Talking About Sex in Therapy: What Every Clinician Should Know
with Dr. Lisa Marie Bobby and Dr. Nicole McNichols
The Conversation We Quietly Steer Around
Avoidance is a training gap, not a character flaw. Most of us were never taught to stay in the room when sex surfaces — and silence becomes the default move.
You have been doing this long enough to ask a client almost anything. Their childhood, their grief, the worst thing they have ever done. And then a session drifts toward sex, and you feel yourself do the thing. You reflect, you validate, and you quietly steer the conversation somewhere safer. If you have ever wondered why talking about sex in therapy feels harder than almost any other subject in the room — it is not you. Most of us were never trained to stay in that moment.
I sat down with Dr. Nicole McNichols — an associate teaching professor at the University of Washington whose course on the diversity of human sexuality is the most popular in the university’s history (over 4,000 students enroll each year). Her new book, You Could Be Having Better Sex (Simon Element, 2026), translates current sex research into something genuinely usable. She is, quite literally, the person teaching the next generation of clinicians and the public the material most of us never received.
We talked through why most therapists avoid sex in session, how to bring it up without making it awkward, what the longitudinal research actually shows about sex and relationship satisfaction (the arrow may run the opposite direction you think), the countertransference nobody prepped you for, and where your scope of competence as a generalist ends and a sex therapist’s begins.
“Relationships take work and sex lives do too, even in healthy relationships.” — Dr. Nicole McNichols
Moments from this episode
Episode transcript
Dr. Lisa Marie Bobby: Okay, team — so, confession time. After more than 20 years of being a therapist, after being a supervisor of other therapists and training other clinicians, I still sometimes work with clients and have this weird awkwardness that comes up when it’s time to ask somebody about their sex lives.
Dr. Nicole McNichols: Sexual wellness is part of your overall wellness. Part of being healthy is having a profound sense of sexual health. Sexual health isn’t just about your STI status or whether you have some kind of sexual problem. It really means feeling authentic and empowered and understanding of your body, your desires, your relationships — and being able to talk about these things that have for so long been so stigmatized.
Dr. Lisa Marie Bobby: Even as a marriage and family therapist, I have noticed inside of myself a certain level of avoidance. And I know this is a thing for other clinicians. I also know it’s such an important part of relational health, mental health, and emotional health — and that’s why we’re talking about this on today’s episode of Love, Happiness, and Success for Therapists.
Dr. Lisa Marie Bobby: My guest today is Dr. Nicole McNichols, who is a professor at the University of Washington where she teaches the largest human sexuality course in the country — over 4,000 students enroll in it every year — and today she is here to share her wisdom and perspective with us.
Dr. Nicole McNichols: Thank you, Lisa Marie. I’m so excited to be here.
Dr. Lisa Marie Bobby: We had the great pleasure of visiting on my general-population podcast, where we were talking all about your brand-new book, You Could Be Having Better Sex. At the very end, we were talking about how important this topic is for therapists to be comfortable with, and you were gracious enough to come on this show and give us the behind-the-scenes scoop on how to apply some of these ideas in our clinical practice. So — why is it so hard for therapists to talk about S-E-X with their clients?
Dr. Nicole McNichols: Even therapists struggle talking about it. There are a few reasons. First, most therapists don’t receive a lot of training about it in school. A lot of doctors in medical school don’t have wonderful curriculums around sex education or tools for how to talk to patients about sex.
Dr. Nicole McNichols: But sexual wellness is part of your overall wellness. Part of being healthy is having a profound sense of sexual health. And it’s been treated as if it’s peripheral as opposed to a core central element of our wellbeing.
Dr. Lisa Marie Bobby: Talk about a parallel process. I would wager to guess one of the primary obstacles to people having a positive sex life is how awkward we feel saying these things out loud to our partner. But then we as therapists are dealing with our own awkwardness, and sometimes not even facilitating those conversations in the very environment where they should be happening.
Dr. Nicole McNichols: There can be this assumption that if you are addressing the relationship issues overall, that alone is going to solve any kinds of sexual challenges. Yes, sometimes sexual challenges are due to relational dynamics that need to be worked through. But a lot of times it has to do with something entirely different. Even in healthy relationships we find couples in sexless marriages, or couples where everything seems great but they’re not having as much sex as they’d like, or one partner has a fantasy and isn’t sure how to bring it up.
Dr. Nicole McNichols: Even when the relational stuff is fixed, my point is that we should still be talking about sex. Couples therapists should still be bringing it up and asking questions, which is going to give patients permission to ask questions about their sex life. It’s normalizing it. Not just “okay, how’s the sex?” and moving on — but, “Do you feel like it’s happening as frequently as you would like? Is there anything about your sexual life you wish you could express to a partner but maybe you’ve felt uncomfortable or embarrassed to do so?” Sexual intimacy deserves airtime in therapy, individual or couples. It shouldn’t just be lumped into, “Okay, the relationship’s doing well, so I’m just going to assume the sex life is on track too.”
Dr. Lisa Marie Bobby: Even among MFTs, the unspoken assumption is that when communication and parenting and resentments get resolved, it will lead to feelings of emotional connection, which will then seamlessly flow into increased sexual satisfaction. And you’re saying — no, that’s actually something you still need to talk about. In a therapeutic stance, we are often trained to follow a client. So a client comes in saying “we’re not on the same page about parenting,” and that’s where we go. I have questioned myself: how much do I ask about somebody’s sex life when nobody is telling me that’s the problem? Am I being weird and intrusive by asking?
Dr. Nicole McNichols: I want to hold space for the fear that you’re going to feel like a predator if you’re asking about salacious details, and what they really want to talk about are their parenting struggles. I absolutely respect that therapy should follow the issues the patients are bringing to you. If you completely deflect and switch straight to sex, that’s going to make them feel not heard. But there are avenues in. Even with parenting — a common issue is that one parent feels like they’re doing it all.
Dr. Nicole McNichols: There’s really interesting research by Sari van Anders that looks at how the blurring of the mother-partner role can detract from sexual desire, particularly in women. Let’s say a couple is talking about parenting, but what really comes out is that the mother feels like she’s taking care of all the kids’ needs and now she’s also taking care of her partner’s needs — the partner becomes yet another person whose needs she has to take care of, lending to overall exhaustion and resentment. We know from the research that’s also leading to decline in sexual desire.
Dr. Nicole McNichols: So often what comes out is not just “I’m sick of doing all the parenting,” but, “I’m sick of doing all the parenting, and I don’t feel appreciated, and I don’t feel seen.” Or the other partner feeling, “I see you giving 110% to our kids, but I don’t feel like there’s enough connection left over for our relationship.” When you talk about that, there are entry points for therapists to say: “Do you feel like that sense is feeding over into sexual intimacy as well?” There are paths in that don’t make you feel like you’re avoiding the topic the couple is bringing, but make them realize it’s also tied to sex.
Dr. Lisa Marie Bobby: I love this. As you’re talking, I’m imagining that sex is one of those things that’s like the hub all the spokes of the wheel are connected to.
Dr. Nicole McNichols: It really is. If you learn to do sex, it’s creating a tool set that allows you to do relationships. One of the primary tools for improving sexual intimacy in a relationship is communication. It’s acknowledging that you may not always be on the same page about what you’re interested in trying, what turns you on, what you feel comfortable with. If you can teach a couple how to assert their own interests and desires without shame or stigma, but also hear their partner’s perspective — those communication skills, that self-awareness, the respect for the other partner and the trust the communication is building within the sexual context, that’s also going to translate into being able to communicate and negotiate in other areas of the relationship.
Dr. Nicole McNichols: We’re trained in our culture to think that sex exists as a separate domain — this hush-hush thing that isn’t relevant. To have a sense of sexual wellness, you’re developing the skills that carry over into a healthy relationship. So sex really is the hub with a lot of these spokes. And one of the biggest myths is that sex, when it’s great, shouldn’t require any work. Relationships take work, and sex lives do too, even in healthy relationships. Just because you’re helping a couple work through issues with their relationship, that’s not going to just solve sexual intimacy issues on its own.
Dr. Nicole McNichols: There’s research from Dr. Amy Muise’s lab — she’s followed thousands of couples, looking at longitudinal data. What she has found is that when there is an uptick in sexual satisfaction, it usually precedes upticks in relationship satisfaction. But the reverse is not necessarily true.
Dr. Lisa Marie Bobby: Oh, how interesting.
Dr. Nicole McNichols: It’s very interesting if you think about it. It almost suggests: okay, they addressed their sex life — got communication in place, found out what was pleasurable, felt safe communicating to each other. Because their sex life improved, later on we saw upticks in relationship satisfaction and happiness with wellbeing overall. We assume “happy relationship leads to a good sex life” — but this is further proof that sometimes working on your sex life first is what’s going to lead to an increase in relationship satisfaction.
Dr. Lisa Marie Bobby: Fascinating. Even as you were dropping some of the information from these studies, I personally was thinking, “I did not know that, and I don’t even know how I would have come across that data.” Which is why books like yours are so important — because of all of the research that went into it. How long did it take to put all of that together?
Dr. Nicole McNichols: Four years.
Dr. Nicole McNichols: It is a researched book. It’s written in a way that’s meant to be extremely engaging and accessible to a popular audience — by no means a textbook. But it’s different than most books on sexual wellness in the market because it’s coming at these questions from a research-informed perspective. I wrote it hoping it will get into the hands of therapists and be recommended to their patients. A lot of couples wonder, “How do we even start having these conversations?” Reading books together can be a great way to start. Listen to the audiobook together in the car. It’s filled with the most compelling research, written for a broad array of audiences — couples in long-term relationships, people who are newly divorced trying to figure out what they want, younger people struggling with hookup culture, couples thinking about whether opening up the relationship is the solution, couples interested in ways to spice things up.
Dr. Nicole McNichols: It takes away the shame and stigma and normalizes so many of the experiences and desires people have, and provides a resource that gives actionable advice that feels like something you really can do to improve intimacy. It’s organized as a blueprint, because a lot of people want to have better sex but don’t know where to start. It presents a hierarchy of sexual needs, starting with understanding your body and the types of erotic touch that tend to help most of us experience pleasure. Then it gets into the pleasure cycle and what gets in the way of desire — shame, guilt, body-image issues. The second section, “Engage,” is about how to communicate to a partner and improve sex within a relationship. The third section gets into what if long-term monogamy isn’t the right choice, what if you want to open a relationship, what if you’re interested in kinks. It’s evidence-backed.
Dr. Lisa Marie Bobby: Such a comprehensive resource. As a clinician there’s a sense of responsibility — if I’m going to advise a client struggling with something, what resources are available, I really want them to be trustworthy. As a supervisor, I have so many trainees asking, “Where are the resources?”
Dr. Nicole McNichols: A million percent I agree with you. That’s why I have a whole chapter looking at the pleasure cycle and the exact mental-health issues that can be tied into this. A person struggling with anxiety and depression and stress is not going to have a very high interest in sex. Sometimes before you treat the sexual issues, you need to be treating the underlying anxiety and depression. I’ve even had students who end up in my office hours — they’ll come in with a particular sexual issue, and through talking with them, my conversation often involves me telling them that they don’t actually have a sexual problem. They have a mental-health issue, and they need and deserve to find care and treatment for the anxiety, depression, trauma, or the extreme level of guilt and shame that needs to be unpacked and addressed.
Dr. Nicole McNichols: The mental-health piece has to be front and center. That’s why it goes right at the very beginning of my book. It shocks me how many people message me asking if stress can detract from sex drive. We just assume people know this, but they don’t necessarily.
Dr. Lisa Marie Bobby: Speaking as an MFT — when there is a lack of sexual interest, particularly in one partner, the partner with higher interest might believe it’s just about desire. To have a resource like yours and have that be an entry point to a more compassionate perspective around an untreated trauma history, or the physical impacts of medication or stress — to have the level of understanding that there’s more context. On the other side: I’ve worked with so many people who aren’t experiencing sexual desire for their partner and make a lot of meaning out of that about who their partner is, or “they’ve gained 10 pounds,” focusing on the character of the person in an unhelpful way — not recognizing it might be due to their own physical health.
Dr. Nicole McNichols: Sometimes we need to be attracted to ourselves before we can feel attracted to a partner. It doesn’t mean we need to achieve a certain standard of sexual beauty. It means we need a sense of vitality, our mental health needs to be in a good place, we’re addressing any trauma or medications getting in the way. It’s the fundamental attribution error — we see our partner, so we assume our lack of attraction has to do with what we can see. But sometimes it’s us. You can change yourself. You can’t change your partner. If this is about healing from something, pay attention to that, show self-compassion, and work through it with a therapist — because until you do, it’s going to be hard to feel attracted to a partner.
Dr. Nicole McNichols: Having said all that — I see on the internet this idea that you need to be fully healed before you can fall in love, and I think that’s a bit of a dangerous message. Relationships are vehicles for growth. A lot of healing can happen in a relationship, but you have to also be doing the work on yourself, be an active participant on yourself, if that work is going to occur.
Dr. Lisa Marie Bobby: I’m thinking about the experience of therapists in the room — working with a member of the opposite sex (or whatever sex you happen to be attracted to) and broaching sexual conversations. Have you ever encountered transference or countertransference coming up around these kinds of conversations in a way that needs to be managed? I have had that experience.
Dr. Nicole McNichols: That happens all the time. It’s probably a really common experience. Therapists are trained to be aware of when that’s happening, so you can be mindful of it. People fall in love with their therapist probably pretty frequently, and you might be aware you’re also feeling that transference — but you look at those feelings and know, okay, that’s natural, it’s common for that to happen, but I’m going to be mindful of the very strong ethical boundary here.
Dr. Nicole McNichols: A patient should feel safe saying, “I feel like because of what we’re talking about, I’ve developed feelings for you.” If that happens, there might need to be a conversation about a safe way to find a different person who can care for them. It can be tricky to navigate. It’s important to call out and talk about, just because it can really get in the way of the therapeutic process if it’s not acknowledged.
Dr. Lisa Marie Bobby: Clear ethical boundaries around not going down that pathway. But I would suspect a more common situation is avoidance of things a client probably really needs to talk about. Avoidance by the therapist — we’re actually not doing a good job because of these things coming up. And to be able to make ethical decisions around, you know what, maybe I should actually refer this person to someone who can advance their work in less of a fraught way. To say this out loud — yet another reason why it is so important for therapists to be connected to consultation, supervision, mentorship, peer consultation. So we have a safe place to be talking about these things.
Dr. Lisa Marie Bobby: Scope of practice can be such — it’s not always completely clear. As an MFT, it drives me bonkers when I see people who don’t have specific training in couples and family therapy seeking to do deep relational dynamic work — not because they are a bad therapist, but because the scope of their practice is really around the diagnosis and treatment of clinical mental-health issues, and couples and family therapy is such a different thing. All of us are trained to a degree to be a general practitioner, and we do need to have some growth edges — “this is newer for me, I’m going to educate myself, get supervision, I think I can help this person.” Versus where do you draw the line?
Dr. Nicole McNichols: If you’re talking about issues you’ve talked about with patients before tied to intimacy, and intuitively you feel very confident in the advice you’re giving, that’s great. But for couples who are really going to be doing sex therapy specifically, you really need to be AASECT certified. That’s the professional organization that gives certification and runs classes. There’s also the Modern Institute of Sex Therapy. AASECT is the gold standard for being qualified to handle these trickier cases with sex therapy, because it’s such an important issue, it is so nuanced, and there really are extremely well-proven techniques for people struggling with specific sexual problems.
Dr. Nicole McNichols: If it’s an issue that’s more relational in nature — problems in the relationship spilling over into how much you both want sex, like sexual desire discrepancy, and you have tried-and-true methods that have worked on many couples — absolutely. But when you get into the more concrete issues, like one partner clearly has very low sexual desire, or trouble orgasming, or sexual pain — those are the types of issues with solid evidence-backed strategies for treatment. If you’re interested in treating patients with those problems, it really pays to get AASECT certified.
Dr. Lisa Marie Bobby: Would it be safe to say that if it’s fairly garden-variety in the context of relational work — having these conversations with clients and they seem to be benefiting from it, or you’re assigning a chapter of your book and people are going and reading the things and coming back thoughtfully, experimenting with stuff, and you’re seeing improvement — that would be a green light. This is within the realm of okay to keep going.
Dr. Nicole McNichols: That’s the most obvious standard. Yes. If progress is being made and they are getting closer to where they want to be, that’s wonderful. I would just say that if you feel like they’re getting stuck and you’ve kind of exhausted your skill set in that area — that’s maybe where to refer them out. If you’re interested in treating more patients and going a little bit deeper into the issues around sex, get AASECT certified and do that training. It is robust, and the types of diagnoses and treatments coming out and the research now is so advanced — so far beyond even where we were 10 years ago.
Dr. Lisa Marie Bobby: Such an important thing for every therapist listening, especially early-career therapists or people just coming out of school — to think about what excites you, what do you feel passionate about, what would you enjoy helping your clients around? And then invest in those niches so you can really become an authentic expert and able to assist people in a more robust way. Part of that is a professional-development process we all need to go through. Coming out of graduate training, so much of we’re just trained as, you have to be able to assist with so many different things — and a lot of times we get exposure to different stuff, but not a lot of encouragement to focus. Further out in your career, this is a great time to do it.
Dr. Nicole McNichols: Please use the resources that are available. You can get my book, You Could Be Having Better Sex, at any bookstore. I also have a newsletter at nicolethesexprofessor.com, or follow me on Instagram at nicole_thesexprofessor.
What to take with you
Avoidance is a training gap, not a character flaw.
Most of us were never taught to stay in the room when sex surfaces, so silence becomes the default move.
Sexual health is clinical, not peripheral.
It belongs in the same category as the other dimensions of wellbeing we routinely assess.
Fixing the relationship does not automatically fix the sex.
The longitudinal research suggests the arrow often runs the other way, with sexual satisfaction leading.
Permission comes before information.
Normalizing the topic and asking plain, direct questions gives clients permission to bring it in at all.
Scope of competence is the real skill.
Knowing what you can hold as a generalist and when to refer to an AASECT-certified specialist protects you both.
The work continues after grad school.
Building a niche on purpose, with community and supervision, is how generalists close the gaps their training left.
Talking About Sex in Therapy: What Every Clinician Should Know
You have been doing this long enough to ask a client almost anything. Their childhood, their grief, the worst thing they have ever done. And then a session drifts toward sex, and you feel yourself do the thing. You reflect, you validate, and you quietly steer the conversation somewhere safer. If you have ever wondered why talking about sex in therapy feels harder than almost any other subject in the room, here is the short version. It is not you. Most of us were never trained to stay in that moment, and the avoidance is a gap in our education, not a flaw in our character.
I want to name that honestly, because I still feel it. After more than two decades as a psychologist and a clinical supervisor, I can sit with someone through almost anything, and I will still catch a flicker of avoidance when it is time to ask about their sex life. It is one of the most common things clinicians admit to me, usually in a lowered voice. If that is you, you are in good company, and you are not doing anything wrong. It is exactly the kind of thing we talk about openly in the Therapist Growth Collective, the community I built for clinicians who want a place to bring the questions that do not have clean answers.
Here is what I have come to believe after years of supervising therapists and building a team of them. The discomfort is not the real problem. The real problem is that most of us carry it alone, with nowhere to take the parts of this work that grad school skipped. What follows will give you language and a framework you can use on Monday. But language on a page is not the same as having somewhere to bring the messy, specific version of it, and that ongoing part is the work we do together.
Why don’t most therapists talk about sex with their clients?
Because we were not trained to. Most graduate programs devote almost no time to human sexuality, so we walk into practice without a working model for what a competent, comfortable conversation about sex even sounds like. Research on family therapists found that comfort and willingness to discuss client sexuality track closely with training and knowledge, not with years in the chair (Harris and Hays, 2008). The discomfort is predictable, and it is fixable.
Left unexamined, that gap tends to surface as avoidance, and it quietly feeds the quiet worry that you are doing it wrong, the sense that everyone else got a manual you missed. You did not miss it. It mostly was not handed out.
If reading that produced a flicker of recognition, that is worth saying out loud to someone. Naming the gaps in our training is a starting point, not an admission of failure, and it is the kind of conversation the Collective exists to hold.
How do you bring up sex without making it awkward?
You normalize first, then you ask plainly. Framing sex as a routine part of overall wellbeing, the same way you would ask about sleep or appetite, signals that the topic is allowed here. Then you ask simple, direct questions: is sex happening as often as you would like, and is there anything about your sexual life you wish you could say to your partner but never have.
The fear most of us carry is that we will sound like we are prying for salacious detail when the client came in to talk about parenting or money. So you find the entry point inside what they brought, rather than swerving to sex out of nowhere. A couple describing a lopsided parenting load is often also describing eroded desire, and a gentle question about whether that exhaustion is reaching their intimacy rarely lands as intrusive. This is less a script than a question of clinician posture in unfamiliar terrain.
Practicing these openers in your own voice, and debriefing the ones that land badly, is the kind of thing clinicians sharpen with peers rather than alone in their own heads at 9pm.
Why doesn’t improving the relationship automatically improve the sex?
Because the two do not move in the order we assume. A four-year study following more than two thousand couples found that gains in sexual satisfaction tend to come before gains in relationship satisfaction, not the other way around (Park et al., 2023). The intuitive model, fix the relationship and the sex will follow, often runs backward.
There is also a quieter dynamic underneath a lot of low desire. Work on the link between caregiving and desire suggests that as one partner absorbs more and more of the nurturing load, desire can erode, an effect documented particularly in women (van Anders, 2012). The complaint that arrives as “I am tired of doing all the parenting” is frequently also a complaint about no longer feeling like a partner, and that is squarely relational work a skilled generalist can do.
Knowing the research is one thing. Holding it in the room with a couple who are quietly furious at each other is another, and that is exactly the kind of work we keep sharpening together in the Collective.
The countertransference nobody prepped you for
Here is the part that rarely comes up in consultation until it is urgent. When sexual material enters the room, transference and countertransference can come with it. Clients sometimes develop feelings for their therapist, and you may notice something stirring in yourself too. The feelings are common and human; the ethical line is firm and not negotiable. What helps is naming it early, to yourself and in supervision, rather than managing your own discomfort with sensitive topics in silence.
In practice, the more common failure is not boundary crossing. It is avoidance: steering away from what a client needs to discuss because it stirs something uncomfortable in us, and quietly doing a worse job as a result. That is one reason consultation, supervision, and peer community are not luxuries. They are where we take the things we cannot see in ourselves.
If any of this is landing close to home, it is worth sitting with the blind spots we all carry into the room, and worth remembering that taking care of yourself as a clinician is part of the competence, not a footnote to it.
What’s the difference between a generalist therapist and a sex therapist?
A relationally trained generalist can hold a great deal: desire discrepancy, communication, the meaning a couple makes of their sex life. A sex therapist has specialized training, often certified through AASECT, for specific sexual problems and more complex presentations. The difference is scope of training, not a ranking of skill. Knowing where your scope of competence when sex comes up actually ends is itself a clinical skill.
Relational concerns that spill into how much sex a couple wants, where you have tried and true methods, are usually yours to hold. The more concrete, individual sexual problems are where specialized training earns its keep.
Most clinicians I work with can feel the edge of their competence before they can name it. Putting language to that edge, with colleagues who think about it the same way, is part of what the Collective is for.
When should I refer a client out for sex therapy?
Refer when the concern is a specific sexual problem rather than a relational one — low desire as a standalone issue, arousal or orgasm difficulty, or sexual pain — and it sits outside your training. Refer, too, when you have honestly exhausted your skill set and the work has stalled. Framing referral as expanding the client’s team, with the help of ethical practice when stepping outside your trained scope, protects the alliance rather than threatening it.
There is a simple green-light test for the gray zone in between. If the client is making progress and getting closer to where they want to be, whether through the conversations you are having or a book you have assigned between sessions, you are within range and can keep going. If they stall and you have run out of moves, that is the signal to refer. The scope map in this article lays the two columns out side by side.
If sexual concerns keep surfacing in your caseload and you want a place to build real competence around them, that is exactly the kind of professional development that happens best in community.
The Therapist Growth Collective is where the parts of this work grad school skipped get the time they deserve — peer consultation, supervision, and the kind of conversations that move you from “I know I should be doing this” to “I did this on Monday, here’s what happened.”
Explore the Collective →Why reading this article isn’t the work
I want to be honest with you, because it would be easy to close this tab feeling informed and have nothing actually change. The frameworks here are real and they work. But reading them is not the same as doing them. What almost always happens is that you nod along, make a mental note to ask the next couple about their sex life, and then the moment arrives in session and your old discomfort does what it has always done.
The reason is not that you are unmotivated. It is that you are trying to change a deeply grooved professional habit, alone, in the exact moment the habit is loudest. That is the hardest possible way to do it, and it is most of why the isolation many of us feel in private practice keeps us stuck. What changes it is having somewhere to bring the work, and for clinicians who want to go further, a path toward the coaching certification for therapists.
That is what the Therapist Growth Collective is for: a room of colleagues who get it, where you can say “I froze again this week” and get something useful back. You do not need to have failed at this, or have it all figured out, to come and see what it is like. Have questions? We will give you a real answer, not a sales pitch.
Building this competence on purpose
Here is the through-line I keep coming back to. Coming out of graduate training, we were taught to do a little of everything and given almost no encouragement to focus. The clinicians who feel most alive in their work, and what effective generalist clinicians do differently, tend to have chosen something on purpose: a topic that genuinely interests them, and then built real competence around it.
Sexual health might be that thing for you, or it might not. Either way, the move is the same. Notice what you keep avoiding, get curious about why, and stop trying to grow in isolation. That is the whole reason this community exists, and it is the most reliable way I know to turn a gap in your training into something your clients can feel. If something here named your week, come find us. We would love to think it through with you.
XO,
Dr. Lisa Marie Bobby
About this episode’s experts
Dr. Nicole McNichols
Dr. Nicole McNichols is not a sex therapist — and that is exactly why this conversation matters for us. She is an associate teaching professor at the University of Washington, where her course on the diversity of human sexuality is the most popular in the university’s history, enrolling more than four thousand students a year. She is the person teaching the next generation of clinicians and the broader public the material most of us never received, which makes her read on our blind spots unusually clear-eyed. Her new book, You Could Be Having Better Sex (Simon Element, 2026), translates current sex research into something genuinely usable — which is what makes it work as bibliotherapy for clients. She writes regularly for Psychology Today and keeps a newsletter at nicolethesexprofessor.com.
Dr. Lisa Marie Bobby
Licensed psychologist, marriage and family therapist, and Board Certified Coach. Founder of Growing Self Counseling & Coaching. Host of the Love, Happiness & Success podcast (15M+ downloads). 25+ years of clinical practice. Creator of the Growing Self Institute, where she trains licensed mental health professionals in evidence-based coaching psychology.
Resources Dr. Lisa talked about in this episode
Sources cited in this episode
- Harris, S. M., & Hays, K. W. (2008). Family therapist comfort with and willingness to discuss client sexuality. Journal of Marital and Family Therapy, 34(2), 239–250.
- Park, H. G., Leonhardt, N. D., Johnson, M. D., Muise, A., Busby, D. M., Hanna-Walker, V. R., Yorgason, J. B., Holmes, E. K., & Impett, E. A. (2023). Sexual satisfaction predicts future changes in relationship satisfaction and sexual frequency: New insights from within-person associations over time. Personality Science, 4, e11869.
- van Anders, S. M. (2012). Testosterone and sexual desire in healthy women and men. Archives of Sexual Behavior, 41, 1471–1484.
- McNichols, N. (2026). You Could Be Having Better Sex: The Definitive Guide to a Happier, Healthier, and Hotter Sex Life. Simon Element.
