Sex Therapy
On Call
Some Clients Too Ashamed or Uncomfortable for
In-Person Therapy Are Getting Treatment for Sexual Problems Via
Phone and Computer
By Jason Feifer
Special to The Washington
Post
Tuesday, June 15, 2004; Page HE01
Michael has received sex therapy at the top of a mountain.
He's also had counseling outside his Silicon Valley apartment and in
the parking lot of a nearby airport. In each of these locations and
many others, he speaks from the privacy of his car. There, he feels
he can be more frank with sexologist Gloria Brame than he could
inside a therapist's office.
According to Michael, the unconventional character of the
sessions has been the critical factor in helping him face his
problems. (Because of the personal nature of his therapy, Michael
agreed to be interviewed for this story only on the condition that
his full name not be published.) Inside his car, the 27-year-old
said, he has confronted his desire to seek out sadomasochistic
relationships, something he couldn't put into words a year ago.
Then, the end of a relationship left him worried about his needs and
his ability to meet them. Anxious for reassurance and guidance from
someone knowledgeable about kink culture, he picked Brame after
stumbling onto an online reference to one of her books on the
subject. He said Brame (dubbed "the Dr. Albert Einstein of kinky
sex" by one sex educator) has helped him address some of his body
image issues as well.
He's even lost some weight. But Brame wouldn't know that
firsthand. Although she's been his therapist for 10 months, and they
talk once a week, the two have never met. She lives three time zones
away, outside Athens, Ga., and conducts sessions with Michael by
phone and e-mail.
"I think there was something about not knowing the person,
not seeing the person, not blushing in front of the person, that
made it easier to talk initially," Michael said. "Even over the
phone, my first conversations with her, we talked about things that
made me sweat."
For Michael and others who are uncomfortable discussing
sexual issues face-to-face, distance sex therapy, as it's known, is
providing a new option. Its practitioners include credentialed sex
therapists who counsel clients by phone, e-mail or in Internet chat
rooms, where they address deeply personal issues without ever
meeting. In doing so, they've set off a debate about the ethics,
legality and effectiveness of such practice.
"If therapy works, there's some processes and mechanisms
that occur in the session that make it work," said William
O'Donohue, professor of psychology at the University of Nevada at
Reno, whose articles on sex therapy have been published in the
journal Clinical Psychology Review. Such mechanisms, he said, can
include homework exercises or communication training as well as good
rapport and empathy from the therapist. But he said, "What we don't
know is, are the processes and mechanisms still working in e-mails
and . . . in telephone contact?"
Distance sex therapy has been growing over the last five
years, according to Barnaby Barratt, president of the American
Association of Sex Educators, Counselors and Therapists (AASECT), a
Richmond-based professional organization that certifies various
health and social service professionals who specialize in
sexuality-related education and treatment.
Barratt bases that opinion on what's he's observed on the
Internet and what he's heard from clients and fellow sex therapists;
he and other experts say there is no official count of how many
therapists offer the service, nor has the treatment method been well
studied. Professional groups, including AASECT, have only recently
begun efforts to better understand the trend and draft guidelines
for practitioners.
But some sex therapists are skeptical. Deborah Fox, a
Washington-based clinical social worker and AASECT-certified sex
therapist, said a phone conversation or e-mail exchange can't
resolve deep-seated problems.
She came to that conclusion after she began offering an
online service in 1995, and found that the e-mails she received came
in two forms: problems that could be resolved quickly with
suggestions and information, and serious issues that required
in-depth therapy. Without a personal meeting, she said, she was
unwilling to address the latter.
© 2004 The Washington Post
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