Putting Clients At Ease With Sensitive Topics

A lot of my clients come to me specifically to work on sex-related issues. Nonetheless, I find that even those clients are often quite uncomfortable talking about their sex lives.

That’s perfectly understandable. Most people were taught not to talk about sex openly–not even with lovers, in some cases, let alone strangers or therapists. Because of this, lots of people don’t have comfortable or accurate language to discuss sex, and some don’t know enough about sex to be specific about what is going on when things go amiss.

At the same time, I am a much more effective helper when my clients are comfortable enough to share unreservedly.

I’ve developed a few strategies that help put my clients at ease when talking about sensitive topics, including but not limited to sex. Whether or not you frequently work with sex issues in your practice, these tips may come in handy with clients who struggle to discuss topics that are sensitive, emotionally charged, and/or somewhat taboo.

• Remind clients that you’re comfortable. Often, a client’s discomfort comes from a fear of freaking you out or putting you off. I see this all the time, even when the thing they’re afraid of sharing is far from freaky! I can’t tell you how many clients have told me that they were too afraid of being judged by their previous therapists to bring up the topic of sex. That, to me, implies that you need to be proactive. Reassure your clients that you want to hear whatever they have to tell you, or else they are likely to assume otherwise. Personally, I like to tell my clients that I’ve pretty much heard it all, and that they’d have to work pretty hard to shock me. That might be more true for me than it is for you. But even if you think your client MIGHT tell you something that could shock you, get clear in your mind why it is important for you to create a safe space for honest disclosure, and don’t make a big fuss. Probably you will hear things that are very easy for you to hear, but in case you hear something that rocks you a little, control your facial expressions, stay calm and normalize (or at least remain neutral and don’t pathologize). Get some consultation or supervision if you need to (certainly before deciding there is a problem). If you can tell you’re way out of your depth, you can always refer the client to a certified sex therapist.
• Focus on the process, not the content. This is one of the most useful strategies in my toolkit. Focussing on process–by which I mean how an interaction plays out, and how both participants feel about it, rather than what specific activity is involved–keeps clients from feeling pathologized, while also keeping therapists from getting overly unsettled by uncomfortable explicit information. It also means that often clients can share just as much as they’re comfortable with, telling you everything you need to know about a sexual interaction, without going into details that feel too personal.
• Ask permission before asking a question about specifics. Although focussing on process rather than content means that I let clients determine how much they’re comfortable sharing, sometimes I need to know something really specific in order to understand an interaction or figure out what the problem is. In those instances, it helps to gain consent for the deeper conversation, and explain why I need the information. I might say something like, “Would it be ok with you if I ask you some very specific detailed questions about this? This is a situation where some specific information will help me figure out what is going on, and then I’ll be more likely to be able to help”. Once in a while, a client is quite reserved and says they don’t feel comfortable. I always let them know that is fine with me. We can continue in vague terms, and focus on process, and probably make some good progress. However, this doesn’t stop me from gently inviting deeper or more specific disclosures, never with any pressure. My comfort with the topic, combined with this absolute permission not to tell me anything they don’t want to reveal, often ends up making my client comfortable enough to open up.