Sex Therapy On Call

Some Clients Too Ashamed or Uncomfortable for In-Person Therapy Are Getting Treatment for Sexual Problems Via Phone and Computer

Michael has received sex therapy at the top of a mountain. He's also had counseling outside his Silicon Valley apartment and in the parking lot of a nearby airport. In each of these locations and many others, he speaks from the privacy of his car. There, he feels he can be more frank with sexologist Gloria Brame than he could inside a therapist's office.

According to Michael, the unconventional character of the sessions has been the critical factor in helping him face his problems. (Because of the personal nature of his therapy, Michael agreed to be interviewed for this story only on the condition that his full name not be published.) Inside his car, the 27-year-old said, he has confronted his desire to seek out sadomasochistic relationships, something he couldn't put into words a year ago. Then, the end of a relationship left him worried about his needs and his ability to meet them. Anxious for reassurance and guidance from someone knowledgeable about kink culture, he picked Brame after stumbling onto an online reference to one of her books on the subject. He said Brame (dubbed "the Dr. Albert Einstein of kinky sex" by one sex educator) has helped him address some of his body image issues as well.

He's even lost some weight. But Brame wouldn't know that firsthand. Although she's been his therapist for 10 months, and they talk once a week, the two have never met. She lives three time zones away, outside Athens, Ga., and conducts sessions with Michael by phone and e-mail.

"I think there was something about not knowing the person, not seeing the person, not blushing in front of the person, that made it easier to talk initially," Michael said. "Even over the phone, my first conversations with her, we talked about things that made me sweat."

For Michael and others who are uncomfortable discussing sexual issues face-to-face, distance sex therapy, as it's known, is providing a new option. Its practitioners include credentialed sex therapists who counsel clients by phone, e-mail or in Internet chat rooms, where they address deeply personal issues without ever meeting. In doing so, they've set off a debate about the ethics, legality and effectiveness of such practice.

"If therapy works, there's some processes and mechanisms that occur in the session that make it work," said William O'Donohue, professor of psychology at the University of Nevada at Reno, whose articles on sex therapy have been published in the journal Clinical Psychology Review. Such mechanisms, he said, can include homework exercises or communication training as well as good rapport and empathy from the therapist. But he said, "What we don't know is, are the processes and mechanisms still working in e-mails and . . . in telephone contact?"

Distance sex therapy has been growing over the last five years, according to Barnaby Barratt, president of the American Association of Sex Educators, Counselors and Therapists (AASECT), a Richmond-based professional organization that certifies various health and social service professionals who specialize in sexuality-related education and treatment.

Barratt bases that opinion on what's he's observed on the Internet and what he's heard from clients and fellow sex therapists; he and other experts say there is no official count of how many therapists offer the service, nor has the treatment method been well studied. Professional groups, including AASECT, have only recently begun efforts to better understand the trend and draft guidelines for practitioners.

But some sex therapists are skeptical. Deborah Fox, a Washington-based clinical social worker and AASECT-certified sex therapist, said a phone conversation or e-mail exchange can't resolve deep-seated problems.

She came to that conclusion after she began offering an online service in 1995, and found that the e-mails she received came in two forms: problems that could be resolved quickly with suggestions and information, and serious issues that required in-depth therapy. Without a personal meeting, she said, she was unwilling to address the latter.