A Final Thought

This chapter was included to introduce the reader to other variations in sexuality, to educate the therapist, and create options for competency in treating diverse expressions of sexuality. The major scope of this text is to describe the etiology and treatment of the major sexual disorders, yet we believe it would be a serious omission to exclude a significant evolving group of individuals with presentations beyond the scope of disordered sexual concerns.

Gender diverse people deal with stigmatization on a daily basis and have developed coping mechanisms to defend against discrimination. Accordingly, they might not anticipate safety in the therapeutic setting. Equally important is the fact that therapists are also products of their society and may, therefore, be prone to a range of countertransference reactions to kinky, queer, and other gender-nonconforming clients. Since countertransference reactions usually derive from unconscious beliefs, the insidious nature of the process must be carefully monitored during the course of therapy.

Often, in search of a safe psychotherapeutic environment, clients might seek treatment with openly LGBT+ therapists, assuming similarities will guarantee acceptance. A better way to evaluate competence is to frankly discuss similarities and differences between therapist and client at the beginning of treatment and incorporate such discussions as therapy progresses the purpose of relationship building in the psychotherapeutic process.

As with any client, gender-nonconforming clients will experience transference feelings toward the therapist. Some of these feelings might be about discomfort with a straight therapist or assuming the therapist is not accepting of open lifestyles or gender fluidity. The client might be suspicious, defensive, frightened, or awkward because of the perceived differences between themselves and the therapist. Clinicians should expect that gender-nonconforming clients might hold their own set of prejudices about gender-conforming therapists and might expect heteronormative privilege to be operating in the therapist. The reverse may also be true. For example, assume the therapist is openly gay and the client is heterosexual. The client may expect that the therapist will not be able to understand them or may somehow, explicitly or implicitly, be coercing for their own agenda.

With any client, there is also the possibility for erotic transference, viewing the therapist as warm and accepting and, therefore, as a potential love object. In cases of transference and countertransference, any permutations are possible. One might assume it is somewhat unorthodox to even mention these concepts in a book dealing with a systemic approach to sex therapy because the early systems thinkers so assiduously avoided anything that was associated with psychoanalytic and psychodynamic ideas. Putting therapeutic camps aside, some concepts are useful irrespective of the general theoretical framework, and the Intersystem Approach is an inclusive rather than exclusionary frame.