Patient education and counseling · 2026
Barriers to the assessment of patients' sexuality and sexual health among psychotherapists: A mixed-methods study.
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López Luana, Schweizer Katinka, Martyniuk Urszula, Schröder Johanna
Аннотация
OBJECTIVES: Sexual health is a fundamental aspect of well-being, yet sexual problems remain highly prevalent and are rarely addressed in psychotherapy. This study examined psychotherapist- and patient-related factors preventing psychotherapists from addressing sexuality and sexual health in psychotherapy.
METHODS: In this cross-sectional study, anonymous data from 220 licensed psychotherapists and psychotherapists in training in Germany were collected online. Psychotherapist characteristics associated with more or less frequent sexual health assessment were analysed using t-tests, linear regression, and Pearson correlations. Responses to open-text questions regarding perceived patient-related barriers were analysed using thematic analysis.
RESULTS: No significant gender differences were found among psychotherapists, t(216) = -0.44, d = -0.08, p = .329, in addressing sexual health. Psychotherapists working in urban areas (d = -0.31, p = .010) and those with psychodynamic orientation (d = 0.30, p = .015) addressed sexual health more frequently. Older age (f2 = 0.03, p = .019), more years of professional experience (f2 = 0.02, p = .014), and greater subjective knowledge about sexuality (r = .31, p < .001), was associated with higher engagement in sexual health assessment. Thematic analysis revealed 19 patient characteristics (e.g., gender constellations, therapeutic relationship dynamics, patient emotional reactions) perceived as barriers.
CONCLUSIONS: Younger age, lesser work experience, and lesser knowledge about sexuality are associated with lesser assessment of patients' sexuality and sexual health by psychotherapists. Urban and psychodynamic therapists assess sexuality and sexual health more often. Various patient characteristics and interaction dynamics are perceived as sexual communication barriers by psychotherapists.
PRACTICE IMPLICATIONS: Sexuality education based on the identified barriers is necessary to strengthen psychotherapists' competence and confidence in adressing sexuality in psychotherapy, which can improve health care significantly.
METHODS: In this cross-sectional study, anonymous data from 220 licensed psychotherapists and psychotherapists in training in Germany were collected online. Psychotherapist characteristics associated with more or less frequent sexual health assessment were analysed using t-tests, linear regression, and Pearson correlations. Responses to open-text questions regarding perceived patient-related barriers were analysed using thematic analysis.
RESULTS: No significant gender differences were found among psychotherapists, t(216) = -0.44, d = -0.08, p = .329, in addressing sexual health. Psychotherapists working in urban areas (d = -0.31, p = .010) and those with psychodynamic orientation (d = 0.30, p = .015) addressed sexual health more frequently. Older age (f2 = 0.03, p = .019), more years of professional experience (f2 = 0.02, p = .014), and greater subjective knowledge about sexuality (r = .31, p < .001), was associated with higher engagement in sexual health assessment. Thematic analysis revealed 19 patient characteristics (e.g., gender constellations, therapeutic relationship dynamics, patient emotional reactions) perceived as barriers.
CONCLUSIONS: Younger age, lesser work experience, and lesser knowledge about sexuality are associated with lesser assessment of patients' sexuality and sexual health by psychotherapists. Urban and psychodynamic therapists assess sexuality and sexual health more often. Various patient characteristics and interaction dynamics are perceived as sexual communication barriers by psychotherapists.
PRACTICE IMPLICATIONS: Sexuality education based on the identified barriers is necessary to strengthen psychotherapists' competence and confidence in adressing sexuality in psychotherapy, which can improve health care significantly.