Not every therapist is going to be able to offer the same level of skill as a therapist who has specialized training. For those who feel that their therapist may not able to provide support Jestina suggested asking for a referral. Jestina also empowered people looking for a sex therapist to consider the qualities that would support them best, “Sex therapists are trained to help process concerns such as low libido, mismatched libidos, lack of desire, pain during sex, erectile dysfunction, sexuality and identitiy, and alternative relationships such as polyamay or open relationships and a host of other sexual health or wellness concerns,” Jestina explained.

“I would encourage people to ask questions and advocate for yourself. You can ask about a therapist’s education and qualifications. For example some sex therapists are AASECT certified which means they have gone through extensive training. You also will want to know if the therapist has had experience working with a population similar to yours.” 

Cultural sensitivity and community experience can have a positive impact in building rapport, and people may with to seek out sex therapists within or allies of the LGBTQIA+ community, have experience working with people who have a history of sexual abuse, or  people experiencing issues with sex and intimacy post divorce or loss, and  aging populations may want a therapist who has insight in maintaining a positive sex life in their golden years. According to Jestina sex therapy needs to be culturally sensitive, and inclusive, otherwise it will completely miss the mark.

“There’s a need for therapists who want to get more training in sex and intimacy. For those interested in the field I would encourage them to check their bias at the door. What appeals to a client may not appeal to you, but it’s not your job to judge. Those unique desires and preferences may be key pieces to that individual’s overall identity and experience of the world. It’s a sex therapist’s job to guide and support the healthiest and most authentic experience of sex and intimacy for the person they are helping,” concluded Jestina.

And, for those still nervous to talk about sex during therapy, or unsure of the benefits, Jestina had this to say, “Seeking professional help can give you the tools and resources to process what you have experienced. [Sex therapy in particular] will give you a safe space to process your trauma, learn coping skills, explore ways to feel safe in your body, learn how to create and set boundaries, and use positive communication skills.”

Important skills for everyone – no matter their relationship status. 

For those interested in learning more about sexual health, sex education, and sex therapy, the American Association of Sexuality Educators, couselors, and Therapists has resources for patients and providers at AASECT.org

When asked about her perspective on receiving mental health counseling for someone of the same race, Shaunae’s response was nuanced and thoughtful. It was clear this is a topic she’s considered often in her own life and in her career. 

“I have a mixed perspective. It’s not always necessary for your therapist to look like you, but sometimes it can help. Some of the greatest therapists I saw were white women. I never felt like they couldn’t help me because they didn’t understand my struggle or that I couldn’t meet with them, but I also will add that at the time I was already studying this work. So I had some awareness. But, in reflecting back, the biggest reason I was able to navigate [having a white therapist] was because growing up my mom always made a way to ensure we were able to go charter schools. I was not a stranger to being in predominantly white environments.”

One important aspect of reducing stigma and improving care and access for the Black community relates back to a greater need for diversity in the mental health field in general. The APA reported that as of 2015 the field of psychology was less diverse than the nation as a whole, and that only 4% of professionals in the psychology field identified as Black. While beneficial care is not reliant upon racial, gender, or sexual orientation matching between patient and provider, there are real benefits to care when a patient feels more comfortable building a rapport with someone of their own background. 

In Shaunae’s own therapy journey, connecting with a therapist who was a Black woman made a difference for her. She shared, “When I got my first Black therapist, that shifted things for me. I can’t even pinpoint the exact shift, but it took my treatment to a deeper level. Having that connection of culture was significant. A lot of the things that I explore with my current therapist, who is a Black woman, are also things that I explored with white therapists. However, now with that shared connection I’ve been able to revisit those topics and process the experiences more deeply. Her understanding of the Black experience, and being able to ask certain questions about the Black experience and being a Black woman especially, helped.”

Rapport is a significant indicator of therapeutic success, even more so than a specific theory or modality used in session. Research on cultural competency and its relationships to therapeutic outcomes is gaining more traction though a precise definition of what it means to offer culturally competent care is still difficult to pinpoint. But, research shows that providers can unintentionally contribute to increased racial and ethnic disparities in care, and on the whole the system needs improvement. Though the fact remains that racial and ethnic minorities are less likely to receive psychological care than the white majority, and in order to meet the need more BIPOC are needed and white providers need to become more immersed in providing care to a culturally diverse patient population.

“For Black people who may be resistant to therapy, or nervous to talk, having someone that they immediately feel like they can trust and relate to might make a big difference. Someone of a different race, who’s just very textbook, just not aware and simply feeding what CBT told you to say if a client says a certain thing – that’s a turn off.”

Given that the overwhelming majority of psychology professions are white there is a tremendous need for learning and education around what it means to offer culturally competent, sensitive, and relevant care. Shaunae shared, “Clients who have come to me after experiencing a white therapist or someone who just wasn’t culturally aware said it was off putting and it made them quit there because to them it’s like, ‘I don’t need you to tell me what the textbook said or to watch calming soothing videos, I don’t need that, I need you to hear me and know what I’m talking about.’”

Over years of treating patients, Julie notes that, in addition to common mental symptoms, there are also common physical symptoms of both depression and anxiety disorders.

“To be honest, no one is sleeping,” notes Julie.  “When we’re dealing with a major mental illness, we’re either sleeping too much with low-quality sleep, or we’re not sleeping enough. But, in truth, no one is rested. And there’s only so much you can do when your body is exhausted. Therapists need to be curious about what’s going on in someone’s body and not just their mind and emotions; depression and anxiety don’t simply exist from the neck up.”

The conversation about mental health is becoming less and less siloed from other aspects of health. Mental illness has a strong physical component.   Both anxiety and depression can involve changes in appetite, sleep, and energy levels, as well as difficulty concentrating. Studies show that mental illness can even impact our immune systems and cause or exacerbate other physical conditions such as heart failure, high blood pressure, and cancer. 

As such, many people benefit from a holistic approach to healing that includes biological and lifestyle interventions, mindfulness practices, and regular exercise. Additionally, more and more the field of psychiatry is also turning towards interventional treatments like ketamine, and psychedelic research, to address the neural pathways within the brain in ways that traditionally prescribed medications do not.

Comprehensive treatment is often needed when depression, anxiety, and PTSD become severe or recurrent. When this happens, it’s particularly helpful to have a team that is highly trained in these specific disorders to deliver personalized treatment.