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70 Spring 2016 Independent Practitioner
Mulcultural and Diversity
The need for psychotherapists to be edu-
cated about, and mindful of, diversity and
multiculturalism has been hammered home
with such force that the message risks becom-
ing cliché. The ubiquitous acceptance of this
imperative may ironically lead to complacency
and a reduction in the rigorous considerations
our own assumptions and biases. Sexuality-re-
lated issues may be particularly vulnerable to
this danger due to the lack of training many
psychologists have in such topics, as well as the
discomfort many clinicians face in discussing
them. In addition, although sexual orientation
has become an established domain of multi-
culturalism, sexual and relational diversity
extends far beyond sexual orientation and into
a wide variety of practices, identities, and spec-
trums. Even multiculturally-minded clinicians
may therefore fail to see such emergent sexual
and relational expressions as aspects of diversi-
ty, increasing the risk that one’s personal biases
or cultural values may be unwittingly imposed
on clients. In an eort to reduce this risk, the
present article will discuss how clinicians can
utilize sex-positivity as a conceptual frame-
work to work eectively and armatively with
sexually diverse clients of all types.
Sex-Posivity
Sex-positivity is an open-minded, non-judg-
mental approach to sexuality with roots in
humanistic and feminist discourses, particular-
ly the works of Wilhelm Reich (1951) and Carol
Queen (1997). Operating from an underlying
premise that sexual pleasure and diversity are
healthy, a sex-positive approach expects and
appreciates a wide variety of consensual sexual
(and relational) practices, and emphasizes the
pleasurable and creative aspects of sexuality
(Williams, Prior, & Wegner, 2013). This could
be contrasted with a sex-negative approach
which presumes that sex is “inherently bad,” a
belief which sexuality educator Charlie Glick-
man has called “one of our most deeply rooted
convictions”
(Glickman,
2000, p. 1). A
sex-negative
society, as
many would
argue ours is,
encourages
“sexual as-
ceticism” and
views sex
as “particu-
larly risky,
problematic,
or perhaps
adversarial”
(Williams
et al., 2013,
p. 273). An illustrative example of this phe-
nomena could be Americans’ tendency to judge
sexual risks, and those who take them, much
more harshly than other objectively riskier
health-related behaviors (Conley, Moors, Mat-
sick, & Ziegler, 2015).
Perhaps most importantly for clinicians,
sex-positivity rejects ideas of normality and
deviance in the context of sex, and instead
focuses on individual perspectives and layers
of cultural context. This stance stems from a
broad perspective of human sexuality which
emphasizes a “sensitive, ’trans-cultural’” view-
point that acknowledges the “socio-political
and value-based” variations in sexual diversity
throughout the world (Popovic, 2006, p. 171).
Unfortunately, unlike other largely cultural-
ly-bound aspects of behavior such as commu-
nication, child-rearing, and spiritual beliefs,
Using Sex-Posivity to Arm Clients’ Sexual and Relaonal
Diversity
Ryan G. Witherspoon
Independent Practitioner Spring 2016 71
few clinicians have been encouraged to view
sexual and relational practices through such
a multicultural lens. Therefore, culturally-en-
capsulated conceptions of what constitutes
“normal” or “healthy” sexual practices are more
likely to subtly pervade perceptions of clients.
Clinicians may unwittingly gauge the relative
health or merit of a client’s sexual or relational
activities by their deviance from implicit, often
unexamined, beliefs about sexuality that the
clinician holds. Practitioners whose own sexual
beliefs contrast sharply with those of their cli-
ents may therefore be at risk of unconsciously
enacting microaggressions, or worse (Kolmes &
Witherspoon, 2012).
Addressing Sexual Diversity
The challenge of addressing sexual diversity
from a multicultural mindset is compounded
by the fact that sexuality represents a serious
gap in psychologist’s training. Most psychol-
ogists receive very little, if any, education and
experience in sexuality-specic topics during
graduate school and formal clinical training
(Miller & Byers, 2010). Such training is crucial
for enhancing clinicians’ comfort and willing-
ness to address sexual issues (Miller & Byers,
2009, 2010), and without it many psychol-
ogists may rarely (or even never) ask clients
about sex (Reissing & Di Giulio, 2010). This is
particularly worrisome considering the stag-
gering lifetime prevalence estimates for sexual
diculties, such as 43% for women and 31%
for men in one representative national sample
(Laumann, Paik, & Rosen, 1999).
Examining sexuality only through the lens of
sexual challenges or problems faced by clients
represents only one facet of its clinical impor-
tance. Sexuality also comprises an enormous
aspect of many people’s sense of identity. This
is certainly true for those with minority sexual
orientations, but sexual diversity expands far
beyond orientation to cover a huge variety of
sexual practices, subcultures, and identities.
Examples include sexual fetishes, emergent
identities such as asexual (i.e., no sexual feel-
ings or desires towards anyone), pansexual (i.e.,
attraction across sex, gender, and gender iden-
tity spectrums), and demisexual (i.e., requiring
strong emotional connection and trust to expe-
rience attraction), kink/BDSM, and more. Fur-
thermore, sexual diversity can also encompass
relational diversity, which refers to the wide
variety of romantic or intimate relationship
practices and identities clients may present
with, such as consensually non-monogamous
(CNM) relationships like polyamory or swing-
ing, part or full-time dominant/submissive
(D/s) relationships, and others.
It would obviously be unrealistic to expect
clinicians to become conversant in the full
spectrum of human sexual and relational ex-
pressions. Fortunately, adopting a sex-positive
approach largely negates this requirement by
focusing less on developing an encyclopedic
knowledge base and more on cultivating an
open and accepting attitude about sex.
Developing Your Sex-Posivity
Many psychologists may be familiar with their
gender, racial, or other biases but less cogni-
zant of their sexual biases. In an eort to help
interested readers expand their awareness, the
following questions could be considered as
starting points for personal exploration. Ideal-
ly, questions such as these might be discussed
with trusted colleagues or shared in peer con-
sultation groups, however clinicians may also
benet from journaling about these questions
privately.
»What dierentiates healthy romantic and/
or sexual relationships from unhealthy
ones?
»What sexual or relational practice would
you be most upset to nd that a partner of
yours endorses or desires? What about a
child of yours?
»What, if anything, is “wrong” with con-
sensual non-monogamy (e.g., polyamory,
swinging)? What beliefs, traditions, or
values does it challenge?
»Have your views or comfort levels regard-
ing any LGBTQ population(s) changed over
the years? What else might or might not
change?
A follow-up to each question would be: why?
When considering these questions, pay partic-
ular attention to the responses which seem to
72 Spring 2016 Independent Practitioner
come automatically or forcefully, as these may
indicate particularly strong internalized beliefs.
Sex-positivity seeks not the complete purg-
ing of one’s beliefs and attitudes, but merely
a greater awareness of them and the myriad
personal, cultural, and familial factors which
fostered them, in order to mitigate the risk that
such biases may unconsciously inuence the
treatment of clients.
Building one’s knowledge and comfort levels
around sexuality is also a crucial element of
sex-positivity, particularly regarding those
practices and populations which generate the
strongest biases or negative feelings. Consid-
er non-traditional ways to learn more about a
particular sexual or relational practice or subcul-
ture. For example, this author’s local county psy-
chological association has sponsored education-
al visits to professional BDSM dungeons. Many
large cities oer classes on topics such as kink or
CNM, and some cities host sexuality-focused ed-
ucation institutes, such as San Francisco Sex In-
formation (http://sfsi.org). Clinicians could also
consider consulting with community leaders or
educators (e.g., authors of popular culture books
on CNM), or professionals from outside elds
such as sexology. Finally, the internet oers a
limitless pool of research possibilities about any
element of sexual diversity via resources such
as Youtube videos, Facebook groups, and large
community sites such as Reddit (http://reddit.
com) or Fetlife (http://fetlife.com).
Sex-Posivity in Acon
Fostering a more sex-positive perspective lays
the groundwork to avoid inadvertently stigma-
tizing or harming sexually diverse clients, as
well as facilitating sex-positive interventions.
Below are some potential avenues through
which psychologists could utilize sex-positivity
to inform their work with clients, using kink
and polyamory as illustrative examples.
Idenfy and Support Sexuality-Based
Strengths
Sex-negativity often encourages us to react to
sexuality-related topics outside of our com-
fort zone by immediately examining the risks,
drawbacks, and dierences involved, rather than
considering potential strengths or benets. For
example, research has found that polyamory
may foster improvements in communication
skills, emotional intelligence, and adaptability
(She, 2014). Similarly, engaging in kink can
often help enhance boundary setting and man-
agement, sexual self-advocacy, creativity, and
trust building (Kleinplatz, 2006). Researchers
have recently begun advocating for a strengths-
based approach to sexual orientation, arguing
that LGBTQ identity formation, community
values, and character strengths can all be mined
for unique sources of resilience and growth
(Vaughan & Rodriguez, 2014). A similar ap-
proach can work with other sexual and relation-
al minorities, so long as clinicians remember
to ask themselves what attributes, benets, or
strengths a client’s sexuality may potentiate for
them.
Remain Open to Opportunies for Healing
In addition to sources of strength, aspects of
sexual diversity can sometimes open the door
to healing experiences for clients. For example,
a female client with a past history of domestic
violence victimization may nd that exploring
kink with her new partner allows her the op-
portunity to practice setting physical and sex-
ual boundaries, and having them be respected,
within a safe container of consent and negoti-
ation. Some people have found that navigating
CNM relationships helps them confront and heal
issues of trust and self-worth brought about by
past indelities or other relational wounds. Of
course, not all situations will lend themselves to
these sorts of healing narratives, but clinicians
who remain open-minded may nd that alterna-
tive sexualities aord unexpected opportunities
for reparative experiences.
Help Sexually Diverse Clients Self-Advocate
As with LGBTQ populations, many clients with
minority sexual or relational identities face
signicant stigmatization, minority stress, and
decits in familial or social support. Some may
have suered prejudicial treatment by other
mental health professionals. Accordingly, they
may be reticent to divulge these aspects of self
to a clinician, or may disclose abruptly early-on
as a test. The pervasive sex-negativity of so-
Independent Practitioner Spring 2016 73
ciety may be internalized by sexually diverse
clients, and clinicians can serve as crucial allies
by helping clients explore these inuences
and identify sources of resilience against their
harmful eects. A sex-positive psychologist
can also support sexually diverse clients by fa-
cilitating connections to communities of their
peers. Just as importantly, sex-positivity rec-
ognizes that sexually diverse clients may (and
likely usually do) seek therapy for unrelated
reasons, and that unduly focusing on a client’s
sexuality may be experienced as invalidating
(Kolmes & Witherspoon, 2012).
Conclusion
The prevalence of sexual concerns in psycho-
therapy and the importance of sexuality to
many people’s sense of identity has led some
to argue that sexuality should be considered
a cross-cutting competency, in contrast to the
widespread perception of sexuality as a special-
ty within psychological practice (Reissing & Di
Giulio, 2010). The lack of formal training in
sexuality leaves most psychologists ill-prepared
to meet this need. Sex-positivity oers a useful
tool to address this issue by helping clinicians
become more aware of their own biases and
assumptions, increasing their comfort with
sexual topics, and setting the stage for creative
and armative interventions.
References
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(2015). Sexuality-related risks are judged more
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Glickman, C. (2000). The language of sex positivity.
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Ryan G. Witherspoon, M.A. is a Ph.D. student at
the California School of Professional Psychology at
Alliant Internaonal University in Los Angeles. He
publishes and presents on topics including relaon-
al diversity, alternave sexualies, sex-posivity,
and mindfulness. Ryan’s current research focuses
on the intersecons of consensual non-monogamy
with sgma, minority stress, and resilience.
