Collaborations between Psychotherapists and Sexological Bodyworkers by Jack Morin, Ph.D.

Sexological Bodywork (SB) in particular builds a bridge from talking to experience in cases that involve one’s sexuality. I have felt that a profession such as SB was needed, so it’s exciting to see this new profession, with its specialized training and ethical operating principles, being utilized by therapy clients. It has changed the way

that I work to have this kind of therapy available. It is so much simpler now to recommend clients get bodywork with a defined and specialized profession. My clients have been getting very powerful results.

Therapists are taken aback at first to hear of Sexological Bodywork. Then come the questions, serious thoughtful questions, mixed with concerns. Some have an understandable reluctance to refer clients for such work. They are not really sure what the potential benefits are of including bodywork as a piece of a psychotherapeutic process and to collaborate with it. They don’t know the kinds of issues that might call for SB work nor what SB has to offer. They’re unclear how to make such a decision, and when to consider discussing it with a client. They worry about something going horribly wrong and they’re concerned about lawsuits. More immediately, they don’t know how to present this work to a client as an option.

It’s normal that therapists would express uncertainty about the benefits for their clients and concern about questions of legitimacy. But once a therapist has seen the benefits firsthand and understands how these issues are being addressed in the SB training, it becomes incredibly easy for them to refer clients in need.

Some of the earliest cases of bringing in a touch professional were with sexual surrogates. They were the first group doing erotic touch in a refined, respectful way. They worked with a great deal of

success to set up professional guidelines, to offer training using a well-developed curriculum, and to create a serious profession. Sexual surrogacy is a big decision for a client. It is usually an ongoing process – long, expensive, and complicated. Sexual surrogacy can be threatening for clients, and some people still cannot separate sexual surrogacy from prostitution in their minds.

Sexological Bodywork fills the gap between a touch professional who does not do any erotic touch, like a massage therapist, and the complexity of sexual surrogacy. I appreciate the simplicity of making a referral to a professional who operates in a more traditional bodywork model. The client will be attended to, and the touch will be one-way, from the professional to the client. That boundary will be respected, and within that there is a lot of freedom. This makes it simpler to explain, and safer for many people. It is flexible and adaptable; someone can benefit from just a couple of sessions. Others may need more, but it is not always necessary. Although some of the surrogates I know have been very successful at their profession and wonderful with my clients, I find referrals to Certified Sexological Bodyworkers to be easier to make.

There are seven different therapeutic areas in which I have seen Sexological Bodywork to be extremely helpful. The first of these, and the one where I have seen the most profound impact of SB on my work, is when people have pleasure anxiety or erotophobia. This

category includes sexual aversions from mild to some really extreme forms, which can be experienced by abuse survivors. There is a huge spectrum of these cases.

Anxiety tends to be self-perpetuating; once you generate it, there’s probably going to be more. A bodyworker is in a position to observe the bodily experience of anxiety. Their access to the client’s breathing, muscles, and general physical state also gives Certified Sexological Bodyworkers (CSBs) the ability to head off some anxious reactions. That’s what I encourage them to do. That way, the client can gradually enjoy more touch without anxiety being generated. In a session that encourages awareness during physical touch, the client gets to experience the anxiety arising at the time it is easiest for them to access the thoughts that might have triggered it. That is incredibly useful. Also, a CSB can give feedback to a client about the level of constriction in their pelvis or other areas when they get nervous. This is not about what is “wrong,” but is given as information with compassionate understanding.

The second category of therapeutic issues that benefit from SB includes situations such as body image, body dysphoria, and body hatred. In a deep conversation, you can find that what they see when they look in the mirror is far from what you experience yourself looking at them. A person’s body image can take a long time to catch up with reality if they have had bodily changes. Abuse situations also can

cause body dysphoria, because the person can’t get a fix on who they are. Some of these problems can be very difficult.

For clients in these situations, touch can be very grounding. Over time, the body becomes “more solid” as they work with a CSB, then talk about it later with me. Generalized body hatred usually radiates out from certain body areas. These can be very specific, and discovering this can be a great breakthrough. Through attentive touch, they can begin to construct a reality that helps them discover who they really are. They sometimes change dramatically in the way they talk about their body. These kinds of cases call for gentleness and the ability of the CSB to be softly attuned, and to give feedback on what they are observing. This must be done in such a non-judgmental way that the person can actually hear it.

Another category is sexual dysfunctions; this is where I have the most experience giving referrals. These cases include lack of arousal, orgasmic dysfunction, erectile dysfunction and other situations. Often they include anxiety. These can be complicated cases. These days, when people have a problem, they often read a book, get some Viagra, and sort of muddle through on their own. So the people with simple problems usually won’t come to me. But Viagra cannot counteract extreme anxiety.

When people get stuck, hands-on work can help them. SB gives the client with erectile dysfunction an actual encounter with their own

performance anxiety. More often than not they are very performance oriented; sex is a test to demonstrate normalcy. It doesn’t help to jump on a bandwagon trying to “fix” the person so they can perform. If the person is performance oriented that won’t help them. Our purpose is to help people approach it in a different way, to change the focus from performance to pleasure. So a performance-oriented man can get the opportunity in a Sexological Bodywork session to not have an erection – with a person who’s not attached to whether he does or not. Then he can see what he experiences without the expectation of arousal or erection.

In these cases, first we build rapport. Then the CSB spends several sessions touching the client in ways that are not explicitly sexual. I suggest that the client seek a pleasure orientation and even accept the situation as it is. Some see acceptance as an enemy of change, but experience tells me that’s often the first step to real change. The process leads toward the client being ready to get total body stimulation, including genital stimulation. Eventually the client learns what it means to experience pleasure when there’s no performance involved.

Women who come to me often have problems with inorgasmia, and though Sexological Bodywork could really help, they are more reticent to try it. There’s a fear, collectively speaking, that women carry about what’s going to happen if they allow themselves to be

touched. One courageous woman who tried SB discovered she could have lots of different orgasms. I could never have facilitated that.

The next category includes anal concerns: negativity and taboo imagery about pleasure there, chronic medical problems, or chronic pelvic tension in the anal sphincter muscles or the pelvic floor. Constipation is often representative of a chronic tension state. Massage, as it becomes comfortable, is beneficial for tension. Once a certain level of comfort is attained, the bodyworker can, through the anus, reach and gently massage the inner musculature of the whole pelvic floor. During this process, CSBs can help clients learn how to release the tension. This kind of work, with someone else as a guide giving feedback, can be combined very effectively with self-exploration, self-anal massage in the shower, and deep breathing. In this way, my clients have had success with chronic anal pain.

Another whole area of work is in substance abuse recovery, especially when substance use has become closely connected with sex. When going off the drugs, a person can regress to a very inhibited state until nothing works for them sexually; everything is boring. Some addiction counselors take the attitude that the important thing is just to get sober and not to worry about your sex life. They just don’t recognize how important sex is; some people will never get sober until they get their erotic energy back. Clients will have a much better chance at recovery if they find another, healthy way to revitalize

their sexuality. In these cases, a CSB can educate them about new erotic possibilities.

The most complicated group of disorders for therapists and CSBs alike includes hypersexuality or compulsive sexuality; and paraphilias, which I call “troublesome turn-ons.” Hypersexuality does not mean the person has a lot of sex; it means the person is compulsive about having sex, whether they enjoy it or not. Compulsive people aren’t having much pleasure; they experience a love-lust split. Body-based touch and awareness are crucial parts of healing this split, so SB can be helpful in these cases.

With a paraphilia, sex becomes more and more disembodied. It’s a “head trip” that requires a specific sexual ritual. The affected person might be very orgasmic, but their main experience is the head trip, a form of disembodied trance. Hypersexual individuals do not act in this kind of ritualized way, but there are similarities; they also go into erotic trances that are negative.

This is a trance of a sort where the person is not present; they are like a robot. They replay super intense repetitive erotic scenarios, and can’t get aroused without this specific script. This can be a difficult distinction to make from an embodied erotic trance, but the body awareness interrupts the mental script. SB is a very powerful method for embodiment; it gets them back in touch with their physiological capacities, and gives them a chance to work through their head trip. In

therapy with someone, I can point out the issues, but talking does not help a person to get re-embodied. Fighting the urges is fuel that keeps compulsion going, so to make peace with it, they need to make a space for the compulsion. SB doesn’t replace or eliminate the paraphilia; it helps the person to learn new kinds of arousal.

Sexological Bodywork offers great modalities for educating couples. The intention is to open doors into more ways to connect. One approach is the CSB offering guidance and coaching to the couple on how to do erotic massage and other SB techniques with each other, as an alternative way to be sexual or sensual together. Sometimes only one of the couple needs the support or wants it. In those cases, I insist that individuals tell their partners they are getting SB. Most are glad for their partner to get help.

One man learned from a CSB about a whole new way of touching that he started doing with his wife. At first the wife was a little threatened, but he became a gentler, sensitive, experimental lover. As he became a more sensual person, she had a much better time. Sex became dramatically more interesting for her, and it transformed their sex life.

Even when it’s clear that this kind of work is a good idea, it can be a bit tricky to bring it up with a client. The therapist must be prepared to deal with, or accept, the client’s feelings about the idea. For example, a client who is dealing with a sexual issue and has

moved into an avoidance state can be a really good candidate. I’ll ask the client what they think it would be like with some combination of these questions: What if you could have some sessions with someone who is an experienced bodyworker, someone who is comfortable talking about sexual responses and erotic feelings, and you were free to have any sexual response you might have? What would it be like to not feel any pressure, where you could be yourself, be nervous, experience that fear that makes you want to avoid these situations, in a place where everything is allowed, all feelings, all responses? What if you could be free to just explore? What if it were totally pressure free, but the focus was on you, to explore your body, to reconnect with it? You wouldn’t have to have any sexual responses, you wouldn’t have to respond in any particular way. You could see what touch can mean, you could just be aware of your breathing, and you could get feedback on how you’re holding your muscles at certain moments. What do you think that would be like?

I encourage clients to think about the idea of professional touch as a possibility. That’s how to set the stage. People who are comfortable with me will reveal in their imagining some of the fears that they have about what might or might not happen, or what the expectations would be. They can thoroughly explore the fears and concerns as well as the possibilities. I have even raised these questions in a first session when SB appeared to be an appropriate

option, and the client seemed ready. Clients very often see immediately and easily how it can help them.

It has been my experience that there is a period of preparation once they express interest. They start to see the possibilities, and acknowledge that they are open to it, then there is a process to follow. I will give them a name and phone number and have them do a phone chat and make an appointment if it feels right.

Then the client signs a release for the CSB and me to be in communication. The communication goes both ways. We could not do this without written permission. It is a simple permission, just one sentence. Once I get a release from the client, usually before they actually meet with the CSB, I will call the bodyworker and give the whole story. (We use initials as a habit, not names.) When the client talks with them, the client will repeat their story with their own words. While we maintain lots of communication, the CSB does not receive full information of what happens in the therapist’s office, only what directly impacts what they are doing and what might be important for them to know. I often encourage the client to talk to them about anything important; it is better if they do it. For my part, I do not need to know exactly what happened in the bodywork session or how, just what the CSB observed and generally how it went.

When I work in conjunction with a bodyworker, they send me an email after each session, and I put it right into my notes. So I have an

ongoing communication and know what is going on. I see what the client emphasizes to the CSB, which can be very useful. The client tells me how it went and if there is anything the CSB needs to be aware of, I will send them an email. Each session – both therapy and bodywork – begins with a recap of where the client is that day, what they are bringing into the session, and their reflections on their last session. It has so far never been necessary to have a meeting of the three of us.

Just as it is important for the practitioners to be clear, I want the client going to the CSB to be clear what they want from the work. I ask them to articulate what they are hoping to get. If they can’t do this, they are not ready. Their ability to articulate how they hope to benefit from the experience can make a difference in the success of the session. The best experiences include some time at the beginning of the session discussing what the client sees himself getting out of it. The client is better off with a clear sense of approximately what is going to happen in a session and the CSB can focus on the most beneficial way to approach the session. As clients benefit, they become increasingly articulate when describing what is happening with them and how they are changing. Clients benefit by being able to state what the benefit is.

Sexological Bodywork requires certain skills that not everyone can do. CSBs must have the ability to be with someone in a non-judgmental way, to be clear they are there for the client and that no one needs to prove anything. It also requires the ability to discern when a traumatic reaction happens. Even when the client doesn’t say anything, a professional can tell when something is going on in the body. The CSB will respond accordingly, will be very gentle, very still; then they’ll ask the person about it, staying calm. That is tremendously reassuring to most clients. It says that the bodyworker is paying attention, is respectful; that they see that the client’s feelings matter. These are advanced skills. Not everyone can do them.

Therapists and Certified Sexological Bodyworkers alike need to be part of defining how to do this collaborative process: What should happen, what can happen, what framework to use to ensure safety and clear boundaries. People are better able to drop normal inhibitions if they have a safe space in which to do that. The professionals must be watching the boundaries to make sure the clients are safe. When clients feel how defined the situation is, they can let go and move beyond their inhibitions.