Background

As regular readers of the Journal know, my essential brief for the last decade has been to give voice to my opinion as strongly and stroppily as possible. In this issue, however, I’m stepping back. For my latest commission was to explore the topic of therapy in sexual health not by shouting from my own soapbox, but by allowing others' voices to be heard. To which end, in late 2011, I sent out a call to several psychosexual therapy (PST) organisations asking for respondents to a short survey.

Forty-two psychosexual practitioners answered the call. Respondents came from two main sources: those who had trained initially in counselling itself and those who had trained initially in medicine. Within these two broad streams, there were a range of original backgrounds, with respondents having worked in fields as disparate as general practice, academia, nursing, education, family planning, clinical psychology and genitourinary medicine. There was a range of lengths of service. There was a range of therapeutic approaches. (There were also several well-known names hiding under my guaranteed cloak of anonymity.) To a man – or rather, to a woman, the gender balance being 38-4 to the X chromosome – they answered openly, honestly and at length. Their responses totalled the size of a small book.

Original motivation

The first question which fascinated me was why my respondents had originally been drawn to working in the psychosexual field. Some motivations were rooted in practicality, a wish to fill a perceived gap in services: “there wasn't anywhere for [patients] to go without paying huge sums of money … we had difficulty in recruiting clinicians trained in PST … there was a shortage of support”. Other motives were to do with professional competence: “It was a natural progression of my development as a counsellor”, or (perceived) professional incompetence: …