Mental Health, Sexuality

Is Talking About Sexuality with a Professional a Privilege?


I went to a graduate school in Athens, Georgia for a degree in Professional Counseling. After I graduated, I took a leap of faith and moved to the opposite side of the country and went straight to finding a job in Seattle, WA. During the interview for my current job as a Clinician/Case Manager, I sold myself as a counselor comfortable talking about sex. I told them my plan to become a sex therapist. Many people, even mental health counselors, aren’t comfortable talking about sex making me an asset. I knew that I could be the queer, trans, kink, poly inclusive, and confirming mental health counselor for the agency. I wanted to tap into a sensitive, vulnerable part of self that needs more attention in therapy. I was so excited to start my work as a clinician, and help people with their mental health, especially in ways it impacts their sexuality.

As I began my work I noticed that most clients didn’t want to talk about sex 😦

This was obviously a surprise for me. I know one of the primary symptoms of Major Depressive Disorder is lack of motivation, interests or pleasure in life. Sex being a part of life can loose its luster. I know someone with Generalized Anxiety Disorder can experience anxiety across a spectrum of concerns, including sex. I know mental health issues of any kind can effect relationships with family, peers, and/or intimate partners. I know 1 in 4 cisgender girls, and 1 in 6 cisgender boys suffer from childhood sexual abuse, which is the history of most of the adults I work with. My hope is that these people can benefit from having a professional to talk to about sex and intimate relationships.

So why doesn’t my work turn to the topic of sex more often?

What I can say about this comes from personal observation and opinion, and, like any of my posts, may change with a deeper and shifting understanding. As a Case Manager in a community mental health agency, many of the clients I work with across vast intersections of identity have severe, persistent mental health issues.

Here are some of examples:

  • A Black, homeless cis-woman, with Schizophrenia disorder and substance use issues. She has a partner, also homeless, and their situation is taking a toll on their relationship.
  • A young, White cis-male in his early 20’s who experienced childhood sexual abuse for seven years before moving away from the family member that abused him. He is unable to hold a job due to the constant symptoms of PTSD and is living in transitional youth housing.
  • A trans-woman with Borderline Personality Disorder who had frequent suicide attempts in the past year. They lost their job due to frequent hospitalization and are trying to apply for Supplemental Security Income (SSI).
  • A single, Mexican American cis-woman with two children. She lives with her undocumented parents and is fearful of what may happen to them during a Trump presidency.

(Please know these are not descriptions of individual clients I work with, they’re made up, yet extremely plausible.)

These are the kinds of experiences I hear on a day-to-day basis, from the wonderful, resilient people that I serve. The many challenges people in community mental health face make talking about sex a low priority. Getting housing, finding a safe shelter, managing their symptoms in order to find stability, these are their priorities.

Is talking about sex still important?

I think so, but a deeper conversation about sex and sexuality should happen when basic needs are (mostly) met. A very real issue for people with severe and persistent mental health problems is that it can take months to years before goals come to fruition. It seems that in community mental health at least, talking about sexuality is a privilege. People who have their basic needs already met have the advantage of going deeper. This doesn’t mean I don’t bring it up when I can, and it doesn’t mean it’s not possible, but it does make it more challenging.

I want to continue exploring the gap between those of privilege and those without as it pertains to sexuality. Sexuality is relevant across all social, economic, political, racial, and gender spectrums. I am curious to learn more about what allows people the space for talking about sex, and others not.


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