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How To Respond When Patients Get Aroused In Therapy


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Sex, Self

What happens when talking about sex during therapy gets you turned on?

There are a number of issues that come about when working with clients around sexuality, and there are a few that are especially relevant to Rubenfeld Synergy, as it involves touch. The most obvious of these is a client becoming sexually aroused during a session.

During the second year of my training, I began to see practice clients. We were doing very basic sessions: practicing the somatic moves, doing some basic verbal interventions ("what do you notice," etc.). One of my practice clients was a young man I'll call him Carl. He was quiet and nervous, and didn't seem to know what he was doing there, exactly. I could tell immediately that I needed to take care with him. There was something more going on with him than he was telling me, but at the time, I wasn't experienced enough to press before proceeding.

Whenever I did moves involving the hip, he would tell me that it was making him excited. There were a lot of apologies and embarrassment involved, and I did my best to dispel his shame while making it clear that what we were doing here wasn't sexual. But of course, it was sexual — for him. At the time, my mentor advised me to just acknowledge the arousal, let him know it was okay as something that was in the room, and for now, to avoid hip moves. I was fairly new and wasn't ready to go down the road of what the arousal might mean. After a couple of sessions, Carl decided to stop, as the arousal part was distracting and distressing to him. Itwas also getting in the way of progressing my own education.

Since then, I've had a few clients who respond this way, particularly men. There is a lot going on here: sometimes men are just not used to receiving gentle, loving touch in anything other than a sexual way. Men don't get touched in adulthood as much as women tend to, and for an adult man, touch often equals sex. Educating men about this fact has proved to be helpful; many a thoughtful nod and relieved sigh has followed my voicing of this. With one client, it recently became clear that part of what he was dealing with was a submissive sexual nature, and because that's what his current work is around, lying on a table and being touched by a woman who is standing above him evokes those feelings. In that instance, acknowledgement is still the first answer. I have him talk about what's happening, and I choose in the moment either to delve or to redirect, to ground him in the now or let him explore what's going on in his head. The important thing is that the arousal not be discarded, dismissed, or forbidden, as if it weren't a natural part of human experience, or part of how people experience emotion in their bodies.

Arousal is something that can accompany many different emotions. Sometimes, it is simply about pleasure: gentle contact can trigger arousal that goes along with the pleasure of being touched. When acknowledged in a matter-of-fact, accepting way, this arousal often dissipates and proves unimportant to the session. In other cases, arousal can accompany fear: sex and death, as Freud knew, are closely linked. Finding where that fear leads can be a valid path for getting to the root of an issue for a client. And arousal can be linked to shame, as a client remembers being scolded for masturbating, trying on his mother’s clothes, or having sex with her boyfriend as a teenager. The body remembers the arousal as well as the emotion that accompanied or followed it, and links them together.

In this same way, arousal can also be linked to trauma. Years after I stopped seeing Carl, he wrote me to tell me that our sessions had led him to go into traditional therapy, and working there, he recovered memories of being sexually abused as a young teen. The assaults had happened with him lying down, while an adult touched him. At first I felt appalled and horrified that I hadn't seen it, and worried I might have retraumatized him. But he assured me that actually, the work we'd done was what allowed him to begin to remember, and thus, to heal. Had I been fully trained and credentialed at the time, I might have been able to follow the thread of his arousal to those memories, and help him heal directly. As it is, I'm happy I was just able to be with it, non-judgmentally, so he could begin to experience what his body was telling him.

Being present with arousal in therapeutic settings can be tricky for any number of reasons, which I'll go into in other posts. But when appropriate boundaries can be maintained, allowing that response can bring great rewards. It is, after all, just another signal from our bodies, like pain, tension or warmth.

This article was originally published at . Reprinted with permission from the author.

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