Professor and Director of Specialized Graduate, Academic and Professional Studies, The Institute for Advanced Study of Human Sexuality, San Francisco, CA
Lecturer, Skyline College, San Bruno, CA
Private Practice, San Francisco/Palo Alto, CA
 

Why is it important for a therapist to obtain a history of a person's sexual experience? There is little opportunity for people in our society to talk to anyone about their sex life or sexual concerns--or even to clarify some sexual information--in a confidential and non-judgmental atmosphere. Since sex is an integral part of each person's self-expression, it is essential for the therapist to have the tools for eliciting accurate information from clients. Interviewing is also integral to the establishment of the therapeutic relationship.

Following are some suggestions concerning how to talk with clients about sex, especially in the initial interviewing process.

1. You need to feel comfortable about your own sexuality. This is the single most important aspect of talking about sex. Are you relaxed and non-judgmental about masturbation, same-sex activity, unmarried sexual expressions, etc.? This is not to imply that you need to engage in any or all of these activities yourself; merely that you can allow others their freedom of expression.

Example: A young male client presents to you with inability to relate sexually with women. One possible diagnosis is that he is primarily oriented to men but uncomfortable about or unaware of his orientation. How can you as a therapist find out about the client's same-sex experience if you are uncomfortable with homosexuality? He will inevitably respond to this judgement by censoring the information he gives you, thus leaving you vulnerable to a misdiagnosis.

2. Begin by asking about the least taboo sexual activities and progressing to the most taboo in order to facilitate the client's relaxation. This means you need to know the hierarchy of "forbiddenness" for these various behaviors--these vary from socio-economic class or culture and from male to female (e.g., in many current U.S. cultures, masturbation is OK for men, but
not for women).

3. Use those sexual and non-sexual terms with which your client is comfortable. Technical language can create a barrier and distance between client and therapist and may be experienced as patronizing.

4. Assume that everyone does everything. I can't stress this enough, because it gives the interviewer the latitude of allowing clients to be themselves and to have whatever experiences they have had, with no judgements. Example: Don't ask, "Do you masturbate?" but rather, "How old were you when you first masturbated?"

5. Give positive feedback. This helps the client to know that you are responding favorably to what is being said and are comfortable with the exchange of information. Feedback includes using "yes," "uh-huh," "all right," "of course," etc.

6. One of the most valuable aspects of taking a sex history is that it can open and close doors in therapy. For example, if a client is asked about her/his same-sex experience and she/he has had none, that door can be closed and no further questions regarding same-sex activity need be asked (unless, of course, your intuition suggests otherwise). However, if the question is not asked, this door must remain open. Example: A male client presents with erection concerns. Etiology may be complex, with both physical and emotional contributing factors. You would ask about the client's average alcohol intake. If he responds that he doesn't drink, this door can be closed and you need ask no more questions about alcohol.

7. Don't suggest answers. If the client reports that her frequency of partnered sexual activity is "average," and you respond by saying "that means about twice a week?," you are only disclosing what your concept of average is, and that may be a long way from what the client's concept is; the client may agree with your definition simply to create a favorable impression. Remember
that "normal" sexual behavior is an entirely subjective concept and varies from person to person. It is important not to give any impression that there is any such thing as "normality." Someone once asked Kinsey for his definition of "promiscuous," and he jocularly replied, "Anyone who has sex more often than I do."*

8. Use checklists, both for frequency and techniques. Do not use any ascending or descending hierarchy that a client may interpret as being socially acceptable. Example: question about frequency of masturbation--"How often do you masturbate?" Response, "A fair amount." Therapist: "Is that four times a week, once a month, three times a day, twice an hour, or what?"
Notice the absence of order. Always give many examples, as there are so many variations.
 

The foregoing information reflects my sexological training and experience in taking many sex histories; however, it can be modified to include interviewing a client about any information; for instance, relationships with parents, siblings, etc. The basic principles of non-judgmental, supportive, information-giving interviewing are essential ingredients in the therapeutic process.

*Wardell B. Pomeroy, personal communication to author.