After 25 years as a psychologist, I still catch myself doing it. A client edges toward something sexual, I reflect, I validate, and I quietly move us somewhere safer. If you have done the same thing in a session, you are not a bad clinician. You were just never taught how to stay in that moment, and almost none of us were.
In this episode, I sit down with Dr. Nicole McNichols, the University of Washington professor who teaches the largest human sexuality course in the country, more than four thousand students a year. Nicole is not a sex therapist. She is the person who teaches the next generation of clinicians, and I wanted her read on the gap most of us walked out of grad school with: what to actually do when sex shows up in the room. Her new book, You Could Be Having Better Sex, just landed, and it turns out to be a genuinely useful tool for our clients too.
Why generalist training programs skip sex almost entirely, and what that absence quietly costs your clients
The assumption that fixing a couple's communication will fix their sex life, and why the research often runs the other way
How to open a conversation about sex without feeling like you are prying for salacious details
What more than two thousand couples revealed over four years about which kind of satisfaction comes first
How a caregiving role can quietly erode desire, and the parenting complaint that is often really about sex
The moment a presenting sexual concern is not a sex problem at all, and what scope of competence asks of you then
How to handle attraction, transference, and your own discomfort when sexual material enters the room
Where your scope as a relationally trained generalist ends and an AASECT-certified sex therapist's beginsThis episode is for any clinician who has sat across from a client, felt the conversation drift toward sex, and chosen, almost without deciding to, to steer somewhere else. Maybe you told yourself it was outside your scope, or that the client was not ready, or that it simply was not the focus of the work. I have told myself all three. This conversation is about what becomes possible when we stop avoiding the one topic we were never trained to hold, and start treating it as part of the work we are already good at.
00:00:00 The Conversation We Quietly Steer Around
00:03:51 Why Sexual Health Is Clinical, Not Peripheral
00:04:43 Fix the Relationship, Fix the Sex? Not Quite
00:08:33 How to Open the Door Without Feeling Intrusive
00:12:30 Sex as the Skill Set That Builds the Whole Relationship
00:15:27 What the Research Actually Shows
00:17:23 Using a Book as a Clinical Tool
00:25:22 When It's Not a Sex Problem
00:34:04 The Transference Nobody Prepped You For
00:40:14 Where Your Scope Ends and a Sex Therapist's Begins
Full episode and show notes
The Therapist Growth CollectiveIf this episode put words to something you have been quietly carrying, share it with one colleague who would feel the same way. That is the whole game with a show like this. And if you want an ongoing place to keep growing into the parts of the work grad school skipped, come find us.
xoxo, Dr. Lisa Marie BobbyÂ