Comfort in Treating Sexual Problems: Current Training and Counselor Self-Efficacy

Abstract

Counselor discomfort with sex can impede couple growth during the therapeutic process. As couples address multifaceted problems during therapy, counselors should be prepared to professionally discuss a couple’s sexuality during the therapeutic process. As such, the continued taboo surrounding the discussion of sex may illicit embarrassment or nondisclosure of the sexual difficulties by the individual or couple, or worse, be ignored completely by the counselor. Therefore, counselor self-efficacy of sexual topics requires continued analysis within the literature and clinical practice. Thus, the focus of this article is to bridge the gap between counselor sexual discomfort and building self-efficacy of sexual topics through the use of practical strategies (i.e., assessments and interventions) to use in treatment by (a) presenting an overview of literature on sexual perspectives of counselors that inhibit therapeutic discussion of sexuality in the counseling environment, (b) highlighting therapeutic lenses of sexuality that assist in understanding how sexual problems positively and/or negatively impact clients while promoting healthy communication between the counselor and client, (c) providing evidence for the use of sexually based assessments to assist counselors in the development of sexual conversations in treatment, and (d) presenting a brief overview of treatment methods for sexual problems. Implications for practice and research are discussed.

Keywords

counselor self-efficacy sexual problems couples counseling assessment

Between 30% and 50% of couples in the United States experience sexual problems at some point (Flynn et al., 2015). Sexual problems affect both genders at high rates (Heiman, 2002), occur in multiple cultural populations (Metz & McCarthy, 2010), and continue to be expressed in multifaceted forms (Metz & Epstein, 2002). Therefore, the probability of counselors seeing couples and/or individuals seeking counseling for sexual problems remains high. Continued discussion of how counselors build self-efficacy to address sexual issues in clinical practice provided a platform for the current exploration (Almås & Almås, 2016; West, Vinikoor, & Zolnoun, 2004).

Even with expansive treatment modalities concerning sexual dysfunction and distress in relationships (i.e., Corsini-Munt, Bergeron, Rosen, Mayrand, & Delisle, 2014; Hiller & Hekster, 2007; Monson et al., 2012; Rosen & Leiblum, 1995), there exists a disparity in the amount of sexually based assessment techniques counselors implemented during initial assessment (McCarthy & Thestrup, 2008). A potential cause for the lack of assessment use surrounds the notion that the majority of those involved in the counseling environment (i.e., counselors, supervisors, and clients) struggle to discuss the topic of sex (Long, Burnett, & Thomas, 2006; Rutter, Leech, Anderson, & Saunders, 2010). Specifically, counselor discomfort with the subject of sex may hinder the assessment and treatment of the sexual relationship of couples (Bloom, Guiterrez, Lambie, & Ali, 2016; Kazukauskas & Lam, 2009, 2010; Miller & Byers, 2010, 2012; Walters & Spengler, 2016). Therefore, comfort addressing sexual problems requires the counselor to examine their physiological and anxiety states as a source of feedback to assess counselor self-efficacy (Bandura, 1997; Ooi, Wan Jaafar, & Baba, 2018). Thus, counselor self-efficacy when encountering clients with sexual problems (Miller & Byers, 2010) remains paramount to comprehensively assessing and treating clients.

As clients brought forth an increasing number of sexually based problems to therapy, professionals and organizations began to take notice of the need for increased education of new professionals on how to address sexual conversations in treatment (Kelly, 1976; Ussher, et al., 2013). As such, counseling associations encouraged members to build awareness of the multiphasic nature of sexually based problems within relationships (i.e., The American Association of Sexuality Educators, Counselors, and Therapists, 2013; The American Counseling Association, 2014; American Association of Marital and Family Therapists, 2015); however, there is no specific protocol to enhance counselor self-efficacy with the topic of sexuality in the therapeutic process. Furthermore, human sexuality courses are only required for individuals graduating from Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2016) accredited specialty tracks of rehabilitation or marriage, couples, and family counseling. Therefore, the aims of this article are to (a) review literature associated with counseling student’s and counselors’ sexuality self-efficacy and comfort perspectives (Harris & Hays, 2008; McAuliffe & Eriksen, 2011), (b) provide evidence for the use of psychometrically sound assessments to assist counselors surrounding sexually based problems of clients, (c) identify practical evidence-based interventions for the treatment of couple sexual problems, and (e) provide an assessment case example.

Sexuality in Assessment and Counseling

The Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (American Psychiatric Association, 2013) provided diagnostic definitions of the biological and psychosocial aspects of sexual problems that assist counselors in developing treatment plans. Clinicians using the biomedical model interpret sexual problems as occurring on a spectrum that encompasses biologically based sexual distress (Moreau, Kågesten, & Blum, 2016). On the other hand, the psychosocial model focuses on the social construction of sexual behaviors and the distress that can occur from those constructions and expectations (Bellamy, Gott, & Hinchliff, 2013). Therefore, counselors must be able to differentiate between medically based sexual dysfunction and psychologically based sexual problems to create the appropriate treatment plan and provide possible referrals for adjunct medical treatment.

Typologies of sexual problems involve more complex issues that impact relationship satisfaction (Lieser, Tambling, Bischof, & Murry, 2007). For example, even with the introduction of medications to combat sexually based problems, anxiety and stress can continue to permeate the couple surrounding sex (McCarthy & Fucito, 2005). As such, pharmacological support for sexual problems cannot be overlooked (Pacey, 2008); however, adjunct psychotherapeutic approaches address the intrapersonal and social constructs that effect the couple’s sexual relationship (Simopoulos & Trinidad, 2013). Furthermore, scholars established an increase in sexual dysfunction with certain forms of mental health medications (see Apantaku-Olajide, Gibbons, & Higgins, 2011; Simopoulos & Trinidad, 2013; Stulberg, Ewigman, & Hickner, 2008). Therefore, counselors who are both competent and have high self-efficacy as it relates to assessing sexual problems may result in more effective overall treatment (Joanning & Keoughan, 2005; Southern & Cade, 2011; Walters & Spengler, 2016).

Sources of Counselor Self-Efficacy With Sexual Topics

Self-efficacy is the ability of an individual to recognize that he or she can accomplish something with his or her current skill set and an intrapersonal attribute learned and cultivated through experience (Bandura, 1995, 1997). Therefore, historical messages and experiences may be affected by an individual’s schemas surrounding certain topics (e.g., do not talk about sex, politics, or religion in public). Within those schemas, individuals create their perceptions of self and their abilities that are affected by the culmination of assessments from the four areas Bandura (1997) reported as creating self-efficacy: situational mastery, social persuasion, vicarious learning, and physiological and anxiety states.

Harris and Hays’s (2008) findings supported the notion that anxiety connected to sexual topics created an environment of minimizing the importance of the topic (Schnarch, 1991). Additionally, Harris and Hays (2008) reported education, supervision, and knowledge accounted for 48% of the variance of clinician sexual topic self-efficacy. Therefore, the essential components to building clinical self-efficacy in the use of sexually based assessments and subsequent treatment planning (Kratochwill & McGivern, 1996) include appropriate training, knowledge, and supervision. Furthermore, Miller and Byers (2008, 2009) supported the use of continuing education as a form of sexual education development with specific requirements for developing skills to assist clients. These requirements included (a) multicultural awareness of perceptions and practices of sexuality, (b) didactic forms of education (e.g., books and videos) promoting evidence-based sexual knowledge, and (c) utilizing sexually based continuing education.

Clinical Perspectives of Couple Sexual Health

The lens through which counselors view the origins of sexually based problems affect the assessment strategies (Jones, Meneses da Silva, & Soloski, 2011). As such, there is no universally applied assessment method(s) that capture all forms of sexually based problems; however, several researchers provided variations (e.g., Snyder, 1979: Woody & D’Souza, 1994) that assist the therapist and couple in their understanding of the sexual problem. For example, a therapist may utilize The International Survey of Relationships (ISR, Fisher et al., 2015; Heiman, et al., 2011) from a biopsychosocial lens to help the couple conceptualize sexual problems impacting the relationship and develop appropriate therapeutic interventions based on the results of the ISR.

Jannini, Isidori, Aversa, Lenzi, and Althof (2013) discussed the importance of analyzing the problem from a medical perspective to diagnose correctly and refer out for medical testing and subsequent pharmaceutical intervention(s). According to Metz and McCarthy (2007), sexual problems may benefit from pharmacological remedies, while Althof (2006) espoused the benefit of combining medical and psychosocial interventions to provide holistic care to the couple. Therefore, Jannini et al. (2013) encouraged the inclusion of medically based assessments to rule out medical dysfunctions that require medical referrals and/or initiate counseling-based interventions for the couple. For example, the Female Sexual Functioning Index (Rosen et al., 2000) and the International Index of Erectile Function (Rosen et al., 1997) aid in delineating the need for medical referral and/or couples-based therapeutic interventions for males and females.

Instead of perpetuating the biomedical lens of assessment, Zielinski (2013) proposed an assessment lens that places the client and their experiences at the forefront of deciding the normality or abnormality of their sex life. By implementing a sociocultural assessment lens, the client becomes the expert in describing their sexual experiences and how those experiences impact the couple’s life. Therefore, the assessment’s purpose expands the discussion of sexuality to include the positive aspects of the client’s sex life as opposed to just focusing on psychopathology (Zielinski, 2013). By balancing between a problematic and positive sexual health discussion, counselors and clients create avenues of sexually based psychoeducation within the context of the assessment (Fahs & Swank, 2011). Furthermore, allowing the client to be the expert in their experiences provides pathways to learning about the client’s culture (Adams, Bell, Goodman, & Joshi, 2016; Jun, 2010).

Several researchers found an increase in self-efficacy when new counselors expanded their understanding of specified areas of treatment through a multicultural lens (e.g., Barbee, Scherer, & Combs, 2003; Bloom et al., 2016). Gaining multicultural competency through formal education, didactic education, and/or continuing education assisted in reducing stereotypes surrounding the wide spectrum of sexual activity (Morrison et al., 2015; Rehor, 2015) while reducing the possibility of harm to clients or misinterpretation by the therapist of culturally acceptable behavior (Platt & Laszloffy, 2013). As such, multicultural awareness encourages professionals to examine how culture may impact sexual expression and behaviors while providing appropriate therapeutic interventions that enhance the dyad’s relationship (Hill, Vereen, McNeal, & Stotesbury, 2013; Holocomb-McCoy & Myers, 1999). For example, Cruz, Greenwald, and Sandil (2017) recommended counselor self-assessment to become aware and address biases and assumptions of sexual behaviors their clients may express.

In summary, the multitude of sexual assessment lenses provides different opportunities for therapists to engage couples in sexual discussion. Clinicians are able to align their sexual problem assessment and treatment lens with their therapeutic orientation. Therefore, clinicians may incorporate their knowledge base of problems into the sexual interventions used to treat the couple.

Common Sexual Distress Interventions

Couples can present to counseling with multiple causes of decreased satisfaction in their sexual relationship (Doss, Simpson, & Christensen, 2004). Examples include the introduction of children (Ahlborg, Rudeblad, Linnér, & Linton, 2008; Leavitt, McDaniel, Maas, & Feinberg, 2017), length of relationship (Birnbaum, Cohen, & Wertheimer, 2007; Smith et al., 2011), physical health (del Mar Sánchez-Fuentes & Sierra, 2015), and medications (Stulberg et al., 2008). Therefore, assessment practices should include questions that incorporate the abovementioned examples aimed at understanding the couples’ systemic contributions to their sexual relationship. Once contributions are uncovered during the assessment, tailored interventions may be implemented to help improve the couple’s intimate relationship.

Kelly, Strassberg, and Turner (2006) argued for the importance of incorporating interventions aimed at couples developing healthy communication to enhance the sexual experience. In fact, several researchers reported similar results that emphasize the development of healthy communication patterns to improve sexual satisfaction (e.g., Rancourt, Rosen, Bergeron, & Nealis, 2016; Yoo, Bartle-Haring, Day, & Gangamma, 2014). Communication can influence sexual satisfaction (Rosier & Tyler, 2017) as couples struggle to express sexual preferences, and/or because they may slide into negative communication patterns when sexual expectations are not met (e.g., frequency). Researchers suggested discussions of sexual expectations enhanced overall communication patterns while building awareness of individual sexual thoughts and feelings (Jourard, 1971; Schenk, Pfrang, & Rausche, 1983; Slater & Aholou, 2009). Therefore, sharing each other’s sexual thoughts and feelings promotes the couple to build a closer relationship while implementing behavioral changes (Metz & McCarthy, 2007; McCarthy & Metz, 2008). Furthermore, productive communication is essential to the implementation of behavioral, cognitive, or other types of interventions for sexual problems (Barnes & Eardley, 2007).

Behaviorally based interventions were influenced by the work of Masters and Johnson (1966, 1970) as they began to revolutionize professional perspectives of sexuality among couples. Sarwer and Durlak (1997) synthesized the information related to the use of behaviorally based sex therapy interventions that included the start–stop technique (Semans, 1956) and the squeeze technique for male ejaculatory control (Masters & Johnson, 1970). Furthermore, Rosenbaum (2011) suggested behavioral interventions (i.e., in vivo systematic desensitization) for vaginismus. Metz and McCarthy (2007) encouraged both partners to work as a team to implement behavioral interventions as a dyadic exercise. For example, the good enough sex model (Metz & McCarthy, 2007, 2010) incorporates aspects of behavioral, cognitive, sex therapy, and communication to define the sexual problem (e.g., premature ejaculation) as a dyadic problem, so both members of the couple become active in implementing changes toward their couple goals.

Case Illustration

The following case illustration is intended to provide an example of the intersectionality of multiple factors that may influence sexual problems and the use of assessments to provide direction for the counselor and couple in treatment:

Brian (31) and Kelly (29) had been married for 3 years and came to therapy at the behest of Kelly. During the assessment, Kelly and Brian were given the global measure of sexual satisfaction (GMSEX, Byers, 2005; Byers & MacNeil, 2006; Lawrance & Byers, 1995, 1998) to assess their global sexual satisfaction and for its brevity (<1 minute to complete). Brian and Kelly scored a 14 and 17, respectively, indicating sexual dissatisfaction. After which, exploratory questioning (i.e., “Tell me a little bit about your sex life?”; “How would you rate your sex life on a scale from 0 to 10, 0 being extremely distressful and 10 being extraordinary?”; and “How do you communicate about your sex life?”) exposed several factors contributing to the low scores on the GMSEX. Kelly explained her concern that her marriage to Brian had become stale, while Brian expressed a sexual complacency in their marriage that materialized a couple months into their marriage. “We just do the same thing every time,” Brian exclaimed. Kelly explained, “all he wants to do is have sex with me; there is no intimacy anymore.” After implementing a sexual genogram (Hof & Berman, 1986) to extract understanding of Brian and Kelly’s schemas surrounding marital sexual behavior, it became apparent that Brian and Kelly were raised in similar southern conservative families, where sexual discussion was confined to one talk, by their respective parents, that provided academic descriptions of sexual intercourse and its purpose of procreation. As a result, Brian and Kelly reported minimal sexual experience prior to marriage. Furthermore, Brian and Kelly explained their knowledge of sexual behavior outside of procreation came from pornographic sources (i.e., videos and novels).

The initial stages of their sexual relationship consisted of open discussions about Brian and Kelly’s sexual fantasies and collaborating on how they could implement those fantasies. Now, Brian and Kelly explained their concern that their communication about their sexual encounters had grown stale. Their sexual activity had devolved into monotonous encounters with little to no communication or intimacy. They were at a stalemate in their sexual relationship.

The case example provided a plethora of information for the counselor to use during intervention development and implementation, such as (a) sexual inexperience and its effects on sexual performance, (b) pornography use and its effects on sexual schemas (Miller, Hald, & Kidd, 2018), (c) sexual communication patterns of the couple, (d) fantasies and their role in sexual satisfaction, (e) the role familial messages of sex play in Brian and Kelly’s sexual relationship, and (f) Brian and Kelly’s understanding of the fluidity of sexual satisfaction in marriage (Schmiedeberg & Schröder, 2016). From information obtained through assessment use, the counselor utilized communication and behavioral interventions. First, sexual psychoeducation assisted Brian and Kelly in understanding each other’s physical and emotional needs that attribute to sexual activity. In addition, the counselor assisted Brian and Kelly in developing communication skills surrounding their needs and desires with active listening skills. To assist in the “monotony” of sex, the counselor had Brian and Kelly collaboratively (Metz & McCarthy, 2010) create a sexual fantasy journal to build their shared interest in a better sexual relationship and were encouraged to enact a fantasy once a week or at their desired pace.

Once Brian and Kelly were able to actively listen to their partner’s needs, they were able to collaboratively create a working relationship surrounding their desire for a better sexual relationship (McCarthy & Thestrup, 2008). Furthermore, the use of assessments opened discussions surrounding thought patterns and external messages of sex that may interfere in their sexual relationship development. As seen in the case illustration, the use of communication and behavioral interventions promoted the couple to work together and focus on an aspect of their relationship that both deemed as important.

Implications for Practice

Counselors who work with couples have a responsibility to seek sexually based trainings (Daughhetee, Puleo, & Thrower, 2010) in order to increase self-efficacy through knowledge development (Harris & Hays, 2008). Further, objective assessments help clients build awareness of areas that require specific examination and specific interventions (Peterson, Lomas, Neukrug, & Bonner, 2014). Many counselors may not be aware of available sexuality assessments. See Table 1 for five assessments that examine sexual functioning within the context of individual and a couple’s relationship. Table 1 provides a description of the assessment, normalized information of the assessment, validity, reliability, clinical use, assessment limitations, and how to obtain the assessment. The assessments were chosen based on their sound psychometric properties and their prevalent use in clinical practice and research.

Table 1.

Commonly Used Sexually Based Couples’ Assessments.

Assessment	Description	Normative information
Index of Sexual Satisfaction (ISS; Hudson, Harrison, & Crosscup, 1981).	– 25-item (Likert-type scale) self-report questionnaire. – Rated on a 0–100 scale. – Higher scores indicate higher levels of sexual dissatisfaction. – Cutoff score of 30.	– Normed on three samples (N = 1,167). – Mixture of multiple races/ethnicities represented in samples (e.g., Caucasian, Japanese, Hawaiian, Chinese).
Derogatis Sexual Functioning Inventory (Derogatis & Melisaratos, 1979).	– 254-item Likert-type scale. – 10 subscales (e.g., sexual information, sexual experience, sexual fantasy, and sexual satisfaction). – Higher scores indicate higher levels of sexual satisfaction.	– Normed using 230 individuals. – The majority of normed individuals were White, middle age, middle to upper class, and married.
The Global Measure of Sexual Satisfaction (Byers, 2005; Byers & MacNeil, 2006; Lawrance & Byers, 1995, 1998).	– 5-item Likert-type scale self-report measure. – Scores range from 5 to 35. – Higher scores indicate higher levels of sexual satisfaction.	– Normed on 244 participants self-reporting being in long-term relationships (at least one year) within a college and community setting. – Age range: 20–66.
Female Sexual Functioning Index (Rosen et al., 2000).	– 19-item self-report questionnaire. – Score ranges from 2 to 36. – Focuses on the previous month’s sexual activity. – Multidimensional assessment (desire, pain, lubrication, arousal, orgasm, and satisfaction).	– Normed using a normal control group (n = 131) and age-matched participants diagnosed with female sexual arousal disorder (n = 128). – Age range: 21–69.
The New Sexual Satisfaction Scale (NSSS, Štulhofer, Buško, & Brouillard, 2010).	– 20 items. – Scored on a 5-point Likert-type scale questionnaire. – Scores range from 20 to 100. – Higher scores indicate greater sexual satisfaction. – Two subscales.	– Normed on (N = 2,474) heterosexual and nonheterosexual individuals from Croatia and the United States between the ages of 18 and 58.
Validity	Reliability
– Discriminant validity with the Index of Marital Satisfaction (Cheung & Hudson, 1982; Hudson & Glisson, 1976). – Convergent validity. – Construct validity. – Factor validity.	– 1-week test–retest reliability: r > .90. – 2-week test–retest reliability: r > .76 to .86. – Internal consistency: α > .90.
– Discriminate validity. – Construct validity.	– 2-week test–retest reliability range between .77 and >.90. – Internal consistency for subscales: α = .56 to .94.
– Construct validity with the ISS (Hudson et al., 1981), r = −.65, p < .001, and a single-item measure, r = .70, p < .001. – Convergent validity with the Sexual Desire Inventory (Spector, Carey, & Steinberg, 1996), r = .68, p < .001 (Mark, Toland, Rosenkrantz, Brown, & Hong, 2018).	– Internal consistency: α = .90 to .96. – High test–retest reliability at 2 weeks: r = .84, p < .001. – 3 months: r = .78 and 18 months: r = .73.
– Construct validity between control and diagnostic groups. – Divergent validity. – Discriminate validity between clinical and nonclinical populations.	– Test–retest reliability: r = .79 to .86. – Internal consistency α ≥ .82.
– Convergent validity with a global, single-item measure, r = .44 to .67 (moderately high). – Discriminate validity between clinical and nonclinical groups.	– 1-month test–retest reliability: r = .72 to .84. – Internal Consistency: α = .94 to .95.
Clinical Use	Limitations	Obtaining Assessment
– Developed for clinical and research use. – Developed as a repeated-measures instrument for multiple uses through treatment. – Easy to understand, administer, and score.	– The clinician must remember the index measure sexual dissatisfaction. – Two options of the cutoff score require scrutiny: 28 (optimal) or 30 (convenience). – Vulnerable to response bias.	– WALMYR, Inc. PO Box 12217 Tallahassee, FL 32317 https://www.walmyr.com/.
– Can extract subscales for specific topics of interest. – Created specifically for clinical use. – Translated into multiple languages (e.g., Spanish, French, Chinese).	– 45–60 min to complete. – Measures individual perceptions of sexual functioning, not couples.	– Clinical Psychometric Research, Inc. 1228 Wine Spring Ln. Towson, MD 21204 http://www.derogatis-tests.com/.
– Clinically relevant as a unidimensional measure of sexual satisfaction. – Quickly taken: ≤1 min.	– Self-report assessment may be affected by response bias.	– Free access from the original article.
– Developed with clinical practice implications in mind. – Quickly taken. – Previous samples included heterosexual, bisexual, lesbian women, and postmenopausal females (Opperman, Benson, & Milhausen, 2013).	– Five subscales include an option of no sexual activity, which require follow-up questions. – Does not account for psychosocial influences of sexual dysfunction (Boehmer, Timm, Ozonoff, & Potter, 2012). – Single-gender assessment.	– Free access through the original publication.
– Developed within the clinical literature of sexual satisfaction to assist in diagnosis and intervention. – Normed with multiple sexual orientations, genders, ages, and cultures. – Croatian, English, and Spanish versions.	– Multiple studies used the NSSS as opposed to the full 20-item scale. – Requires continued research with the Diagnostic and Statistical Manual 5th Edition (American Psychiatric Association, 2013).	– Free access through the original publication (A. Štulhofer, personal communication, January 7, 2019).

Additionally, Table 2 provides practical questions and prompts for counselors to utilize during sexually based questioning. The table is broken into three categories of past-, present-, and future-focused questions that provide a framework for questioning clients at different stages of the counseling process. The questions are an extension of previous recommendations on integrating sexually based questions into couples and individual therapy (e.g., Belous, Timm, Chee, & Whitehead, 2012; Cruz, Greenwald, & Sandil, 2017; Hof & Berman, 1986).

Table 2.

Past-, Present-, and Future-Based Sex-Focused Questions/Prompts.

Past	– Tell me how you learned about sex. – What messages did you receive about sex when you were growing up from your family, friends, and significant others? – When did you first experiment with sexual activities? What were the results of those activities? – How would you define your sexual history? – What did you learn about yourself from your sexual history?
Present	– Tell me about your thoughts associated with sex. – How would you describe your sex life in the present? – How would you rate your current sex life on a scale of 1–10 (1 = dissatisfied; 10 = satisfied)? – What have you tried to alleviate (sexual problem)? What has worked; partially worked; not worked? – What does (sexual problem) mean to you? – How do you feel about the idea of sex? – What do you enjoy about your sexuality? What do you dislike about your sexuality?
Future	– How would you like your sex life to be? – How would you like to communicate to your partner about your sex life? – What would your life look like without (sexual problem)? – How do you think this problem can be resolved?

Implications for Research

Future research should identify the potential causes for the underutilization of sexually based assessments among counselors (McCarthy & Thestrup, 2008). Although there are numerous studies associated with varying degrees of counselor assessment use in multiple therapeutic settings (e.g., Blacher, Murray-Ward, & Uellendahl, 2005; Bradbury, 1995; Peterson et al., 2014), there is a dearth of research associated with sexually based assessments used by counselors with couples. Furthermore, correlations between sexually based assessment use and counselor self-efficacy of sexual topics require further exploration. If correlations do exist, would the knowledge and implementation of sexually based assessments increase counselor self-efficacy?

Another area of further research surrounds the use of human sexuality courses and their effectiveness in developing self-efficacy associated with counseling of sexual topics. In the past 20 years, the complexity of human sexuality required researchers and academics to broaden their scope of sexual behavior and integrate that scope into their classes (Diambra, Pollard, Gamble, & Banks, 2016). As CACREP-accredited programs require marriage, family, and couples counseling and rehabilitation counseling students to take at least one course in human sexuality, does one course prepare student efficacy in assessment use and leading sexually based interventions with clients? Furthermore, when do students begin to experience self-efficacy during human sexuality coursework in their ability to work with clients on sexual topics?

Conclusion

The evidence exists supporting the need for more education, experience, and supervision of counselors and counseling students pertaining to human sexuality (Britton & Bright, 2014). The current literature review associated with human sexuality assessments and interventions provided a platform for counselors to follow as they build their practice. By providing commonly used assessments, lenses to view sexual problems, and specific interventions to use with sexual problems, counselors can assess their usefulness in clinical practice. The recommendations of education, supervision, and training remain critical components to building self-efficacy while working with a number of complex, sexual problems seen by counselors. Furthermore, sexual assessments may provide a richer description of the couple and highlight therapeutic interventions that assist in alleviation of couple’s sexual problems while increasing marital satisfaction (McCarthy & Wald, 2013).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Christopher J. Hipp

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