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It’s nearly Valentine’s Day and people are talking sex and relationships. In a full-circle moment for me, I sit down to chat with sex therapist Sallie Foley, my friend and former professor at the University of Michigan. On enrollment day, her courses at the university filled up within minutes. Not because she’s an easy “A”, but because she’s one of the most fascinating and dynamic professors on campus. To this day, a decade later, when people find out I attended the University of Michigan School of Social Work, they ask me, “Did you take Sallie Foley’s class?”
Sallie, there’s an elephant in the room so let’s clear one thing up right away. People are curious about what happens behind closed doors of a sex therapist’s office. When people find out you’re a sex therapist, do they think there’s actual sex going on?
People can go online and see much more graphic sex than what they’d see or learn in my office or classroom. As teachers we’re here to teach about human sexuality, the reality and research, not to show people sexual activity. As sex therapists it’s important for us to be known as highly trained professionals who are licensed and do not touch their clients. We have hundreds of hours in human sexuality training and we provide a bio-psycho-social model to develop a treatment plan.
We explore a couple’s communication, personal history, and biological components of sex. We talk about therapeutic aspects of sex. We teach meditative and mindfulness techniques and we refer to physical therapists. You have to be willing to be curious for the rest of your life as a sex therapist because sex therapy has continued to evolve. But sex therapy most often resembles outpatient mental health counseling with individuals or couples.
Now that that’s cleared up, let’s start at the beginning. How does one go about getting into this field? Did you wake up one day and announce to your family, “Hey everybody, I’m going to become a sex therapist!”
I’ve been a sex therapist since 1985. I didn’t go looking for that job, it was actually the only job that was open in the medical center at the time. Up until then I had been an oncology social worker for many years. The new job combined OB/GYN and urology work with sex therapy training if I was willing to commit to two years. I ended up staying until 2010.
For the first 5 or 6 months I was getting trained by an established sex therapist on how to even approach patients. I mock-interviewed 40 people in the mental health field, cold calling them with sex questions: "Hey so-and-so, pretend to be anyone you want with a sexual problem and let me interview you." It got so bad that people would see me coming down the hall and would duck into rooms because they didn’t want to do another interview on erectile dysfunction.
I loved the intense work of being an oncology social worker, talking about grief and loss and how to use grief to grow. So then I became afraid that becoming a sex therapist would be like eating the frosting off a carrot cake.
Do you remember your very first client?
My first client was a woman with cancer and she needed to have her vulva removed. She wanted to know how to be orgasmic.
My second client was a man who was so traumatized from being sexually abused by his mother in childhood that he was unable to get close to women. He would have panic attacks.
My third client was a couple who'd been partnered for 15-20 years and because of vaginal pain they’d been unable to have penetrative vaginal sex.
I was quick to realize that this work was still about helping people with loss and helping people grow.
So what you learned and valued in oncology social work ended up coming into play in sex therapy.
At the time, I didn’t have any more education about sex than anybody else growing up in the ‘50s and ‘60s. I could barely even say "ma-ma-ma masturbate" and was stumbling over all the terms. I tried to use my old cancer jargon to be supportive and empathic but it didn’t translate into sex therapy. For instance, in oncology when a patient has difficult decisions to make, a social worker might say: “Sounds like you’re feeling stuck between a rock and a hard place.” The first time I tried that with a man with erectile dysfunction he said "Don’t I wish!”
And now that you’re’ comfortable using all the terms, it must make you a very interesting conversationalist.
I think it’s important to note that sex therapists are most believable if they walk the talk. A sex therapist gets very comfortable talking about sex. I can talk about sex with family and friends and I think that’s what we want to aim for- that sex is such a comfortable topic that we can turn to people we know and trust and say “I’m having some pain”, “I’m having trouble with arousal”, or “I can’t stop being aroused.”
It’s a lot like other important conversations we have with people we care about. We have to pitch it to the age of the person. I have three adult children but for many years, when they were young kids, we (my husband is a psychologist) simply told them we work with people who have problems. By the time they were in college they were good at saying “Not now mom.” Or, “Too much information!” Or, “I have a question about…”
At home, writing books can be a ‘jealous lover'. While working on Sex Matters for Women one evening, my handsome husband came into the study and asked "Am I going to get lucky tonight?” To which I couldn’t help but answer, "Hey, I don't actually 'do' sex, I just write about it!"
Knowing that others may not have the same comfort level about sex as you do, it seems like talking about sex would be a delicate dance. Whether you’re with family or with clients, knowing when the moment is right to laugh, when to teach, or when to just be present with people when they’re experiencing emotional pain.
It’s often very tough work for a therapist. We have to deliver some very hard choices to people. It’s very challenging to me to figure out how to reach an individual or a couple where they are. To pinpoint what’s troubling them - and here I refer to the wisdom of Martha Stark MD – to then use empathy, insight, and authenticity to speak to them where they are so they can take hold of the reigns.
I believe a fundamental part of mental health is education and education empowers people. They need to be with a professional who has a lot of training and isn’t self-absorbed. It’s for the client, nobody else, with a singular focus on that moment.
These moments sometimes require humor and lightness and people are taught early on that sex is so serious that they don’t know how to laugh, play, and enjoy themselves sexually.
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The latest edition of Sallie Foley’s co-authored book Sex Matters For Women: A Complete Guide to Taking Care of Your Sexual Self recently received the Society for Sex Therapy and Research (SSTAR) 2013 Consumer Book Award. Sallie maintains a psychotherapy and consultation private practice in Ann Arbor, Michigan. She is an AASECT certified sexuality educator, supervisor, and diplomate of sex therapy. She recommends the following sexual health resources:
