Anyone surfing the net looking for sexual information will have probably encountered the term “sex-positive.” Individuals seeking therapists for sexual difficulties will also have inevitably read a therapist profile or bio which indicated that the clinician identified as sex positive. But what does this term mean, especially coming from a therapist?

I will offer a quote from sexologist Carol Queen to get the discussion going–

“Sex-positive, a term that’s coming into cultural awareness, isn’t a dippy love-child celebration of orgone – it’s a simple yet radical affirmation that we each grow our own passions on a different medium, that instead of having two or three or even half a dozen sexual orientations, we should be thinking in terms of millions. “Sex-positive” respects each of our unique sexual profiles, even as we acknowledge that some of us have been damaged by a culture that tries to eradicate sexual difference and possibility.

It’s the cultural philosophy that understands sexuality as a potentially positive force in one’s life, and it can, of course, be contrasted with sex-negativity, which sees sex as problematic, disruptive, dangerous. Sex-positivity allows for and in fact celebrates sexual diversity, differing desires and relationships structures, and individual choices based on consent.”

In my mind, being sex positive at its core means that one’s default position is that sex is natural, generally healthy in all its variations, and can be utilized positively in the service of personal growth and creativity. Now, that of course does not mean that sex can’t be used destructively, just that pathology is never the underlying assumption. For a distinction between the two, click here. (Cliffs Notes version– according to the DSM V, sex is “pathological” if it a) creates personal distress that is not due to social stigma, b) is non consensual, and/or c) feels compulsive or out of control).

The first and last issues are often interconnected. If something is a compulsion, it will initially relieve tension and anxiety, but cause remorse and distress afterward. Another reason that a sexual behavior may cause personal distress is if it is so exclusive that the individual cannot experience pleasure in any other way. For example, someone who has a foot fetish and can only reach orgasm through fondling feet may often experience distress when his (and it usually is a he) partner desires to introduce more variety into the sexual dynamic. Because he does not experience arousal any other way, this individual may start experiencing anxiety, depression and hopelessness regarding his sexuality, especially if he feels distress about pleasing the partner.

I would say, however, that the examples above are the exceptions and that in my experience, most distress around sexuality is indeed societally generated.  It is unfortunately not uncommon for someone to come into my office as the identified patient simply because someone else has a problem with their sexual behavior. I’m not talking about infidelity and affairs here, which would be classified as nonconsensual behavior, but more along the lines of sexual interests which the people around the individual would consider to be abnormal and deviant. This is where maintaining a sex positive stance is crucial. In these situations, it is important to parse out the meaning of the sexual behaviors for everyone involved. What does the behavior mean to the individual? What does it mean to the partner?  And what about it feels so threatening? For example, does it feel like it’s the main event, more important than making a true connection? Is there a way to integrate it into other aspects of sex play?

I don’t mean to make it sound like someone who is distressed with their sexual behavior will only come in at the prompting of a partner. Sometimes an individual will seek counseling because he or she is too afraid to reveal their sexual desires and interests to a partner, so they come in of their own volition. Or sometimes they don’t have a partner but feel that their sexual interests are dystonic, or at odds with their core values. In these situations, it is sometimes hard to separate where social influence begins and ends.

At any rate, my main point here is that for me, keeping a sex positive perspective is essential to maintaining an open-minded and nonjudgmental stance, in which I help my clients define their own identity and make their own choices. In my mind, sex negativity in the consulting room poses many substantial risks, including re-traumatization, further shaming, and even iatrogenic (“brought forth by the healer”) injury. Unfortunately, most therapist have little or no training in sexuality, and as a result may bring forth their own biases into treatment. For these reasons, I strongly believe that adequate sex training should be a basic requirement for all therapists. And for all of these reasons, a “sex positive” attitude is an indispensable attribute for any therapist and is the gold standard in sex therapy care