You may find this hard to believe, but most therapists, psychologists and doctors have received no training in sexuality.
A minority of mental health, social work or medical training programs offer graduate-level training in sexuality issues, beyond covering the paraphilias and sexual disorders included in DSM-5. Some programs address sexual diversity issues, but not all. Few, if any, states require specific training in sexuality issues in order to qualify for licensure. Only a very few states (California and Florida when I last looked) require a license or documented training in order to call oneself a sex therapist.
Why and how this came to be is a long, socially-driven tale, and I’m not sure anyone has ever really documented the story. But, what this lack of training means, is that therapists are subject to the same sexual biases, misconceptions, and myths, which permeate general society. Most therapists learn about sexual issues from the general media – NOT from professional journals or research. As a result, many therapists hold some dangerous myths and misconceptions, and use these mistaken beliefs in their practice.
Here are five of the most common ones, which I’ve encountered as I supervise, correspond with and train therapists around the world.
Kink is Rare and Unhealthy
Since the ideas of fetishes/paraphilias were first introduced in the late 1800’s, therapists have believed that sexually unusual behaviors and desires were just that: unusual, rare, and usually abnormal. But, the DSM-5 makes the distinction between paraphilic interests, and paraphilia disorders, now acknowledging that people can have unusual sexual interests, with no distress or dysfunction. In Scandinavia, they abolished the paraphilia diagnoses several years ago, with no regrets or reconsiderations in the time since. Recent research in Canada suggests that nearly half the population endorses interest in “unusual” sexual practices. Which begs the question if anyone really knows what “usual” or “normal” actually is. Numerous recent studies of people involved in BDSM show that they are often more emotionally healthy than the average person. And, the Fifty Shades of Grey Effect has shown that many, many "normal" people are interested in exploring their sexual boundaries.
Open or Non-Monogamous Relationships Don’t Work Long-Term
Therapists tend to be remarkably biased and judgmental about relationships that explore negotiated alternatives to infidelity. In a recent NY Times article, noted anthropologist Helen Fisher proclaimed that humans aren’t wired for nonmonogamy, and are fooling themselves if they pursue it. But, increasing numbers of relationships are negotiating these boundaries, and many researchers and therapists like myself are writing about the many kinky, polyamorous, swinger and gay male couples that we’ve seen establish and maintain very healthy relationships for decades. Several studies of nonmonogamous couples show that they tend to be more egalitarian, more open to sexual diversity, and more likely to practice safe sex. Given the incredibly high rates of infidelity and divorce in allegedly monogamous relationships, it leads one to wonder what exactly, therapists are thinking of when they say that monogamy works and nonmonogamy does not.
Porn Causes Divorce
I can’t turn around without hearing the statistic that porn use is involved in 50% of divorces. I’ve heard this from countless therapists, who write to tell me how wrong I am to suggest that porn use can be healthy. The origin of this seems to lie with two groups.
First, the Family Research Council has asserted that they conducted research, and found that porn was involved in over 50% of divorces, but the Family Research Council is a group founded by James Dobson, which promotes “traditional family values” and lobbies against divorce, pornography, abortion, gay rights, gay adoption and gay marriage. The FRC’s study of pornography and divorce was not published in a research journal, nor subjected to peer review.
The second origin of this mysterious statistic about divorce and porn is from The American Academy of Matrimonial Lawyers. In 2003, at one of their conferences, the Academy reportedly did a survey of 350 of their attorneys. About half of these attorneys reported that they had seen online porn play a part in divorces. Because the methodology is unclear, we don't know if they said they'd seen it in half of divorces, or if half of the attorneys had EVER seen it at least once. But again, this survey has never been published, and these data and methods never analyzed. I think it likely that therapists do see porn use in men involved in divorce – because men increase their porn use when they are lonely, depressed, and when they are not having enjoyable sex in their relationships. But therapists are mistaking a symptom, an effect, for a cause, when they blame porn for divorces.
Trauma Causes Unwanted Same Sex Attractions
Many therapists, especially within the sex addiction field, argue that childhood sexual trauma can lead males to engage in homosexual behaviors that are inconsistent with the man’s sexual orientation. This belief ignores a few important points:
· First, gay and bi males are at higher risk of experiencing sexual abuse, not because abuse made them gay, but because gay/bi youth are often isolated and vulnerable.
· Secondly, Occam’s Razor suggests that these men experiencing “unwanted same sex attractions” are actually not as heterosexual as they may want to be, reflecting the moralistic and homophobic attitudes of the families/religions they were raised in. Blaming abuse for the sexual desires is a distraction.
· Thirdly, the idea of “unwanted same sex attraction” ignores the important theory of sexual fluidity, which is now helping us to recognize that sexual orientation is not the rigid concept that therapists once believed.
· Finally, I always like to ask therapists who believe this concept of “trauma-induced same sex attraction” if they believe that a woman sexually abusing a homosexual male could lead that male to experience “unwanted heterosexual attractions”? If a therapist doesn’t believe that this mythical effect could go both ways, then they are really just voicing stigma against male homosexuality.
A therapist helping these men to suppress their same sex attractions is dangerously close to conversion treatment, and further, is unlikely to be effective or therapeutic.
Patients experiencing distress at such desires deserve education, support and affirmative treatment to help them understand and normalize their desires – treating sexual attractions as symptoms of trauma is inherently labeling them as abnormal and unhealthy, directly contrary to best practices and ethical standards.
Casual Sex is Unhealthy
Many therapists believe that casual sex, sex outside an emotionally-committed relationship, is inherently unhealthy. It’s not hard to understand why therapists think this: our society promotes the idea that casual sex is less meaningful, and is cheap, compared to the ideal, of emotionally-committed bonding sex. Further, the research on casual sex is nuanced, and a bit difficult to parse out. Some research has shown that many women experience depression after casual sex, and are less likely to have orgasms.
Further research on casual sex suggests that it is people’s attitudes towards the activity which predict their experiences. If you think casual sex is cheap and unhealthy, you’ll probably feel bad afterwards, if you have sex with someone you’re not in a relationship with. But, it’s likely that it’s the people who feel bad after casual sex who are telling their therapists about it, not the people who enjoy it and feel fine about it. So, it’s easy to understand how therapists could end up thinking that casual sex is unhealthy for everyone, in spite of what research is now revealing.
Therapists who believe these myths aren’t being intentionally biased. As said, they’ve rarely had training on dealing with these sexual issues. They are inundated with the panicked, sex-negative information that abounds in general media. They see a limited sample of people struggling with these issues, and don't understand how sample bias affects their judgment.
Many therapists endorsing these myths identify as Christian counselors, and these misconceptions are consistent with the sexual morals promoted in conservative religious beliefs, but licensed clinical practitioners are held by their ethics to practice based on the best, most current clinical information available. They are also prohibited from engaging in stigmatizing treatments, regardless of the therapists’ religious beliefs.
Patients - If your therapist tells you any of these myths, know that they are likely doing so out of ignorance. Feel free to share this article with them. But, if they refuse to consider that their beliefs may be evidence of bias or stigma, you may need to consider finding another therapist, one who is interested in providing treatment based on evidence, rather than bias and assumption.
More folks are now recognizing this need, and offering training to therapists to help them understand modern sexuality.
What are some sex/relationship myths you've heard?
How do you help your patients move past these myths?