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Psychotherapists often believe if couples improve their communication and emotional dynamics, good sex follows. In practice we often find otherwise and have many questions about how to proceed to work with sexuality issues more directly. This paper presents the many challenges working with sex including the following: the fluidity and multidimensionality of sex and gender, the incongruities and paradoxes in sexual behavior, thoughts, attractions, feelings, and sensations, and the powerful feelings, impasses, surprises, and confusion therapists often experience doing the work. In essence, what is queer about sex? Using the couple as client, expansive ways of thinking and working with sexuality are presented including the development of inclusive models of sex, gender, and sexual response, as well as new approaches to standard sex therapy techniques such as sexual history-taking, redefining sex, and sensate focus. Techniques are presented with an emphasis on the therapist's use of self as sexual change agent including integrating multiple theoretical perspectives (psychodynamic, systemic, and cognitive-behavioral), co-creating a safe treatment frame, and how to intervene within the cognitive, affective, behavioral, somatic, and discursive realms.
Keywords: Queer; Sexual Fluidity; Couples and Sex Therapy; Gender Diversity; Sexual Menu
Fam Proc 49:291-308, 2010
Sex is a queer experience for everyone at one time or another. It can be unruly, ecstatic, routine, mysterious, transgressive, confusing, unpredictable, and changeable over the lifespan. It defies easy generalization, categorization, and explanation. Most of us think of queer experience as relating to gay or lesbian experience or as gender nonconforming experience. The term "queer" has carried various meanings throughout history-a mid-20th century epithet for gay people, a reappropriated anthem for 1980s gay/lesbian activism, and a rejection of sex/gender binaries in more recent times.
Queer will be used in this paper in three ways. First, it reminds us of the potential fluidity and multidimensionality of same and other sex/gender experience in all people. Such a therapeutic conceptual frame creates safe space for clients to (re)imagine themselves in whatever inclusive or expansive ways they need. Second, it embodies the confounding nature of sexuality in general with its incongruities and paradoxes in sexual behaviors, attractions, thoughts, feelings, fantasies, and sensations. Thirdly, it normalizes our awkwardness as we challenge our own cherished frames about sexuality and gender in clinical practice. Working with complex...