How can a Somatic Sex Educator and Sexological Bodyworker work with Gender, Sex and Relationship Diverse (GSRD) people presenting trauma?

 

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This essay is the final submission for the yearlong Gender, Sex and Relationship Diversity (GSRD) Therapy training with Pink Therapy[1].

This specialist training for mental health professionals is designed to help them work with LGBTQA+ clients. While I am not a mental health professional, I gained a place through the ‘Studies’ award for people in allied professions engaged in therapeutic work due to my training in Somatic Sex Education and Certified Sexological Bodywork[2]. Additionally, many of my clients were and are GSRD, and the Director of training, Dominic Davies, and I recognised it would be a welcome addition to my work.

In this essay, I will set the context, provide a window into Somatic Sex Education and Sexological Bodywork in practice, including 3 case studies and conclude with reflections and considerations.

 

A. Introduction

In this introduction, I will explain:

  • Terms used in this essay
  • Why I am writing this
  • My background, training & interests
  • What are somatic sex education and sexological bodywork?
  • What is GSRD?
  • What is trauma?
  • My assumptions
  • My intended audience
  • What this essay is not
  • Impact of COVID-19

 

(i) Terms used in this essay

  • Talk-based therapists are practitioners who talk with clients and where physical touch is not permitted as part of the therapeutic agreement, e.g. counsellor, many psychotherapists
  • Body-based practitioners include therapists and bodyworkers who talk with and can physically touch clients as part of the therapeutic agreement, e.g. osteopath, masseur, Certified Sexological Bodyworker, Gestalt psychotherapists.
  • Multi-modality practitioners have two or more sets of skills and training which may be offered individually to a client, or with components from different modalities working together.

 

(ii) Why I am writing this

Many people are unaware of or have misinformation about the role of somatic sex educators and sexological bodyworkers. I wrote an article about this as part of my final credits for the Sexological Bodywork Certification process[3] which can be read in the Articles section of The Feel Institute website. The most common questions my colleagues and I are asked include, ‘Are you a prostitute?’, ‘Is this sex work?’ and ‘Is this legal?’. Others questioned whether it is a ‘real’ qualification and if it was the result of a weekend workshop.

 

My primary motives for enrolling in the yearlong training with Pink Therapy were three-fold:

  • to develop my personal and professional understanding of gender, sex and relationship diversity (GSRD)
  • to help develop the progression of a collaborative and holistic approach, with talk-based therapists, educators and body-based practitioners working together for the health and wellbeing of the client
  • demonstrate and raise awareness of Somatic Sex Education and Certified Sexological Bodywork.

 

(iii) My background, training & interests

I have a long-standing and growing fascination of shame, power, trauma, how the body communicates, consent and sexuality. There was no formal education available around these topics during my childhood and early adult years. Yet, I became increasingly aware of how they were part of everything around me, including the relationships with others and my sense of self.

After three decades working in the corporate world, with one mighty burnout under my belt, I became a self-employed change consultant. Within three years, my body said its most substantial no to date.

After some time out in nature, tough internal conversations and sense-checking with those around me, I recognised the need to understand more about how I felt, why those feelings showed up the way they did, and discover what I wish I’d learnt at school.  The body and sexuality seemed an apt place to start, and I sought out a professional qualification with a code of ethics.

Nowadays, I am a multi-modality body-based practitioner which includes Somatic Sex Education, Certified Sexological Bodywork, Breathwork Facilitation and Trauma Release Exercises (TRE)[4]. I have a private practice called The Feel Institute[5] based in London, England, and run education-based workshops.

I continue to study and train to develop, diversify and deepen my learning to bolster my private practice and have regular supervision to work with any issues arising and potential blind spots.

I was assigned female at birth, and my pronouns are they/she. I identify as genderfluid, pansexual, kinky, and non-monogamous.

 

(iv) What are somatic sex education and sexological bodywork?

Joseph Kramer PhD created Sexological Bodywork on the back of the AIDS epidemic in the 1980s. Initially focussing on ways people could be sexual and in their bodies in a safe and shame-free way.

Since then, this training has incorporated the developments and increased awareness and understanding of consent, neuroscience, somatic psychology, bodywork, anatomy, physiology, gender, sexuality, relationships, trauma, sexual issues, sex education, and more.

Somatic Sex Educators and Sexological Bodyworkers coach, teach and support individuals, partners and groups to learn about their bodies by offering a neutral space, free from expectations and performance, to practice and integrate new techniques.

My initial training amounted to around 330 hours of somatic enquiries, study, reports, peer review, a residential intensive and 25 supervised sessions.

 

(v) What is GSRD?

Gender, sex and relationship diversity (GSRD) is an inclusive term for the evolving, fluid, complex and wide range of gender, sex or sexuality, and relationship. Rather than focusing on a specific identity or aspect of identity, GSRD includes underrepresented and misrepresented identities. The acronym also emphasises the linkage and intersectional nature of gender, sex and relationship.

 

(vi) What is trauma?

There are many schools of thought and ways to define trauma. I am adopting a Tension, Stress and Trauma Release (TRE®) [6] lens, which, in its simplest terms, describes trauma as a state of overwhelm which results in mobilisation or immobilisation.

Trauma can be related to an event, a series of events, everyday experiences, impressions, thoughts and feelings that have grown over time.

Mobilisation is often regarded as fight or flight responses and immobilisation a freeze response; however, there are other emotions within these states of arousal. Irritation, anger and rage are associated with a fight response, and unease, anxiety and panic attacks are associated with a flight response.

Both these mobilisation responses can lead to numbing, disassociating and withdrawal and ultimately a freeze response.

Returning to a socially engaged desired state where a person is present, grounded, and open is the desired outcome.

 

(vii) My assumptions

There are a range of ways to work with trauma, and I am particularly interested in the link with shame, conformity and power, especially power over.

I start from an assumption and belief that everyone has experienced some trauma and shame at some point during their lives.
On that basis, we are all likely to have thoughts, feelings, memories and experiences that remain unspoken, and that we disassociate from in varying degrees.

What we show on the outside, via our expressions, actions, interactions and more is often different, and in some cases, vastly different from what we know, feel, think and desire on the inside.

 

(viii) Intended audience

I hope therapists, practitioners, bodyworkers and colleagues, who work with people in a therapeutic context will engage with the content on a personal, professional and broader societal perspective. My intention is for this to be a conversation starter. A basis from which to have discussions on how we work with each other ongoing.

I want people seeking professional support, and those that know them, to consider how this way of working might help them.

I also welcome thoughts and opinions from people, like me, who prioritise learning and raising awareness—those who simply want to know more.

 

(ix) What this is not

It is important to name that this essay is a window into these subjects. It is in no way a definitive guide, as the question posed is vast. In many ways, the understanding of this work, these topics and how they are connected are still emerging.

 

(x) Impact of COVID-19

It is worth noting that this essay is written in 2020, where there have been restrictions around in-person sessions. Whilst this has changed what Sexological Bodyworkers can offer clients, I regularly worked with clients virtually before the emergence of COVID-19. Working online has become widespread in 2020, and I, along with many colleagues, continue to develop our online offerings to support people virtually.

 

 

B. A window into Somatic Sex Education and Sexological Bodywork in practice

In this central section, I will present:

  • Description of the therapeutic situation
  • My role
  • Ethics
  • Framework of sessions
  • Foundational exercises
  • Touch-based exercises
  • 3 Case studies

 

(i) Description of the therapeutic situation

Ongoing consent and agreements are laced into all that I offer, right from the first moment a person contacts me. Recognising and modelling that vulnerability requires boundaries and trust (Brown, 2012) and trust is developed over time, often in small regular actions.

In initial sessions, I work with the client, to create a neutral place where they can develop choices about the environment, from choosing where to sit, the temperature of the room, where they would like me to be in relation to them, and more.

Increasingly, on a case by case basis, naming potential inequalities, such as gender, race, class, disability and age, have helped develop trust.

Some sessions are via video conferencing. The integrity remains with the focus initially on making sure the client feels as comfortable as possible by choosing the technology, having flexibility on how close or far I am from the screen, my background, and anything else that matters to them.

 

(ii) My role

I am there to support them on their exploration and process, which can include, agreeing to and creating educational and experiential techniques and exercises. Fostering an environment where the client can experience, increase understanding, develop awareness, and use practical tools which can be useful outside of sessions.

 

(iii) Ethics

When I am providing Sexological Bodywork sessions, I follow the Code of Ethics[7] for Certified Sexological Bodyworkers, which state:

  1. I must remain fully clothed.
  2. Where touch has been agreed and indicated on the Intake and Waiver Form, touch is one way from me to the client unless I am teaching the Wheel of Consent.
  3. I must wear gloves for all genital and anal touch.

 

(iv) Framework of sessions

While every session is different, each involves the creation of a container which has core elements. Sessions include:

  • settling in and creating a neutral environment
  • witnessing and listening to updates on any pertinent situations and experiences in their life since the last session, i.e. anything that might be relevant to our work, or distracting from being in the session physically, emotionally, or mentally
  • creating educational and experiential verbal agreements
  • co-regulation and developing self-regulation
  • reflections and awareness building
  • foundational exercises (a prerequisite to bodywork)
  • touch-based bodywork (always optional)
  • integration time (always after touch-based bodywork)
  • harvesting of main takeaway(s)
  • thoughts on topics to explore in the next session (optional)
  • agreeing actions or homework before the next session (optional)

This framework I continue to develop and stems from Sexological Bodywork training, Like A Pro professional training with Betty Martin (the founder of the Wheel of Consent), my own experiences in therapy, workshops, conscious movement practices such as 5Rhythms, and trauma studies.

It might be evident from the above framework the time spent in physical contact with the client. For the avoidance of doubt, as a sex educator and bodyworker, the proportion of time that is touch-based bodywork can range from zero to 50%, with the majority in the zero to 30% range.

Most of the session involves developing a trust-based therapeutic relationship for the client to use my presence, skills and experience to support their processes.

 

(v) Foundational Exercises

Foundational exercises are experiential tools offered to develop awareness, and assess a clients ability to feel, discover their boundaries, verbalise those feelings and ask for what they want. These exercises are discovery and trust developing exercises and a prerequisite to any kind of body-based touch.

I explain to the client that I will avoid telling them what to do or what we should do. Instead, I give options to the client. They choose one of the suggestions or, after hearing the suggestions, which always include a minimum of 3 choices and a ‘something else’, come up with their idea.

I name the intention of minimising their toleration of unwanted experiences or touch and practice and model an ‘opt-in’ rather than ‘opt-out’ approach to reinforce choice.

For many clients, this is the first time they have experienced this approach.

We agree that to get into the body it is essential that we experience some exercises where they can vocalise choices and develop an awareness of feelings and sensations.

The aim of wanting to minimise any toleration is explicitly named and reiterated in sessions, expanding their awareness of ‘going along with’.

There are three core exercises offered:

  • Determining the names of body parts
  • Waking up the hands
  • The distance game

 

a) Determining the names of body parts

Before referring to any part of the body, undertaking a body-based exercise such as a guided body scan, or any type of bodywork, I will discover the names the client uses to refer to that part of their body.

I place my hands on the relevant part of my body and ask, “What do you call this part of your body?”. This action is repeated to include the abdominal area, chest, genitals, buttocks, and any other area where we’re focusing the attention, or named during the Intake process.

I make a note of these as well as say the word back to them and thank them for sharing with me. Where there is a reluctance, I encourage the client to use the words that they want to use rather than the words they think I might like or approve of.

Where there are no words, I ask if they would like some suggestions of some commonly used words and explore which resonate.

Where there are multiple words, I ask which they would like me to use today and to remind them that they can change that word or words at any time during the session.

This exercise can reveal the language and absence of language for the body, develop trust, be a source of laughter, open up the possibility of choice, reveal a level of politeness and honesty, potential numbness, judgement and shame about the body.

 

b) Waking up the hands

I invite the client to join me in a shared mirrored exercise. I participate in the exercise using my own hands to demonstrate whilst guiding the client in the exercise.

Sitting opposite each other we each place the palms of our hands together and rub vigorously for 10 to 20 seconds, before releasing the hands, so they are shoulder-width apart and elevated at around chest height.

I ask the client if they notice any sensations in their hands. I may offer what I notice in mine and repeat the hand rubbing several times whilst the client becomes more aware of sensations or lack of.

Slowly the client is invited to start bringing the palms of the hands together. They are noticing if there are sensations and whether there is a sense of pulling away or pulling towards.

The invitation is then to take a fingertip from one hand and slowly trace and touch the palm of the other hand. Playing with speed and pressure, finding different qualities of touch and whether the touch is felt more in the fingertip or the receiving palm. Focus is also on the quality of the breath and which part of their torso they are breathing from.

Depending on the client’s reaction and response, this exercise can last anywhere from 5 minutes to an hour and is particularly useful for getting people with quick and active minds into their bodies and slowing down.

 

c) The distance game:

The distance game involves the client and practitioner positioned facing each other with an agreed distance between them. Before the exercise starts, I explain how the game works. As the practitioner, I will be focusing on voice, body, communication, distance, choice, awareness, felt sense, trust and more. If we agree to play, I use a hallway which measures 7 metres long.

The essence of the game is that the client gets to decide where I am in relation to them. They do this with the use of three hand gestures which can include a vocal instruction. They may gesture a ‘come towards’ hand gesture, a ‘stop gesture’ or a ‘go back’ gesture.

The physical gesturing uses the body to communicate. I explain that I will be looking after my boundaries and that they do not have to wonder or worry about my willingness to follow their instruction. Furthermore, I will honour my boundaries and let them know when I am on the cusp of a boundary.

The focus is on what they want.

When the game starts, I will follow the gesture, slowly putting just one foot in front of the other. This slowing down and the vocalisation of any noticing often reveal thoughts, emotions, feelings, and bodily sensations associated.

 

(vi) Touch-based exercises

Touch-based exercises are available only after the foundational exercises and if there is an explicit educational agreement in place.

First physical touch is based on the theory within the Wheel of Consent[8] and takes the form of either ‘The 3-Minute Game’[9], which explores the four quadrants and boundaries, or a ‘Bossy Massage’[10], where the client asks for what they want.

 

a) The 3-minute game

The 3-minute game was invented by Harry Faddis and developed by Betty Martin. It is a game designed to learn about consent, develop self-awareness, state and honour boundaries, and practice choice. It can also be playful and fun.

Many people believe the game is about touch; however, it is primarily about choice. Developing awareness of what an individual wants, as well as what they don’t want is the key.

The game has two questions and is for two people to play. The questions asked are:

  • How would you like me to touch you?
  • How would you like to touch me?

 

By asking these questions, each person playing the game explores and develops awareness experientially of the quadrants of the Wheel which are:

  • Serve (or giving) – action to benefit the other, i.e. I touch you the way you want
  • Accept (or receiving) – benefit from actions of the other, i.e. you touch me the way I want
  • Take – action to benefit yourself, i.e. I touch you the way I want
  • Allow – action by the other to benefit the other, i.e. you touch me the way you want

 

Throughout this process, a key question is ‘Who is this for?’.

 

b) Bossy Massage

The bossy massage focuses on the ‘Serve’ and ‘Accept’ quadrants of the Wheel of Consent.

The premise of the bossy massage is that the client asks for what they want.

Sometimes this game is preceded by a body scan, where the client relaxes, often with their eyes closed, and is guided through a meditation by the practitioner focussing on the breath and noticing various parts of the body.

It is crucial when doing a body scan that the practitioner has already determined the names of the body parts as using a name that the client does not associate with, or feels uncomfortable with, can take them out of their body and back into their head.

In the bossy massage, the client is guided to notice if they would like touch and if they do, what that touch is. The client needs to be able to verbalise the touch they want, and the practitioner may ask for clarification and detail. If the practitioner is willing to give the client this touch, they will get the touch for around 5 seconds or a couple of breaths.

The reason for the time limit is to reinforce that most people tolerate touch that they do not want. The touch a person receives is often different to the touch they want or requested. Asking for modifications can be both new and uncomfortable.

This game teaches the client how to refine their requests, make adjustments and develop an awareness of when the touch they are receiving is the touch they wanted. Sometimes there is an adjustment needed concerning the speed and pressure. Sometimes the touch is something that the mind thought was wanted and didn’t quite hit the spot.

Many people do not know what they want, and this experiential learning can help the client develop that awareness.

This exercise is an incredibly useful precursor to more intimate touch and contact where there is numbness, sensitivity, scars and pain. The ability to refine touch is a skill that is developed and honed over time, as many people find it difficult or uncomfortable asking for modifications to touch.

 

(viii) Case Studies

These case studies have been anonymised with identifying names, situation, gender, age, and other elements changed to protect the identities of the clients. I have gained explicit consent from each of the clients to share parts of their experiences and the therapeutic context in this essay, to create greater professional awareness of the work.

The level and nature of the trauma in these case studies may or may not be immediately evident to you as the reader.

The minority stress model (Mayer, 2003) raised awareness of the unique, chronic and socially based stress experienced by many GSRDs. Many people underestimate the pervasive, often subtle effect, of both intentional and unintentional microaggressions. Microaggressions are brief, commonplace and often daily. They can be verbal, environmental, both intentional and unintentional, and communicate hostile, derogatory slights and insults towards an oppressed group or minority (Nadal, 2013; Shelton & Delgado-Romero, 2011; Sue et al., 2017).

Additionally, there is often a conscious or unconscious hierarchy to traumatic experiences and events.

I encourage you to notice any judgements and prejudices that arise during these case studies.

 

a) Case Study 1 – Chris

Chris identifies as male, is in his 20s and presents as ‘confused about his sexuality’. He has shame and curiosity around his sexuality and what it means for ‘his gender’.

In the initial session, we unpacked what he meant by his gender, the expectations he felt from his family and friends and how this impacted how he could show up.  He thought there was something wrong with him because he wanted to do things that nobody else was doing around him. We explored whether he felt safe enough to talk about the things he wanted to do. He concluded that he might next time.

In the second session, I introduced him to the Gender Unicorn[11]. I explained that gender is a dynamic rather than static identity and an intricate and complex overlap of many components. Components include:

  • the identity we have in our mind, i.e. gender identity
  • the way we express our gender, i.e. gender expression
  • the gender or sex we were assigned at birth
  • whom we are physically attracted to
  • whom we are emotionally attracted to.

Chris started to recognise that he had been confusing gender and sexuality, and maybe he wasn’t quite as ‘broken’ as he initially thought. He seemed to be particularly interested in gender expression and on more in-depth inquiry, he revealed that he wanted to wear clothes that some women wore and quite liked the idea of wearing nail polish. We talked about what prevented him from doing that, and his main concern was what other people would think. I shared that I knew lots of people who wore clothes that were often associated with a different gender identity.

In the next session, Chris revealed that he had a secret stash of clothes that he increasingly wore in private. He also wore makeup, polished his nails and had a desire to do this with other people around. I offered that this is something he could do in sessions, and he could bring those to the next session.

During the next session, Chris tried on every outfit that he had amassed, and we talked through how it felt, while he looked at himself in a full-length mirror. Initially, Chris seemed to watch my reaction. I was genuinely enjoying the process and expressed the curiosity about what he had in his bag and how he felt. With each outfit, Chris gained more confidence and spent more time looking in the mirror than at me.

Over the coming months, through regular sessions, Chris started relaxing into his desire to wear a variety of clothing and accessories and that this had little to do with his sexual orientation. He remains sexually and romantically attracted to women and is more comfortable with his gender expression.

Chris books sessions periodically with me to explore issues on an ad-hoc basis and continues to refer to the gender unicorn as a type of check-in barometer of where he is now and what has evolved.

 

b) Case Study 2 – Tracy

Tracy identifies as female and bisexual, is in her mid 30’s and has recently met a woman she is sexually attracted to. She feels excited about the connection and has sexual feelings towards this person; however, has anxiety around the possibility of sexual touch. Tracy is avoiding being sexually intimate with this person, has started having problems sleeping and feels there is a barrier to a deeper connection when they are together as she is tense and avoidant. She doesn’t know her sexuality well and is worried about the ability to orgasm with this woman and give her pleasure.

During foundational exercises, it became apparent in the naming the body parts exercise that Tracy did not have a name for her genitals. Additionally, there was a sharp intake of breath when I asked the name of that part of her body. On deeper inquiry, there is a recognition that ‘the place between her legs’ was a cause of embarrassment and shame. She didn’t know how to talk about ‘it’ or touch ‘it’ despite having been sexually active with people for around 15 years.

In the first two sessions, we focused on breathing techniques to help her ground when feeling anxious and becoming more comfortable talking about her body by developing language around parts of her body that didn’t have names. Using anatomically correct vulva cushions, we explored the anatomy of a vulva. Tracy requested exercises that she could do at home, and we agreed on developing a solo self-pleasure practise where she could explore her body and discover how she liked to be touched.

By the 3rd session, Tracy had a newfound excitement around her body and the possibility of sharing it with this woman she was starting to relate to. It became apparent in the dialogue that she had never seen her own genitals and had never really looked properly at her vulva and that this was a source of anxiety with this new partner.

I have an extensive library in the session room, and we looked through ‘Womanhood the bare reality’ by Laura Dodsworth, which has photos and stories of 100 vulvae. Tracy was surprised and amazed by the variety and how different they all were and giggled at what her new partners might look like. Tracy was also nervous about what hers might look like, and we agreed that in the next session, we could use one of the mirrors for her to see her genitals.

In session 4, Tracy sat upright on the massage table and looked at her genitals for the first time using a mirror. They were prettier than she had imagined and decided she looked like a ‘Lola’. Tracy expressed feelings of joy and relief that she knew more now as well as sadness and anger at the length of time she had worried about this. There was a sense of what could have been if she had done this earlier.

Using an anatomically correct vulva cushion, we matched up the different parts we had discovered in previous sessions with the view of ‘Lola’ in the mirror. I verbally guided her through different types of touch and how the tissues change with different levels of arousal.

In the harvesting at the end of the session, she was excited about playing with her newly named ‘Lola’ and introducing her to her new partner. This was the last session we had, and I received an email a few days later thanking me and sharing that she had ‘gone all the way’ with her new partner.

 

c) Case Study 3 – Darius

‘Darius’ had worked with two therapists for 15 years before our work. He continued to meet with a therapist throughout the 14 months we worked together.

Darius, who is in his forties, identified as heteroflexible, male, and monogamous. He was in the process of ending a 3-year co-habiting relationship in which sexual contact is rare.

Darius experienced parental sexual abuse as a child. He is aware of a recurring freeze response and suppresses his unprocessed anger. There is shame around his body and desires and a desire to feel physical touch and experience pleasure. He has unspoken sexual domination fantasies, is uncomfortable with his appearance, sees himself as overweight and undesirable. He compensates for and reduces his physical frame with a quiet voice, kindness, and inward posture to minimise a perceived threat to others.

He would like to explore his sexuality and be able to express his wants, needs and desires.  There are fears, insecurity and a sense of unworthiness.

Over 15 months, Darius and I had 16 sessions equating to 28 hours of session time.

Foundation exercises revealed a fear of speaking up, a desire for slowness, developing awareness of fear of a ‘no’ response and recognition of sensations and emotions in and around the throat.

Body-based touch started with a Bossy Massage, and with a growing desire to be less cerebral and more in the body, I suggested an abdominal massage. This massage soon became a self-care option and was requested nine times. It was a practice of asking for what he wanted despite the inner critic berating him for not having more imagination.

Each time Darius was able to drop into deeper levels of feeling, and through this touch, Darius learnt how to let go. He could release tension and receive physical contact, which was for him while developing the ability to verbally refining the touch to meet his needs.

Emotions were able to rise to the surface and be expressed while receiving touch and maintaining a sense of safety. The ability to tolerate and control emotions, thoughts, feelings, and sensations independently developed.

During these massages, he recognised that he has powerful, full-bodied, sexual energy and that if he was able to satisfy his sexual needs, then everything else through a relationship with others could be a gift. He strengthened his identity and sense of self.

Non-monogamy was a source of curiosity initially, and during the 14 months Darius explored non-monogamy and significant part of session time was spent witnessing the stories around these connections. He was exploring the feelings that arose, developing boundaries and creating relationship agreements.

Shame dominated masturbation, both during and after self-touch. Through masturbation coaching with home practises, Darius was able to work with self-regulation, and remote support for me to recognise his body differently. He explored himself more sensually and erotically with a kinder regard and developed a stronger sense of worthiness. He also started to incorporate anal touch into his self-pleasure practice.

Being able to talk openly about anal touch and how this could be a source of pleasure opened up a dialogue around the emotional and psychological abuse from his parents and specifically the sexual abuse from his father.

In later sessions, intense feelings of anger, rage and grief held within for years were able to emerge. We co-created intentional containers with clear, direct intentions to allow visceral and emotional expression, encouraging sound, breath and movement. Offering support is part of the process of creating the containers, as well as ensuring that there was sufficient time to practise self-regulation, integrate and harvest learnings before the end of each session. There was an invitation to assert himself and clearly express his beliefs and reflect on patterns, actions and behaviours whilst maintaining a sense of safety.

Through these emotional expression containers, the reality of the mask worn become apparent to Darius.

In our 9th session, during an abdominal massage, Darius expressed a desire to explore genital touch and rosebud anal massage for the view of continuing to develop a healthier relationship with this part of his body. We first talked about the desire for a rosebud massage in session 3.

The educational agreement was to determine scales of sensitivity, numbness and pleasure. Initially, for the rosebud massage, Darius was on his side with one knee near his chest, and we explored various types of massage including the buttocks, perineum, and external anal touch, aka rosebud massage.

Through the continued dialogue, Darius expressed a desire to get on all fours. Being on all fours was the position his father used to put him in when he sexually abused him as a child. He wanted to explore whether he could be in this position for himself.

We exchanged repeated verbal dialogue to verify that he wanted to do this, and when he was ready, he moved into the position. Self-regulation and co-regulation were a crucial part of this process. He was feeling his feelings and being with the bodily resistance combined with the strong desire to reclaim this part of him. In his position, on request, I explored the rosebud with my gloved finger. There was a request for penetration, i.e. for me to insert my finger into his anus.

Again, we exchanged repeated verbal dialogue to verify the request. I was looking for non-verbal signs that Darius may be forcing his body through this. Confirming the request, we agreed I would verbalise every touch, gain ongoing consent for every subsequent change of touch and ensure several breaths between each change.

He asked for one hand on his lower back and one finger on his rosebud.  When he was ready, I rested my finger on his rosebud, confirming that it was not going move, it was staying external and we were just going to breathe in that position. I reinforced that he could change the touch at any time.

In this position, he requested that a finger penetrate his anus. I offered that I could keep my finger still, and he could move his body onto the finger. He pushed himself back onto my finger, and I could feel the clenching muscle of the external anal sphincter. It was held tight and firmly shut. He was at his resilient edge, which he later confirmed verbally in the debrief.

I said, “What if your body does not want this?”

On hearing these words came a surge of anger followed by, “I was just a child”.

I repeated back these words to him replacing ‘I’ with ‘you’, maintaining my hand on his lower back and my motionless finger on his external rosebud. We continued to breathe together, keeping the connection while many tears flowed.

I explained that I was keeping my hand on his back and my finger on his rosebud until he told me he wanted a different type of touch, and he thanked me. Tears continued, and the emotions appeared to be coursing through his body. When the tension subsided, and after a series of deep breaths there seemed to be a type of release which the client later referred to as a ‘deeply cathartic moment’.

When he was ready, he asked for my finger slowly to be removed from his rosebud and to keep one hand on his back. He lifted his hands off the massage table from all fours and sat back on his heels.

Physical contact slowly and consensually reduced while maintaining a slow breath, low voice and soft tone. Integrative solo time was agreed, and after some space for a few minutes, I returned and waited for a verbal prompt before engaging in dialogue.

During the harvesting, two things were evident for him: “The sense of safety created which helped me overcome concerns around being touched ‘there’ and any judgements around a possible mess. I felt physically and emotionally held, unlike the physical distance of talk therapy which always left a lingering doubt in my mind. That trust extended then to knowing you could handle the strength of feeling that needed to emerge, and I trusted that you weren’t going to be triggered by my release. That you would still be there for me on the other side. I didn’t feel your attention waver. I felt you there with me and supporting me with every step.”

Over the next five sessions, Darius continued to become more confident, curious, and excited about his exploration into non-monogamy and masturbation. Additionally, he started to embrace his desire to be less submissive and more dominant sexually. Latter sessions focussed on non-monogamy, education around BDSM etiquette, including creating scenes, safe words and consent.

The last two sessions focussed on conscious completion of the co-created work and reviewing the work to date. His ten-year talk-based therapy and our sessions completed in the same month. As at the final meeting, Darius identified as heteroflexible, male, non-monogamous, kinky and sex-positive.

 

 

C. Reflections and considerations

Talk-based therapies are commonplace and widely accepted in most communities and societies these days. While I’ve long been an advocate for the therapeutic nature of sharing innermost thoughts and exploring the past with another human being, I’ve also had a growing awareness that my body is wise, in a different way, beyond anything I can imagine or understand with my conscious brain.

Making meaning of these feelings and experiences is, at times, helpful. It can also, at times, get in the way of allowing a person to heal and integrate the mind and body.

 

(i) Trauma and the nervous system

When I hear people say they had a traumatic event or experience, or that they are traumatised I remember this quote:

“Trauma is in the nervous system, not the event” Peter A. Levine PhD

Understanding how the nervous system works can be a game-changer for people. Far too often, I’ve heard people criticise their body and how they reacted during an incident or an experience believing it is their fault. When they understand that the nervous system is there to keep them safe and that what the nervous system did during experiences that they’ve had was what it was supposed to do can be a revelation.

Recognising that there are remnants of an experience that has yet to be fully processed and developing a persons ability to slowly work with uncomfortable feelings in a neutral space with another can be life-changing.

Through co-regulation professionals can help the person in front of them today slowly and compassionately dip a toe into an area which is previously been too dangerous, too scary or whatever the feeling is, to encounter until then.  The tone and speed of our voice, our embodiment, breath and ability to calmly listen, accept and be with the person in front of us, are all examples of co-regulation. Helping an individual develop resilience through self-regulation can allow the person to gain agency over the impact of their experiences. Recognising that they are not this event, they are not this experience, and in the present can often be the support that they need.

 

(ii) Shame and empathy

Brené Brown[12] is a shame researcher who teaches that shame thrives on secrecy, silence and judgement. The antidote to shame is empathy.

Shame does not like company.

Many of the people I meet struggle with judgement, what they ‘should’ do, feel or say.

Working with people to develop a neutral environment where trust can develop allows the possibility for the unspoken words to be said. It often takes tremendous amounts of courage to say the unspoken words.

 

(iii) Vulnerability and judgement

I remember first reading Daring Greatly (Brown, 2012) and this sentence stayed with me, ‘Vulnerability is about sharing our feelings and our experiences with people who have earned to the right to hear them.’

Vulnerability is ‘risk, uncertainty & emotional exposure’ (Brown & Cox, 2020)[13]

When those words are spoken, often for the first time, the reaction or response is crucial. The reaction and response are where further lasting damage can occur. The person trusted with these words must have empathy.

 

(iv) Role of the professional

To this end, much of our work as professionals involves non-judgmental witnessing, ongoing training, professional development and supervision to reveal and address blind spots.

  • Can we be engaged, listening, and witnessing without judgement?
  • Can we let what needs to be said emerge?
  • What if a client does not need to remember?
  • Can we recognise when the client needs a referral to another professional?
  • Can we refer to other professionals currently within the framework of the professional bodies we are members of?

 

(v) Barriers to talk-based and body-based practitioners working together

I have been interested in training to be a talking based therapist; however, the existing Codes of Ethics of the associated governing bodies would prevent me from continuing my body-based practice. Ceasing the bodywork aspect of my multi-modality work is not an option for me. It is too valuable to those who need it.

Furthermore, as it stands, many talking based therapists based in the U.K. cannot ethically and legally refer clients to bodyworkers, let alone engage in bodywork.

Upon reviewing the Codes of Ethics for 4 of the U.K. professional bodies the focus is on not behaving sexually, not having any sexual touch or any kind of sexual relationship. None contain written support of any professional bodywork practices.

 

A. An excerpt from the Code of Ethics and Conduct for College of Sexual and Relationship Therapists (COSRT)[14] states:

“24. You should not provide, or actively help service users procure sexual surrogacy or bodywork involving touch.

 25. You should only perform a physical examination if you have the proper medical qualifications, have written consent, and there is a medical requirement.”

 

B. An excerpt from the British Association for Counselling and Psychotherapy (bacp) Ethical Framework for the Counselling Professions[15] states:

34. We will not have sexual relationships with or behave sexually towards our clients, supervisees or trainees.

 35. We will not exploit or abuse our clients in any way: financially, emotionally, physically, sexually or spiritually.

 36. We will avoid having sexual relationships with or behaving sexually towards people whom we know to be close to our clients in order to avoid undermining our clients’ trust in us or damaging the therapeutic relationship.”

 

C. An excerpt from The National Counselling Society (NCS)[13] states:

“3. Refrain from using their position of trust and confidence to:

 a. Cross the boundaries appropriate to the therapeutic relationship. This includes, but not limited to: having sexual relationships with or behaving sexually towards clients, supervisees or trainees; maintaining the confidentiality of counselling as far as the law allows; or by exploiting them emotionally, financially or in any other way whatsoever.

 b. Touch the client in any way that may be open to misinterpretation, for example, but not limited to: a hand on the knee, or a supportive hug. N.B. Before using any touch as a component of counselling, an explanation should be given, and permission received. This can be verbal permission and should be written in case notes.”

 

D. Finally, an excerpt from the UK Council for Psychotherapy (UKCP)[17] states:

As a practitioner you must:

 Best interests of clients

 1. Act in your client’s best interests.

 2. Treat clients with respect.

 3. Respect your client’s autonomy.

 4. Not have sexual contact or sexual relationship with clients.”

 

(vi) Network and referring

Having a range of trusted and experienced professionals with robust ethics and accountability, who are dedicated to continued professional development to refer to is essential in this work for the wellbeing and integrity of both the client and the professional.

Knowing when to refer is vital. Many talk-based therapists have restrictions to this currently. I question why the restrictions are there:

  • Are they fear-based?
  • Are they outdated?
  • Do they need a review?
  • What measures could be put in place to ensure the integrity and safety of all parties involved?

In my experience, massage therapists do considerable unwanted touch.

  • Would you recommend that a client has a massage?
  • Would you recommend that a client sees a professional Certified Sexological Bodyworker?

I am curious about the difference in the answers to these questions and if there are any prejudices.

 

(vii) Final thought

I’ve been debating how to finish this essay, and my closing comment is a question for you to consider.

If you have experienced trauma or shame, do you want to explore this experientially with a friend, a partner, a new lover, an unknown or a professional?

While there is no one answer to this question, and context and resources available matter and impact the choices you make, some people, like me and many of my clients, want to explore by experience as well as by talking.

I hope one day, talk-based therapists can openly and ethically refer people to professionally trained, trusted body-based practitioners and bodyworkers to do this valuable and worthy work.

References and Bibliography:

Berceli, D. (2008a) The Revolutionary Trauma Release Process. Transcend Your Toughest Times. Vancouver: Namaste Publishing.

Brown, B. (2012) Daring Greatly. How the courage to be vulnerable transforms the way we live, love, parent and lead. London: Penguin Books Ltd.

Brown, B and Cox, L. (2020) Brené with Laverne Cox on Transgender Representation, Advocacy + the Power of Love https://brenebrown.com/podcast/brene-with-laverne-cox-on-transgender-representation-advocacy-the-power-of-love/

Dodsworth, L. (2019) Womanhood: The Bare Reality. London: Pinter & Martin Ltd

Haines, S. (2015) Pain Is Really Strange. London: Jessica Kingsley Publishers.

Haines, S. (2015) Trauma Is Really Strange. London: Jessica Kingsley Publishers.

Haines, S. (2018) Anxiety Is Really Strange. London: Jessica Kingsley Publishers.

van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin Books.

Levine, P.A. (1997) Walking the Tiger: Healing Trauma – The Innate Capacity To Transform Overwhelming. Berkeley, California: North Atlantic Books, U.S.

Levine, P.A. (2010) In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, California: North Atlantic Books, U.S.

Levine, P.A. (2015) Trauma and Memory: Brain and Body in a Search for the Living Past: A Practical Guide for Understanding and Working with Traumatic Memory. Berkeley, California: North Atlantic Books, U.S.

Meyer, I. H. (2003) Prejudice, Social Stress, and Mental Health in Lesbian, Gay and Bisexual Populations: Conceptual Issues and Research Evidence. Columbia University.

Nadal, K.L. (2013) That’s So Gay!: Microaggressions and the Lesbian, Gay, Bisexual, and Transgender Community. Washington D.C.:American Psychological Association

Pelmas, C. (2017) Trauma: A Practical Guide to Working with Body and Soul (Somatic Sex Educator’s Handbook) CreateSpace Independent Publishing Platform.

Porges, S (2017) The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe (Norton Series on Interpersonal Neurobiology). W.W. Norton & Company.

Shelton, K., Delgado-Romero, E.A. (2011) Sexual orientation microaggressions: the experience of lesbian, gay, bisexual, and queer clients in psychotherapy. University of Georgia

Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., Esquilin, M. (2007). Racial microaggressions in everyday life–Implications for clinical practice. US: American Psychologist, 62, 271–286.

 

 

[1] https://pinktherapy.org/foundation/

[2] https://www.somaticsexeducation.com/

[3] https://thefeelinstitute.com/articles/what-is-sexological-bodywork/

[4] https://traumaprevention.com/

[5] www.thefeelinstitute.com

[6] https://traumaprevention.com/

[7] https://sexologicalbodyworkers.org/ethics/

[8] https://bettymartin.org/videos/

[9] https://bettymartin.org/how-to-play-the-3-minute-game/

[10] https://bettymartin.org/the-bossy-massage/

[11] http://www.transhealthsa.com/wp-content/uploads/2017/05/The-Gender-Unicorn.pdf

[12] https://brenebrown.com/

[13] https://brenebrown.com/podcast/brene-with-laverne-cox-on-transgender-representation-advocacy-the-power-of-love/

[14] https://www.cosrt.org.uk/

[15] https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf

[16] https://nationalcounsellingsociety.org/about-us/code-of-ethics

[17] https://www.psychotherapy.org.uk/wp-content/uploads/2019/06/UKCP-Code-of-Ethics-and-Professional-Practice-2019.pdf

Gratitude and thanks

Thank you for taking the time to read this essay.

One of my favourite practises is to honour and recognise the people that I’ve learned from. The ones who have helped me, who said that thing that I now say, and whose wisdom I’ve benefited from. When I see other people modelling this behaviour, I respect them more too.

Whilst it is my name on the paper, this has not been a solo piece of work.

I have deep gratitude for Dominic Davies. He took the risk of allowing a sexological bodyworker onto the year-long training programme for mental health therapists. Thank you, Dominic.

Once I discovered I was going to be allowed on the reality hit on how I was going to raise the money for the course fees. The wonderful Chris Mousley-Jones suggested putting a GoFundMe page together. I asked another mate Rich if he thought it was ok and the short version is I did it.

Thank you to the people who generously contributed, some anonymously, to help raise some of the fees. I was broke from previous trainings and couldn’t have done it without you.

I learnt from every person, tutors and students alike on the Pink Therapy GSRD training. I recommend it highly. In terms of this final essay, Daniel Bąk passed me. Thank you! More importantly, he gave me brilliant pointers on where to dig deeper and clarify more.

Then came the We team. There is no publication for the work I do. Where would it go? I know it is meant to be read, listened to and talked about.

That’s when the We team started forming. They are my cheerleaders, advocates, and damn fine, get in the detail and talk this out, editing people. On the We team are DK Green, Barbara Carrellas, Anna Sansom, Tania Glyde, Alison Pilling, Rupert Allison and Stu Dixon, my web person and friend. Seriously. Thank you. How lucky am I!

So there you have it. What do you think? How do you feel? Tell me.

If you know of anyone who will benefit from reading it, please share it with them.

Let’s have a conversation.

*Image credit: Queer pride – Marseille 2017. Photo by Juliette F on Unsplash