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Jun 2014 by PCI College

Developing Comfort and Competence with Gender and Sexual Issues in Therapy

Dr. James Kelly will deliver a free public lecture in PCI College, Dublin City Centre Campus on Wednesday 11th June, introducing issues in the therapeutic environment when problems with gender and sexuality arise. In this article, he introduces us to some of the key themes of his lecture.

If you're a recent graduate, it probably feels pretty good to congratulate yourself, say 'mission accomplished' and feel relieved that this undertaking is finally finished. You worked hard and deserve to feel good about all you have done to meet your requirements for graduation.  For some of you, finishing the post-graduate clinical hours might be seen as the 'final task'. Both are accomplishments that took dedication and hard work, and have put you in a position to truly begin your work as a counsellor/psychotherapist. Hopefully, however, a shift in perspective will have occurred at some point during your studies and initial explorations in this field. You probably realized that, while milestones like graduation and passing clinical requirements are important and valuable, that to be truly in this work, the learning, relearning, unlearning, and the seemingly continuous adjusting to current trends is… an ongoing process. And you realized, as well, that it has to be. You've come to understand that you now have a responsibility to remain well informed in areas that are likely to emerge in therapy, and even in some that you might expect never will.

Not all CPD opportunities appear completely applicable at first to our respective areas of interest. Some people may naturally avoid subject areas they think might make them uncomfortable, such as those focusing on areas of sexuality and related themes. It is natural to avoid situations that may make us uncomfortable. Some therapists even decline to work with clients on sexual or gender related themes. Many of us don't think that's acceptable, some consider it to be irresponsible. When a client in need sees a healthcare professional avoid or refuse to deal with sensitive or very private issues, such as problems with sexuality or gender, it can compound the shame and reluctance they may have to face their problems and learn ways of  dealing with them. This is not to say we can develop a knowledge base to address all clients’ specific needs for every situation. Certainly, a good therapist knows when the limits of their expertise are reached and when it may be prudent to refer for specialized services. But it is important that therapists can talk about each of these issues comfortably, as well as discuss the rationale for referral if indicated. It must not be seen by clients as avoidance of, or an unwillingness to talk about, issues around sexuality or gender identity.

It is important for clients to trust in their therapist’s competence. Becoming comfortable and knowledgeable about issues relating to sexuality is crucial, as many clients will need to discuss these issues in confidence and with a shared sense of safety. In order to fully understand the impact of sexual issues on our clients, an understanding of sexuality and a progressive grasp of trends in therapy, treatment, and sexual behaviour is fundamental. If therapists are not entirely comfortable with frank and open discussions with clients regarding their intimacy, sexuality and/or gender expression and how it is impacting their lives, their relationships and their general well-being, then they should not consider themselves to be completely prepared to work as a counsellor/psychotherapist. To actively avoid continued learning in these areas is not a solution.

Sexuality lies at the core of our identities as human beings. It affects almost every area of our lives, in some way, and impacts our relationships, daily functioning and well-being. Sexual imagery is everywhere, and both adults and children are exposed to more explicit sexual content than any generation before. Online exposure to sexual deviance and exploitation can normalize these practices and attitudes to developing minds. Children and teens grow up surrounded by sexual imagery and at increasingly early ages they begin to venture online and have to quickly learn to deal with attempts to groom and or sexualize them via chat and social networking sites. They grow-up believing that this is normal sexuality and the confusion as adults can manifest in myriad ways.

Hopefully, we can begin to see how important it is for therapists to understand the nature and power of sexuality, and the impact a rapidly shifting view of sexuality might have on an individual’s functioning and emotional well-being.  For many, the subject of sex remains mysterious. It is difficult for many people to discuss sexual matters and to know which are normal expectations and feelings, and which might be best addressed in a therapeutic environment, particularly in the context of a constant barrage of confusing and sometimes bizarre messages about sex. Even though we are surrounded by sexual themes and images, many people remain ignorant of some the most elementary aspects of sexual anatomy and function.  Some therapists may have difficulty communicating around sexual matters or feel unable or unprepared to help clients to make informed decisions about their own sex lives and sexual or gender-related problems.

Usually, CPD is part of accreditation requirements for professional associations, required by codes of conduct or codes of ethics. Meeting the requirements for professional association membership should be the least of reasons to seek out new knowledge in the field. For therapists who find the highest degrees of satisfaction in their work, the CPD experience is a coveted resource that enriches, renews, and inspires, as well as informs. This applies especially to areas that are out of our 'comfort zone'. If we are not completely comfortable dealing with the sexual problems of our clients, it is precisely for that reason we must endeavor to increase our knowledge and comfort with sexuality and related issues.

Continuing Professional Development in sexuality can only help to ensure your competence as a therapist, as it enhances your understanding of your clients’ experiences. The ultimate outcome for a therapist engaging in sexuality-related CPD is that it safeguards the clients you will work with, as well as you, the therapist. These are the responsibilities we undertake when we set out to do this work. We must not only maintain and enhance the knowledge and skills we will need to deliver a professional service to our clients and the community, we must also ensure that our knowledge stays relevant and up to date, and that we remain aware of changing trends and directions in the field. To do this work effectively, we must love to do this work, and feel confident that we are indeed prepared for it. We must yearn to continue in this ongoing learning process. To see CPD as a refuge, it is important to understand the connection between our confidence in our own readiness, and the confidence clients will have in our skills, knowledge base and abilities to help them address their most private and intimate issues.

Dr. James Kelly
Clinical Psychologist

(Update September 2014: Dr. Kelly will deliver a 1 Day CPD Workshop on the topic of Human Sexuality on in PCI College, Dublin City Centre Campus (7 Burgh Quay, Dublin 2) on Saturday 27th September 9.30am - 5.00pm.  You can book your place online by clicking here.

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