Sex in the Consulting Room

Use the tone of your voice, your posture, your expression, your words, to convey that you are OK, that you are trustworthy. Do not take notes or just jot down key words and fill them in later, it is very threatening if we are seen to be writing down every word about, for example, a painful childhood incident of sexual abuse.

Sexual Health

People are rather concerned with achieving various goals, with getting it up and getting it off. How we express our sexuality has a lot more to it than just the sexual act itself that culminates in being able to achieve an orgasm. Intimacy, love, tenderness, friendship, affection, compassion and bonding make up a ‘holistic’ intimate relationship, and we may choose to have that intimate relationship not with a person of the opposite sex.

My definition, for what it is worth, of a healthy sexual relationship is that it be between one or more consenting adults where both people explore or negotiate this intimate relationship within an atmosphere of trust and safety, where both the ‘no’ and the ‘yes’ are responded to. Where the power balance is more or less equal.

Labelling Abuse

I sometimes see or hear of abuse being acted out in a relationship, and because of the way I work, I am committed to taking a position if that happens, if I spot abuse and my patient has not. I am thinking right now of a woman I saw recently who had been married for fifteen years, who has four or five children. Her husband demanded sex of her every night, sometimes more than once a night. Sometimes she wanted to make love and sometimes she did not, but it did not matter to him whether she did or did not and an awful lot of nights she lay there gritting her teeth whilst her husband ‘did it to her’ and he had never noticed.

There are several issues here – there is the issue of her ability to say ‘no’ and be heard. We can only do that if we know that what is happening is wrong. When I labelled his behaviour as abusive she cried with gratitude because she had had that feeling, but in talking to her GP, for example, she had not had that support.

I will not collude with perpetrators of abuse either. If a patient comes to me and says, “I have just beaten up my wife and now we are together again,” I will ask if he has agreed to a “non-violence contract” and if he has not, I will not treat him. That is partly because my own safety is important to me, and I am not going to put that at risk.

My guess is that some of you are thinking, “If only we can get the right remedy, then we do not have to say any of these things or do any of these things.” For example, the woman with the over-sexed husband – if we just give her Staphysagria, or Sepia, or whatever, won’t it just sort itself out? There are many levels of healing, not just with little white pills. Patients are expecting more of their practitioners – are expecting a higher level of integrity, more inter-personal skills.

I think we need a level of understanding and sophistication (as practitioners) to be able to deal with these situations. And that is why I believe that a training in interpersonal skills as well as on-going supervision or patient management, some form of looking into ourselves, is so vital.

My experience, which is also born out in my eight years of practice is that people repeat their patterns, their mistakes. We can help our patients understand consciously how they became ill, understand the part they had to play in letting stress get the better of them, begin to be aware of the different choices they might make, and prescribe a good remedy. In my own practice, I hope that the next time a similar situation surfaces for a particular patient, that he or she may be able to deal with it differently, as it happens, and not fall ill with the stress of it – and therefore not need me.

Sex In The Forbidden Zone

There are many books out now on sexual abuse. I want to introduce you to one that I recommend on professional sexual abuse. It is called Sex In The Forbidden Zone by Peter Rutter.

Professionals in most of the health care professions are thrashing out this issue of sexual abuse, what constitutes sexual abuse and what does not. When is it OK to commence an intimate relationship with an ex-patient? Is it for example, an issue of time? Or what?

Peter Rutter takes the position that people in a position of power (be they teachers, clergy, lawyers or doctors) enter into a relationship with a person who comes to them for help (their students, parishioners, clients and patients) with a particular contract, often unspoken. A contract of trust. These relationships have a particular psychological dynamic that, he believes, is difficult to change.

This book deals with this issue in great depth and with great sensitivity. If you are interested in clarifying sexual abuse as a professional, read it! I cannot recommend this book too highly.

Sexual Abuse and The Society Of Homeopaths

What position does the professional body that represents us, The Society of Homeopaths, take with regard to this issue? How many of you have read our Code of Ethics carefully and thoroughly? You may be interested to check out the Code of Ethics of the British Association for Counselling. It is interesting to look at the other ‘sister’ organizations to look at how they deal with these issues in their professional communities.

I believe that we have to update our attitudes and beliefs towards sex. A lot of them date from the 19th century in all its glory. We need to be aware of differences between the more old-fashioned attitudes towards sexuality and the growing body of evidence and opinion that is exploring a more holistic, healthier belief system,which supports the healthy expression of a person’s sexuality – even if it does differ from a conservative ‘norm’.

Traditionally homeopathy has taken a rigid stand against certain sexual practices regarding for example, homosexuality and masturbation as perversions. In the light of an expanding awareness in the areas of psychology and sexuality, there is a growing acceptance that people can express themselves in different ways sexually and still be OK. Be healthy and normal.

Conclusion

I have asked many questions today. I do not pretend to have all the answers with regard to this issue. I am hoping to stimulate you to thinking about your own attitudes and beliefs, both your personal and your professional attitudes and beliefs. There are no simple answers. It is a complex topic. We are all working to a common goal of health and healing – this is a part of our healing, as a profession. We have a responsibility to be sensitive and aware. Habitual secrecy and denial have made this a taboo subject. It is like the Emperor’s New Clothes – people are afraid to talk about something that is obvious to them but is being studiously ignored by everyone around them.

This is a newish topic. It may be new for you, may have sparked off memories of events that happened to you, or others in your life. Many people have been abused and not known or recognized that that is what they were doing simply because their abuse was learnt behaviour. How many of you here today feel that you have an issue to work on around your own sexuality? How do you think that your own difficulty may affect your attitude to your patients or your attitude to a patient with a similar difficulty?

I am not wishing to lay blame; to say you did this or this wrong, that you should have done it this way. All I am asking of you is this; that you think this through for yourselves, each and everyone of you; that you talk with your friends, peers, colleagues and even your family if you can, that you evolve with this issue of sex in the consulting room, that you share your thoughts and feelings with each other with me, with this journal and with the newsletter.

I value this being a continuing debate. Let us face this issue and deal with it in order to heal it, for ourselves and our patients. We need to be open to dealing with our mistakes. After all we are all trying to get better, because it is by talking, by being honest and open, that we can work through it and forgive and heal the old wounds, and create a healthy model of which we can all be proud – for ourselves and our patients.

POST SCRIPT – Summer 2006

Gosh. Sex. That presentation caused quite a stir. A presentation I gave on Confidentiality a number of years ago is the only other topic that has resulted in people shouting at me in public places.

After Sex in the Consulting Room I received a letter – from a psychotherapist who was a homeopathy student – asking why I hadn’t stated explicitly that engaging in a sexual relationship with a student or patient was unethical. It has always astonished me that more people didn’t ask me this question. Mostly I was scared. Our Code of Ethics at the time was a bit vague. Our community had simply not addressed this ethical issue directly. I felt it to be an extremely sensitive area. Our history seems to have given us tacit permission to engage in intimate relationships with our students and patients. Starting with Hahnemann. And Melanie of course. A love story. Because we hadn’t addressed this issue and because there was so many sexual misbehaviours going on I wanted simply to raise the wide variety of issues that fell under the umbrella of ‘sex’ at that time. I didn’t want people to get stuck on thinking I was telling them with whom they should or shouldn’t have sex.

Innumerable practitioners and students told me afterwards how uncomfortable they had always felt asking about patient’s “sex lives”, how relieved they were to have an opportunity to think about it and change how they addressed this topic – and to share their solutions. I now ask people “How is your sexual energy” and I may follow it up with “Do you have any problems or difficulties in that area you would like to address?” or “Is that part of your relationship/marriage working well?” In any case I’m more interested in their history in intimate relationships – sex may or may not be a part of that history.

I am thrilled that the Board of Directors of the Society of Homeopaths picked up this baton and created ethical codes that are in line with other professional organizations, codes that provide us with appropriate guidelines and protect both patients and students from harm. Of course these guidelines protect us as well – giving us clear boundaries to adhere to. My goal was to open up the topic for dialogue and that has happened in spades! Issues around sex and sexuality are taught more sensitively in schools and we are more open and respectful in general in how we deal with this subject with each other and our patients.

If humanity does not opt for integrity we are through completely. It is absolutely touch and go. Each one of us could make a difference.

—Buckminster Fuller

REFERENCES

1 Peter Rutter, Sex in the Forbidden Zone, 1990, Unwin Hyman, reviewed in The Homoeopath 1990,10: 2.

2 Spectrum Incest Intervention Project, 7 Endymion Road, London N4 lEE.

About the author

Miranda Castro

Miranda Castro

Miranda Castro is a British-trained professional homeopath who has been in practice since 1983. She lives in Gainesville (Florida) where she practices and teaches. She has published three books: The Complete Homeopathy Handbook, Homeopathy for Pregnancy, Birth & Your Baby"™s First Years and Homeopathic Guide to Stress. She also has a background in acupuncture, iridology and humanistic psychology. Visit her website : http://www.mirandacastro.com/

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