Navigating the frontier: a grounded theory study of how therapists address sexuality in therapy

Background: Human sexuality is a highly debated topic in the social sciences and psychology. Counselling psychology has contributed to the body of knowledge by publishing guidelines on sex-affirmative practice, but little is known about what happens in the therapy space. Much research on best practice seems to be based on assumptions, rather than what is happening on the ground. Existing studies tend to focus on patients’ experience of therapy, highlighting specific issues related to gender and sexual orientation. A review of the existing literature suggests a gap in the knowledge of how therapists address sexuality in sessions, especially using a qualitative methodology. Aim: This study aimed to understand and build a grounded theory of how psychological therapists address sexuality in therapy. Method: Ten psychological therapists, all working in Greater London, participated in this study. Two identified as male and eight as female; six identified as heterosexual, one as omnisexual, two as gay and one did not disclose. In terms of professional registration, three were Counselling Psychologists, one Forensic Psychologist, three Clinical Psychologists, one CBT therapist, one Systemic Family Therapist and one Psychotherapist. Regarding preferred model of practice, three participants described working integratively, one pluralistically, three espoused CBT principles, two psychodynamic and one systemic. All participants were between the ages of 30 and 59 and five identified as white British, two as White Other, one as Black British and another as Asian British. Intensive individual interviews were used, and the data were treated according to constructivist grounded theory guidelines, as advised by Charmaz (Charmaz, 2014; Charmaz & Henwood, 2017). Findings: Sexuality remains a largely unknown and unexplored frontier in the field of therapy. Acknowledging its significance for identity and well-being, therapists must navigate their own personal and clinical experiences of sexuality to address it with clients. Curiosity is first ignited in personal experiences and is subsequently honed through training or, in its absence, clinical experience. This is the exploration of uncharted territories, providing opportunities for growth and development while simultaneously causing anxiety and discomfort. Best practice guidelines and available social-cultural signs and practices function as a map, leading them through their work. However, these maps are frequently incomplete, unclear or conflicting, creating further uncertainty on how to proceed. In the therapeutic encounter, the client is the captain of their journey, with therapists co-developing the necessary tools and individual meanings through language. Feelings of shame and discomfort often act as barriers to exploring sexuality, for both therapist and client. However, supported by a therapeutic relationship that fosters collaboration, it is possible to navigate the frontier of sexuality in a healthy, meaningful, and affirming manner. This study draws upon cultural-historical and activity theories (CHAT) to build upon therapists’ experiences and puts forward a model of addressing sexuality that goes beyond Cartesian arguments and model tribalism. By bringing together every day concepts grounded in participants experiences and scientific concepts provided by psychanalysis and CHAT, this theory highlights areas for further development while providing a working model for training and practice, thus contributing to the Counselling Psychology agenda of pluralism and social justice.

Name dc:type.qualificationname

other

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

London Metropolitan University

Year dc:date.issued

2024

Author dc:creator

• Videira, Monica

• 610 Medicine & health

Dc Identifier Grantnumber

N/A

OAI identifier oai:identifier

oai:repository.londonmet.ac.uk:9116