Psychotherapy Matters book series – Sexual Diversity: Being Human through Understanding and Acceptance

In this blog, Silva writes about his new book Sexual Diversity: Being Human through Understanding and Acceptance, published in the Psychotherapy Matters book series. 

How comfortable are you exploring your clients’ sexual and erotic world?

Psychotherapists often ask me questions like:

• ‘My client told me they are pansexual. I don’t understand it.'
• ‘My client doesn’t want to date people; he wants to stay single – is he avoiding something?’
• ‘My client says she’s heterosexual, but she has sex with women. I don’t get it”.’
• ‘I’m confused on how to assess my client who watches too much porn. Is he addicted?’
• ‘My client has unprotected sex with strangers. Is this self-harm?’
• ‘My client is turned on by wearing latex. Is it normal?’
• ‘My client loves being humiliated during sex. Should I worry?’

And so on.

The topic of sex and eroticism can be uncomfortable because it is not discussed enough among peers or in society.

As a psychosexual and relationship psychotherapist, working with gender, sex and relationship diversity (GSRD), I’m aware that most of our psychotherapy clinical training programmes do not cover in-depth (and sometimes, not at all) the vast landscape of human sexuality and eroticism.

This leaves psychotherapists (trainees, newly qualified and experienced) unequipped to work with sexual diversity. In fact, for many of our colleagues, the topic of sex and eroticism can be uncomfortable because it is not discussed enough among peers or in society. I frequently see clients who say: ‘My previous therapist was really great but we never talked about sex, so here I am’.

Central parts of our clients’ lives

Although psychosexual and relationship therapy is a specialist field that requires substantial further training, I feel sad that many clients don’t feel confident to talk about their sex lives with their therapist. I believe all therapists should be well trained in talking about sexual diversity and GSRD, because these elements can be core parts of our clients’ lives.

This inspired me to write Sexual Diversity: Being Human Through Understanding and Acceptance. I’m passionate about making my little contribution to help our profession bridge the knowledge gap in our clinical training and in peer/supervisory discussions, ultimately making therapeutic spaces more available for clients who do not identify with the dominant populations of heterosexual, monogamous and vanilla (non-kinky) sex. In fact, even within the dominant populations, there is a wide range of diversity. Heterosexuality, for instance, is not a single, uniform experience.

Challenging assumptions about heterosexuality

When I deliver training, I ask colleagues: ‘If you see a heterosexual-looking couple in therapy, do you automatically assume that they are heterosexual and monogamous? Do you ask about their sexual orientations?’ Most often, therapists don’t think of asking about sexual orientation. However, it is very possible that some of these couples may not be heterosexual. They may identify within the wide range of sexual diversity, or they may question, wonder and ponder on their multiple feelings and sexual/romantic attractions towards others.

When clients identify as heterosexual, it’s often assumed that their experience of sexual and romantic attraction is the same – in reality, each person may understand and express their heterosexuality differently. In my work, I learned that if the therapist doesn’t ask sexuality-related questions, clients may not disclose this by themselves because of shame, embarrassment or fear that the therapist might judge or misunderstand them.

When therapists are aware of sexual and erotic diversity, the psychotherapeutic process is deep, meaningful and rich. Helping clients discover their authentic selves and keep in touch with the constant flow of their erotic world significantly contributes to their overall wellbeing.

Threads: @silvanevespsychotherapy

Bluesky: @silvaneves.bsky.social

Psychotherapy Matters is a new series published by Karnac Books in partnership with UKCP. It will consist of accessible books for professionals with a crossover into a general readership on topical subjects. The aim is to bring diverse subjects into focus with enjoyable and inspiring reads to energise much-needed conversations around mental health.