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Sex Therapy During a Pandemic: A Check-In

It's been four months; how you doing? Here's a sex therapist's check-in.

Like actor Leslie Jordan often says on his Instagram Live videos, “How y’all doin’, my fellow hunker downers?” Seems like a good time to check in with my readers.

I am four months into doing video sessions, aka telehealth, with my clients. I quickly (and painfully) converted my sex therapy practice back in mid-March when the first cases of COVID-19 were medically confirmed in my community and we knew so little about this virus. I now continue doing teletherapy because we know more about the virus and it appears in-person psychotherapy, and all that it entails, is a higher-risk activity.

Boy was it a tough transition initially. The laws, the ethics, the paperwork, the rolling it out to clients, the overall anxiety and uncertainty that were palpable in the air even over Zoom. There is so much about the ritual of welcoming clients to my office that I enjoy and, in therapy speak, sets the frame. I miss it. I like to think of my office as a comfortable space my clients can visit, escape the duties and pressures of their daily lives, and sink into depth, self-reflection, vulnerability, and acceptance.

But now I see a new vulnerability with my clients: their pets and children that sometimes and sweetly hijack their sessions for a minute. How they decorate their living room. Their bedrooms where they have—or don't have—sex.

© 2020 Diane Gleim

What has helped make it easier? The client’s comfort with technology plays a role. I have noticed those clients who already do Zoom meetings as part of their work can do therapy over video fairly well. If a client is new to most forms of video chat it is a rougher transition—and the novelty of teletherapy is a distraction at first. Another factor is family life: One couple I worked with pre-shutdown had to put their sex therapy work on hold because their kids have been home 24/7 for months and the couple does not have a private/quiet space to talk about sex for an hour in their small, 100+-year-old house with thin walls. Another client found the only quiet/private/away-from-the family location was in their car parked in their garage.

And I have had to change how I work. As someone somatically trained, when I would sit with my clients in person I would see and hear their breathing, notice their posture, where they were holding muscle tension in their body. Now all I see is from about the collarbone up. All head (and face). It has taken me some time to realize I can still do somatic work; now I focus more on their eye gaze, the speed at which they talk, and yes their breathing.

I still go into my office every day and see my clients on Zoom from there. Doing this has helped my own mental health immensely. Getting up and going to work every day, even if I do not see another human being in the flesh, has maintained normalcy in my own life.

Some clients are doing really incredible work, both in their sex lives and elsewhere. Life has slowed down. The stress of a global pandemic, economic uncertainty, and social isolation has squarely put a spotlight on the parts of their relationships and themselves that they believe need change. One client is ordering sex toys galore because they can finally commit time to learning more about their body, its responses, and their preferences (something that was a key treatment issue before shutdown).

Pre-pandemic, I saw several clients who traveled one-plus hour each way for our in-person appointments. Now with Zoom sessions, they have all said they like no longer having to take three to four hours out of their day just for their appointment. Even if things open back up in the future, I will probably continue with Zoom sessions with them for the duration of our work together.

But other clients are, understandably, really struggling. If I had to generalize, there seem to be three categories of clients in my caseload that are having a particularly difficult time during lockdown. The first are those that are under the age of 60 who have health conditions that make them at high risk of contracting the virus or they live with someone in that category so they are living a very constricted life. They are getting bored of “staring at the same four walls all day every day” and both depression and legit existential anxiety are settling in. Maintaining positivity is a daily, sometimes hourly, active process we talk about in each session. The second are seniors. For obvious reasons: they too probably have health conditions that put them in the high-risk category so are living a diminished life and missing their activities, friends, and families and the touch that accompanies seeing loved ones. But also some of them are expressing deeper thoughts and feelings about the length of time we will be doing this adapting-to-COVID lifestyle, how long they will live, is this how their final chapter ends. Death anxiety is a real thing. And the third group of clients struggling are trans folks who are mid-transition. Their treatments and surgeries have been deemed “non-essential” or “elective surgeries” by the medical community and are now put on hold. These clients are in awkward stopping points of the transitioning process. My heart hurts for all these people; they did not choose this way of living but know they must.

New clients are reaching out as well. Whether it’s “I/we now have the time to work on this issue” or “Shutdown life is hard, I’m/we’re struggling." I have honestly been surprised by this. In the beginning I wondered aloud, “Will people want or need sex therapy during a global pandemic?” The answer is a very clear “oh hell yes." I am inspired by all my clients’ desire to keep on keeping on while in the midst of a global crisis none of us have experienced before.

I’m also hearing about people thinking of creating “social pods” to help them and their families get through this pandemic. The idea is that a small number of people/couples/families are comfortable with each others’ risk-taking behaviors (or lack of risk-taking behaviors) and commit to being in community just with each other to ride this out: to socialize, for support, for shared child care, etc. This reminds of me of closed polyamory systems. I have said it before that “straight” society can learn a thing or two from sexual minorities.

Setting politics aside, the future is deeply uncertain for us all. Our impatience and fear must be mitigated by safety measures, logic, science, hope, and an unequivocal acceptance of living life on life’s terms. This virus has a profoundly spiritual principle it is teaching some and reminding others: that my choices affect you and your choices affect me. To examine the consequences of your choices and choose thoughtfully. The laws of cause and effect and interdependence. Funny: this is also what psychotherapy tries to teach its participants.

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