One of the most controversial, yet rarely discussed, issues in couples sex therapy is the management of patients’ secrets. If handled poorly, the keeping or not keeping of secrets in couples sex therapy can be a clinical and ethical nightmare. I have been a practicing psychologist and sex therapist for almost 40 years, and while I have developed my own protocols regarding secrets in couples therapy, there is little agreement among sex therapists about the best way to manage this delicate, and potentially volatile, area of working with couples. The purpose of this essay is to outline and discuss the various structural elements of couples’ sex therapy, to delineate the benefits and risks of each of those styles, and to propose an ethical construct designed to minimize poor therapeutic outcomes due to the mismanagement of the therapeutic process. Navigating the holding of patients’ secrets in sex therapy is a vital element of effective psychotherapy. Oftentimes, patients will reveal thoughts, feelings, interests, and behaviors to their sex therapist that they have never before spoken about aloud.
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