Chemsex and Therapy (2/2): Clinical Presentations and Therapist Competencies
9 December, 2023
There isn’t an agreed definition of ‘problematic Chemsex’ because it is subjective. The reports of problematic Chemsex use usually include the following:
- Finding it difficult or impossible to have sober sex. Some people report not having had sober sex for a very long time.
- Chemsex becomes the central preoccupation of people’s lives, leading to them neglecting other activities and life obligations, and planning their entire life around Chemsex.
- Finding it difficult to stop Chemsex in service of self-care. For example, planning to have Chemsex on Friday night only but ending up doing it all weekend long until Sunday night.
- Chemsex having a significant negative impact on the rest of life. For example, missing workdays, which then creates problems with their employment or income, or missing important occasions with friends and / or family.
- Feeling exhausted because there aren’t enough rests or breaks between Chemsex episodes.
- Severe impact on physical health. For example, when people don’t drink enough water, eat or sleep enough during Chemsex, not taking enough care with their sexual health, or pushing their bodies with sexual activities that may need more care or preparation, such as fisting, causing injuries and physical health problems.
- Severe impact on mental health with chronic sadness, depression, anhedonia (not feeling pleasure), acute anxiety, emotional dysregulation. Occasionally, Chemsex may induce hallucinations, paranoia and psychosis.
How to help clients struggling with Chemsex
Firstly, it is important to understand that the primary motivation for Chemsex is pleasure seeking and an ‘antidote’ to minority stress and homophobia, so it is important not to shame clients and consider them addicts. Therapists need to be sex-positive and not judge clients’ sexual behaviours, including fisting, group sex, or being a ‘cumdump’.
It is also crucial to have a collaborative goal with clients and not impose total abstinence on them. Some clients may want help to manage Chemsex more safely, while others may want help to stop Chemsex completely.
It is best to start with harm minimisation first. This includes SMART goals and helping clients minimise the risks to their physical and mental health by making small changes on how they engage with Chemsex, as well as managing the week(s) in between Chemsex episodes.
Gradually, therapists can help clients with integrating Chemsex into their lives when the severe negative impacts have significantly reduced, and when there is a good balance between Chemsex and sober sex as and when clients choose to. Or, if it is the client’s wish, to have a satisfying sex life completely free of Chemsex.
An essential component to working effectively with clients struggling with Chemsex is to co-create a safe therapeutic space, which involves being culturally competent in the specific landscape of MSM (men who have sex with men), understanding the effects of the oppression of homophobia and heteronormativity, and having thorough knowledge of shame, trauma and grief. Therapists need to have a contemporary and sex-positive understanding of sexual and erotic diversities.
Chemsex is a complex clinical presentation but with a robust therapeutic relationship informed by a thorough understanding of the MSM populations, therapy is very effective in helping clients have a fulfilling and joyful sex life with good relationships.
Read the first of Silva Neves' two blog posts on chemsex – Chemsex and Therapy (1/2): Understanding Chemsex.
Silva Neves is a COSRT-accredited and UKCP-registered psychosexual and relationship psychotherapist, and a trauma psychotherapist. He is a Pink Therapy Clinical Associate. Silva is a member of the editorial board for the leading international journal Sexual and Relationship Therapy and the author of two books: Compulsive Sexual Behaviours, A Psycho-Sexual Treatment Guide for Clinicians (Routledge), Sexology: The Basics (Routledge), and he co-edited two textbooks with Dominic Davies: Erotically Queer (Routledge) and Relationally Queer (Routledge), and he speaks internationally. Silva is the recipient of the Sexual Freedom Ally Award in 2023.
Speaker Disclosures:
Financial: Silva Neves maintains a private practice and receives compensation as an international speaker. She receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Silva Neves is a member of the College of Sexual and Relationship Therapists, the UK Council for Psychotherapy, the National Counselling and Psychotherapy Society, the British Association for Counselling and Psychotherapy, the EMDR Association UK & Ireland, the European Society for Sexual Medicine, and the UK Psychological Trauma Society.
