How to Find an (actually) Sex-Positive Therapist
By Katherine Control and Jesse Belle-Jones
Reading time: 8-10 minutes
Choosing a therapist can seem like a tough task. You’re deciding who’s safe to share your deepest secrets with, but trying to avoid disclosing too much before you’re ready. And it's even tougher if you have any kind of sexual or gender minority identities - including being kinky, and especially if you do sex work.
Who hasn’t heard stories from someone whose counselor judged them for sex work, for their kinks, or for other aspects of their life? Or whose therapist tried to get them to stop doing things they enjoyed - or needed to do to pay the bills?
Maybe the therapists thought they were helping, but ultimately, that doesn't matter. Their clients thought they were in a safe and comfortable space, and found out they weren't. That's harmful, and has been the end of many therapeutic relationships.
We'd like to help you avoid that.
So whether you’re looking for a counselor right now, or just bookmarking this for future use, we're guessing you’re here because you’d like to avoid that, too.
You want a counselor who will:
- Accept you as you are, without shaming or judging
- Understand your sex work, your sexuality, or your experiences with gender (or all three)
- Keep your secrets - they'll make sure that what you share stays in their office and never, ever gets shared with anyone else - least of all the police or the legal system
So...we can't guarantee you'll find the first two right away, but we've got some tools here for that search. We'll give you things to look for on their website - and things to look out for. And we'll help with questions to ask the first time you talk to them, and what you can expect to hear in response from a sex work or kink affirming therapist.
The last one, though - the bit about keeping your secrets - that one, we can help you with today.
- This article - and the free one-page PDF you can download at the end - both assume you’re in the US. We can’t speak to privacy laws, education, or counseling ethics anywhere else in the world; it's a lot of information to know even for just one country!
- We are not legal professionals, so this is definitely not legal advice, just our personal experiences with law and ethics in the counseling profession and in regard to sex work.
That said, even if you’re located outside the US, or need to consult a lawyer for confirmation of what we're sharing, what you read here may still be helpful as you figure out how to find a counselor near you.
Also, while we're writing this piece with the assumption that you found it because you do or have done sex work, we hope that most people who hold marginalized sexual or gender identities will find something helpful here. So please feel free to take what works and leave the rest - this is meant to be supportive, not prescriptive.
In the wrong place? Want to book a session instead?
Before you Call
Lots of therapists offer free or reduced-fee consults to help you figure out if they’re a good fit for you.
Just like screening a playmate, a date, or a client, though, you want to do your homework first (if you can), and find out the basics before you even talk to them. Fortunately, many therapists have websites where you can find this info.
Here’s what to look for:
The school they went to should be CACREP, COAMFTE, APA, and/or CSWE certified. It'll say so on the school website.
All counselors come with training of some sort. For ones who went the academic route, their school should be accredited, which just means that it is held to certain standards. (Of course, in some communities, school is contraindicated or inaccessible, so feel free to skip ahead a bit if this part doesn’t apply to you.)
Accredited schools ensure their students are taught ethics, and exposed to a broad base of knowledge. This includes education on social justice and diversity.
Accredited schools also usually offer clinicians opportunities to explore their own biases, which helps prepare them to counsel people who have different identities, experiences, or goals than their own.
- Having a sex certification is shorthand for having done their homework about sex-related topics. Certifications often require some of the things I recommend asking your clinician during your consult. This may save you time in screening them. (We’ll get to that more below.)
- Certifications are a lot of work, and counselors have limited time. They require many hours of continuing education which may be better allocated elsewhere, especially if their clients’ primary goals in therapy aren’t related to sexuality! If sex work, kink, or gender identity is part of your life, but not something you feel you need counseling around, you may not need someone with a sex certification.
- Current certifications don’t always prepare therapists to counsel sex working people. However, they do mean a clinician has been extensively exposed to sex-related topics and their own attitudes and values around them.
- Requirements vary! AASECT certifications can be extremely comprehensive. Others may not be, and may just indicate interest in the topic – or a desire to acquire letters after someone’s name.
Of course, there are also things to look out for:
- Don't assume sex-/poly-/kink-positive therapists to be sex work affirming. Some are. Some really, really aren’t.
- References to sex addiction. This doesn't guarantee that the clinician is anti-SW, but should be addressed in your consultation. (We'll get to that in the next section.)
Questions to Ask
So you made it through their website and everything seems good so far.
Now you’re getting ready to talk to them either in your consultation or in a first appointment. What can you ask that will tell you what you need to know, but won’t give away anything private until you’re ready to share it?
As a sex worker and a counselor-in-training, here are the three big questions Katherine would ask - and what she’s asked in the past (she found a great sex work affirming therapist, btw):
- Have you taken a SAR (Sexual Attitude Reassessment)? Why/why not?
A SAR helps clinicians become aware of their attitudes and values related to sexuality, and how these affect them professionally and personally. This isn’t mandatory for all licenses.
Most states do not require training in sexuality to become licensed as a mental health clinician. Scary, but true.
It’s ok to see someone who hasn’t taken one, but trust your instincts when they tell you why not. If you have a sense that a particular counselor is not for you, that’s ok -- for any reason at all!
- Can you tell me a little about your experience working with sexual minorities?
What a counselor tells you about their experience with sexual minority identities can give you tons of information about how they see sexuality in general.
Even if you don’t consider sex working as part of your personal sexual identity, from a clinical lens it can be viewed as a sexual minority identity. It has to do with sex behaviors, and not everyone does it.
(We actually advocate for clinicians to view it this way because it can help ensure sex working people are included in their social justice advocacy).
This is also when you'll want to inquire about any mentions of sex addiction on their website. You can start by asking what sex addiction means to them, and if they find it often in their practice. If they're evasive, sex-negative, or inflexible, you'll get a sense of it here.
- Have you had experiences where you struggled to maintain neutrality around a client’s experience, which seemed like pathology (or unwellness) to you, but not to the client?
In counseling, “pathology” just means that there is harm.
Take depression, for example: someone may be experiencing depression because of harm to them, or there may be harm coming from their depression - or both. Some clinicians are going to assume that sex working is always related to pathology.
Regardless of their perspective on sex work in particular, an experienced counselor will have had times when a client felt just fine about something in their life but they, as a clinician, didn’t agree.
What they say about that can tell you a lot about how they might respond if you disclose something you may be OK with, and they think perhaps you shouldn’t be so fine with it.
And if they say “no”, that’s a huge red flag. They may lack self-awareness or not have experience working with diverse populations.
Trust your gut - if they say something that feels off, follow up! You are the expert on your own experience. Only you know what feels like harm vs. not harm to you.
So here’s where you get to breathe a huge sigh of relief: when you’re working with a licensed clinician, what you disclose to them is protected information. This is true even when it’s illegal activity, including criminalized forms of sex work and drug use, past or present - unless a victim is in a vulnerable population such as a minor or an elder.
Here are the few exceptions, when counselors are required to report what you say:
Harm to Self or Others
Each state in the US is different, but counselors most places must report risk of serious harm to self or others. This is especially true when the risk is to someone in a vulnerable population such as children, elders, and dependents.
In most states, that risk of harm must be to a specifically identified individual, and there must typically also be a plan and intention to carry it out at a specific time, and soon.
For example, telling your therapist, “I feel like punching someone” is not a risk of harm. There’s no identifiable victim and no plan. Telling them, “I’m going to go home today and steal all the money from my grandpa’s wallet, then smack him over the head with my frying pan” would make them start asking questions to see if you mean what you say, and if there is actual risk of harm.
To make sure you understand what counts as harm, your clinician will have you sign a consent form before counseling begins. This will give you details about what they have to report. If they don’t include that in their consent form, ask for clarification in your first session.
If they’re a licensed clinician and they don’t have you sign a consent form at all, RUN.
States also vary in what counselors are required or allowed to protect in court, if you were ever involved in a law suit. This also should be covered in their consent form or in your first session. Don’t hesitate to ask!
You made it! That was long, but we hope it was useful. A few final things you should know before we get to that PDF:
Communicating With Your Therapist
Just like any other interaction in which you’d like privacy and security, there are ways of communicating with a therapist which are confidential and ways which aren’t.
Regulations require encrypted messaging systems for confidential communications. Phone and email are not confidential, so use discretion in what you share.
Clinicians who work at agencies may be required to stay within agency policy regarding sex working and/or criminalized activity, even if they are not legally required to report. For example, they might not be allowed to treat sex working people without attempting to help them exit the profession.
If you’re looking at an agency-affiliated counselor, you might want to anonymously call the agency and ask about this.
Now, maybe you’ve used this guide and already found a therapist for yourself, or are underway with that process. Or maybe you’re just wondering how you’re going to remember all of this (it’s a lot, we know), or how you can pass it along to a friend who can’t or shouldn’t visit this site.
So...here's that one-page handout we promised. It has all the most important points, and it's free for you to use and share anywhere you like, with anyone who needs it. The link for this article is on there, too, in case someone wants more details.
We hope it helps you, and we wish you all the best on your search. May you find comfort, safety, and kindness, and may all of your needs be met.
If you are having a medical emergency, please dial 911, or go to the nearest emergency room.
Crisis Line: 800-273-8255
This is the National Suicide Prevention Lifeline, and offers 24/7 support. You do NOT have to have thoughts of suicide to use this resource. You could also get help by texting “HEAL” to the Crisis Text Line at 741741
Support specific for LGBTQIA+: LGBT National Hotline: 888-843-4564
*Hours of operation: M-F: 1 PM-9 PM PST; Sat: 9AM-2PM*
If you feel like you are not in a crisis, but would still like immediate support, consider using a Warm Line. Warm lines are staffed with peer support who have lived experience with mental health concerns and can typically stay on calls longer than your traditional crisis line.
WA Warm Line: 877-500-9276
Hours of Operation: 12:30PM-9:00PM 7 days a week
If you do sex work and/or are LGBTQIA+ and feel like you are not in crisis but would just like someone to listen – someone who understands the experience of having a sexual minority identity and who may currently be or may have been a sex worker – please consider contacting 7cups via Pineapple Support.
Unlike the other support lines, where you are assigned someone to support you, you will typically have an opportunity to choose among several options:
If you do sex work, Pineapple Support can also help connect you with a counselor. Start here: https://pineapplesupport.org/