Sex and Therapy 4/6: Working with GSRD

Some therapists assume that issues of sexual identity or diversity are only relevant to young people thinking about coming out as gay or trans when, in fact, all age groups may wish to explore their sexual identity or may feel marginalised by it.

To facilitate this, therapists are encouraged to refer to Gender, Sexual and Relationship Diversity (GSRD) rather than LGBT+ which doesn’t take into account the variety of all our identities. Even straight, cisgender clients may feel marginalised in relation to an aspect of their sexual feelings or behaviour which affects the way they see themselves. We often see clients who feel they ‘ought’ to be having more frequent sex or that they ‘shouldn’t’ watch pornography or fantasise.

Indeed, sexual guilt and shame is highly associated with people who identify with the dominant group, because they assume global ways to behave are ‘normal’ rather than questioning their beliefs in the way someone who identifies with a more diverse group might do. Non-monogamies, asexualities, fetishes, kink and BDSM may or may not be considered ‘diverse’, but they can certainly affect the way people feel about themselves, especially as they may be far from obvious. It’s therefore always helpful to discuss clients’ pride and shame issues in relation to the contexts that affect them – particularly their sexuality.

How clients define themselves is important to know, and we must recognise that those definitions are fluid, changing in light of their experiences, mood and our conversations with them. Exploring what it’s like to be them and how all their contexts intersect and affect them can usefully open up stories of oppression and marginalisation, but also unlock recognition of delight, joy, pleasure and pride, as well as resilience.

Such multifaceted and nuanced exploration avoids the way sex positivity can sometimes miss or dismiss an individual’s genuine concerns or underlying traumas. It also avoids an assumption that clients with a diverse or marginalised GSRD inevitably want to explore traumas associated with this, especially if their presenting problem is unrelated.

Clients’ presenting concerns around sexual identity are often relational, frequently involving dilemmas about how their relationships will change if they come out to friends, family or colleagues and how to do this. One of the most helpful interventions is to emphasise that there is no template for these conversations and that it’s okay for everyone involved to make mistakes.

Sometimes, partners, parents or children seek therapy when they’re coming to terms with discoveries about a family member. Their own sense of identity may have been profoundly affected by what they’ve learned, and this can in turn affect the way they relate to other family members. Reactions ranging from deep understanding to cruel judgement may exist in the same family or even the same individual. Many of those who seek reassurance through certainty may be particularly unwilling to accept that someone has only recently become aware of their sexual interests or identity issues or that a long struggle to suppress feelings that seem unacceptable has caused them harm. It also needs to be remembered that some clients will have lived in countries where homosexuality is illegal with extremely harsh punishments, or come from families which would ostracise them if their sexual identity were to be revealed.

There is a great deal more sexual diversity among our clients than we will ever know, but we can improve our experience by a willingness to explore GSRD – starting with our own.

Next week, I will discuss some of the less well-known sexually-related issues that may arise in therapy.