks like, yeah, on there, like there’s so

so tell us specifically what you would put on the intake,

I would go. First I asked about relationship, like, who’s your favorite partner? Who’s your partner? How long have you been together? I have a rate your relationship between one to 10. I love that. Which is always really interesting, because then I go through it. And I was like, so you rated your relationship as six, like, let’s talk about that. And then you can put in that space to like, whether it’s right underneath, or not, like how would you rate or describe your sexual relationship with your partner? That’s it just a little, you’re just kind of opening the door just a smidge, like, Hey, we’re gonna talk about your whole life, not just your anxiety?

Absolutely. Yeah. And you know, we all learn pretty quickly that clients don’t necessarily come in with what they’ve told you. The issue is really benign, and then they hit you with the big stuff. And I have definitely learned the poker face over the years, just like literally people can say anything to me. And inside that might be crunchy. But I’m like, Okay, well, let’s talk about

that. Mm hmm. Yeah. Or what does that mean for you? If it’s something that you don’t know? Right, if it’s a terminology, yes. issue to me, like, tell me more about that. Right. Like, just be curious. Absolutely. And yes, absolutely.

Yeah. And that’s in general, with our work being curious as the best thing. Because we we’re not there to give the answers. We don’t know all the answers. And so it’s really, we need to understand where they’re coming from, because it’s easy to jump into something just like you do with kids. They ask this really benign question. And then you give them this whole Historical Dialogue that they’re just like, why, you know, so just you we need to learn from them.

Yeah, absolutely. And yeah, I think definitely the case, right, you’re gonna get all of these big stories, and you’re not going to be prepared. And just to take a deep breath and be like, Okay, here I am. And you can just answer the question or just, again, approach with curiosity and tell me, you know, the classic line, tell me more about that, or what does it mean to you? How is that impacting arrow?

Right? Yeah, that’s great. Yeah, and I guess it’s a fine line between wanting our clients to educate us about things versus needing to kind of own up like, that’s not something really familiar with, can you share a little bit more about that with me?

Yes. So that’s generally it does client and I see some people seek out sex therapy, because they’re on the internet late in the evening, sometimes in the middle of the night, and researching about relationship therapy, and that comes up because of the way I tag my website. And so I get people that are like, Oh, terrified about their relationship, or they’re sent to me by another clinician, who has then recognize, oh, this is well outside of my training, which I am so grateful that clinicians do realize that so when you get to that space of where it’s beyond kind of general questions, when you are hearing about maybe physical impact of the relationship, whether it’s painful, and that is really impacting the client every day and or every other day, or very significantly. One, we need to refer that client to the doctor right to talk to their court, which okay, we all know how to do that. Right? But then it’s Hey, tell me you’re talking more about the relationship specifically. And if you’re like, why don’t you I don’t know, vaginal missus, like pain during sex, then it’s time to send that person on over. Or if it’s an issue with if there’s any kind of ejaculation issue. We don’t want to take what is known in pop culture in our society and apply that which listen, I’m assuming established clinicians that I because I listen to the podcast so far, like established clinicians, but we don’t want to be like, Okay, well, you just need to like, relax, because I can’t tell you how many clients that’s helpful. Right, like so I have anxiety when someone’s like, telling me to relax during a panic attack. I want to sit out hurt them deeply. Yes. Yeah. Right. So like, it’s not relaxing, telling someone like, okay, let’s use your, your breathing techniques about you know, how to reduce your anxiety, or your pain in that moment, that’s not going to be helpful because you don’t know what the root causes. Right? So if you can get to that space and do a deep dive in sexual history and sexual knowledge for the client, then it’s time to send them on their way to someone like me where I can do that, and I’m very comfortable doing so

good. Yeah. So do you typically, if I’m working with a client, and I’ve identified like, they need more than what I can provide, so I send them to a sex therapist, like when I refer someone maybe specifically for EMDR. I might continue working with that client, the EMDR therapist works with them, and then we you know, we kind of both do our own thing as long as the client needs that, but then they still are my client is that sort of the way it works with a sex therapist,

you really depends on the client, I let the client leave that as and I would say, Look, I’m not going to see you on the same day, let’s not do that. Well, I only do that if they’re a couples therapy, and I see the individual and if they want to do like a whole therapy day, and that works for them. Cool. But I really leave that up to the client, because I’m going to also talk about, because everything else in your life impacts your sexual desire, curiosity, drive pleasure. So we’re not going to just be talking about sex, we’re going to talk about your kids, we’re going to talk about your level of stress, we’re going to talk about your education. So I informed my clients in the beginning, that’s what I do. And it’s really up to you, if you want to keep seeing your other clinician, and some people do, right. And they just like, hey, yeah, I’ve, I’ve been with that person a really long time. And maybe I’ll just check in with them monthly. And then if we resolve whatever sexual health issues are going on, and they might just float on back or, or just me, I’m with therapy for now. So yeah, it’s client.

Yeah. And that’s a good point. Because I typically if I’m sending someone from like, EMDR, I’m like, we can keep working together. But if you love that other person, and they were really meeting your needs, you can absolutely stay with them. Because you know, clients feel guilty about hurting people’s feelings and stuff like that. So that’s an important thing to discuss as well,

for sure. But if it’s like, yeah, if someone’s been seeing someone for 10 years, because I have a lot of long term clients to wear because sex changes throughout your lifespan drastically. So, you know, I’m like, I have you want to go see someone else for a while. Come back. I have like an open door policy. So yeah, yeah. As long as it’s available, right, like scheduling.

Yeah, absolutely. Okay. So, are there like, the top five things that people that show up in a lot of people, I’m sure developmental stage, you know, people in menopause? Like, I’m sure that there is, depending on the age of the person? For

sure. Yeah, I would say the top five things I’m just going to go to go off of my caseload currently is women that have pain with sex. I’ve seen a lot of women with painless sacks. And that is so frustrating for them. And so difficult and overwhelming problems with orgasm. We’ve been taught as a society, I think that orgasm is the end all be all. And while I enjoy an orgasm, it is not the end all be all right? Like there’s so much more to a sexual connection with someone rather than just an orgasm. So I see a lot of that I see a lot of clients that are just struggling relationships about 40, I would say probably right now, maybe even 50% of my caseload is couples. So it’s, oh, we haven’t had sex in five years. So we need to figure that out. And I have a lot of people that I’m trying to think what else is going on? Erectile issues. So either premature ejaculation or delayed ejaculation. So I see kind of both ends of the spectrum. Or my favorite is always one person coming in being like, my partner doesn’t want to have sex with me, or our sex life has drastically changed. And I don’t know why. And that’s why we’re here or why a person is here. So, so it’s physical issues, and then anxiety around sex or just relationship issues in general, and their sex life has just tanked. And you don’t know why. Like, oh, you’re fighting every day. Yeah, her foreigner probably doesn’t want to do things with you. So

you’re Yeah, yeah. Yeah, hot topics right now.


So I’m curious with the ejaculation issues. I imagined, sometimes it’s a medical cause. But sometimes there’s also, you know, a psychological issue going on.

Yeah. So the first thing I do, if I see a client that’s coming in for ejaculation is you have to go to the urologist. So we want to make sure that blood flow is going the way it should, and what is happening. So we do that first. And usually clients most of the time, come back and say, Oh, Doc says everything’s good. And I’m like, of course, that’s just fine. But we want to rule out any kind of medical issue and I’m going to do that with all of my clients across the board. And I have different OB gyns that I work with, and neurologists and primary care physicians that I’m okay, go see this person or this clinic specifically because they can get you in and they will take care of what’s going on. So then we come back and then I do a sex history, right? So then we’re gonna deep dive what’s going on and tell me in detail, which in the beginning of sessions, as we know, getting to know someone and if I’m on third session, they’re like, tell me about your your ejaculation issues. And I’m like, okay, and then I like to kindly remind them, hey, this is what I talk about all the time. And it kind of build that rapport, right, because it’s really embarrassing. For some people. We also talk about medication like what’s going on because there’s a lot of especially if there’s anxiety and depression, a lot of meds can impact that yeah, or for men hair. I don’t want to say this wrongly, but I’m not going to tell you the right way but like if they’re taking any medication for hair growth, okay. That is a huge side effect is erection issues and ejaculation issues.

Really? Okay. I think it’s something that I think we all need to know. Wow. Yeah.

So I was like, Okay, well, we need to look, can you go off of that medication and see what’s going on. And then I also talk about what’s going on when you wake up in the morning, right? Because most, most penis owners will wake up and have an erection. And if they’re having an erection in the morning, we know it’s that we’ve been to the doctor, this is happening. We know it’s not a functioning issue. It’s a what’s going on? How do you feel about your partner? What’s your level of stress? How do you feel about sex in general? You know, are you carrying around the old information you got as a child, you kind of using that subconsciously, for what you think sex should be like air quotes, kind of just go through all of that? Very, very slowly. So we are really peeling back all of the layers of, of thoughts and feelings? Sure,

sure. Okay. And I would imagine if someone’s coming to see a sex therapist, they at least have a slight idea that they’re going to be talking about sex, not that it makes it comfortable, but they’re not shocked when you start asking those questions. Yes,

no, they generally aren’t. But if it’s a referral from a urologist, or I see a lot of referrals from pelvic floor, physical therapists, okay? And so that is, that can be a little bit of a barrier, right? Because the pelvic floor PT is saying, hey, everything is looking good. Like physically, you have made progress, but this person still isn’t able, because the goal for that person was to have penetrative sex is not able to do so, or insert a tampon or what’s going on, but they’re like, hey, everything’s, you’re technically physically okay. So really depends on the background of the client. They know that sex talk is coming. But I’m like, I want to know as much detail as you want to tell me because that helps me figure everything out with you. Right? Yes, but some people are still like, shy and reserved. Sure.

So have you always been virtual?

No, I used to have. I used to have a lovely little office. And I loved it. Because it’s just me right now. I do have we just started a group practice. But we’re still both virtual. I used to have a little waiting room and I used to keep out lubrication and chocolate. Cool. My clients are like, you’re out a loop. Can you put somewhere Lou about them? Sure. No problem. But now virtual is just amazing. Because I can see clients, I think, as we all know, right? Like, I see clients that are like, Okay, I’m in my driveway, because my partner’s in there working. Or I’ve seen clients that are like, I’m in the closet because my purse. Okay, I’m like, where are you? So I’m really enjoy that. And I don’t know if I’ll have a standing office again. I don’t know. But I love it.

Yeah, yeah, I definitely I went virtual before the pandemic. And I had a cute little office too. And it was sad to leave. But there were really good reasons to do it. And virtual has been great. And what I experienced was that people were sharing trauma with me earlier, virtually than I think they would have in my office. And I’m wondering if you’re feeling that as well, being a sex therapist virtually allows people to have that level of comfort, so that they’re sharing sooner. Absolutely. Like you

said, people come to me because they know they’re gonna talk about sex. But it’s definitely we’re diving right in and people are going to, I’ve only had a few people that it’s been like a regular kind of in person process. But they get right into it because you’re comfortable. Like if they’re, you know, in their living room or in their bedroom, right? Like, as long as you’re dressed. I don’t care where you’re sitting, right? Like, you’re cool. You’re on your back patio, looking at, you know, whatever’s out there, your dog and your cat are with you to like that level of comfortability that is offered through virtual sessions, I think is so amazing. And people get right into the work or like, they’ll be like, oh, when they pull up their book, because I’m always like a hero that 17,000 resources in the beginning. And they’re like, on page 292. And I’ll pull my book down and they’ve got it. And it’s, it’s really fun to do that. And I still feel like I have really strong relationships and rapport with my clients, even though for sure.

Yeah, yeah, for sure. Yeah. Yeah. So I also would imagine that the comfort level of working with you, the age impacts that significantly because we know the younger generations are so much more comfortable and open about everything. And seniors not so much and and a lot of seniors are sort of content to say like, for whatever reason we’re not having sex anymore, and that’s just the way it is. Yeah, and which is sad.

Yeah, that it makes me really sad because they’re, you know, you can have sex until the day you die. There’s no reason that you can’t unless you have like some physical issues, right, obviously, but yeah, if you’re in good health, you can have sex until the day you die. So it makes me really sad when people say that but I do see I have a wide variety of clients. So I am very early 20s Up to people right currently like in their mid 60s, and I’ve had older just I just don’t have them currently right now. But I do love the ones that are like, okay, so on tick tock, I saw XYZ, what do you think about this? And I’d be like, Well, can you tell me more about that? Like, right? And I love it. So I think it’s great when they they’re very open and like, hey, what do you think about this? Or right? Tell me more about this type of relationship or, or this lubrication? Or these toys. Right, which, let’s talk about it.

Yeah, yeah. That’s so wonderful. Yeah, yeah. So for the average clinician, in addition to putting in the end of the intake, some questions to kind of open up the conversation, do you recommend periodically checking in about that, or if a client hasn’t talked about that at all, but maybe on the intake? There were some things that made you think that might come up? Like, do you recommend that they start exploring that or really leave that to the client? I know, it’s situational. And it’s hard? It’s a hard question to answer. But do you have any general thoughts about that?

Yeah, I think you should always be talking about it. I think I mean, not maybe not every session, because it’s not going to be appropriate every session. But especially if you’re talking if if this person has a lot of stress and anxiety, or depression, or whatever reason they’re coming to see you, that absolutely does impact their sexual relationship. And often we don’t tie Oh, if I’m really, really stressed at work, or if I have this big project due at the end of the month, and I haven’t wanted to have sex all month. People don’t tie that together. So you can just be like, hey, so how’s how’s your erotic connection? I use that a lot. Or just specifically, how is your sex life with your partner? Is it where you want it to be? And if they shut it down? Okay, that has nothing to do with you as a clinician, but we’ll come back to that in a couple weeks. Okay. So you know, last time I asked you, you weren’t really, you know, do want to talk about that a little bit more? What’s that like for you? And just keep, again, keep exploring for but i Yes, it should be on your radar with all of your clients in some capacity.

Yeah. Okay. And I also would imagine that you will get referrals from therapists who have a client that one of them wants to start exploring kink, or having an open relationship, or ethical non monogamy, those types of things. So those are the types of issues I would imagine that you work with as well.

Yes, yes. And that’s I think it’s so I work with most sexual health issues, I do not work with individuals who are attracted to minors, that’s just beyond my scope. I have a little one at home. And so I knew that that was best for me not to do that. But there are other wonderful clinicians that do especially in my area. But yeah, if it’s if we’re talking about kink, and BDSM, and giving education, and especially ethical non monogamy, there’s lots of rules. And there’s lots of books, and there’s lots of good things to read. But you really should talk all of that out. If you’re starting to explore if it’s like a new thing for you to know what your boundaries are, what you’re comfortable with. And then how do you talk to your partner about that? And I do a lot of that, right. A lot of therapy with my clients is educating unhealthy communication. So they Yeah, yeah, absolutely.

That’s been my experience. I don’t have a lot of clients that have wanted to explore alternative sexual experiences with their partner. But when it has come up, it’s always like, Well, have you talked to your partner about that? And have you done any research about because there’s so much information about things to consider before you jump into this areas that might be difficult that you wouldn’t have thought of? Because you’ve never done it before? That you need to be aware of? Like, what are some rules? Yeah, in the communication is so huge,

so big, I think a nice way into those conversations. If you’re someone who’s thinking about talking your partner about is like bringing up an yes, no, maybe list. It’s one of my favorite tools. It’s really so I love that, like so what are you absolutely open to sexually? what do you kind of like? Well, I’m be interested to hear more about that and kind of the take, you know, your partner’s take on that. And what do you absolutely not going to do? Right? And just be like, Hey, let’s do this together and make it a fun thing. Yeah, doesn’t have to be embarrassing, right? Because I find a lot of people actually don’t talk about sex with their partner. It’s just like, well, you’re human, you should be able to do that. Right? It’s complicated. It is so much more than that. So yes, yeah. So to talk about it in that capacity with like, okay, Friday Night Dinner, or you know, don’t have that conversation in the bedroom. Have it at the dining room table or in a cozy spot in your house with candles if you want.

Yeah, the my mind, the US know, maybe goes right to a vacation in Greece and the stick figures in the bathrooms were not allowed to happen. And I was like, wow, Isn’t those things were sticky? Maybe partners could do that. Figure? Yes, no, maybe?

Yes. Yeah, I’m gonna look for that. I’m sure that there’s a print of that on Etsy. I’m going to try to find out. Yeah. Love it. Yeah. Right. It’s such an easy thing to do with a partner, right? Like just to be like, hey, what do you think about? Or if you’re, like, bring out one thing? What’s one new thing? You want to try and see what they say?

Yeah, yeah. And it’s also making me think that when you’re working with younger clients who are in and I’m not talking about really young clients, but you know, clients who are of consenting age who were starting to have a relationship with a partner, really encouraging them from the get go like it, because if you start from the beginning, having really open communication, then you’re not going to reach that point where you really, really want to discuss something, but you’ve never discussed this type of thing with your partner before. And it feels excruciating to bring it up.

Absolutely. Yeah, you don’t want to leave and is kind of a cheesy thing to say. But you don’t want to leave things unsaid. Right. So even if you are, so maybe you’re not talking about it consistently, but I would say after you have any kind of intimate connection with your partner debrief about it, yeah, right. Maybe not that night, if it’s like later in the evening, and you’re all going you’re going to bed, but maybe the next morning, be like hey, I really liked it when you did XYZ. what was really enjoyable for you, and just all that’s a nice way to start that conversation. Okay, that’s great. Yeah, but even when you’re dating, like talking, what do you like? what are you interested in? How do you feel like, what seems like a normal amount for you to have sex each week, whatever is in I’m using sex in that big umbrella term. So it can be a lot of different things. And talk about that right away. Because if someone’s like, Oh, I’m fine with sex, like once a month, and the other person is like, well, I prefer four times a week. Right? Might not be a good match. Exactly. Right. And you don’t want to find that out. 10 years later, right?

Yes. And again, I gotta have to give it to the younger generations, they do that stuff, so Well, not that it was modeled for them at all.

No, that wasn’t there. Awesome. I love them.

Yeah, I mean, I just like think about the TV shows when I was growing up, where they had the twin beds and the, you know, the married couple twin beds, because you know, we’re not going to represent that and might be having sex in that room? Because that’s no, like, not a good topic there.

Yeah, absolutely. Well, yeah, the younger like they’re born with cell phones in their hands. Yes. Right. So you know, the stat right now, which not to scare you wonder what but like, kids are gonna see porn at the age of eight. If they have Yeah, a device. Okay, there, it’s them searching for accidentally coming upon it. Like, if you’ve been on YouTube, you can go down it up pretty quick, whole, you can click, I think it’s three clicks is the last, okay, I saw where they could get to something like that. So you don’t want porn to be? what is going to be informing anyone for what sex should be like, but you have to think about this generation has access to everything. And I think that maybe and I don’t know what research there is on this, but creates more openness and more dialogue about what relationships should be like, and they’re seeing like, hey, you know, I’m a sexual being, it’s okay to be a sexual being and what does this mean in relationship? So Right? Yeah, they just have a lot of exposure more so then. I mean, I remember watching those shows to being like, oh, twin beds, like, that’s cool. Like, but you have six kids. So I don’t you know, like, how does that work?

How does that work? Yeah, yeah. Okay, so for therapists that is working with parents, and they’re asking for guidance around Okay, so we know our kids are going to access porn, nothing we can really do about it these days. Is there a way to approach that? Are there respectful, appropriate ways for a parent to even introduce a child to porn? Because, you know, back in the day, you could sneak into 711 and get the Playboy or you could look at the, you know, the National Geographic magazines, those types of things. And now everything is so locked down, that there is no sort of mundane, safe way for natural curiosity to be addressed.

Yeah. So there’s a great question. So I think the best way is you should be talking and I would say for the youngest kids, right, we want to be labeling. Some talking babies here. Like toddlers, we want to be labeling body parts with the correct terminology. We don’t want to be calling a vulva, anything else except a vulva. Right? And so, by vulva for all the listeners, right? Is the label for female genitalia and to talk about safety with touch, right? Who can touch them, right? Especially if they’re learning to like, you know, have a little one like teaching her to wipe and like who’s allowed to help her who is not like, what does this look like? Right? So we want to label body parts correctly, talking about safe touch, also talking about not using secrets and some parents might fight me on this one, but not keeping secrets from your grown up. Yes. Right. So if we start laying wedge as early as they can understand it, and start talking about body parts and things like that, then they’re gonna be more comfortable with their bodies. And then I think keeping an open dialogue about hey, what are you seeing on your screen? Right? Like, what does this mean? Or like, look at that relation, like pointing out things, tickets, they just want the information. Yes, right. Yeah, they’re not looking at it, as most of them and I could, depending on the age aren’t looking at it, like, Ooh, look at this sexual thing that the people are doing. They’re like, what are those people doing? And they have no idea that weight is what it is until another kid, maybe on the back of the bus, or on the other corner of the room was like, That sucks. And they’re like, what’s next? Right? You give them the basic information, just like we’re labeling body parts. This is what sex is. Whatever you’re comfortable with saying, but try to make that medically accurate, please, yeah. And then kind of offer age appropriate information as they keep going and make it a part of regular conversation. Right? It doesn’t need to be the talk. It’s how are you starting these conversations and continuing them as they age. And as they go through puberty. And as stuff comes up, maybe they’re watching something and you weren’t prepared for whatever scene comes up, because it can be a little sneaky. And you’re not prepared for that. But talk about it. The other thing I would say too, is making sure that as a parent yourself that you’re prepared, and you’ve dealt with all your stuff, so that you’re very clear on what your values are for a healthy sexual relationship, that you’re talking to your kids about pleasure, and consent, and how those should be absolutely a part of any kind of sexual interaction with anyone else. But we have to deal with our stuff too, because you don’t want to be a deer in headlights when your kids like so mom. Where do babies come from? Right? Because I had that conversation like, maybe six months ago, and I was like, well, here we go. Okay. In the car. Yeah, right.

Yeah, so my kids were born in the 90s. So they really were the very beginning of cellphones, internet access, all of that kind of stuff. And I remember having a conversation, as a parent saying, you might find things on the internet, that aren’t normal sex. And now I kind of cringe about that I was, I wasn’t a really good way to say, a typical way that partners will start if we’re looking at a male and a female, what are ways that typically people will have a healthy sexual relationship versus some of these really extreme things that if you’re a consenting adult, and that works for you, that’s fine. But for a child on the internet, or teen who’s finding these sites, you know, we hope they don’t, but if they do, because they’re easy to find, yeah, then that is forming their idea of what sex should look like.

Right? Right. So I always say, right, let’s remember that porn or anything like that is a fantasy. Oh, I love that. Okay. Yeah, it is a fantasy. And then I also say, and I learned this while I was getting my, you know, sex therapy, education is what actually goes out what happens on the sidelines, what happens off screen, you know, so what happens off screen in most porn, right? When we don’t know where it’s coming from? You don’t know who those people are? You don’t know how they’re paid? You don’t know where they came from? who’s directing them? You don’t know what’s going on? Right. So what also is happening off off camera, there’s meds for sure given right to, to male people, people with penises, there’s also they’re not being told what positions that they’re going to be asked to be doing over and over and over and over and over again. Right? Because it’s not, it’s not one take. And you’re good. Right? Like, you know, depending on what you’re watching, right, like someone’s home video, like, that’s a whole other story. But, you know, they’re doing these things for hours and hours at a time. And then it probably is becoming painful and overwhelming and distressing, right? There’s not a right. So I kind of say, Hey, this is this is a fantasy. This is not real. Right. And let’s talk about what real connection with pleasure and caring Enos right, because, you know, I would also don’t, you don’t have to be in love to have sex. So let’s not, you know, that’s my personal belief. But you know, like, let’s not pass that on. Talk about what does it actually look like, but that what you’re seeing that porn you saw on on PornHub? Because they all know Pornhub. Yeah, they do. is not real. It’s not. Right. Yeah. So it’s a tough subject. And I get it like because you don’t I think a lot of people think, Oh, if we talk about sex, and they’re gonna have sex, and research tells us the exact opposite, right? Give them the information. They’re going to wait longer to have sex. There are so many beautiful stats about that. And so okay, that’s Wonderful to hear afraid about it right? Like even your younger clients, right? Because this can come up with younger clients. Right? Hey, let’s talk. Do you know what consent means? They usually do, because. But what does that look like in relationship? what does that look like with your friends? Right? Because it’s not consent doesn’t have to just be about sex as we all know.

Of course. Yeah. Yeah. Well, I there’s just so much depth here that I’m sure you know, if we could have listeners call in, I’m sure.


yeah. And so then you also talked about, we need to explore our own views our own sexuality, we need and you know, just like, you know, it’s like things that we’re learning about with racism and all kinds of other things. Like, it’s not like one and done, like you learned about it, you looked at it, and now you’re good to go. Like, these are areas ourselves as therapists, that we need to be constantly checking in with ourselves and evaluating ourselves. So that we can make sure that we are providing a healthy atmosphere for our clients to be able to discuss these things, and that we can set limitations like the one that you set, you know, and recognizing, okay, this is absolutely an area where I need to draw a line because it doesn’t work for me. And and that’s not saying others shouldn’t do that. It’s saying that I personally can’t do that correct?

Yeah, I think the best you know, and maybe this is not for everybody, but one I’m always reading about sex stuff. This is my specialty. I’m always diving in. I mean, you know, the age old, we have like the 13 books stacked up that you know, you’re gonna read right? Are gonna read, right? Right. But besides the books, right, like staying up to like, what’s coming out, and like my friends who are writing books, like about gender and pelvic floor stuff, and I’m lucky, I have a great cohort of people around me that are freaking brilliant, and writing books about it now. So reading what my colleagues are writing, and then but also social media, like I know, as much as we shouldn’t be on it, right? It is a blessing for us with groups. And I would say even like Instagram, are you following other clinicians? Are you following sex therapists? Are you following sex educators, because it’s a nice way to get this little tiny minute of information, or maybe a book recommendation, you can be like, oh, I want to know more about that. And that’s wonderful. And then, you know, people like myself and other sex therapists offer, you know, consulting, were like, Hey, if you don’t know something about, reach out, like, let’s have a session, I will give you some resources. And that’s what’s so brilliant about, you know, the internet, right, is that everything is right there. You can get it, you can order that book, and it’s going to be at your house in two days. So staying abreast of the information is really important. Yeah,

yeah, I gave a just a couple of weeks ago, a clinician your contact information, as there were issues in their therapy session that they weren’t quite sure how to navigate. And I was like, Well, you might need to refer out because Sarah, Sarah, will take care of, oh, yeah,

I love it. And that’s, you’re gonna get a lot of calls about the the program I went through for sex therapy at the University of Michigan. It’s like, if I can help you, like where you can figure out an issue with your client. And they stay with you? Because it’s kind of just an aside. Yeah, let’s do that. Right. Like, let’s educate. Like, I think, you know, if we could change grad programs, I mean, there’s a boatload of things we’d all change. Right. But I would love right. Yeah. Right. Like, let’s teach you really how to do this. But giving more information about sex would be top on my list? For sure. Yes, yes,

absolutely. We’re even just letting therapists know that it’s going to come up a lot. Oh, so many shows that we didn’t even know.

Oh, my gosh, I never practiced this in the school. Never, never. Right. And I was just like, oh, my gosh, you do what? And being like, oh, that’s totally normal. And this is going to continue to come up with all clients. And especially if you do couples work, if you’re doing couples work and not talking about sex, you need to stop right now and start doing some research about sex. Okay, that’s a huge part of their relationship.

Yeah, absolutely. Yeah. And that and not letting our own fears or perspectives, you know, color our work and recognizing that maybe if we can’t, again, if you can’t work around that issue, then maybe couples work isn’t where you need to be working if it’s not comfortable for you to discuss sex.

Exactly. Exactly. Right. And I think that’s what I you know, that’s one of the things I continue to offer it to other clinicians is, how can we sit back and go through I have a load of questions. You’ve seen some of them about like, how do you get like, how do you go through what you your own beliefs and what you’re carrying with you around sex? Because if you are partnered, as a clinician, you have thoughts and feelings about sex. If you’re a human, you have thoughts and feelings about sex, you’re born a sexual being right? Everywhere. And it’s, especially with our media and in our society. It’s so many mixed messages. And if you grew up in a religious household, y’all got messages too, right? So did I I is in a very Christian and went to Catholic school. So like, private, religious school my whole life and that definitely informed part of my journey and why I’m doing what I’m doing now. Right?

Yeah. Yeah, that’s wonderful. I love that. So if therapists want to learn more, do you what are good, some good sources that you can send people to if they want to start exploring how they can be a better clinician when it comes to talking to their clients about sex? Hmm, I would your Instagram is probably a good stuff.

Thank you. Yes. Yeah, I post a lot of good stuff on Instagram. I would do I think it did. Okay, so like any kind of specialty, they’re like, sub specialty. So if you’re working with couples, let’s talk about couples and sex. And let’s look for books that are about that. I am a huge, huge fan of Estera Perell. She is very I’m sure most listeners are listeners have heard of, of her. If you’ve not read her books. You could do that. But you could also I think the lovely way that as we’re talking right now is the easy way to digest Astaire is her podcasts or her TED Talks. Or she has a masterclass which I did not I don’t have and I haven’t done that yet. But she has got stuff everywhere. She’s so one. I love listening to her. I just love her voice.

She’s calm. She just knows what she’s talking about. She’s so well known in the field. And


you know, so I love as stare. I love Emily, Nick kowski. She is an educator. She wrote the book come as you are. Yeah, I recommend all of my clients to read. Also her book burnout with her sister Amelia. Oh, yeah. Oh, my God. Yeah, that’s not about sex. But that’s so good. I’m going to look at my bookshelf and tell you what else to read. Think there’s a lot about a there’s a lot of sexual trauma that has happened. And I noticed with the meet, I feel like me to happen to, you know, a while ago now, but just getting through getting more information about how to deal with sexual trauma, because that is a lot. And I want to tell you, we might have to pause this one because I’m trying to Oh, Wendy Maltz is great. It’s healing your sexual journey. Okay, the sexual healing journey, excuse me, healing journey. Okay. Yeah, yeah, she’s great. So I think it really just kind of depends on what you’re looking for. But I would also, you know, if you’re doing couples work, you got to be really strong in that and figuring out just again, what’s your own stuff? And then what issues are they having if they’re having issues, connecting or with initiation or things like that they’re your sizzling sex life. Sizzling sex for life, by Michael Carmichael is wonderful. And then okay, you have lots of resources. So tell me about the last time you had sex is by Dr. Ian Kerner, who are also very well known in our field in the sex therapy field, such a great book, and he talks he uses the on the term sex script. And what he means by that is just how are you going into any kind of sexual encounter? what do you have playing in your head? Right? Yeah. Should it go 1234? You know, you’re like, This is what happens first, we do this, and then we do this, and then there’s an orgasm, and then it’s done. And how does that help you? And he kind of goes through all of the history of that. Okay. Love that book. Lots of good exercises in there. So those are some of my top favorites. Oh, great.

That’s wonderful. That’s wonderful. Yeah. This is this is so good. And I hope that therapists are listening to this and being curious and wanting to learn more, and recognizing that we can help ourselves and our clients, if we start looking at some of these areas that are important parts of our work that we weren’t really trained in, weren’t even really prepared. We’re going to come about did anyone teach you about impostor syndrome? And

there shouldn’t be a whole right and a whole year, right?

Yeah, so. So thank you for all the wonderful resources. Yeah, so we’ll put we’ll we’ll put those in the show notes. And we also have your, your Instagram and your website that we can put in there as well. So you do consultations with therapists if working with cases where they need some guidance?

Absolutely. And I love love, love talking to other clinicians and helping them figure out what’s going on and getting their clients to kind of go down the path that they need to go on. So definitely offer that and so my webpage right now it’s being it’s being redesigned. So hopefully in a couple of weeks, it’ll be back and ready. It’s still there. So you can contact me through that page, but okay, doesn’t have the consulting on there, but I do do that. Okay, good. Jeanette.

Okay. All right. So

I want to ask you if you have a favorite metaphor or analogy, catchphrase, something like that, that you’d like to use with your clients?

Speaker 1 44:58
Yes. So I have a few You have one is not mine. So it’s from Emily Nagurski. And she talks about how pleasure is the measure. So instead of you know, we were talking earlier about orgasm, and so often do clients while Well, she didn’t have an orgasm, and I couldn’t do that for her or vice versa. And the reframe on that, is that was it pleasurable? Right? Then yes, then you’re going to measure any kind of encounter as pleasure is the measure not orgasm is the measure, right?

Yeah, yes, that’s huge. That right there for everyone to just think go on for a minute to explain to our clients, because we do have these societal expectations around all kinds of things, and especially about sex, and what a healthy sex life should look like, or what it should include or what you should or shouldn’t be doing. And all of those things.

Yeah, absolutely. So I use that all the time. And sometimes my clients are like, Yes, I know. But and I’m like, Yeah, but what No, we’re that’s the measure. The other one that I often use with my clients is that you’re not a light switch. And so if your partner is like, Hey, you want to have sex, and you’re not like immediately, like, aroused and ready to go, it’s because you’re not a light switch. On and off, there are things that are going to get us going. And there are things that are going to stop arousal and desire. So we have to pay attention to those things. And know that it’s absolutely normal that even if your partner starts touching you in a maybe semi central way that you may not be like ready to go. So light switch friends, and that’s totally normal. Totally normal. Love that. Those are my two that are I often go to great, great. Therapists

always have the best therapies and analogies. I always love it. Okay, guys. Well, Sara, thank you so much for joining me today. This has been so it will it’s been good seeing you and talking with you. But hopefully it was very informative. I know. I’ve certainly learned some helpful things today and need to incorporate some more of these things into my practice as well. Oh, great. Well,

thank you so much for having me. I

appreciate Absolutely, yeah. So for everyone listening, there are new episodes of The colleague down the hall podcast released every Thursday on all major platforms. And please remember, our work is hard, but it doesn’t have to be lonely.

Thank you so much for listening to the colleague down the hall podcast for shownotes links and downloads, head over to colleague down the where you’ll be able to learn more about getting the clinical support you need and resources to help you work in a supportive sustainable way. If you’ve enjoyed this episode, please share with your therapy friends and colleagues. subscribe to the podcast and if you love this episode, please leave a review.

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