Sex in the Time of Corona

A latex cosplay medical mask. Timely, fashionable, but not effective COVID-19 protection.

The social distancing behaviors recommended by public health authorities pose a severe challenge to those who crave the physical intimacy of sex.  We know from the HIV/AIDS epidemic that people were slow to adapt to the dangers of HIV transmission even when the vectors of transmission were well understood.  Over thirty-five years into our grapple with the HIV, a few people are virus chasing and bareback riding.  If you need such risks to get satisfaction, no amount of evidence-based advice will be of much help.  But if you are concerned about your health, there are things you can do to manage your risk.

  1.  Have sex with fewer partners and only with those who you know are managing their risks well.  Because the COVID-19 virus has a 14-day incubation and hardly anyone has been tested, it is very difficult to know who is a carrier but not yet symptomatic.  While obviously ill people can be avoided by simply moving away from them, being intimate with a non-symptomatic carrier creates a high risk of transmission.  Mostly, that is a matter of trust, not certainty. For certainty, you can only have the kind of sex in which you stay 6 feet away from your partner(s) if you cannot know they are infection free.
  2. Practice R.A.C.K. — Risk Aware Consensual Kink. This term from BDSM is a method used by people who commonly deal with sexual risks to manage those risks as ethically as possible. RACK entails disclosing your concerns and desires to partners, discussing your risks with each other, and contracting to act strictly within your partner(s) and your own desires and limits. You do not need to be kinky to do this, and it is a great idea because all sexual activity carries some risks.  The only new element here is the COVID-19’s risk characteristics. Sex has always required trust. Even with a thorough examination of the risks and benefits of any activity, be aware that you may feel very differently if it goes wrong than you anticipated during contracting.  Drive slowly, in the fog, your headlights only extend so far.
  3. Often, you will make a more rational decision if you take the advice of others rather than just relying your imagination and making your best guess.  Reading articles like this really can help make more rational decisions if you follow the advice given.  But no advice is perfect, and in an ambiguous situation like this one, there are no guarantees. The people who write well meaning advice like this do not get the direct consequences of your decisions, even if psychological research says taking advice is more rational.
  4. Use barriers.  Jokes about having sex in skin-tight latex bodysuits and hazmat gear are meant to be funny, but they are correct that barriers are essential when dealing with infected people.  And many potential partners have limited control over their exposure due to work or living circumstances.  The biggest risks are through body orifices, especially eyes, nose and mouth.  It is not yet known how many cases have been sexually transmitted. Expect other openings and wounds to be vulnerabilities. COVID-19 is known to be transmitted through contact with fecal matter.
  5. The smaller the social groups in which you solicit, the better.  Sex with your long term monogamous partner really is safer than using Tindr, and within your polycule is safer than with most new partners.  The more partners you have, the less statistics are on your side.  And risk is determined by actual behavior, not by verbal claim or psychological identification.  If you or your partner cheat, or fail to use protection, the risks are real.
  6. Grieve the loss of intimacy and connection that social distancing entails.  Lots of funny memes are circulating that Love in the Time of Corona is the party introverts have been waiting for all their lives.  But these enforced changes are scary, stressful, and involve sacrifice, even for introverts.  Having the kids home all day means no private time for your sexual relief.  Partners are unavailable who you could count on before.  The electronics you like to use for sex need may now need to be shared.  And all those stirred up emotions can have a deadening effect on your, or your partner’s sex drive.  Acknowledging feelings of loss is important in managing them.
  7. Being psychologically flexible is an advantage, but takes a lot of energy.  If your risk tolerance means you must change your way of being pleasured, this takes real emotional labor.  Give yourself as much time and leeway as you can to make difficult changes.  Be tolerant with yourself and your loved ones when you or they can’t do everything you ask right away.
  8. Be creative with getting pleasure at a distance. Porn, teledildonics, phone sex and reading erotica are all ways of preserving some of your pleasure when your favorite activities are too unsafe to use right now. 
  9. Clean yourself, your toys, your clothing, your electronics and your bedding much as you would wash your hands.  If you have studied how long the virus can survive on various materials, wait to use them again until after a period in which the virus would naturally have expired.
  10. Tolerance of delayed gratification, ambiguity, your anxiety and the anxiety of others are all important lubricants that smooth the dramatic changes social distancing requires.  Others are going to handle this differently than you do and in ways that you cannot anticipate or control.  Be sure to manage your psychological distance from these things if they become to frustrating.
  11. Give yourself permission to try to preserve as much pleasure, touch, sensuality and fun as you can.  That is what this post is all about, and one of the rich sources of meaning that makes necessary sacrifices bearable. 

Many of these sexual coping strategies have a huge amount in common with psychological resilience.  The American Psychological Association has good resources on resilience here. https://www.apa.org/topics/resilience   Elephant in the Hot Tub: Kink in Context has a longer post on resilience here.  https://elephantinthehottub.com/2019/01 Sex is an important part of life.  Despite the fact that sex can be over-regulated and heavily socially stigmatized, many of the principles that make your general life more effective and satisfying apply to sexuality, too.

© Russell J Stambaugh, PhD Ann Arbor MI, March 2020

Touch, Part II

If a ban on CE for touch is not needed for CE reciprocity with APA, why is it important to have?  Here is my understanding of the reasons AASECT has given for this policy:

  1. Touch is overstimulating. Traumatized and neuro-atypical trainees might be overstimulated by emotionally intense content.
  2. AASECT has a problem with sexual solicitation and harassment in its programs, and a strong barrier against touch in educational programs is needed to protect against such abuse.
  3. AASECT is assuming additional organizational risk to defend touch programing which could lead to pushback from powerful social conservatives and might threaten AASECT’s other work.  Educational touch is too dangerous to defend with AASECT’s limited resources.
  4. BDSM and other touching activities are more dangerous than other sexual activity and need special treatment by AASECT to teach with adequate safety to their trainees.
  5. AASECT is entitled to set its own boundaries, just like any individual is, so it has every right to declare educational touch to be outside its boundaries.
  6. AASECT has an obligation to protect the public, and that same obligation applies equally to trainees.  Therefore, if AASECT thinks clients should be protected from touch by our professionals, trainees must be protected in the same way.
  7. There are power differences among various members of the AASECT community.  Programs where trainees have the option to consent to educational touch constitute coercion to participate because of what powerful members of the AASECT community might think, and this kind of opportunity might affect later professional evaluations of trainees.
  8. Other organizations exclude educational touch from their training policies (perhaps not APA as noted in the previous post) so AASECT is behaving normatively and prudently to decide similarly using their examples.
  9. Implicitly, AASECT has argued that declining their proposed boundary rules constitutes unfair coercive treatment.  AASECT’s changing its boundary rules should not be cause for adverse consequences.
  10. AASECT also says that touch goes against their Ethical Code of Conduct because it forbids touch with “consumers.”

I will tackle these in turn:

“The Scream” by Edvard Munch, 1893 It is not always possible to foresee and avoid being overwhelmed by intense feelings. Informed consent and psychological support are very appropriate when learning about material that might be troubling.

1. AASECT, myself, or other outsiders do not get to decide what is triggering or overstimulating for others, including trainees.  It is entirely possible that an AASECT trainee might be triggered by intense material.  Because the ‘decision’ about what material is triggering is highly personal and subjective, any AASECT trainer might incorrectly estimate what is triggering.  In fact, traumatized people may have imperfect ability to anticipate what will trigger them, even with content warnings. There is legitimate scientific question and mixed research evidence that such warnings significantly protect readers.  However, AASECT does not shrink from presenting didactic material that might be triggering, and furthermore deliberately requires SAR material that might be triggering because AASECT has determined that the educational objectives of such programs justify the risks given the cautions and safety features of the program in question.  It is therefore marginalizing to ban consensual educational touch programs categorically as it implies no adequate safety could be programmed, nor that educational objectives could ever justify the risk.  AASECT’s own history of educational programs has repeatedly demonstrated such assumptions are not justified.  Past complaints of triggering by AASECT trainees does not justify banning any programs categorically, there have been too few such incidents to constitute reliable and representative data.  It is fair and reasonable to accurately describe content to be presented and allow trainees to decide whether they wish to undertake the risks and benefits of enrolling in it.

Susanna and the Elders by Guido Reni (1575-1642)

2. AASECT may have a problem with sexual harassment, although I am unclear that our problem exceeds that of similar organizations.  Many of them have genuine problems with this too. AASECT should act to further discourage sexual harassment.  What is clear that AASECT already has a good policy against sexual harassment and support for respectful communication, yet the incidence of such behaviors remains too high.  But AASECT completely lacks scientific evidence that programs containing consensual educational touch constitute any sort of additional risk of harassment than other AASECT programing including dances, fundraisers, munches and other activities that AASECT has not categorically banned, even though they carry no CEs.   AASECT’s Code of Ethical Conduct would suggest that regulation of professional conduct be based on sound clinical or scientific evidence.  No such evidence has been provided for this CE policy. Likewise, changes in sexual harassment policy need to take into account differences among diverse populations about how solicitation behavior is understood, and be evidence-based as to its effectiveness. The presence of some sexual harassment in the AASECT community does not constitute sufficient evidence for banning CE programs categorically.  This is evidence of prejudice against touch and kink, not of their association with harassment.

J W Marriott Hotels have sex negative policies and AASECT often holds meetings there. AASECT sometimes has contractual obligations that interfere with quality programing. Probably not at this one, which is in Dubai!

3. It is true that it is riskier for AASECT to support experiential programing, and to support consensual educational touch, than to avoid them.  I argued earlier that AASECT cannot afford to cede responsibility for some of these risks and continue to claim leadership in the field of sexuality training.  Indeed, AASECT has an important training role because other organizations  declined to undertake the risks of human sexuality training.  Yes, touch is riskier, but it is necessary risk given AASECTs Mission, Vision of Sexual Health, and AASECT’s role in the training community.  While I am inclined to discount the risks of social conservatives per se, AASECT does deal with large hospitality corporations.  Some, like Marriott, have policies against single women at the bar in the hotel restaurants and discouraging sex talk in the hallways where minors and families might hear.  The law is very clear that Marriott has that right.  This might require some training be conducted off-site to protect AASECT, but doesn’t justify a change in CE policy for AASECT’s strict adherence to business contracts.  AASECT has less stigmatizing options it has failed to take.

4. Despite the prima facie evidence that some BDSM activities are dangerous, I hasten to point out that many sexual activities that AASECT undertakes to teach about are less safe than most kinky activities and that did not dissuade it from teaching about STI transmission, dating apps, sexual assault, child sexual abuse and exploitation, problem sexual behavior, and trauma, all of which are fraught content.  It is stigmatizing to single out the risks of kink behaviors or touch as special cases of such risks given the severity of content AASECT routinely assumes the responsibility to teach.  Indeed, AASECT has the responsibility of dealing sensitively with all content, touch or not.  That requires sensitivity to context.  This policy is an egregious example of marginalizing sexual diversity AASECT should shrink from modeling.  It is setting a terrible example for education about touch, too, and marginalizes others who use touch completely unnecessarily and unprofessionally.  Much of this content does not lend itself to being taught experientially or with educational touch.  But where experiential training and/or touch can be effective, they should get full credit.

Witch burning: setting boundaries or oppression? When you undertake regulation, you are setting boundaries for everyone.

5. In claiming the right to set its own boundaries, AASECT is failing to acknowledge its powerful role as a regulator.  AASECT is depriving its trainees and its professional members the right to consent to programs that involved sexual touch by refusing to grant full credit for them.  That is boundary setting for everybody else, not just for AASECT.  This boundary analogy breaks down because of the inherent power imbalance between AASECT and its members.  I do not get to unilaterally set my boundaries so as to limit your professional freedoms.  The best analogy here is to the behavior of American fundamentalist religious organizations who are claiming that it violates their religious freedom to limit their ability to regulate the behavior of nonbelievers, a position AASECT rightly opposes as repressive.  Ultimately, AASECT does get to set its own boundaries. Prior to this policy it  was completely able to deny CE to any program, touch-based or not, that fails to protect it trainees or discredited the field in any manner and it had that power before this policy change without marginalizing anyone gratuitously.

6. It is my contention that AASECT’s primary responsibility is to protect the public first, and trainees second.  This is where their boundaries belong.  This does not license the abuse of trainees, but neither does it prevent training experiences that may be effortful and even painful to some.  If AASECT declines to certify experiential training that includes touch, it is reasonable to think AASECT will be unable to tell if trainees are emotionally and intellectual competent to handle such material.  That would abrogate its responsibilities to assess that trainees have adequate self-knowledge and emotional control to safely provide services to the publics the trainees intend to serve under the aegis of legitimacy conferred by their AASECT certifications.  While it would be better if no trainees were ever stressed or triggered by such instruction, it is far better that AASECT discovered their vulnerabilities now when it could support addressing such vulnerabilities than have them emerge in educational or therapeutic services later with clients.  Anyone evaluating whether AASECT certification provides any assurance that people are qualified to work with kinky clients should be alarmed to hear that it has entirely banned programs that might better assure that trainees or certified professionals can handle the emotional stressors of working with this population. This educational policy assures that AASECT is failing to guarantee that trainees are taught the skills to manage their personal feelings about content in the areas in which the trainees intend to practice.  All of this is emphatically true given that no AASECT touch based CE has ever been required for certification, and most such approved programs have had safeties, security arrangements to keep out the public, and even signed waivers as evidence of consent to participate.  Because touch is fraught content, mostly presenters who used it have been very careful with it.

7. It is a general flaw in our efforts to support consent education that we too often assume that there is relative social equality in negotiations for social contracting.  In fact, considerable discrepancies in social power are the norm, and contracting between relative equals is simpler, but far from common.  There are differences in status, education, power, attractiveness, historical service to the organization, as well as race, ethnicity, sex preference and gender identity in the AASECT community.  AASECT handles some of the differences better than others, but inequality exists and cannot be fully mitigated.  In consequence, the criticism that consent to AASECT’s rules, including the Code of Ethical conduct and AASECT’s Certification guidelines and educational policies and credit bearing programs is fraught.  It is partly out of recognition of these differences that I left AASECT.  I could afford to do this to oppose AASECT educational touch policy.  Others cannot professionally abandon their certifications, even if AASECT has acted to decrease their value.  Apprehensiveness about what supervisors and presenters may think is real.  It figured very prominently in my graduate training.  We were always discussing what clinical supervisors might think of our work.  Some of my colleagues were marginalized and their careers harmed by supervisors’ poor opinions of their work.  That is an inevitable consequence of the power which we cede to others when we submit to education.  But banning educational touch to reduce this does not make sense unless you imagine that consensual educational touch constitutes a special vulnerability that doesn’t apply to written work, presentation ratings, and every other conduct that might be evaluated in AASECT’s professional space.  We do not ban social activity because a supervisor might think badly of a supervisee in such a setting, or ban fundraisers where a powerful person might make a judgment about a less powerful person’s generosity. Eventually, this boils down to AASECT not being willing to stand behind the professional conduct of supervisors.  It is natural for trainees to have these fears.  It is one of the obligations of having the power to supervise not to abuse that power.  A ban on educational touch is a crabwalk away from standing up for professionalism.  I frankly have not seen failure to supervise professionally about touch content in any AASECT educational content.  There has been a program where unapproved touch was demonstrated by a guest presenter from outside the professional community.  I will discuss that in the next part of this series.  There have been too few programs for such a pattern to emerge, nor to make an evidence-based case that they are dangerous.

8. It has been argued that some organizations, e.g. The Woodhull Freedom Foundation, have bans on educational touch in their events so AASECT should do the same.  That is nice for Woodhull, is certainly their prerogative, but except APA, which I have already much belabored, most other sexuality organizations do not have the responsibility of certifying fitness for professional practice in sexuality education, counseling or sex therapy.  The risk/rewards and advocacy purposes of such an organization like Woodhull are fundamentally different for those of AASECT.  I fail to see why anyone would find Woodhull’s behavior relevant.  Removing a total ban on CE for programs that involve touch in no way requires AASECT or its CE providers to offer them, although the field would be ill-served if no one offered any.  Someone will design quality programs if AASECT doesn’t prohibit CE for them.

The Peaceable Kingdom by American Artist Edward Hicks circa 1830-32

9. AASECT is not entitled to freedom from pushback of their policies, even from non-members, under any reasonable boundary rules about consent.   In BDSM social organizations, Safe Sane and Consensual never meant that anyone had to agree to play with everyone else.  But neither did it imply that there were no consequences to declining to consent.  If I decline to consent to AASECT’s educational policies, I have to leave AASECT.  If you violate your contract with me, as AASECT has, I might be offended or speak ill of your professionalism, which I have.  And if you marginalize a community by your behavior, it may choose to take social action against you.  Consent does not mean that that everyone lies down together in a peaceable kingdom, the lion lying benignly with the lamb.  Consent means orderly agreement when there is agreement about boundaries.  Sometimes it means war where boundaries cannot be negotiated.  To paraphrase Carl von Clausewitz, war is not just policy by other means, but peaceful agreements about boundaries are policy, too.  They reflect shared common interests.  Where consent cannot be secured, nonconsensual conflict resolution continues.  In creating social justice and mutual alliance, that matters to community, too.

Do good fences make good neighbors? The Berlin Wall shortly before its fall was a symptom of conflict between the Soviet Bloc and the West.

10. While it is crucially important that the consumers of services from AASECT’s certified professionals can trust that they will be treated ethically and professionally, it is not true that this requirement prevents AASECT trainees from ever consenting to AASECT approved educational credits that might involve consensual touch.  There is nothing inherently unprofessional or unethical about approving CE’s of professionally conducted instruction that is apt to the content being conveyed and offers adequate protection against mishaps or problems.  Touch is not that risky, and some content is best conveyed in that manner, and if a trainee does have problems with material they have consented to participate in, the resolution of those problems is an opportunity to protect the trainee and the consumer from later problems that it is AASECT’s mission to address.  To treat trainees as if they were the same as general consumers makes the mistake of equating trainees’ power and responsibilities with those of people seeking mental health services.  If trainees seek to become providers, they must shoulder the responsibilities of protecting consumers even if that sacrifice is stressful.  This is the decision AASECT made about SARs, and it is appropriate to extend it to other well designed content that involves consensual touch.  I know of no AASECT program where touch was offered where trainees couldn’t elect to opt out, and no AASECT content except SARs that is compulsory. No one is suggesting that touch be compulsory, or kink training be compulsory in an organization in which only a large minority of trainees are interested in working with this population

Other arguments have been made in favor of the marginalizing aspects of this educational touch policy that deserve even less serious rebuttal.  Some have claimed superior knowledge about kink because they are community insiders.  This is identity politics and based upon very weak critical thinking.   The kink/consensual non-monogamy/swinging communities which NCSF represents are very diverse.  It took NCSF about 5 years to hammer out agreeable wording on what constitutes consent, and this by no means levelled all the differences in how it is implemented across our various Coalition Partners.  Other organizations in kink declined to join, complaining that outside moralists were trying to control them.  NCSF represents over 100 different kinky and non-monogamous organizations, some very large and of longstanding such as The Eulenspiegel Society and  Kink.com, and others, like a single kink-aware psychology practice which just joined last week.  Research by Debby Herbenick suggests that while NCSF represents only a fraction of all kink organizations, all ‘out’ kinky social clubs and events have only touched about 10% of the Americans who do kinky behaviors once a month of more often.  We at NCSF are more representative than any one person’s opinion, but we do not encompass everyone.  What NCSF has found is that people who try to assert that their version of kink is better than everyone else’s are often self-interested and those least deserving of consideration.  Worst among these are the predators whose claim to expertise about kink is really a power play intended to seduce the inexperienced.  Any claim to credibility my personal views have in this matter has to do with correctly predicting what Ruby Bouie Johnson and the Philadelphia demonstrators, the NCSF Board, and APA were going to do, not my personal standing or experience in kink being better than someone else’s.  Indeed, Herbenick et al have the first data set capable of speaking to what the 90% of non-joiners are like.  I mention this because most clients who come to AASECT professionals for education or training are likely to do so because they have avoided, rather than joined kinky communities.  In fact, given our fraught professional histories kink social organizations compete to some extent with AASECT educators and with the health professions in educating their members and helping them resolve conflicts.  There are good reasons to suspect that kink insiders do not understand these people particularly well.

This brings up another danger from the AASECT touch policy that I am eager to prevent in forcing its repeal.  In the last two years, guidelines have been established for treating the kinky population have been generated mostly outside of the AASECT community.  “Guidelines for the Treatment of Consensual Non-Monogamy” has been developed by the aforementioned American Psychological Association Division 44: Sexual Orientation and Gender Diversity Task Force on Consensual Non-Monogamy.  Leadership in developing the Kink Treatment Guidelines does not reside primarily in AASECT either having been taken up by the leadership in the Community-Academic Consortium for Research on Alternative Sexualities (CARAS) chaired by Richard Sprott, PhD and the Diverse Sexualities Research and Education Institute (DSREI) chaired by Charles Moser, MD.  Although AASECT members are part of both of these bodies, and both of the clinical guidelines efforts, AASECT as an organization missed the opportunity to lead these efforts that are central to its mission.

Those missed opportunities, like the retrograde educational touch policy and discussions about weakening AASECT Certification standards, actually reflect growing fragmentation of the field in the age of Trump.  His election is an example of a world-wide trend towards greater nationalism, less tolerance of diversity, and tribalism.  In these conditions, people identify with micro-communities and are less willing to conform to the demands of larger polities.  This is a problem for psychotherapy, which needs to be provided by practitioners that understand whomever walks through the consulting room door. I have often heard it said that it takes a kinky person to provide good kinky therapy, and that the first step to dealing with social stigma is out oneself and to join a local kink community.  That is good advice for some clients, but by no means a sound general practice applicable to all clients.   Needless to say, we would not say this about problem porn use, erectile dysfunction, and persistent genital arousal disorder!  In those conditions, support groups are often helpful, but we do not encourage people to identify their diagnosis as an identity, and we do not assume that good education, which kink social groups often do provide, is all the treatment that is needed.  Providing permission and information are the first steps in Jack Anon’s PLISSIT Model, not the equivalent of all the intervention that is ever needed.  So any fragmentation of the communities that requires shared identity politics as a precondition for the best treatment is a barrier to fighting stigma and to the best client centered treatment.

Lastly, the argument has been raised that the AASECT touch policy change is about the educational program Taste of Kink.  AASECT, NCSF, and I have all tried to dispel this idea, but because Taste of Kink was scheduled to occur in Philadelphia and had been run successfully in Minnesota and in Denver, the fate of the program has become emblematic of the policy change.   I will discuss the history, program objectives, approval and implementation of Taste of Kink in my next post.  For the record, Taste of Kink was cancelled by AASECT in Philadelphia when NCSF, backed by its designers, notified AASECT that the policy change revoking a full three CE’s for the three-hour program. That was a violation of the contract NCSF had with AASECT that rendered it impossible to recruit the demonstration teams.  That dispute provides an instructive case study in boundary negotiation and consent, and intersectionality, but is not crucial to understanding the larger issues of AASECT’s policy role in sexuality education and sex therapy training, thus it merits a separate post.

AASECT is strongly encouraged to rewrite its policies regarding consensual educational touch so that all educational modalities are genuinely protective of AASECT trainees, but the legitimacy of all valuable instructional modalities, including touch specifically, are not marginalized.  It is AASECT’s courage, leadership, embrace of diversity and expertise that legitimize its position of leadership in training for practice in the professional fields of sexuality, not its rejection of touch.  That is weak, scared and divisive, and fails to protect the public, especially the erotically marginalized part of the public who are in most is need of AASECT’s protection.

© Russell J Stambaugh, PhD Ann Arbor MI, March 2020

Touch, Part I: A Brief History of AASECT Regarding Consensual Educational Touch

Michelangelo’s Sistine Chapel features the power of touch in creation.

“…so loving to my mother that he might not beteem the winds of heaven visit her face too roughly.”

Hamlet, Act I, scene 2 — William Shakespeare

“Oh, my love, my darling

I’ve hungered for your touch…” 

Unchained Melody — Hy Zaret and Alex North

The Power of Touch:  A casual perusal of Western mythology suggests that it is scarcely possible to overestimate the power of touch.  Sleeping Beauty is entirely overcome by a mere pin prick and awakened by a single kiss.  A frog is transformed back into a prince by, again, a single kiss.  Smeagol is embarked upon the loathsome transformation into Gollum by unknowingly grasping the One Ring of Power.  Sophie is doomed by the wrenching loss of her son to the Nazi perpetrators of the Holocaust as he is torn violently from her grasp.  There is no shortage of tales about the transformative power of touch, for good or for ill in our culture. 

A cat and person taking pleasure in touch.

The power of touch domesticated horses, dogs and cats.  It undergirds the power of healing to so great a degree that many religions including Christianity have powerful stories of healing by touch alone.   These are not restricted to the revival tent, Freud and Breuer, having initially discovered resistance, experimented with overcoming it by laying hands on their hysterical patients, pressing their foreheads in a naive attempt to overcome it.  Amidst our recognition of its power, Masters and Johnson formulated behavioral therapy for sexual problems that emphasized the power of pleasurable touch to change behavior.  We are regularly learning of the role of neurotransmitters and hormones that are triggered by touch, and our professional and criminal regulations struggle to delineate the boundaries between professional and therapeutic touch and abusive behavior.  National scandals around it are a daily occurrence in the news media, from the American women’s gymnastics scandal to the chronic crises of sexual exploitation that enmire the Roman Catholic Church internationally, to stories of politicians at the highest level who sexually exploit interns in the Oval Office or brag on national TV that their power can coerce acquiescence, if not consent, from beauty pageant contestants by touch alone.

Bill Masters and Virginia Johnson’s pioneering work in sex therapy relied on touch and physiological measurement of sexual response. It would have been impossible without touch. They advocated sexual surrogacy, and tried to legitimate it with only partial success.

The Need for Legitimacy:  Our friends at AASECT then, can be forgiven for a certain apprehension about the power of educational touch in their educational programs.  Striving to define their sexual health practitioners amidst the power and danger of touch and desire is a daunting task.  Striving for legitimacy, sex educators, counselors and therapists know that legitimacy is hard to sustain in stigmatized sexual discourse.  In an age where public perceptions of a thing often trump established scientific facts, legitimacy is evanescent and always under challenge.  One need only examine the titles of AASECT Annual Conferences to see how difficult this is.  Although sexuality is strongly associated with pleasure, AASECT commonly goes for 7-8 years at a time before frustrated activists put ‘pleasure’ in the title.   For an enlightening comparison, look at how long it has been since their conference title included the word ‘touch.’  For the curious, AASECT has used “pleasure” twice and “sensuality” once in the 25 years over which I have records.  It has used touch zero times.

Medieval guildhalls in the Grote Markt in Antwerp, Belgium. As trade became increasingly important in the Middle Ages, guilds of craftsmen became powerful. They controlled who could become a journeyman and acted politically to protect their professions. Today, professional associations perform many of the same functions.

Guilding Politics and Protection of the Public:  Partly this is a consequence of the guilding politics of AASECT.  AASECT was founded in 1967, as an organization of sexuality educators. In 1973, they made the controversial decision to welcome sex therapists into their community.  In order to bolster their professional legitimacy, sex therapists require that candidates for sex therapy certification attain licensure as professional mental health practitioners before they began training as certified sex therapists.  Because of the dangers of unprofessional sexual conduct between mental health practitioners and their vulnerable clients, touch between therapists and patients is strictly limited by State licensing bodies.  Surveys indicate that about 8% of clients have had unprofessional touch from mental health professionals up to and including sexual assault, with male therapists about three times more likely than female therapists to have admitted sexual contact with a client.  In this climate, it is unsafe for the professions or the public to fundamentally relax these professional boundaries even in the face of evidence in that touch can be therapeutic.  Thus, AASECT Certified Sexuality Educators have become bound by the legitimacy needs of sex therapists whether they made specific sense in many educational contexts.  

The awkwardness of this position has become increasingly evident over time as AASECT has established a reputation for providing high quality sexuality training in a larger society where such resources are relatively scarce.  A great many people attend AASECT events for this training that do not anticipate being able to benefit from AASECT certification or nor benefit from mental health licenses.   Sexual surrogates need sexuality training to work effectively with sex therapists as originally intended in protocols worked out by Masters and Johnson.  Although such auxiliary treatment is regarded as illegal sex work in many states, it is permitted in others, and AASECT does not certify surrogacy training, although it occasionally provides courses about working with sex surrogates.  Sex workers, massage therapists, tantra instructors, lifestyle educators, sex toy makers and marketers, and other sexuality professionals benefit from sound instruction on human sexuality and AASECT has not only historically been a good place to get it, but these other professionals enrich the diversity of discourse about human sexuality through their participation in AASECT.  But their participation in AASECT’s community also poses concerns about service, power, and equity.  AASECT’s mission is to educate the general public about human sexuality, but to specifically service the interests of its certified professionals who comprise most of its membership and vote on AASECT’s Directors. Certified Sex Therapists make up 80% of AASECTs certified professionals, and it is their interests that are most reflected in the actions of the AASECT Board of Directors.  Certified Members stay affiliated with AASECT longer and more of them vote in AASECT elections.

Professional Marginalization of Touch:  AASECT’s Code of Ethical Conduct is often the fulcrum of conflict about the differing needs and sensibilities of the various populations served by AASECT.  The code applies to all AASECT certified professions and is assumed to be aspirational for all AASECT trainees.  It enshrines boundaries appropriate for psychotherapists despite the fact that these are all subject to the aforementioned strict state licensing authorities, and educators are often practicing in contexts where they have lesser power over their clients and less need for strict boundaries.  This is even more true for allied sexuality professionals or sex workers whose work routinely uses touch.  One of the functions of AASECT’s boundary, whether intended or not, is to marginalize these other activities.  Often, it is specifically intended to do just that. 

During the past administration, and on the advice of the attorney provided AASECT by Bostrom, AASECT’s professional management company, the Board of Directors has approved an extension of this policy so as to ban AASECT Continuing Education Credits (CEs) for any experiential programs involving educational touch.  This is not part of the AASECT Code of Ethical Conduct but does govern what programs AASECT will mount itself or approve by AASECT approved CE providers.  It constitutes an aggressive change to protect AASECT from any adverse consequences of any such programs which might create legal liability for AASECT.  AASECT seems to have had advice from this attorney that the only way AASECT can be fully protected from such potential liability is a total ban on all CE for such programs. That advice, as far as it goes, is probably technically correct.  Certifying sexuality professionals carries some risk, certifying educational programs carries additional risk and the task of differentiating good programs involving touch from bad ones carries more risk.  In a stigmatized environment, any educational program caries some risk, and minimizing liability is a directorial responsibility.  Note also that Bostrom, which manages no other sexuality organizations, has no special interest in AASECT engaging in risks that might interfere with its ability to buy Bostrom’s liability.  From the point of view of Bostrom and their attorney, there is no advantage in carrying the risks of certifying programs that employ educational touch. 

If, as I have claimed, protecting CE for quality touch programs is a necessary part of AASECT’s business model, it is AASECT’s responsibility to use legal advice to protect such programs, not abandon CE for them.  I am not an attorney, but I seriously doubt that, should a mishap occur at an AASECT activity where AASECT approved the program and recruited the demonstrators, the fact that CE was not approved would significantly improve AASECT’s legal protection from possible damages.  It is quite possible to be a responsible director and doubt the protective value of this recommended policy.

AASECT’s History of Educational Programing: Previously, AASECT had approved on a case by case basis a very narrow handful of programs that would violate this recent ban on CEs for educational touch.  These were among the most popular and successful AASECT programs ever conducted, including a live clinical demonstration of a gynecological exam in 2006 in St Louis, and two Taste of Kink programs in Minneapolis in 2016 and Denver in 2018.  (An important point of self-disclosure here: my colleague Susan Wright and I are the designers of record for those Taste of Kink programs which were mounted in cooperation with the AASECT AltSex Special Interest Group and demonstration teams recruited by the National Coalition for Sexual Freedom which Susan chaired.  I have served on the NCSF Board since 2018.)  Occasional programs on tantra, spirituality, and other topics included limited touch.  All of these events that provided for consensual educational touch were optional sources of CEs, not mandatory for certification, but providing full credit towards it if trainees elected them. 

The most prominent experiential component of AASECT training is SARs, Sexual Attitude Reassessment programs that are a required component of all AASECT certifications.  They do not involve touch but do require participants to view and discuss a wide variety of sexuality topics include porn, sexual variability, coercive sexuality, gender expression, HIV, loss and stigma that are highly stressful for some participants.  Supervised group discussions provide stressed participants some support for dealing with their feelings about stressful material but also pressure to discuss it.   I describe this feature of the program here as context for later criticisms about optional CE programs that might involve touch as potentially too stressful for AASECT trainees.  AASECT is aware that practice of its professions in a sex negative culture is stressful, and that trainees come to AASECT in highly variable states of self-knowledge, self-acceptance, and tolerance for different sexual content.

Harvard University is perhaps Americas best school. Not in human sexxulaity, however. They have no human sexuality program. No Ivy leagues school does, either. The Big Ten Conference has 14 schools. Only two have sexuality training programs, University of Michigan and Minnesota. Indiana University operates the Kinsey Institute. Such programs are highly exceptional rather than routine at American universities.

Why AASECT is the Certifying Body for Sexuality Training Programs: Why little AASECT with less than 3000 members and annual conferences of about 700 participants is brokering conversations about what constitutes credit worthy sexuality instruction is a consequence of much more powerful social institutions having abrogated their responsibility to undertake this task.  First on this list of non-joiners are most American academic institutions.  There are fewer sexuality degree programs in the US than in Canada which has less than one eighth our population, and many of the best US programs including Widener University and The University of Michigan School of Social Work’s Sexual Health Certificate Program train explicitly to standards developed by AASECT.   Second on the list are the mental health professional associations such as the American Psychiatric Association, American Psychological Association, and National Association of Social Workers all of whom train and talk about sexuality but have declined to set standards or even mount internal organizations to support systematic teaching and discussion of sexuality.  The American Psychological Association, for example, has 56 divisions including a division for men’s studies, one for women’s studies, and another for sexual orientation and gender diversity, but not one for human sexuality.  Organizations that explicitly train and certify competence to treat sex ‘addiction’ (International Institute for Trauma and Addiction Professionals, IITAP and Society for the Advancement of Sexual Health, SASH) and marital and relationship problems lack any human sexuality training requirements whatsoever.  Similar circumstances propelled Patricia Schiller JD, an SEC lawyer (that’s right, the United States Securities Exchange Commission, the outfit that regulates trading in stocks and bonds) to found AASECT over 50 years ago and these conditions persist to this day.  Like it or not, AASECT is in a position of relative power and authority to control what constitutes effective instruction in the fields of sexuality education, sexuality counseling, sex therapy, and the supervision of those disciplines, and AASECT’s actions dominate the professional ethics under which those professions are conducted.

The Core Criticism of AASECT’s Educational Touch Policy:  Up to this point one might imagine that I am primarily sympathetic to AASECT’s plight in this educational touch decision, and I am sympathetic with AASECT’s dilemma, but I am also one of AASECT’s most out and prominent critics of the decision to ban CE’s for programs including educational touch.   Having worked hard over the last 15 years to expand the field of sex therapy to include the treatment of kinky clients in our clientele, I am necessarily opposed to any decision that would damage our credibility or effectiveness in treating them.  This CE policy does that, and it does so unnecessarily.   But my opposition is not just theoretical and clinical.  I am in a leadership role in work with this community, and as a retired member and major donor to AASECT, I am free to take steps that other certified members could not for reasons of professional vulnerability.   It is my responsibility as an ally of these clients to take this position and to refuse to support AASECT if it marginalizes some of its clients in an attempt to protect itself. 

I maintain that AASECT’s first responsibility is to the clients of our certified members, and this properly belongs ahead of our collective self-interests, where those may diverge from those of our potential clients.   In this, I am listening to Michel Foucault, who 40 years ago observed that the history of sex since the Enlightenment was primarily about the professional guilds licensing their right to discuss and treat sex rather than about effectively protecting the public.  Somewhat prophetically, Foucault was among the first of the French intelligentsia to die in the HIV epidemic even as politicians opposed funding to combat this pandemic because AIDs should be viewed as God’s punishment for homosexual and recreational drug behaviors.  AASECT is not deliberately trying to harm kinky clients, tantra instructors, lifestyle educators and sex workers by banning CE’s for educational touch.   But they are making a stigmatizing choice absent the slightest scientific evidence that fully accrediting these programs makes AASECT’s professionals’ clients or AASECT’s trainees more vulnerable to any social ills whatsoever.

The core of my argument is that risky and powerful as touch may be, touch is a core part of human sexuality and integral to our business.  If AASECT does not effectively license and permit experiential training that involves touch, clients will be further exposed to underqualified professionals, a problem that has plagued the historical treatment by the well-meaning but self-interested mental health professions.  For example, these professionals have only recently stopped categorically classifying a wide spectrum of diverse sexual interests and practices as prima facie evidence of psychopathology.  That only stopped in 2013 with the publication of DSM – 5.  Modern data shows that sexual variability is not in and of itself pathological. 

An early protest against the Operation Spanner prosecutions. All of the gay sadomasochists eventually served time for their convictions and Britain’s laws disallowing consent as a defense against criminal assault were eventually upheld by Parliament and the European Court of Human Rights. Positive legacies of Spanner include the rise of BDSM advocacy groups like the Spanner Trust and NCSF, and educational programs for kinksters and law enforcement differentiating kink from abuse.

But a look at the list of diverse practices certainly gives even the most casual observer pause that some kink activities include elevated risks relative to conventional and socially approved of sex practices.  Coitus is rarely life threatening except through disease transmission, but choking, sexual asphyxia and bondage can be dangerous.  BDSM practices often mimic violence and are often misunderstood as violence.  And a very high degree of sexual violence is already readily tolerated in many cultures, especially intimate partner violence (IPV) and sexual assault.  It is not automatically stigmatizing to negatively impact relatively safe kink practices in the effort to curb other prevalent dangerous practices.   This was at the core of the infamous 1988 Operation Spanner Case in which the British equivalent of our Supreme Court eventually ruled that consent should not constitute a defense against criminal charges of assault lest victims of IPV, who routinely decline to prosecute their assailants, be deprived of the protection of criminal statutes.  The narrow ruling may have been unfair to the tiny number of consenting gay sadomasochists in this Spanner case, but it would constitute a greater unfairness to the much greater number of IPV victims if their continuous consent was required to proceed with prosecutions designed to protect them.   For the record, I completely understand the sexual freedom is not the ultimate value in all matters, and it must sometimes be subordinate to other goods.

Betty Dodson has extended the field of sex therapy into body positivity with her training efforts to have women examine their genitals. She never pursued AASECT certification as an educator or therapist precisely to side step the limits imposed on touch by the AASECT Code of Ethical Conduct.

That said, abdicating responsibility for approving quality CE experiences involving touch undermines the AASECT Vision of Sexual Health, suggests that such instruction is not valuable enough to defend, and surrenders leadership in the field that many historical figures as diverse as Bill Masters and Virginia Johnson and Betty Dodson, Beverly Whipple and John Money, Gina Ogden and David Schnarch and Peggy Kleinplatz have worked hard to establish.  Some, like Dodson, were never AASECT Members, but tried hard to expand the field, explicitly used nudity and touch.   When I came to the field, the bio-psycho-social model of sex therapy extolled by Helen Singer Kaplan was very influential, and bio was clearly understood to include touch and pleasure but that model broadened sex therapy by challenging that idea that behaviorism held all the important insights in understanding sexual expression,.   While touch has always been important, its importance and how to teach about it have been subject to continual struggle and revision.   The AASECT Code of Ethical Conduct was intended to be the bulwark that defended AASECT’s legitimacy while struggling to teach stigmatized content.   This marks a great divergence in AASECT from organizations like APA.  In the American Psychological Association, every member operated under boundary rules that the state licensing authorities have adopted under APA’s urging.   All clinical practitioners operate under state regulations.  And most struggles in APA are between their different practice environments of academic and clinical practitioners.  So, contrary to incorrect reports from AASECT officials in trying to sell their CE ban for consensual touch, APA does not have any such ban.  We at NCSF wrote to the APA and checked.  The popular touch-based programs formerly held at AASECT were all accepted for APA CE credit.  Academic psychologists do not need a touch ban for University training and the great diversity of therapy disciplines and practices already have licensing boundaries.  AASECT officials erroneously tried to bolster the legitimacy of their proposed boundary because someone much more powerful than AASECT did it and our CE needs to be reciprocal with theirs.  Although I’m not sure that reciprocity assumption might require some checking, after all, APA does not even require training in human sexuality in their own accreditation processes, APA has no ban.  It is regrettable the official most responsible for CE with APA didn’t actually check to see that their claim was true.

© Russell J Stambaugh, PhD, Ann Arbor, Michigan, March 2020

Touch: Prologue

The next four posts explore the problem of using educational touch in the training of sexuality educators, sexuality counselors, and sex therapists.  By implication, it covers all professionals and paraprofessionals in sexuality, from medicine to sex workers.

This discussion arises in the context of professional regulation and consumer protection, but it has a much broader context.  Given that I have subtitled this blog “Kink in Context”, that deserves a little elucidation up front.

Leather contests look alot like the intersection of a beauty pageants and professionalism. Professionalism as a legitimacy tactic is not exclusively the province of therapists and educators!

In the face of stigma surrounding sexuality, everyone involved is concerned about their legitimacy.  This is why early in this blog I described the work of Erving Goffman and Michel Foucault, this was one of their prime interests.  One of the main strategies for solving the legitimacy problem is professionalism.  It is commonly believed that professionals are trained, objective, scientific, expert, and put the needs of consumers and the public first, or at least very high in their ethics.  Very often, those common understandings are mostly true.  But not always.  That is why I have included critics of professionalism so prominently in this discussion.

This makes almost every post, including this series, indeed in all of Elephant, a post about ethics.  We have discussed the ethics of kink, ethics of psychoanalysis, ethics of sexuality research, and the ethics of the professions.  Ethics, of course, is about resolving values conflicts. 

In scientific research, the resolution of conflict between different theoretical models is primarily a conflict of data interpretation and the technical problems of arranging for gathering evidence that resolves theoretical disputes.  But eventually, even the most abstruse technical problems give way in science to value conflicts when it becomes time to make resource allocation decisions about which test to conduct next.  This goes part of the way to explain the uncanny relationship between the scientific insights of any given era to the zeitgeist of that era.   The larger thinking of an era influences what scientific topics are regarded as relevant, important, and worth funding; and scientific insights inform how we think about the world and establish how the world works and what is socially important.   The unknown gets framed by the known.

Salvador Dali’s Temptation of Saint Anthony. You might not think of Freudian theory as very scientific. In the early twentieth century it was regarded as cutting edge science and had a huge influence on surrealism.

But much of what is important about human sexuality is regarded as emotional and intensely subjective.  This has led many to argue that sexuality is not a proper subject for scientific study, and not subject to legitimate professionalization.  It has led Nazis to destroy the Magnus Hirschfeld’s Institute for Sex Research, and Tennessee to ban the teaching of Darwinian evolution leading to the theater of the Scopes trial.  It has resulted in a serious campaign to institute abstinence-only education in American schools and to defund Planned Parenthood.  It has led CDC to become more concerned about expunging language like ‘fetus’ and “evidence-based” from its documents than preparing for the current global pandemic.  The fear of subjectivity is a key part of the fear of sexuality.  Of course, subjectivity is profound in kink, where the ultimate justification for any consensual sexual practice is, ”I like it!”  Think Sancho Panza, Don Quixote’s amanuensis in Man of La Mancha.

Sancho Panza, Don Quixote’s sidekick in Man of La Mancha sings “I Like Him!” He may not know why, but he certainly feels it!

I will close with the following conclusion that is largely inspired by the work of Edward D Cheng, JD of Vanderbilt University.  What he said of torts applies liberally to all social construction, but the words that follow are my application of his insights about tort law.

The illusion of factual causality:

Sometimes causality can be definitively established.  I release my grip on the mike and it drops to the floor due to gravity.  But in the social construction of reality the interesting and very common cases do not involve clear consensus as to cause.  Often factual causation cannot be established:

Perhaps only correlational or anecdotal data are available.

Perhaps parties cannot agree as to what constitutes data.

Perhaps they agree, but multiple and/or mutual causality creates conflict or ambiguity as to cause.

Perhaps no relevant data exists.

Perhaps data exists, but they conflict.

It is my claim that these are the difficult and interesting cases in torts and in social construction of reality.

In these circumstances, value-free or purely logical social construction is impossible.

Edward Cheng, JD. Photo courtesy of Vanderbilt University

If you thought to do value-free psychotherapy based upon a solid scientific foundation was going to be possible, think again.  All slopes are slippery.  The object of this blog is to help you strap on skis.

© Russell J Stambaugh, PhD, Ann Arbor, MI March 2020