Countertransference in Sex Therapy: How to Recognize and Manage Your Reactions

Countertransference isn’t inherently bad—it’s a natural part of being a therapist. The key is recognizing when it’s happening and responding to it consciously rather than letting it dictate our clinical choices.

Here are some common types of countertransference that can show up in sex therapy:

1. Discomfort with Certain Sexual Topics

• Feeling awkward, judgmental, or emotionally charged when discussing specific sexual practices (e.g., kink, non-monogamy, fantasies).
• Changing the subject or avoiding follow-up questions when a client shares something outside of your comfort zone.

💡 What to do:

• Explore your own biases and areas of discomfort. What messages did you receive about sex growing up? How do they shape your reactions today?
• Continue training in diverse areas of human sexuality to expand your knowledge and increase comfort.

2. Feeling Frustrated When Clients Don’t “Improve”

• A sense of impatience when a client resists behavioral interventions like sensate focus or scheduling sex.
• Believing that a client “should” be making faster progress and feeling personally responsible for their outcomes.

💡 What to do:

• Examine whether your expectations are realistic or if you’re carrying pressure to “fix” the client’s sex life.
• Consider whether the client’s resistance is a sign of deeper emotional barriers that need to be explored before behavioral work.

3. Attraction Toward a Client

• Feeling drawn to a client in a way that extends beyond therapeutic connection.
• Dressing differently or finding yourself looking forward to sessions in a way that feels different from your other clients.

💡 What to do:

• Normalize the experience—therapists are human, and attraction happens. The problem isn’t the feeling itself but what you do with it.
• Bring it to supervision or consultation to process it ethically. If it becomes unmanageable, consider referring out.