How to talk about sex with clients (with Emma St John)

Bronwyn 

This is mental work, the podcast unpacking the challenges faced by early career psychologists and I'm your host, Dr. Bronwyn Milkins. Hello mental workers and welcome back to the podcast. We are talking about sex today. That's how I'm introducing it - just really excited. And I am stoked to have with me Emma St John. Hi, Emma.

Guest 

Hello, lovely to meet you. Lovely to be here.

Bronwyn 

lovely to have you, Emma St John is a Clin Psych registrar and sexologist and today listeners we are going to take you through what sex therapy is? What the current vibe is towards sex in psychology? Does our training include enough of it? Heads up? No. So we're going to talk about why that is the case and how you can upskill to include sex therapy skills in your practice. I'm really excited.

Guest 

Yeah, me too. I think this is an area that perhaps gets overlooked when we talk about psychology training. And many early career psychologists that I've talked to don't know that it's an option for a specialty or population that we work in. So I'm excited to have more conversations like this.

Bronwyn 

Yeah, I certainly didn't know that it was an option at all. And I've never had a single lecture, maybe we'll start with this. How much? How much training did you get in sex? I guess throughout your psych degree, Mr. None, none. Okay. So I was going to say I've never had a lecture. I've never had anyone talk to me about sex therapy, or how to take a sexual history. Did you get any of that?

Guest 

No. So none of my masters of Clin Psych had anything to do with sex. There wasn't yet one lecture, one webinar, one reading on sex, or actually relationships, like intimate relationships or romantic relationships. It felt like it was a bit of a gaping hole in my training. Yeah, that's what

Bronwyn 

I'm thinking like, it sounds bizarre, doesn't it? When you think about how big sex is a part of everyone's life to sexuality, sexual pleasure, sexual health?

Guest 

Yes. And I understand that there has to be some things that can't be taught in a Master's of Psych, or in any other kind of pathway to psychology or mental health training. There is so much that we're expected to learn in such a short amount of time that some things have to be put to the side. But I am interested in the decision making of why Sex and Relationships had to be that thing. Yeah, yeah, because the two

Bronwyn 

are very much interlocked. It's like when people come with sexual concerns, sometimes it's in relation to a partner. Sometimes it's in relation to themselves, but the relationship component usually is almost always there. Do you find that? Yes, yeah. So why do you think this is? Why don't we actually have so I'm sure there's some decision making behind the curtain. But why don't we talk about sex more in general?

Guest 

Yeah, look, I'm not sure about the decision making for the training programs. I mean, there is a whole section of the DSM five that's devoted to psychosexual conditions. So it's certainly well located within the mental health realm. And so you would think that a comprehensive knowledge of all mental health conditions would also include at least a preliminary knowledge of sexual health conditions. So I'm not sure about the decision making, but I think it reflects perhaps, overall societal discomfort with talking about sex. It's difficult enough for us to talk about when sex is going right, let alone when we're finding sex hard or confusing or painful or traumatic. So maybe it's a joint process of, perhaps clinicians not wanting to talk about it either. And there isn't that many people that might be able to facilitate the kind of training that would need to Yes, I'm

Bronwyn 

curious, maybe I'll flip it on its head and you seem very comfortable in this space. You're a sexologist, you've done a very long degree title, which you told me before, which is the masters of science and medicine and sexual and reproductive health specializing a psychosexual therapy. Well keep that because it is but I'm curious to know in our I'm gonna say a sex phobic society where we find it very difficult to talk about sex, what led you to taking an interest in this area.

Guest 

I fell in love with talking about sex in my undergraduate degree, which was psychology and philosophy, actually. So I did a lot of the philosophy of sex and gender philosophy of consent and bodies and like sexual objectification and sex work and those kinds of things. So that gave me a really good grounding in learning about the ethics of sex. And then when I knew that I wanted to become a psychologist and a clinician, it felt like a natural progression to extend what I really loved learning about that into So how I can best work with clients. And also kind of in a bit of a weird way, but I was very naive to the process of how intense it was to become a psychologist in Australia. And so I came out of my honours, I'd done quite well. And then I applied to one program, one master's program, and I just assumed that I would get in. And that was not the case. So I had at least one year until I could reapply. And then it was the same time that the TV show Sex education was all over Netflix. And everyone was saying, Oh, my gosh, the show was so amazing, the sex therapist is in it, and I was thinking, hang on, I could actually really do this. And it just so happened that the Master's full time was a year. So I threw myself into it. I convinced the faculty that I would become a psychologist afterwards. So I did it in reverse. I became a sexologist first psychologist. Second. Yeah, that's the unusual pathway.

Bronwyn 

That's amazing, though, it really demonstrates as well, because getting into Masters is really difficult. There's just simply not enough places for how many applicants there are. So I do get a lot of questions from listeners about well, what else is there other than honors? And you've presented a great solution?

Guest 

Yeah, it's a great solution. But I would say that probably, it is better to do some kind of mental health training first. And that doesn't have to be psychology, it could be counseling or therapy of other kinds. But I definitely found like the six therapy masters was building on existing skills in counseling and interventions that I just didn't have. So I was kind of back feeling once I did my masters to be like, Oh, that lecture we spoke about a year ago. That's what they meant by cognitive challenging, things like that. So it worked as a pathway, but maybe do it the other way.

Bronwyn 

Okay. No, really good to know. I mentioned, was that difficult for you to be a no selection? So are you just kind of faking it till you made it? Yeah, there was a lot

Guest 

of imposter syndrome. Yeah, I was the youngest by quite a while, I think I was one of the only people doing it full time, because everyone else was already existing clinicians. And not just psychologists. So it's multidisciplinary. So there was lots of nurses and OTs, and psychologists of all different backgrounds. But everyone else I felt like had this grounding and what it was like to work with clients. And I had never worked with a client before. So I was doing lots of smiling and sitting at the back of the room being like, what is happening?

Bronwyn 

Oh, my gosh, how intimidating? Yeah, yeah, it was

Guest 

a baptism by fire. But by the time I got to do my clinical training, I actually felt much more confident than maybe some other people in the class. So it all came around in the end,

Bronwyn 

few. I'm glad that worked out for you persevering and just really aligning yourself with your goals. It really sounds like to me that through your philosophy degree, you would already overcome some of the biases that clinicians might have against sex so that I don't know where you get all sorts of stuff from society from our families growing up, right? Like, yes, pleasure is bad sexism, icky topics. X is disgusting. It's private, you shouldn't talk about it. Did you receive any of those sorts of messages growing up or from society? I

Guest 

think I got a heavy dose just from being a young woman in society. Yeah, that perhaps that like woman's pleasure is secondary to other people's or that pain is normal, or some kind of sexual trauma is just to be expected. Those kinds of messages were apparent, like in the peer group I went grew up in, in TV that we see. And I certainly was not always this open about talking about sex. I was a awkward, anxious, you know, prudish. 12 year olds, like many other people. It was it's through practice and open discussion that you lose the, you know, blushing reflex when talking about sex. Yeah,

Bronwyn 

yeah. That was my next question. Like, how did you overcome that because it's reinforced by peer group, family society as well, that these attitudes that might be negative towards sex. So I'm curious to know what the process was like for you in overcoming some of these perhaps internalized biases.

Guest 

I think it's a lot to do with where you get your information from and the kind of media that you consume day to day. So there are so many wonderful sex positive, like Instagram accounts and podcasts and books that you can read, and communities that you can surround yourself and where you can feed yourself a very nourishing diet of sex positive information that can go a long way in correcting the beliefs or messages that we might have had growing up and also the more training that you do in this area, the more clients that you see, facing these kinds of challenges, we realize that six concerns are mainly like health concerns. It's not dissimilar to talking about other kinds of chronic pain, for example, or other kinds of different bodily functions. After a while it loses its scandal. It just becomes interesting. Yeah, yeah.

Bronwyn 

Wow, that's so fascinating, because, okay, let's catch listen set up to where we're up to. So we've talked about how there isn't much training, if at all, about sex in clinical psychology, or just psychology in general. And then combining that with societal forces, which are usually quite negative. Some people have positive upbringing send positive societal messages, but particularly like, I guess, 80% of our workforce is don't know if they fabs assigned female at birth, but female identified folks. And they might have had unique messages as well, that are quite negative about sexuality and sexual desire and pleasure. So you've overcome that, by it through practice, through education, through training, through examination of your own internalized attitudes?

Guest 

Yes, yes. And part of the training is looking at your own biases. And you spend a lot of time watching different kinds of sexual stimuli. So different kinds of pornography, reading about different kinds of stories of people's sexual experiences, and really tuning into the kind of automatic reactions that that can bring to you. Because clients don't need our automatic reactions based on our own experiences, they need us to really attuned to what's happening to them in the moment. And as clinicians, we're used to doing that for a whole bunch of things that can trigger us in the room when we're working with clients. But it's only when that's happened. And then they've been examined that we can not respond to clients in a way.

Bronwyn 

Exactly. So we don't really want to bring, say, a face of judgment or disgust when clients are presenting perhaps vulnerable things to us or

Guest 

Yes. And so for many clients, we would have been the first person that they're sharing this sexual trauma or insecurity or fear around. And often clients can't even look me in the eye when they're saying it, or they have to write it down on a piece of paper. Or they haven't even been able to say to their GP, or you know, the receptionist when they're booking in for the intake. So our reaction and those first moments of just holding whatever they've come to us with is so important. And dare I say probably where the healing starts for them.

Bronwyn 

Yeah. No, absolutely. And so this is like, we'll touch on later listeners about how you can get some more support in this area. But I'm curious to know, Emma, maybe we can move on to what is sex therapy? And what do you like about working in this space?

Guest 

Yeah, I think sex therapy is the amazing interconnection between health psychology, so looking at people's sexual health functioning, so the interaction between people's like sexual organs so like their erectile functioning, there are ejaculatory functioning in a fair people that can be their level of sexual arousal or orgasm, and then relationships as well. So I work with lots of people who, you know, would only have solo sex, but I also work with people who are interested in partner texts are having sex in a variety of different relationship structures. And so it's this incredible interconnection between sexual functionings of physical health, relationship functioning, and then you've also got the individual client in front of you. So you've got all the amazing kind of their histories and experiences, which we're familiar with working with as a whole. Yeah,

Bronwyn 

I think it's so amazing, like, the more that I get into this field, so listeners, I'm doing a graduate diploma in sexology at Curtin University, and the more that I get into it, it's just so expensive, the range of presentation so I think like polyamorous relationships, kink are just like two huge areas, which also fall under sex therapy,

Guest 

right? Yes. Yes. So I think I there's people have different specialty areas for me, I'm really interested in working in the sexual functioning space. For that's people might come to me with premature ejaculation or delayed ejaculation or sexual pain or like vaginal dryness. And then there would be people who exclusively work with, as you said, say like kink communities how to integrate that into their sex lives. polyamorous or relationship anarchists. How do we adapt couples therapy to where it's not just to couples? They would also be people who work in the gender space that might still kind of go under the banner of Have sex therapy. And then there's a whole other space of helping people discover and explore their sexual orientation and their sexuality. So sex therapy is a big umbrella term for a lot of different kinds of populations and ways of working.

Bronwyn 

So maybe first myths that we're going to bust. But Emma, do you need to have a degree in sexology, or sexual health to be able to talk with clients about their sexual functioning?

Guest 

Absolutely not? Well, I, it's because sex is a part of client's bio psychosocial lives. And if I think if we're doing a comprehensive assessment of what is really happening for the client's lives, then talking about sex, and their sex with themselves and others is part of that. It's, you know, one of the biggest, for example, symptoms of major depressive disorder is drop in libido, or lack of sexual desire, and Adonia, lack of, you know, interest in activities that were once pleasurable. So it's even a core diagnostic category of some of the conditions that we feel really familiar with all the time. Yeah,

Bronwyn 

it's so true. It's one of it's one of the reasons I wanted to study sexology, actually, because I kept on hearing from clients that about that side effect of some medications where they can have reduced desire, or they can have erectile difficulties. And I was talking about it so clumsily, I felt with clients. And I'd be like, that sucks. Okay, next thing, because I hadn't examined my own biases. And that's the most I could do to talk about it. And I wasn't sure how to open this conversation. But it was an important conversation to them. Like, usually, it's one of the main reasons that people come off some medications.

Guest 

Yes, yes, I think when they've looked at the reasons why people go off SSRIs in particular, its lack of sexual desire, or erectile difficulties at orgasm, so not being able to orgasm anymore. And then also, maybe second to that is like weight gain, or like physical side effects like that. But the most participants reported that they didn't tell their GP about the sexual health concerns, out of shame that they would think it was weird, or that it was just them all that there was no cures, and it was just you might as well just go off the medication. We know that clients generally aren't going to bring up sexual health concerns with psychologists, unless we ask about it.

Bronwyn 

I feel like that's a really key thing to emphasize. So they're not going to tell us unless we ask about it. For those reasons, they might feel shame to them, I feel like they're the only ones or that there's no hope that they can receive.

Guest 

Exactly right. And so I also work with a variety of adults on presentations, that they might come to me with an intake form that looks like it's got nothing to do with sex, but I say, as a kind of part of my default assessment. Just want to ask, are there any kinds of concerns with your sexual health or sexual functioning that you think it's important to address? I've also found having a few books with spicy titles. Behind me as I work has really opened things up like I've had clients that I've worked with for 10 sessions about something completely different go. Oh, come as you are. That's that book about women's sexuality. Isn't it interesting. Maybe we could talk about that next session. So sometimes you just need a few indicators, perhaps on your website or in your room or in your language, that this is a space that it would be okay to bring up themes like that.

Bronwyn 

I guess if clients are fearing shame, then having that visibility, that it's okay to talk to me about this. You don't have to fear being shamed by this. I'm comfortable talking about this sounds important.

Guest 

Yes, yeah. And then I also reiterate that, because I talk about sex all day. I need to be wary that just because I asked a question, it doesn't mean they need to answer it. So I do a little bit of a spiel at the start of my sessions where I say, I'm going to ask you a whole bunch of questions about sex and sexuality that I asked people all day many years ago, I lost my blush reflex. Nothing fazes me, nothing embarrasses me. But because this is new and unusual, you don't have to answer just because I asked. I respect your pace and your timing. And that I think helps put clients at ease that it's okay to say it, but it's also okay to not share as well. Yeah,

Bronwyn 

I love what you're doing there because you're doing two things. So I do the spiel, as in a similar way. I usually say something like, we're just strangers like we just met. So I completely fine. If you don't want to answer questions today, please just let me know. I'm not ready to talk about that. Or can we talk about that another time where I'd like to pass on that and that's completely okay. So you're doing the spiel to make them uncomfortable, but you're also explicitly naming sex as a thing that they can talk about.

Guest 

Yes, yeah, it's so important. If we don't explicitly ask about these things, and explicitly ask about components of sex like experiences of unwanted touch in the past or experiences that they would categorize as non consensual, then it's in my experience that clients do not share it with us, or share it with us a really long way down the track when it would have been helpful for formulation at the outset.

Bronwyn 

That's it. It's a key formulation aspect. Because I now ask about trauma I think I started doing a few years ago, but after realizing that same thing that clients would disclose trauma, say, 10 sessions down the track, I was like, I need to be asking about at session one. And I usually say something to clients like this might be a difficult topic. And I don't need all the details now. But I'm happy to listen, if you want to share, have you had any kinds of traumatic experiences growing up? And if they're unsure, then I might name a few. But yeah, you're right. It's so crucial to have this formulation detail because the clients might be doing things that we can't make sense of. But once we have that bit of information, we're like, Oh, of course. Of course, that makes sense.

Guest 

Yes. And it's it's not up to the client to be able to draw these links between their past experiences and their present behaviors, like that's what they're paying now. It's hard for us to know what we're seeing in the present had any kind of link if we're not explicitly asking,

Bronwyn 

yeah, so maybe correct me if I'm wrong, but it really sounds like I'm pretty sure every psychologist would do a social functioning assessment in their first assessment, they'd be like, What are your relationships? Like? It sounds to me as though you want to make asking about people's sexual health and functioning as normal as our social functioning assessment.

Guest 

Yes, cool. And that we could give people standardized questionnaires about their sexual functioning link alongside the desks or the K 10. If it's something that you think clients may find difficult to verbalize in session, then you could even invite them to send you an email or something like that, just to open up the lines of communication around this as much as possible. Okay, so

Bronwyn 

let's say that I'm a good little psychologist, I've asked the client, whether they're having any sexual health concerns, and they say to me, yeah, I'm actually having a lot of pain when I have sex. And then my little psychic turtle reflex goes, Oh, crap, oh, crap, I have to refer them. What do we do next? If they say yes, and I don't know what to do?

Guest 

Well, I don't want to jump right into is how we assess perfectionist. So what I'll do is, I'll say, firstly, many clients have been living with sexual health concerns alongside other things in their life for a really long time. And they truly may have come into session wanting to work on something completely different. So I think it's narrowing back down to what does the client want to work on? If it is that sexual health concern that they've just said yes to, then you follow down a different path than if they said, Yes, I have been experiencing pain with sex. But what I really want to work on is my perfectionism at work, and then you could just signal to them. Okay, well, it seems like we've got a few different things on the list to work on what feels most important to do right now. We don't have to jump on to the sexual health things right away, if that's not what the client wants. Also, I think I get a lot of referrals from psychologists who, in my mind may have preemptively referred on these are clients who have really good relationships with their psychologists, they want to work on this with them. But as good psychologists, we are wary of practicing outside of our scope. And we would never want to, you know, Veer out of our lane of competency. But I have a feeling that with some extra supervision and some extra reading, and working with this client in the context of a multidisciplinary team, psychologists can do a lot more with the existing skills that they have than I think they give themselves credit for.

Bronwyn 

Yeah, that's really interesting that you're assessing it as that it's like you see, this client has a great relationship with their therapist. It's not necessarily that they've wanted to seek alternative therapists, but the psychologist has said, Yeah, this is outside of my scope. I guess for the psychologists, there's a tension there between wanting to stay within their scope. But I would also be weighing up the cons to the client in starting a new therapeutic relationship with another psychologist who maybe they don't have that rapport and trust with like I said, I guess I'm wondering if it's necessarily in the client's best interest to go seek therapy elsewhere. Is that what you've found yourself thinking?

Guest 

Yes, I've found that as well, especially because many of my clients continue to work with their other psychologists. Okay. And then we get into this bit of a weird dance where that me and the other psychologists both aren't wanting to mess with each other's work. And when I try not to not overburden then the client with homework, or overburdened financially with too many appointments. But it feels like what if we all just kind of sit in the same room would probably be able to figure out how to best help the client together. But that's really difficult in a private practice setting. And so yeah, there are many times where I think, gosh, if the client could just stay with this existing psychologist and the psychologist have a frame for working with this concern with them, I think the client might feel safer in that relationship. Yeah, it makes

Bronwyn 

you feel like it's such a shame, then because they feel like it comes back to the training then. And it's like, well, if they only had that framework that they had learned in, in their training and stuff, okay. But failing that, and they don't have a framework, how can we do like an upskill? Is it simply set keen supervision? Or are there other things that we can do to upskill? A little bit?

Guest 

Definitely, yeah. So there are a few people in Australia, who are both psychologists, and psychologists, and the you can find psychologists that offer supervision around this by going to the society of Australian psychologists or assert, which is the other kind of organization, and they will have the people that are registered as both of those things. Spoiler alert, it's really not many. Yeah. So there are many more people who are registered as sexologist with these organizations that actually don't have any formal mental health training. And that's because sexology and sex therapy aren't registered names. So anyone on the street can call themselves that. And I think there's a large variety of experience and a larger variety of training that people have had similar to within the psychology profession. But it also means that it's hard for clients to know the difference between someone who has this label versus that label when they all sound really similar. Yeah, I

Bronwyn 

feel really bad for clients in that respect, because there is so much diversity in the sex therapist world, I feel, which is, on the one hand, fantastic. Like I've seen sex therapists who are say, have lots of lift X personal experience in say, sex work, or kink scenes and stuff like that. And I'm, like, great, like there are probably clients who would be a great fit for that person. But on the other hand, it's hard for clients to discern which framework that clinicians are coming from.

Guest 

Exactly right. I sometimes worry that we're sending perhaps our most vulnerable clients into the most unregulated part of the mental health, physical health field, they're worried. Yeah, yeah. And I want to really emphasize there are so many wonderful, incredible work. And so if you're, maybe it's about establishing a network with some sexologist that you feel like you can trust that you've heard good work from from clients or other psychologists if you have done that referral process. But so that's supervision, you can have supervision from sexologist about sexual health things, but unfortunately, won't count towards your registration. If you're looking to do those kinds of things. Unless you can find the the unicorn of the people that have the double training, yeah. But there's also lots of sexual health training that you can do online. So I think we were talking before that ships, the online resources, a really great training that which is offered by a psychologist in how to upskill into sexual health. SAS and assert always have webinars, you can join as a student member and learn from them. There's 1,000,003 books about you know, CBT for every single thing under the sun, there's handbooks of sex therapy that you can have on your doorstep with Amazon by the end of the night. And once you start reading these manuals, I think people will be surprised with how familiar these interventions are. But instead of cognitive challenging for fears around negative evaluation, your cognitive challenging for fears around negative evaluation of not being able to maintain a direction like it's not that longer, a jump of being able to adjust some of these skills for sex therapy.

Bronwyn 

Let's talk about that for a moment. Because I think that's really interesting. The idea that it's not so much of a leap, it's just applying to a different set of concerns. That's what it sounds like. Yeah, so I guess like, let's think of mindfulness skills, like how might you apply mindfulness skills as a sexologist?

Guest 

Yes, yeah. So mindfulness, which is you know, paying attention to the present moment, yeah, compassionately, and on purpose is a skill that we often feel really confident talking to clients about. And mindfulness is probably one of the most evidence based treatments that we have for a range of sexual dysfunctions, most significantly low sexual arousal. I'm actually running a whole mindfulness for low sexual arousal course as well. And, and the first four weeks of that program, we don't even talk about sex, we just get people to tune in to the sensations in their body. And then after week four, we start to get clients to self stimulate a little bit or watch some sexually stimulating material. And then, like they would do a body scan of their body, they do a body scan, but it's including their genitals, they're paying attention to sensations in their genitals, or we're helping clients manage distractions or anxious thoughts during sex so that they can stay in the present with their partner rather than worrying about evaluation or how their body looks. It's a helpful antidote to performance anxiety. So, and this is, you know, this isn't just necessarily sexual mindfulness. This is just mindfulness that we already can teach clients, it has flow on effects. Yeah.

Bronwyn 

I think that's just incredible. Because when you say it like that, I'm like, Yeah, I can talk about mindfulness and teach that to clients until the cows come home. I've got a range of things and just imagining teaching a client leaves on a stream whilst they are in a sexually intimate moment. And I'm like, Yes, that'd be great. So it's, it's really interesting that I wonder if the thing that is really holding us back is our confidence, and perhaps our biases and attitudes towards the NHS,

Guest 

I think it really is, confidence, and that we're not having these discussions in supervision, perhaps with our supervisors are in our training. And you know, the last time we ever want to try something new is in front of a client. Especially if we're feeling perfectionistic, and a need to perform and only do our very best in front of a client. But I think with clients that you have an established relationship, and they bring to you something, I think it's okay to signpost? Look, this is something that I haven't worked on before. And I can refer you on to an expert if we think that it's going there. But at the moment, do we want to try using some of these existing skills and applying it in this way, and then see how we go. Clients are always asking us to be perfectly asking us to be honest and educated and try our reasonable best. And so walking beside them as you learned things might be an okay, first step.

Bronwyn 

Yeah, it very well might be. And I really love that because it puts the choice and control back in the clients hands. And it's part of that informed consent, I really see it as it's really telling them. Look, here's the here's what I think is possibly the limitation of my skill. What would you like to do? Now knowing this? Exactly, Ryan? Exactly right. And then as a psychologist, we can seek a bit of assistance to be able to support this person as best we can. Rather than having that panic reflex and then flicking them off, and perhaps terminating a relationship that the client didn't want to end.

Guest 

It also, it's okay to send people for discreet package of care. I've worked with clients, you know, for for six sessions around a specific thing. And then I often will say, Okay, do you want to go back to your other psychologist now? Or do you want to stay with me? So if you're worried about, oh, I've got all these long term goals. We're working on this. And this, I don't want to lose this client for the sex therapy than an alternative option is, why don't you go see someone for this discrete amount of time? And then come back? Yeah. So if you feel like you're balancing a few goals, and option is to say, Well, why don't we try this for just a little bit, and then come back, and we can keep working on these other things as well?

Bronwyn 

And if you say that work in practice, yeah, yeah, cool. Yeah.

Guest 

I've seen it work. Well, I've worked in a group practice. And I'll see a couple for kind of a sexual concern while they keep seeing that individuals. I'm working with a few clients now who were seeing me concurrently with it other psychologists, and yeah, I plan on sending the clients back to their home therapist, if they want to. It's all about giving the client options, right? Yeah,

Bronwyn 

yeah, definitely. I feel very uplifted and empowered. Emma, thank you.

Guest 

That's good. I'm glad. Emma, I'm

Bronwyn 

just wondering about how you go about working with a multidisciplinary team. It sounds like you have yourself and then perhaps a few other professionals on occasion with clients, is that right?

Guest 

Yeah, that's right. So I'm, generally get most of my referrals from GPS or from other psychologists who have been looking for sexology psychologists to send their client to, so I'll generally have a conversation with the referring psychologist if the client gives me consent to at the start, just to see if there's anything that they think I should be aware of. Same with the GP. I make it clear to my client that I'm not a medical professional by any means. So if I am seeing anything that I think needs further investigation from a gynecologist or an anthropologist or men's sexual health specialists, then I ask them to go back to that up and get referrals to those specialists. And I always ask the specialists to send me reports as well. Not that I am an expert in everything kind of physical health, but often doctors will tell clients things like, Oh, you have vaginal dryness. And then I look at the report and it says it's vulvodynia and to a client that's you know, it's, it's a confusing word that starts with a V. But actually, the treatment type might be quite different, depending on different types of pain, for example. So sometimes it's helpful for me to get the reports directly. And other people that I work with quite a lot include pelvic floor physiotherapist, especially for a fair people with genital pelvic pain or pain after pregnancy. And so I have always a list of people that have had positive trusting experiences with people, because those are treatments that are quite intensive and involve often internal vaginal examinations and treatments. So it's about getting a list of people that you feel as confident as you can be sending your clients to. And then they often become quite a nice reciprocal referral pathway as well, if you can find a good team.

Bronwyn 

Great. So building up these relationships is really important in this field. Yes, because

Guest 

of the intricacy of the physical and mental health connection, I will try and gather as much information from as many people as possible. And that's really helpful with the formulation. And often there will be treatments that I can't provide in the room, right? Like, for example, with erectile functioning, maybe the client does want to try Viagra kind of medication. And it's worth them talking to their providers about that. So you want to have as much open two way channels of communication with people and for clients to know the difference, because I can't tell you how many clients have come to me and then at the end of a session for erectile functioning, say so can I just get the Viagra from you now. So we have to also do the education around I'm not a doctor sexologist is not a doctor psychologist is not a prescriber?

Bronwyn 

Yes. Like that. Yeah. sounds important. Yes. Emma, I'm wondering, do you pick up the phone a lot and talk to GPS or other providers? Or is it more through written communication?

Guest 

I try and phone as much as possible. Obviously, it's hard, you know, were back to back there back to back. But I try to as much as possible. But often, in reality looks like when I send my six session report to the GP, I send it to the whole team. And vice versa, as you've just got to get the client to sign all of those permission to release forms on all and so you're covered. But I've never had a client that hasn't wanted me to have all of the information necessary. Generally, by the time that a client is seeing me for six therapy, they have seen a number of different providers, we often the last rung on the ladder, have a number of different health experiences of varying efficacy, and satisfaction. So clients are often like, yeah, please just know everything. I'm so sick of telling people this, which is really difficult, but does mean that they are open.

Bronwyn 

Does that mean you might have a few presentations where clients, their professionals have been like, I don't know what's wrong with you better see the head shrink? And then they've come to you and be like, yes, it's just all in my head. Yes. Because they'd be presenting like quite helpless, hopeless, like understandably.

Guest 

Yeah, people have come to me with a variety of true horror stories of what medical professionals like people experiencing genital pelvic pain and penetration. I've been told to drink a glass of wine before having sex. Yes. Yeah. Or, you know, a young man with erectile difficulties saying like, he just has, you know, performance anxiety. And if you find someone that he's really attracted to, it'll work and like, what does that mean for his girlfriend that he's in love with? Right? Yeah, there's unhelpful measures is sometimes come from society, but also, they're coming from the journey that people have taken to get to see us. Yeah, so often, a lot of those initial sessions are just unlearning that,

Bronwyn 

oh my gosh, it's and laughing because it's sad, because I feel like it also reflects, perhaps professionals who haven't examined their own biases. Like I know, as a psychologist, I'm not a dietitian. So when people talk to me about their eating, I'm not going to say are you really should be eating this, that and that over there, and less of that, because it's not my scope, but it seems like with sex, I don't know. Professionals seem to be like, very ready and willing to dispense advice that might not be all too evidence based.

Guest 

Yes, I can put lightly agree. And then as psychologists were too often too scared to dispense sexual advice, yeah, even if we actually have really strong clinical trials, yeah. And strong evidence that if we suggest clients to do these specific techniques, then it will break cycles for them. Yes, because we want to stay in our lane. We're not giving clients that information. Yeah, but we

Bronwyn 

need to it's really needs to be a whole change doesn't amor, it's like, we really need to include sex in like, I was reflecting on this, like, I've never seen a value sheet that has, has had sexual pleasure as one value of domain of life for anything. And I've never seen a self care sheet that has said, attend to your sexual pleasure. And I feel like we just need a whole revamping of like psychology, really just flip it on its head and just include sex everywhere, just add sex to actually is added everywhere. That is so true.

Guest 

And hearing some realms it is, I think we got to celebrate the progress, like at least the NDIS has, you can now get funding for some sex toys, you can get funding for sex surrogates or some kind of sex workers. It's considered an activity of daily living that is now being taught to occupational therapists and things like that. So there are some fields in which it is really becoming talked about as something that we should all be assessing. But I think psychology really needs to catch up.

Bronwyn 

Well, hopefully this episode is the catalyst to changing that, Emma. I hope so. Well, Emma, I feel like we're coming up to an end. So I really want to thank you for coming on the podcast, it's been a delight to have your experience and insights. And I feel like I've learned a lot. So I feel that listeners will have as well. I want to ask you, if listeners want to learn more about you or get in touch, where can they find you.

Guest 

So I have a website which is MLS st john.com.au You can find me on Instagram at MLS and John's psychology. And I work in private practice and Sydney so in hula and in Newtown, but I work in the telehealth clients across Australia. So if you're ever interested in referring a client, or even just having a conversation about some resources that might be helpful for a client of yours. I would love to just chat. So come get in touch and I can point you in the right direction.

Bronwyn 

Thank you so much, Emma. I really appreciate it.

Guest 

Thank you so much for having me.

Bronwyn 

Thank you listeners. Have a good one and catch you next time. Bye. Thanks so much for listening to another episode of the Mental Health podcast. Just want to give a shout out to Emily who brought me a virtual coffee. Emily said thank you Bronwyn. Your podcast has helped me so much as an early career Psych. Thank you so much, Emily. If you want to be amazing, like Emily, please head over to five me a coffee.com/mental work. The link is in the show notes. And all funds go directly back into the show. I do not make a profit from making this podcast. In fact, I actively spend money to make it great for you. You can also find mental work on our brand new website. We're who it is mental work podcast.com It's a fat website. And you can also submit your questions and episode requests there. Yes, we are going to do more of those a lot of the episodes are listener driven, but I want to hear even more. So you can contact me through the website or you can send an email at mentalhealthpodcast@gmail.com Thanks so much and catch you next time. Bye