Handbook for Human Sexuality Counseling E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Veröffentlichungsjahr: 2022

Beschreibung

Sexuality is a significant part of the human experience, yet it is often a neglected topic in both counselor training and the counseling process. In this preeminent guide, expert clinicians with a variety of mental health and medical backgrounds write on diverse issues related to sexuality through a radical acceptance lens. Each chapter illustrates an affirmative and expansive approach to sexuality that consider's clients' sexual an cultural idetntities and emphasizes sexual wellness. Students and professionals alike will learn how to respectfully and ethically approach sexuality considerations not commonly mentioned in the profesioonal literature, such as sexuality and disability, healing after sexual violence, older adult sexuality, the impact of chronic illness on sexual expression, and paraphilias.

The text is organized around eight comprehensive parts- Foundations; Physiological and Psychological; Attraction, Orientation, and Gender; Sexual Wellness; Sexual Agency; Approaches to Sexual Divergence; Relationships; and Education- with case examples, "Questions You Always Wanted to Ask," and additional resources interwoven throughout.

Leseprobe

Table of Contents

Cover

Title Page

Copyright Page

Dedication Page

Preface

Henry’s Voice

Angela Schubert’s Voice

Why We Created This Book

Sex Positive Counseling

Chapter Highlights

References

About the Editors

About the Contributors

PART 1: Foundations

CHAPTER 1: Ain’t No Shame in This Game

Counselor Education and Training

Counselor Comfort With Sexual Issues

Sexual Issues

Sexual Wellness

A Sex Positive Framework to Sexual Wellness Counseling

Conclusion

Case Example

Questions You Always Wanted to Ask

References

CHAPTER 2: Adam and Eve/Steve/Pat and the History of Sexual Behavior

First

Animals as Analogues

Ancient Philosophical and Religious Contributions

Sex and the Scientific Method

Politics of Sexual Deviance to Sexual Difference

From Disease to Difference

Conclusion

References

CHAPTER 3: Nonmaleficence

Ethics of Sex Positivity

Boundary and Relationship Considerations

Scope of Practice

Research Ethics

Case Example

Conclusion

References

PART 2: Physiological and Psychological

CHAPTER 4: The Physiology of Sex

Biology 101, or Some Caveats Regarding Oversimplification

Talking About Sexual Dysfunction: Nomenclature

Lines and Circles: Diagramming Sexual Response

Conclusion

Questions You Always Wanted to Ask

References

CHAPTER 5: The Role of the Brain in Sex and Desire

The Brain in a Nutshell

What Happens in the Brain During Sex?

A Step-by-Step Guide

Brain Plasticity and Sexual Learning

Conclusion

References

CHAPTER 6: The Big Bang? The Role of Orgasm

Addressing Orgasm in Counseling

Defining Orgasm

Sex Positive Approach to Barriers to Orgasm

Treatment Approach and Practice With Barriers to Orgasm

Conclusion

Questions You Always Wanted to Ask

References

CHAPTER 7: It’s Not All in Your Head, But It’s Pretty Close: Those Damn Societal Messages

Socially Constructed Sexuality

Sexual Scripts

Culturally Informed Sex Positive Approach

Case Example: Seth and Magaly

Suggested Practices

Conclusion

References

PART 3: Attraction, Orientation, and Gender

CHAPTER 8: The Multidimensional Nature of Attraction

What Is Attraction? Unpacking Common Myths

Context in Attraction

Exploring Attraction in Clinical Practice

Case Example: Jack

Conclusion

Questions You Always Wanted to Ask

References

CHAPTER 9: Sexual Orientation and Identity: Let Me Be Perfectly Queer

What Is Sexual Orientation?

What Is Sexual Identity?

Case Example: Ryu

Conclusion

References

CHAPTER 10: Exploring Sex and Gender Diversity

Historical Perspectives

Waves of Gender Identity

Gender Markers and Pronouns

Why Is the T With LGB?

Intersex People

Trans People of Color

Standards and Guidelines

Conclusion

References

PART 4: Sexual Wellness

CHAPTER 11: Masturbation, Vibration, and Lube— Oh My!

Brief History of Masturbation

Debunking Myths Around Masturbation

Approaches to Masturbation

Sex Positive Approach to Masturbation

Conclusion

Case Example

Questions You Always Wanted to Ask

Resources

References

CHAPTER 12: They Hurt Me and I Didn’t Ask Them To: Healing After Sexual Violence

Therapeutic Techniques

Case Example Using the Sexual Violence ALERT Points

Conclusion

References

CHAPTER 13: I Still Yearn for Connection: Illness and Chronic Pain

Chronic Disease and Illness

Caregiving

Theoretical Framework(s)

Interventions

Success Outcomes

Transference and Countertransference Issues

Multicultural Issues

Crisis Issues

A Sex Positive Approach

Case Example

Practice Issues for Approaching the Topic With Clients

Practice Issues for Advocating for a Sex Positive Environment

Questions You Always Wanted to Ask

References

CHAPTER 14: Healthy While Sexual: Preventing and Living With Sexually Transmitted Infections

STIs: Nomenclature and Trends

HIV Basics

HIV Prevention and Treatment

Communicating About Sex, Sexuality, and STIs

Case Example: Christian and Felicia

Conclusion

Questions You Always Wanted to Ask

References

PART 5: Sexual Agency

CHAPTER 15: “Yes, We Can and We Will!” Sexuality in Later Life

Barriers and Solutions

Dignity and Pleasure

Reframing the Script

Case Example

Conclusion

Questions You Always Wanted to Ask

References

CHAPTER 16: The Queer Crip

The Literature

What Can Be Done: Disability Justice/Crip Culture Speaks

Affirming Therapies

Case Example

Inclusive Spaces

Partner Surrogacy: What Is It? How Does It Work? When Should You Refer? Is It Legal?

Conclusion

Questions You Always Wanted to Ask

References

CHAPTER 17: Embracing Our Sex, Race, and Ethnicity

Voices of Black Girl Magicians

Final Thoughts of Stereotyping and the Black Female Experience

Case Example

Conclusion: Blooming Into the Light

Questions You Always Wanted to Ask

References

CHAPTER 18: You Want Me to Feel Ashamed? The Influence of Religion on Sexuality

Defining Religion

Shame, Sexual Shame, and Religious Sexual Shame

Religious Traditions and How They Shape Beliefs and Understandings of Sexuality

Case Example: Erin and Don

Questions You Always Wanted to Ask

References

PART 6: Approaches to Sexual Divergence

CHAPTER 19: Beyond Awareness: Becoming a Kink-Affirming Counselor

A Cultural View of Kink

Ethics of Kink and BDSM

Kink and Mental Health

Distinguishing BDSM From Abuse

Becoming a Kink-Affirming Counselor

Conclusion

Questions You Always Wanted to Ask

References

CHAPTER 20: You Want to Do What? Treating Paraphilic Disorders Through a Sex Positive Framework

DSM-5

Approach to Paraphilias

Voyeuristic Disorder

Exhibitionistic Disorder

Frotteuristic Disorder

Sexual Masochism Disorder

Sexual Sadism Disorder

Pedophilic Disorder

Fetishistic Disorder

Transvestic Disorder

Conclusion

Case Example

Questions You Always Wanted to Ask

References

CHAPTER 21: You Can Have Too Much Sex? The Line Between Sexual Expression and Addiction

The Neuroscience of Pleasure

Nosological Classification Constraints

Clinical Considerations

Other Perspectives

The Intersection of Sexuality and Substance Addiction

Case Example

Final Remarks

Questions You Always Wanted to Ask

References

PART 7: Relationships

CHAPTER 22: Sex and Love: What’s Love Got to Do With It?

Evolution of Connecting

Let’s Talk About Sex, Baby

Counselor Values Around OSA

Therapeutic Use of Cyber Activities

Is Your 3 O’Clock “The One”?

Case Example

Conclusion

References

CHAPTER 23: Flipping the Scarlet Letter: A New Approach to Infidelity

Counseling Theories and Research

Infidelity Defined

Preparing for Infidelity Work

Three Phases of Healing

Case Example

Questions You Always Wanted to Ask

References

PART 8: Education

CHAPTER 24: Adolescents Do It Too! Sex Education in America

Opposing Viewpoints: Morality Versus Science

Comparison of AOSE and CSE

References

CHAPTER 25: Human Sexuality Is Not an Elective: Why Sexuality Education in Counseling Is an Ethical Imperative

Professional Standards and Code of Ethics

Call to the Profession: An Ethical Imperative

Introduction of the Authors

Challenges With Sexuality Training in the Field and the Classroom

Counseling Profession Positioned as a Leader in Human Sexuality

Counseling Sexuality Pedagogy

Sex Positive Approach

Postmodern Feminist Approach

Developing a Brave Environment and Maintaining Confidentiality

Conclusion

References

APPENDIX 25.A

Sexual Scripts

Biological Sex/Gender/Gender Expression/Gender Roles

Sexual Orientation

Sexual Behavior

Index

End User License Agreement

List of Tables

Chapter 1

Table 1.1 Intersectional Factors and Client Concerns Related to Sexuality

Chapter 3

Table 3.1 How the American Counseling Association’s (ACA, 2014)

ACA Code of

...

Chapter 4

Table 4.1 Evolution of Sexual Diagnoses Since 1994—Female

Table 4.2 Evolution of Sexual Diagnoses Since 1994—Male

Chapter 10

Table 10.1 Terms for Transgender People Among Cultures

Table 10.2 Pronoun Usage

Table 10.3 Intersex Conditions

Table 10.4 Proportion of U.S. Transgender Population (2014–2015) by Race or ...

Chapter 14

Table 14.1 Sexually Transmitted Infections (STIs) at a Glance

Chapter 20

Table 20.1 Examples of Transvestic Motivations Across the Circles of Sexuali...

Chapter 21

Table 21.1 The Sexual Addiction Model (SAM) Compared Against the Clinical Se...

Chapter 22

Table 22.1 Summary of Online Mingling Applications and Cyber Dating Sites

List of Illustrations

Chapter 1

Figure 1.1 Radically Informed Sex Positive Framework

Chapter 3

Figure 3.1 Rubin’s (1980) Charmed Circle

Figure 3.2 Knowledge-Based Decision-Making Matrix

Chapter 4

Figure 4.1 Cyclic Model of Sexual Physiology

Figure 4.2 Neurologic Pathways

Figure 4.3 Sexual Tipping Point®: A Biomedical-Psychosocial and Cultural Model ...

Figure 4.4 Neurotransmitters in Sexual Response

Figure 4.5 Comparison of Arousal Physiology

Chapter 5

Figure 5.1 Medial View of the Brain Showing Location of Brain Structures

Figure 5.2 Topographical View of the Brain Showing the Lobes of the Cerebrum ...

Figure 5.3 The Nerve Cell

Guide

Title Page

Copyright Page

Dedication Page

Preface

About the Editors

About the Contributors

Table of Contents

Begin Reading

Index

Wiley End User License Agreement

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HANDBOOK FOR Human Sexuality COUNSELING

A Sex Positive Approach

edited by

Angela M. SchubertMark Pope

American Counseling Association2461 Eisenhower Avenue, Suite 300 • Alexandria, VA 22331www.counseling.org

Copyright © 2023 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.

American Counseling Association2461 Eisenhower Avenue, Suite 300Alexandria, VA 22331

Publisher • Carolyn C. Baker

Digital and Print Development Editor • Nancy Driver

Senior Production Manager • Bonny E. Gaston

Cover and text design by Bonny E. Gaston

Library of Congress Cataloging-in-Publication Data

Names: Schubert, Angela M., editor. | Pope, Mark, 1952– editor.Title: Handbook for human sexuality counseling : a sex positive approach / edited by Angela M. Schubert and Mark Pope.Description: Alexandria, VA : American Counseling Association, [2022] | Includes bibliographical references and indexIdentifiers: LCCN 2022020487 | ISBN 9781556203985 (paperback)Subjects: LCSH: Sex counseling.Classification: LCC HQ60.5 .H36 2022 | DDC 306.76—dc23/eng/20220604LC record available at https://lccn.loc.gov/2022020487

Dedication

Thank you to my mama, friends, and dear mentors for all your support.And a very special thank you to my wildlings and lovies forteaching me the greatest lesson of all—to love with courage and an open heart.

—Angela M. Schubert

Preface

To set the tone of this book, we wish to share a clinical vignette to demonstrate the power of a sex positive approach. To do so, coauthor and coeditor Dr. Angela Schubert asked permission from her client to share his personal perspective of what brought him to counseling and the poem that was birthed from the ashes of his personal sexual script—one that was informed by religion, disability, identity loss, and the internal conflict that occurred as each of those aspects challenged the very essence of his sexual being. We give you Henry, in his own words.

Henry’s Voice

One of the main reasons I finally went to therapy was because I felt I had no identity. I was no longer in high school, no longer defined by school pride or religion, or by the characters I had been inhabiting during high school as a means of survival. I felt like a gray blob: unnamed, uncharacterized, unworthy. I hoped I had identities in me; I certainly had questions about what identities I could claim and what claiming an identity meant. I started with what felt most pressing and uncomfortable: disability. I live with epidermolysis bullosa, a genetic skin condition that causes my skin to be as fragile as a butterfly’s wings. I have always lived as a disabled person, but only through therapy was I able to comfortably claim and identify as disabled. This poem tackles the intersectionality of disability and sex. It tells my story of how I grappled with sex as a disabled person raised in a Catholic school system that taught purity culture and denied the questions I had about my own human desire. A denial that ultimately pushed me to pornography as an alternative sex educator. Pornography is, of course, a shit teacher and only heightened my anxieties and worries that manifested over the years. Therapy has been tremendously helpful because it provides the space and safety to explore, unlearn, and craft identities. Self-love has been one of the constant areas of exploration for me to unlearn self-hatred, to challenge incorrect ideas, and, most importantly, to grow and craft and claim the identities I want to live.

My One RegretHenry DeAngelis

I audibly chokedSwallowing the hopeless tasteOf purity culture.“No, I don’t have any questions.”

My one regret.My one moment I cannot forget.The beginning of my emotional debt.

Fuck purity culture.Fuck it until it restores to meWhat should have always been mine:A curious exploration of my body.My sexuality.My sexiness.

Oh yes.Fuck purity culture.Fuck it until it lets me ask those questions again.Fuck it until it has a better answer than“you shouldn’t be thinking about it.” (nasally)

Purity culture pushed me away.Purity culture threatened toTell my parentsAll my embarrassing questionsThreatened to shame me for wondering how sex worked with disability.Shame me for wondering how I could be loved, when I was taught not to love myself;

Wondering how I could be desired, when I was taught disabled people wereUndesirables.

Wondering how my crip hands could unclasp a button or bra.

How my tied tongue could french kiss,How my coarse hands could soothe,And stumpy fingers pleasure, And fragile skin be touched.

Or even how to open the heavy door at the restaurantOr have my date be seen as my date and not my nurseOr have my date not pity meAnd people not call my date a hero for going out with me

These are the questions purity culture pushed down my throat

to the very bottom of my stomachFrom there it jumped up to my mind

And scolded me for wondering about my own human desireAnd before it leftIt whispered one final thing into my ear

Shame.

Shame for thinking about sex.Shame for thinking about one day having children.Shame for not being the asexual person purity culture believes I should be.

And with that purity’s damage was wroughtAnd it left me content with its knowledgeThat I would forever shame myselfFor my own human desire.

My one regret.My one moment I can’t forget.The beginning of my emotional debt.

As in that moment,Purity.Pushed.Me. To.Pornography.

Angela Schubert’s Voice

Henry was fearless in his pursuit to find his own truth and narrate his own story. His story and reliance on sexually explicit material, also known as pornography, for sex education is not unique to Henry. Considering the utter void of comprehensive sex education across all social fronts, it is no wonder sexually explicit materials have become the sex educator for all who are interested. This is not to say that sexually explicit material is to blame for existing and thriving as the default sex educator, but rather that the finger is pointed at the gap that allows sexually explicit material to be the default educator in people’s lives.

Henry chose counseling as a means to explore his own path as a sexual being with desires and needs, to challenge his own assumptions and biases, and to redefine his own sexual script. Henry took the path toward awareness, acceptance, and self-love, and I humbly held the lantern to shine a light on the path. My foundation as a counselor educator and sex therapist is rooted in the firm belief that everyone is deserving of their sexual story, and everyone is capable of narrating their own sexual script. Throughout this book, you will find the term “sexual script” repeated. A sexual script is the result of embedded cultural beliefs, social messaging, biology, personal experiences, and any formal/informal education about sexuality a person has received over their lifetime.

In the counseling session, counselors are gifted the opportunity to support a person as they come into their awareness of themselves and, sometimes, awareness of their sexual script. As mental health professionals, we are absolutely capable of facilitating therapeutic conversations to help clients better understand how their upbringing and personal experiences have crafted a view of their sexual selves. We are in the perfect place to illuminate the path as they begin to explore their sexuality, their sexual essence, and as a result, honor the parts of sexuality they wish to keep and release the parts that no longer work for them.

This book is an attempt to help mental health professionals and budding mental health students understand how to approach specific issues with clients yearning to explore their sexual story—without judgment and full of radical acceptance.

Why We Created This Book

Human sexuality counseling is an area rarely addressed directly in either the human sexuality literature or the professional counseling literature. Human sexuality textbooks generally consist of the fundamentals of sexuality, specifically the physiological aspects. The 2016 Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards now address the need for educating counseling students about human sexuality counseling, specifically in clinical rehabilitation counseling (CACREP, 2016, Section 5, Standard D.2.m.); marriage, couple, and family counseling (Section 5, Standard F.2.e.); and rehabilitation counseling (Section 5, Standard H.2.h.).

Furthermore, there is a belief by some that “information is enough.” According to this approach, all that needs to be covered in sex education classes in secondary schools are basic and introductory facts and data. That approach may then carry over through a counseling student’s undergraduate coursework too. By the time that the counseling student reaches graduate school, they too may have integrated into their own belief system that information is enough. Researchers have found, however, time and time again that training in sexuality-related pathology is too limited and that information alone is not enough in terms of which topics are addressed in counseling related to sexuality (Blount et al., 2017). It is, therefore, ethically imperative for counselor education curriculum to include an affirmative and expansive training in known pathologies wherein sexual arousal is attributed directly to typical and atypical (or nonmajority/nonrepronormative/nonheteronormative) fantasies, behaviors, or partners that cause danger, distress, or dysfunction (Blount et al., 2017).

Understanding and comprehensive application of effective treatment approaches associated with sexuality is absolutely necessary for the wellness of the counseling clients. Many people with sexuality-related concerns that are discovered in a medical setting are often referred to a mental health professional in conjunction with pharmacological interventions. For example, the American Urological Association (Burnett et al., 2018) guidelines for treating erectile difficulties recommend that urologists connect patients with a mental health professional to enhance communication about sexual concerns and to reduce performance anxiety. Furthermore, practicing urologists see an average of 70 patients per week, or 3,360 patients per year, and the types of cases they serve also include erectile dysfunction, pelvic floor, urinary tract concerns, penile rehabilitation following prostate cancer, reproduction, ejaculatory dysfunction, hypo-gonadism, penile implants, and sexually transmitted diseases—to name a few. Specifically, Burnett et al. (2018) explained that “psychotherapy and psychosexual counseling focus on helping patients and their partners improve communication about sexual concerns, reduce anxiety related to entering a sexual situation and during a sexual situation, and discuss strategies for integrating ED [erectile dysfunction] treatments into their sexual relationship” (p. 14).

Furthermore, physiological sexual dysfunctions in women are predominantly treated by pelvic floor therapists. Pelvic floor therapists are physiotherapists and occupational therapists who specialize in pelvic health. Berghmans (2018) identified a psychosomatic element in cases of female sexual dysfunction that cannot be treated with pelvic floor therapy alone. Instead, Berghmans advocated for a biopsychosocial approach that includes mental health treatment in conjunction with physiotherapy. Counselors need to be prepared to have these conversations with clients struggling with physiological disturbances in their sexuality and sexual expression to enhance the client’s quality of life.

The Handbook for Human Sexuality Counseling: A Sex Positive Approach is a straightforward, honest, and positive book on human sexuality counseling. This book consists of much more than the fundamentals of sexuality and gender. It is a book that steers away from the older views of human sexuality and that eschews pathology and “othering” approaches that pathologize and discriminate against sexual behaviors and expressions that are not heteronormative, repronormative, or cisnormative. Sexuality is part of the human experience; however, it is often disregarded in both counselor training and the actual process of counseling (Reissing & Giulio, 2010). Ultimately, students and counseling professionals alike are left with resources that address the basic concepts of sexuality and gender many times from a narrow cisgender, heteronormative, and pathological framework. The foundation of each of the mental health professions’ codes of ethics is a nonjudgmental approach to issues of counseling. A sex positive approach to sexuality in counseling is a perfect integration of these issues as it challenges pathology and emphasizes nonjudgmental openness, sexual freedom, and liberation of sexual expression (Donaghue, 2015).

This book will be useful for both undergraduate and graduate students, as well as counselors and other mental health professionals. It is designed for those whose work will bring them into contact with clients of all types of sexual backgrounds and experiences. Most books try to broadly cover sexuality and gender-related topics in hopes to be generalizable, but the material is foundational at best. In this book, we selected expert authors to write on a variety of diverse topics related to sexuality. Our aim was to be both fun and sex positive in the book’s approach to human sexuality.

As counselor educators with a combined 40 years of experience training counselors, we find that counseling students still complain of a lack of training in working with clients regarding sex. Many graduate programs provide only a cursory treatment of human sexuality counseling as part of their multicultural counseling course or as a small part of their foundational counseling courses, with school counselors especially noting a lack of knowledge and skills in this particular area. We believe that this book is a critical resource in bridging that gap in the training of counselors and other mental health professionals.

Sex Positive Counseling

The task of sex positive human sexuality counseling is to view all people and their sexuality as central and self-defining, rather than as marginal and defined by cisgender and heterosexual norms (Morrow, 2000). Sex positive human sexuality counseling is geared to the creative enhancement of an individual’s sexual and cultural identities. To be effective in their work, counselors must understand their own sexual orientation; have an appreciation for gender diversity; and understand their own sexuality, sexual beliefs, and values.

The bottom line is that clinicians of any theoretical framework can practice sex positive counseling, as long as they have examined their own heterosexism, homonegativity, or bi-negativity and the oppressive messages around transgenderism and clients who are questioning (Ritter & Terndrup, 2002). Therefore, it is our perspective that experience and expertise are more important than the counselor’s sexual orientation when practicing affirming human sexuality counseling with clients.

In the core traditions of the counseling profession, this book includes a strengths-based, developmentally appropriate, psychoeducational, and sex positive approach to human sexuality counseling. This approach permeates each chapter.

As Phillips (2000) stated, “Students with little experience are especially appreciative if they are given examples of what . . . therapists tend to do and say and what they tend not to do and say” (p. 349). Since training in this area is limited, it is not only students who are hungering for concrete examples of human sexuality counseling. Counseling professionals who are many times already licensed and practicing are also eager to understand what they should be doing and what they should be considering when working with clients addressing issues of their sexuality (Dworkin & Pope, 2012). In addition, both students and professionals need a constant reminder about how important it is to get in touch with and stay in touch with biases, stereotypes, and the negative messages from religion, society, and even parents.

Rather than simply reviewing the literature about therapy with a given population, each chapter in this book integrates current research and clinical practice by providing examples of evidence-based, sex positive, and practical treatment planning and implementation. Each individual chapter author, or group of authors, addresses their topic with a modern, empowering approach and provides a specific protocol to follow in the treatment of clients.

Written from a multidisciplinary perspective, this book uses expert narratives to address treatment approaches for the sexual issues that many individuals and couples are facing today. The chapter authors provide examples of inclusive and affirming language to use in counseling, as well as describing the attitudes and behaviors counselors should exhibit when addressing clients’ sexuality. Many of the authors have included a case example illustrating a sex positive approach to working with a fictional client. Some provide answers to questions readers may have “always wanted to ask” about their topic, and some take a personal stance, offering their personal and professional perspectives.

Chapter Highlights

The chapters in this book are organized into eight sections providing a comprehensive view of the human sexual experience:

Foundations

Physiological and psychological

Attraction, orientation, and gender

Sexual wellness

Sexual agency

Approaches to sexual divergence

Relationships

Education

Part 1: Foundations

Chapter 1 expands on current issues in mental health, explains the distinction between a sexual wellness and a medical framework, and provides a radically informed sex positive approach to sexual issues.

Chapter 2 provides an intersectional perspective on the history of sex, including cultural taboos around the world, contributions of religion to sexuality, and cultural differences in sexual norms. This chapter also addresses the politics of sex, including issues of sexual rights, reproductive rights, and the medicalization of sex.

Chapter 3 expands on the intersecting realities that exist in relation to ethical practices, decision-making, and sexual concerns. This chapter addresses common ethical and professional pitfalls specific to sexuality, including the professional obligation to identify personal biases, assumptions, and belief systems regarding sexuality and sexual concerns, as well as the need to ensure competency for any given sexuality topic and the process of referring to a sex therapist or other professional in cases where the sexual concern is beyond the competency of the counselor. This chapter provides an informative matrix, the knowledge-based decision-making matrix, to evaluate clinical competency.

Part 2: Physiological and Psychological

Chapter 4 provides readers with medical information associated with the reproductive systems of the human body as well as the physiology of sex in human beings, including the role of hormones and how human anatomy affects sexual expression. This chapter also describes the ways that a person’s physical body interacts with their psyche to promote or inhibit sexual health and response to therapeutic psychological interventions.

Chapter 5 examines the role of the brain during arousal and desire and in human beings. The chapter further elaborates on research that has used advanced brain imaging, such as functional MRI and positron-emission tomography (i.e., PET) scans, during sexual activity. The chapter uses illustrations to elaborate on sexual functioning, sexual response, and arousal in hopes to provide education on how clinicians may better understand how to overcome barriers to sexual wellness.

Chapter 6explores the perception and act of orgasm through an intersectional lens. It also addresses misconceptions, myths, and prescriptions around orgasm and how they influence a person’s perception of themself as a sexual being. This chapter also examines techniques and strategies to clinically treat and support the orgasm explorations of clients from a therapeutic standpoint.

Chapter 7 explores the messages humans receive and communicate about sex and sexuality and addresses how these messages (implicit and explicit) affect the perception of oneself as a sexual being, such as with internalized anxiety around performance, faking interest and climax, and comparing one’s performance to sexual behavior that is depicted in commercial pornography.

Part 3: Attraction, Orientation, and Gender

Chapter 8 addresses the multidimensional role of sexual attraction in human sexual expression and how expression may change over time. Addressing the role of sexual attraction from a multiculturally responsive perspective, the chapter debunks myths related to sexual attraction and highlights the nuances of attraction and affectional identities.

Chapter 9 explores the sexuality orientation spectrum, including sexual and romantic attraction, straight, gay, lesbian, bisexual, pansexual, and asexual. This chapter also addresses constructs of sexual attraction that fall outside of these labels, such as men who have sex with men.

Chapter 10 reviews the spectrum of gender identity and gender expression. Topics include cisgender and transgender, sex role stereotyping, intersex, agender; masculinity and femininity explored; derailing the binary, trans people of color, hijra; two-spirited; eunuch; and more.

Part 4: Sexual Wellness

Chapter 11 reviews historical and current literature on the health benefits of masturbation and helps to familiarize counselors on how to support and empower clients to begin to see themselves as the protagonist of their sexual story. Myths surrounding masturbation are critiqued and factual explanations are provided. A sex positive approach is described to assist clinicians with this conversation with future clients.

Chapter 12 addresses information on how counselors can assist survivors of sexual harassment, assault, trauma, and trafficking. Of those who have experienced sexual trauma of any sort, many become disconnected from their sexual selves and, as a result, the very personal definitions of sexuality, sexual safety, and sexual script. The chapter also explores the consequences for victims of sexual abuse or exploitation and how this may affect their later sexual health or functioning.

Chapter 13 addresses the physical and psychological impact of chronic illness and pain on sexual attitudes and desire. This chapter also helps counselors understand the reality and possibility of sexual expression after diagnoses.

Chapter 14 describes the most common sexually transmitted infections (STIs) and how mental health professionals can approach clinical work with individuals with HIV and other STIs.

Part 5: Sexual Agency

Chapter 15explores aging sexuality from a sex positive framework by first addressing the barriers and myths surrounding older adult sexuality. This chapter expands on how adults change and adapt to their bodies and sexual functioning, and how vitality and resiliency support sexual needs and expression.

Chapter 16 provides readers with the opportunity to experience a “person first” approach to disability and sexuality. Counselors will learn how to support clients to embrace both their sexuality and their disability. This chapter also introduces sex surrogacy and describes potential mental health and physical benefits of receiving sex surrogacy treatment.

Chapter 17 takes a unique approach to exploring the narrative of Black sexuality and sexual expression. Through their individual narratives, the authors reveal the ways in which Black bodies have been sexualized, objectified, and vilified. This chapter will help counselors explore their own implicit and explicit biases surrounding the intersection of race/ethnicity and sexuality as well as the role that the constructs of race and ethnicity play in attraction and desire.

Chapter 18 provides a comprehensive review of sexuality as it pertains to the most common religious groups. The chapter will explore the role of religion in sexuality and the taboos associated with certain religions. This chapter will help counselors better understand how to support sexual discussion within the confines of one’s religious values.

Part 6: Approaches to Sexual Divergence

Chapter 19 will explore alternative sexual activities such as kink, swinging, BDSM, fetishes, and consensual objectification. This chapter helps readers become acquainted with the current literature on sexual behaviors and activities that are focused on multiple definitions of pleasure and are not necessarily reproduction centered. Counselors will be confronted with many different aspects of sexual behavior in their counseling practice, and through exposure to such topics, this chapter seeks to increase comfort with addressing these topics.

Chapter 20 takes a sex positive approach to sexual divergence in relation to the paraphilic section of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (5th ed.; DSM-5-TR; American Psychiatric Association, 2022). The authors challenge the criteria of each of the paraphilic diagnoses and offer a sex positive approach to treatment by addressing the presence and severity of distress, dysfunction, and/or danger.

Chapter 21 explores the neuroscience of pleasure and healthy sexual behavior. This chapter challenges the medicalized framework used to approach frequent sexual proclivities and potentially troublesome sexual behaviors and offers a sex positive approach to treat hypersexual behaviors. This chapter will help counselors understand and treat clients who struggle with problematic sexual behavior.

Part 7: Relationships

Chapter 22 addresses modern love, dating, and hookup culture. Additionally, values are explored in terms of how people understand and engage in cyber dating, hooking up, and gamers and cyber love. Counselors will be better prepared to evaluate their own values on love, sex, and intimacy after reading this chapter.

Chapter 23 addresses how infidelity impacts relationships and how counselors can best help couples heal after infidelity. This chapter will define infidelity and provide current literature on how infidelity impacts emotional well-being and the relational dynamic of both the individual and couple. The chapter also provides a step-by-step approach to helping the couple process the infidelity and move toward a place of compassion and healing.

Part 8: Education

Chapter 24examines current laws and policies regarding K–12 sexual education in the United States and other countries. This chapter reviews the research results of both comprehensive sex education and abstinence-only sex education with respect to teen pregnancy, reported abstinence, and sexual engagement. The chapter also identifies implications of comprehensive sex education on decreasing rape and sexual assault, increasing sex positivity and body image, decreasing mental health concerns, and normalizing healthy sexual behavior. These implications are examined in terms of how they may surface in the counseling session.

Chapter 25 provides a rationale for sex education and counselor training across all states and all programs. This chapter addresses clinician ethical responsibilities and examines the current literature on counselors’ and counselor educators’ perceived comfort when addressing sexuality in both the counseling session and the counseling classroom. The chapter also addresses how specific sexuality counseling training will enhance comfort level and competency among counselors, increase clinical efficacy, and further enhance the professional role of the counselor in professional interactions with other mental health fields.

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About the Editors

Angela M. Schubert, PhD, LPC, NCC, BC-TMH, is a clinical practitioner and associate professor for the Council for Accreditation of Counseling and Related Educational Programs (CACREP)-accredited clinical mental health counseling program at Central Methodist University. A member of the American Counseling Association (ACA), Association for Counselor Education and Supervision (ACES), Sexuality and Aging Consortium, American Association of Sexuality Educators, Counselors, and Therapists (AASECT), and the Society for the Scientific Study of Sexuality, Schubert served for 6 years as Missouri state chair for AASECT. She currently serves on the editorial board for the Journal of Counseling Sexology & Sexual Wellness. Dr. Schubert is the past president of the Association of Counseling Sexology and Sexual Wellness (ACSSW) and cohost of the Let’s Get Uncomfortable podcast. Her research interest focuses on intersectionality of culture, gender, age, and sexuality through a relational-cultural theoretical lens. She has continued to act as expert consultant on sexuality-related topics such as sexual wellness, aging sexuality, sexual consent, sexual assault, and body image. She is currently undergoing supervision to become an AASECT-certified sex therapist.

Mark Pope, EdD, NCC, CCC, MAC, ACS, is Curators’ Distinguished Professor Emeritus and Thomas Jefferson Fellow in the CACREP-accredited counseling and family therapy programs at the University of Missouri–St. Louis. He is the author/editor of 11 books, more than 100 other professional publications, as well as more than 150 keynote addresses, research symposia, and workshops at international, national, regional, and state venues from 1978 to 2021. From Dr. Pope’s first publication in 1990 on the sexual behavior and attitudes of midlife and aging gay men to his most recent article on the trials that lesbian, gay, bisexual, and transgender international students face as they study in the United States, his work has been groundbreaking in the counseling literature. Through his scholarly work and leadership, he has been instrumental in bringing to the forefront of the counseling profession broadly and the career counseling field in particular the special issues that lesbian and gay individuals face in American society. Dr. Pope has served as president of ACA; the National Career Development Association; the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling; and the Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44 of the American Psychological Association). He was also editor of The Career Development Quarterly, the preeminent professional journal in career counseling and development, and senior associate editor of the Journal of Counseling & Development (the flagship journal of ACA) and the Psychology of Sexual Orientation and Gender Diversity (the primary journal of the Society for the Psychology of Sexual Orientation and Gender Diversity, Division 44 of the American Psychological Association).

About the Contributors

Aninda B. Acharya, MD, is a neurologist at Saint Louis University School of Medicine, Department of Neurology, in Saint Louis. He is part of SLUCare Physician Group. He is board-certified in neurology and vascular neurology and holds a master’s degree in public health. Dr. Acharya has expertise in general clinical neurology, rehabilitation medicine, and stroke, as well as migraine and other headache disorders. Dr. Acharya was recognized by St. Louis Magazine as one of the Best Doctors of Saint Louis.

James P. Ahearn, JD, MEd, LPC, is currently pursuing a PhD in counselor education and supervision at the University of Missouri–St. Louis. He also works as an adjunct instructor at local universities and serves on the board of Psychotherapy Saint Louis.

M. N. Barringer, PhD, (she/her) is an assistant professor of sociology at the University of North Florida. Her research interests include sexualities, gender, religion, and applied sociology. She has used quantitative data to examine gender and sexual minorities’ religious identities, subjective well-being, and attitudes toward American mainline religious traditions. Her academic articles also cover religiosity, religious identity, and birth cohort attitudes. Her work has been published in journals such as Social Currents, Journal of Homosexuality, and Sociological Inquiry.

Caitlyn McKinzie Bennett, PhD, LMHC (FL), LMFT (FL), LPC (TX), NCC, (she/her/hers) is an assistant professor of counseling at Rollins College in Winter Park, Florida. Dr. Bennett’s clinical specialty focuses on anxiety, stress, family-of-origin issues, sexuality, gender, and sexual and gender minority experiences for adolescents, young adults, and couples. Dr. Bennett’s research agenda has focused on neuro-informed counseling approaches (i.e., neurofeedback training) to mitigate experiences of anxiety, stress, and depression.

Nicole Woodcox Bolden, MSW, LCSW, is a therapist, trainer, family support specialist, and cofounder of Thriving With Baby LLC, a clinical service in Chicago. Bolden specializes in supporting birthing people in creating and adjusting to their new role as a parent through therapy, childbirth education, and pregnancy and family wellness coaching services.

Laurie Bonjo, PhD, is an associate professor in the Department of Counseling and School Psychology at Southern Connecticut State University and program coordinator of the doctoral program in counselor education and supervision. Dr. Bonjo’s research interests include clinical applications with members of groups at risk for marginalization and disenfranchisement particularly by attending to destigmatization, decolonization, and liberation in clinical practice.

Ethan L. Bratt, MS, LMFT, CST, (he/his) is a licensed marriage and family therapist and certified sex therapist. Having treated clients since 2007, in 2012 Bratt established Pivotal Counseling, a group practice specializing in relationship and sexual health issues that serves clients throughout Colorado and southeast Wyoming. He also works with many individuals and couples struggling to reconcile their religiosity and sexuality or seeking to reclaim and heal their sexuality after damaging religious experiences.

Roseina Britton, PhD, is originally from Queens, New York, and has a master’s degree in clinical mental health from North Carolina Agricultural and Technical State University. She earned her PhD in counselor education and supervision from the University of Iowa in 2019. As a licensed professional counselor in Illinois, Dr. Britton specializes in researching, educating, and alleviating the stigma and related hardships associated with contracting and living with HIV/AIDS in the United States.

H. L. Brostrand, PhD, LPCC, is a counselor at Contra Costa County Behavioral Health Services and adjunct faculty at Napa Valley College in California.

Lexx Brown-James, PhD, (she/her/hers) is a best-selling author on Amazon, a licensed marriage and family therapist, and certified sexuality educator and supervisor who specializes in sex therapy. Dr. Lexx provides individual and group therapy, coaching, and supervision. Dr. Lexx also provides mental health workshops on adolescent sexual development, sex positive parenting, sexuality educator antiracist training, parenting, sexting, and porn, and on utilizing her sexual intervention model with Black women. In classrooms and training, Dr. Lexx uses experiential pedagogy coupled with affective-based learning to challenge attitudes and support learners in being able to apply knowledge and skills.

Anastasia Canfield, MA, MT-BC, LPCC, NCC, specializes in music therapy with mental health populations across the life span, as well as children and young adults with developmental disabilities, intellectual disabilities, and autism spectrum disorders. Canfield recently completed her clinical training at Brightside Counseling as an intern under Dr. Angela Schubert, while she pursued a second master’s degree in mental health counseling from Northwestern University, earning dual licensure as a licensed professional counselor and a board-certified music therapist.

Christian D. Chan, PhD, NCC, (he, him, his) is an assistant professor in the Department of Counseling and Educational Development at The University of North Carolina at Greensboro, past president of the Association for Adult Development and Aging, and a proud queer person of color. As a scholar-activist, his interests revolve around intersectionality; multiculturalism in counseling practice, supervision, and counselor education; social justice and activism; career development; critical research methodologies; and couple, family, and group modalities with socialization/communication of cultural factors.

Michael P. Chaney, PhD, is an associate professor in the Department of Counseling at Oakland University in Rochester, Michigan, and a licensed professional counselor and approved clinical supervisor. He has held several leadership positions, including president of the Society for Sexual, Affectional, Intersex, and Gen der Expansive Identities (SAIGE). He currently serves as editor-in-chief for the Journal of LGBTQ Issues in Counseling and as an editorial board member for the Journal of Addictions & Offender Counseling and Journal of Counseling Sexology & Sexual Wellness. He has numerous publications in prestigious peer-reviewed journals and regularly gives presentations and workshops nationally and internationally in the areas of substance use disorders; sexual compulsivity; lesbian, gay, bisexual, transgender, queer, plus other identities (LGBTQ+) issues; male body image; and social justice and advocacy in counseling.

Barbara M. Chuback, MD, is an assistant professor of urology at the Icahn School of Medicine at Mount Sinai, New York, where she specializes in the diagnosis and treatment of sexual dysfunction for all patients, regardless of sex, gender, orientation, or congenital condition. In addition to her training in medicine and surgery, she holds master’s degrees in the history of medicine and bioethics and applies all of these disciplines to clinical care, research, and teaching. She is an active member and regularly invited speaker for several professional organizations focused on sexual medicine, both within the United States and internationally.

L. Allen Crosby, LMHCA, LPSC, earned her master’s degree in clinical mental health counseling from Trinity Washington University in Washington, DC, and is currently a counselor education and supervision doctoral candidate at Walden University. Her research is focused on the empowerment of Black women, trauma-informed schools, Black mental health, and Black sexuality.

V. A. Dansereau, MA, is a qualified mental health professional and a student of clinical psychology at The Chicago School of Professional Psychology in Washington, DC, with a dissertation on the etiology of violent sexual fantasy. She holds master’s degrees in both forensic and clinical psychology and is kink and poly-allied. She primarily works with populations that are court involved.

Leslie E. Davis, MA, LPC, CST, is a private practice counselor who is obtaining her PhD in counselor education and certificate in university teaching from the University of Missouri–St. Louis. Her specializations and research interests in counseling include trauma, sexuality and disability, somatic experiencing, polyvagal theory, eye movement desensitization and reprocessing (EMDR), BDSM, addiction, spiritual trauma, and trauma-informed teaching.

lore m. dickey, PhD, a board-certified counseling psychologist, is retired. A longtime member of Girl Scouts of the USA for over 50 years, dickey has taught over 25 different courses for undergraduate and graduate students; has more than 65 publications, including three books; and has presented more than 135 times throughout the world. He has been recognized numerous times for his commitment to making the world a safe place for transgender and gender diverse people.

Molly Eames, MEd, LPC, is a sex educator and wellness consultant at Molly Eames Counseling in St. Louis, with more than a decade of professional experience and certification in sex therapy and sex education from the University of Michigan.

Cheryl A. Faber, MD, is a board-certified neurologist in Saint Louis. Part of BJC Medical Group, Dr. Faber has been recognized by St. Louis Magazine as one of the Best Doctors of Saint Louis.

Melissa Franzen, PhD, LPC, received her doctorate in counselor education and supervision at Walden University. Dr. Franzen is a student development professional at Lincoln Land Community College. Her research interests include sexual wellness, play therapy, and supervision.

Sharon Gerstein, LMFT, is a self-employed marriage and family therapist in Long Beach, California, who has specialized in mental health and clinical supervision since 1990.

Hannah Glusenkamp, (she/her/hers) is pursuing a master of science in clinical mental health counseling with a certificate in animal-assisted therapy in counseling from the University of North Florida. As a graduate-level counseling intern, she has provided community mental health counseling at a sexual violence advocacy center and at a no-cost community clinic in Jacksonville, Florida. Prior to counseling, she taught comprehensive sexual health education in community and school settings. Glusenkamp, who strives to be a holistic, trauma-focused, sex positive, antiracist, and growth-oriented counselor, has interests that include mindfulness and narrative, somatic, nature-based, and creative arts therapies and healing modalities.

Reginald W. Holt, PhD, NCC, MAC, LPC, is assistant professor and clinical program coordinator in the Department of Counselor Education and Family Therapy at Central Connecticut State University. He completed a PhD in counseling/counselor education at the University of Missouri–St. Louis, an MA in clinical psychology at East Tennessee State University, and a 2-year postgraduate training program in advanced psychodynamic psychotherapy at the St. Louis Psychoanalytic Institute. Dr. Holt is recognized by the Connecticut Certification Board as an advanced alcohol and drug counselor and by the International Certification and Reciprocity Consortium as an internationally certified advanced alcohol and drug counselor. In addition to operating his own private practice, he has had an extensive clinical career that included work in behavioral health care hospitals, the correctional system, and a Fortune 500 managed care organization.

Kim Lee Hughes, PhD, served as the 2020–2021 president for the Association of Multicultural Counseling and Development, a division of ACA. She served as a tenure-track assistant professor in the Department of Mental Health Counseling at Clark Atlanta University and The University of Texas at San Antonio. Dr. Lee Hughes’s research centers on the expansion of social justice and cultural responsivity within counseling and related professions, women of color across the life span, the impact and efficacy of group practices based on positionality, women in leadership, collaboration in counselor education, queer communities and social mobility, and best practices in qualitative methodology in counselor education.

J. Richelle Joe, PhD, NCC, is an associate professor in the Department of Counselor Education and School Psychology at the University of Central Florida (UCF). Her scholarship and service focus on culturally responsive services for underserved and marginalized clients and communities and includes an emphasis on the experiences of individuals of color and the mental health and wellness implications of HIV for individuals and families. Dr. Joe has written extensively about HIV, with publications that address the ethics of counseling clients living with HIV, the importance of using stigma-free language in counseling, and the value of relationally and culturally informed therapeutic approaches for women affected by HIV and intimate partner violence. At UCF, she leads the HIV Education, Awareness, and Research Team, known as HEART, which collaborates with university and community organizations in their efforts to provide HIV education and prevention programming.

Theresa L. Keown, PhD, LPC, NCC, is an associate professor, program director, and Park Hills coordinator for the master of science in clinical counseling program at Central Methodist University’s College of Graduate and Extended Studies. She is currently trained in EMDR and Applied Suicide Intervention Skills Training and is dialectical behavior therapy (DBT) informed. Her research interests include group therapy, community mental health, and marriage and family counseling.

Stacey Diane Arañez Litam, PhD, LPCC-s, NCC, CCMHC, (she, her, hers) is an assistant professor of counselor education at Cleveland State University. Dr. Litam is an award-winning and nationally recognized researcher, educator, clinical counselor, and social justice advocate on topics related to human sexuality, sex trafficking, and Asian American and Pacific Islander concerns. She is an immigrant and identifies as a Chinese and Filipina American woman. As a researcher and scholar, Dr. Litam’s work has been published in prestigious journals such as Journal of Counseling & Development, The Professional Counselor, The International Journal for the Advancement of Counselling, Counseling Outcome Research and Evaluation, The Journal of Sexual Aggression, Journal of Counseling Sexology & Sexual Wellness, and Journal of Child Sexual Abuse. Dr. Litam has published in over 20 academic journals and facilitated over 100 presentations at international, national, regional, and state levels, and she has served as a content expert for National Public Radio, podcasts, media and news outlets, and within legislative arenas.

Frances L. McClain, PhD, LCPC, NCC, received her PhD in counselor education and supervision from The Chicago School of Professional Psychology and her master’s in counseling from Governors State University. She is a director of clinical training in counseling psychology at The Chicago School of Professional Psychology in Chicago. She specializes in working with individuals with co-occurring illnesses, trauma, and sexuality-related issues and those in LGBTQ+ and other sexual minoritized communities.

Virginia Ogletree, PsyD, graduated from Wright State University School of Professional Psychology in 2019 after many educational, vocational, and personal detours, then finally finding her calling in a community college classroom during an introductory psychology class. As a survivor of childhood maltreatment, her professional interests are focused on the stress and growth that result from trauma. As a person who experiences both privilege and oppression, she aligns with the oppressed peoples of the world in seeking and working toward liberation.

Karen O’Hearn, MEd, LSC, (she/her) is a retired high school teacher and counselor in St. Louis and retired associate professor of counseling at the University of Missouri–St. Louis and Saint Louis University. Her counseling coursework and research focus is career development and adolescent sexual health and wellness. Since retirement, she promotes comprehensive sexuality education by speaking at school district and community resource board meetings in St. Charles, Missouri.

Jun Park, MA, P-LPC, is in clinical practice in Texas. His prior work includes being a clinical assistant at an eating disorders treatment and research facility and as a behavioral therapist for children with autism. His interests include researching culturally marginalized groups, providing empirically based therapeutic treatment, and social justice advocacy in counseling.

Faith Ponti, is a second-year master’s student in the clinical mental health counseling program at the University of North Florida in Jacksonville, Florida. A counseling intern at both Volunteers in Medicine Jacksonville and Child Guidance Center, Faith is interested in advocacy and public policy, community education, and working with adolescents and emerging adults. Her research interests include gender and sexuality, social inequality, and the effect of social media on mental health. Faith is a passionate advocate of social justice, which is reflected in much of her professional and educational pursuits.

Sarah Richards, MA, LPC