#S3E16 | How to Talk to a Therapist About Sex

Wild & Sublime Podcast Transcript

#S3E16 | How to Talk to a Therapist About Sex

Tom Doctor: I think there is also somewhat of a scarcity of like, really, really, super awesome, sex positive, great people. But that doesn't mean that this can't be a compassionate, caring, thoughtful person that can hear me and be where I am at.

Karen Yates: Welcome to Wild & Sublime, a sexy spin on infotainment®, no matter your preferences, orientation, or relationship style, based on the popular live Chicago show. I chat about sex and relationships with citizens from the world of sex positivity. You'll hear meaningful conversations, dialogues that go deeper, and information that can help you become more free in your sexual expression. I'm sex educator and intimacy coach Karen Yates. Today, we'll be delving into how to talk with your therapist about sex, and how to go about selecting a sex-positive therapist if you need one. Keep listening.

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Hey, folks. Are you thinking about getting a psychotherapist or counselor? Or maybe you already have one? Since COVID began in early 2020, demand for therapists increased exponentially, especially now, with the ability to leverage teletherapy from within your own home. Perhaps you want to investigate some issues around sex that you might be having, or you're interested in becoming more expansive in your sexual expression and want support. How do you go about talking with your therapist about these things, or finding a professional to talk to? I thought I'd chat with some of the gang from Best Therapies, a sex-positive group therapy practice here in Chicago, about optimal ways to engage an open and understanding clinician. We talk about how to broach the topic of sex, and figure out if your clinician is supportive, how to check your internal bias if you yourself are a counselor, and when to look for a new therapist. We had a really in depth conversation about therapy that gave me a lot to consider. And we recorded from the unceded lands of the Ojibwe, Odawa and Potawatomi nations, colonially known as Chicago. You'll be hearing from sex and relationship therapist Tom Doctor, Licensed Professional Counselor and harm reductionist Hannah Schwartz, and Licensed Clinical Social Worker Blake Mackie. Enjoy.

Hannah, welcome.

Hannah Schwartz: Hi, thank you.

Karen Yates: Blake. Welcome.

Blake Mackie: Thank you. I'm excited to be here.

Karen Yates: And Tom, welcome.

Tom Doctor: Yeah, thanks for having me.

Karen Yates: So I'm really excited about this conversation, because I love the interplay between therapy and sex, and the support that people can get from their therapist around their sexual needs or sexual issues. And of course, there are all types of therapists out there in the world, and some more concerned with actually the subject of sexuality. Others more generalists, if you will. I thought we would just start in the more general category right now, I've been in therapy a long time. And I talk with my therapist about sex. Not, like, super specifics, but like just stuff around my sexual life. And I was really surprised to find out that, in general, people don't talk about sex with their therapists. Like, it's not a natural thing that comes up in conversation, either from the therapist side, the therapist doesn't bring it up, or the client doesn't bring it up. Is it the responsibility of the client? Or is it the responsibility of the therapist to bring it up? Or is there any responsibility whatsoever?

Tom Doctor: I think that it's not necessarily responsibility as much. But I think — granted, I am a sex therapist; that's, like, much more the focus of my practice — and so it's very often that clients will come in specifically wanting to talk about sex. And if they don't, then I often, in the intake process, will, at some point, bring up sexual health as a piece of greater general health. And so it'll become a topic. I think that it's not required. Nobody has to talk about sex. But for me, it feels notably missing. If we're not talking about sex, or if we're not at least acknowledging that sex exists.

Hannah Schwartz: Yeah, I totally agree with what Tom is saying. When people come to see me, we talk mostly about grief or substance use. So sex doesn't always get brought up right away. I come from a mindset of, I provide the space, and when somebody feels ready to talk about that, they can. I also reflected on this question, recognizing that a lot of the places I work, sex was always involved in some way, within the session, mostly around harm reduction and sexual wellness. So I'm kind of struggling to think about, like, how would I approach this had I not had that experience? Like, what would I be like as a therapist talking about sex? So, I love this question. Thank you for asking it.

Karen Yates: Sure. Blake, what is your thought on this?

Blake Mackie: It falls on, I think, both parties, because there's so many different things to cover in therapy, or that can be covered. And sex and sex therapy is certainly a passion of mine. But there's, again, so many other topics out there that are also really important. So I think if you're a client coming into therapy, and sex is something on your mind, it's important to really bring that up and advocate for that to be a focus, or the therapist might not take you there, even though I certainly agree, it's important for the therapists to do that as well.

Karen Yates: What do you think keeps a therapist from, besides, say, the general drift of a client, where a client is going in conversation, or the trajectory of their treatment? You know, what do you think keeps the therapist from bringing the topic of sexuality up?

Tom Doctor: I think it's very similar to, often in medical appointments, why do we not talk about sex? Why in any other relationship in our life, it feels like it is so culturally norm to only talk about sex when you are either in situations where it is almost like commiserating about sex, or when you are in a conversation where there's like — we are moving towards sex, and so sex is a topic for that reason. I think just general talking about sex as a topic that affects folks in their lives, despite sex being everywhere, is not generally a topic that is often investigated in a meaningful way. I think often for clinicians early in their career also, there is a want to like, "Okay, I know that I need to talk about emotions." And so we go to therapy, and we talk about emotions. And I'm going to talk about the emotions that are stressing me out. And that's the thing we're going to do. And there's sort of a shying away from other things, even though there's like a million ways that we get emotions, one of them being sex and sexuality. Unless that is explicitly brought up, many clinicians will be like, okay, cool. That's like a private thing, though. That's your private thing. We're only going to talk about your relationship with your mom, you know, the stuff that's not private. So... yeah.

Karen Yates: Wow. Okay, this is really interesting. Like, I love that you just made this kind of distinction, like, "the private," even though you're in a therapy office, talking about other private things. But this is, like, super private. There's something to be breached if you go there. Any responses? Everyone's kind of nodding their head.

Hannah Schwartz: I just think in the beginning, in general, therapy is awkward, when you first need a therapist. Like, who is this stranger? Who is this person that I'm supposed to tell all my deep, deep, dark secrets to, all the intrusive thoughts, all the bad shit that may have gone on, and all the good stuff? So, meeting that therapist, it's weird! It's awkward, like, who are you? And so, it takes time to build that rapport and that trust. And then even with somebody I've been meeting with for years, in some ways, sex is seen as like this taboo private — like, oh, I can't let you in all the way.

Karen Yates: Yeah, it's one thing not to bring up sex, maybe in the first couple of months of conversation with a new therapist. But like, after you've seen someone for a couple of years, and you still haven't brought it up, then maybe it's almost worse, you know, gets harder. It's like, oh, yeah, we haven't been talking about sex, ever. And now I want to bring it up.

Blake Mackie: Yes, sex is put in this special category of secretiveness, right? We can go into trauma in your childhood, and all these complicated things. But sex does feel, I think, like one of the most kind of personal and uncomfortable things to talk about. Hopefully the therapist is comfortable with that. If not, then you're already at a disadvantage there. But even with a therapist that's competent in that, not knowing how the client might feel, and knowing that there is so much stigma there, I think that makes it difficult to go there sometimes.

Karen Yates: So what's a good way if someone is uncomfortable? If you're seeing a therapist and you want to bring up sex, and you're nervous, what is the best way to do it? What is the best way to broach the conversation?

Blake Mackie: One good strategy is to remember that in therapy, you can talk about talking about things. So you don't have to go straight into the nitty-gritty of your sex life, or your struggles there. You can bring up, "Hey, I want to talk about sex, but I'm kind of nervous. Here's what I'm worried about. Is this okay to do here?" And then you can build a little bit more comfort and confidence, and get a better sense of where things might go with your therapist.

Karen Yates: That's a very interesting idea. Because, you know, one of the things I'm interested in talking about today is talking about sex or sensation play where, you know, it's alt. It's like, not conventional, within normative society. So, it's like, you can also do that same thing with that method, of like, "Hey, I want to talk about sex. But I actually want to talk about something that I don't know how you're going to react." You can do that whole thing, of like, talking around it before you talk about it.

Blake Mackie: Exactly.

Karen Yates: So how can you tell? How can you tell that your therapist is cool with the conversation? And I know that sounds odd. But we've talked a number of times on the show that, like, your medical professional, your therapist, everyone goes through life with a particular filter, or a particular perspective. And you might not have a sex-positive therapist. You might have someone that has a very rigid idea of what sexuality is. So how do you, once you broach the topic, how do you gauge therapeutic reaction? Is it similar to what you would say to a friend? Like, looking at a friend's reaction?

Tom Doctor: I think it can be somewhat similar. And a thing that I would normally look for is, like, is the clinician willing to language match with me? So if I talk about getting fucked in the ass by 12 dudes, is the client going to be like, "Oh, when you were having anal intercourse with several gentleman..." That's gonna be like, oh, wow, there is some discomfort here. Like, this is a person that is trying to meet me, and like, just not doing it.

Karen Yates: [giggling] Or maybe like, crossing the legs, crossing the arms, like, all of the physical—

Tom Doctor: RIght. There's all those same physical things that you would get with a friend. But another, like, a major piece of being a clinician is like, can we language match our clients? Can we like, engage with them and meet them where they are? And this is often, for some folks that I know, they will go into a therapist, and in the first session, as like a feeling-out process, be like, talk about blood play, talk about some of their more edgy experiences, in order to feel out, like, is this person going to be a good fit? Is this person going to be able to hang with me? Or am I going to be ostracized or seen differently, based on the way that I show up to therapy? Because, I think — I mean, there's all sorts of studies that would indicate the therapeutic relationship is the single most important piece of effective therapy. And so, I know for some folks, they will just come in guns ablazin', specifically for the reason that they want to test that right off the bat.

Hannah Schwartz: I kind of even want to take it back even a step further, before the first session. I encourage people to interview potential therapists. See if they do like a 15, 20 minute-phone or Zoom consultation. Because this is somebody who will be working for you. Also even looking at the potential clinicians resume that they might have online, like, where did they work previously? If they did research, what are those research papers? Where were they educated? I've had some folks reach out to me specifically, because I was educated in the Bay Area. And their automatic assumption is, oh, this is somebody who gets it. Somebody who's open minded, somebody who is a little bit more liberal-leaning. I've interviewed my own therapists, like, saying, can you match my energy? Can you understand my world? Even in this brief, 15-minute conversation? Will I be safe with you?

Karen Yates: I'm really surprised when I talk to my friends, how few of them exact standards for their new therapists. Blake, what do you make of that, in terms of like, why don't people hold therapists to the same standards that they would, I don't know, their caterer?

Blake Mackie: I think part of it is, people don't really know their options. They don't know that asking for a consultation is a thing. And I think sometimes, we just had kind of settled into convenience, of okay, found someone that works and it seems okay. I'm just going to keep going with this. I completely agree with what Hannah said, that I really recommend doing a consultation. And even just in a few minutes of talking to someone, you get such a better sense of their energy, and if it's a good match, and if this is someone you're going to be comfortable asking questions about sex, even if you don't get into that during the consultation. And then even better, if you do, you can get a sense of how they respond to those kinds of questions.

Karen Yates: Yeah. So, Tom was talking about language matching. And what else are the qualities of a sex-positive, affirming therapist? What should a client be looking for? As you bring out the big guns, in terms of your most edgy sexual stuff? Or the things that you're most ashamed about? Not that you're necessarily going to do the super-shameful stuff in the first conversation. But like, what are you looking for? What does affirmation look like?

Blake Mackie: For me, I think the most important thing is really listening to your gut. How does this person make me feel? More than any specific thing they say, how do we feel in our body when we're talking to this person? Do we feel safe? Do we feel comfortable? Do we feel like they aren't judging us?

Hannah Schwartz: I really like what both Blake and Tom have said — the language matching, the body language as well. Do they look distracted? Do they look like they would rather be somewhere else? Are they constantly watching the clock? Or are they watching me? Are they listening to me? When they repeat something that I said, is it verbatim? Or is there like more kind of therapeutic language that might come from a textbook type of thing? Are they talking with me? Are they talking at me?

Tom Doctor: Yeah, I think that everything Blake and Hannah shared is awesome. I will add that if you are leaving therapy, feeling challenged, that's not a bad thing. If you're leaving therapy feeling judged — like sure, we can reflect on like, oh, is this normal for me? Like, do I, every time I talk about sex, regardless of how it goes, I'm going to walk away feeling judged, because I'm judging myself. So like, yes. Have some introspection there. Yes, reflect on that. And figure out like, is this the therapist that's putting it on? Is this me that's putting it on me? But I think there can be a lot of ways that a therapist can respond with warmth, and not be shocked by things. Anytime that a therapist is willing to meet the client where they are, it's probably going to be okay. I don't want to also write off, like, oh, I had a bad session, and so therefore, this person is probably a trash therapist and will never fit for me. I think it's important that there is some nuance there. Because there is, that some folks may not know that there's more variety out there. I think there is also somewhat of a scarcity of like, really, really, super-awesome sex-positive, great people. And so sometimes, we are balancing this between, like, is this workable? Does this feel like I can be heard, because not everyone is going to be an expert. Not everybody will have a ton of experience in the kink community going to munches even know what a munch is even known. Like, when I say blood play what that means. But that doesn't mean that this can't be like a compassionate, caring, thoughtful person that can hear me and meet me where I'm at.

Karen Yates: You're bringing up a really good point, which is, there is a dearth of expert sex therapists in the world, right? It is a niche therapy at this moment. And if a person is with a compassionate therapist, and says one day, "Hey, by the way, I haven't told you I'm regularly beaten, like, that's my thing. I really love it. And I feel so empowered." What is the responsibility of, say, the compassionate therapist who is completely meeting their client? Totally right there for them, but knows nothing about kink? What is the responsibility of the therapist to educate themselves around something that their client is bringing up? Or is it cool to just be there for their client, and whatever the client is experiencing?

Hannah Schwartz: I think it'd be a bit of both. You know, you can ask the client, like, what's that experience like for you? But I think the biggest responsibility that a clinician has is supervision. And self education, whether that's going to training seminars, reaching out to trusted colleagues — and if the therapist does some self reflection, realizes, I might not be able to work with this person, it's their responsibility to refer out.

Karen Yates: I'm on a listserv for therapists and coaches, and folks are constantly referring out their new clients, basically saying, you know, this person needs someone who has more specialization than I do.

Blake Mackie: I agree with Hannah, that if we're noticing any of our own biases are getting in the way, or just a complete lack of have information, it's the therapist's responsibility to seek that out, and to find someone safe that they can talk through things, so any of those biases aren't showing up in front of the client.

Karen Yates: It's sort of known — I mean, a lot of times people who, say, have a kink lifestyle, find themselves having to educate their therapist, if their therapist is not, you know, kink aware. And I'm assuming that's something you really don't want to have to be doing with your therapist, of like, the education component, correct?

Tom Doctor: Yeah, I think that that's really common with folks of various marginalized identities. I think it's really common anytime that you have a therapist that doesn't share identities with you, you are probably going to, in order to get the care that you want, or if you want to be cared for by someone who is really knowledgeable in that area, there is often a certain amount of like, well fuck, I guess it's on me to educate this person. And that feels gross. I don't love that feeling. And so when I'm supervising someone, or when I'm talking to clinicians, I will often say like, if we are going to ask a client a clarifying question, it should be directed at that client specifically. It should not be, tell me what that practice means generally. So if somebody comes in and says, Oh, I was in this impact scene, and this happened, and that happened, and that happened, I may ask a question about, like, tell me about what is it about impact play for you that you get out of it? I won't be like, why do kinksters want to get hit?

And so, that may be a way that you can do that work in-session with the client specifically, and then afterwards be like, What the fuck is — like, why would anyone want to do this? I don't get it. Let me check my own bias outside of session. And let me talk to colleagues — all the things that Blake and Hannah talked about. But I think, how do we get to the meaning for the client specifically, and then we can build the knowledge base on the back end. So like, if somebody comes in and says, "Oh, I'm queer," I know queer means fucking 1000 things! And so I'm not going to ask the client to explain what queer means for all people. I am going to say, what does that mean to you? Or if somebody says, Oh, I'm in a 24/7 D/s relationship with my nesting partner, I'm going to be like, Okay, tell me about how that relationship affects you. Tell me about the dynamic that y'all are in. Because that is actually a meaningful question about this client that is sitting in the chair right now. So the client is educating the clinician about themselves; they are not educating about community. And so, they are not educating about, here's a thing about kink. There's a, this is a thing about me.

Karen Yates: I love that. I love that. And I want to ask — Blake, some of your work is about gender identity issues, and also family of origin and mental illness in family of origin. And that's right out there in your bio. How important is it for a client to find a therapist that matches as closely as possible their own identity? That could be multiple identities?

Blake Mackie: So of course, everyone's different. I would say most people do prefer to have a therapist that matches some of their more salient identities, especially if they are coming in for challenges related to that identity. But typically, we're not going to find a therapist that matches us completely, or has all the specialties we're looking for. So figuring out, what are our priorities here? What am I really, really looking for in therapy right now? And seeing right who we can find that has that.

Karen Yates: I'll return to the conversation in a moment. Did you know Wild & Sublime has transcripts of all episodes for easy accessibility? Go to wildandsublime.com and click on the transcript link just below each player. As a somatic intimacy coach, I work with couples online and in Chicago, helping them learn how to verbalize erotic desires in the moment, and master skills of sensual cooperation. If you and your partner are looking for ways to more deeply connect with one another and get out of limiting patterns, I can help. Go to karen-yates.com for more information.

I'll now go back to my conversation with Tom Doctor, Hannah Schwartz and Blake Mackie from Best Therapies. In this half, we talk about different types of therapy, when to look for a new therapist, and how to handle your therapist having some of the same identities as you, perhaps being part of the same sexual community. Tom Doctor starts us off on that last topic.

Tom Doctor: There are kind of costs and benefits associated with having similar identities and similar communities in which we move. So obviously, like, on one side, there may be knowledge gaps, or there may be education. So like, if somebody has a different cultural background, different racial background, different — various things that affect our lived experience, like, the positionality of the therapist matters, always. I will also say that there is sometimes — I think I got this from Multiplicity of the Erotic, is a conference. And I heard one of the best quotes I've ever heard about kink-identified clinicians, which is that both clinician and client pay a tax in order to have that relationship. So, if we are in community together, there is obviously confidentiality, and there are things that need to happen in order to maintain confidentiality. And so, it was discussed as like, maybe we are both going to the same kink conference, and we're not going to be in the dungeon at the same time. And so that is a negotiation that we would have, as a piece of our therapeutic relationship. It is a tax that the client pays in order to be in therapeutic relationship with someone that really kind of deeply understands the way that they see the world. And it's a tax that the therapist pays, in order to work with the clients that are really meaningful to work with. And so, there are ways that it can be a challenge to have closer identities, especially when we're talking about, like, sexual minorities. So if I am seeing a client that is a cis gay man, it may be a question like, is this person going to run into their therapist at Steamworks? Because that's a real fucking thing that I'm sure has happened many times. And so, you weigh that balance of, is it worth it to be understood as a gay man, in order to maybe have this really uncomfortable situation? And how do we negotiate that? Because if I have a monogamous vanilla therapist, it's real unlikely that I'm going to run into that person at the dungeon.

Karen Yates: Right? Or if you do, then it becomes a whole different thing.

Tom Doctor: Right, exactly.

Karen Yates: And I'm really glad you brought that up, because I went to a similar workshop a couple of years ago — about, yeah, if you are in a sexual minority, what does it mean if you see your therapist in the room, as it were? You know, and negotiating that, that it does have to be brought up and talked about, and what does it mean? And I'm guessing that this conversation falls on the therapist. It doesn't fall on the client, the broaching of the negotiation?

Tom Doctor: Yeah, I look at it the same way, as I do a dual relationship conversation with every single client, whether we are ever going to be in a space together or not. Because I exist in the world. I buy groceries, I get my hair cut, I leave my house. And so, any of those interactions, I may run into a client. And so I will have the same conversation with everyone,  about, I'm going to pretend I don't know you. If you want to acknowledge me, I will keep it light and polite and keep moving. But I am not going to approach you as you're sitting down with your family at dinner and be like, hey, remember the sexual trauma that we were talking about last week? Like, that is — we have a relationship under these agreements. And that also extends to various other community spaces.

Hannah Schwartz: I'm smiling because I have run into people at the most random places you would suspect to see a therapist. But remember, we are people too. We have lives. We go in and enjoy our lives. But I am also of the same mind frame of, I will not initiate contact first. You are more than welcome to say hi to me, but we're not going to have therapy right there at dinner. Or at the music festival.

Karen Yates: Yeah, I guess that would be kind of a danger, of someone pigeonholing you. "Oh, my God, I'm with this guy. I can't believe it. What do I do?" [laughs] Right?

Hannah Schwartz: We will talk about that in session on Tuesday.

Karen Yates: Right, right? Blake, what do you have to say?

Blake Mackie: Yeah, I agree. It's really on the therapist to set those expectations. And as the client, you can always ask any questions if you're not sure about how things work or what to do in a certain situation. It's not on you to be able to figure that out. It's really up to the therapist to support you there.

Karen Yates: Because as a therapist, HIPAA is our thing. That's not the responsibility of the client.

Okay, explain HIPAA.

Hannah Schwartz: just private confidentiality, all that stuff. Like I'm not I'm going to be live-tweeting my sessions, and all that. But if my client shares with their friend, like, oh my god, I saw my therapist at such and such place. Like, they can say that. I can't go to my friends and be like, you'll never believe who I saw. I forgot what Blake said, but something along the lines of, it's our responsibility to hold space for our client; it's not the responsibility of the client to take care of my needs and my comfort level.

Karen Yates: So one thing I wanted to talk about is, sometimes when you're looking at a bio or a bullet-pointed list of how a therapist approaches therapy, you'll see acronyms, you'll see phrases. And sometimes I have no idea what that means. So I would love for us briefly to talk about some of the current methods that are around, and how they specifically help people. Cognitive Behavioral Therapy, and how they would actually help folks, maybe in areas of sexuality,

Blake Mackie: Yeah, I can start with Cognitive Behavioral Therapy, or CBT, is one of the most common types of therapy that you'll see out there. And the general idea with that is that if we want to change our feelings around something, we kind of have two ways to approach that. Either with our thoughts — that's the cognitive piece — or with our actions, the behavioral piece. So maybe we're not feeling great about our sex life. So we might spend some time thinking about the narrative in our head, the beliefs that we have, and seeing if we can challenge any of those so that we do feel better. Or, again, we might look at some of our actions and see, what are some different coping skills I can use? Or different ways I can connect with people. And that can change how we feel, too.

Hannah Schwartz: Harm reduction. That's my thing. You know, we are going to do what we want to do. But I want to make sure that we're safe about it, and getting the most pleasure and the most safety out of it. Not just the physical safety, but the emotional safety, kind of the aftercare. Is this somebody I trust? Is this somebody that I feel safe with? Harm reduction can be anything from getting vaccinated, wearing a mask, to wearing your seatbelt, to using lube, lots of lube if you don't have a condom available. It could also be just talking to your partner about what you feel safe doing and what you don't feel safe doing.

Tom Doctor: I can talk a little bit about TBT, or ACT, third wave behaviorism, which is a lot about mindfulness and attention. S,o let's say that somebody struggles with, well, I have anxiety, and sex. So what we would do there is, how do we attend to what's happening? So, stay grounded in our body, feel all of our self, and be able to recognize anxiety is going to happen. And when anxiety happens, we can tolerate that and it can move through us. That anxiety does not need to control us. And so we can have anxiety, be present, and we'll let it sit in the passenger seat while I'm driving. So there's way more that goes into third-wave behaviorism. There's like, millions of skills we can do to manage the anxiety. There are a ton of other things. But generally speaking, the idea is that, how do we let distress not steer the ship? And instead build more intentionality and more active ability to do the things that we want to do.

Karen Yates: We then went on to talk about methods outside of standard talk therapy.

Tom Doctor: There are a lot of ways that talk therapy can dig into meanings of things. They can dig into a lot of the kind of like, underlying mental health-type symptoms that are associated with sexual issues. And often, there may be physiological things going on; there may be a whole host of other areas that need to be addressed as well. And so that can look like pelvic floor physical therapy. That can look like hormones; that can look like a whole wide variety of medications and things like that. It can also look like being in community is a type — like, it is so often that I will see people that come in with such great shame as their main presenting issue. And what they really need is not to sit alone in a room with one other person. What they need is to be held by community. And so, community is a type of treatment in my mind. And so there's sort of this, like, predominant white medical model of talk therapy that, like, we go alone into a quiet room, and we sit with just the two of us, and that's how you get to tell your deepest, darkest secrets. And often, it is actually in very non-white, non-medicalized settings that the most healing happens.

Hannah Schwartz: One of my favorite quotes comes from Dr. Judith Herman. She wrote the book "Trauma and Recovery," that's one of my favorite personal favorite books, both as a clinician, but also as a trauma survivor myself. She says that healing takes place in community. And it really does. You don't have to heal alone. You don't have to do it alone. You don't have to face it alone.

Karen Yates: It's so interesting, because today is my 34th sober anniversary. So like, I'm just sort of thinking about, like, community, and the aspect of community that enabled me to do that. Because you're right — healing does not happen in a room with one other person. I mean, like, we have therapists, and they can be immensely life changing in our journey. But yeah, to be held by a group of people is really something.

Blake Mackie: I think it's a great question, to not limit ourselves to just talk therapy. That there are somatic therapists and other somatic workers that are focusing more on the body and how that affects the way we feel, rather than starting with our thoughts. There's also different types of coaches. And I think, right, to not leave out physical health and medical professionals, because sometimes things are over medicalized. So we don't want to go too far that way. But there are a lot of resources that can be helpful to address physical health problems that may affect our sexuality to address our mental health potentially through medication, if that's the right fit for us. So to make sure, right, we're really looking at all of our options.

Tom Doctor: Yeah, often also, like early in talk therapy, or if I see a couple that is coming in and wants to talk about sex, we'll talk about before we get there is, what does pleasure look like? Like, non-sexual pleasure? That is a question that I ask all the time. Often, that means do some investigation that has nothing to do with therapy. What does play look like for you? Often, that means not sitting alone with one other person in a room, having a conversation about emotions. So doing those type of investigations, I think, can be as therapeutic if not more therapeutic than a lot of individual one on one sessions. And so thinking about, how do we diversify healing? Or how do we diversify support, beyond just one person? Because you can't rely on, "Well, I go to therapy once a week, so therefore I'm going to be all better now." It's a lot more than that. And there's a lot more diversity in interventions that you can be doing.

Karen Yates: One thing I'm really interested in hearing is, like, let's say you've invested some time with a therapist, right? And now you've broached the subject of sex, or maybe you haven't. But is it valuable at any point to leave the therapeutic relationship and search for another therapist?

Hannah Schwartz: I think Tom has said something earlier of like, the question, "Am I getting anything out of this relationship or this experience?" Some people are with a therapist for years, decades, a lifetime. And that's wonderful. But if you don't feel like therapy's serving a purpose in your life, or you're feeling like a broken record, and there's no real movement, one, I encourage you — I'm speaking from my own experience; I love feedback from my clients. So you know, you can ask your therapist, it's your treatment, where are we going? What should I be getting out of this? What are we really working on right now? And if you don't feel comfortable with their answer, it's okay to fire your therapist and look for someone else. Your job as the client is not to make sure that the therapist can afford their rent and pay their bills. Your job is not to hold that space for that therapist. We're trained to deal with that stuff. I work with a lot of folks who I call therapy refugees, where they came from a not-so-great therapeutic relationship. And I enjoy those folks. Because I'm like, What do you want me to do? How do you want this space to be held? What are you hoping to get out of this experience? Because it's all about you.

Karen Yates: Yeah.

Tom Doctor: I will say that, like so many things, I encourage self reflection first. And so from this, I will think about – a therapeutic relationship is one type of relationship. And think about the other types of relationships in your life. Are you a person that goes on three dates, and then  is like, "Fuck this person. They're not doing what I want them to do, so I'm out of here." Are you someone that gets in five year long relationships where you know three months in, "I am miserable here, and this isn't meeting my needs." And then you stay. I think a therapeutic relationship can be an opportunity to have some healing from those patterns that you've experienced in your life. And so, if you are of the variety that has treated relationships as disposable in the past, that doesn't mean that you're not going to have a bad match. That doesn't mean that it isn't eventually very good to move on to a different therapist. But I may reflect on the immediate urge to drop this person, and think about, is this about the therapeutic work that I'm getting? Or is this about my discomfort with attending to the relationship, or getting close, or getting deep, or whatever? Is that why I'm feeling a want to push away? Or in the other case, am I staying? Because this is the person that has always been here, that's just comfortable? And like, yeah, I'm not getting my needs met. But like, this way, I don't have to find another therapist, and I don't have to have the conflict of breaking up with this person. Then that may be a case where we really do some more introspection around, like, what do you actually need out of therapy, and how do we center it more on you? Because that's the beauty of a therapeutic relationship, is that it gets to be entirely centered on the client. And you really get to reflect on, is this serving me? In a way that I think often other relationships in our life don't get to be so sort of person-centered, or so self centered in that way. And so, thinking about like, yes, is the work that we're doing good together — but is the relationship also serving me?

Blake Mackie: Yeah, I think it's really important to remember that our therapists work for us. That I think sometimes when we see a therapist or a medical provider, we almost treat them like they're our supervisor that we have to please, or there's some instinct there, but to remember, right, we're paying our therapists to come in and talk with us. So to keep that in mind, that it's not our job to please them or make them comfortable. And that as a client, we can steer the ship and really ask for what we want and direct the conversations.

Karen Yates: Great. Thank you, Blake Mackie, Hannah Schwartz, and Tom Doctor. Really appreciate this conversation. For more information on Hannah, Blake and Tom and Best Therapies, go to the show notes. Wild & Sublime is supported in part by our Sublime Supporter, Full Color Life Therapy, therapy for all of you at fullcolorlifetherapy.com.

Well, that's it folks. Have a very pleasurable week. Thank you for listening. If you know someone who might be interested in this episode, send it to them. Do you like what you heard? Then give us a nice review on your podcast app. You can follow us on social media @wildandsublime and sign up for newsletters at wildandsublime.com. I'd like to thank associate producer Julia Williams and design guru Jean-Francois Gervais. Theme Music by David Ben-Porat. This episode was edited by The Creative Imposter studios. Our media sponsor is Rebellious Magazine, feminist media, at rebelliousmagazine.com.