Sex

Sex Therapists Are Not Sex Workers

Sorry, but therapy isn't supposed to be kinky or humiliating.

Posted Oct 28, 2020

Victoria Vendetta, via Wikimedia
Source: Victoria Vendetta, via Wikimedia

I get pretty wild emails on a regular basis. But this request takes the cake:

I really like that you are accepting of other's kinks and likes sexually. I actually have a fetish I don't know how to approach, or if it is even possible. I would like to find a therapist and have sessions where I'm humiliated by my therapist. I'd like to be made to discuss all my physical and emotional insecurities as well as fears, and have my therapist make fun of me, belittle me, really make me feel self-conscious about it all. I've never known how to approach anyone about this, or if there is even a chance any therapist would do it. I'd be very curious as to your thoughts on if something like this is even possible.

As therapists are becoming less judgmental and better informed about sexuality and kinks, these kinds of requests and intersections are becoming more common. I've had patients who attempted to sexualize our therapy by, for instance, coming to therapy not wearing undergarments, and "inadvertently" flashing me. (We had a clear discussion about boundaries, consent, and what therapy is and is not.) The COVID-19 pandemic and the shift to remote services has also confused boundaries a bit, and I've heard from colleagues who have had to set boundaries with their patients — to participate in teletherapy while fully clothed, not laying in bed, and not drinking alcohol. I haven't yet heard from a therapist whose patient was masturbating during their remote session, although such behavior is actually somewhat common in corrections work and in work with the severely mentally ill.

Unfortunately, many sex therapists have long experience with getting phone calls from prospective patients who masturbate during the call, deceptively using their request for therapy as a way to get a sexual experience without consent. But sex therapists are not sex workers, and further, nonconsensual sexual behavior is unacceptable for anyone — including sex workers!

Therapy can be personally challenging, bringing up hard issues in a way that sometimes might be humiliating, although good therapy should be about reducing the barriers such as shame that prevent people from discussing their secret thoughts and desires. Often, particularly with sexual issues, patients come to therapy to share secret fantasies with another person because they have no other place in their lives to discuss it. Sometimes that can turn into a less than therapeutic process in which the therapist is an audience. 

I suggested to the gentleman who wrote to me that he find an online sex worker or dominatrix with whom he could engage to consensually explore his fantasy, elaborating: It would be unethical for a therapist to participate in this with you, as therapists exist to heal, not to give sexual gratification. What you COULD do is find a pro dominant willing to pretend to be a therapist and role play with you, on the phone, video, or in person (after the pandemic). Some provide so-called "hypno" dominant sessions such as “sissification,” which may be somewhat close to your fantasy. 

Sex therapists aren't in our jobs to fulfill our patients' sexual fantasies. We do help them understand their fantasies and integrate them in a mindful, ethical manner. We often have discussions with our patients about how to discuss their fantasies with partners, negotiating how to enact them in their lives with consent, integrity, and responsibility. And our job as therapists is often to model and defend those boundaries.