Mental health articles

sexual conflict in humans A safe therapeutic environment is essential for establishing client trust and
a working alliance. Yet, minimizing resistance and creating a collaborative
partnership are particularly challenging when exploring issues in which guilt
and shame are oft en normative. Unlike countless behaviors which young people
feel they can control, sexual desire and function are oft en experienced as
arising from beyond self—or even as being “not of self.” As a lesbian character
in the fi lm Kinsey asserts about her fi rst same-sex love, “You have no idea
what it’s like to have your own thoughts turn against you.” Society instructs
young people to deny and conceal their once quiescent sexual selves, abandoning
them to worry whether their newly evolved and unrelenting sexual
lusts are abnormal. Inadequately informed and frightened of pathology, students
may live with unspoken feelings of sexual inadequacy that corrode selfesteem,
taint self-concept, and diminish their readiness to seek help for sexual
concerns.
Sexual confl icts are usually amenable to therapeutic interventions, yet
young people are oft en too uncomfortable to articulate these issues to themselves,
let alone others. Th erapists must therefore normalize and destigmatize
sexual desires and behaviors. Th is process begins with messages presented in
the waiting room and questions posed on intake forms. Th ereaft er, a therapist
models sexual comfort and acceptance by assuring confi dentiality and using
explicit, at times vernacular, nomenclature to clarify meaning. Precise language
is generally preferable to euphemisms and scientifi c terms. “Have you
ever engaged in vaginal or anal intercourse with men or women?” is preferable
to “Have you ever had sex?” “Have you ever given or received a blowjob from a guy?” is preferable to “Have you ever engaged in fellatio?” Questions must
be specifi c; penile–vaginal intercourse should be distinguished from vaginalobject
and anal intercourse.
It is equally important to clarify the sex of the partner: “Have you ever
been sexually active with a male or a female, or both?” or “Are you currently
dating someone, perhaps a woman or a man, or both?” Th ese nondiscriminatory
questions convey the normality of such behavior better than asking about
“signifi cant others” or “partners,” which anxious students may ignore for fear
of misinterpreting the question and unintentionally outing themselves (Cohen
& Savin-Williams, 2004).
Perhaps the largest stumbling block to treatment is a therapist’s reluctance
to probe sexual matters. Avoidance of sexuality for fear that it is superfl uous
or inappropriate or because it generates sexual arousal communicates that sex
is an unsafe topic and thwarts processing of potentially useful sexual transference.
Th erapists should remain cognizant of emotional reactions during
therapy around sexual issues and seek supervision or make a referral when
these responses hinder treatment.