Few topics are more controversial or downright uncomfortable to talk about than sex and sexuality. It seems we could examine any period of time in human history and find a number of social values and ideas related to sexual behavior, all of which might be discussed with some nuanced language or slang of the time. More often than not, we would find some positive messages about sex but also a fair share of messages that promote — intentionally or not — feelings of guilt and shame. Even with the timeless double binds that accompany messages around sex and sexuality, it is important to recognize that sex remains an important part of our storied history. After all, without sex, we wouldn’t even be here to have this conversation.
When we talk about sex, we are talking about something loaded with assumptions and values. Sex does not exist in a vacuum; rather, it is woven into our personal identities. It is with that idea that I want to encourage sensitivity and tolerance for a topic that has been dressed up and dressed down: pornography.
Sex and pornography in the 21st century
When considering key markers of sex and sexuality that exemplify the zeitgeist of today’s technological era, one might think of pornography, an industry that pulls in billions of dollars each year. Access to pornography has only increased with widespread use of the internet and the diverse number of gadgets available to connect to it. As such, it makes sense that counselors report working with more and more clients who have issues related to their pornography use.
Researchers have attempted to establish correlations between pornography use and a number of other issues of clinical concern (e.g., depression, anxiety), but it has been difficult to draw any definitive conclusions. However, we do know that clients are presenting to counseling for issues in their romantic relationships related to pornography use (e.g., fighting about how much or how often it should be viewed, if at all), for issues that mirror symptoms of addiction related to their pornography use and for a variety of other issues that can be traced back to their pornography use.
Some of the more nuanced issues related to pornography use include clients reporting decreased sexual satisfaction in their primary relationship or even an inability to perform sexually because of a desensitization to sexual stimuli. Some clients report experiencing anxiety and distress about expectations — either self-imposed or solicited by a partner — to replicate acts depicted in pornography that contrast with the client’s value system. Similarly, some clients report experiencing distress connected to feelings of inadequacy that result from comparing themselves with the actors and actresses in the pornography industry.
This is not an exhaustive list, but I believe it speaks to what has been identified in the counseling literature and what counselors have anecdotally reported seeing in their practices, which parallels what I have seen in my own clinical practice. It is also worth noting that clients are more likely to come to counseling with presenting issues that appear not to connect to their pornography use. Most often, this is because the presenting issue simply has no connection to their pornography use. Other times, it is because clients have not yet gained awareness of how their presenting issue relates to their pornography use or, commonly, do not yet feel safe enough in the therapeutic relationship to talk about their pornography use. Yet the question remains: Why are clients now coming to counseling for issues related to pornography?
Accessing pornography
Imagine a child on a school playground in Anywhere, America, playing with their friends when they hear a sexual word or phrase that they’ve never heard before. Maybe they don’t even know that the word has anything to do with sex or sexuality. Now imagine that the child is too embarrassed to ask their friends about it, so the child either types the word into an internet browser on their smartphone or waits until they get home to Google it. In a matter of seconds, the child is confronted with definitions that might go beyond their scope of understanding or is seeing a sexual act, either via high-definition images or video.
Although this example doesn’t fit as well for older age groups, it is representative of how the cultural narrative around pornography has changed from previous decades. You can imagine that the same child in the 1970s or 1980s would not have had easy access to that kind of content. Instead, the child would have needed to ask a friend or relative to explain the concept or term. Even if this person felt uncomfortable with the question or was not the ideal person to ask, there still would have been a connection between the two people. In other words, the child would not have been left to wrestle with this concept in isolation.
In previous decades, if minors wanted to access pornography, they had to find it, borrow it or steal it. Adults needed to show an ID to purchase it. Today, the only thing required to access pornography is a technological device. Even devices with software blocking services work inconsistently at best. Consequently, we are simultaneously more connected and more isolated than we have ever been in human history.
When we think about the dynamic and contrasting messages that society promotes about sex and sexuality and place that in conjunction with sexuality being tied into a person’s identity and valuation of themselves and others, it makes sense that we are seeing an increase in problems related to client pornography use.
Discomfort with sexuality
One could make the argument that most clinical issues might increase or decrease along with the availability of and accessibility to: fill in the blank. For example, a couple might argue more when they reach retirement and spend more time together (i.e., an increase of minutes together). The issue of pornography, however, is more dynamic than its presence or absence because it is a piece of the larger puzzle of sexuality. As readers are likely aware, there is often a significant amount of shame and guilt tied to issues of sexuality — for clients and counselors alike.
Sexuality is described as being part of the human experience, and the helping professions’ various accrediting bodies recognize it as such. However, human sexuality is not a standard and mandated part of counselors’ training. In fact, the general sex education that a counselor receives as a child and adolescent in elementary, middle and high school varies in depth and breadth — if it’s covered at all. Consequently, counselors experience a wide spectrum of comfort levels when it comes to discussing issues of sexuality in general. In addition, counselors’ comfort with sexuality influences their propensity to assess and treat clients for sexual issues.
Perhaps because of their lack of formal or meaningful sex education, some people — including counselors — have reported turning to pornography to learn about sexuality. The concern about this is that pornography is not considered to be a realistic portrayal of sex or intimate relationships. Thus, it might lead individuals to form unrealistic expectations about what happens in a sexual encounter and to pursue sexual activities that could interfere with fostering a successful or satisfying sexual experience. At the same time, counselors might be impaired to provide helpful or accurate psychoeducation to their clients related to sexuality if they do not have a more reliable source of information than pornography.
Taking down barriers
The best way to position yourself to meet your clients’ needs when it comes to working with issues of sexuality or pornography is to know yourself. These are controversial topics, and the first step in being available to your clients is to take ownership of your own beliefs, values and attitudes about sex, sexuality and sexual behaviors. As a starting point, ask yourself how comfortable you feel when thinking about working with a client who reports wanting to reduce their pornography use or who says their pornography use is interfering with their romantic relationship. If you notice discomfort or an aversion to working with a client on those issues, it might be a good time to seek consultation or supervision concerning the source of your discomfort.
In my experience with counselors-in-training and counselors I have met at various conferences, the discomfort tends to stem from one of three things:
1) Religious or spiritual values that make it difficult to maintain a stance of unconditional positive regard
2) Previous experiences of trauma that make it difficult to stay present when delving into discussions of sexuality
3) Feelings of incompetence when it comes to forming or maintaining healthy sexual relationships
For issues of personal values and beliefs — whether stemming from religious/spiritual foundations or not — I think it can be beneficial to pursue counseling services to explore those feelings of discomfort. Counseling can be an effective way to question and deconstruct beliefs that might be interfering with the formation or maintenance of a therapeutic relationship with a client who is wrestling with any of these issues. I find it helpful to allow myself to maintain my belief system and simultaneously place brackets on that belief system so that I can join a client or couple without my lens impeding on their experience. Sometimes I find that working with a client or a couple might remind me of an old belief or value that I once held. I can recognize that the belief is no longer serving me and that I am ready to discard it.
As this discussion relates to previous experiences of trauma, we understand that healing is an ongoing process. Sometimes we might believe that we are healed until we are confronted by our own limitations. We then recognize that it is time to delve further into healing from the past so that we can stay in the present. This, of course, extends beyond issues related to sexuality; it applies anywhere in the counseling relationship in which we find ourselves bumping up against our own walls.
As it concerns feelings of incompetence, counselors’ training in treating issues of human sexuality and their general exposure to sex education vary. I suggest that counselors ask themselves three things: What do I know? What do I want to know? Do I feel confident to relay this information?
To address any deficit in knowledge or any identified room to grow or learn more, I recommend that counselors prepare themselves to work with clients by finding educational resources on sex and sexuality. I also encourage counselors to pursue additional training or workshops through their professional memberships and state and regional conferences. Through identifying our areas of discomfort and our learning curve for the future, we prepare ourselves to best meet the needs of our clients. Of course, we need to be aware throughout the entire process of what our limitations are and when it is time to refer out to another helping professional and possibly even to a certified sex therapist.
In addition to preparing ourselves for working with clients through their sexual issues or regarding their pornography use, we need to provide a space for clients to address these issues. Counselors who report working with clients for issues related to their sexuality or pornography use also often report that they did not ask their clients about these issues. I believe that by soliciting that information early in the counseling relationship — through an intake questionnaire or intake interview — we implicitly state to our clients, “I am willing to discuss this issue, and this is something you can talk about here.” Again, because of the amount of guilt and shame our clients can feel around issues of sexuality, it becomes that much more important to ensure that we are maintaining a safe, supportive and confidential professional relationship.
In my clinical practice, my intake questionnaire includes a space for clients to report on areas in which they have concerns (or in which a family member or friend has raised concerns about them). These areas include gaming, eating, gambling, shopping, sexual activity and pornography use. Only rarely do clients circle “yes” to sexual activity or pornography use. More fruitfully, however, when reviewing the intake packet with clients in session, I ask, “Would this be a place where you might feel comfortable enough to talk about any issues related to sexual activity or pornography use if it came up?” Even if clients state that they do not have a problem in those areas, by having that conversation early on, the implicit message I send is that they can address any concerns related to sexuality or pornography should they ever want or need to.
The work
Beyond knowing ourselves and our own limitations — including when to seek counseling ourselves and when to refer out — there are a handful of recommendations for working with clients regarding sexual issues or pornography use. First, it is necessary to co-create a working definition with the client regarding the presenting issue and any important terms being discussed. In the case of pornography, I recommend asking clients how they define what pornography is. Across the counseling literature, definitions of pornography vary, but what is most important is that you and your client are speaking the same language. So, from the client’s perspective, does something qualify as pornography only if explicit sexual acts are involved, or is it anything that includes nudity? Does sexually provocative material count, even if it does not include nudity?
It is necessary to create this shared definition so that you don’t accidentally dismiss a client’s use of “pornography” as not warranting attention when it is something that is causing the client distress. For example, if a client experiences feelings of guilt for viewing images of clothed people in sexually provocative positions, we want to validate the client’s experience of guilt,
even if it might not intuitively resonate with the way that we personally define pornography.
In the same vein, we want to ensure we have a shared definition so that we do not miss opportunities to assist our clients in meeting their clinical goals. For example, I once worked with a man who wished to abstain from pornography use and masturbation for religious and spiritual reasons, and he seemed to be making progress. However, I came to realize that although he was abstaining from traditional pornography use and masturbation, he had begun to engage in more frequent promiscuous sexual behavior. After finding out more about his promiscuous behavior, we were better able to define the “spirit” of his counseling goal, which was to gain greater control over his sexual activity — including abstaining from anonymous sex.
Both in co-creating definitions of pornography with our clients and in the clinical work we do with them, it is also necessary that we model appropriate language. There are compelling reasons to believe that pornography use might promote sexist or harmful beliefs about women resulting from how they are portrayed in pornography. As social justice advocates, it is our job as counselors to balance the deconstruction of sexist or misogynistic ideas without alienating our clients by using overly clinical language or shaming them.
In practice, this means finding a way to ask clients to clarify what they mean when they use a certain term. Similarly, when we use a sexual term, we want to make sure we are using language that the client understands that is also as free of negative associations as possible. In my experience working with clients, depending on the length and strength of our therapeutic relationship, I will typically begin by using the client’s language — asking for clarification when I hear a new term with which I am unfamiliar — and gradually introducing more neutral language to replace the previously value-laden language. As I do this, sometimes the client will follow my lead and it becomes a trend that continues until we are using more value-neutral language throughout all of our sessions.
Other times, I might find a way to introduce a moment of psychoeducation in which I clarify my change in language with the client. I then ask the client to try changing their language too as an experiment to see if they notice any differences in the way they are thinking or feeling. Usually, I can find a way to do this that supports the presenting clinical concern. For example, with a client who presents for counseling for symptoms of depression resulting from the termination of a romantic relationship, I might be able to make a connection between “power” in a relationship and the importance of “respect” in a relationship. We can then discuss how altering our language is a concrete step we can take toward facilitating the change of finding more respect and more even distributions of power in a relationship.
Beyond taking general steps to prepare yourself for working with issues related to sexuality and pornography use, it is also important to be able to provide specific psychoeducation to clients regarding their presenting issue. This is not something that is achieved and completed but rather an ongoing component of being a counselor. Sexuality is diverse, and we need to have sound sources of information not only for ourselves but also for our clients.
Typically, I find in my work that a client’s presenting issue includes myths or deficits in knowledge about sex and sexuality. With younger clients, I find that the deficit in knowledge is often related to safe sex practices. Therefore, I recommend familiarizing yourself with books that you can feel comfortable promoting and sharing with your clients, and internet videos or links that are not pornographic in nature that can serve as educational resources.
Individuals and couples I have seen in counseling for issues related to sexuality or pornography use tend to have one thing in common: They want to have a fulfilling sex life. Consistent with findings in the counseling literature, I emphasize to my clients that a fulfilling sex life comes from a sexual relationship that is founded on trust and vulnerability. In line with that, for some individuals and for some couples, pornography use can be a barrier toward open, honest and vulnerable sexual expression, especially when their sexuality is framed by messages of expectation. Instead, I promote mindfulness practices, sensate focus activities and building on previous experiences of success. Overall, I find that clients make the most progress when they understand that the sexual fulfillment they are seeking is with their actual partner and not with an imagined conceptualization of their partner or a different and more ideal partner.
As part of counselors’ work of addressing issues of sexuality and pornography use, we need to be prepared for clients to ask us about our own sexual experiences and whether we use pornography. I don’t know how often clients actually raise questions along those lines, but I think that we need to be prepared for such instances. As with most topics, I encourage counselors to explore their own levels of comfort with disclosure and to assess whether their disclosure is for their clients or for themselves. Some disclosures are more or less appropriate with certain clients but not others. However, the entire topic of disclosure becomes especially complicated and potentially harmful when discussing sexuality and pornography. Because of the sensitive nature of the topic, I would encourage you to err on the side of caution when making any disclosures with clients about your own experiences, and I would also encourage you to be prepared with a statement so that you are not caught off guard by a client’s questions.
In the classroom, in session and at various counseling conferences, I have been asked about my personal stance on pornography use. The response that resonates most for me is to remind my clients that what might be right or wrong for me might not be right or wrong for them. In addition, I would not want to influence their choice or decision beyond assisting them in identifying their beliefs about sexuality and helping them to live congruently within their value system.
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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.
Zachary David Bloom is an assistant professor at Northeastern Illinois University. He is also a licensed clinical professional counselor and a licensed marriage and family therapist. He specializes in working with couples and with individual clients with trauma. His research interests include the influence of technology on romantic relationships. Contact him at zacharydbloom@gmail.com.
Letters to the editor: ct@counseling.org
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Related reading, from the Counseling Today archives: “Entering the danger zone”
The absence of formal and accurate sexual education is a particularly American problem that may find its way into the offices of professional counselors. wp.me/p2BxKN-3JE
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.